Psychological Interventions and Sleep Improvement for Patients with Gastric Cancer: Effects on Immune Function, Inflammation, and Tumor Progression-A Randomized Controlled Trial.

Abstract

Postoperative gastric cancer patients often experience psychologic distress, sleep disturbances, and impaired immune function, negatively impacting long-term prognosis. This study evaluated the effects of a combined psychological intervention and sleep enhancement program on mental health, sleep quality, immune function, inflammation, and survival outcomes. This prospective, single-blind, randomized controlled trial involved 198 patients who underwent radical gastrectomy. The patients were randomly assigned to either the intervention group (n = 99) or the control group (n = 99). The primary endpoints were psychological well-being and immune function, evaluated by changes in Hospital Anxiety and Depression Scale (HADS) scores and the CD4⁺/CD8⁺ T cell ratio at 3 months. The secondary outcomes were the Pittsburgh Sleep Quality Index (PSQI), inflammatory markers, and long-term oncologic outcomes, including the tumor recurrence rate (TRR), 2-year disease-free survival (DFS), and overall survival (OS). The intervention group participated in a 12-week structured program combining cognitive behavioral therapy (CBT), psychological counseling, sleep hygiene education, melatonin supplementation, and sleep behavior training. At 3 months, the intervention group showed significant reductions in anxiety (HADS-A, 12.3 → 7.1; P < 0.01), depression (HADS-D, 11.8 → 6.5; P < 0.01), and perceived stress (Perceived Stress Scale [PSS], 21.4 → 14.2; P < 0.01). Sleep quality improved (PSQI, 10.5 → 6.2; P < 0.001), with enhanced immune function (CD4⁺/CD8⁺ ratio, 1.78 → 1.44; P = 0.001) and decreased inflammatory markers (interleukin 6 [IL-6], 12.4 → 8.2 pg/mL [P = 0.001]; tumor necrosis factor alpha [TNFα], 9.3 → 6.1 pg/mL [P = 0.003]). The DFS rate (81.2 % vs. 68.5 %; P = 0.005), OS rate (88.5 % vs. 76.7 %; P = 0.003), and TRR (18.8 % vs. 31.5 %; P = 0.006) were significantly improved. The combined psychological and sleep intervention effectively reduced anxiety, depression, and stress; enhanced sleep quality; boosted immune function; reduced inflammation; and improved survival outcomes in gastric cancer patients.