Psychological and psychosocial interventions in patients with lung cancer: A meta-analysis of randomised controlled trials and trial sequential analysis.

Lung cancer carries a heavy psychological burden, yet whether psychological and psychosocial interventions meaningfully improve outcomes in this population, and whether the accumulated evidence is sufficient, remains unconfirmed. We searched seven databases from inception to August 2025 for randomised controlled trials, pooled effects using random-effects meta-analysis with robust variance estimation for dependent effect sizes, appraised bias with Cochrane RoB 2.0, explored heterogeneity through moderator analyses, and applied trial sequential analysis (TSA). Across 46 trials (5309 participants), interventions reduced anxiety (Hedges' g = -0.53), depression (g = -0.42), stress (g = -0.44), fatigue (g = -0.52), pain (g = -0.39), self-perceived burden (g = -1.33) and sleep problems (g = -1.28), and improved dyspnoea (g = 0.40), quality of life (g = 0.39), well-being (g = 0.39), coping (g = 0.45), self-efficacy (g = 0.47), self-management efficacy (g = 0.82), pulmonary function (g = 0.69) and physical functioning (g = 0.51), with several gains sustained at follow-up. Moderator analyses favoured more frequent delivery and shorter sessions (≤60 min). Heterogeneity was substantial for several outcomes, and small-study effects were detected for anxiety, depression, stress and quality of life; trim-and-fill attenuated but did not abolish these effects (adjusted g = -0.33 and -0.32 for anxiety and depression). TSA showed that the cumulative Z-curve crossed the conventional significance boundary for every outcome tested, but the required information size was not reached. Psychological and psychosocial interventions are therefore associated with benefits across psychological, symptom, sleep, behavioural and functional domains in adults with lung cancer; evidence is most consistent for anxiety, depression, stress and quality of life. Adequately powered trials remain necessary, alongside optimisation of intervention dose, timing, delivery mode and patient targeting.