The results of this randomized trial demonstrate that a psychosocial intervention significantly reduced levels of depression and anxiety compared to a control group. Further, the intervention was effective for improving elements of QOL, such as global health status and physical functioning; it also increased emotional functioning, significantly decreased insomnia, and was similar in cost-effectiveness in comparison with usual care. The subgroup analysis suggested that female patients and patients received high dose radiotherapy or underwent adjuvant chemotherapy would benefit more from the intervention. However, the intervention was not effective in prolonging survival.
More than half of the patients in our study undergoing RT for the various types of cancer expressed symptoms of depression or anxiety. This prevalence is consistent with previous reports of symptoms of psychosocial problems that ranged between 30% and 70%
[37, 38]. There were significant gender differences between anxiety and depression in our sample, and the female patients were generally more anxious and depressed compared to male patients. This result complied with Massie’s findings
. The reason for the appearance of negative moods in participants could be due to trepidation about a poor prognosis of cancer, misunderstanding of RT and worry about adverse effects of RT. In particular, for women with cancers, more misgivings were here compared to men, including fear of the diseases would impact their attractiveness, sexual relationships, fertility and even family happiness
[40, 41]. Despite a high prevalence of mental ill-health following the diagnosis of cancer, little effort has been applied to meeting such needs
[42, 43]. Therefore, it is imperative to assess the mental health of patients and take some measures to alleviate anxiety and depression throughout the process of RT.
The results of a psychosocial intervention in this study were encouraging. Following the psychosocial intervention, significant differences in depression and anxiety between two groups were observed after the completion of RT. A marked decrease in levels of depression and anxiety occurred within the intervention group. However, in the control group the results showed a trend for a deterioration. Thus, we could speculate that daily anticancer treatment will aggravate psychiatric distress if the patient does not also receive psychological care and provision of support from medical personnel during RT. The findings were in line with those reported in other studies. For example, Goerling U et al., using random sample analyses, reported an increase in the psychological condition of patients with cancer on a surgical ward after patients underwent psycho-oncological support
. Faul LA et al. designed a randomised study to evaluate the effectiveness of skill in stress management for cancer patients receiving chemotherapy. The authors demonstrated that psychosocial care was an efficient approach that clearly reduced anxiety and depression in patients with cancer
. Arguably, it is acceptable to define tailored psychological support plans whenever needed, with the aim of preventing or managing emotional problems appearing in RT.
This study also evaluated differences in QOL in a large sample of cancer patients, with and without intervention during RT. The results showed a trend for a deterioration in the control group compared to a stabilization in the intervention group. After RT, patients in the intervention group achieved significantly higher scores for global health status, physical and emotional functioning, and improvement in insomnia than patients in the control group. Therefore interventions are more necessary for these patients. Our findings agree with those from a randomized controlled trial conducted by Breitbart W, who found that participants who received psychotherapy demonstrated significantly greater improvement than the control group in terms of spiritual well-being and QOL
. Similarly, Eom CS et al. investigated the association between mental health, QOL and perceived social support in 1930 patients with cancer recruited from multiple centers and found that interventions improved mental health and QOL in cancer patients through a direct effect
. Moreover, our data showed that there was no significant difference in the financial difficulties subscale between the intervention and control groups at assessment after RT. Mean costs in the intervention group were CNY45,000, and were not higher than for the control group receiving usual care. The findings were similar to previous studies
, and suggested that a psychological support during RT could be a cost-effective tool for improving QOL in patients with cancer.
Unplanned subgroup analysis demonstrated that obvious associations between psychological distress or QOL and clinical characteristics (including gender, radiation dose and chemotherapy modes) among oncology patients. A possible reason may be that women possessed more misgivings and trepidation, and high dose radiotherapy or adjuvant chemotherapy always resulted in severely toxic side effect, which significantly impacts mental status and QOL of patients. Thus, when screening of mental health and QOL in cancer patients who undergoing radiotherapy, female patients, those that received high dose radiotherapy, and those that underwent adjuvant chemotherapy should be routinely emphasized, who would benefit more from the psychosocial intervention.
Survival analyses from this trial indicated that patients with cancer randomized to receive a psychosocial intervention had no reduction in their risk for cancer recurrence and death compared to those who did not receive the intervention. An earlier finding that intervention was correlated with longer survival was not replicated
. Our results are in accordance with the literature showing that interventions for patients with cancer did not extended survival times
[26, 49, 50]. Our results demonstrated that beneficial effects on survival is the major reason for patients receiving more anti-cancer treatment, and the key benefit of psychotherapeutic interventions is improved psychological well-being. However, the survival debate continues.
There is no consensus on how to define the psychological symptoms and problems of QOL in patients with cancer, and therapists always find it difficult to know what tests to order and which patients to treat, when and how long to treat, and what the available treatment options are. During the therapeutic process in our study, we observed that many factors could affect the moods and QOL, and that different patients varied in their receptiveness to psychosocial interventions. Although some of these factors cannot be avoided, psychosocial intervention effectively achieved benefits for patients. Therefore, as Simon Wein has stated, it is essential that clinical staff in oncology departments gain some knowledge of psycho-oncology, including communication skills, psychotropic medications and psychological therapies in routine clinical practice, so that they can clinically identify distress and provide initial psychosocial support if necessary
Our trail has some potential limitations. First, duration of time of the survey for anxiety, depression and QOL was short, which meant that we were unable to determine what changes of moods and QOL in cancer patients would take place in the time after the end of RT. Second, survival following RT is often short, so the results may not exactly reflect the relationship between intervention therapy and survival. Finally, this study was performed using a single-center design and the sample size was relatively small, which may cause potential sampling errors. To investigate the usefulness and feasibility of intervention, further work, including a prospective longitudinal multicenter study, is recommended.