Chien, C.H., Liu, K.L., Chien, H.T., & Liu, H.E. (2013). The effects of psychosocial strategies on anxiety and depression of patients diagnosed with prostate cancer: A systematic review. International Journal of Nursing Studies.

To evaluate, by means of meta-analysis and systematic review, evidence regarding the effectiveness of psychosocial interventions for anxiety and depression in patients with prostate cancer

Databases searched were PubMed, CINAHL, PsycINFO, Cochrane Collaboration, and two Chinese databases.

A study was included in the review if it

• Was a randomized controlled trial
• Reported on patients with prostate cancer at any disease stage
• Compared psychosocial strategies to usual or standard care
• Measured anxiety and depression.

A study was excluded if it focused on disease other than prostate cancer and lacked intergroup comparison.

• A total of 8,144 references were retrieved.
• Researchers evaluated the quality of studies by using the Jadad scale.

• After evaluation, 14 studies, relating to a total of 1,484 patients, were included in the review.
• Sample range across studies/total patients included in the review was 36–400 patients.
• Patient age range was 60–76 years.
• In all but four studies, patients were newly diagnosed.

Patients were undergoing multiple phases of care.

• Interventions included education (n = 8), cognitive behavioral strategies (n = 6), counseling or psychotherapy (n = 1), and social support (n = 1).
• Analysis showed that psychosocial strategies did not have a significant immediate effect on reducing anxiety. After three months, there was a significant overall effect on reducing anxiety from two studies included in meta-analysis (SMD = –1.13, 95% CI –1.64, –0.63, p < 0.0001).
• Eight studies resulted in an overall positive effect on depression in the short term (SMD = –0.43, 95% CI –0.68, –0.18, p < 0.001). Three studies resulted in no significant effect at one-month follow-up. Across two studies, analysis showed a positive effect at three months (SMD = –0.78, 95% CI –1.54, –0.02, p = 0.04) in regard to reducing depression. There were no longer-term significant effects.
• All types of psychosocial interventions were analyzed together, with no separate analysis based on the type of intervention. Only 35.7% of studies were considered to be of high quality.

Findings suggest that psychosocial interventions can be helpful in reducing anxiety and depression, at various time points in the cancer trajectory, for men who are newly diagnosed with prostate cancer. Positive effects were generally short-term only.

• In studies examining effect on depression, depression levels were low, causing one to question the clinical relevance of statistically significant findings.
• No study required patients to have levels of depression that were clinically meaningful.
• Authors noted that the majority of studies were of low quality and with small sample size. These factors limit the confidence one can have in the findings.
• The analysis considered all types of very different interventions to be the same. This methodology did not allow researchers to determine the specific types of interventions that are truly most effective.
• Studies involved very different intervention types, different timing and frequency of intervention or follow-up, and multiple types of patient care settings. These factors make interpreting overall effectiveness difficult.

Findings of this analysis suggest that various types of psychosocial interventions can help reduce anxiety and depression in men with prostate cancer. Effects shown tended to be short-lived. Nurses can help reduce anxiety and depression among patients with prostate cancer by using psychosocial types of strategies. Information about ways to sustain this effect is limited, and the analysis does not identify the types of approaches that are the most helpful. Further exploration of longer-term sustainable effects and associated dosage and intervention frequency is needed. Given the relatively low level of quality of research in this area, more well-designed studies are needed.