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Effects of psychosocial interventions on psychological outcomes among caregivers of advanced cancer patients: a systematic review and meta-analysis

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Abstract

Purpose

This systematic review aimed to synthesize the effectiveness of psychosocial interventions on caregivers of advanced cancer patients, in comparison with usual care, on caregivers’ quality of life (QoL), anxiety, and depression symptoms.

Methods

Comprehensive searches for published and unpublished studies were performed using nine electronic databases, two trial registers, and reference lists of included studies. Two reviewers independently screened, appraised, and extracted data. The Cochrane risk of bias tool was used to appraise the methodological quality of included studies, while the Cochrane data extraction tool was used to elicit relevant information. Meta-analysis, narrative analysis, and sensitivity analysis were conducted to synthesize data. Standardized mean differences (SMD) represented effects of psychosocial interventions.

Results

Fifteen randomized controlled trials were included in this review. At post-intervention, findings revealed a significant small pooled effect size (SMD = 0.45) on QoL and significant moderate effect on depression (SMD = − 0.65). However, a small non-significant pooled effect size was observed on anxiety (SMD = − 0.24). At follow-up assessments, effect sizes of all outcomes were small and non-significant. Overall quality of evidence was rated very low for all outcomes and most studies had unclear or high risk of bias. Thus, results should be interpreted with caution.

Conclusion

Psychosocial interventions were effective in improving QoL and depression among caregivers of persons with advanced cancer. However, future randomized control trials with lower risk of bias, larger sample size, detailed participant characteristics, and informative interventions are desirable.

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References

  1. World Health Organization. All cancers. http://gco.iarc.fr/today/data/factsheets/cancers/39-All-cancers-fact-sheet.pdf. Accessed 8 Dec 2019

  2. American Cancer Society. Understanding advanced cancer, metastatic cancer, and bone metastasis. 2016. Access December 8, 2019. https://www.cancer.org/treatment/understanding-your-diagnosis/advanced-cancer/what-is.html

  3. Doorenbos AZ, Given B, Given CW, Wyatt G, Gift A, Rahbar M, Jeon S (2007) The influence of end-of-life cancer care on caregivers. Res Nurs Health 30(3):270–281. https://doi.org/10.1002/nur.20217

    Article  PubMed  Google Scholar 

  4. McDonald J, Swami N, Pope A, Hales S, Nissim R, Rodin G, Zimmermann Z (2017) Caregiver quality of life in advanced cancer: qualitative results from a trial of early palliative care. Palliat Med 32(1):69–78. https://doi.org/10.1177/0269216317739806

    Article  PubMed  Google Scholar 

  5. LeSeure P, Chongkham-ang S (2015) The experience of caregivers living with cancer patients: a systematic review and meta-synthesis. J Personal Med 5(4):406–439. https://doi.org/10.3390/jpm5040406

    Article  Google Scholar 

  6. Joad A, Chaturvedi M, Mayamol T (2011) What does the informal caregiver of a terminally ill cancer patient need? A study from a cancer centre. Indian J Palliat Care 17(3):191–196. https://doi.org/10.4103/0973-1075.92335

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hastert TA, Ruterbusch JJ, Nair M, Noor MI, Beebe-Dimmer JL, Schwartz K, Schwartz AG (2019) Employment outcomes, financial burden, anxiety, and depression among caregivers of African American cancer survivors. J Oncol Pract 16(3):JOP.19.00410. https://doi.org/10.1200/jop.19.00410

    Article  Google Scholar 

  8. Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM (2003) Patterns of functional decline at the end of life. JAMA. 289(18):2387–2392. https://doi.org/10.1001/jama.289.18.2387

    Article  PubMed  Google Scholar 

  9. Bee PE, Barnes P (2009) Luker KA A systematic review of informal caregivers’ needs in providing home-based end-of-life care to people with cancer. J Clin Nurs 18(10):1379–1393. https://doi.org/10.1111/j.1365-2702.2008.02405.x

    Article  PubMed  Google Scholar 

  10. Badr H, Smith CB, Goldstein NE, Gomez J (2015) Redd WH Dyadic psychosocial intervention for advanced lung cancer patients and their family caregivers: results of a randomized pilot trial. Cancer. 121(1):150–158. https://doi.org/10.1002/cncr.29009

    Article  PubMed  Google Scholar 

  11. Applebaum AJ, Breitbart W (2013) Care for the cancer caregiver: a systematic review. Palliat Support Care 11(3):231–252. https://doi.org/10.1017/s1478951512000594

    Article  PubMed  Google Scholar 

  12. Fu F, Zhao H, Tong F, Chi I (2017) A systematic review of psychosocial interventions to cancer caregivers. Front Psychol 8:834. https://doi.org/10.3389/fpsyg.2017.00834

    Article  PubMed  PubMed Central  Google Scholar 

  13. Northouse LL, Katapodi MC, Song L, Zhang L, Mood DW (2010) Interventions with family caregivers of cancer patients: meta-analysis of randomized trials. CA Cancer J Clin 60(5):317–339. https://doi.org/10.3322/caac.20081

    Article  PubMed  PubMed Central  Google Scholar 

  14. Treanor CJ, Santin O, Prue G, Coleman H, Cardwell C, O’Halloran P, Donnelly M (2019) Psychosocial interventions for informal caregivers of people living with cancer. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.cd009912.pub2

  15. Waldron EA, Janke EA, Bechtel CF, Ramirez M, Cohen A (2013) A systematic review of psychosocial interventions to improve cancer caregiver quality of life. PsychoOncology. 22(6):1200–1207. https://doi.org/10.1002/pon.3118

    Article  PubMed  Google Scholar 

  16. Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097. https://doi.org/10.1371/journal.pmed.1000097

    Article  PubMed  PubMed Central  Google Scholar 

  17. Higgins JPT, Green S (2011). Cochrane handbook for systematic reviews of interventions (Version 5.1.0). Accessed 10 October 2019. www.training.cochrane.org/handbook

  18. Given B, Sherwood P (2006) Family care for the older person with cancer. Semin Oncol Nurs 22(1):43–50. https://doi.org/10.1016/j.soncn.2005.10.006

    Article  PubMed  Google Scholar 

  19. The Cochrane Collaboration. (2014). Data collection form for intervention reviews: RCTs only [Word document]. Accessed 11 November 2019. https://dplp.cochrane.org/data-extraction-forms

  20. Schünemann H, Brożek J, Guyatt G, Oxman, A. GRADE handbook, 2013. Accessed 10 October 2019. https://gdt.gradepro.org/app/handbook/handbook.html#h.svwngs6pm0f2

  21. Cohen J (1988) Statistical power analysis in the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Inc., Hillsdale

    Google Scholar 

  22. Walsh K, Jones L, Tookman A, Mason C, McLoughlin J, Blizard R, King M (2007) Reducing emotional distress in people caring for patients receiving specialist palliative care - randomised trial. Br J Psychiatry 190:142–147. https://doi.org/10.1192/bjp.bp.106.023960

    Article  PubMed  Google Scholar 

  23. Younis MKB, Al-Rawashdeh A, Alnajadat RM (2019) The effect of palliative care intervention program on the quality of life among Jordanian caregivers of cancer patients. Home Health Care Serv Q 38(4):286–296. https://doi.org/10.1080/01621424.2019.1661325

    Article  Google Scholar 

  24. Leow M, Chan S, Moon FC (2015) A pilot randomized, controlled trial of the effectiveness of a psychoeducational intervention on family caregivers of patients with advanced cancer. Oncol Nurs Forum 42:E63–E72. https://doi.org/10.1188/15.ONF.E63-E72

    Article  PubMed  Google Scholar 

  25. Dionne-Odom JN, Azuero A, Lyons KD, Hull JG, Tosteson T, Li Z, Bakitas MA (2015) Benefits of early versus delayed palliative care to informal family caregivers of patients with advanced cancer: outcomes from the ENABLE III randomized controlled trial. J Clin Oncol 33(13):1446–1452. https://doi.org/10.1200/JCO.2014.58.7824

    Article  PubMed  PubMed Central  Google Scholar 

  26. Clark MM, Rumman TA, Atherton PJ, Cheville L, Johnson ME, Frost MH, Brown PD (2013) Randomized controlled trial of maintaining quality of life during radiotherapy for advanced cancer. Cancer. 119(4):880–887. https://doi.org/10.1002/cncr.27776

    Article  PubMed  Google Scholar 

  27. McMillan SC, Small BJ, Weitzner M, Schonwetter R, Tittle M, Moody L, Haley WE (2006) Impact of coping skills intervention with family caregivers of hospice patients with cancer: a randomized clinical trial. Cancer. 106(1):214–222. https://doi.org/10.1002/cncr.21567

    Article  PubMed  Google Scholar 

  28. Meyers FJ, Carducci M, Loscalzo MJ, Linder J, Greasby T, Beckett LA (2011) Effects of a problem-solving intervention (COPE) on quality of life for patients with advanced cancer on clinical trials and their caregivers: simultaneous Care Educational Intervention (SCEI): Linking palliation and clinical trials. J Palliat Med 14(4):465–473. https://doi.org/10.1089/jpm.2010.0416

    Article  PubMed  PubMed Central  Google Scholar 

  29. Washington KT, Demiris G, Oliver DP, Albright DL, Craig KW, Tatum P (2018) Delivering problem-solving therapy to family caregivers of people with cancer: a feasibility study in outpatient palliative care. Psychooncology. 27(10):2494–2499. https://doi.org/10.1002/pon.4859

    Article  PubMed  PubMed Central  Google Scholar 

  30. McLean L, Walton T, Rodin G, Esplen M, Jones JM (2013) A couple-based intervention for patients and caregivers facing end-stage cancer: outcomes of a randomized controlled trial. Psychooncology. 22(1):28–38. https://doi.org/10.1002/pon.2046

    Article  PubMed  Google Scholar 

  31. Ammari ABH, Hendriksen C, Rydahl-Hansen S (2018) Results from the family and coping oriented palliative homecare intervention study (FamCope)—a randomized controlled trial. J Psychosoc Oncol 36(5):557–581. https://doi.org/10.1080/07347332.2018.1460003

    Article  PubMed  Google Scholar 

  32. von Heymann-Horan A, Bidstrup P, Guldin MB, Sjøgren, Andersen EAW, von der Maase H, Johansen C (2018) Effect of home-based specialised palliative care and dyadic psychological intervention on caregiver anxiety and depression: a randomised controlled trial. Br J Cancer 119(11):1307–1315. https://doi.org/10.1038/s41416-018-0193-8

    Article  Google Scholar 

  33. Beck C, McSweeney JC, Richards KC, Roberson PK, Tsai PF, Souder E (2010) Challenges in tailored intervention research. Nurs Outlook 58(2):104–110. https://doi.org/10.1016/j.outlook.2009.10.004

    Article  PubMed  PubMed Central  Google Scholar 

  34. Karabekiroğlu A, Demir EY, Aker S, Kocamanoğlu B, Karabulut GS (2018) Predictors of depression and anxiety among caregivers of hospitalised advanced cancer patients. Singap Med J 59(11):572–577. https://doi.org/10.11622/smedj.2018066

    Article  Google Scholar 

  35. Jorm AF, Morgan AJ, Hetrick SE (2008) Relaxation for depression. Cochrane Database Syst Rev:8(4). https://doi.org/10.1002/14651858.cd007142.pub2

  36. Given B, Wyatt G, Given, Sherwood P, Gift A, DeVoss D, Rahbar M (2004) Burden and depression among caregivers of patients with cancer at the end of life. Oncol Nurs Forum 31(6):1105–1117. https://doi.org/10.1188/04.onf.1105-1117

    Article  PubMed  PubMed Central  Google Scholar 

  37. Button KS, Munafo MR (2015) Addressing risk of bias in trials of cognitive behavioral therapy. Shanghai Arch Psychiatry 27(3):144–148. https://doi.org/10.11919/j.issn.1002-0829.215042

    Article  PubMed  PubMed Central  Google Scholar 

  38. Ambekar A, Mongia M (2018) Planning research in psychosocial interventions. Indian J Psychiatry 60(4):S575–S582. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_27_18

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Alice Lee Centre for Nursing Studies, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, Singapore, 117597, Singapore

    Jocelyn Zhi Jia Lee, Hui-Chen Chen & Piyanee Klainin-Yobas

  2. Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore, 609606, Singapore

    Jia Xin Lee

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Contributions

JZJL planned and implemented the project; participated in data screening, appraisal, extraction, and analysis; and prepared the manuscript. HC participated in data appraisal, extraction, and analysis; and reviewed the manuscript. JXL participated in data appraisal, extraction, and analysis; and reviewed the manuscript. PKY planned the project; participated in data appraisal, extraction, and analysis; and finalized the manuscript.

Corresponding author

Correspondence to Piyanee Klainin-Yobas.

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Lee, J.Z.J., Chen, HC., Lee, J.X. et al. Effects of psychosocial interventions on psychological outcomes among caregivers of advanced cancer patients: a systematic review and meta-analysis. Support Care Cancer 29, 7237–7248 (2021). https://doi.org/10.1007/s00520-021-06102-2

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  • DOI: https://doi.org/10.1007/s00520-021-06102-2

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