Acta medica Lituanica ISSN 1392-0138 eISSN 2029-4174

2026. Vol. 33. No 1, pp. 58–73 DOI: https://doi.org/10.15388/Amed.2026.33.1.5

Effects of Psychological Interventions on Depression Symptoms in Oncology Patients: A Systematic Review

Ignas Lapeikis*
Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania
E-mail: ignas.lapeikis@stud.lsmu.lt
ORCID ID https://orcid.org/0009-0003-9520-390X

Ieva Armonaitė
Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania
E-mail: armoieva@gmail.com

Vakarė Baranauskytė
Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania
E-mail: vakare.baranauskyte@stud.lsmu.lt
ORCID ID https://orcid.org/0009-0002-4359-8586

Irina Banienė
Lithuanian University of Health Sciences, Department of Health Psychology, Kaunas, Lithuania
E-mail: irina.baniene@lsmu.lt

Abstract. Background: Depression is one of the most common psychological comorbidities among cancer patients and contributes substantially to a reduced quality of life and impaired treatment adherence. A range of psychosocial interventions have been proposed to address depressive symptoms in oncology, but evidence across intervention types remains heterogeneous.
Aim: To evaluate the effectiveness of psychological interventions in reducing depressive symptoms among cancer patients.
Methods: A systematic search of PubMed, ScienceDirect, Web of Science, and Clinical Key databases was conducted for studies published between 2016 and 2026. Randomized controlled trials and controlled intervention studies assessing psychological interventions for depressive symptoms in adult cancer patients were included. Data on the study design, patient characteristics, intervention type, depression assessment scales, and outcomes were extracted. Due to heterogeneity in interventions and outcome measures, the findings were synthesised narratively.
Results: Twenty studies met the inclusion criteria. Interventions included cognitive behavioural therapy (CBT), mindfulness-based interventions (MBIs), mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), and positive psychology approaches. Most studies reported significant reductions in depressive symptoms measured by using validated scales such as PHQ-9, HADS, BDI, and SDS. CBT- and mindfulness-based approaches demonstrated the most consistent improvements, although several trials reported no significant differences compared with control groups.
Conclusions: Psychological interventions, and particularly CBT- and mindfulness-based approaches, are associated with reductions in depressive symptoms among cancer patients. However, substantial heterogeneity in the intervention design and outcome reporting limits direct comparison across studies. Further large-scale randomized trials using standardised outcome measures are needed to establish optimal psychosocial treatment strategies in oncology.
Keywords: cancer, depression, psycho-oncology, psychological interventions, cognitive behavioural therapy, mindfulness, systematic review.

Psichologinių intervencijų poveikis onkologinių pacientų depresijos simptomams: sisteminė literatūros apžvalga

Santrauka. Įvadas: Depresija yra viena iš dažniausių vėžiu sergančių pacientų psichologinių gretutinių ligų ir reikšmingai prisideda prie prastesnės gyvenimo kokybės bei blogesnio gydymo laikymosi. Onkologijoje depresijos simptomams mažinti taikomos įvairios psichosocialinės intervencijos, tačiau skirtingų intervencijų rūšių įrodymai išlieka heterogeniški.
Tikslas: Įvertinti psichologinių intervencijų veiksmingumą mažinant vėžiu sergančių pacientų depresijos simptomus.
Metodai: Atlikta sisteminė paieška „PubMed“, „ScienceDirect“, „Web of Science“ ir „ClinicalKey“ duomenų bazėse, įtraukiant 2016–2026 m. publikuotus tyrimus. Įtraukti atsitiktinių imčių kontroliuojami tyrimai ir kontroliuojami intervenciniai tyrimai, kuriuose vertintos psichologinės intervencijos, skirtos suaugusių vėžiu sergančių pacientų depresijos simptomams mažinti. Buvo renkami duomenys apie tyrimo dizainą, pacientų charakteristikas, intervencijos tipą, depresijos vertinimo skales ir rezultatus. Dėl intervencijų ir baigčių vertinimo priemonių heterogeniškumo rezultatai apibendrinti naratyviniu būdu.
Rezultatai: Įtraukimo kriterijus atitiko dvidešimt tyrimų. Intervencijos apėmė kognityvinę elgesio terapiją (KET), dėmesingo įsisąmoninimo principais grįstas intervencijas, dėmesingu įsisąmoninimu grįstą streso mažinimą, dėmesingu įsisąmoninimu grįstą kognityvinę terapiją ir pozityviosios psichologijos metodus. Daugumoje tyrimų nustatytas reikšmingas depresijos simptomų sumažėjimas, vertintas validuotomis skalėmis, tokiomis kaip PHQ-9, HADS, BDI ir SDS. KET ir dėmesingo įsisąmoninimo metodais grįstos intervencijos parodė nuosekliausią pagerėjimą, nors keliuose tyrimuose reikšmingų skirtumų, palyginti su kontrolinėmis grupėmis, nenustatyta.
Išvados: Psichologinės intervencijos, ypač KET ir dėmesingo įsisąmoninimo metodais grįstos intervencijos, yra susijusios su vėžiu sergančių pacientų depresijos simptomų sumažėjimu. Tačiau reikšmingas intervencijų dizaino ir rezultatų pateikimo heterogeniškumas riboja tiesioginį tyrimų palyginimą. Reikia tolesnių didelės apimties atsitiktinių imčių tyrimų, taikant standartizuotas baigčių vertinimo priemones, siekiant nustatyti optimalias psichosocialinio gydymo strategijas onkologijoje.
Raktažodžiai: vėžys, depresija, psichoonkologija, psichologinės intervencijos, kognityvinė elgesio terapija, dėmesingo įsisąmoninimo praktikos, sisteminė apžvalga.

___________

* Corresponding author

Received: 11/10/2025. Revised: 08/12/2025. Accepted: 28/04/2026
Copyright © 2026 Ignas Lapeikis, Ieva Armonaitė, Vakarė Baranauskytė, Irina Banienė. Published by Vilnius University Press.This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Introduction

Cancer is one of the leading causes of premature death globally, particularly among individuals aged 30–70 years. For every 10 persons who die prematurely due to non-communicable diseases, three die of cancer [1]. Worldwide, the 5-year prevalence of all cancers is estimated at 50.5 million people [2].

Mental comorbidities, particularly depression, are common among individuals diagnosed with cancer [3]. A meta-analysis of 94 interview-based studies reported that depression affects approximately 16% of patients at any stage of treatment [4]. In breast cancer, pooled prevalence rates are even higher, with depressive symptoms observed in 20–24% of patients [5]. Psychological symptoms in oncology populations are frequently under-recognized and under-treated, as emotional distress is often interpreted as a normal reaction to diagnosis or attributed to physical disease-related symptoms [2].

Beyond its impact on the quality of life, depression may influence oncological outcomes [6]. A meta-analysis including more than 2.6 million individuals demonstrated that depression and anxiety were associated with a 13% increased risk of cancer incidence and a 21–24% higher cancer-specific mortality [7]. In breast cancer specifically, depression was associated with a 30% increase in all-cause mortality and a 24% increase in recurrence [8]. While causality remains debated, these associations are clinically significant.

The proposed biological mechanisms include dysregulation of the hypothalamic–pituitary–adrenal axis, immune suppression, and elevated inflammatory cytokines such as interleukin-6 and C-reactive protein [9,10]. Psychological distress is also correlated with poorer adherence to anticancer treatments and delays in seeking care, thus further compromising prognosis [11].

Psychosocial and psychiatric interventions, including cognitive behavioural therapy, mindfulness-based stress reduction, and structured exercise programs, have demonstrated efficacy in reducing depressive symptoms among cancer patients [12–14]. Accordingly, this systematic review aims to evaluate and synthesize existing evidence on the effectiveness of stress-reducing psychological interventions in reducing depression symptoms among adult patients with distinct types of cancer. In contrast to prior meta-analyses that have often been limited to specific cancer types due to methodological constraints [15–17], this systematic review allows inclusion of more diverse oncology populations and provides a broader synthesis of available evidence.

Objectives

1. To analyse the characteristics and severity of depression symptoms among cancer patients, considering disease diagnosis, stage, treatment modality, and sociodemographic factors.
2. To analyse different psychological intervention types and their effectiveness in reducing the severity of depression symptoms among cancer patients.

Materials and Methods

Search Strategy

This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 

A comprehensive literature search was performed in four major medical databases: PubMed, ScienceDirect, Web of Science, and Clinical Key. The search covered the period from January 1, 2016, to February 1, 2026, to ensure that only contemporary evidence was included. The search strategy employed a combination of keywords and Boolean operators, including primary keywords like psychological interventions, depression, psychological distress, cancer patients, oncology. Boolean combinations: (psychological interventions OR psychotherapy OR cognitive behavioural therapy OR mindfulness) AND (depression OR psychological distress) AND (cancer patients OR oncology). Relevant Medical Subject Headings (MeSH) terms were also applied to enhance search sensitivity.

Eligibility Criteria

The inclusion criteria for this study were: 1) studies that focused on adult cancer patients aged 18 years or older, 2) published in English, and with open access to full-text versions being provided, 3) randomized controlled trials, cohort studies, and case-control studies evaluating psychological interventions and their effects on depression in oncology patients were considered. The study’s exclusion criteria were as follows: 1) case reports, conference abstracts, editorials, or commentaries, 2) studies lacking clearly defined depression outcomes, 3) articles in languages other than English, 4) literature reviews or meta-analyses, 5) studies with inaccessible full text.

The selection process involved an initial screening of titles and abstracts in order to remove duplicates and clearly irrelevant studies. Four reviewers independently assessed the full texts of potentially eligible articles, and any disagreements were resolved through discussion until consensus was reached. 

Data Extraction and Management

For each included study, information was systematically extracted, including the authors and publication year, the study design, aim, population (age, cancer type and stage, and treatment modalities), the type of psychological intervention, psychological outcomes (depression levels and the assessment tools applied), as well as the main findings and the risk of bias. 

To assess the methodological quality, the Newcastle–Ottawa Scale (NOS) was used for cohort, and case-control studies and Cochrane RoB 2.0 tool for RCT. Quality assessments were conducted independently by four reviewers, and discrepancies were resolved through discussion. Data synthesis was primarily narrative, by summarizing the key findings across the included studies. 

Before the first screening phase, 478 records were excluded because of other reasons (titles did not contain any relevant keywords related to psychological intervention, depression, or oncology), and 38 duplicates were removed. The remaining 355 abstracts were independently reviewed by four investigators. After assessing their relevance and methodological suitability, 51 articles were excluded because they were in languages other than English, and 183 were removed due to an inaccessible full text. Out of 121 full-text articles, 57 were removed due to not mentioning depression outcomes, and 44 were excluded as literature reviews or meta-analyses. 

Ultimately, 20 studies met all inclusion criteria and were included in the final analysis. The detailed selection process is illustrated in Figure 1.

Figure 1. PRISMA flow diagram. 871 articles were identified through database searching. After removal of duplicates, title and abstract screening and further full-text assessment, 20 articles were included in the analysis

Results

Study-level data were extracted into a structured spreadsheet by using a pre-specified extraction framework (Table 1). The extracted items included the study design, aim, sample characteristics (including the cancer type/stage – wherever reported), depression assessment method(s), intervention type, and the main depression-related findings. Where details were not reported in the extracted dataset (e.g., the cancer stage/type, outcome instrument, timing of assessments, randomisation procedures), these were recorded as ‘not reported’ (NR) and were treated as ‘unclear’ within risk-of-bias judgements.

Table 1. Summary of studies included in the systematic review (n=20)

The 20 included studies in the supplied order were: [18]–[37]. Specifically: [18] compared meaning-centred psychotherapy with CBT in a mixed cancer cohort; [19] compared three psychotherapy modalities in depressed women with breast cancer; [20] evaluated a brief CBT-based intervention (with mindfulness/ACT elements) in ovarian cancer; [21] tested computer-assisted CBT after laryngectomy; [22] evaluated MBCT in stage I–III breast cancer; [23] examined an internet stepped-care-intervention with a long follow-up; [24] tested MBSR in head and neck cancer; [25] evaluated online MBSR combined with music therapy; [26] assessed group CBT in breast cancer post-mastectomy; [27] tested a nurse-led positive psychology intervention in cervical cancer survivors; [28] evaluated online group psychotherapy for NSCLC with depression; [29] tested MBCT in breast cancer with a follow-up up to week 12; [30] described a mind–body and lifestyle programme; [31] evaluated MBSR and self-instructing MBSR in early-stage breast cancer; [32] reported an MBSR programme in metastatic breast cancer (with key details NR); [33] evaluated MBSR group counselling in non-metastatic breast cancer; [34] tested guided self-help mindfulness in breast cancer; [35] compared MBCT and CBT (cancer type/stage NR); [36] evaluated MBSR in newly diagnosed early-stage breast cancer (depression instrument NR); and [37] reported an observational pilot of MBSR during postoperative chemotherapy.

The total participants across all studies were n=2,166. Cancer populations were heterogeneous, dominated by breast cancer cohorts (early stage, metastatic, postoperative and chemotherapy settings) [19], [22], [26], [29], [31]–[34], [36], [37], with additional cohorts in ovarian cancer [20], cervical cancer [27], head and neck cancer [24], NSCLC [28], post laryngectomy laryngeal carcinoma [21], and mixed cancer cohorts [18], [23], [35]. Study designs were predominantly randomised, though nonrandomised and observational designs were also included [28], [30], [32], [37].

Risk of bias

Overall, most RCTs were judged as having some concerns of bias (Table 2), primarily due to unclear randomization procedures and reliance on self-reported outcomes. Non-randomized studies demonstrated a serious risk of bias related to confounding and selection bias.

Table 2. Risk of bias assessment of included studies

Outcome measures

Depression symptoms were assessed by using multiple validated instruments (Table 3), dominated by HADS (6 studies) [22], [23], [24], [29], [30], [31], and PHQ9 (5 studies) [20], [21], [26], [28], [34]. BDI was used in three studies [25], [33], [35], SDS in two [27], [37], and single studies used HAM-D (with BDI) [19] or ODSIS [18]. Two studies did not specify the depression instrument within the extracted dataset [32], [36]. This heterogeneity underpinned the decision to synthesise outcomes narratively rather than pool the effect sizes.

Table 3. Depression assessment scales used across the included studies

Psychological interventions and depressive symptoms

As pooled estimates were not available from the extraction dataset and depression outcomes varied by measure and analytic reporting, findings are summarised as a narrative synthesis across intervention types and clinical contexts.

In a mixed cancer cohort, meaning-centred psychotherapy and CBT were both associated with statistically significant improvements in depression, with no differential efficacy between the arms [18]. In depressed women with breast cancer, interpersonal psychotherapy, problem-solving therapy, and brief supportive psychotherapy each produced statistically significant improvements in depression, with similar effects across the modalities [19]. A brief CBT intervention including mindfulness/ACT elements in ovarian cancer was associated with PHQ-9 improvement in both intervention and control groups, with a statistically insignificant between-group effect on depression [20]. In contrast, computer-assisted CBT after laryngectomy was associated with statistically significant improvement in depressive symptoms compared with control (PHQ-9 reduction) [21]. In stage I–III breast cancer, MBCT produced significantly better outcomes in psychological distress compared with controls (HADS-based outcomes) [22]. An internet-based stepped care programme reduced depression from the baseline to 18 months but not at 24 months compared with controls [23]. MBSR reduced the depressive symptom severity compared with treatment as usual in stage I–IV head and neck cancer (HADS), with accompanying mediation analysis involving internalised stigma [24]. Online MBSR combined with music therapy reduced depression (BDI) and stress, and improved psychological well-being compared with controls, although cancer type and stage were not specified in the extraction dataset [25]. Group CBT in patients undergoing mastectomy for stage I–III breast cancer significantly reduced PHQ-9 depressive symptoms, with maintenance of effect to the third-month follow-up [26]. A nurse-led positive psychology intervention in early-stage cervical cancer survivors demonstrated statistically significant improvements in depression and well-being at 3 and 6 months compared with usual care (SDS) [27]. A pilot non-randomised trial of online group psychotherapy for NSCLC patients with depression reported unclear differences in depression outcomes between the intervention and control groups [28]. Another MBCT study reported improvements in mental health outcomes by week 8, with between-group differences persisting at week 12 (HADS) [29]. Two studies relevant to mind–body/MBSR approaches had key depression outcome details that were not extractable from the dataset [30], [32]. In early-stage breast cancer, an MBSR trial (with a self-instructing MBSR arm) reported significant improvement in depression scores versus nonMBSR- comparators (HADS) [31]. Conversely, MBSR group counselling in non-metastatic breast cancer found no significant between-group reduction in depression or perceived stress (BDI) [33]. Guided self-help mindfulness interventions produced significant improvements in depression (PHQ-9), with maintenance at a 1- and 3-month follow-up compared with wait-list controls [34]. In a further direct comparison, MBCT and CBT both reduced depression relative to control, with no significant between-group difference between MBCT and CBT [35]. A further MBSR trial in newly diagnosed early-stage breast cancer reported favourable trajectories in depressive symptoms (instrument NR in the extraction dataset) alongside improvements in stress/behavioural and immunological domains [36]. An observational pilot study during postoperative chemotherapy reported improvement in depression (SDS) within an MBSR programme compared with controls, though the non-randomised design limits causal inference [37].

Overall, across the intervention families, the direction of effect most often favoured intervention over control for depressive symptoms, but multiple studies reported null between the group effects or incomplete reporting, and findings varied by intervention intensity, delivery mode, and population [18]– [37].

Depression assessment instruments

Depression assessment was heterogeneous, limiting cross study comparability without pooling. The most frequently used instruments were HADS [22], [23], [24], [29], [30], [31], and PHQ9 [20], [21], [26], [28], [34]. BDI was used in several mindfulness and comparative psychotherapy studies [25], [33], [35], SDS was used in the positive psychology RCT and an observational chemotherapy pilot study [27], [37], and single studies used HAMD/BDI (paired) [19] or ODSIS [18]. Two studies did not report the depression instrument within the extracted dataset [32], [36]. Across studies, the use of both clinician-rated (HAMD) and self-report scales (e.g., PHQ9, HADS, BDI, SDS, ODSIS) implies differences in sensitivity to change and susceptibility to the expectancy and reporting effects.

Depression prevalence among cancer patients

The included evidence base is not designed to estimate the population level prevalence of depression in oncology, because most included studies are intervention trials (often with symptom/distress inclusion criteria) rather than epidemiological cohorts [18]–[37]. Nevertheless, the study samples demonstrate that a clinically relevant depressive symptom burden is common enough to support repeated trial recruitment across cancer settings. Some studies explicitly enrolled participants with depression or significant depressive symptoms (e.g., depressed women with breast cancer in a psychotherapy trial [19]; NSCLC patients with depression in a pilot intervention study [28]), which represents enriched samples and cannot be interpreted as prevalence in the underlying oncology population. Where trials enrolled broader oncology cohorts (commonly, breast cancer) without explicit depression case inclusion, depressive symptoms were typically evaluated as continuous outcomes rather than as prevalence estimates [18], [22], [23], [31], [36], [37].

Discussion

Principal interpretation

Across head-to-head psychotherapies and CBT-family interventions, most trials reported significant improvements in depressive symptoms, while consistent superiority of any single modality was uncommon [18–21]. Mindfulness-family interventions and stepped digital care similarly tended to favour intervention over control, but null findings occurred and durability was inconsistent, particularly where clinical characterisation or delivery intensity was limited [22–25].

Symptom-guided intervention

A pragmatic, symptom-guided approach may improve intervention ‘fit’ (Table 4). For post-mastectomy adjustment with behavioural withdrawal and low mood, group CBT showed sustained PHQ-9 improvement to three months [26]. In survivorship contexts where depressive symptoms co-occur with reduced well-being (including sexual health burden), nurse-led positive psychology improved depression at three and six months [27]. Where access constraints necessitate remote delivery, non-specialist online group psychotherapy showed uncertain between-group benefit in depressed NSCLC, supporting the need for engagement scaffolding and stepped escalation [28]. For rumination- and worry-dominant distress, MBCT showed short-term benefit on HADS-based outcomes [29]. Evidence for broader mind–body/lifestyle programmes was incomplete (NR for key depression effects), limiting inference [30]. For early-stage breast cancer with mood disturbance, structured MBSR approaches improved HADS-depression in some trials, whereas evidence in metastatic disease remains sparse and under-reported (NR) [31,32]. Divergent MBSR findings (including null effects) highlight probable moderation by baseline severity, dose, and adherence [33]. Low-intensity guided self-help mindfulness can reduce PHQ-9 depression with maintenance to three months and may suit patients with limited capacity for frequent appointments [34]. When fatigue is prominent alongside low mood, CBT and MBCT appear similarly effective for depression, suggesting symptom-cluster priorities can guide modality choice [35]. Some trials also reported improvements in stress-behavioural and immune-related trajectories alongside depressive symptom change, but observational designs during chemotherapy leave residual confounding [36,37].

Contextualisation with external evidence

Broader depression evidence supports scalability: behavioural activation delivered by less specialised staff was non-inferior to CBT and more cost-effective, aligning with task-sharing logic in oncology [38]. Cancer-specific syntheses and observational work indicate that depression correlates and needs vary by cancer site and treatment context, and comparative efficacy across psychotherapies is often modest, thus reinforcing a matched-care rather than a one-size-fits-all model [39–44]. Digital and blended approaches are feasible, but engagement is a key constraint; usage/adherence predicts outcome, and adjunctive modalities (e.g., hypnosis, dignity-focused work, music-based supportive care) may be appropriate for selected depressive presentations, though the trial quality and sample sizes remain limiting [45–49].

Limitations and implications

This review is limited by substantial heterogeneity in cancer populations, intervention dose/delivery, and depression instruments (including NR in some studies), thus precluding meta-analysis and complicating cross-study comparability. Risk of bias was frequently driven by incomplete reporting of randomisation/allocation, unblinded self-report outcomes, and non-randomised designs.

Table 4. Symptom-guided selection of psychological intervention families for depressive symptoms in oncology

Conclusion

This systematic review shows that depressive symptoms are common among cancer patients and are associated with poorer psychological outcomes in prospective cohorts. Although psychosocial interventions consistently reduce the depressive symptom severity and improve the quality of life, current evidence does not clearly demonstrate direct effects on depression progression.

From a clinical perspective, these findings support routine screening for depressive symptoms while using validated instruments and timely referral to the appropriate psychosocial care. Integration of psychological support into oncology care pathways may improve patient well-being and could indirectly influence outcomes through better treatment adherence and patient engagement.

Future research should prioritise well-powered randomized controlled trials which also needed to clarify biological mechanisms linking depression with cancer progression and to evaluate scalable models of care, such as tele-based and collaborative psychosocial interventions. Standardised approaches to screening, intervention delivery, and outcome reporting will be important for strengthening the evidence base and improving the integration of mental health care in oncology.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflict of Interest

The authors declare no conflict of interest related to this study.

Author contributions

I. L.: conceptualization, methodology, data curation, formal analysis, investigation, project administration, visualization, writing – original draft preparation, writing – review and editing.

I. A.: data curation, investigation, validation, visualization, writing – review and editing.

V. B.: conceptualization, methodology, data curation, investigation, visualization, writing – original draft preparation, writing – review and editing.

I. B.: conceptualization, methodology, supervision, validation, project administration, writing – review and editing.

Abbreviations

ACT – Acceptance and Commitment Therapy

BDI – Beck Depression Inventory

CBT – Cognitive Behavioural Therapy

cCBT – Computer-assisted Cognitive Behavioural Therapy

FOP – Fear of Progression

HADS – Hospital Anxiety and Depression Scale

MBCT – Mindfulness-Based Cognitive Therapy

MBI – Mindfulness-Based Intervention

MBSR – Mindfulness-Based Stress Reduction

PHQ-9 – Patient Health Questionnaire-9

QoL – Quality of Life

RCT – Randomized Controlled Trial

RoB – Risk of Bias

SDS – Self-Rating Depression Scale

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