Cancer care time of day 'could influence outcomes'

Researchers have found that the time of day at which cancer patients get their treatment could have a significant effect on survival rates.

Patients who had morning immunotherapy sessions lived longer than those treated in the afternoon, the research suggested.

Cancer specialists at the University of Southampton and Cardiff University are expected to carry out randomised trials to confirm the hypothesis.

Prof Paul Lorigan, consultant medical oncologist at The Christie NHS Foundation Trust in Manchester and senior author of the study, said: "The most important message from this research is that there appears to be a signal worth investigating further."

"Our findings suggest that patients receiving immunotherapy earlier in the day may have better outcomes than those receiving treatment later in the day," he confirmed.

"But this was a retrospective study, so we cannot conclude that timing alone is responsible."

The study, published in the British Journal of Cancer, is one of the largest to date exploring whether the time of day patients receive immunotherapy influences how well treatment works.

It analysed outcomes for 2,631 patients with advanced cancer who received immune checkpoint inhibitors (ICIs) at The Christie between January 2018 and December 2023.

ICIs help the body's immune system identify and attack cancer cells, but responses vary significantly between patients and cancer types.

As such, scientists explored whether the body's internal biological clock played a part.

Patients with advanced lung cancer, melanoma, kidney cancer, head and neck cancer and urothelial cancer were looked at in the study.

Those in the early treatment group had a median overall survival of 21.4 months compared with 13.1 months in the late group.

Prof Lorigan told the BBC: "It might be that people arriving for treatment later are less well, are more frail, are relying on hospital transport, etc.

"So we really need to look at this more systematically, and as a result with colleagues in Southampton and in Cardiff, we've designed a trial to test this, and why the immune system might be more receptive at specific times of the day."

He added: "When we're trying to improve our treatments, we're adding in new drugs, more expensive drugs, causing more side effects, but this would be essentially cost-neutral.

"It's just quite - if it works - a significant benefit just based on giving the treatment at a different time of the day."

The team is seeking funding to carry out the research under tightly controlled conditions on patients with melanoma and haematological cancers.

Researchers say patients should keep attending appointments as scheduled while further studies are undertaken.

Any eventual changes would likely involve only the first three or four cycles of treatment, they said.