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: 8196046
• 负责人: William H Redd
• 金额: $ 22.83万
• 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 2013-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8196046
• 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. PUBLIC HEALTH RELEVANCE: Cancer related fatigue (CRF) severely interferes with cancer survivors' daily living, physical capacity, and ability to work, and can linger long after all treatment has ended. To date, CRF treatments have produced only moderate results. The proposed project will investigate the impact of systematic bright white light exposure in cancer survivors to minimize their CRF.

描述（由申请人提供）：癌症相关疲劳（CRF），由国家综合癌症网络定义为“与癌症或癌症治疗相关的身体、情感和认知疲劳或疲惫的痛苦、持续、主观感觉，与近期活动不成比例”，可严重干扰日常生活活动、体能和工作能力。甚至有报告称，疲劳是患者要求加速死亡的一个因素。在所有治疗结束后，CRF可能代表严重的临床问题。在我们对完成造血干细胞移植（HSCT）后1至3年的癌症幸存者的研究中，我们采访的40%的人报告说CRF是恢复日常活动的主要障碍。尽管CRF对生活质量有影响，但其报告不足、诊断不足和治疗不足。目前还没有被广泛接受的CRF干预措施证明具有临床疗效。已经研究了多种药物治疗CRF;最显著的是精神兴奋剂、抗抑郁药和皮质类固醇。但是没有足够的证据推荐使用任何现有的药理学药物。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在总体疗效上是相等的，但只有中等效果。事实上，目前还没有CRF的“金标准”治疗。一种有希望的治疗慢性肾功能衰竭的新干预措施是“亮白色光”（BWL --每天系统性暴露于市售“灯箱”发出的亮白色光30分钟）治疗。在一项小型随机对照临床试验中，BWL可防止化疗周期中睡眠障碍、情绪症状和疲劳的增加。我们希望研究BWL控制HSCT存活1至3年的CRF，原因有三。首先，CRF是大部分幸存者（40%）的主要问题。第二，BWL可能比CBT或运动更容易被幸存者接受，因为BWL对身体的要求不高，可以在家里进行。第三，BWL可能更便宜，因为它可以通过电话实施，需要的专业和耐心的时间和精力比锻炼和CBT所需的时间和精力更少。我们已经确定了一组150名HSCT幸存者，他们报告了临床显著水平的CRF，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）在患有CRF的HSCT幸存者中开发并初步测试BWL暴露干预，以使用客观和主观测量评估对疲劳，睡眠质量和生活质量的影响; 2）调查抑郁对疲劳的可能介导作用;和3）评估BWL作为癌症幸存者中CRF干预的可行性和可接受性。 公共卫生关系：癌症相关疲劳（CRF）严重干扰癌症幸存者的日常生活，身体能力和工作能力，并且在所有治疗结束后仍会持续很长时间。迄今为止，CRF治疗仅产生中等效果。拟议的项目将调查系统明亮的白色光暴露对癌症幸存者的影响，以尽量减少他们的CRF。