Strengthening the shield: Cognitive behavioral therapy as a critical adjunct in ovarian cancer chemotherapy – Evidence from a systematic review and meta-analysis of randomized controlled trials

A BSTRACT Ovarian cancer is the most lethal gynecologic malignancy and is frequently diagnosed at an advanced stage. Chemotherapy remains a cornerstone of treatment but is commonly associated with psychological distress, including anxiety, depression, fatigue, and reduced quality of life (QoL). This systematic review and meta-analysis evaluated the effects of cognitive behavioral therapy (CBT) in women with ovarian cancer undergoing chemotherapy. The study was registered in PROSPERO and conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Randomized controlled trials published between 2018 and 2025 were identified through PubMed, Scopus, ScienceDirect, and Google Scholar. Risk of bias (RoB-2) was assessed using the Cochrane RoB 2 tool. Outcomes included depression and anxiety measured by the Self-Rating Depression Scale (SDS), Patient Health Questionnaire-8, Hospital Anxiety and Depression Scale (HADS), and Self-Rating Anxiety Scale (SAS), fatigue, fear of cancer recurrence assessed by Fear of Cancer Recurrence Inventory–Short Form, and QoL evaluated using the EORTC QLQ-C30. Meta-analysis was performed using RevMan version 5.4. CBT significantly reduced depressive symptoms measured by SDS (mean difference MD = −5.11; 95% confidence interval CI −6.45 to −3.76; P < 0.00001; I 2 = 0%). Anxiety was significantly reduced across both HADS (MD = −2.35; 95% CI −3.94 to −0.77; P = 0.004; I 2 = 0%) and SAS scales (MD = −6.22; 95% CI −7.63 to −4.80; P < 0.00001; I 2 = 0%). Fatigue was also significantly decreased (MD = −0.76; 95% CI −1.31 to −0.20; P = 0.008; I 2 = 0%), while overall QoL improved (MD = 1.26; 95% CI 0.58–1.94; P = 0.0003; I 2 = 38%). These findings suggest that CBT provides beneficial supportive effects in reducing psychological distress and improving QoL in women with ovarian cancer undergoing chemotherapy.