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

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