In a meta-analysis recently published in Cancer Medicine, researchers examined the effects of cognitive behavioral therapy (CBT) on the mental health (MH) and quality of life (QoL) of cancer patients.

Study: The effectiveness of cognitive behavioral therapy on mental health and quality of life in people diagnosed with cancer: A systematic review and meta-analysisPhoto credit: Yavdat/Shutterstock.com

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Cancer affects millions of people around the world. While treatments improve life expectancy and survival, they also impact the physical, psychological and social well-being of cancer patients.

Affected individuals often experience depression, anxiety and reduced well-being, which may persist even after treatment. Addressing these problems is critical to the long-term well-being of cancer patients.

Cognitive behavioral therapy is a widely used treatment for mental disorders such as depression and anxiety, improving quality of life and reducing disease relapses. However, its effectiveness in cancer survivors remains limited. While cognitive behavioral therapy effectively treats stress, pain, insomnia, fatigue, fear, anxiety, and depression in cancer patients, its combined effectiveness in treating mental health and overall well-being remains unclear.

About the meta-analysis

In the present meta-analysis, the researchers investigated the effects of cognitive behavioral therapy on the mental health and quality of life of cancer patients.

The researchers searched eleven digital databases, four professional websites, and manual searches of reference lists of relevant published studies for randomized controlled trials (RCTs) and non-randomized studies from inception to July 2023.

They excluded records without cognitive behavioral therapy intervention or control conditions, lack of focus on mental health and quality of life outcomes, missing statistical data, duplicate results, and records deemed ineligible using automation tools.

The study population included cancer survivors identified according to the National Cancer Institute (NCI) definition. Controls included waitlist controls and those receiving standard therapy or active/alternative treatment. Interventions included cognitive behavioral therapy with its variations, and outcomes were mental health and quality of life.

Two investigators independently conducted title abstract and full-text screening using the Covidence platform. Disagreements were resolved by consensus or consultation with an experienced investigator. The second version of the Cochrane Risk of Bias (RoB 2) tool assessed the risk of bias of RCTs and the Risk of Bias in Non-randomized Studies-of Interventions (ROBINS-I) tool for non-RCTs.

The researchers used only intercept meta-regressions with robust variance estimation (RVE) for the meta-analysis. They also conducted subgroup assessments and univariate meta-regression moderator analyses, controlling for age and implementation of cognitive behavioral therapy.

Age was categorized as under 40 years, 40-64 years, and ≥ 65 years. Delivery formats included in-person, technology only, a mix of technology and in-person, pre-programmed only, and technology only pre-programmed and interpersonal.

The study assessed publication bias by plotting each effect size estimate against standard errors using a funnel plot and performing sensitivity assessments using a priori weighted functions.

Results

The researchers identified 2,412 records from databases, 229 from reviews, and eight from the grey literature. A total of 1,840 records were subjected to title abstract review and 433 to full-text review.

Of 190 data sets 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 people who received cognitive behavioral therapy between 1986 and 2023 (mean age 53 years, 79% were female).

Seventy-six (58%) of the interventions used face-to-face approaches, 21% used technology-assisted and face-to-face approaches, 10% used pre-programmed technology only, 9.1% used interpersonal technology only, and three used interpersonal and pre-programmed technology.

Regarding the primary intervention, 52% of the studies used individual techniques and 42% used small group methods. The studies had a low risk of bias.

Cognitive behavioral therapy moderately improved mental health and quality of life in cancer patients. However, age and delivery method influenced effectiveness. Cognitive behavioral therapy was significant for young and middle-aged people, but ineffective for older people; each increase in age reduced the effect size by 0.01.

Cognitive behavioral therapy had a significant effect on patients who received in-person therapy or pre-programmed therapy. However, purely technology-based interpersonal and pre-programmed treatment did not show significant results, suggesting that in-person therapy is critical for effective treatment.

Patients prefer human contact, which is difficult to replace with technology. However, cancer patients also benefit from other forms of cognitive behavioral therapy, suggesting that cognitive behavioral therapy can be used on a large scale.

Cognitive behavioral therapy had a higher effect size for mental health but a lower effect size for quality of life. However, moderator analysis indicated that there were no significant differences in treatment effect sizes.

The findings suggest that oncology providers need to continue to view cognitive behavioral therapy as an evidence-based treatment to improve quality of life and mental health, and that researchers should focus on maximizing the mental health benefits of cognitive behavioral therapy.

Conclusions

The study shows that cognitive behavioral therapy significantly improves the mental health and quality of life of cancer patients during and after treatment. The benefits suggest that cognitive behavioral therapy should also be accessible to cancer patients without a mental health diagnosis.

Oncologists must consider the age and type of cognitive behavioral therapy when evaluating cognitive behavioral therapy as a psychotherapeutic intervention.

The findings are valuable for clinical practice and understanding the best approach to cancer treatment.

Future research on cognitive behavioral therapy for cancer should focus on its reliability, maturity, and large sample size, as well as its impact on interpersonal supportive care of older patients. The nonsignificant treatment effects of cognitive behavioral therapy in the elderly require further investigation.