University of British Columbia, BC Cancer Agency, Vancouver, BC, Canada.
Psychooncology. 2012 Apr;21(4):343-50. doi: 10.1002/pon.2035. Epub 2011 Sep 1.
The effectiveness of psychological treatment for distress reduction in cancer patients has been frequently studied and reviewed in systematic reviews but reviewer conclusions vary considerably. Clear and consistent evidence is needed to assist clinicians and administrators with their decision-making. We hypothesized that uneven handling of confounding methodological features are at least partly the reason for disagreements and reviewed the literature in this light.
A systematic review of 14 published meta-analyses was conducted to determine whether due consideration of moderating variables in psycho-oncological treatments permits clearer recommendations. Quality of the reviews, treatment type, dosage, therapist qualities, outcomes at follow-up, and screening versus not screening for elevated distress were examined as moderator variables.
Treatment effects are consistently positive but also vary greatly in magnitude. There is lacking evidence for many important questions, in particular, differential treatment effects for different cancer types and stages. Regarding moderators of outcome, quality of review had no impact on results for depression but including lower quality reviews actually lead to underestimation of treatment effects for anxiety. The most potent negative moderator variable, however, is a floor effect that arises when patients are recruited for treatment studies without being selected for high levels of distress. Such indiscriminate recruitment is very frequent in psycho-oncology and leads to small reported treatment effects; when, however, patients are first screened for elevated distress, the ratio of observed treatment effects sizes is roughly three times greater.
Sweeping judgments about the effectiveness of psycho-oncological treatments for distress reduction are somewhat misleading and counter-productive. Among moderator variables, floor effects are particularly pervasive and have a large suppressor effect on observed outcomes.
针对癌症患者减轻痛苦的心理治疗效果，系统评价和综述已对此进行了大量研究，但评价者的结论差异较大。需要明确一致的证据来帮助临床医生和管理人员做出决策。我们假设，对混杂方法特征的处理不均衡至少是意见分歧的部分原因，并从这一角度审查了文献。
对 14 项已发表的荟萃分析进行了系统评价，以确定在心理肿瘤学治疗中是否充分考虑调节变量可以提供更明确的建议。质量评价、治疗类型、剂量、治疗师素质、随访时的结果以及是否对升高的痛苦进行筛查被视为调节变量。
治疗效果始终为阳性，但幅度差异也很大。对于许多重要问题，缺乏证据，特别是不同癌症类型和阶段的治疗效果差异。关于结局的调节因素，评价质量对抑郁无影响，但纳入质量较低的评价实际上会低估焦虑的治疗效果。然而，最有力的负向调节变量是地板效应，当患者因接受治疗而被招募，而不是因高压力水平而被选择时，就会出现这种效应。这种不加选择的招募在心理肿瘤学中非常普遍，导致报告的治疗效果较小；然而，当患者首先因压力升高而被筛选时，观察到的治疗效果大小之比约为三倍。
对心理肿瘤学治疗减轻痛苦的有效性进行全盘判断有些误导且适得其反。在调节变量中，地板效应尤其普遍，对观察结果有很大的抑制作用。
