Wearable device-measured circadian rest–activity rhythm with mortality risk in patients with cancer

Sep 10, 2025BMJ health & care informatics

Body clock activity patterns measured by wearable devices linked to death risk in cancer patients

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Abstract

Among 7456 cancer patients, 12.5% died over a median follow-up of 9.00 years.

Disruptions in (CRAR) are linked to an increased risk of all-cause mortality.
Specific CRAR disruptions, such as low amplitude and high fragmentation, are associated with higher mortality rates from cancer and cardiovascular disease.
The hazard ratios for mortality linked to CRAR disruptions range from 1.30 to 2.66 across different causes of death.
CRAR disruptions may be more predictive of mortality than traditional risk factors like poor sleep and obesity.
These associations remain consistent across various types of cancer.

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OBJECTIVES: The objectives were to examine the associations between accelerometer-measured (CRAR), the most prominent circadian rhythm in humans and the risk of mortality from all-cause, cancer and cardiovascular disease (CVD) in patients with cancer.

METHODS: 7456 cancer participants from the UK Biobank were included. All participants wore accelerometers from 2013 to 2015 and were followed up until 24 January 2024, with a median follow-up of 9.00 years. The multidimensional parameters of the CRAR were calculated using the 7-day accelerometer data collected under free-living conditions. Cox proportional hazard models were used to evaluate the associations between CRAR and all-cause, cancer and CVD mortality.

RESULTS: Among 7456 cancer patients (mean age: 65.7±6.87 years; 58.85% women) aged 44-79 years, 934 (12.5%) deaths occurred over 9.00 years (64 525 person-years). CRAR disruptions, including low amplitude, low mesor and high fragmentation, were significantly associated with an increased risk of all-cause mortality (adjusted HR range, 1.30-2.00), cancer (adjusted HR range, 1.46-1.83) and CVD mortality (adjusted HR range, 1.73-2.66) in patients with cancer.

DISCUSSION: These associations were robust across various cancer types. In addition, CRAR disruptions, particularly low amplitude, exceeded multiple traditional risk factors such as poor sleep, smoking, alcohol consumption, obesity and unhealthy diet in predicting mortality.

CONCLUSION: CRAR parameters may serve as novel and robust predictors of mortality in patients with cancer.

Key numbers

1.30–2.00

Increased Risk of All-Cause Mortality

Adjusted hazard ratio range for all-cause mortality.

1.46–1.83

Cancer Mortality Risk Increase

Adjusted hazard ratio range for cancer mortality.

1.73–2.66

CVD Mortality Risk Increase

Adjusted hazard ratio range for cardiovascular disease mortality.

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Wearable device-measured circadian rest–activity rhythm with mortality risk in patients with cancer

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