Technology-Assisted Intervention for Adolescents and Young Adults with Cancer: A Systematic Review and Meta-Analysis

Background/Purpose: Psychosocial outcomes are central to the treatment of and recovery from cancer, as they are associated with medical compliance, effective communication, and enhanced family and peer support. Many cancer patients do not receive much needed supportive care/intervention due to significant health and mental health barriers. Common mental health barriers, e.g., geographic location or financial toxicity, are arguably more salient among young cancer patients due to their greater susceptibility to these challenges. Tech-assisted interventions are critical in supporting psychosocial outcomes among cancer survivors, including and especially for children, adolescents, and young adults (AYAs) with cancer, a tech-savvy generation. This study is a systematic review and meta-analysis of technology-assisted interventions for pediatric and AYA (PAYA) cancer survivors. Methods: Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, our team used a pre-defined set of key words and searched studies across 11 electronic databases and 4 professional websites, and conducted a manual search of reference lists from published reviews. After title/abstract and full-texts screening, we extracted study data and statistical information for data analyses. Treatment effect sizes were calculated using small sample size corrected Hedges' g. Meta-analysis was facilitated, first, with an intercept-only meta-regression model with robust variance estimation (RVE). Then, we conducted subgroup and moderator analyses to explore sources of heterogeneity across studies and effect sizes. Results: The final analysis included 28 clinical trials, with 237 effect sizes, reported an overall statistically significant treatment effect of technology-assisted psychosocial interventions for childhood and AYA cancer survivors, g = 0.382, 95% confidence interval (CI) 0.243 to 0.521, p < 0.0001. Subgroup analysis revealed that distraction-based interventions and interventions for psychosocial and emotional health were overall statistically significant, whereas interventions for childhood and AYA cancer survivors' cancer knowledge outcomes and physical and functional health outcomes were statistically nonsignificant. Moderator analysis found intervention target was a significant moderator. Conclusions and Implications: Technology-assisted interventions for childhood and AYA cancer survivors were overall effective across domains of survivorship outcomes. Favorable evidence was found primarily for childhood cancer survivors with limited support for AYA cancer survivors. Although existing technology-assisted interventions are overall promising, research support for cancer survivors from different age groups and with different psychosocial challenges varies and should be considered individually.