Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Korean Med Sci. 2023 Aug 7;38(31):e236. doi: 10.3346/jkms.2023.38.e236.
Lung cancer is associated with significant psychological distress, including fear of progression (FoP). Because insomnia and depression are highly prevalent and associated with FoP, we examined the association between FoP, insomnia, and depression in cancer patients. Furthermore, we tested the mediation effect of cancer-related dysfunctional beliefs about sleep (C-DBS) on this association.
We analyzed data collected from patients with surgically resected non-small cell lung cancer from a single-center randomized controlled study investigating digital healthcare applications. Baseline demographic and clinical variables were collected. In addition, self-reported questionnaires including the Fear of Progression Questionnaire-Short Form, Patients Health Questionnaire-9 items (PHQ-9), Insomnia Severity Index, and C-DBS were administered.
Among the 320 enrolled patients with lung cancer, a regression model showed that FoP was predicted by age (β = -0.13, = 0.007), PHQ-9 (β = 0.35, < 0.001), and C-DBS (β = 0.28, < 0.001). Insomnia did not directly influence FoP, but C-DBS mediated the association. Depression directly influenced FoP, but C-DBS did not mediate this association.
Among patients with surgically resected lung cancer, C-DBS mediated the effects of severity of insomnia on FoP. Depression directly influenced FoP, but C-DBS did not influence this association. To reduce FoP among patients with lung cancer, C-DBS should be addressed in the cognitive behavioral therapy module.
肺癌与严重的心理困扰有关，包括对进展的恐惧（FoP）。由于失眠和抑郁非常普遍且与 FoP 相关，我们研究了癌症患者中 FoP、失眠和抑郁之间的关系。此外，我们测试了癌症相关的睡眠功能障碍信念（C-DBS）对这种关联的中介作用。
我们分析了一项单中心随机对照研究中从接受手术切除的非小细胞肺癌患者中收集的数据，该研究调查了数字医疗应用。收集了基线人口统计学和临床变量。此外，还进行了自我报告问卷评估，包括恐惧进展问卷短表、患者健康问卷-9 项（PHQ-9）、失眠严重程度指数和 C-DBS。
在 320 名患有肺癌的入组患者中，回归模型显示 FoP 可由年龄（β = -0.13， = 0.007）、PHQ-9（β = 0.35，<0.001）和 C-DBS（β = 0.28，<0.001）预测。失眠并未直接影响 FoP，但 C-DBS 介导了这种关联。抑郁直接影响 FoP，但 C-DBS 未介导这种关联。
在接受手术切除的肺癌患者中，C-DBS 介导了严重失眠对 FoP 的影响。抑郁直接影响 FoP，但 C-DBS 对这种关联没有影响。为了降低肺癌患者的 FoP，认知行为治疗模块中应解决 C-DBS 问题。
