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作者：SCI天天读
SCI
15 April 2024
Randomized Controlled Trial of Virtually Delivered Cognitive Behavioral Therapy for Insomnia to Address Perceived Cancer-Related Cognitive Impairment in Cancer Survivors
（Journal of clinical oncology；IF：45.3）
Garland SN, Tulk J, Savard J, Rash JA, Browne S, Urquhart R, Seal M, Thoms J, Laing K. Randomized Controlled Trial of Virtually Delivered Cognitive Behavioral Therapy for Insomnia to Address Perceived Cancer-Related Cognitive Impairment in Cancer Survivors. J Clin Oncol. 2024 Mar 29:JCO2302330. doi: 10.1200/JCO.23.02330. Epub ahead of print. PMID: 38552188.
CORRESPONDING AUTHOR:Sheila N. Garland, PhD; e-mail: sheila.garland@mun.ca.
Purpose 目的
Comorbid insomnia and cancer-related cognitive impairment (CRCI) are experienced by up to 26% of individuals diagnosed with cancer. This study examined the efficacy and durability of cognitive behavioral therapy for insomnia (CBT-I) on perceived CRCI in cancer survivors.
多达26%的癌症患者患有合并失眠和癌症相关认知障碍（CRCI）。本研究评估了失眠认知行为疗法（CBT-I）对癌症幸存者感知CRCI的疗效和持久性。
Methods 方法
Atlantic Canadian cancer survivors with insomnia and CRCI were randomly assigned to receive seven weekly virtual CBT-I sessions (n = 63) or placed in a waitlist control group (n = 69) to receive treatment after the waiting period. Participants completed assessments at baseline, 1 month (mid-treatment), and 2 months (post-treatment). Age- and education-adjusted mixed-effects models using intention-to-treat principles assessed change at post-treatment. Data from both groups were then pooled to assess the durability of effects at 3 and 6 months. A mediation analysis examined whether change in insomnia symptoms mediated the effect of CBT-I on cognitive outcomes.
加拿大大西洋地区患有失眠和CRCI的癌症幸存者，被随机分配接受七次每周一次的模拟CBT-I治疗（n=63）中，或在等待期结束后放入等待名单对照组（n=69）中接受治疗。参与者在基线、治疗中期（1个月）和治疗后（2个月）完成评估。年龄和教育调整混合效应模型使用意向性治疗原则评估了治疗后的变化。然后将两组数据汇总，以评估3个月和6个月时效果的持久性。一项中介分析检验了失眠症状的变化是否介导了CBT-I对认知结果的影响。
Results 结果
The mean age of the sample was 60 years, 77% were women, and breast cancer was the most common diagnosis (41%). The treatment group reported an 11.35-point reduction in insomnia severity, compared with a 2.67-point reduction in the waitlist control group (P < .001). The treatment group had a greater overall improvement than the waitlist control on perceived cognitive impairment (P < .001; d = 0.75), cognitive abilities (P < .001; d = 0.92), and impact on quality of life (P < .001; d = 1.01). These improvements were maintained at follow-up. Change in insomnia symptoms fully mediated the effect of CBT-I on subjective cognitive outcomes.
样本的平均年龄为60岁，77%为女性，乳腺癌是最常见的诊断（41%）。与等待名单对照组降低2.67分相比，治疗组的失眠严重程度降低了11.35分（P<.001）。与等待名单对照组相比，治疗组在感知的认知障碍（P < .001；d = 0.75）、认知能力（P < .001；d = 0.92）和生活质量影响（P < .001；d = 1.01）上有更大的总体改善。这些改进在随访时得到了维持。失眠症状的变化完全介导了CBT-I对主观认知结果的影响。
Conclusion 结论
Treating insomnia with CBT-I produces clinically meaningful and durable improvements in CRCI. There is an urgent need increase access to evidence-based treatment for insomnia in cancer centers and the community.
使用CBT-I治疗失眠对CRCI具有临床意义上的持久改善。迫切需要在癌症中心和社区增加失眠循证治疗的机会。
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