The effect of melatonin on sleep and quality of life in patients with advanced breast cancer
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Fatigue and sleep problems are prevalent in cancer patients and can be associated with disruption of circadian rhythmicity. In this prospective phase II trial, we sought to assess the effect of melatonin on circadian biomarkers, sleep, and quality of life in breast cancer patients.
Thirty-two patients with metastatic breast cancer, receiving hormonal or trastuzumab therapy, took 5 mg of melatonin at bedtime for 2 months. Before starting and after 2 months on melatonin therapy, sleep and circadian rhythmicity were assessed by actigraphy, diurnal patterns of serum cortisol, and the expression of the core clock genes PER2 and BMAL1 in peripheral blood mononuclear cells. The European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire was completed for subjective parameters.
Bedtime melatonin was associated with a significant improvement in a marker of objective sleep quality, sleep fragmentation and quantity, subjective sleep, fatigue severity, global quality of life, and social and cognitive functioning scales. Morning clock gene expression was increased following bedtime melatonin intake. Melatonin did not affect actigraphy measure of circadian rhythmicity, or the diurnal cortisol pattern.
These results invite further investigation of melatonin as a potentially useful therapeutic agent for improving sleep and quality of life in cancer patients.
KeywordsMelatonin Breast cancer Actigraphy Circadian Sleep Quality of life Clock genes
Supported by a grant from the Ontario Cancer Research Network 03-APR-0316OCRN to Dr. Bjarnason, the National Cancer Institute K07CA132916 to Dr. Palesh, and the Canadian Institutes of Health Research OOG MOP125934 to Dr. Lim.
Conflict of interest
The authors have no conflict of interest to declare.
- 1.Palesh OG, Roscoe JA, Mustian KM, Roth T, Savard J, Ancoli-Israel S, Heckler C, Purnell JQ, Janelsins MC, Morrow GR (2010) Prevalence, demographics, and psychological associations of sleep disruption in patients with cancer: University of Rochester Cancer Center-Community Clinical Oncology Program. J Clin Oncol 28(2):292–298PubMedCentralCrossRefPubMedGoogle Scholar
- 9.Bonde JP, Hansen J, Kolstad HA, Mikkelsen S, Olsen JH, Blask DE, Harma M, Kjuus H, de Koning HJ, Olsen J, Moller M, Schernhammer ES, Stevens RG, Akerstedt T (2012) Work at night and breast cancer—report on evidence-based options for preventive actions. Scand J Work Environ Health 38(4):380–390CrossRefPubMedGoogle Scholar
- 15.Innominato PF, Giacchetti S, Bjarnason GA, Focan C, Garufi C, Coudert B, Iacobelli S, Tampellini M, Durando X, Mormont MC, Waterhouse J, Levi FA (2012) Prediction of overall survival through circadian rest-activity monitoring during chemotherapy for metastatic colorectal cancer. Int J Cancer 131(11):2684–2692CrossRefPubMedGoogle Scholar
- 16.Innominato PF, Focan C, Gorlia T, Moreau T, Garufi C, Waterhouse J, Giacchetti S, Coudert B, Iacobelli S, Genet D, Tampellini M, Chollet P, Lentz MA, Mormont MC, Levi F, Bjarnason GA (2009) 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 69(11):4700–4707PubMedCentralCrossRefPubMedGoogle Scholar
- 18.Cohen L, Cole SW, Sood AK, Prinsloo S, Kirschbaum C, Arevalo JM, Jennings NB, Scott S, Vence L, Wei Q, Kentor D, Radvanyi L, Tannir N, Jonasch E, Tamboli P, Pisters L (2012) Depressive symptoms and cortisol rhythmicity predict survival in patients with renal cell carcinoma: role of inflammatory signaling. PLoS One 7(8), e42324PubMedCentralCrossRefPubMedGoogle Scholar
- 25.Lissoni P, Barni S, Mandala M, Ardizzoia A, Paolorossi F, Vaghi M, Longarini R, Malugani F, Tancini G (1999) Decreased toxicity and increased efficacy of cancer chemotherapy using the pineal hormone melatonin in metastatic solid tumour patients with poor clinical status. Eur J Cancer 35(12):1688–1692CrossRefPubMedGoogle Scholar
- 29.Mormont MC, Waterhouse J, Bleuzen P, Giacchetti S, Jami A, Bogdan A, Lellouch J, Misset JL, Touitou Y, Levi F (2000) 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 6(8):3038–3045PubMedGoogle Scholar
- 32.Lim AS, Chang AM, Shulman JM, Raj T, Chibnik LB, Cain SW, Rothamel K, Benoist C, Myers AJ, Czeisler CA, Buchman AS, Bennett DA, Duffy JF, Saper CB, De Jager PL (2012) A common polymorphism near PER1 and the timing of human behavioral rhythms. Ann Neurol 72(3):324–334.PubMedCentralCrossRefPubMedGoogle Scholar