针对乳腺癌女性的正念减压疗法：一项更新的系统评价与荟萃分析。
Mindfulness-based interventions for women with breast cancer: an updated systematic review and meta-analysis.
作者信息
Haller Heidemarie, Winkler María M, Klose Petra, Dobos Gustav, Kümmel Sherko, Cramer Holger
机构信息
a Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine , University of Duisburg-Essen , Essen , Germany.
b Department of Obstetrics and Gynecology , Robert Bosch Hospital , Stuttgart , Germany.
出版信息
Acta Oncol. 2017 Dec;56(12):1665-1676. doi: 10.1080/0284186X.2017.1342862. Epub 2017 Jul 7.
BACKGROUND
The aim of this meta-analysis was to systematically update the evidence for mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT) in women with breast cancer.
MATERIAL AND METHODS
In October 2016, PubMed, Scopus, and Central were searched for randomized controlled trials on MBSR/MBCT in breast cancer patients. The primary outcome was health-related quality of life. Secondary outcomes were fatigue, sleep stress, depression, anxiety, and safety. For each outcome, standardized mean differences (SMD/Hedges' g) and 95% confidence intervals (CI) were calculated. Risk of bias was assessed by the Cochrane risk of bias tool.
RESULTS
The Literature search identified 14 articles on 10 studies that included 1709 participants. The overall risk of bias was unclear, except for risk of low attrition bias and low other bias. Compared to usual care, significant post-intervention effects of MBSR/MBCT were found for health-related quality of life (SMD = .21; 95%CI = [.04-.39]), fatigue (SMD = -.28; 95%CI = [-.43 to -.14]), sleep (SMD = -.23; 95%CI = [-.40 to -.05]), stress (SMD = -.33; 95%CI = [-.61 to -.05]), anxiety (SMD = -.28; 95%CI = [-.39 to -.16]), and depression (SMD = -.34; 95%CI = [-.46 to -.21]). Up to 6 months after baseline effects were significant for: anxiety (SMD = -.28; 95%CI = [-.47 to -.09]) and depression (SMD = -.26; 95%CI = [-.47 to -.04]); and significant for anxiety (SMD = -.21; 95%CI = [-.40 to -.03]) up to 12 months after baseline. Compared to other active interventions, significant effects were only found post-intervention and only for anxiety (SMD = -.45; 95%CI = [-.71 to -.18]) and depression (SMD = -.39; 95%CI = [-.65 to -.14]). However, average effects were all below the threshold of minimal clinically important differences. Effects were robust against potential methodological bias. Adverse events were insufficiently reported.
CONCLUSIONS
This meta-analysis revealed evidence for the short-term effectiveness and safety of mindfulness-based interventions in women with breast cancer. However, their clinical relevance remains unclear. Further research is needed.
背景
本荟萃分析的目的是系统更新关于基于正念减压疗法（MBSR）和基于正念认知疗法（MBCT）对乳腺癌女性患者疗效的证据。
材料与方法
2016年10月，检索了PubMed、Scopus和Cochrane图书馆对照试验注册库，以查找关于MBSR/MBCT用于乳腺癌患者的随机对照试验。主要结局是与健康相关的生活质量。次要结局包括疲劳、睡眠、压力、抑郁、焦虑和安全性。对于每个结局，计算标准化均数差（SMD/Hedges' g）和95%置信区间（CI）。采用Cochrane偏倚风险工具评估偏倚风险。
结果
文献检索共识别出10项研究的14篇文章，涉及1709名参与者。除低失访偏倚风险和低其他偏倚风险外，总体偏倚风险尚不清楚。与常规护理相比，MBSR/MBCT在干预后对与健康相关的生活质量（SMD = 0.21；95%CI = [0.04 - 0.39]）、疲劳（SMD = -0.28；95%CI = [-0.43至-0.14]）、睡眠（SMD = -0.23；95%CI = [-0.40至-0.05]）、压力（SMD = -0.33；95%CI = [-0.61至-0.05]）、焦虑（SMD = -0.28；95%CI = [-0.39至-0.16]）和抑郁（SMD = -0.34；95%CI = [-0.46至-0.21]）有显著影响。在基线后长达6个月时，焦虑（SMD = -0.28；95%CI = [-0.47至-0.09]）和抑郁（SMD = -0.26；95%CI = [-0.47至-0.04]）有显著影响；在基线后长达12个月时，焦虑（SMD = -0.21；95%CI = [-0.40至-0.03]）有显著影响。与其他积极干预措施相比，仅在干预后发现显著影响，且仅针对焦虑（SMD = -0.45；95%CI = [-0.71至-0.18]）和抑郁（SMD = -0.39；95%CI = [-
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