ArticleCancer medicine2018
Circadian rest-activity rhythm as an objective biomarker of patient-reported outcomes in patients with advanced cancer.
Article in Cancer medicine, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 47 papers, 3 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
47 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Comparative Efficacy of Various Exercise Types on Cancer-Related Fatigue for Cancer Survivors: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials.Cancer medicine · 2025Pooled it
- Disrupting the clock: meta-analysis of irregular night shifts and migraine, proposing shift work migraine disorder with chronobiology strategies.Frontiers in neurology · 2025Pooled it
- Prevalence of cancer-related fatigue based on severity: a systematic review and meta-analysis.Scientific reports · 2023Pooled it
- Relationships between rest-activity rhythms, cancer-related fatigue, and quality of life: Results from a time-restricted eating randomized controlled trial.Chronobiology international · 2026Trial
- Melatonin supplementation for quality of life in older patients with advanced cancer: a randomized controlled trial.BMC geriatrics · 2025Trial
- Combined Treatment With Cognitive Behavioral Therapy for Insomnia and Acceptance and Commitment Therapy Enhances Objective and Subjective Reports of Sleep in Patients With Advanced Cancer.Psycho-oncology · 2025Trial
- Rest-activity rhythms predict time to hospitalizations and emergency department visits among participants in a randomized control of adults with heart failure and insomnia.Sleep medicine · 2023Trial
- The short-term impact of methylprednisolone on patient-reported sleep in patients with advanced cancer in a randomized, placebo-controlled, double-blind trial.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2021Trial
- The circadian architecture of tumor immunity: mechanistic insights and treatment strategies.Biomarker research · 2026Review
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- Blood Clock Correlation Distance (BloodCCD) as a novel marker to detect circadian rhythm disruption in cancer survivors with insomnia.BJC reports · 2025Article
- Neuroscience of cancer: unraveling the complex interplay between the nervous system, the tumor and the tumor immune microenvironment.Molecular cancer · 2025Review
- Longitudinal associations of diurnal rest-activity rhythms with fatigue, insomnia, and health-related quality of life in survivors of colorectal cancer up to 5 years post-treatment.The international journal of behavioral nutrition and physical activity · 2024Article
- Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study.JMIR research protocols · 2024Observational
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- Article
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- Circadian rhythm disorders in patients with advanced cancer: a scoping review.Frontiers in oncology · 2023Article
- The Impact of Immunotherapy on Sleep and Circadian Rhythms in Patients with Cancer.Frontiers in oncology · 2023Review
- Circadian, hormonal, and sleep rhythms: effects on cancer progression implications for treatment.Frontiers in oncology · 2023Review
Corrections and comments
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Authors and funding
14 authors.
Funding
Abstract
backgroundPsychosocial symptoms often cluster together, are refractory to treatment, and impair health-related quality of life (HR-QoL) in cancer patients. The contribution of circadian rhythm alterations to systemic symptoms has been overlooked in cancer, despite a causal link shown under jet lag and shift work conditions. We investigated whether the circadian rest-activity rhythm provides a reliable and objective estimate of the most frequent patient-reported outcome measures (PROMs).
methodsTwo datasets were used, each involving concomitant 3-day time series of wrist actigraphy and HR-QoL questionnaires: EORTC QLQ-C30 was completed once by 237 patients with metastatic colorectal cancer; MD Anderson Symptom Inventory (MDASI) was completed daily by 31 patients with advanced cancer on continuous actigraphy monitoring, providing 1015 paired data points. Circadian function was assessed using the clinically validated dichotomy index I < O. Nonparametric tests compared PROMs and I < O. Effect sizes were computed. Sensitivity subgroup and temporal dynamics analyses were also performed.
resultsI < O values were significantly lower with increasing symptom severity and worsening HR-QoL domains. Fatigue and anorexia were worse in patients with circadian disruption. The differences were both statistically and clinically significant (P < 0.001; d ≥ 0.33). Physical and social functioning, and global quality/enjoyment of life were significantly better in patients with robust circadian rhythm (P < 0.001; d ≥ 0.26). Sensitivity analyses validated these findings.
conclusionObjectively determined circadian disruption was consistently and robustly associated with clinically meaningfully severe fatigue, anorexia, and interference with physical and social functioning. This supports an important role of the circadian system in the determination of cancer patients' HR-QoL and symptoms that deserves therapeutic exploitation.
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