接受和承诺疗法对转移性乳腺癌患者症状干扰的影响：一项初步随机试验。
Acceptance and commitment therapy for symptom interference in metastatic breast cancer patients: a pilot randomized trial.
机构信息
Department of Psychology, Indiana University-Purdue University Indianapolis, 402 North Blackford Street, LD 124, Indianapolis, IN, 46202, USA.
Department of Biostatistics, Indiana University Fairbanks School of Public Health, Health Sciences Building (RG), 1050 Wishard Blvd. Floors 5 and 6, Indianapolis, IN, 46202, USA.
出版信息
Support Care Cancer. 2018 Jun;26(6):1993-2004. doi: 10.1007/s00520-018-4045-0. Epub 2018 Jan 12.
PURPOSE
Breast cancer is the leading cause of cancer mortality in women worldwide. With medical advances, metastatic breast cancer (MBC) patients often live for years with many symptoms that interfere with activities. However, there is a paucity of efficacious interventions to address symptom-related suffering and functional interference. Thus, this study examined the feasibility and preliminary efficacy of telephone-based acceptance and commitment therapy (ACT) for symptom interference with functioning in MBC patients.
METHODS
Symptomatic MBC patients (N = 47) were randomly assigned to six telephone sessions of ACT or six telephone sessions of education/support. Patients completed measures of symptom interference and measures assessing the severity of pain, fatigue, sleep disturbance, depressive symptoms, and anxiety.
RESULTS
The eligibility screening rate (64%) and high retention (83% at 8 weeks post-baseline) demonstrated feasibility. When examining within-group change, ACT participants showed decreases in symptom interference (i.e., fatigue interference and sleep-related impairment; Cohen's d range = - 0.23 to - 0.31) at 8 and 12 weeks post-baseline, whereas education/support participants showed minimal change in these outcomes (d range = - 0.03 to 0.07). Additionally, at 12 weeks post-baseline, ACT participants showed moderate decreases in fatigue and sleep disturbance (both ds = - 0.43), whereas education/support participants showed small decreases in these outcomes (ds = - 0.24 and - 0.18 for fatigue and sleep disturbance, respectively). Both the ACT and education/support groups showed reductions in depressive symptoms (ds = - 0.27 and - 0.28) at 12 weeks post-baseline. Group differences in all outcomes were not statistically significant.
CONCLUSIONS
ACT shows feasibility and promise in improving fatigue and sleep-related outcomes in MBC patients and warrants further investigation.
目的
乳腺癌是全球女性癌症死亡的主要原因。随着医学的进步，转移性乳腺癌（MBC）患者通常能存活多年，并伴有许多影响其活动的症状。然而，针对症状相关痛苦和功能障碍，目前缺乏有效的干预措施。因此，本研究旨在检验基于电话的接受与承诺疗法（ACT）对 MBC 患者症状对功能的干扰的可行性和初步疗效。
方法
将有症状的 MBC 患者（N=47）随机分为 6 次电话接受与承诺疗法或 6 次电话教育/支持。患者完成了症状干扰和疼痛、疲劳、睡眠障碍、抑郁症状和焦虑严重程度评估的测量。
结果
合格筛选率（64%）和高保留率（83%在基线后 8 周）表明该研究具有可行性。在组内变化的检验中，ACT 组患者在基线后 8 周和 12 周时表现出症状干扰（即疲劳干扰和睡眠相关损害）的下降（Cohen's d 范围为-0.23 至-0.31），而教育/支持组患者在这些结果上变化不大（d 范围为-0.03 至 0.07）。此外，在基线后 12 周，ACT 组患者表现出中度疲劳和睡眠障碍（均为 ds=-0.43）的下降，而教育/支持组患者在这些结果上表现出较小的下降（ds 分别为-0.24 和-0.18）。ACT 组和教育/支持组在基线后 12 周时均显示出抑郁症状的减轻（ds 分别为-0.27 和-0.28）。两组在所有结果上的差异均无统计学意义。
结论
ACT 显示出在改善 MBC 患者的疲劳和睡眠相关结果方面具有可行性和潜力，值得进一步研究。
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