Treating Cancer-Related Fatigue Through Systematic Bright White Light

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令人痛苦的、持续的、主观的身体、情绪和认知疲劳或疲惫的感觉，与最近的活动不成比例”，可严重干扰日常生活、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。在所有治疗结束后，慢性肾功能衰竭可能是一个严重的临床问题。在我们对完成造血干细胞移植(HSCT)后1到3年的癌症幸存者的研究中，40%的受访者报告说，CRF是恢复正常活动的主要障碍。尽管CRF对生活质量有影响，但它被低估了报告，低估了诊断，也低估了治疗。目前还没有被广泛接受的CRF干预措施显示出临床疗效。治疗慢性肾功能衰竭的药物种类繁多，其中最著名的是精神刺激剂、抗抑郁剂和皮质类固醇。但没有足够的证据建议使用目前可用的任何一种药理学药物。已经测试了许多非药物策略。最有希望的是锻炼和认知行为疗法(CBT)。两个随机临床试验的结果表明，运动和CBT在总体疗效上是相同的，但只有中等效果。事实上，目前还没有治疗慢性肾功能衰竭的“黄金标准”。一种有希望的治疗慢性肾功能衰竭的新干预方法是“明亮的白光”(BWL-有系统地每天暴露在来自商业“灯箱”的明亮的白光下30分钟)治疗。在一项小型随机对照临床试验中，BWL对化疗周期中睡眠障碍、情绪症状和疲劳的增加具有保护作用。基于三个原因，我们希望研究体重指数(BWL)来控制1-3年HSCT幸存者的CRF。首先，慢性肾功能衰竭是很大一部分幸存者(40%)的主要问题。其次，BWL可能比CBT或锻炼更容易被幸存者接受，因为BWL对体力的要求较低，而且可以在家里进行。第三，BWL可能会更便宜，因为它可以通过电话实施，比锻炼和CBT所需的专业和耐心的时间和精力更少。我们已经确定了150名HSCT幸存者，他们报告了临床上有意义的CRF水平，并提供了参与进一步研究的知情同意，这一事实确保了拟议研究的可行性。具体目标：1)开发和试点针对患有CRF的HSCT幸存者的BWL暴露干预措施，以评估其对疲劳、睡眠质量和生活质量的影响；2)调查抑郁对疲劳的可能中介作用；以及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。 公共卫生相关性：癌症相关性疲劳(CRF)严重干扰癌症幸存者的日常生活、身体能力和工作能力，并可能在所有治疗结束后持续很长时间。到目前为止，慢性肾功能衰竭的治疗只产生了适度的效果。这项拟议的项目将调查系统性白光暴露对癌症幸存者的影响，以最大限度地减少他们的CRF。

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.