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An observational cohort of 72 outpatients followed for 1 year used objective accelerometry and subjective patient diaries alongside symptom and sleep instruments and inflammatory and clinical markers. CARDs occurred in up to 60% of patients and correlated with more advanced metastatic disease, poorer performance status, higher inflammation, anaemia, and iron deficiency, as well as greater fatigue, drowsiness, distress, and worse global health and functioning.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/circadian-rest-activity-rhythm-disorders-in-advanced-cancer-assessment-diagnosis-and-clinical-correlates/446842/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/circadian-rest-activity-rhythm-disorders-in-advanced-cancer-assessment-diagnosis-and-clinical-correlates/446842.png","ImageObject",300,407,{"name":92,"@type":93},"Bulrr","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"How are circadian rest-activity rhythm disorders assessed in advanced cancer in this study?","Question",{"text":112,"@type":113},"Assessment combined objective accelerometry and subjective patient diary measures of rest-activity rhythms, alongside patient-reported outcomes and clinical markers.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What proportion of patients with advanced cancer had CARDs?",{"text":117,"@type":113},"CARDs affected up to 60% of patients with advanced cancer.",{"name":119,"@type":110,"acceptedAnswer":120},"Which patient and clinical factors were associated with greater circadian disruption and CARDs?",{"text":121,"@type":113},"Greater disruption and CARDs were linked to more advanced disease with metastatic organ involvement, poorer performance status, higher inflammatory status, anaemia, and iron deficiency.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},446842,1790765913,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":39,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":46,"preview_page_count":4},5909892115043,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","Original research  \nCircadian rest-activity rhythm disorders in advanced cancer: assessment, diagnosis and clinical correlates  \nCraig Gouldthorpe  , 1,2 Andrew Neil Davies  1,2  \n► Additional supplemental material is published online only. To view, please visit the journal online ([https://doi](https://doi). org/10.1136/spcare-2025- 005410) .  \n1School of Medicine, Trinity College Dublin, Dublin, Ireland 2Academic Department of Palliative Medicine, Our Lady’s Hospice & Care Services, Dublin, Ireland  \nCorrespondence to  \nDr Craig Gouldthorpe; [cgouldthorpe@olh.ie](cgouldthorpe@olh.ie)  \nReceived 28 January 2025 Accepted 17 September 2025  \n© Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group.  \nTo cite: Gouldthorpe C, Davies AN. BMJ Supportive & Palliative Care Epub ahead of print: [please include Day Month Year] . doi:10 . 1136/ spcare-2025-005410  \nABSTRACT  \nIntroduction and aims Circadian rest-activity rhythms describe patterns in rest and physical activity across and between 24-hour periods. Research highlights important associations between circadian disruption, including the restactivity rhythm, and clinical outcomes in patients with cancer. This study aimed to assess the circadian rest-activity rhythms, and prevalence of  \ncircadian rest-activity rhythm disorders (CARDs), in patients with advanced cancer.  \nMethods An observational study of 72  \noutpatients with locally advanced or metastatic cancer took place over a 1-year period, considering objective (accelerometry) and subjective (patient diary) measures of circadian rest-activity rhythms, patient-reported outcomes (Memorial Symptom Assessment Scale-Short Form, European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire, brief Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale) and clinical markers.  \nResults CARDs affected up to 60% of patients with advanced cancer. Increased circadian disruption was seen in patients with more advanced disease, particularly with metastatic organ involvement (p=0 .038), poorer performance status (p=0 .018), higher inflammatory status (p=0 .018), anaemia (p=0 .007) and iron deficiency (p=0 .002) . The study also highlights that patients with advanced cancer and a CARD diagnosis have a higher symptom burden, particularly fatigue (p=0 .003) and drowsiness (p=0 .005), higher symptomrelated distress (p\u003C0 .001), a poorer Global Health tatus (p=0 .005) and poorer functioning subscales (p\u003C0 .014) .  \nConclusion This is the first study to assess circadian rest-activity rhythms in accordance with new assessment and diagnostic guidelines. Further research is now required to validate the diagnostic criteria, standardise technical approaches to assessment and consider risk factors for the development of a CARD and additional clinical outcomes of interest.  \nWHAT IS ALREADY KNOWN ON THIS TOPIC  \n⇒ Circadian rhythms are commonly disordered in patients with advanced cancer. Disordered circadian rhythms may impact clinical outcomes, including worse symptomatology, quality of life and survival. Approaches to investigating and reporting circadian rhythms have previously lacked standardisation. However, recent guidelines outline an approach to the assessment of an observable circadian rest-activity rhythm and the diagnosis of circadian rest-activity rhythm disorders (CARDs) in patients with cancer. This study assessed the circadian rest-activity rhythms, prevalence of CARDs and associations with patient characteristics and clinical outcomes in a cohort of patients with advanced cancer.  \nINTRODUCTION  \nCircadian rhythms describe physiological and biochemical changes that occur across 24-hour periods.1 Such changes may be demonstrated in observable behaviours, such as sleeping, eating and physical activity, but also in measurable serological changes, such as levels of cortisol and melatonin. Cells throughout the human body function in a circadian fashion under the inst","cbCaimGimauLBQvU","https://ap.wps.com/l/cbCaimGimauLBQvU","pdf",1509568,"English","# Abstract\n## Introduction and aims\n## Methods\n## Results\n## Conclusion\n# What is already known on this topic\n# Introduction\n# What this study adds\n## How this study might affect research, practice or policy","[{\"question\":\"How are circadian rest-activity rhythm disorders assessed in advanced cancer in this study?\",\"answer\":\"Assessment combined objective accelerometry and subjective patient diary measures of rest-activity rhythms, alongside patient-reported outcomes and clinical markers.\"},{\"question\":\"What proportion of patients with advanced cancer had CARDs?\",\"answer\":\"CARDs affected up to 60% of patients with advanced cancer.\"},{\"question\":\"Which patient and clinical factors were associated with greater circadian disruption and CARDs?\",\"answer\":\"Greater disruption and CARDs were linked to more advanced disease with metastatic organ involvement, poorer performance status, higher inflammatory status, anaemia, and iron deficiency.\"}]","Circadian rest-activity rhythm disorders in advanced cancer - assessment, diagnosis and clinical correlates | PDF",1790717393]