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. 2023 Jul 6;22(1):88.
doi: 10.1186/s12904-023-01202-8.

Non-pharmacological interventions to manage psychological distress in patients living with cancer: a systematic review

Carole A Paley  1 , Jason W Boland  2 , Martina Santarelli  2 , Fliss E M Murtagh  2 , Lucy Ziegler  3 , Emma J Chapman  3
Affiliations

Non-pharmacological interventions to manage psychological distress in patients living with cancer: a systematic review

Carole A Paley et al. BMC Palliat Care. .

Abstract

Background: Psychological distress is common in patients with cancer; interfering with physical and psychological wellbeing, and hindering management of physical symptoms. Our aim was to systematically review published evidence on non-pharmacological interventions for cancer-related psychological distress, at all stages of the disease.

Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered on PROSPERO (CRD42022311729). Searches were made using eight online databases to identify studies meeting our inclusion criteria. Data were collected on outcome measures, modes of delivery, resources and evidence of efficacy. A meta-analysis was planned if data allowed. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT).

Results: Fifty-nine studies with 17,628 participants were included. One third of studies included mindfulness, talking or group therapies. Half of all studies reported statistically significant improvements in distress. Statistically significant intervention effects on distress were most prevalent for mindfulness techniques. Four of these mindfulness studies had moderate effect sizes (d = -0.71[95% CI: -1.04, -0.37] p < 0.001) (d = -0.60 [95% CI: -3.44, -0.89] p < 0.001) (d = -0.77 [CI: -0.146, -1.954] p < 0.01) (d = -0.69 [CI: -0.18, -1.19] p = 0.008) and one had a large effect size (d = -1.03 [95% CI: -1.51, -0.54] p < 0.001). Heterogeneity of studies precluded meta-analysis. Study quality was variable and some had a high risk of bias.

Conclusions: The majority of studies using a mindfulness intervention in this review are efficacious at alleviating distress. Mindfulness-including brief, self-administered interventions-merits further investigation, using adequately powered, high-quality studies.

Systematic review registration: This systematic review is registered on PROSPERO, number CRD42022311729.

Keywords: Distress; psychological distress; psychological intervention; neoplasms; palliative care; psychosocial oncology.

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Conflict of interest statement

FM is a National Institute for Health and Care Research (NIHR) Senior Investigator.

LZ is a RESOLVE research programme Chief Investigator.

All other authors declared no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram [34]
See this image and copyright information in PMC

References

    1. Huda N, Shaw MK, Chang HJ. Psychological Distress Among Patients With Advanced Cancer: A Conceptual Analysis. Cancer Nurs. 2022;45:E487–e503. doi: 10.1097/ncc.0000000000000940. - DOI - PubMed
    1. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Distress Management V.2.2023. © National Comprehensive Cancer Network, Inc. 2023. NCCN.org. Accessed 10 May 2023.
    1. LeBlanc TW, Kamal AH. Assessing psychological toxicity and patient-reported distress as the sixth vital sign in cancer care and clinical trials. AMA J Ethics. 2017;19:460–466. doi: 10.1001/journalofethics.2017.19.5.stas1-1705. - DOI - PubMed
    1. IPOS. IPOS international standard of quality cancer care, https://www.ipos-society.org/about/quality (2010). Accessed 19 July 2022.
    1. Watson M, Bultz BD. Distress, the 6th vital sign in cancer care. Psycho-Oncologie. 2010;4:159–163. doi: 10.1007/s11839-010-0269-z. - DOI

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