title: Effects of psycho-behavioral interventions on immune functioning in cancer patients: a systematic review.
abstract: OBJECTIVE
  This study aimed at summarizing evidence about effects of psycho-behavioral interventions (PBIs) on immune responses among cancer patients and analyzing quality of published studies so as to inform future researches.
  
  
  METHODS
  Literature retrieval utilized both highly inclusive algorithms searching randomized controlled studies published in English and Chinese and manual searching of eligible studies from references of relevant review papers. Two researchers examined the articles selected separately and extracted the information using a pre-designed form for soliciting data about the trials (e.g., sample size, disease status, intervention, immune responses) and quality ratings of the studies. Both narrative descriptions and meta-analysis (via Review manager 5) were used synthesizing the effects of PBIs on immune responses among cancer patients and state of art of the researches in this area.
  
  
  RESULTS
  Seventy-six RCTs met inclusion criteria. PBIs implemented were divided into three major categories including psychological state adjustment, physical activity and dietary modification. Immune indicators measured included CD4+ cells, CD8+ cells, CD4/CDC8+ ratio, CD3+ cells, NK cell activity, etc. Effects of PBIs on immune responses documented in individual papers were mixed and pooled analysis of CD4+ cells, CD4+/CD8+ ratio, CD3+ cells, NKCA, IgG, IgM and IL-2 showed modest effects. However, there were huge discrepancies in intervention effects between studies published in English and Chinese and the results should be interpreted with caution. Besides, most studies suffer from some quality flaws concerning blinding, randomization procedures, compliance, attrition and intention-to-treat analyses, etc.
  
  
  CONCLUSIONS
  Although there are considerable evidences of PBI effects on some immune indicators, the effect sizes are modest and it is still premature to conclude whether PBIs have effects on immune functions among cancer patients. There is a clear need for much more rigorous efforts in this area and future researches should pay particular attention to intervention dose and focus, sample size and comparable immune measures.
authors.affiliation: School of Health Services Management, Anhui Medical University, Hefei, China, 381378037@qq.com.
authors.forename: Guixian
authors.initials: G
authors.lastname: Tong
authors.forename: Qingqing
authors.initials: Q
authors.lastname: Geng
authors.forename: Jing
authors.initials: J
authors.lastname: Cheng
authors.forename: Jing
authors.initials: J
authors.lastname: Chai
authors.forename: Yi
authors.initials: Y
authors.lastname: Xia
authors.forename: Rui
authors.initials: R
authors.lastname: Feng
authors.forename: Lu
authors.initials: L
authors.lastname: Zhang
authors.forename: Debin
authors.initials: D
authors.lastname: Wang
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D006801:Humans; D009369:Neoplasms / Q000276:immunology* / Q000523:psychology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
references.citation: Dig Dis Sci. 2007 Sep;52(9):2452-9
references.pmid: 17417728
references.citation: Med Sci Sports Exerc. 2005 Nov;37(11):1827-35
references.pmid: 16286849
references.citation: Semin Oncol. 1998 Jun;25(3):255-64
references.pmid: 9633839
references.citation: Eur J Cancer. 2004 May;40(7):951-62
references.pmid: 15093569
references.citation: Support Care Cancer. 2008 Jan;16(1):57-65
references.pmid: 17562086
references.citation: Cancer Epidemiol. 2012 Apr;36(2):e128-36
references.pmid: 22018935
references.citation: Health Psychol. 2001 Jan;20(1):47-63
references.pmid: 11199066
references.citation: Immunol Allergy Clin North Am. 2011 Feb;31(1):133-40
references.pmid: 21094928
references.citation: J Clin Oncol. 2005 Sep 1;23(25):6097-106
references.pmid: 16135476
references.citation: Psychooncology. 2011 Jul;20(7):681-97
references.pmid: 20690112
references.citation: Cancer Prev Res (Phila). 2011 Oct;4(10):1590-8
references.pmid: 21764858
references.citation: Cancer. 2002 May 15;94(10):2719-27
references.pmid: 12173342
references.citation: Arch Phys Med Rehabil. 2000 Jun;81(6):777-9
references.pmid: 10857523
references.citation: J Clin Oncol. 2006 Mar 1;24(7):1105-11
references.pmid: 16505430
references.citation: Brain Behav Immun. 2007 Nov;21(8):1000-8
references.pmid: 17706917
references.citation: Nat Clin Pract Oncol. 2008 Aug;5(8):466-75
references.pmid: 18493231
references.citation: Int J Psychiatry Med. 2002;32(1):37-53
references.pmid: 12075915
references.citation: Breast. 2009 Feb;18(1):17-25
references.pmid: 19008099
references.citation: Brain Behav Immun. 2009 Jul;23(5):580-91
references.pmid: 18835434
references.citation: Integr Cancer Ther. 2009 Mar;8(1):37-46
references.pmid: 19190034
references.citation: N Engl J Med. 2001 Dec 13;345(24):1719-26
references.pmid: 11742045
references.citation: BJU Int. 2008 May;101(10):1227-31
references.pmid: 18218061
references.citation: World J Gastroenterol. 2005 Apr 21;11(15):2313-8
references.pmid: 15818744
references.citation: Psychosom Med. 2009 Sep;71(7):715-24
references.pmid: 19622708
references.citation: J Clin Oncol. 2007 Jun 10;25(17):2397-405
references.pmid: 17557953
references.citation: J Clin Oncol. 2005 Feb 1;23(4):899-909
references.pmid: 15681536
references.citation: J Psychosoc Oncol. 2006;24(1):3-26
references.pmid: 16803749
references.citation: Psychosom Med. 2011 Apr;73(3):218-25
references.pmid: 21257977
references.citation: Cancer. 1995 Aug 15;76(4):631-7
references.pmid: 8625157
references.citation: Psychooncology. 2009 Aug;18(8):875-85
references.pmid: 19137506
references.citation: Arch Gen Psychiatry. 1990 Aug;47(8):729-35
references.pmid: 2143062
references.citation: Am J Epidemiol. 2003 Mar 1;157(5):415-23
references.pmid: 12615606
references.citation: Am J Chin Med. 2008;36(3):459-72
references.pmid: 18543381
references.citation: J Psychosom Res. 2004 Jan;56(1):1-8
references.pmid: 14987957
references.citation: Int J Oral Maxillofac Implants. 2001 Nov-Dec;16(6):783-92
references.pmid: 11769828
references.citation: Breast Cancer Res Treat. 2013 Jan;137(1):175-86
references.pmid: 23139058
references.citation: J Urol. 2005 Sep;174(3):1065-9; discussion 1069-70
references.pmid: 16094059
references.citation: Soc Sci Med. 1991;33(2):177-83
references.pmid: 1887281
references.citation: BMJ. 2001 Jul 7;323(7303):42-6
references.pmid: 11440947
references.citation: Psychooncology. 2007 Apr;16(4):277-86
references.pmid: 17385190
references.citation: Psychother Psychosom. 1997;66(4):185-91
references.pmid: 9259041
references.citation: Support Care Cancer. 2006 Jul;14(7):699-712
references.pmid: 16447036
references.citation: BMJ. 2002 Nov 9;325(7372):1066
references.pmid: 12424165
references.citation: Psychooncology. 1997 Dec;6(4):311-20
references.pmid: 9451750
references.citation: Eur J Oncol Nurs. 2004 Mar;8(1):61-5
references.pmid: 15003745
references.citation: Psychother Psychosom. 2001 Nov-Dec;70(6):307-18
references.pmid: 11598430
references.citation: Cancer. 2009 Nov 15;115(22):5349-61
references.pmid: 19753617
references.citation: J Psychosom Res. 2007 Dec;63(6):647-55
references.pmid: 18061756
references.citation: Int J Cancer. 2010 Dec 15;127(12):2893-917
references.pmid: 21351269
references.citation: Med Sci Sports Exerc. 2003 Jan;35(1):2-9
references.pmid: 12544628
references.citation: Int J Behav Med. 2011 Dec;18(4):333-41
references.pmid: 21336679
references.citation: Br J Cancer. 2000 Dec;83(11):1448-53
references.pmid: 11076652
references.citation: Cancer Treat Rev. 2010 Apr;36(2):185-94
references.pmid: 19962830
references.citation: Integr Cancer Ther. 2013 Jul;12(4):323-35
references.pmid: 22831916
references.citation: J Psychosom Res. 1997 May;42(5):453-66
references.pmid: 9194018
references.citation: Acta Oncol. 2011 Feb;50(2):167-78
references.pmid: 21091401
references.citation: J Cancer Surviv. 2012 Jun;6(2):146-54
references.pmid: 22160628
references.citation: Eur J Cancer. 2013 Apr;49(6):1365-73
references.pmid: 23265707
references.citation: Immunol Allergy Clin North Am. 2011 Feb;31(1):109-32
references.pmid: 21094927
references.citation: Arch Gen Psychiatry. 1993 Sep;50(9):681-9
references.pmid: 8357293
references.citation: J Psychosom Res. 1992 Sep;36(6):531-41
references.pmid: 1640391
references.citation: CA Cancer J Clin. 2005 Mar-Apr;55(2):74-108
references.pmid: 15761078
references.citation: Int J Cancer. 2003 Dec 20;107(6):1023-9
references.pmid: 14601065
references.citation: Psychol Rep. 1986 Oct;59(2 Pt 2):967-74
references.pmid: 3809353
references.citation: J Psychosom Res. 1991;35(2-3):355-63
references.pmid: 2046066
references.citation: Cancer Detect Prev. 2004;28(3):208-13
references.pmid: 15225901
references.citation: J Urol. 2010 Jan;183(1):345-50
references.pmid: 19914662
references.citation: Health Psychol. 1994 Nov;13(6):539-47
references.pmid: 7889909
references.citation: Anticancer Res. 2012 Sep;32(9):3875-84
references.pmid: 22993332
references.citation: Support Care Cancer. 2010 May;18(5):591-9
references.pmid: 19609570
references.citation: J Psychosom Res. 2006 Apr;60(4):423-7
references.pmid: 16581368
references.citation: Support Care Cancer. 2012 Jun;20(6):1235-42
references.pmid: 21688163
references.citation: Urology. 2008 Dec;72(6):1324-8
references.pmid: 18400281
references.citation: J Clin Oncol. 2005 Oct 1;23(28):7105-13
references.pmid: 16192594
references.citation: Res Nurs Health. 2007 Feb;30(1):72-83
references.pmid: 17243109
references.citation: Urology. 2008 Dec;72(6):1319-23
references.pmid: 18602144
references.citation: J Psychosoc Oncol. 2007;25(3):19-42
references.pmid: 19341012
references.citation: J Clin Oncol. 2007 Jul 1;25(19):2702-8
references.pmid: 17602075
references.citation: Clin Breast Cancer. 2011 Jun;11(3):161-70
references.pmid: 21665136
references.citation: Health Psychol. 2009 Mar;28(2):137-46
references.pmid: 19290705
references.citation: J Psychosom Res. 2007 Sep;63(3):233-9
references.pmid: 17719359
references.citation: Psychol Med. 2004 Apr;34(3):481-90
references.pmid: 15259833
references.citation: Int J Neurosci. 2008 Jun;118(6):839-55
references.pmid: 18465428
references.citation: J Clin Oncol. 2004 Sep 1;22(17):3570-80
references.pmid: 15337807
references.citation: J Psychosom Res. 2009 Nov;67(5):369-76
references.pmid: 19837199
references.citation: J Clin Oncol. 1987 Mar;5(3):348-53
references.pmid: 3546612
references.citation: Phys Ther. 2008 Feb;88(2):156-75
references.pmid: 18073267
references.citation: Psychosom Med. 2008 Nov;70(9):1044-9
references.pmid: 18842742
references.citation: Complement Ther Clin Pract. 2012 Aug;18(3):182-9
references.pmid: 22789796
references.citation: Cancer. 2008 Dec 15;113(12):3450-8
references.pmid: 19016270
references.citation: World J Gastroenterol. 2004 Jan 15;10(2):268-72
references.pmid: 14716837
references.citation: J Psychosom Res. 2000 Feb;48(2):187-94
references.pmid: 10719136