Journal of Cancer Survivorship

, Volume 13, Issue 6, pp 943–955 | Cite as

Psychosocial interventions for cancer survivors: A meta-analysis of effects on positive affect

  • John M. SalsmanEmail author
  • James E. Pustejovsky
  • Stephen M. Schueller
  • Rosalba Hernandez
  • Mark Berendsen
  • Laurie E. Steffen McLouth
  • Judith T. Moskowitz



Positive affect has demonstrated unique benefits in the context of health-related stress and is emerging as an important target for psychosocial interventions. The primary objective of this meta-analysis was to determine whether psychosocial interventions increase positive affect in cancer survivors.


We coded 28 randomized controlled trials of psychosocial interventions assessing 2082 cancer survivors from six electronic databases. We calculated 76 effect sizes for positive affect and conducted synthesis using random effects models with robust variance estimation. Tests for moderation included demographic, clinical, and intervention characteristics.


Interventions had a modest effect on positive affect (g = 0.35, 95% CI [0.16, 0.54]) with substantial heterogeneity of effects across studies (\( \hat{\tau}=0.40 \); I2 = 78%). Three significant moderators were identified: in-person interventions outperformed remote interventions (P = .046), effects were larger when evaluated against standard of care or wait list control conditions versus attentional, educational, or component controls (P = .009), and trials with survivors of early-stage cancer diagnoses yielded larger effects than those with advanced-stage diagnoses (P = .046). We did not detect differential benefits of psychosocial interventions across samples varying in sex, age, on-treatment versus off-treatment status, or cancer type. Although no conclusive evidence suggested outcome reporting biases (P = .370), effects were smaller in studies with lower risk of bias.


In-person interventions with survivors of early-stage cancers hold promise for enhancing positive affect, but more methodological rigor is needed.

Implications for Cancer Survivors

Positive affect strategies can be an explicit target in evidence-based medicine and have a role in patient-centered survivorship care, providing tools to uniquely mobilize human strengths.


Meta-analysis Cancer Positive affect Interventions Randomized controlled trials 


Funding information

This research was supported by National Cancer Institute Grant No. R03 CA184560 (PI: Salsman). Dr. McLouth was supported by National Cancer Institute R25 CA122061 (PI: Avis). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Study authors received exempt approval from the Wake Forest University School of Medicine Institutional Review Board under IRB00034301. Study procedures described by the authors did not meet the federal definition of research involving human subjects, and research described in this manuscript constituted secondary analysis of published, de-identified data. Thus, informed consent was not applicable.

Supplementary material

11764_2019_811_MOESM1_ESM.docx (31 kb)
ESM 1 (DOCX 30 kb)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • John M. Salsman
    • 1
    Email author
  • James E. Pustejovsky
    • 2
  • Stephen M. Schueller
    • 3
  • Rosalba Hernandez
    • 4
  • Mark Berendsen
    • 5
  • Laurie E. Steffen McLouth
    • 1
  • Judith T. Moskowitz
    • 6
  1. 1.Department of Social Sciences and Health Policy, Wake Forest School of MedicineWake Forest Baptist Comprehensive Cancer CenterWinston SalemUSA
  2. 2.Department of Educational PsychologyUniversity of Texas at AustinAustinUSA
  3. 3.Department of Psychological ScienceUniversity of California, IrvineIrvineUSA
  4. 4.School of Social WorkUniversity of Illinois at Urbana-ChampaignUrbana-ChampaignUSA
  5. 5.Galter Health Sciences LibraryNorthwestern University Feinberg School of MedicineChicagoUSA
  6. 6.Department of Medical Social SciencesNorthwestern University Feinberg School of MedicineChicagoUSA

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