Study Objectives This pilot randomized controlled trial (RCT) was conducted to assess the preliminary effects of Brief Behavioral Therapy for Cancer-Related Insomnia (BBT-CI) delivered by trained research staff in comparison to a sleep hygiene pamphlet control and to assess moderators of treatment effect in patients with breast cancer undergoing chemotherapy. Methods Of 74 participants recruited, 37 were randomized to BBT-CI and 37 were randomized to the control condition. Trained staff members delivered the intervention during chemotherapy treatments to reduce patients’ burden. Insomnia was assessed with the Insomnia Severity Index (ISI), anxiety was assessed with the Spielberger State-Trait Anxiety Inventory, symptom burden was assessed with the Symptom Inventory (SI), and study staff recorded previous treatments and surgeries received by patients. Results Patients randomized to BBT-CI showed significantly greater improvements in their ISI scores compared to the sleep hygiene group. Additionally, several treatment moderators were identified. The effect of BBT-CI was greater among individuals with lower baseline state-trait anxiety, with previous surgery for cancer, and with higher baseline somatic symptom severity. Conclusions BBT-CI shows preliminary efficacy compared to the sleep hygiene handout on insomnia in cancer patients undergoing chemotherapy. A large-phase III RCT needs to be conducted to replicate the preliminary findings.
Purpose of review The current review outlines the existing research on the impact of circadian rhythm on gastrointestinal toxicity associated with cancer treatment and explores clinical evidence for utilizing circadian-based approaches in addressing gastrointestinal symptoms such as nausea, vomiting, diarrhea, mucositis, and hepatotoxicity. Recent findings Recent evidence highlights circadian control of gastrointestinal physiology of appetite, digestion, nutrient absorption, and cellular proliferation in the digestive system. In addition, animal models support the mechanistic rationale of using chronotherapy (a type of anticancer therapy delivered at specific times with the goal of producing less toxicity and greater treatment response) to minimize gastrointestinal-impact of systemic cancer treatments. In addition, earlier research demonstrates that many chemotherapeutic agents are responsive to circadian timing in animals. On the contrary, clinical trials focused on minimizing gastrointestinal toxicity using chronotherapy have been limited in recent years and have not yielded the efficacy initially hoped for. Instead, researchers focused on understanding circadian rhythm's influence on the gastrointestinal system at a mechanistic level as well as measuring circadian rhythm at an individual level. Summary Although using circadian timing is a promising target for reducing gastrointestinal toxicity, recent evidence suggests that more research is needed to understand circadian rhythm before circadian-based interventions can be developed that will result in lessening of gastrointestinal toxicity.
<p>Speleothem fluid inclusions contain relics of past precipitation water, which constitute a powerful tool for studying the past hydrological cycle. Analyses of hydrogen and oxygen isotopes of the water stored in fluid inclusions allow the reconstruction of paleoclimate information such as temperature. A previous study has shown the potential of speleothems from Milandre Cave to address temperature-related issues such as the so-called &#8220;Holocene temperature conundrum&#8221;. It additionally shows the main Holocene climate feature such as the cooling occurring at the Younger Dryas or the 8.2 ka event. The mean temporal resolution achieved for the samples is relatively high, with sampling intervals ranging between 10 years for the most recent times and 50-70 years for the early Holocene. Using our new analytical line at the Department of Environmental Sciences at the University of Basel, we aim to increase the temporal resolution of the record by a factor two to four in order to provide highly-resolved water isotope and inferred temperature records for the entire Holocene. The revised Milandre Cave Fluid Inclusion temperature (MC-FIT) allows us to gain more detailed information on shorter scale events such as the 8.2 ka cooling and other prominent Holocene climatic events. The new MC-FIT record, supported by additional speleothems from neighboring caves, allows a better understanding of the central European annual temperature variability during the Holocene.</p>
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