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

摘要 癌症患者在治疗过程中经常会经历身体内部生物钟的破坏。 治疗，这有助于恶化的副作用和生活质量。这些副作用包括癌症- 相关性疲劳（CRF），影响数百万患者，并可持续数月至数年后结束 治疗尽管慢性肾功能衰竭的普遍性，治疗它的指导方针在很大程度上限于运动， 认知行为疗法和其他心理社会干预，这对依从性提出了挑战， 可访问性和可扩展性。然而，光疗法具有较低的进入门槛，并已显示出作为一种治疗方法的前景。 通过靶向昼夜节律途径减少癌症患者疲劳症状的方法。光是主要的 输入到身体的内部时钟。通过定时曝光--例如，增光和减光 在晚上--照明干预可以支撑生物钟，改善疲劳和巩固睡眠。的 一个更强健的生物钟的优势也可能不仅仅是疲劳和睡眠， 患者的昼夜节律受到的干扰较少。尽管轻度干预具有潜在价值， 但是有几个限制阻碍了它们作为治疗方法的广泛采用。人们对以下问题的认识有限： 光的时间是如何影响生物钟的，这是复杂的事实， 在一天中的变化。此外，任何照明干预措施都需要根据个人的 “个人时区”（即，他们的生物钟的当前状态），以便有效。两个人住在 如果同一地点的日常日程安排差异很大，则该地点可能在明显不同的时间需要照明，或者 如果一个人的生物钟比另一个人紊乱得多这项提案中的工作是一项临床试验， 推荐个性化照明干预以减少癌症患者的疲劳的应用程序（“照明”）。138 患者将从密歇根大学癌症中心招募，并提供Tumblr应用程序， 以及一副防蓝光眼镜和一个Fitbit可穿戴设备。将对患者进行纵向跟踪， 疲劳是主要结果，睡眠障碍、助眠剂的使用、情绪和焦虑是主要结果 次要结果。我们希望观察到统计学上的显着差异，疲劳的结果，有针对性的 照明干预。最终的产品将是一个量化的应用程序的能力，以改善疲劳， 癌症患者和迭代改进应用程序的路线图。

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.