Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs

J Kalter¹, I M Verdonck-de Leeuw^{2

3}, M G Sweegers¹, N K Aaronson⁴, P B Jacobsen⁵, R U Newton⁶, K S Courneya⁷, J F Aitken^{8

9

10}, J Armes¹¹, C Arving¹², L J Boersma^{13

14}, A M J Braamse¹⁵, Y Brandberg¹⁶, S K Chambers^{8

9

17}, J Dekker^{18

19}, K Ell²⁰, R J Ferguson²¹, M F M Gielissen¹⁵, B Glimelius¹², M M Goedendorp²², K D Graves²³, S P Heiney²⁴, R Horne²⁵, M S Hunter²⁶, B Johansson¹², M L Kimman²⁷, H Knoop¹⁵, K Meneses²⁸, L L Northouse²⁹, H S Oldenburg³⁰, J B Prins³¹, J Savard³², M van Beurden³³, S W van den Berg³¹, J Brug^{1

34}, L M Buffart^{1

6

35}

Affiliations

¹ Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
² Department of Clinical Psychology, VU University Amsterdam, The Netherlands.
³ Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health research institute and Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
⁴ Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
⁵ Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, Maryland, FL, USA.
⁶ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
⁷ Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada.
⁸ Menzies Health Institute Queensland, Griffith University, Southport, Australia.
⁹ Cancer Council Queensland, Brisbane, Australia.
¹⁰ Institute for Resilient Regions, University of Southern Queensland, Brisbane, Australia.
¹¹ Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
¹² Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
¹³ Department of Radiation Oncology, Maastricht University Medical Center (MAASTRO clinic), Maastricht, The Netherlands.
¹⁴ GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
¹⁵ Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands.
¹⁶ Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
¹⁷ Prostate Cancer Foundation of Australia, Sydney, NSW, Australia.
¹⁸ Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
¹⁹ Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
²⁰ Department of Adults and Healthy Aging, University of Southern California, Los Angeles, CA, USA.
²¹ Division of Hematology-Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
²² Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
²³ Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
²⁴ College of Nursing, University of South Carolina, Columbia, SC, USA.
²⁵ UCL School of Pharmacy, University College London, London, UK.
²⁶ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
²⁷ Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands.
²⁸ University of Alabama at Birmingham, School of Nursing, Birmingham, AL, USA.
²⁹ University of Michigan School of Nursing, Ann Arbor, MI, USA.
³⁰ Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
³¹ Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands.
³² School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, QC, Canada.
³³ Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
³⁴ Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands.
³⁵ Department of Medical Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.

PMID: 29361206
PMCID: PMC5947559
DOI: 10.1002/pon.4648

Review

Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs

J Kalter et al. Psychooncology. 2018 Apr.

. 2018 Apr;27(4):1150-1161.

doi: 10.1002/pon.4648. Epub 2018 Mar 15.

Authors

Affiliations

¹ Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.
² Department of Clinical Psychology, VU University Amsterdam, The Netherlands.
³ Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health research institute and Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.
⁴ Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
⁵ Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, Maryland, FL, USA.
⁶ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
⁷ Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada.
⁸ Menzies Health Institute Queensland, Griffith University, Southport, Australia.
⁹ Cancer Council Queensland, Brisbane, Australia.
¹⁰ Institute for Resilient Regions, University of Southern Queensland, Brisbane, Australia.
¹¹ Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
¹² Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
¹³ Department of Radiation Oncology, Maastricht University Medical Center (MAASTRO clinic), Maastricht, The Netherlands.
¹⁴ GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands.
¹⁵ Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands.
¹⁶ Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden.
¹⁷ Prostate Cancer Foundation of Australia, Sydney, NSW, Australia.
¹⁸ Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.
¹⁹ Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
²⁰ Department of Adults and Healthy Aging, University of Southern California, Los Angeles, CA, USA.
²¹ Division of Hematology-Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
²² Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
²³ Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA.
²⁴ College of Nursing, University of South Carolina, Columbia, SC, USA.
²⁵ UCL School of Pharmacy, University College London, London, UK.
²⁶ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
²⁷ Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands.
²⁸ University of Alabama at Birmingham, School of Nursing, Birmingham, AL, USA.
²⁹ University of Michigan School of Nursing, Ann Arbor, MI, USA.
³⁰ Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
³¹ Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands.
³² School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, QC, Canada.
³³ Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
³⁴ Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands.
³⁵ Department of Medical Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.

PMID: 29361206
PMCID: PMC5947559
DOI: 10.1002/pon.4648

Abstract

Objective: This individual patient data (IPD) meta-analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention-related characteristics.

Methods: Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed-effect model analyses were used to study intervention effects on the post-intervention values of QoL, EF, and SF (z-scores), adjusting for baseline values, age, and cancer type. We studied moderator effects by testing interactions with the intervention for demographic, clinical, personal, and intervention-related characteristics, and conducted subsequent stratified analyses for significant moderator variables.

Results: PSI significantly improved QoL (β = 0.14,95%CI = 0.06;0.21), EF (β = 0.13,95%CI = 0.05;0.20), and SF (β = 0.10,95%CI = 0.03;0.18). Significant differences in effects of different types of PSI were found, with largest effects of psychotherapy. The effects of coping skills training were moderated by age, treatment type, and targeted interventions. Effects of psychotherapy on EF may be moderated by cancer type, but these analyses were based on 2 randomized controlled trials with small sample sizes of some cancer types.

Conclusions: PSI significantly improved QoL, EF, and SF, with small overall effects. However, the effects differed by several demographic, clinical, personal, and intervention-related characteristics. Our study highlights the beneficial effects of coping skills training in patients treated with chemotherapy, the importance of targeted interventions, and the need of developing interventions tailored to the specific needs of elderly patients.

Keywords: coping skills training; individual patient data meta-analysis; neoplasm; psychosocial care; psychotherapy; quality of life.

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Figures

**Figure 1**
Flowchart of inclusion of randomized controlled trials (RCTs) in the POLARIS study. For this study on the effects and moderators of psychosocial interventions, individual patient data (IPD) of 22 RCTs were available. PA, physical activity interventions; PI, principal investigator; PSI, psychosocial interventions

See this image and copyright information in PMC

References

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1. Linden W, Girgis A. Psychological treatment outcomes for cancer patients: what do meta‐analyses tell us about distress reduction? Psychooncology. 2012;21(4):343‐350. - PubMed

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Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs

Affiliations

Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs

Authors

Affiliations

Abstract

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References

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LinkOut - more resources

Full Text Sources

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Medical