Comparative effectiveness of mental health interventions on anxiety, depression and quality of life among cancer patients: A systematic review and network meta-analysis.

Abstract

e23047 Background: Cancer patients frequently experience mental health (MH) concerns, which have a detrimental impact on their overall well-being. Numerous therapeutic approaches have been examined, although their comparative effectiveness (CE) are unknown among cancer patients. In order to address this void, we conducted CE research on the impact of various MH therapies and its impact on anxiety, depression, Post-traumatic stress disorder (PTSD), and Quality of life (QoL). Methods: We conducted an extensive literature search in PubMed and EMBASE for randomized controlled trials published between 2000 and 2023. The inclusion criteria of this study focused on cancer patients who were 18 years or older and were taking therapies for depression, anxiety and PTSD. The exclusion criteria encompassed studies using pilots, protocols, and cancer survivors. Cochrane Risk of Bias assessment tool was used for risk assessment. CE research of systematic review and network meta-analysis were conducted to evaluate the efficacy of each intervention. Results: Our search yielded 39 studies out of a total of 7,132. The results of network meta-analysis on CE research showed that Exercise (Surface Under the Cumulative Ranking (SUCRA) ranking: 0.99), Mirtazapine (SUCRA) ranking: 0.82) and Psychosocial support (SUCRA ranking: 0.82) were more effective than other interventions in improving anxiety. Pairwise comparison showed a reduction in anxiety, random effects model (mean difference (MD)-2.35;95%CI: -3.82-0.87), heterogeneity: I 2 > 50%, t2 = 13.11, p < 0.01, test for subgroup differences (random effects): ChiSq2 = 26.96, d.f. = 8 (p < 0.01), and for depression (MD:-1.59;95%CI: -2.41-0.76), heterogeneity: I 2 = > 50%, t2 = 4.46, p < 0.01, test for subgroup differences (random effects): ChiSq2 = 34.38, d.f. = 5 (p < 0.01). And further examining odds of > = 50% reduction in depression score from baseline was OR:2.62;95%CI: 1.52-4.51, Heterogeneity: I 2 > 50%, t2 = 0.30, p < 0.01. And additionally examining the QoL score, the interventions improved the outcomes, MD, 8.59; 95%CI: 3.72-13.46. However, there were no difference in the PTSD outcomes (MD, -1.34; 95%CI: -4.53-1.84). Furthermore, subgroup analyses have shown the efficacy of combination therapies in diminishing anxiety and depression scores. Conclusions: Exercise , Mirtazapine and Psychosocial support demonstrated efficacy in alleviating anxiety and depression in cancer patients. Although Exercise appears to be the most effective short-term treatment for moderate-to-severe MH disorder in cancer patients, even though there is a lack of high-quality evidence on the topic. On the basis of individual circumstances, patients, caregivers, and physicians should weigh the risks and benefits of all active interventions in cancer patients with mental health, taking into account the fact that these interventions' effects could differ from patient to patient.