Effects of Psychological Intervention Based on Digital Health Technology on Psychological Outcomes in Cancer Survivors: Systematic Review and Meta-Analysis.

Abstract

Objectives: Digital health technology (DHT)-based psychological interventions are emerging as a means to enhance psychological outcomes for cancer survivors. This study aims to assess the effects of DHT-based psychological interventions on anxiety, depression, sleep disturbances, fatigue, and quality of life among cancer survivors.

Methods: A systematic search was conducted in PubMed, Web of Science, the Cochrane Library, and Embase. The Cochrane risk-of-bias tool RoB 2 was used to evaluate the quality of the included studies. The Template for Intervention Description and Replication (TIDieR) checklist was used to check if the interventions reviewed were described in detail to be implemented in the clinical setting. Data synthesis was conducted in Review Manager (Version 5.4), and the effect size was calculated by the standardized mean difference and its 95% confidence interval. Sensitivity analysis and subgroup analysis were also conducted. The certainty of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation approach.

Results: This meta-analysis encompassed 46 randomized controlled trials, involving 5211 participants. DHT-based psychological interventions significantly reduced anxiety (SMD = -0.41, 95% CI -0.59/-0.24), depression (SMD = -0.26, 95% CI -0.39/-0.13), sleep disturbance (SMD = -0.39, 95% CI -0.64/-0.14), fatigue (SMD = -0.47, 95% CI -0.77/-0.17), and improved quality of life (SMD = 0.42, 95% CI 0.22/0.62). Subgroup analysis indicated that interventions lasting for a duration of ≥ 12 weeks, and integrated interventions might be the most effective in addressing adverse psychological outcomes. And cognitive-behavioral therapy interventions demonstrated significant effectiveness in managing sleep disturbance.

Conclusion: DHT-based psychological interventions might be effective for improving anxiety, depression, sleep disturbances, fatigue, and quality of life in cancer survivors. We cannot draw definitive conclusions due to intervention and study design heterogeneity. Further rigorous trials are crucial to identify optimal interventions for different types of cancers, determine suitable durations, specify types of DHT-based psychological interventions and validate intervention therapies.