Journal: Communications psychology
This publication reports a preregistered systematic review, meta-analysis, and multiverse meta-analysis of randomized controlled trials evaluating structured psychosocial interventions delivered alongside medical treatment in adults with cancer.
Key methods:
- Data sources: Multiple major databases plus Google Scholar, through October 17, 2025.
- Included studies: 32 RCTs, 5704 participants.
- Primary outcome: Overall survival, analyzed via pooled hazard ratios (HRs).
- Additional analyses: Median survival benefit, psychological components of interventions, risk of bias and study quality, post hoc power, sponsorship bias, 25 moderators, publication bias, p-hacking, and a multiverse meta-analysis exploring how analytic choices affect results.
Main findings:
- Survival effect: Pooled HR 0.80 (95% CI 0.71–0.90), indicating a small but statistically significant survival benefit for patients receiving psychosocial interventions in addition to standard oncologic care.
- Heterogeneity: I² = 48%, with a wide 95% prediction interval (HR 0.49–1.29), suggesting that effects vary meaningfully across settings and populations.
- Median survival gain: Estimated at 3.9 months (95% CI −0.7 to 8.5) based on 16 trials, consistent with a modest average benefit but with uncertainty.
- Intervention content: Most commonly included educational, cognitive-behavioral, emotionally expressive, and group-based social-support components.
- Study power: Meta-analytic post hoc power averaged only 17%, helping explain prior inconsistent trial-level findings.
- Multiverse meta-analysis: Across a range of reasonable analytic specifications mirroring past meta-analyses, a general survival benefit persisted. The analysis suggests past conflicting conclusions largely arose from differences in effect size metrics and analytic decisions, rather than absence of an underlying effect.
- Certainty of evidence: Rated moderate, mainly downgraded for statistical heterogeneity and concerns about generalizability to all cancer populations and settings.
Clinical implications:
- Survival benefit: Psychosocial interventions appear to confer a small but robust survival advantage, with effect sizes in the same order of magnitude as some established medical cancer therapies (e.g., certain chemo-, radio-, or hormone treatments), though not a substitute for them.
- Clinical integration: Given favorable safety, low cost, and established benefits for quality of life and psychological outcomes, the authors argue these data support integrating structured psychosocial interventions as a standard component of comprehensive cancer care.
- Future research: Future work should refine which patient subgroups, intervention components, and delivery formats maximize survival and psychosocial benefit, and address heterogeneity with adequately powered trials.