Non-pharmacological interventions on anxiety and depression in lung cancer patients' informal caregivers: A systematic review and meta-analysis

What can we learn from the evidence of psychosocial support for carers of people with cancer and how do we advance our efforts? A meta-review study

PURPOSE

Literature concerning programmes to support the well-being of carers of cancer survivors is vast, complex, and difficult to navigate, posing difficulties for identifying and translating relevant evidence. This study will advance the field by mapping and synthesising reviews to address the question: "What psychosocial interventions are available to promote the well-being of carers for people diagnosed with cancer, as reported in the evidence from reviews?".

METHODS

A meta-review was conducted of reviews published between 2013 and 2024. PsycINFO, MEDLINE, CINAHL, and Cochrane Database of Systematic Reviews databases and relevant reference lists were searched for eligible reviews. Records were screened and assessed in accordance with the method with data from included reviews extracted and synthesised. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guided reporting. Reviews were appraised using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses.

RESULTS

Ultimately, 54 reviews met the inclusion criteria. This evidence was mapped regarding populations, interventions, and outcomes, including depression, anxiety, quality of life, and distress. On average, reviews addressed nine of 11 quality checklist items. Insights were gained concerning the role of theory, carer populations, and intervention characteristics.

CONCLUSION

Key features of the body of evidence were identified that can hinder progress and which point to ways forward. It is concluded that a recalibrated carer research agenda is needed, one that is designed to synthesise evidence concerning what works, for which carers to achieve what outcomes, or to address which kinds of psychosocial support needs.

IMPLICATIONS FOR CANCER SURVIVORS

Despite the need to ensure that carers have access to programs that support their wellbeing as they care for their loved ones, the evidence to guide program development is complex and difficult to navigate. A refocusing of research efforts is needed to advance understanding of what is most effective for carers, and how this can be translated into clinical practice.

The novel manualized RELIEVE-group treatment for burdened relatives of cancer patients: a feasibility study

Introduction

The experience of cancer among relatives is characterized by an increase in anxiety and depression, stress, and a reduction in quality of life. However, there is a paucity of psychosocial support programmes for relatives and a dearth of evidence-based, manualized interventions. Accordingly, the present study aims to assess the acceptability, defined as participant drop-out and satisfaction, and feasibility, in terms of mental health improvement, of a novel manualized psycho-educational group intervention.

Methods

The manual was developed on the basis of previous research into psychotherapy. A total of 33 relatives of cancer patients were recruited from the West German Tumor Center and participated in the five modules of the RELIEVE treatment which included an introduction, communication skills, stress and anxiety management and self-care. The primary outcome was assessed using a range of measures, including anxiety (GAD-7), depression (PHQ-8), stress (PSQ), self-efficacy (SES), need for support (SCNSP&C-G), and quality of life (WGOQOL-BREF) before and after the completion of the treatment programme. A paired samples T-test was employed to assess the feasibility of the treatment, with pre- and post-scores being compared. The secondary outcome of treatment acceptance was evaluated by calculating the drop-out rate and scoring a treatment satisfaction questionnaire.

Results

A high level of satisfaction was reported by participants. The drop-out rate for the treatment was minimal, at only 2.86%. Following the completion of the treatment programme, there were significant improvements in anxiety, depression and stress scores, as well as an improvement in quality of life. No significant improvements were observed in self-efficacy, work and social security needs, and quality of life in the social relationships domain.

Discussion

The RELIEVE intervention demonstrated high feasibility and acceptance among emotionally affected relatives of cancer patients, addressing a gap in previous interventions that were often limited in scope and lacked standardised manuals.

Conclusion

This feasibility study on treatment acceptance underlines the importance of measures that are tailored to the specific needs of cancer patients' relatives, and of integrating them into the general healthcare system.

Interventions for Prevention of Tobacco Smoking in School-Aged Children and Adolescents: A Systematic Review and Meta-Analysis

Smoking is a major worldwide health concern and a leading cause of preventable diseases such as cancer and heart disease. Adolescence, marked by experimentation and risk-taking behaviors, is a critical developmental stage where tobacco smoking frequently begins. Early smoking is associated with an increased risk of health problems, reduced life expectancy, and lifetime addiction, making prevention during this stage imperative. Despite its urgency, evidence on effective non-pharmacological preventative techniques for this demographic remains limited. This systematic review and meta-analysis aimed to assess the components, efficacy, and potential negative consequences of behavior-based, non-pharmacological interventions. A systematic search of PubMed and the Cochrane Library was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria for randomized controlled trials (RCTs) published between 2014 and 2024. Eligible studies included school-aged children and evaluated smoking initiation or cessation as outcomes. Data from six RCTs involving 10,192 participants were analyzed using Review Manager (RevMan v5.4, The Cochrane Collaboration, Oxford, UK). Risk ratios (RR) with 95% confidence intervals (CI) and I² statistics were calculated to evaluate heterogeneity and intervention efficacy. Results showed that school-based educational programs significantly reduced smoking initiation rates at six months (RR = 0.38, 95% CI: 0.23-0.61, p < 0.001), though effects diminished at longer follow-up periods (12-36 months). Culturally tailored, peer-led interventions demonstrated moderate efficacy in improving attitudes toward smoking and reducing consumption. Combined interventions were the most effective overall, but variability in study design and follow-up durations limited generalizability. This research highlights the short-term effectiveness of school-based and culturally sensitive interventions in reducing adolescent tobacco use. Future research should prioritize long-term strategies that integrate digital tools, family, and community involvement to sustain behavioral changes and combat the global tobacco epidemic effectively.

The effect of targeted palliative care interventions on depression, quality of life and caregiver burden in informal caregivers of advanced cancer patients: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

To investigate the efficacy of targeted palliative care interventions on depression, quality of life and caregiver burden in informal caregivers of advanced cancer patients, along with the consequences of various intervention types.

DESIGN

This study performed a comprehensive review and a meta-analysis of randomized controlled trials.

METHOD

An extensive search was carried out across eight databases, namely, PubMed, Embase, CLNAHL, PsyclNFO, Cochrane, VIP, CNKI, and WANFANG, spanning from the inception of the library to May 4, 2024. Two examiners independently screened the articles and extracted the data according to the eligibility criteria formulated in accordance with the PICOS principles. The meta-analysis was conducted utilizing the StataCorp (version 16.0), estimating the impacts of the interventions through the computation of the standardized mean difference (SMD) and the 95 % confidence interval (CI). Sensitivity analysis was carried out using a one-way-out method. Egger's test and the Duval and Tweedie trim-and-fill methods were used to explore the potential publication bias. The Cochrane risk-of-bias tool was used to evaluate the methodological quality of the included studies, and the overall quality of evidence was evaluated using the GRADE method.

RESULTS

This study pooled 16 RCTs (including 2046 informal caregivers) that were published from 2007 to 2023. The meta-analysis results indicated that the targeted palliative care interventions significantly improved depression (SMD = -0.74, 95 % CI: [-1.25, -0.23], P < 0.01) and quality of life (SMD = 0.63, 95 % CI: [0.08, 1.17], P = 0.03), though not in terms of caregiver burden (SMD = -0.33, 95 % CI: [-0.95, 0.29], P = 0.30) among informal caregivers of advanced cancer patients. Analysis of the subgroups revealed a correlation between short-term interventions, under three months, and the improvement of depression. Strategies focused solely on caregivers have proven effective in alleviating depression. Interventions utilizing offline methods have been shown to not only lower depression levels but also improve the quality of life for caregivers.

CONCLUSIONS

The targeted palliative care interventions effectively improved informal caregivers' depression and quality of life, yet they fail to markedly lessen the caregiver burden. To better support informal caregivers, interveners ought to adopt personalized strategies based on comprehensive consideration of the duration, format, and delivery methods of the interventions. Simultaneously, further exploration and effort from scholars are necessary to enhance the accessibility of palliative care services, and to effectively incorporate academic research findings into clinical practice.

REGISTRATION

CRD42023475620.

Psychological interventions to enhance positive outcomes in adult cancer caregivers: A systematic review

This systematic review aims to examine the characteristics of psychological interventions that aim to enhance positive outcomes, such as wellbeing, post-traumatic growth, or hope in cancer caregivers. Studies published until December 2023 were searched on PubMed, Scopus, PsycINFO, WOS, PsycARTICLES and were included when examining interventions targeting positive outcomes with adult cancer caregivers. Of the 1424 articles retrieved through the databases, 16 studies were eligible for inclusion in this review, targeting 908 caregivers (70.2% female; Mage = 53.5). A narrative synthesis was used to describe the interventions, which were based on a variety of approaches such as psychoeducation, mindfulness, or Existential Behavioral Therapy, and reported positive gains for the positive outcomes. The results show few randomized controlled trials published to date, highlight the contrast between the focus shift towards these outcomes and the need for systematic testing of the interventions, to be able to inform evidence-based service delivery.

Fear of cancer recurrence and associated factors in family caregivers of patients with hematologic malignancy receiving chemotherapy: A latent profile analysis

Objective

This study identified the potential subgroups of fear of cancer recurrence (FCR) in family caregivers (FCs) of patients with hematologic malignancies receiving chemotherapy, as well as exploring factors associated with subgroups.

Methods

This was a cross-sectional study involving 206 pairs of participating patients with hematologic malignancies receiving chemotherapy and their FCs. Using Mplus 8.3 to perform the latent profile analysis of FCs' FCR, the FCs' burden, quality of life, psychological resilience, and anxiety as well as their demographic characteristics were compared between the subgroups, with a logistic regression analysis being applied to examine the factors associated with the FCR subgroups.

Results

A total of 206 FCs were classified into two subgroups: "a low level of FCR" (Class 1, 65.4%) and "a high level of FCR" (Class 2, 34.6%). Quality of life, anxiety, and frequency of chemotherapy were significantly associated with the two subgroups.

Conclusions

FCs of patients with hematologic malignancy receiving chemotherapy had two FCR subgroups, "a low level of FCR" and "a high level of FCR", in association with quality of life, anxiety, and frequency of chemotherapy. These findings provide the theoretical foundations for screening the FCR factor of FCs and conducting interventions for them.