Abstract
Purpose: Little is known about the effectiveness of bright white light therapy (BWL) for depressive symptoms in cancer survivors, many of whom prefer non-pharmacological treatments. The purpose of this study was to compare the effectiveness of BWL versus dim red light therapy (DRL) on depressive symptoms within individual cancer survivors using personalized (N-of-1) trials. Methods: Cancer survivors with at least mild depressive symptoms were randomized to one of two treatment sequences consisting of counterbalanced crossover comparisons of three-weeks of lightbox-delivered BWL (intervention) or DRL (sham) for 30 min each morning across 12 weeks. A smartphone application guided cancer survivors through the treatment sequence and facilitated data collection. Cancer survivors tracked end-of-day depressive symptoms (primary outcome) and fatigue using visual analog scales. Within-patient effects of BWL were assessed using an autoregressive model with adjustment for linear time trends. Results: Eight of nine cancer survivors completed the 12-week protocol. Two survivors reported significantly (i.e., p < 0.05) lower depressive symptoms (−1.3 ± 0.5 and −1.30 ± 0.9 points on a 10-point scale), five reported no difference in depressive symptoms, and one reported higher depressive symptoms (+1.7 ± 0.6 points) with BWL versus DRL. Eight of nine cancer survivors recommended personalized trials of BWL to others. Conclusions: There were heterogeneous effects of three-week BWL on self-reported depressive symptoms among cancer survivors, with some finding a benefit but others finding no benefit or even harm. Implications for Cancer Survivors: Personalized trials can help cancer survivors learn if BWL is helpful for improving their depressive symptoms.
Highlights
More than one in five cancer survivors has elevated depressive symptoms, three-fold the prevalence in the general population [1,2,3]
Even though evidence for their effectiveness is often lacking, complementary and alternative medicine (CAM) treatments have become increasingly popular among cancer survivors, with up to 80% of cancer survivors reporting CAM use at least once after diagnosis [10,11,12]
Recent small randomized clinical trials (RCTs) suggest that bright white light therapy (BWL) may be effective for reducing depressive symptoms and fatigue in cancer survivors [14,15,16]
Summary
More than one in five cancer survivors has elevated depressive symptoms, three-fold the prevalence in the general population [1,2,3]. Depressive symptoms are a major contributor to poor quality of life in cancer survivors [4]. Cancer survivors with depressive symptoms are at risk of poor adherence to preventive therapies, [5,6] worse prognosis, [7,8], and higher health care costs [9]. Among CAM treatments for depressive symptoms, there is growing evidence in support of bright white light therapy (BWL) [13]. Recent small randomized clinical trials (RCTs) suggest that BWL may be effective for reducing depressive symptoms and fatigue in cancer survivors [14,15,16]. RCTs, estimate the effect of BWL for the average patient in the trial, and provide limited information on the treatment effect that an individual patient can expect to receive
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