Programmed Environmental Illumination (PEI) of Hospital Rooms to Prevent/Reduce Cancer-Related Fatigue

Study Overview
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Brief Summary
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A sample of 60 patients scheduled for HSCT in the treatment of MM will be recruited in the weeks to months prior to their hospitalization. Light therapy incorporating ambient Programmed Environmental Illumination (PEI) will be used in patient hospital rooms (during scheduled transplant) to control cancer-related fatigue (CRF). The FDA has certified that light therapy, like that used in this study, is a low-risk intervention. When admitted to the hospital for a stem cell transplant, there will be a light fixture in the hospital room which the researchers will be testing to see how it may affect cancer related fatigue, sleep quality, and other negative side effects often seen with the transplant and subsequent treatment. The light fixture will turn on and off by itself in the morning. There are two treatment arms used in the study, each of the arms uses different light intensities. The study treatment received, i.e. which of the two lights, will be chosen by chance, like flipping a coin. There is an equal chance of being given each study treatment. Participants will not be told which study treatment they are getting until after the study is completed. Each light will be turned on from 7 AM to 10AM every day during transplantation. While in the hospital, assessment of fatigue, sleep activity, depression, circadian rhythms, and quality of life will continue through the course of hospitalization (14-21 days of treatment, to determine immediate impact of sPI), then repeat at one month and three months post-discharge follow-ups (to determine lasting effects). Outcomes will be assessed through standardized scales (e.g., FACIT-Fatigue Scale) and objective measures (e.g., actigraphy, daysimeter for light monitoring, melatonin from urine collection, blood inflammatory markers, all explained below). This trial will: 1) be the first randomized clinical trial (RCT) to investigate the effects of sPI to prevent CRF and other biopsychosocial side effects of transplant; 2) focus on a distinct, relatively homogenous patient population (MM-HSCT patients) with high prevalence of CRF; and 3) explore possible circadian rhythm mediation via melatonin analysis and blood analysis. This investigation will have major public health relevance as it will determine if an inexpensive and low patient burden intervention (sPI) is able to control fatigue associated with medical illnesses and related problems.

Official Title
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Programmed Environmental Illumination (PEI) of Hospital Rooms to Prevent/Reduce Cancer-Related Fatigue During Hematopoetic Stem Cell Transplantation for Multiple Myeloma

Conditions
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Cancer-related Problem/Condition, Depression, Circadian Rhythm Disorders

Intervention / Treatment
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* Device: PEI Experimental Light
* Device: Comparison Light


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Who will undergo their first autologous HSCT procedure as treatment for multiple myeloma AND: Who are currently 21 years of age or older English language proficient Able to provide informed consent Exclusion Criteria: Under age 21 Previous HSCT procedure (autologous or allogeneic)Pregnancy Eye Diseases which limit the ability of light to be processed (e.g., untreated cataracts, severe glaucoma, macular degeneration, blindness, pupil dilation problems or retina damage) Secondary cancer diagnosis within the last 5 years Severe sleep disorders (e.g., Narcolepsy) History of bipolar disorder or manic episodes (which is a contra-indication for light treatment) Severe psychological impairment (e.g., hospitalization for depressive episode in the past 12 months) Previous use of light therapy to alleviate fatigue or depressive symptoms

Ages Eligible for Study
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Minimum Age: 21 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: PEI Experimental Light<br>Ambient light fixture installed in the patient's hospital room | Device: PEI Experimental Light<br>* Ambient Light Fixture will turn on automatically and illuminate the hospital room from 7 to 10 AM each morning.<br>|
| Active Comparator: Comparison Light<br>Ambient light fixture installed in the patient's hospital room | Device: Comparison Light<br>* Ambient Light Fixture will turn on automatically and illuminate the hospital room from 7 to 10 AM each morning.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| FACIT-Fatigue Scale | The FACIT-Fatigue scale is a13 item scale, full scale 0-52, with higher score indicating better functioning or less fatigue. | Baseline, Day 2, 7, 14, 28 and 90 | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Multidimensional Fatigue | The Multidimensional Fatigue Inventory (MFI) is a 20-item self-report instrument designed to measure fatigue. It covers the following dimensions: General Fatigue, Physical Fatigue, Mental Fatigue, Reduced Motivation and Reduced Activity. Tested for its psychometric properties in cancer patients receiving radiotherapy, patients with the chronic fatigue syndrome, psychology students, medical students, army recruits and junior physicians, it was found to have good Test-retest Reliability (r=0.80) and great Internal Consistency (Cronbach's alpha = 0.92). | up to 3 months | 
| The Pittsburgh Sleep Quality Index | The Pittsburgh Sleep Quality Index consists of 19 self-rated instrument full scale from 0-21, with higher score indicating poorer sleep quality. | Baseline, Day 30 and Day 90 | 
| SF-36 Scale | Quality of life assessed using the SF-36 scale. The SF-36 is a multi-purpose, short form health survey consisting of 36 questions. The SF-36 consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability | Baseline and 30 days post hospital discharge | 
| Number of Participants With Score 16 or Greater on CES-D (Center for Epidemiologic Studies Depression Scale) | Number of participants with score 16 or greater on CES-D, 20 item questionnaire that reflects major dimensions of depression: depressed mood; feelings of guilt and worthlessness; feelings of helplessness and hopelessness; psychomotor retardation; loss of appetite; and sleep disturbance. Full score from 0- 20, with higher score indicating more symptomology. | Baseline, Day 2, Day 7, and Day 14 post transplant | 
| CES-D (Center for Epidemiologic Studies Depression Scale) | CES-D, 20 item questionnaire that reflects major dimensions of depression: depressed mood; feelings of guilt and worthlessness; feelings of helplessness and hopelessness; psychomotor retardation; loss of appetite; and sleep disturbance. Full score from 0- 20, with higher score indicating more symptomology. | Baseline, Day 2, 7, 14, 28, and 90 | 
| The Positive and Negative Affect Schedule (PANAS) | PANAS is a 20-item self-report measure of positive and negative affect. Each item rated on a 5-point scale of 1 (not at all) to 5 (extremely), each subscale from 1-5, full score from 1-5, with higher score indicating more symptoms. Change in PANAS at Day 30 and Day 90 as compared to baseline. | Baseline, Day 30, Day 90 | 
| Change in Brief Symptoms Inventory-18 (BSI-18) | Brief Symptom Inventory-18 (BSI-18) - self-report 18-item instrument. Raw scores on the BSI-18 are converted to t-scores based on gender-specific normative data from non-patient community dwelling U.S. adults. A T-score = 50 indicating average function compared to the reference population and a standard deviation of 10, with a higher score indicating more symptom. | Baseline and Day 90 | 
| Fatigue Line Scale | Simple numeric graphic rating scale, marked on a line numbering 0-100, with higher score indicating more fatigue. Replaces the FACIT fatigue scale for daily fatigue assessment during inpatient procedures. | baseline, day 2, 7, and 14 | 
| Multidimensional Fatigue Symptom Inventory- Short Form (MFSI-SF) | Multidimensional Fatigue Symptom Inventory- Short Form (MFSI-SF) is a 30-item short form of the MFSI that measures ﬁve dimensions: general, physical, emotional, mental fatigue, and vigor. Each item is rated on a ﬁve-point Likert scale from 0 (not at all) to 4 (extremely). The total MFSI-SF score ranges from 0-4, with a higher score indicating a higher fatigue level. | Baseline, Day 30 after Discharge, Day 90 after Discharge | 
| Sleep Latency | Sleep latency measured by actigraph - Sleep latency is the average period of time between bed time and sleep start time | Baseline, Day 2, Day 7, 3rd day post Engraftment, Discharge | 
| Sleep Efficiency | Sleep efficiency measured by actigraph - Sleep efficiency is defined as the average percentage of time in bed actually spent sleeping | Baseline, Day 2, Day 7, 3rd day post Engraftment, Discharge | 
| Wake Time | Wake time measured by actigraph. Wake time is the average number of minutes the participant spent awake each night during the 5 day period. Baseline assessments were taken before transplant and day 2 is two days after transplant which is at least one week after the baseline. | Baseline, Day 2, Day 7, 3rd day post Engraftment, Discharge | 
| Wake Percent | Wake percent measured by actigraph - Wake percent is the average percent of each night spent awake | Baseline, Day 2, Day 7, 3rd day post Engraftment, Discharge | 
| Sleep Time | Sleep time measured by actigraph. Sleep time - average number of minutes the participant was asleep each night during the 5 day period. Baseline assessments were taken before transplant and day 2 is two days after transplant which is at least one week after the baseline. | Baseline, Day 2, Day 7, 3rd day post Engraftment, Discharge | 
| Sleep Percent | Sleep percent measured by actigraph. Sleep percent is the percent of time spent in bed that the participant is asleep. | Baseline, Day 2, Day 7, 3rd day post Engraftment, Discharge | 
| Melatonin | Melatonin level | Baseline and Discharge | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Autologous Stem Cell Transplant, Multiple Myeloma, oncology, circadian rhythms, light therapy, Hematopoietic stem cell transplantation