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International e-Delphi Consensus Recommendations for the Assessment and Diagnosis of Circadian rest-Activity Rhythm
Craig Gouldthorpe1,2, Sonia Ancoli-Israel3, Elizabeth Cash4
1School of Medicine, Trinity College Dublin, D02 PN40 Dublin, Ireland.
Insights
International recommendations were developed for assessing and diagnosing Circadian Rest-Activity Rhythm Disorders (CARDs) in cancer patients. This aims to standardize research and reporting for these common, impactful conditions.
Area of Science:
- Oncology
- Sleep Medicine
- Chronobiology
Background:
- Circadian Rest-Activity Rhythm Disorders (CARDs) are prevalent in cancer patients, especially those with advanced disease.
- CARDs negatively impact symptom burden, quality of life, and survival in cancer patients.
- Current research and reporting lack standardization, with no formal diagnostic criteria for CARDs.
Purpose of the Study:
- To formulate international recommendations for the assessment and diagnosis of CARDs in cancer patients.
- To address the lack of standardized practices in research and reporting of CARDs.
- To establish formal diagnostic criteria through an expert consensus process.
Main Methods:
- An international electronic Delphi (e-Delphi) study was conducted using the Welphi online platform.
- Participants developed and rated statements on circadian rhythms, diagnostic criteria, and assessment techniques over three rounds.
- Consensus was defined as 67% agreement and stability between rounds, followed by recommendation finalization.
Main Results:
- Sixteen international experts from nine specialties participated, with thirteen completing all rounds.
- Out of 164 generated statements, 66% reached consensus.
- Response stability was achieved between the final two rounds, indicating robust agreement.
Conclusions:
- The e-Delphi study successfully generated international recommendations for assessing and diagnosing CARDs in cancer patients.
- These recommendations are expected to promote standardized research and reporting practices in future oncology studies.
- Establishing clear guidelines will improve the management and understanding of CARDs in this population.
Purpose:
Circadian rest-Activity Rhythm Disorders (CARDs) are common in patients with cancer, particularly in advanced disease. CARDs are associated with increased symptom burden, poorer quality of life, and shorter survival. Research and reporting practices lack standardization, and formal diagnostic criteria do not exist. This electronic Delphi (e-Delphi) study aimed to formulate international recommendations for the assessment and diagnosis of CARDs in patients with cancer.
Methods:
An international e-Delphi was performed using an online platform (Welphi). Round 1 developed statements regarding circadian rest-activity rhythms, diagnostic criteria, and assessment techniques. Rounds 2 and 3 involved participants rating their level of agreement with the statements and providing comments until consensus (defined internally as 67%) and stability between rounds were achieved. Recommendations were then created and distributed to participants for comments before being finalized.
Results:
Sixteen participants from nine different clinical specialties and seven different countries, with 5-35 years of relevant research experience, were recruited, and thirteen participants completed all three rounds. Of the 164 generated statements, 66% achieved consensus, and responses were stable between the final two rounds.
Conclusions:
The e-Delphi resulted in international recommendations for assessing and diagnosing CARDs in patients with cancer. These recommendations should ensure standardized research and reporting practices in future studies.
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