Temporal tuning of daily rhythms helps advanced cancer patients and cancer survivors feel better, live better, and live longer

Abstract:

There is now little doubt that disrupted day/night (circadian) time structures are involved in the initiation and promotion of neoplastic disease. It has been established that the incidence of breast cancer, colorectal cancer, and prostate cancer is increased as a result of nocturnal exposure to light and circadian function disruption and that cancer patient survival is diminished. So the question is: what public health measures can be implemented to minimize these health hazards? In addition, untreated cancer patients experience the symptom cluster of brief, interrupted, and poor nighttime sleep; depressed mood/anxiety; daytime fatigue/lethargy; and anorexia/early satiety/diminished taste sensation – each of which is virtually pathognomonic of a disrupted circadian temporal organization. Direct measurements of patients’ activities and their timing and intensity using actigraphy reveal that untreated cancer patients experience severe deterioration in the robustness (amplitude) and day-to-day phase stability of their daily rest/activity rhythms – and one of the most personal and socially destructive results of such circadian disorientation is unplanned, unwanted, and avoidable temporal isolation from family, friends, and society. Thus, therapeutic manipulation of the circadian clock is a powerful tool for improving cancer patients’ quality of life (QOL), making life more worth living and perhaps prolonging higher quality survival. We herein take what we have learned to design and execute strategies shown to be beneficial and carefully measure cancer patient benefits. Outcome measures include indices that describe our ability to enhance/maintain circadian organization and orientation, diminish the above-mentioned symptoms, and improve QOL and survival prolongation. We herein implement a suite of noninvasive, riskless and costless, largely behavior-based circadian rhythm entrainment and disturbance avoidance techniques for widespread everyday use by cancer patients and survivors together with real-time actigraphic monitoring, continuous electronic feedback, and positive reinforcement of these simple temporal tuning interventions.

Keywords::

• actigraphy
• circadian clock
• circadian rhythm
• circadian therapy
• nighttime sleep
• daytime activity
• fatigue
• depression
• anxiety
• functional status
• quality of life
• survival
• 24-hour activity monitoring

Acknowledgments

The Gateway for Cancer Research; National Cancer Institute (1982–2000 RO1CA031635 grant, WJMH); VA (1989–2006 Merit Award, WJMH; 1989–2001 Merit Award, PAW); Life Extension Foundation; Oncology Analytics, Inc., Plantation, FL, USA; Ambulatory Monitoring, Inc., Ardsley, NY, USA.

Disclosure

The authors report no conflict of interest in this work.