Fatigue and circadian activity rhythms in breast cancer patients before and after chemotherapy: a controlled study
Fatigue and circadian activity rhythms in breast cancer patients before and after chemotherapy: a controlled study
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DOI：
10.1080/21641846.2012.741782
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发表时间：
2013-01-01
影响因子：
2.8
通讯作者：
Ancoli-Israel, Sonia
中科院分区：
文献类型：
--
作者：
Liu, Lianqi;Rissling, Michelle;Ancoli-Israel, Sonia
背景：乳腺癌（BC）患者在化疗前、化疗中和化疗后经常出现癌症相关性疲乏（CRF）。昼夜节律是由内部起搏器产生并由时间表（例如，光）。一些研究表明，疲劳和昼夜节律之间的关系，在一些临床人群。研究方法：148名被诊断为I-III期乳腺癌并计划接受至少4个周期的辅助或新辅助化疗的女性和61名对照（无癌症的健康女性）参加了这项研究。在化疗前（基线）和4个周期后（周期-4）收集数据。疲劳评估采用多维疲劳症状量表简表（MFSI-SF）;昼夜活动节律（CAR）记录采用腕关节活动记录仪（6个参数包括：振幅、顶相、中位、上中位、下中位和F统计量）。使用混合模型分析来检查与对照相比疲劳和CAR参数的变化，并检查BC患者中疲劳和CAR参数之间的纵向关系。结果如下：在基线和第4周期，与对照相比，在BC患者中观察到更严重的CRF（总分和子量表评分）和破坏的CAR（振幅、中尺度和F统计量）（所有p <0.05）;与基线相比，BC患者在第4周期还经历了更多的疲劳和振幅和中尺度降低，以及中尺度上升时间延迟（所有p <0.05）。MFSI-SF总分的增加与振幅、中位和F统计量的降低显著相关（所有p <0.006）。结论：CRF在化疗开始前就已存在，CAR在化疗开始前就已被破坏。CRF和CAR之间的显著关系表明可能的潜在联系。使用有效的干预措施（如明亮的光疗法）重新携带受干扰的CAR也可能改善CRF。
Background: Breast cancer (BC) patients often experience cancer-related fatigue (CRF) before, during, and after their chemotherapy. Circadian rhythms are 24-hour cycles of behavior and physiology that are generated by internal pacemakers and entrained by zeitgebers (e.g., light). A few studies have suggested a relationship between fatigue and circadian rhythms in some clinical populations. Methods: One hundred and forty-eight women diagnosed with stage I-III breast cancer and scheduled to receive at least four cycles of adjuvant or neoadjuvant chemotherapy, and 61 controls (cancer-free healthy women) participated in this study. Data were collected before (Baseline) and after four cycles of chemotherapy (Cycle-4). Fatigue was assessed with the Short Form of Multidimensional Fatigue Symptom Inventory (MFSI-SF); circadian activity rhythm (CAR) was recorded with wrist actigraphy (six parameters included: amplitude, acrophase, mesor, up-mesor, down-mesor and F-statistic). A mixed model analysis was used to examine changes in fatigue and CAR parameters compared to controls, and to examine the longitudinal relationship between fatigue and CAR parameters in BC patients. Results: More severe CRF (total and subscale scores) and disrupted CAR (amplitude, mesor and F-statistic) were observed in BC patients compared to controls at both Baseline and Cycle-4 (all p's < 0.05); BC patients also experienced more fatigue and decreased amplitude and mesor, as well as delayed up-mesor time at Cycle-4 compared to Baseline (all p's < 0.05). The increased total MFSI-SF scores were significantly associated with decreased amplitude, mesor and F-statistic (all p's < 0.006). Conclusion: CRF exists and CAR is disrupted even before the start of chemotherapy. The significant relationship between CRF and CAR indicate possible underlying connections. Re-entraining the disturbed CAR using effective interventions such as bright light therapy might also improve CRF.