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.
Plain language summary
Individual therapy for people diagnosed with cancer
Cancer occurs in one in four of the population with over a quarter of a million people in the UK diagnosed each year (excluding non-melanoma skin cancer). A diagnosis of cancer can be emotionally challenging. UK government policy recommends that all individuals who are diagnosed with cancer should be assessed for emotional problems and given access to appropriate psychological support services. However, the nature and content of services and their delivery is unclear. This review examines the effectiveness of individual psychosocial interventions in the first 12 months after diagnosis. The psychosocial interventions involve a ‘trained helper’ providing therapeutic dialogue, sometimes referred to as talking therapy, with an individual diagnosed with cancer with the aim of improving quality of life and emotional wellbeing. The review combines research data from 1249 people who took part in clinical trials to test psychosocial interventions. The results are inconclusive. No improvement in general quality of life was found, but small improvements in ‘illness related’ quality of life were observed. No improvements in anxiety or depression were found, but small improvements in mood were detected. Nurse-led interventions using telephone and face-to-face delivery appear to show some promise. Future research should test assessment methods designed to identify patients who may benefit from psychosocial interventions, such as patients who are at risk of emotional problems; evaluate which type of ‘trained helper’ is the most appropriate professional to deliver psychosocial interventions for cancer patients; and conduct economic appraisals of the cost-effectiveness of interventions.
