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Pre-intervention distress moderates the efficacy of psychosocial treatment for cancer patients: a meta-analysis
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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 Published articles and unpublished dissertations between 1980 and 2005 were searched for interventions reporting the Hospital Anxiety and Depression Scale (HADS) or the Spielberger State-Trait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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“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
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“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]
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“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
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“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]
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“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].”
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Metadata
- Authors
- Schneider, S., Moyer, A., Knapp-Oliver, S., Sohl, S., Cannella, D., & Targhetta, V.
- Affiliations
- Stony Brook University (US)
- Corresponding author
- Schneider, Stefan
- Venue
- Journal of Behavioral Medicine
- Published
- 2009-09-27
- Volume
- 33
- Issue
- 1
- Pages
- 1-14
- ISSN
- 0160-7715 (ISSN-L)
- 1573-3521
- 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
- green
- www.ncbi.nlm.nih.gov
- 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 › Psychology › Clinical Psychology › 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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