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Meta-Analysis
. 2012 Nov 14;11(11):CD007064.
doi: 10.1002/14651858.CD007064.pub2.

Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients

Karen Galway  1 , Amanda Black, Marie Cantwell, Chris R Cardwell, Moyra Mills, Michael Donnelly
Affiliations
Meta-Analysis

Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients

Karen Galway et al. Cochrane Database Syst Rev. .

Abstract

Background: A cancer diagnosis may lead to significant psychological distress in up to 75% of cases. There is a lack of clarity about the most effective ways to address this psychological distress.

Objectives: To assess the effects of psychosocial interventions to improve quality of life (QoL) and general psychological distress in the 12-month phase following an initial cancer diagnosis.

Search methods: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE, EMBASE, and PsycINFO up to January 2011. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. Electronic searches were carried out across all primary sources of peer-reviewed publications using detailed criteria. No language restrictions were imposed.

Selection criteria: Randomised controlled trials of psychosocial interventions involving interpersonal dialogue between a 'trained helper' and individual newly diagnosed cancer patients were selected. Only trials measuring QoL and general psychological distress were included. Trials involving a combination of pharmacological therapy and interpersonal dialogue were excluded, as were trials involving couples, family members or group formats.

Data collection and analysis: Trial data were examined and selected by two authors in pairs with mediation from a third author where required. Where possible, outcome data were extracted for combining in a meta-analyses. Continuous outcomes were compared using standardised mean differences and 95% confidence intervals, using a random-effects model. The primary outcome, QoL, was examined in subgroups by outcome measurement, cancer site, theoretical basis for intervention, mode of delivery and discipline of trained helper. The secondary outcome, general psychological distress (including anxiety and depression), was examined according to specified outcome measures.

Main results: A total of 3309 records were identified, examined and the trials subjected to selection criteria; 30 trials were included in the review. No significant effects were observed for QoL at 6-month follow up (in 9 studies, SMD 0.11; 95% CI -0.00 to 0.22); however, a small improvement in QoL was observed when QoL was measured using cancer-specific measures (in 6 studies, SMD 0.16; 95% CI 0.02 to 0.30). General psychological distress as assessed by 'mood measures' improved also (in 8 studies, SMD - 0.81; 95% CI -1.44 to - 0.18), but no significant effect was observed when measures of depression or anxiety were used to assess distress (in 6 studies, depression SMD 0.12; 95% CI -0.07 to 0.31; in 4 studies, anxiety SMD 0.05; 95% CI -0.13 to 0.22). Psychoeducational and nurse-delivered interventions that were administered face to face and by telephone with breast cancer patients produced small positive significant effects on QoL (in 2 studies, SMD 0.23; 95% CI 0.04 to 0.43).

Authors' conclusions: The significant variation that was observed across participants, mode of delivery, discipline of 'trained helper' and intervention content makes it difficult to arrive at a firm conclusion regarding the effectiveness of psychosocial interventions for cancer patients. It can be tentatively concluded that nurse-delivered interventions comprising information combined with supportive attention may have a beneficial impact on mood in an undifferentiated population of newly diagnosed cancer patients.

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Conflict of interest statement

None

Figures

1
1
Study flow diagram.
2
2
Funnel plot of comparison: Quality of Life; all studies.
3
3
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
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4
Forest plot of comparison: 1 Primary outcome Quality of Life, outcome: 1.2 Measures of Quality of Life.
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Forest plot of comparison: 1 Primary outcome Quality of Life, outcome: 1.4 Type of Intervention.
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Forest plot of comparison: 1 Primary outcome Quality of Life, outcome: 1.6 Discipline of 'Trained Helper'.
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Forest plot of comparison: 3 Secondary outcomes, outcome: 3.2 Mood measures.
1.1
1.1. Analysis
Comparison 1: Primary outcome: quality of life, Outcome 1: All Studies
1.2
1.2. Analysis
Comparison 1: Primary outcome: quality of life, Outcome 2: Measures of Quality of Life
1.3
1.3. Analysis
Comparison 1: Primary outcome: quality of life, Outcome 3: Cancer Site
1.4
1.4. Analysis
Comparison 1: Primary outcome: quality of life, Outcome 4: Type of Intervention
1.5
1.5. Analysis
Comparison 1: Primary outcome: quality of life, Outcome 5: Mode of Delivery
1.6
1.6. Analysis
Comparison 1: Primary outcome: quality of life, Outcome 6: Discipline of 'Trained Helper'
2.1
2.1. Analysis
Comparison 2: Risk of bias, Outcome 1: Allocation Concealment
2.2
2.2. Analysis
Comparison 2: Risk of bias, Outcome 2: Intention to Treat Analysis
3.1
3.1. Analysis
Comparison 3: Secondary outcomes, Outcome 1: General Psychological Distress
3.2
3.2. Analysis
Comparison 3: Secondary outcomes, Outcome 2: Mood Measures
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