Preyde, M., & Synnott, E. (2009). Psychosocial intervention for adults with cancer: A meta-analysis. Journal of Evidence-Based Social Work, 6, 321–347.

To evaluate types of psychosocial interventions employed in patients with cancer

To update and extend a previous review by conducting a search and reporting on recent trials

Databases searched were MEDLINE, CINAHL, PsycINFO, Social Sciences Citation Index, Social Services Abstracts, and PubMed databases from 1999–2007.

Search keywords were psychosocial care, intervention, service, support, oncology, effectiveness (effect*) and evaluation (evaluat*).

Studies were included in the review if they reported

• Any type of psychosocial intervention delivered during the treatment phase of cancer
• Primary cancer of any histological type
• A randomized controlled trial (RCT) or quasi-experimental design
• Measurements of one or more intended effects of psychosocial intervention
• An English-language samples of patients age 18 or older.

Studies were excluded if they reported on patients with metastatic disease.

A total of 1,702 studies were initially identified. After elimination of studies that did not meet inclusion criteria, 27 studies were included. Study quality was evaluated using a modified Jadad scoring approach. There were 22 final RCTs and 5 pilot studies used.

There were few studies with a high-quality rating, and the mean rating for the entire sample of studies was 2.41 on a 5-point scale. Effect sizes were calculated for only nine studies, in which statistically significant results were reported. Patient outcomes measured in this subgroup of studies varied and included general health, emotional control, social support, global adjustment to illness, relationship quality, optimism, self-esteem, and self-efficacy. Studies were conducted in the United States, Canada, Europe, Hong Kong, Australia, and New Zealand.

• Across the final set of 27 studies, sample sizes reported ranged from 17 to 260, with a total of more than 3,600 patients.
• Breast cancer was the most common diagnosis.
• Studies also included melanoma, gynecologic, head and neck, lung, colon, prostate, and other cancer types.

The mean effect size was small, at 0.28, across the varied outcomes measured in studies. 

Individual interventions: psychosocial, psychoeducational, and cognitive behavioral

• Nine studies examined the effect of psychosocial counseling.
  • Three studies demonstrated mixed results, with negative effects.
  • Two studies did not report actual statistical findings.
  • Three studies did not demonstrate statistically significant findings. 
  • One study demonstrated significantly better scores for self-administered stress reduction on some general health and depression scales compared to controls and those in a professionally led intervention.
  • One small pilot study reported significant improvement in body image perception.
• Four studies used cognitive behavioral interventions.
  • One study reported mixed results.
  • Two studies did not find statistically significant results. In one of these, there was no main effect, but symptoms improved more in a subgroup of patients who had more severe symptoms at baseline.
  • One study demonstrated significant differences in anxiety and perceived social support.

 Telephone intervention

• Four studies used telephone interventions primarily to address educational and resource needs.
• Only one of these studies showed a trend toward improvement in depression and fatigue; however, there were unadjusted differences between groups at baseline.

Group counseling

• Four studies tested group interventions. Three of these did not find significant differences between groups, and one study reported significant effects on psychological distress at 6 months, but not at 12 months.

Miscellaneous

• One study reported significant differences in relationship quality with couples counseling and psychological distress, but only at a 1 week time point in the study.
• One study examined the effect of feedback to the physician regarding patients’ distress. No significant effects were found.

Attrition was a problem in many of the studies. In a few studies, positive effects or trends were seen with individuals who had more severe problems at baseline; however, attrition was also highest among these patients.

There appears to be some evidence supporting interventions targeting stress and coping; however, there is no strong support for any one type of intervention evaluated here. Where significant findings were seen, effect sizes were small and the clinical relevance of this level of effect could not be evaluated. There do not appear to be any long-term effects with the interventions examined here.

The quality of most studies was not high.

While no long-term effects were clearly found, even short-term effects on distress for people with cancer can be important for patients and clinically useful.

Positive results in one study using self-managed approaches for stress reduction suggest that this may be a practical and cost-effective way to address short-term patient needs.

Patients with cancer are a heterogeneous group, and the nature of psychosocial interventions is such that one should expect them to be highly individualized, as is the approach in clinical practice. Further, psychosocial interventions delivered on an individual basis versus group therapy were better supported and easier to maintain. This represents one of the challenges in this area of research that should be addressed in future studies.

Given attrition levels discussed here along with findings that greater effect is seen among patients with more severe baseline problems, in future work, care needs to be taken to consider for whom psychosocial interventions is indicated and how onerous the intervention and study protocol are for participants.

Findings point to the need for higher quality research design and reporting in this field.

Psychoeducational interventions addressing patients’ informational needs about cancer, progression, treatment, and side effects were found to be beneficial.

Psychosocial interventions found to be most beneficial include cognitive adaption, coping management, and encouraging patients to practice stress management techniques at home.