Jun J. Mao，MD，MSCE，癌症康復者受失眠困擾的試驗結果

翻譯 ： Helen Law / 癌症資訊網

2018年ASCO年會

失眠是癌症康復者的常見問題，高達60％的癌症康復者曾受失眠困擾，對生活質素構成負面影響。我們進行了一項隨機臨床試驗，比較利用「針灸」與「認知行為療法」（CBT-I）來治療失眠的效果。我們將160名癌症康復者隨機分配，一半進行針灸，另一半接受CBT-I。針灸乃使用非常幼細的針刺激特定的身體穴位來治療失眠，以及焦慮和疼痛的合併症狀；CBT-I則透過輔導來改變對失眠的想法和與失眠有關的行為。試驗持續8週，我們在隨後的12週進行個別隨訪，以評估治療效果及其持久度。我們發現，兩種治療方法在試驗結束後均具臨床效益，而且這些臨效益在停止針灸和CBT-I後仍然持續。 整體而言，CBT-I的療效略勝於針灸。我們再將這批研究參與者分為輕度失眠及中度至重度失眠組別。在中度至重度失眠的組別中，CBT-I的效果比針灸明顯。然而，在中度至重度失眠組別中，患者對針灸的反應率與CBT-I非常相似。所以，這兩種治療方法都改善了患者的生理和心理質素。因此，對患者而言，我認為這兩種治療方法都具有臨床效益，而且有一定的持久度。對於輕度失眠患者，CBT-I效果比針灸理想；對於中度至重度失眠患者，如果CBT-I不可行或患者比較喜歡針灸，針灸可能是一個不錯的選擇。我們希望這些信息能幫助腫瘤學家和患者作出明智的決定，選擇治療失眠的最佳方法。

Jun J. Mao, MD, MSCE, on Insomnia in Cancer Survivors: Trial Results

Insomnia is a common symptom affecting up to 60% of cancer survivors and can negatively impact quality of life and functions. So we did a randomized control trial that comparing the effect of Acupuncture vs. Cognitive Behavior Therapy for Insomnia (CBT-I) in cancer survivors. So we randomized a hundred and sixty survivors, half to acupuncture and half to CBT-I. Acupuncture uses very thin needles to stimulate specific points to treat insomnia as well as comorbid anxiety and pain, and the CBT-I group of people received counseling to address mal-adoptive thoughts and the behaviors related to insomnia. So the intervention lasts for 8 weeks and after that we follow individuals for additional 12 weeks to evaluate the durability of the treatment effects. So we found that among individuals with insomnia both treatments resulted in clinically meaningful benefit at the end of intervention and the effects was carried forward for additional 12 weeks without any more treatments for both acupuncture and CBT-I. But overall CBT-I was slightly more benefit than acupuncture and now we strive to find by people with mild insomnia versus moderate to severe insomnia. In the moderate to severe insomnia group of people responded definitely more to CBTI than acupuncture. However, in those with moderate to severe insomnia acupuncture produced very similar response rate as CBTI. So both treatments improved the physical and mental quality of life measures. So what do we say to a patient is I think both treatments are clinically beneficial and produce durable treatment effects, but for people with mild insomnia currently use CBTI and that definitely more beneficial than acupuncture, but for people with moderate to severe insomnia, acupuncture can be a good choice if CBTI is not available or patients prefer acupuncture. We hope this information can help oncologists as well as patients make informed decision to choose best treatment for treating insomnia.

http://www.ascopost.com/videos/2018-asco-annual-meeting/jun-mao-on-insomnia-in-cancer-survivors/