A systematic review and meta-analysis of multi-health behavior interventions to reduce common mental health symptoms in people living with and beyond cancer.

Abstract

Background: People living with and beyond cancer often report lower levels of physical activity, poorer sleep, and poorer diet quality, all of which may contribute to an increased risk of common mental health symptoms. This systematic review aimed to investigate the effects of multi-health behavior interventions designed to reduce common mental health symptoms in people living with and beyond cancer.

Methods: This systematic review and meta-analyses followed PRISMA guidelines. The search, conducted up to July 2, 2025, included PubMed, Embase, Web of Science, PsycInfo, and PsyAPA, and grey literature. Multi-health behavior interventions (randomized and non-randomized trials) for people living with and beyond cancer, that targeted at least two behaviors (physical activity, diet, sleep, mindfulness) and assessed effects on common mental health outcomes (depression, anxiety, stress) were included.

Results: A total of 22 studies (n = 2,191 participants, 77.5% female; mean age 55 years) were included. Multi-health behavior interventions demonstrated small but significant improvements in depression (g = 0.40, 95% CI [0.26,0.55], p < 0.001), anxiety (g = 0.33, 95% CI [0.22,0.45], p < 0.001), and stress (g = 0.26, 95% CI [0.09,0.43], p = 0.003). Effects were consistent across treatment phases, cancer types, intervention type (flexible interventions and structured programs), number of intervention components, and intervention duration, with all subgroups showing significant improvements in at least one mental health outcome.

Conclusion: Multi-health behavior interventions are associated with small but significant improvements in common mental health symptoms among people living with and beyond cancer. However, given the limitations and variable certainty of the available evidence, further high-quality RCTs are needed to confirm these findings.