基于正念减压疗法对持续性疲劳癌症幸存者的随机对照试验研究
Randomized controlled pilot study of mindfulness-based stress reduction for persistently fatigued cancer survivors.
作者信息
Johns Shelley A, Brown Linda F, Beck-Coon Kathleen, Monahan Patrick O, Tong Yan, Kroenke Kurt
机构信息
Indiana University School of Medicine, Indianapolis, IN, USA.
Regenstrief Institute, Inc., Indianapolis, IN, USA.
出版信息
Psychooncology. 2015 Aug;24(8):885-93. doi: 10.1002/pon.3648. Epub 2014 Aug 17.
OBJECTIVE
Cancer-related fatigue (CRF) is one of the most common, persistent, and disabling symptoms associated with cancer and its treatment. Evidence-based treatments that are acceptable to patients are critically needed. This study examined the efficacy of mindfulness-based stress reduction (MBSR) for CRF and related symptoms.
METHOD
A sample of 35 cancer survivors with clinically significant CRF was randomly assigned to a 7-week MBSR-based intervention or wait-list control group. The intervention group received training in mindfulness meditation, yoga, and self-regulatory responses to stress. Fatigue interference (primary outcome) and a variety of secondary outcomes (e.g., fatigue severity, vitality, disability, depression, anxiety, and sleep disturbance) were assessed at baseline, post-intervention, and 1-month follow-up. Bonferroni correction was employed to account for multiple comparisons. Controls received the intervention after the 1-month follow-up. Participants in both groups were followed for 6 months after completing their respective MBSR courses to assess maintenance of effects.
RESULTS
Compared to controls, the MBSR group reported large post-intervention reductions as assessed by effect sizes (d) in the primary outcome, fatigue interference (d = -1.43, p < 0.001), along with fatigue severity (d = -1.55, p < 0.001), vitality (d = 1.29, p < 0.001), depression (d = -1.30, p < 0.001), and sleep disturbance (d = -0.74, p = 0.001). Results were maintained or strengthened at 1-month follow-up, the point at which significant improvements in disability (d = -1.22, p < 0.002) and anxiety (d = -0.98, p = 0.002) occurred. Improvements in all outcomes were maintained 6 months after completing the course. MBSR adherence was high, with 90% attendance across groups and high rates of participant-reported home practice of mindfulness.
CONCLUSIONS
Mindfulness-based stress reduction is a promising treatment for CRF and associated symptoms.
目的
癌症相关疲劳（CRF）是与癌症及其治疗相关的最常见、持续且致残的症状之一。亟需患者可接受的循证治疗方法。本研究考察了基于正念减压疗法（MBSR）对CRF及相关症状的疗效。
方法
选取35名有临床显著CRF的癌症幸存者样本，随机分为基于MBSR的7周干预组或等待名单对照组。干预组接受正念冥想、瑜伽及应激自我调节反应方面的培训。在基线、干预后及1个月随访时评估疲劳干扰（主要结局）及多种次要结局（如疲劳严重程度、活力、残疾、抑郁、焦虑及睡眠障碍）。采用Bonferroni校正法处理多重比较。对照组在1个月随访后接受干预。两组参与者在完成各自的MBSR课程后随访6个月，以评估效果维持情况。
结果
与对照组相比，MBSR组干预后主要结局疲劳干扰的效应量（d）显示大幅降低（d = -1.43，p < 0.001），同时疲劳严重程度（d = -1.55，p < 0.001）、活力（d = 1.29，p < 0.001）、抑郁（d = -1.30，p < 0.001）及睡眠障碍（d = -0.74，p = 0.001）也有改善。在1个月随访时结果得以维持或增强，此时残疾（d = -1.22，p < 0.002）和焦虑（d = -0.98，p = 0.002）出现显著改善。完成课程6个月后，所有结局的改善均得以维持。MBSR的依从性较高，各组的出勤率为90%，且参与者报告的正念家庭练习率也很高。
结论
基于正念减压疗法对CRF及相关症状是一种有前景的治疗方法。
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