Effectiveness of Psychosocial Interventions for Demoralization in Patients with Cancer: A Systematic Review and...

To evaluate the effectiveness of psychosocial interventions in reducing demoralization among cancer patients through a systematic review and meta-analysis, and to inform evidence-based psycho-oncological practice.

Ten electronic databases were systematically searched. Two reviewers independently conducted the study selection, data extraction, and risk-of-bias assessment using RoB 2 for randomized controlled trials and ROBINS-I for quasi-experimental studies. The certainty of evidence was evaluated via the GRADE framework. Meta-analyses were performed with random effects models. Heterogeneity was assessed via the I² statistic and Cochran's Q test. Subgroup and leave-one-out sensitivity analyses were used to examine robustness. When meta-analysis was not feasible, findings were synthesized narratively, with effect sizes calculated as Cohen's d.

Psychosocial interventions significantly reduced overall demoralization (SMD = -0.82, 95% CI -1.54 to -0.10, p = 0.03). Although heterogeneity was substantial (I² = 92%), sensitivity analyses reduced heterogeneity(I² = 57%) while preserving a significant effect (SMD = -0.36, p = 0.03). Significant improvements were observed across demoralization domains, including loss of meaning, dysphoria, disheartenment, helplessness, and sense of failure, with stable effects in several subdomains after sensitivity analyses. Subgroup analyses indicated greater benefits for narrative-based interventions, third-wave behavioral therapies, and nurse-led programs, particularly in single-cancer-type interventions. Psychosocial interventions also significantly reduced anxiety (SMD = -1.42, p = 0.007) and depressive symptoms (SMD = -1.48, p = 0.001), with the results remaining robust.

Psychosocial interventions effectively reduce demoralization and psychological distress in cancer patients, with greater effects observed in patients with the same cancer diagnosis. Third-wave behavioral therapies show particular promise. Nurse-led interventions are feasible but require greater standardization. Future research should focus on large, rigorous trials and develop individualized, mechanism-guided digital interventions.