Psychological Intervention Improves Quality of Life, but Not Survival in Patients with Early-Stage Cancer: a Systematic Review and Meta-analysis of randomized clinical trials

Abstract

Abstract The effectiveness of psychological interventions (PI) for malignant diseases is still controversial. Our aim was to investigate the effect of PI on survival and quality of life (QoL) in patients with cancer. We performed a systematic search of MEDLINE, Cochrane, and Embase databases to identify randomized controlled trials comparing PI to standard care (PROSPERO registration number CRD42021282327). Outcomes were overall survival (OS), recurrence-free survival (RFS), and different domains of QoL: global, emotional, social, and physical. A subgroup analysis was performed based on provider, type, environment, duration, and cancer stage of intervention. Pooled hazard ratios (HR) and standardized mean difference (SMD) with 95% confidence intervals (CI) were calculated using a random-effects model. We found 129 articles eligible for data analysis. The OS and RFS did not differ significantly between the PI and the standard care groups (OS: HR=1.01; CI: 0.95-1.07; RFS: HR=0.99; CI: 0.84-1.16). However, our analysis showed significant improvements in the intervention group in all the analyzed domains of QoL; in the global (SMD=0.84; CI: 0.37-1.31), emotional (SMD=0.52; CI: 0.20-0.83), physical (SMD=0.45; CI: 0.11-0.79) and social (SMD=0.34; CI: 0.08-0.60) domains. Importantly, the effect of PI on QoL was generally positive immediately, 12 and 24 weeks after intervention, but PI decreased over time, and was no longer found significant at 48 weeks. The results were better in early stages of cancer. Psychological interventions do not prolong survival, but they significantly improve the QoL of cancer patients. Our results suggest that PI should be standard of care for 3-4 times a year at least for patients especially with early-stage cancer.