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Br J Cancer. 1999 Aug; 80(11): 1770–1780.
PMCID: PMC2363129

The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses


The findings of two meta-analyses of trials of psychological interventions in patients with cancer are presented: the first using anxiety and the second depression, as a main outcome measure. The majority of the trials were preventative, selecting subjects on the basis of a cancer diagnosis rather than on psychological criteria. For anxiety, 25 trials were identified and six were excluded because of missing data. The remaining 19 trials (including five unpublished) had a combined effect size of 0.42 standard deviations in favour of treatment against no-treatment controls (95% confidence interval (CI) 0.08–0.74, total sample size 1023). A most robust estimate is 0.36 which is based on a subset of trials which were randomized, scored well on a rating of study quality, had a sample size > 40 and in which the effect of trials with very large effects were cancelled out. For depression, 30 trials were identified, but ten were excluded because of missing data. The remaining 20 trials (including six unpublished) had a combined effect size of 0.36 standard deviations in favour of treatment against no-treatment controls (95% CI 0.06–0.66, sample size 1101). This estimate was robust for publication bias, but not study quality, and was inflated by three trials with very large effects. A more robust estimate of mean effect is the clinically weak to negligible value of 0.19. Group therapy is at least as effective as individual. Only four trials targeted interventions at those identified as at risk of, or suffering significant psychological distress, these were associated with clinically powerful effects (trend) relative to unscreened subjects. The findings suggest that preventative psychological interventions in cancer patients may have a moderate clinical effect upon anxiety but not depression. There are indications that interventions targeted at those at risk of or suffering significant psychological distress have strong clinical effects. Evidence on the effectiveness of such targeted interventions and of the feasibility and effects of group therapy in a European context is required. © 1999 Cancer Research Campaign

Keywords: cancer, psychological interventions, counselling, psychotherapy, anxiety, depression, meta-analysis

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Selected References

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  • Andersen BL. Psychological interventions for cancer patients to enhance the quality of life. J Consult Clin Psychol. 1992 Aug;60(4):552–568. [PMC free article] [PubMed]
  • Bindemann S, Soukop M, Kaye SB. Randomised controlled study of relaxation training. Eur J Cancer. 1991;27(2):170–174. [PubMed]
  • Bloom JR, Ross RD, Burnell G. The effect of social support on patient adjustment after breast surgery. Patient Couns Health Educ. 1978 Fall;1(2):50–59. [PubMed]
  • Bridge LR, Benson P, Pietroni PC, Priest RG. Relaxation and imagery in the treatment of breast cancer. BMJ. 1988 Nov 5;297(6657):1169–1172. [PMC free article] [PubMed]
  • Cain EN, Kohorn EI, Quinlan DM, Latimer K, Schwartz PE. Psychosocial benefits of a cancer support group. Cancer. 1986 Jan 1;57(1):183–189. [PubMed]
  • Capone MA, Good RS, Westie KS, Jacobson AF. Psychosocial rehabilitation of gynecologic oncology patients. Arch Phys Med Rehabil. 1980 Mar;61(3):128–132. [PubMed]
  • Davis H., 4th Effects of biofeedback and cognitive therapy on stress in patients with breast cancer. Psychol Rep. 1986 Oct;59(2 Pt 2):967–974. [PubMed]
  • Decker TW, Cline-Elsen J, Gallagher M. Relaxation therapy as an adjunct in radiation oncology. J Clin Psychol. 1992 May;48(3):388–393. [PubMed]
  • Derogatis LR, Morrow GR, Fetting J, Penman D, Piasetsky S, Schmale AM, Henrichs M, Carnicke CL., Jr The prevalence of psychiatric disorders among cancer patients. JAMA. 1983 Feb 11;249(6):751–757. [PubMed]
  • Devlen J, Maguire P, Phillips P, Crowther D, Chambers H. Psychological problems associated with diagnosis and treatment of lymphomas. I: Retrospective study. Br Med J (Clin Res Ed) 1987 Oct 17;295(6604):953–954. [PMC free article] [PubMed]
  • Fallowfield LJ. Counselling for patients with cancer. BMJ. 1988 Sep 17;297(6650):727–728. [PMC free article] [PubMed]
  • Fawzy FI, Cousins N, Fawzy NW, Kemeny ME, Elashoff R, Morton D. A structured psychiatric intervention for cancer patients. I. Changes over time in methods of coping and affective disturbance. Arch Gen Psychiatry. 1990 Aug;47(8):720–725. [PubMed]
  • Greenberg RP, Bornstein RF, Greenberg MD, Fisher S. A meta-analysis of antidepressant outcome under "blinder" conditions. J Consult Clin Psychol. 1992 Oct;60(5):664–677. [PubMed]
  • Greer S, Moorey S, Baruch JD, Watson M, Robertson BM, Mason A, Rowden L, Law MG, Bliss JM. Adjuvant psychological therapy for patients with cancer: a prospective randomised trial. BMJ. 1992 Mar 14;304(6828):675–680. [PMC free article] [PubMed]
  • Halttunen A, Hietanen P, Jallinoja P, Lönnqvist J. Getting free of breast cancer. An eight-year perspective of the relapse-free patients. Acta Oncol. 1992;31(3):307–310. [PubMed]
  • Heinrich RL, Schag CC. Stress and activity management: group treatment for cancer patients and spouses. J Consult Clin Psychol. 1985 Aug;53(4):439–446. [PubMed]
  • Houts PS, Whitney CW, Mortel R, Bartholomew MJ. Former cancer patients as counselors of newly diagnosed cancer patients. J Natl Cancer Inst. 1986 May;76(5):793–796. [PubMed]
  • Linn MW, Linn BS, Harris R. Effects of counseling for late stage cancer patients. Cancer. 1982 Mar 1;49(5):1048–1055. [PubMed]
  • Lipsey MW, Wilson DB. The efficacy of psychological, educational, and behavioral treatment. Confirmation from meta-analysis. Am Psychol. 1993 Dec;48(12):1181–1209. [PubMed]
  • Maguire P, Tait A, Brooke M, Thomas C, Sellwood R. Effect of counselling on the psychiatric morbidity associated with mastectomy. Br Med J. 1980 Nov 29;281(6253):1454–1456. [PMC free article] [PubMed]
  • Robinson LA, Berman JS, Neimeyer RA. Psychotherapy for the treatment of depression: a comprehensive review of controlled outcome research. Psychol Bull. 1990 Jul;108(1):30–49. [PubMed]
  • Rosenthal R, Kleid JJ, Cohen MV. Abnormal mitral valve motion associated with ventricular septal defect following acute myocardial infarction. Am Heart J. 1979 Nov;98(5):638–641. [PubMed]
  • Shapiro DA, Shapiro D. Meta-analysis of comparative therapy outcome studies: a replication and refinement. Psychol Bull. 1982 Nov;92(3):581–604. [PubMed]
  • Steinbrueck SM, Maxwell SE, Howard GS. A meta-analysis of psychotherapy and drug therapy in the treatment of unipolar depression with adults. J Consult Clin Psychol. 1983 Dec;51(6):856–863. [PubMed]
  • Telch CF, Telch MJ. Group coping skills instruction and supportive group therapy for cancer patients: a comparison of strategies. J Consult Clin Psychol. 1986 Dec;54(6):802–808. [PubMed]
  • Thompson SG. Controversies in meta-analysis: the case of the trials of serum cholesterol reduction. Stat Methods Med Res. 1993;2(2):173–192. [PubMed]
  • Trijsburg RW, van Knippenberg FC, Rijpma SE. Effects of psychological treatment on cancer patients: a critical review. Psychosom Med. 1992 Jul-Aug;54(4):489–517. [PubMed]
  • Watson M. Psychosocial intervention with cancer patients: a review. Psychol Med. 1983 Nov;13(4):839–846. [PubMed]
  • Youssef FA. Crisis intervention: a group-therapy approach for hospitalized breast cancer patients. J Adv Nurs. 1984 May;9(3):307–313. [PubMed]

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