Effects of cognitive-behavioural therapy on psychological, physical and social outcomes of children with cancer: A systematic review and meta-analysis

Objective: This systematic review aimed to summarise the effects of cognitive-behavioural therapy on psychological, physical and social outcomes of children with cancer without limitations on publication date. Methods: Thirteen English and seven Chinese electronic databases were searched from April to June 2021. Randomised control trials, quasi-experimental studies, pre-test post-test studies with a control group, factorial or cross-over designs that included children <= 18 years old and during various stages of the cancer trajectory, who have received cognitive-behavioural therapy, and reported (anxiety, depression, stress, quality of life, self efficacy, fatigue, pain, behavioural distress, anger, and/or academic performance) were included. Results: Eight studies with quality of evidence ranging from low to high risk of bias were included. The results show cognitive-behavioural therapy has favourable effects on anxiety, depression, pain and behavioural distress. The meta-analysis also show that it reduces anxiety (SMD =-0.89, 95% CI (-1.45,-0.32), p < 0.002), depression (SMD =-0.90, 95% CI (-1.40, 0.39), p < 0.0005), and pain (SMD =-0.56, 95% CI (-1.04,-0.08), p < 0.002). It also has a favourable effect on stress, anger and self-efficacy, though the results are drawn from a single study. Conclusion: Cognitive-behavioural therapy has the potential to reduce anxiety, depression and pain for children with cancer. It also shows promise in reducing behavioural distress. Although effects on stress, anger, and self efficacy have been found to be significant, there have been limited studies on these aspects of functioning and more research is needed. The findings are drawn from heterogeneous participants and interventions, thus emphasising the need to conduct well-designed intervention studies, including cancer survivors.