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

and Ulrike Heckl and Joachim Weis, Tumor Biology Center, University of Freiburg, Freiburg, Germany.
Journal of Clinical Oncology (Impact Factor: 18.43). 01/2013; 31(6). DOI: 10.1200/JCO.2011.40.8922
Source: PubMed


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 We applied standard meta-analytic techniques to analyze both published and unpublished data from the retrieved studies.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.

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    • "Many studies have explored the negative psychological consequences of cancer, which include fatigue, distress and depression (Haberkorn et al., 2013; Sheppard, et al., 2013). In fact, the mere diagnosis of cancer is reported to produce distress in 35-38% of patients (Faller et al., 2013). There is now a considerable body of evidence associating this distress with poorer quality of life (QoL), less adherence to cancer treatments and worse general survival, as well as a less healthy lifestyle and poorer self-care. "

    Full-text · Chapter · Jan 2016
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    • "A strength of such interventions is that eligibility is often limited to cancer survivors who meet a threshold for relatively poor function on the targeted outcome, unlike the large majority of psychosocial RCTs conducted during medical treatment, which are often open to all-comers. Effect sizes for interventions are substantially larger when cancer survivors are selected on the basis of a threshold on the outcome variable than when participants are included regardless of their baseline standing (Faller et al., 2013). Fatigue is a frequently targeted outcome in posttreatment RCTs. "
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    ABSTRACT: The number of individuals living with a history of cancer is estimated at 13.7 million in the United States and is expected to rise with the aging of the population. With expanding attention to the psychosocial and physical consequences of surviving illness, psychological science and evidence-based practice are making important contributions to addressing the pressing needs of cancer survivors. Research is demonstrating that adults diagnosed with cancer evidence generally positive psychosocial adjustment over time; however, a subset is at risk for compromised psychological and physical health stemming from long-term or late effects of cancer and its treatment. In this article, we characterize survivorship after medical treatment completion during the periods of reentry, early survivorship, and long-term survivorship. We describe the major psychosocial and physical sequelae facing adults during those periods, highlight promising posttreatment psychosocial and behavioral interventions, and offer recommendations for future research and evidence-based practice. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Full-text · Article · Feb 2015 · American Psychologist
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    • " , but it is possible that too few patients were close to their sur - gery date for those effects to emerge . Second , our sample was not particularly distressed at baseline , providing little room for improvement . It is becoming clear that psychoso - cial interventions may only be effective for cancer survivors with high psychological distress ( Faller et al . , 2013 ; Schneider et al . , 2010 ) . Our exploratory analyses of the interactions between experimental condition and baseline levels of distress and quality of life outcomes did not support this hypothesis , but there may have been too few patients with very high distress and very low quality of life to adequately test the inter - actions . D"
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    ABSTRACT: Abstract Objective: This randomized trial tested (1) whether a home-based expressive writing (EW) intervention improves quality of life in patients with colorectal cancer and (2) whether the intervention is more beneficial for men or for people who feel constrained in disclosing cancer-related concerns and feelings. Design: Patients treated for colorectal cancer were randomized to an EW (n = 101) or control writing (CW; n = 92) group. Assessments were completed at 1 month pre- and post-intervention. Sex and perceived social constraints on disclosure were evaluated as moderators. Main Outcome Measures: Primary outcomes were depressive symptoms, sleep problems and quality of life indicators. Results: 81% of participants completed all writing assignments. Consistent with hypotheses, relative to the CW group, participants in the EW group expressed more emotion in writing and rated their writings as more meaningful, personal, and emotionally revealing. There were no significant main effects of EW or moderating effects of sex or social constraints on outcomes. Conclusions: Although EW is feasible to use with persons who have colorectal cancer, it was not effective as a stand-alone psychotherapeutic intervention. Nor was it more effective for men or for people who felt they could not freely disclose cancer-related concerns and feelings.
    Full-text · Article · Oct 2014 · Psychology and Health
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