Psychosocial Interventions for Distress
The efficacy of psychosocial interventions in adult cancer patients is supported by an extensive literature.[Level of evidence: IV];[35,36,37][Level of evidence: I] Reviews have concluded that, in general, psychosocial interventions for cancer patients have shown positive benefits.
Psychosocial interventions have generally been defined as nonpharmacologic interventions that include a variety of psychological and educational components. Typical components include the following:
- Relaxation training.
- Cognitive and behavioral coping strategies.
- Cancer education/information sessions.
- Group social support.
Interventions have included various combinations of these components, have varied in length (single session to multiple weekly sessions), and have been administered in both individual and group formats. The most common patient population has been U.S. Caucasian women of middle to higher socioeconomic status who have breast cancer; however, some studies include mixed cancer diagnoses, and studies from European countries have appeared. Outcome measures have varied and have included the following:[34,35]
- Emotional adjustment (e.g., depression, anxiety).
- Functional impairment (e.g., return to work, social roles).
- Disease-related symptoms (e.g., nausea/vomiting, fatigue, pain).
- Health behaviors (e.g., diet, smoking, exercise).
- Immune system functioning.
A biobehavioral model  hypothesizing psychological, behavioral, and biologic pathways from cancer stressors to disease outcome has guided much of this research; however, the most common outcome measured has been emotional adjustment.
Although positive benefits have been found, their clinical significance has been questioned. Reviewers have offered varying conclusions regarding the size of these positive effects,[Level of evidence: I] ranging from negligible for depression, to small for overall emotional outcomes, to moderate for anxiety.[Level of evidence: I]
Effect sizes may be related to the timing of the intervention and patient selection procedures. For most patients, levels of psychosocial distress are highest during the earliest days of their cancer experience and, for many, dissipate quickly. Thus, if interventions are offered later in the cancer experience (weeks or months after diagnosis and treatment), patients may be experiencing less distress than they would have experienced if interventions had been offered earlier, making large effects more difficult to detect.[Level of evidence: II]
In one study, 249 breast cancer patient-partner dyads were randomly assigned to one of four groups:
- A control group receiving standard disease management.
- A standardized psychoeducation group.
- A group receiving telephone counseling.
- A group receiving psychoeducation plus telephone counseling.
Patients and partners who received the study interventions had less side-effect distress and severity as well as higher levels of psychological well-being than those who received standard care. In addition, the study supports the efficacy of low-cost, replicable interventions by video and telephone to achieve these physical and psychological benefits.
Two meta-analytic reviews [35,36][Level of evidence: I] report the following effect sizes:
- 0.19 for depression  and functional adjustment.
- 0.24 for emotional adjustment.
- 0.26 for treatment- or disease-related symptoms.
- 0.28 for global measures of outcome.
- 0.36 for anxiety.