156 Feasibility of a multi-modal, non-pharmacological intervention for circadian rest-activity rhythm disorders in patients with advanced cancer

<h3></h3> Circadian rest-activity rhythm disorders (CARDs) relate to a disruption in rest and physical activity levels, within or between days, for a patient. In patients with advanced cancer, CARDs have recently been shown to have significant associations with an increased symptom burden, poorer patient functioning, and poorer quality of life. Several non-pharmacological approaches, which aim to improve circadian rhythmicity, exist. This includes bright light therapy and exercise, with reported small-to-moderate size improvements in subjective and objective sleep measures, symptom burden and physical activity. As circadian disruption is common in patients with cancer, and appears to worsen with advancing disease, increased inflammatory status and poorer physical function, it was postulated that a multi-modal approach may be required to overcome and improve circadian rest-activity rhythm disruption in patients with advanced cancer. A multi-modal feasibility study, utilising bright light therapy, cognitive behavioural therapy for insomnia and a personalised physical activity plan was carried out for patients with advanced cancer over an 8-week period. 20 participants were recruited to the study which demonstrated acceptability, usability, safety and preliminary efficacy of the intervention. Several patient-reported physical activity interests, and barriers to engagement, were also captured. The study demonstrated similar recruitment (51%) and attrition (20%) rates to other exercise interventional studies in this patient cohort. Attrition was largely unavoidable and related to clinical deteriorations at various stages of the study. Further work is required to easily identify patients with a CARD diagnosis. A future definitive, multi-arm study is now advised to compare single interventions, multimodal interventions and standard of care in the management of CARDs in patients with advanced cancer. Improvement of circadian disruption has the potential to improve several clinical outcomes for patients with cancer.