Effectiveness Comparisons of Various Psychological Therapies for Fear of Cancer Recurrence in Cancer Patients: A Systematic Review and Network Meta-Analysis.

BACKGROUND

Fear of cancer recurrence (FCR) is one of the most prevalent psychological burdens among cancer patients and exerts a substantial negative impact on their quality of life and overall well-being. Although various psychological interventions have demonstrated promise in alleviating FCR, their comparative effectiveness remains unclear.

OBJECTIVE

To conduct an up-to-date systematic review and network meta-analysis to compare the relative efficacy of psychological interventions for alleviating FCR in cancer patients.

METHODS

Six electronic databases were systematically searched from inception to October 2025 to identify randomized controlled trials comparing psychological interventions with each other or with control conditions. Two investigators independently conducted study selection, data extraction, and risk-of-bias assessment using the Cochrane RoB 2.0 tool. Pairwise meta-analyses and a frequentist random-effects network meta-analysis were performed using Review Manager 5.4, R 4.4.0, and STATA 14.0. Interventions were ranked using the Surface Under the Cumulative Ranking Curve (SUCRA). The protocol was registered with PROSPERO (CRD42023414987).

RESULTS

Sixty-one randomized controlled trials involving 6932 patients and 10 psychological interventions were included in the network meta-analysis. Cancer and living meaningfully interventions (SMD ranged from -1.78 to -2.68), comprehensive therapy (SMD ranged from -0.97 to -1.67), mindful-ness-based interventions(SMD = -0.90; 95%CrI [-1.56, -0.24]), and cognitive behavioral therapy(SMD = -0.71; 95%CrI [-1.18, -0.23]) were superior to control comparisons for improving FCR. Subgroup analyses showed that face-to-face delivery formats and longer intervention durations were consistently associated with greater effectiveness. Global and local consistency diagnostics indicated good model fit.

CONCLUSIONS

Cancer and living meaningfully, comprehensive therapy, acceptance and commitment therapy, mindfulness-based interventions and cognitive behav-ioural therapy are the most efficacious psychological interventions for reducing FCR and should be prioritized in clinical care. Clinicians should consider implementing interventions delivered face-to-face and of longer duration to maximize therapeutic benefits.