Cognitive-Behavioral Sleep and Nutritional Intervention Enhances Recovery and Survival in Rectal Cancer Patients Undergoing Abdominoperineal Resection: A Randomized Controlled Trial.

OBJECTIVE

Patients with rectal cancer undergoing abdominoperineal resection (APR) frequently experience perioperative sleep disturbance and nutritional decline, both linked to impaired recovery, heightened inflammation, and poorer survival. Evidence for combined behavioral sleep and nutritional interventions in this high-risk population is limited.

METHODS

In this single-center randomized controlled trial, 186 stage I-III rectal cancer patients scheduled for APR were assigned (1:1) to receive standard enhanced recovery after surgery (ERAS) or ERAS plus a structured cognitive-behavioral sleep intervention (CBSI) with individualized nutritional support. Initiated 2 weeks preoperatively and continued for 6 months postoperatively, the program included cognitive restructuring, stimulus control, sleep restriction, relaxation training, relapse prevention, and tailored nutrition plans. The primary outcome was the change in the Pittsburgh Sleep Quality Index (PSQI) at 6 months. Secondary outcomes were Hospital Anxiety and Depression Scale (HADS) scores, inflammatory markers (IL-6, CRP), and 2-year disease-free survival (DFS) and overall survival (OS).

RESULTS

Compared with controls, the intervention group showed greater PSQI improvement at 6 months (-3.8, 95% CI=-4.5 to -3.1, p <.001), with benefits sustained at 12 months. Reductions in HADS-anxiety (-2.1, p <.001) and HADS-depression (-2.3, p <.001) were observed, along with lower IL-6 and CRP at 3 months. Two-year DFS (88.2% vs. 74.2%, p =.018) and OS (92.5% vs. 80.6%, p =.024) were higher in the intervention group.

CONCLUSIONS

Integrating CBSI with nutritional support significantly improved sleep, psychological well-being, inflammation, and survival in rectal cancer patients undergoing APR, supporting its inclusion in perioperative oncology care.