Cognitive-behavioral and mindfulness-based interventions for distress in patients with advanced cancer: A meta-analysis.

A meta-analysis of 37 randomized controlled trials found that cognitive-behavioral and mindfulness-based interventions produce a small reduction in distress (Hedges's g = 0.21) and a minimal improvement in quality of life (Hedges's g = 0.15) for patients with advanced cancer. The two types of interventions did not differ in effectiveness. Delivering interventions to individuals rather than dyads or groups yielded larger effects on quality of life. No factors were found to moderate the effect on distress. The authors note that the small number and variable quality of studies limit the conclusions and call for more rigorous trials.

Study at a glance

Abstract

Various psychosocial interventions have been developed to reduce distress and improve quality of life (QoL) in patients with advanced cancer, many of which are traditional cognitive-behavioral interventions (CBIs) or mindfulness-based interventions (MBIs). The aims of this meta-analysis were to determine and compare the overall effects of traditional CBIs and MBIs on distress and QoL in this population and to explore potential moderators of intervention efficacy. A systematic search was conducted in CINAHL, Embase, PsycINFO, PubMed, and Web of Science. Randomized controlled trials (RCTs) comparing CBIs or MBIs to controls on distress and QoL outcomes were eligible for inclusion. Random effects meta-analyses using standardized baseline to post-intervention mean differences were calculated using Hedges's g. Meta-regressions were used to compare intervention effects and examine potential moderators. Across 37 RCTs (21 CBIs, 14 MBIs, 2 combination therapies), there was a small decrease in distress (Hedges's g = 0.21) and a minimal improvement in QoL (Hedges's g = 0.15). Traditional CBIs and MBIs did not differ in effect sizes. Heterogeneity was significant across distress effect sizes but not across QoL effects. Interventions delivered to individuals (vs. dyads/group) had larger effects on QoL. No moderators of intervention effects on distress were found. Findings suggest traditional CBIs and MBIs produce small reductions in distress compared to controls in patients with advanced cancer, although effects on QoL appear minimal. Given limitations in the number of studies and their quality, rigorous trials are needed to directly compare the impact of traditional CBIs and MBIs in this population.