Treating Cancer-Related Cognitive Impairment Through Systematic Light Exposure

通过系统光照治疗与癌症相关的认知障碍

• 批准号: 8752903
• 负责人: William H Redd
• 金额: $ 19.37万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8752903
• 关键词: Affect; Affective; Aftercare; Area; Boxing; Brain; Brain Injuries; Cancer Intervention; Cancer Patient; Cancer Survivor; Circadian Rhythms; Cognition; Cognitive; Development; Diagnosis; Exposure to; Fatigue; Goals; Health Personnel; Hematologic Neoplasms; Hematopoietic stem cells; Impaired cognition; Intervention; Investigation; Israel; Life; Light; Malignant Neoplasms; Mediating; Mediator of activation protein; Memory; Motor; Neurologic; Outcome Measure; Participant; Patients; Preparation; Procedures; Provider; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Recruitment Activity; Regimen; Research; Research Personnel; Retinal Photoreceptors; Self-Administered; Sleep; Speed; Stem cell transplant; Survivors; System; Testing; Training; Transplant Recipients; Vertebrate Photoreceptors; Vision; Visual; Work; chemotherapy; cognitive function; cognitive rehabilitation; experience; improved; injured; light effects; light treatment; malignant breast neoplasm; member; neuroimaging; post intervention; public health relevance; retinal rods; satisfaction; tool

DESCRIPTION (provided by applicant): Patients who have undergone hematopoietic stem cell transplant (HSCT) for the treatment of hematological malignancies often experience cognitive problems due to cancer and/or its treatment. Indeed, even 5 years post- treatment, 40% of HSCT survivors experience persistent cognitive impairments. Despite its deleterious impact on quality of life, cancer-related cognitive impairments (CRCI) are under-diagnosed and under-treated. There is a dearth of research on interventions to treat CRCI. The limited research examining traditional cognitive rehabilitation approaches to ameliorate CRCI in HSCT patients has been disappointing, failing to yield significant benefit. Moreover, traditional cognitive rehabilitation approaches are costly, require the presence of trained clinicians to work one-to-one with patients, and require patients to live in close proximity to providers. Clearly, there is need for the development of a cognitive rehabilitation intervention for HSCT survivors. The proposed study investigates a promising non-pharmacologic intervention for CRCI - systematic light exposure therapy. Research involving neuroimaging has shown that light can modulate cognitive brain function. Light's effect on cognitive functioning involves a non-image forming system that is unrelated to vision, and is, in part, mediated by a retinal photoreceptor system distinct from rods and cones. Results from preliminary research with breast cancer patients undergoing chemotherapy suggest that bright white light (BWL) exposure is associated with an improvement in overall cognitive functioning but dim red light (DRL) exposure is not. The goal of the proposed research is to determine the feasibility and acceptability of BWL as an intervention for CRCI and to determine the preliminary efficacy of BWL on long-term HSCT survivors' cognitive functioning. The potential mediating effects of circadian activity rhythms and sleep on cognitive functioning will also be explored. The approach will be informed by procedures investigators developed for research with breast cancer patients undergoing chemotherapy and for brain injured patients. Sixty HSCT survivors who are 1 to 5 years post-HSCT will be recruited and randomized to either BWL or DRL. Both groups will self-administer the light for 30 minutes each morning for 4 weeks and standardized outcome measures (including cognitive functioning, CAR, and sleep) will be administered before the intervention, during the fourth week of the intervention, and four weeks post-intervention. The study will be the first to investigate BWL vs. a comparison DRL to ameliorate CRCI among HSCT survivors. If effective, the BWL intervention has the potential to have major public health impact as it can be easily administered and, thus, widely disseminated. Overall, this study would provide important information about BWL as a new cognitive rehabilitation approach, giving health care providers and HSCT survivors a much-needed tool to help with CRCI.

描述（由申请人提供）：接受造血干细胞移植（HSCT）治疗恶性血液病的患者经常会因癌症和/或其治疗而出现认知问题。事实上，即使在治疗后5年，40%的HSCT幸存者经历持续的认知障碍。尽管癌症相关认知障碍（CRCI）对生活质量产生有害影响，但其诊断和治疗不足。目前缺乏对CRCI干预措施的研究。对传统认知康复方法改善HSCT患者CRCI的有限研究令人失望，未能产生显著的益处。此外，传统的认知康复方法成本高昂，需要训练有素的临床医生与患者一对一地工作，并要求患者与提供者住得很近。显然，有必要为HSCT幸存者制定认知康复干预措施。这项拟议的研究调查了CRCI的一种有前途的非药物干预-系统性光暴露疗法。涉及神经成像的研究表明，光可以调节大脑的认知功能。光对认知功能的影响涉及与视觉无关的非图像形成系统，并且部分地由不同于视杆细胞和视锥细胞的视网膜感光系统介导。对接受化疗的乳腺癌患者的初步研究结果表明，明亮的白色光（BWL）暴露与整体认知功能的改善相关，但昏暗的红光（DRL）暴露则不然。拟议研究的目标是确定BWL作为CRCI干预措施的可行性和可接受性，并确定BWL对长期HSCT幸存者认知功能的初步疗效。还将探讨昼夜活动节律和睡眠对认知功能的潜在介导作用。该方法将由研究人员为接受化疗的乳腺癌患者和脑损伤患者的研究开发的程序提供信息。将招募60名HSCT后1 - 5年的HSCT幸存者，并随机分配至BWL或DRL组。两组将每天早上自我管理光照30分钟，持续4周，并在干预前，干预第四周和干预后四周进行标准化结果测量（包括认知功能，CAR和睡眠）。该研究将是第一个研究BWL与比较DRL改善HSCT幸存者CRCI的研究。如果BWL干预措施有效，则有可能产生重大的公共卫生影响，因为它易于管理，因此可以广泛传播。总的来说，这项研究将提供关于BWL作为一种新的认知康复方法的重要信息，为医疗保健提供者和HSCT幸存者提供急需的工具来帮助CRCI。