The Cochrane Collaboration’s suggested framework was used in the creation of this review. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement was followed in the reporting of all outcomes. The protocol of this study was registered with PROSPERO (reg. no. CRD42024560622) (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024560622).

In February 2024, we conducted a literature search on Cochrane, PubMed, CINAHL, PsycInfo, EMBASE, China Biomedical Literature Database, CNKI, Wanfang Database, and VIP Database to identify studies examining the treatment outcomes and effectiveness of SFBT in cancer patients. The search time starts with the building of the library and the results are not limited by language.

The Cochrane Collaborative Network’s optimal sensitivity technique was applied to find RCTs in PubMed. A similar term-based search method was used to find and identifying studies of SFBT in treatment outcomes in cancer patients. Sensitive searches were performed using keywords and their synonyms, and free-text retrieval was carried out with terms like “tumor/cancer/hematologic neoplasms/lymphoma/myeloma/leukemia” and “focal solution treatment/focal solution/Solution-Focused Brief Therapy/Solution-Focused Therapy/Solution-Focused/SFBT.” Table 1 provides an example of how to use the search technique in PubMed.

Each identified abstract was independently reviewed by two authors (YL and SyL). If at least one of the writers deemed a reference eligible, the complete text was retrieved for a thorough review. They independently evaluated the entire text of the selected articles to ensure they met the criteria for inclusion or exclusion. In case of any disagreement, the writers addressed the reasons for their decisions, and a consensus was achieved.

We conducted a comprehensive search and analysis of all available studies on the application of SFBT in cancer patients. Our search encompassed published papers, gray literature, and materials acquired through additional manual searches of the literature.

The included randomized controlled studies evaluated the use of SFBT as an intervention to assess psychological distress and/or CRF and QoL in cancer patients over the age of 18. Studies were excluded if they (a) lacked original patient data, (b) was an editorial comment, a letter, a review, a case report, an author’s reply, (c) was not in Chinese and English, (d) Chinese articles published in non-Chinese science and technology core journals (this standard aims to prioritize research that has undergone more mature, internationally recognized peer review processes, while acknowledging that this approach may result in the exclusion of some studies with local relevance), (e) articles in Chinese with only one author (clinical studies cannot be done by one person), or (f) were unpublished studies with only abstracts presented at national and international conferences. The references of all listed publications were searched to find more relevant studies.

Two authors (FG and XjY) extracted descriptive and outcome data from the included studies using pre-established standardized forms. We considered the following aspects: (a) characteristics of the investigated, including name, nationality, and publication date; (b) details of the intervention conducted, such as tumor type, age, sample size, and study content; (c) SFBT technique; (d) lost to follow-up (if applicable); (e) evaluation indicators; and (f) presentation of results. If duplicate cohorts were suspected to be from the same author or institution, higher quality or more recent data were used in the analyses. All discrepancies related to data extraction were resolved through consensus with co-authors.

All studies included in the research (regardless of language or journal) underwent a standardized, rigorous risk of bias assessment, ensuring transparency in the quality evaluation. The risk of bias of the included studies was assessed using the risk of bias assessment tool recommended by the Cochrane Review’s Handbook (5.1.0), which consists of seven items, and the judgment of “low risk,” “unclear,” and “high risk” was made for each item. The risk of bias assessment was also done independently by two researchers (YL and SyL), and their assessments were agreed upon through comparison and discussion, with a third person (LqZ) acting as a mediator to deal with disagreements.

To assess evidence quality, two evaluators (YL and SyL) applied the GRADEprofiler to determine the quality of evidence for all outcomes. Evidence quality was classified into four levels: “very low,” “low,” “moderate,” and “high.” Although evidence from randomized controlled trials was initially rated as “high” quality, it was downgraded due to the following five factors: study limitations (risk of bias), inconsistency of results, indirect evidence, imprecision of results, and reporting bias.

Meta-analyses were performed using RevMan 5.4.1. The outcome indicators included in the literature for this study were continuous variables, and as different assessment tools were chosen for different studies, the standardized mean difference (SMD) was selected as an indicator of effect size, and a 95% confidence interval (CI) value was calculated to assess the effectiveness of the intervention. SMD in contrast the difference scores before and after intervention between the intervention team and the control group. Heterogeneity of research questions was tested by Cochran’s Q and I². p ≥ 0.1 and I² ≤ 50% is considered low heterogeneity and analyzed using a fixed-effects model; p < 0.1 and I² > 50% is considered high heterogeneity and analyzed using a random-effects model. We used the “calculator” in the “RevMan” software to calculate the combined SE value and then calculated the SD value using the formula SD=SE×N.

For subgroup analyses based on SFBT intervention duration (short-term effect: within 3 months, medium-term effect: 3–6 months), country, assessment scale, and tumor type were performed to explore heterogeneity between different subgroups. Sensitivity analyses through case-by-case exclusion.

A total of 10,575 articles were obtained through the initial search, 3 articles were obtained through other means, and 4,759 articles remained after de-duplication and management using Endnote 9.0. After screening by reading the titles and abstracts, 155 articles were retained, while 142 articles were excluded after further in-depth reading of the articles, and the final 13 articles included in this study. See Figure 1 for a detailed description of the inclusion and exclusion process according to PRISMA.

All eligible studies were published between 2014 and 2023. Among them, there are six studies in English (Aminnasab et al., 2018; Liu et al., 2020; Man et al., 2019; Pirzadi et al., 2023; Wang et al., 2021; Xian et al., 2022) and 7 studies in Chinese (Huiqin et al., 2015; Jia et al., 2023; Jie and Weilian, 2016; Jie et al., 2014; Mei et al., 2019; Qianqian et al., 2023; Xiaoqun et al., 2016). Two studies were from Iran (Aminnasab et al., 2018; Pirzadi et al., 2023) and the rest were from China (Huiqin et al., 2015; Jia et al., 2023; Jie and Weilian, 2016; Jie et al., 2014; Liu et al., 2020; Man et al., 2019; Mei et al., 2019; Qianqian et al., 2023; Wang et al., 2021; Xian et al., 2022; Xiaoqun et al., 2016). Only one study (Aminnasab et al., 2018) explicitly stated follow-up data, which was not meta-analyzed given that none of the other studies had follow-up data. Three studies (Jie et al., 2014; Liu et al., 2020; Xian et al., 2022) reported that participants were lost to visits due to withdrawal, transfer to hospital, deterioration of condition, or off-site. The total sample size of the included studies was 1,146 cases, with 576 cases in the intervention group and 570 cases in the control group. The demographics of each included study are summarized in Table 2.

46% of studies (n = 6) reported using the random numbers method, and 38% of studies (n = 5) reported using other random allocation methods to assign participants to either the intervention or control group, which were considered to have a lower risk of bias. All studies did not describe allocation concealment, which is considered to have a high risk of bias. All but 2 (15%) studies did not blind participants and staff; however, blinding is more difficult to implement due to the nature of psychological interventions. Three studies (23.08%) reported lost-to-follow-up rates, ranging from 12.9∼17.5% in the intervention group and from 3.33∼19.35% in the control group. Only one (Xian et al., 2022) of the 13 studies described registration in a clinical trial registry, and none of the others did, so there may be a risk of selective reporting bias. Similarly, most studies were considered to be at unclear risk due to the presence of other biases, as there was insufficient evidence to assess the risk of these biases. Figure 2 show the risk of bias assessment. The quality of the evidence was low according to the Guidelines for Recommendation, Assessment, Development and Evaluation (see Table 3).

The funnel plot for anxiety shows a relatively symmetrical funnel, indicating little risk of publication bias.

There were no significant changes in the effect sizes and no significant directional changes in the conclusions after using different effects models and eliminating the studies one by one, suggesting that the results of this study are relatively stable and reliable.

This study provides valuable insights through a systematic review and meta-analysis of the efficacy of SFBT on anxiety, depression, CRF, and quality of life QoL in cancer patients. However, several limitations remain. The most significant limitation lies in the overall low certainty of evidence for all outcomes. This primarily stems from significant methodological flaws in the included randomized controlled trials (RCTs), such as the widespread absence of allocation concealment and blinding, as well as the lack of trial registration in most studies. These deficiencies introduced a high risk of bias, substantially undermining the robustness of the study’s conclusions. Although the pooled effect size was statistically significant, its interpretation requires caution due to the inherent fragility of the original evidence.

Furthermore, although the search covered multiple databases, the included studies predominantly originated from Asia (particularly China and Iran), which may limit the cross-cultural generalizability of the conclusions. The number of available studies, participants, and the mix of Asian and Western populations were limited. This reduces the precision of our effect estimates. Results need validation in more RCTs. Studies varied in sample characteristics, intervention protocols, and outcome measures. While subgroup analyses explored some sources of heterogeneity, unexplained heterogeneity may persist. Future research could employ stricter criteria or sensitivity analyses for further investigation.

Regarding intervention implementation, SFBT was predominantly delivered by nurses rather than licensed mental health professionals in the studies included in this analysis. While reflecting clinical practice, this may introduce implementation heterogeneity (e.g., variations in skill proficiency) and compromise intervention consistency. Future research comparing the efficacy of professional versus non-professional practitioners could advance the standardization of intervention protocols.

This study primarily included published RCTs. Although attempts were made to construct funnel plots, the small number of studies made it difficult to reliably detect publication bias. Therefore, more high-quality research is still needed to confirm the true efficacy of SFBT. Furthermore, this analysis primarily focused on short-term outcomes, with a significant gap in the absence of long-term follow-up data. Given that the psychological state of cancer patients often fluctuates with disease progression, future research should evaluate whether the efficacy of SFBT is sustained over the long term and whether enhanced interventions are required to maintain these effects.

The findings of this study, based on the integration of quantitative data, did not delve into the qualitative aspects of SFBT implementation (such as patient experiences and key therapeutic factors). Additionally, this study exhibits high heterogeneity, potentially attributable to the diversity of included studies—including cancer types, diagnostic stages, and patient baseline characteristics. Although we conducted subgroup analyses (e.g., cancer type and intervention duration), most original studies failed to report cancer staging or diagnostic details, limiting further analysis. Future research should standardize reporting of such variables to reduce heterogeneity. Finally, future studies may integrate qualitative research methods to provide a more comprehensive evaluation. It is recommended to conduct larger-scale, high-quality RCTs covering diverse cancer types and stages to validate the long-term efficacy and generalizability of SFBT. Additionally, exploring integrated models combining SFBT with other interventions could better address the complex psychological needs of cancer patients.

The results of this meta-analysis have important implications for the practice of psychosocial support for cancer patients. The study confirmed the significant effect of SFBT in improving psychological symptoms such as anxiety and depression in cancer patients, which provides an evidence-based basis for the clinical introduction of this therapy. Healthcare organizations may consider incorporating SFBT into daily care as a useful supplement to existing interventions. In particular, the short-course nature of SFBT makes it a highly effective option when resources are limited or when patients are unable to receive long-term treatment. The results of the subgroup analysis suggest that SFBT may be suitable for different types of cancer patients, but the strategy can be adjusted according to the specific conditions of the patients. In addition, considering the impact of the intervention duration on the effect, the clinical work can adopt the mode of “short intensive + regular follow-up” to consolidate the effect of the treatment and prevent the recurrence of symptoms. Psychological problems such as anxiety and depression not only affect the quality of life of patients, but also may have a negative impact on treatment adherence and physical recovery. Therefore, clinics should pay more attention to the psychological status of cancer patients and routinely conduct psychological screening to identify patients in need of timely intervention. For patients with significant anxiety or depression, psychotherapeutic services should be actively provided in addition to necessary pharmacological treatments. SFBT, as a non-pharmacological, patient-centered intervention, can be safely administered concurrently with antitumor therapy to help patients better cope with the psychological challenges of the treatment process. This integration of SFBT principles into holistic care can help create a positive therapeutic atmosphere and enhance patients’ psychological resilience.