Psychosocial interventions for men with prostate cancer: a C ochrane systematic review

To evaluate the effectiveness of psychosocial interventions for men with prostate cancer in improving quality of life ( Q o L ), self‐efficacy and knowledge and in reducing distress, uncertainty and depression. We searched for trials using a range of electronic databases including the C ochrane C entral R egister of C ontrolled T rials ( CENTRAL ), MEDLINE , EMBASE and P syc INFO to O ctober 2013, together with hand searching 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 Q o L , self‐efficacy and knowledge and a reduction in distress, uncertainty and depression. Pairs of review authors independently extracted data and assessed risk of bias. We analysed data using standardised mean differences ( SMD s), random‐effects models and 95% confidence intervals ( CI s). In all, 19 studies with a total of 3 204 men, with a diagnosis of prostate cancer, comparing psychosocial interventions vs 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 Q o L ( GHQ o L ) at end of intervention ( SMD 0.12, 95% CI 0.01–0.22) based on low quality evidence. There was no clear evidence of benefit associated with psychosocial interventions for the mental component of GHQ o L at end of intervention ( SMD −0.04, 95% CI −0.15 to 0.06) based on moderate quality evidence. At end of intervention, cancer‐related Q o L showed a small improvement after psychosocial interventions ( SMD 0.21, 95% CI 0.04–0.39). For prostate cancer‐specific and symptom‐related Q o L , 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 ( SMD 0.16, 95% CI −0.05 to 0.38) based on very low quality evidence. Men in the psychosocial intervention group had a moderate increase in prostate cancer knowledge at end of intervention ( SMD 0.51, 95% CI 0.32–0.71) based on very low quality evidence. A small increase in knowledge with psychosocial interventions was noted at 3 months after intervention ( SMD 0.31, 95% CI 0.04–0.58). The results for uncertainty ( SMD −0.05, 95% CI −0.35 to 0.26) and distress ( SMD 0.02, 95% CI −0.11 to 0.15) 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 ( SMD −0.18, 95% CI −0.51 to 0.15) based on very low quality evidence. The overall risk of bias in the included studies was unclear or high, primarily as the result of performance bias. No data about stage of disease or treatment with androgen‐deprivation therapy were extractable for subgroup analysis. Only one study addressed adverse effects. 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 GHQ o L and cancer‐related Q o L when compared with usual care. Prostate cancer knowledge was also increased. However, this review failed to show a statistically significant effect on other domains such as symptom‐related Q o L , self‐efficacy, uncertainty, distress or depression. Moreover, when beneficial effects were seen, 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 the G rading of R ecommendations A ssessment, D evelopment, and E valuation ( GRADE ) system, 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 method. 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 executed and transparently reported research studies are necessary to establish the role of psychosocial interventions in men with prostate cancer.