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

1
Cancer Chronotherapy Team, Warwick Medical School, Coventry CV4 7AL, UK
2
European Laboratory U935, Institut National de la Santé et de la Recherche Médicale (INSERM), Paris-Saclay University, 94801 Villejuif, France
3
Hepato-Biliary Centre, Paul Brousse Hospital, Assistance Publique Hôpitaux de Paris (AP-HP), 94800 Villejuif, France
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Department of Statistics, University of Warwick, Coventry CV4 7AL, UK
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Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, Middlesex HA6 2RN, UK
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Salford Royal NHS Foundation Trust, Salford M6 8HD, UK
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Gastrointestinal Sciences, Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, UK
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North Wales Cancer Treatment Centre, Ysbyty Gwynedd, Betsi Cadwaladr University Health Board, Bangor LL57 2PW, UK
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Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02130, USA
10
Philips Respironics, Murrysville, PA 15668, USA
*
Author to whom correspondence should be addressed.
Cancers 2020, 12(7), 1938; https://doi.org/10.3390/cancers12071938
Received: 30 June 2020 / Revised: 13 July 2020 / Accepted: 14 July 2020 / Published: 17 July 2020
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)low—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)low were identified through correlation and regression analyses. Median compliance with protocol exceeded 95%. Circadian disruption—(I < O)low—was identified in 13 (52%) patients and four (12%) controls (p = 0.002). Cancer patients with (I < O)low 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)high—(p < 0.012). Six (I < O)low 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)low. 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. View Full-Text
Keywords: gastro-intestinal cancer; circadian rhythms; sleep; circadian regulation; biomarkers; patient-reported outcome measures; cortisol; melatonin; age; sex gastro-intestinal cancer; circadian rhythms; sleep; circadian regulation; biomarkers; patient-reported outcome measures; cortisol; melatonin; age; sex
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MDPI and ACS Style

Lévi, F.; Komarzynski, S.; Huang, Q.; Young, T.; Ang, Y.; Fuller, C.; Bolborea, M.; Brettschneider, J.; Fursse, J.; Finkenstädt, B.; White, D.P.; Innominato, P. Tele-Monitoring of Cancer Patients’ Rhythms during Daily Life Identifies Actionable Determinants of Circadian and Sleep Disruption. Cancers 2020, 12, 1938. https://doi.org/10.3390/cancers12071938

AMA Style

Lévi F, Komarzynski S, Huang Q, Young T, Ang Y, Fuller C, Bolborea M, Brettschneider J, Fursse J, Finkenstädt B, White DP, Innominato P. Tele-Monitoring of Cancer Patients’ Rhythms during Daily Life Identifies Actionable Determinants of Circadian and Sleep Disruption. Cancers. 2020; 12(7):1938. https://doi.org/10.3390/cancers12071938

Chicago/Turabian Style

Lévi, Francis; Komarzynski, Sandra; Huang, Qi; Young, Teresa; Ang, Yeng; Fuller, Claire; Bolborea, Matei; Brettschneider, Julia; Fursse, Joanna; Finkenstädt, Bärbel; White, David P.; Innominato, Pasquale. 2020. "Tele-Monitoring of Cancer Patients’ Rhythms during Daily Life Identifies Actionable Determinants of Circadian and Sleep Disruption" Cancers 12, no. 7: 1938. https://doi.org/10.3390/cancers12071938

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