Diggens Justine, Bullen Dani, Maccora Jordan, Wiley Joshua F, Ellen Steve, Goldin Jeremy, Jefford Michael, Hickey Martha, Ftanou Maria
Peter MacCallum Cancer Centre, 3000, Melbourne, VIC, Australia.
School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Australia.
J Cancer Surviv. 2025 Feb;19(1):174-182. doi: 10.1007/s11764-023-01457-3. Epub 2023 Sep 26.
This study aimed to evaluate the feasibility and clinical efficacy of the Can-Sleep stepped-care intervention for people with cancer-related sleep disturbance.
A total of 147 individuals with cancer were screened. Participants who reported sleep disturbances and were at low-moderate risk for intrinsic sleep abnormalities were given self-managed cognitive behavioral therapy for insomnia (SMCBT-I). Those reporting sleep disturbance and scoring at high risk of intrinsic sleep abnormalities (i.e., restless leg syndrome and obstructive sleep apnoea) were referred to a specialist sleep clinic. In both groups, participants received a stepped-up group CBT-I intervention (GCBT-I) if they continued to report sleep disturbance following SMCBT-I or the specialist sleep clinic.
Overall, 87 participants reported sleep disturbance or screened at risk for intrinsic sleep abnormality. Thirty-four were referred to a specialist sleep clinic, and of the 17 who declined this referral, 14 were rereferred to SMCBT-I. In total, 62 participants were referred to SMCBT-I, and 56 commenced SMCBT-I. At post-intervention, the SMCBT-I group showed a significant decline in insomnia symptoms (p < .001, d = 1.01). Five participants who reported sleep disturbance after SMCBT-I and/or the specialist sleep clinic, accepted GCBT-I. Those who received the GCBT-I showed a significant reduction in insomnia symptoms (p < .01, d = 3.13).
This study demonstrates the feasibility and efficacy of a stepped-care intervention for sleep disturbances in people with cancer.
A stepped-care intervention for sleep disturbance is a feasible and potentially effective method of addressing a significant and unmet patient need.
本研究旨在评估“能睡”阶梯式照护干预对癌症相关睡眠障碍患者的可行性和临床疗效。
共筛查了147名癌症患者。报告有睡眠障碍且存在中低风险的内在睡眠异常的参与者接受了失眠自我管理认知行为疗法（SMCBT - I）。那些报告有睡眠障碍且内在睡眠异常风险评分高（即不安腿综合征和阻塞性睡眠呼吸暂停）的参与者被转介到专科睡眠诊所。在两组中，如果参与者在接受SMCBT - I或专科睡眠诊所治疗后仍报告有睡眠障碍，他们将接受强化团体认知行为疗法（GCBT - I）干预。
总体而言，87名参与者报告有睡眠障碍或筛查出有内在睡眠异常风险。34人被转介到专科睡眠诊所，在17名拒绝该转介的人中，14人被重新转介到SMCBT - I。总共有62名参与者被转介到SMCBT - I，56人开始接受SMCBT - I。干预后，SMCBT - I组的失眠症状显著下降（p <.001，d = 1.01）。5名在接受SMCBT - I和/或专科睡眠诊所治疗后仍报告有睡眠障碍的参与者接受了GCBT - I。接受GCBT - I的参与者失眠症状显著减轻（p <.01, d = 3.13）。
本研究证明了阶梯式照护干预对癌症患者睡眠障碍的可行性和有效性。
针对睡眠障碍的阶梯式照护干预是一种可行且可能有效的方法，可满足患者一项重大且未得到满足的需求。
