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.

To describe an evidence-based approach to using psychosocial interventions to manage anxiety and depression in adults with cancer

• Initially, authors included 14 systematic reviews and meta-analyses, including randomized and nonrandomized studies of patients with cancer. The final report included 13 studies. Literature was summarized in terms of randomized controlled trials (RCTs) that demonstrated efficacy, in managing anxiety or depression, based on intervention type and patient disease or treatment status.
• Authors presented intervention recommendations with significant (p < 0.05) effects relative to control.
• In addition, authors reviewed National Comprehensive Cancer Care Network (NCCN) Distress Management Guidelines and the clinical practice guidelines of Australia's National Breast Cancer Centre and the National Cancer Control Initiative's Practice Guidelines for the Psychosocial Care of Adults with Cancer (2003).
• The search strategy involved MEDLINE and PsychINFO resources. Authors did not list keywords.
• In addition, authors included existing systematic reviews and meta-analyses of effects of psychosocial interventions on anxiety and depression in adults with cancer and reviews of clinical practice guidelines relevant to distress and psychosocial care of adults with cancer. Exclusion criteria were not listed.

Authors provided examples of psychosocial interventions found to be effective. To be effective, the interventions

• Had to have been superior to a control condition in a published RCT
• Must have demonstrated good potential for dissemination
• Must have addressed common indications for preventing or managing anxiety or depression

Five interventions are illustrated:

• Psychoeducation for new patients with cancer, which resulted in significantly (p < 0.001) fewer symptoms of anxiety and depression as well as greater satisfaction (p < 0.01) with care provided than with usual care
• Patients randomized to problem-solving therapy, which demonstrated significantly (p < 0.05) less depression and maintained results through the one-year follow-up period
• Stress management techniques of paced abdominal breathing, progressive muscle relaxation with guided imagery, and the use of coping self-statements. These techniques yielded significantly less anxiety and depression (p < 0.05) than did usual care.
• Cognitive therapy evaluated against a wait-list control in breast cancer. Women who had clinically significant symptoms of depression demonstrated significantly (p < 0.01) less depression postintervention, with even further reduction occurring during the six-month follow-up period.
• Group cognitive-behavioral therapy for early-stage breast cancer survivors post-treatment, 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.

Nine of the 13 publications reached positive conclusions about the efficacy of psychosocial interventions for depression in patients with cancer. Positive supporting evidence recommends behavioral therapy, counseling or 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.

In “summarizing the summaries,” limitations included differences in the scope, methods, and manner of summarizing findings and determining recommendations.

Weaknesses found in nearly all the studies included

• Gaps regarding the 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 cancer.
• Inconsistency in the evaluation of interventions, number and timing of outcome assessments, and outcome measures used.
• Inadequate reporting of study methodology.
• Lack of research on patients who experience clinically significant anxiety or depression.

Future research should focus on men, minorities, patients with advanced disease, and those who have completed treatment. Studies must include patients who experience significant depression or anxiety prior to intervention. Combinations of interventions should also be studied. Last, timing for screening and intervening is needed as evidence to guide practice.