Open Access, Peer-reviewed
eISSN 2093-758X
    J Korean Acad Nurs. 2014 Aug;44(4):446-457. Korean.
    Published online Aug 29, 2014.
    https://doi.org/10.4040/jkan.2014.44.4.446
    © 2014 Korean Society of Nursing Science
    Review

    Effects of Psychosocial Interventions on Cortisol and Immune Parameters in Patients with Cancer: A Meta-analysis

    Pok Ja Oh,1 and Eun-su Jang2
      • 1Department of Nursing, Sahmyook University, Seoul, Korea.
      • 2Department of Nursing, Graduate School, Sahmyook University, Seoul, Korea.
    • Address reprint requests to: Oh, Pok-Ja. Department of Nursing, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul 139-742, Korea. Tel: +82-2-3399-1589, Fax: +82-2-3399-1594, Email: ohpj@syu.ac.kr
    Received March 25, 2014; Revised April 08, 2014; Accepted July 03, 2014.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0/) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

    Abstract

    Purpose

    This study was done to evaluate the effects of psychosocial interventions on cortisol and immune response in adult patients with cancer.

    Methods

    MEDLINE via PubMed, Cochrane Library CENTRAL, EMBASE, CINAHL and domestic electronic databases were searched. Twenty controlled trials (11 randomized and 9 non-randomized trials) met the inclusion criteria with a total of 862 participants. Methodological quality was assessed using the Cochrane's Risk of Bias for randomized studies and the Risk of Bias Assessment tool for non randomized studies. Data were analyzed using the RevMan 5.2.11 program of Cochrane library.

    Results

    Overall, study quality was moderate to high. The weighted average effect size across studies was -0.32 (95% CI [-0.56, -0.07], p=.010, I2=45%) for cortisol concentration, -0.62 (95%CI [-0.96,-0.29], p<.001, I2=0%) for T lymphocyte (CD3) and -0.45 (95%CI [-0.74, -0.16], p=.003, I2=0%) for Th lymphocyte (CD4) numbers. Psychosocial interventions were not effective for Tc lymphocyte (CD4), NK cell, monocyte, and cytokine response.

    Conclusion

    Although these results provide only small evidence of successful immune modulation, they support the conclusion that psychosocial interventions can assist cancer patients in reducing emotional distress and improving immune response.

    Keywords
    Neoplasm; Cortisol; Immune; Intervention studies; Meta-analysis

    Figures

    Figure 1
    Flow of studies included from database search.

    Figure 2
    Forest plot of effect size and 95% CI by psychosocial intervention on cortisol.

    Figure 3
    Forest plot of effect size and 95% CI by psychosocial intervention on immune parameters.

    Figure 4
    Funnel plot of effective sizes by standard error for immune parameters.

    Tables

    Table 1
    Descriptive Summary of Included Studies (N=21)

    Notes

    This paper was supported by the Sahmyook University Research Fund in 2014.

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    MeSH Terms
    CD4-Positive T-Lymphocytes/cytology
    CD4-Positive T-Lymphocytes/immunology
    Cytokines/metabolism
    Databases, Factual
    Humans
    Hydrocortisone/analysis*
    Killer Cells, Natural/cytology
    Killer Cells, Natural/immunology
    Monocytes/cytology
    Monocytes/immunology
    Neoplasms/metabolism
    Neoplasms/pathology
    Neoplasms/therapy*
    Psychotherapy
    T-Lymphocytes/cytology
    T-Lymphocytes/immunology*
    Metrics
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