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

Authors Hrushesky W, Grutsch J, Huff DF, Tavolacci L, Kazlausky T

Received 10 September 2014

Accepted for publication 10 December 2014

Published 8 January 2016 Volume 2016:6 Pages 1—13

DOI https://doi.org/10.2147/CPT.S74070

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Marc Hébert


Video abstract presented by William Hrushesky.

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William Hrushesky,1–5 James F Grutsch,6 Dinah Faith Q Huff,1 Linda Tavolacci,7 Thomas Kazlausky7

1Oncology Analytics, Inc., Plantation, FL, USA; 2South Carolina College of Pharmacy, 3Arnold School of Public Health, University of South Carolina, Columbia, SC, USA; 4Hollings Cancer Center, 5Department of Public Health Science, Medical University of South Carolina, Charleston, SC, USA; 6Department of Epidemiology and Biostatistics, University of Illinois School of Public Health, Chicago, IL, USA; 7Ambulatory Monitoring, Inc., Ardsley, NY, USA

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

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