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Bright white light therapy reduces fatigue among cancer survivors
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Cancer survivors who used systematic bright white light therapy in the mornings experienced beneficial effects with sleep and also felt less fatigued, according to results of a randomized trial.
Disturbances in sleep patterns are common among cancer survivors. Although bright light therapy has been used to improve sleep in other patient populations, it has not been thoroughly studied in the cancer population.
William H. Redd, PhD, professor of population health science and policy at Icahn School of Medicine at Mount Sinai, and colleagues examined whether morning administration of bright white light therapy affected sleep quality among 37 fatigued cancer survivors.
Researchers randomly assigned participants to either a bright white light or dim red light condition group with instruction to use a light box every morning for 30 minutes for 4 weeks. The researchers used wrist actigraphy and the Pittsburgh Sleep Quality Index at baseline, 2 weeks into the intervention, within the last week of the intervention and 3 weeks after the intervention to measure the effect.
Study results showed mean sleep efficiency in the bright white light group was in the normal range both at the end of the intervention and 3 weeks after the intervention.
Researchers observed medium to large positive effects on sleep quality, total sleep time and wake after sleep onset for participants who used the bright light therapy.
HemOnc Today spoke with Redd about the bright white light therapy approach, why it may be beneficial, and the questions that must be answered in future research.
Question: Can you provide an overview of this approach?
Answer: We based this approach on the fact that circadian rhythm changes and follows a pattern around a 24-hour period. This occurs in all organisms and has been studied in other populations. We all have these circadian rhythms that keep our bodies coordinated in a way. When someone has cancer and undergoes cancer treatment, circadian rhythm becomes disrupted. These patients experience various symptoms, including fatigue, depression and sleep problems. Light is the strongest regulator of these problems.
Q: Why is sleep disruption a concern for individuals with cancer ?
A: Sleep problems are a serious issue for patients with cancer because they contribute to other issues, such as fatigue, depression and frailty. We believe sleep problems among patients with cancer are caused by many factors, including the disruption in normal schedules caused by hospital stays. Additionally, sleep problems are linked to disruption in circadian rhythms caused by the disease and the treatment. Sleep problems can become a vicious cycle, with worse sleep leading to biological changes that, in turn, cause worse sleep.
Q: How did you conduct the study?
A: We randomly assigned patients with confirmed symptoms of circadian rhythm disruption — sleep problems, fatigue and depression — to one of two interventions. We then assessed outcomes.
Q: What did you find?
A: Our initial results have been very exciting. Within 10 days, we saw improvements in patient-reported fatigue symptoms. Patients who underwent the bright white light therapy demonstrated reduced depression, better sleep and less fatigue than those who did not receive bright white light therapy.
Q: What are the clinical implications of the findings?
A: Bright white light therapy is very low cost and does not demand much of patients. No side effects and no damage occur from the light. We could deliver inexpensive, reliable and effective treatment.
Q: What will be assessed in future research ?
A: We are looking at what biological factors change when we give the patients bright white light therapy and whether there are improvements in patient symptoms. We also are examining the light in hospital rooms in hopes of re-engineering that light to reduce patient symptoms. We are assessing light therapy for patients with metabolic syndrome, which occurs with some chemotherapies, particularly in the adjuvant setting. We are using bright white light therapy to determine whether we can prevent metabolic syndrome, as this condition is associated with cancer recurrence and spread.
Q: Is there anything else that you would like to mention?
A: This work is extremely exciting, and it is amazing that we have not studied this among patients with cancer before. We all feel better on sunny days. We want to travel south for the winter, not only for the warm weather but also for the sunlight. Circadian rhythm is important, and its disruption negatively impacts people, particularly patients with and survivors of cancer.
Reference:
Wu LM, et al. J Clin Sleep Med. 2017;doi:10.5664/jcsm.6874.
For more information:
William H. Redd, PhD, can be reached at Icahn School of Medicine, Icahn (East) Building, 1425 Madison Ave., New York, NY 10029.
Disclosure: Redd reports no relevant financial disclosures.