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Psychosocial interventions for cancer survivors: A meta-analysis of effects on positive affect

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Abstract

Purpose

Positive affect has demonstrated unique benefits in the context of health-related stress and is emerging as an important target for psychosocial interventions. The primary objective of this meta-analysis was to determine whether psychosocial interventions increase positive affect in cancer survivors.

Methods

We coded 28 randomized controlled trials of psychosocial interventions assessing 2082 cancer survivors from six electronic databases. We calculated 76 effect sizes for positive affect and conducted synthesis using random effects models with robust variance estimation. Tests for moderation included demographic, clinical, and intervention characteristics.

Results

Interventions had a modest effect on positive affect (g = 0.35, 95% CI [0.16, 0.54]) with substantial heterogeneity of effects across studies (\( \hat{\tau}=0.40 \); I2 = 78%). Three significant moderators were identified: in-person interventions outperformed remote interventions (P = .046), effects were larger when evaluated against standard of care or wait list control conditions versus attentional, educational, or component controls (P = .009), and trials with survivors of early-stage cancer diagnoses yielded larger effects than those with advanced-stage diagnoses (P = .046). We did not detect differential benefits of psychosocial interventions across samples varying in sex, age, on-treatment versus off-treatment status, or cancer type. Although no conclusive evidence suggested outcome reporting biases (P = .370), effects were smaller in studies with lower risk of bias.

Conclusions

In-person interventions with survivors of early-stage cancers hold promise for enhancing positive affect, but more methodological rigor is needed.

Implications for Cancer Survivors

Positive affect strategies can be an explicit target in evidence-based medicine and have a role in patient-centered survivorship care, providing tools to uniquely mobilize human strengths.

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Funding

This research was supported by National Cancer Institute Grant No. R03 CA184560 (PI: Salsman). Dr. McLouth was supported by National Cancer Institute R25 CA122061 (PI: Avis). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

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Authors and Affiliations

  1. Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Wake Forest Baptist Comprehensive Cancer Center, Winston Salem, NC, 27157, USA

    John M. Salsman & Laurie E. Steffen McLouth

  2. Department of Educational Psychology, University of Texas at Austin, Austin, TX, USA

    James E. Pustejovsky

  3. Department of Psychological Science, University of California, Irvine, Irvine, CA, USA

    Stephen M. Schueller

  4. School of Social Work, University of Illinois at Urbana-Champaign, Urbana-Champaign, IL, USA

    Rosalba Hernandez

  5. Galter Health Sciences Library, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Mark Berendsen

  6. Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Judith T. Moskowitz

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  1. John M. Salsman
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  2. James E. Pustejovsky
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  3. Stephen M. Schueller
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  4. Rosalba Hernandez
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  6. Laurie E. Steffen McLouth
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  7. Judith T. Moskowitz
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Correspondence to John M. Salsman.

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The authors declare that they have no conflict of interest.

Study authors received exempt approval from the Wake Forest University School of Medicine Institutional Review Board under IRB00034301. Study procedures described by the authors did not meet the federal definition of research involving human subjects, and research described in this manuscript constituted secondary analysis of published, de-identified data. Thus, informed consent was not applicable.

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Portions of this manuscript were presented as part of a symposium at the 2017 Annual Meeting of the Society of Behavioral Medicine: Moskowitz, J. T., Pustejovsky, J. E., Hernandez, R., Schueller, S. M., Berendsen, M., Salsman, J. M. (2017). Don’t worry, be happy? Meta-analysis of intervention trials on positive affect in cancer patients and survivors. In J.M. Salsman (Chair), Promoting psychological well-being in cancer patients and survivors: Meta-analyses of randomized clinical trials. Annals of Behavioral Medicine, 51(Suppl.): S1624.

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Salsman, J.M., Pustejovsky, J.E., Schueller, S.M. et al. Psychosocial interventions for cancer survivors: A meta-analysis of effects on positive affect. J Cancer Surviv 13, 943–955 (2019). https://doi.org/10.1007/s11764-019-00811-8

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