Light Therapy/Visible Light Therapy

Light Therapy/Visible Light Therapy

PEP Topic 
Fatigue
Description 

Light therapy/visible light therapy involves exposure to light wavelengths that are in the visible spectrum. Light therapy has been studied for its effect on fatigue and oral mucositis.

Effectiveness Not Established

Research Evidence Summaries

Ancoli-Israel, S., Rissling, M., Neikrug, A., Trofimenko, V., Natarajan, L., Parker, B. A., . . . Liu, L. (2012). Light treatment prevents fatigue in women undergoing chemotherapy for breast cancer. Supportive Care in Cancer, 20, 1211–1219.

doi: 10.1007/s00520-011-1203-z
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Study Purpose:

To test the hypothesis that increased exposure to morning bright light would result in less fatigue during chemotherapy.

Intervention Characteristics/Basic Study Process:

Women were randomly assigned to bright white light or dim red light groups. Light was administered via a light box. Sixty LED lights were used (red LEDs for the dim light groups and lights with a distribution of energy concentrated in the middle and long wavelengths for the bright light group). The light box was placed on a table or countertop at a distance of about 18 inches and was to be used for 30 minutes every morning on awakening. The boxes were modified to include an integrated meter that recorded the duration of light box use each day. Study measures were obtained at baseline, during cycle 1 treatments, the last week of cycle 1, a treatment week of cycle 4, and the last week of cycle 4.

Sample Characteristics:

  • The study included 39 women, primarily Cacausian, with a mean age of  53.92 years (range 32–70).
  • All patients were newly diagnosed with breast cancer who were set to receive four cycles of chemotherapy containing araC.

Setting:

Patient homes in California

Phase of Care and Clinical Applications:

Patients were undergoing the active antitumor treatment phase of care.

Study Design:

The study was a repeated-measures, randomized, controlled trial.

Measurement Instruments/Methods:

  • Wrist actigraphy
  • Multidimensional Fatigue Symptom Inventory–Short Form (MFSI-SF)

Results:

No significant changes were observed in fatigue scores for women in the bright light group. Those in the dim light group showed an average increase in fatigue of 11.7 points (p = 0.003) to the last week in cycle 1, and a 22.2-point increase (p < 0.001) by the last week of cycle 4. Scores on the emotional fatigue subscale showed improvement in the bright light group compared to baseline over all study time points, with significant differences shown at the end of cycle 1 (p = 0.006). All other subscales showed increased fatigue in both groups over time. No relationship existed between fatigue scores and actigraphy results. Patients adhered to light box use for an average of 48.7% of the days in the study, with no difference in compliance between groups.

Conclusions:

Findings suggested that light therapy may be of some benefit to prevent worsening of fatigue during chemotherapy treatment.

Limitations:

  • The study had a small sample size, with less than 100 patients.
  • The study had a risk of bias due to no blinding.
  • Unintended interventions or applicable interventions not described could influence the results.
  • Patient withdrawals were 10% or greater.
  • No other interventions that could have influenced fatigue were described or mentioned.

Nursing Implications:

Light therapy may be helpful to patients in reducing fatigue during chemotherapy, particularly in the area of emotional fatigue. This is a low-risk intervention that might be useful. Patients could increase light exposure by spending more time outdoors or by using a light box.

Redd, W.H., Valdimarsdottir, H., Wu, L.M., Winkel, G., Byrne, E.E., Beltre, M.A., . . . Ancoli-Israel, S. (2014). Systematic light exposure in the treatment of cancer-related fatigue: A preliminary study. Psycho-Oncology, 23, 1431–1434.

doi: 10.1002/pon.3553
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Study Purpose:

To evaluate the impact of bright white light exposure on fatigue among cancer survivors

Intervention Characteristics/Basic Study Process:

Patients were randomized to receive bright white light or dim red light treatment, using a lightbook device that used light-emitting diode (LED) light. Participants were instructed to self-administer the treatment at home by placing the light box at a 45-degree angle, 18 inches from the face, for 30 minutes every morning for four weeks. Study questionnaires were completed at baseline, after two weeks, at four weeks, and three weeks after study completion.

Sample Characteristics:

  • N = 36  
  • MALES: 19%, FEMALES: 81%
  • KEY DISEASE CHARACTERISTICS: Patients with multiple types of cancer. Initial curative treatment had been completed. Patients were an average of 17 months post diagnosis.
 

Setting:

  • SITE: Single site  
  • SETTING TYPE: Home    
  • LOCATION: New York

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active antitumor treatment

Study Design:

  • Randomized, controlled trial

Measurement Instruments/Methods:

  • Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale

Results:

Fatigue declined in all over time. At all study time points, the white light group had less fatigue (p = 0.00125). The pattern of change in fatigue also differed between groups. In the red light group, fatigue improved at two weeks but became worse at four weeks and at follow-up. At the end of four weeks, no patients in the bright white light condition were still clinically fatigued.

Conclusions:

Daily exposure to bright white light was associated with a significant reduction in fatigue.

Limitations:

  • Small sample (< 100)
  • Risk of bias (no control group)
  • Risk of bias (no blinding)
  • No information is provided about any other interventions received for fatigue during the study.

Nursing Implications:

The findings suggest that exposure to bright white light can be an effective alternative in managing fatigue. This is a relatively low-cost and low-risk intervention that may be helpful. Further research in this area is warranted.

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