Gonzalez Alyssa Alinda, Jimenez-Torres Gladys Janice, Rozman de Moraes Aline, Geng Yimin, Pawate Varsha, Khan Rida, Narayanan Santhosshi, Yennurajalingam Sriram
Department of Palliative Care, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
Cancers (Basel). 2024 Nov 16;16(22):3850. doi: 10.3390/cancers16223850.
BACKGROUND/OBJECTIVES: Insomnia is a frequent and distressing symptom with limited treatment in patients with cancer. Among the available treatments for insomnia, psychological interventions are some of the most assessed. While studies and reviews show promise of interventions improving insomnia in patients with cancer, inconsistent approaches to operationalizing and measuring insomnia combined with the heterogeneity of available treatments render comparisons and synthetization difficult. This review sought to rigorously synthesize psychological interventions for patients with cancer and insomnia by describing current therapies, identifying gaps in the literature, and offering supportive interventions.
A comprehensive search of five databases-Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, EBSCO CINAHL Plus with Full Text, and Cochrane Library-was conducted through 1 August 2024. The review included randomized trials and non-inferiority trials evaluating psychological interventions for patients with various types of cancers. Twenty-one studies were included, and study quality ranged from good to excellent, according to the PEDro scale.
The current evidence supports the use of cognitive behavioral therapy (CBT) to treat insomnia over and above psychoeducation alone, mindfulness-based stress reduction, Brief Behavioral Therapy, the Benson Relaxation Technique, progressive muscle relaxation, mindfulness meditation, mind-body bridging, and home-based psychological nursing. Digital, minimal, and internet-based intervention modalities are effective, though professional-delivered CBT proved most effective.
CBT remains the most effective psychological intervention for insomnia in this population. Challenges exist regarding the implementation of CBT, so further research is warranted to identify the best psychological interventions for specific settings and subsets of patients with cancer.
背景/目的：失眠是癌症患者常见且令人苦恼的症状，治疗方法有限。在现有的失眠治疗方法中，心理干预是评估最多的方法之一。虽然研究和综述显示干预措施有望改善癌症患者的失眠状况，但失眠的操作化和测量方法不一致，加上现有治疗方法的异质性，使得比较和综合分析变得困难。本综述旨在通过描述当前疗法、找出文献中的空白并提供支持性干预措施，对癌症合并失眠患者的心理干预进行严格的综合分析。
截至2024年8月1日，对五个数据库——Ovid MEDLINE、Ovid Embase、Ovid PsycInfo、EBSCO CINAHL Plus with Full Text和Cochrane Library进行了全面检索。该综述纳入了评估针对各类癌症患者心理干预的随机试验和非劣效性试验。共纳入21项研究，根据PEDro量表，研究质量从良好到优秀不等。
目前的证据支持使用认知行为疗法（CBT）治疗失眠，其效果优于单纯的心理教育、基于正念的减压疗法、简短行为疗法、本森放松技巧、渐进性肌肉松弛、正念冥想、身心联结疗法和家庭心理护理。数字、极简和基于互联网的干预方式是有效的，不过专业提供的CBT被证明是最有效的。
CBT仍然是该人群失眠最有效的心理干预方法。CBT的实施存在挑战，因此有必要进一步研究，以确定针对特定环境和癌症患者亚组的最佳心理干预措施。
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