Block Center for Integrative Cancer Treatment, Evanston, IL 60201, USA.
Integr Cancer Ther. 2009 Dec;8(4):371-86. doi: 10.1177/1534735409352028.
Practical circadian therapy for the cancer patient involves 3 spheres of intervention-improving lifestyle, optimizing internal biochemical milieu, and adjusting treatment times. The potential value of improving overall circadian functioning is shown in the work of Mormont et al in which pronounced rest-activity rhythms were associated with better survival in colorectal cancer patients receiving chronomodulated chemotherapy. Lifestyle interventions that may improve circadian functioning involve diet, physical activity, and mind-body therapies. A diet that is anti-inflammatory and has appropriate carbohydrate intake, as well as regular meal timing, encourages normal circadian cycles. Adequate daytime physical activity encourages restful sleep, and morning light exposure during exercise may entrain melatonin rhythms. Meditation and other mind-body therapies can reduce anxiety and depression that may disrupt sleep. Aspects of the biochemical milieu that specifically disrupt circadian functioning are inflammation and stress hormones. Inflammation and cytokine disruption can be addressed with diet, herbs, and other natural substances. Chronomodulation of chemotherapy in a US clinical setting will be discussed. A series of 12 cases will be presented of patients who experienced grade 3 to 4 toxicities with various chemotherapy regimens for colorectal cancer. When rechallenged with the same regimens administered chronotherapeutically, none of the patients experienced grade 3 to 4 toxicity. Integrating all the above treatment modalities has the potential to improve both the quality of life and disease outcomes in cancer patients.
改善生活方式、优化内部生化环境和调整治疗时间。改善整体昼夜节律功能的潜在价值在 Mormont 等人的工作中得到了体现，他们发现接受时间治疗化疗的结直肠癌患者中，明显的休息-活动节律与更好的生存相关。可能改善昼夜节律功能的生活方式干预措施包括饮食、体育活动和身心疗法。抗炎且碳水化合物摄入适当、定时进餐的饮食可促进正常的昼夜节律循环。白天进行足够的体育活动可促进安静的睡眠，而运动时的晨光照可使褪黑素节律同步。冥想和其他身心疗法可以减轻可能扰乱睡眠的焦虑和抑郁。具体扰乱昼夜节律功能的生化环境方面包括炎症和应激激素。可以通过饮食、草药和其他天然物质来解决炎症和细胞因子紊乱问题。将化疗的时间治疗在美国临床环境中的应用将进行讨论。将介绍 12 例接受结直肠癌各种化疗方案治疗时出现 3 级至 4 级毒性的患者的情况。当用时间治疗法重新使用相同方案进行治疗时，没有患者出现 3 级至 4 级毒性。整合所有上述治疗方式有可能改善癌症患者的生活质量和疾病结局。
