title: A systematic review of randomized controlled trials testing the efficacy of psychosocial interventions for gastrointestinal cancers.
abstract: BACKGROUND
  Psychological morbidity in those diagnosed with cancer has been shown to result in poorer quality of life and increase the risk of mortality. As a result, researchers have designed and tested psychosocial interventions to improve quality of life and survival of patients diagnosed with cancer.
  
  
  METHODS
  A systematic review of the literature was performed to describe the psychosocial interventions that have been tested in patients with gastrointestinal cancers. Databases such as MEDLINE, PsychINFO, PubMed, MedLine, and Cochrane Reviews were searched. The searches were inclusive of studies published in English between 1966 and October 2013. Raters conducted full-text review of the resulting articles for the following eligibility criteria: (1) participants were 18 years or older, (2) the majority of patients in the sample were diagnosed with a gastrointestinal cancer, (3) the trial was testing a psychosocial intervention, and (4) random assignment to one or more interventions versus a usual care, placebo, attention control, or waiting-list control condition.
  
  
  RESULTS
  The interventions that were eligible for this review included psychosocial or behavioral intervention (e.g., cognitive behavioral therapy, problem solving, educational, and collaborative care), physical activity, and/or psychopharmacologic treatment (e.g., selective serotonin reuptake inhibitor). Interventions that included dietary changes were not included in the present review. Study quality was also assessed using the Physiotherapy Evidence Database (PEDro) system. The results of the review resulted in a finding of eight studies to have been conducted, testing psychosocial interventions, in patients with gastrointestinal cancers. Findings of these studies suggested that the interventions were effective in reducing psychological and physical symptoms associated with the cancer, improved quality of life, and reduced immune system dysregulation, and one study demonstrated an improvement in survival. Two studies reported no benefit from psychosocial intervention when compared with a control group. The quality of the studies varied greatly, but reporting of the details of the trials, and the methodological rigor, improved over time.
  
  
  CONCLUSIONS
  Further research is warranted to design and test interventions that may be effective in patients diagnosed with gastrointestinal cancers.
authors.affiliation: Department of Surgery, University of Pittsburgh School of Medicine, 3459 Fifth Avenue; Montefiore 7S, Pittsburgh, PA, 15213, USA, steeljl@upmc.edu.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Steel
authors.forename: Kathryn
authors.initials: K
authors.lastname: Bress
authors.forename: Lydia
authors.initials: L
authors.lastname: Popichak
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Evans
authors.forename: Alexandra
authors.initials: A
authors.lastname: Savkova
authors.forename: Michelle
authors.initials: M
authors.lastname: Biala
authors.forename: Josh
authors.initials: J
authors.lastname: Ordos
authors.forename: Brian I
authors.initials: BI
authors.lastname: Carr
mesh_terms: D005770:Gastrointestinal Neoplasms / Q000523:psychology*; D006801:Humans; D011379:Prognosis; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic
references.citation: Eur J Cancer. 2002 Jul;38(11):1447-57
references.pmid: 12110489
references.citation: Arch Phys Med Rehabil. 2000 Jun;81(6):777-9
references.pmid: 10857523
references.citation: Ann Oncol. 1997 Feb;8(2):163-8
references.pmid: 9093725
references.citation: Ann Pharmacother. 2002 Apr;36(4):585-91
references.pmid: 11918503
references.citation: J Clin Oncol. 2007 Jun 10;25(17):2397-405
references.pmid: 17557953
references.citation: J Psychosom Res. 2004 Aug;57(2):123-31; discussion 133-5
references.pmid: 15465065
references.citation: Br J Addict. 1991 Oct;86(10):1283-98
references.pmid: 1836410
references.citation: Br J Cancer. 1999 Aug;80(11):1770-80
references.pmid: 10468295
references.citation: Psychooncology. 2005 Nov;14(11):949-61
references.pmid: 15669014
references.citation: J Psychosoc Oncol. 2007;25(3):19-42
references.pmid: 19341012
references.citation: Patient Educ Couns. 2003 Jun;50(2):179-86
references.pmid: 12781933
references.citation: Palliat Med. 2004 Jan;18(1):25-31
references.pmid: 14982204
references.citation: Health Technol Assess. 2001;5(35):1-173
references.pmid: 12387733
references.citation: Lancet. 1998 Oct 31;352(9138):1413-8
references.pmid: 9807987
references.citation: J Clin Oncol. 2007 Oct 10;25(29):4526-7
references.pmid: 17846452
references.citation: Psychooncology. 2004 Dec;13(12):837-49; discussion 850-6
references.pmid: 15578622
references.citation: J Clin Oncol. 2011 Feb 1;29(4):413-20
references.pmid: 21149651
references.citation: Br J Psychiatry. 2004 Jul;185:55-62
references.pmid: 15231556
references.citation: Cancer Detect Prev. 2004;28(3):208-13
references.pmid: 15225901
references.citation: Br J Psychiatry. 2006 Oct;189:297-308
references.pmid: 17012652
references.citation: J Clin Oncol. 2007 Jul 1;25(19):2702-8
references.pmid: 17602075
references.citation: Int J Psychiatry Med. 2006;36(1):13-34
references.pmid: 16927576
references.citation: BMC Health Serv Res. 2007 Feb 26;7:28
references.pmid: 17324283
references.citation: Psychol Med. 2010 Nov;40(11):1797-810
references.pmid: 20085667