Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York.
Department of Psychology, Fordham University, Bronx, New York.
Cancer. 2018 Aug 1;124(15):3231-3239. doi: 10.1002/cncr.31539. Epub 2018 May 14.
Patients with advanced cancer have high rates of psychological distress, including depression, anxiety, and spiritual despair. This study examined the effectiveness of individual meaning-centered psychotherapy (IMCP) in comparison with supportive psychotherapy (SP) and enhanced usual care (EUC) in improving spiritual well-being and quality of life and reducing psychological distress in patients with advanced cancer.
Patients (n = 321) were randomly assigned to IMCP (n = 109), SP (n = 108), or EUC (n = 104). Assessments were conducted at 4 time points: before intervention, midtreatment (4 weeks), 8 weeks after treatment, and 16 weeks after treatment.
Significant treatment effects (small to medium in magnitude) were observed for IMCP, in comparison with EUC, for 5 of 7 outcome variables (quality of life, sense of meaning, spiritual well-being, anxiety, and desire for hastened death), with Cohen's d ranging from 0.1 to 0.34; no significant improvement was observed for patients receiving SP (d < 0.15 and P > .05 for all variables). The effect of IMCP was significantly greater than the effect of SP for quality of life and sense of meaning (d = 0.19) but not for the remaining study variables.
This study provides further support for the efficacy of IMCP as a treatment for psychological and existential/spiritual distress in patients with advanced cancer. Significant treatment effects (small to moderate effect sizes) were observed in comparison with usual care, and somewhat more modest differences in improvement (small effect sizes) were observed in comparison with SP. Thus, the benefits of meaning-centered psychotherapy appear to be unique to the intervention and highlight the importance of addressing existential issues with patients approaching the end of life. Cancer 2018. © 2018 American Cancer Society.
晚期癌症患者存在较高的心理困扰发生率，包括抑郁、焦虑和精神绝望。本研究旨在评估个体意义中心心理疗法（IMCP）与支持性心理疗法（SP）和强化常规护理（EUC）相比，改善晚期癌症患者的精神幸福感和生活质量、减轻心理困扰的效果。
将 321 名患者随机分为 IMCP 组（n=109）、SP 组（n=108）和 EUC 组（n=104）。在 4 个时间点进行评估：干预前、治疗中期（4 周）、治疗后 8 周和治疗后 16 周。
与 EUC 相比，IMCP 组在 7 项结局变量中的 5 项（生活质量、意义感、精神幸福感、焦虑和加速死亡的愿望）上有显著的治疗效果（中等至小幅度），Cohen's d 值为 0.1 至 0.34；SP 组患者的改善不显著（所有变量 d 值均小于 0.15，P 值均大于 0.05）。与 SP 组相比，IMCP 组在生活质量和意义感方面的效果更为显著（d=0.19），但在其余研究变量上并无显著差异。
本研究进一步支持了 IMCP 作为治疗晚期癌症患者心理和存在/精神困扰的有效性。与常规护理相比，IMCP 具有显著的治疗效果（中等至小幅度效应），与 SP 相比，改善效果也略有不同（小幅度效应）。因此，意义中心心理疗法的益处似乎是干预措施所特有的，突出了在接近生命终点时与患者探讨存在问题的重要性。癌症 2018；124：3452-3461。©2018 美国癌症协会。
