Interventions for Anxiety and Depression for Adults Living With and Beyond Cancer (2018–2022)

Abstract

Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents finding related to anxiety and depression for adults living with and beyond cancer.

Full Systematic Review Question

This systematic review addressed the question “What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve performance and participation for adults living with cancer?”

Current Theme Reported

The main theme of the studies included in this systematic review brief is interventions for anxiety and depression for adults living with and beyond cancer.

Clinical Scenario

Individuals with cancer commonly experience feelings of anxiety, distress, and depression, as their emotional health may be affected by a cancer diagnosis (American Cancer Society, 2022). Various factors may impact individuals experiencing depression and anxiety, including the type of cancer, stage, and prognosis (Niedzwiedz et al., 2019). Mindfulness-based interventions (MBIs) have been shown to be feasible, low cost, and effective in reducing symptoms of depression and anxiety in patients with cancer at post- and follow-up points in time (Chayadi et al., 2022). Psychological interventions, including cognitive behavioral interventions, have been found to be helpful in understanding the thoughts, feelings, and behaviors that can cause or contribute to symptoms of depression or anxiety (Pitman et al., 2018). Anxiety and depression may be experienced by those across the continuum and can be addressed by occupational therapy practitioners in various settings including home and community, acute hospital, outpatient clinic, long-term care, and skilled nursing facilities (American Occupational Therapy Association, 2022).

Summary of Key Findings

Three systematic reviews were included related to anxiety and depression for adults living with and beyond cancer (Table 1). They were divided into two subthemes (MBIs and psychological interventions). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009). The strength-of-evidence designations are based on the guidelines of the U.S. Preventive Services Task Force (2018).

Table 1.

Evidence Table for Interventions for Anxiety and Depression for Adults Living With and Beyond Cancer

Author, YearLevel of Evidence (types of study designs)Risk of Bias (RoB)Setting	Systematic Review Details	Findings From Reviews
Subtheme: Mindfulness-based Interventions One Level 1a review provided moderate strength of evidence to support occupational therapy practitioners’ use of MBIs to improve psychological outcomes including anxiety and depression for adults with varying types of cancer (majority breast) at all stages.
Cillessen et al. (2019) Level 1a—Systematic review and meta-analysis RoB Moderate Setting Not reported	Participants N = 3,274; mixed types of cancer; however, 70% had breast cancer; mean age: 55; % female: 86%; race/ethnicity: not reported Number of Articles (and Level) 29 RCT Databases Searched 4 databases: PubMed, Web of Science, PsycINFO, and CINAHL Outcome(s) Primary outcome: overall psychosocial distress. Secondary outcomes: anxiety, depression PTSD symptoms, fear of cancer recurrence, fatigue, pain, sleep disturbance, and QOL Intervention(s) MBIs with mindfulness as the main component and including formal meditation homework; most common type of MBI was MBSR (13.45%); interventions included: MAPS, MBAT, MBSR, MBT, NEP, PE, SMS Delivery Methods Not reported Dose Ranges (If Available) 4.5–28.5 hr; on average 15.5 contact hours	MBIs showed statistically significant improvement (small to moderate effect size) on self-reported symptoms of anxiety, depression, fear of cancer recurrence, and fatigue. MBIs also showed a statistically significant improvement on psychological distress at posttreatment.
Subtheme: Psychological Interventions One Level 1a review and one Level 2a review provided moderate strength of evidence to support occupational therapy practitioners’ use of psychological interventions to improve anxiety and depression for adults predominantly with prostate and breast cancer at all stages.
Mundle et al. (2021) Level 1a—Systematic review RoB Moderate Setting Not reported	Participants n = 1,082 in intervention arm, n = 1,010 in control arm; 20/22 studies included patients with prostate cancer; 4/20 studies included patients with multiple tumor types with approximately one-third of patients with prostate cancer (breast and colorectal cancer were the other main tumor types); stage varied from localized disease (n = 14) to advanced cancer; time since initial diagnosis, reported in 17 studies, ranged from <6 mo to 6 yr; seven studies included data on partners, two of which included only spouses or caregivers without corresponding prostate cancer patients; mean age: not reported; race/ethnicity: not reported Number of Articles (and Level) 22 RCT Databases Searched PubMed, EMBASE Outcome(s) Anxiety n = 14, depression n = 17, general distress n = 10, prostate cancer specific distress n = 7 Intervention(s) Predominately disease and/or health education or CBT. “Educational” intervention provided in many ways, including tele-information, printed handbooks, or in-person seminars with disease expert. Interventions included: cognitive n = 10, cognitive and education n = 3, education/skill training n = 8, social support intervention strategy n = 1 Delivery Methods Varied: calls, group and individual, face to face Dose Ranges (If Available) Significant variability (from those mentioned): weekly, monthly, 2 to 10 sessions	Significant improvement in depression, anxiety, general, and prostate-cancer specific distress as compared with that in the control study group. Intervention study group had strong positive correlation of percent change in distress with that in depression (Pearson’s correlation coefficient, r = .959, p = .003) as well as with that in anxiety (Pearson’s correlation coefficient, r = .827, p = .042). Directional and descriptive data only demonstrated a median percent change in anxiety, depression, and distress, when compared across the three intervention categories. This was superior in studies using a combined cognitive and educational strategy (n = 3 studies) as compared with cognitive (n = 10 studies) or educational intervention alone (n = 8 studies).
Guarino et al. (2020) Level 2a—Systematic review and meta-analysis RoB Low Setting Varied from “inpatient treatment” n = 3 to “after treatment n = 42)	Participants N = 8,472 participants in the clinical trials, considering the preintervention evaluation and 7,834 participants viewing the posttreatment assessment, with a drop-out of around 8% (N = 638); breast cancer; stages varied from 0 to IV; ages: 18–65; 100% women; race/ethnicity: not reported Number of Articles (and Level) 25 studies included in meta-analysis; studies with multiple outcomes were considered as independent and therefore meta-analysis included 45 independent studies Databases Searched PsychINFO, PubMed, Medline, and PsycArticles Outcome(s) Anxiety (n = 10), depression (n = 12), mood (n = 10), and QOL (n = 13) Intervention(s) Psychological group interventions: CBT (n = 17), PET (n = 4), SET (n = 4) Delivery Methods Group Dose Ranges (If Available) Duration ranged from 1 to 26 wk	Anxiety Overall effect size of the studies about anxiety reduction on women with breast cancer was medium (0.39; 95% CI; −0.91 to 0.14). Studies on CBT and PET interventions showed larger effect sizes (95% CI: CBT (n = 8) −0.45 [−1.14, 0.24] and PET (n = 1) −0.45 [−0.49, −0.40]) Depression Overall effect size of psychological interventions on depression was medium (−0.35; 95% CI: −0,79 to –0.10). Largest effect size found in interventions lasting from 6 to 12 wk (−0.40). Results confirmed effectiveness of CBT in reducing depressive symptoms (n = 10 CBT)

Note. CBT = cognitive behavioral therapy; MAPS = mindfulness awareness practices; MBAT = mindfulness-based art therapy; MBI = mindfulness-based interventions; MBSR = mindfulness-based reduction; MBT = mindfulness-based training; NEP = nutrition education program; PE = psychoeducation; PET = psychoeducational treatment; QOL = quality of life; RCT = randomized clinical trial; SET = supportive expressive group therapy; SMS = stress management seminar.

Bottom Line for Occupational Therapy Practice

Managing psychological outcomes of anxiety and depression can support optimal occupational performance in adults living with and beyond cancer. The use of MBIs and psychological interventions is beneficial to support the psychological outcomes of anxiety and depression at all stages of cancer, especially for adults living with and beyond breast and prostate cancer. Within this review, psychological interventions encompass a range of interventions including psychological, psychosocial, cognitive, behavioral, or psychoeducational interventions. Specifically, cognitive interventions were demonstrated to be effective in reducing depression. The combination of cognitive and educational interventions may be more effective for anxiety and depression than cognitive or educational interventions alone and should be considered as a combined approach.