Home > Research Portfolio = > by Title > = Effect of Bright Light on Fatigue in Breast Cancer =

Effect of Bright Light on Fatigue in Breast Cancer

Institution:	University=20 of California, San Diego
Investigator(s):	Sonia=20 Ancoli-Israel , Ph.D. -
Award Cycle:	2005=20 (Cycle 11)	Grant #: 11IB-0034 =	Award: = $141,282
Award Type:	IDEA=20
Research Priorities =
Sociocultural,=20 Behavioral, and Psychological Issues>Sociocultural, Behavioral, = and=20 Psychological Issues: the human = side

Initial Award Abstract = (2005)
Introduction:=20 Patients treated with chemotherapy complain of poor sleep, fatigue and=20 depression. In addition, chemotherapy disrupts the body's internal = "biological=20 clock", which may make sleep, fatigue and depression all worse. Women = with=20 breast cancer undergoing chemotherapy are not exposed to much bright = light and=20 this may also contribute to the disruption of their body's internal = "biological=20 clock," because bright light is necessary for a strong biological clock. = One of=20 the easiest ways to strengthen the biological clock is by increasing = bright=20 light exposure. The correct timing of the light exposure will help the = women=20 feel more alert during the day.=20

Hypotheses: Fatigue is described as a general tiredness or an=20 overwhelming lack of energy that is often associated with a need to = rest,=20 inability to regain energy even with rest, and lack of interest in = events. The=20 principal focus of this proposal is to examine the effect of bright = light=20 exposure on fatigue, sleep, mood, and daily functioning in women with = breast=20 cancer undergoing chemotherapy. The three main hypotheses are that = increased=20 bright light exposure during chemotherapy will: 1) decrease fatigue and = improve=20 mood and daily functioning; 2) improve both the quality and quantity of = sleep,=20 and 3) strengthen the body's internal "biological clock," particularly = the=20 sleep/wake rhythm.=20

Methodology: Fatigue, mood, daily functioning, sleep and the = sleep/wake=20 cycle will be measured with questionnaires and with sleep recordings = before=20 chemotherapy begins in women with breast cancer. Women will be assigned = to=20 either bright light treatment or dim light treatment. The light will be=20 administered with special light boxes during cycles 1-4 of chemotherapy. = Fatigue, mood, daily functioning, sleep and the sleep/wake cycle will be = re-measured during the first and last weeks of cycle 1 and of cycle 4 of = chemotherapy to evaluate the effect of light treatment.=20

Innovative elements: This proposal is innovative because it is = one of the=20 first to look at how fatigue might be improved with non-drug therapy. It = also=20 looks to see if the non-drug therapy will improve the women's sleep, = mood and=20 daily functioning. Understanding how the sleep/wake cycle can be = strengthened to=20 reduce fatigue is a relatively new topic within the field of breast = cancer.=20 Finding ways to reduce fatigue without drugs may help women tolerate = their=20 chemotherapy better, and be able to function better each day. All of = these=20 findings should help health professionals be more effective in the = treatment of=20 fatigue.=20

Advocacy involvement: The Y-ME National Breast Cancer = Organization and=20 Susan G. Koman Breast Cancer Foundation list fatigue as one of the most = common=20 side effects of cancer treatment, making it an important area for = research.=20 Symptoms of fatigue include weakness, difficulty thinking, and tiredness = and=20 lead to a decreased ability to perform everyday activities, like eating = or=20 visiting with family and friends. Treatments listed for fatigue include = resting,=20 getting enough sleep, exercising, eating right and conserving energy. = But none=20 of these treatments is wholly effective. Dr. Ancoli-Israel and Dr. = Sadler are=20 members of the UCSD Cancer Center's Outreach Program, which has also = identified=20 fatigue and poor sleep as common complaints among breast cancer patients = and=20 facilitates research in this area. Women have reported a desire for=20 non-pharmacological ways to improve both sleep and fatigue and have = promised=20 support in helping with the project.

Final=20 Report (2007)
Women with breast cancer undergoing = chemotherapy often=20 report disturbed sleep and increased symptoms of fatigue and depression. = These=20 patients also exhibit a disrupted circadian rhythm, also known as the=20 =93biological clock.=94 This internal clock is driven by exposure to = bright light.=20 In a previous study we found that women with breast cancer are exposed = to less=20 bright light during chemotherapy, and that less light exposure is = related to=20 increased fatigue.=20

The aims of this study were to explore the effect of increased = bright=20 light exposure on decreasing fatigue, improving sleep and improving = mood. Women=20 undergoing chemotherapy were assigned to self-administer either bright = white=20 light (BWL) or dim red light (DRL) for 30 minutes on each morning of = their first=20 four cycles of chemotherapy. Sleep/wake activity was recorded with an = actigraph=20 for 72-hours before the start of chemotherapy and during the first and = last=20 weeks of cycle 1 and cycle 4. The actigraph is a device worn on the = wrist which=20 records activity levels from which sleep and wake can be estimated. = Patients=20 also completed questionnaires on fatigue, mood, daily function, = menopause, and=20 sleep quality. Both groups had good compliance, with the average = duration of=20 each session being 33 minutes (SD=3D17) for the BWL group and 30 minutes = for the=20 DRL group.=20

The initial pace of recruitment was slower than expected, causing = us to=20 enroll three patients fewer than projected. We addressed this issue by=20 introducing the study to several community oncologists, asking for their = help in=20 referring patients to our study. These referrals also gave us access to = patients=20 from the communities who are largely underrepresented in academic = research=20 studies. In total, 27 women agreed to participate and 7 of them then = withdrew=20 from the study. Most of the women who discontinued the study chose to do = so=20 before their second cycle of chemotherapy, stating their reason for = withdrawal=20 as being =93overwhelmed=94 with their diagnosis.=20

Twenty patients, 10 in each treatment group, completed the study. = Results=20 suggest that increased light exposure during chemotherapy results in = less=20 fatigue and better sleep at the end of four cycles of chemotherapy = compared to=20 before chemotherapy. Specifically, total sleep time increased by 22 = minutes and=20 wake time during the night decreased by 12 minutes with increased light=20 exposure, and general fatigue, as measured by a fatigue questionnaire, = was=20 reduced. The quality of sleep was also improved, although with this = small group=20 we did not reach a statistical significance for this measure.=20

We have received addition funding from Litebook Inc to continue = this line=20 of research. In the continuation of this study, we aim to repeat the = protocol in=20 a greater number of patients to continue testing the effect of bright = light on=20 sleep, fatigue and mood, as well as to test whether improved sleep and = fatigue=20 result in less cognitive impairment (=93chemobrain=94). Each participant = will have a=20 complete neuropsychological test battery, administered prior to = chemotherapy and=20 during the last week of cycle 4. A larger sample size will help us = further=20 address the original aims, and to elucidate the clinical value of light = as a=20 non-pharmacological approach to improving the quality of life in breast = cancer=20 patients.

Symposium Abstract=20 (2007)
Background: Studies have shown that women with breast = cancer=20 undergoing chemotherapy report disturbed sleep. Studies have also = suggested that=20 these women have very little bright light exposure, yet it is known that = bright=20 light may improve sleep. This study examined whether increasing exposure = to=20 bright light will improve fatigue in women with breast cancer.=20

Methods: 11 women (mean age=3D50.3 yrs, SD=3D8.4, range: 35-70 = yrs) diagnosed=20 with stage I-III breast cancer, scheduled to receive at least 4 cycles = of=20 adjuvant or neoadjuvant anthracycline-based chemotherapy participated. = Sleep=20 quality was assessed with the Pittsburgh Sleep Quality Index (PSQI) and=20 objective measures of sleep were assessed with 72-hours of actigraphy=20 (Ambulatory Monitoring, Inc. and Respironics) at baseline = (pre-chemotherapy) and=20 during the last week of cycle 4 (C4). An actigraph is a device worn on = the wrist=20 which measure sleep/wake patterns. Participants were randomized into two = treatment groups: bright white light (BWL) and dim red light (DRL). Both = groups=20 were instructed to self-administer light therapy for 30 minutes every = morning=20 throughout 4 cycles of chemotherapy.=20

Results: In the BWL group, total sleep time (TST) increased by 41 = min=20 (SD=3D69), while wake time during the night stayed approximately the = same. In the=20 DRL group TST decreased by 32 minutes (SD=3D30), while wake time = increased by 27=20 minutes (SD=3D39). Subjectively, PSQI sleep latency subscale for BWL was = reduced=20 from 2.6 (SD=3D3.0, range=3D0-5) at baseline to 1.9 (SD=3D2.3, = range=3D0-6) at C4, while=20 for DRL, mean sleep latency increased from 2.7 (SD=3D2.5, range=3D0-5) = at baseline=20 to 3.0 (SD=3D3.0, range=3D0-6) at C4. PSQI total score for BWL decreased = from 12.0=20 (SD=3D4.7, range=3D7-19) at baseline to 10.9 (SD=3D4.2, range=3D5-16) at = C4 while for=20 DRL it decreased from 8.3 (SD=3D3.1, range=3D5-11) at baseline to 7.7 = (SD=3D5.1,=20 range=3D2-12) at C4.=20

Conclusions: Preliminary results suggest that bright white light = may=20 increase the number of hours of sleep in women undergoing chemotherapy, = as well=20 as decreasing the amount of time it takes to fall asleep and improving = sleep=20 quality

The relative importance of specific risk factors for insomnia in = women=20 treated for early-stage breast cancer. =
Periodical:Psycho-oncology=20
Index Medicus:
Authors: = Bardwell=20 WA, Profant J, Casden DR, Dimsdale JE, Ancoli-Israel S, et al.=20

Yr: 2008

Vol: 17

Nbr: 1

Abs:

Pg:9-18 =

Taking fatigue seriously, II: variability in fatigue levels in cancer = patients.
Periodical:Psychosomatics=20
Index Medicus: Psychosomatics=20
Authors: Dimsdale JE, Ancoli-Israel S, Ayalon L, = Elsmore=20 TF, Gruen W=20

Yr: 2007

Vol: 48

Nbr: 3

Abs:

Pg:247-52 =

Sleep dysfunction in patients with cancer.=20
Periodical:Current=20 Treatment Options in Neurology
Index Medicus: = Curr=20 Treat Options Neurol
Authors: Fiorentino L, = Ancoli-Israel S=20

Yr: 2007

Vol: 9

Nbr:

Abs:

Pg:337-346 =

Predictors of inflammation in response to anthracycline-based = chemotherapy=20 for breast cancer.
Periodical:Brain,=20 Behavior, and Immunity
Index Medicus: Brain = Behav Immun=20
Authors: Mills PJ, Ancoli-Israel S, Parker B, = Natarajan L,=20 Hong S, Jain S, Sadler GR, von K=E4nel R=20

Yr: 2008

Vol: 22

Nbr: 1

Abs:

Pg:98-104 =