Psychosocial Technology and Telehealth-Based Interventions for Adults 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 findings related to psychosocial technology and telehealth-based interventions for adults 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 includes psychosocial technology and telehealth-based interventions for adults with and beyond cancer.

Clinical Scenario

Advancements in technology, especially, telecommunication and information technologies, have contributed to the emergence of health care delivery via telehealth. Telehealth, which includes health care services, health information, and health education, offers an additional means of health care access and delivery in providing evaluative, consultative, preventative, and therapeutic services (American Occupational Therapy Association, 2018). Occupational therapy telehealth services can be delivered synchronously or asynchronously and can be provided at a location that is remote from the client, allowing for services to occur across a variety of locations that individuals may participate in during daily life (American Occupational Therapy Association, 2018). Telehealth services can reduce the cost of delivering services due to decreased travel expenses, resulting in fewer missed appointments, and contributing to positive health outcomes compared with onsite services (Feldhacker et al, 2022). Psychosocial telehealth interventions, including cognitive behavioral therapy, have been demonstrated to show significant improvements in psychosocial outcomes including quality of life (Hwang et al., 2020).

Summary of Key Findings

Three systematic reviews were included related to psychosocial technology and telehealth interventions with psychosocial outcomes for adults with and beyond cancer (Table 1). 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 Psychosocial Technology and Telehealth-Based Interventions for Adults With and Beyond Cancer

Author, YearLevel of Evidence (types of study designs)Risk of Bias (RoB)Setting	Systematic Review Details	Findings From Reviews
Three Level 1A reviews provided strong strength of evidence to support occupational therapy practitioners’ use of technology and telehealth-based interventions to improve psychosocial outcomes for adults with varying types of cancer at all stages.
Golita and Baban (2019) Level 1a—Systematic review RoB Low Setting Community (personal computers)	Participants N = 4,084 (baseline sample range: n = 28–450); mixed types of cancer, most studies had bias to breast cancer, n = 9 specific cancer diagnosis (breast cancer, hematologic cancer, and prostate cancer), n = 10 focused on heterogeneous cancer diagnosis; n = 12 targeted cancer survivorship, n = 5 aimed at first 18 mo after diagnosis, n = 3 recruited irrespective of treatment stage; mean age: 39–72; most studies had high bias toward female gender; race/ethnicity: most studies had bias toward higher education and white ethnicity Number of Articles (and Level) 19 studies (RCT) across 21 articles Databases Searched EBSCOhost, ProQuest, PubMed, and Web of Science interfaces to search CINAHL, PsycINFO, PubMed, and Web of Science databases Outcome(s) Distress (n = 16 total, n = 8 as primary outcome) and/or QoL (n = 15 total; n = 6 as primary outcome) Intervention(s) Web-based psychotherapeutic interventions defined as nonpharmacologic intervention using psychological procedures (psychoeducation, coping skills training, counseling, relaxation, and psychotherapy) that had a proposed mechanism as a way in which it is believed that the intervention brings about change in the desired outcome (e.g., belief change). Most interventions used CBT or CBT components. Three interventions used MBCT Delivery Methods All delivered via internet on personal computers and used e-mail reminders for participants, n = 5 predominantly self-guided (i.e., only e-mail feedback/prompts on homework); n = 5 had tailorable content to patient’s needs Dose Ranges (if available) Duration ranged from 4 wk to 6 mo; ranged from 4 to 20 modules; procedural elements also varied with respect to incrementally releasing materials (one module/wk) to releasing all materials simultaneously; time spent in intervention varied from 1.5 hr total to 7.3 hr	Psychological Distress 9/16 (56%) studies that aimed to improve psychological distress demonstrated statistically significant improvement for this outcome over the control condition used in their studies (waitlist control, and treatment as usual). Clinically significant improvement in distress in the intervention versus the control group was reported in six studies (37.5%). No clear conclusion as to what is the best stage of treatment to target distress, or for which population.
Li et al. (2021) Level 1a—Meta-analysis RoB Low Setting Home (internet/web-based, telephone, and application)	Participants N = 7,227 (range in studies n = 55–799); all cancer survivors; mean age: 43.7–73.5; n = 13 breast cancer, n = 4 prostate, n = 4 colorectal, n = 4 nonsmall cell lung, n = 4 esophageal; cancer stages varied (newly diagnosed, stage I–IV, advanced); race/ethnicity: not reported Number of Articles (and Level) 28 RCT Databases Searched MEDLINE, Embase, Cochrane Central Register of Controlled trials, CINAHL, PsycINFo, and Web of Science Outcome(s) QoL Intervention(s) Varied: some include CBT; psychoeducational program; symptom tracking; MBCT; computer-tailored physical activity intervention Delivery Methods Web/internet-based on varying means (13), telephone-based (9), or app (6) Dose Ranges (if available) 2–3 days to 12 mo	Eleven studies reported improved QoL, and the difference between the intervention and control groups was statistically significant effects of telehealth interventions on cancer survivors’ QoL (p < .05). Effects of telehealth interventions based on applications (n = 6) and website-based (n = 13) showed significant effects; however, telephone-based interventions were not statistically significant. Interventions including short- (<3 mo), medium-, and long-term (3–6 mo) duration resulted in a significant difference between intervention and control groups. Subgroup analysis showed that the most effective method was application-based intervention (SMD = 0.41, 95% CI: 0.17–0.66) and the short-term telehealth intervention was more effective than other durations of intervention (SMD = 0.28, 95% CI: 0.06–0.50). The effects on breast cancer survivors’ QoL were greater than those on the other types of cancer survivors (SMD = 0.30, 95% CI: 0.10–0.51).
Wang et al. (2020) Level 1a—Systematic review with meta-analysis RoB Low Setting n = 2 hospitals; n = 5 unclear	Participants N = 1,220, CG 4,949 and IG 603; mixed types of cancer with n = 3 breast cancer, n = 1 glioma, n = 2 several types of cancer, n = 1 unclear regarding cancer type; mean age: not reported; female: 84.8%; race/ethnicity: not reported Number of Articles (and Level) 7 RCT addressing technology interventions Databases Searched Medline, Embase, CINAHL, PsycINFO, Web of Science, CENTRAL, Proquest Digital Dissertations, Foreign Medical Retrieval System, China National Knowledge Infrastructure, China Science and Technology Journal Database, China Wanfang Database, and Taiwanese Airiti Library Outcome(s) Distress (n = 5), depression (n = 4), QoL n = 6, fatigue (n = 2) Intervention(s) Psychoeducational interventions: counseling, education, behavioral therapy, and social support—most used single or mixed modules Delivery Methods n = 5 website programs; n = 1 e-mail counseling, n = 1 single-session psychoeducational intervention/tablet PC Dose Ranges (if available) Range of study duration was 3–16 wk—3 wk (n = 1), 5 wk (n = 1), 8–12 wk (n = 5); frequencies were reported at least once per week (n = 3) or unclear (n = 4)	Depression Meta-analysis showed a significant difference in improvement between the intervention and control groups (SMD −0.58, 95% CI (−1.12, −0.03), p = .04) (n = 3) Fatigue A significant difference in improvement between the intervention and control groups (MD −9.83, 95% CI (−14.63, −5.03), p < .01) (n = 2) No significant findings for distress or QoL

Note. CBT = cognitive-behavioral therapy; CENTRAL = Cochrane Central Register of Controlled Trials; CI = confidence interval; MBCT = mindfulness-based cognitive therapy; PC = personal computer; QoL = quality of life; RCT = randomized clinical trial; SMD = standardized mean difference.

Bottom Line for Occupational Therapy Practice

The use of technology and telehealth interventions are beneficial to support psychosocial outcomes including distress, depression, and quality of life across the cancer continuum and various cancer diagnoses. Occupational therapy practitioners should use these interventions to address psychosocial needs and to promote optimal psychosocial outcomes in adults living with and beyond cancer. Technology and telehealth interventions encompass a wide range of interventions including but not limited to cognitive behavioral therapy, psychoeducational interventions, and psychotherapeutic interventions. Telehealth interventions can increase access to occupational therapy services as they are used remotely and can be delivered in a range of ways (e.g., internet, personal computers, smartphones, tablets, and telephone).