Jacobsen, P.B., & Jim, H.S. (2008). Psychosocial interventions for anxiety and depression in adult cancer patients: Achievements and challenges. CA: A Cancer Journal for Clinicians, 58, 214–230.

DOI Link

Purpose

STUDY PURPOSE: To describe an evidence-based approach to the use of psychosocial interventions to manage anxiety and depression in adults with cancer

TYPE OF STUDY: Combined systematic review and meta-analysis

Search Strategy

DATABASES USED: MEDLINE and PsycINFO
 
INCLUSION CRITERIA: Existing systematic reviews and meta-analyses of the effects of psychosocial interventions on anxiety and depression in adults with cancer; clinical practice guidelines relevant to distress and psychosocial care of adults with cancer
 
EXCLUSION CRITERIA: Not listed

Literature Evaluated

TOTAL REFERENCES RETRIEVED: Initially, 14 systematic reviews and meta-analyses; randomized and nonrandomized studies of patients with cancer included
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: This literature was summarized in terms of the number of randomized controlled trials that demonstrated efficacy in managing anxiety or depression based on intervention type and patient disease or treatment status. Intervention recommendations with significant effects (p < 0.05) relative to control were presented. The NCCN Guidelines for Distress Management, and the National Breast Cancer Center and the National Cancer Control Initiative in Australia’s Clinical Practice Guidelines for the Psychosocial Care of Adults with Cancer (2003) were also reviewed.

Sample Characteristics

  • FINAL NUMBER OF STUDIES INCLUDED = 13
  • TOTAL PATIENTS INCLUDED IN REVIEW = Not stated
  • SAMPLE RANGE ACROSS STUDIES: Not described
  • KEY SAMPLE CHARACTERISTICS: Not described

Phase of Care and Clinical Applications

PHASE OF CARE: Active treatment

APPLICATIONS: Late effects and survivorship

Results

Nine of the 13 publications reached positive conclusions about the efficacy of psychosocial interventions for depression in patients with cancer. Positive supporting evidence yielded recommendations for behavioral therapy, counseling/psychotherapy, and either of these approaches combined with education, relaxation training for patients not undergoing surgery, and cognitive-behavioral therapy.  

Six of eight publications reached positive conclusions about the efficacy of psychosocial interventions for anxiety. Recommended are behavioral interventions for patients undergoing treatment, relaxation training for patients not undergoing surgery, and cognitive-behavioral therapy in the post-treatment period.

The authors provide examples of psychosocial interventions found to be effective using three considerations as guides. First, the interventions had to have been found superior to a control condition in a published randomized controlled trial. Second, the interventions must show good potential for dissemination (acceptable to patients, easy to implement, 12 sessions or less, and requiring no more than one mental health professional). Third, interventions that addressed common indications for preventing or managing anxiety or depression were sought. Five interventions were illustrated: 
  1. Psychoeducation for new patients with cancer reported significantly less anxiety and depressive symptoms (p < 0.001) as well as greater satisfaction with their care than usual care (p < 0.01).
  2. Patients randomized to problem-solving therapy demonstrated significantly less depression (p < 0.05), and results were maintained through a one-year follow-up period.
  3. Stress-management techniques of paced abdominal breathing, progressive muscle relaxation with guided imagery, and the use of coping self-statements were briefly taught and provided to patients via print and audiovisual materials prior to beginning chemotherapy. Significantly less anxiety and depression (p < 0.05) was found versus usual care.
  4. Cognitive therapy evaluated against a wait-list control in women with breast cancer who had clinically significant depressive symptoms demonstrated significantly less depression postintervention (p < 0.01), with even a further reduction occurring during the six-month follow-up period.
  5. Group cognitive-behavioral therapy was offered to early-stage breast cancer survivors post treatment; the efficacy of this intervention in an randomized controlled trial compared with no-intervention controls indicated that the intervention group reported significantly (p < 0.05) less depression immediately postintervention and at two-year follow-up.

Limitations

In “summarizing the summaries,” limitations include review differences in scope, methods used to summarize findings, and the manner in which recommendations were reached. 
 
Weaknesses found in nearly all the studies include:
  • Gaps regarding benefits of psychosocial interventions for diverse demographic, disease, and treatment characteristics. Men and ethnic and racial minorities were underrepresented, and most studies were based on several different types of cancer, usually early stage. 
  • Inconsistency in the evaluation of interventions, the number and timing of outcome assessments, and outcome measures used
  • Inadequate reporting of study methodology 
  • Lack of research on patients experiencing clinically significant anxiety or depression (most patients studied were experiencing low levels when recruited)

Nursing Implications

Future research is needed, particularly focusing on men, minorities, patients with advanced disease, and patients who have completed treatment. Studies must include patients experiencing significant depression and/or anxiety prior to intervention. Combinations of interventions should also be studied. Last, timing for screening and intervening is important, but current data specify only “vulnerable times” rather than evidence to guide practice.

Legacy ID

5931