ideasIdea
Treat insomnia in survivors and measure whether the cancer notices
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.
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.
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.
What would test it
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
Who has to act
clinic
Cost to try
Medium ($1M to $50M)
Years to first evidence
6
Bottlenecks it attacks
- Survivorship and late effects are neglected · Tens of millions of people live after cancer with heart damage, infertility, second cancers and fear, and few services.
- Toxicity and quality of life are undervalued · Trials measure how long people live, not how they live. Side-effects are under-reported and under-treated.