Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer : an individual patient data meta-analysis of 21 RCTs

Objective: This individual patient data (IPD) meta‐analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention‐related characteristics. Methods: Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed‐effect model analyses were used to study intervention effects on the post‐intervention values of QoL, EF, and SF (z‐scores), adjusting for baseline values, age, and cancer type. We studied moderator effects by testing interactions with the intervention for demographic, clinical, personal, and intervention‐related characteristics, and conducted subsequent stratified analyses for significant moderator variables.Results: PSI significantly improved QoL (β = 0.14,95%CI = 0.06;0.21), EF (β = 0.13,95%CI = 0.05;0.20), and SF (β = 0.10,95%CI = 0.03;0.18). Significant differences in effects of different types of PSI were found, with largest effects of psychotherapy. The effects of coping skills training were moderated by age, treatment type, and targeted interventions. Effects of psychotherapy on EF may be moderated by cancer type, but these analyses were based on 2 randomized controlled trials with small sample sizes of some cancer types. Conclusions: PSI significantly improved QoL, EF, and SF, with small overall effects. However, the effects differed by several demographic, clinical, personal, and intervention‐related characteristics. Our study highlights the beneficial effects of coping skills training in patients treated with chemotherapy, the importance of targeted interventions, and the need of developing interventions tailored to the specific needs of elderly patients

A Study of the Psychosocial Adjustment of Patients and Spouses to Breast Cancer (Mastectomy, Social Support, Coping, Family).

This study was designed to investigate the psychosocial adjustment of mastectomy patients and their husb and s and to determine how two factors, social support and spouse involvement, were related to subjects' adjustment over time. Data were obtained from a sample of newly diagnosed breast cancer patients and their husb and s (n = 80) who were interviewed at two points in time. Time 1 interviews were completed approximately three days after surgery while the patient was still hospitalized, and Time 2 interviews were completed approximately one month later. St and ardized instruments, structured interview formats, and researcher-designed questionnaires were used to measure the variables in this study. Paired t analyses were used to compare the adjustment scores of patients and husb and s and regression techniques were used to determine the relationships between the independent variables and the multiple adjustment measures. The results of the study indicated that both patients and husb and s experienced alterations in mood and symptoms of distress in response to the mastectomy. The psychosocial adjustment scores of patients and husb and s did not differ significantly in regard to level of mood or symptoms of distress at Time 1 or Time 2. Social support was related to both patients' and husb and s' psychosocial adjustment on the mood and distress measures but not on the measure of psychosocial role function. Husb and s, in contrast to patients, perceived significantly less support from health professionals at Time 1 and Time 2. Level of spouse involvement was not related to either patients' or husb and s' psychosocial adjustment at Time 1 and Time 2. Overall, the findings of this study are consistent with family systems theory and suggest that both mastectomy patients and their husb and s have difficulty adjusting to the effects of breast cancer. The findings also suggest that social support is an important factor related not only to the psychosocial adjustment of patients but also to the psychosocial adjustment of their husb and s.Ph.D.NursingUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/160846/1/8600515.pd