Study of cognitive behavioral therapy for cancer survivors has ‘major clinical implications’
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Key takeaways:
- Cancer survivors had improved mental health and quality of life after receiving cognitive behavioral therapy.
- Younger cancer survivors derived greater benefit.
Cognitive behavioral therapy improved mental health and quality of life for cancer survivors, according to results of a systematic review and meta-analysis.
Younger cancer survivors derived more benefit from cognitive behavioral therapy (CBT) than older individuals. CBT hat included an in-person component appeared more effective than CBT delivered only through technology-assisted methods.
“In addition to confirming the general benefit of CBT for individuals with cancer, this study unveiled important nuances of how CBT can be most effective and for which populations,” researcher Anao Zhang, PhD, assistant professor of social work at University of Michigan and clinical research director of the adolescents and young adults oncology program at Michigan Medicine, said in a press release. “This has major clinical implications for supportive oncology providers.”
Background and methods
Individuals diagnosed with cancer can develop a variety of mental health conditions, including depression and anxiety. They also can experience reduced general wellness. These quality-of-life impacts can persistent long after treatment has ended, according to study background.
CBT — a type of psychotherapy — has been used to treat distress, pain, insomnia, PTSD, fatigue, fear, anxiety and depression among people with cancer.
“While these studies have shown CBT is effective [for] treating mental health and general wellness [among people with cancer], they do not address which outcome is better benefitted in response to CBT, and little is known about other factors that may influence the efficacy of CBT,” Zhang and colleagues wrote.
In addition, it had not been established whether CBT is more effective than standard care for treatment of combined mental health and general wellness.
Zhang and colleagues aimed to assess the effects of CBT vs. control — defined as standard therapy, waitlist control or active/alternative therapy — on metal health and quality of life among people with cancer or cancer survivors.
They also evaluated the effect of CBT on mental health and quality of life based on age and delivery method.
Researchers used 11 databases, four professional websites and a manual search of reference lists to identify relevant literature published through July 2023.
The analysis included data from 132 trials that included a combined 13,226 individuals (mean age, 53.38 years across 129 trials that reported age; 78.85% women across 131 trials that reported participants’ sex).
Results and next steps
Results showed CBT conferred a small to moderate but statistically significant treatment effect size for cancer survivors’ mental health and quality of life (d = 0.388; 95% CI, 0.29-0.48).
Subgroup analyses that included 119 studies showed overall moderate but statistically significant treatment effect sizes of CBT on mental health outcomes (d = 0.406; 95% CI, 0.29-0.51) and quality-of-life outcomes (d = 0.254; 95% CI, 0.14-0.36).
Younger individuals derived greater benefit from CBT on mental health and quality of life (40 years or younger, d = 0.773; 95% CI, 0.204-1.34; age 40 to 64 years, d = 0.0384; 95% CI, 0.28-0.48; age 65 years or older, d = 0.092; 95% CI, –0.09 to 0.27).
“Given the majority of individuals diagnosed with cancer are those who are of older age, an overall statistically nonsignificant treatment of CBT for this age group’s mental health and quality of life outcome is concerning and [warrants] further investigation,” researchers wrote.
Mental health and quality of life improved for survivors when they received CBT in-person (d = 0.391; 95% CI, 0.22-0.52), through a mix of in-person and technology (d = 0.307; 95% CI, 0.13-0.48) or in a pre-programmed format (d = 0.483; 95% CI, 0.22-0.74).
CBT delivered in a technology-only interpersonal format for through a combination of technology-only interpersonal and pre-programmed formats did not confer statistically significant benefits.
Researchers acknowledged study limitations, including the potential for unfound literature and missed factors for subgroup analyses.
“The broad scope of CBT benefits suggests that CBT being made available to [people with cancer or cancer survivors], even when a formal mental health diagnosis is not imminently present, could be warranted,” researchers wrote.
References:
- Dils AT, et al. Cancer Med. 2024;doi:10.1002/cam4.70063.
- Does cognitive behavioral therapy benefit cancer survivors? (press release). Available at: https://scienmag.com/does-cognitive-behavioral-therapy-benefit-cancer-survivors/. Published Aug. 21, 2024. Accessed Aug. 21, 2024.
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