Non-pharmacological interventions on anxiety and depression in lung cancer patients’ informal caregivers: A systematic review and meta-analysis
Open accessAbstract
Background: Lung cancer is one of the common cancers and the leading cause of death. Tremendous caregiving burden of informal caregivers of lung cancer causes psychological disorders, such as anxiety and depression. Interventions for informal caregivers of patients with lung cancer to improve their psychological health, which ultimately leads to patients’ positive health outcomes, are crucial. A systematic review and meta-analysis was conducted to: 1) evaluate the effect of non-pharmacological interventions on the outcomes of depression and anxiety for lung cancer patients’ informal caregivers; and 2) compare the effects of interventions with differing characteristics (i.e. intervention types, mode of contact, and group versus individual delivery). Methods: Four databases were searched to identify relevant studies. Inclusion criteria for the articles were peer-reviewed non-pharmacological intervention studies on depression and anxiety in lung cancer patients’ informal caregivers published between January 2010 and April 2022. Systematic review procedures were followed. Data analysis of related studies was conducted using the Review Manager Version 5.4 software. Intervention effect sizes and studies’ heterogeneity were calculated. Results: Eight studies from our search were eligible for inclusion. Regarding total effect for the caregivers’ levels of anxiety and depression, results revealed evidence for significant moderate effects of intervention on anxiety (SMD -0.44; 95% CI, -0.67, -0.21; p = 0.0002) and depression (SMD -0.46; 95% CI, -0.74, -0.18; p = 0.001). Subgroup analyses for both anxiety and depression of informal caregivers revealed moderate to high significant effects for specific intervention types (cognitive behavioral and mindfulness combined with psycho-education interventions), mode of contact (telephone-based interventions), and group versus individual delivery. Conclusion: This review provides evidence that cognitive behavioral and mindfulness-based, telephone-based, individual or group-based interventions were effective for informal caregivers of lung cancer patients. Further research is needed to develop the most effective intervention contents and delivery methods across informal caregivers with larger sample size in randomized controlled trials.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Hybrid approaches may combine the benefits of in-person therapeutic engagement with delivery flexibility.
“Hybrid approaches may combine the benefits of in‐person therapeutic engagement with delivery flexibility. 117 , 123”
From Nonpharmacologic interventions for managing distress, anxiety, and depression for patients with cancer and their family caregivers: A systematic review and meta‐analysis (2026) · cites this paper as [123]
The Results (Effect by mode of contact) and Discussion report that in-person and telephone-based interventions each reduced anxiety and depression among informal caregivers of lung cancer patients. The review assessed those delivery modes separately; it does not report that a hybrid approach combines therapeutic engagement with delivery flexibility. (LLM, conf=0.82)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Measuring inconsistency in meta-analyses
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003) · BMJ · doi:10.1136/bmj.327.7414.557 · Cited by 63,139 · see citing works
Interpretation of random effects meta-analyses
Riley, R. D., Higgins, J. P. T., & Deeks, J. J. (2011) · BMJ · doi:10.1136/bmj.d549 · Cited by 2,884 · see citing works
How Many Studies Do You Need?: A Primer on Statistical Power for Meta-Analysis
Valentine, J. C., Pigott, T. D., & Rothstein, H. R. (2010) · Journal of Educational and Behavioral Statistics · doi:10.3102/1076998609346961 · Cited by 1,294 · see citing works
Interventions with Family Caregivers of Cancer Patients: Meta-Analysis of Randomized Trials
Northouse, L. L., Katapodi, M. C., Song, L., Zhang, L., & Mood, D. W. (2010) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.20081 · Cited by 857 · see citing works
FERRELL, B. R., Twaddle, M. L., Melnick, A., & Meier, D. E. (2018) · Journal of Palliative Medicine · doi:10.1089/jpm.2018.0431 · Cited by 775 · see citing works
A Re-Analysis of the Cochrane Library Data: The Dangers of Unobserved Heterogeneity in Meta-Analyses
Kontopantelis, E., Springate, D. A., & Reeves, D. (2013) · PLoS ONE · doi:10.1371/journal.pone.0069930 · Cited by 508 · see citing works
Clinical Practice Guidelines for Quality Palliative Care
(2018) · PEDIATRICS · doi:10.1542/peds.2018-3310 · Cited by 455 · see citing works
The symptom burden of non-small cell lung cancer in the USA: a real-world cross-sectional study
Iyer, S. S., Roughley, A., Rider, A., & Taylor‐Stokes, G. (2013) · Supportive Care in Cancer · doi:10.1007/s00520-013-1959-4 · Cited by 225 · see citing works
Badr, H., Smith, C. B., Goldstein, N. E., Gomez, J. E., & Redd, W. H. (2014) · Cancer · doi:10.1002/cncr.29009 · Cited by 214 · see citing works
Sherifali, D., Ali, M. U., Ploeg, J., Markle-Reid, M., Valaitis, R., Bartholomew, A., Fitzpatrick-Lewis, D., & McAiney, C. (2018) · Journal of Medical Internet Research · doi:10.2196/10668 · Cited by 151 · see citing works
Psychosocial interventions for informal caregivers of people living with cancer
Treanor, C. J., Santin, O., Prue, G., Coleman, H., Cardwell, C. R., O'Halloran, P., & Donnelly, M. (2019) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009912.pub2 · Cited by 145 · see citing works
Litzelman, K., Kent, E. E., Mollica, M., & Rowland, J. H. (2016) · Journal of Clinical Oncology · doi:10.1200/jco.2016.67.3434 · Cited by 140 · see citing works
Fujinami, R., Sun, V., Zachariah, F., Uman, G., Grant, M., & Ferrell, B. (2015) · Psycho-Oncology · doi:10.1002/pon.3562 · Cited by 140 · see citing works
Borges, E. L., Franceschini, J., Costa, L. H. D., Fernandes, A. L. G., Jamnik, S., & Santoro, I. L. (2017) · Jornal Brasileiro de Pneumologia · doi:10.1590/s1806-37562016000000177 · Cited by 139 · see citing works
How many studies do you need? A primer on statistical power for meta-analysis
Valentine, J. C., Pigott, T., & Rothstein, H. R. (2011) · Quality Engineering · Cited by 138 · see citing works
Li, J., Li, C., Puts, M., Wu, Y.-C., Lyu, M.-M., Yuan, B., & Zhang, J.-P. (2023) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2023.104447 · Cited by 127 · see citing works
Caring for the informal cancer caregiver.
Sun, V., Raz, D. J., & Kim, J. Y. (2019) · Current Opinion in Supportive & Palliative Care · doi:10.1097/spc.0000000000000438 · Cited by 125 · see citing works
Dharmawardene, M., Givens, J., Wachholtz, A., Makowski, S., & Tjia, J. (2016) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2014-000819 · Cited by 110 · see citing works
Psychosocial Aspects of Caregiving: Perceptions of Cancer Patients and Family Caregivers
Deshields, T., Rihanek, A., Potter, P., Zhang, Q., Kuhrik, M., Kuhrik, N., & O’Neill, J. (2011) · Supportive Care in Cancer · doi:10.1007/s00520-011-1092-1 · Cited by 109 · see citing works
Gonzalez, M., Pascoe, M. C., Yang, G., de Manincor, M., Grant, S., Lacey, J., Firth, J., & Sarris, J. (2021) · Psycho-Oncology · doi:10.1002/pon.5671 · Cited by 102 · cited 1× · see citing works
“Furthermore, the present findings are inconsistent with a meta-analysis that revealed significant small to moderate effects on both anxiety and depression in yoga interventions for cancer patients [37].”
ResultMosher, C. E., Secinti, E., Hirsh, A. T., Hanna, N., Einhorn, L. H., Jalal, S. I., Durm, G., Champion, V. L., & Johns, S. A. (2019) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2019.06.021 · Cited by 98 · see citing works
Evolution of symptom burden of advanced lung cancer over a decade
Sung, M. R., Patel, M. V., Djalalov, S., Le, L. W., Shepherd, F. A., Burkes, R. L., Feld, R., Lin, S., Tudor, R., & Leighl, N. B. (2017) · Clinical Lung Cancer · doi:10.1016/j.cllc.2016.12.010 · Cited by 98 · see citing works
van den Hurk, D. G. M., Schellekens, M. P. J., Molema, J., Speckens, A. E. M., & van der Drift, M. A. (2015) · Palliative Medicine · doi:10.1177/0269216315572720 · Cited by 95 · see citing works
Mosher, C. E., Winger, J. G., Hanna, N., Jalal, S. I., Einhorn, L. H., Birdas, T. J., Ceppa, D. P., Kesler, K. A., Schmitt, J., Kashy, D. A., et al. (2016) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2016.04.006 · Cited by 91 · see citing works
Gravier, F., Smondack, P., Prieur, G., Médrinal, C., Combret, Y., Muir, J., Baste, J., Cuvelier, A., Boujibar, F., & Bonnevie, T. (2021) · Thorax · doi:10.1136/thoraxjnl-2021-217242 · Cited by 88 · see citing works
O'Toole, M. S., Zachariae, R., Renna, M. E., Mennin, D. S., & Applebaum, A. (2017) · Psycho-Oncology · doi:10.1002/pon.4144 · Cited by 86 · see citing works
Sleep quality, anxiety and depression in advanced lung cancer: patients and caregivers
He, Y. M., Sun, L., Peng, K., Luo, M.-J., Deng, L., Tang, T., & You, C. (2020) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2018-001684 · Cited by 64 · see citing works
Litzelman, K., Kent, E. E., & Rowland, J. H. (2017) · Health Education & Behavior · doi:10.1177/1090198117705164 · Cited by 60 · see citing works
Couple-based Tibetan yoga program for lung cancer patients and their caregivers
Milbury, K., Chaoul, A., Engle, R., Liao, Z. X., Yang, C. C., Carmack, C. L., Shannon, V. R., Spelman, A. R., Wangyal, T., & Cohen, L. G. (2014) · Psycho-Oncology · doi:10.1002/pon.3588 · Cited by 55 · see citing works
Vivekananda Yoga Program for Patients With Advanced Lung Cancer and Their Family Caregivers
Milbury, K., Mallaiah, S., Lopez, G., Liao, Z. X., Yang, C. C., Carmack, C. L., Chaoul, A., Spelman, A. R., & Cohen, L. G. (2015) · Integrative Cancer Therapies · doi:10.1177/1534735415583554 · Cited by 54 · see citing works
Cochrane, A., Reid, O., Woods, S., Gallagher, P., & Dunne, S. (2021) · Psycho-Oncology · doi:10.1002/pon.5694 · Cited by 43 · see citing works
Multidimensional Needs of Caregivers for Patients With Cancer
Skalla, K. A., Smith, E., Li, Z., & Gates, C. (2013) · Clinical journal of oncology nursing · doi:10.1188/13.cjon.17-05ap · Cited by 41 · see citing works
Lyons, K. S., Bennett, J. A., Nail, L. M., Fromme, E. K., Dieckmann, N. F., & Sayer, A. G. (2014) · Journal of Family Psychology · doi:10.1037/fam0000017 · Cited by 40 · see citing works
Lee, J. Z. J., Chen, H., Lee, J. X., & Klainin‐Yobas, P. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06102-2 · Cited by 36 · see citing works
Optimism, pessimism, and depressive symptoms in spouses of lung cancer patients
Pinquart, M., & Duberstein, P. R. (2005) · Psychology and Health · doi:10.1080/08870440412331337101 · Cited by 30 · see citing works
Nenova, M., Morris, L., Paul, L., Li, Y., Applebaum, A., & DuHamel, K. (2013) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.27.3.258 · Cited by 26 · see citing works
Yan-wei, L., Minghui, F., Manman, Q., Zhuchun, Y., Liu, D., & Pan, Z. (2018) · Current Problems in Cancer · doi:10.1016/j.currproblcancer.2018.03.006 · Cited by 16 · see citing works
Zhu, R.-Y., Chen, H., Gao, Y., Pan, Z.-H., & Wang, J.-Y. (2022) · Medicine · doi:10.1097/md.0000000000029914 · Cited by 16 · see citing works
Sato, T., Fujisawa, D., Arai, D., Nakachi, I., Takeuchi, M., Nukaga, S., Kobayashi, K., Ikemura, S., Terai, H., Yasuda, H., et al. (2021) · Palliative Medicine · doi:10.1177/02692163211001721 · Cited by 15 · see citing works
Choratas, A., Papastavrou, E., Charalambous, A., & Kouta, C. (2020) · Frontiers in Oncology · doi:10.3389/fonc.2020.01366 · Cited by 14 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [26]Hedges L, Olkin I. Statistical methods for medta-analysis. New York: Academic Press; 1995.
Cited by
Sorted by citations
Yan, Q., Zhu, C., Li, L., Li, Y., Chen, Y., & Hu, X. (2024) · International Journal of Nursing Studies · doi:10.1016/j.ijnurstu.2024.104895 · Cited by 30 · see citing works
Sheng, L., Zhu, Y., Liu, Y., Hua, H., Zhou, J., & Ye, L. (2024) · Asia-Pacific Journal of Oncology Nursing · doi:10.1016/j.apjon.2024.100382 · Cited by 14 · see citing works
Lin, X., Fei, F., Zhang, X., Zhou, Y., Qin, F., Sun, X., Zhang, Y., & Koffman, J. (2025) · Journal of Clinical Nursing · doi:10.1111/jocn.70006 · Cited by 11 · see citing works
Alsahli, F., Alruwais, N., Alsultan, L. S., Abojalid, B. S., Nughays, R. O., Humedi, A. M., Alosaimi, A., Alrubaian, M. T., Almuteri, D., & Alkhunizan, M. (2025) · Cureus · doi:10.7759/cureus.77008 · Cited by 6 · see citing works
Christodoulou, L., Parpottas, P., & Petkari, E. (2024) · Journal of Health Psychology · doi:10.1177/13591053241236254 · Cited by 7 · see citing works
Easpaig, B. N. G., Newman, B., Johnson, J., Laidsaar‐Powell, R., Sansom‐Daly, U. M., Jones, L., Hofstätter, L., Robertson, E. G., Mears, S. R., Sattarshetty, K., et al. (2025) · Journal of Cancer Survivorship · doi:10.1007/s11764-025-01802-8 · Cited by 3 · see citing works
Neumann, J., Beckord, J., Hesse, S., Martin, C., Mons, C., Chur, D., Hense, J., Tewes, M., Teufel, M., & Skoda, E.-M. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1492219 · Cited by 2 · see citing works
Schiess, L. C., Song, L. L., Schädelin, S., Fürst, T., Urech, C., Friese, C. R., & Katapodi, M. C. (2026) · CA: A Cancer Journal for Clinicians · doi:10.3322/caac.70076
“117,123 Cancer types and stages”
Xu, T., Lu, H., Xiao, W. H., Liao, J., & Gu, D. (2026) · Supportive Care in Cancer · doi:10.1007/s00520-026-10483-7
Lung Cancer Survivorship: Challenges and Care Needs
Cani, M., Cotogni, P., Greco, A., Ronconi, G., Lombardi, E., Fracchiolla, M., Vallone, S., Pacchiana, M. V., Capizzi, I., Bertaglia, V., et al. (2026) · Cancers · doi:10.3390/cancers18172856
Hosseini, F. A.-S., Choobforoushzadeh, A., Mortazavizadeh, S. M. R., & Mirsaleh, Y. R. (2026) · Supportive Care in Cancer · doi:10.1007/s00520-026-11205-9
- Authors
- Lei, F., Lee, E., Shin, J., & Lee, S.-Y.
- Affiliations
- University of Minnesota (US)
- University of California, Los Angeles (US)
- University of California, San Francisco (US)
- Chosun University (KR)
- Corresponding author
- Lee, Shin-Young
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2023-03-13
- Volume
- 18
- Issue
- 3
- Pages
- e0282887
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC10010534
- OpenAlex
- W4324019024
- Cited by
- 11
- References
- 40
- Citations by year
- 2026: 4 · 2025: 4 · 2024: 3
- FWCI
- 0.36
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Health Professions › Pharmacy › Nursing care and research
- Social Sciences › Psychology › Clinical Psychology › Family Caregiving in Mental Illness
- Keywords
- lung cancer, informal caregivers, caregiver burden, anxiety, depression, non-pharmacological treatment, cognitive behavioral therapy, mindfulness-based interventions, psychoeducation, telephone-delivered intervention
- MeSH terms
- Anxiety, Anxiety Disorders, Humans, Lung Neoplasms, Quality of Life, Caregivers
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
