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: 8900244
• 负责人: William H Redd
• 金额: $ 22.57万
• 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/8900244
• 关键词: Affect; Affective; Aftercare; Area; Boxing; Brain; Brain Injuries; Breast 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; Phototherapy; 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; cancer-related cognitive impairment; chemotherapy; cognitive function; cognitive rehabilitation; dexterity; experience; improved; injured; light effects; 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(申请人提供)：接受了造血干细胞移植(HSCT)治疗血液系统恶性肿瘤的患者通常会因为癌症和/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幸存者仍经历着持续性的认知障碍。尽管癌症对生活质量有有害影响，但与癌症相关的认知障碍(CRCI)仍未得到充分诊断和治疗。目前对CRCI干预治疗的研究较少。检查传统认知康复方法以改善HSCT患者CRCI的有限研究一直令人失望，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，并要求患者生活在离提供者很近的地方。显然，有必要为HSCT幸存者开发一种认知康复干预。这项拟议的研究调查了一种有前景的CRCI的非药物干预-系统光暴露疗法。涉及神经成像的研究表明，光可以调节认知大脑功能。光对认知功能的影响涉及一个与视觉无关的非成像系统，部分是由与视杆细胞和视锥细胞不同的视网膜光感受器系统介导的。对接受化疗的乳腺癌患者进行的初步研究结果表明，暴露在明亮的白光(BWL)下与整体认知功能的改善有关，但暴露在暗淡的红光(DRL)下并不相关。这项研究的目的是确定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中介作用。这一方法将由研究人员为研究接受化疗的乳腺癌患者和脑损伤患者而开发的程序提供信息。60名HSCT后1至5年的幸存者将被招募并随机分为BWL组或DRL组。两组都将每天早上自我照射30分钟，持续4周，并在干预前、干预4周期间和干预后4周进行标准化结果测量(包括认知功能、CAR和睡眠)。这项研究将首次探讨BWL与DRL在改善HSCT存活者CRCI方面的比较。如果有效，BWL干预可能会对公共卫生产生重大影响，因为它很容易管理，因此可以广泛传播。总体而言，这项研究将提供有关BWL作为一种新的认知康复方法的重要信息，为卫生保健提供者和HSCT幸存者提供一个急需的工具来帮助CRCI。