Presentation on theme: "Dott. Carlo Garufi Oncologia Medica C Istituto Regina Elena, Roma Scuola Mediterranea di Oncologia “Actigrafia nel tumore della mammella” Roma 28.11.2008."— Presentation transcript:
Dott. Carlo Garufi Oncologia Medica C Istituto Regina Elena, Roma Scuola Mediterranea di Oncologia “Actigrafia nel tumore della mammella” Roma 28.11.2008
BREAST CANCER Fatigue is the most prevalent and distressing symptom experienced by pts receiving adjuvant ChT for early stage BC Higher fatigue levels are related to sleep maintenance problems and low daytime activity in pts after ChT Sparse data available about circadiam rhythms alteration and fatigue prior to chemotherapy
Ample evidence suggest doctors might systematically misjudge patients' perception levels of symptoms or related important aspects of their illness….and there is wide agreement that patient themselves should be the primary source of information. (Slevin et al 1988; Sprangers et al. 1992; Da Silva et al. 1996; Stephens et al. 1997 Passik et al. 1998; Fayers et al. 2000; Wilson et al. 2000; Titzer et al. 2001) http://www.ispor.org/Meetings/va0502/symposium.asp Is the doctor’s view a reliable measure of patients HRQOL?
Cancer Related Fatigue “distressing, persistent, subjective, sense of tiredness or exhaustion related to cancer or to cancer treatment that is not proportional to recent activity and interferes with usual functioning” NCCN 2006
REST/ACTIVITY RHYTHM: THE ACTIGRAPH Piezo-electric accelerometer; Number of wrist accel./minute; Allows continuous recording, over a long time period. Parameters: 24-h pattern and alternance of rest and activity.
Independent prognostic value of the rest/activity circadian rhythm on overall survival (OS) in patients (pts) with metastatic colorectal cancer (MCC) receiving first line chemotherapy with 5-fluorouracil, leucovorin and oxaliplatin: a companion study to EORTC 05963. C. Garufi et al. ASCO 2005 The data confirmed the strong and indipendent prognostic value of the RAR for the survival of MCC patients in a multicentre randomized trial
Quality of life (QoL) correlates with the rest/activity circadian rhythm (RAR) in patients (pts) with metastatic colorectal cancer (MCC) on first line chemotherapy with 5-fluorouracil, leucovorin and oxaliplatin : an international multicenter study (EORTC 05963). P.F. Innominato et al. ASCO 2005 The correlation between RAR and Global QoL and symptom scores as fatigue and anorexia was confirmed for the first time in a multicenter setting
5FU/FA FFL Garufi et al Anticancer Drugs ‘01 CPT-11 + FF 5-16 Garufi et al Cancer ‘01 EORTC 05011 CPT-11 + FFL 5FU/FA Garufi et al EJC ‘97 Studi di Cronotherapia presso l’IRE CPT-11 bolus + FFL crono Garufi et al BJC ‘03 CPT-11 crono vs standard + FF 4-10 Garufi et al EJC ’06
VariablesHazard ratio (HR)95% Confidence IntervalP-value UNIVARIATE Sex0.6770.462-0.9910.04 Performance Status0.2770.163-0.469<0.0001 Agen.s. Site of primary tumorn.s Number site involved0.6050.402-0.9110.01 Qol parameters Physical Functionig0.9880.979-0.9960.004 Emotional Functioning0.990.982-0.9980.01 Social Functioning0.9920.923-1.0000.04 Fatigue1.0141.007-1.021<0.0001 Pain1.0111.004-1.0180.002 Nausea/vomitingn.s. Appetite Loss1.0071.000-1.0140.04 Costipationn.s. Diarrhoean.s. Global QoL0.9780.970-0.986<0.0001 MULTIVARIATE Performance Status0.3870.221-0.677<0.0001 Global QoL0.9770.969-0.986<0.0001 Analisi Univariata e Multivariata sec Cox per la Sopravvivenza
Individual patient circadian rhythm assessment by actigraphy. Cortisol Ratio (Slope) Serum TGF- Serum IL-6 Symptoms Robust Rhythm * (autocorrelation >0.47) 1.72 (Steep) Low Less fatigue, appetite loss. Dampened Rhythm (autocorrelation <0.35) 1.60 (Flat) High More fatigue and appetite loss. * p = < 0.05 Correlation: Rest/activity and Cortisol rhythms, TGF- and cytokines, and symptoms. Clin Cancer Res 2005; 11(5):1757-1764
85 women with stage I-IIIA breast cancer evaluation 7 days prior adjuv (n=72) or neoadjuv (n=13) ChT Women report fatigue and disturbed sleep before ChT begins Significant relationship between subjective poor sleep and fatigue and/or reduction of functional outcome Objective measures confirm disrupted and disturbed sleep However no significant correlation between objective sleep variable at night or during the day and fatigue and/or functional outcome Although their circadian rhythms are robust, pts with more delayed rhythms experience more daily disfunction secondary to fatigue Possible correlation between depression and fatigue Supp Care Cancer 2006, 12: 201-9
219 women with stage I-IIIA breast cancer Evaluation 48 h prior adjuvant ChT Measure of sleep (PSQI), fatigue (PFS) and circadian rhythms (Actigraph) J Pain Sympt Manag 2007, 33: 398-409
Conclusions Fatigue correlates with sleep distrubance Actigraph can be used to monitor circadian rhythms alteration Strategy of intervention through light exposure or phisical activity could help in preventing CRF