{"entity":{"id":"sleep-circadian-interventions","kind":"technology","name":"Sleep and circadian interventions in cancer","aka":[],"tldr":"Half of people with cancer sleep badly, so sleep and body-clock interventions matter. Talking therapy for insomnia works well and is under-used; whether fixing sleep or body-clock disruption changes the cancer itself is unproven.","summary":"Insomnia affects 30-60% of cancer patients and survivors and worsens fatigue, pain, depression and cognition. Cognitive behavioural therapy for insomnia (CBT-I), including digital versions, has strong randomised evidence in cancer survivors and is first-line in guidelines; hypnotics are second-line and mindfulness, acupuncture and exercise have moderate evidence. Night-shift work involving circadian disruption is 'probably carcinogenic' (IARC Group 2A, 2019) on breast, prostate and colorectal cancer evidence. Disrupted rest-activity rhythms measured by actigraphy predict shorter survival in metastatic colorectal and breast cancer, and morning versus afternoon dosing of checkpoint inhibitors has been associated with better outcomes in retrospective cohorts, prompting randomised chronotherapy trials. Melatonin, widely marketed, has inconsistent evidence for sleep in cancer and none for anticancer effect at physiological doses. The disease-modifying claims for sleep and circadian interventions therefore remain hypotheses; the symptom benefit is real.","status":"emerging","asOf":"2026-09-08","wikipedia":"https://en.wikipedia.org/wiki/Chronotherapy_(treatment_scheduling)","links":[{"label":"IARC Monograph 124: night shift work (Lancet Oncol 2019)","url":"https://doi.org/10.1016/S1470-2045(19)30455-3"},{"label":"ASCO sleep disturbance guideline (JCO 2024)","url":"https://doi.org/10.1200/JCO.23.02545"}],"tags":[],"related":["idea-chronotherapy-immunotherapy","idea-nl-sleep-circadian-survivorship-rct","cbt-insomnia-cancer"],"cancers":["breast-hr-positive","colorectal","prostate","nsclc"],"sections":["nutrition-lifestyle","supportive-care","rejuvenation"],"technologies":["chronotherapy","exercise-oncology","survivorship-care-plan","rejuv-mind-sleep-after-cancer","rejuv-mind-sleeping-tablets-after-cancer"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":["circadian-control"],"terms":[],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-toxicity-qol"],"keyPapers":["paper-iarc-monographs-vol-124-group-lancet-oncol"],"journals":[],"dependsOn":[],"notes":[],"principle":"Restoring consolidated sleep and robust circadian rhythms normalises cortisol and melatonin secretion, immune cell trafficking and cell-cycle gene expression, and improves tolerance of and possibly response to time-sensitive therapies.","strengths":["CBT-I has level-1 evidence for insomnia in survivors","Actigraphy is a cheap prognostic biomarker","Chronotherapy trials are inexpensive"],"limitations":["No evidence yet that treating sleep changes survival","Melatonin and supplements over-promoted","Access to CBT-I limited"]},"route":"/technologies/sleep-circadian-interventions/","neighbours":{"idea":[{"id":"idea-chronotherapy-immunotherapy","kind":"idea","name":"Give immunotherapy in the morning","route":"/ideas/idea-chronotherapy-immunotherapy/"},{"id":"idea-nl-sleep-circadian-survivorship-rct","kind":"idea","name":"Treat insomnia in survivors and measure whether the cancer notices","route":"/ideas/idea-nl-sleep-circadian-survivorship-rct/"}],"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":"exercise-oncology","kind":"technology","name":"Exercise & lifestyle oncology","route":"/technologies/exercise-oncology/"},{"id":"melatonin-cancer","kind":"technology","name":"Melatonin as a cancer adjunct","route":"/technologies/melatonin-cancer/"},{"id":"mindfulness-based-interventions","kind":"technology","name":"Mindfulness-based stress reduction and cognitive therapy","route":"/technologies/mindfulness-based-interventions/"},{"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":"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":"survivorship-care-plan","kind":"technology","name":"Survivorship care and late-effects surveillance","route":"/technologies/survivorship-care-plan/"},{"id":"tai-chi-qigong","kind":"technology","name":"Tai chi and qigong","route":"/technologies/tai-chi-qigong/"},{"id":"rejuv-frontier-what-works","kind":"technology","name":"What actually works after treatment","route":"/technologies/rejuv-frontier-what-works/"}],"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/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"section":[{"id":"nutrition-lifestyle","kind":"section","name":"Diet, Exercise & Lifestyle","route":"/fronts/nutrition-lifestyle/"},{"id":"rejuvenation","kind":"section","name":"Recovery & Rejuvenation","route":"/fronts/rejuvenation/"},{"id":"supportive-care","kind":"section","name":"Supportive Care & Survivorship","route":"/fronts/supportive-care/"}],"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/"}],"paper":[{"id":"paper-iarc-monographs-vol-124-group-lancet-oncol","kind":"paper","name":"Carcinogenicity of night shift work","route":"/key-papers/paper-iarc-monographs-vol-124-group-lancet-oncol/"}],"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/"}]}}