Are digital psychological interventions for psychological distress and quality of life in cancer patients effective? A systematic review and network meta-analysis

Tao Zhang; Zhihong Ren; Claire Elizabeth Wakefield; Bryant Pui Hung Hui; Tatsuo Akechi; Congrong Shi; Xiayu Du; Wenke Chen; Lizu Lai; Chunxiao Zhao; Ying Li; Yubu Zhou

doi:10.1016/j.cpr.2024.102520

Are digital psychological interventions for psychological distress and quality of life in cancer patients effective? A systematic review and network meta-analysis

Clin Psychol Rev. 2024 Nov 26:115:102520. doi: 10.1016/j.cpr.2024.102520. Online ahead of print.

Authors

Tao Zhang¹, Zhihong Ren², Claire Elizabeth Wakefield³, Bryant Pui Hung Hui⁴, Tatsuo Akechi⁵, Congrong Shi⁶, Xiayu Du⁷, Wenke Chen⁷, Lizu Lai⁷, Chunxiao Zhao⁷, Ying Li⁷, Yubu Zhou⁷

Affiliations

¹ Key Laboratory of Adolescent Cyberpsychology and Behavior (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, National Intelligent Society Governance Experiment Base (Education), School of Psychology, Central China Normal University, Wuhan, China; Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR.
² Key Laboratory of Adolescent Cyberpsychology and Behavior (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, National Intelligent Society Governance Experiment Base (Education), School of Psychology, Central China Normal University, Wuhan, China. Electronic address: ren@ccnu.edu.cn.
³ School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Sydney, New South Wales, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, Australia.
⁴ Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR; Mental Health Research Centre, The Hong Kong Polytechnic University, Hong Kong SAR.
⁵ Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Japan.
⁶ School of Educational Science, Anhui Normal University, China.
⁷ Key Laboratory of Adolescent Cyberpsychology and Behavior (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, National Intelligent Society Governance Experiment Base (Education), School of Psychology, Central China Normal University, Wuhan, China.

PMID: 39615074
DOI: 10.1016/j.cpr.2024.102520

Abstract

Background: Many cancer patients experience psychological distress and/or poor quality of life during or after their cancer treatment, yet they face multiple barriers to accessing psychological support. Digital psychological interventions represent a promising approach for addressing these barriers, however their comparative effectiveness remains uncertain.

Methods: Nine databases were searched for randomized controlled trials (RCTs) from inception to July 2024. The primary outcomes were psychological distress and quality of life, and the secondary outcomes were measures of depression, anxiety, insomnia, fatigue, and fear of cancer recurrence in this study.

Results: One hundred and thirty-six RCTs with 23,154 participants were identified. Of these interventions, three types-digitally-delivered cognitive behavioral therapy (CBT), health education, and virtual reality therapy (VRT)-demonstrated significant reductions in psychological distress compared to non-active controls. Digital CBT, narrative interventions, and VRT significantly improved quality of life compared to non-active controls. For depression, both digital CBT and VRT were superior to the non-active control group. Regarding anxiety, CBT, psychoeducation, and VRT outperformed the non-active control group. In terms of fatigue, CBT, psychoeducation, VRT, and multi-component interventions all showed enhanced efficacy compared to the non-active control group. However, only CBT exhibited significantly superior effectiveness in alleviating insomnia compared to non-active controls. Similarly, only mindfulness-based interventions significantly reduced fear of cancer recurrence compared to the non-active control condition.

Conclusions: Our results suggest that digital CBT and VRT are highly promising options for reducing psychological distress and enhancing the quality of life among cancer patients; further high-quality randomized controlled trials involving diverse populations are essential to validate these findings.

Keywords: Digital psychological interventions; Network meta-analysis; Psychological distress; Quality of life; cancer patients.

Publication types

Review