Treating Cancer-Related Cognitive Impairment Through Systematic Light Exposure

描述（由申请人提供）：接受造血干细胞移植（HSCT）治疗血液系统恶性肿瘤的患者通常会因癌症和/或其治疗而出现认知问题。事实上，即使在治疗5年后，40%的HSCT幸存者仍经历持续的认知障碍。尽管癌症相关认知障碍（CRCI）对生活质量有有害影响，但其诊断和治疗都不足。目前缺乏治疗CRCI的干预措施研究。关于传统认知康复方法改善HSCT患者CRCI的有限研究令人失望，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进行一对一的工作，并且要求患者住在离提供者很近的地方。显然，有必要为HSCT幸存者开发认知康复干预。本研究探讨了一种有前景的非药物干预CRCI -系统光照射治疗。涉及神经成像的研究表明，光可以调节大脑的认知功能。光对认知功能的影响涉及与视觉无关的非图像形成系统，并且部分由不同于视杆细胞和视锥细胞的视网膜感光系统介导。对接受化疗的乳腺癌患者的初步研究结果表明，明亮的白光（BWL）暴露与整体认知功能的改善有关，而昏暗的红光（DRL）暴露则没有。本研究的目的是确定BWL作为CRCI干预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。生理活动节律和睡眠对认知功能的潜在调节作用也将被探讨。该方法将由研究人员为乳腺癌化疗患者和脑损伤患者开发的研究程序提供信息。将招募60名移植后1 - 5年的HSCT幸存者，随机分为BWL组和DRL组。两组患者将在4周内每天早上进行30分钟的自我照明，并在干预前、干预第四周和干预后四周进行标准化的结果测量（包括认知功能、CAR和睡眠）。该研究将首次调查BWL与比较DRL在HSCT幸存者中改善CRCI的效果。如果有效，BWL干预措施有可能对公共卫生产生重大影响，因为它易于管理，因此可以广泛传播。总的来说，本研究将提供关于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幸存者提供一种急需的帮助CRCI的工具。

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.