Journal: Palliative medicine
Study type and population
- – Prospective, single-arm, 8-week outpatient feasibility study.
- – Adult patients (≥18) with locally advanced or metastatic cancer and objectively identified circadian rest–activity rhythm (RAR) disruption, recruited from an acute hospital and hospice service.
Intervention
Multi-modal, entirely non-pharmacologic approach:
- – Clinical review.
- – Daily bright light therapy.
- – Online cognitive behavioural therapy for insomnia (CBT‑I).
- – Individualised physical activity plan.
Feasibility outcomes
- – N=20 participants.
- – High engagement: questionnaires completed by 80%, accelerometry by 75%.
- – Intervention uptake: 100% for CBT‑I and physical activity, 80% for bright light therapy.
- – Intervention was reported as acceptable and usable; no intervention‑related adverse events observed.
Preliminary efficacy (exploratory)
Statistically significant improvements were observed over 8 weeks in:
- – Fatigue (p=0.003).
- – Insomnia (p=0.021).
- – Symptom-related distress (all p<0.01).
- – Functioning domains: social (p=0.001), cognitive (p=0.006), emotional (p=0.012), physical (p=0.046).
Conclusion
A structured, multi-modal, non-pharmacologic intervention targeting RAR disruption in advanced cancer is feasible, acceptable, and safe, with early signals of benefit in fatigue, sleep, symptom burden, and quality-of-life domains. A larger, controlled trial is justified to determine impact on clinically meaningful outcomes.