Stress management or post-traumatic growth facilitation to diminish distress in cancer survivors? a randomized controlled trial

What works in peer support for breast cancer survivors: A qualitative systematic review and meta-ethnography

Breast cancer is associated with adverse physical and psychological consequences. Although research has identified the various benefits linked to psychosocial interventions, mixed results have been found in relation to peer support. The aim of the present systematic review and meta-ethnography is to explore the qualitative evidence on the experience of breast cancer survivors in peer support. A systematic search of the literature was conducted until June 2023, and a meta-ethnographic approach was used to synthesize the included papers. Eleven articles were included, collecting the experience of 345 participants. The following four core areas involved in peer support implementation were identified from the synthesis: Peer support can create understanding and a mutual therapeutic and emotional connection; peer support can facilitate an educational and supportive patient-centered journey; peer support should monitor group members for unpleasant emotional experiences; peer support should have professional supervision of recruitment and training to prioritize quality. These results can be used as patient-centered insights by healthcare professionals to provide evidence-informed peer support programs and address current limitations in the field.

Psychosocial interventions on the posttraumatic growth of adults with cancer: A systematic review and meta-analysis of clinical trials

BACKGROUND

It has been increasingly recognized that some people experience post-traumatic growth (PTG) as a result of struggling with cancer.

OBJECTIVE

This systematic review aims to identify psychosocial interventions that might facilitate PTG in adults with cancer.

METHODS

A search was conducted in PsycINFO, PubMed, Scopus, the Cochrane Library, and ProQuest up to 16 September 2022. The PRISMA guidelines were followed; all included interventional studies had to comprise 30 or more adults with cancer, using the Posttraumatic Growth Inventory, from 1994 forward.

RESULTS

A total of 2731 articles were retrieved, 1028 of those were screened and 37 unique trials were included (46 articles). A large number of studies were published since 2018 (52.4%), were randomized controlled trials (43.2%), and had group interventions (34.8%), including mainly female participants (83.8%) with a single cancer type (54.1%). Most interventions (75.7%) were moderately to highly effective in increasing PTG (d = 0.65, 95% CI 0.39-0.91) with the most effective interventions using Cognitive Behavioral Therapy (d = 1.24, 95% CI: 0.05-2.44), Mindfulness-based (d = 0.54, 95% CI = 0.14-0.94) and Education, Peer Support and Health Coaching interventions (d = 0.28, 95% CI: 0.1-0.46). Expression-based and Positive Psychology-based approaches also showed promising results. Notably, the majority of studies had a high risk of bias.

CONCLUSIONS

PTG facilitation is a promising field that should be pursued as it not only allows people with cancer to overcome their trauma but also results in them going over and above their pre-cancer state, enhancing resilience, health, and well-being.

Therapist‐led Interventions for the Treatment of Traumatic Stress Symptoms in Cancer Survivors: A SYSTEMATIC LITERATURE REVIEW

Objective

We reviewed the evidence regarding the effectiveness of therapist‐led interventions for reducing symptoms of traumatic stress in cancer survivors.

Methods

This systematic review was completed in accordance with the guidelines illustrated by Popay and colleagues and the following online databases, PsychInfo, Medline, CINAHL, were searched for peer‐reviewed literature. Further studies were searched through Google Scholar and manually scanning the reference lists of all included studies. The PRISMA guidelines were followed to report results.

Results

Sixteen studies were identified, their quality varied and the interventions broadly fell into two categories: CBT‐based and non‐CBT interventions. Effect sizes were small to moderate in 12 studies and large in four. Drop‐out rates were mostly low.

Conclusion

This review has demonstrated that the research in this field is still scarce and due to the data mostly suggesting a small to moderate effect, firm conclusions cannot be drawn on the effectiveness of the included interventions.

Stressful Life Events and Distress in Breast Cancer: A 5-Years Follow-Up

Background/Objective

Method

Results

Conclusions

Positive interventions for stress-related difficulties: A systematic review of randomized and non-randomized trials

The effectiveness of positive psychology interventions in the treatment of stress-related difficulties have not been well established. To estimate the effectiveness of positive psychology interventions on the reduction of stress-related symptoms, a systematic review using PubMed, Scopus, Wiley, Psychinfo, Cochrane and Sage databases with no limitation of date of publication was conducted. We identified additional studies by searching positive psychology reviews and academic books. Only studies trying positive interventions that included measures of anxiety, stress, or posttraumatic stress disorder symptoms were reviewed. We extracted data using predefined data fields and study quality was assessed with the National Institutes of Health study quality assessment tools. Twenty-nine records were included in this study: 23 controlled trials and six pre-post studies. Every study showed significant improvement in at least one dimension. Several studies reported improvements in well-being as well. This review shows promising results of positive psychology interventions as a treatment for stress-related difficulties. However, important methodological biases and strong heterogeneity among the studies highlight the need for replication and better validation of positive psychology interventions.

Posttraumatic growth experiences of refugees: A metasynthesis of qualitative studies

Although forced displacement may lead to many adverse psychological problems, this experience may also result in positive psychological consequences. Given the increasing disturbance in countries, many people are forcibly displaced, a comprehensive understanding of the posttraumatic growth (PTG) experiences of refugees is warranted. In this study, we examined 12 primary studies exploring PTG among refugees using the qualitative metasynthesis method. Our analysis of the primary studies consisting of 319 adults revealed four themes: (a) improved psychologic functioning; (b) enhanced interpersonal relationships; (c) reconstruction of the meaning of life; and (d) positive future direction. These findings indicate that no matter how traumatic experiences are painful, people can hold on to life, build a new life, and grow from adversity.

E-health ecosystem with integrated and stepped psychosocial services for breast cancer survivors: study protocol of a multicentre randomised controlled trial

INTRODUCTION

Psychosocial interventions for patients with breast cancer (BC) have demonstrated their effectiveness at reducing emotional distress and improving quality of life. The current digitisation of screening, monitoring and psychosocial treatment presents the opportunity for a revolution that could improve the quality of care and reduce its economic burden. The objectives of this study are, first, to assess the effectiveness of an e-health platform with integrated and stepped psychosocial services compared with usual psychosocial care, and second, to examine its cost-utility.

METHODS AND ANALYSIS

This study is a multicentre randomised controlled trial with two parallel groups: E-health intervention with integrated and stepped psychosocial services vs usual psychosocial care. An estimated sample of 338 patients with BC in the acute survival phase will be recruited from three university hospitals in Catalonia (Spain) and will be randomly assigned to one of two groups. All participants will be evaluated at the beginning of the study (T1: recruitment), 3 months from T1 (T2), 6 months from T1 (T3) and 12 months from T1 (T4). Primary outcome measures will include number of clinical cases detected, waiting time from detection to psychosocial intervention and proportion of cases successfully treated in the different steps of the intervention, as well as outcomes related to emotional distress, quality of life, post-traumatic stress and growth, treatment adherence and therapeutic alliance. Secondary outcomes will include the acceptability of the platform, patients' satisfaction and usability. For the cost-utility analysis, we will assess quality-adjusted life years and costs related to healthcare utilisation, medication use and adherence, work absenteeism and infrastructure-related and transport-related costs.

ETHICS AND DISSEMINATION

This study was approved by the Ethics committee of the Institut Català d'Oncologia network in Hospitalet, Spain. Findings will be disseminated through peer-reviewed journals, reports to the funding body, conferences among the scientific community, workshops with patients and media press releases.

TRIAL REGISTRATION NUMBER

Online Psychosocial Cancer Screening, Monitoring and Stepped Treatment in Cancer Survivors (ICOnnectat-B),NCT04372459.

Video conference vs face-to-face group psychotherapy for distressed cancer survivors: A randomized controlled trial

OBJECTIVE

This study assesses the effectiveness of face-to-face group positive psychotherapy for cancer survivors (PPC) compared to its online adaptation, online group positive psychotherapy for cancer survivors (OPPC), which is held via videoconference. A two-arm, pragmatic randomized controlled trial was conducted to examine the effects of both interventions on emotional distress, post-traumatic stress symptoms (PTSS), and post-traumatic growth (PTG) among cancer survivors and analyze attrition to treatment.

METHODS

Adult women with a range of cancer diagnoses were invited to participate if they experienced emotional distress at the end of their primary oncological treatment. Emotional distress, PTSS, and PTG were assessed at baseline, immediately after treatment, and 3 months after treatment. Intention-to-treat analyses were carried out using general linear mixed models to test the effect of the interventions overtime. Logistic regressions were performed to test differential adherence to treatment and retention to follow-up.

RESULTS

A total of 269 individuals participated. The observed treatment effect was significant in both modalities, PPC and OPPC. Emotional distress (b = -2.24, 95% confidence interval [CI] = -3.15 to -1.33) and PTSS (b = -3.25, 95% CI = -4.97 to -1.53) decreased significantly over time, and PTG (b = 3.08, 95% CI = 0.38-5.78) increased significantly. Treatment gains were sustained across outcomes and over time. Analyses revealed no significant differences between modalities of treatment, after adjusting for baseline differences, finding that OPPC is as effective and engaging as PPC.

CONCLUSIONS

The OPPC treatment was found to be effective and engaging for female cancer early survivors. These results open the door for psycho-oncology interventions via videoconference, which are likely to lead to greater accessibility and availability of psychotherapy.