Table 3.
Effects of psychological interventions on depression and anxiety in adult with cancer: subgroup analyses
| Subgroup | No. of studies | No. of subjects | SMD | 95% CI | Q | I2(%) | Pa |
|---|---|---|---|---|---|---|---|
| Depression | |||||||
| Caner typeb | <0.001 | ||||||
| Mixed cancer | 60 | 6506 | 1.113 | 0.966-1.260 | 440.61*** | 86.6 | |
| Lung cancer | 8 | 592 | 1.481 | 0.811-2.151 | 90.26*** | 92.2 | |
| Head/neck cancer | 8 | 734 | 1.403 | 1.150-1.167 | 16.50* | 57.6 | |
| Gynecological cancer | 19 | 1592 | 1.268 | 1.015-1.520 | 94.81*** | 81.0 | |
| Breast cancer | 15 | 1114 | 1.106 | 0.830-1.382 | 63.82*** | 78.1 | |
| Digestive tract cancer | 9 | 851 | 1.283 | 0.928-1.638 | 40.26*** | 80.1 | |
| Cancer stage | 0.502 | ||||||
| Advanced | 21 | 1810 | 1.220 | 0.927-1.513 | 160.64*** | 87.5 | |
| Early | 8 | 596 | 1.401 | 0.821-1.980 | 70.28*** | 90.0 | |
| Patients’ selection | 0.004 | ||||||
| Nonselective | 103 | 10310 | 1.170 | 1.058-1.282 | 693.41*** | 85.3 | |
| Selective | 19 | 1261 | 1.368 | 1.095-1.642 | 85.42*** | 78.9 | |
| Intervention format | 0.202 | ||||||
| Individual | 25 | 2103 | 1.256 | 1.015-1.497 | 151.98*** | 84.2 | |
| Other formats | 79 | 7811 | 1.167 | 1.043-1.291 | 490.91*** | 84.1 | |
| Appropriate randomization | 0.923 | ||||||
| No | 19 | 1788 | 1.161 | 0.920-1.401 | 98.77*** | 81.8 | |
| Yes | 27 | 2572 | 1.145 | 0.990-1.300 | 152.60*** | 83.0 | |
| Questionnaires | 1.000 | ||||||
| SDS | 104 | 10134 | 1.189 | 1.080-1.298 | 646.84*** | 84.1 | |
| HAMD | 15 | 1104 | 1.442 | 1.050-1.834 | 114.76*** | 87.8 | |
| Timing of assessmentc | 0.113 | ||||||
| ≤1 week | 8 | 759 | 1.180 | 0.698-1.662 | 63.77*** | 89.0 | |
| 2 weeks-4 weeks | 22 | 2599 | 1.150 | 0.934-1.366 | 134.10*** | 84.3 | |
| 6 weeks-8 weeks | 19 | 1644 | 1.226 | 0.940-1.512 | 124.72*** | 85.6 | |
| >8 weeks | 9 | 765 | 1.323 | 0.922-1.724 | 49.61*** | 83.9 | |
| Anxiety | |||||||
| Caner typeb | 0.020 | ||||||
| Mixed cancer | 58 | 6563 | 1.242 | 1.075-1.409 | 538.86*** | 89.4 | |
| Lung cancer | 9 | 676 | 1.588 | 0.994-2.182 | 90.75*** | 91.2 | |
| Head/neck cancer | 7 | 645 | 1.468 | 0.943-1.992 | 51.74*** | 88.4 | |
| Gynecological cancer | 22 | 1740 | 1.385 | 1.139-1.630 | 110.22*** | 80.9 | |
| Breast cancer | 20 | 1622 | 1.153 | 0.857-1.448 | 141.59*** | 86.6 | |
| Digestive tract cancer | 11 | 1020 | 1.371 | 1.024-1.718 | 58.7*** | 83.0 | |
| Cancer stage | 0.777 | ||||||
| Advanced | 22 | 2175 | 1.178 | 0.923-1.434 | 154.64*** | 86.4 | |
| Early | 7 | 512 | 1.271 | 0.687-1.855 | 54.27*** | 88.9 | |
| Patients’ selection | 0.114 | ||||||
| Nonselective | 111 | 11241 | 1.322 | 1.201-1.444 | 932.67*** | 88.2 | |
| Selective | 20 | 1327 | 1.152 | 0.906-1.399 | 81.57*** | 76.7 | |
| Intervention format | <0.001 | ||||||
| Individual | 28 | 2287 | 1.575 | 1.266-1.884 | 277.89*** | 90.3 | |
| Other formats | 81 | 8285 | 1.161 | 1.045-1.276 | 464.52*** | 82.8 | |
| Appropriate randomization | 0.458 | ||||||
| No | 21 | 2018 | 1.245 | 0.955-1.535 | 172.30*** | 88.4 | |
| Yes | 26 | 2508 | 1.383 | 1.140-1.627 | 187.05*** | 86.6 | |
| Questionnaires | <0.001 | ||||||
| SAS | 113 | 10918 | 1.276 | 1.163-1.390 | 810.72*** | 86.2 | |
| HAMA | 9 | 624 | 1.295 | 0.856-1.733 | 48.06*** | 83.4 | |
| STAI | 4 | 546 | 1.800 | 0.717-2.884 | 83.95*** | 96.4 | |
| SAI | 4 | 420 | 1.639 | 0.916-2.362 | 30.86*** | 90.3 | |
| Timing of assessmentc | 0.246 | ||||||
| ≤1 week | 10 | 1211 | 1.224 | 0.881-1.566 | 64.58*** | 86.1 | |
| 2 weeks-4 weeks | 24 | 2519 | 1.207 | 0.986-1.427 | 145.26*** | 84.2 | |
| 6 weeks-8 weeks | 14 | 1294 | 1.283 | 0.920-1.646 | 114.14*** | 88.6 | |
| >8 weeks | 8 | 658 | 1.021 | 0.801-1.241 | 12.10 | 42.2 |
Abbreviations: SDS Self-rating Depression Scale, SAS Self-rating Anxiety Scale, HAMD Hamilton Depression Rating Scale, HAMA Hamilton Anxiety Rating Scale, STAI State-Trait Anxiety Inventory, SAI State Anxiety Inventory.
*p < 0.05.
***p < 0.001.
aP of comparison between these subgroups [30], which is akin to analysis of variance. We partition the total variance into variance within groups and variance between groups, and then test these various components of variance for statistical significance, with the last (variance between groups) addressing the hypothesis that effect size differs as function of group membership.
bDue to a few of studies (the number is less than or equal to 2) separately reporting the effect size for depression and anxiety in patients with urinary cancer, bone metastatic cancer, and blood cancer, the subgroup comparison of depression and anxiety in these cancer types were not included.
cTiming of assessment was aimed at the specified time range (e.g., days, weeks, months and years) post-treatment(e.g., surgery and chemotherapy) or post-intervention.