Holistic Needs Assessment of Cancer Survivors—Supporting the Process Through Digital Monitoring of Circadian Physiology

Abstract

The year 2022 could represent a significant juncture in the incorporation of mHealth solutions in routine cancer care. With the recent global COVID-19 pandemic leading a surge in both observation- and intervention-based studies predominantly aimed at remote monitoring there has been huge intellectual investment in developing platforms able to provide real time analytics that are readily usable. Another fallout from the pandemic has seen record waiting times and delayed access to cancer therapies leading to exhausting pressures on global healthcare providers. It seems an opportune time to utilize this boom in platforms to offer more efficient “at home” clinical assessments and less “in department” time for patients. Here, we will focus specifically on the role of digital tools around cancer survivorship, a relevant aspect of the cancer journey, particularly benefiting from integrative approaches. Within that context a further concept will be introduced and that is of the likely upsurge in circadian-based interpretation of continuous monitoring and the engendered therapeutic modifications. Chronobiology across the 24-hour span has long been understood to control key bodily aspects and circadian dysregulation plays a significant role in the risk of cancer and also the response to therapy and therefore progressive outcome. The rapid improvement in minimally invasive monitoring devices is, in the opinion of the authors, likely to advance introducing chronobiological amendments to routine clinical practices with positive impact on cancer survivors.

Circadian lifestyle determinants of immune checkpoint inhibitor efficacy

“…Altogether, appropriate physical exercise in terms of timing, intensity, duration and type, adapted to the individual constraints of cancer patients, can be exploited to entrain the CTS and increase the robustness of circadian rhythms. Mobile health devices can lend useful tools to implement tailored circadian-based exercise schedules, even in cancer patients on ICI ( 16 , 86 , 87 ).…”

“…Thus, with regards to circadian entrainment, both timing, including fasting duration, and composition of the meal are relevant and could be potentially manipulated for therapeutic purposes. Modern digital tools can provide monitoring capability of feeding and fasting habits over the 24-h period and a way to behavioural dietary interventions ( 16 , 86 , 97 – 99 ).…”

“…In this review, we critically summarise existing evidence on key lifestyle factors of interest – diet, physical exercise, and bright light exposure – with regards to ICI efficacy, through CTS manipulation, and impact on the immune system and the microbiome. We then discuss how these factors all interact to form a complex web which, with further understanding, may be manipulated by the empowered patient in conjunction with clinicians and various specialised healthcare professionals to optimise response to cancer immunotherapy ( 15 , 16 ).…”