Systematic Programmed Illumination (sPI) of Hospital Rooms to Prevent/Reduce Cancer-Related Fatigue During Hematopoeitic Stem Cell Transplantation for Multiple Myeloma

项目总结 癌症相关性疲劳(CRF)是癌症治疗中最常见的副作用， 美国国家综合癌症网络将其定义为“令人痛苦的、执着的、主观的 与癌症或癌症相关的身体、情绪和认知疲劳或疲惫的感觉 与最近的活动不成比例的治疗。这种疲倦常常与睡眠有关。 问题、抑郁、生活质量和烦躁不安。不幸的是，目前可用的干预措施 CRF充其量只能起到一定的效果。已经研究了治疗慢性肾衰的药理药物，但 没有足够的证据建议使用它们。非药物干预显示 临床上有好处，但对患者来说可能是劳动密集型、昂贵和繁琐的。那盏灯 待研究的疗法包括系统地暴露在蓝白光下，假设是缠绕 昼夜节律，在大脑的细胞和生理功能中起着至关重要的作用 尸体。事实上，这些节律的中断已经被证明会影响睡眠的数量和质量， 癌症患者中的抑郁和疲劳。拟议的研究将探索可接受性， 系统程序光照射(SPI)预防的可行性和潜在效果 CRF在自体干细胞移植治疗多发性骨髓瘤中的应用 骨髓瘤，如他们在住院期间提供的，大约两周后 干细胞的输注。SPI将提供适当定时的环境、低电平、蓝白光以 在住院期间，患者使用旨在提供高昼夜刺激的落地灯 一天中的进程。参与者将被随机分为两种治疗条件之一：一种是 一种是积极干预，一种是非主动对照。在住院期间，SPI将 包括：早上6点至10点的高强度(400勒克斯)，然后降低 上午晚些时候至傍晚早些时候(上午10点至下午6点)的强度(低于50勒克斯)，在 晚上(下午6点至凌晨6点)。非活动比较条件将由小于20勒克斯的蓝白组成 早上6点到下午6点有灯，下午6点到6点没有灯 拟议的研究将解决三个具体目标：1)确定SPI是否会导致显著的 预防/减少慢性肾功能衰竭、抑郁、睡眠问题、昼夜节律的发展 与比较轻的条件相比，干扰和降低了生活质量。2)探索 SPI对CRF的影响是否通过睡眠变化、抑郁症状、 昼夜活动节律和/或褪黑激素3)决定了SPI的可行性和可接受性， 活动描记、尿液收集和光暴露监测。

PROJECT SUMMARY Cancer-related fatigue (CRF) is the most commonly reported side effect of cancer treatment and is 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.” Such fatigue is often associated with sleep problems, depression, quality of life, and agitation. Unfortunately, currently available interventions for CRF are, at best, only modestly effective. Pharmacological agents have been studied for CRF, but there is insufficient evidence to recommend their use. Non-pharmacological interventions have shown clinical benefit, but they can be labor-intensive, expensive, and cumbersome for patients. The light therapy to be studied incorporates systematic exposure to bluish-white light is hypothesized to entrain circadian rhythms, which play a crucial role in the cellular and physiological functions of the brain and body. Indeed, disruption of these rhythms has been shown to affect sleep quantity and quality, depression, and fatigue among cancer patients. The proposed research will explore the acceptability, feasibility and potential efficacy of systematic programmed light illumination (sPI) exposure to prevent CRF in patients undergoing autologous stem cell transplantation in the treatment of Multiple Myeloma, as provided during their inpatient hospital stay for approximately two weeks following infusion of stem cells. sPI will deliver appropriately timed ambient, low-level, bluish-white light to patients during their hospital stay with floor lamps designed to deliver high circadian stimulation over the course of the day. Participants will be randomized to one of two treatment conditions: one with an active intervention, and one with a non-active comparison. During inpatient hospitalization, sPI will consist of: high intensity (400 lux) during morning hours (6AM to 10AM), followed by a decrease in intensity (lower than 50 lux) during late morning to early evening hours (10AM to 6PM), and no sPI at night (6PM to 6AM). The non-active comparison condition will consist of less than 20 lux blue-white light during 6AM-6PM period and no light from 6PM-6AM. The proposed research will address three specific aims: 1) Determine if sPI results in significant prevention/reduction of the development of CRF, depression, sleep problems, circadian rhythm disruption and diminished quality of life compared to the comparison light condition. 2) Explore whether the effects of sPI on CRF are mediated by changes in sleep, depressive symptoms, circadian activity rhythms, and/or melatonin 3) Determine the feasibility and acceptability of sPI, actigraphy, urine collection and monitoring of light exposure.