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Effectiveness of Non-Pharmacological Interventions to Reduce Procedural Anxiety in Children and Adolescents Undergoing Treatment for Cancer: A Systematic Review and Meta-Analysis

Objective: Children and young people (CYP) with cancer undergo painful and distressing procedures. We aimed to systematically review the effectiveness of non-pharmacological interventions to reduce procedural anxiety in CYP. Methods: Extensive literature searches sought randomised controlled trials that quantified the effect of any non-pharmacological intervention for procedural anxiety in CYP with cancer aged 0-25. Study selection involved independent title and abstract screening and full text screening by two reviewers. Anxiety, distress, fear and pain outcomes were extracted from included studies. Where similar intervention, comparator and outcomes presented, metaanalysis was performed, producing pooled effect sizes (Cohen’s d) and 95% confidence intervals (95% CI). All other data were narratively described. Quality and risk of bias appraisal was performed, based on the Cochrane Risk of Bias tool. Results: Screening of 11,727 records yielded 56 relevant full texts. There were 15 included studies, eight trialling hypnosis, and seven non-hypnosis interventions. There were large, statistically significant reductions in anxiety and pain for hypnosis, particularly compared to treatment as usual (anxiety: d=2.30; 95% CI: 1.30 to 3.30, p<0.001; pain: d=2.16; 95% CI: 1.41 to 2.92, p<0.001). Evidence from non-hypnosis interventions was equivocal, with some promising individual studies. There was high risk of bias across included studies limiting confidence in some positive effects. Conclusions: Evidence suggests promise for hypnosis interventions to reduce procedural anxiety in CYP undergoing cancer treatment. These results largely emerge from one research group, therefore wider research is required. Promising evidence for individual non-hypnosis interventions must be evaluated through rigorously conducted randomised controlled trials.