Treating Cancer-Related Fatigue Through Systematic Bright White Light

通过系统亮白光治疗与癌症相关的疲劳

• 批准号: 8306110
• 负责人: William H Redd
• 金额: $ 17.59万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-08-01 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8306110
• 关键词: Activities of Daily Living; Adjustment Disorders; Adrenal Cortex Hormones; Antidepressive Agents; Boxing; Cancer Burden; Cancer Control; Cancer Intervention; Cancer Patient; Cancer Survivor; Cessation of life; Chemotherapy-Oncologic Procedure; Clinical; Cognitive; Cognitive Therapy; Diagnosis; Distress; Emotional; Exercise; Exposure to; Fatigue; Foundations; Goals; Gold; Hematopoietic stem cells; Home environment; Informed Consent; Intervention; Interview; Israel; Life; Light; Malignant Neoplasms; Measures; Mediating; Mental Depression; Moods; National Comprehensive Cancer Network; Outcome; Patients; Physical Capacity; Placebos; Procedures; Quality of life; Randomized Clinical Trials; Randomized Controlled Clinical Trials; Recruitment Activity; Reporting; Research; Sleep; Sleep disturbances; Stem cell transplant; Survivors; Symptoms; Telephone; Testing; Time; Treatment-Related Cancer; Work; arm; cancer therapy; chemotherapy; clinical efficacy; clinically significant; efficacy testing; exhaustion; light treatment; malignant breast neoplasm; psychostimulant; standard care; standardize measure

DESCRIPTION (provided by applicant): Cancer related fatigue (CRF), defined by the National Comprehensive Cancer Network as "a distressing, persistent, subjective sense of physical, emotional, and cognitive tiredness or exhaustion related to cancer or cancer treatment that is not proportional to recent activity," can severely interfere with activities of daily living, physical capacity, and ability to work. There are even reports of fatigue being a factor in patient requests for hastened death. CRF can represent a serious clinical problem after all treatment has ended. In our research with cancer survivors 1 to 3 years after completion of hematopoietic stem cell transplant (HSCT), 40% of those we interviewed reported that CRF was a major obstacle to the resumption of usual activities. Despite its impact on quality of life, CRF is under-reported, under-diagnosed, and under- treated. There is no widely accepted CRF intervention that has demonstrated clinical efficacy. A variety of pharmacologic agents have been studied to treat CRF; most notably psychostimulants, antidepressants, and corticosteroids. But there is not sufficient evidence to recommend the use of any of the currently available pharmacologic agents. A number of non-pharmacologic strategies have been tested. The most promising are exercise and cognitive-behavior therapy (CBT). Results from two randomized clinical trials suggest that exercise and CBT are equal in overall efficacy, but with only moderate effects. Indeed, at this time there is no "gold standard" treatment for CRF. One promising new intervention for CRF is "bright white light" (BWL --- systematic daily 30-minute exposure to bright white light from a commercially available "lightbox") treatment. In a small randomized controlled clinical trial, BWL was protective against increases in sleep disturbances, mood symptoms and fatigue across cycles of chemotherapy. We want to investigate BWL to control CRF in 1 to 3 year survivors of HSCT for three reasons. First, CRF is a major problem for a large proportion of survivors (40%). Second, BWL may be more acceptable to survivors than CBT or exercise because BWL is less physically demanding and can be carried out at home. Third, BWL is likely to be less expensive since it can be implemented by phone, requiring less professional and patient time and effort than that required for exercise and CBT. The feasibility of the proposed research is assured by the fact that we have identified a group of 150 HSCT survivors who report clinically significant levels of CRF and who have provided informed consent to participate in further research. Specific Aims: 1) Develop and pilot test a BWL exposure intervention with HSCT survivors suffering from CRF to assess the impact on fatigue, sleep quality, and quality of life using objective and subjective measures; 2) To investigate the possible mediating effects of depression on fatigue; and 3) Assess the feasibility and acceptability of BWL as an intervention for CRF in cancer survivors.

描述（由申请人提供）：国家综合癌症网络将癌症相关疲劳 (CRF) 定义为“与癌症或癌症治疗相关的、与近期活动不成比例的令人痛苦的、持续的、主观的身体、情绪和认知疲劳或疲惫感”，可能严重干扰日常生活活动、身体能力和工作能力。甚至有报道称，疲劳是患者要求加速死亡的一个因素。所有治疗结束后，CRF 可能代表严重的临床问题。在我们对造血干细胞移植 (HSCT) 完成后 1 至 3 年的癌症幸存者进行的研究中，我们采访的 40% 的人表示，CRF 是恢复日常活动的主要障碍。尽管 CRF 影响生活质量，但其报告、诊断和治疗不足。目前尚无广泛接受的 CRF 干预措施已证明具有临床疗效。已经研究了多种治疗 CRF 的药物；最值得注意的是精神兴奋剂、抗抑郁药和皮质类固醇。但没有足够的证据推荐使用任何现有的药物。已经测试了许多非药物策略。最有希望的是运动和认知行为疗法（CBT）。两项随机临床试验的结果表明，运动和 CBT 的总体疗效相同，但效果中等。事实上，目前还没有治疗 CRF 的“金标准”。一种有前途的 CRF 新干预措施是“亮白光”（BWL——每天系统性地暴露于来自市售“灯箱”的亮白光 30 分钟）治疗。在一项小型随机对照临床试验中，BWL 可防止化疗周期内睡眠障碍、情绪症状和疲劳的增加。我们希望研究 BWL 以控制 HSCT 1 至 3 年幸存者的 CRF，原因有以下三个。首先，CRF 对于很大一部分幸存者 (40%) 来说是一个主要问题。其次，BWL 可能比 CBT 或锻炼更容易被幸存者接受，因为 BWL 对体力要求较低，并且可以在家中进行。第三，BWL 可能会更便宜，因为它可以通过电话实施，与锻炼和 CBT 相比，需要更少的专业和耐心的时间和精力。我们已经确定了一组 150 名 HSCT 幸存者，他们报告了临床上显着的 CRF 水平，并提供了参与进一步研究的知情同意书，这一事实保证了拟议研究的可行性。具体目标： 1) 针对患有 CRF 的 HSCT 幸存者制定并试点 BWL 暴露干预措施，以使用客观和主观措施评估对疲劳、睡眠质量和生活质量的影响； 2）探讨抑郁对疲劳可能的中介作用； 3) 评估 BWL 作为癌症幸存者 CRF 干预措施的可行性和可接受性。