Systematic light exposure in the treatment of cancer-related fatigue: a preliminary study

Psycho-Oncology Psycho-Oncology (2014) Published online in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/pon.3553 Clinical Correspondence Systematic light exposure in the treatment of cancer-related fatigue: a preliminary study William H. Redd 1 *, Heiddis Valdimarsdottir 1,2 , Lisa M. Wu 1 , Gary Winkel 1 , Emily E. Byrne 1 , Melba A. Beltre 1 , Elizabeth S. Liebman 1 , Tanya Erazo 1 , Judy A. Hayes 1 , Luis Isola 3 , Eileen Scigliano 3 , Yeraz Meschian 1 , Susan Lutgendorf 4 and Sonia Ancoli-Israel 5 Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA Department of Psychology, Reykjavik University, Iceland Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA Department of Psychology, University of Iowa, Iowa, IA, USA Departments of Psychiatry and Medicine, University of California, San Diego, CA, USA *Correspondence to: Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA. E-mail: william. redd@mssm.edu Received: 1 October 2013 Revised: 13 March 2014 Accepted: 25 March 2014 Dear Editor, Introduction Cancer-related fatigue (CRF) is the most commonly reported side effect of cancer treatment [1]. It is 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’. Patients feel tired even after resting, have reduced capacity to carry out normal activities, experience slow physical recovery from tasks, and report diminished concentration. Most patients experience CRF during their treatment, and many continue to experience CRF long after all treatment has ended. In our research with survivors of hematopoietic stem cell transplantation (HSCT) 1–3 years off treatment, 40% of those interviewed reported clinically significant CRF. Various pharmacological and nonpharmacological interventions have been studied to treat CRF with generally mild to moderate effect sizes [1]. An alternate intervention may be systematic bright white light (BWL) exposure, which is far less costly and involves less patient burden than other interventions. Reviews and meta-analyses [2] have reported that BWL is effective in reducing sleep and circadian rhythm problems associated with other disorders (e.g., depression and jet lag) but has not been previously tested for the effect on fatigue. Recent research from our group has shown that, when given during chemotherapy, BWL compared with Copyright © 2014 John Wiley & Sons, Ltd. dim red light (DRL) keeps CRF from getting worse [3]. However, to date, the impact of BWL on fatigue among survivors of cancer has not been examined. This preliminary efficacy trial sought to determine the impact of BWL on CRF among survivors of breast and gynecologic cancers who had completed all cancer treat- ment and survivors of hematological malignancy who had completed HSCT. We tested the hypothesis that the BWL condition would result in a significant reduction in CRF compared with the DRL condition. Methods Participants Thirty-six survivors of cancer from the Mount Sinai Hospital in New York, NY, participated in the study (Figure 1) across all four seasons. Inclusion criteria were the following: up to 3.5 years post-HSCT, up to 3 years postcompletion of che- motherapy or chemotherapy and radiation for breast cancer, or any time postcompletion of treatment for gynecologic cancer; 18 years of age or older; and reporting clinically significant fatigue as measured by the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) scale. Exclusion criteria were the following: pregnancy, confounding underlying medical illnesses such as signi- ficant preexisting anemia, history of mania (which is a contraindication for light treatment) or current clinical depression, and any other physical or psychological impairment including a sleep disorder that would limit par- ticipation. The study was approved by the Program for the Protection of Human Subjects at Mount Sinai Hospital.