Treating Cancer-Related Cognitive Impairment Through Systematic Light Exposure

通过系统光照治疗与癌症相关的认知障碍

• 批准号: 8752903
• 负责人: William H Redd
• 金额: $ 19.37万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-08-01 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8752903
• 关键词: Affect; Affective; Aftercare; Area; Boxing; Brain; Brain Injuries; Cancer Intervention; Cancer Patient; Cancer Survivor; Circadian Rhythms; Cognition; Cognitive; Development; Diagnosis; Exposure to; Fatigue; Goals; Health Personnel; Hematologic Neoplasms; Hematopoietic stem cells; Impaired cognition; Intervention; Investigation; Israel; Life; Light; Malignant Neoplasms; Mediating; Mediator of activation protein; Memory; Motor; Neurologic; Outcome Measure; Participant; Patients; Preparation; Procedures; Provider; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Recruitment Activity; Regimen; Research; Research Personnel; Retinal Photoreceptors; Self-Administered; Sleep; Speed; Stem cell transplant; Survivors; System; Testing; Training; Transplant Recipients; Vertebrate Photoreceptors; Vision; Visual; Work; chemotherapy; cognitive function; cognitive rehabilitation; experience; improved; injured; light effects; light treatment; malignant breast neoplasm; member; neuroimaging; post intervention; public health relevance; retinal rods; satisfaction; tool

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.

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由于癌症和/或其治疗而遇到认知问题。实际上，即使在治疗后5年，HSCT幸存者中有40％的经历持续认知障碍。尽管对生活质量的影响有害，但与癌症相关的认知障碍（CRCI）的诊断不足和治疗未经诊断。关于治疗CRCI的干预措施的研究缺乏。对HSCT患者改善CRCI的传统认知康复方法进行了有限的研究，令人失望，未能带来可观的好处。此外，传统的认知康复方法是昂贵的，需要训练有素的临床医生与患者一对一地工作，并要求患者与提供者紧邻。显然，需要为HSCT幸存者开发认知康复干预。拟议的研究调查了CRCI - 系统光暴露疗法的有希望的非药物干预措施。涉及神经影像学的研究表明，光可以调节认知脑功能。 Light对认知功能的影响涉及与视觉无关的非图像形成系统，部分是由视网膜光感受器系统介导的，与杆和锥体不同。对接受化学疗法的乳腺癌患者初步研究的结果表明，明亮的白光（BWL）暴露与整体认知功能的改善有关，但昏暗的红光（DRL）暴露却没有。拟议的研究的目的是确定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。还将探讨昼夜节律节奏和睡眠对认知功能的潜在介导作用。该方法将由开发的研究人员为接受化学疗法和脑损伤患者的乳腺癌患者进行研究而告知。 HSCT后1至5年的60名HSCT幸存者将被招募并随机分为BWL或DRL。两组将每天早晨自加工30分钟，持续4周，并在干预之前，干预的第四周和干预后四周进行标准化的结果指标（包括认知功能，汽车和睡眠）。这项研究将是第一个研究BWL与比较DRL与HSCT幸存者中CRCI的比较。如果有效，BWL干预措施可能会产生重大的公共卫生影响，因为它可以轻松地进行管理，从而广泛传播。总体而言，这项研究将提供有关BWL作为一种新的认知康复方法的重要信息，从而为医疗保健提供者和HSCT幸存者提供了一种急需的帮助CRCI的工具。