Relationships among Inflammatory Biomarkers and Objectively Assessed Physical Activity and Sleep during and after Chemotherapy for Gynecologic Malignancies

SIMPLE SUMMARY: Physical inactivity and sleep problems are commonly reported by women going through chemotherapy for gynecologic cancer. Inflammation from cancer and its treatment might contribute to these issues, but existing findings are limited. We examined relationships between biomarkers of inflammation and data from wearable devices to objectively measure physical activity and sleep. We collected data from women with gynecologic cancer during chemotherapy and followed up with them for a year after completing chemotherapy. We also compared their results to women without cancer who were assessed at similar time intervals. We found that women with cancer were less active and had more sleep problems than controls even a year after completing chemotherapy. Greater inflammation was also related to less physical activity and more sleep problems. Future research should test whether interventions aimed at reducing inflammation can help women with cancer to be more active and have fewer sleep problems. ABSTRACT: Little is known regarding associations between inflammatory biomarkers and objectively measured physical activity and sleep during and after chemotherapy for gynecologic cancer; thus, we conducted a longitudinal study to address this gap. Women with gynecologic cancer (patients) and non-cancer controls (controls) completed assessments before chemotherapy cycles 1, 3, and 6 (controls assessed contemporaneously), as well as at 6- and 12-month follow-ups. Physical activity and sleep were measured using wrist-worn actigraphs and sleep diaries, and blood was drawn to quantify circulating levels of inflammatory markers. Linear and quadratic random-effects mixed models and random-effects fluctuation mixed models were used to examine physical activity and sleep over time, as well as the associations with inflammatory biomarkers. On average, patients (n = 97) and controls (n = 104) were 62 and 58 years old, respectively. Compared to controls, patients were less active, more sedentary, had more time awake after sleep onset, and had lower sleep efficiency (p-values < 0.05). Across groups, higher levels of TNF-α were associated with more sedentary time and less efficient sleep (p-values ≤ 0.05). Higher levels of IL-1β, TNF-α, and IL-6 were associated with lower levels of light physical activity (p-values < 0.05). Associations between inflammatory biomarkers, physical activity, and sleep did not differ between patients and controls. Given these results, we speculate that inflammation may contribute to less physical activity and more sleep problems that persist even 12 months after completing chemotherapy.