Galway, K., Black, A., Cantwell, M., Cardwell, C.R., Mills, M., & Donnelly, M. (2012). Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients. Cochrane Database of Systematic Reviews, 11, CD007064.

To assess the effects of psychosocial interventions on quality of life and mood symptoms in patients diagnosed with cancer within the past 12 months

• Databases searched, up to January 2011, were Cochrane Central Register, MEDLINE EMBASE, CINAHL, and PsycINFO.
• Authors provided an extensive listing of keywords and specific search strategies.
• To be included, studies had to
  • Be randomized controlled trials (RCTs) or quasi-RCTs involving interpersonal dialog between a trained helper and individual newly diagnosed patients with cancer.
  • Measure quality of life and general psychological distress.
  • Include control groups that received standard care only.
• Authors excluded trials involving a combination of psychosocial and pharmacologic interventions, as well as group- and couples-based interventions.

• A total of 3,272 references were retrieved.
• Quality evaluation used criteria specified in the review for random allocation and allocation concealment, blinding, loss to follow-up, and assessment of reporting bias.

• Authors chose 30 trials to include, with 20 included in the meta-analysis.
• The sample range across studies was 17–558, with a total sample across studies of 5,155.
• All studies involved patients diagnosed within the past 12 months only.
• Disease types included breast, colon, gastric, skin, prostate, and testicular cancers as well as, in some mixed trials, a few others.
• All participants were adult patients.

Multiple phases of care

• Anxiety outcomes were evaluated in four studies, depression outcomes were evaluated in six studies, and mood measures were evaluated in eight studies.
• Analysis of studies involving mood measures resulted in a standard mean difference (SMD) of –0.81 (95% CI, 1.44, –0.18, p = 0.01) in favor of the intervention.
• Analysis of quality-of-life outcomes showed mixed results with cognitive behavioral therapy, positive findings in favor of psychoeducational interventions (SMD = 0.29, 95% CI, 0.05, 0.54, p = 0.02), and no significant effects of counseling. Nurse-delivered interventions showed a significant positive effect (SMD = 0.23, 95% CI, 0.04, 0.43, p = 0.02) for quality of life. Interventions provided by a psychologist; general practitioner; and combined nurse, social worker, or others did not demonstrate significant effects.
• No meta-analysis addressed the outcomes of anxiety or depression only.
• Many studies were of relatively low quality, and the studies included substantial heterogeneity.

Findings suggest that psychosocial interventions have a positive impact on quality of life among newly diagnosed patients with cancer. Psychoeducational interventions and nurse-delivered interventions demonstrate a small significant effect across combined trials. Overall evidence does not indicate that individual psychosocial interventions are effective at improving the mood- and quality-of-life–related symptoms of patients newly diagnosed with cancer.

A small number of studies in meta-analysis related to mood changes. Effect sizes in mood changes were small, and study samples comprised high heterogeneity, demonstrating that findings should be interpreted with some caution in terms of clinical relevance.

The fact that nurse-delivered psychosocial interventions demonstrated a positive and statistically significant effect is promising, although the effect size was small. This finding provides some support for interventions delivered by nurses rather than by other healthcare professionals. Other studies have reported this finding. Nurses may be uniquely positioned to provide such interventions: Their knowledge base includes both physiologic and psychosocial components of the cancer experience, and individual interventions can simultaneously and effectively address physical and psychosocial symptom management. The findings of this study provide general support for the effectiveness of psychoeducational interventions.