© 2002 by Oxford University Press
Journal of the National Cancer Institute, Vol. 94, No. 8, 558-584,
April 17, 2002
© 2002 Oxford University Press
REVIEW |
Systematic Review of Psychological Therapies for Cancer Patients: Overview and Recommendations for Future Research
For the NSW Cancer Council Cancer Education Research Program
Affiliations of authors: S. A. Newell, Faculty of Medicine and Health Sciences, University of Newcastle, New South Wales, Australia, Health Promotion Unit, Northern Rivers Area Health Service, Lismore, New South Wales, and Southern Cross University, Lismore; R. W. Sanson-Fisher, Faculty of Medicine and Health Sciences, University of Newcastle; N. J. Savolainen, Commonwealth Grants Commission, Canberra, Australian Capital Territory.
Correspondence to: The Secretary, NSW Cancer Council Cancer Education Research Program, Locked Bag 10, WALLSEND, NSW, 2287 (e-mail: sallien{at}nrhs.health.nsw.gov.au).
Many cancer patients use psychological therapies because they expect them to cure their cancer or to improve their recovery. Despite these high expectations, both patients and oncologists report being moderately to very satisfied with the results of psychological therapies. Previous reviews of the literature have concluded that psychological therapies may help cancer patients in various ways, ranging from reducing the side effects of cancer treatments to improving patients' immune function and longevity. However, because those reviews lacked methodologic rigor, we critically and systematically reviewed all identifiable publications about psychological therapies used by cancer patients to provide an objective and scientific evaluation of nontraditional therapies. We identified 627 relevant papers that reported on 329 intervention trials by searching MEDLINETM, HealthplanTM, PsychlitTM, and Allied and Complementary MedicineTM databases and in the bibliographies of the papers identified. Despite increased use of randomized, controlled trial designs over time, the methodologic quality of the intervention trials, on 10 internal validity indicators, was generally suboptimal, with only one trial achieving a quality rating of "good" for its methodology. Using effectiveness results from 34 trials with psychosocial outcomes, 28 trials with side effect outcomes, 10 trials with conditioned side-effect outcomes, and 10 trials with survival or immune outcomes, we make only tentative recommendations about the effectiveness of psychological therapies for improving cancer patients' outcomes. Nevertheless, by exploring the relative effectiveness of the different intervention strategies for each outcome and follow-up period, we suggest the specific therapies that should be considered for further investigation. In addition, we suggest how future trials can maximize their internal validity by describing the minimal reporting standards that should be required in this field.
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