Differential patterns of circadian rhythmicity in women with malignant versus benign gynecologic tumors

Patterns of dietary quality, physical activity, and sleep duration among cancer survivors and caregivers

Fruit and vegetable intake (FVI), moderate-to-vigorous physical activity (MVPA), and sleep duration are each independently associated with cancer-related and general health outcomes among cancer survivors. Past research suggests that health behaviors cluster among cancer survivors, with caregivers demonstrating similar patterns. This analysis examined co-occurrence of FVI, MVPA, and sleep duration among cancer survivors and informal cancer caregivers and identified sociodemographic and clinical correlates of health behavior engagement. Using data from the Health Information National Trends Survey (HINTS), an exploratory latent profile analysis (LPA) was conducted among those self-reporting a history of cancer or identifying as a cancer caregiver. The LPA model was fit with daily self-reported FVI (cups/d), MPVA (minutes/d) and sleep duration (hours/d). Multinomial logistic regression models were used to predict profile membership based on sociodemographic and clinical characteristics. Four health behavior profiles were identified (Least Engaged-No MVPA, Least Engaged-Low MVPA, Moderately Engaged, and Highly Engaged). The largest profile membership was Least Engaged-No MVPA, capturing 37% of the sample. Profiles were most distinguished by MVPA, with the lowest variance in sleep duration. Participants reporting higher FVI also often reported greater MVPA and longer sleep duration. Profile membership was significantly associated with age, relationship status, education, income, rurality, alcohol use, self-efficacy, psychological distress, BMI, and cancer type. This study identified four health behaviors patterns and sociodemographic correlates that distinguished those patterns among cancer survivors and caregivers drawn from a nationally representative sample. Results may help identify for whom health behavior interventions could be of greatest benefit.

Stakeholder-informed refinement of a behavioral sleep/circadian intervention for gynecologic cancer survivors: an application of the MOST preparation phase

BACKGROUND

Sleep disturbance is among the most frequent and distressing symptoms reported by gynecologic cancer survivors. Existing evidence-based behavioral sleep interventions are limited by implementation burden, which can decrease adherence.

PURPOSE

As part of the preparation phase of the multiphase optimization strategy (MOST), this study solicited stakeholder feedback to maximize adherence in a planned behavioral sleep/circadian intervention optimization trial.

METHODS

Thirteen post-treatment survivors of early-stage gynecologic cancer completed the protocol for the planned optimization trial, including simultaneous receipt of all candidate intervention components. This included six weeks of combined sleep restriction, stimulus control, and systematic exposure to morning bright light. Participants then completed a semi-structured interview to provide feedback on their experience. We used a rapid analytic approach to quickly identify actionable feedback from de-identified transcripts.

RESULTS

Participants generally reacted positively to the intervention components. Actionable feedback identified recommended protocol modifications and was categorized into four overarching themes: (i) remove barriers to engagement; (ii) revise for clarity; (iii) augment content; and (iv) consider individual circumstances.

CONCLUSIONS

Rapid qualitative analysis enabled us to effectively modify our planned study protocol on an expedited timeline. This approach is consistent with the core principles of MOST and can be incorporated into the Preparation phase to enhance optimization efforts.

Circadian Rhythmicity as a Predictor of Quality of Life in Allogeneic Hematopoietic Cell Transplant Patients

CONTEXT

Quality of life (QoL) is increasingly recognized as an important outcome of cancer treatment. Previous studies have examined clinical predictors of QoL, but with the increasing prevalence of wearable sensors that monitor sleep and activity patterns, further investigation into whether these behaviors are predictive of post-treatment QoL is now feasible. Among patients receiving aggressive cancer treatment such as hematopoietic cell transplantation (HCT), analysis of circadian rhythms (24-hour patterns of sleep and activity) via wearable sensors is limited.

OBJECTIVE

To evaluate the relationship between overall QoL and circadian rhythms in patients receiving allogeneic HCT.

METHODS

Patients wore an ActiGraph GT3X (Pensacola, FL) activity monitor for at least 72 hours before the initiation of conditioning chemotherapy and transplantation and completed a QoL (Functional Assessment of Cancer Therapy-General [FACT-G]) assessment. QoL assessments were also completed 1, 3, and 6 months after HCT.

RESULTS

Patients (n = 45, M age = 55) were mostly male (66%) with a total FACT-G score of 80.96 (SD = 16.05) before HCT. Mixed models revealed robust cross-sectional associations between overall QoL and multiple circadian rhythmicity parameters, including durations of high physical activity, overall circadian rhythmicity, and earlier starts of daily activity (P's < .01). Recovery of QoL after transplant was predicted by longer pre-transplant durations of high physical activity (P = .04) and earlier evening retirement (P = .04).

CONCLUSION

Our findings suggest that wearable sensor information is a promising method of predicting recovery of QoL after HCT. Additional studies are needed to confirm these findings in a larger sample.