Chronic pain. Constant nausea. Sudden and severe weight loss. These aren’t the symptoms of a rare genetic disorder, they’re common side effects associated with chemotherapy treatments.

Many patients choose to end treatment early and risk the return of their cancer rather than suffer such a dramatic detriment to their quality of life. But what if these side effects could be minimized by changing the timing of their treatments?

Circadian rhythms, the daily “schedules” your body follows to regulate everything from hormone levels to cell regeneration, favor certain times of day for processing the harsh chemicals used in chemotherapy.

In fact, a treatment schedule that’s more in sync with your circadian rhythms can make a whole slew of chronic conditions more manageable: heart disease, diabetes, even clinical depression.

Never knew there was an optimal timing to these treatments? You’re not alone—neither do most medical professionals.

“Unless they pursue highly specialized training or a rotation at a dedicated sleep center, the average American medical student only receives about three hours of lecture time on circadian rhythms,” said Julia Selfridge, a fourth-year medical student in the Virginia Tech Carilion School of Medicine. “This may make it more difficult for future physicians to diagnose how disruptions to those rhythms impact the effectiveness of treatment or the onset of new diseases.”

But researchers at the Biocomplexity Institute of Virginia Tech are working with faculty in the Virginia Tech Carilion School of Medicine to make circadian rhythms a more accessible component of the demanding medical school curriculum.

In a policy paper published in the Journal of Circadian Rhythms, the team outlined key opportunities to build circadian competencies into standard coursework and professional development activities.

Their proposals cover a doctor’s entire educational lifespan: introductory lectures on metabolism and gene expression can be fleshed out with a deeper explanation of their circadian-regulated functions while more advanced students and practicing physicians could be given provided opportunities to pursue hands-on training in sleep medicine.

“Filling this knowledge gap is more critical than ever since economic necessity and modern convenience have made disruptions to our circadian rhythms a common facet of American life,” said Carla Finkielstein, an associate professor of biological sciences in the College of Science and a biology fellow at the Biocomplexity Institute. “Overnight shift work, irregular sleep schedules, and prolonged exposure to artificial light all have serious long-term health effects that our medical professionals need to be able to factor into their diagnoses.”

A careful analysis of the “big picture” data further emphasizes an urgent need for reform: around 15 million full-time employees work overnight or irregular shifts according to the U.S. Bureau of Labor Statistics and multiple studies have linked consistent circadian disruption to the two top causes of death among Americans—heart disease and cancer.

A mounting body of Biocomplexity Institute research has further demonstrated that circadian disruption isn’t just a personal health problem, it’s driven by systems that extend from labor policy and environment, all the way down to the cellular level. Through collaboration with colleagues in the Carilion School of Medicine, Biocomplexity Institute researchers are now exploring a new means of intervention: education.

“This is an incredibly novel approach to an issue affecting not only the health of our patients, but our own medical professionals,” said Kurtis Moyer, co-author on the project and associate professor of surgery in the Virginia Tech Carilion School of Medicine. “Only recently have we begun to incorporate fatigue management and the importance of circadian rhythms into medical student and resident education. Although a lot of work is yet to be done, this collaborative effort is making great strides toward a better understanding of a far-ranging health problem.”

Complex conditions like heart disease, diabetes, and depression resist simple solutions. There is no single cause, cure, or means of prevention, making treatments that work with the body’s natural circadian rhythms all the more essential. For many, the quality of life afforded by this holistic approach to medical care could be a deciding factor in whether they choose to pursue treatment.

“There is a serious need to depart from the traditional approach of diagnosing and treating diseases to one that recognizes the daily dynamics of our organism’s physiology,” Finkielstein said. “This is a major challenge, and not one that can be addressed within the confines of a single discipline. Incorporating these concepts into existing structures throughout our medical care system will give us new tools to balance maximum effectiveness with the lowest possible treatment dose so patients can experience enhanced quality of life throughout their care journey.” 

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