July 12, 2024

The psychosocial difficulties experienced by cancer patients in the long term are broad and include a wide range of symptoms such as anxiety, uneasiness, mourning, helplessness, fatigue, concentration difficulties, sleep problems, mental and cognitive impairments, sexual dysfunction, psychological distress, and psychiatric illnesses30. These symptoms are even more common in patients with poor prognosis and advanced-stage cancer31. Therefore, the above-mentioned psychosocial symptom-free period and QoL have become the primary endpoints32. Firkinns et al.33 found that QoL was significantly affected 2 to 26 years after cancer diagnosis. All these means that providing psychological support to cancer survivors in the long term is crucial.

Although our analysis concluded that psychological interventions do not prolong survival time, they can improve the quality of life of patients and the time that these patients and their families have left. Our analysis revealed significant improvements in all four measured QoL domains (global, emotional, social, and physical) in the intervention group compared to the control group, with the highest clinical effect in the emotional domains.

Moreover, our subgroup analysis showed significant improvements in QoL in the experimental group regardless of the intervention provider in most cases. This suggests that the rigorous research intervention and training have a strong influence on provider self-efficacy leaving less emphasis on the provider’s profession or personality itself34. The interventions used in the studies were mostly non-psychotherapies, where the role of a licensed psychologist would be essential.

The environment in which the interventions take place also influences the beneficial effect. Our analysis showed that face-to-face interventions were the most effective. This implies that personal interactions are important factors in delivering psychological interventions. The online form was only significant in global and emotional domains. This suggests that an online form can also be effective if a patient has difficulty going to hospital. A review article conducted on this topic found that even though online interventions may supplement traditional treatment setups for mental disorders, they could not provide consistent quality or replace face-to-face therapy35. Further research should evaluate how online therapies could be improved to be more effective in providing quality treatment for less mobile patients.

Regarding the type of interventions, there were significant improvements for individual therapies in all measured domains. Group-based therapies were significantly effective in the global and emotional domains. Cancer patients often express a preference for individual over group therapy for various fears despite their effectiveness36. Participating in group therapy where fellow patients are suffering from the same condition in a worse condition might be frightening to see. It is also possible that heterogeneous groups make it difficult to tailor the best possible treatment for each patient group. For this reason, individual therapies could be a better choice. Guided self-help was only statistically significant in the global domain, but we cannot draw conclusions due to the limited data.

It has been proposed that psychological interventions only affect the prognosis of patients with early-stage cancer, as the natural course of more advanced stages might obviate the possible effect of psychosocial factors8. Our results may support these findings as the point estimates were higher for early-stage patients but did not prove significant. The results for the cancer stage suggest that psychological interventions are most effective when provided in the early stages rather than in the advanced or survival phase. An interesting finding is that these interventions did not affect the survival category. These patients may have gone through post-traumatic growth, and these interventions are not strong enough for them to make a difference. A study conducted on post-traumatic self-growth among cancer survivors found that the positive effects of surviving cancer can last up to 4 years; however, after that, patients started to have lower scores37. We must highlight that we had limited data to analyze the effect of the cancer stage, but monitoring patients’ needs, even for survival patients, should be a standard.

Regarding cancer type, we found that breast cancer patients benefited most from the psychological interventions. No improvement was seen in the prostate cancer group in any domains. This raises the question of whether gender plays a role in seeking and accepting psychological help. There is evidence in the literature to support the idea that gender is a predictor of attitudes toward seeking professional psychological help; however, other factors like cultural background and educational level are important factors, too38,39.

Interestingly, our results showed that the duration of the intervention is not an important factor for psychological interventions in improving the four analyzed QoL domains. This aligns with the results of a study where researchers found that the number of sessions, length, and treatment intensity were unrelated to therapeutic gains40. Due to the heterogeneity of interventions, we were not able to analyze data by duration, frequency, and occasion; therefore, further research is needed in this subgroup. This is, however, an important finding for future recommendations and funding, as we could standardize short but intensive interventions at least three or four times a year to be cost- and time-effective when treating these patients for their QoL. Figure 10. shows the sum of the subgroup analysis of QoL domains.

Figure 10
figure 10

Sum of the subgroup analysis of QoL domains. The figure shows the cumulative findings of subgroup analysis of all measured QoL domains. We indicated the significant differences between the intervention and the control groups with the bold *.

Our results suggest that psychological interventions are effective and should be introduced into the routine care of oncological patients. We have gained important information based on provider, type, environment, and duration of intervention efficacy, as well as on cancer stage and type, that can be used to improve the effectiveness of psychological interventions. At the same time, the significance varying across subgroups indicates that patients have different needs; therefore, we should strive to provide personalized patient care.

Strengths and limitation

One of the strengths of this work is its absolute objectivity, which was performed using meta-analyses and rigorous methodology. We were able to provide the highest level of evidence available by including only RCTs with a large number of enrolled patients. To our knowledge, this is the most comprehensive meta-analysis to report on the effectiveness of psychological intervention by provider, environment, type, and cancer stage subgroup. Although the results of this meta-analysis seem promising, the conclusions should be interpreted with caution. In terms of the limitations of this work, the first and most important thing to note is the heterogeneous study/clinical settings between the included studies, in particular, the different types of interventions, cancer types, and measurement tools. These differences made it necessary to use less sensitive statistical analysis. Criteria were developed to define psychological interventions; however, these terms and methods can often be used interchangeably, and the distinction may be subjective. This is further aggravated by insufficient details on interventions; therefore, decisions on inclusion or exclusion may also be superficial7. We could only rely on a small amount of data for the survival analysis, so conclusions should be drawn carefully. Lastly, a further limitation is the presence of moderate to high risk of bias in some areas.

Implications for practice and research

Implementing scientific results in everyday clinical practice is crucial and can improve disease management, diagnosis, and therapy41,42. Our results suggest that psychotherapy should be introduced as standard care for patients with cancer. Psychologists are not part of the patient care team in many countries, and psychotherapy is unavailable for oncological patients. However, psychological interventions should be provided, especially in the early stages of cancer, and should be repeated at least three or four times to maintain the beneficial effects. Further trials could make more personalized recommendations based on cancer types, stages, and psychological methods.

Another important aspect of this review is that our results highlight the need for randomized-controlled clinical trials with standardized methods and reporting on results to accurately assess the effect of psychological interventions. Psychological research is always challenging; however, more objective analyses could be obtained by standardizing intervention methods, questionnaires, intervention duration, frequency, and how data and results are reported.

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