Randomized controlled pilot trial of mindfulness-based stress reduction compared to psychoeducational support for persistently fatigued breast and colorectal cancer survivors.
Randomized controlled pilot trial of mindfulness-based stress reduction compared to psychoeducational support for persistently fatigued breast and colorectal cancer survivors.
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DOI：
10.1007/s00520-016-3220-4
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发表时间：
2016-10
期刊：
影响因子：
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通讯作者：
Kroenke K
中科院分区：
文献类型：
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作者：
Johns SA;Brown LF;Beck-Coon K;Talib TL;Monahan PO;Giesler RB;Tong Y;Wilhelm L;Carpenter JS;Von Ah D;Wagner CD;de Groot M;Schmidt K;Monceski D;Danh M;Alyea JM;Miller KD;Kroenke K
癌症相关性疲劳（CRF）是许多幸存者的破坏性症状。尽管正念减压（MBSR）在减少CRF方面的疗效有希望的证据，但尚未发表将其与疲劳幸存者的活性对照品进行比较的试验。本试验的目的是比较正念减压疗法和心理教育对慢性肾衰竭及其相关症状的疗效。乳腺癌（n=60）和结直肠癌（n=11）幸存者（0-III期）完成化疗和/或放疗后，平均28个月前登记的临床显着的CRF被随机分配到MBSR或心理教育/支持组（PES）。MBSR专注于正念训练; PES专注于CRF自我管理。结果包括CRF干预（主要）、CRF严重程度和总体改善、活力、抑郁、焦虑、睡眠障碍和疼痛。使用意向治疗分析评估基线（T1）、干预后（T2）和6个月随访（T3）的结局。在任何时间点，CRF干扰的组间差异都不显著;然而，在T2时有一种有利于MBSR的趋势（d=-0.46，p=0.073）。在T2时，与PES组相比，MBSR参与者报告活力显著改善（d=0.53，p=0.003），并且更有可能报告CRF中度至完全改善（χ2（1）=4.1765，p=0.041）。正念减压疗法参与者在T2时也报告了疼痛的显著减轻（d=0.53，p=0.014）。此外，与T1相比，MBSR和PES在T2和T3的所有疲劳结果、抑郁、焦虑和睡眠方面都产生了中等到大的组内显著改善。MBSR和PES对CRF和相关症状有效。需要进行包括常规护理组在内的更大规模的试验。
Cancer-related fatigue (CRF) is a disruptive symptom for many survivors. Despite promising evidence for efficacy of Mindfulness-Based Stress Reduction (MBSR) in reducing CRF, no trials comparing it to an active comparator for fatigued survivors have been published. The purpose of this trial was to compare MBSR to psychoeducation for CRF and associated symptoms. Breast (n=60) and colorectal (n=11) cancer survivors (stage 0–III) with clinically significant CRF after completing chemotherapy and/or radiation therapy an average of 28 months prior to enrollment were randomized to MBSR or psychoeducation/support groups (PES). MBSR focused on mindfulness training; PES focused on CRF self-management. Outcomes included CRF interference (primary), CRF severity and global improvement, vitality, depression, anxiety, sleep disturbance, and pain. Outcomes were assessed at baseline (T1), post-intervention (T2), and 6-month follow-up (T3) using intent-to-treat analysis. Between-group differences in CRF interference were not significant at any time point; however, there was a trend favoring MBSR (d=−0.46, p=0.073) at T2. MBSR participants reported significantly greater improvement in vitality (d=0.53, p=0.003) and were more likely to report CRF as moderately-to-completely improved compared to the PES group (χ2 (1)=4.1765, p=0.041) at T2. MBSR participants also reported significantly greater reductions in pain at T2 (d=0.53, p=0.014). In addition, both MBSR and PES produced moderate-to-large and significant within-group improvements in all fatigue outcomes, depression, anxiety, and sleep at T2 and T3 compared to T1. MBSR and PES appear efficacious for CRF and related symptoms. Larger trials including a usual care arm are warranted.