Skip to main content

Advertisement

SpringerLink
Log in

Morning chronotype is a protective factor against chemotherapy-induced hot flashes in premenopausal women with breast cancer

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Purpose

Adjuvant chemotherapy in patients with breast cancer often causes hot flashes, impairing quality of life. However, the chronobiological or psychiatric factors associated with the development of chemotherapy-induced hot flashes (CIHFs) remain undetermined. The purpose of this study was to investigate whether chronotype was associated with the incidence of CIHFs.

Methods

A total of 119 premenopausal women with non-metastatic breast cancer awaiting adjuvant chemotherapy after surgery without hot flashes were included. The presence of CIHF was defined as having moderate to severe hot flashes, as measured by the subscale of hot flashes in the Menopause Rating Scale, at 4 weeks after the completion of chemotherapy. Chronotype (Morning/Intermediate/Evening) was assessed with the Composite Scale of Morningness before adjuvant chemotherapy. To examine the association between chronotype and CIHF, we built logistic regression models, adjusting for age, body mass index, sleep quality, and radiation therapy.

Results

CIHF occurred in 50.4% of participants. Morning type was inversely associated with CIHF (reference: Intermediate type, odds ratio [OR], 0.37; 95% confidence interval [CI], 0.16–0.94; p = 0.040) in the univariate model, and the association remained significant (OR, 0.37; CI, 0.13–0.96; p = 0.045) after adjusting for age, body mass index, sleep quality, and radiation therapy.

Conclusions

Morning chronotype is a protective factor against the development of CIHF in patients with breast cancer. Chronotypes should be assessed and considered in the prediction and management of CIHF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Jung K-W, Won Y-J, Kong H-J, Lee ES (2018) Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2015. Cancer Res Treat 50(2):303–316

    Article  Google Scholar 

  2. Crandall C, Petersen L, Ganz PA, Greendale GA (2004) Association of breast cancer and its therapy with menopause-related symptoms. Menopause 11(5):519–530

    Article  Google Scholar 

  3. Stein KD, Jacobsen PB, Hann DM, Greenberg H, Lyman G (2000) Impact of hot flashes on quality of life among postmenopausal women being treated for breast cancer. J Pain Symptom Manag 19(6):436–445

    Article  CAS  Google Scholar 

  4. Carpenter JS, Johnson D, Wagner L, Andrykowski M (2002) Hot flashes and related outcomes in breast cancer survivors and matched comparison women. Oncol Nurs Forum 29(3):E16–E25

    Article  Google Scholar 

  5. Savard J, Liu L, Natarajan L, Rissling MB, Neikrug AB, He F, Dimsdale JE, Mills PJ, Parker BA, Sadler GR, Ancoli-Israel S (2009) Breast cancer patients have progressively impaired sleep-wake activity rhythms during chemotherapy. Sleep 32(9):1155–1160

    Article  Google Scholar 

  6. Savard MH, Savard J, Quesnel C, Ivers H (2009) The influence of breast cancer treatment on the occurrence of hot flashes. J Pain Symptom Manag 37(4):687–697

    Article  Google Scholar 

  7. Lee KM, Jung D, Hwang H et al (2017) Late chronotypes are associated with neoadjuvant chemotherapy-induced nausea and vomiting in women with breast cancer. Chronobiol Int 30(4):480–491

    Article  Google Scholar 

  8. Jung D, Lee KM, Kim WH, Lee JY, Kim TY, Im SA, Lee KH, Spiegel D, Hahm BJ (2016) Longitudinal association of poor sleep quality with chemotherapy-induced nausea and vomiting in patients with breast cancer. Psychosom Med 78:959–965

    Article  CAS  Google Scholar 

  9. Lee KM, Jung D, Hwang H, Son KL, Kim TY, Im SA, Lee KH, Hahm BJ (2018) Pre-treatment anxiety is associated with persistent chemotherapy-induced peripheral neuropathy in women treated with neoadjuvant chemotherapy for breast cancer. J Psychosom Res 108:14–19

    Article  Google Scholar 

  10. Carpenter JS, Gilchrist JM, Chen K, Gautam S, Freedman RR (2004) Hot flashes, core body temperature, and metabolic parameters in breast cancer survivors. Menopause 11(4):375–381

    Article  Google Scholar 

  11. Foster RG, Peirson SN, Wulff K, Winnebeck E, Vetter C, Roenneberg T (2013) Sleep and circadian rhythm disruption in social jetlag and mental illness. Prog Mol Biol Transl Sci 119:325–346

    Article  Google Scholar 

  12. Horne JA, Ostberg O (1976) A self-assessment questionnaire to determine morningness-eveningness in human circadian rhythms. Int J Chronobiol 4(2):97–110

    CAS  PubMed  Google Scholar 

  13. Wittmann M, Dinich J, Merrow M, Roenneberg T (2006) Social jetlag: misalignment of biological and social time. Chronobiol Int 23(1–2):497–509

    Article  Google Scholar 

  14. Heinemann LA, Potthoff P, Schneider HP (2003) International versions of the Menopause Rating Scale (MRS). Health Qual Life Outcomes 1(1):28

    Article  Google Scholar 

  15. National Institutes of Health (2005) National Institutes of Health State-of-the-Science Conference statement: management of menopause-related symptoms. Ann Intern Med 142(12):1003–1013

    Google Scholar 

  16. Barnabei VM, Cochrane BB, Aragaki AK, Nygaard I, Williams RS, McGovern PG, Young RL, Wells EC, O’Sullivan MJ, Chen B, Schenken R, Johnson SR, Women’s Health Initiative I (2005) Menopausal symptoms and treatment-related effects of estrogen and progestin in the Women’s Health Initiative. Obstet Gynecol 105(5 Pt 1):1063–1073, 2005

  17. Sloan JA, Loprinzi CL, Novotny PJ, Barton DL, Lavasseur BI, Windschitl H (2001) Methodologic lessons learned from hot flash studies. J Clin Oncol 19(23):4280–4290

    Article  CAS  Google Scholar 

  18. Smith CS, Reilly C, Midkiff K (1989) Evaluation of three circadian rhythm questionnaires with suggestions for an improved measure of morningness. J Appl Psychol 74(5):728–738

    Article  CAS  Google Scholar 

  19. Torsvall L, Åkerstedt T (1980) A diurnal type scale: construction, consistency and validation in shift work. Scand J Work Environ Health 6:283–290

    Article  CAS  Google Scholar 

  20. Bohle P, Tilley AJ, Brown S (2001) Psychometric evaluation of the early/late preferences scale. Ergonomics 44(10):887–900

    Article  CAS  Google Scholar 

  21. Di Milia L, Adan A, Natale V, Randler C (2013) Reviewing the psychometric properties of contemporary circadian typology measures. Chronobiol Int 30(10):1261–1271

    Article  Google Scholar 

  22. Buysse DJ, Reynolds CF, Monk TH (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28:193–213

    Article  CAS  Google Scholar 

  23. Carpenter JS, Andrykowski MA (1998) Psychometric evaluation of the Pittsburgh Sleep Quality Index. J Psychosom Res 45(1):5–13

    Article  CAS  Google Scholar 

  24. Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67:361–370

    Article  CAS  Google Scholar 

  25. Bjelland I, Dahl AA, Haug TT, Neckelmann D (2002) The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res 52(2):69–77

    Article  Google Scholar 

  26. Carpenter JS, Gautam S, Freedman RR, Andrykowski M (2001) Circadian rhythm of objectively recorded hot flashes in postmenopausal breast cancer survivors. Menopause 8(3):181–188

    Article  CAS  Google Scholar 

  27. Freedman RR (2001) Physiology of hot flashes. Am J Hum Biol 13(4):453–464

    Article  CAS  Google Scholar 

  28. Kronenberg F (1990) Hot flashes: epidemiology and physiologya. Ann N Y Acad Sci 592(1):52–86

    Article  CAS  Google Scholar 

  29. Negriff S, Dorn LD (2009) Morningness/Eveningness and menstrual symptoms in adolescent females. J Psychosom Res 67(2):169–172

    Article  Google Scholar 

  30. Takeuchi H, Oishi T, Harada T (2005) Association between moringness-eveningness preference and mental/physical premenstrual symptoms in Japanese females 12 to 31 years of age. Chronobiol Int 22(6):1055–1068

    Article  Google Scholar 

  31. Toffol E, Merikanto I, Lahti T, Luoto R, Heikinheimo O, Partonen T (2013) Evidence for a relationship between chronotype and reproductive function in women. Chronobiol Int 30(6):756–765

    Article  Google Scholar 

Download references

Funding

This work was supported by the National Research Foundation of Korea (NRF; grant number NRF-2013R1A1A2013480).

Author information

Author notes

  1. Kyung-Lak Son and Dooyoung Jung contributed equally to this work.

Authors and Affiliations

  1. Department of Psychiatry, Dongguk University Ilsan Hospital, Goyang, South Korea

    Kyung-Lak Son

  2. Department of Human Factors Engineering, Ulsan National Institute of Science and Technology, Ulsan, South Korea

    Dooyoung Jung

  3. Department of Psychiatry and Behavioral Sciences, Seoul National University College of Medicine, Seoul, South Korea

    Kwang-Min Lee & Bong-Jin Hahm

  4. Department of Public Health Medical Service, Seoul National University Hospital, Seoul, South Korea

    Kwang-Min Lee

  5. Department of Psychiatry, Chungcheongnam-do Seosan Medical Center, Seosan, South Korea

    Kwang-Min Lee

  6. Department of Psychiatry, Bucheon Korea Hospital, Bucheon, South Korea

    Heesung Hwang

  7. Department of Psychiatry, University of Maryland Medical Center, Baltimore, MD, USA

    JooYoung Lee

  8. Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea

    Tae-Yong Kim, Seock-Ah Im & Kyung-Hun Lee

  9. Cancer Research Institute, Seoul National University, Seoul, South Korea

    Tae-Yong Kim, Seock-Ah Im & Kyung-Hun Lee

  10. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

    Seock-Ah Im

  11. Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA

    David Spiegel

  12. Department of Psychiatry, Seoul National University Hospital, Seoul, South Korea

    Bong-Jin Hahm

Authors
  1. Kyung-Lak Son
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dooyoung Jung
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kwang-Min Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Heesung Hwang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. JooYoung Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tae-Yong Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Seock-Ah Im
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kyung-Hun Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. David Spiegel
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Bong-Jin Hahm
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bong-Jin Hahm.

Ethics declarations

The study protocol was approved by the Institutional Review Board of Seoul National University Hospital (IRB No. H-1105-092-363), and the clinical trial registration number was NCT 01887925 (WWW.CLINICALTRIALS.GOV).

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study protocol was approved by the Institutional Review Board of Seoul National University Hospital (IRB No. H-1105-092-363).

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Son, KL., Jung, D., Lee, KM. et al. Morning chronotype is a protective factor against chemotherapy-induced hot flashes in premenopausal women with breast cancer. Support Care Cancer 28, 1351–1358 (2020). https://doi.org/10.1007/s00520-019-04949-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-019-04949-0

Keywords

Search

Navigation