Globally, cancer is recognized as a leading cause of death due to the disease progression and nonlinear illness trajectory. In 2020, cancer accounted for almost 10 million deaths.1 Cancer-related deaths are expected to increase to 16.4 million by 2040, alongside the incidence of cancer rising to 29.5 million new cases annually.2 In fact, cancer is increasingly being regarded as a chronic disease due to its progressive, longstanding, and in certain cases, incurable nature with only symptomatic management as best care.3 This is comparable with other established chronic diseases like diabetes mellitus and heart failure.

Cancer patients refer to individuals clinically diagnosed with one or more cancer types at any point along the survivorship continuum, who are still living with and managing their condition. Cancer caregivers are uncompensated family members, spouses, friends, or neighbors who provide care for cancer patients in one way or more, especially within physical, emotional, social, and psychological health domains.4 Most experience multifaceted caregiver burden, which potentially diminishes their quality of care provided and negatively affects patients.5,6 A patient–caregiver dyad reflects the cancer patient and caregiver as a combined functional unit, with their dyadic relationship being a significant resource along the cancer continuum.5 There is increasing recognition of the patient–caregiver dyad offering mutually beneficial outcomes for both parties.7 As cancer patients and caregivers are inexorably affected by the profound impact of a cancer diagnosis and respond to the cancer experience as a pair,8 it is imperative to include this area of focus in the review.

As a form of nonpharmacological care which comprises psychological and social aspects, psychosocial interventions seek to enhance health-related quality of life (HRQOL), symptom management, and personal sense of fulfilment among other health outcomes.9 Alongside active interventions, healthcare professionals deliver conventional psychosocial interventions to cancer patients face-to-face, with or without a caregiver's presence, as part of holistic care management. Likewise, there are numerous psychosocial interventions targeted at cancer caregivers to achieve improved health outcomes. Psychosocial interventions are likely to have higher efficacy when tailored to meet caregivers’ needs, with personalized support in place according to various types and stages of cancer.10 Paired interventions involving the patient–caregiver dyad have also gained traction, showing considerable effect on HRQOL,11 as well as psychological outcomes like depression.12 Examples include cognitive-behavioral therapy (CBT), psychoeducation, and skills training. They address strategies to facilitate cognitive restructuring of maladaptive thoughts, techniques for cancer management, skills for coping, and self-care, respectively.13

TBPIs are delivered by healthcare professionals via virtual platforms such as mobile applications, telephone, Internet, and other online modes. The COVID-19 pandemic has driven the acceleration of uptake of technology-based interventions for cancer patients in many countries worldwide.14 With the increased uptake, TBPIs have the potential to improve health outcomes within psychosocial oncology as innovative processes for long-term cancer care are in demand.15 Advantages include greater convenience, cost-effectiveness, and ease of access to health-promotion strategies for cancer patients and cancer caregivers16 as compared with most conventional psychosocial interventions.

An amalgamation of the Self-Efficacy Theory and Social Cognitive Theory17,18 guided this review. This modified framework expounded the effect of TBPIs on cancer patients and caregivers. Fig 1 illustrates that self-efficacy is attained through four facets of the Self-Efficacy Theory; performance accomplishments, vicarious experiences, social persuasion, and psychological arousal.17,19 It exemplifies the interconnected triad of personal-cognitive, behavioral, and environmental factors which all play significant roles in individual self-efficacy levels20 through positive behavioral changes. Likewise, the Social Cognitive Theory demonstrates that an individual's behavior is affected by self-regulatory mechanisms and influences.17 Through a combination of these factors, psychosocial interventions potentially motivate positive health-related behavior changes,17 thereby improving self-efficacy and HRQOL. With enhanced self-efficacy, emotional, and social support, better coping mechanisms are likely to be used by patients and caregivers alike. Depression symptoms may possibly be reduced as well.

Psychological outcomes, including HRQOL, coping, self-efficacy, and depression, are major determinants of overall well-being within psychosocial oncology.21 Overall well-being broadly refers to the all-encompassing domains of an individual's state of health; namely, one's physical, mental, emotional, and social health. As a subset of overall well-being, HRQOL is a multifaceted concept comprising physiological, psychological, and social aspects of life closely associated with an individual or group's health perception.22,23 As such, HRQOL is a significant outcome criterion of overall well-being when evaluating the effectiveness of psychosocial oncology interventions.24 HRQOL is affected by a multitude of factors, including physiological and psychological sequelae of treatment,25,26 particularly chemotherapy.27 However, the implementation of psychosocial interventions potentially alleviates psychosocial burden and psychological distress caused by cancer, thereby improving HRQOL.28

Problem-focused and emotion-focused coping mechanisms are considered. The former entails addressing the situation directly to manage problems, while the latter refers to regulating one's emotional reaction towards the situation.29 Problem-focused coping is considered possibly more adaptive and effective than emotion-focused coping.30 Using effective coping strategies correlates with reduced cancer caregiver burden,31 enhanced HRQOL, and psychological well-being, especially among terminal cancer patients.32

Self-efficacy is an individual's perceived ability to proficiently execute tasks and achieve desired outcomes.33 Greater self-efficacy is a precursor to better health-promoting behaviors, adaptive coping, and self-care,34,35 thereby improving HRQOL among cancer patients and caregivers.18,36 Depression is highly prevalent among cancer patients37 and caregivers,38 especially advanced cancer caregivers.39 As an indicator of psychological distress among cancer patients and caregivers,40 depression has negative implications for overall HRQOL, cancer management, mortality, and psychological outcomes.41

Existing systematic reviews examined the effectiveness of TBPIs on either cancer patients15,42, 43, 44, 45, 46 or cancer caregivers.47,48 Two reviews included only pediatric and young adult patients with cancer44,46 while another review43 was limited to telephone-based psychosocial interventions. One review49 explored the effectiveness of TBPIs on quality of life for patient–caregiver dyads; however, face-to-face interventions were also included. No reviews consolidated and presented findings related to the effectiveness of TBPIs for the two distinct, yet strongly interrelated population groups of cancer patients and caregivers. As such, there appeared to be an incomplete understanding concerning the unique amalgamation of insights into the effectiveness of TBPIs when both population groups of cancer patients and caregivers are analyzed concurrently in the same article. Furthermore, a dearth of evidence evaluated the effectiveness of TBPIs on HRQOL, coping, self-efficacy, and depression for adult cancer patients and caregivers.

This review strives to minimize gaps in literature regarding the effectiveness of TBPIs among adult cancer patients and caregivers. Positive findings would support the integration of TBPIs into routine oncology care involving multidisciplinary healthcare teams and patient–caregiver dyads. Future endeavors are warranted to address current research gaps in literature. Through the synthesis of best available evidence, this review aimed to evaluate the effectiveness of TBPIs on HRQOL, coping, self-efficacy, and depression among adult cancer patients and caregivers. Two review questions are addressed:

What is the effectiveness of TBPIs on HRQOL, coping, self-efficacy, and depression among adult cancer patients compared to control groups?

What is the effectiveness of TBPIs on HRQOL, coping, self-efficacy, and depression among caregivers of cancer patients compared to control groups?

What is the effectiveness of TBPIs on HRQOL, coping, self-efficacy, and depression among patient–caregiver dyads compared to control groups?