Interventions

Systematic Light Exposure (sLE)

Systematic Light Exposure for Fatigue in Stem Cell Transplant Survivors

  • Population: Multiple Myeloma and Diffuse Large B-Cell Lymphoma Survivors
  • Eligibility: Survivors 1 month to 5 years post autologous stem cell transplant (ASCT) who experience clinical levels of CRF
  • Patients are given a portable light device for four weeks to use every morning for 30 minutes after they received an autologous stem cell transplant. The aims of this study are to determine whether sLE yields reductions in CRF and whether it affects sleep, circadian rhythm activity, and depressive symptoms. We are examining whether the effects of sLE are mediated by changes in sleep, depressive symptoms, and/or circadian rhythm activity. Additionally, we are investigating whether sLE normalizes circadian cortisol rhythms and whether the effects of sLE are mediated by changes in these circadian cortisol rhythms.

Published Findings

1. Reduced Cancer-Related Fatigue

Figure 1. Mean FACIT-Fatigue Scores over Four Assessments. Mean FACIT-Fatigue scores for Bright White Light and Dim Red Light conditions over four assessment time points. Higher FACIT-Fatigue score corresponds to less fatigue. FACIT-Fatigue score equal to or less than 30 constitutes clinically significant fatigue, Standard errors are given.

  • Data analyses performed on results from mixed group of cancer survivors (n=36). CRF was significantly reduced across all time points in participants in the active condition (F(1,28)=7.12; p=0.0125; d = 0.98).
  • Participants in the active condition were not clinically fatigued during and after the light intervention, while participants in the inactive condition remained clinically fatigued throughout.

2. Improved Sleep Efficiency

 

Figure 2. Least squares mean and standard error bars for sleep efficiency over time with mean levels of time in bed (in hours) included for reference. The repeated-measures linear mixed model showed that the main effect for time was not significant (P = .49). The main effect for treatment condition was also not statistically significant (P = .07). However, the time × treatment condition was statistically significant (P = .003). tib = time in bed in hours.

  • Data analyses performed on results from mixed group of cancer survivors (n=44). Participants in the circadian-effective condition had significant improvements in sleep efficiency (F3,42= 5.55; p = 0.003; partial η2 = 0.28) in comparison to participants in the circadian-ineffective condition.
  • The sleep efficiency of participants in the circadian-effective condition was determined to be in the clinically normal range at the end of the intervention and at follow-up (mean = 86.06% and 85.77% respectively) whereas the sleep efficiency of participants in the circadian-ineffective condition remained impaired throughout.

Systematic Light Exposure to Treat Fatigue in Breast Cancer Patients

  • Population: Stage 1-3a Breast Cancer Patients
  • Eligibility: Breast Cancer Patients undergoing adjuvant or neoadjuvant chemotherapy
  • Patients are given a portable light device to use every morning for 30 minutes during their chemotherapy regimens. The aims of this study are to determine if sLE prevents CRF from worsening in Breast Cancer patients undergoing chemotherapy and if sLE normalizes circadian cortisol rhythms. Additionally, we are investigating whether sLE affects sleep, depression, and circadian rhythms and whether the effects of sLE on fatigue are moderated/mediated by sleep quality, depression, and/or circadian rhythms.

 

Programmed Environmental Illumination (PEI)

Programmed Environmental Illumination to Treat Fatigue in Cancer Patients Undergoing Autologous Stem Cell Transplantation

  • Population: Multiple Myeloma patients
  • Eligibility: Autologous Stem Cell Transplant (ASCT) Recipients
  • Patients receive the light intervention daily during ASCT hospitalization from 7-10AM via an ambient light fixture that illuminates the hospital room. The aims of this feasibility study are to assess whether PEI results in significant prevention/reduction of the development of CRF, depression, sleep problems, circadian rhythm disruption and diminished quality of life. Additionally, we are exploring whether the effects of PEI on CRF are mediated by changes in sleep, depressive symptoms, circadian activity rhythms, and/or melatonin.

Published Findings:

1. Reduced Depressive Symptoms

Figure 3. CES-D total score as a function of time by condition. Mean ± Standard Deviation of CES‐D scores obtained at each time point. As hypothesized, there was a significant difference in CES‐D total scores by Day 14 post‐transplant (day 3 of engraftment).

  • Data performed on participants from group of ASCT recipients (n=44). Greater increase in depressive symptoms 7 days and 14 days post ASCT for participants in the circadian-ineffective condition compared to participants in the circadian-ineffective condition (F(3,107) = 2.90; p = 0.0386; d = 0.59; ɳ2 = 0.08).
  • Participants in the circadian-effective condition remained below the cutoff for clinical depression on the CES-D scale during the ASCT hospitalization.