# Treat insomnia in survivors and measure whether the cancer notices

Source: https://onco.cc/ideas/idea-nl-sleep-circadian-survivorship-rct/  
OnCo record `idea-nl-sleep-circadian-survivorship-rct` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- 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.
- Proposed 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

## Sources

- Bottleneck evidence (Survivorship and late effects are neglected): NCI Office of Cancer Survivorship statistics: https://cancercontrol.cancer.gov/ocs/statistics

## Connected records

- ideas: [Give immunotherapy in the morning](https://onco.cc/ideas/idea-chronotherapy-immunotherapy/)
- cancers: [Colorectal cancer](https://onco.cc/cancers/colorectal/), [HR-positive / HER2-negative breast cancer](https://onco.cc/cancers/breast-hr-positive/)
- fronts: [Diet, Exercise & Lifestyle](https://onco.cc/fronts/nutrition-lifestyle/), [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- technologies: [Chronotherapy: timing treatment to the body clock](https://onco.cc/technologies/chronotherapy/), [Cognitive behavioural therapy for insomnia (CBT-I)](https://onco.cc/technologies/cbt-insomnia-cancer/), [Sleep after cancer: how common insomnia is, how long it lasts, and the treatment that works](https://onco.cc/technologies/rejuv-mind-sleep-after-cancer/), [Sleep and circadian interventions in cancer](https://onco.cc/technologies/sleep-circadian-interventions/), [Sleeping tablets after cancer: what they do and what they do not](https://onco.cc/technologies/rejuv-mind-sleeping-tablets-after-cancer/), [Structured exercise programmes after curative treatment](https://onco.cc/technologies/structured-exercise-survivorship/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/)
- pathways: [Circadian control](https://onco.cc/pathways/circadian-control/)
- bottlenecks: [Survivorship and late effects are neglected](https://onco.cc/bottlenecks/b-survivorship/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- roadmaps: [Diet, exercise and lifestyle roadmap: causes established → interventions that disappointed → exercise proven as treatment](https://onco.cc/roadmaps/nutrition-lifestyle-roadmap/)

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