The effect of psychologically informed practice with behavioural graded activity in cancer survivors: systematic review and meta‑analysis

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Purpose This systematic review and meta-analysis aimed to determine the effectiveness of psychologically informed practice (PIP) with behavioural graded activity (BGA) compared to (1) waitlist controls (WLC), (2) other interventions (OI), (3) PIP alone or (4) BGA alone in cancer patients and survivors (CPaS). Methods PubMed, Web of Science and Embase were screened for randomised controlled trials encompassing BGA + PIP in CPaS. Effect sizes were inventoried for outcomes regarding physical activity (PA), quality of life (QoL) and debilitating symptoms (DS), which were assessed at four time points: post-intervention (PI), follow-up F1 (1 to 3 months), F2 (4 to 6 months) and F3 (> 6 months). The quality of the evidence was classified by the GRADE approach. Results Thirty-three studies were found eligible, comprising 4330 participants. Significant effects with low heterogeneity of PIP + BGA comparing to WLC were found for anxiety (SMD − 1.29 [−1.71; − 0.86]), depression (SMD − 0.79 [− 1.10; − 0.48]), functional impairment (SMD − 0.72 [− 0.95; − 0.50]), PA (self-reported: (SMD − 0.58 [− 0.84; − 0.32]) and objectively measured: (SMD − 0.51 [− 0.90; − 0.13])) and social impairment (SMD − 0.33 [− 0.58; − 0.08]). When comparing PIP + BGA to OI, fatigue (SMD − 0.35 [− 0.51; − 0.20]) and PA (SMD − 0.26 [− 0.41; − 0.11]) at PI, and fatigue (SMD − 0.34 [− 0.58; − 0.10]) at F1 were found significant with low heterogeneity. No significant effects were observed in the meta-analyses of studies comparing PIP + BGA to BGA or PIP alone. Conclusions PIP with BGA has a favourable effect on DS, PA and QoL in CPaS when compared to non-behavioural interventions such as WLC, usual care and education. However, further research is needed on ‘how’ and ‘when’ PIP + BGA should be provided in cancer rehabilitation. Implications for Cancer Survivors PIP + BGA has the potential to facilitate CPaS to reach the recommended amount of PA and reduce DS.
Original languageEnglish
Pages (from-to)1-46
Number of pages46
JournalJournal of Cancer Survivorship
VolumeOnline ahead of print
Issue numberOnline ahead of print
Publication statusPublished - 26 Jan 2023

Bibliographical note

Funding Information:
AL is a research fellow funded by the Research Foundation Flanders (FWO), Belgium (grant number 11B1920N). ER is funded by Stand Up To Cancer (Kom op tegen Kanker — KOTK), a Belgian cancer charity (project code ANI251). LL is a postdoctoral research fellow appointed on two funded projects, one by the Research Foundation Flanders (FWO) (grant number G040919N) and one by Stand up to Cancer (Kom op tegen Kanker (KOTK) — project code ANI251). JN is holder of a chair on oncological rehabilitation funded by the Berekuyl Academy/European College for Decongestive Lymphatic Therapy, the Netherlands.

Publisher Copyright:
© 2023, The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

Copyright 2023 Elsevier B.V., All rights reserved.


  • Adverse effects · Behaviour therapy · Exercise · Meta-analysis · Neoplasms · Quality of life


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