Journal of Cancer Survivorship

, Volume 6, Issue 3, pp 305–314 | Cite as

Circadian rhythms, symptoms, physical functioning, and body mass index in breast cancer survivors

  • Ann M. Berger
  • Melody Hertzog
  • Carol R. Geary
  • Patricia Fischer
  • Lynne Farr
Article
First Online:
Received:
Accepted:

Abstract

Introduction

Research has been limited in circadian activity rhythms and their relationship with health status in early-stage breast cancer survivors. Maintaining strong circadian parameters may reduce symptoms and improve physical functioning and disease-free survival.

Methods

This is a descriptive, correlational, secondary analysis of data from a randomized controlled trial collected 1 year after the first chemotherapy treatment; n = 156 cases with 7 days of wrist actigraph data of six circadian activity rhythm parameters; measures of function, fatigue, sleep, and anxiety/depression; and demographic/medical data including body mass index (BMI).

Results

In the total sample and three BMI categories, acrophase was the only circadian parameter that reached means established in healthy adults. In the total sample, phase-delayed acrophase was associated with higher depression (r = 0.180, p = 0.025) and lower morning energy (r = −0.194, p = 0.016) and trended for higher fatigue (r = 0.153, p = 0.057). Lower morning energy was also associated with a lower circadian quotient (r = 0.158, p = 0.05). As BMI increased, weaker circadian parameters were recorded consistently. When compared with women in normal BMI categories, obese women’s amplitude and 24-h autocorrelation coefficient were significantly weaker (p = 0.011–0.015). In obese women, phase-delayed acrophase was correlated with higher fatigue and anxiety and with lower morning energy and physical functioning.

Discussion/conclusions

Amplitude and 24-h autocorrelation parameters were significantly weaker, and phase-delayed acrophase was linked to several more intense symptoms and lower physical functioning in obese women.

Implications for cancer survivors

Clinicians need to target high-risk women with phase-delayed rhythms, higher symptoms, and lower physical functioning for intervention.

Keywords

Circadian activity rhythm Actigraph Breast cancer Physical functioning Obesity Fatigue Sleep Anxiety Depression 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

This study was funded by the National Institute of Health and National Institute of Nursing Research (5R01NR007762-05).

References

  1. 1.
    Eismann EA. Circadian effects in cancer-relevant psychoneuroendocrine and immune pathways. Psychoneuroendocrinology. 2010;35:963.PubMedCrossRefGoogle Scholar
  2. 2.
    Filipski E, King VM, Li X, Granda TG, Mormont MC, Liu X, et al. Host circadian clock as a control point in tumor progression. J Natl Cancer Inst. 2002;94:690–7.PubMedCrossRefGoogle Scholar
  3. 3.
    Hrushesky WJM, Grutsch J, Wood P, Yang X, Oh E, Ansell C, et al. Circadian clock manipulation for cancer prevention and control and the relief of cancer symptoms. Integr Cancer Ther. 2009;8:387–97.PubMedCrossRefGoogle Scholar
  4. 4.
    Berger AM, Higginbotham P. Correlates of fatigue during and following adjuvant breast cancer chemotherapy: a pilot study. Oncol Nurs Forum. 2000;27:1443–8.PubMedGoogle Scholar
  5. 5.
    Berger AM, Weilgus K, Hertzog M, Fischer P, Farr L. Patterns of circadian activity rhythms and their relationships with fatigue and anxiety/depression in women treated with breast cancer adjuvant chemotherapy. Support Care Cancer. 2010;18:105–14.PubMedCrossRefGoogle Scholar
  6. 6.
    Mormont MC, Waterhouse J, Bleuzen P, Giacchetti S, Jami A, Bogdan A, et al. Marked 24-h rest/activity rhythms are associated with better quality of life, better response, and longer survival in patients with metastatic colorectal cancer and good performance status. Clin Cancer Res. 2000;6:3038–45.PubMedGoogle Scholar
  7. 7.
    Payne JK. Altered circadian rhythms and cancer-related fatigue outcomes. Integr Cancer Ther. 2011;10:221–33.PubMedCrossRefGoogle Scholar
  8. 8.
    Otte JL, Carpenter JS, Russell KM, Bigatti S, Champion VL. Prevalence, severity, and correlates of sleep–wake disturbances in long-term breast cancer survivors. J Pain Symptom Manage. 2010;39:535–47.PubMedCrossRefGoogle Scholar
  9. 9.
    Talley A, Molix L, Schlegel RJ, Bettencourt A. The influence of breast cancer survivors’ perceived partner social support and need satisfaction on depressive symptoms: a longitudinal analysis. Psychol Health. 2010;25:433–49.PubMedCrossRefGoogle Scholar
  10. 10.
    Alexander S, Minton O, Andrews P, Stone P. A comparison of the characteristics of disease-free breast cancer survivors with or without cancer-related fatigue syndrome. Eur J Cancer. 2009;45:384–92.PubMedCrossRefGoogle Scholar
  11. 11.
    Bower JE, Ganz PA, Desmond KA, Rowland JH, Meyerowitz BE, Belin TR. Fatigue in breast cancer survivors: occurrence, correlates, and impact on quality of life. J Clin Oncol. 2000;18:743–53.PubMedGoogle Scholar
  12. 12.
    Ganz PA, Kwan L, Stanton AL, Bower JE, Belin TR. Physical and psychosocial recovery in the year after primary treatment of breast cancer. J Clin Oncol. 2011;29:1101–9.PubMedCrossRefGoogle Scholar
  13. 13.
    Nieboer P, Buijs C, Rodenhuis S, Seynaeve C, Beex LV, van der Wall E, et al. Fatigue and relating factors in high-risk breast cancer patients treated with adjuvant standard or high-dose chemotherapy: a longitudinal study. J Clin Oncol. 2005;23:8296–304.PubMedCrossRefGoogle Scholar
  14. 14.
    Andrykowski M, Donovan KA, Laronga C, Jacobsen PB. Prevalence, predictors, and characteristics of off-treatment fatigue in breast cancer survivors. Cancer. 2010;116:5740–8.PubMedCrossRefGoogle Scholar
  15. 15.
    Gerber LH, Stout N, McGarvey C, Soballe P, Shieh CY, Diao G, et al. Factors predicting clinically significant fatigue in women following treatment for primary breast cancer. Support Care Cancer. 2011;19:1581–91.PubMedCrossRefGoogle Scholar
  16. 16.
    Meeske K, Smith AW, Alfano CM, McGregor BA, McTiernan A, Baumgartner KB, et al. Fatigue in breast cancer survivors two to five years post diagnosis: a HEAL Study report. Qual Life Res. 2007;16:947–60.PubMedCrossRefGoogle Scholar
  17. 17.
    Reinertsen KV. Predictors and course of chronic fatigue in long-term breast cancer survivors. J Cancer Surviv. 2010;4:405.PubMedCrossRefGoogle Scholar
  18. 18.
    Goodwin PJ. Commentary on: “Effect of obesity on survival in women with breast cancer: systematic review and meta-analysis” (Melinda Protani, Michael Coory, Jennifer H. Martin). Breast Cancer Res Treat. 2010;123:637–40.PubMedCrossRefGoogle Scholar
  19. 19.
    Protani M, Coory M, Martin JH. Effect of obesity on survival of women with breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat. 2010;123:627–35.PubMedCrossRefGoogle Scholar
  20. 20.
    Caan BJ. Pre-diagnosis body mass index, post-diagnosis weight change, and prognosis among women with early stage breast cancer. Cancer Causes Control. 2008;19:1319.PubMedCrossRefGoogle Scholar
  21. 21.
    Saquib N. Weight gain and recovery of pre-cancer weight after breast cancer treatments: evidence from the Women’s Healthy Eating and Living (WHEL) Study. Breast Cancer Res Treat. 2007;105:177.PubMedCrossRefGoogle Scholar
  22. 22.
    Freedman RJ. Weight and body composition changes during and after adjuvant chemotherapy in women with breast cancer. J Clin Endocrinol Metab. 2004;89:2248.PubMedCrossRefGoogle Scholar
  23. 23.
    Han H. Weight changes after adjuvant treatment in korean women with early breast cancer. Breast Cancer Res Treat. 2009;114:147.PubMedCrossRefGoogle Scholar
  24. 24.
    Irwin ML. Changes in body fat and weight after a breast cancer diagnosis: influence of demographic, prognostic, and lifestyle factors. J Clin Oncol. 2005;23:774.PubMedCrossRefGoogle Scholar
  25. 25.
    Heideman WH. The frequency, magnitude and timing of post-diagnosis body weight gain in dutch breast cancer survivors. Eur J Cancer. 2009;45:119.PubMedCrossRefGoogle Scholar
  26. 26.
    Makari-Judson G, Judson CH, Mertens WC. Longitudinal patterns of weight gain after breast cancer diagnosis: observations beyond the first year. Breast J. 2007;13:258–65.PubMedCrossRefGoogle Scholar
  27. 27.
    Berger AM, Kuhn BR, Farr L, Lynch JC, Agrawal S, Chamberlain J, et al. Behavioral therapy intervention trial to improve sleep quality and cancer-related fatigue. Psychooncology. 2009;18:634–46.PubMedCrossRefGoogle Scholar
  28. 28.
    Berger AM, Kuhn BR, Farr L, Von Essen SG, Chamberlain J, Lynch JC, et al. One-year outcomes of a behavioral therapy intervention trial on sleep quality and cancer-related fatigue. J Clin Oncol. 2009;27:6033–40.PubMedCrossRefGoogle Scholar
  29. 29.
    Buysse D, Reynolds 3rd CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28:193–213.PubMedCrossRefGoogle Scholar
  30. 30.
    Littner M, Kushida CA, Anderson WM, Bailey D, Berry RB, Davila DG, et al. Practice parameters for the role of actigraphy in the study of sleep and circadian rhythms: an update for 2002. Sleep. 2003;26:337–41.PubMedGoogle Scholar
  31. 31.
    Ancoli-Israel S, Cole R, Alessi C, Chambers M, Moorcroft W, Pollak CP. The role of actigraphy in the study of sleep and circadian rhythms. Sleep. 2003;26:342–92.PubMedGoogle Scholar
  32. 32.
    Levin RD, Daehler MA, Grutsch JF, Quiton J, Lis CG, Peterson C, et al. Circadian function in patients with advanced non-small-cell lung cancer. Br J Cancer. 2005;93:1202–8.PubMedCrossRefGoogle Scholar
  33. 33.
    Farr L and Boen L. Comparison of rectal and axillary temperature rhythms with activity. In: Anonymous NASA space grant consortium symposium, Nebraska Academy of Sciences, Lincoln, NE; 1996.Google Scholar
  34. 34.
    Lentz MJ. Time-series analysis—cosinor analysis: a special case. West J Nurs Res. 1990;12:408–12.PubMedCrossRefGoogle Scholar
  35. 35.
    Berger AM. Patterns of fatigue and activity and rest during adjuvant breast cancer chemotherapy. Oncol Nurs Forum. 1998;25:51–62.PubMedGoogle Scholar
  36. 36.
    Monk TH. Aging human circadian rhythms: conventional wisdom may not always be right. J Biol Rhythms. 2005;20:366–74.PubMedCrossRefGoogle Scholar
  37. 37.
    Ancoli-Israel S, Liu L, Marler MR, Parker B, Jones V, Sadler GR, et al. Fatigue, sleep, and circadian rhythms prior to chemotherapy for breast cancer. Support Care Cancer. 2006;14:201–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Miaskowski C. Sleep–wake circadian activity rhythm parameters and fatigue in oncology patients before the initiation of radiation therapy. Cancer Nurs. 2011;34:255.PubMedCrossRefGoogle Scholar
  39. 39.
    Chevalier V, Mormont MC, Cure H, Chollet P. Assessment of circadian rhythms by actimetry in healthy subjects and patients with advanced colorectal cancer. Oncol Rep. 2003;10:733–7.PubMedGoogle Scholar
  40. 40.
    Fernandes R, Stone P, Andrews P, Morgan R, Sharma S. Comparison between fatigue, sleep disturbance, and circadian rhythm in cancer inpatients and healthy volunteers: evaluation of diagnostic criteria for cancer-related fatigue. J Pain Symptom Manage. 2006;32:245–54.PubMedCrossRefGoogle Scholar
  41. 41.
    Piper BF, Dibble SL, Dodd MJ, Weiss MC, Slaughter RE, Paul SM. The revised piper fatigue scale: psychometric evaluation in women with breast cancer. Oncol Nurs Forum. 1998;25:677–84.PubMedGoogle Scholar
  42. 42.
    National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology: cancer-related fatigue. National Comprehensive Cancer Network; 2012. www.nccn.org
  43. 43.
    Berger AM, VonEssen S, Kuhn BR, Piper BF, Agrawal S, Lynch JC, et al. Adherence, sleep, and fatigue outcomes after adjuvant breast cancer chemotherapy: results of a feasibility intervention study. Oncol Nurs Forum. 2003;30:513–22.PubMedCrossRefGoogle Scholar
  44. 44.
    Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.PubMedCrossRefGoogle Scholar
  45. 45.
    Ware JE, Kosinski M, Dewey JE. How to score version two of the SF-36® health survey. Lincoln, RI: QualityMetric Incorporated; 2000.Google Scholar
  46. 46.
    Berger AM, Lockhart K, Agrawal S. Variability of patterns of fatigue and quality of life over time based on different breast cancer adjuvant chemotherapy regimens. Oncol Nurs Forum. 2009;36:563–70.PubMedCrossRefGoogle Scholar
  47. 47.
    Berger AM, Wielgus K, Young-McCaughan S, Fischer P, Farr L, Lee KA. Methodological challenges when using actigraphy in research. J Pain Symptom Manage. 2008;36:191–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Campbell SS, Gillin JC, Kripke DF, Erikson P, Clopton P. Gender differences in the circadian temperature rhythms of healthy elderly subjects: relationships to sleep quality. Sleep. 1989;12:529–36.PubMedGoogle Scholar
  49. 49.
    Goodwin PJ, Ennis M, Pritchard KI, McCready D, Koo J, Sidlofsky S, et al. Adjuvant treatment and onset of menopause predict weight gain after breast cancer diagnosis. J Clin Oncol. 1999;17:120–9.PubMedGoogle Scholar
  50. 50.
    Nissen MJ, Shapiro A, Swenson KK. Changes in weight and body composition in women receiving chemotherapy for breast cancer. Clin Breast Cancer. 2011;11:52–60.PubMedGoogle Scholar
  51. 51.
    Khaodhiar L, McCowen KC, Blackburn GL. Obesity and its comorbid conditions. Clin Cornerstone. 1999;2:17–31.PubMedCrossRefGoogle Scholar
  52. 52.
    Zanquetta MM, Corrêa-Giannella ML, Monteiro MB, Villares SM. Body weight, metabolism and clock genes. Diabetol Metab Syndr. 2010;2:53.PubMedCrossRefGoogle Scholar
  53. 53.
    Wielgus K, Berger AM, Hertzog M. Predictors of fatigue 30 days after completing anthracycline plus taxane adjuvant chemotherapy for breast cancer. Oncol Nurs Forum. 2009;36:38–48.PubMedCrossRefGoogle Scholar
  54. 54.
    Tranah GJ, Blackwell T, Ancoli-Israel S, Paudel ML, Ensrud KE, Cauley JA, et al. Circadian activity rhythms and mortality: the study of osteoporotic fractures. J Am Geriatr Soc. 2010;58:282–91.PubMedCrossRefGoogle Scholar
  55. 55.
    Ewertz M. Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol. 2011;29:25.PubMedCrossRefGoogle Scholar
  56. 56.
    Courneya KS, Katzmarzyk PT, Bacon E. Physical activity and obesity in Canadian cancer survivors: population-based estimates from the 2005 Canadian community health survey. Cancer. 2008;112:2475–82.PubMedCrossRefGoogle Scholar
  57. 57.
    Emery CF, Yang H, Frierson GM, Peterson LJ, Suh S. Determinants of physical activity among women treated for breast cancer in a 5-year longitudinal follow-up investigation. Psychooncology. 2009;18:377–86.PubMedCrossRefGoogle Scholar
  58. 58.
    Demark-Wahnefried W, Morey MC, Sloane R, Snyder DC, Cohen HJ. Promoting healthy lifestyles in older cancer survivors to improve health and preserve function. J Am Geriatr Soc. 2009;57 Suppl 2:S262–4.PubMedCrossRefGoogle Scholar
  59. 59.
    Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol. 2005;23:5814–30.PubMedCrossRefGoogle Scholar
  60. 60.
    Stout N, Blinkley J, Schmitz K, Andrews K, Hayes S, Campbell K, et al. Prospective surveillance model for rehabilitation for women with breast cancer. Cancer. 2012;118 Suppl 8:2191–2200.Google Scholar
  61. 61.
    Damush TM, Perkins A, Miller K. The implementation of an oncologist referred, exercise self-management program for older breast cancer survivors. Psychooncology. 2006;15:884–90.PubMedCrossRefGoogle Scholar
  62. 62.
    Grutsch JF, Wood PA, Du-Quiton J, Reynolds JL, Lis CG, Levin RD, et al. Validation of actigraphy to assess circadian organization and sleep quality in patients with advanced lung cancer. J Circadian Rhythms. 2011;9:4.PubMedCrossRefGoogle Scholar
  63. 63.
    Innominato PF, Focan C, Gorlia T, Moreau T, Garufi C, Waterhouse J, et al. Circadian rhythm in rest and activity: a biological correlate of quality of life and a predictor of survival in patients with metastatic colorectal cancer. Cancer Res. 2009;69:4700–7.PubMedCrossRefGoogle Scholar
  64. 64.
    Innominato PF, Mormont MC, Rich TA, Waterhouse J, Levi FA, Bjarnason GA. Circadian disruption, fatigue, and anorexia clustering in advanced cancer patients: implications for innovative therapeutic approaches. Integr Cancer Ther. 2009;8:361–70.PubMedCrossRefGoogle Scholar
  65. 65.
    Darga LL, Magnan M, Mood D, Hryniuk WM, DiLaura NM, Djuric Z. Quality of life as a predictor of weight loss in obese, early-stage breast cancer survivors. Oncol Nurs Forum. 2007;34:86–92.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Ann M. Berger
    • 1
  • Melody Hertzog
    • 1
  • Carol R. Geary
    • 1
  • Patricia Fischer
    • 2
  • Lynne Farr
    • 3
  1. 1.College of Nursing985330 NE MED CENTEROmahaUSA
  2. 2.Nebraska Medical CenterOmahaUSA
  3. 3.University of Nebraska Medical CenterOmahaUSA

Personalised recommendations