网络化认知行为疗法对乳腺癌康复期患者症状改善效果的Meta分析

doi:10.3761/j.issn.0254-1769.2024.10.014

摘要/Abstract

摘要：

目的系统评价网络化认知行为疗法对乳腺癌康复期患者的症状改善效果。方法计算机检索PubMed、Embase、Cochrane Library、PsycINFO、Web of Science、中国知网、维普数据库、万方数据库、中国生物医学文献数据库中有关使用网络化认知行为疗法对乳腺癌康复期患者进行干预的随机对照试验，检索时限为建库至2023年2月。由2名研究者根据纳入和排除标准对文献进行筛选、提取资料以及方法学质量评价，运用RevMan 5.4软件进行Meta分析。结果共纳入11篇文献，纳入病例1 476例。Meta分析结果显示，接受网络化认知行为疗法干预的乳腺癌康复期患者在干预结束时的焦虑[SMD=-0.20，95%CI（-0.31~-0.10），P<0.001]、抑郁[SMD=-0.16，95%CI（-0.27~-0.05），P=0.006]、睡眠质量[SMD=0.45，95%CI（0.25~0.66），P<0.001]、失眠症状[SMD=-0.71，95%CI（-1.36~-0.06），P=0.030]、疲劳症状[SMD=-0.22，95%CI（-0.37~-0.07），P=0.004]、更年期症状[MD=2.27，95%CI（0.77~3.76），P=0.003]、性功能[SMD=0.20，95%CI（0.02~0.37），P=0.020]及生活质量[SMD=0.24，95%CI（0.12~0.36），P<0.001]均优于对照组，且差异有统计学意义。对可以进行亚组分析的结局指标进行整合，结果显示，在基线后6个月的随访评估中，试验组的焦虑[SMD=-0.15，95%CI（-0.28~-0.01），P=0.030]、抑郁[SMD=-0.16，95%CI（-0.29~-0.03），P=0.020]、睡眠质量[SMD=0.36，95%CI（0.16~0.57），P<0.001]和生活质量[SMD=0.21，95%CI（0.06~0.36），P=0.006]均优于对照组，且差异有统计学意义。结论应用网络化认知行为疗法能够降低乳腺癌康复期患者的焦虑、抑郁等负性情绪，可有效提升患者的睡眠质量，减少其失眠症状；并能减少患者的更年期症状、改善其性功能，有效提高乳腺癌康复期患者的生活质量。

关键词: 网络化认知行为疗法, 互联网, 认知行为疗法, 乳腺癌, Meta分析

Abstract:

Objective To systematically evaluate the efficacy of Internet-delivered cognitive-behavioral therapy in improving symptoms of breast cancer survivors. Methods Randomized controlled trials of Internet-delivered cognitive-behavioral therapy for breast cancer survivors were searched in PubMed，Embase，Cochrane Library，PsycINFO，Web of Science，CNKI，VIP database，Wanfang database and Sinomed. Literature retrieval time was from the inception of the databases to February 2023. According to the inclusion and exclusion criteria，2 researchers independently screened the literature，extracted the data and evaluated the methodological quality，and used RevMan5.4 software for Meta-analysis. Results A total of 11 articles and 1476 cases were included. The results of the meta-analysis showed that the anxiety[SMD=-0.20，95%CI（-0.31~-0.10），P<0.001]，depression[SMD=-0.16，95%CI（-0.27~-0.05），P=0.006]，sleep quality[SMD=0.45，95%CI（0.25~0.66），P<0.001]，insomnia symptoms[SMD=-0.71， 95%CI（-1.36~-0.06）， P=0.030]，fatigue symptoms[SMD=-0.22，95%CI（-0.37~-0.07），P=0.004]，menopausal symptoms[MD=2.27，95%CI（0.77~3.76），P=0.003]，sexual function[SMD=0.20，95%CI（0.02~0.37），P=0.020] and quality of life [SMD=0.24，95%CI（0.12~0.36），P<0.001] of breast cancer survivors who received the Internet-delivered cognitive-behavioral therapy intervention were better than those in the control group at the end of the intervention，and the differences were statistically significant. The outcome measures that could be analyzed by subgroups were integrated. The results showed that anxiety[SMD=-0.15，95%CI（-0.28~-0.01），P=0.030]，depression[SMD=-0.16，95%CI（-0.29~ -0.03），P=0.020]，sleep quality[SMD=0.36，95%CI（0.16~0.57），P<0.001] and quality of life[SMD=0.21，95%CI（0.06~0.36），P=0.006] in the intervention group were better than those in the control group at 6 months after baseline，and the differences were statistically significant. Conclusion The application of Internet-delivered cognitive-behavioral therapy can help reduce anxiety，depression and other negative emotions in breast cancer survivors，and it can effectively improve the quality of sleep and reduce insomnia symptoms. It can also reduce menopausal symptoms in breast cancer survivors，improve sexual function，and effectively improve the quality of life of patients.

Key words: Internet-Delivered Cognitive Behavioral Therapy, Internet, Cognitive Behavioral Therapy, Breast Cancer, Meta-Analysis

余莉莉, 宋涵, 王会宁, 孙小玲. 网络化认知行为疗法对乳腺癌康复期患者症状改善效果的Meta分析[J]. 中华护理杂志, 2024, 59(10): 1248-1254.

YU Lili, SONG Han, WANG Huining, SUN Xiaoling. A meta-analysis of symptom improvement effects of Internet-delivered cognitive-behavioral therapy in breast cancer survivors[J]. Chinese Journal of Nursing, 2024, 59(10): 1248-1254.

图/表 3

图1 文献筛选流程图

Figure 1 Flow chart of literature screening

表1 纳入文献的基本特征（n=11）

Table 1 Characteristics of the included studies（n=11）

表2 纳入文献的质量评价（n=11）

Table 2 Quality evaluation of the literature（n=11）

参考文献 29

[1]	梁锌, 杨剑, 高婷, 等. 全球女性乳腺癌发病趋势及年龄变化情况分析[J]. 中华肿瘤杂志, 2023, 45(4):313-321. PMID
	Liang X, Yang J, Gao T, et al. Analysis on the trends of incidence and age change for global female breast cancer[J]. Chin J Oncol, 2023, 45(4):313-321. DOI PMID
[2]	So WKW, Law BMH, Ng MSN, et al. Symptom clusters expe-rienced by breast cancer patients at various treatment stages:a systematic review[J]. Cancer Med, 2021, 10(8):2531-2565.
[3]	潘明月, 赵佳鑫, 黄海群, 等. 网络化认知行为疗法在乳腺癌患者中的研究进展[J]. 中华护理杂志, 2022, 57(3):363-367. DOI
	Pan MY, Zhao JX, Huang HQ, et al. Research progress of internet-based cognitive behavioral therapy in breast cancer patients[J]. Chin J Nurs, 2022, 57(3):363-367. DOI
[4]	朱文敏, 魏小龙. 非药物干预方法对乳腺癌患者康复效果的网状Meta分析[J]. 中华护理杂志, 2020, 55(6):862-867. DOI
	Zhu WM, Wei XL. A comparative study on the rehabilitation effects of non-pharmacological interventions in patients with breast cancer:a network meta-analysis[J]. Chin J Nurs, 2020, 55(6):862-867.
[5]	Hagatun S, Vedaa, Harvey AG, et al. Internet-delivered cognitive-behavioral therapy for insomnia and comorbid symptoms[J]. Internet Interv, 2018, 12:11-15. DOI PMID
[6]	Green S, Higgins JP. Cochrane handbook for systematic reviews of interventions version 5.1.0[R]. The Cochrane Collaboration, 2011.
[7]	Akkol-Solakoglu S, Hevey D. Internet-delivered cognitive beha-vioural therapy for depression and anxiety in breast cancer survivors:results from a randomised controlled trial[J]. Psy-chooncology, 2023, 10:1002
[8]	Oswald LB, Morales-Cruz J, Eisel SL, et al. Pilot randomized controlled trial of eHealth cognitive-behavioral therapy for insomnia among Spanish-speaking breast cancer survivors[J]. J Behav Med, 2022, 45(3):503-508. DOI PMID
[9]	Holtdirk F, Mehnert A, Weiss M, et al. Results of the optimune trial:a randomized controlled trial evaluating a novel internet intervention for breast cancer survivors[J]. PLoS One, 2021, 16(5):e0251276.
[10]	Bellens A, Roelant E, Sabbe B, et al. A video-game based cognitive training for breast cancer survivors with cognitive impairment:a prospective randomized pilot trial[J]. Breast, 2020, 53:23-32. DOI PMID
[11]	Myers JS, Cook-Wiens G, Baynes R, et al. Emerging from the haze:a multicenter,controlled pilot study of a multidimensio-nal,psychoeducation-based cognitive rehabilitation intervention for breast cancer survivors delivered with telehealth confe-rencing[J]. Arch Phys Med Rehabil, 2020, 101(6):948-959.
[12]	Atema V, van Leeuwen M, Kieffer JM, et al. Efficacy of inter-net-based cognitive behavioral therapy for treatment-induced menopausal symptoms in breast cancer survivors:results of a randomized controlled trial[J]. J Clin Oncol, 2019, 37(10):809-822. DOI PMID
[13]	Zachariae R, Amidi A, Damholdt MF, et al. Internet-delivered cognitive-behavioral therapy for insomnia in breast cancer survivors:a randomized controlled trial[J]. J Natl Cancer Inst, 2018, 110(8):880-887. DOI PMID
[14]	Abrahams HJG, Gielissen MFM, Donders RRT, et al. The effi-cacy of Internet-based cognitive behavioral therapy for severely fatigued survivors of breast cancer compared with care as usual:a randomized controlled trial[J]. Cancer, 2017, 123(19):3825-3834. DOI PMID
[15]	Hummel SB, Oldenburg HSA, et al. Effi-cacy of internet-based cognitive behavioral therapy in impro-ving sexual functioning of breast cancer survivors:results of a randomized controlled trial[J]. J Clin Oncol, 2017, 35(12):1328-1340.
[16]	Damholdt MF, Mehlsen M, O’Toole MS, et al. Web-based cog-nitive training for breast cancer survivors with cognitive com-plaints-a randomized controlled trial[J]. Psychooncology, 2016, 25(11):1293-1300. DOI PMID
[17]	Ferguson RJ, Sigmon ST, Pritchard AJ, et al. A randomized trial of video conference-delivered cognitive behavioral therapy for survivors of breast cancer with self-reported cognitive dysfun-ction[J]. Cancer, 2016, 122(11):1782-1791. DOI PMID
[18]	Vedaa O, Hagatun S, Kallestad H, et al. Long-term effects of an unguided online cognitive behavioral therapy for chronic insomnia[J]. J Clin Sleep Med, 2019, 15(1):101-110. DOI PMID
[19]	Niedzwiedz CL, Knifton L, Robb KA, et al. Depression and anxiety among people living with and beyond cancer:a growing clinical and research priority[J]. BMC Cancer, 2019, 19(1):943. DOI PMID
[20]	Dozeman E, Verdonck-de Leeuw IM, Savard J, et al. Guided web-based intervention for insomnia targeting breast cancer patients:feasibility and effect[J]. Internet Interv, 2017, 19(9):1-6.
[21]	Ganz PA, Kwan L, Stanton AL, et al. Physical and psychosocial recovery in the year after primary treatment of breast cancer[J]. J Clin Oncol, 2011, 29:1101-1109. DOI PMID
[22]	Aricò D, Raggi A, Ferri R. Cognitive behavioral therapy for insomnia in breast cancer survivors:a review of the literature[J]. Front Psychol, 2016, 3(7):1162.
[23]	Amidi A, Buskbjerg CR, Damholdt MF, et al. Changes in sleep following internet-delivered cognitive-behavioral therapy for insomnia in women treated for breast cancer:a 3-year follow-up assessment[J]. Sleep Med, 2022, 96:35-41. DOI PMID
[24]	Hall DL, Arditte Hall KA, Gorman MJ, et al. The Survivorship Sleep Program(SSP):a synchronous,virtual cognitive behavio-ral therapy for insomnia pilot program among cancer survi-vors[J]. Cancer, 2022, 128(7):1532-1544.
[25]	Rajabi Majd N, Broström A, Ulander M, et al. Efficacy of a theory-based cognitive behavioral technique app-based inter-vention for patients with insomnia:randomized controlled trial[J]. Med Internet Res, 2020, 22(4):e15841
[26]	荆凤, 邢唯杰. 乳腺癌患者内分泌治疗相关症状及非药物干预的研究进展[J]. 中华护理杂志, 2021, 56(4):635-640. DOI
	Jing F, Xing WJ. Review of symptoms and non-pharma-cologi-cal interventions among breast cancer survivors under-going adjuvant endocrine therapy[J]. Chin J Nurs, 2021, 56(4):635-640.
[27]	Hummel SB, Oldenburg HSA, et al. Inter-net-based cognitive behavioral therapy realizes long-term improvement in the sexual functioning and body image of breast cancer survivors[J]. J Sex Marital Ther, 2018, 44(5):485-496.
[28]	Abrahams H, Gielissen M, Schmits I, et al. Risk factors,preva-lence,and course of severe fatigue after breast cancer treat-ment:a meta-analysis involving 12327 breast cancer survivors[J]. Ann Oncol, 2016, 27:965-974. DOI PMID
[29]	Duncan M, Moschopoulou E, Herrington E, et al. Review of sys-tematic reviews of non-pharmacological interventions to imp-rove quality of life in cancer survivors[J]. BMJ Open, 2017, 7(11):e015860.