Telephone interventions for symptom management in adults with cancer
Open accessAbstract
BACKGROUND: People with cancer experience a variety of symptoms as a result of their disease and the therapies involved in its management. Inadequate symptom management has implications for patient outcomes including functioning, psychological well-being, and quality of life (QoL). Attempts to reduce the incidence and severity of cancer symptoms have involved the development and testing of psycho-educational interventions to enhance patients' symptom self-management. With the trend for care to be provided nearer patients' homes, telephone-delivered psycho-educational interventions have evolved to provide support for the management of a range of cancer symptoms. Early indications suggest that these can reduce symptom severity and distress through enhanced symptom self-management. OBJECTIVES: To assess the effectiveness of telephone-delivered interventions for reducing symptoms associated with cancer and its treatment. To determine which symptoms are most responsive to telephone interventions. To determine whether certain configurations (e.g. with/without additional support such as face-to-face, printed or electronic resources) and duration/frequency of intervention calls mediate observed cancer symptom outcome effects. SEARCH METHODS: We searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 1); MEDLINE via OVID (1946 to January 2019); Embase via OVID (1980 to January 2019); (CINAHL) via Athens (1982 to January 2019); British Nursing Index (1984 to January 2019); and PsycINFO (1989 to January 2019). We searched conference proceedings to identify published abstracts, as well as SIGLE and trial registers for unpublished studies. We searched the reference lists of all included articles for additional relevant studies. Finally, we handsearched the following journals: Cancer, Journal of Clinical Oncology, Psycho-oncology, Cancer Practice, Cancer Nursing, Oncology Nursing Forum, Journal of Pain and Symptom Management, and Palliative Medicine. We restricted our search to publications published in English. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and quasi-RCTs that compared one or more telephone interventions with one other, or with other types of interventions (e.g. a face-to-face intervention) and/or usual care, with the stated aim of addressing any physical or psychological symptoms of cancer and its treatment, which recruited adults (over 18 years) with a clinical diagnosis of cancer, regardless of tumour type, stage of cancer, type of treatment, and time of recruitment (e.g. before, during, or after treatment). DATA COLLECTION AND ANALYSIS: We used Cochrane methods for trial selection, data extraction and analysis. When possible, anxiety, depressive symptoms, fatigue, emotional distress, pain, uncertainty, sexually-related and lung cancer symptoms as well as secondary outcomes are reported as standardised mean differences (SMDs) with 95% confidence intervals (CIs), and we presented a descriptive synthesis of study findings. We reported on findings according to symptoms addressed and intervention types (e.g. telephone only, telephone combined with other elements). As many studies included small samples, and because baseline scores for study outcomes often varied for intervention and control groups, we used change scores and associated standard deviations. The certainty of the evidence for each outcome was interpreted using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. MAIN RESULTS: Thirty-two studies were eligible for inclusion; most had moderate risk of bias,often related to blinding. Collectively, researchers recruited 6250 people and studied interventions in people with a variety of cancer types and across the disease trajectory, although many participants had breast cancer or early-stage cancer and/or were starting treatment. Studies measured symptoms of anxiety, depression, emotional distress, uncertainty, fatigue, and pain, as well as sexually-related symptoms and general symptom intensity and/or distress. Interventions were primarily delivered by nurses (n = 24), most of whom (n = 16) had a background in oncology, research, or psychiatry. Ten interventions were delivered solely by telephone; the rest combined telephone with additional elements (i.e. face-to-face consultations and digital/online/printed resources). The number of calls delivered ranged from 1 to 18; most interventions provided three or four calls. Twenty-one studies provided evidence on effectiveness of telephone-delivered interventions and the majority appeared to reduce symptoms of depression compared to control. Nine studies contributed quantitative change scores (CSs) and associated standard deviation results (or these could be calculated). Likewise, many telephone interventions appeared effective when compared to control in reducing anxiety (16 studies; 5 contributed quantitative CS results); fatigue (9 studies; 6 c
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A systematic review of 21 studies showed CBT and other interventions, when delivered either face-to-face or by telephone, to improve anxiety and depression in patients with cancer.
“A systematic review of 21 studies showed CBT and other interventions, when delivered either face-to-face or by telephone, to improve anxiety and depression in patients with cancer.58”
From Management of Anxiety and Depression in Adult Survivors of Cancer: ASCO Guideline Update (2023) · cites this paper as [58]
The Discussion (Summary of main results; page not provided) says the review included 32 studies, not 21; 21 assessed depressive symptoms and 16 assessed anxiety. The outcomes sections report some improvements, including equivalent anxiety and depression outcomes for telephone and face-to-face CBT in one trial, but also studies with no significant benefit. The claim overstates these mixed findings as a result of the review’s interventions generally. (LLM, conf=0.91)
Experimental — accuracy not yet measuredPrevious reviews rarely examine whether non-clinical professionals are included in the design, implementation, or evaluation of digital oncology services.
“Previous reviews provide valuable evidence on specific digital technologies and patient or clinical outcomes, but they rarely examine whether non-clinical professionals, such as managers, administrators, and service coordinators, are included in the design, implementation, or evaluation of digital oncology services.”
From Digital health technologies in oncology services: A scoping review of clinical implementation, organisational evidence gaps, and policy implications (2026) · cites this paper as [12]
The review’s ‘Health professionals delivering interventions’ section describes who delivered telephone interventions, while ‘Selection of studies’ notes that studies could be excluded if interventions were not delivered by health or social care professionals. This supports the cited paper as an example of a review focused on a specific technology and clinical intervention, but it does not establish that previous reviews *rarely* examine managers, administrators, or service coordinators in the design, implementation, or evaluation of digital oncology services. The supplied copy gives no page numbers for these sections. (LLM, conf=0.78)
Experimental — accuracy not yet measuredPrevious systematic reviews in oncology have generally examined a single category of technology or concentrated on specific user groups, most often patients and nurses.
“Previous systematic reviews in oncology have generally examined a single category of technology, such as artificial intelligence (AI) applications in cancer nursing [11], telephonebased symptom management [12], patient empowerment platforms [13], large language models (LLMs) for clinical decision-making [14], or telehealth during the COVID-19 pandemic [15], or have concentrated on specific user g”
From Digital health technologies in oncology services: A scoping review of clinical implementation, organisational evidence gaps, and policy implications (2026) · cites this paper as [12]
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- Authors
- Ream, E., Hughes, A. E., Cox, A., Skarparis, K., Richardson, A., Pedersen, V. H., Wiseman, T., Forbes, A., & Bryant, A.
- Affiliations
- University of Surrey (GB)
- Memorial Sloan Kettering Cancer Center (US)
- Northumbria University (GB)
- University of Southampton (GB)
- King's College London (GB)
- Royal Marsden NHS Foundation Trust (GB)
- Newcastle University (GB)
- ORCID
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2020-06-02
- Volume
- 2020
- Issue
- 6
- Pages
- CD007568-CD007568
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC7264015
- OpenAlex
- W1946242310
- Cited by
- 113
- References
- 113
- Citations by year
- 2026: 10 · 2025: 16 · 2024: 20 · 2023: 22 · 2022: 21 · 2021: 18 · 2020: 4 · 2014: 1
- FWCI
- 1.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Northumbria Research Link (Northumbria University) (acceptedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Surrey Research Insight Open Access (The University of Surrey) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, other-oa)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- National Institute for Health and Care Research
- Evidence Synthesis Programme
- National Cancer Institute (P30CA008748)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- telephone-delivered intervention, cancer symptom management, psychoeducational intervention, symptom self-management, quality of life, psychological distress, cancer pain, fatigue, nausea and vomiting, sleep disorders, anxiety, home care, intervention duration and frequency, face-to-face support, adult cancer patients, treatment side effects, palliative care, oncology nursing
- MeSH terms
- Cancer Pain, Adult, Anxiety, Depression, Dyspnea, Fatigue, Female, Humans, Male, Neoplasms, Self Care, Sexual Dysfunction, Physiological, Stress, Psychological, Telephone, Time Factors, Randomized Controlled Trials as Topic, Telemedicine, Uncertainty, Symptom Assessment
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