The document summarizes several studies that examined sleep patterns and quality of life in colorectal cancer patients. The studies found that colorectal cancer patients had less variability between daytime activity and nocturnal sleep compared to controls. An exercise program was shown to improve sleep quality, mobility and fatigue in colorectal cancer patients. Other studies found that disrupted circadian rhythms were associated with poorer quality of life and reduced survival rates in colorectal cancer patients. Longer sleep duration was associated with increased risk of colorectal cancer in overweight individuals or regular snorers.

1. Lit Search
June 19, 2015
Sleep in colorectal cancer patients
Source:
Chevalier V, Mormont MC, Cure H, Chollet P. Assessment of circadian
rhythms by actimetry in healthy subjects and patients with advanced
colorectal cancer. Oncology reports. 2003;10:733-737.
Synopsis: Colorectal cancer patients and controls wore actiwatches to look at
daytime activity and sleep patterns. Chevalier, et al found that colorectal cancer
patients had less variability between daytime activity and nocturnal sleep compared
to controls.
Answers Question: Colorectal patients develop more sleep problems.
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Source:
Cheville AL, Kollasch J, Vandenberg J, et al. A home-based exercise program
to improve function, fatigue, and sleep quality in patients with Stage IV lung
and colorectal cancer: a randomized controlled trial. Journal of pain and
symptom management. 2013;45:811-821.
Synopsis: A randomized portion of a total 66 adults with Stage IV lung or colorectal
cancer completed an 8-week trial home exercise program. After the 8 weeks,
participants in the intervention group reported improved mobility, fatigue, and
sleep quality, as compared to the control group.
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Source:
Innominato PF, Focan C, Gorlia T, et al. Circadian rhythm in rest and activity:
a biological correlate of quality of life and a predictor of survival in patients
with metastatic colorectal cancer. Cancer research. 2009;69:4700-4707.
Synopsis: The rest-activity circadian rhythm, or “CircAct,” which reflects the
function of the circadian timing system, was estimated in metastatic colorectal
cancer patients by two parameters, I<O and r24. Innominato et al found that
interventions normalizing dysfunctional circadian timing systems may affect quality
of life and survival.
Quote: “I<O was confirmed to correlate with global quality of life, physical
functioning, social functioning, fatigue, and appetite loss” (Abstract).

2. Source:
Innominato PF, Giacchetti S, Bjarnason GA, et al. Prediction of overall survival
through circadian rest-activity monitoring during chemotherapy for
metastatic colorectal cancer. International journal of cancer. Journal
international du cancer. 2012;131:2684-2692.
Synopsis: Watches were used to monitor the I<O of 77 metastatic colorectal cancer
patients undergoing chemotherapy. The I<O parameter independently predicted
overall survival before chemotherapy. Circadian disruption, which occurred in 39
patients, was associated with a significantly shorter overall survival.
Quotes: “I< O was computed as the percentage of minutes of activity counts in bed
which were below the median of activity out of bed. Circadian disruption was
defined by I<O equal to or less than 97.5%” (Abstract).
Answers Question: I<O is a “quantitative and clinically relevant circadian
Estimate” (131) that measures the relative amount of activity in bed (I) versus out
of bed (O).
Source:
Jiao L, Duan Z, Sangi-Haghpeykar H, Hale L, White DL, El-Serag HB. Sleep
duration and incidence of colorectal cancer in postmenopausal women.
British journal of cancer. 2013;108:213-221.
Synopsis: Jiao et al estimated the hazard ratio and its associated confidence interval
(using the Cox proportional hazards regression model) of colorectal cancer in
postmenopausal women. For both short and long sleep durations, there was a
moderate increase in risk of colorectal cancer in postmenopausal women.
Source:
Lemasters T, Madhavan S, Sambamoorthi U, Kurian S. A population-based
study comparing HRQoL among breast, prostate, and colorectal cancer
survivors to propensity score matched controls, by cancer type, and gender.
Psycho-oncology. 2013
Synopsis: This study compared health-related quality of life (HRQoL) of breast
cancer, prostate cancer, and colorectal cancer survivors against matched controls.
Cancer survivors were found to experience a worse HRQoL than the controls
without a history of cancer, with severity depending on time since diagnosis, type of
cancer, and gender.
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3. Source:
Lin KY, Shun SC, Lai YH, Liang JT, Tsauo JY. Comparison of the Effects of a
Supervised Exercise Program and Usual Care in Patients With Colorectal
Cancer Undergoing Chemotherapy. Cancer nursing. 2013.
Synopsis: Stage II or III colorectal cancer patients were assigned to either a 12-week
supervised exercise group or a “usual care” control group during their
chemotherapy treatment. Before the study, and then after intervention, researchers
measured outcomes such as quality of life, muscle strength, physical activity, and
sleep quality, among others. The exercise group experienced larger effects on
physical activity, and the quality of life subscales of role functioning and pain.
Quotes: “Nurses or physical therapists should promote the importance of exercise
and encourage patients to participate in supervised exercise during adjuvant
chemotherapy” (E27).
Source:
Mormont MC, Waterhouse J, Bleuzen P, et al. Marked 24-h rest/activity
rhythms are associated with better quality of life, better response, and longer
survival in patients with metastatic colorectal cancer and good performance
status. Clinical cancer research : an official journal of the American
Association for Cancer Research. 2000;6:3038-3045.
Synopsis: A group of 200 metastatic colorectal cancer patients wore actigraphs to
measure rest/activity circadian cycles prior to their chemotherapy treatments.
Patients with marked activity rhythm, compared to those with rhythm alteration,
had better survival at two years (fivefold higher), as well as better quality of life and
less fatigue.
Source:
Mota DD, Pimenta CA, Caponero R. Fatigue in colorectal cancer patients:
prevalence and associated factors. Revista latino-americana de enfermagem.
2012;20:495-503.
Synopsis: Mota et al assessed fatigue scores of colorectal cancer outpatients using
the Piper Fatigue Scale, and identified three predictors of fatigue: depression,
performance status, and sleep disturbance. Researchers say these factors can help
estimate the probability of fatigue occurrence.

4. Quotes: “The prevalence of fatigue among colorectal cancer patients was 26.8%.
Fatigue predictors were sleep disturbance, depression and performance status.
When all factors were present, the chance a patient had fatigue was 80%, which
indicated good prediction. When all factors were absent, the chance a patient had
fatigue was 8%” (501).
Source:
Palesh O, Peppone L, Innominato PF, et al. Prevalence, putative mechanisms,
and current management of sleep problems during chemotherapy for cancer.
Nature and science of sleep. 2012;4:151-162.
Synopsis: The article discusses existing evidence and literature on sleep problems in
cancer patients undergoing chemotherapy. The article says “dedicated intervention
trials” are needed to test current treatments to sleep problems in patients receiving
chemotherapy.
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Source:
Zhang X, Giovannucci EL, Wu K, et al. Associations of self-reported sleep
duration and snoring with colorectal cancer risk in men and women. Sleep.
2013;36:681-688.
Synopsis: Researchers measured information on sleep duration and snoring, looking
at nearly 2000 colorectal cancer patients among the participants. Longer sleep
duration than an average of 7 hours in individuals who were overweight or snored
regularly was associated with increased risk of colorectal cancer.
Quotes: “We found that men with long sleep duration (≥ 9 h per day) had a
significantly increased risk of developing colorectal cancer compared with those
with 7 h of sleep. In subgroup analyses, men or women who were overweight or
who were regular snorers and who reported sleeping ≥ 9 h per day were at an
approximately 1.4 to 2-fold increased risk of developing colorectal cancer compared
to overweight or regular snorers with 7 h of sleep per day” (683).
“The novel observation of increased risk among regular snorers who sleep long
raises the possibility that sleep apnea and its attendant intermittent hypoxemia may
contribute to cancer risk” (687).