Department of Health Psychology, School of Population Health, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephen's Green, Dublin, 2, Ireland.
School of Social Work and Social Policy, Trinity College Dublin (TCD), Dublin, 2, Ireland.
Syst Rev. 2022 Nov 12;11(1):239. doi: 10.1186/s13643-022-02107-y.
Depression is common among patients with cancer and is associated with lower treatment participation, lower satisfaction with care, poorer quality of life, greater symptom burden and higher healthcare costs. Various types of interventions (e.g. pharmacological, psychotherapy) are used for the treatment of depression. However, evidence for these among patients with cancer is limited. Furthermore, the relative effectiveness and acceptability of different approaches are unknown because a direct comparison between all available treatments has not been carried out. We will address this by conducting a network meta-analysis (NMA) of interventions for depression among people with cancer using a hybrid overview of reviews and systematic review methodology.
We will search for and extract data from systematic reviews of randomised controlled trials (RCTs) of depression interventions for patients with cancer from inception, before performing a supplemental search for more recent RCTs. We will include RCTs comparing pharmacological, psychotherapy, exercise, combination therapy, collaborative care or complementary and alternative medicine interventions with pill placebo, no treatment, waitlist, treatment as usual or minimal treatment control groups, or directly in head-to-head trials, among adults who currently have cancer or have a history of any cancer and elevated depressive symptoms (scores above a cut-off on validated scales or meeting diagnostic criteria). Our primary outcomes will be change in depressive symptoms (standardised mean difference) and intervention acceptability (% who withdrew). Our secondary outcomes will be 6-month change in depressive symptoms, health-related quality of life, adverse events and mortality. We will independently screen for eligibility, extract data and assess risk of bias using the RoB 2 tool. We will use frequentist random-effects multivariate NMA in Stata, rankograms and surface under the cumulative ranking curves to synthesise evidence and obtain a ranking of intervention groups. We will explore heterogeneity and inconsistency using local and global measures and evaluate the credibility of results using the Confidence in NEtwork Meta-Analysis (CINeMA) framework.
Our findings will provide the best available evidence for managing depression among patients with cancer. Such information will help to inform clinical guidelines, evidence-based treatment decisions and future research by identifying gaps in the current literature.
Submitted to PROSPERO (record number: 290145), awaiting registration.
癌症患者中常见抑郁症，与较低的治疗参与度、对护理的满意度较低、较差的生活质量、更大的症状负担和更高的医疗保健费用相关。各种类型的干预措施（如药理学、心理疗法）用于治疗抑郁症。然而，癌症患者的相关证据有限。此外，由于尚未对所有可用治疗方法进行直接比较，因此不同方法的相对有效性和可接受性尚不清楚。我们将通过使用混合综述和系统综述方法对癌症患者的抑郁干预措施进行网络荟萃分析（NMA）来解决这个问题。
我们将从研究开始时搜索并提取来自癌症患者抑郁干预措施的随机对照试验（RCT）的系统综述数据，然后再进行补充搜索以获取最近的 RCT。我们将纳入 RCT，比较药物治疗、心理治疗、运动、联合治疗、协作护理或补充和替代医学干预与安慰剂、无治疗、候补治疗、常规治疗或最低治疗对照组的疗效，或在头对头试验中，纳入目前患有癌症或有癌症病史且抑郁症状升高（在经过验证的量表上得分高于临界值或符合诊断标准）的成年人。我们的主要结局将是抑郁症状的变化（标准化均数差）和干预措施的可接受性（退出治疗的百分比）。我们的次要结局将是 6 个月时抑郁症状的变化、健康相关生活质量、不良事件和死亡率。我们将独立筛选合格性、提取数据并使用 RoB 2 工具评估偏倚风险。我们将使用 Stata 中的频率论随机效应多元 NMA、排名图和累积排序曲线下的表面来综合证据并对干预组进行排名。我们将使用局部和全局测量方法来探索异质性和不一致性，并使用置信网络荟萃分析（CINeMA）框架评估结果的可信度。
我们的研究结果将为癌症患者的抑郁管理提供最佳的现有证据。这些信息将有助于为临床指南、基于证据的治疗决策和未来研究提供信息，通过识别当前文献中的空白来确定治疗方案。
已提交给 PROSPERO（注册号：290145），正在等待注册。
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