Tele-Monitoring of Cancer Patients' Rhythms during Daily Life Identifies Actionable Determinants of Circadian and Sleep Disruption

• Published in: Cancers Vol. 12; no. 7; p. 1938
• Main Authors: Lévi, Francis, Komarzynski, Sandra, Huang, Qi, Young, Teresa, Ang, Yeng, Fuller, Claire, Bolborea, Matei, Brettschneider, Julia, Fursse, Joanna, Finkenstädt, Bärbel, White, David Pollard, Innominato, Pasquale
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 17-07-2020; MDPI
• Subjects: Age; Biomarkers; Cancer; Chemotherapy; Chest; Circadian rhythm; Circadian rhythms; Colorectal cancer; Compliance; Cortisol; COVID-19; Health care; Hospitals; Melatonin; Metastasis; Patients; Physiology; Quality; Questionnaires; Sleep; Telemedicine; sleep; cortisol; biomarkers; sex; gastro-intestinal cancer; circadian rhythms; melatonin; patient-reported outcome measures; age; circadian regulation
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers12071938

The dichotomy index (I < O), a quantitative estimate of the circadian regulation of daytime activity and sleep, predicted overall cancer survival and emergency hospitalization, supporting its integration in a mHealth platform. Modifiable causes of I < O deterioration below 97.5%-(I < O)
-were sought in 25 gastrointestinal cancer patients and 33 age- and sex-stratified controls. Rest-activity and temperature were tele-monitored with a wireless chest sensor, while daily activities, meals, and sleep were self-reported for one week. Salivary cortisol rhythm and dim light melatonin onset (DLMO) were determined. Circadian parameters were estimated using Hidden Markov modelling, and spectral analysis. Actionable predictors of (I < O)
were identified through correlation and regression analyses. Median compliance with protocol exceeded 95%. Circadian disruption-(I < O)
-was identified in 13 (52%) patients and four (12%) controls (
= 0.002). Cancer patients with (I < O)
had lower median activity counts, worse fragmented sleep, and an abnormal or no circadian temperature rhythm compared to patients with I < O exceeding 97.5%-(I < O)
-(
< 0.012). Six (I < O)
patients had newly-diagnosed sleep conditions. Altered circadian coordination of rest-activity and chest surface temperature, physical inactivity, and irregular sleep were identified as modifiable determinants of (I < O)
. Circadian rhythm and sleep tele-monitoring results support the design of specific interventions to improve outcomes within a patient-centered systems approach to health care.