Cognitive Behavioral Therapy for Psychological Distress, Self Care and Quality of Life in Patients with Cancer: A Meta-analysis

Pok Ja Oh; Eun Ai Lee

doi:10.7475/KJAN.2013.25.4.377

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Oh and Lee: Cognitive Behavioral Therapy for Psychological Distress, Self Care and Quality of Life in Patients with Cancer: A Meta-analysis

Original Research

Korean J Adult Nurs 2013;25(4):377-388.

Published online: 18 August 2013

DOI: https://doi.org/10.7475/KJAN.2013.25.4.377

Cognitive Behavioral Therapy for Psychological Distress, Self Care and Quality of Life in Patients with Cancer: A Meta-analysis

Pok Ja Oh^1,, Eun Ai Lee²

^¹Department of Nursing, Sahmyook University, Seoul

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

Corresponding author: Oh, Pok Ja Department of Nursing, Sahmyook University, 815 Hwarangro, Nowon-gu, Seoul 139-742, Korea Tel: +82-2-3399-1589, Fax: +82-2-3399-1594, E-mail: ohpj@syu.ac.kr

Received 5 March 201324 July 2013 Accepted 7 August 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to assess the effects of cognitive behavioral therapy (CBT) on depression, anxiety, self care behavior and quality of life in cancer patients.

Methods

Two thousand and eighty three abstracts were identified through six electronic databases (1980 to June 2012) in Korea. Seventeen studies involving 679 participants met the inclusion criteria for meta analysis. Two authors independently assessed trial quality by Cochrane's Risk of Bias and Methodological Items for Non Randomized Studies and extracted data. The data were analyzed by the RevMan 5.2 program of Cochrane library.

Results

Overall, study quality was moderate to high. CBT was conducted for a mean of 4.2 weeks, 7 sessions and an average of 36.1-minutes per session. CBT was effective for depression (d=-0.85; 95% CI=-1.09, -0.61), anxiety (d=-0.52; 95% CI=-0.75, -0.29), self care behavior (d=-1.34; 95% CI=-1.93, -0.74), and quality of life (d=-0.42; 95% CI=-0.80, -0.04). Publication bias was not detected as evaluated by funnel plot and Egger's test.

Conclusion

CBT has small to large effects on depression, anxiety, self care and quality of life. These finding suggests that various CBT interventions can assist cancer patients in reducing emotional distress and improving self care and quality of life.

Keywords: Neoplasm, Distress, Quality of life, Intervention studies, Meta-analysis

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Figure 1.

Flow of included studies through database searching.

Figure 2.

Forest plot of effect size and 95% CI by cognitive behavioral therapy on psychological distress.

Figure 3.

Forest plot of effect size and 95% CI by cognitive behavioral therapy on self-care.

Figure 4.

Forest plot of effect size and 95% CI by cognitive behavioral therapy on quality of life.

Table 1.

Characteristics of Included Studies (N=17)

ID	Design	Subject (stage)	Sample size		Scale	Interventions		Source	Outcomes	Direction of effect
ID	Design	Subject (stage)	Exp. (n)	Con. (n)	Scale	Name/Type	Weeks/Number of Sessions /Min	Source	Outcomes	Direction of effect
Kam et al (2003)	NRCCT	Cancer patients	26	26	Oh et al (2007)'s scale/ STAI	Self efficacy promoting program/individual	2/2/25	Master's (nursing)	Self efficacy/ self care/anxiety	+/+/No diff
Shin (2007)^†	RCT	Cancer patients (home based)	17	19	Miller's hope scale/hope index scale from nursing outcomes classification/ Zung (1965)'s depression scale	Hope intervention/ individual	8/8/40	Master's (nursing)	Hope/hope index/ depression	+/+/No diff
Tae & Youn (2006)	NRCCT	Cancer patients	15	15	Hearth (1991)'s hope scale/ Youn (1997)'s QOL scale	Forgiveness nursing intervention program/individual	1/4/60	Journal (nursing)	Hope/quality of life	+/+
Kim et al (2008)^†	RCT	Cancer patients (home based)	20	20	Nowtony (1989)'s hope scale/ Index scale from nursing outcomes classification/ Cella (1993)'s functional assessment cancer therapy- general QOL	Hope intervention/ individual	6/6/40~60	Journal (nursing)	Hope/hope index/ quality of life	+/+/No diff
Ko & Park (2011)^\|\|	NRCCT	Breast cancer patients	17	22	Sherer's self efficacy scale/ Song's self efficacy scale/ Dodd's self care scale/ Tae's QOL scale	Self efficacy promoting program/individual and group	4/6/21	Journal (nursing)	General self efficacy/ specific self efficacy/ self care behavior/ quality of life	No diff/+/No diff/ No diff
Lee (2006)^\|\|	NRCCT	Lung cancer patients	12	16	Jang (1996)'s QOL scale	Programs using strategies for promoting self efficacy/group	4/4/2	Journal (nursing)	Knowledge/ self efficacy/ quality of life	+/+/No diff
Lee & Oh (2004)^‡§	NRCCT	Cancer patients (stage 1-2)	15	15	BDI/STAI	Guided imagery program	1/6/15	Journal (nursing)	Anxiety/depression	-/No diff
Kim a (2008)	NRCCT	Cancer patients (stage 1-3)	20	20	Yesavage (1986)'s depression scale/Oh, Song, Kim (1998)'s sleep scale	Guided imagery with visual screen/individual	1/12/18	Master's (nursing)	Depression/sleep	-/+
Byun (1997)	NRCCT	Cancer patients (stage 1-4)	14	17	Rhodes's index of nausea and vomiting/STAI	Guided imagery program/individual	2/11/15	Master's (nursing)	Nausea & vomiting/ anxiety	No diff/-
Oh (2008)^‡\|\|	NRCCT	Cancer patients (stage 1-4)	21	21	HADS	Spirituality/ hope promoting program/individual and group	4/4/30~50	Journal (nursing)	Fighting spirit/ helplessness/ anxiety/self-care	+/-/No diff/+
Jeong (2011)^§	NRCCT	Cancer patients (stage 1-4)	8	8	STAI/BAI/PPI/VAS	Mindfulness-based stress reduction program/group	8/8/90	Master's (non- nursing)	Anxiety/pain/ blood pressure/pulse	-/-/-/-
Kim b (2008)	NRCCT	Gastric cancer patients	20	22	Sherer& Maddux (1982)'s self efficacy scale/Oh (1997)'s self care scale/Tae et al (2002)'s QOL scale	Web based self-efficacy promoting program/individual and group	6/6/25	Doctoral (nursing)	General self-efficacy/ specific self-efficacy/ self-care behavior/ body weight/BMI/ quality of life	+/+/+/-/+/+
Kim et al (2005)	NRCCT	Cancer patients	19	19	STAI/BDI/Nowotny (1989)'s hope scale/Jang (1993)'s QOL scale	Guided imagery program/individual	5/14/45	Journal (nursing)	Anxiety/depression/ quality of life/ hope	No diff/-/No diff/+
Park (2010)^‡§	NRCCT	Cancer patients	15	17	Park (2006)'s mindfulness scale/Hayes et al (2004)'s AAQ;acceptance&action questionnaire-16/ Kim (2006)'s clinging scale/ SCL-90-R/EORTC QLQ-C30	Meditation and group counseling/group	unclear/unclear /3night 4days	Journal (non-nursing)	Mindfulness/ acceptance behavior/ cling/ anxiety/ depression/hostility/ quality of life/ somatization	+/+/-/-/-/-/ No diff/ No diff
Shim (2007)^‡§	NRCCT	Leuemia patients	30	30	VAS/STAI/Blood test	Imagery therapy/ individual	4/12/13	Master's (nursing)	Stress/state anxiety/ anxiety/ WBC/ ANC/ lymphocyte	-/No diff/-/-/-/+
Jang (2010)∗	RCT	Breast cancer patients	21	21	PKPCT/HADS/Fact-B	Meditation program/ group	8/8/60	Doctoral (nursing)	Power/Anxiety/ Depression/ quality of life	+/-/-/+
Park & Oh (2010)^§\|\|	NRCCT	Cancer patients	39	42	SCL-90-R/Nowontny (1989)'s scale/ C-QOL	Psychosocial intervention/individ ual and group	8/8/60	Journal (nursing)	Depression/hope/ quality of life	-/+/+

Exp.=experimental group; Con.=control group; diff=difference; RCT=randomized controlled trials; NRCCT=non-randomized controlled clinical trial; BDI=beck depression inventory; STAI=state-trait anxiety inventory.

^∗ Allocation concealment;

^† Blind stated;

^‡ Intention-to-treat;

^§ ＜5% Attrition rate;

^|| Calculation of sample size.

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