Cognitive impairment related to cancer and its treatment (also known as cancer-related cognitive impairment [CRCI]) has been well-documented. Hematopoietic stem cell transplant (HSCT) patients often experience CRCI before and after transplantation. Although up to 40% of patients experience CRCI even 5 years after transplant, there is a dearth of research on interventions to treat CRCI. Existing non-pharmacologic approaches tend to be costly and require close clinician involvement. A new approach to treating CRCI is needed, as well as a better understanding of the mechanisms that underlie CRCI. Dr. Lisa Wu, Instructor at the Icahn School of Medicine at Mount Sinai is a clinical neuropsychologist with a strong interest in CRCI. Her years of clinical experience working with medically ill and cognitively impaired populations have formed the foundation for her research interests. The career development plan provides Dr. Wu with new training and skills that will enable her to develop competence in: i) examining sleep and chronobiological markers of behavioral outcomes in cancer patients, ii) examining biological markers of behavioral outcomes in cancer patients, and iii) the design and testing of theory-driven non- pharmacological interventions that target the mechanisms and processes that underlie CRCI. Dr. Wu will be supported by an outstanding mentoring team: Dr. William Redd, a leading cancer control researcher is her primary mentor; Sonia Ancoli-Israel provides expertise in sleep and circadian rhythms; Miriam Merad provides expertise in cancer immunology; and Gary Winkel has expertise in biostatistics. Advisors Abraham Reichenberg, and Luis Isola will provide complementary guidance in psychoneuroimmunology, cognitive assessment and the clinical aspects of HSCT. Through a tailored curriculum of courses, conferences, workshops, and mentored research, Dr. Wu will develop the necessary skills to achieve her long-term goal of becoming a successful independent investigator with expertise in the study and management of CRCI. The research plan will 1) assess the feasibility and acceptability of a promising non-pharmacologic intervention for treating CRCI - bright white light exposure, 2) evaluate the preliminary efficacy of the intervention in preparation for a larger scale trial, and 3) explore whether biological, chronobiological, sleep, and psychological factors mediate the effects of bright white light on cognitive functioning. Eighty autologous HSCT survivors assessed as having CRCI will be randomized to either a bright white light or dim red light treatment condition. Assessments will be administered at baseline, at the end of the 4- week intervention, and 3 weeks after the intervention. Standardized measures of sleep, chronobiological (circadian activity rhythms), biological (inflammatory immune markers) and psychological outcomes (fatigue and depressed mood) will be assessed. Overall, this award will position Dr. Wu to become a leader in the field of cancer and cognition, and to be able to make important contributions to improving the quality of life of cancer survivors suffering from CRCI. Research findings will form the basis for future research (including an R01 submission) and, ultimately, reduce the public health burden associated with CRCI.
Cognitive impairment (such as memory problems) due to cancer and its treatment can interfere with quality of life and can linger long after treatment has ended, yet research examining cognitive rehabilitation approaches has produced limited clinical benefit. The proposed study will provide information about systematic light exposure for the treatment of cognitive impairment in hematopoietic stem cell transplant (HSCT) survivors and will investigate how it works. This study would facilitate the development of this potential treatment, giving health care providers and cancer survivors a much-needed tool to help with cancer-related cognitive impairment.
