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Psychosocial interventions for cancer survivors: A meta-analysis of effects on positive affect.

ABSTRACT: PURPOSE:Positive affect has demonstrated unique benefits in the context of health-related stress and is emerging as an important target for psychosocial interventions. The primary objective of this meta-analysis was to determine whether psychosocial interventions increase positive affect in cancer survivors. METHODS:We coded 28 randomized controlled trials of psychosocial interventions assessing 2082 cancer survivors from six electronic databases. We calculated 76 effect sizes for positive affect and conducted synthesis using random effects models with robust variance estimation. Tests for moderation included demographic, clinical, and intervention characteristics. RESULTS:Interventions had a modest effect on positive affect (g =?0.35, 95% CI [0.16, 0.54]) with substantial heterogeneity of effects across studies ([Formula: see text]; I²?=?78%). Three significant moderators were identified: in-person interventions outperformed remote interventions (P =?.046), effects were larger when evaluated against standard of care or wait list control conditions versus attentional, educational, or component controls (P?=?.009), and trials with survivors of early-stage cancer diagnoses yielded larger effects than those with advanced-stage diagnoses (P?=?.046). We did not detect differential benefits of psychosocial interventions across samples varying in sex, age, on-treatment versus off-treatment status, or cancer type. Although no conclusive evidence suggested outcome reporting biases (P =?.370), effects were smaller in studies with lower risk of bias. CONCLUSIONS:In-person interventions with survivors of early-stage cancers hold promise for enhancing positive affect, but more methodological rigor is needed. IMPLICATIONS FOR CANCER SURVIVORS:Positive affect strategies can be an explicit target in evidence-based medicine and have a role in patient-centered survivorship care, providing tools to uniquely mobilize human strengths.

SUBMITTER: Salsman JM

PROVIDER: S-EPMC7330880 | biostudies-literature | 2019 Dec

REPOSITORIES: biostudies-literature

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Psychosocial interventions for cancer survivors: A meta-analysis of effects on positive affect.

Salsman John M JM Pustejovsky James E JE Schueller Stephen M SM Hernandez Rosalba R Berendsen Mark M McLouth Laurie E Steffen LES Moskowitz Judith T JT

Journal of cancer survivorship : research and practice 20191119 6

<h4>Purpose</h4>Positive affect has demonstrated unique benefits in the context of health-related stress and is emerging as an important target for psychosocial interventions. The primary objective of this meta-analysis was to determine whether psychosocial interventions increase positive affect in cancer survivors.<h4>Methods</h4>We coded 28 randomized controlled trials of psychosocial interventions assessing 2082 cancer survivors from six electronic databases. We calculated 76 effect sizes for ...[more]

PMID: 31741250

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Project description:Meaning and purpose in life are associated with the mental and physical health of patients with cancer and survivors and also constitute highly valued outcomes in themselves. Because meaning and purpose are often threatened by a cancer diagnosis and treatment, interventions have been developed to promote meaning and purpose. The present meta-analysis of randomized controlled trials (RCTs) evaluated effects of psychosocial interventions on meaning/purpose in adults with cancer and tested potential moderators of intervention effects. Six literature databases were systematically searched to identify RCTs of psychosocial interventions in which meaning or purpose was an outcome. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, rater pairs extracted and evaluated data for quality. Findings were synthesized across studies with standard meta-analytic methods, including meta-regression with robust variance estimation and risk-of-bias sensitivity analysis. Twenty-nine RCTs were identified, and they encompassed 82 treatment effects among 2305 patients/survivors. Psychosocial interventions were associated with significant improvements in meaning/purpose (g = 0.37; 95% CI, 0.22-0.52; P < .0001). Interventions designed to enhance meaning/purpose (g = 0.42; 95% CI, 0.24-0.60) demonstrated significantly higher effect sizes than those targeting other primary outcomes (g = 0.18; 95% CI, 0.09-0.27; P = .009). Few other intervention, clinical, or demographic characteristics tested were significant moderators. In conclusion, the results suggest that psychosocial interventions are associated with small to medium effects in enhancing meaning/purpose among patients with cancer, and the benefits are comparable to those of interventions designed to reduce depression, pain, and fatigue in patients with cancer. Methodological concerns include small samples and ambiguity regarding allocation concealment. Future research should focus on explicitly meaning-centered interventions and identify optimal treatment or survivorship phases for implementation.

Dataset Information

Psychosocial interventions for cancer survivors: A meta-analysis of effects on positive affect.

Publications

Psychosocial interventions for cancer survivors: A meta-analysis of effects on positive affect.

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