Summary of findings 1. Summary of findings.

Telephone interventions compared with control interventions for symptom management in adults with cancer
Patient or population: individuals with any cancer at any stage Settings: randomised controlled trials Intervention: telephone interventions with or without additional support Comparison: control intervention
Outcomes	Risks	Effects of interventions	No. of participants (studies)	Certainty of the evidence (GRADE)
Anxiety	We could not present illustrative absolute effects because a representative control group risk could not be ascertained from the studies nor from any external source. Furthermore, results were reported in narrative form and varied considerably	Effect measures (using change score (CS)) ranged from: SMD ‐5.1 (95% CI ‐6.1 to ‐4.1) for breast cancer to SMD ‐0.3 (95% CI ‐0.3 to 0.9) for prostate cancer Other cancer sites including colorectal and lung and trials including participants with mixed cancers The 5 trials reporting data where change scores could be calculated were generally very heterogeneous in terms of demographics, including age and gender (gender specific or mixed cancers), FIGO stage (early or advanced disease), and delivery of interventions and controls. This may have differed in the number of telephone calls and whether additional management components were used in intervention arms, and in controls being sufficiently different to consider any data synthesis methods	277 participants (5 studies) Sample sizes were often small, and baseline outcome values for intervention and control groups largely differed widely in 11 further studies. Therefore displaying only studies that used change scores seemed appropriate, and in future updates of the review, meta‐analytical approaches will be attempted	⊕⊝⊝⊝ Very lowa,b,c
Depression		Effect measures (CS) ranged from: SMD ‐2.2 (95% CI ‐2.7 to ‐1.7) for colorectal cancer to SMD 0.3 (95% CI 0.04 to 0.5) for mixed cancers Other cancer sites including breast, lung, and prostate cancer. There was scope in the breast and mixed cancer subgroups to potentially pool results, but even within these more restrictive analyses, there was considerable heterogeneity, imprecision, and inconsistency across trials. Therefore results were reported by single trials, and results were presented narratively The 9 trials reporting data where change scores could be calculated were generally very heterogeneous in terms of demographics, including age and gender (gender specific or mixed cancers), FIGO stage (early or advanced disease), and delivery of interventions and controls. This may have differed in the number of telephone calls and whether additional management components were used in intervention arms, and in controls being sufficiently different to consider any data synthesis methods	1059 participants (9 studies) Sample sizes were often small, and baseline outcome values for intervention and control groups largely differed widely in 12 further studies. Therefore displaying only studies that used change scores seemed appropriate, and in future updates of the review, attempts at meta‐analysis will be made	⊕⊝⊝⊝ Very lowa,b,c
Fatigue		Effect measures (CS) ranged from: SMD ‐0.9 (95% CI ‐1.5 to ‐0.3) for breast cancer to SMD 0.0 (95% CI ‐0.2 to 0.2) for mixed cancers Another cancer site, including prostate cancer. There was scope in the mixed cancer subgroup to potentially pool results, but even within these more restrictive analyses, there were sufficient clinical differences between trials to justify not using this approach. Therefore results were reported by single trials and are presented narratively The 6 trials reporting data where change scores could be calculated were generally very heterogeneous in terms of demographics, including age and gender (gender specific or mixed cancers), FIGO stage (early or advanced disease), and delivery of interventions and controls	895 participants (6 studies) Sample sizes were often small, and baseline outcome values for intervention and control groups largely differed widely in 3 further studies. Therefore displaying only studies that used change scores seemed appropriate, and in future updates of the review, attempts at meta‐analysis will be made	⊕⊝⊝⊝ Very lowa,b,c
Emotional distress		SMDs (CS) in each individual trial all indicated uncertainty as to whether telephone interventions or control interventions were best for minimising emotional distress (all estimates were imprecise) Cancer sites included breast, prostate, and mixed cancers. There was scope in the breast cancer subgroup to potentially pool results, but there were sufficient clinical differences between the 2 trials in terms of including participants at different stages and ages to justify not using this approach. Therefore results were reported by single trials and are presented narratively The 5 trials reporting data where change scores could be calculated were generally very heterogeneous in terms of demographics, including age and gender (gender specific or mixed cancers), FIGO stage (early or advanced disease), and delivery of interventions and controls. This may have differed in the number of telephone calls and whether additional management components were used in intervention arms, and in controls being sufficiently different to consider any data synthesis methods	968 participants (5 studies) Sample sizes were often small, and baseline outcome values for intervention and control groups largely differed widely in 2 further studies. Therefore displaying only studies that used change scores seemed appropriate, and in future updates of the review, attempts at meta‐analysis will be made	⊕⊝⊝⊝ Very lowa,b,c
Other outcomes included uncertainty, pain, sexually related symptoms, dyspnoea, and general symptoms. Data for any of these outcomes were not pooled due to considerable heterogeneity across all aspects. Magnitudes of effect were not reported			Studies for each outcome ranged from 2 to 6 (10 were included in the wider 'general symptoms' outcome)	⊕⊝⊝⊝ Very lowa,b,c
*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; CS: change score; FIGO: International Federation of Gynecology and Obstetrics; SMD: standardised mean difference.
GRADE Working Group grades of evidence. High certainty: further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty: we are very uncertain about the estimate.

^aDowndraded by one level due to concerns about overall risk of bias being unclear or high.

^bDowndraded by one level due to concerns about precision.

^cDowndraded by one level due to inconsistencies in results and general heterogeneity.