Effects of digital psychological interventions on physical symptoms in cancer patients: A systematic review and meta-analysis

Effects of using app-based interventions on quality of life among breast cancer patients: a systematic review with meta-analysis

BACKGROUND

Application-based interventions have gradually emerged as potential tools for improving the health status of cancer patients. However, the conclusions of existing studies on the effectiveness of app-based intervention in managing breast cancer symptoms vary.

METHODS

This study systematically searched the PubMed, Web of Science, Scopus, Cochrane Library, and EMBASE databases from the inception of each database to October 25, 2024. Two researchers independently screened studies, extracted data, and evaluated the quality using the Cochrane Risk of Bias Tool. Data analysis was performed using RevMan 5.3 software, and the effect size was expressed as the standardized mean difference (SMD).

RESULTS

Of 16 included randomized controlled trials, meta-analysis results indicated that, compared to usual care, app-based interventions significantly improved breast cancer patients' quality of life (14 studies, SMD = 0.84, 95%CI = 0.48 - 1.19, p < 0.00005, I2 = 90%, GRADE = low), and positively alleviated physical pain and anxiety (5 studies, SMD = - 0.60, 95%CI = -0.92 to -0.29, p = 0.0002, I2= 56%, GRADE = very low; 3 studies, SMD = -0.75, 95% CI = -1.40 to -0.09, p = 0.03, I2= 86%, GRADE = very low). However, no statistically significant differences were observed in improving fatigue (3 studies, SMD = 0.18, 95%CI = - 0.05 - 0.42, p = 0.13, I2 = 0%) and depression (2 studies, SMD = -0.65, 95%CI = - 2.12 - 0.82, p = 0.38, I2 = 96%).

CONCLUSION

Application-based interventions can significantly improve the quality of life of breast cancer patients, effectively relieve pain, and reduce anxiety.

Effects of Psychological Intervention Based on Digital Health Technology on Psychological Outcomes in Cancer Survivors: Systematic Review and Meta-Analysis

OBJECTIVES

Digital health technology (DHT)-based psychological interventions are emerging as a means to enhance psychological outcomes for cancer survivors. This study aims to assess the effects of DHT-based psychological interventions on anxiety, depression, sleep disturbances, fatigue, and quality of life among cancer survivors.

METHODS

A systematic search was conducted in PubMed, Web of Science, the Cochrane Library, and Embase. The Cochrane risk-of-bias tool RoB 2 was used to evaluate the quality of the included studies. The Template for Intervention Description and Replication (TIDieR) checklist was used to check if the interventions reviewed were described in detail to be implemented in the clinical setting. Data synthesis was conducted in Review Manager (Version 5.4), and the effect size was calculated by the standardized mean difference and its 95% confidence interval. Sensitivity analysis and subgroup analysis were also conducted. The certainty of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation approach.

RESULTS

This meta-analysis encompassed 46 randomized controlled trials, involving 5211 participants. DHT-based psychological interventions significantly reduced anxiety (SMD = -0.41, 95% CI -0.59/-0.24), depression (SMD = -0.26, 95% CI -0.39/-0.13), sleep disturbance (SMD = -0.39, 95% CI -0.64/-0.14), fatigue (SMD = -0.47, 95% CI -0.77/-0.17), and improved quality of life (SMD = 0.42, 95% CI 0.22/0.62). Subgroup analysis indicated that interventions lasting for a duration of ≥ 12 weeks, and integrated interventions might be the most effective in addressing adverse psychological outcomes. And cognitive-behavioral therapy interventions demonstrated significant effectiveness in managing sleep disturbance.

CONCLUSION

DHT-based psychological interventions might be effective for improving anxiety, depression, sleep disturbances, fatigue, and quality of life in cancer survivors. We cannot draw definitive conclusions due to intervention and study design heterogeneity. Further rigorous trials are crucial to identify optimal interventions for different types of cancers, determine suitable durations, specify types of DHT-based psychological interventions and validate intervention therapies.

Digital Psychological Interventions for Adults in the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

This study evaluates the effect of digital psychological interventions on anxiety, depression, and stress symptoms in adults affected by the pandemic. A systematic search across five digital databases, from 1 January 2020 to 6 March 2024, identified 36 studies encompassing 8,662 participants. Compared with all control conditions, random-effects meta-analyses indicated that digital psychological interventions significantly reduced anxiety (g = -0.374; 95% CI, -0.529 to -0.218), depression (g = -0.568; 95% CI, -0.776 to -0.360), and stress (g = -0.452; 95% CI, -0.608 to -0.295). Smaller effect sizes were observed when compared with active controls than with inactive controls. Notable heterogeneity across three outcomes was observed. Publication bias was noted in depression symptoms. Several moderators were identified compared with inactive controls, including participant type for anxiety (psubgroup = 0.005), and region for depression symptoms (psubgroup = 0.000). Larger sample sizes (b = 0.0004; p = 0.028) related to stronger effects on depression symptoms. Publication year positively correlated with effects on stress (b = 0.1573; p = 0.032). This study supports the efficacy of digital psychological interventions in alleviating anxiety, depression, and stress symptoms for adults during the pandemic, offering insights for developing targeted mental health strategies in future public health crises.

Digital Health Interventions to Improve Mental Health in Patients With Cancer: Umbrella Review

BACKGROUND

Mental health plays a key role across the cancer care continuum, from prognosis and active treatment to survivorship and palliative care. Digital health technologies offer an appealing, cost-effective tool to address psychological needs.

OBJECTIVE

This umbrella review aims to summarize and evaluate the available evidence on the efficacy of digital health interventions for improving mental health and psychosocial outcomes for populations with cancer.

METHODS

Literature searches were conducted in Embase, PsycINFO, PubMed, CINAHL, the Cochrane Library, and Web of Science from their inception to February 4, 2024. Systematic reviews (with or without meta-analysis) investigating the efficacy of digital health interventions for psychosocial variables in patients with cancer were included. Quality was assessed using the Assessing the Methodological Quality of Systematic Reviews-2 tool.

RESULTS

In total, 78 systematic reviews were included in this review. Among diverse delivery modalities and types of digital interventions, websites and smartphone apps were the most commonly used. Depression was the most frequently addressed, followed by quality of life, anxiety, fatigue, and distress. The qualities of the reviews ranged from critically low to high. Generally, despite great heterogeneity in the strength and credibility of the evidence, digital health interventions were shown to be effective for mental health in patients with cancer.

CONCLUSIONS

Taken together, digital health interventions show benefits for patients with cancer in improving mental health. Various gaps were identified, such as little research specifically focusing on older adult patients with cancer, a scarcity of reporting high-precision emotion management, and insufficient attention to other certain mood indicators. Further exploration of studies with standardized and rigorous approaches is required to inform practice.

TRIAL REGISTRATION

PROSPERO CRD42024565084; https://tinyurl.com/4cbxjeh9.

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

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.

Effectiveness of Digital-Based Interventions on Physical and Psychological Outcomes Among Cancer Patients: A Systematic Review and Meta-Analysis

OBJECTIVE

Evolving digital technology has paved the way for endless potentiality. Leveraging on digital technology for healthcare purposes can target cancer patients, thus improving physical and psychological symptoms. Nevertheless, there is limited consolidated evidence on the effectiveness of virtual reality (VR) and mobile applications. This review aimed to synthesize evidence concerning the effectiveness of VR and mobile-based interventions on physical (pain, fatigue, and sleep) and psychological (anxiety and depression) outcomes among cancer patients.

METHODS

A comprehensive literature search was conducted on ten electronic databases, ongoing trials, and grey literature, reported between 2013 to 2023. All randomized controlled trials (RCTs) examining VR and mobile-based interventions on the physical or psychological outcomes among people with cancer were included. Two independent reviewers screened records for eligibility, appraised methodological quality, and extracted data from included studies. The Cochrane Risk of Bias tool was used for data appraisal, and a modified Cochrane data extraction form was used for data extraction. Meta-analysis and subgroup analysis were used to analyze data.

RESULTS

In total, 43 studies were included. VR relaxation videos and game-based activities were efficacious in improving cancer-related pain. Mobile applications with educational content, symptom monitoring, relaxation videos, teleconsultation, and regular reminders contributed to positive effects on all outcomes. Mindfulness practice appeared to improve sleep quality, anxiety, and depression. Intervention effects sustained at least 6 months for all outcomes, except sleep.

CONCLUSIONS

VR and mobile-based interventions had the potential to improve pain, fatigue, sleep, anxiety, and depression at post-intervention. Future RCTs are required to further test both digital interventions on specific types of cancer on multiple research settings.

IMPLICATIONS TO NURSING PRACTICE

VR and mobile-based interventions can be offered in clinical settings to help cancer manage their pain, fatigue, sleep, anxiety, and depression. VR relaxation videos, game-based activities, teleconferences, mindfulness, education, and system reminders can be included.

The impact of malignancy on death anxiety and psychological well-being in middle-aged and older patients undergoing abdominal surgery: a quasi-experimental study

BACKGROUND

Malignancy is a critical factor affecting death anxiety and psychological well-being. This study examined the impact of malignancy on death anxiety and psychological well-being in middle-aged and older adult patients undergoing abdominal surgery and projected it along with sociodemographic profiles.

METHODS

This study is quasi-experimental in design. It was conducted with patients undergoing abdominal surgery at a university hospital due to suspected malignancy. A total of 93 patients participated in the study: 57 patients diagnosed with malignancy were included in the experimental group, while 36 patients without a malignancy diagnosis were included in the control group. Data were collected using a questionnaire developed by the researchers based on the literature, the 'Turkish Death Anxiety Scale', and the 'Psychological Well-being Scale'. The analyses revealed that the data were normally distributed, and parametric tests were used to analyze differences between demographic variables and groups. Cohen's d and r values were examined to assess the effect size in the tests.

RESULTS

The study found a significant difference in death anxiety between the experimental and control groups (P < 0.05), with higher mean scores in the experimental group. Malignancy had a large effect on death anxiety (d = 1.42). Additionally, the control group had significantly higher mean psychological well-being scores compared to the experimental group (P < 0.05).

CONCLUSIONS

The study found that malignancy significantly affects death anxiety and psychological well-being. Increased death anxiety in patients with malignancy was associated with reduced psychological well-being. Thus, assessing death anxiety and providing targeted nursing care are essential for supporting the psychological well-being of these patients.

Can Digital Health Improve Therapeutic Compliance in Oncology?

PURPOSE

Therapeutic compliance, or adherence, is critical in oncology because of the complexity and duration of cancer treatment regimens. Nonadherence can lead to suboptimal therapeutic outcomes, increased disease progression, higher mortality rates, and elevated health care costs. Traditional methods to enhance compliance, such as patient education and regular follow-ups, have shown limited success.

MATERIALS AND METHODS

This review examines the potential of digital health technologies to improve adherence in oncology. Various studies and trials are analyzed to assess the effectiveness of these technologies in supporting patients with cancer.

RESULTS

mHealth applications have been shown to improve medication adherence through features like medication reminders and symptom tracking. Telemedicine facilitates continuous care and reduces the need for travel, significantly improving adherence and patient satisfaction. Patient-reported outcome measures enhance clinical decision making and personalized treatment plans by incorporating patient feedback. Electronic medical records and patient portals improve compliance by providing easy access to medical information and fostering better patient-provider communication. Connected pillboxes aid in consistent medication intake and reduce dispensing errors.

CONCLUSION

Digital health technologies offer significant benefits in oncology by enhancing patient engagement, improving adherence to treatment protocols, and enabling comprehensive cancer care management. However, challenges such as the digital divide, data privacy concerns, and the need for tailored interventions must be addressed. Future research should focus on evaluating the effectiveness of digital interventions and developing personalized digital health tools to maximize therapeutic compliance.