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Lai F, Luo Z, Zhang J, Xia W, Tian L. Bright light therapy has a positive effect on sleep quality in patients with cancer: A meta-analysis. Sleep Med Rev 2024; 75:101925. [PMID: 38537515 DOI: 10.1016/j.smrv.2024.101925] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/29/2024] [Accepted: 03/17/2024] [Indexed: 06/04/2024]
Abstract
Cancer patients frequently encounter difficulties associated with suboptimal sleep quality. Bright Light Therapy (BLT), an innovative treatment approach, has shown promise in enhancing sleep quality. However, several literature reviews showed conflicting results, and more analysis should be conducted regarding detailed BLT settings on sleep. This meta-analysis was undertaken to comprehensively assess the impact of BLT on sleep quality among cancer patients. Twelve studies with 679 patients were included. Compared with the control group, BLT overall resulted in significant improvements in terms of sleep quality [g = -0.34], total sleep time [g = 0.24], wake after sleep onset [g = -0.80], and fatigue [g = -0.54]. However, it did not yield a statistically significant effect on sleep efficiency, sleep onset latency, and insomnia severity. Regarding light settings, interventions featuring light intensities >5000lux, intervention duration ≥4 weeks, spectral emission peak at 464∼465 nm, and using a lightbox demonstrated heightened efficacy in improving sleep. BLT may be considered a supplementary therapeutic option to improve sleep quality among cancer patients. However, more extensive and rigorous studies are necessary to determine the optimal timing of BLT delivery and its applicability to cancer patients across different age groups.
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Affiliation(s)
- Fengxia Lai
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China; School of Nursing, Medical College of Soochow University, Suzhou, 215006, China
| | - Zhen Luo
- School of Nursing, Medical College of Soochow University, Suzhou, 215006, China
| | - Jiyin Zhang
- School of Nursing, Medical College of Soochow University, Suzhou, 215006, China
| | - Wangjie Xia
- School of Nursing, Medical College of Soochow University, Suzhou, 215006, China
| | - Li Tian
- The First Affiliated Hospital of Soochow University, Suzhou, 215006, China; School of Nursing, Medical College of Soochow University, Suzhou, 215006, China.
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2
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Grassi L, Zachariae R, Caruso R, Palagini L, Campos-Ródenas R, Riba MB, Lloyd-Williams M, Kissane D, Rodin G, McFarland D, Ripamonti CI, Santini D. Insomnia in adult patients with cancer: ESMO Clinical Practice Guideline. ESMO Open 2023; 8:102047. [PMID: 38158225 PMCID: PMC10774975 DOI: 10.1016/j.esmoop.2023.102047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/29/2023] [Accepted: 09/29/2023] [Indexed: 01/03/2024] Open
Abstract
•Insomnia is common in patients with cancer, with a higher prevalence than observed in the general population. •Insomnia is often under-recognised and inadequately treated in patients with cancer. •Brief validated screening tools are available for the evaluation of insomnia in clinical practice. •First-line therapy should be based on international guidelines recommending cognitive behavioural therapy for insomnia.
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Affiliation(s)
- L Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - R Zachariae
- Unit for Psychooncology and Health Psychology (EPoS), Department of Oncology, Aarhus University Hospital, Aarhus; Danish Center for Breast Cancer Late Effects (DCCL), Aarhus University Hospital, Aarhus, Denmark
| | - R Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - L Palagini
- Sleep Clinic, Department of Clinical and Experimental Medicine, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - R Campos-Ródenas
- Department of Psychiatry, Hospital Clínico Universitario Lozano Blesa, University of Zaragoza, Zaragoza, Spain
| | - M B Riba
- Department of Psychiatry, University of Michigan, Ann Arbor; University of Michigan Rogel Cancer Center, University of Michigan, Ann Arbor, USA
| | - M Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group (APSCSG), Primary Care and Mental Health, University of Liverpool, Liverpool; Department of Supportive and Palliative Care, Liverpool John Moores University, Liverpool, UK
| | - D Kissane
- Department of Psychiatry, Monash University and Monash Medical Centre, Monash Health, Clayton, Australia
| | - G Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, Canada
| | - D McFarland
- Department of Psychiatry, University of Rochester, Rochester; Wilmont Cancer Institute, University of Rochester Medical Center, Rochester, USA
| | - C I Ripamonti
- School of Speciality in Palliative Medicine, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia
| | - D Santini
- Medical Oncology A, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
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3
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Lin LY, Tam KW, Huang TW. Effect of bright light therapy on cancer-related fatigue and related symptoms: A systematic review and meta-analysis of randomized controlled trials. J Psychosom Res 2023; 174:111501. [PMID: 37797569 DOI: 10.1016/j.jpsychores.2023.111501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 09/24/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Cancer-related fatigue (CRF) is a common side effect in cancer patients, possibly due to disrupted circadian rhythms. While bright light therapy (BLT) is known to modulate circadian rhythms, its role in mitigating CRF remains unclear. This study examined the impact of BLT on CRF and other related symptoms. METHODS PubMed, Embase, Cochrane Library, and SCOPUS databases were searched. The trials were selected according to the PRISMA guidelines. The severity and quality of CRF and related symptoms were investigated in post-BLT intervention. RESULTS Twelve trials involving 691 were included. BLT significantly reduced CRF (SMD = -0.92, 95% CI: -1.45 to -0.40, p < 0.00001, I2 = 90%) and insomnia (SMD = -2.80, 95% CI: -4.61 to -0.98, I2 = 0%). Subgroup analyzes were performed based on various factors including light illuminance and intervention duration. BLT was found to be effective in both preventing and treating CRF, though it did not significantly enhance sleep quality, depression, and quality of life (QoL). CONCLUSION BLT is a promising intervention for managing CRF in cancer patients. Its efficacy in improving sleep quality, and insomnia, reducing depression, and enhancing QoL requires further exploration. A 4-week BLT intervention with ≥10,000 lx is recommended for preventing and treating CRF, with longer or less intense interventions also showing effectiveness. Otherwise, BLT exhibited minimal adverse effects.
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Affiliation(s)
- Lee-Yuan Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Ka-Wai Tam
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
| | - Tsai-Wei Huang
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Department of Nursing, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
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4
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Yao L, Zhang Z, Lam LT. The effect of light therapy on sleep quality in cancer patients: a systematic review and meta-analysis of randomized controlled trials. Front Psychiatry 2023; 14:1211561. [PMID: 37492065 PMCID: PMC10363736 DOI: 10.3389/fpsyt.2023.1211561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/22/2023] [Indexed: 07/27/2023] Open
Abstract
Background Sleep problem is one of the major issues of cancer patients and may have detrimental effects on the ongoing treatment and recovery of patients. However, the evidence for the effect of light therapy on sleep problems in this population remained scarce. This study aimed to examine the effect of light therapy on self-reported and physiological measures of sleep quality of cancer patients. It also aimed to quantify the magnitude of the effect using a meta-analytical approach. Methods Six databases were searched for randomized control trials (RCTs). The primary outcome was the sleep quality using the Pittsburgh sleep quality index (PSQI) measurement of self-reported scores, and the secondary outcomes included total sleep time and sleep efficiency measured by actigraphy. Meta-analyses were performed with the random effects model using the RevMan software. The standardized mean difference (SMD) of the PSQI scores and other measures with their 95% confidence intervals (CIs) were used for assessing the treatment effect (CRD42023370947). Results Nine RCTs were identified and included in the study. Light therapy significantly improved the self-reported sleep quality with a reduction of the pooled PSQI score (SMD = -0.72; 95% CI: -1.24 to -0.21; p = 0.006). Regarding total sleep time (p = 0.72) and sleep efficiency (p = 0.47), no significant effects of light therapy were found. Conclusion Light therapy could improve self-reported sleep quality in cancer patients. However, due to the heterogeneity and small sample size of the included trials, the results should be interpreted cautiously. Trials with better designs and larger sample sizes are suggested to be conducted for a more definitive conclusion.Systematic review registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=370947.
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Affiliation(s)
- Liqing Yao
- Faculty of Medicine, Macau University of Science and Technology, Taipa, Macao SAR, China
| | - Zhiyi Zhang
- Faculty of Health Sciences, University of Macau, Taipa, Macao SAR, China
| | - Lawrence T. Lam
- Faculty of Medicine, Macau University of Science and Technology, Taipa, Macao SAR, China
- Faculty of Health, The University of Technology Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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5
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Dose B, Yalçin M, Dries SPM, Relógio A. TimeTeller for timing health: The potential of circadian medicine to improve performance, prevent disease and optimize treatment. Front Digit Health 2023; 5:1157654. [PMID: 37153516 PMCID: PMC10155816 DOI: 10.3389/fdgth.2023.1157654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 03/27/2023] [Indexed: 05/09/2023] Open
Abstract
Circadian medicine, the study of the effects of time on health and disease has seen an uprising in recent years as a means to enhance health and performance, and optimize treatment timing. Our endogenous time generating system -the circadian clock- regulates behavioural, physiological and cellular processes. Disruptions of the clock, via external factors like shift work or jet lag, or internal perturbations such as genetic alterations, are linked to an increased risk of various diseases like obesity, diabetes, cardiovascular diseases and cancer. By aligning an individual's circadian clock with optimal times for performing daily routines, physical and mental performance, and also the effectiveness of certain therapies can be improved. Despite the benefits of circadian medicine, the lack of non-invasive tools for characterizing the clock limits the potential of the field. TimeTeller is a non-invasive molecular/digital tool for the characterization of circadian rhythms and prediction of daily routines, including treatment timing, to unlock the potential of circadian medicine and implementing it in various settings. Given the multiple known and potentially yet unknown dependent health factors of individual circadian rhythms, the utility of this emerging biomarker is best exploited in data driven, personalized medicine use cases, using health information across lifestyle, care, and research settings.
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Affiliation(s)
| | - Müge Yalçin
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology, and Tumour Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Institute for Systems Medicine and Faculty of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | | | - Angela Relógio
- Institute for Theoretical Biology (ITB), Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Molecular Cancer Research Center (MKFZ), Medical Department of Hematology, Oncology, and Tumour Immunology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
- Institute for Systems Medicine and Faculty of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
- Correspondence: Angela Relógio
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6
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Amidi A, Wu LM. Circadian disruption and cancer- and treatment-related symptoms. Front Oncol 2022; 12:1009064. [PMID: 36387255 PMCID: PMC9650229 DOI: 10.3389/fonc.2022.1009064] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/28/2022] [Indexed: 07/27/2023] Open
Abstract
Cancer patients experience a number of co-occurring side- and late-effects due to cancer and its treatment including fatigue, sleep difficulties, depressive symptoms, and cognitive impairment. These symptoms can impair quality of life and may persist long after treatment completion. Furthermore, they may exacerbate each other's intensity and development over time. The co-occurrence and interdependent nature of these symptoms suggests a possible shared underlying mechanism. Thus far, hypothesized mechanisms that have been purported to underlie these symptoms include disruptions to the immune and endocrine systems. Recently circadian rhythm disruption has emerged as a related pathophysiological mechanism underlying cancer- and cancer-treatment related symptoms. Circadian rhythms are endogenous biobehavioral cycles lasting approximately 24 hours in humans and generated by the circadian master clock - the hypothalamic suprachiasmatic nucleus. The suprachiasmatic nucleus orchestrates rhythmicity in a wide range of bodily functions including hormone levels, body temperature, immune response, and rest-activity behaviors. In this review, we describe four common approaches to the measurement of circadian rhythms, highlight key research findings on the presence of circadian disruption in cancer patients, and provide a review of the literature on associations between circadian rhythm disruption and cancer- and treatment-related symptoms. Implications for future research and interventions will be discussed.
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Affiliation(s)
- Ali Amidi
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Sleep and Circadian Psychology Research Group, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Lisa M. Wu
- Unit for Psycho-Oncology and Health Psychology, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Sleep and Circadian Psychology Research Group, Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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7
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Fox RS, Gaumond JS, Zee PC, Kaiser K, Tanner EJ, Ancoli-Israel S, Siddique J, Penedo FJ, Wu LM, Reid KJ, Parthasarathy S, Badger TA, Rini C, Ong JC. Optimizing a Behavioral Sleep Intervention for Gynecologic Cancer Survivors: Study Design and Protocol. Front Neurosci 2022; 16:818718. [PMID: 35310101 PMCID: PMC8931410 DOI: 10.3389/fnins.2022.818718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/28/2022] [Indexed: 11/13/2022] Open
Abstract
Sleep difficulties, particularly symptoms of insomnia and circadian disruption, are among the primary complaints of gynecologic cancer survivors before, during, and after treatment. Moreover, difficulty sleeping has been linked to poorer health-related quality of life and elevated symptom burden in this population. Although leading behavioral sleep interventions have demonstrated efficacy among cancer survivors, up to 50% of survivors are non-adherent to these treatments, likely because these interventions require labor-intensive behavior and lifestyle changes. Therefore, there is a need for more effective and acceptable approaches to diminish sleep disturbance among cancer survivors. This manuscript describes the methodology of a two-part study guided by the Multiphase Optimization Strategy (MOST) framework to identify a streamlined behavioral sleep intervention for gynecologic cancer survivors. Three candidate intervention components previously shown to decrease sleep disturbance will be evaluated, including sleep restriction, stimulus control, and systematic bright light exposure. Participants will be adult women with a history of non-metastatic gynecologic cancer who have completed primary treatment and who report current poor sleep quality. Fifteen participants will be recruited for Part 1 of the study, which will utilize qualitative methods to identify barriers to and facilitators of intervention adherence. Results will inform changes to the delivery of the candidate intervention components to promote adherence in Part 2, where 80 participants will be recruited and randomized to one of eight conditions reflecting every possible combination of the three candidate intervention components in a full factorial design. Participants will complete assessments at baseline, post-intervention, and 3-months post-intervention. Part 2 results will identify the combination of candidate intervention components that yields the most efficacious yet efficient 6-week intervention for diminishing sleep disturbance. This is the first known study to apply the MOST framework to optimize a behavioral sleep intervention and will yield a resource-efficient treatment to diminish sleep disturbance, improve health-related quality of life, and decrease symptom burden among gynecologic cancer survivors. ClinicalTrials.gov Identifier: NCT05044975.
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Affiliation(s)
- Rina S. Fox
- Division of Community and Systems Health Science, University of Arizona College of Nursing, Tucson, AZ, United States
- University of Arizona Cancer Center, Tucson, AZ, United States
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- *Correspondence: Rina S. Fox,
| | - Julia S. Gaumond
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Phyllis C. Zee
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Karen Kaiser
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
| | - Edward J. Tanner
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, San Diego, CA, United States
| | - Juned Siddique
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Frank J. Penedo
- Department of Medicine and Psychology and Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Lisa M. Wu
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Aarhus Institute of Advanced Studies, Aarhus University, Aarhus, Denmark
| | - Kathryn J. Reid
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Sairam Parthasarathy
- Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Department of Medicine, University of Arizona, Tucson, AZ, United States
- University of Arizona Health Sciences – Center for Sleep and Circadian Science, University of Arizona, Tucson, AZ, United States
| | - Terry A. Badger
- Division of Community and Systems Health Science, University of Arizona College of Nursing, Tucson, AZ, United States
- University of Arizona Cancer Center, Tucson, AZ, United States
| | - Christine Rini
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, United States
| | - Jason C. Ong
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Nox Health, Suwanee, GA, United States
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Xiao P, Ding S, Duan Y, Li L, Zhou Y, Luo X, Xie J, Cheng AS. Effect of Light Therapy on Cancer-Related Fatigue: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2022; 63:e188-e202. [PMID: 34563631 DOI: 10.1016/j.jpainsymman.2021.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 12/19/2022]
Abstract
CONTEXT Light therapy is a non-pharmacological therapy that is currently being studied in cancer-related symptoms and is certificated as a low-risk intervention by FDA. Cancer-related fatigue (CRF) is the most common symptom reported by cancer patients. OBJECTIVE To examine the effectiveness of light therapy for CRF in cancer patients through a systematic review and meta-analysis. METHODS We conducted a systematic review of four electronic databases targeted randomized clinical trials evaluating light therapy for CRF (CRD42020215446), from inception to May 2021. The primary outcome was changes of CRF scores; secondary outcomes included depression, sleep, and quality of life (QoL). We quantitatively pooled outcomes using meta-analysis with random-effects models and assessed methodological bias. RESULTS We identified thirteen RCTs representing 551 cancer patients, encompassing breast (n = 5), ovarian or endometrial (n = 1), multiple myeloma (n = 1), lung (n = 1), or combined (n = 5) cancers. The comparison groups included dim light (n = 12) and waiting list (n = 1). Duration of intervention ranged from 1 to 12 weeks. Light intensities ranged from 417.9 to 12,000 lux. Light therapy was associated with a significant improvement in CRF (SMD = 0.45, P = 0.007), depression (SMD = -0.26, P = 0.03) and sleep difficulty (SMD = -2.46, P = 0.0006); a statistically non-significant trend was observed for QoL (SMD = 0.33, P = 0.09). Funnel plots for CRF suggest not significant publication bias. CONCLUSION Light therapy could be a feasible and effective option for improving CRF in cancer patients. Larger sample, rigor trials design and a standard protocol of intervention are needed to draw more conclusive conclusions.
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Affiliation(s)
- Panpan Xiao
- Xiangya Nursing School (P.X., L.L., Y.Z., X.L.), Central South University, Changsha, Hunan, China
| | - Siqing Ding
- Department of Nursing (S.D., J.X.), The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yinglong Duan
- Department of Emergency (Y.D.), The Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Lijun Li
- Xiangya Nursing School (P.X., L.L., Y.Z., X.L.), Central South University, Changsha, Hunan, China
| | - Yi Zhou
- Xiangya Nursing School (P.X., L.L., Y.Z., X.L.), Central South University, Changsha, Hunan, China
| | - Xiaofei Luo
- Xiangya Nursing School (P.X., L.L., Y.Z., X.L.), Central South University, Changsha, Hunan, China
| | - Jianfei Xie
- Department of Nursing (S.D., J.X.), The Third Xiangya Hospital of Central South University, Changsha, Hunan, China.
| | - Andy Sk Cheng
- Department of Rehabilitation Sciences (A.S.K.C.), The Hong Kong Polytechnic University, Hong Kong, China
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9
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Palagini L, Miniati M, Massa L, Folesani F, Marazziti D, Grassi L, Riemann D. Insomnia and circadian sleep disorders in ovarian cancer: Evaluation and management of underestimated modifiable factors potentially contributing to morbidity. J Sleep Res 2021; 31:e13510. [PMID: 34716629 DOI: 10.1111/jsr.13510] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/13/2021] [Accepted: 09/26/2021] [Indexed: 12/21/2022]
Abstract
Ovarian cancer is the leading cause of gynaecological cancer deaths and the seventh most commonly diagnosed cancer among women worldwide, so that, as it is related to substantial and increasing disease burden, the management of ovarian cancer survivors should be a priority. Such issues involve prevention and management of emotional distress, anxiety/depressive symptoms, and maintenance of quality of life from initial diagnosis to post-treatment. Within this framework, sleep disturbances, in particular insomnia, are emerging as modifiable determinants of mental health, also contributing to substantial morbidity among cancer, including ovarian cancer. To this aim we conducted a systematic review according to PRISMA guidelines on prevalence and management of insomnia and circadian sleep disorders in ovarian cancer, while selecting 22 papers. Insomnia was evaluated in ovarian cancer and, while circadian sleep disturbances were poorly assessed in ovarian cancer, insomnia increased from 14% to 60% of patients. Insomnia was associated with cancer-related comorbid conditions such as emotional distress, anxiety/depressive symptoms and low quality of life. Despite this evidence, no studies have been conducted about insomnia treatment in ovarian cancer. The burden of insomnia and circadian sleep disorders in patients with ovarian cancer still needs to be addressed, and requires a call to action for the evaluation and management of these potential modifiable factors that might contribute to ovarian cancer morbidity.
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Affiliation(s)
- Laura Palagini
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Mario Miniati
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Lucia Massa
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy
| | - Federica Folesani
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Donatella Marazziti
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, University of Pisa, Pisa, Italy.,UniCamillus - Saint Camillus University of Health Sciences, Rome, Italy
| | - Luigi Grassi
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
| | - Dieter Riemann
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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10
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Light Therapy for Cancer-Related Fatigue in (Non-)Hodgkin Lymphoma Survivors: Results of a Randomized Controlled Trial. Cancers (Basel) 2021; 13:cancers13194948. [PMID: 34638428 PMCID: PMC8508131 DOI: 10.3390/cancers13194948] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 09/22/2021] [Accepted: 09/26/2021] [Indexed: 11/16/2022] Open
Abstract
Simple Summary Cancer-related fatigue (CRF) is one of the most frequently reported symptoms with prevalence rates of 25 to 60 percent in (non-)Hodgkin lymphoma survivors. Several (pilot) studies showed promising effects of light therapy to reduce CRF. The aim of the current study is to evaluate the short- and long-term efficacy of light therapy on CRF and associated symptoms in chronically fatigued (non-)Hodgkin lymphoma survivors. Eighty-three survivors were exposed to bright white light (intervention) and another 83 survivors were exposed to dim white light (comparison). Results showed that all participants, irrespective of light condition, reported reduced levels of fatigue after the completion of light therapy. Similar results were found for depression, sleep quality, and some aspects of quality of life. No effect was found on circadian rhythms or objectively assessed sleep. Therefore, it is important to further investigate which aspects of intervention are associated with the improvements observed after light therapy. Abstract Purpose: To evaluate the short- and long-term effects of light therapy on fatigue (primary outcome) and sleep quality, depression, anxiety, quality of life, and circadian rhythms (secondary outcomes) in survivors of (non-)Hodgkin lymphoma presenting with chronic cancer-related fatigue. Methods: We randomly assigned 166 survivors (mean survival 13 years) to a bright white light intervention (BWL) or dim white light comparison (DWL) group. Measurements were completed at baseline (T0), post-intervention (T1), at three (T2), and nine (T3) months follow-up. A mixed-effect modeling approach was used to compare linear and non-linear effects of time between groups. Results: There were no significant differences between BWL and DWL in the reduction in fatigue over time. Both BWL and DWL significantly (p < 0.001) improved fatigue levels during the intervention followed by a slight reduction in this effect during follow-up (EST0-T1 = −0.71; EST1-T3 = 0.15). Similar results were found for depression, sleep quality, and some aspects of quality of life. Light therapy had no effect on circadian rhythms. Conclusions: BWL was not superior in reducing fatigue compared to DWL in HL and DLBCL survivors. Remarkably, the total sample showed clinically relevant and persistent improvements on fatigue not commonly seen in longitudinal observational studies in these survivors.
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