Abstract PO-063: A systematic review of tandem cognitive behavioral therapy and healthy lifestyle interventions on health-related outcomes
Authors: Addison Sarah , Shirima Damalie , Dunovan Shanon , Lustberg Maryam , Arthur Elizabeth K. , Nolan Timiya S. 
Published: December 2020

Background Early screening and innovative treatments has elongated the lives of cancer survivors, bringing more focus on minimizing the adverse effects of cancer and its treatment. Healthy lifestyle (HL) behaviors reduce the risk of cancer recurrence and intensity of cancer-related adverse effects such as fatigue and cognitive dysfunction. However, maintaining a HL may be difficult for many.

Cognitive behavioral therapy (CBT) has been used to help change behavior. Studies with patients engaged in healthy lifestyle behaviors alone and CBT alone have improved adverse effects. Yet, little is known about how such programs in tandem affect health-related outcomes. Here, we evaluate extant literature on tandem interventions with CBT and HL on health-related outcomes in cancer survivors.

Methods We conducted a systematic review of randomized controlled studies examining CBT plus healthy lifestyle against a control condition in PubMed, Embase, and CINAHL databases published between 1990-2019. The search yielded 1494 studies which were evaluated by two reviewers based on pre-determined inclusion and exclusion criteria. Thirty-nine articles met inclusion criteria and were critically appraised for bias. Findings The 39 articles included a total of 5239 participants, primarily breast cancer and prostate cancer survivors. Most (27 of 39) articles omitted racial demographic data or noted that the participants were majority White. Only four articles recorded over 10% of blacks. Intervention conditions ranged from CBT with smoking cessation to CBT with physical activity. These conditions were which were compared against no intervention, usual care, and/or CBT alone or HL alone. Interventions were delivered by a variety of trained interventionists and over different durations. The most common HL targets were stress, insomnia, and quality of life. Nearly all articles (36 of 39) reported a clinically significant reduction in adverse effects. Of note, 2 studies compared CBT/HL vs HL vs usual care finding that physical activity alone was no different than CBT/HL. Moreover, only 24 articles addressed long term (&gt;2 months) outcomes. Of those, positive effects ranged from being sustained (21 articles), attenuating over time (1 article), and disappearing (2 articles). Articles were appraised as poor to good quality. Conclusion This review showed that tandem interventions with CBT and healthy lifestyle components can improve health-related outcomes for cancer survivors as compared to usual care, but there is a paucity of knowledge to suggest differential outcomes in tandem interventions as compared to CBT alone or HL alone. Findings were biased with the overrepresentation of breast and prostate cancer survivors, and underrepresentation of minority groups. Thus, this review highlights the need for further research to test tandem interventions against CBT alone and HL alone, toward identifying the most efficacious interventions for dissemination and implementation across diverse groups of cancer survivors.

Citation Format: Sarah Addison, Damalie Shirima, Shanon Dunovan, Maryam Lustberg, Elizabeth K. Arthur, Timiya S. Nolan. A systematic review of tandem cognitive behavioral therapy and healthy lifestyle interventions on health-related outcomes [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-063.