ABSTRACT

Insomnia is an adverse cancer outcome impacting mood, pain, quality of life, and mortality in cancer patients. Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for diverse psychophysiological disorders, including pain and insomnia. Primarily studied in breast cancer, there is limited research on CBT within gynecology oncology. This study examined CBT effects on subjective and behavioral sleep outcomes: Sleep Efficiency (SE), Sleep Quality (SQ), Total Wake Time (TWT), Sleep Onset Latency (SOL), and Wake After Sleep Onset (WASO). Thirty-five women with insomnia status/post-surgery for gynecologic cancer were randomized to CBT for insomnia and pain (CBTi.p., N = 18) or Psychoeducation (N = 17). Sleep was assessed via sleep diaries and wrist-worn actigraphy at baseline (T1), post-intervention (T2), and two-month follow-up (T3). Intent-to-treat analyses utilizing mixed linear modeling examined longitudinal group differences on sleep controlling for age and advanced cancer. All participants demonstrated improved (1) subjective SE (0.5, p < .01), SOL (−1.2, p < .01), TWT (−1.2, p < .01), and (2) behavioral SE (0.1, p = .02), TWT (−1.2, p = .03), WASO (−0.8, p < .01) across time. Group-level time trends were indicative of higher subjective SE (6.8, p = .02), lower TWT (−40.3, p = .01), and lower SOL (−13.0, p = .05) in CBTi.p. compared to Psychoeducation. Supplemental analyses examining clinical significance and acute treatment effects demonstrated clinical improvements in SE (T1), TWT (T2, T3), and SOL (T3). Remaining effects were not significant. Despite lacking power to detect interaction effects, CBTi.p. clinically improved sleep in women with gynecologic cancers and insomnia during the active treatment phase. Future research will focus on developing larger trials within underserved populations.

摘要

失眠是癌症的一种不良后果，影响癌症患者的情绪、疼痛、生活质量和死亡率。认知行为疗法（CBT）是一种针对多种心理生理疾病（包括疼痛和失眠）的循证治疗方法。CBT 主要研究乳腺癌，妇科肿瘤学领域对 CBT 的研究有限。本研究考察了 CBT 对主观和行为睡眠结果的影响：睡眠效率 (SE)、睡眠质量 (SQ)、总唤醒时间 (TWT)、入睡潜伏期 (SOL) 和入睡后唤醒 (WASO)。35 名患有失眠状态/妇科癌症手术后的女性被随机分配接受治疗失眠和疼痛的 CBT (CBTi.p., N = 18) 或心理教育 ( N= 17）。在基线（T1）、干预后（T2）和两个月随访（T3）时通过睡眠日记和腕戴式体动记录仪评估睡眠。利用混合线性模型的意向治疗分析检查了控制年龄和晚期癌症的睡眠方面的纵向组间差异。所有参与者均表现出改善 (1) 主观 SE (0.5, p < .01)、SOL (−1.2, p < .01)、TWT (−1.2, p < .01) 和 (2) 行为 SE (0.1, p = .02)、TWT (−1.2, p = .03)、WASO (−0.8, p < .01) 随时间变化。组级时间趋势表明主观 SE 较高（6.8，p = .02）、TWT 较低（−40.3，p = .01）和 SOL 较低（−13.0，p = .05) 在 CBTi.p 中。与心理教育相比。检查临床意义和急性治疗效果的补充分析表明 SE (T1)、TWT (T2、T3) 和 SOL (T3) 的临床改善。其余影响并不显着。尽管缺乏检测相互作用效应的能力，CBTi.p。在积极治疗阶段，临床上改善了患有妇科癌症和失眠的女性的睡眠。未来的研究将侧重于在服务不足的人群中进行更大规模的试验。