Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA.
Department of Psychology, University of Calgary, Calgary, AB, Canada.
Neuropsychiatr Dis Treat. 2014 Jun 18;10:1113-24. doi: 10.2147/NDT.S47790. eCollection 2014.
Individuals with cancer are disproportionately affected by sleep disturbance and insomnia relative to the general population. These problems can be a consequence of the psychological, behavioral, and physical effects of a cancer diagnosis and treatment. Insomnia often persists for years and, when combined with already high levels of cancer-related distress, may place cancer survivors at a higher risk of future physical and mental health problems and poorer quality of life. The recommended first-line treatment for insomnia is cognitive behavioral therapy for insomnia (CBT-I), a non-pharmacological treatment that incorporates cognitive and behavior-change techniques and targets dysfunctional attitudes, beliefs, and habits involving sleep. This article presents a comprehensive review of the literature examining the efficacy of CBT-I on sleep and psychological outcomes in cancer patients and survivors. The search revealed 12 studies (four uncontrolled, eight controlled) that evaluated the effects of CBT-I in cancer patients or survivors. Results suggest that CBT-I is associated with statistically and clinically significant improvements in subjective sleep outcomes in patients with cancer. CBT-I may also improve mood, fatigue, and overall quality of life, and can be successfully delivered through a variety of treatment modalities, making it possible to reach a broader range of patients who may not have access to more traditional programs. Future research in this area should focus on the translation of evidence into clinical practice in order to increase awareness and access to effective insomnia treatment in cancer care.
与一般人群相比，癌症患者受到睡眠障碍和失眠的影响不成比例。这些问题可能是癌症诊断和治疗的心理、行为和身体影响的结果。失眠常常持续多年，并且当与已经很高的癌症相关痛苦结合时，可能会使癌症幸存者面临更高的未来身心健康问题和较差的生活质量风险。失眠的推荐一线治疗方法是失眠认知行为疗法 (CBT-I)，这是一种非药物治疗方法，结合了认知和行为改变技术，并针对涉及睡眠的功能失调态度、信念和习惯。本文全面回顾了检查 CBT-I 在癌症患者和幸存者中的睡眠和心理结果方面的疗效的文献。搜索结果显示，有 12 项研究（4 项非对照研究，8 项对照研究）评估了 CBT-I 在癌症患者或幸存者中的效果。结果表明，CBT-I 与癌症患者主观睡眠结果的统计学和临床显著改善相关。CBT-I 还可能改善情绪、疲劳和整体生活质量，并且可以通过多种治疗方式成功实施，从而使更多可能无法接受更传统方案的患者受益。该领域的未来研究应侧重于将证据转化为临床实践，以提高癌症护理中有效失眠治疗的认识和可及性。
