J Korean Acad Nurs.  2014 Aug;44(4):446-457. 10.4040/jkan.2014.44.4.446.

Effects of Psychosocial Interventions on Cortisol and Immune Parameters in Patients with Cancer: A Meta-analysis

• Oh PJ
• Jang ES

• KMID: 1791874
• DOI: http://doi.org/10.4040/jkan.2014.44.4.446

Abstract

PURPOSE
This study was done to evaluate the effects of psychosocial interventions on cortisol and immune response in adult patients with cancer.
METHODS
MEDLINE via PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL and domestic electronic databases were searched. Twenty controlled trials (11 randomized and 9 non-randomized trials) met the inclusion criteria with a total of 862 participants. Methodological quality was assessed using the Cochrane's Risk of Bias for randomized studies and the Risk of Bias Assessment tool for non randomized studies. Data were analyzed using the RevMan 5.2.11 program of Cochrane library.
RESULTS
Overall, study quality was moderate to high. The weighted average effect size across studies was -0.32 (95% CI [-0.56, -0.07], p=.010, I2=45%) for cortisol concentration, -0.62 (95%CI [-0.96,-0.29], p<.001, I2=0%) for T lymphocyte (CD3) and -0.45 (95%CI [-0.74, -0.16], p=.003, I2=0%) for Th lymphocyte (CD4) numbers. Psychosocial interventions were not effective for Tc lymphocyte (CD4), NK cell, monocyte, and cytokine response.
CONCLUSION
Although these results provide only small evidence of successful immune modulation, they support the conclusion that psychosocial interventions can assist cancer patients in reducing emotional distress and improving immune response.

Keyword

Neoplasm; Cortisol; Immune; Intervention studies; Meta-analysis

MeSH Terms

CD4-Positive T-Lymphocytes/cytology/immunology
Cytokines/metabolism
Databases, Factual
Humans
Hydrocortisone/*analysis
Killer Cells, Natural/cytology/immunology
Monocytes/cytology/immunology
Neoplasms/metabolism/pathology/*therapy
Psychotherapy
T-Lymphocytes/cytology/*immunology
Cytokines
Hydrocortisone

Figure

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  Figure 1 Flow of studies included from database search.

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  Figure 2 Forest plot of effect size and 95% CI by psychosocial intervention on cortisol.

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  Figure 3 Forest plot of effect size and 95% CI by psychosocial intervention on immune parameters.

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  Figure 4 Funnel plot of effective sizes by standard error for immune parameters.

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