{"entity":{"id":"idea-nl-sleep-circadian-survivorship-rct","kind":"idea","name":"Treat insomnia in survivors and measure whether the cancer notices","aka":[],"tldr":"Insomnia therapy works well for cancer survivors and is barely offered. A trial that fixes sleep and then follows recurrence would test whether restoring the body clock changes the disease as well as the symptom.","summary":"CBT-I has strong evidence for insomnia symptoms in survivors, and disrupted rest-activity rhythms predict shorter survival in metastatic cancer, but no trial has tested whether treating sleep and circadian disruption affects recurrence or survival. Digital CBT-I and timed light therapy are scalable and cheap, making a large pragmatic trial with an oncological endpoint feasible for the first time.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Survivorship and late effects are neglected): NCI Office of Cancer Survivorship statistics","url":"https://cancercontrol.cancer.gov/ocs/statistics"}],"tags":[],"related":["idea-chronotherapy-immunotherapy"],"cancers":["breast-hr-positive","colorectal"],"sections":["nutrition-lifestyle","supportive-care"],"technologies":["sleep-circadian-interventions","chronotherapy","survivorship-care-plan","structured-exercise-survivorship"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":["circadian-control"],"terms":[],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-toxicity-qol"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"In breast or colorectal cancer survivors with insomnia, a six-month programme of digital CBT-I plus morning bright-light exposure improves actigraphic rest-activity rhythm and reduces inflammatory markers, and over five years is associated with lower recurrence compared with sleep hygiene advice alone.","rationale":"Circadian disruption is IARC Group 2A; rest-activity dysrhythmia predicts survival; cortisol and melatonin rhythms modulate immune surveillance and cell-cycle genes in tumours. The symptom benefit alone justifies the intervention, so the trial carries no ethical cost.","test":"Pragmatic randomised trial (n about 1,200) embedded in survivorship clinics, with insomnia severity and actigraphic rhythm at 6 months as primary outcomes and recurrence-free survival at 5 years as a pre-specified secondary endpoint powered for a hazard ratio of 0.8.","maturity":"preclinical-evidence","actor":"clinic","cost":"medium","horizonYears":6},"route":"/ideas/idea-nl-sleep-circadian-survivorship-rct/","neighbours":{"idea":[{"id":"idea-chronotherapy-immunotherapy","kind":"idea","name":"Give immunotherapy in the morning","route":"/ideas/idea-chronotherapy-immunotherapy/"}],"cancer":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"}],"section":[{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"technology":[{"id":"chronotherapy","kind":"technology","name":"Chronotherapy: timing treatment to the body clock","route":"/technologies/chronotherapy/"},{"id":"cbt-insomnia-cancer","kind":"technology","name":"Cognitive behavioural therapy for insomnia (CBT-I)","route":"/technologies/cbt-insomnia-cancer/"},{"id":"rejuv-mind-sleep-after-cancer","kind":"technology","name":"Sleep after cancer: how common insomnia is, how long it lasts, and the treatment that works","route":"/technologies/rejuv-mind-sleep-after-cancer/"},{"id":"sleep-circadian-interventions","kind":"technology","name":"Sleep and circadian interventions in cancer","route":"/technologies/sleep-circadian-interventions/"},{"id":"rejuv-mind-sleeping-tablets-after-cancer","kind":"technology","name":"Sleeping tablets after cancer: what they do and what they do not","route":"/technologies/rejuv-mind-sleeping-tablets-after-cancer/"},{"id":"structured-exercise-survivorship","kind":"technology","name":"Structured exercise programmes after curative treatment","route":"/technologies/structured-exercise-survivorship/"},{"id":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"}],"pathway":[{"id":"circadian-control","kind":"pathway","name":"Circadian control","route":"/pathways/circadian-control/"}],"bottleneck":[{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"},{"id":"b-toxicity-qol","kind":"bottleneck","name":"Toxicity and quality of life are undervalued","route":"/bottlenecks/b-toxicity-qol/"}],"roadmap":[{"id":"nutrition-lifestyle-roadmap","kind":"roadmap","name":"Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment","route":"/roadmaps/nutrition-lifestyle-roadmap/"}]}}