Authors' objectives: The aim of this report was to conduct a review of existing systematic reviews, in order to (i) examine the types of psychosocial interventions that have been used with people suffering from heart disease or cancer, (ii) evaluate the effects of such interventions on physical outcomes, psychological outcomes or health care usage, and (iii) evaluate the methodological quality of the included systematic reviews.

Authors' results and conclusions: A total of 5,735 references were identified from the literature searches, with a total of 35 systematic reviews finally considered appropriate for inclusion. Of the 35 included systematic reviews of the effects of psychosocial interventions, 22 related to cancer, 10 to heart disease, and three included primary studies that contained both groups of patients. Of the 10 heart disease reviews, two existed only as protocols at the time of report production. The 35 reviews covered a very broad range of psychosocial interventions, including approaches such as group therapy, individual therapy, family therapy, counselling, psychoanalysis, education, stress management, cognitive behavioural therapy, relaxation, imagery, meditation training, emotional expression, biofeedback, coping skills training, problem solving training, social skills training, cognitive/attentional distraction, hypnosis, desensitisation, rehearsal modelling, and contingency management. The methodological quality of these reviews was generally quite low; with only ten reviews (29%) meeting more than four of the seven quality criteria. Overall, the results of the included reviews indicated some beneficial effect of psychosocial intervention on broad psychological outcomes for patients with heart disease and cancer. In terms of physical outcomes the evidence remains unclear in cancer, but appears to be more promising in heart disease.

Authors' recommendations: Cancer In general, the reviews of psychosocial interventions in cancer patients indicated that psychosocial interventions are likely to produce some beneficial effect on psychological distress or emotional adjustment of patients. The effects on specific outcomes such as depression are unclear. Findings relating to the relative effects of different treatment settings and paradigms (e.g. cognitive behavioural therapy vs. counselling) were inconsistent. The findings of reviews investigating physical outcomes (such as immune outcomes, survival) mostly failed to detect any beneficial effect of psychosocial intervention on these outcomes, though there is insufficient high quality evidence to determine whether small effects might exist. Due to the considerable limitations of the reviews concerned with psychosocial interventions in cancer, recommendations are made for the conduct of any future reviews in this area. Heart disease Six of the eight heart disease reviews favoured the adoption of psychosocial interventions into cardiac care. Those reviews that investigated psychological outcomes generally reported some benefit of psychosocial interventions for the reduction of psychological distress and modification of type A behaviour (a behaviour pattern characterised by aggressiveness, ambitiousness, restlessness and a strong sense of time urgency). There is some limited evidence about the positive effects of psychosocial interventions on morbidity and mortality. There is equivocal evidence about the effects of psychosocial interventions on heart disease risk factors. Educational interventions may influence some behavioural (e.g. exercise and diet) and clinical (blood pressure and mortality) outcomes in heart disease.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.york.ac.uk/inst/crd/CRD_Reports/crdreport30.pdf

Year Published: 2005

URL for published report: https://www.york.ac.uk/media/crd/crdreport30.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: University of York

Contact Address: University of York, York, Y01 5DD, United Kingdom. Tel: +44 1904 321040, Fax: +44 1904 321041,

Contact Name: crd@york.ac.uk

Contact Email: crd@york.ac.uk

Copyright: Centre for Reviews and Dissemination