Effects of Psycho-Oncologic Interventions on Emotional Distress and Quality of Life in Adult Patients With Cancer: Systematic Review and Meta-Analysis

ArticleinJournal of Clinical Oncology 31(6) · January 2013with89 Reads
DOI: 10.1200/JCO.2011.40.8922 · Source: PubMed
Abstract
PURPOSEThis study aimed to evaluate the effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer. METHODS Literature databases were searched to identify randomized controlled trials that compared a psycho-oncologic intervention delivered face-to face with a control condition. The main outcome measures were emotional distress, anxiety, depression, and quality of life. Outcomes were evaluated for three time periods: post-treatment, ≤ 6 months, and more than 6 months. We applied standard meta-analytic techniques to analyze both published and unpublished data from the retrieved studies. Sensitivity analyses and meta-regression were used to explore reasons for heterogeneity.ResultsWe retrieved 198 studies (covering 22,238 patients) that report 218 treatment-control comparisons. Significant small-to-medium effects were observed for individual and group psychotherapy and psychoeducation. These effects were sustained, in part, in the medium term (≤ 6 months) and long term (> 6 months). Short-term effects were evident for relaxation training. Studies that preselected participants according to increased distress produced large effects at post-treatment. A moderator effect was found for the moderator variable "duration of the intervention," with longer interventions producing more sustained effects. Indicators of study quality were often not reported. Small-sample bias indicative of possible publication bias was found for some effects, particularly with individual psychotherapy and relaxation training. CONCLUSION Various types of psycho-oncologic interventions are associated with significant, small-to-medium effects on emotional distress and quality of life. These results should be interpreted with caution, however, because of the low quality of reporting in many of the trials.
    • "Hence, we offered patients up to four sessions, each of up to 30 min in duration. Our finding that patients who received fewer sessions had a greater reduction in HADS scores is not consistent with reports that intensive longer term therapies are needed to achieve benefit [30, 31]. However, it should be noted that in this study, the decision regarding the number of sessions was based on patient need. "
    [Show abstract] [Hide abstract] ABSTRACT: PurposeA stepped-wedge cluster-randomised controlled trial was conducted to evaluate the feasibility and effectiveness of a brief psychosocial intervention for depressed cancer patients, delivered by trained front-line health professionals in routine clinical care. Methods Nine hundred two patients were assessed across four treatment centres which were allocated in random order from control epoch to intervention epoch. Eligible patients had Hospital Anxiety and Depression Scale (HADS) scores of 8 or greater. Of eligible patients, 222 were recruited in control epoch and 247 in intervention epoch. Twenty-seven health professionals (HPs) were trained to deliver the psychosocial intervention consisting of up to four sessions, tailored to patient symptoms and distress. HPs participated in group supervision with a psychiatrist. The primary outcome, analysed by intention to treat, was depression measured with the HADS at 10 weeks after receiving the intervention. ResultsAt 10-week follow-up, there were no significant differences in HADS score for the 181 patients in control epoch and 177 in intervention epoch (adjusted difference −1.23, 95 % CI −3.81––1.35, p = 0.35). Patients with disease progression who received the intervention experienced significant benefits in unmet practical support needs including care and support, information, and physical and daily living. ConclusionA brief psychosocial intervention delivered by front-line oncology health professionals is feasible to deliver but is insufficient as a stand-alone treatment for depression in cancer patients. Psychosocial interventions should be targeted to populations most likely to experience benefit.
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    • "For clinicians providing survivorship care for PC survivors, there are a number of resources that can be considered. Evidence demonstrates that individual and group-based psychotherapeutic and psycho-educational interventions are effective at improving emotional health and general quality of life [42], which is important given how frequently PC survivors experience extreme distress in the form of suicidal ideation [23]. Patients who are experiencing poor physical function may benefit from targeted physical activity trials, with compelling research demonstrating efficacy at improving upper/lower body strength, fatigue, functional quality of life, and mood [43]. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: Many men diagnosed with prostate cancer (PC) will experience physical and psychosocial late effects of treatment. Their interest/preferences for receiving information about addressing common sequelae is not well understood. We examined long-term PC survivors' level of interest, whether this differed based upon symptomatology, and their preferred coping information source. Methods: N=615 PC survivors (3-8 years post-diagnosis) completed a survey on physical and psychological health and their information interests and preferences related to late effects of cancer treatment. Results: Over half of PC survivors reported interest in information about late effects of treatment or sexual health, while approximately a quarter were interested in emotional health information. Survivors preferred to receive information about late effects of treatment from their oncologists, sexual health information from their primary care providers (PCP), oncologist, or written/online resources, and emotional health information from their PCP. Information needs were more commonly reported among men with poorer domain-specific health functioning. Conclusion: Long-term PC survivors report significant interest in receiving information about their physical, sexual, and emotional health. Practice implications: Medical providers caring for these men should inquire about survivors' information needs and future intervention efforts should consider who delivers the information, dependent upon the type of dysfunction reported.
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    • "Although some patients refuse to be treated, most studies indicate high acceptance rates of intervention programs ( ). The effects of psychooncologic interventions on emotional distress and quality of life in adult patients with cancer have been well studied (Faller et al., 2013). Specifically for our study, palliative care units are made to provide comfort to the patient and family in a medical, psychosocial, existential and spiritual context (Chochinov, 2006). "
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