Are psychological interventions effective on anxiety in cancer patients? A systematic review and meta‐analyses

Sanjida, Saira; McPhail, Steven; Shaw, Joanne; Couper, Jeremy; Kissane, David W.; Price, Melanie A.; Janda, Monika

doi:10.1002/pon.4794

Cited by 56 publications

(44 citation statements)

References 111 publications

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“…Currently, screening is recommended in clinical practice as well as for trial recruitment, but in our trial screening (which was part of standard care) proved little effective in terms of detecting individuals with care needs. Only 1.0% of the approached individuals participated in the RCT.…”

Section: Discussionmentioning

confidence: 95%

“…As a means to reflect on reasons why an RCT following high‐quality methodological standards failed to work in clinical practice, this observational study examined the reasons for nonparticipation in the RCT and the demographic and medical characteristics of depressed survivors that did (not) participate. Cancer survivors in our trial were consecutively screened on depressive symptoms as a part of standard care, as recommended by the current clinical screening guidelines and regarded as a quality standard in setting up an RCT . Yet, the screening procedure was not efficient (ie, resulting in low uptake).…”

Section: Introductionmentioning

confidence: 99%

“…Cancer survivors in our trial were consecutively screened on depressive symptoms as a part of standard care, as recommended by the current clinical screening guidelines 7,8 and regarded as a quality standard in setting up an RCT. 14,15 Yet, the screening procedure was not efficient (ie, resulting in low uptake). Findings of our study may therefore add to the debate regarding the feasibility and efficiency of current screening guidelines for identifying patients in need for care.…”

Section: Introductionmentioning

confidence: 99%

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Reasons for low uptake of a psychological intervention offered to cancer survivors with elevated depressive symptoms

et al. 2019

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Objective In line with screening guidelines, cancer survivors were consecutively screened on depressive symptoms (as part of standard care), with those reporting elevated levels of symptoms offered psychological care as part of a trial. Because of the low uptake, no conclusions could be drawn about the interventions' efficacy. Given the trial set‐up (following screening guidelines and strict methodological quality criteria), we believe that this observational study reporting the flow of participation, reasons for and characteristics associated with nonparticipation, adds to the debate about the feasibility and efficiency of screening guidelines. Methods Two thousand six hundred eight medium‐ to long‐term cancer survivors were consecutively screened on depressive symptoms using the Patient Health Questionnaire‐9 (PHQ‐9). Those with moderate depressive symptoms (PHQ‐9 ≥ 10) were contacted and informed about the trial. Patient flow and reasons for nonparticipation were carefully monitored. Results One thousand thirty seven survivors (74.3%) returned the questionnaire, with 147 (7.6%) reporting moderate depressive symptoms. Of this group, 49 survivors (33.3%) were ineligible, including 26 survivors (17.7%) already receiving treatment and another 44 survivors (30.0%) reporting no need for treatment. Only 25 survivors (1.0%) participated in the trial. Conclusion Of the approached survivors for screening, only 1% was eligible and interested in receiving psychological care as part of our trial. Four reasons for nonparticipation were: nonresponse to screening, low levels of depressive symptoms, no need, or already receiving care. Our findings question whether to spend the limited resources in psycho‐oncological care on following screening guidelines and the efficiency of using consecutive screening for trial recruitment in cancer survivors.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Reasons for low uptake of a psychological intervention offered to cancer survivors with elevated depressive symptoms

et al. 2019

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“…This is in the context of consent rates that, while varied, had a median of less than a third of those approached across the studies, meaning that while many caregivers were eligible, this did not translate to enrolment. A recent systematic review and meta‐analysis exploring the efficacy of psychological interventions on anxiety in cancer patients found that low psychological distress at baseline was a key reason for low effectiveness, with authors advocating for screening and assessment of anxiety as an inclusion criterion before enrolment in psychological interventions . Caregivers not experiencing a problem may have low motivation to spend time in an intervention study they see as not relevant to their situation.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review and meta-analysis exploring the efficacy of psychological interventions on anxiety in cancer patients found that low psychological distress at baseline was a key reason for low effectiveness, with authors advocating for screening and assessment of anxiety as an inclusion criterion before enrolment in psychological interventions. 63 Caregivers not experiencing a problem may have low motivation to spend time in an intervention study they see as not relevant to their situation. Others have noted the need to increased research for vulnerable caregiving populations and risk stratification to target those most in need of support.…”

Section: Discussionmentioning

confidence: 99%

A systematic review of cancer caregiver interventions: Appraising the potential for implementation of evidence into practice

et al. 2019

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Objective nformal caregivers provide substantial support for people living with cancer. Previous systematic reviews report on the efficacy of cancer caregiver interventions but not their potential to be implemented. The aim of this systematic review was to explore the potential for cancer caregiver interventions to be implemented into practice. Methods We searched three electronic databases to identify cancer caregiver interventions on 5 January 2018. We operationalised six implementation outcomes (acceptability, adoption, appropriateness, feasibility, fidelity, and costs) into a tool to guide data extraction. Results The search yielded 33 papers (27 papers from electronic databases and six papers from other sources) reporting on 26 studies that met review criteria. Fewer than half the studies (46%) contained evidence about the acceptability of interventions from caregivers' perspectives; only two studies (8%) included interventions developed with input from caregivers. Two studies (8%) addressed potential adoption of interventions, and no studies discussed intentions, agreement, or action to implement interventions into practice. All studies reported on intervention appropriateness by providing a rationale for the interventions. For feasibility, on average less than one‐third of caregivers who were eligible to be involved consented to participate. On fidelity, whether interventions were conducted as intended was reported in 62% of studies. Cost data were reported in terms of intervention delivery, requiring a median time commitment of staff of 180 minutes to be delivered. Conclusions Caregiver intervention studies lack components of study design and reporting that could bridge the gap between research and practice. There is enormous potential for improvements in cancer caregiver intervention study design to plan for future implementation.

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Effectiveness of a Psychosocial Care Quality Improvement Strategy to Address Quality of Life in Patients With Cancer

Caminiti

Annunziata²,

Verusio

et al. 2021

JAMA Netw Open

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IMPORTANCEMany patients with cancer who would benefit from psychosocial care do not receive it. Implementation strategies may favor the integration of psychosocial care into practice and improve patient outcomes. OBJECTIVE To evaluate the effectiveness of the Humanization in Cancer Care (HuCare) Quality Improvement Strategy vs standard care as improvement of at least 1 of 2 domains (emotional or social function) of patient health-related quality of life at baseline and 3 months. A key secondary aim included investigation of the long-term effect. DESIGN, SETTING, AND PARTICIPANTS HuCare2 was a multicenter, incomplete, stepped-wedge cluster randomized clinical trial, conducted from May 30, 2016, to August 28, 2019, in three 5-center clusters of cancer centers representative of hospital size and geographic location in Italy. The study was divided into 5 equally spaced epochs. Implementation sequence was defined by a blinded statistician; the nature of the intervention precluded blinding for clinical staff. Participants included consecutive adult outpatients with newly diagnosed cancer of any type and stage starting medical cancer treatment. INTERVENTIONS The HuCare Quality Improvement Strategy comprised (1) clinician communication training, (2) on-site visits for context analysis and problem-solving, and (3) implementation of 6 evidence-based recommendations. MAIN OUTCOMES AND MEASURES The primary outcome was the difference between the means of changes of individual scores in emotional or social functions of health-related quality of life detected at baseline and 3-month follow-up (within each group) and during the postintervention epoch compared with control periods (between groups). Long-term effect of the intervention (at 12 months) was assessed as a secondary outcome. Intention-to-treat analysis was used. RESULTS A total of 762 patients (475 [62.3%] women) were enrolled (400 HuCare Quality Improvement Strategy and 362 usual care); mean (SD) age was 61.4 (13.1) years. The HuCare Quality Improvement Strategy significantly improved emotional function during treatment (odds ratio [OR],1.13; 95% CI, 1.04-1.22; P = .008) but not social function (OR, 0.99; 95% CI, 0.89-1.09; P = .80).Effect on emotional function persisted at 12 months (OR, 1.05; 95% CI, 1.00-1.10; P = .04). CONCLUSIONS AND RELEVANCEIn this trial, the HuCare Quality Improvement Strategy significantly improved the emotional function aspect of health-related quality of life during cancer treatment and at 12 months, indicating a change in clinician behavior and in ward organization. These (continued) Key Points Question Does an implementation strategy integrating psychosocial care into cancer centers improve at least 1 of 2 domains (emotional or social function) of health-related quality of life? Findings This stepped-wedge cluster randomized clinical trial included 762 patients with cancer at high risk for reduced quality of life. Health-related quality of life score improved from baseline to 3 months among participants in the Humanization in Cancer Care ...

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Are psychological interventions effective on anxiety in cancer patients? A systematic review and meta‐analyses

Cited by 56 publications

References 111 publications

Reasons for low uptake of a psychological intervention offered to cancer survivors with elevated depressive symptoms

Reasons for low uptake of a psychological intervention offered to cancer survivors with elevated depressive symptoms

A systematic review of cancer caregiver interventions: Appraising the potential for implementation of evidence into practice

Effectiveness of a Psychosocial Care Quality Improvement Strategy to Address Quality of Life in Patients With Cancer

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