The efficacy of interventions to improve psychosocial outcomes following surgical treatment for breast cancer: a systematic review and meta-analysis Hannah Matthews, Professor Elizabeth Grunfeld and Professor Andrew Turner
Breast cancer is the most commonly diagnosed cancer in women across the world and it is estimated that one out of every nine women will develop breast cancer at some point in their lives [1].
Results
Aim
Background
The aim of this meta-analysis was to identify the efficacy of psychosocial interventions for women following breast cancer surgery.
Moderate effect sizes: Anxiety g=0.31 (95% confidence interval of 0.19 to 0.43; p=0.001) Depression g=0.38 (95% confidence interval of 0.24 to 0.52; p=0.001) Quality of Life g=0.40 (95% confidence interval of 0.27 to 0.54; p=0.001)
In the United Kingdom:
Search strategy Searched electronic databases: PsycINFO, CINAHL, MEDLINE, Academic Search Complete, AMED, Cochrane Library and EMBASE. 3817 Studies obtained
new cases of invasive breast cancer, 2013 of females survived breast cancer for 10 or more years 2010-11, England and Wales [2]
Exclusion of duplicates 1455 Studies.
Mortality rates have fallen over recent decades partly due to advances in early detection and treatment, [3] resulting in a growing cohort of breast cancer survivors [1]. Improved survival rates have placed increased importance on promoting and supporting a high quality of life and optimal psychosocial adjustment among breast cancer patients. The primary treatment for breast cancer is surgical consisting of either a mastectomy or breast conservation surgery [4]. The period following breast cancer surgery is also associated with considerable psychosocial morbidity, with as many as 30% of women experiencing anxiety and depression [5]. Body image issues and sexual difficulties are also significantly higher following surgical treatment [6].
Review titles and abstracts of search results. Obtained full text of relevant articles. Review full text of identified articles. Inclusion and exclusion criteria applied. Backward search 8 studies obtained Forward search 7 studies obtained 2 low quality studies were removed
@HannahMatthews5
32 studies included in the review
Exclusion of unsuitable studies. 1376 studies were excluded for the following reasons: a) Abstract not relevant b) Review paper c) Comparative study d) Case study e) Conference or dissertation abstract f) Qualitative methodology g) Prophylactic mastectomy interventions.
Exclusion of irrelevant studies 19 studies were included 42 excluded for these reasons: a) Full text was not relevant b) Palliative or metastatic c) Omission of mastectomy patients d) Decision aid interventions e) Rehabilitation or physiological interventions.
Mood disturbance g=0.31(95% confidence interval 0.12 to 0.51; p=0.001) Sleep disturbance g=0.67 (95% confidence interval of 0.29 to 1.05; p=0.001) Body image g=0.40 (95% confidence interval of 0.16 to 0.63; p=0.001) Self-esteem g=0.35 (95% confidence interval of 0.00 to 0.69; p=0.05). Small effect sizes: Sexual functioning g=0.22 (95% confidence interval of -0.07 to 0.50; p=0.14) Distress g=0.27 (95% confidence interval 0.05 to 0.49; p=0.02) Anxiety (k=14), Depression (k=14) and Quality of Life (k=13) were the most commonly reported outcomes.
Key findings and implications This is the first meta-analysis to demonstrate the efficacy of interventions on a range of psychosocial outcomes following breast cancer surgery. The meta-analysis provides clear evidence for the efficacy of cognitive behavioural therapy in improving outcomes in relation to anxiety, depression and quality of life. There are shortcomings in existing studies, the length of the follow-up period is typically short and the generalizability of findings was limited by small samples.
[email protected] References 1. 2. 3. 4. 5. 6.
Rowland JH, Aziz N, Tesauro G, Feuer EJ. The changing face of cancer survivorship. Seminars in Oncology Nursing 2001; 17(4):236–240. Cancer Research UK. 2016. Breast Cancer Statistics. http://www.cancerresearchuk.org/health-professional/breast-cancer-statistics [accessed 24 February 2016]. Manos D, Sebastián J, Mateos N, Bueno M. Results of a multi-componential psychosocial intervention programme for women with early-stage breast cancer in Spain: quality of life and mental adjustment. European Journal of Cancer Care 2009; 18(3):295-305. Graham LJ, Shupe MP, Schneble EJ, Flynt FL, Clemenshaw MN, Kirkpatrick AD, Gallagher C, Nissan A, Henry L, Stojadinovic A, Peoples GE, Shumway NM. Current Approaches and Challenges in Monitoring Treatment Responses in Breast Cancer. Journal of Cancer 2014; 5 (1):58-68. Kydd LA, Reid SA, Adams J. The Breast Surgery Gallery: an educational and counseling tool for people with breast cancer or having prophylactic breast surgery. Clinical Journal of Oncology Nursing 2010; 14(5):643-8. doi:10.1188/10.CJON.643-648. Maguire P. Body image and sexual problems: ABC of breast diseases (2nd ed.). BMJ Books: London, England: 2000.
