Open Access Open Badges Research article

The association of quality of life with potentially remediable disruptions of circadian sleep/activity rhythms in patients with advanced lung cancer

James F Grutsch15, Carol Ferrans4, Patricia A Wood2, Jovelyn Du-Quiton2, Dinah Faith T Quiton3, Justin L Reynolds2, Christine M Ansell2, Eun Young Oh2, Mary Ann Daehler1, Robert D Levin1, Donald P Braun1, Digant Gupta1, Christopher G Lis1 and William JM Hrushesky23*

Author Affiliations

1 Cancer Treatment Centers of America® at Midwestern Regional Medical Center, 2520 Elisha Ave. Zion, IL 60099, USA

2 School of Medicine University of South Carolina, 6311 Garners Ferry Road, Columbia, SC 29209, USA

3 School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC 29208, USA

4 University of Illinois, School of Nursing, 845 South Damen Avenue, Chicago, IL 60612 USA

5 University of Illinois, School of Public Health, 1603 W. Taylor Street, Chicago, IL 60612, USA

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BMC Cancer 2011, 11:193  doi:10.1186/1471-2407-11-193

Published: 23 May 2011



Cancer patients routinely develop symptoms consistent with profound circadian disruption, which causes circadian disruption diminished quality of life. This study was initiated to determine the relationship between the severity of potentially remediable cancer-associated circadian disruption and quality of life among patients with advanced lung cancer.


We concurrently investigated the relationship between the circadian rhythms of 84 advanced lung cancer patients and their quality of life outcomes as measured by the EORTC QLQ C30 and Ferrans and Powers QLI. The robustness and stability of activity/sleep circadian daily rhythms were measured by actigraphy. Fifty three of the patients in the study were starting their definitive therapy following diagnosis and thirty one patients were beginning second-line therapy. Among the patients who failed prior therapy, the median time between completing definitive therapy and baseline actigraphy was 4.3 months, (interquartile range 2.1 to 9.8 months).


We found that circadian disruption is universal and severe among these patients compared to non-cancer-bearing individuals. We found that each of these patient's EORTC QLQ C30 domain scores revealed a compromised capacity to perform the routine activities of daily life. The severity of several, but not all, EORTC QLQ C30 symptom items correlate strongly with the degree of individual circadian disruption. In addition, the scores of all four Ferrans/Powers QLI domains correlate strongly with the degree of circadian disruption. Although Ferrans/Powers QLI domain scores show that cancer and its treatment spared these patients' emotional and psychological health, the QLI Health/Function domain score revealed high levels of patients' dissatisfaction with their health which is much worse when circadian disruption is severe. Circadian disruption selectively affects specific Quality of Life domains, such as the Ferrans/Powers Health/Function domain, and not others, such as EORTC QLQ C30 Physical Domain.


These data suggest the testable possibility that behavioral, hormonal and/or light-based strategies to improve circadian organization may help patients suffering from advanced lung cancer to feel and function better.