Effects of cognitive behavioral therapy on psychological distress in patients with cancer: a systematic review and meta-analysis

To evaluate the effects of cognitive behavioral therapy (CBT) on psychological distress, quality of life (QoL), fatigue, and fear of cancer recurrence (FCR) in adult cancer patients and examine whether intervention format and delivery setting influence its effectiveness. PubMed, Web of Science, Scopus, Embase, and EBSCO were searched from inception to January 24, 2026. Randomized controlled trials (RCTs) evaluating CBT or CBT-based interventions were included. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, evidence certainty with GRADE, and meta-analyses were performed using Review Manager 5.4. Thirteen RCTs involving 1,193 participants were included. For psychological distress, two three-arm RCTs were disaggregated into separate intervention–control comparisons, yielding 15 pairwise comparisons for the primary analysis. CBT significantly reduced psychological distress (SMD = − 0.49, 95% CI: −0.70 to − 0.28). Compared with controls, CBT reduced fatigue (SMD = − 0.32, 95% CI: −0.60 to − 0.04) and FCR (SMD = − 0.36, 95% CI: −0.56 to − 0.16) and improved QoL (SMD = 0.50, 95% CI: 0.30 to 0.70). Subgroup analyses of psychological distress suggested greater effects for group-based than individual-based CBT, whereas no statistically significant difference was detected between online and face-to-face delivery. CBT effectively reduces psychological distress, fatigue, and FCR while improving QoL in adult cancer patients. Further high-quality trials with long-term follow-up are needed.