This meta-analysis examined whether effects of psychosocial interventions on psychological distress in cancer patients are conditional upon pre-intervention distress levels. Published articles and unpublished dissertations between 1980 and 2005 were searched for interventions reporting the Hospital Anxiety and Depression Scale (HADS) or the Spielberger State-Trait Anxiety Inventory (STAI). Multilevel mixed-effects modeling was used to meta-analyze effect-sizes separately for the HADS (27 trials, 2424 patients) and STAI (34 trials, 2029 patients). Pre-intervention distress significantly moderated intervention effects, explaining up to 50% of the between-study effect-size variance: effects on anxiety and depression were generally negligible when pre-intervention distress was low and pronounced when it was high. These results could not be explained by differences in intervention type, setting, dose, and whether intervention was targeted at distressed patients. Psychosocial interventions may be most beneficial for cancer patients with elevated distress. Future research should identify which treatment components are most effective for these patients to facilitate optimal treatment tailoring and cost-effective health care. KeywordsAnxiety; depression; cancer; psychosocial; intervention; meta-analysis A considerable number of trials have tested psychosocial interventions designed to reduce emotional distress and improve the quality of life of adult cancer patients. The overall efficacy of these interventions is vigorously debated (Stefanek et al., 2006). Studies have yielded mixed results, and previous systematic and meta-analytic reviews have drawn disparate conclusions about whether psychosocial treatment is generally beneficial (Meyer and Mark, 1995;Rehse and Pukrop, 2003;Tatrow and Montgomery, 2006) or ineffective Newell et al., 2002) in reducing distress among cancer patients. Thus, it appears crucial to examine potential determinants of differential treatment efficacy, that is, to identify for whom and under what conditions interventions prove successful or not (King et al., 2008).Intervention studies have commonly included cancer patients regardless of their current emotional well-being Sheard and Maguire, 1999). However, there is substantial heterogeneity in the psychological sequelae of cancer diagnosis. While 20-40% of patients show clinically meaningful anxiety and depression, many report only transient emotional disruption and overall adjust quite well to the illness (van't Spijker et al., 1997;Zabora et al., 2001). For that reason, it has been argued that the efficacy of intervention might well increase if it was selectively provided for those who are most in need because they Sheard and Maguire, 1999;Stanton, 2005).In recent years, evidence has emerged suggesting greater benefits of psychosocial interventions among patients who show elevated distress (Andersen et al., 2004;Boesen et al., 2005;Carmack Taylor et al., 2007;Given et al., 2004;Goodwin et al., 2001;Taylor et al., 2003) or lack psychoso...

Objective-To evaluate the effectiveness of tailored interventions, designed to reach one specific person based on her unique characteristics, for promoting mammography use.Method-This systematic review used meta-analytic techniques to aggregate the effect size of 28 studies published from 1997 through 2005. Potential study-level moderators of outcomes (sample, intervention, and methodological characteristics) were also examined.Results-A small but significant aggregate odds ratio effect size of 1.42 indicated that women exposed to tailored interventions were significantly more likely to get a mammogram (p < 0.001).The type of population recruited and participants' pre-intervention level of mammography adherence did not significantly influence this effect. Tailored interventions that used the Health Belief Model and included a physician recommendation produced the strongest effects. Interventions delivered in person, by telephone, or in print were similarly effective. Finally, defining adherence as a single recent mammogram as opposed to regular or repeated mammograms yielded higher effect sizes. Tailored interventions, particularly those that employ the Health Belief Model and use a physician recommendation, are effective in promoting mammography screening. Future investigations should strive to use more standardized definitions of tailoring and assessments of mammography outcomes. Conclusion-

Proactive coping, directed at an upcoming as opposed to an ongoing stressor, is a new focus in positive psychology research. However, two differing conceptualizations of this construct create confusion. This study compared how each operationalization of proactive coping relates to well-being. Participants (N = 281) facing an upcoming college examination completed the Proactive Coping Inventory (PCI; consisting of two subscales that each assess one of the conceptualizations), the Proactive Competence Scale (PCS; that assesses the proactive coping process), and measures of well-being. The results demonstrated that conceptualizing proactive coping as a positively-focused striving for goals was predictive of well-being (the shared variance from affect, subjective well-being and physical symptoms), whereas conceptualizing proactive coping as focused on preventing a negative future was not. The first conceptualization of proactive coping’s unique association with well-being was explained by two of the proactive competencies, use of resources and realistic goal setting, and the remaining variance in well-being was explained by the first factor of optimism. These results demonstrated that aspiring for a positive future is distinctly predictive of well-being and that research should focus on accumulating resources and goal setting in designing interventions to promote proactive coping.

Background Cancer survivors may experience posttraumatic growth (PTG), positive psychological changes resulting from highly stressful events; however, the longitudinal course of PTG is poorly understood. Purpose To determine trajectories of PTG in breast cancer survivors and associated characteristics. Methods Women (N=653) participating in a longitudinal observational study completed questionnaires within 8 months of breast cancer diagnosis and 6, 12, and 18 months later. Group-based modeling identified PTG trajectories. Chi-square tests and ANOVA detected group differences in demographic, medical and psychosocial variables. Results Six trajectory groups emerged. Three were stable at different levels of PTG, two increased modestly, and one increased substantially over time. Trajectory groups differed by age, race, receipt of chemotherapy, illness intrusiveness, depressive symptoms, active-adaptive coping, and social support. Conclusions This first examination of PTG trajectories in US cancer survivors elucidates heterogeneity in longitudinal patterns of PTG. Future research should determine whether other samples exhibit similar trajectories and whether various PTG trajectories predict mental and physical health outcomes.

The considerable amount of research examining psychosocial interventions for cancer patients makes it important to examine its scope and methodological quality. This comprehensive overview characterizes the field with as few exclusions as possible. A systematic search strategy identified 673 reports comprising 488 unique projects conducted over a 25-year time span. Although the literature on this topic has grown over time, the research was predominantly conducted in the United States (57.0%), largely with breast cancer patients (included in 70.5% of the studies). The intervention approach used most frequently was cognitive behavioral (32.4%), the treatment goal was often improving quality of life generally (69.5%), and the professionals delivering the interventions were typically nurses (29.1%) or psychologists (22.7%). Overall, there was some discrepancy between the types of interventions studied and the types of supportive services available to and sought by cancer patients. Strengths of this research include using randomized designs (62.9%), testing for baseline group equivalence (84.5%), and monitoring treatment, which rose significantly from being used in 48.1% to 64.4% of projects over time. However, deficiencies in such areas as examining treatment mechanisms and the adequacy of reporting of methodology, essential for useful syntheses of research on these interventions, remain to be addressed. Methodological challenges related to the complexity of this applied research, such as participants seeking treatment outside of research, contamination, and reactions to randomization, also were apparent. Future research could benefit from closer interactions between academic and voluntary sectors and expanding the diversity of participants. Key termscancer; psychosocial; intervention; treatment; quality of life Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptCancer Treat Rev. Author manuscript; available in PMC 2010 August 1. Interventions for Cancer PatientsAt most recent report, more than 11 million Americans were living with cancer. 1 Cancer's diagnosis, treatment, and aftermath present challenges that can contribute to psychological morbidity and can compromise quality of life. Diagnosis involves many stressors and can provoke worries about functioning, social value, finances, burden on one's family, and death. 2,3 Cancer treatments produce side effects, such as fatigue, nausea, and changes in appearance and functioning that can be difficult to cope with. [4][5][6][7] After treatment is complete, stressors involve continued med...

Response expectancies, defined as expectations for nonvolitional responses, have been proposed to contribute to the experience of side effects of cancer and its treatment. To statistically evaluate this association, a systematic search of the published literature was conducted, resulting in fourteen studies appropriate for meta-analysis. Results revealed a significant (Z = 6.58, P < 0.001) mediumsized (r = 0.36) association between patients' response expectancies for cancer treatment-related side effects and the experience of these side effects. Assessment of response expectancies with reference to the time the treatment-related side effect would occur resulted in larger effect sizes than when such temporal specificity in assessment was not included, Q(1) = 10.27, P < 0.01. AU: SHOULD THIS BE 0.01? In your original, it was just 01. Effect sizes were also moderated by patients' prior experience with cancer treatment, Q(1) = 18.91, P = 0.001, such that prior experience led to stronger associations between response expectancies and side effects than no prior experience. Relationships between response expectancies and pain, fatigue, nausea and vomiting were explored. Effect sizes did not differ between side effects, with the exception that the relationship was significantly stronger for pain than for vomiting (P < 0.05). Overall, these results support the contribution of response expectancies to cancer treatment-related side effects. Additionally, the results support the conduct of research on interventions to alter response expectancies, with the goal of reducing side effects and improving patient quality of life.

Purpose Reviews of yoga research that distinguish results of trials conducted during (versus after) cancer treatment are needed to guide future research and clinical practice. We therefore conducted a review of non-randomized studies and randomized controlled trials of yoga interventions for children and adults undergoing treatment for any cancer type. Methods Studies were identified via research databases and reference lists. Inclusion criteria: (1) children or adults undergoing cancer treatment; (2) intervention stated as yoga or component of yoga; and (3) publication in English in peer-reviewed journals through October 2015. Exclusion criteria: (1) samples receiving hormone therapy only; (2) interventions involving only meditation; and (3) yoga delivered within broader cancer recovery or mindfulness-based stress reduction programs. Results Results of non-randomized (adult: n=8, pediatric: n=4) and randomized controlled trials (adult: n=13, pediatric: n=0) conducted during cancer treatment are summarized separately by age group. Findings most consistently support improvement in psychological outcomes (e.g., depression, distress, anxiety). Several studies also found that yoga enhanced quality of life, though further investigation is needed to clarify domain-specific efficacy (e.g., physical, social, cancer-specific). Regarding physical and biomedical outcomes, evidence increasingly suggests that yoga ameliorates sleep and fatigue; additional research is needed to advance preliminary findings for other treatment sequelae and stress/immunity biomarkers. Conclusions Among adults undergoing cancer treatment, evidence supports recommending yoga for improving psychological outcomes, with potential for also improving physical symptoms. Evidence is insufficient to evaluate the efficacy of yoga in pediatric oncology. We describe suggestions for strengthening yoga research methodology to inform clinical practice guidelines.

Because yoga is increasingly recognized as a complementary approach to cancer symptom management, patients/survivors and providers need to understand its potential benefits and limitations both during and after treatment. The authors reviewed randomized controlled trials (RCTs) of yoga conducted at these points in the cancer continuum (N = 29; n = 13 during treatment, n = 12 post‐treatment, and n = 4 with mixed samples). Findings both during and after treatment demonstrated the efficacy of yoga to improve overall quality of life (QOL), with improvement in subdomains of QOL varying across studies. Fatigue was the most commonly measured outcome, and most RCTs conducted during or after cancer treatment reported improvements in fatigue. Results also suggested that yoga can improve stress/distress during treatment and post‐treatment disturbances in sleep and cognition. Several RCTs provided evidence that yoga may improve biomarkers of stress, inflammation, and immune function. Outcomes with limited or mixed findings (eg, anxiety, depression, pain, cancer‐specific symptoms, such as lymphedema) and positive psychological outcomes (such as benefit‐finding and life satisfaction) warrant further study. Important future directions for yoga research in oncology include: enrolling participants with cancer types other than breast, standardizing self‐report assessments, increasing the use of active control groups and objective measures, and addressing the heterogeneity of yoga interventions, which vary in type, key components (movement, meditation, breathing), dose, and delivery mode.