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Original research
Cancer-related fatigue: light therapy: updated meta-analysis of randomised controlled trials
  1. Chao-Ming Hung1,2,
  2. Bing-Yan Zeng3,
  3. Bing-Syuan Zeng3,
  4. Cheuk-Kwan Sun4,5,
  5. Yu-Shian Cheng6,
  6. Kuan-Pin Su7,8,9,
  7. Yi-Cheng Wu10,
  8. Tien-Yu Chen11,12,13,
  9. Pao-Yen Lin14,15,
  10. Chih-Sung Liang12,16,17,
  11. Chih-Wei Hsu14,
  12. Che-Sheng Chu18,19,
  13. Yen-Wen Chen20,
  14. Pin-Yang Yeh21,
  15. Ming-Kung Wu14,
  16. Ping-Tao Tseng20,21,22 and
  17. Yutaka J Matsuoka23
  1. 1Division of General Surgery, Department of Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan
  2. 2School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan
  3. 3Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
  4. 4Department of Emergency Medicine, E-Da Hospital, Kaohsiung, Taiwan
  5. 5School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
  6. 6Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai’s Home, Kaohsiung, Taiwan
  7. 7Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
  8. 8College of Medicine, China Medical University, Taichung, Taiwan
  9. 9An-Nan Hospital, China Medical University, Tainan, Taiwan
  10. 10Department of Sports Medicine, Landseed International Hospital, Taoyuan, Taiwan
  11. 11Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
  12. 12School of Medicine, National Defense Medical Center, Taipei, Taiwan
  13. 13Institute of Brain Science, National Yang Ming Chiao Tung University, Taipei 112, Taiwan
  14. 14Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
  15. 15Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
  16. 16Department of Psychiatry, Beitou Branch, Tri-Service General Hospital, Taipei, Taiwan
  17. 17Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
  18. 18Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
  19. 19Center for Geriatric and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
  20. 20Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung, Taiwan
  21. 21Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
  22. 22Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
  23. 23Research and Development Division, Health Policy Bureau, Ministry of Health, Labour and Welfare, Tokyo, Japan
  1. Correspondence to Dr Ping-Tao Tseng, Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung City 81166, Taiwan; ducktseng{at}gmail.com; Dr Ming-Kung Wu, Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; mingkung180{at}gmail.com; Prof. Yutaka J Matsuoka, Research and Development Division, Health Policy Bureau, Ministry of Health, Labour and Welfare, Tokyo, Japan; dottore.matsuoka{at}gmail.com

Abstract

Background Moderate-to-severe cancer-related fatigue occurs in 45% of patients with cancer and interferes with many aspects of quality of life. Although physical exercise has level 1 evidence for improvement of cancer-related fatigue, it has a relatively high behavioural demand compared with other non-pharmacological interventions. The aim of this updated meta-analysis was to address the efficacy of light therapy in improving cancer-related fatigue in patients with cancer.

Methods We included randomised controlled trials investigating the efficacy of bright white light (BWL) therapy in ameliorating cancer-related fatigue in patients with cancer. This meta-analysis was conducted using a random-effects model. The target outcomes were changes in cancer-related fatigue associated with BWL or dim red light (DRL).

Results There were 9 articles with 231 participants included. The main results revealed that daily morning BWL for 30 min was associated with significantly better improvement in fatigue severity compared with DRL (k=5, Hedges’ g=−0.414, 95% CI −0.740 to −0.087, p=0.013). The subgroup without psychiatric comorbidities (k=4, Hedges’ g=−0.479, 95% CI −0.801 to −0.156, p=0.004) was associated with significantly better improvement in fatigue severity with BWL than with DRL. In contrary, BWL was not associated with significantly different changes in depression severity or quality of life compared with DRL. Finally, BWL was associated with similar acceptability (ie, dropout rate) and safety profile (ie, any discomfort) as those of DRL.

Conclusions This meta-analysis provides an updated evidence on the rationale for application of BWL in ameliorating cancer-related fatigue in patients with different types of cancer.

Trial registration number INPLASY202140090.

  • complementary therapy
  • fatigue
  • supportive care
  • symptoms and symptom management
  • quality of life
  • depression

Data availability statement

Data are available upon reasonable request.

http://dx.doi.org/10.1136/bmjspcare-2021-003135

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Twitter @tao_tseng

    • M-KW, P-TT and YJM contributed equally.

    • Contributors C-MH took the whole responsibility of literature search, data synthesis and manuscript drafting. B-YZ and B-SZ took the responsibility of searching for articles, risk of bias assessment, data extraction, concept formation and data analysis. C-KS, Y-SC, K-PS, Y-CW, T-YC, P-YL, C-SL, C-WH, C-SC, Y-WC and P-YY all contributed significantly to concept formation, study design, data interpretation and manuscript revision. M-KW took the whole responsibility of project construction, concept formation, data interpretation, manuscript revision and manuscript submission. P-TT took the whole responsibility of data supervision, data extraction, data analysis, manuscript revision and manuscript submission. P-TT submitted the manuscript in the online system on behalf of all the coauthors. YJM took the whole responsibility of study design, concept formation, data interpretation, manuscript revision and manuscript submission.

    • Funding The work of K-PS is supported by the following grants: ANHRF109-31 from An-Nan Hospital, China Medical University, Tainan, Taiwan; CMU108-SR-106 from China Medical University, Taichung, Taiwan; and CMU104-S-16-01, CMU103-BC-4-1, CRS-108-048, DMR-108-216, DMR-109-102, DMR-109-244, DMR-HHC-109-11 and DMR-HCC-109-12 from China Medical University Hospital, Taichung, Taiwan. The work by P-YL is supported by the following grants: MOST 106-2314-B-182A-085-MY2 and MOST 105-2314-B-182A-057 from the Ministry of Science and Technology, Taiwan. The work of YJM is supported by the following grants: National Cancer Center Research and Development Fund (30-A-17) from the National Cancer Center Japan, and Health Labour Sciences Research Grant from the Japanese Ministry of Health, Labour and Welfare (H30-Gantaisaku-Ippan-005).

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.