The findings of two meta-analyses of trials of psychological interventions in patients with cancer are presented: the first using anxiety and the second depression, as a main outcome measure. The majority of the trials were preventative, selecting subjects on the basis of a cancer diagnosis rather than on psychological criteria. For anxiety, 25 trials were identified and six were excluded because of missing data. The remaining 19 trials (including five unpublished) had a combined effect size of 0.42 standard deviations in favour of treatment against no-treatment controls (95% confidence interval (CI) 0.08–0.74, total sample size 1023). A most robust estimate is 0.36 which is based on a subset of trials which were randomized, scored well on a rating of study quality, had a sample size > 40 and in which the effect of trials with very large effects were cancelled out. For depression, 30 trials were identified, but ten were excluded because of missing data. The remaining 20 trials (including six unpublished) had a combined effect size of 0.36 standard deviations in favour of treatment against no-treatment controls (95% CI 0.06–0.66, sample size 1101). This estimate was robust for publication bias, but not study quality, and was inflated by three trials with very large effects. A more robust estimate of mean effect is the clinically weak to negligible value of 0.19. Group therapy is at least as effective as individual. Only four trials targeted interventions at those identified as at risk of, or suffering significant psychological distress, these were associated with clinically powerful effects (trend) relative to unscreened subjects. The findings suggest that preventative psychological interventions in cancer patients may have a moderate clinical effect upon anxiety but not depression. There are indications that interventions targeted at those at risk of or suffering significant psychological distress have strong clinical effects. Evidence on the effectiveness of such targeted interventions and of the feasibility and effects of group therapy in a European context is required.
Andersen, B. L. (1992). Psychological interventions for cancer patients to enhance quality of life. J Consult Clin Psychol 60: 552–568.
Beck, A. T. & Steer, R. A. (1987). Beck Depression Inventory Manual. The Psychological Corporation
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. & Erbaugh, J. (1961). An inventory for measuring depression. Arch Gen Psychiatry 4: 53–63.
Bindemann, S., Soukop, M. & Kaye, S. B. (1991). Randomised controlled study of relaxation training. Eur J Cancer 27: 170–174.
Bloom, J. R., Ross, R. D. & Burnell, G. (1978). The effect of social support on patient adjustment after breast surgery. Pat Counsell Health Educ 1: 50–59.
Brennan, J. H. & Sheard, T. A. B. (1994). Psychosocial support and therapy in cancer care. Eur J Palliat Care 1: 136–139.
Bridge, L. R., Benson, P., Pietroni, P. C. & Priest, R. (1988). Relaxation and imagery in the treatment of breast cancer. Br Med J 297: 1169–1172.
Burton, M. V. & Parker, R. W. (1988). A randomized controlled trial of preoperative psychological preparation for mastectomy. A preliminary report. In Psychosocial Oncology, Watson M, Greer S and Thomas C (eds). Pergamon: Oxford
Cain, E. N., Kohorn, E. I., Quinlan, D. M., Latimer, K. & Schwartz, P. E. (1986). Psychosocial benefits of a cancer support group. Cancer 57: 183–189.
Capone, M. A., Good, R. S., Westie, K. S. & Jacobson, A. F. (1980). Psychosocial rehabilitation of gynaecologic oncology patients. Arch Phys Med Rehabil 61: 128–132.
Carpenter, J. G. (1984). A study of group psychosocial intervention with cancer patients and their families. PhD Thesis, Virginia Commonwealth University, US
Christensen, D. N. (1983). Postmastectomy couple counselling: An outcome study of a structured treatment protocol. J Sex Marital Ther 9: 266–275.
Clacey, R., Thomas, C. & Pearson, H. (1988). Does counselling by nurses for mastecomy patients work? In Psychosocial Oncology, Watson M, Greer S and Thomas C (eds). Pergamon: Oxford
Cook, T. D. & Campbell, D. T. (1979). Quasi Experimentation: Design and Analysis Issues for Field Settings. Houghton Miflin: Boston
Cumbia, G. G. (1985). Therapeutic intervention in the treatment of adult patients with metastatic cancer: a comparative study of two group counselling approaches. D Ed Thesis, College of William and Mary, Virginia, USA
Cunningham, A. J. (1988). From neglect to support to coping: the evolution of psychosocial intervention for cancer patients. In Stress and Breast Cancer, Cooper CL (ed). Wiley: Chichester
Davis, H. (1986). Effects of biofeedback and cognitive therapy on stress in patients with breast cancer. Psychol Rep 59: 967–974.
Decker, T. W., Cline-Elsen, J. & Gallagher, M. (1992). Relaxation therapy as an adjunct in radiation oncology. J Clin Psychol 48: 388–393.
Derogatis, L. R., Morrow, G. R., Fetting, D., Penman, S., Piasetsky, S., Schmale, A. M., Henrichs, M. & Carnicke, C. L. M. (1983). The prevalence of psychiatric disorders among cancer patients. JAMA 249: 751–757.
Devlen, J., Maguire, P., Phillips, P., Crowther, D. & Chambers, H. (1987). Psychological problems associated with diagnosis and treatment of lymphomas. Br Med J 295: 953–957.
Fairbanks, C. A. (1981). The effects of psychological intervention on the psychological and survival status of advanced cancer patients. PhD Thesis, Florida School of Professional Psychology, USA
Fallowfield, L. (1995). Psychosocial interventions in cancer should be part of every patient’s management plan. Br Med J 311: 1316–1317.
Fallowfield, L. J. (1988). Counselling for patients with cancer. Br Med J 297: 727–728.
Fallowfield, L. J. & Roberts, R. (1992). Cancer counselling in the United Kingdom. Psychol Health 6: 107–117.
Farash, J. L. (1977). Effect of counselling on resolution of loss and body image disturbance following a mastectomy. PhD Thesis, California School of Professional Psychology, Los Angeles, USA
Fawzy, F. I., Cousins, N., Fawzy, N. W., Kemeny, M. E., Elashoff, R. & Morton, D. (1990). A structured psychiatric intervention for cancer patients: 1. Changes over time in methods of coping and affective disorders. Arch Gen Psychiatry 47: 720–725.
Fawzy, F. I., Fawzy, N. W. & Wheeler, J. G. (1996). A post-hoc comparison of the efficiency of a psychoeducational intervention for melanoma patients delivered in group versus individual formats: an analysis of data from two studies. Psycho-Oncology 5: 81–90.
Frankel, H. B. (1985). The effectiveness of a psychosocial intervention with cancer patients. PhD Thesis, Kent State University, USA
Golonka, L. M. (1976). The use of group counselling with breast cancer patients receiving chemotherapy. D Ed Thesis, State University of New York, Albany USA
Gordon, W. A., Freidenbergs, I., Diller, L., Hibbard, M., Wolf, C., Levine, L. & Lucido, D. (1980). Efficacy of psychosocial intervention with cancer patients. J Consult Clin Psychol 48: 743–759.
Greenberg, R. P., Bornstein, R. F., Greenberg, M. D. & Fisher, S. (1992). A meta-analysis of antidepressant outcome under “blinder” conditions. J Consult Clin Psychol 60: 664–669.
Greer, S., Moorey, S., Baruch, J. D. R., Watson, M., Robertson, B. M., Mason, A., Rowden, L., Law, M. G. & Bliss, J. M. (1992). Adjuvant psychological therapy for patients with cancer: A prospective randomised trial. Br Med J 304: 675–680.
Guerrant, D. (1984). Attitude adjustment of cancer patients after treatment based on a holistic model. PhD Thesis, Florida Institute of Technology, USA
Halttunen, A., Hietanen, P., Jallinoja, P. & Lonnqvist, J. (1992). Getting free of cancer: an eight-year perspective of the relapse free patients. Acta Oncol 31: 307–310.
Harman, M. J. (1991). The use of group psychotherapy with cancer patients: a review of recent literature. J Spec Group Work 16: 56–61.
Hayes, F. (1981). The effects of the Simonton’s methods including relaxation and imagery training in alleviating the psychological state of depression characteristic of cancer patients. PhD Thesis, Florida School of Professional Psychology, USA
Hedges, L. V. & Olkin, I. (1985). Statistical Methods for Meta-analysis. Academic Press: Orlando
Heinrich, R. L. & Coscarelli Schag, C. (1985). Stress and activity management: group treatment for cancer patients and spouses. J Consult Clin Psychol 53: 439–446.
Hopwood, P. & Maguire, P. (1992). Priorities in the psychological care of cancer patients. Int Rev Psychiatry 4: 35–44.
Houts, P. S., Whitney, C. W., Mortel, R. & Bartholomew, M. J. (1986). Former cancer patients as counsellors of newly diagnosed cancer patients. J Natl Cancer Inst 76: 793–796.
Hurst, D. F. (1986). An adaptation of a psychoeducational program for individuals with cancer to a small group. PhD Thesis, Indiana State University, USA
Johnson, J. (1982). The effects of a patient education course on persons with a chronic illness. Cancer Nurs 5: 117–123.
Linn, M. W., Linn, B. S. & Harris, R. (1982). Effects of counselling for late stage cancer patients. Cancer 49: 1048–1055.
Lipsey, M. W. & Wilson, D. B. (1993). The efficacy of psychological, educational and behavioural treatment: confirmation from meta-analysis. Am Psychol 48: 1181–1209.
Maguire, P., Tait, A., Brooke, M., Thomas, C. & Sellwood, R. (1980). Effect of counselling on the psychiatric morbidity associated with mastectomy. Br Med J 281: 1454–1456.
Massie, M. & Holland, J. (1990). Overview of normal reactions and prevalence of psychiatric disorders. In Holland J and Rowland J. Handbook of Psycho-oncology, pp. 273–282. OUP: New York
McNair, D. M., Lorr, M. & Dropplemann, L. F. (1971). Manual, Profile of Mood States. Educational and Industrial Testing Service: San Diego
Meyer, T. J. & Mark, M. M. (1995). Health Psychol 14: 101–108.
Parle, M., Jones, B. & Maguire, P. (1996). Maladaptive coping and affective disorders among cancer patients. Psychol Med 26: 735–744.
Price, R. G. (1982). An evaluation of a psychotherapeutic program for cancer patients in terms of depression. PhD Thesis, United States International University, USA
Quality Assurance Project (1983). A treatment outline for depressive disorders. Aus NZ J Psychiatry 17: 129–146.
Raudenbush, S. W. (1994). Random effects models. In The Handbook of Research Synthesis, Cooper H and Hedges LV (eds). Russel Sage Foundation: New York
Robinson, L. A., Berman, J. S. & Neimeyer, R. A. (1990). Psychotherapy for the treatment of depression: A comprehensive review of controlled outcome research. Psychol Bull 108: 30–49.
Rosenthal, R. (1979). The file drawer problem and tolerance for nul results. Psychol Bull 86: 638–641.
Shapiro, D. A. & Shapiro, D. (1982). Meta-analysis of comparative therapy outcome studies: A replication and refinement. Psychol Bull 92: 481–604.
Smith, M. L., Glass, G. V. & Miller, T. I. (1980). The Benefits of Psychological Therapy. Johns Hopkins University Press: Baltimore
Spiegel, D., Bloom, J. R. & Yalom, I. (1981). Group support for patients with metastatic breast cancer: A randomised prospective outcome study. Arch Gen Psychiatry 38: 527–533.
Spielberger, C. D., Gorsuch, R. L., Luschene, R., Vagg, P. R. & Jacobs, G. A. (1983). Manual for the State-trait Anxiety Inventory. Consulting Psychologists Press: Palo Alto
Steinbrueck, S. M., Maxwell, S. E. & Howard, G. S. (1983). A meta-analysis of psychotherapy and drug therapy in the treatment of unipolar depression with adults. J Consult Clin Psychol 51: 856–863.
Telch, C. F. & Telch, M. J. (1986). Group coping skills instruction and supportive group therapy for cancer patients: a comparison of strategies. J Consult Clin Psychol 54: 802–808.
Thompson, S. G. (1993). Controversies in meta-analysis: the case of the trials of serum cholesterol reduction. Stat Methods Med Res 2: 173–192.
Trijsburg, R. W., van Knippenberg, F. C. E. & Rijpma, S. E. (1992). Effect of psychological treatment on cancer patients: a critical review. Psychosom Med 54: 489–517.
Vachon, M. L. S. (1988). Counselling and psychotherapy in paliative/hospice care: a review. Palliat Med 2: 36–50.
Watson, M. (1983). Psychosocial intervention with cancer patients: a review. Psychol Med 13: 839–846.
Watson, M., Denton, S., Baum, M. & Greer, S. (1988). Counselling breast cancer patients: a specialist nurse service. Counsell Psychol Quart 1: 25–33.
West, B. L. (1980). Cognitive behavioural analysis system of psychotherapy (C-BASP) as applied to depression in a cancer population. PhD Thesis, Virginia Commonwealth University, USA
Worden, J. W. & Weisman, A. D. (1984). Preventive psychosocial intervention with newly diagnosed cancer patients. Gen Hosp Psychiatry 6: 243–249.
Youssef, F. A. (1984). Crisis intervention: a group-therapy approach for hospitalised breast cancer patients. J Adv Nurs 9: 307–313.
1 Three trials were common to the anxiety and depression samples and the negative effect can be attributed to the intervention groups being considerably more distressed at baseline (Bloom et al, 1978; Davis, 1986; Decker et al, 1992). In the other three anxiety trials one used a post-test only design (Cumbia, 1985), one was an evaluation of the effect of a brief telephone intervention given to subjects already receiving a psychosocial care programme (Houts et al, 1986), and one had no features that might obviously account for the intervention group faring worse than the controls (Hurst, 1986).
About this article
Cite this article
Sheard, T., Maguire, P. The effect of psychological interventions on anxiety and depression in cancer patients: results of two meta-analyses. Br J Cancer 80, 1770–1780 (1999) doi:10.1038/sj.bjc.6690596
- psychological interventions
JAMA Internal Medicine (2019)
Enhancing palliative care patient access to psychological counseling through outreach telehealth services
A randomized controlled trial of a group acceptance-based intervention for cancer survivors experiencing anxiety at re-entry (‘Valued Living’): study protocol
BMC Cancer (2019)
Couple-based interventions for improving dyadic adjustment in people with cancer and their spousal partners
Cochrane Database of Systematic Reviews (2019)
Emotional functioning to screen for psychological distress in breast and colorectal cancer patients prior to adjuvant treatment initiation
European Journal of Cancer Care (2019)