Psychosocial interventions to improve quality of life for men with prostate cancer: a network meta-analysis of 31 randomised controlled trials

Abstract

BackgroundThe diagnosis and treatment of prostate cancer can trigger a sequence of life-altering decisions that can induce depression and affect health-related quality of life. We aimed to simultaneously compare all available psychosocial interventions using both direct and indirect data. MethodsIn this systematic review and network meta-analysis, we searched Embase, MEDLINE, PreMedline, PsycINFO, and the Cochrane Central Register of Controlled Trials for randomised controlled trials published before Oct 31, 2016, comparing active treatments dealing with psychosocial problems in patients with prostate cancer after treatment. We extracted data from published reports. The primary outcome was improvement in health-related quality of life as measured by the 36-Item Short-Form Health Survey (SF-36), the Functional Assessment of Cancer Therapy–General (FACT-G), and the Prostate-Specific Module of European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire 25-item (EORTC QLQ-PR25). Psychological morbidity and global distress were assessed with the Hospital Anxiety and Depression Scale (HADS). We report mean differences and risk ratios with 95% credible intervals (CrIs) compared with placebo. This study was registered with PROSPERO, number CRD42016049621. FindingsWe screened 113 potentially eligible studies and identified 31 randomised controlled trials, examining seven psychosocial interventions in 3643 participants with prostate cancer. The quality of evidence was rated as low in most comparisons. In terms of SF-36, cognitive behavioural therapy (standard mean difference [SMD] 2·48, 95% CrI 0·23 to 4·46) and group-based counselling intervention (SMD 1·36, CrI 0·40 to 3·17) had significantly greater effects than did usual care. Considering FACT-G and QLQ-PR25, no clear evidence showed benefit associated with any psychosocial interventions. Participants assigned to all assessed interventions had a significant improvement in depression compared with usual care, except for those assigned to supportive therapy (SMD −0·05, 95% CrI −0·35 to 0·26) and psychoeducational therapy (SMD 0·02, 95% CrI −0·11 to 0·15). InterpretationCognitive behavioural therapy, group-based counselling, and exercise might have significant beneficial effects considering SF-36 and HADS when compared with usual care. Although some findings of this review are encouraging, they do not provide sufficiently strong evidence to permit meaningful conclusions about the effects of these interventions in men with prostate cancer. Additional well-done and transparently reported research studies are necessary to establish the role of psychosocial interventions in men with prostate cancer. FundingProstate Cancer Foundation Young Investigator Award 2013, National Natural Science Foundation of China (81300627, 81500522 and 81370855), Programs from Science and Technology Department of Sichuan Province (2013SZ0006 and 2014JY0219).