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Cited by 0Cancer survivorship and careNursing care and researchFamily Support in Illness

Nonpharmacologic interventions for managing distress, anxiety, and depression for patients with cancer and their family caregivers: A systematic review and meta‐analysis

Open access
Schiess, Lisa C., Song, Lixin L., Schädelin, Sabine, Fürst, Thomas, Urech, Corinne, Friese, Christopher R., Katapodi, Maria C.·2026·CA: A Cancer Journal for Clinicians
DOI 10.3322/caac.70076PMC PMC13078667
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Abstract

As more cancer treatments take place in outpatient settings, family caregivers provide essential care and emotional support over long periods. Unaddressed patient and caregiver psychological distress can lead to worse outcomes, reflecting the challenges of managing complex care demands in the home setting. This systematic review and meta‐analysis examined how well nonpharmacologic interventions (NPIs) reduce distress, anxiety, and depression in adult patients with solid tumors and their family caregivers. The authors included 68 randomized controlled trials (RCTs) with a total of 11,987 participants. NPIs were characterized as psychoeducation, therapeutic counseling, skills training, or behavior modification. By using random‐effects models (Hedges g), they observed that NPIs significantly reduced patient distress at both 0.0–3.0 months (g = 0.13) and 3.1–6.0 months (g = 0.18), but NPIs did not significantly reduce caregiver distress. In the short term (0.0–3.0 months), NPIs also significantly reduced anxiety (g = 0.31 for patients; g = 0.15 for caregivers) and depression (g = 0.28 for patients; g = 0.25 for caregivers). Subgroup analyses examined the impact of patient and caregiver characteristics along with NPI type, delivery format, dose, and duration. NPIs delivered jointly to patients and caregivers yielded significant effects that were higher compared with NPIs delivered separately. NPIs can help manage distress in patients and reduce anxiety and depression in both patients and caregivers. However, the lack of long‐term follow‐up limits our understanding of their impact on patients and caregivers with prolonged or delayed psychological symptoms (PROSPERO registration number CRD42024536629).

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis of 68 RCTs with 11,987 participants found that nonpharmacologic interventions significantly reduced patient distress in the short and intermediate term and short-term anxiety/depression in patients and caregivers, but effects generally did not persist beyond 3 months except for patient distress and caregiver depression up to 3.1–6.0 months. Caregiver distress did not significantly improve at any time point.

Key findings

  • Among 68 RCTs and 11,987 participants, NPIs significantly reduced patient distress at 0.0–3.0 months (g = 0.13; 95% CI, 0.03–0.23; p = .008) and 3.1–6.0 months (g = 0.18; 95% CI, 0.02–0.34; p = .027), but not beyond 6.0 months (g = 0.05; 95% CI, −0.09 to 0.18; p = .520). Caregiver distress was not significantly reduced at 0.0–3.0 months (g = 0.05; p = .581), 3.1–6.0 months (g = 0.22; p = .198), or >6.0 months (g = 0.22; p = .140).
  • In the short term (0.0–3.0 months), NPIs significantly reduced patient anxiety (g = 0.31; 95% CI, 0.16–0.46; p = .000), caregiver anxiety (g = 0.15; 95% CI, 0.02–0.28; p = .023), patient depression (g = 0.28; 95% CI, 0.17–0.40; p = .000), and caregiver depression (g = 0.25; 95% CI, 0.11–0.38; p = .000).
  • Caregiver depression remained significant at 3.1–6.0 months (g = 0.22; 95% CI, 0.01–0.43; p = .037) but not beyond 6.0 months (g = 0.25; 95% CI, −0.04 to 0.54; p = .095); patient anxiety and depression were not significant after 3 months.
  • Subgroup analyses found therapeutic counseling was associated with significant reductions in patient and caregiver anxiety and depression; dyad-together delivery significantly reduced patient distress and anxiety/depression in both groups; mixed face-to-face/remote formats significantly reduced patient distress, anxiety, and depression; higher attrition was associated with smaller effects for patient and caregiver anxiety and caregiver depression.

Methods

  • Systematic review and meta-analysis conducted per PRISMA 2020, registered with PROSPERO (CRD42024536629); databases searched included Medline, Cochrane CENTRAL, APA PsycInfo, CINAHL, ClinicalTrials.gov, and WHO ICTRP through January 27, 2025 (CINAHL through December 11, 2023).
  • Included 68 RCTs (70 reports) of adult patients with solid tumors and their adult family caregivers; excluded children with cancer and patients with hematologic malignancies. NPIs were categorized as psychoeducation (k = 9), therapeutic counseling (k = 33), skills training (k = 20), or behavior modification (k = 6).
  • Outcomes were grouped at 0.0–3.0, 3.1–6.0, and >6.0 months; random-effects models used Hedges g; heterogeneity assessed with Cochran Q; subgroup and meta-regression analyses examined moderators; sensitivity used leave-one-study-out; publication bias assessed with Egger t-test; GRADE assessed certainty. The 68 RCTs included 5,795 patients and 6,192 caregivers; median NPI dose was 6.0 hours, 6.0 sessions, and 6.0 weeks.

Limitations

  • Stated in the paper: risk of bias was assessed only for primary outcomes of each RCT; 12 studies were excluded because of incomplete or incompatible data; excluded caregivers were younger but represented a smaller sample (1,443 vs. 6,192 included); certainty of evidence was moderate for short-term outcomes and low to very low for longer-term outcomes; generalizability was limited by concentration in high-income countries, predominantly female and Caucasian samples, and poor race/ethnicity reporting outside the United States; patients with hematologic malignancies and dyads in which both members were willing and able to participate were excluded; pharmacologic treatments were addressed in only two RCTs; bereavement-related outcomes were outside scope; and heterogeneity across studies limits precision of pooled estimates.
  • Evident from the text: long-term follow-up was limited, with most RCTs assessing outcomes within the first 3 months (n = 59) versus intermediate (n = 22) and long-term (n = 14) outcomes; the median contact time of approximately 6 hours may explain short-term benefits and limited durability; and 27 RCTs (39.7%) did not report disease stage, limiting interpretation by cancer stage.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.3322/caac.70076

Cites

134 of 134 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

25 of 49 cited sources checked · 10 supported · 0 flagged · accuracy not yet measured

  • Findingown data

    Twelve studies lacked sufficient data or had incompatible designs and were included only in the narrative synthesis.

    “Twelve studies (13 reports because of one pair of publications from the same RCT 42 , 43 ) lacked sufficient data or had incompatible designs (e.g., re‐randomization, multiple overlapping intervention arms) and were included only in the narrative synthesis”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [42] Porter LS, Keefe FJ, Baucom DH, et al. Partner‐assisted emotional disclosure for patients with gastrointestinal cancer: results from a randomized controlled trial. Cancer. 2009; 115(18 suppl): 4326‐ 4338. doi: 10.1002/cncr.24578 19731357 PMC2762322 source

      The Method > Data Analyses section describes this paper’s randomized trial and its analysis of 130 couples, not a synthesis of multiple studies. I searched for the twelve-study count, insufficient data, incompatible designs, and narrative synthesis; our copy does not address which studies a later review included only in its narrative synthesis. The indexed passages provide section labels but no page numbers. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [43] Porter LS, Keefe FJ, Baucom DH, et al. Partner‐assisted emotional disclosure for patients with GI cancer: 8‐week follow‐up and processes associated with change. Support Care Cancer. 2012; 20(8): 1755‐ 1762. doi: 10.1007/s00520-011-1272-z 21947440 source
  • Premisecitation

    Prolonged and unmanaged psychological and physical burden may lead to psychological distress and symptoms of anxiety and/or depression that often co-occur with a cancer diagnosis.

    “Prolonged and unmanaged psychological and physical burden may lead to psychological distress 9 , 10 and symptoms of anxiety and/or depression 11 that often co‐occur with a cancer diagnosis. 12 , 13 , 14”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [9] Dhumal T, Siddiqui ZA, Kelley GA, Harper F, Kelly KM. Systematic review and meta‐analysis of randomized controlled trials of interventions addressing caregiver distress and burden among cancer caregivers. PEC Innov. 2023; 2: 100145. doi: 10.1016/j.pecinn.2023.100145 37214528 PMC10194362 source

      The Introduction links the burden of caring for someone with cancer to physical and psychological distress and says informal caregivers may experience anxiety and depressive symptoms. It does not specify that the burden is prolonged or unmanaged, or establish how often those symptoms co-occur with a cancer diagnosis. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [10] Hamer M, Chida Y, Molloy GJ. Psychological distress and cancer mortality. J Psychosom Res. 2009; 66(3): 255‐ 258. doi: 10.1016/j.jpsychores.2008.11.002 19232239 source
    • cites [11] Ross CE. Social Causes of Psychological Distress. 2nd ed. Routledge; 2003.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Premisecitation

    Nonpharmacologic interventions have been tested for distress, anxiety, and depression in patients with cancer and their caregivers.

    “Nonpharmacologic interventions (NPIs) have been tested for distress, anxiety, and depression in patients with cancer and their caregivers. 9 , 19 , 20 , 21 , 22 , 23 , 24 , 25”
    Quote in the paperSubstantial claim3 of 3 sources checked
    • cites [9] Dhumal T, Siddiqui ZA, Kelley GA, Harper F, Kelly KM. Systematic review and meta‐analysis of randomized controlled trials of interventions addressing caregiver distress and burden among cancer caregivers. PEC Innov. 2023; 2: 100145. doi: 10.1016/j.pecinn.2023.100145 37214528 PMC10194362 source

      The Results, Intervention characteristics section (page not provided) describes nonpharmacologic interventions tested for caregiver distress, anxiety, and depression. The paper discusses patient–caregiver interventions, but the cited passages do not establish that those interventions were tested for all three outcomes in patients with cancer as well as their caregivers. (LLM, conf=0.84)

      Experimental — accuracy not yet measured
    • cites [19] Northouse LL, Katapodi MC, Song L, Zhang L, Mood DW. Interventions with family caregivers of cancer patients: meta‐analysis of randomized trials. CA Cancer J Clin. 2010; 60(5): 317‐ 339. doi: 10.3322/caac.20081 20709946 PMC2946584 source
    • cites [20] Ferrell B, Wittenberg E. A review of family caregiving intervention trials in oncology. CA Cancer J Clin. 2017; 67(4): 318‐ 325. doi: 10.3322/caac.21396 28319263 source
  • Interpretationcitation

    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”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [117] Kim M, Tan KR, Coombs LA. Efficacy of web‐based interventions on depression and anxiety in cancer caregivers: a systematic review and meta‐analysis. Psychooncology. 2024; 33(7): e9301. doi: 10.1002/pon.9301 39039753 source
    • cites [123] Lei F, Lee E, Shin J, Lee S‐Y. Non‐pharmacological interventions on anxiety and depression in lung cancer patients’ informal caregivers: a systematic review and meta‐analysis. PLoS One. 2023; 18(3): e0282887. doi: 10.1371/journal.pone.0282887 36913399 PMC10010534 source

      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
  • Premisecitation

    NPIs designed for both patients and caregivers often focus primarily on patients' needs, whereas caregivers receive less attention.

    “NPIs designed for both patients and caregivers often focus primarily on patients' needs, whereas caregivers receive less attention. 25”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [25] Chow R, Mathews JJ, Cheng EY, et al. Interventions to improve outcomes for caregivers of patients with advanced cancer: a meta‐analysis. J Natl Cancer Inst. 2023; 115(8): 896‐ 908. doi: 10.1093/jnci/djad075 37279594 PMC10407714 source

      The introductory passage (indexed under Abstract > Conclusions; page unavailable) says that patient-centered care has led to unintended neglect of caregivers. The Methods distinguish interventions for patient–caregiver dyads from those directed at patients, but the paper does not say that interventions designed for both typically prioritize patients’ needs. (LLM, conf=0.85)

      Experimental — accuracy not yet measured
  • Classified as probably not a substantial claim. 59
  • May combine two claims. 57
  • The quote only partly states this claim. 1

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Risk of bias was assessed by two reviewers with the Cochrane RoB tool version 2.

    “The risk of bias (RoB) was assessed by two reviewers with the Cochrane RoB tool (version 2). 30”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [30] Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366: l4898. doi: 10.1136/bmj.l4898 31462531 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The study was conducted according to current guidelines following the 2020 PRISMA statement.

    “The study was conducted according to current guidelines 26 , 27 following the 2020 Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. 28”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [26] Higgins JPT, Thomas J, Chandler J, et al., eds. Cochrane Handbook for Systematic Reviews of Interventions, version 6.5. Cochrane; 2024. Accessed July 7, 2025. www.cochrane.org/handbook

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [27] Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z, eds. JBI Manual for Evidence Synthesis. JBI; 2024. Accessed July 7, 2025. https://synthesismanual.jbi.global source
    • cites [28] Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372: n71. doi: 10.1136/bmj.n71 33782057 PMC8005924 source

      The Abstract identifies this paper as the PRISMA 2020 statement and describes its guidance for reporting systematic reviews. The Scope of the guideline explicitly says PRISMA 2020 is not intended to guide systematic review conduct. The source therefore supports the reference to PRISMA 2020, but not the implication that it provides guidelines for how the study was conducted. (LLM, conf=0.85)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Six publications reporting outcomes from three different RCTs were considered as single studies.

    “Six publications reporting outcomes from three different RCTs 38 , 39 , 40 , 41 , 42 , 43 were considered as single studies.”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [38] Badr H, Herbert K, Chhabria K, Sandulache VC, Chiao EY, Wagner T. Self‐management intervention for head and neck cancer couples: results of a randomized pilot trial. Cancer. 2019; 125(7): 1176‐ 1184. doi: 10.1002/cncr.31906 30521075 PMC6420382 source
    • cites [39] Badr H, Herbert K, Bonnen MD, Asper JA, Wagner T. Dyadic coping in patients undergoing radiotherapy for head and neck cancer and their spouses. Front Psychol. 2018; 9: 1780. doi: 10.3389/fpsyg.2018.01780 30374316 PMC6196240 source
    • cites [40] Clark MM, Rummans TA, Atherton PJ, et al. Randomized controlled trial of maintaining quality of life during radiotherapy for advanced cancer. Cancer. 2013; 119(4): 880‐ 887. doi: 10.1002/cncr.27776 22930253 PMC4405146 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Contemporary trends favor self-directed technologies (e.g., mobile applications) compared with in-person or clinic-based approaches.

    “with contemporary trends favoring self‐directed technologies (e.g., mobile applications) compared with in‐person or clinic‐based approaches, 20”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [20] Ferrell B, Wittenberg E. A review of family caregiving intervention trials in oncology. CA Cancer J Clin. 2017; 67(4): 318‐ 325. doi: 10.3322/caac.21396 28319263 source

      The Discussion (page not available in our copy) reports increased attention to home-based caregiver interventions and says self-directed technology is on the rise compared with earlier reliance on face-to-face clinical visits. It does not identify mobile applications as an example or say self-directed technologies are favored over other formats; telephone contact was the most prevalent format. (LLM, conf=0.84)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationcitation

    Therapeutic counseling may work by fostering emotional exploration and patient-caregiver dialogue.

    “Therapeutic counseling may work by fostering emotional exploration and patient–caregiver dialogue. 121 , 122”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [121] Stanton A, Luecken L, MacKinnon D, Thompson E. Mechanisms in psychosocial interventions for adults living with cancer: opportunity for integration of theory, research, and practice. J Consult Clin Psychol. 2012; 81(2): 318‐ 335. doi: 10.1037/a0028833 22663900 source
    • cites [122] Cook SC, Schwartz AC, Kaslow NJ. Evidence‐based psychotherapy: advantages and challenges. Neurotherapeutics. 2017; 14(3): 537‐ 545. doi: 10.1007/s13311-017-0549-4 28653278 PMC5509639 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Psychosocial support is limited by resource constraints.

    “Psychosocial support is limited by resource constraints. 126”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [126] Kayser K, Brydon DM, Moon H, Zebrack B. Institutional capacity to provide psychosocial care in cancer programs: addressing barriers to delivering quality cancer care. Psychooncology. 2020; 29(12): 1995‐ 2002. doi: 10.1002/pon.5488 32691456 source

  • May combine two claims.

    Premisecitation

    High caregiver distress is associated with poorer quality of care, greater unplanned health care use, and higher caregiver symptom burden.

    “High caregiver distress is associated with poorer quality of care, 16 greater unplanned health care use, 114 , 115 and higher caregiver symptom burden. 116”
    Quote in the paperNot a substantial claim3 of 3 sources checked
    • cites [16] Ehlers SL, Davis K, Bluethmann SM, et al. Screening for psychosocial distress among patients with cancer: implications for clinical practice, healthcare policy, and dissemination to enhance cancer survivorship. Transl Behav Med. 2018; 9(2): 282‐ 291. doi: 10.1093/tbm/iby123 PMC6610173 30566662 source

      Citation 16 is attached to the poorer-quality-of-care clause; the later clauses have separate citations. The Introduction (page unavailable) says caregivers can experience distress and that identifying and addressing distress can help improve quality of care. It does not establish an association between high caregiver distress and poorer quality of care. (LLM, conf=0.76)

      Experimental — accuracy not yet measured
    • cites [114] Badger T, Segrin C, Crane TE, et al. Symptom management interventions influence unscheduled health services use among cancer survivors and caregivers. J Cancer Surviv. Published online November 29, 2024. doi: 10.1007/s11764-024-01723-y PMC12151082 39612086 source

      The Introduction (page unavailable) says symptom burden often drives unscheduled health-service use and identifies psychological distress among symptoms reported by cancer caregivers. It does not establish that caregivers with higher distress have greater unplanned health-care use; the association it explicitly reports for greater use is with younger age and more comorbid conditions. The other clauses of the citing sentence have separate citations and are not assessed here. (LLM, conf=0.78)

      Experimental — accuracy not yet measured
    • cites [115] Qdaisat A, Stroh E, Reyes‐Gibby C, et al. Severity of symptoms as an independent predictor of poor outcomes in patients with advanced cancer presenting to the emergency department: secondary analysis of a prospective randomized study. Cancers (Basel). 2024; 16(23): 3988. doi: 10.3390/cancers16233988 39682175 PMC11640218 source

      The citation appears to support the clause about greater unplanned health care use. The Introduction discusses ED visits and hospitalization among patients with advanced cancer, but does not link that use to caregiver distress. A search for caregiver distress and health care use found no passage establishing the claimed association. (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    The systematic review and meta-analysis included 68 randomized controlled trials with a total of 11,987 participants.

    “The authors included 68 randomized controlled trials (RCTs) with a total of 11,987 participants.”
    • Also stated in: § RESULTS · plain
      “This meta‐analysis includes 68 RCTs (70 reports because of two pairs of reports from two different RCTs) published between 1983 and 2025, all with complete data for calculating effect sizes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Psychoeducation (k = 9) focused primarily on increasing knowledge through structured information about cancer, treatment, symptom management, and psychosocial impacts.

    “Psychoeducation (k = 9) focused primarily on increasing knowledge through structured information about cancer, treatment, symptom management, and psychosocial impacts.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Enrollment rates varied from 10.0% to 94.0%, with a median of 55.0%, although this information was not reported for all RCTs.

    “Enrollment rates varied from 10.0% to 94.0%, with a median of 55.0%, although this information was not reported for all RCTs (Table 2).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The 68 RCTs included 74 primary NPIs as their experimental arms.

    “The 68 RCTs included 74 primary NPIs as their experimental arms.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    In protocols that combined joint and separate delivery (k = 8), the content was usually identical (k = 5) or was tailored by duration (k = 2) or by both content and duration (k = 1).

    “In protocols that combined joint and separate delivery (k = 8), the content was usually identical (k = 5) or was tailored by duration (k = 2) or by both content and duration (k = 1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Among the RCTs reporting sex (n = 64), 53.6% of patients were female.

    “Among the RCTs reporting sex (n = 64), 53.6% of patients were female.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Most protocols were delivered by psychologists (k = 21) or nurses (k = 21), followed by social workers (k = 17).

    “Most protocols were delivered by psychologists (k = 21) or nurses (k = 21), followed by social workers (k = 17).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Among the RCTs reporting race/ethnicity (n = 32), patients were predominantly Caucasian (72.6%), followed by Hispanic (13.6%), African American (7.1%), and Asian (1.6%).

    “Among the RCTs reporting race/ethnicity (n = 32), patients were predominantly Caucasian (72.6%), followed by Hispanic (13.6%), African American (7.1%), and Asian (1.6%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    When delivered separately (k = 10), content was identical in one half of the studies (k = 5) or was tailored by duration (k = 4) or by both content and duration (k = 1).

    “When delivered separately (k = 10), content was identical in one half of the studies (k = 5) or was tailored by duration (k = 4) or by both content and duration (k = 1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The number of NPIs (k = 74) exceeds the number of reports (N = 68) because five included more than one experimental arm.

    “The number of NPIs (k = 74) exceeds the number of reports (N = 68) because five included more than one experimental arm.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Behavior modification (k = 6) included NPIs that targeted sustained lifestyle changes, including physical activity, nutrition, or sleep, using behavior change strategies, such as goal-setting and self-monitoring.

    “Behavior modification (k = 6) included NPIs that targeted sustained lifestyle changes, including physical activity, nutrition, or sleep, using behavior change strategies, such as goal‐setting and self‐monitoring.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Skills training (k = 20) was interactive and aimed at strengthening practical abilities, such as improving symptom management, and/or psychological skills, including coping, problem-solving, stress management, communication, and adaptability to make caregiving more effective.

    “Skills training (k = 20) was interactive and aimed at strengthening practical abilities, such as improving symptom management, and/or psychological skills, including coping, problem‐solving, stress management, communication, and adaptability to make caregiving more effective.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    NPIs were categorized into four primary types based on their core therapeutic approach and delivery focus.

    “NPIs were categorized into four primary types based on their core therapeutic approach and delivery focus.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Most RCTs were conducted in the United States (n = 40), followed by China (n = 9) and Canada (n = 5).

    “Most RCTs were conducted in the United States (n = 40), followed by China (n = 9) and Canada (n = 5)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Group meetings were the least common delivery format (k = 6).

    “Group meetings were the least common delivery format (k = 6).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Most RCTs included patients with one type of cancer (64.7% homogeneous), whereas 35.3% included multiple types of cancer.

    “Most RCTs included patients with one type of cancer (64.7% homogeneous), whereas 35.3% included multiple types of cancer.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The total number of hours of NPIs had a median of 6.0 hours and a range of 0.43-30.0 hours.

    “The dose and duration of each NPI were calculated as the total number of hours (median, 6.0 hours; range, 0.43–30.0 hours), the total number of sessions (median, 6.0 sessions; range, 1.0–56.0 sessions), and the duration in weeks (median, 6.0 weeks; range, 0.14–27.0 weeks).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Self-directed communication technology, such as mobile applications, was used in k = 18 protocols.

    “Self‐directed communication technology, such as mobile applications, was used in k = 18 protocols.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Most RCTs assessed outcomes within the first 3 months (n = 59), whereas fewer evaluated intermediate (3.1-6.0 months) and long-term (>6 months) outcomes (n = 22 and n = 14, respectively).

    “Most RCTs assessed outcomes within the first 3 months (n = 59), whereas fewer evaluated intermediate (3.1–6.0 months) and long‐term (>6 months) outcomes (n = 22 and n = 14, respectively).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most protocols were delivered to patients and caregivers together simultaneously (k = 50).

    “Most protocols were delivered to patients and caregivers together simultaneously (k = 50).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most common cancer types were breast (27.7%), colorectal (18.1%), and lung (16.3%) cancers.

    “Most common cancer types were breast (27.7%), colorectal (18.1%), and lung (16.3%) cancers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The total number of sessions of NPIs had a median of 6.0 sessions and a range of 1.0-56.0 sessions.

    “The dose and duration of each NPI were calculated as the total number of hours (median, 6.0 hours; range, 0.43–30.0 hours), the total number of sessions (median, 6.0 sessions; range, 1.0–56.0 sessions), and the duration in weeks (median, 6.0 weeks; range, 0.14–27.0 weeks).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Therapeutic counseling (k = 33) emphasized active dialogue between the counselor and participants to address the psychosocial impact of cancer, build a supportive relationship, and encourage reflection, expression, and meaning-making around illness and caregiving.

    “Therapeutic counseling (k = 33) emphasized active dialogue between the counselor (e.g., psychologist, nurse, social worker) and participants to address the psychosocial impact of cancer, build a supportive relationship, and encourage reflection, expression, and meaning‐making around illness and caregiving.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The 68 RCTs involved a total of 5795 patients (median, 64 patients per study; range, 14-302 patients per study).

    “The 68 RCTs involved a total of 5795 patients (median, 64 patients per study; range, 14–302 patients per study).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    The duration in weeks of NPIs had a median of 6.0 weeks and a range of 0.14-27.0 weeks.

    “The dose and duration of each NPI were calculated as the total number of hours (median, 6.0 hours; range, 0.43–30.0 hours), the total number of sessions (median, 6.0 sessions; range, 1.0–56.0 sessions), and the duration in weeks (median, 6.0 weeks; range, 0.14–27.0 weeks).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Most NPIs were delivered through guided communication technology (phone or videocall conference; k = 43), followed by face-to-face visits (k = 39).

    “Most NPIs were delivered through guided communication technology (phone or videocall conference; k = 43), followed by face‐to‐face visits (k = 39).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Among protocols that were delivered face-to-face, the largest proportion took place in an unspecified location (k = 23), followed by clinical settings (k = 18), or at patients' homes (k = 6).

    “Among protocols that were delivered face‐to‐face, the largest proportion took place in an unspecified location (k = 23), followed by clinical settings (k = 18), or at patients' homes (k = 6).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Caregivers were identified by the patient and were subsequently invited to participate in most RCTs (n = 29).

    “Caregivers were identified by the patient and were subsequently invited to participate in most RCTs (n = 29).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Approximately one in three protocols (k = 21) combined face-to-face sessions with additional guided communication technology contact.

    “Approximately one in three protocols (k = 21) combined face‐to‐face sessions with additional guided communication technology contact.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The most common theoretical frameworks were cognitive behavioral theory (k = 8), social cognitive theory (k = 6), and theory of stress and coping (k = 5).

    “most commonly cognitive behavioral theory (k = 8), social cognitive theory (k = 6), and theory of stress and coping (k = 5).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Self-care was found in k = 65 protocols for patients and k = 64 protocols for caregivers and provided strategies to manage one's well-being, maintain social support, and access resources.

    “Self‐care was found in k = 65 protocols for patients and k = 64 protocols for caregivers and provided strategies to manage one’s well‐being, maintain social support, and access resources.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given

    Alternatively, both individuals of the dyad were approached e.g., during clinic visits (n = 25).

    “Alternatively, both individuals of the dyad were approached e.g., during clinic visits (n = 25).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Cancer stage was reported in 41 RCTs: 62.1% included patients with stage 0-III disease; 32.5% included those with stage IV disease; and, for 5.4% of RCTs, this information was missing.

    “Cancer stage was reported in 41 RCTs: 62.1% included patients with stage 0–III disease; 32.5% included those with stage IV disease; and, for 5.4% of RCTs, this information was missing.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Assessment of fidelity was mentioned in k = 47 protocols, e.g., through NPI manuals and checklists, recording and random review of sessions, or regular supervision with feedback to the interventionists.

    “Assessment of fidelity was mentioned in k = 47 protocols, e.g., through NPI manuals and checklists, recording and random review of sessions, or regular supervision with feedback to the interventionists.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    For the RCTs that included follow-up assessments at 3.1-6.0 months and >6.0 months, median attrition rates were 22.0% and 21.0%, respectively.

    “For the RCTs that included follow‐up assessments at 3.1–6.0 months and >6.0 months, median attrition rates were 22.0% and 21.0%, respectively.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Most RCTs were published in the past 5 years (n = 39).

    “and were published in the past 5 years (n = 39).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Therapeutic counseling appeared to be associated with significant reductions in anxiety among patients and in depression among both patients and caregivers.

    “Therapeutic counseling appeared to be associated with significant reductions in anxiety among patients and in depression among both patients and caregivers.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Remote interventions significantly reduced patient anxiety and depression, whereas face-to-face NPIs reduced caregiver depression.

    “Remote interventions significantly reduced patient anxiety and depression, whereas face‐to‐face NPIs reduced caregiver depression.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Patients with colorectal cancer and their caregivers experienced significant reductions in anxiety and depression, and patients with breast cancer experienced significant reductions in anxiety.

    “Regarding cancer type, patients with colorectal cancer and their caregivers experienced significant reductions in anxiety and depression, and patients with breast cancer experienced significant reductions in anxiety.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    When delivered to patients and caregivers together, NPIs significantly reduced distress in patients and anxiety and depression in both groups.

    “When delivered to patients and caregivers together, NPIs significantly reduced distress in patients and anxiety and depression in both groups.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Caregiver sex was reported in 64 RCTs; most caregivers were female (57.6%) and spouses (79.7%).

    “Caregiver sex was reported in 64 RCTs. Most were caregivers were female (57.6%) and spouses (79.7%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Stage-specific analyses indicated benefits among patients with stage 0-III disease for anxiety and caregiver depression, but not among patients with stage IV disease and their caregivers.

    “Stage‐specific analyses indicated benefits among patients with stage 0–III disease for anxiety and caregiver depression, but not among patients with stage IV disease and their caregivers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The certainty of evidence (GRADE) was generally moderate for short-term outcomes and was low to very low for longer term effects, mainly because of RoB, heterogeneity, and imprecision.

    “The certainty of evidence (GRADE [Grading of Recommendations, Assessment, Development, and Evaluation] assessments; see Table S3) was generally moderate for short‐term outcomes and was low to very low for longer term effects, mainly because of RoB, heterogeneity, and imprecision (see Table S4).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Possible publication bias was observed for patient distress and for caregiver anxiety and depression at >6.0 months.

    “Possible publication bias was observed for patient distress and for caregiver anxiety and depression at >6.0 months”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    For caregivers, there was no significant effect on distress at 0.0-3.0 months (g = 0.05; 95% CI, −0.14, 0.24; p = .581).

    “For caregivers, there was no significant effect at 0.0–3.9 months (g = 0.05; 95% CI, −0.14, 0.24; p = .581)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    NPIs produced strong effects in patients with colorectal cancer for almost all outcomes, particularly when colorectal cancer was among the three most common diagnoses in the sample.

    “NPIs produced strong effects in patients with colorectal cancer for almost all outcomes, particularly when colorectal cancer was among the three most common diagnoses in the sample.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Therapeutic counseling was the most common NPI and produced the largest, statistically significant reductions in patient and caregiver anxiety and depression.

    “Therapeutic counseling was the most common NPI and produced the largest, statistically significant reductions in patient and caregiver anxiety and depression.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Both multicenter and single-center RCTs showed significant reductions in patient and caregiver anxiety and depression.

    “Both multicenter and single‐center RCTs showed significant reductions in patient and caregiver anxiety and depression.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Single-center RCTs consistently yielded larger effects than multicenter RCTs, possibly because of more homogeneous samples.

    “However, single‐center RCTs consistently yielded larger effects than multicenter RCTs, possibly because of more homogeneous samples.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The median age of caregivers was 51.7 years (range, 39.5-66.6 years).

    “The median age of caregivers was 51.7 years (range, 39.5–66.6 years).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Among patients with stage IV disease, breast cancer was overrepresented, colorectal cancer was aligned with SEER data, and lung cancer was underrepresented.

    “Among patients with stage IV disease, breast cancer was overrepresented, colorectal cancer was aligned with SEER data, and lung cancer was underrepresented.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Among the studies reporting race/ethnicity (n = 35), caregivers were predominantly Caucasian (81.4%), followed by African American (6.3%), Hispanic (5.6%), and Asian (1.4%).

    “Among the studies reporting race/ethnicity (n = 35), caregivers were predominantly Caucasian (81.4%), followed by African American (6.3%), Hispanic (5.6%), and Asian (1.4%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingreasoning

    Certainty of evidence ranged from moderate for short-term to low or very low for longer term outcomes, driven by limited long-term data and RCT quality.

    “Certainty of evidence ranged from moderate for short‐term to low or very low for longer term outcomes, driven by limited long‐term data and RCT quality.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    NPI duration was generally brief, and greater dose was not associated with better outcomes.

    “NPI duration was generally brief, and greater dose was not associated with better outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Caregivers in excluded studies were younger.

    “Caregivers in excluded studies were younger (see Figure S1)”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    For each outcome, validated measures reported in the RCT were used.

    “For each outcome, we used validated measures reported in the RCT.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    When multiple publications reported outcomes from the same RCT, data were extracted as a single study.

    “When multiple publications reported outcomes from the same RCT, data were extracted as a single study.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Data were pooled using a random-effects model, with studies weighted by the inverse of their sampling variance, to account for heterogeneity in NPI content, delivery format, and sample characteristics.

    “Data were pooled using a random‐effects model, with studies weighted by the inverse of their sampling variance, to account for heterogeneity in NPI content, delivery format, and sample characteristics.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    References were screened by two independent reviewers, with conflicts resolved by a senior team member.

    “deduplicated, and screened by two independent reviewers; conflicts were resolved by a senior team member.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Certainty of evidence for each outcome was assessed using GRADE.

    “Certainty of evidence for each outcome was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. 36”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [36] Schünemann H, Brożek J, Guyatt G, Oxman A, eds. GRADE handbook for grading the quality of evidence and the strength of recommendations using the GRADE approach. Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group; 2013. Accessed July 7, 2025. https://gdt.gradepro.org/app/handbook/handbook.html

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Publication bias was assessed with funnel plots and Egger t-test, with significance based on one-tailed p values.

    “Publication bias was assessed with funnel plots and Egger t‐test, with significance based on one‐tailed p values.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Only RCTs were included to ensure similar methodological rigor and reliability of conclusions.

    “Only RCTs were included to ensure similar methodological rigor and the reliability of conclusions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The research protocol was registered with PROSPERO (CRD42024536629).

    “The research protocol was registered with the international Prospective Register of Systematic Reviews (PROSPERO identifier CRD42024536629) and provides a detailed description of the project.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Sensitivity analyses used the leave-one-study-out approach for each outcome and follow-up time point.

    “To assess the robustness of pooled effect sizes, sensitivity analyses used the leave‐one‐study‐out approach 33 for each outcome and follow‐up time point.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [33] Viechtbauer W, Cheung MWL. Outlier and influence diagnostics for meta‐analysis. Res Synth Methods. 2010; 1(2): 112‐ 125. doi: 10.1002/jrsm.11 26061377 source

  • May combine two claims.

    Interpretationown data

    NPIs can help manage distress in patients and reduce anxiety and depression in both patients and caregivers.

    “NPIs can help manage distress in patients and reduce anxiety and depression in both patients and caregivers.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Two reviewers independently extracted study characteristics and outcomes by intervention group and follow-up period for patients and caregivers.

    “Two reviewers independently extracted study characteristics and outcomes by intervention group and follow‐up period for patients and caregivers.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Resources to address distress, anxiety, and depression in patients with cancer and family caregivers are often inadequate, perpetuating adverse effects of the disease and its treatments and increasing the estimated annual €199 billion global economic burden of cancer.

    “However, resources to address distress, anxiety, and depression in patients with cancer and family caregivers are often inadequate, perpetuating adverse effects of the disease and its treatments 5 and increasing the estimated annual €199 billion global economic burden of cancer. 17 , 18”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [5] Carlson LE, Zelinski EL, Toivonen KI, et al. Prevalence of psychosocial distress in cancer patients across 55 North American cancer centers. J Psychosoc Oncol. 2019; 37(1): 5‐ 21. doi: 10.1080/07347332.2018.1521490 30592249 source
    • cites [17] Hofmarcher T, Lindgren P, Wilking N, Jönsson B. The cost of cancer in Europe 2018. Eur J Cancer. 2020; 129: 41‐ 49. doi: 10.1016/j.ejca.2020.01.011 32120274 source
    • cites [18] Coumoundouros C, Ould Brahim L, Lambert SD, McCusker J. The direct and indirect financial costs of informal cancer care: a scoping review. Health Soc Care Community. 2019; 27(5): e622‐ e636. doi: 10.1111/hsc.12808 31293013 source

  • May combine two claims.

    Premisecitation

    Northouse et al. did not find any effect of NPIs on caregiver depression, a finding confirmed by Pang et al.

    “Northouse et al. 19 did not find any effect of NPIs on caregiver depression, a finding that was confirmed by Pang et al. 21”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Northouse et al. 19

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Pang et al. 21

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisereasoning

    The meta-analyses by Pang et al. and Dhumal et al. did not report the timeframe for assessing NPI effects, which may partially explain inconsistencies.

    “The meta‐analyses by Pang et al. 21 and Dhumal et al. 9 did not report the timeframe for assessing NPI effects, which may partially explain these inconsistencies.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Pang et al. 21

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Dhumal et al. 9

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Pang et al. in 2022 partially confirmed the effect for patients, but not for caregivers.

    “a finding that was partially confirmed by Pang et al. 21 in 2022 for patients, but not for caregivers”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Pang et al. 21

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In 2019, Northouse et al. reported that NPIs showed small but significant effects on caregiver distress and anxiety beyond 6 months.

    “In 2019, Northouse et al. 19 reported that NPIs showed small but significant effects on caregiver distress and anxiety beyond 6 months”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Northouse et al. 19

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisereasoning

    Although the number of randomized clinical trials has increased notably over the past 20 years, findings have been inconsistent because of heterogeneity of NPIs, modes of delivery, and assessment time points.

    “Although the number of randomized clinical trials (RCTs) has increased notably over the past 20 years, findings have been inconsistent because heterogeneity of NPIs, modes of delivery, and assessment time points.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Family caregivers assume essential responsibilities for an average 8 hours per day for 14 months.

    “with family caregivers assuming essential responsibilities for an average 8 hours per day for 14 months. 2 , 3”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [2] Sun V, Puts M, Haase K, et al. The role of family caregivers in the care of older adults with cancer. Semin Oncol Nurs. 2021; 37(6): 151232. doi: 10.1016/j.soncn.2021.151232 34753644 source
    • cites [3] Yabroff RK, Kim Y. Time costs associated with informal caregiving for cancer survivors. Cancer. 2009; 115(S18): 4362‐ 4373. doi: 10.1002/cncr.24588 19731345 source

  • May combine two claims.

    Premisecitation

    SEER data from 2013 to 2022 show stage IV diagnoses in 6.0% of patients with breast cancer, 21.8% of those with colorectal cancer, and 47.4% of those with lung cancer.

    “Surveillance, Epidemiology, and End Results (SEER) data from 2013 to 2022 124 show stage IV diagnoses in 6.0% of patients with breast cancer, 21.8% of those with colorectal cancer, and 47.4% of those with lung cancer.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [124] National Cancer Institute; Surveillance, Epidemiology, and End Results (SEER) Program. SEER*Explorer: An interactive website for SEER cancer statistics. National Cancer Institute; 2025. Accessed July 17, 2025. https://seer.cancer.gov/statistics‐network/explorer/

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationown data

    NPIs showed the strongest effects within 0.0-3.0 months postintervention and generally became nonsignificant afterward, except for patient distress and caregiver depression, which remained significant up to 3.1-6.0 months.

    “NPIs showed the strongest effects within 0.0–3.0 months postintervention and generally became nonsignificant afterward, except for patient distress and caregiver depression, which remained significant up to 3.1–6.0 months.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Effects were stronger in patients with stage 0-III disease, especially for patient anxiety and caregiver depression, possibly reflecting better prognosis and shorter treatment.

    “Effects were also stronger in patients with stage 0–III disease, especially for patient anxiety and caregiver depression, possibly reflecting better prognosis and shorter treatment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Higher attrition was associated with smaller effects, suggesting that retention may also indicate NPI feasibility and effectiveness.

    “Higher attrition was associated with smaller effects, suggesting that retention may also indicate NPI feasibility and effectiveness.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    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.

    “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.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Structured NPIs can provide short-term benefits for patients with cancer and modest effects for family caregivers.

    “In summary, structured NPIs can provide short‐term benefits for patients with cancer and modest effects for family caregivers.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The use of pharmacologic treatments for psychological symptoms was addressed only in two RCTs and could not be systematically examined in this analysis.

    “The use of pharmacologic treatments for psychological symptoms was addressed only in two RCTs and could not be systematically examined in this analysis.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    Effect attenuation may reflect unmeasured factors, such as timing, continuity, or context, rather than the number of sessions and duration.

    “Effect attenuation may reflect unmeasured factors, such as timing, continuity, or context, rather than the number of sessions and duration.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationnone given

    Although effects were not statistically significant, NPIs may help achieve clinically meaningful outcomes.

    “Although effects were not statistically significant, NPIs may help achieve clinically meaningful outcomes.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Twelve studies were excluded because of incomplete or incompatible data.

    “Twelve studies were excluded because of incomplete or incompatible data.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductnone given

    This review synthesizes NPIs that target patients and family caregivers using rigorous meta-analytic methods, including prespecified subgroup and sensitivity analyses across all outcomes and time points.

    “This review synthesizes NPIs that target patients and family caregivers using rigorous meta‐analytic methods, including prespecified subgroup and sensitivity analyses across all outcomes and time points.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    Additional limitations include the exclusion of patients with hematologic malignancies and recruitment of dyads in which both members were willing and able to participate, limiting generalizability to vulnerable patients without caregiver support.

    “Additional limitations include the exclusion of patients with hematologic malignancies and recruitment of dyads in which both members were willing and able to participate, limiting generalizability to vulnerable patients without caregiver support.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Generalizability of the current results is limited by the concentration of RCTs in high-income countries, predominantly female and Caucasian samples, and poor reporting of race/ethnicity outside the United States.

    “Generalizability of the current results is limited by the concentration of RCTs in high‐income countries, predominantly female and Caucasian samples, and poor reporting of race/ethnicity outside the United States, which is critical information for promoting cultural relevance in psychosocial oncology.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Caregiver effects were weaker, in which distress did not improve, and only depression showed sustained benefit beyond 3 months.

    “Caregiver effects were weaker, in which distress did not improve, and only depression showed sustained benefit beyond 3 months.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Interpretationnone given

    The inclusion of diverse NPI types, delivery formats, and cancer populations enhances generalizability.

    “The inclusion of diverse NPI types, delivery formats, and cancer populations enhances generalizability.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Outcomes assessed after patient death, including bereavement-related distress, were outside the scope of this analysis.

    “Outcomes assessed after patient death, including bereavement‐related distress, were outside the scope of this analysis.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    Heterogeneity across studies, including variation in NPI characteristics and duration, reflects a limitation of the current literature that influences the precision of pooled effect estimates and warrants cautious interpretation.

    “Heterogeneity across studies, including variation in NPI characteristics and duration, reflects a limitation of the current literature that influences the precision of pooled effect estimates and warrants cautious interpretation.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    NPI effects for patients were strongest at 0-3 months, with little evidence of sustained benefit thereafter.

    “NPI effects for patients were strongest at 0–3 months, with little evidence of sustained benefit thereafter.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Limitations include RoB assessment only for primary outcomes of each RCT.

    “Limitations include RoB assessment only for primary outcomes of each RCT.”
    Quote in the paperNot a substantial claim
99 of 99

  • The paper relies on this without support.

    The outcome measures for distress, anxiety, and depression across the included RCTs are sufficiently comparable to be pooled in meta-analysis.

    “Table 3 reports pooled effect sizes, 95% confidence intervals (CIs), heterogeneity across studies (Q statistic), and publication bias (Egger t‐test).”

  • The paper relies on this without support.

    The Egger t-test is a valid method for assessing publication bias in this meta-analysis.

    “The Egger t‐test detected no funnel plot asymmetry for all outcomes at 0.0–3.0 and 3.1–6.0 months (Table 3).”

  • The paper relies on this without support.

    The median contact time of approximately 6 hours is a meaningful measure of intervention dose.

    “The median contact time was approximately 6 hours, likely explaining the short‐term benefits and the limited durability.”
3 of 3

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Caregiver-distress short-term interval changes to 0.0-3.9 months

    Minor

    The caregiver-distress result in the prose uses 0.0-3.9 months, while the corresponding Table 3 row and Figure 3 caption specify 0.0-3.0 months.

  • Multicenter caregiver-depression result is called significant despite p = .052

    Minor

    The text says multicenter RCTs showed significant reductions in caregiver depression, but Table 4 gives that subgroup p = .052 and a confidence interval crossing zero. The row also carries a significance asterisk despite the table's definition of that symbol as p < .05.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 7

  1. Ferlay J, Global Cancer Observatory: Cancer Today
  2. Ross CE, 2003, Social Causes of Psychological Distress
  3. Higgins JPT, 2024, Cochrane Handbook for Systematic Reviews of Interventions, version 6.5
  4. Lipsey MW, 2001, Practical Meta‐Analysis
  5. BioStat, Inc, 2022, Comprehensive Meta‐Analysis, Version 4
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Authors
Schiess, L. C., Song, L. L., Schädelin, S., Fürst, T., Urech, C., Friese, C. R., & Katapodi, M. C.
Affiliations
  • University of Basel (CH)
  • The University of Texas at San Antonio (US)
  • University Hospital of Basel (CH)
  • University of Michigan (US)
Corresponding author
Katapodi, Maria C.
ORCID
Venue
CA: A Cancer Journal for Clinicians
Publisher
Wiley
Published
2026-03
Volume
76
Issue
2
Pages
e70076-e70076
ISSN
  • 0007-9235 (ISSN-L)
  • 1542-4863
DOI
10.3322/caac.70076
PMC
PMC13078667
OpenAlex
W7154404923
Semantic Scholar
cea3396212a7fe10c5c12f31169c11980034e0cc
Cited by
0
References
102
FWCI
0.00
Type
journal article
Language
en
Open access
Licence
Locations
  • CA A Cancer Journal for Clinicians (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion, cc-by-nc-nd)
Funders
  • Universität Basel
  • University of Texas at San Antonio
Topics
  • Health Sciences › Medicine › Oncology › Cancer survivorship and care
  • Health Sciences › Health Professions › Pharmacy › Nursing care and research
  • Social Sciences › Sociology and Political Science › Family Support in Illness
Keywords
non-pharmacological treatment, psychological distress, anxiety, depression, cancer patients, family caregivers, solid tumors, psychoeducation, therapeutic counseling, skills training, behavior modification, outpatient oncology
MeSH terms
Psychological Distress, Adult, Anxiety, Counseling, Depression, Humans, Neoplasms, Stress, Psychological, Randomized Controlled Trials as Topic, Caregivers

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