Alarming findings of psycho-socio-spiritual interventions on physical, mental, and social health for children with cancer and their families in low- and middle-income countries: a meta-analysis

Background: Children residing in low- and middle-income countries (LMICs) are at a higher risk of cancer. The provision of psycho-socio-spiritual care to address stressors accompanying a cancer diagnosis is largely unknown in these countries, and evidence on psycho-socio-spiritual interventions in LMICs remains unexplored. Objective: This meta-analysis aimed to synthesize findings on psycho-socio-spiritual interventions for children and families with cancer in LMICs in comparison with those from resource-rich developing nations. Design: This study employs a prospective comprehensive meta-analysis approach. Settings: The study covers low- and middle-income countries and resource-rich developing countries as per the World Bank classification. Participants: The participants came from a total of 18 studies that recruited 3,072 children (0-18) with cancer or their family members and carers who were included in this meta-analysis. Methods: A systematic search of five databases PubMed, PsycINFO, CINAHL, Cochrane Databases, and a gray literature ProQuest was conducted to identify all possible hits. Following screening, data were extracted on a comprehensive list of variables to allow pooled and moderation analysis. The meta-analysis was performed via CMA-v2, the quality of the included studies was assessed via the Cochrane software "Risk of Bias-v2.0 (RoB2)", and PRISMA and AMSTAR 2 guidelines were followed throughout. Results: A highly significant OR of 4.933 (95% CI: 3.423-7.108, p < 0.0001) indicated approximately fivefold improvement in children and families with cancer in 11 LMICs as a result of the psycho-socio-spiritual interventions. Four more LMICs showed evidence of qualitative psycho-socio-spiritual services for children with cancer. The quality of evidence was rated as 2B in most of the eligible studies. We established a model that can test >400,000 combinations of factors. Conclusions: The childhood oncology community has been alerted on the lack of equitable holistic care for children and families with cancer in 126 out of the 137 LMICs and to seize the opportunity to target the underserved populations through development, adaptation, and investment in psycho-socio-spiritual care. Our model can aid in future studies and policy making. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42023460114.