Meta-analysis of the effects of psychosocial interventions on survival time in cancer patients

Smedslund, Geir; Ringdal, Gerd Inger

doi:10.1016/s0022-3999(03)00575-0

Cited by 101 publications

(60 citation statements)

References 51 publications

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“…While most studies show psychological benefit, especially for those who are anxious or depressed, an editorial by Speigel in 2001 reported that only 5 out of 10 published intervention trials showed that various forms of psychotherapy prolonged survival [12]. A later meta-analysis of 14 controlled intervention trials [13] showed inconclusive results, and therefore a definite conclusion about whether psychosocial interventions prolong cancer survival seemed premature. Three of these studies showed a benefit for individual treatment, while six studies suggested that group treatments were ineffective.…”

Section: Discussionmentioning

confidence: 99%

Influence of psychological response on breast cancer survival: 10-year follow-up of a population-based cohort

Watson

Homewood

Haviland

et al. 2005

European Journal of Cancer

172

120

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The possibility that psychological response within a few weeks of a breast cancer diagnosis can influence the outcome of the disease is a contentious issue. Psychological response, including helplessness/hopelessness, fighting spirit and depression was assessed in early-stage breast cancer patients between 1 and 3 months post-diagnosis, in order to ascertain effect on cancer prognosis. Patients were followed up for a period of 10 years in order to clarify the effect of psychological response on disease outcome. After 10 years, there is a continuing effect of helplessness/hopelessness on disease-free survival (adjusted hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.11-2.11) but not of depression (adjusted HR for overall survival for ÔcasesÕ 2.43, 95% CI 0.97-6.10). Longer follow-up also indicates that a high fighting spirit confers no survival advantage. The results showed that, in patients who were disease-free at 5 years, their baseline helpless/hopeless response still exerted a significant effect on disease-free survival beyond 5 (and up to 10) years. The effect is therefore maintained for up to 10 years of follow-up. Clinicians may wish to screen for helplessness around the time of diagnosis in order to target psychological care resources. Further large studies, with similarly prolonged follow-up, are needed to replicate this effect and clarify its mechanism of action.

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Section: Discussionmentioning

confidence: 99%

Influence of psychological response on breast cancer survival: 10-year follow-up of a population-based cohort

Watson

Homewood

Haviland

et al. 2005

European Journal of Cancer

172

120

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“…Fortunately, cancer survivors receiving psychosocial interventions have shown improved immune function (63)(64)(65) and lower recurrence rates (61,66,67). The impact of such interventions on survival remains inconclusive (68).…”

Section: Psychological Risk Factors For Adverse Late Effectsmentioning

confidence: 99%

Survivors at Higher Risk for Adverse Late Outcomes Due to Psychosocial and Behavioral Risk Factors

Carmack

Basen-Engquist

Gritz

2011

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Cancer survivors face significant morbidity and mortality associated with their disease and treatment regimens, some of which can be improved through modifying behavioral and psychosocial risk factors. This article examines risk factors for adverse late effects that contribute to morbidity and mortality in cancer survivors, provides a literature review on interventions to modify these risks factors, and summarizes the national recommendations and associated current practices for identifying and managing these risk factors. Finally, future directions for research and clinical practice are discussed. Cancer Epidemiol Biomarkers Prev; 20(10); 2068-77. Ó2011 AACR.

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“…Roughly equal numbers of published trials show longer survival associated with psychosocial interventions or an absence of any associated survival benefit (6). Several factors have been identified that may contribute to this ambiguous body of data (3,5).…”

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confidence: 99%

Stress, Immunity, and Cervical Cancer: Biobehavioral Outcomes of a Randomized Clinical Trail

Nelson

Wenzel

Osann

et al. 2008

Clinical Cancer Research

131

100

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Purpose: Cancer diagnosis and treatment imparts chronic stressors affecting quality of life (QOL) and basic physiology. However, the capacity to increase survival by improving QOL is controversial. Patients with cervical cancer, in particular, have severely compromised QOL, providing a population well-suited for the evaluation of novel psychosocial interventions and the exploration of mechanisms by which modulation of the psychoneuroimmune axis might result in improved clinical outcomes. Experimental Design: A randomized clinical trial was conducted in cervical cancer survivors that were enrolled at z13 and <22 months after diagnosis (n = 50), comparing a unique psychosocial telephone counseling (PTC) intervention to usual care. QOL and biological specimens (saliva and blood) were collected at baseline and 4 months post-enrollment. Results: The PTC intervention yielded significantly improved QOL (P = 0.011). Changes in QOL were significantly associated with a shift of immune systemT helper type 1and 2 (Th1/Th2) bias, as measured by IFN-g/interleukin-5 ELISpot T lymphocyte precursor frequency; improved QOL being associated with increasedTh1bias (P = 0.012). Serum interleukin-10 and the neuroendocrine variables of cortisol and dehydroepiandrosterone revealed trends supporting this shift in immunologic stance and suggested a PTC-mediated decrease of the subject's chronic stress response. Conclusions: This study documents the utility of a unique PTC intervention and an association between changes in QOL and adaptive immunity (T helper class).These data support the integration of the chronic stress response into biobehavioral models of cancer survivorship and suggests a novel mechanistic hypotheses by which interventions leading to enhanced QOL could result in improved clinical outcome including survival.The association between cancer patient survival and performance status at diagnosis, i.e., baseline quality of life (QOL), is well documented. Patient-reported outcomes, broadly addressed as QOL variables, are now integral components of cancer clinical trials (1) and highlight opportunities for psychosocial interventions to improve these outcomes for patients with cancer. Whether effective psychosocial interventions improve both patient QOL and survival remains controversial (2 -10). Nevertheless, any potential cancerspecific survival benefit implies improved control of occult micrometastatic disease (11) and the immune system is a prime candidate effector for this biological antitumor activity. The recognition of cross-talk between neurologic, neuroendocrine, and immune systems has given rise to the concept of psychoneuroimmunology, the psychoneuroimmune axis, and the so-called ''mind-body '' connection (5, 12 -15). This conceptual framework provides a foundation for biobehavioral paradigms (16 -18) and for the postulation of potential mechanisms by which a psychosocial intervention might influence cancer patient survival (2,5,11,17,18).Various studies evaluating if psychosocial interventions could affect ...

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Meta-analysis of the effects of psychosocial interventions on survival time in cancer patients

Cited by 101 publications

References 51 publications

Influence of psychological response on breast cancer survival: 10-year follow-up of a population-based cohort

Influence of psychological response on breast cancer survival: 10-year follow-up of a population-based cohort

Survivors at Higher Risk for Adverse Late Outcomes Due to Psychosocial and Behavioral Risk Factors

Stress, Immunity, and Cervical Cancer: Biobehavioral Outcomes of a Randomized Clinical Trail

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