癌症相关疲劳的治疗：认知行为疗法可行性研究的结果。
Treatment of Cancer-related-Fatigue in Acute Hematological Malignancies: Results of a Feasibility Study of using Cognitive Behavioral Therapy.
机构信息
Department of Palliative, Rehabilitation, and Integrative Medicine, (S.Y.,C.C.,H.M.,Z.L.,P.S.,E.B.), The University of Texas MD Anderson Cancer Center, Houston, USA Center.
Departments of Leukemia and Stem Cell Transplantation, (M.K.,C.D.), The University of Texas MD Anderson Cancer Center, Houston, USA.
出版信息
J Pain Symptom Manage. 2023 Mar;65(3):e189-e197. doi: 10.1016/j.jpainsymman.2022.11.003. Epub 2022 Nov 13.
BACKGROUND
Despite cancer related fatigue (CRF) being the most common, and debilitating symptom in patients with recently diagnosed acute hematological malignancies (HM), there are limited effective treatments for CRF in HM. The aim of this study was to determine the feasibility of cognitive behavioral therapy (CBT) for CRF in HM.
METHODS
In this preliminary longitudinal prospective study, HM patients diagnosed a median of one month previously with moderate to severe fatigue were enrolled. Patients received CBT in seven weekly sessions for eight weeks. Change in Functional Assessment of Cancer Illness Therapy (FACIT) - Fatigue (primary), FACT-G, Pittsburg Sleep Quality Index (PSQI), Hospital Anxiety Depression Scale (HADS), M.D. Anderson Symptom Inventory - Acute Myeloid Leukemia (MDASI-AML/MDS), and Herth Hope Index (HHI) were analyzed.
RESULTS
Twenty-seven of 36 (75 %) patients were evaluable. Adherence and satisfaction rates to the CBT intervention were 78.6% (95% CI 67.2%, 89.9%), and 92% (95% CI 76.7%, 98.3%) respectively. The median age 66, 64% female, the most common HM was AML (60%), median FACIT-F was 27. The mean (SD) improvement at end eight weeks for FACIT-F was 5.5(13.6), Cohen δ 0.4, P=0.046; and for PSQI total was 2.9 (3), Cohen δ -1, P=0.006. We also found significant improvement in HADS anxiety -2.7(4.5), P=0.049, MDASI Sleep -1.8(3.0), P=0.022, MDASI mean module symptom severity -0.7(1.6), P=0.006. However, no significant improvements were found in FACT-G, HHI, and HADS-depression scores.
CONCLUSIONS
The use of CBT was feasible with improvement of CRF, sleep quality, and anxiety scores in HM. Randomized controlled trials are justified.
背景
尽管癌症相关疲劳（CRF）是最近诊断出的急性血液恶性肿瘤（HM）患者中最常见和最具致残性的症状，但 HM 患者的 CRF 治疗方法非常有限。本研究旨在确定认知行为疗法（CBT）治疗 HM 患者 CRF 的可行性。
方法
在这项初步的纵向前瞻性研究中，招募了中位诊断时间为一个月的 HM 患者，这些患者被诊断为中度至重度疲劳。患者接受每周 7 次、持续 8 周的 CBT。分析了功能性评估癌症治疗疲劳量表（FACIT）-疲劳（主要终点）、FACT-G、匹兹堡睡眠质量指数（PSQI）、医院焦虑抑郁量表（HADS）、MD 安德森症状评估量表-急性髓系白血病（MDASI-AML/MDS）和赫特希望指数（HHI）的变化。
结果
36 例患者中有 27 例（75%）可评估。CBT 干预的依从性和满意度分别为 78.6%（95%CI 67.2%，89.9%）和 92%（95%CI 76.7%，98.3%）。中位年龄为 66 岁，64%为女性，最常见的 HM 为 AML（60%），中位 FACIT-F 为 27。8 周结束时 FACIT-F 的平均（SD）改善为 5.5（13.6），Cohen δ 0.4，P=0.046；PSQI 总分改善 2.9（3），Cohen δ -1，P=0.006。我们还发现 HADS 焦虑评分显著改善 -2.7（4.5），P=0.049，MDASI 睡眠评分 -1.8（3.0），P=0.022，MDASI 平均模块症状严重程度 -0.7（1.6），P=0.006。然而，FACT-G、HHI 和 HADS 抑郁评分无显著改善。
结论
CBT 的使用是可行的，可改善 HM 患者的 CRF、睡眠质量和焦虑评分。有理由进行随机对照试验。
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