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healthcare Article Clinical Usefulness of Bright White Light Therapy for Depressive Symptoms in Cancer Survivors: Results from a Series of Personalized (N-of-1) Trials Ian M. Kronish 1,* , Ying Kuen Cheung 2, Jacob Julian 1, Faith Parsons 1, Jenny Lee 1, Sunmoo Yoon 3, Heidis Valdimarsdottir 4,5, Paige Green 6 , Jerry Suls 7, Dawn L. Hershman 8 and Karina W. Davidson 7 1 2 3 4 5 6 7 8 * Correspondence: ik2293@columbia.edu; Tel.: +1-212-342-1335 Received: 18 November 2019; Accepted: 24 December 2019; Published: 30 December 2019 Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, New York, NY 10032, USA; jej11190@gmail.com (J.J.); fep2110@cumc.columbia.edu (F.P.); sjl2172@cumc.columbia.edu (J.L.) Department of Biostatistics, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY 10032, USA; yc632@cumc.columbia.edu Division of General Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA; sy2102@cumc.columbia.edu Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; heiddisb@ru.is Department of Psychology, Reykjavik University, 101 Reykjavik, Iceland Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD 20850, USA; paige.green@nih.gov Center for Personalized Medicine, Feinstein Institutes for Medical Research, Northwell Health, New York, NY 10022, USA; jsuls@northwell.edu (J.S.); kdavidson2@northwell.edu (K.W.D.) Department of Medicine, Columbia University Irving Medical Center, New York, NY 10032, USA; dlh23@cumc.columbia.edu 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. Healthcare 2020, 8, 10; doi:10.3390/healthcare8010010 www.mdpi.com/journal/healthcare PDF Image | Bright White Light Therapy for Depression in Cancer Survivors
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