In a recent meta-analysis published in Cancer Medicine, researchers evaluated the impact of cognitive-behavioral treatment (CBT) on the mental health (MH) and quality of life (QoL) of cancer patients.
Study: The efficacy of cognitive behavioral therapy for mental health and quality of life among individuals diagnosed with cancer: A systematic review and meta-analysis. Image Credit: Yavdat/Shutterstock.com
Background
Cancer affects millions globally, and while treatments improve longevity and survival rates, they also affect the physical, psychological, and social well-being of cancer patients.
Affected individuals often experience depression, anxiety, and decreased wellness, which can persist even after treatment. Addressing these concerns is crucial for the long-term well-being of cancer patients.
CBT is a widely used treatment for mental health disorders like depression and anxiety that enhances quality of life and reduces disease relapse. However, its effectiveness on cancer survivors remains limited. While CBT effectively treats distress, pain, insomnia, fatigue, fear, anxiety, and depression in cancer, its combined effectiveness in treating mental health and general wellness remains unclear.
About the meta-analysis
In the present meta-analysis, researchers examined the effects of CBT on mental health and QoL of individuals with cancer.
Researchers searched randomized controlled trials (RCTs) and non-randomized trials from inception through July 2023 across 11 digital databases, four professional websites, and manual searches from reference lists of relevant published studies.
They excluded records without CBT intervention or control conditions, lacking focus on mental health and QoL outcomes, missing statistical data, duplicate results, and those determined as ineligible using automation tools.
The study population included cancer survivors, identified using the National Cancer Institute (NCI) definition. Control individuals included waitlist controls and those receiving standard therapy or active/alternate treatment. Interventions included CBT with its variations, and outcomes were mental health and quality of life.
Two researchers independently performed title-abstract and full-text screening using the Covidence platform. Discrepancies were resolved by consensus or by consulting a senior scholar. The second version of the Cochrane Risk of Bias (RoB 2) tool determined the bias risk of RCTs and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for non-RCTs.
Researchers used intercept-only meta-regressions with robust variance estimation (RVE) for meta-analysis. They also performed subgroup assessments and univariate meta-regression moderator analyses, considering age and CBT delivery.
Age was stratified as below 40 years, between 40 and 64 years, and ≥65 years. Delivery formats included in-person, technology-only, mixed technology and in-person, pre-programmed exclusively, and technology-only pre-programmed and interpersonal.
The study evaluated publication bias by plotting each effect size estimate against standard errors using a funnel plot and conducting sensitivity evaluations with a priori weighted functions.
Results
Researchers identified 2,412 records from databases, 229 from reviews, and eight from gray literature. In total, 1,840 records underwent title-abstract screening, and 433 underwent full-text screening.
Of 190 records eligible for statistical extraction, the team included 154 in the original dataset and 132 in the final analysis. The meta-analyses included 1,030 effect sizes for 13,226 individuals receiving CBT during 1986-2023 (mean age, 53 years; 79% were female).
Among interventions, 76 (58%) used in-person, 21% used technology-aided and in-person approaches, 10% used only pre-programmed technology, 9.1% used only interpersonal technology, and three used interpersonal and pre-programmed technology.
Concerning the primary intervention, 52% of trials used individual-based techniques, and 42% used small-group-type methods. The studies had a low risk of bias.
CBT moderately improved the mental health and QoL of cancer patients. However, age and delivery format affect its efficacy. CBT was significant for young and middle-aged individuals but ineffective for older ones; each unit increase in age reduced the effect size by 0.01.
CBT had a significant effect on patients receiving in-person therapy and pre-programmed therapy. However, technology-only interpersonal and pre-programmed treatment did not show significant results, suggesting that in-person therapy is crucial for effective treatment.
Patients prefer human-to-human connections, which can be difficult to replace with technology. However, other formats of CBT benefit cancer patients, indicating the ability of CBT for large-scale uptake.
CBT had a higher effect size for MH but lower for QoL; however, moderator analysis indicated non-significant differences in the treatment effect sizes.
The finding suggests that oncological service providers must continue to consider CBT an evidence-supported treatment for QoL and MH outcomes, and researchers should focus on maximizing CBT benefits for MH outcomes.
Conclusions
The study reveals that CBT significantly improves mental health and QoL for cancer patients during and after treatment. The benefits suggest that CBT should be accessible to cancer patients, even without a mental health diagnosis.
Oncologists must consider age and CBT delivery type when evaluating CBT as a psychotherapeutic intervention.
The findings are valuable for clinical practice and understanding the best approach to cancer treatment.
Future research on CBT in cancer should focus on its fidelity, maturity, and large sample size, as well as its impact on interpersonal supportive care for older patients. The non-significant treatment effects of CBT among elder individuals warrant further investigation.
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