A Pilot Randomized Controlled Trial of Brief Cognitive-Behavioral Therapy for Anxiety in Patients with Terminal Cancer
A Pilot Randomized Controlled Trial of Brief Cognitive-Behavioral Therapy for Anxiety in Patients with Terminal Cancer
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DOI：
10.1634/theoncologist.2012-0041
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发表时间：
2012-10-01
期刊：
影响因子：
5.8
通讯作者：
Safren, Steven A.
中科院分区：
文献类型：
--
作者：
Greer, Joseph A.;Traeger, Lara;Safren, Steven A.
介绍。晚期癌症患者经常经历明显的焦虑，这与生活质量差有关。尽管认知行为疗法（CBT）是一种基于证据的焦虑症治疗方法，但该方法需要适应与癌症相关的现实问题，例如对疾病进展、残疾和死亡的担忧。在这个试点随机对照试验（临床试验）中。（NCT00706290），我们研究了短期CBT减少晚期癌症患者焦虑的可行性和潜在疗效。我们通过开发针对放松技能、应对癌症担忧和活动节奏的治疗模块来适应CBT。根据汉密尔顿焦虑评定量表（HAM-A），患有无法治愈的恶性肿瘤和焦虑升高的成年人被随机分配到单独的CBT组或候补对照组。主要结果包括完成CBT访问的次数和HAM-A评分从基线到8周随访的变化。可行性标准为75%的干预依从性。我们将40例晚期癌症患者随机分为CBT组（n = 20）或等候组（n = 20）；70%完成治疗后评估。大多数接受CBT治疗的患者（80%）至少参加了要求的6次治疗中的5次。对协方差模型进行分析，根据基线评分进行调整，结果显示，与对照组相比，CBT组在HAM-A评分方面有更大的改善，调整后的平均差异为-5.41(95%可信区间：-10.78至-0.04)，干预的效应量很大（Cohen’s d = 0.80）。针对晚期癌症患者的关注点提供简短的CBT不仅可行，而且显著改善了患者的焦虑。肿瘤学家2012；17: 1337 - 1345
Introduction. Patients with terminal cancer often experience marked anxiety that is associated with poor quality of life. Although cognitive-behavioral therapy (CBT) is an evidence-based treatment for anxiety disorders, the approach needs to be adapted to address realistic concerns related to having cancer, such as worries about disease progression, disability, and death. In this pilot randomized controlled trial (clinicaltrials. gov identifier NCT00706290), we examined the feasibility and potential efficacy of brief CBT to reduce anxiety in patients with terminal cancer.Methods. We adapted CBT by developing treatment modules targeting skills for relaxation, coping with cancer worries, and activity pacing. Adults with incurable malignancies and elevated anxiety based on the Hamilton Anxiety Rating Scale (HAM-A) were randomly assigned to individual CBT or a waitlist control group. Primary outcomes included the number of completed CBT visits and the change in HAM-A scores from baseline to 8-week follow-up per a treatment-blind evaluator. The feasibility criterion was 75% adherence to the intervention.Results. We randomized 40 patients with terminal cancers to CBT (n = 20) or waitlist control (n = 20) groups; 70% completed posttreatment assessments. Most patients who received CBT (80%) participated in at least five of the required six therapy sessions. Analysis of covariance models, adjusted for baseline scores, showed that those assigned to CBT had greater improvements in HAM-A scores compared to the control group, with an adjusted mean difference of -5.41 (95% confidence interval: -10.78 to -0.04) and a large effect size for the intervention (Cohen's d = 0.80).Conclusion. Providing brief CBT tailored to the concerns of patients with terminal cancer was not only feasible but also led to significant improvements in anxiety. The Oncologist 2012; 17: 1337-1345