The effectiveness of e-Health interventions on caregiver burden, depression, and quality of life in informal caregivers of patients with cancer: A systematic review and meta-analysis of randomized controlled trials

Abstract

Background: With the increasing incidence and survival rate of cancer, there are more people living with cancer, which increases the responsibilities of informal caregivers and results in a significant caregiver burden, depression, and low quality of life. The efficacy of e-Health interventions has already been proven in decreasing caregiver burden, addressing psychosocial concerns, and increasing quality of life among caregivers of patients with chronic diseases. However, the utilization of e-Health interventions on the informal caregivers of cancer patients is still limited and the effectiveness is unclear.

Objectives: To assess the impact of e-Health interventions on the caregiver burden, depression, and quality of life of informal caregivers of cancer patients.

Methods: A literature search was conducted in six electronic databases (PubMed, EMBASE, Web of Science, CENTRAL, PsycInfo, and CINAHL Plus with Full Text) from the inception of the databases to 31 May 2021. Two authors independently screened the studies and extracted the data. Cochrane's bias risk tool for randomized controlled trials was used to examine the methodological quality of the included studies. The intervention effect was estimated by calculating the standard mean difference (SMD) and 95% confidence interval (CI) with Review Manager 5.3. A sensitivity analysis was conducted to test the robustness of the pooled results.

Results: Seven randomized controlled trials with 326 participants were included in the review. The results of the meta-analysis showed that e-Health interventions could significantly improve the depression (SMD = -0.90, 95% CI [-1.76∼-0.04], P = 0.04) and quality of life (SMD = 0.45, 95% CI [0.13∼0.77], P = 0.006), but not caregiver burden (SMD = -0.29, 95% CI [-0.61∼0.02], P = 0.07) in informal caregivers. Sensitivity analysis showed that only the caregiver burden was stable.

Conclusion: e-Health interventions are a convenient method to support the informal caregivers of cancer patients, and can mitigate depression and enhance the quality of life of informal caregivers, but had no significant effect on easing the caregiver burden. In future, tailored e-Health intervention, based on informal caregivers' demographic characteristics and cultural context, is warranted to improve informal caregivers' well-being.

Registration number: CRD42021250253 (PROSPERO).

Keywords: Cancer; Caregiver burden; Depression; Informal caregivers; Meta-analysis; Quality of life; Systematic review; e-Health.