Prevention of quality-of-life deterioration with light therapy is associated with changes in fatigue in women with breast cancer undergoing chemotherapy
Neelum Jeste, Lianqi Liu, Michelle Rissling, Vera Trofimenko, Loki Natarajan, Barbara A Parker, Sonia Ancoli-Israel, Neelum Jeste, Lianqi Liu, Michelle Rissling, Vera Trofimenko, Loki Natarajan, Barbara A Parker, Sonia Ancoli-Israel
Abstract
Purpose: During chemotherapy, women with breast cancer not only experience poor quality of life (QOL), they also have little exposure to bright light, which has been shown to be associated with depression, fatigue, and poor sleep in other chronic illnesses. This study examined whether increased light exposure would have a positive effect on QOL.
Methods: Thirty-nine women with stage I-III breast cancer scheduled to receive ≥ 4 cycles of chemotherapy were randomized to a bright white light (BWL, n = 23) or dim red light (DRL, n = 16) treatment group. Data were collected before (baseline) and during cycles 1 and 4 of chemotherapy. Light was administered via a light box (Litebook(®), Ltd.). QOL was assessed with the Functional Assessment of Cancer Therapy-Breast (FACT-B) and the Functional Outcomes of Sleep Questionnaire (FOSQ).
Results: Compared with baseline, the DRL group demonstrated significant decline in QOL during the treatment weeks of both cycles (all ps < 0.02), whereas the BWL group had no significant decline (all ps > 0.05). Mixed model analyses revealed that there was a group-by-time interaction for FOSQ at the treatment week of cycle 4, and this interaction was mediated by fatigue.
Conclusion: The data suggest that increased exposure to bright light during chemotherapy may prevent the decline in QOL via preventing the increase in fatigue.
Figures
![Figure 1](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3780416/bin/nihms398708f1.jpg)
![Figure 2. Total FACT-B scores by group…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3780416/bin/nihms398708f2.jpg)
Figure 3. Total FOSQ scores by group…
Figure 3. Total FOSQ scores by group and time
Total FACT-B Scores (mean ± SEM)…
Figure 4. Total CES-D scores by group…
Figure 4. Total CES-D scores by group and time
Total CES-D Scores (mean ± SEM)…
- Light treatment prevents fatigue in women undergoing chemotherapy for breast cancer.Ancoli-Israel S, Rissling M, Neikrug A, Trofimenko V, Natarajan L, Parker BA, Lawton S, Desan P, Liu L. Ancoli-Israel S, et al. Support Care Cancer. 2012 Jun;20(6):1211-9. doi: 10.1007/s00520-011-1203-z. Epub 2011 Jun 11. Support Care Cancer. 2012. PMID: 21660669 Free PMC article. Clinical Trial.
- Bright light therapy protects women from circadian rhythm desynchronization during chemotherapy for breast cancer.Neikrug AB, Rissling M, Trofimenko V, Liu L, Natarajan L, Lawton S, Parker BA, Ancoli-Israel S. Neikrug AB, et al. Behav Sleep Med. 2012;10(3):202-16. doi: 10.1080/15402002.2011.634940. Behav Sleep Med. 2012. PMID: 22742438 Clinical Trial.
- Bright light shows promise in improving sleep, depression, and quality of life in women with breast cancer during chemotherapy: findings of a pilot study.Wu HS, Davis JE, Chen L. Wu HS, et al. Chronobiol Int. 2021 May;38(5):694-704. doi: 10.1080/07420528.2021.1871914. Epub 2021 Jan 21. Chronobiol Int. 2021. PMID: 33478260 Free PMC article. Clinical Trial.
- Novel Augmentation Strategies in Major Depression.Martiny K. Martiny K. Dan Med J. 2017 Apr;64(4):B5338. Dan Med J. 2017. PMID: 28385173 Review.
- Quality-of-life considerations in the treatment of early-stage breast cancer in the elderly.Reimer T, Gerber B. Reimer T, et al. Drugs Aging. 2010 Oct 1;27(10):791-800. doi: 10.2165/11584700-000000000-00000. Drugs Aging. 2010. PMID: 20883059 Review.
- Preventing Sleep Disruption With Bright Light Therapy During Chemotherapy for Breast Cancer: A Phase II Randomized Controlled Trial.Rissling M, Liu L, Youngstedt SD, Trofimenko V, Natarajan L, Neikrug AB, Jeste N, Parker BA, Ancoli-Israel S. Rissling M, et al. Front Neurosci. 2022 Mar 9;16:815872. doi: 10.3389/fnins.2022.815872. eCollection 2022. Front Neurosci. 2022. PMID: 35356054 Free PMC article.
- Reductions in sleep quality and circadian activity rhythmicity predict longitudinal changes in objective and subjective cognitive functioning in women treated for breast cancer.Ancoli-Israel S, Liu L, Natarajan L, Rissling M, Neikrug AB, Youngstedt SD, Mills PJ, Sadler GR, Dimsdale JE, Parker BA, Palmer BW. Ancoli-Israel S, et al. Support Care Cancer. 2022 Apr;30(4):3187-3200. doi: 10.1007/s00520-021-06743-3. Epub 2021 Dec 26. Support Care Cancer. 2022. PMID: 34957532 Free PMC article.
- Evaluating chronotypically tailored light therapy for breast cancer survivors: Preliminary findings on fatigue and disrupted sleep.Wu HS, Gao F, Yan L, Given C. Wu HS, et al. Chronobiol Int. 2022 Feb;39(2):221-232. doi: 10.1080/07420528.2021.1992419. Epub 2021 Nov 3. Chronobiol Int. 2022. PMID: 34732099 Free PMC article. Clinical Trial.
- Light Therapy for Cancer-Related Fatigue in (Non-)Hodgkin Lymphoma Survivors: Results of a Randomized Controlled Trial.Starreveld DEJ, Daniels LA, Kieffer JM, Valdimarsdottir HB, de Geus J, Lanfermeijer M, van Someren EJW, Habers GEA, Bosch JA, Janus CPM, van Spronsen DJ, de Weijer RJ, Marijt EWA, de Jongh E, Zijlstra JM, Böhmer LH, Houmes M, Kersten MJ, Korse CM, van Rossum HH, Redd WH, Lutgendorf SK, Ancoli-Israel S, van Leeuwen FE, Bleiker EMA. Starreveld DEJ, et al. Cancers (Basel). 2021 Sep 30;13(19):4948. doi: 10.3390/cancers13194948. Cancers (Basel). 2021. PMID: 34638428 Free PMC article.
- Development of a Home-Based Light Therapy for Fatigue Following Traumatic Brain Injury: Two Case Studies.Connolly LJ, Ponsford JL, Rajaratnam SMW, Lockley SW. Connolly LJ, et al. Front Neurol. 2021 Sep 13;12:651498. doi: 10.3389/fneur.2021.651498. eCollection 2021. Front Neurol. 2021. PMID: 34589041 Free PMC article.
- Randomized Controlled Trial
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
- Research Support, U.S. Gov't, Non-P.H.S.
- Adult
- Aged
- Antineoplastic Agents / therapeutic use*
- Breast Neoplasms / complications
- Breast Neoplasms / drug therapy*
- Breast Neoplasms / psychology
- Depression / diagnosis
- Depression / psychology
- Fatigue / etiology
- Fatigue / prevention & control*
- Female
- Humans
- Light
- Middle Aged
- Neoplasm Staging
- Phototherapy / methods*
- Phototherapy / psychology
- Pilot Projects
- Quality of Life*
- Surveys and Questionnaires
- Time Factors
- Treatment Outcome
- Antineoplastic Agents
- Full Text Sources
- Medical
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![Figure 3. Total FOSQ scores by group…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3780416/bin/nihms398708f3.jpg)
Figure 4. Total CES-D scores by group…
Figure 4. Total CES-D scores by group and time
Total CES-D Scores (mean ± SEM)…
- Light treatment prevents fatigue in women undergoing chemotherapy for breast cancer.Ancoli-Israel S, Rissling M, Neikrug A, Trofimenko V, Natarajan L, Parker BA, Lawton S, Desan P, Liu L. Ancoli-Israel S, et al. Support Care Cancer. 2012 Jun;20(6):1211-9. doi: 10.1007/s00520-011-1203-z. Epub 2011 Jun 11. Support Care Cancer. 2012. PMID: 21660669 Free PMC article. Clinical Trial.
- Bright light therapy protects women from circadian rhythm desynchronization during chemotherapy for breast cancer.Neikrug AB, Rissling M, Trofimenko V, Liu L, Natarajan L, Lawton S, Parker BA, Ancoli-Israel S. Neikrug AB, et al. Behav Sleep Med. 2012;10(3):202-16. doi: 10.1080/15402002.2011.634940. Behav Sleep Med. 2012. PMID: 22742438 Clinical Trial.
- Bright light shows promise in improving sleep, depression, and quality of life in women with breast cancer during chemotherapy: findings of a pilot study.Wu HS, Davis JE, Chen L. Wu HS, et al. Chronobiol Int. 2021 May;38(5):694-704. doi: 10.1080/07420528.2021.1871914. Epub 2021 Jan 21. Chronobiol Int. 2021. PMID: 33478260 Free PMC article. Clinical Trial.
- Novel Augmentation Strategies in Major Depression.Martiny K. Martiny K. Dan Med J. 2017 Apr;64(4):B5338. Dan Med J. 2017. PMID: 28385173 Review.
- Quality-of-life considerations in the treatment of early-stage breast cancer in the elderly.Reimer T, Gerber B. Reimer T, et al. Drugs Aging. 2010 Oct 1;27(10):791-800. doi: 10.2165/11584700-000000000-00000. Drugs Aging. 2010. PMID: 20883059 Review.
- Preventing Sleep Disruption With Bright Light Therapy During Chemotherapy for Breast Cancer: A Phase II Randomized Controlled Trial.Rissling M, Liu L, Youngstedt SD, Trofimenko V, Natarajan L, Neikrug AB, Jeste N, Parker BA, Ancoli-Israel S. Rissling M, et al. Front Neurosci. 2022 Mar 9;16:815872. doi: 10.3389/fnins.2022.815872. eCollection 2022. Front Neurosci. 2022. PMID: 35356054 Free PMC article.
- Reductions in sleep quality and circadian activity rhythmicity predict longitudinal changes in objective and subjective cognitive functioning in women treated for breast cancer.Ancoli-Israel S, Liu L, Natarajan L, Rissling M, Neikrug AB, Youngstedt SD, Mills PJ, Sadler GR, Dimsdale JE, Parker BA, Palmer BW. Ancoli-Israel S, et al. Support Care Cancer. 2022 Apr;30(4):3187-3200. doi: 10.1007/s00520-021-06743-3. Epub 2021 Dec 26. Support Care Cancer. 2022. PMID: 34957532 Free PMC article.
- Evaluating chronotypically tailored light therapy for breast cancer survivors: Preliminary findings on fatigue and disrupted sleep.Wu HS, Gao F, Yan L, Given C. Wu HS, et al. Chronobiol Int. 2022 Feb;39(2):221-232. doi: 10.1080/07420528.2021.1992419. Epub 2021 Nov 3. Chronobiol Int. 2022. PMID: 34732099 Free PMC article. Clinical Trial.
- Light Therapy for Cancer-Related Fatigue in (Non-)Hodgkin Lymphoma Survivors: Results of a Randomized Controlled Trial.Starreveld DEJ, Daniels LA, Kieffer JM, Valdimarsdottir HB, de Geus J, Lanfermeijer M, van Someren EJW, Habers GEA, Bosch JA, Janus CPM, van Spronsen DJ, de Weijer RJ, Marijt EWA, de Jongh E, Zijlstra JM, Böhmer LH, Houmes M, Kersten MJ, Korse CM, van Rossum HH, Redd WH, Lutgendorf SK, Ancoli-Israel S, van Leeuwen FE, Bleiker EMA. Starreveld DEJ, et al. Cancers (Basel). 2021 Sep 30;13(19):4948. doi: 10.3390/cancers13194948. Cancers (Basel). 2021. PMID: 34638428 Free PMC article.
- Development of a Home-Based Light Therapy for Fatigue Following Traumatic Brain Injury: Two Case Studies.Connolly LJ, Ponsford JL, Rajaratnam SMW, Lockley SW. Connolly LJ, et al. Front Neurol. 2021 Sep 13;12:651498. doi: 10.3389/fneur.2021.651498. eCollection 2021. Front Neurol. 2021. PMID: 34589041 Free PMC article.
- Randomized Controlled Trial
- Research Support, N.I.H., Extramural
- Research Support, Non-U.S. Gov't
- Research Support, U.S. Gov't, Non-P.H.S.
- Adult
- Aged
- Antineoplastic Agents / therapeutic use*
- Breast Neoplasms / complications
- Breast Neoplasms / drug therapy*
- Breast Neoplasms / psychology
- Depression / diagnosis
- Depression / psychology
- Fatigue / etiology
- Fatigue / prevention & control*
- Female
- Humans
- Light
- Middle Aged
- Neoplasm Staging
- Phototherapy / methods*
- Phototherapy / psychology
- Pilot Projects
- Quality of Life*
- Surveys and Questionnaires
- Time Factors
- Treatment Outcome
- Antineoplastic Agents
- Full Text Sources
- Medical
![Figure 4. Total CES-D scores by group…](https://www.ncbi.nlm.nih.gov/pmc/articles/instance/3780416/bin/nihms398708f4.jpg)
Source: PubMed