Comparative Efficacy of Different Cognitive Behavior Therapy Delivery Formats for Depression in Patients With Cancer: A Network Meta‐Analysis of Randomized Controlled Trials

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Abstract
Background: Cognitive behavior therapy (CBT) has been shown to be effective in improving depression in patients with cancer. However, diversity exists in the CBT delivery formats, and the optimal delivery format remains unconfirmed.Objectives: To compare the efficacy of different delivery formats of CBT interventions on depression in patients with cancer.Design: Network meta‐analysis of randomized controlled trials.Data Source: Six databases, including PubMed, Web of Science, Embase, CINAHL, the Cochrane Central Register of Controlled Trials and PsycINFO, were searched from inception to May 30, 2024.Methods: Two reviewers independently conducted study inclusion, data extraction, and risk of bias assessment. A pairwise meta‐analysis and a network meta‐analysis were performed sequentially to determine the efficacy of CBT delivery formats for improving depression in patients with cancer.Results: A total of 34 randomized controlled trials involving six delivery formats of CBT were included. Face‐to‐face group CBT (SMD = −0.88, 95% CI [−1.33, −0.44]), internet‐based individual CBT (SMD = −0.49, 95% CI [−0.92, −0.06]), app‐based individual CBT (SMD = −0.81, 95% CI [−1.45, −0.18]), and combined delivery formats of CBT for individual (SMD = −0.35, 95% CI [−0.62, −0.09]) were significantly more effective than the inactive control. The ranking probabilities revealed that face‐to‐face group CBT (P‐score = 0.86), app‐based individual CBT (P‐score = 0.74) and internet‐based individual CBT (P‐score = 0.57) were the three most effective delivery formats of CBT.Conclusions: This study revealed the efficacy ranking of different CBT delivery formats in improving depression in patients with cancer. These findings are expected to provide evidence‐based support for future research and clinical decision making for improving depression in patients with cancer.Trial Registration: PROSPERO (CRD42024553977)

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