Effects of Psycho-Oncologic Interventions on Emotional Distress and Quality of Life in Adult Patients With Cancer: 

Systematic Review and Meta-Analysis

1. Hermann Faller⇓,Michael Schuler, Matthias Richard, Ulrike Heckl, Joachim Weis and
2. Roland Küffner

© 2013 by American Society of Clinical Oncology+ Author Affiliations

1. Hermann Faller, Michael Schuler, Matthias Richard, and Roland Küffner, University of Würzburg, Würzburg; and Ulrike Heckl and Joachim Weis, Tumor Biology Center, University of Freiburg, Freiburg, Germany.

1. Corresponding author: Hermann Faller, MD, PhD, Department of Medical Psychology, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken, University of Würzburg, Klinikstr. 3, D 97070 Würzburg, Germany; e-mail: h.faller@uni-wuerzburg.de.

1. Presented in part at the 30th Annual Meeting of the German Cancer Society, Berlin, Germany, February 22-25, 2012.

Abstract

Purpose This study aimed to evaluate the effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer.

Methods Literature databases were searched to identify randomized controlled trials that compared a psycho-oncologic intervention delivered face-to face with a control condition. The main outcome measures were emotional distress, anxiety, depression, and quality of life. Outcomes were evaluated for three time periods: post-treatment, ≤ 6 months, and more than 6 months. We applied standard meta-analytic techniques to analyze both published and unpublished data from the retrieved studies. Sensitivity analyses and meta-regression were used to explore reasons for heterogeneity.

Results We retrieved 198 studies (covering 22,238 patients) that report 218 treatment-control comparisons. Significant small-to-medium effects were observed for individual and group psychotherapy and psychoeducation. These effects were sustained, in part, in the medium term (≤ 6 months) and long term (> 6 months). Short-term effects were evident for relaxation training. Studies that preselected participants according to increased distress produced large effects at post-treatment. A moderator effect was found for the moderator variable “duration of the intervention,” with longer interventions producing more sustained effects. Indicators of study quality were often not reported. Small-sample bias indicative of possible publication bias was found for some effects, particularly with individual psychotherapy and relaxation training.

Conclusion 

Various types of psycho-oncologic interventions are associated with significant, small-to-medium effects on emotional distress and quality of life. 

These results should be interpreted with caution, however, because of the low quality of reporting in many of the trials.

Footnotes

• Supported in part by Grants No. 108883 and 110002 from German Cancer Aid, the German Cancer Society, and the Association of Scientific Medical Societies within the Research Program for the Development of Guidelines in Oncology.
• Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.