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Review Article
Effects of Psychosocial Interventions on Cortisol and Immune Parameters in Patients with Cancer: A Meta-analysis
Pok Ja Oh, Eun-su Jang
Journal of Korean Academy of Nursing 2014;44(4):446-457.
DOI: https://doi.org/10.4040/jkan.2014.44.4.446
Published online: August 29, 2014

1Department of Nursing, Sahmyook University, Seoul, Korea.

2Department of Nursing, Graduate School, Sahmyook University, Seoul, Korea.

Address reprint requests to: Oh, Pok-Ja. Department of Nursing, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 139-742, Korea. Tel: +82-2-3399-1589, Fax: +82-2-3399-1594, ohpj@syu.ac.kr
• Received: March 25, 2014   • Revised: April 8, 2014   • Accepted: July 3, 2014

© 2014 Korean Society of Nursing Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

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  • 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.
  • Keywords: Neoplasm; Cortisol; Immune; Intervention studies; Meta-analysis
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Figure 1
Flow of studies included from database search.
jkan-44-446-g001.jpg
Figure 2
Forest plot of effect size and 95% CI by psychosocial intervention on cortisol.
jkan-44-446-g002.jpg
Figure 3
Forest plot of effect size and 95% CI by psychosocial intervention on immune parameters.
jkan-44-446-g003.jpg
Figure 4
Funnel plot of effective sizes by standard error for immune parameters.
jkan-44-446-g004.jpg
Table 1
Descriptive Summary of Included Studies (N=21)
jkan-44-446-i001.jpg

Exp.=Experimental group; Con.=Control group; RCT=Randomized controlled trials; Non-RCT=Non-randomized controlled clinical trial; CBSM=Cognitive-behavioral stress management; MBSR=Mindfulness-based stress reduction; +=Statistically significant difference between two groups; No diff.=No significant difference between two groups; *Cognitive behavioral therapy; †Supportive expressive therapy; ‡Education intervention.

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        Effects of Psychosocial Interventions on Cortisol and Immune Parameters in Patients with Cancer: A Meta-analysis
        J Korean Acad Nurs. 2014;44(4):446-457.   Published online August 29, 2014
        DOI: https://doi.org/10.4040/jkan.2014.44.4.446
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      Effects of Psychosocial Interventions on Cortisol and Immune Parameters in Patients with Cancer: A Meta-analysis
      Image Image Image Image
      Figure 1 Flow of studies included from database search.
      Figure 2 Forest plot of effect size and 95% CI by psychosocial intervention on cortisol.
      Figure 3 Forest plot of effect size and 95% CI by psychosocial intervention on immune parameters.
      Figure 4 Funnel plot of effective sizes by standard error for immune parameters.

      Figure 1

      Figure 2

      Figure 3

      Figure 4

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

      Descriptive Summary of Included Studies (N=21)

      Exp.=Experimental group; Con.=Control group; RCT=Randomized controlled trials; Non-RCT=Non-randomized controlled clinical trial; CBSM=Cognitive-behavioral stress management; MBSR=Mindfulness-based stress reduction; +=Statistically significant difference between two groups; No diff.=No significant difference between two groups; *Cognitive behavioral therapy; †Supportive expressive therapy; ‡Education intervention.
      Table 1 Descriptive Summary of Included Studies (N=21)

      Exp.=Experimental group; Con.=Control group; RCT=Randomized controlled trials; Non-RCT=Non-randomized controlled clinical trial; CBSM=Cognitive-behavioral stress management; MBSR=Mindfulness-based stress reduction; +=Statistically significant difference between two groups; No diff.=No significant difference between two groups; *Cognitive behavioral therapy; †Supportive expressive therapy; ‡Education intervention.

      Table 1

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