Bean Helena R, Diggens Justine, Ftanou Maria, Alexander Marliese, Stafford Lesley, Bei Bei, Francis Prudence A, Wiley Joshua F
School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.
Peter MacCallum Cancer Centre, Melbourne, Australia.
Sleep. 2022 Mar 14;45(3). doi: 10.1093/sleep/zsab246.
Sleep problems are common during chemotherapy for breast cancer (BC). We evaluated whether combined brief cognitive behavioral and bright light therapy (CBT-I + Light) is superior to treatment as usual with relaxation audio (TAU+) for insomnia symptoms and sleep efficiency (primary outcomes).
We randomized women receiving intravenous chemotherapy, stratified by tumor stage and insomnia severity index, to 6-week CBT-I + Light or TAU+. CBT-I + Light included 1 in-person session, 1 telephone call, 7 emails, and 20 min bright light (BL) each morning. TAU+ comprised usual treatment and two emails with relaxation audio tracks. Patient-reported outcomes were assessed at baseline, midpoint (week 3), post (week 6), and 3-month follow-up.
Women (N = 101) were randomly assigned to CBT-I + Light or TAU+. The CBT-I + Light group showed significantly greater improvement in insomnia symptoms than the TAU+ group (-5.06 vs -1.93, p = .009; between-group effect size [ES] = .69). At 3-month follow-up, both groups were lower than baseline but did not differ from each other (between-group ES = .18, p = .56). CBT-I + Light had higher patient-reported sleep efficiency than TAU+ immediately after the start of intervention (p = .05) and significantly greater improvement in fatigue (between-group ES = .59, p = .013) and daytime sleep-related impairment (between-group ES = .61, p = .009) than the TAU+ group.
CBT-I + Light had a clinically significant impact on insomnia and fatigue with moderate ESs. Results support offering cognitive behavioral therapy for insomnia and BL therapy during chemotherapy for BC to help manage sleep and fatigue.
Australian New Zealand Clinical Trials Registry (http://anzctr.org.au/). Registration number: ACTRN12618001255279.
睡眠问题在乳腺癌化疗期间很常见。我们评估了联合简短认知行为疗法和强光疗法（CBT-I + 光照）在改善失眠症状和睡眠效率（主要结局）方面是否优于常规的放松音频治疗（TAU+）。
我们将接受静脉化疗的女性患者按肿瘤分期和失眠严重程度指数进行分层，随机分为接受为期6周的CBT-I + 光照组或TAU+组。CBT-I + 光照包括1次面对面咨询、1次电话咨询、7封电子邮件，以及每天早上20分钟的强光照射（BL）。TAU+包括常规治疗和两封带有放松音频的电子邮件。在基线、中点（第3周）、治疗后（第6周）和3个月随访时评估患者报告的结局。
101名女性被随机分配到CBT-I + 光照组或TAU+组。CBT-I + 光照组在失眠症状改善方面显著优于TAU+组（-5.06对-1.93，p = 0.009；组间效应量[ES] = 0.69）。在3个月随访时，两组均低于基线水平，但两组之间无差异（组间ES = 0.18，p = 0.56）。干预开始后，CBT-I + 光照组患者报告的睡眠效率高于TAU+组（p = 0.05），且在疲劳改善方面（组间ES = 0.59，p = 0.013）和日间与睡眠相关的功能损害方面（组间ES = 0.61，p = 0.009）显著优于TAU+组。
CBT-I + 光照对失眠和疲劳有临床显著影响，效应量适中。结果支持在乳腺癌化疗期间为患者提供失眠认知行为疗法和强光疗法，以帮助管理睡眠和疲劳。
澳大利亚和新西兰临床试验注册中心（http://anzctr.org.au/）。注册号：ACTRN12618001255279。
