Journal List > J Korean Acad Nurs > v.44(4) > 1003008

Oh and Jang: Effects of Psychosocial Interventions on Cortisol and Immune Parameters in Patients with Cancer: A Meta-analysis

Abstract

Purpose

This study was done to evaluate the effects of psychosocial interventions on cortisol and immune response in adult patients with cancer.

Methods

MEDLINE via PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL and domestic electronic databases were searched. Twenty controlled trials (11 randomized and 9 non-randomized trials) met the inclusion criteria with a total of 862 participants. Methodological quality was assessed using the Cochrane's Risk of Bias for randomized studies and the Risk of Bias Assessment tool for non randomized studies. Data were analyzed using the RevMan 5.2.11 program of Cochrane library.

Results

Overall, study quality was moderate to high. The weighted average effect size across studies was -0.32 (95% CI [-0.56, -0.07], p=.010, I2=45%) for cortisol concentration, -0.62 (95%CI [-0.96,-0.29], p<.001, I2=0%) for T lymphocyte (CD3) and -0.45 (95%CI [-0.74, -0.16], p=.003, I2=0%) for Th lymphocyte (CD4) numbers. Psychosocial interventions were not effective for Tc lymphocyte (CD4), NK cell, monocyte, and cytokine response.

Conclusion

Although these results provide only small evidence of successful immune modulation, they support the conclusion that psychosocial interventions can assist cancer patients in reducing emotional distress and improving immune response.

Figures and Tables

Figure 1
Flow of studies included from database search.
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Figure 2
Forest plot of effect size and 95% CI by psychosocial intervention on cortisol.
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Figure 3
Forest plot of effect size and 95% CI by psychosocial intervention on immune parameters.
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Figure 4
Funnel plot of effective sizes by standard error for immune parameters.
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Table 1
Descriptive Summary of Included Studies (N=21)
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Exp.=Experimental group; Con.=Control group; RCT=Randomized controlled trials; Non-RCT=Non-randomized controlled clinical trial; CBSM=Cognitive-behavioral stress management; MBSR=Mindfulness-based stress reduction; +=Statistically significant difference between two groups; No diff.=No significant difference between two groups; *Cognitive behavioral therapy; Supportive expressive therapy; Education intervention.

Notes

This paper was supported by the Sahmyook University Research Fund in 2014.

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