Assessing the impact of app-delivered lighting interventions on fatigue in three populations of cancer patients

评估应用程序提供的照明干预措施对三组癌症患者疲劳的影响

• 批准号: 10262965
• 负责人: Olivia Walch
• 金额: $ 73.94万
• 依托单位: ARCASCOPE, INC
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-09-12 至 2024-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10262965
• 关键词: Adoption; Affect; Aftercare; Algorithms; Anxiety; Autologous Stem Cell Transplantation; Awareness; Back; Behavioral; Biological Clocks; Breast; Cancer Center; Cancer Patient; Cancer Survivor; Chronotherapy; Circadian Dysregulation; Circadian Rhythms; Clinical Trials; Cognitive Therapy; Comprehensive Cancer Center; Computer software; Data; Exercise; Fatigue; Feedback; Goals; Gold; Guidelines; Hygiene; Individual; Inferior; Intervention; Light; Lighting; Link; Location; Malignant Neoplasms; Measures; Melatonin; Methods; Michigan; Moods; Outcome; Participant; Pathway interactions; Patients; Phase; Phototherapy; Population; Prostate; Provider; Quality of life; Randomized Controlled Trials; Recommendation; Research; Risk; Schedule; Sleep; Sleep disturbances; Small Business Innovation Research Grant; Symptoms; Testing; Therapeutic; Time; Toxic effect; Treatment Side Effects; Universities; Update; Work; base; cancer therapy; cancer type; circadian; circadian pacemaker; environmental change; experience; fitbit; improved; metastatic colorectal; mobile application; novel; patient population; phase I trial; primary outcome; prospective; psychosocial; recruit; reduce symptoms; repaired; secondary outcome; side effect; sleep quality; survival outcome; technological innovation; time use; treatment response; wearable device

ABSTRACT Cancer patients often experience disruptions to their body's internal, circadian clock over the course of treatment, which contribute to worsened side-effects and quality of life. These side-effects include cancer- related fatigue (CRF), which affects millions of patients and can persist for months to years after the end of treatment. Despite the pervasiveness of CRF, the guidelines for treating it are largely limited to exercise, cognitive behavioral therapy, and other psychosocial interventions, which present challenges of compliance, accessibility, and scalability. Light therapy, however, has a lower barrier to entry and has shown promise as a way of reducing symptoms of fatigue in cancer patients by targeting circadian pathways. Light is the primary input to the body's internal clock. By timing light exposure-- e.g., increasing morning light and decreasing light at night-- lighting interventions can bolster the clock, improving fatigue and consolidating sleep. The advantages of a more robust clock may also go beyond fatigue and sleep, as better outcomes in cancer patients are associated with less disrupted circadian rhythms. Despite the potential value in light interventions, several limitations have held back their wide-spread adoption as a treatment. There is limited awareness about how light timing affects the circadian clock, which is complicated by the fact that the clock's sensitivity to light changes over the course of the day. In addition, any lighting interventions need to be tailored to an individual's “personal time zone” (i.e., their circadian clock's current state) in order to be effective. Two individuals living in the same location may need light at markedly different times if their daily schedules are sufficiently different, or if one's circadian clock is much more disrupted than the other. The work in this proposal is a clinical trial to test an app (“SHIFT”) that recommends personalized lighting interventions to reduce fatigue in cancer patients. 138 patients will be recruited from the University of Michigan's Cancer Center and provided with the SHIFT app, as well as a pair of blue-blocking glasses and a Fitbit wearable device. The patients will be tracked longitudinally, with fatigue as the primary outcome, and sleep disturbances, sleep aid usage, mood, and anxiety as secondary outcomes. We expect to observe statistically significant differences in fatigue as a result of targeted lighting interventions. The final product will be a quantification of the SHIFT app's ability to improve fatigue in cancer patients and a roadmap for iteratively improving the app.

摘要 癌症患者通常在以下过程中经历体内生物钟的紊乱 治疗，这会加重副作用和生活质量。这些副作用包括癌症- 相关性疲劳(CRF)，影响数百万患者，并可在结束后持续数月至数年 治疗。尽管慢性肾功能衰竭很普遍，但治疗指南在很大程度上仅限于运动， 认知行为疗法和其他心理社会干预，这对遵从性提出了挑战， 可访问性和可扩展性。然而，光疗法的进入门槛较低，并显示出作为一种 通过针对昼夜节律通路减少癌症患者疲劳症状的方法。光是首要的 输入到人体内部的时钟。通过定时光照--例如，增加晨光和减少光线 在夜间，灯光干预可以提振时钟，改善疲劳，巩固睡眠。这个 更强健的时钟的优点也可能超越疲劳和睡眠，因为更好的结果是癌症 患者的昼夜节律较少受到干扰。尽管光干预有潜在的价值， 一些限制阻碍了它们作为一种治疗方法的广泛采用。人们对以下问题的认识有限 光的计时如何影响生物钟，这是复杂的事实，因为时钟对光的敏感性 一天中的变化。此外，任何照明干预都需要针对个人的 “个人时区”(即生物钟的当前状态)才能起作用。两个人住在 如果同一地点的日常作息时间有很大不同，那么他们在明显不同的时间可能需要照明，或者 如果一个人的生物钟比另一个人受到的干扰更大。这份提案中的工作是一项临床试验，以测试 一款推荐个性化照明干预以减轻癌症患者疲劳的应用程序(“Shift”)。138 患者将从密歇根大学癌症中心招募，并提供Shift应用程序，因为 以及一副蓝色遮挡眼镜和一台Fitbit可穿戴设备。患者将被纵向追踪， 以疲劳为主要结果，以睡眠障碍、助眠剂使用、情绪和焦虑为主要结果 次要结果。我们期望观察到由于有针对性的结果在疲劳方面的统计上的显著差异 照明干预。最终的产品将是对Shift应用程序改善疲劳的能力的量化 癌症患者和反复改进该应用程序的路线图。