Psychosocial interventions for children and adolescents across the cancer care continuum: A systematic review and meta-analysis.

PURPOSE: To evaluate the impact of psychosocial interventions on health outcomes among children and adolescents (0-19 years) living with cancer across the care continuum, specifically on (1) neurocognitive, (2) psychological, and (3) health-related quality of life (HRQOL) outcomes. METHODS: Five electronic databases (APA PsycINFO, CINAHL, MEDLINE, Scopus and the Cochrane Central Register of Controlled Trials [CENTRAL]) were searched with no date restrictions, supplemented by backward citation chaining of the reference lists of included studies and relevant systematic reviews. All identified citations were imported into Covidence systematic review software for the removal of duplicate records and the study selection process by two reviewers. Methodological quality and meta-analyses were performed. RESULTS: Two thousand nine hundred sixty-one articles were identified, and 34 studies were included. The studies were conducted in 17 countries and representative of 1988 participants. Studies investigating the effects of cognitive interventions demonstrated a significant positive effect on neurocognitive outcomes (SMD: 0.51 [95% CI: 0.32, 0.69]; I2 = 0%, p < 0.01). Play and creative therapies, animal assistance therapy, self-management education, and physical activity were associated with a significant overall improvement in psychological outcomes (SMD: 0.42 [95% CI: 0.17, 0.68]; I2 = 70.1%, p < 0.01). Animal assistance therapy, play and creative therapies, and physical activity interventions led to a significant improvement in quality-of-life outcomes (SMD: 0.80 [95% CI: 0.48, 1.11]; I2 = 87.1%, p < 0.01). CONCLUSIONS: Psychosocial interventions improved neurocognitive, psychological, and HRQOL outcomes in children and adolescents with cancer, with the most consistent benefits for neurocognition (working memory), anxiety, and pain; effects on depression, coping, self-worth, fatigue and global HRQOL were not significant. Future trials should identify optimal intervention timing, dosage and delivery format, and stratify outcomes by age, diagnosis, and treatment intensity. IMPLICATIONS FOR CANCER SURVIVORS: These findings suggest the promise of interventions for improving neurocognitive, psychological, and HRQOL outcomes in children and adolescents affected by cancer, while also highlighting substantial evidence gaps, particularly for early targeted approaches in the cancer care continuum.