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Dott. Carlo Garufi Oncologia Medica C Istituto Regina Elena, Roma

Scuola Mediterranea di Oncologia “Actigrafia nel tumore della mammella” Roma 28.11.2008. Dott. Carlo Garufi Oncologia Medica C Istituto Regina Elena, Roma. BREAST CANCER. Fatigue is the most prevalent and distressing symptom experienced by pts receiving adjuvant ChT for early stage BC

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Dott. Carlo Garufi Oncologia Medica C Istituto Regina Elena, Roma

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  1. Scuola Mediterranea di Oncologia “Actigrafia nel tumore della mammella” Roma 28.11.2008 Dott. Carlo Garufi Oncologia Medica C Istituto Regina Elena, Roma

  2. 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

  3. Is the doctor’s view a reliable measure of patients HRQOL? 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

  4. 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

  5. (Cleeland, et al, 2004)

  6. Pain Lower sleep quality Anxiety Cancer Related Fatigue Poor PS Physical Inactivity

  7. 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.

  8. 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

  9. 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

  10. Studi di Cronotherapia presso l’IRE 5FU/FAGarufi et alEJC ‘97 5FU/FAFFL Garufi et al Anticancer Drugs ‘01 CPT-11 + FF 5-16Garufi et al Cancer ‘01 CPT-11 bolus + FFL cronoGarufi et al BJC ‘03 CPT-11 crono vs standard + FF 4-10Garufi et al EJC ’06 EORTC 05011 CPT-11 + FFL

  11. Analisi Univariata e Multivariata sec Cox per la Sopravvivenza

  12. Correlation: Rest/activity and Cortisol rhythms, TGF- and cytokines, and symptoms. * p = < 0.05 Clin Cancer Res 2005; 11(5):1757-1764

  13. 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

  14. 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

  15. Berger et al., J Pain Sympt Manag 2007

  16. Circadian rhythm Fatigue Depression Mood Change in the actigraphy measures over time were significantly correlated with chenges in fatigue, mood, and depression Supp Care Cancer 2002, 10: 329-336

  17. Roscoe et al., Supp Care Cancer 2002

  18. 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

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