Liu Weimin, Gao Fengli, Ma Ning, Zhang Huaguo, Chui Ping Lei, Che Chong Chin
Department of Nursing Science, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Federal Territory of Kuala Lumpur, Malaysia.
Department of Oncology, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Breast Cancer. 2025 May 14. doi: 10.1007/s12282-025-01711-9.
The systematic review and meta-analysis aimed to comprehensively evaluate the impact of cognitive-behavioral therapy (CBT)-based interventions on health outcomes in patients with breast cancer. Additionally, it assessed the implementation and sustainability of these interventions in clinical and healthcare settings.
A search of electronic databases including PubMed, Web of Science, Cochrane Library, CINAHL, CNKI, and Wanfang Data Knowledge Service Platform was conducted for relevant studies published between July 2014 and July 2024. Standardized Mean Differences (SMD) with 95% Confidence Intervals (CIs) were used to determine the effects of the interventions. The pooled effect size was calculated using a random-effects model. The RE-AIM Framework was used to evaluate the potential implementation and sustainability of the interventions in real-world settings.
This systematic review incorporated 14 randomized controlled trials and quasi-experimental studies. We found that various CBT-based interventions had positive effects on fear of cancer recurrence (SMD = - 0.64; 95% CI [- 1.02, - 0.26]; P = 0.0011), anxiety (SMD = - 0.38; 95% CI [- 0.65, - 0.10]; P = 0.0068), depression (SMD = - 0.49; 95% CI [- 0.80, - 0.19]; P = 0.0017), mindfulness skills (SMD = 0.80; 95% CI [0.48, 1.13]; P < 0.0001), fatigue (SMD = - 0.37; 95% CI [- 0.59, - 0.15]; P = 0.0011), quality of life (SMD = 0.54; 95% CI [0.14, 0.93]; P = 0.0080), sleep (SMD = - 0.16; 95% CI [- 0.32, - 0.01]; P = 0.0398), positive psychology (SMD = 2.19; 95% CI [0.38, 4.00]; P = 0.0178) and spiritual well-being (SMD = 0.89; 95% CI [0.56, 1.21]; P < 0.0001). However, there was no significant effect on perceived stress in patients with breast cancer (SMD = - 0.70; 95% CI [- 1.44, 0.04]; P = 0.0634).
CBT-based interventions are effective in improving the health outcomes of patients with breast cancer. Rigorously designed randomized controlled trials are needed to validate CBT-based interventions (such as personalized, long-term, and diversified intervention strategies) to optimize psychological health interventions and enhance health outcomes for these patients.
本系统评价和荟萃分析旨在全面评估基于认知行为疗法（CBT）的干预措施对乳腺癌患者健康结局的影响。此外，还评估了这些干预措施在临床和医疗环境中的实施情况及可持续性。
检索电子数据库，包括PubMed、科学网、Cochrane图书馆、护理学与健康领域数据库、中国知网和万方数据知识服务平台，查找2014年7月至2024年7月发表的相关研究。采用标准化均数差（SMD）及95%置信区间（CI）来确定干预措施的效果。使用随机效应模型计算合并效应量。采用RE-AIM框架评估干预措施在现实环境中的潜在实施情况及可持续性。
本系统评价纳入了14项随机对照试验和准实验研究。我们发现，各种基于CBT的干预措施对癌症复发恐惧（SMD = -0.64；95% CI [-1.02, -0.26]；P = 0.0011）、焦虑（SMD = -0.38；95% CI [-0.65, -0.10]；P = 0.0068）、抑郁（SMD = -0.49；95% CI [-0.80, -0.19]；P = 0.0017）、正念技能（SMD = 0.80；95% CI [0.48, 1.13]；P < 0.0001）、疲劳（SMD = -0.37；95% CI [-0.59, -0.15]；P = 0.0011）、生活质量（SMD = 0.54；95% CI [0.14, 0.93]；P = 0.0080）、睡眠（SMD = -0.16；95% CI [-0.32, -0.01]；P = 0.0398）、积极心理（SMD = 2.19；95% CI [0.38, 4.00]；P = 0.0178）和精神幸福感（SMD = 0.89；95% CI [0.56, 1.21]；P < 0.0001）有积极影响。然而，对乳腺癌患者的感知压力没有显著影响（SMD = -0.70；95% CI [-1.44, 0.04]；P = 0.0634）。
基于CBT的干预措施在改善乳腺癌患者的健康结局方面是有效的。需要严格设计的随机对照试验来验证基于CBT的干预措施（如个性化、长期和多样化的干预策略），以优化心理健康干预并改善这些患者的健康结局。
