Psychological interventions for women with metastatic breast cancer - PubMed (original) (raw)

Review

Psychological interventions for women with metastatic breast cancer

Mohammed Mustafa et al. Cochrane Database Syst Rev. 2013.

Abstract

Background: Psychological symptoms are associated with metastatic breast cancer. This is the basis for exploring the impact of psychological interventions on psychosocial and survival outcomes. One early study appeared to show significant survival and psychological benefits from psychological support while subsequent studies have revealed conflicting results. This review is an update of a Cochrane review first published in 2004 and previously updated in 2007.

Objectives: To assess the effects of psychological interventions on psychosocial and survival outcomes for women with metastatic breast cancer.

Search methods: We searched the Cochrane Breast Cancer Group Specialised Register, MEDLINE (OvidSP), EMBASE (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCO), online trials and research registers in June/July 2011. Further potentially relevant studies were identified from handsearching references of previous trials, systematic reviews and meta-analyses.

Selection criteria: Randomised controlled trials (RCTs) and cluster RCTs of psychological interventions, which recruited women with metastatic breast cancer. Outcomes selected for analyses were overall survival, psychological outcomes, pain, quality of life, condition-specific outcome measures, relationship and social support measures, and sleep quality. Studies were excluded if no discrete data were available on women with metastatic breast cancer.

Data collection and analysis: Two review authors independently extracted the data and assessed the quality of the studies using the Cochrane Collaboration risk of bias tool. Where possible, authors were contacted for missing information. Data on the nature and setting of the intervention, relevant outcome data, and items relating to methodological quality were extracted. Meta-analyses was performed using a random-effects or fixed-effect Mantel-Haenszel model, depending on expected levels of heterogeneity.

Main results: Ten RCTs with 1378 women were identified. Of the seven RCTs on group psychological interventions, three were on cognitive behavioural therapy and four were on supportive-expressive group therapy. The remaining three studies were individual based and the types of psychological interventions were not common to either cognitive behavioural or supportive-expressive therapy. A clear pattern of psychological outcomes could not be discerned as a wide variety of outcome measures and durations of follow-up were used in the included studies. The overall effect of the psychological interventions across six studies, on one-year survival, favoured the psychological intervention group with an odds ratio (OR) of 1.46 (95% confidence interval (CI) 1.07 to 1.99). Pooled data from four studies did not show any survival benefit at five-years follow-up (OR 1.03, 95% CI 0.42 to 2.52). There was evidence of a short-term benefit for some psychological outcomes and improvement in pain scores.

Authors' conclusions: Psychological interventions appear to be effective in improving survival at 12 months but not at longer-term follow-up, and they are effective in reducing psychological symptoms only in some of the outcomes assessed in women with metastatic breast cancer. However, findings of the review should be interpreted with caution as there is a relative lack of data in this field, and the included trials had reporting or methodological weaknesses and were heterogeneous in terms of interventions and outcome measures.

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Conflict of interest statement

None declared

Figures

1

1

Study flow diagram for 2012 review update.

2

2

Risk of bias summary: Review authors' judgements about each risk of bias item for each included study.

3

3

Forest plot of comparison: 1 Psychological intervention versus usual practice, outcome: 1.1 Survival at one year.

4

4

Forest plot of comparison: 1 Psychological intervention versus usual practice, outcome: 1.2 Survival at five years.

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5

Forest plot of comparison: 1 Psychological intervention versus usual practice, outcome: 1.11 Profile of Mood States (full version) at 10 to 12 months.

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6

Forest plot of comparison: 1 Psychological intervention versus usual practice, outcome: 1.13 Pain at one year.

1.1

1.1. Analysis

Comparison 1 Psychological intervention versus usual practice, Outcome 1 Survival at 1 year.

1.2

1.2. Analysis

Comparison 1 Psychological intervention versus usual practice, Outcome 2 Survival at 5 years.

1.3

1.3. Analysis

Comparison 1 Psychological intervention versus usual practice, Outcome 3 Survival at 10 years.

1.4

1.4. Analysis

Comparison 1 Psychological intervention versus usual practice, Outcome 4 Anxiety at 6 months.

1.5

1.5. Analysis

Comparison 1 Psychological intervention versus usual practice, Outcome 5 Profile of Mood States (full version) at 6 months.

1.6

1.6. Analysis

Comparison 1 Psychological intervention versus usual practice, Outcome 6 Self‐esteem at 6 months.

1.7

1.7. Analysis

Comparison 1 Psychological intervention versus usual practice, Outcome 7 Profile of Mood States (short version) at 8 months.

1.8

1.8. Analysis

Comparison 1 Psychological intervention versus usual practice, Outcome 8 Functional Living Index at 8 months.

1.9

1.9. Analysis

Comparison 1 Psychological intervention versus usual practice, Outcome 9 Courtauld Emotional Control Scale at 8 months.

1.10

1.10. Analysis

Comparison 1 Psychological intervention versus usual practice, Outcome 10 Anxiety at 1 year.

1.11

1.11. Analysis

Comparison 1 Psychological intervention versus usual practice, Outcome 11 Profile of Mood States (full version) at 10‐12 months.

1.12

1.12. Analysis

Comparison 1 Psychological intervention versus usual practice, Outcome 12 Quality of Life (EORTC QLQ‐C30 score) at 1 year.

1.13

1.13. Analysis

Comparison 1 Psychological intervention versus usual practice, Outcome 13 Pain at 1 year.

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