Hines, S., Ramis, M.A., Pike, S., & Chang, A.M. (2014). The effectiveness of psychosocial interventions for cognitive dysfunction in cancer patients who have received chemotherapy: A systematic review. Worldviews on Evidence-Based Nursing, 11, 187–193.

DOI Link

doi: 10.1111/wvn.12042

Purpose

STUDY PURPOSE: To determine the effectiveness of psychosocial interventions for chemotherapy-related cognitive dysfunction (CRCD)

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: Published literature including Cochrane Central, PsycInfo, PsycArticles, CINAHL, PubMed, Biomed, APAIS Health (Informit), Academic Search Elite, and EMBASE; unpublished studies including ProQuest Dissertations and Theses, Grey Literature Report, PsycEXTRA, Mednar, and direct communication with researchers

KEYWORDS: Search terms were not iterated in this article but were specified in the JBL Library of Systematic Reviews as (a) cancer or neoplasm or tumor and cognition or memory or concentration and antineoplastic agent or chemo or drug and psychosocial, and (b) neoplasms and cognition or cognition disorders and antineoplastic agent and psychology, social.

INCLUSION CRITERIA: Studies were included if participants were ≥ 18 years of age, diagnosed with any type of cancer, and received chemotherapy as a component of treatment either during or before the intervention. Interventions included cognitive behavioral training, psychological counseling, and education on compensatory techniques. Published and unpublished studies between 1985 and 2010 were included. Studies were determined to meet quality criteria if they were randomized, contained blinded participants or outcome assessors, used intention-to-treat analyses, and reported data for all measured outcomes.

EXCLUSION CRITERIA: Studies with ill-described or absent methods were not included in this review.

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 122

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: The authors assessed articles for inclusion using a form based on Cochrane Collaboration recommendations. They assessed the articles chosen for inclusion for quality with standardized appraisal instruments (i.e., the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument [JBI-MAStARI]). No articles were included that ranked as having poor quality. Data were extracted with tools from the JBI-MAStARI. Results from two of the articles were pooled in a statistic meta-analysis (Review Manager 5.1, The Nordic Cochrane Centre, and The Cochrane Collaboration). Weighted mean differences and 95% confidence intervals were calculated for the continuous variables. A Chi-square test was used to assess heterogeneity. Narrative form was used when statistic pooling was not possible.

Sample Characteristics

FINAL NUMBER STUDIES INCLUDED = 6
TOTAL PATIENTS INCLUDED IN REVIEW = 812
KEY SAMPLE CHARACTERISTICS: Five studies (two ongoing at the time of publication) were designed to investigate cognitive behavioral training (CBT). One study involved an intervention based on CBT. A meta-analyses was conducted for two of the studies for which the authors provided additional data. Participants were primarily female, and the mean age range was 49.2–60.4 years.

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship

Results

Six studies were included. Five investigated CBT (two ongoing at the time of publication), and one involved a CBT-based neuropsychological intervention. CBT interventions were examined for concentration (n = 3) and memory (n = 4) in the systematic review. Low heterogeneity was noted (X2 = 0.00) for pooling trial results.

Concentration: The meta-analysis included two studies (Doorenbos et al., 2005; Given et al., 2004) indicating that CBT significantly reduced concentration problems at 20 weeks for intervention groups (p = 0.004). Only one study included 32-week assessment. Concentration results were not sustained (Doorenbos et al., 2005). The third CBT trial (Poppelreuter et al., 2009) demonstrated a significant improvement in concentration across two intervention groups and healthy controls at the completion of therapy (p < 0.001), but no sustained intervention effects were seen at a six-month follow-up (p = 0.09).

Memory: Differences between interventions and measurement outcomes prevented a meta-analysis (Ferguson et al., 2007; Ferguson et al., 2010; Given et al., 2008; Poppelreuter et al., 2009). Differences in initial memory were observed at the intervention's completion but were not sustained (Ferguson et al., 2010; Poppelreuter et al., 2009). Mixed results were seen for subjects receiving symptom advice for cognitive concerns through personal versus automated intervention approaches (Given et al., 2004), and no results were observed in a more rigorous second study by Ferguson et al. (2010).

Conclusions

The authors indicated that there was insufficient evidence to recommend these interventions and concluded that future research involving CBT interventions for CRCD are unlikely to yield different findings. However, this systematic review and meta-analysis is limited because CBT and neuropsychological interventions and instruments differed, resulting in the inability to pool results.

Limitations

The meta-analysis was conducted on only two studies.
More studies with long-term follow-up periods are needed to draw conclusions about the efficacy of CBT. Additional information regarding intervention descriptions, subject characteristics, and the instruments used for outcome measures are necessary to complete this review for comparison.

Nursing Implications

The authors indicated that additional research using CBT for CRCD is unlikely to indicate efficacy. However, this review was limited by the limited number of studies reviewed, its lack of longitudinal timepoints, and the differences between the CRCD interventions.

Legacy ID

5462