Table 1 General characteristics of included studies

Mindfulness interventions

 Chambers, SK [41]

2017

Mindfulness-Based Cognitive Therapy in Advanced Prostate Cancer: A Randomized Controlled Trial

RCT

190 consented 189 randomised

Prostate Cancer (advanced)

Y

MBCT

N/A

Minimally enhanced usual care (Control)

BSI-18 and IES

Not sig

 Chui, PL [42]

2021

Mindful Breathing Effects of a five-minute practice on perceived stress and mindfulness among patients with cancer

RCT

83

Any stage I-III cancer

N

Mindful Breathing

N/A

Standard Care

PSS-10

Not sig

 Compen, F [43]

2018

Face-to-Face and Internet-Based Mindfulness-Based Cognitive Therapy Compared with Treatment as Usual in Reducing Psychological Distress in Patients with Cancer: A Multicenter Randomized Controlled Trial

RCT

245

Cancer of any type or stage

Y

MBCT (mindfulness-based cognitive therapy)

eMBCT

Treatment as Usual (TAU)

HADS

Sig reduction in distress post both interventions p < 0.001

Effect sizes

MBCT: d = -0.45 (small)

95% CI: -0.83, -0.14

eMBCT: d = -0.71 (mod)

95% CI: -1.04, -0.37

[RCI also shows clinical effectiveness for both]

Liu, Z [44]

2022

A randomized clinical trial of guided self-help intervention based on mindfulness for patients with hepatocellular carcinoma: effects and mechanisms

RCT

122

Hepatocellular carcinoma

Not reported

Guided self-help mindfulness-based intervention (GSH-MBI)

N/A

Waiting list control (CG)

HADS

Sig reduction in distress post intervention p < 0.001

Effect sizes:

T2: d = -0.49 P < 0.01 (small);

CI: -3.13, -0.51

T3: d = -0.60 P < 0001 (mod); 95% CI: -3.44, -0.89

 Milbury, K [45]

2020

A Mindfulness-Based Intervention as a Supportive Care Strategy for Patients with Metastatic Non-Small Cell Lung Cancer and their Spouses: Results of a Three-Arm Pilot Randomized Controlled Trial

RCT

150 (75 patients and 75 spouses)

Metastatic non-small cell lung cancer

Y

Couple-based meditation (CBM)

Supportive-expressive intervention (SE)

Usual Care (UC)

IES

Not sig

 Ng, CG [46]

2016

The Effect of 5 Minutes of Mindful Breathing to the Perception of Distress and Physiological Responses in Palliative Care Cancer Patients: A Randomized Controlled Study

RCT

60

Any site

Y

Mindful Breathing (MB)

N/A

Normal Listening (Control)

DT

Sig reduction in distress post-intervention and 10 min after (T3) p < 0.01

Effect size:

T3: d = -0.77 (mod)^a

CI: -0.146, -1.954^b

 Park, S [47]

2020

Mindfulness-Based Cognitive Therapy for Psychological Distress, Fear of Cancer Recurrence, Fatigue, Spiritual Well-Being, and Quality of Life in Patients with Breast Cancer a Randomized Controlled Trial

RCT

74

Stage I-III breast cancer

N

Mindfulness-based cognitive therapy (MBCT)

N/A

Wait-list control

HADS (TMD)

Sig reduction in distress post-intervention p < 0.001

Effect sizes:

T1: d = -1.17 (large)

CI: -1.67, -0.68^b

T2: d = -1.03 (large)

CI: -1.51, -0.54^b

 Schellekens, MPJ [48]

2017

Mindfulness-based stress reduction added to care as usual for lung cancer patients and/or their partners: A multicentre randomized controlled trial

RCT

63 patients, 44 partners

Lung:

non-small cell

Small cell

Mesothelioma -

Y

Mindfulness-based stress reduction (MBSR) + Care as Usual (CAU)

N/A

CAU (control)

HADS

Sig reduction in distress p = 0.008 post intervention

Effect size:

CAU + MBSR: d = -0.69 (mod); CI:- 0.18, -1.19

 Wurtzen, H [49]

2015

Effect of mindfulness-based stress reduction on somatic symptoms, distress, mindfulness and spiritual wellbeing in women with breast cancer: Results of a randomized controlled trial

RCT

336

Breast cancer stage I-III

N (Stage I-III)

Mindfulness-based stress reduction (MBSR)

N/A

Usual care

SCL-90r

Sig reduction in distress post-intervention (p = 0.01), 6 months p < 0.001 and 12 months (p = 0.04)

Effect size: d = -0.43 (small)

CI not calculated as no SDs provided

Talking/communication/CBT/group therapies

 Acevedo-Ibarra, JN [50]

2019

Cognitive Behavioral Stress Management intervention in Mexican colorectal cancer patients: Pilot study

RCT

94 randomised

Colorectal cancer

N

CBSM

N/A

PE

HADS

Not sig

 Andersen, BL [51]

2007

Distress reduction from a psychological intervention contributes to improved health for cancer patients

RCT

227

Breast cancer

Stage II (90%)

Stage III (10%)

Not reported

Coping strategies, muscle relaxation training, effective use of social support

N/A

Assessment only

POMS TMD

A sig 3-way interaction was found at 12-months depending upon initial levels of Cancer Stress p < 0.05. Sample and data same as Andersen (2004) below

 Andersen, BL [52]

2004

Psychological, Behavioral, and Immune Changes After a Psychological Intervention: A Clinical Trial

RCT

227

Breast cancer stage II/III

N

Psychological intervention

N/A

Assessment only

POMS

POMS sig at p < 0.05. Sig 3-way interaction (P = .03). POMS TMD decr more in intervention arm than assessment arm (p = .04) for subjects with high initial cancer stress

Full data not provided

 Boesen, EH [53]

2011

Psychosocial group intervention for patients with primary breast cancer: A randomised trial

RCT

205

Breast cancer stage I-III

Y (in some pts)

Existential-cognitive group therapy

N/A

Not stated—assume treatment-as-usual

POMS

Not sig

 Boesen, EH [54]

2005

Psychoeducational Intervention for Patients with Cutaneous Malignant Melanoma: A Replication Study

RCT

262

Cutaneous Malignant Melanoma

Y (various)

Group healthcare info and advice with relaxation and guided imagery in groups/at home

N/A

Control group

POMS

Not sig

 Chambers, SK [55]

2018

Web-Delivered Cognitive Behavioral Therapy for Distressed Cancer Patients: Randomized Controlled Trial

RCT

163

Not recorded

CancerCope programme

N/A

Patient education website

BSI-18 and IES

Sig reduction in psych distress p = 0.04 and cancer- specific distress p = 0.02 at 8 weeks (not sig on ITT analysis)

Effect size: d = 0.63 (mod): for cancer-specific distress

CI: 0.15, 1.10

 Hejazi, F [56]

2017

The Effect of a Communicational Program on Psychological Distress in the Elderly Suffering from Cancer

RCT

64

Any cancer

Not reported

Communicational program

N/A

Usual care

Kessler (K10)

Sig reduction in distress p < 0.001 post-intervention

Effect size:

d = –9.34^a (large)

CI: -12.97, -5.71^b

 Manne, SL [57]

2017

A Comparison of Two Psychological Interventions for Newly-diagnosed Gynecological Cancer Patients

RCT

352

Gynaecological cancers

Y—31% of full sample

Communication-enhancing intervention (CCI)

Supportive counselling intervention (SC)

Usual care (UC)

IES

Not sig

 Mertz BG [58]

2017

The effects of individually tailored nurse navigation for patients with newly diagnosed breast cancer: a randomized pilot study

RCT

50

Breast Cancer

Not reported

Screening and counselling (IG)

N/A

Standard care (CG)

DT

Sig reduction in distress at 12 months post-intervention p < 0.01

Effect sizes: 6 mth d = -0.38

CI: -1.95, 1.19 (not sig)

12 mth: d = -2.40 (large)^a

CI: -4.02, -0.78^b

 Taylor, K [59]

2003

Psychological Adjustment Among African American Breast Cancer Patients: One-Year Follow-Up Results of a Randomized Psychoeducational Group Intervention

RCT

73

Breast Cancer stage 0—IIIa

Not reported

Psychosocial support group

N/A

Control group

POMS, IES and MHI

Sig reduction in distress using POMS only (p < 0.24)

Effect size: authors gave “small” (no figures)

Data not provided to calculate confidence intervals

Screening or assessment only

 Braeken, APB [60]

2013

Psychosocial screening effects on health-related outcomes in patients receiving radiotherapy. A cluster RCT

Pragmatic Cluster RCT (Solomon four-group design)

568

Prostate/bladder, lung, breast, cervix/endometrium, rectum, non-Hodgkin’s

N 83.7%

Unknown 16.3%

Psychological screening instrument (Dutch screening inventory (SIPP))

N/A

Usual care

HADS

Not sig

 Carlson, LE [61]

2012

Online screening for distress, the 6th vital sign, in newly diagnosed oncology outpatients: RCT of computerised vs personalised triage

RCT

3133

All new cancers

Not reported

Computer Triage

N/A

Personalised Triage

DT

Sig reduction in distress p < 0.0001. Computer triage group had lower % participants with distress above the clinical cut-off (p < 0.05) at 3 months. Effect size: (gender and surgery subgroups: d < 0.15 (negligible)

 Carlson, LE [62]

2010

Screening for Distress in Lung and Breast Cancer Outpatients: A Randomized Controlled Trial

RCT

1134

New breast or lung cancer

Y

Full Screening

Triage (full screening + included optional telephone triage)

Minimal screening (DT + usual care)

DT

Triage group had sig lower distress at 3 months (p = .031), controlling for baseline distress. Effect size: Full screen vs min screen d = 0.39 (small)^a

CI: -0.88, 0.10^b

Triage vs min screen

d = -0.56^a CI: -1.06, -0.06^b

 Oerlemans, S [63]

2021

Web-Based Return of Individual Patient-Reported Outcome Results Among Patients with Lymphoma: Randomized Controlled Trial

RCT

227

Any lymphoma

Y

Return of patient reported outcome (PRO) results

PRO + living with lymphoma

Care as Usual (CAU)

HADS

Not sig

 O'Hea, E [64]

2020

Impact of the mental health and dynamic referral for oncology (MHADRO) program on oncology patient outcomes, health care utilization, and health provider behaviors: A multi-site randomized control trial

RCT

836

Any cancer

Not reported

MHADRO + DR + provider report

N/A

MHADRO only

DT

Not sig

Expressive or creative writing

 de Moor, C [65]

2002

A Pilot Study of the Effects of Expressive Writing on Psychological and Behavioral Adjustment in Patients Enrolled in a Phase II Trial of Vaccine Therapy for Metastatic Renal Cell Carcinoma

Other: Random assignment using minimization

42

Metastatic Renal Cell Carcinoma

Y

76.2% had 2 or more metastases

Expressive Writing (IG)

N/A

Neutral Writing (CG)

IES

Not sig

 Mosher, CE [66]

2012

Randomised trial of expressive writing for distressed metastatic breast cancer patients

RCT

90 baseline interviews. 87 randomised

Stage IV breast cancer

Y

Expressive writing

N/A

Neutral writing

DT

Not sig

 Nesterova, D [67]

2022

Group-led creative writing and behavioural health in cancer: a randomised clinical trial

RCT

60

Any stage cancer

Y—Stage IV 38%

Creative Writing Workshop (CWW)

N/A

Active control (AC)

Emotion thermometer Scale (ETS)

Sig reduction in distress p < 0.0001. Withdrawal rate was high, reducing study power. Effect sizes not calc – no SDs provided. Distress in CWW group p = 0.0346

CI: -4.31, -2.47 (large)

 Stanton, AL [68]

2002

Randomized, Controlled Trial of Written Emotional Expression and Benefit Finding in Breast Cancer Patients

RCT

63

Stage I or II breast cancer

N

EMO

POS

CTL

POMS and own ‘distress index’

Not sig

Psychological and psychosocial therapies

 Clark, PG [69]

2010

Decreasing Psychological Distress in Cancer Inpatients Using FLEX Care®: A Pilot Study

Other: Pre-post control group study

35

Any cancer diagnosis

Not clear

17.1% Stage IV

60% Stage not known

FLEX psychological intervention

N/A

Routine psychological intervention

BSI-18

Sig at p = 0.001 but small sample size and attrition of 26% resulted in an underpowered study and therefore effect sizes were not calculated

 Mahendran, R [70]

2015

Efficacy of a brief nurse-led pilot psychosocial intervention for newly diagnosed Asian cancer patients

Quasi-experimental pilot study with patient self-selection of study group

121

Newly diagnosed first cancer

N

Brief nurse-led psychosocial intervention programme

N/A

Treatment as usual

DT

Sig reduction in distress p = 0.001 but at baseline intervention group had sig higher distress than control and therefore effect sizes are not meaningful

 Semple, CJ [71]

2009

Development and evaluation of a problem-focused psychosocial intervention for patients with head and neck cancer

Quasi-experimental design patients self-selecting study group

54

Head and Neck Cancer

Y

Psychosocial (IG)

N/A

Usual Care (CG)

HADS

Sig in distress using HADS anxiety and depression scales (p = 0.001 and p = 0.005 respectively)

Effect size:

Anxiety d = -0.21 (small)^a

CI: -3.53, 3.11^b

Depression d = -1.5 (large)^a

CI: -4.04, 1.04^b

 Wang, S [72]

2020

A Psychological Nursing Intervention for Patients with Thyroid Cancer on Psychological Distress and Quality of Life

RCT

268

Thyroid cancer

Y

Psychological nursing intervention (IG)

N/A

Routine care (CG)

POMS and HADS

Sig decrease in POMS TMD at 4 weeks p = 0.03 but not at 8 weeks (p = 0.08)

Effect sizes:

8 weeks d = -0.2485 (small)^a

CI: -0.4811, -0.0158^b

Dignity Therapy

 Chochinov, HM [73]

2011

Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a RCT

RCT

441

Terminal cancer life expectancy ≤6 months

Y

Dignity Therapy (DT)

Client-Centred Care (CT)

Standard Care (SC)

Palliative Performance Scale,

PDI, HADS

Not sig

 Hall, S [74]

2011

A novel approach to enhancing hope in patients with advanced cancer: a randomised phase II trial of dignity therapy

RCT

45

Any advanced cancer

Not reported

Dignity therapy

N/A

Control group (usual care)

PDI

Not sig

 Li, Y-C [75]

2020

The Effectiveness of Dignity Therapy as Applied to End-of-Life Patients with Cancer in Taiwan: A Quasi-Experimental Study

Other: quasi experimental non RCT

30

Any end-stage cancer

Y

Dignity Therapy

N/A

Control group

PDI

Not sig

 Vuksanovic, D [76]

2017

Dignity Therapy and Life Review for Palliative Care Patients: A Randomized Controlled Trial

RCT

70

Terminal disease

Not reported

Dignity Therapy (DT)

Life Review (LR)

Waitlist Control (WC)

PDI

Not sig

Web-based or mobile app interventions

 Çınar, D [77]

2021

Effect of mobile phone app-based training on the quality of life for women with breast cancer

Other: Randomised pre-post-test design

64

Non-metastatic breast cancer

N

Mobile app-based education (IG)

N/A

Control group—assessment only (CG)

DT

Sig reduction in distress at 12 weeks (p < 0,05). ANOVA significant (F = 11,214, p = 0,001)

Effect size: d = -0.56 (mod)

CI: -1.0635, -0.0638

 de Hosson, LD [78]

2019

Web-based personalised information and support for patients with a neuroendocrine tumour: RCT

RCT

105

NET

Not reported

Web-based, personalised information and support system (WINS)

N/A

Standard Care

DT

Not sig

 Salzer, MS [79]

2010

A randomized, controlled study of Internet peer-to-peer interactions among women newly diagnosed with breast cancer

RCT

78

Breast cancer stage I-II

N

Internet peer support (IG)

N/A

Internet-based control condition (CG)

HSCL-25 and IES

Not sig

Life Review

 Chen, Y [80]

2020

Effects of a mind map-based life review programme on psychospiritual well-being in cancer patients undergoing chemotherapy: A RCT

RCT

84

Cancer (any)

Y 88.09%

N 11.91%

Mind map-based life review programme (MBLRP) + routine care

N/A

Routine care

DT

Not sig

 Sun, FK [81]

2021

The Effects of Logotherapy on Distress, Depression, and Demoralization in Breast Cancer and Gynecological Cancer Patients

Other: Quasi experimental (pre-test, post-test)

64

Breast, ovarian, cervical or endometrial cancer

Unclear

22% stage 3 or above

Logotherapy

N/A

Control—education session

DT

Not sig

 Xiao, H [82]

2013

Effect of a Life Review Program for Chinese Patients with Advanced Cancer

RCT

80

Advanced cancer of any type

Y

Life Review Programme

N/A

Control group

QoL existential distress subscale

Not sig

Problem-solving approaches, education and information

 Nezu, AM [83]

2003

Project Genesis: Assessing the Efficacy of Problem-Solving Therapy for Distressed Adult Cancer Patients

RCT

150

Cancer

N

Problem-solving therapy (PST)

PST for patient and significant other PST-SO)

Waiting-list control (WLC)

POMS

Sig reduction in distress at 6 months and 1-year post-intervention p < 0.001

Effect size: d = 2.17 (large) patients only

d = 2.04 (large) for patients + significant other (p < 0.001). Rate of improvement = 67% and 59% respectively

 Passalacqua, R [84]

2009

Prospective, Multicenter, Randomized Trial of a New Organizational Modality for Providing Information and Support to Cancer Patients

Other: pragmatic, two-arm cluster randomized trial

38 oncology centres and 3,197 patients

Any cancer

Not reported

Point of Information and Support (PIS)

N/A

No PIS

HADS

Not sig

 Sandgren, AK [85]

2007

Long-term telephone therapy outcomes for breast cancer patients

RCT

218

Breast cancer: stages I-III

N

Health education therapy (IG1)

Emotional expression therapy (IG2)

Control group (CG)

POMS

Sig reduction in distress at 0–6 months and 6–13 months in ALL groups including control. Therefore, no significant intervention effect

Couples’ (dyadic) therapies

 Manne, SL [86]

2019

Couple-focused interventions for men with localized prostate cancer and their spouses: A randomized clinical trial

RCT

237

Localised prostate cancer

N

Intimacy enhancing therapy (IG1)

General health and wellness intervention (IG2)

Usual care CG

IES

Not sig

 Manne, SL [87]

2016

A Randomized Clinical Trial of a Supportive versus a Skill-Based Couple-Focused Group Intervention for Breast Cancer Patients

Other: Randomised clinical trial, no usual control group

302 couples (604 people)

Breast cancer

N (up to stage 3a)

Couples-focused support group (ECG)

Support Group (SG)

No control group

IES

Sig reductions in distress for SG group for most distressed pts. Sig reductions in distress in ECG group for less distressed pts (p < 0.01). Effect sizes: given as between d = 0.29 and 0.55 (small – moderate) [CIs not given]

Physical Therapies

 Araújo, RV [88]

2021

Effect of Raja Yoga Meditation on the Distress and Anxiety Levels of Women with Breast Cancer

RCT

50

Breast cancer

Y

Raja Yoga meditation

N/A

Educational activity

DT

Sig reduction in distress post-intervention p < 0.001 Effect size: d = 1.49 (large)

[CIs not given]

 Kovacic, T [89]

2011

Impact of Relaxation Training According to Yoga in Daily Life® System on Perceived Stress After Breast Cancer Surgery

RCT

32

Breast cancer stage I or II

N (Stage III and IV excluded)

Physiotherapy plus Yoga in Daily Life (YIDL)

N/A

Standard physiotherapy

RSCL (psych subscale) and GHQ-12

Sig reduction in distress at 4 weeks using RSCL p < 0.0005. GHQ-12 sig at p < 0.05. Effect sizes:

GHQ-12: d = -17.57^a

CI: -20.13, -15.01 (large)^b

RSCL = -16.50^a

CI: -18.37, -14.63 (large)^b

Art or music therapies

 Hanser, SB [90]

2006

Effects of a Music Therapy Intervention on Quality of Life and Distress in Women with Metastatic Breast Cancer

RCT

70

Metastatic breast cancer

Y

Music Therapy (MT)

N/A

Usual care

HADS

Not sig

 Radl, D [91]

2018

The effects of Self-Book© art therapy on cancer-related distress in female cancer patients during active treatment: A randomized controlled trial

RCT

60

Any cancer site

Stage IV

Self-Book—30%

Standard care—20%

Self-book

N/A

Standard care

DT

Not sig

Others (uncategorised)

 Eychmüller S [92]

2021

Single early palliative care intervention added to usual oncology care for patients with advanced cancer: A randomized controlled trial (SENS Trial)

RCT

150

Lung, colorectal, prostate, breast, urothelial, pancreatic

Metastatic 99%

Usual care 97%

Early palliative care intervention (IG)

N/A

Usual care (CG)

DT

Not sig

 Ferrell, B [93]

2021

A Palliative Care Intervention for Patients on Phase 1 Studies

RCT

479

Solid tumour cancer

Not reported

Palliative care intervention

N/A

Usual care

DT

Sig reduction in distress at site 1 (-2.03 points on scale p < 0.001) but not at site 2 (-0.26 points, p = 0.80) but site 1 nurses were more experienced

 Grégoire, C [94]

2018

Efficacy of a hypnosis-based intervention to improve well-being during cancer: a comparison between prostate and breast cancer patients

CCT

92 breast and 42 prostate—total = 138

Non-metastatic breast or prostate cancer

N

Self-hypnosis/self-care (SH)

N/A

Usual care

HADS anxiety and depression

Prostate: not sig

Breast: Sig reduction in distress p = 0.031. Group sig reductions p = 0.023 (but women had higher scores at baseline)

Effect sizes:

d = 0.66 anxiety (mod) d = 0.47 depression (low)

 Grégoire, C [95]

2017

Group interventions to reduce emotional distress and fatigue in breast cancer patient: a 9-month follow-up pragmatic trial

CCT; Pragmatic design

138

Non-metastatic breast cancer

N

Yoga

Self -hypnosis/self care

CBT and 4th group Control (usual care)

HADS

Not sig for CBT. Sig for self-hypnosis (anxiety and depression) (both p = 0.000) and yoga (anxiety only) (p = 0.024) with sig time- effects as well

Effect sizes: NOT GIVEN

 Han, X-B [96]

2021

Efficacy of combined naikan and morita therapies on psychological distress and posttraumatic growth in Chinese patients with advanced cancer. A randomized controlled trial

RCT

130

Stage III or IV breast, lung, colorectal or renal cancer

Stage IV

Treatment 30.77%

Control 27.69%

Naikan/Morita program

N/A

Usual Care control (CG)

DT

Sig at p < 0.001 at immediate post-treatment

Effect sizes:

d = -2.39 (large)^a

CI: -2.86, -1.92

 Schuurhuizen CSEW [97]

2019

Screening and Stepped Care Targeting Psychological Distress in Patients with Metastatic Colorectal Cancer: The TES Cluster Randomized Trial

Other: Cluster RCT

349

Metastatic colorectal cancer

Y

Screening and Stepped Care (TES) programme

N/A

Care as Usual (CAU)

HADS

Not sig

 Young, JM [98]

2013

Multicenter Randomized Trial of Centralized Nurse-Led Telephone-Based Care Coordination to Improve Outcomes After Surgical Resection for Colorectal Cancer: The CONNECT Intervention

RCT

775

Colorectal cancer

Y

CONNECT telephone intervention

N/A

Usual care

FACT-C and DT

Not sig

 Young, J [99]

2010

Development and feasibility assessment of telephone-delivered supportive care to improve outcomes for patients with colorectal cancer: pilot study of the CONNECT intervention

Other: Prospective non-randomised trial

41

Colorectal cancer

Y

CONNECT intervention

N/A

Control group

FACT-C and DT

Not sig