Effects of cognitive-behavioural therapy on psychological, physical and social outcomes of children with cancer: A systematic review and meta-analysis

Effectiveness of Cognitive Behavioral Therapy in Reducing Psychological Distress in Nurses: A Systematic Review and Meta-Analysis of Experimental Studies

Work-related stress, a major contributor to physical and mental health issues of nurses, has a direct impact on patient safety and nurses' well-being. However, few studies have investigated the effectiveness of cognitive behavioral therapy in reducing psychological distress in nurses. Systematic search of six databases including CINAHL Plus with Full Text, Cochrane Library, Embase, Medline, PubMed, and Web of Science from their inception to February 27, 2024. The primary outcomes assessed were reductions in stress, anxiety, and depression following the implementation of cognitive behavioral therapy. A random effects model, accounting for study differences, was applied in the meta-analyses. Egger's regression test was utilized to assess potential publication bias in the pooled analyses. The meta-analysis included 10 studies that demonstrated the intervention's beneficial effects in reducing stress, anxiety, and depression among nurses. Despite the positive effects observed with cognitive behavioral therapy (CBT) in alleviating psychological distress among nurses, the generalizability of these findings may require further confirmation due to the diversity of cognitive behavioral therapies.

The Challenge of Managing Neuropathic Pain in Children and Adolescents with Cancer

Neuropathic pain (NP) is a common complication associated with some types of childhood cancer, mainly due to nerve compression, chronic post-surgical pain, chemotherapy, and radiotherapy. NP is usually less responsive to traditional analgesics, and there is generally a lack of evidence on its management in cancer patients, leading to recommendations often based on clinical trials conducted on other forms of non-malignant NP. In pediatric oncology, managing NP is still very challenging for physicians. Different factors contribute to increasing the risk of undertreatment: (a) children may be unable to describe the quality of pain; therefore, the risk for NP to be underestimated or remain unrecognized; (b) specific tools to diagnose NP have not been validated in children; (c) there is a lack of randomized clinical trials involving children, with most evidence being based on case series and case reports; (d) most drugs used for adult patients are not approved for childhood cancers, and drug regulation varies among different countries; (e) recommendations for pediatric pain treatment are still not available. In this paper, a multidisciplinary team will review the current literature regarding children with cancer-related NP to define the best possible diagnostic strategies (e.g., clinical and instrumental tests) and propose a therapeutic care pathway, including both non-pharmacological and pharmacological approaches, which could help pediatricians, oncologists, neurologists, and pain therapists in designing the most effective multidisciplinary approach.

Cognitive-Behavioral Intervention for Children With Hematological Cancer Receiving Chemotherapy: A Randomized Controlled Trial

OBJECTIVE

Cognitive-behavioral intervention (CBI) has shown positive effects in improving psychological and health-related outcomes in children with cancer. However, no evidence has been found in Ethiopia. This study aimed to evaluate the effects of CBI on anxiety, depression and quality of life (QoL) in Ethiopian children with hematological cancer receiving chemotherapy.

METHODS

A parallel, two-armed, assessor-blinded, randomized controlled trial was conducted among 76 children randomized (1:1) to receive CBI or usual medical care. The intervention group received five weekly face-to-face CBI sessions of 30-40 min each, which included an introduction to CBI; identifying and challenging maladaptive thoughts, beliefs and behavior; behavior activation; deep breathing exercises; and treatment evaluation and relapse prevention. The outcomes were measured at baseline (T0), immediately post-intervention (T1) and 1 month post-intervention (T2).

RESULTS

The intervention group showed a significant reduction in anxiety scores from T0 at T1 (β = -6.67, 95% CI [-9.16, -4.19], p < 0.001) and T2 (β = -8.14, 95% CI [-10.70, -5.57], p < 0.001), depression at T1 (β = -4.09, 95% CI [-6.94, -1.23], p = 0.005) and T2 (β = -6.12, 95% CI [-9.10, -3.13], p < 0.001) and improvement in QoL at T2 (β = 3.02, 95% CI [0.49, 5.56], p = 0.019) compared with the control group.

CONCLUSIONS

CBI has positive effects in reducing anxiety and depression and in improving QoL in children with hematological cancer receiving chemotherapy. The results suggest the need to incorporate CBI into pediatric hematology-oncology and studies on its long-term effects and cost-effectiveness are warranted.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05270655). Registered on 08 March 2022.

Psychometric properties of the Turkish Version General Self-Efficacy Scale in children and adolescents with cancer

OBJECTIVES

The study aimed to evaluate the validity and reliability of the Turkish version of the General Self-Efficacy Scale in children and adolescents aged 8-18 undergoing cancer treatment.

METHODS

The sample of this methodological and descriptive study consisted of 128 children and adolescents between the ages of 8 and 18 in the pediatric hematology-oncology wards and outpatient units of a university hospital. The study was implemented in a university hospital in Turkey between March 2023 and November 2023. Data were collected through face-to-face interviews with children and adolescents attending the clinic or outpatient clinic. Data were collected using the information form and General Self-Efficacy Scale psychometric tests, Cronbach's alpha, Test-retest, validity and reliability analysis). Item-total score correlation was used.

RESULTS

In the exploratory factor analysis, Kaiser Meyer Olkin was p 0.77, for which Bartlett's test of sphericity was significant (p < 0.001). Exploratory factor analysis revealed a ten-item unidimensional structure with satisfactory representation. Item-total score correlations of the scale ranged between 0.32 and 0.52. In the confirmatory factor analysis, the model fit indices of this scale were obtained as follows: χ2/sd = 1.36, Goodness-of-Fit Index = 0.94, Comparative Fit Index = 0.92, Adjusted Goodness-of-Fit Index = 0.90, and Cronbach alpha value, indicating the internal consistency of the entire scale, was 0.76.

CONCLUSIONS

The scale is a valid and reliable tool for assessing self-efficacy in children and adolescents between the ages of eight and eighteen undergoing cancer treatment.

PRACTICE IMPLICATIONS

The study will provide precious information for experimental interventions and follow-up studies to assess the self-efficacy of children and adolescents with cancer.

The effects of mindfulness-based interventions on anxiety, depression, stress, and mindfulness in menopausal women: A systematic review and meta-analysis

Background

Mindfulness-based interventions (MBIs) are psychological interventions widely used in menopausal women. Currently, there is no evidence summary on the effectiveness of MBIs on anxiety, depression, stress, and mindfulness in menopausal women. This meta-analysis examines the effectiveness of MBIs in improving anxiety, depression, stress, and mindfulness scores in menopausal women.

Methods

A systematic search was conducted in PubMed, Embase, Web of Science, the Cochrane Library, CNKI (China National Knowledge Infrastructure), and Wanfang, using relevant terms such as MBIs as keywords and covering all studies published before March 13, 2022. The outcomes were anxiety, depression, stress, and mindfulness. The screening and extraction of data were conducted by two independent reviewers.

Results

A total of 1,138 menopausal women participated in 13 studies. Meta-analysis results showed that MBIs significantly reduced stress in menopausal women (SMD = -0.84, 95% CI: -1.64 to -0.05, p = 0.04), but no statistical differences were found in reducing anxiety (SMD = -0.40, 95% CI: -0.81 to 0.01, p = 0.06) and depression (SMD = -0.19, 95% CI: -0.45 to 0.07, p = 0.16) and in raising the scores of mindfulness (SMD = 0.37, 95% CI: -0.06 to 0.81, p = 0.09) in menopausal women.

Conclusion

MBIs may reduce stress in menopausal women, but their effect on improving anxiety, depression, and mindfulness needs further validation.

Systematic review registration

https://www.crd.york.ac.uk/prospero/#recordDetails.

Virtual reality in chemotherapy support for the treatment of physical functions, fear, and quality of life in pediatric cancer patients: A systematic review and meta-analysis

Background

Appropriately selected complementary therapies, such as virtual reality (VR) and active video games (AVG), provide support to young patients during the process of cancer treatment. Therefore, this systematic review with meta-analysis aimed to analyze the effects of VR and AVG on fear, physical functions, and quality of life.

Methods

A systematic search was performed independently in Scopus, PubMed, Embase, Web of Science and Cochrane Library electronic databases for relevant randomized controlled and crossover studies. From a total of 5,963 records, 11 met the inclusion criteria. After full-text screening two publications were excluded, yet six studies were included in the quantitative analysis because three studies had a large discrepancy in their measured outcomes. For methodological quality assessments, the RoB2 software program was used, while RevMan 5.4.1 was used for statistical analysis and meta-analysis. Standard Mean Difference (SMD) outcome measures were used for the analysis. Statistical heterogeneity was assessed using the I2 statistic with a cut-off value of 50% considering intervention and outcome measures.

Results

Our systematic review includes six randomized controlled studies and three randomized crossover studies. The participants represented both sexes and were children and adolescents (<18 years old) with a diagnosis of cancer. The analysis of the results allows for a careful conclusion that VR has the potential to become an accessory tool in rehabilitation and oncologic treatment. All of the included studies noted a significant advantage of this intervention.

Conclusion

VR has the potential to be an effective and important tool in the oncologic treatment of children. VR immerses the patient, and as a result, produces a distraction that effectively reduces pain associated with standard oncologic care procedures in children. However, this systematic review and meta-analysis highlights the need for more research into the use of VR as support for pediatric oncologic care.

Systematic review registration

PROSPERO database (https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=319000), CRD42022319000.

Efficacy of a culturally tailored cognitive-behavioural intervention for Ethiopian children with haematological malignancies: study protocol for randomised controlled trial

BACKGROUND

Paediatric cancer patients often experience anxiety and depression. Evidence suggests that cognitive-behavioural interventions may help reduce anxiety and depression in children undergoing cancer treatment. However, only a few studies evaluated its impact on the psychological well-being and quality of life of paediatric cancer patients globally. In Ethiopia, there has been no published study to date. Thus, this trial aims to evaluate the efficacy of a culturally tailored cognitive-behavioural intervention for Ethiopian children with haematological malignancies receiving chemotherapy.

METHODS

A single-blinded, parallel-group, two-arm, repeated measure randomised controlled trial will be conducted. Eighty children aged 8 - 18 years with haematological malignancy receiving chemotherapy will be recruited and randomly assigned to experimental or control groups. The experimental group will receive five sessions of introducing cognitive-behavioural intervention, identifying and modifying maladaptive thoughts and behaviour, behavioural activation, practising deep breathing exercises, reassessing goals or treatment plans, and encouraging participants to maintain changes. Each session will be conducted face-to-face for 30-35 min a week. The control group will receive usual care. The outcomes will be measured at baseline, post-intervention, and one month after the intervention using the Revised Child Anxiety and Depression Scale and Paediatric Quality of Life Inventory Generic Core Score 4.0.

DISCUSSION

The findings of this study will provide evidence to support the integration of culturally effective cognitive-behavioural intervention strategies into paediatric oncology practice and thus, add new knowledge to the literature and help improve the care of children with haematological malignancies receiving chemotherapy. If the cognitive-behavioural intervention is shown to be effective and culturally acceptable, it will provide evidence to include the intervention as a standard of care in paediatric haematology/oncology.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05270655. Registered on March 8, 2022.