Pre-intervention distress moderates the efficacy of psychosocial treatment for cancer patients: a meta-analysis

Abstract

This meta-analysis examined whether effects of psychosocial interventions on psychological distress in cancer patients are conditional upon pre-intervention distress levels. Published articles and unpublished dissertations between 1980 and 2005 were searched for interventions reporting the Hospital Anxiety and Depression Scale (HADS) or the Spielberger State-Trait Anxiety Inventory (STAI). Multilevel mixed-effects modeling was used to meta-analyze effect-sizes separately for the HADS (27 trials, 2424 patients) and STAI (34 trials, 2029 patients). Pre-intervention distress significantly moderated intervention effects, explaining up to 50% of the between-study effect-size variance: effects on anxiety and depression were generally negligible when pre-intervention distress was low and pronounced when it was high. These results could not be explained by differences in intervention type, setting, dose, and whether intervention was targeted at distressed patients. Psychosocial interventions may be most beneficial for cancer patients with elevated distress. Future research should identify which treatment components are most effective for these patients to facilitate optimal treatment tailoring and cost-effective health care. KeywordsAnxiety; depression; cancer; psychosocial; intervention; meta-analysis A considerable number of trials have tested psychosocial interventions designed to reduce emotional distress and improve the quality of life of adult cancer patients. The overall efficacy of these interventions is vigorously debated (Stefanek et al., 2006). Studies have yielded mixed results, and previous systematic and meta-analytic reviews have drawn disparate conclusions about whether psychosocial treatment is generally beneficial (Meyer and Mark, 1995;Rehse and Pukrop, 2003;Tatrow and Montgomery, 2006) or ineffective Newell et al., 2002) in reducing distress among cancer patients. Thus, it appears crucial to examine potential determinants of differential treatment efficacy, that is, to identify for whom and under what conditions interventions prove successful or not (King et al., 2008).Intervention studies have commonly included cancer patients regardless of their current emotional well-being Sheard and Maguire, 1999). However, there is substantial heterogeneity in the psychological sequelae of cancer diagnosis. While 20-40% of patients show clinically meaningful anxiety and depression, many report only transient emotional disruption and overall adjust quite well to the illness (van't Spijker et al., 1997;Zabora et al., 2001). For that reason, it has been argued that the efficacy of intervention might well increase if it was selectively provided for those who are most in need because they Sheard and Maguire, 1999;Stanton, 2005).In recent years, evidence has emerged suggesting greater benefits of psychosocial interventions among patients who show elevated distress (Andersen et al., 2004;Boesen et al., 2005;Carmack Taylor et al., 2007;Given et al., 2004;Goodwin et al., 2001;Taylor et al., 2003) or lack psychoso...

A Multicenter Randomized Trial of the Effects of Exercise Dose and Type on Psychosocial Distress in Breast Cancer Patients Undergoing Chemotherapy

“…There was no effect of higher dose exercise in patients with subclinical levels of depressive symptoms at baseline; however, both the higher dose exercise interventions (HIGH and COMB) produced meaningful standardized effect sizes of d ¼ À0.40 to À0.50 compared with STAN in patients who had clinical levels of depressive symptoms at baseline. This finding is consistent with the meta-analysis of Schneider and colleagues (13) showing that baseline depression is a strong predictor of the effectiveness of psychosocial interventions in patients with cancer. It is also consistent with the standardized effect sizes of d ¼ À0.60 reported in meta-analyses of exercise interventions in clinically depressed patients without cancer (9,28).…”

“…Unfortunately, these reviews have also noted major methodologic limitations in these trials, inconsistent evidence concerning a dose-response effect, and the inclusion of few depressed patients with cancer. The significance of this last limitation is highlighted by a recent systematic review of psychosocial interventions in patients with cancer (13) that clearly showed that the beneficial effects of psychosocial interventions on depression are strongly related to baseline distress. Here, we report what we believe to be the largest exercise trial to date to examine depression in patients with cancer; the first to examine exercise dose and type effects, and the first to examine whether the effects of exercise on depression are related to baseline depression levels.…”

Acceptability and Feasibility of a Meaning-Based Intervention for Patients With Advanced Cancer and Their Spouses

“…Our results were not as robust as they might have been if the sample had been restricted to distressed couples, given that baseline distress can be a critical moderator of efficacy of psychosocial interventions of patients with cancer. 46 Future research should include follow-up beyond the post-intervention assessment.…”

Working mechanisms of a web-based self-management intervention for cancer survivors: a randomised controlled trial

“…As a result, participants at baseline scored relatively low on depression (Mitchell et al, 2013). Since the baseline level of distress influences intervention effectiveness (Schneider et al, 2010), greater effects could be expected when participants were doing less well in this area. This might also have had influence on the mediating effect of personal control on depression: there was more variation in experienced levels of fatigue than there was in depression, which was generally low.…”