Psychological Interventions to Reduce Stress, Anxiety, and Depression in Cancer Patients: A Systematic Review

Abstract

Introduction: Cancer imposes not only a physical but also a substantial psychological burden, manifesting as anxiety, stress, and depression that may disrupt the hypothalamic–pituitary–adrenal (HPA) axis and compromise immune function. This study aimed to evaluate the effectiveness of psychological interventions in alleviating these symptoms among patients with cancer. Methods: This systematic review followed JBI, CRD, and PRISMA guidelines to assess the efficacy of psychological therapies in reducing stress, anxiety, and depression among cancer patients. Eligible studies were English-language randomized controlled trials (RCTs) published from 2020 to 2025, identified through Web of Science, ProQuest, ScienceDirect, and Scopus using MeSH terms and related keywords. Study selection was conducted independently by two reviewers using the PICOS criteria and comprised the identification, screening, and inclusion stages. Data were extracted using a standardized, pilot-tested form that covered study characteristics, intervention details, and outcomes, with all data cross-checked for accuracy and consistency. Results: Twenty-two RCTs involving adult cancer patients met the inclusion criteria. Interventions examined included mindfulness-based programs, cognitive behavioral therapy (CBT), yoga, music therapy, virtual reality (VR), light therapy, digital-based approaches, and multimodal interventions. Overall, most interventions significantly reduced psychological distress. Mindfulness and CBT consistently improved stress, anxiety, and depression, while yoga and music therapy enhanced emotional well-being. Technology-based and VR interventions showed promising results in increasing accessibility to mental health care. Some studies also reported positive effects on cortisol regulation. However, variations in study populations, intervention duration, and outcome measures limited comparability. Conclusion: Psychological interventions were effective in alleviating stress, anxiety, and depression among cancer patients and may contribute to improved biological stress regulation. Integrating these non-pharmacological therapies into routine cancer care is recommended, and further long-term, culturally sensitive studies are needed to strengthen evidence-based practice.