School of Health Services Management, Anhui Medical University, Hefei, China,
J Cancer Res Clin Oncol. 2014 Jan;140(1):15-33. doi: 10.1007/s00432-013-1516-z. Epub 2013 Sep 14.
This study aimed at summarizing evidence about effects of psycho-behavioral interventions (PBIs) on immune responses among cancer patients and analyzing quality of published studies so as to inform future researches.
Literature retrieval utilized both highly inclusive algorithms searching randomized controlled studies published in English and Chinese and manual searching of eligible studies from references of relevant review papers. Two researchers examined the articles selected separately and extracted the information using a pre-designed form for soliciting data about the trials (e.g., sample size, disease status, intervention, immune responses) and quality ratings of the studies. Both narrative descriptions and meta-analysis (via Review manager 5) were used synthesizing the effects of PBIs on immune responses among cancer patients and state of art of the researches in this area.
Seventy-six RCTs met inclusion criteria. PBIs implemented were divided into three major categories including psychological state adjustment, physical activity and dietary modification. Immune indicators measured included CD4+ cells, CD8+ cells, CD4/CDC8+ ratio, CD3+ cells, NK cell activity, etc. Effects of PBIs on immune responses documented in individual papers were mixed and pooled analysis of CD4+ cells, CD4+/CD8+ ratio, CD3+ cells, NKCA, IgG, IgM and IL-2 showed modest effects. However, there were huge discrepancies in intervention effects between studies published in English and Chinese and the results should be interpreted with caution. Besides, most studies suffer from some quality flaws concerning blinding, randomization procedures, compliance, attrition and intention-to-treat analyses, etc.
Although there are considerable evidences of PBI effects on some immune indicators, the effect sizes are modest and it is still premature to conclude whether PBIs have effects on immune functions among cancer patients. There is a clear need for much more rigorous efforts in this area and future researches should pay particular attention to intervention dose and focus, sample size and comparable immune measures.
本研究旨在总结心理行为干预（PBIs）对癌症患者免疫反应的影响证据，并分析已发表研究的质量，以为未来的研究提供信息。
文献检索采用了两种方法，包括在英文和中文数据库中搜索包含随机对照试验的高度包容性算法，以及手动搜索相关综述论文参考文献中符合条件的研究。两名研究人员分别对入选的文章进行评估，并使用预先设计的表格提取有关试验（如样本量、疾病状况、干预措施、免疫反应）和研究质量评分的信息。使用叙述性描述和荟萃分析（通过 Review manager 5）综合 PBIs 对癌症患者免疫反应的影响，并对该领域的研究现状进行分析。
76 项 RCT 符合纳入标准。实施的 PBIs 分为三大类，包括心理状态调整、身体活动和饮食改变。测量的免疫指标包括 CD4+细胞、CD8+细胞、CD4/CDC8+比值、CD3+细胞、NK 细胞活性等。个别论文中记录的 PBIs 对免疫反应的影响混杂，对 CD4+细胞、CD4+/CD8+比值、CD3+细胞、NKCA、IgG、IgM 和 IL-2 的荟萃分析显示出适度的影响。然而，英文和中文发表的研究之间的干预效果存在巨大差异，结果应谨慎解释。此外，大多数研究在盲法、随机分组程序、依从性、失访和意向治疗分析等方面存在质量缺陷。
虽然有相当多的证据表明 PBIs 对某些免疫指标有影响，但影响幅度较小，目前还不能确定 PBIs 是否对癌症患者的免疫功能有影响。在这一领域需要更加严格的努力，未来的研究应特别注意干预剂量和重点、样本量和可比的免疫措施。
