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

Journal of Korean Academy of Nursing 2014; 44(4): 446-457.

Published online: 29 August 2014

DOI: https://doi.org/10.4040/jkan.2014.44.4.446

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

Pok Ja Oh1, Eun-su Jang2

1Department of Nursing, Sahmyook University, Seoul, Korea.

2Department of Nursing, Graduate School, Sahmyook University, Seoul, Korea.

Address reprint requests to: Oh, Pok-Ja. Department of Nursing, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 139-742, Korea. Tel: +82-2-3399-1589, Fax: +82-2-3399-1594, ohpj@syu.ac.kr

Received 25 March 2014       Revised 8 April 2014       Accepted 3 July 2014

© 2014 Korean Society of Nursing Science

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

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.

Keywords: Neoplasm, Cortisol, Immune, Intervention studies, Meta-analysis

Figures and Tables

Figure 1
Flow of studies included from database search.
jkan-44-446-g001
Figure 2
Forest plot of effect size and 95% CI by psychosocial intervention on cortisol.
jkan-44-446-g002
Figure 3
Forest plot of effect size and 95% CI by psychosocial intervention on immune parameters.
jkan-44-446-g003
Figure 4
Funnel plot of effective sizes by standard error for immune parameters.
jkan-44-446-g004
Table 1
Descriptive Summary of Included Studies (N=21)
jkan-44-446-i001

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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