Impact of psychological interventions on the intraoperative outcomes in transcatheter arterial chemoembolization for hepatocellular carcinoma: A meta-analysis

  • Lingna Ren Department of Medical Oncology, The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou First People’s Hospital, Hangzhou 310000, Zhejiang, China; Department of Medical Oncology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang, China; Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang, China
  • Lihong Wang Department of Medical Oncology Ward 3, Hangzhou Cancer Hospital, Hangzhou 310002, Zhejiang, China
  • Mengshi Wang Department of Medical Oncology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang, China; Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang, China
  • Weihong Zhu * Department of Medical Oncology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang, China; Department of Gastroenterology, Affiliated Hangzhou First People’s Hospital, School of Medicine, Westlake University, Hangzhou 310000, Zhejiang, China
Article ID: 3713
15 Views
Keywords: hepatocellular carcinoma; psychological intervention; transarterial chemoembolization (TACE); intraoperative outcomes; meta-analysis

Abstract

Objective: This meta-analysis aimed to evaluate the impact of psychological interventions on the intraoperative outcomes in patients undergoing transcatheter arterial chemoembolization (TACE) for liver cancer. Methods: A comprehensive search was conducted using computer databases including PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), and Wanfang Database. Reference lists of relevant studies were also reviewed to ensure completeness. The quality of included studies was assessed using the Jadad scoring system. Meta-analysis was performed using RevMan 5.2.7, a statistical software provided by the Cochrane Collaboration. Results: A total of eight studies comprising 790 patients were included, comparing psychological intervention groups with control groups. The meta-analysis revealed significant differences favoring the psychological intervention group in systolic blood pressure (MD = −15.95 mmHg, 95% CI: −22.31 to −9.25, P < 0.0001), heart rate (MD = −10.68 bpm, 95% CI: −13.87 to −7.48, P < 0.0001), anxiety scores (MD = −2.39, 95% CI: −3.35 to −1.43, P < 0.0001), and the incidence of intraoperative anxiety (OR = 0.32, 95% CI: 0.19 to 0.52, P < 0.0001) compared to the control group. Conclusion: Psychological interventions significantly alleviated negative emotions in patients undergoing TACE for liver cancer, contributing to better intraoperative stability in the control group. These findings suggest that psychological support may facilitate the smooth conduct of the TACE and potentially enhance overall treatment outcomes.

Published
2026-02-06
How to Cite
Ren, L., Wang, L., Wang, M., & Zhu, W. (2026). Impact of psychological interventions on the intraoperative outcomes in transcatheter arterial chemoembolization for hepatocellular carcinoma: A meta-analysis. Psycho-Oncologie, 20(2), 3713. https://doi.org/10.18282/po3713
Section
Article

References

1. Aydin O, Colakoglu MK, Turan Gokce D, et al. Extrahepatic liver metastasis in the follow-up of patients undergoing liver transplantation for hepatocellular carcinoma: Single-Center Experience. Exp Clin Transplant. 2025; 23(2): 133–137. doi: 10.6002/ect.2023.0111

2. Hu WH, Sun JA, Liu C. Causal associations between dietary habits and liver cancer risk: A two-sample Mendelian randomization study. Discover Oncology. 2025; 16(1): 120. doi: 10.1007/s12672-025-01885-w

3. Yue T, Xu M, Cai T, et al. Gender disparity and temporal trend of liver cancer in China from 1990 to 2019 and predictions in a 25-year period. Frontiers in Public Health. 2022; 10: 956712. doi: 10.3389/fpubh.2022.956712

4. Deng X, Li H, Zhong Y, et al. Burden of liver cancer attributable to hepatitis b and alcohol globally, in China, and for five sociodemographic index regions from 1990 to 2021: A population-based study. Journal of Clinical and Translational Hepatology. 2024; 000(000): 000–000. doi: 10.14218/jcth.2024.00351

5. Xia L, Yu SX, Bai YS, et al. Effect of surgery on overall survival and cancer-specific survival in patients with primary HCC: A study based on PSM in the SEER cohort. Medicine. 2025; 104(8): e41521. doi: 10.1097/md.0000000000041521

6. Galanakis N, Kehagias E, Matthaiou N, et al. Transcatheter arterial chemoembolization combined with radiofrequency or microwave ablation for hepatocellular carcinoma: a review. Hepatic Oncology. 2018; 5(2): HEP07. doi: 10.2217/hep-2018-0001

7. Yang W, Wang D, Huang L, et al. Thalidomide combined with transcatheter arterial chemoembolization (TACE) for intermediate or advanced hepatocellular carcinoma: A systematic review and GRADE approach. Asian Pacific Journal of Cancer Prevention: APJCP. 2018; 19(8): 2043–2055. doi: 10.22034/APJCP.2018.19.8.2043

8. Ju MD, Qin Q, Li M. Whole-process case management effects on mental state and self-care ability in patients with liver cancer. World Journal of Gastrointestinal Surgery. 2024; 16(3): 833–841. doi: 10.4240/wjgs.v16.i3.833

9. Zou H, Lai Y, Chen X, et al. Cost-effectiveness of camrelizumab plus rivoceranib versus sorafenib as first-line treatment of unresectable hepatocellular carcinoma. Therapeutic Advances in Gastroenterology. 2025; 18: 17562848241310314. doi: 10.1177/17562848241310314

10. Paik JM, Eberly KE, Kabbara K, et al. Non-alcoholic fatty liver disease is associated with greater risk of 30-day hospital readmission in the United States (U.S.). Annals of Hepatology. 2023; 28(4): 101108. doi: 10.1016/j.aohep.2023.101108

11. Zhang X, Zhang H, Zhang Z, et al. The mediating effect of resilience on the relationship between symptom burden and anxiety/depression among Chinese patients with primary liver cancer after liver resection. Patient Preference and Adherence. 2023; 17: 3033–3043. doi: 10.2147/ppa.s430790

12. Rowe DG, O’Callaghan E, Yoo S, et al. Perioperative Trends in Distress Among Cancer Patients: A Systematic Review and Meta‐Analysis. Cancer Medicine. 2025; 14(6): e70456. doi: 10.1002/cam4.70456

13. Gao L, Chen W, Qin S, et al. The impact of preoperative interview and prospective nursing on perioperative psychological stress and postoperative complications in patients undergoing TACE intervention for hepatocellular carcinoma. Medicine. 2024; 103(2): e35929. doi: 10.1097/md.0000000000035929

14. Li N, Wang G, Duan G, et al. Clinical observation of transcatheter arterial chemoembolization in super-aged patients with advanced gastric cancer. Supportive Care in Cancer. 2021; 30(2): 1441–1450. doi: 10.1007/s00520-021-06565-3

15. Ramezani A, Johnson M, Alvani SR, et al. The P3-model of perioperative psychological preparation: Pre-surgical and pre-medical procedural psychological preparation and psychophysiological interventions. Clinical Neurology and Neurosurgery. 2022; 222: 107468. doi: 10.1016/j.clineuro.2022.107468

16. Chen QF, Li W, Yu SC ho, et al. Consensus of minimally invasive and multidisciplinary comprehensive treatment for hepatocellular carcinoma – 2020 Guangzhou recommendations. Frontiers in Oncology. 2021; 11: 621834. doi: 10.3389/fonc.2021.621834

17. Abraham J, Holzer KJ, Pedamallu L, et al. Peri‐operative mental health interventions for surgical oncology patients: a narrative synthesis and meta‐analysis. Anaesthesia. 2025; 80(S2): 54–64. doi: 10.1111/anae.16471

18. Hou H, Fang K, Zhang YL, et al. Efficacy of a combination of functional exercise and psychological interventions in improving postoperative rehabilitation and intervention compliance in patients with breast cancer. Clinical Breast Cancer. 2024; 24(8): 699–704. doi: 10.1016/j.clbc.2024.08.007

19. Scarone P, Van Santbrink W, Koetsier E, et al. The effect of perioperative psychological interventions on persistent pain, disability, and quality of life in patients undergoing spinal fusion: A systematic review. European Spine Journal. 2022; 32(1): 271–288. doi: 10.1007/s00586-022-07426-1

20. Nicklas L, Albiston M, Dunbar M, et al. A systematic review of economic analyses of psychological interventions and therapies in health-related settings. BMC Health Services Research. 2022; 22(1): 1131. doi: 10.1186/s12913-022-08158-0

21. Zhang SE, Tang XL. The impact of psychological interventions in the interventional treatment of liver cancer. Modern Nurse. 2005; 1: 62–63. doi: 10.3969/j.issn.1006-6411.2005.01.041

22. Zhang FQ. Survey of preoperative anxiety and depression symptoms in patients with primary liver cancer undergoing interventional treatment and psychological intervention therapy. Journal of Qiqihar Medical College. 2007; 28(4): 465–466. doi: 10.3969/j.issn.1002-1256.2007.04.047

23. Zhang XJ, Liu J, Xia B, et al. The effects of mental intervention on stress reaction caused by interventional therapy on patients with hepatoma. Journal of Medical Imaging. 2009; 19(10): 1293–1295. doi: 10.3969/j.issn.1006-9011.2009.10.024

24. Qiu JY, Chen Y, Liu C. The impact of psychological interventions on liver cancer patients undergoing interventional surgery. World Health Digest. 2011; 8(31): 5–6. doi: 10.3969/j.issn.1672-5085.2011.31.001

25. Lin XH, Zhang CY, Huang YS, et al. The impact of perioperative psychological intervention on patients with liver cancer undergoing TACE treatment. Contemporary Medicine. 2012; 18(27): 3. doi: 10.3969/j.issn.1009-4393.2012.27.117

26. Xia YY, Zhou SL, Li XH, et al. Clinical observation on the effect of psychological intervention in primary carcinoma of liver patients with first-line TACE. Journal of Clinical Medicine in Practice. 2015; 19(18): 38–40. doi: 10.7619/jcmp.201518013

27. Wang Y. Application value of nursing psychological intervention in interventional treatment of primary liver cancer. Journal of Clinic Nursing’s Practicality. 2018; 3(30): 4–5. doi: issn.2096-2479.2018.30.4.02

28. St Peter KS, Vernon LL, Kersten AW. The influence of movement on negative and positive emotional responses to animals. Quarterly Journal of Experimental Psychology. 2021; 75(7): 1289–1301. doi: 10.1177/17470218211049331

29. Waugh CE. The roles of positive emotion in the regulation of emotional responses to negative events. Emotion. 2020; 20(1): 54–58. doi: 10.1037/emo0000625

30. Lu S, Wei F, Li G. The evolution of the concept of stress and the framework of the stress system. Cell Stress. 2021; 5(6): 76–85. doi: 10.15698/cst2021.06.250

31. Peng X, Zheng Y, Xue Y, et al. Super‐Stable homogeneously sustained‐release system mediates transcatheter arterial ionic‐embolization strategy for hepatocellular carcinoma therapy. Advanced Functional Materials. 2023; 34(11): 2311505. doi: 10.1002/adfm.202311505

32. Andersen BL, Farrar WB, Golden-Kreutz DM, et al. Psychological, behavioral, and immune changes after a psychological intervention: A clinical trial. Journal of Clinical Oncology. 2004; 22(17): 3570–3580. doi: 10.1200/jco.2004.06.030

33. Bolier L, Haverman M, Westerhof GJ, et al. Positive psychology interventions: a meta-analysis of randomized controlled studies. BMC Public Health. 2013; 13(1): 119. doi: 10.1186/1471-2458-13-119

34. Luyten P, Campbell C, Moser M, et al. The role of mentalizing in psychological interventions in adults: Systematic review and recommendations for future research. Clinical Psychology Review. 2024; 108: 102380. doi: 10.1016/j.cpr.2024.102380

35. Cong L, Xu X, Yu J, et al. Effects of percutaneous liver ablation combined with psychological intervention on postoperative recurrence, psychological stress, anxiety and depression in patients with liver cancer. Archives of Clinical Psychiatry. 2023; 50(5).

36. Li-Wen L, Jia-Li L. Influence of psychological intervention on the anxiety and depressive symptoms for patients with liver cancer: A meta-analysis. Journal of Evidence-Based Medicine. 2012; 12(6): 369–373.

37. Wenzel A. Basic Strategies of cognitive behavioral therapy. Psychiatric Clinics of North America. 2017; 40(4): 597–609. doi: 10.1016/j.psc.2017.07.001

38. Penedo FJ, Dahn JR, Molton I, et al. Cognitive‐behavioral stress management improves stress‐management skills and quality of life in men recovering from treatment of prostate carcinoma. Cancer. 2003; 100(1): 192–200. doi: 10.1002/cncr.11894

39. Driscoll MA, Edwards RR, Becker WC, et al. Psychological interventions for the treatment of chronic pain in adults. Psychological Science in the Public Interest. 2021; 22(2): 52–95. doi: 10.1177/15291006211008157

40. Abrahams HJG, Gielissen MFM, Verhagen CAHHVM, et al. The relationship of fatigue in breast cancer survivors with quality of life and factors to address in psychological interventions: A systematic review. Clinical Psychology Review. 2018; 63: 1–11. doi: 10.1016/j.cpr.2018.05.004

41. Turk DC, Audette J, Levy RM, et al. Assessment and treatment of psychosocial comorbidities in patients with neuropathic pain. Mayo Clinic Proceedings. 2010; 85(3): S42–S50. doi: 10.4065/mcp.2009.0648

42. Shun SC, Chen CH, Sheu JC, et al. Quality of life and its associated factors in patients with hepatocellular carcinoma receiving one course of transarterial chemoembolization treatment: A longitudinal study. The Oncologist. 2012; 17(5): 732–739. doi: 10.1634/theoncologist.2011-0368

43. Chen NY, Chen KH, Wang YW, et al. The impact of symptom distress on health-related quality of life in liver cancer patients receiving arterial chemoembolization: the mediating role of hope. BMC Gastroenterology. 2022; 22(1): 456. doi: 10.1186/s12876-022-02529-x