Project Funding Details

Purpose/Specific Aims: To assess the effect of morning bright light versus dim light therapy (control) on fatigue and sleep continuity disturbance in lung cancer survivors; to predict efficacy to morning bright light therapy (control) on fatigue and sleep continuity disturbance in lung cancer survivors; and to evaluate, in a preliminary way, the extent to which time from treatment (as a proxy iatrogenic effects), sleep homeostatic "de-prime" (mismatch between sleep opportunity and ability), and circadian factors (phase and amplitude) predict illness severity and treatment response.
Rationale/Significance of the Study: Fatigue and sleep disturbance occur with an exceptional high prevalence in both lung cancer patients and survivors. Since sleep disturbance appears to particularly persistent and serves as a known risk factor for poorer quality of life and new onset and recurrent medical and psychiatric illness, it seems advisable to target these symptoms.
Framework: Two Process Model of Sleep Regulation guides this study.
Main Research Variables: Efficacy of directed bright blue-green light compared to directed red-yellow light on fatigue using the FACIT, sleep continuity using sleep diaries and Insomnia Severity Index (ISI) and circadian activity rhythms using actigraphy.
Design: The proposed pilot study will involve 40 LCS using a 2X2 mixed model with Pre-Post assessments in two groups. Red yellow (control) versus blue green (experimental) directed light therapy will be evaluated.
Setting: Comprehensive cancer center with well-established thoracic surgery practice.
Sample: Forty lung cancer survivors with sleep continuity disturbance will be recruited over 2 years. Eligibility criteria include stage I-III, non-small cell lung cancer, >6-weeks and < 3years post surgical resection who are medically and psychiatrically stable. Fatigue is defined as a FACIT score >30. Sleep continuity disturbance is defined as sleep latency >30 minutes, wake after sleep onset >30 minutes or/and early morning awakening >30 minutes. Circadian activity rhythm disturbance will be defined as a circadian quotient (determined by dividing amplitude by mesor) <0.80.
Methods: Eligible participants will be screened for sleep apnea and hypoxia using the portable ApneaLink device at night. Baseline and end of treatment measures include: 14-day sleep diaries and 14-day actigraphy; Horne-Ostberg/Questionnaire; ISI; FACIT and the Epworth Sleepiness Scale. Following baseline measures, participants will be randomized to either red-yellow (control) versus blue-green (experimental) directed light therapy. Upon awakening, participants will wear the directed light therapy for 60-minutes every morning for 4-weeks. Statistical analysis includes a 2x2 ANOVA for primary and secondary DVs and secondary analysis will predict treatment response with logistic regressions using initial ISI severity and circadian parameters as predictors (MEQ, and phase and amplitude).
Implications for Practice: Results will provide information on an affordable treatment to improve fatigue, sleep continuity and circadian activity rhythm disturbances for lung cancer survivors.