Background: Depression and anxiety are common and debilitating in people with cancer and may adversely affect treatment adherence, quality of life, and medical outcomes. Cognitive Behavioral Therapy (CBT) is a widely recommended psychosocial intervention. While its effectiveness across cancer types and delivery formats has been well studied, this meta-analysis uniquely explores how CBT outcomes vary by geographic region and income level.
Objective: This meta-analysis evaluated the overall effectiveness of CBT in reducing depression and anxiety in people with cancer and examined moderators that may influence treatment outcomes.
Methods: A systematic review of 52 randomized controlled trials (RCTs), including 9,151 participants, was conducted. Random-effects meta-analyses were used to calculate standardized mean differences (SMDs). Subgroup analyses assessed variations by CBT format, delivery mode, cancer type and stage, region, country income level, and comparator type.
Results: CBT reduced both depression (SMD = -1.16) and anxiety (SMD = -0.75) compared to control groups, which included standard care, waitlist, active interventions, and pretest conditions. Improvements were maintained at follow-up (SMD = -0.65), based on the longest available follow-up time point in each study (up to 12 months). Adapted CBT (i.e. CBT tailored to cancer-specific concerns) was associated with larger reductions in symptoms (SMD = -1.17), as were individually delivered CBT (SMD = -2.83) and interventions targeting adults with breast cancer (SMD = -1.30). Regional subgroup analyses showed the largest symptom reductions in North America (SMD = -1.97), followed by Africa (SMD = -1.69) and Asia (SMD = -0.91), indicating geographic variation in symptom improvement. Heterogeneity was substantial (I2 > 90).
Conclusions: CBT reduces depression and anxiety in people with cancer, with improvements that are maintained over time and vary by delivery method, cancer type, and geographic setting. These findings support integrating tailored CBT programs into cancer care, particularly in high-need and resource-limited populations.
Keywords: Cognitive Behavioral Therapy; anxiety; cancer; depression; meta-analysis; psychosocial oncology; randomized controlled trials.