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Cited by 169Cancer survivorship and careArt Therapy and Mental HealthCardiac Health and Mental Health

Pre-intervention distress moderates the efficacy of psychosocial treatment for cancer patients: a meta-analysis

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Schneider, Stefan, Moyer, Anne, Knapp-Oliver, Sarah, Sohl, Stephanie, Cannella, Dolores, Targhetta, Valerie·2010·Journal of Behavioral Medicine
DOI 10.1007/s10865-009-9227-2PMC PMC2813921
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Abstract

This meta-analysis examined whether effects of psychosocial interventions on psychological distress in cancer patients are conditional upon pre-intervention distress levels. Published articles and unpublished dissertations between 1980 and 2005 were searched for interventions reporting the Hospital Anxiety and Depression Scale (HADS) or the Spielberger State-Trait Anxiety Inventory (STAI). Multilevel mixed-effects modeling was used to meta-analyze effect-sizes separately for the HADS (27 trials, 2,424 patients) and STAI (34 trials, 2,029 patients). Pre-intervention distress significantly moderated intervention effects, explaining up to 50% of the between-study effect-size variance: effects on anxiety and depression were generally negligible when pre-intervention distress was low and pronounced when it was high. These results could not be explained by differences in intervention type, setting, dose, and whether intervention was targeted at distressed patients. Psychosocial interventions may be most beneficial for cancer patients with elevated distress. Future research should identify which treatment components are most effective for these patients to facilitate optimal treatment tailoring and cost-effective health care.

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  • Cancer patients with greater psychosocial vulnerability, such as greater distress, depression, or social isolation, typically derive the greatest benefit from psychosocial interventions.

    “Several studies suggest that cancer patients with greater psychosocial vulnerability (e.g., greater distress, depression, or social isolation) typically derive the greatest benefit from psychosocial interventions (Moyer et al., 2009; Schneider et al., 2010), potentially be due to a “ceiling effect” for well-adjusted patients.”

    From Who Benefits Most from a Brief Mindfulness Intervention to Reduce Anxiety During Stereotactic Breast Biopsy: the Moderating Effect of Trait Mindfulness, Spiritual Well-being, and Distress Tolerance (2021) · cites this paper as Schneider et al., 2010

    The Discussion (page unavailable) reports that interventions reduced anxiety and depression more when patients had higher initial distress, supporting that part of the claim. The paper mentions evidence concerning low social support in its background, but its meta-analysis did not test social isolation, and it notes studies with opposite findings. Thus it does not establish that patients with all the listed vulnerabilities typically benefit most. (LLM, conf=0.83)

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  • The STAI is the most commonly used measure to identify which cancer patients benefit most from psychosocial interventions.

    “The STAI is the most commonly used measure to identify which cancer patients benefit most from psychosocial interventions [35].”

    From A randomized controlled trial of a group acceptance-based intervention for cancer survivors experiencing anxiety at re-entry ('Valued Living'): Study protocol (2019) · cites this paper as [35]

    Methods > Study Identification reports STAI-S in 77 projects (16%), more than HADS in 53 (11%), but does not establish that STAI is the most commonly used measure overall. Results > STAI finds that baseline STAI-S scores moderated intervention effects across studies; it does not establish that the measure identifies which individual patients will benefit most. Page numbers are unavailable in our copy. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • A recent meta-analysis of 61 trials evidenced that baseline distress moderates the efficacy of such interventions for cancer patients.

    “a recent meta-analysis of 61 trials evidenced that baseline distress moderates the efficacy of such interventions for cancer patients (Schneider et al., 2010).”

    From The effects of physical activity on cortisol and sleep: A systematic review and meta-analysis. (2022) · cites this paper as Schneider et al., 2010

  • Cancer patients with higher levels of anxiety and distress benefit the most from psychosocial intervention.

    “Meta-analytic evidence suggests that cancer patients with higher levels of anxiety and distress benefit the most from psychosocial intervention [28].”

    From Psychological Intervention and Breast Cancer (2024) · cites this paper as [28]

  • Cancer patients with higher levels of anxiety and distress benefit most substantially from psychosocial interventions relative to less distressed counterparts.

    “Strong evidence demonstrates that cancer patients with higher levels of anxiety and distress benefit most substantially from psychosocial interventions, relative to their less distressed counterparts [35–37].”

    From A randomized controlled trial of a group acceptance-based intervention for cancer survivors experiencing anxiety at re-entry ('Valued Living'): Study protocol (2019) · cites this paper as [35]

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Research works printed but not linked: 7

  1. Carty JL Relaxation with imagery: An adjunctive treatment for anticipatory nausea and/or vomiting (Doctoral dissertation, The Catholic University of America, 1990) Dissertation Abstracts International 1990 51 131
  2. Dobkin PL The use of systematic desensitization, a biobehavioral intervention, in the reduction of aversive chemotherapy side effects in cancer patients (Doctoral dissertation, University of Georgia, 1987) Dissertation Abstracts International 1987 48 163
  3. Feldman CS The role of imagery in the hypnotic treatment of adverse reactions to cancer chemotherapy (Doctoral dissertation, University of South Carolina, 1989) Dissertation Abstracts International 1989 50 4216 4217
  4. Moorey S Greer S Bliss J Law M A comparison of adjuvant psychological therapy and supportive counselling in patients with cancer Psycho-Oncology 1998 7 218 228 9638783
  5. Palekar IS Effect of autogenic relaxation with imagery on chemotherapy side effects, as predicted by personality characteristics (Doctoral dissertation, The University of Akron, 1994) Dissertation Abstracts International 1994 56 311
  6. Prince BJ Hospitalized, post-mastectomy coping modification and anxiety reduction (Doctoral dissertation, Yeshiva University, 1995) Dissertation Abstracts International 1995 56 117
  7. Rash JL The use of guided mental imagery in its effect on anxiety and depression in the cancer patient (Doctoral dissertation, United States International University, 1991) Dissertation Abstracts International 1991 52 154

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Authors
Schneider, S., Moyer, A., Knapp-Oliver, S., Sohl, S., Cannella, D., & Targhetta, V.
Affiliations
Stony Brook University (US)
Corresponding author
Schneider, Stefan
ORCID
Venue
Journal of Behavioral Medicine
Publisher
Springer Science and Business Media LLC
Published
2009-09-27
Volume
33
Issue
1
Pages
1-14
ISSN
  • 0160-7715 (ISSN-L)
  • 1573-3521
DOI
10.1007/s10865-009-9227-2
PMC
PMC2813921
OpenAlex
W2053020196
Cited by
169
References
112
Citations by year
2026: 2 · 2025: 4 · 2024: 7 · 2023: 6 · 2022: 10 · 2021: 5 · 2020: 9 · 2019: 12 · 2018: 10 · 2017: 16 · 2016: 14 · 2015: 18 · 2014: 12 · 2013: 18 · 2012: 14
FWCI
0.73
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Journal of Behavioral Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • Cancer Institute and Hospital, Chinese Academy of Medical Sciences
  • National Cancer Institute (R01CA100810)
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Social Sciences › Arts and Humanities › Conservation › Art Therapy and Mental Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords
cancer patients, psychosocial interventions, psychological distress, moderation, anxiety, depression, treatment tailoring, treatment efficacy
MeSH terms
Adult, Aged, Anxiety, Depression, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasms, Psychiatric Status Rating Scales, Regression Analysis, Stress, Psychological, Time Factors, Models, Statistical, Treatment Outcome

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