Effects of psychological interventions on fear of cancer recurrence: A systematic review and network meta-analysis

The study aimed to systematically compare the effects of psychological interventions on relieving fear of cancer recurrence (FCR) by a systematic review and network meta-analysis (NMA). The relevant randomized controlled trials were searched from China National Knowledge Infrastructure, Wanfang Database, VIP Database for Chinese Technical Periodicals, Chinese Biomedical Literature Database, Cochrane Library, Pubmed, Web of Science, CINAHL, PsycINFO, and Embase. The retrieval time was from the establishment of each database to January 23, 2024. Review Manager 5.4 software was used to evaluate the quality of each literature that met the inclusion and exclusion criteria. Stata16.0 was used for NMA. Standardized mean differences (SMDs) of patients' FCR outcomes and 95% confidence intervals (CIs) were used to determine the effects. Inconsistency test, network map, surface under the cumulative rankings curve (SUCRA), comparison-adjusted funnel plot were performed. A total of 41 articles were included, with 4056 patients and 15 psychological interventions. Six psychological interventions (NT, Narrative Therapy; ACT, Accept and Commitment Therapy; GT, Therapy based on Gratitude-Expanded Behavior Theory; Blend Cognitive Behavior Therapy; PERMA, PERMA Therapy; CBT, Cognitive Behavior Therapy) were effective in alleviating FCR in the short term compared with usual care, whereas the effects of ACT, GT, and CBT were sustained up to more than 3 months postintervention. NT ranked as most likely to alleviate FCR, (SUCRA: 89.8%, SMD: -2.89, 95% CI: -4.08 to -1.69), followed by ACT (SUCRA: 88.1%, SMD: -2.83, 95% CI: -4.38 to -1.27) in short-term effects. GT ranked as most likely to alleviate FCR in long-term effects (SUCRA: 100%, SMD: -3.35, 95% CI: -4.21 to -2.50), followed by ACT (SUCRA: 88.9%, SMD: -1.64, 95% CI: -2.36 to -0.91). However, most of the quality of evidence for pairwise comparison was rated as "very low" to "low." The evidence can help inform evidence-based practice and guide healthcare providers in deciding on the most effective psychological interventions for FCR, which should also be viewed with caution due to the low level of the quality. The study aimed to compare the effects of psychological interventions on relieving fear of cancer recurrence by network meta-analysis and we found NT, ACT, and GT with higher ranks might be favorable to alleviate FCR in short- and long-term effects. image