Structured nonpharmacologic interventions (NPIs) can offer short-term benefits for patients with cancer and have “modest” benefits for family caregivers, according to findings published in CA: A Cancer Journal for Clinicians.
The findings come from a systematic review and meta-analysis evaluating various NPIs for patients with solid tumors and family caregivers. Previous research assessed NPIs for management of distress, anxiety, and depression for patients and caregivers, but the findings have been “inconsistent,” the researchers noted.
“As the number of NPIs for managing distress, anxiety, and depression for patients with cancer and family caregivers continues to grow, with contemporary trends favoring self-directed technologies (e.g., mobile applications) compared with in-person or clinic-based approaches, ongoing assessment is essential to guide the allocation of resources,” the researchers wrote.
Researchers conducted a literature search to identify randomized clinical trials (RCTs) that included adult patients with solid tumor malignancies and their adult family caregivers who had received NPIs, either together or separately. Studies targeting children and those for patients with hematologic malignancies were excluded.
The researchers categorized effect sizes according to the Cohen d as either small (g = 0.20), medium (g = 0.50), or large (g= 0.80).
The meta-analysis included 68 RCTs published between 1983 and 2025. Most were conducted in the US and published in the past 5 years.
The primary types of NPIs were psychoeducation focused on increased knowledge about cancer and treatment, therapeutic counseling, skills training around coping and stress management, and behavior modification targeting lifestyle changes. The most common NPI type employed across the studies was a combination of psychoeducation and skills training.
NPIs showed significantly reduced patient distress in the first 6 months postintervention, but did not maintain that effect beyond that time period. Patients experienced a significant effect on psychological distress from 0-3 months (g = 0.13; P =.008) and at 3.1-6.0 months (g = 0.18; P =.027). Researchers observed no significant effects for reducing caregiver distress.
NPIs showed an effect on patient anxiety from 0-3 months (g = 0.31; P =.000) and on caregiver anxiety from 0-3 months (g = 0.15; P =.023). However, there was no significant effect beyond 3 months.
The effect was again short-lived for depression. NPIs showed a significant effect for patients from 0-3 months only (g = 0.28; P =.000). The caregiver depression effect was significant from 0-3 months (g = 0.25; P =.000) and at 3.1-6.0 months (g = 0.22; P =.037).
“Across outcomes and timepoints, NPIs showed more consistent benefits for patients than for caregivers, with the strongest effects observed in the short-term for anxiety and depression,” the researchers wrote.
Researchers suggested that priority be given to tailored, low-burden support strategies, and possibly to maintenance strategies to boost the impact over time. “Collaboration among the clinician, patient, and family caregiver triad can help integrate these approaches into routine care and achieve the best possible outcomes.”
Disclosures: This research was supported by the University of Basel, Faculty of Medicine; the Stiftung zur Krebsbekämpfung, Switzerland; and the University of Texas at San Antonio, School of Nursing. One study author disclosed conflicts of interest. Please see the original reference for complete disclosures.
