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. 2021 Sep 30;13(19):4948.
doi: 10.3390/cancers13194948.

Light Therapy for Cancer-Related Fatigue in (Non-)Hodgkin Lymphoma Survivors: Results of a Randomized Controlled Trial

Daniëlle E J Starreveld  1 , Laurien A Daniels  2 , Jacobien M Kieffer  1 , Heiddis B Valdimarsdottir  3 , Jessie de Geus  1 , Mirthe Lanfermeijer  4 , Eus J W van Someren  5   6   7 , G Esther A Habers  8 , Jos A Bosch  9 , Cécile P M Janus  10 , Dick Johan van Spronsen  11 , Roel J de Weijer  12 , Erik W A Marijt  13 , Eva de Jongh  14 , Josée M Zijlstra  15 , Lara H Böhmer  16 , Margreet Houmes  17 , Marie José Kersten  18 , Catharina M Korse  4 , Huub H van Rossum  4 , William H Redd  3 , Susan K Lutgendorf  19 , Sonia Ancoli-Israel  20 , Flora E van Leeuwen  1 , Eveline M A Bleiker  1   21
Affiliations

Light Therapy for Cancer-Related Fatigue in (Non-)Hodgkin Lymphoma Survivors: Results of a Randomized Controlled Trial

Daniëlle E J Starreveld et al. Cancers (Basel). .

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.

Keywords: cancer-related fatigue; circadian rhythms; light therapy; randomized controlled trial; sleep.

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Conflict of interest statement

M.J.K. has received institutional research funding from Kite/Gilead and Novartis outsides the submitted work. L.H.B. has received a travel grant from Servier. S.A.-I. is an advisory board member for Eisai and Merck. All remaining authors have declared no conflicts of interest.

Figures

Figure 1
Figure 1
CONSORT diagram. Abbreviations: HL, Hodgkin lymphoma; DLBCL, diffuse large B-cell lymphoma. Note: Number of missing assessments at T1, T2, and T3 were not necessarily cumulative. * Patients could provide more than one reason for non-participation or could be excluded for more than one reason.
Figure 2
Figure 2
Changes in raw mean levels of primary and secondary self-reported outcomes from baseline to nine months follow-up in groups receiving bright white light therapy (BWL; n = 83) and dim white light therapy (DWL; n = 83). Bars indicate standard deviations. Effect sizes are shown for significant changes over time in all participants, irrespective of light intensity. Abbreviations: BWL, bright white light; CES-D, Center for Epidemiological Studies—depression; DWL, dim white light; MFI, Multidimensional Fatigue Inventory; PSQI, Pittsburgh Sleep Quality Index; RAND-36, RAND 36-item Health Survey; STAI-6, State Trait Anxiety Index—short form; VAS, fatigue visual analogue scale; WSAS, Work and Social Adjustment Scale. T0, baseline; T1, directly post-intervention; T2, 3 months after the end of light therapy; T3, 9 months after finishing light therapy. a The total score of the PSQI is shown. Based on the AIC and BIC criteria, the model with the best fit excluded a random slope and included an autoregressive covariance structure. The effect of light therapy on the seven subscales of the PSQI is described in Supplementary material 6. b The energy and general health subscales of the RAND-36 are shown. The remaining subscales are described in Supplementary material Table S5.1.
Figure 3
Figure 3
Changes in raw mean levels of actigraphy-derived sleep variables (A–D), cortisol, and melatonin variables (E–H) in groups receiving bright white light therapy (BWL; n = 83) and dim white light therapy (DWL; n = 83). Bars indicate standard deviations. Abbreviations: BWL, bright white light; CAR, cortisol awakening response; DLMO, dim light melatonin onset; DWL, dim white light; T0, baseline; T1, directly post-intervention; T2, 3 months after the end of light therapy; T3, 9 months after finishing light therapy.
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