Hospitalization-induced exacerbation of the ill effects of chemotherapy on rest-activity rhythm and quality of life of breast cancer patients: a prospective and comparative cross-sectional follow-up study

ABSTRACT

Chemotherapy administration may result in the disruption of circadian rhythms and impairment of quality of life (QoL) of cancer patients. Nevertheless, we have little knowledge on the long-term consequences of chemotherapy and the effects of hospitalization. In the present study, we employed the two-factor repeated-measure cross-sectional design to determine the effects of chemotherapy and hospitalization on rest-activity (RA) rhythm and QoL of breast cancer patients. Initially, we randomly selected 39 inpatients and 42 outpatients, scheduled to receive six cycles of chemotherapy, from the Regional Cancer Center (RCC), Raipur, India. Finally, 30 patients in each group were included in the current study. We monitored circadian RA rhythm and QoL using wrist actigraphy and QLQ-C30 and QLQ-BR23, respectively, during the 1st (C1), 3rd (C3) and 6th (C6) chemotherapy cycles. Results revealed that with the progression of chemotherapy cycles (from C1 to C6), all rhythm parameters, namely mesor, amplitude, acrophase, rhythm quotient (RQ), circadian quotient (CQ), peak activity (PA), dichotomy index and autocorrelation coefficient, significantly decreased in both cancer in- and outpatients. In both groups of patients and during C1–C6, all functional and global QoL measures of QLQ-C30 and QLQ-BR23 significantly decreased and the symptoms significantly increased, except constipation, body image, sexual functioning and future perspectives in outpatients. The hospitalization exacerbated the problems associated with the RA rhythm and the QoL of the patients. In conclusion, the current study highlighted the negative consequences of hospitalization among inpatients, irrespective of the stage of cancer. We, therefore, recommend that cancer patients should be administered with chemotherapy as outpatients. The proposed protocol might have a covert bearing on the expression of better physiological state leading to satisfactory treatment outcomes.

KEYWORDS:

• Breast cancer
• chemotherapy cycle
• hospitalization
• inpatient
• outpatient
• rest-activity rhythm
• quality of life

Acknowledgments

We are grateful to the University Grants Commission, New Delhi, India, for providing fellowship to one of us (AS) through the DRS-SAP scheme sanctioned in the thrust area – Chronobiology to the School of Studies in Life Science, Pt. Ravishankar Shukla University, Raipur, India. We are grateful to all cancer patients who voluntarily participated in the current study. We are thankful to Late Dr. J.M. Waterhouse for helping us in analyzing the dichotomy index. We are also obliged to Mary Ann Muller, the Permissions Coordinator of the Taylor & Francis LLC, for permitting us to use the Figure-2 [outpatients] from our earlier publication [Sultan et al., Chronobiology International, 2017; 34:609-623].

Declaration of interest

The authors report no conflicts of interest.

Additional information

Funding

This work was supported by the Chhattisgarh Council of Science and Technology (CCOST), Raipur, India [grant number 8048/CCOST/MRP/2013 dated 27 December 2013].