OBJECTIVE: Sleep disturbance, psychological distress, and impaired quality of life are prevalent in gastric cancer patients after gastrectomy, yet evidence for effective psychological interventions within standard perioperative care remains limited. This study evaluated the efficacy of a structured psychological program-comprising cognitive behavioral therapy for insomnia (CBT-I) and resilience/narrative therapy-delivered on top of routine nutritional support provided to all patients.
METHODS: In this prospective, parallel-group randomized controlled trial, 260 patients with stage I-III gastric cancer scheduled for curative gastrectomy were randomized (1:1) to psychological intervention or control groups. The intervention consisted of five weekly sessions of CBT-I and resilience/narrative therapy modules. All participants received individualized nutritional optimization as part of usual perioperative care. The primary outcome was the between-group adjusted difference in sleep quality, assessed by the Pittsburgh Sleep Quality Index (PSQI) global score at 3 months, adjusting for baseline PSQI using ANCOVA. Secondary outcomes included global health status/quality of life (GHS/QoL, EORTC QLQ-C30), anxiety (SAS), and depression (SDS). Analyses followed the intention-to-treat principle with multiple imputation; per-protocol analyses were performed for sensitivity.
RESULTS: Of 260 randomized patients, 240 (92.3%) completed follow-up. Compared with usual care, the intervention improved PSQI global scores (aMD - 3.0; 95% CI - 3.8 to - 2.2; p < 0.001), GHS/QoL (aMD + 7.8; 95% CI + 5.1 to + 10.5; p < 0.001), SAS (aMD - 3.8; 95% CI - 5.4 to - 2.2; p < 0.001), and SDS (aMD - 3.6; 95% CI - 5.2 to - 2.0; p < 0.001). Findings were consistent in per-protocol and mixed-effects analyses; no serious adverse events were observed.
CONCLUSION: A brief psychological intervention significantly improved sleep, emotional well-being, and quality of life when delivered alongside standard nutritional care after gastrectomy.
IMPLICATIONS FOR CANCER SURVIVOR: Integrating structured psychological support into perioperative pathways may offer a feasible, patient-centered strategy to optimize recovery and survivorship outcomes in gastric cancer. Larger multicenter studies with longer follow-up are warranted.
