Comparison of the effects of cognitive-supportive-relaxation multimodal psychosocial intervention on fear of cancer recurrence and psychological resilience in breast cancer patients: a network meta-analysis based on randomized controlled trials

TL;DR

This study compares different psychotherapies for breast cancer patients to see which are best at reducing fear of recurrence and improving psychological resilience.

Contribution

The study provides a network meta-analysis comparing the relative efficacy of multiple psychotherapies for fear of cancer recurrence and psychological resilience in breast cancer patients.

Findings

Cognitive behavioral therapy (CBT) and mindfulness therapy were most effective for anxiety and depression.

CBT also showed benefits in reducing fear of progression and enhancing positive psychological capital.

Couple skills training and narrative therapy were effective for specific aspects of fear of recurrence.

Abstract

Fear of cancer recurrence (FCR) is a highly prevalent and clinically significant psychological concern among breast cancer patients, which can substantially impair their physical and psychological well-being. Emerging evidence suggests that psychotherapeutic interventions exert heterogeneous effects on FCR and psychological resilience in this patient population; however, a paucity of comprehensive network meta-analyses has systematically compared the relative efficacy of diverse psychotherapies for FCR in breast cancer survivors. The present network meta-analysis was conducted to systematically evaluate and compare the effectiveness of various mind-body interventions in mitigating FCR and enhancing psychological resilience among breast cancer patients.

Randomized controlled trials (RCTs) on different psychotherapeutic methods for psychological problems such as the fear of cancer recurrence, anxiety, and depression in breast cancer patients were retrieved by computer from PubMed, Embase, Cochrane Library, Web of Science, CNKI (China National Knowledge Infrastructure), VIP Database for Chinese Technical Periodicals, Wanfang Data Knowledge Service Platform, and Chinese Biomedical Literature Database. To ensure the novelty of the research, the retrieval time limit was set from January 2019 to March 2025. Two researchers screened the literature, extracted the data, and evaluated the methodological quality according to the inclusion and exclusion criteria. Network meta-analysis was conducted using RevMan 5.4 and Stata 17.0.

Nineteen eligible randomized controlled trials (RCTs) involving 11 interventions and 2214 participants were included. Network meta-analysis indicated distinct psychotherapeutic approaches had superior efficacy for specific psychological outcomes: couple skills training showed probabilistic advantages for fear of cancer recurrence (FCR, Fear of Cancer Recurrence Inventory); narrative therapy was effective for recurrence-related concerns; cognitive behavioral therapy (CBT) had probabilistic benefits in reducing fear of progression (Fear of Progression Questionnaire-Short Form) and enhancing positive psychological capital (Positive Psychological Capital Questionnaire); and both CBT and mindfulness therapy outperformed other interventions for anxiety and depression (Hospital Anxiety and Depression Scale). Sensitivity and subgroup analyses further validated the robustness of the findings and explored sources of heterogeneity. Subgroup analysis identified measurement time points and treatment status as the primary contributors to substantial overall heterogeneity (I²=91.9%, P<0.001), whereas measurement tools had no notable effect;leave-one-out sensitivity analysis showed the pooled effect size stably ranged from -1.44 to -0.63, with no single study driving overall results, confirming the robustness of core conclusions.

Our findings underscore the outcome-specific advantages of different psychotherapeutic interventions for breast cancer patients, thereby supporting the adoption of a personalized, needs-based approach to address FCR, psychological distress, and resilience. Nevertheless, the current evidence is constrained by substantial heterogeneity in intervention protocols, variability in outcome measurement tools, and a relatively limited number of trials for certain interventions. Future high-quality RCTs with standardized intervention protocols, consistent outcome metrics, and long-term follow-up are warranted to validate these findings and inform the development of clinical practice guidelines for psychological support in breast cancer survivors.

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420251009772.

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