癌症患者失眠的認知行為治療：系統性的文獻回顧

Cognitive Behavioral Treatment for Insomnia on Cancer Patients: A Systematic Review

失眠是癌症患者常有的困擾，但此議題到近二十年才逐漸受到重視。失眠的認知行為療法（CBT-I）已證實為失眠的有效治療法，也可應用在因癌症診斷與治療而產生的失眠之患者身上。本文回顧CBT-I運用在癌症患者失眠問題的實證研究，期能了解CBT-I在癌症患者的適用性與特點，並提出在臨床應用上的建議。整體而言，CBT-I的原有架構可直接運用於處理癌症存活者的失眠問題，其中刺激控制法、睡眠限制法為主要成分，入睡困難的個案，可加入肌肉放鬆訓練，以疲勞或睡眠品質差為主訴的患者，則可再加入疲勞管理的成分，加入認知重建成分有助於改善患者憂鬱情緒。對於長期臥床或正在住院治療等行動受限的癌症患者，則必須在CBT-I的架構下調整其實行方式，方能克服無法完全執行CBT-I方案中各成分的問題。本研究建議可利用電話講授CBT-I克服交通與行動不便的問題，增加患者持續完成療程的意願，或使用以CBT-I的成分為基礎設計的個別化睡眠促進方案，以因應患者在各種不同限制下的需求。

Sleep disturbance in cancer is a significant problem that interferes quality of life, however, this issue has been neglected until recent two decades. Cognitive Behavioral Therapy for Insomnia (CBT-I) has been recognized as an efficacious intervention for people who suffer from primary or secondary insomnia. The purposes of this review article are to evaluate the efficacy of CBT-I for cancer patients, and to identify the barriers and the strategies of CBT-I implications on oncology departments. The results showed that CBT-I was effective in cancer-related insomnia, without altering the main treatment components, especially the stimulus control and the sleep restriction. Additional muscle relaxation training helped to improve sleep onset latency, fatigue management positively affected patients' fatigue and sleep quality, and the cognition reconstruction had benefits to the depressive mood. Those who had limited mobile ability, such as hospitalizing or bedridden, would be impeded to adhere all components of CBT-I. Therefore, some modifications to fit the restrictions of cancer patients would be necessary. The author proposed the strategies to surmount the barriers when applying CBT-I in cancer patients, such as to develop telephone consultation service to keep outpatients' sleep hygiene and to adjust the content of each component according to individualized condition.