Depression

A meta-analysis of 12 RCTs that assessed the efficacy of psychotherapy in patients with advanced, incurable cancer found that psychotherapy moderately improved depression scores (SMD, -0.67; 95% CI, -1.06 to -0.29; P = .0005), although the researchers determined the quality of the evidence was low.6


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A Cochrane review of RCTs of women with nonmetastatic breast cancer determined that 3 of the 4 analyzed studies reported improvements in depression scores after psychotherapy; however, a meta-analysis could not be performed7 — and the analyses did not include patients with clinically diagnosed depression.

Among men with prostate cancer, a meta-analysis of 11 RCTs found that an intervention of some type improved depressive symptom scores. Psychotherapy and/or peer support, specifically, improved scores significantly (SMD, -1.09; 95% CI, -2.05 to -0.13).8

Fatigue

The data regarding the effect of psychotherapy on cancer-related fatigue have been mixed. A Cochrane review of 27 RCTs evaluating psychosocial interventions for fatigue among patients receiving active treatment for cancer found that 7 studies reported a significant improvement in fatigue.9 Psychosocial interventions were more efficacious if they were specific for fatigue.

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Similarly, a Cochrane review of psychosocial interventions for patients with incurable cancer receiving treatment with palliative intent found that psychosocial interventions had no effect on reducing fatigue after the intervention was compared with controls, although there was a small benefit at first follow-up that was not sustained at second follow-up.10 The authors concluded that the evidence supporting the effectiveness of psychotherapy was of low quality.

A meta-analysis of 113 RCTs of adults with cancer that assessed different types of interventions for cancer-related fatigue found that, among the appropriate studies, psychological interventions significantly reduced cancer-related fatigue (weighted effect size [WES], 0.27; 95% CI, 0.21-0.33; P < .001).11 Psychological interventions plus exercise also demonstrated benefit, but pharmacologic interventions did not.

Pain

Two meta-analyses found that psychotherapy improves pain among patients with cancer. One study that included 37 RCTs of adults with cancer found that psychosocial interventions improved pain severity (WES, 0.34; 95% CI, 0.23-0.45; P < .001) and pain interference (WES, 0.40; 95% CI, 0.21-0.60; P < .001).12 Another meta-analysis of 26 RCTs of women with breast cancer similarly found that psychosocial interventions improved pain, though the effect size was more conservative when adjusted for potential publication bias.13

Fear of Recurrence

Two RCTs demonstrated that psychotherapy can reduce fear associated with cancer recurrence. A study of 164 patients with a history of melanoma were randomly assigned to a psychoeducational intervention that included 3 telephone-based sessions over 1 month or usual care.14 The psychoeducational intervention resulted in lower fear of cancer recurrence severity, trigger, and distress scores compared with the control group at 6 months. In another RCT, 222 patients with curable breast cancer, colorectal cancer, or melanoma were randomly assigned to receive psychotherapy with 5 face-to-face sessions or attention control (relaxation therapy).15 There was a greater improvement in the Fear of Cancer Recurrence Index scores and severity subscores with psychotherapy compared with attention control interventions.

Survival

Data regarding the association between psychotherapy and survival are mixed. In a Cochrane review of 10 RCTs of women with metastatic breast cancer, psychological intervention was associated with a 1-year overall survival benefit (odds ratio [OR], 1.46; 95% CI, 1.07-1.99), but a benefit was not seen at the 5-year follow-up point 5-years (OR, 0.103; 95% CI, 0.42-2.52).16 The authors reported that a clear pattern cannot be distinguished because there was a wide variation in outcome measures and duration of follow-up across the studies that were included in the review. Another meta-analysis of 15 RCTs of adults with cancer found no association between psychosocial interventions and survival, although a subgroup analysis based on results from 6 of the 15 trials revealed that psychoeducational intervention was associated with prolonged survival among patients with nonmetastatic disease, resulting in a 41% reduction in the risk of dying of cancer (hazard ratio, 0.59; 95% CI, 0.49-0.71).17

Conclusions

Most studies suggest that psychotherapy interventions may benefit patients with cancer or survivors of cancer for various QoL-related complications associated with disease. Importantly, most meta-analyses deemed the existing evidence as low quality, suggesting that more well-designed studies are needed to definitively evaluate the potential benefit of psychotherapy in this population.

References

  1. What is psychotherapy? American Psychiatric Association website. https://www.psychiatry.org/patients-families/psychotherapy. Updated July 2016. Accessed July 31, 2018.
  2. Galway K, Black A, Cantwell M, Cardwell CR, Mills M, Donnelly M. Psychosocial interventions to improve quality of life and emotional wellbeing for recently diagnosed cancer patients. Cochrane Database Syst Rev. 2012;11:CD007064. doi: 10.1002/14651858.CD007064.pub2
  3. Chong Guan N, Mohamed S, Kian Tiah L, Kar Mun T, Sulaiman AH, Zainal NZ. Psychotherapy for cancer patients. Int J Psychiatry Med. 2016;51(5):414-430. doi: 10.1177/0091217416680197
  4. Matsuda A, Yamaoka K, Tango T, Matsuda T, Nishimoto H. Effectiveness of psychoeducational support on quality of life in early-stage breast cancer patients: a systematic review and meta-analysis of randomized controlled trials. Qual Life Res. 2014;23(1):21-30. doi: 10.1007/s11136-013-0460-3
  5. Peikert ML, Inhestern L, Bergelt C. Psychosocial interventions for rehabilitation and reintegration into daily life of pediatric cancer survivors and their families: a systematic review. PLOS ONE. 2018;13(4):e0196151. doi: 10.1371/journal.pone.0196151
  6. Okuyama T, Akechi T, Mackenzie L, Furukawa TA. Psychotherapy for depression among advanced, incurable cancer patients: a systematic review and meta-analysis. Cancer Treat Rev. 2017;56:16-27. doi: 10.1016/j.ctrv.2017.03.012
  7. Jassim GA, Whitford DL, Hickey A, Carter B. Psychological interventions for women with non-metastatic breast cancer. Cochrane Database Syst Rev. 2015;5:CD008729. doi: 10.1002/14651858.CD008729.pub2.
  8. Newby TA, Graff JN, Ganzini LK, McDonagh MS. Interventions that may reduce depressive symptoms among prostate cancer patients: a systematic review and meta-analysis. Psychooncology. 2015;24(12):1686-1693. doi: 10.1002/pon.3781
  9. Goedendorp MM, Gielissen MFM, Verhagen CA, Bleijenberg G. Psychosocial interventions for reducing fatigue during cancer treatment in adults. Cochrane Database Syst Rev. 2009;1:CD006953. doi: 10.1002/14651858.CD006953.pub2
  10. Poort H, Peters M, Bleigenberg G, et al. Psychosocial interventions for fatigue during cancer treatment with palliative intent. Cochrane Database Syst Rev. 2017;7:CD012030. doi: 10.1002/14651858.CD012030.pub2
  11. Mustian KM, Alfano CM, Heckler C, et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol. 2017;3(7):961-968. doi: 10.1001/jamaoncol.2016.6914
  12. Sheinfeld Gorin S, Krebs P, Badr H, et al. Meta-analysis of psychosocial interventions to reduce pain in patients with cancer. J Clin Oncol. 2012;30(5):539-547. doi: 10.1200/JCO.2011.37.0437
  13. Johannsen M, Farver I, Beck N, Zachariae R. The efficacy of psychosocial intervention for pain in breast cancer patients and survivors: a systematic review and meta-analysis. Breast Cancer Res Treat. 2013;138(3):675-690. doi: 10.1007/s10549-013-2503-4
  14. Dieng M, Butow PN, Costa DS, et al. Psychoeducational intervention to reduce fear of cancer recurrence in people at high risk of developing another primary melanoma: results of a randomized controlled trial. J Clin Oncol. 2016;34(36):4405-4414. doi: 10.1200/JCO.2016.68.2278
  15. Butow PN, Turner J, Gilchrist J, et al. Randomized trial of ConquerFear: a novel, theoretically based psychosocial intervention for fear of cancer recurrence. J Clin Oncol. 2017;35(36):4066-4077. doi: 10.1200/JCO.2017.73.1257
  16. Mustafa M, Carson-Stevens A, Gillespie D, Edwards AG. Psychological interventions for women with metastatic breast cancer. Cochrane Database Syst Rev. 2013;6:CD004253. doi: 10.1002/14651858.CD004253.pub4
  17. Oh PJ, Shin SR, Ahn HS, Kim HJ. Meta-analysis of psychosocial interventions on survival time in patients with cancer. Psychol Health. 2016;31(4):396-419. doi: 10.1080/08870446.2015.1111370