癌症患者抑郁的有效管理（ENHANCE）：一项随机对照试验的混合系统评价和（尝试）网络荟萃分析

IF 3.3 2区医学 Q2 PSYCHIATRY

Journal of Psychosomatic Research Pub Date : 2025-05-28 DOI:10.1016/j.jpsychores.2025.112166

Maria M. Pertl , Rahela Beghean , Sonya Collier , Emer Guinan , Garret Monahan , Katie Verling , Emma Wallace , Aisling Walsh , Arun Ghoshal , Emer Galvin , Frank Doyle

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引用次数: 0

摘要

背景：癌症患者抑郁症的最佳干预措施尚不清楚，因为所有可用的方法尚未进行比较。本混合系统评价旨在利用网络荟萃分析（NMA）确定最有效和可接受的干预措施。方法：在经历抑郁症状的成年癌症患者中进行抑郁干预的随机对照试验（rct），从先前的系统综述和最近的随机对照试验的数据库检索中确定。筛选、数据提取、偏倚风险（RoB2）和研究完整性评估（RIA）；为描述性而非筛选目的)独立进行，一式两份。主要结局是抑郁症状的改变（疗效/有效性）和停药率（可接受性）。由于计划中的NMA不合适，因此进行了叙事批判性综合。结果：纳入70项随机对照试验（6831名受试者），其中心理治疗43项，药物治疗14项，补充和替代医学8项，协同护理7项，运动4项，联合治疗干预3项。在可接受性方面没有明显的差异。使用NMA进行可靠的疗效/有效性比较是不可能的，因为RoB（44.3%有些关注，54.3%高RoB）。只有10项随机对照试验没有完整性问题。完整性问题包括没有预注册（n = 56/ 80%），随机化（n = 27/ 38.6%）和伦理（n = 32/ 40%）报告不足，效应大小有问题（n = 26/ 37%）。最可靠的证据是合作护理。结论：关于癌症患者抑郁干预的文献很少，迫切需要高质量的研究。尽管有一些证据表明协作治疗是有效的，但在获得此类证据之前，治疗决定应继续基于其他患者群体和临床专业知识的证据。系统评价注册号prospero CRD42021290145 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=290145

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Effective maNagement of depression among patients witH cANCEr (ENHANCE): A hybrid systematic review and (attempted) network meta-analysis of randomized controlled trials

Background

Optimal intervention(s) for depression among people with cancer are unknown, as all available approaches have not been compared. This hybrid systematic review aimed to identify the most effective and acceptable intervention(s) using network meta-analysis (NMA).

Methods

Randomized controlled trials (RCTs) of depression interventions among adults with cancer experiencing depressive symptoms were identified from database searches for previous systematic reviews and more recent RCTs. Screening, data extraction, Risk of Bias (RoB2) and Research Integrity Assessment (RIA; for descriptive rather than screening purposes) were performed independently, in duplicate. Primary outcomes were change in depressive symptoms (efficacy/effectiveness) and the rate who discontinued (acceptability). As the planned NMA was not appropriate, a narrative critical synthesis was performed.

Findings

70 RCTs (6831 participants) were included (43 psychotherapy, 14 pharmacotherapy, 8 complementary and alternative medicine, 7 collaborative care, 4 exercise, and 3 combination therapy interventions). No significant differences regarding acceptability were evident. Reliable efficacy/effectiveness comparisons using NMA were not possible due to RoB (44.3 % Some concerns, 54.3 % High RoB). Only 10 RCTs had no integrity concerns. Integrity issues included no pre-registration (n = 56/80 %), insufficient reporting on randomisation (n = 27/38.6 %) and ethics (n = 32/40 %), and questionable effect sizes (n = 26/37 %). The most reliable evidence was for collaborative care.

Conclusions

The literature on depression interventions for people with cancer is at RoB, pointing to an urgent need for high-quality research. Until such evidence is available, treatment decisions should continue to be based on evidence from other patient groups and clinical expertise, though there is some evidence that collaborative care is effective.

Systematic review registration

PROSPERO CRD42021290145 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=290145

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来源期刊

Journal of Psychosomatic Research 医学-精神病学

CiteScore

7.40

自引率

6.40%

发文量

314

审稿时长

6.2 weeks

期刊介绍： The Journal of Psychosomatic Research is a multidisciplinary research journal covering all aspects of the relationships between psychology and medicine. The scope is broad and ranges from basic human biological and psychological research to evaluations of treatment and services. Papers will normally be concerned with illness or patients rather than studies of healthy populations. Studies concerning special populations, such as the elderly and children and adolescents, are welcome. In addition to peer-reviewed original papers, the journal publishes editorials, reviews, and other papers related to the journal''s aims.