TY - JOUR
T1 - Peri-operative mental health interventions for surgical oncology patients
T2 - a narrative synthesis and meta-analysis
AU - Abraham, Joanna
AU - Holzer, Katherine J.
AU - Pedamallu, Lavanya
AU - Kozower, Benjamin D.
AU - Avidan, Michael S.
AU - Lenze, Eric J.
N1 - Publisher Copyright:
© 2025 Association of Anaesthetists.
PY - 2025/2
Y1 - 2025/2
N2 - Introduction: Oncologic surgeries are common and rates of depression and anxiety are high in the peri-operative period, potentially interfering with successful recovery. Methods: We conducted a narrative review and meta-analysis focusing on randomised controlled trials evaluating the effect of peri-operative mental health interventions on anxiety and/or depression in adult patients having oncological surgery. The review included studies published in the last 5 years, identified through EMBASE with no pre-specified criteria for the type of comparison or outcome. A meta-analysis using a random effects model was performed for outcomes with sufficient data, and a vote-counting synthesis was performed for studies with insufficient data or fewer than two studies per outcome. Results: Seventeen randomised controlled trials were included. All were conducted internationally, primarily in Asia. Ten studies assessed psychological interventions (e.g. cognitive behavioural therapy), six assessed pharmacological interventions (e.g. ketamine) and one assessed acupuncture. Meta-analysis revealed significant intervention effects on pre-operative anxiety scores (n = 429, Hedge's g = -1.03, p = 0.001) and postoperative depression scores at hospital discharge (n = 188, Hedge's g = -0.88, p < 0.001), whereas no significant intervention effect was found in anxiety scores at discharge (n = 188, Hedge's g = -1.54, p = 0.08). Vote-counting synthesis identified intervention effects on depression and anxiety scores on day 3 postoperatively and on depression scores at one-week postoperatively, while all other time-points showed no intervention effect. Discussion: Psychological and pharmacological interventions are effective at reducing pre-operative anxiety and immediate postoperative depression scores in patients having oncological surgery, but these benefits do not persist postoperatively. Hence, future research efforts should focus on development and testing of interventions that are effective and implementable within the peri-operative context.
AB - Introduction: Oncologic surgeries are common and rates of depression and anxiety are high in the peri-operative period, potentially interfering with successful recovery. Methods: We conducted a narrative review and meta-analysis focusing on randomised controlled trials evaluating the effect of peri-operative mental health interventions on anxiety and/or depression in adult patients having oncological surgery. The review included studies published in the last 5 years, identified through EMBASE with no pre-specified criteria for the type of comparison or outcome. A meta-analysis using a random effects model was performed for outcomes with sufficient data, and a vote-counting synthesis was performed for studies with insufficient data or fewer than two studies per outcome. Results: Seventeen randomised controlled trials were included. All were conducted internationally, primarily in Asia. Ten studies assessed psychological interventions (e.g. cognitive behavioural therapy), six assessed pharmacological interventions (e.g. ketamine) and one assessed acupuncture. Meta-analysis revealed significant intervention effects on pre-operative anxiety scores (n = 429, Hedge's g = -1.03, p = 0.001) and postoperative depression scores at hospital discharge (n = 188, Hedge's g = -0.88, p < 0.001), whereas no significant intervention effect was found in anxiety scores at discharge (n = 188, Hedge's g = -1.54, p = 0.08). Vote-counting synthesis identified intervention effects on depression and anxiety scores on day 3 postoperatively and on depression scores at one-week postoperatively, while all other time-points showed no intervention effect. Discussion: Psychological and pharmacological interventions are effective at reducing pre-operative anxiety and immediate postoperative depression scores in patients having oncological surgery, but these benefits do not persist postoperatively. Hence, future research efforts should focus on development and testing of interventions that are effective and implementable within the peri-operative context.
KW - anxiety
KW - cancer
KW - depression
KW - evidence synthesis
KW - literature review
UR - http://www.scopus.com/inward/record.url?scp=85214224990&partnerID=8YFLogxK
U2 - 10.1111/anae.16471
DO - 10.1111/anae.16471
M3 - Review article
C2 - 39777730
AN - SCOPUS:85214224990
SN - 0003-2409
VL - 80
SP - 54
EP - 64
JO - Anaesthesia
JF - Anaesthesia
IS - S2
ER -