Department of Nursing, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Department of Rehabilitation Medicine, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Int J Nurs Stud. 2020 Apr;104:103514. doi: 10.1016/j.ijnurstu.2019.103514. Epub 2020 Jan 3.
Conventional meta-analyses can only provide direct comparison evidence, and the best options of nonpharmacological interventions for cancer-related cognitive impairment remain largely unknown.
To evaluate the comparative effects of all known nonpharmacological interventions for cancer-related cognitive impairment, and to rank the best intervention options for adult non- central nervous system cancer patients with cancer-related cognitive impairment.
Systematic review with a new analytic approach of network meta-analysis.
Six electronic databases were searched for randomized controlled trials from January 2010 to July 2019.
Literature screening, data extraction and quality appraisal was undertaken systematically by two independent reviewers. Quantitative network meta-analysis performed to analyze key study outcomes. The primary outcome was the effectiveness of interventions on subjective cognitive function, and the secondary outcome was the safety of nonpharmacological interventions for cancer-related cognitive impairment.
There were 29 eligible randomized controlled trials searched, and a total of 10 interventions identified. All 29 randomized controlled trials that were included had no reported significant adverse events, therefore, these 10 nonpharmacological interventions are safe for cancer-related cognitive impairment management. In terms of effectiveness, the pooled overall effects were in favor of these 10 nonpharmacological interventions. The most effective interventions included meditation, cognitive training, cognitive rehabilitation, and exercise interventions, with a mean difference of effective size plus 95% confidence interval 10.26 (1.53, 19.00), 5.02 (1.41, 8.63), 4.88 (0.65, 9.11), and 3.82 (0.52, 7.13), respectively. Other treatment effects did not show statistically significant differences.
This network meta-analysis found that meditation interventions, cognitive training, cognitive rehabilitation, and exercise were the most effective interventions for adult non-central nervous system cancer patients to manage cancer-related cognitive impairment. Results of this network meta-analysis contribute evidence-based data to inform medical decision-making.
传统的荟萃分析只能提供直接比较的证据，对于癌症相关认知障碍的非药物干预措施，最佳选择仍知之甚少。
评估所有已知的非药物干预措施对癌症相关认知障碍的相对效果，并对成年非中枢神经系统癌症患者癌症相关认知障碍的最佳干预措施进行排名。
系统评价结合网络荟萃分析的新分析方法。
从 2010 年 1 月至 2019 年 7 月，6 个电子数据库搜索了随机对照试验。
由两名独立评审员进行文献筛选、数据提取和质量评估。采用定量网络荟萃分析对关键研究结果进行分析。主要结局是干预措施对主观认知功能的有效性，次要结局是非药物干预对癌症相关认知障碍的安全性。
共检索到 29 项符合条件的随机对照试验，共确定了 10 种干预措施。所有纳入的 29 项随机对照试验均未报告有显著的不良事件，因此，这 10 种非药物干预措施对癌症相关认知障碍的管理是安全的。就有效性而言，汇总的整体效果倾向于这 10 种非药物干预措施。最有效的干预措施包括冥想、认知训练、认知康复和运动干预，其有效大小的平均差异加 95%置信区间分别为 10.26（1.53，19.00）、5.02（1.41，8.63）、4.88（0.65，9.11）和 3.82（0.52，7.13）。其他治疗效果没有显示出统计学上的显著差异。
这项网络荟萃分析发现，冥想干预、认知训练、认知康复和运动是治疗成年非中枢神经系统癌症患者癌症相关认知障碍的最有效干预措施。该网络荟萃分析的结果为医疗决策提供了基于证据的数据。
