Vivek Choudhary

Alterations of the Characteristics of the Circadian Rest‐Activity Rhythm of Cancer In‐Patients

The aim of the present study was to evaluate the characteristics of the circadian rest‐activity rhythm of cancer patients. Thirty‐one in‐patients, consisting of 19 males and 12 females, were randomly selected from the Regional Cancer Center, Pandit Jawaharlal Nehru Medical College, Raipur, India. The rest‐activity rhythm was studied non‐invasively by wrist actigraphy, and compared with 35 age‐matched apparently healthy subjects (22 males and 13 females). All subjects wore an Actiwatch (AW64, Mini Mitter Co. Inc., USA) for at least 4–7 consecutive days. Fifteen‐second epoch length was selected for gathering actigraphy data. In addition, several sleep parameters, such as time in bed, assumed sleep, actual sleep time, actual wake time, sleep efficiency, sleep latency, sleep bouts, wake bouts, and fragmentation index, were also recorded. Data were analyzed using several statistical techniques, such as cosinor rhythmometry, spectral analysis, ANOVA, Duncans multiple‐range test, and t‐test. Dichotomy index (I<O) and autocorrelation coefficient (r24) were also computed. The results validated a statistically significant circadian rhythm in rest‐activity with a prominent period of 24 h for most cancer patients and control subjects. Results of this study further revealed that cancer patients do experience a drastic alteration in the circadian rest‐activity rhythm parameters. Both the dichotomy index and r24 declined in the group of cancer patients. The occurrence of the peak (acrophase, Ø) of the rest‐activity rhythm was earlier (p<0.001) in cancer patients than age‐ and gender‐matched control subjects. Results of sleep parameters revealed that cancer patients spent longer time in bed, had longer assumed and actual sleep durations, and a greater number of sleep and wake bouts compared to control subjects. Further, nap frequency, total nap duration, average nap, and total nap duration per 1 h awake span were statistically significantly higher in cancer patients than control subjects. In conclusion, the results of the present study document the disruption of the circadian rhythm in rest‐activity of cancer in‐patients, with a dampening of amplitude, lowering of mean level of activity, and phase advancement. These alterations of the circadian rhythm characteristics could be attributed to disease, irrespective of variability due to gender, sites of cancer, and timings of therapies. These results might help in designing patient‐specific chronotherapeutic protocols.

Worsening of rest-activity circadian rhythm and quality of life in female breast cancer patients along progression of chemotherapy cycles

ABSTRACT Chemotherapy and its associated side effects can induce the disruption of circadian rest-activity rhythm and may have negative consequences on health-related quality of life (HRQoL) of cancer patients. In the current study, repeated-measures cross-sectional design was implemented to determine the status of circadian rest-activity rhythm and to assess the HRQoL of newly diagnosed female breast cancer patients those were planned to receive six cycles of chemotherapy. Rest activity and HRQoL were assessed in twenty-five patients during chemotherapy cycles 1st (C1), 3rd (C3), and 6th (C6) immediately after they reported to the outdoor ward of the Regional Cancer Center, Pt. J.N.M. Medical College, Dr. B.R. Ambedkar Memorial Hospital, Raipur, India. Wrist actigraphs for consecutive spans of 3–4 days were used to record the rest-activity rhythm, and its parameters were computed with the help of Cosinor Rhythmometry. Quality of life (QoL) parameters were assessed using EORTC QLQ-C30 and QLQ-BR23. Results revealed that average scores of all rhythm parameters, such as MESOR, amplitude, acrophase, rhythm quotient, circadian quotient, peak activity, dichotomy index, and autocorrelation coefficient; and all functional scales of QLQ-C30, such as physical, role, emotional, cognitive, and social, and global quality of life statistically significantly decreased with the increasing number of chemotherapy cycles (C1 to C3 and C6). Scores of symptom scales of QLQ-C30, such as fatigue, pain, dyspnoea, insomnia, appetite loss, and diarrhea increased significantly from C1 to C6. Among the QLQ-BR23 scales, scores of sexual functioning, sexual enjoyment, breast symptoms, and arm symptoms significantly decreased, whereas scores of systemic therapy side effects, and upset by hair loss significantly increased across the chemotherapy cycles. We conclude that rest-activity rhythm disrupted and HRQoL of breast cancer patients worsened along the increasing number of chemotherapy cycles. We suggest that along with the treatment protocol, level of disruption of these parameters should be assessed and managed with the proper interventions that prominently include timing of the chemotherapy administration. The latter is pivotal for maintenance of these parameters, which are likely to enhance the physiological ability of patients for better treatment responses and may improve the overall QoL and survival of the patients.

Implications of the study of rest – activity circadian rhythm in head and neck cancer patients

Abstract Rhythm alterations consisting of decrease in amplitude, modification in peak time, including the suppression of one or several circadian outputs have been reported in patients suffering from breast, ovarian and colorectal cancer. The aim of the present study was to evaluate the rest – activity circadian rhythm in patients suffering from head and neck cancer. Nine patients were randomly selected from the indoor ward of the Regional Cancer Center, Raipur, India. Rest – activity rhythm and various sleep parameters in these patients were studied non-invasively by using wrist actigraphy. A statistically significant circadian rhythm in rest – activity was validated in all cancer patients. They had lower activity levels (p < 0.05) and amplitudes (p < 0.05) as compared to their respective controls. Further, the fragmentation index was found to be more in male cancer patients as compared with their respective female (p < 0.05) and healthy male (p < 0.05) counterparts. In addition, female cancer patients experienced better sleep efficiency (p < 0.05) and had longer actual sleep time (p < 0.05) as compared to male cancer patients. We conclude that the 24-h average activity and amplitude of rest – activity circadian rhythm declined in head and neck cancer patients. A larger peak spread in the circadian rhythm in rest – activity of cancer patients was discovered. Therefore, the scheduling of therapies should be based on patient-specific individual findings.

Temporal profiles of physical activity and energy expenditure in cancer in-patients

Fifty-three cancer in-patients (37 males and 16 females) were randomly selected from the Regional Cancer Center, Pt. J.N.M. College, Dr. B.R. Ambedkar Hospital, Raipur, India. Rhythms in physical activity (PA) and energy expenditure (EE) were studied non-invasively using Actical (Mini Mitter Co. Inc., USA) and compared with 24 apparently healthy subjects (11 males and 13 females). Data were gathered at 1-min epoch length for at least three to four consecutive days and were analyzed using several statistical techniques, such as Cosinor rhythmometry, ANOVA, Duncans multiple-range test, and t-test. Most of the cancer in-patients and all control subjects exhibited a statistically significant circadian rhythm in PA and EE. However, the rhythm detection ratio was low among cancer in-patients. Patients had significantly lower 24-h average, lower amplitude, and an earlier acrophase in PA and EE rhythms. Further, significant effect of factor disease was discerned on total activity count (TAC) and total energy expenditure (TEE). TAC and TEE were significantly lower in cancer in-patients as compared to control subjects, irrespective of gender. In addition, a gradual decrement in PA intensity levels from sedentary to vigorous was validated in patients. From the present findings, it can be concluded that the factor disease might alter the temporal profiles of the PA and EE. However, further intensive studies involving more patients are required to reinforce the above conclusion.

Effect of Chemotherapy on Tumor Marker (Ca 15.3) and Serum in Breast Cancer Patients of Southern Eastern Region of Chhattisgarh; 6 Years Follow up Study

Background: At many centers tumor markers are used to detect disease recurrence and to monitor response to chemotherapy therapy in patients with advanced disease, although the real value of serial observation of marker levels remains disputed. In this study, we evaluated the changes in biochemical and tumor maker (CA 15.3) with respect to Chemotherapy among breast cancer patients. Aim: The present study was aimed to ascertain the changes in biochemical and tumor maker (CA 15.3) with respect to Chemotherapy among breast cancer patients. Material & Methods: 40 breast cancer patients and 10 cancer patient other than breast cancer (control subject) from regional cancer center were studied. All the cancer patients were aged between 27 to 56 years old with BSA and BMI ranged between 1.30-1.98 and 13.06-39.51 respectively. Tumor marker CA 15.3 level was done by ELISA, haematological test was measured by cell counter and biochemical assay was measured by Autoanalyzer. Tumor size was measured before and after chemotherapy. Patients were followed 6 years. Survival at 6 years is 60%. The data were analyzed using SPSS (20.0). Results: The result revealed that as compared to control patients the CA 15.3 maker was statistically significantly higher among breast cancer patients in before as well as in after chemotherapy cycles as well as it accessed the normal range of CA 15.3 (9-36 U/ml). Further, results of Chi-square test revealed statistically significant changes in serum parameters after chemotherapy. Glucose, urea, creatinine, bilirubin (total), bilirubin (direct), ALT (Alanine amino transferase), AST (Aspartate amino transferase), ALP (Alkaline phosphatase) and globulin were found to be significantly increase whereas, CA (15.3), WBC, Hb (haemoglobin), platelets, serum serum sodium, serum potassium, total protein and albumin were found to be significantly decreased, after chemotherapy. 83.3% tumour reduction in case group reported. The 6-year overall survival was 51% in the case group. Overall survival in operated group was 49.4 % and non-operated group was 52.1%. Conclusion: It is concluded that CA (15.3) is specific and sensitive maker for breast cancer. Further, prominent fluctuations in serum parameters due to chemotherapy specify consequent side-effects among breast cancer patients. Keywords: Chemotherapy, CA (15.3), breast cancer, AST, ALT, ALP, T. Protein

Transitional Cell Carcinoma of The ovary A Rare Case Report And Review of Literature.

Transitional cell carcinoma of the ovary is a rare variant of epithelial ovarian cancers(EOC).It has been described as a primary ovarian carcinoma with definite urothelial features but no benign, metaplastic and/or proliferating Brenner tumor (BT) identified. Recognition of such tumors is important because of its rarity, favorable response to chemotherapy and an improved patient survival. Treatment comprised multimodality approach using surgery, chemotherapy and radiotherapy. Surgery remains the mainstay of the treatment of this variant of EOC. Postoperative adjuvant radiotherapy improved local control in patients with adverse prognostic factors. Adjuvant radiotherapy improves outcome in patients with adverse factors.

Carcinoma of The Fallopian Tubes A Rare Case Report And Revi ew of Literature.

Primary fallopian tube cancer (PFTC) is a rare gynecological malignancy and has similar clinical pr esentations like epithelial ovarian cancers (EOC).Treatment comprised multimodality approach using surgery, chemotherapy and radiotherapy. Surgery remains the mainstay of the treatment of PFTC. When considered inop erable neoadjuvant chemotherapy is used for down staging. Postoperative adjuvant chemotherapy improved loc al control in patients with adverse prognostic factors. Adjuvant radiotherapy improves outcome in patients with adverse factors.