Zhang Yizhen, Zhang Xu, Zhang Xiaoming, Duan Yifan, Tao Yanling
Shenzhen Clinical Medical College, Guangzhou University of Chinese Medicine, Shenzhen, China.
Department of Nursing, Longgang Central Hospital of Shenzhen, Shenzhen, China.
Worldviews Evid Based Nurs. 2025 Apr;22(2):e70023. doi: 10.1111/wvn.70023.
Managing cancer and living meaningfully (CALM) therapy is a psychosocial intervention designed to enhance the well-being of cancer patients; however, its impact on health-related outcomes in cancer patients remains unclear.
This study aimed to systematically synthesize current evidence to assess the impact of CALM therapy on health-related health outcomes and identify key features for optimizing the intervention.
An exhaustive search was conducted across seven databases from inception to July 5, 2024. Two reviewers separately evaluated the eligibility of studies, performed data extraction, and examined the methodological quality using the Cochrane's risk of bias tool. The certainty of evidence was evaluated using GRADE, and data analysis was conducted with Review Manager 5.4. The study protocol was registered with PROSPERO (CRD42024568561).
Eleven studies (n = 1284) were included. CALM therapy showed significant improvements in psychological distress (MD = -2.43, 95% CI [-3.99, -0.86], p = 0.002), anxiety (SMD = -1.06, 95% CI [-1.78, -0.34], p = 0.004), depression (SMD = -0.65, 95% CI [-1.13, -0.17], p = 0.008), quality of life (SMD = 1.44, 95% CI [0.47, 2.40], p = 0.003), cancer-related fatigue (SMD = -3.54, 95% CI [-5.84, -1.23], p = 0.003), and sleep disturbance (SMD = -1.00, 95% CI [-1.86, -0.14], p = 0.02). However, its effects on alleviating the fear of cancer recurrence were not statistically significant.
CALM therapy has demonstrated positive effects on psychological distress, anxiety, depression, cancer-related fatigue, sleep disturbance, and quality of life. However, evidence regarding its effects on the fear of cancer recurrence remains limited. While we explored potential sources of heterogeneity, no primary cause was identified. Our findings remained largely consistent after this exploration, but due to the observed heterogeneity, these results should still be interpreted with caution. Further high-quality randomized controlled trials with larger sample sizes are needed to confirm these findings and assess the long-term implications of CALM therapy.
管理癌症与有意义生活（CALM）疗法是一种旨在提高癌症患者幸福感的社会心理干预措施；然而，其对癌症患者健康相关结局的影响仍不明确。
本研究旨在系统综合现有证据，以评估CALM疗法对健康相关结局的影响，并确定优化该干预措施的关键特征。
从各数据库建库至2024年7月5日，在七个数据库中进行了详尽检索。两名评审员分别评估研究的纳入资格、进行数据提取，并使用Cochrane偏倚风险工具检查方法学质量。使用GRADE评估证据的确定性，并使用Review Manager 5.4进行数据分析。该研究方案已在PROSPERO（CRD42024568561）注册。
纳入11项研究（n = 1284）。CALM疗法在心理困扰（MD = -2.43，95%CI[-3.99，-0.86]，p = 0.002）、焦虑（SMD = -1.06，95%CI[-1.78，-0.34]，p = 0.004）、抑郁（SMD = -0.65，95%CI[-1.13，-0.17]，p = 0.008）、生活质量（SMD = 1.44，95%CI[0.47，2.40]，p = 0.003）、癌症相关疲劳（SMD = -3.54，95%CI[-5.84，-1.23]，p = 0.003）和睡眠障碍（SMD = -1.00，95%CI[-1.86，-0.14]，p = 0.02）方面显示出显著改善。然而，其对减轻癌症复发恐惧的效果无统计学意义。
CALM疗法已证明对心理困扰、焦虑、抑郁、癌症相关疲劳、睡眠障碍和生活质量有积极影响。然而，关于其对癌症复发恐惧影响的证据仍然有限。虽然我们探索了潜在的异质性来源，但未发现主要原因。经过此探索后，我们的研究结果在很大程度上保持一致，但由于观察到的异质性，这些结果仍应谨慎解释。需要进一步开展更大样本量的高质量随机对照试验来证实这些发现，并评估CALM疗法的长期影响。
