Psychosocial interventions for men with prostate cancer: A Cochrane systematic review - Abstract

OBJECTIVE: To evaluate the effectiveness of psychosocial interventions for men with prostate cancer in improving quality of life (QoL), self-efficacy and knowledge and in reducing distress, uncertainty and depression.

MATERIALS AND METHODS: We searched for trials using a range of electronic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO to October 2013, together with handsearching of journals and reference lists. Randomised controlled trials were eligible if they included psychosocial interventions that explicitly used one or a combination of the following approaches: cognitive behavioural, psycho-educational, supportive and counselling. Interventions had to be delivered or facilitated by trained or lay personnel. Our outcomes were an improvement in quality of life (QoL), self-efficacy and knowledge and a reduction in distress, uncertainty and depression. We analysed data using standardised mean differences (SMDs), random-effects models and 95% confidence intervals (CIs).

RESULTS: Nineteen studies with a total of 3204 men, with a diagnosis of prostate cancer, comparing psychosocial interventions versus usual care were included in this review. Men in the psychosocial intervention group had a small, statistically significant improvement in the physical component of general health-related quality of life (GHQoL) at end of intervention. There was no clear evidence of benefit associated with psychosocial interventions for the mental component of GHQoL at end of intervention. At end of intervention, cancer-related QoL showed a small improvement following psychosocial interventions. For prostate cancer- specific and symptom-related QoL, the differences between intervention and control groups were not significant. There was no clear evidence that psychosocial interventions were beneficial in improving self-efficacy at end of intervention. Men in the psychosocial intervention group had a moderate increase in prostate cancer knowledge at end of intervention. A small increase in knowledge with psychosocial interventions was noted at three months post-intervention. The results for uncertainty (SMD -0.05, 95% CI -0.35 to 0.26) and distress at end of intervention were compatible with both benefit and harm based on very low-quality evidence. Finally, there was no clear evidence of benefit associated with psychosocial interventions for depression at end of intervention .

CONCLUSIONS: Overall, this review shows that psychosocial interventions may have small, short-term beneficial effects on certain domains of wellbeing, as measured by the physical component of GHQoL and cancer-related QoL when compared with usual care. Prostate cancer knowledge was also increased. However, this review failed to demonstrate a statistically significant effect on other domains such as symptom-related QoL, self- efficacy, uncertainty, distress or depression. Moreover, when beneficial effects were observed, it remained uncertain whether the magnitude of effect was large enough to be considered clinically important. The quality of evidence for most outcomes was rated as very low according to GRADE, reflecting study limitations, loss to follow-up, study heterogeneity and small sample sizes. We were unable to perform meaningful subgroup analyses based on disease stage or treatment modality. Although some findings of this review are encouraging, they do not provide sufficiently strong evidence to permit meaningful conclusions about the effects of these interventions in men with prostate cancer. Additional well-done and transparently reported research studies are necessary to establish the role of psychosocial interventions in men with prostate cancer.

Written by:
Parahoo K, McDonough S, McCaughan E, Noyes J, Semple C, Halstead EJ, Neuberger MM, Dahm P.   Are you the author?
Institute of Nursing and Health Research, University of Ulster, Coleraine, UK.

Reference: BJU Int. 2014 Nov 27. Epub ahead of print.
doi: 10.1111/bju.12989

PubMed Abstract
PMID: 25429987 Prostate Cancer Section