Department of Surgery, University of Rochester Medical Center, 265 Crittenden Blvd., CU 420658, Rochester, NY, 14642-0658, USA.
Departments of Psychology and Oncology, Memorial University, Newfoundland, Canada.
J Cancer Surviv. 2017 Jun;11(3):401-409. doi: 10.1007/s11764-017-0597-0. Epub 2017 Jan 19.
Cancer-related insomnia is associated with diminished quality of life (QOL), suggesting that improvement in insomnia may improve QOL in cancer survivors. Cognitive behavioral therapy for insomnia (CBT-I) has been shown to improve insomnia, but less is known regarding its effect on QOL and whether improvement in insomnia corresponds to improved QOL. The present analysis examines the effects of CBT-I, with and without armodafinil, on QOL both directly and indirectly through improvements of insomnia.
This is an analysis of 95 cancer survivors for a specified secondary aim of a four-arm randomized controlled trial assessing the combined and individual effects of CBT-I and armodafinil to improve insomnia. QOL and insomnia severity were assessed before, during the intervention, at post-intervention, and 3 months later by Functional Assessment of Cancer Therapy-General and Insomnia Severity Index, respectively.
Mean change in QOL from pre- to post-intervention for CBT-I + placebo, CBT-I + armodafinil, armodafinil, and placebo was 9.6 (SE = 1.8; p < 0.0001), 11.6 (SE = 1.8; p < 0.0001), -0.2 (SE = 3.2; p = 0.964), and 3.3 (SE = 2.0; p = 0.124), respectively. ANCOVA controlling for pre-intervention scores showed that participants receiving CBT-I had significantly improved QOL at post-intervention compared to those not receiving CBT-I (p < 0.0001, effect size = 0.57), with benefits being maintained at the 3-month follow-up. Path analysis revealed that this improvement in QOL was due to improvement in insomnia severity (p = 0.002), and Pearson correlations showed that changes in QOL from pre- to post-intervention were significantly associated with concurrent changes in insomnia severity (r = -0.56; p < 0.0001). Armodafinil had no effect on QOL for those who did or did not receive it (p = 0.976; effect size = -0.004).
In cancer survivors with insomnia, CBT-I resulted in clinically significant improvement in QOL via improvement in insomnia. This improvement in QOL remained stable even 3 months after completing CBT-I.
Considering the high prevalence of insomnia and its detrimental impact on QOL in cancer survivors and the effectiveness of CBT-I in alleviating insomnia, it is important that evidence-based non-pharmacological sleep interventions such as CBT-I be provided as an integral part of cancer care.
与癌症相关的失眠与生活质量（QOL）下降有关，这表明改善失眠可能会提高癌症幸存者的生活质量。认知行为疗法（CBT-I）已被证明可以改善失眠，但对于其对 QOL 的影响以及失眠的改善是否对应于 QOL 的改善知之甚少。本分析通过改善失眠的直接和间接方式，检查 CBT-I（联合或不联合阿莫达非尼）对 QOL 的影响。
这是对 95 名癌症幸存者进行的一项分析，该分析是一项四项随机对照试验的指定次要目标，该试验评估了 CBT-I 和阿莫达非尼联合和单独改善失眠的效果。在干预前、干预期间、干预后和 3 个月后，使用功能性评估癌症治疗-一般和失眠严重程度指数分别评估 QOL 和失眠严重程度。
与 CBT-I+安慰剂、CBT-I+阿莫达非尼、阿莫达非尼和安慰剂相比，从干预前到干预后的 QOL 平均变化分别为 9.6（SE=1.8;p<0.0001）、11.6（SE=1.8;p<0.0001）、-0.2（SE=3.2;p=0.964）和 3.3（SE=2.0;p=0.124）。在考虑了干预前的评分后，协方差分析显示，接受 CBT-I 的参与者在干预后 QOL 显著改善，与未接受 CBT-I 的参与者相比（p<0.0001，效应量=0.57），并且在 3 个月的随访中仍保持这种改善。路径分析显示，这种 QOL 的改善是由于失眠严重程度的改善（p=0.002），皮尔逊相关分析显示，从干预前到干预后的 QOL 变化与同时发生的失眠严重程度变化显著相关（r=-0.56;p<0.0001）。对于接受或未接受阿莫达非尼的患者，阿莫达非尼对 QOL 没有影响（p=0.976；效应量=-0.004）。
在患有失眠的癌症幸存者中，CBT-I 通过改善失眠导致 QOL 出现临床显著改善。即使在完成 CBT-I 3 个月后，这种 QOL 的改善仍然稳定。
鉴于失眠在癌症幸存者中的高发生率及其对 QOL 的不利影响，以及 CBT-I 在缓解失眠方面的有效性，作为癌症护理的一个组成部分，提供基于证据的非药物睡眠干预措施（如 CBT-I）非常重要。
