Effects and moderators of coping skills training on symptoms of depression and anxiety in patients with cancer: Aggregate data and individual patient data meta-analyses

L. M. Buffart, M. A.C. Schreurs, H. J.G. Abrahams, J. Kalter, N. K. Aaronson, P. B. Jacobsen, R. U. Newton, K. S. Courneya, J. Armes, C. Arving, A. M. Braamse, Y. Brandberg, J. Dekker, R. J. Ferguson, M. F. Gielissen, B. Glimelius, M. M. Goedendorp, K. D. Graves, S. P. Heiney, R. HorneM. S. Hunter, B. Johansson, L. L. Northouse, H. S. Oldenburg, J. B. Prins, J. Savard, M. van Beurden, S. W. van den Berg, J. Brug, H. Knoop, I. M. Verdonck-de Leeuw

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Purpose: This study evaluated the effects of coping skills training (CST) on symptoms of depression and anxiety in cancer patients, and investigated moderators of the effects. Methods: Overall effects and intervention-related moderators were studied in meta-analyses of pooled aggregate data from 38 randomized controlled trials (RCTs). Patient-related moderators were examined using linear mixed-effect models with interaction tests on pooled individual patient data (n = 1953) from 15 of the RCTs. Results: CST had a statistically significant but small effect on depression (g = −0.31,95% confidence interval (CI) = −0.40;-0.22) and anxiety (g = −0.32,95%CI = -0.41;-0.24) symptoms. Effects on depression symptoms were significantly larger for interventions delivered face-to-face (p =.003), led by a psychologist (p =.02) and targeted to patients with psychological distress (p =.002). Significantly larger reductions in anxiety symptoms were found in younger patients (pinteraction < 0.025), with the largest reductions in patients <50 years (β = −0.31,95%CI = -0.44;-0.18) and no significant effects in patients ≥70 years. Effects of CST on depression (β = −0.16,95%CI = -0.25;-0.07) and anxiety (β = −0.24,95%CI = -0.33;-0.14) symptoms were significant in patients who received chemotherapy but not in patients who did not (pinteraction < 0.05). Conclusions: CST significantly reduced symptoms of depression and anxiety in cancer patients, and particularly when delivered face-to-face, provided by a psychologist, targeted to patients with psychological distress, and given to patients who were younger and received chemotherapy.

Original languageEnglish
Article number101882
Pages (from-to)1-14
Number of pages14
JournalClinical psychology review
Early online date25 Jun 2020
Publication statusPublished - 1 Aug 2020


  • (individual patient data) meta-analysis
  • Anxiety
  • Coping skills training
  • Depression
  • Neoplasm
  • Psychosocial care

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