Grutsch et al. BMC Cancer 2011, 11:193 http://www.biomedcentral.com/1471-2407/11/193 Page 8 of 13 Figure 2 Relationship between quality of life and circadian organization among inpatients and outpatients. Lung cancer patients who are most quiet in the nighttime and active during the day (highest circadian Rhythm Quotient) are the least fatigued, both in hospitalized and at home settings (A). The more stable the day-to-day pattern of daily activity and nighttime sleep (24-hour Autocorrelation), the better the overall ability to fulfill daily functions among outpatients (B), and the greater the patient’s satisfaction with his/her health among inpatients and outpatients (C). The greater the peak activity, the greater the patient’s overall satisfaction with life among outpatients (D, E). circadian organization generates symptoms that range from the fairly minor, such as jet lag, to life limiting dis- orders like depression, metabolic syndrome, cardiovas- cular or gastrointestinal disease, or cancer [41]. A breakdown of circadian organization can result in death in lab animals and may contribute to death in humans [39,42-45]. Cancer bearing degrades circadian organization, which diminishes an individual’s health and capacity to meet the demands of daily life [10,46,47]. Apparently, a patient’s health-related quality of life is adversely affected when the level of disruption of an individual’s circadian organization exceeds a threshold [48]. Our actigraphy data show that non small cell lung cancer patients’ circadian activity/rest rhythms are markedly and characteristically distorted when com- pared to apparently healthy individuals. Our advanced lung cancer patients’ daily activity levels are much lower