黑人和白人癌症幸存者接受针刺和认知行为疗法治疗失眠的治疗依从性和反应的种族差异。

Racial differences in treatment adherence and response to acupuncture and cognitive behavioral therapy for insomnia among Black and White cancer survivors.

机构信息

Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA.

Department of Psychology and Oncology, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.

出版信息

Cancer Med. 2024 Aug;13(16):e7344. doi: 10.1002/cam4.7344.

DOI:10.1002/cam4.7344

PMID:39161103

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11333531/

Abstract

BACKGROUND

Racial disparities in sleep are well-documented. However, evidence-based options for addressing these disparities are lacking in cancer populations. To inform future research on sleep interventions, this study aims to understand racial differences in treatment responses to acupuncture and cognitive behavioral therapy for insomnia (CBT-I) among Black and White cancer survivors.

METHODS

We conducted a secondary analysis of a comparative effectiveness trial evaluating acupuncture versus CBT-I for insomnia in cancer survivors. We compared insomnia severity, sleep characteristics, and co-morbid symptoms, as well as treatment attitudes, adherence, and responses among Black and White participants.

RESULTS

Among 156 cancer survivors (28% Black), Black survivors reported poorer sleep quality, longer sleep onset latency, and higher pain at baseline, compared to White survivors (all p < 0.05). Black survivors demonstrated lower adherence to CBT-I than White survivors (61.5% vs. 88.5%, p = 0.006), but their treatment response to CBT-I was similar to white survivors. Black survivors had similar adherence to acupuncture as white survivors (82.3% vs. 93.4%, p = 0.16), but they had greater reduction in insomnia severity with acupuncture (-3.0 points, 95% CI -5.4 to 0.4, p = 0.02).

CONCLUSION

This study identified racial differences in sleep characteristics, as well as treatment adherence and responses to CBT-I and acupuncture. To address racial disparities in sleep health, future research should focus on improving CBT-I adherence and confirming the effectiveness of acupuncture in Black cancer survivors.

摘要

背景

种族间的睡眠差异已有充分的文献记载。然而，癌症患者群体中缺乏针对这些差异的循证解决方案。为了为未来的睡眠干预研究提供信息，本研究旨在了解黑人和白人癌症幸存者中针刺和认知行为疗法治疗失眠（CBT-I）的反应种族差异。

方法

我们对一项比较针刺与 CBT-I 治疗癌症幸存者失眠的有效性试验进行了二次分析。我们比较了黑人和白人参与者的失眠严重程度、睡眠特征和共病症状，以及治疗态度、依从性和反应。

结果

在 156 名癌症幸存者（28%为黑人）中，与白人幸存者相比，黑人幸存者在基线时报告睡眠质量较差、入睡潜伏期较长和疼痛程度更高（均 p<0.05）。与白人幸存者相比，黑人幸存者对 CBT-I 的依从性较低（61.5% vs. 88.5%，p=0.006），但他们对 CBT-I 的治疗反应与白人幸存者相似。与白人幸存者相比，黑人幸存者对针刺的依从性相似（82.3% vs. 93.4%，p=0.16），但针刺治疗可使失眠严重程度显著降低（-3.0 分，95%CI -5.4 至 0.4，p=0.02）。