The effectiveness of a psycho-educational group after early-stage breast cancer treatment: results of a randomized French study

Management of Fatigue in Adult Survivors of Cancer: ASCO-Society for Integrative Oncology Guideline Update

PURPOSE

To update the ASCO guideline on the management of cancer-related fatigue (CRF) in adult survivors of cancer.

METHODS

A multidisciplinary panel of medical oncology, geriatric oncology, internal medicine, psychology, psychiatry, exercise oncology, integrative medicine, behavioral oncology, nursing, and advocacy experts was convened. Guideline development involved a systematic literature review of randomized controlled trials (RCTs) published in 2013-2023.

RESULTS

The evidence base consisted of 113 RCTs. Exercise, cognitive behavioral therapy (CBT), and mindfulness-based programs led to improvements in CRF both during and after the completion of cancer treatment. Tai chi, qigong, and American ginseng showed benefits during treatment, whereas yoga, acupressure, and moxibustion helped to manage CRF after completion of treatment. Use of other dietary supplements did not improve CRF during or after cancer treatment. In patients at the end of life, CBT and corticosteroids showed benefits. Certainty and quality of evidence were low to moderate for CRF management interventions.

RECOMMENDATIONS

Clinicians should recommend exercise, CBT, mindfulness-based programs, and tai chi or qigong to reduce the severity of fatigue during cancer treatment. Psychoeducation and American ginseng may be recommended in adults undergoing cancer treatment. For survivors after completion of treatment, clinicians should recommend exercise, CBT, and mindfulness-based programs; in particular, CBT and mindfulness-based programs have shown efficacy for managing moderate to severe fatigue after treatment. Yoga, acupressure, and moxibustion may also be recommended. Patients at the end of life may be offered CBT and corticosteroids. Clinicians should not recommend L-carnitine, antidepressants, wakefulness agents, or routinely recommend psychostimulants to manage symptoms of CRF. There is insufficient evidence to make recommendations for or against other psychosocial, integrative, or pharmacological interventions for the management of fatigue.Additional information is available at www.asco.org/survivorship-guidelines.

Comparative effect of different patient education modalities on quality of life in breast cancer survivors: A systematic review and network meta-analysis

PURPOSE

To assess the comparative effect of patient education modalities (online, telephonic, mixed, in-person meetings) on the improvement of quality-of-life in breast cancer survivors.

METHODS

A search was conducted in different databases, being only included randomised controlled trials. The methodological quality and the risk of bias were assessed following the criteria of PEDro and Cochrane Rob-2 tools, respectively. The certainty of the evidence was judged using the GRADE tool. These evaluations were performed by two independent reviewers. When possible, data was pooled in a network meta-analysis (95% confidence interval [CI]).

RESULTS

Fourteen studies were included in the qualitative synthesis (1632 participants) and 11 in the quantitative (1482 participants). Network comparisons revealed that mixed educational modality was the highest ranked intervention at short (MD = 0.62; 95% CI [-0.35, 1.6]) and long -term (MD = 1.1; 95% CI [-1.5, 3.8); the control condition was the last in both cases, with a good convergence of the model observed. However, comparisons did not show significant differences.

CONCLUSIONS

Health policies could benefit from mixed modalities of patient education as it is expected to generate socio-economical savings and promote patient self-management. Probably, online mixed modalities, i.e. virtual face to face meetings, could be a more up-to-date option that fit best to nowadays patients' lifestyle. However, the limitations of this review force us to interpret our results with caution.

Psychological Aspects of Breast Cancer

Breast cancer is the most commonly diagnosed cancer in women. Associated psychological symptoms include stress, adjustment difficulties, anxiety, depression, impaired cognitive function, sleep disturbances, altered body image, sexual dysfunction, and diminished overall well-being. Distress screening and assessment identifies women who will benefit from therapeutic interventions. Addressing these symptoms improves compliance with treatment and outcomes including disease-related outcomes, psychological symptoms, and quality of life. The most effective treatments include teaching coping skills such as expressing emotion, along with other structured cognitive behavioral, interpersonal, and mindfulness approaches. Patients should be provided these psychosocial supports throughout their cancer journey.

Global burden of female breast cancer and its association with socioeconomic development status, 1990-2044

BACKGROUND

Breast cancer is a widespread disease in women worldwide.

AIM

We aimed to explore the global epidemiological trends of female breast cancer (FBC) between 1990 and 2044.

METHODS AND RESULTS

Disease burden, population, and socio-demographic index (SDI) data were obtained from the Global Health Data Exchange (GHDx) database. We analyzed temporal trends, age differences, risk factors, and geographic patterns of FBC disease burden globally and explored the association between age-standardized incidence rate (ASIR) of FBC and SDI. Bayesian age-period-cohort model was also performed to predict the changes in FBC incidence worldwide from 2020 to 2044. First, the global ASIR of FBC increased by 14.31% from 1990 to 2019 (95% Uncertainty Interval 4.75% to 23.98%). The death rate presented a falling trend. Second, alcohol use is the most-highlighted risk factor for FBC in some high-income regions such as Europe. A high fasting plasma glucose levels is the most prominent risk factor for FBC in Latin America and Africa. Third, the ASIR of the FBC increases with the SDI. Fourth, the incidence is expected to increase faster among women aged 35-60 years and fastest for those aged 50-54 years from 2020 to 2044. Countries with a high incidence of FBC that is expected to increase significantly include Barbados, Burkina Faso, Senegal, Monaco, Lebanon, Togo, and Uganda.

CONCLUSION

The disease burden of FBC varies worldwide; the findings suggest attaching importance to the control of middle and low-middle SDI regions. Public health as well as cancer prevention experts should pay more attention to regions and populations at an increased risk of developing FBC, focusing on their prevention and rehabilitation while conducting further epidemiological studies to investigate the risk factors of their increase.

Nonpharmacological Interventions for Management of the Pain-Fatigue-Sleep Disturbance Symptom Cluster in Breast Cancer Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Background

The pain-fatigue-sleep disturbance symptom cluster is commonly experienced by breast cancer patients, and a variety of nonpharmacological interventions are used to treat this symptom cluster.

Objective

To compare the efficacy of nonpharmacological interventions in improving the symptoms of the pain-fatigue-sleep disturbance symptom cluster in breast cancer patients.

Methods

A comprehensive literature search was conducted in the PubMed, EMBASE, Cochrane Library, CINAHL, CNKI, and Wanfang databases to identify randomized controlled studies from database inception to May 2022. Two reviewers independently performed data retrieval and risk of bias assessments. The consistency model was used to conduct network meta-analyses (NMA) based on the frequentist framework to assess the interventions, which were ranked by the surface under the cumulative ranking curve (SUCRA). Finally, the CINeMA application was used to evaluate the results of the NMA and the evidence of quality. The results Twenty-three eligible studies assessing 14 interventions were included. According to SUCRA values, among the management effects of the three symptoms, the effect of progressive muscle relaxation (PMR) ranked first, followed by mindfulness-based stress reduction (MBSR). The overall evidence quality of our study ranges from very low to moderate.

Conclusion

PMR and MBSR were effective interventions for the pain-fatigue-sleep disturbance symptom cluster in breast cancer patients. Clinical recommendations prioritize PMR for symptom management, followed by MBSR. However, this should be interpreted cautiously, as the confidence in the evidence was not high.

Management of Fatigue in Patients with Advanced Cancer

OPINION STATEMENT

Fatigue is a common and distressing symptom experienced by patients with cancer. It is most common in patients with locally advanced or metastatic incurable disease. It can have profound effects on quality-of-life and physical functioning. In addition to general supportive measures (directed at tackling contributory conditions and comorbidities), a variety of specific interventions have been developed which can be broadly categorised as physical therapies, psychological therapies or medication. There is some evidence that each of these approaches can have benefits in patients with earlier stage disease, those undergoing active treatment and in cancer survivors. The best evidence is for aerobic exercise, yoga, cognitive-behavioural therapy (CBT) and psycho-educational interventions. Less strong evidence supports the use of medications such as methylphenidate or ginseng. In patients with advanced disease, it is likely that the mechanisms of fatigue or the factors contributing to fatigue maintenance may be different. Relatively fewer studies have been undertaken in this group and the evidence is correspondingly weaker. The authors recommend the cautious use of aerobic exercise (e.g. walking) in those who are still mobile. The authors advise considering the use of psycho-educational approaches or CBT in those patients who are able to engage in such forms of therapy. In patients near the end-of-life, the authors advise use of dexamethasone (short-term use) and other pharmacological treatments only on the basis of a clinical trial.

Psychological interventions for women with non-metastatic breast cancer

BACKGROUND

Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015.

OBJECTIVES

To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non-metastatic breast cancer.  SEARCH METHODS: We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles.

SELECTION CRITERIA

Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non-metastatic breast cancer.

DATA COLLECTION AND ANALYSIS

Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes.

MAIN RESULTS

We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non-randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow-up time ranged from two weeks to 24 months.  Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD -0.27, 95% confidence interval (CI) -0.52 to -0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low-certainty evidence); anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P = 0.0009; 22 studies, 2702 participants, I2 = 89%, low-certainty evidence); mood disturbance in the intervention group (SMD -0.18, 95% CI -0.31 to -0.04; P = 0.009; 13 studies, 2276 participants, I2 = 56%, low-certainty evidence); and stress (SMD -0.34, 95% (CI) -0.55 to -0.12; P = 0.002; 8 studies, 564 participants, I2 = 31%, low-certainty evidence). The intervention is likely to improve quality of life in the intervention group (SMD 0.78, 95% (CI) 0.32 to 1.24; P = 0.0008; 20 studies, 1747 participants, I2 = 95%, low-certainty evidence). Adverse events were not reported in any of the included studies.

AUTHORS' CONCLUSIONS

Based on the available evidence, psychological intervention may have produced favourable effects on psychological outcomes, in particular depression, anxiety, mood disturbance and stress. There was also an improvement in quality of life in the psychological intervention group compared to control group. Overall, there was substantial variation across the studies in the range of psychological interventions used, control conditions, measures of the same outcome and timing of follow-up.

Effect of Psycho-Educational Intervention to Reduce Anxiety and Depression at Postintervention and Follow-Up in Women with Breast Cancer: A Systematic Review and Meta-Analysis

OBJECTIVES

To examine the effectiveness of the psycho-educational intervention in reducing anxiety and depressive symptoms for women with breast cancer in post- and follow-up status.

DATA SOURCES

A systematic search of 16 electronic databases to identify all randomized controlled trial studies that examine the effects of psycho-education on anxiety and depression among women with breast cancer. The standardized mean differences (SMDs) between groups in depression and anxiety levels for postintervention and follow-up were computed for each study.

CONCLUSION

Evidence suggests that psycho-educational intervention effectively relieves anxiety and depressive symptoms among women with breast cancer postintervention and follow-up.

IMPLICATIONS FOR PRACTICE

A significant effect of the psycho-education intervention was found to reduce anxiety and depressive symptoms in women with breast cancer. Such service was recommended in nursing practice.

Epidemiology and associated factors of depression among cancer patients in Ethiopia: protocol for systematic review and meta-analysis

Background

There is no pooled evidence regarding the prevalence and potential associated factors of depression among cancer patients in Ethiopian community. Hence, the current review aimed to examine the prevalence and associated factors of depression among cancer patients in Ethiopia.

Method

A computerized systematic literature search was made in MEDLINE, Scopus, PubMed, Science Direct, and Google Scholar. Each database was searched from its start date to June 2020. More over we will also add scholars and gray literature consultations. All articles will be included if they were published in English, which evaluated the prevalence and associated factors of depression among cancer patients in Ethiopia. Pooled estimations with a 95% confidence interval (CI) were calculated with DerSimonian-Laird random-effects model. Publication bias was evaluated by using inspection of funnel plots and statistical tests.

Discussion

Since we are using existing anonymized data, ethical approval is not required for this study. Our results can be used to guide clinical decisions about the most efficient way to prevent and treat depression among cancer patients.

Systematic review registration Submitted to Prospero.

Fatigue severity and avoidance among individuals with chronic disease: A meta-analysis

OBJECTIVE

Fatigue is a common, debilitating symptom experienced by individuals with chronic disease. Avoidance, or the act of evading unwanted experiences, is associated with fatigue across chronic disease samples. The current study sought to determine the strength of association between fatigue severity and avoidance in individuals with chronic disease.

METHODS

PubMed, PsycINFO, CINAHL, and ProQuest Dissertations and Theses databases were searched. Eligible studies measured fatigue and avoidance in chronic disease samples. Sixty-six studies were included. Data analyses were conducted in Rstudio. A random effects model was employed, and a weighted mean effect size was computed for fatigue severity and avoidance. Mixed-effects meta-regression analyses were conducted to examine moderating variables, including patient, clinical, and measurement characteristics. Publication bias was examined using funnel plot, trim-and-fill, and p-curve.

RESULTS

The meta-analysis comprised of 71 unique patient samples from 66 studies. The total number of included participants was 13,024. A small, positive association was found between fatigue severity and avoidance, r(71) = 0.22, p < .001, 95% CI [0.18-0.27], SE = 0.02. There was also significant heterogeneity, Q(70) = 349.96, p < .001. Moderator analyses examining age, sex, illness duration, avoidance type, and disease sample were all non-significant. Regarding publication bias, trim-and-fill resulted in a modified weighted mean effect size (r(83) = 0.18, p < .001) and a p-curve analysis supported the evidential value of the current analysis.

CONCLUSION

Findings support that among individuals with chronic disease, fatigue severity and avoidance are positively associated, which has implications for behavioral interventions in this population.

Effectiveness comparisons of various psychosocial therapies for cancer-related fatigue: A Bayesian network meta-analysis

OBJECTIVES

The purpose of this network meta-analysis (NMA) is to compare the effect of several psychosocial therapies on CRF critically.

METHODS

We applied systematic strategies based on eight databases, namely the Cochrane Central Register of Controlled Trials, PubMed, Embase, PsycINFO, China Biology Medicine (CBM), Wan Fang database, VIP, and China National Knowledge Infrastructure (CNKI) database to preliminary literature retrieval to identify relevant randomized controlled trials (RCTs). Studies, including adult patients (≥18 years) diagnosed with cancer, were eligible regardless of cancer stage and current treatment. We carried out an expression analysis for comparing the efficacy of various psychosocial therapies using Bayesian NMA. A battery of analyses and assessments, such as conventional meta-analysis and risk of bias, were performed concurrently.

RESULTS

We identified 41 RCTs including six different psychosocial interventions (4422 participants), namely cognitive-behavioral therapy (CBT), mindfulness-based stress reduction therapy (MBSR), psychoeducational therapy (PE), stress management therapy (SMT), meditation therapy (MT) and comprehensive therapy (CT). Our NMA results showed that three psychosocial intervention therapies were effective for CRF in cancer patients. The most effective psychosocial intervention was MBSR (SMD = -1.23, CrI: -1.88, -0.59, SUCRA = 83.33%), followed by PE (SMD = -0.86, CrI: -1.53, -0.18, SUCRA = 58.51%) and CBT (SMD = -0.84, CrI: -1.31, -0.37, SUCRA = 57.67%).

CONCLUSIONS

Our study showed that MBSR was most likely to be the best psychosocial intervention to relieve CRF in cancer patients. Medical staff should pay attention to applying MBSR to cancer patients in future clinical care.

Meta-Analysis of Randomized Controlled Trials on Yoga, Psychosocial, and Mindfulness-Based Interventions for Cancer-Related Fatigue: What Intervention Characteristics Are Related to Higher Efficacy?

Simple Summary

Many individuals with cancer suffer from persistent exhaustion due to cancer therapy, known as cancer-related fatigue (CRF). Yoga, psychosocial, and mindfulness-based interventions are recommended to reduce CRF. However, it is not clear yet how interventions need to be designed to maximize their efficacy. This meta-analysis aimed to identify intervention characteristics associated with greater reductions in CRF. A total of 70 interventions with 6387 participants were included in the analysis. Our results found a positive effect of yoga, psychosocial, and mindfulness-based interventions, while all invention types revealed large differences in intervention effects. In psychosocial interventions, using a group setting and working on cognition was related to higher efficacy. Regarding yoga and mindfulness-based interventions, no specific intervention characteristics emerged as more favorable than others. Overall, this meta-analysis suggests opportunities to optimize psychosocial interventions for CRF, whereas the design of yoga and mindfulness-based interventions seems to allow for variation.

Abstract

Cancer-related fatigue (CRF) is a burdensome sequela of cancer treatments. Besides exercise, recommended therapies for CRF include yoga, psychosocial, and mindfulness-based interventions. However, interventions conducted vary widely, and not all show a significant effect. This meta-analysis aimed to explore intervention characteristics related to greater reductions in CRF. We included randomized controlled trials published before October 2021. Standardized mean differences were used to assess intervention efficacy for CRF and multimodel inference to explore intervention characteristics associated with higher efficacy. For the meta-analysis, we included 70 interventions (24 yoga interventions, 31 psychosocial interventions, and 15 mindfulness-based interventions) with 6387 participants. The results showed a significant effect of yoga, psychosocial, and mindfulness-based interventions on CRF but with high heterogeneity between studies. For yoga and mindfulness-based interventions, no particular intervention characteristic was identified to be advantageous for reducing CRF. Regarding psychosocial interventions, a group setting and work on cognition were related to higher intervention effects on CRF. The results of this meta-analysis suggest options to maximize the intervention effects of psychosocial interventions for CRF. The effects of yoga and mindfulness-based interventions for CRF appear to be independent of their design, although the limited number of studies points to the need for further research.

Psychoeducation for breast cancer: A systematic review and meta-analysis

BACKGROUND

Psychoeducation has emerged as an intervention for women with breast cancer (BC). This meta-analysis evaluated the effectiveness of psychoeducation on adherence to diagnostic procedures and medical treatment, anxiety, depression, quality of life (QoL), and BC knowledge among patients with BC symptoms or diagnosis and BC survivors.

METHODS

A systematic literature search (in PubMed, Embase, PsycINFO and Cochrane) for randomised controlled trials (RCTs) comparing the effects of psychoeducation to control among patients with BC symptoms or diagnosis and BC survivors. Effects were expressed as relative risks (RRs) and standardized mean differences (SMDs) with their 95% confidence intervals.

RESULTS

Twenty-seven RCTs (7742 participants; 3880 psychoeducation and 3862 controls) were included. Compared with controls, psychoeducation had no significant effect on adherence to diagnostic procedures and medical treatment (RR 1.553; 95% CI 0.733 to 3.290, p = .16), but it significantly decreased anxiety (SMD -0.710, 95% CI -1.395 to -0.027, p = .04) and improved QoL with (SMD 0.509; 95% CI 0.096 to 0.923, p < .01). No effects were found for psychoeducation on depression (SMD -0.243, 95% CI -0.580 to 0.091, p = .14), or BC knowledge (SMD 0.718, 95% CI -0.800 to 2.236, p = .23).

CONCLUSION

We demonstrated that psychoeducation did not improve adherence to diagnostic procedures and treatment, depression and BC knowledge but was valuable for reducing anxiety and improving QoL. Future studies may explore the effectiveness of psychoeducation in promoting adherence across various types of cancer.

Psycho-Oncological Intervention Through Counseling in Patients With Differentiated Thyroid Cancer in Treatment With Radioiodine (COUNTHY, NCT05054634): A Non-randomized Controlled Study

Background

Diagnosis and treatment of differentiated thyroid carcinomas (DTC) cause anxiety and depression. Additionally, these patients suffer hormonal alterations that are associated with psychological symptoms (e.g., changes in mood, emotional instability, and memory loss). This study aims to evaluate the effectiveness of a psycho-oncological intervention based on counseling to reduce anxiety and depression related to the treatment in patients with DTC.

Methods

A non-randomized controlled study, with two groups [experimental group (EG), n = 37, and control group (CG), n = 38] and baseline and posttreatment measures, was designed. Patients in the EG received a psycho-oncological intervention based on counseling in addition to the standard treatment. The independent variable was the assigned group and the dependent one was the evolution of anxiety and depression, which were analyzed separately, and both were evaluated using the Hospital Anxiety and Depression Scale. Other relevant covariables related to the quality of life (QoL) were also analyzed using Short Form-36 Health Survey and Psychological General Wellbeing Index scales.

Results

The difference of the posttreatment-baseline variation showed a statistically significant reduction in anxiety and depression in the EG in relation to the CG (p &lt; 0.001). The mean of the Psychological General Wellbeing Index scales score increased significantly in the EG (p &lt; 0.001) and decreased significantly in the CG (p &lt; 0.001). All the baseline and the posttreatment scores of the variables evaluated showed a statistically significant improvement in the EG vs. the CG.

Conclusion

This study demonstrates significant benefits of psycho-oncological intervention based on counseling in anxiety, depression, QoL, and wellbeing of the patient with differentiated thyroid carcinomas.

The Effect of Educational Intervention Based on PRECEDE Model on Health Promotion Behaviors, Hope Enhancement, and Mental Health in Cancer Patients

In this experimental study, 200 cancer patients (100 subject in experimental group and 100 subjects in control group) referred to Amir Oncology Hospital in Shiraz were investigated. Educational intervention for experimental group consisted of 12 educational sessions for 50 to 55 minutes. A questionnaire including demographic information, PRECEDE constructs (knowledge, attitude, self-efficacy, enabling factors, and social support), was used to measure health promotion behaviors, patients' hope, and mental health before and 6 months after intervention. Six months after intervention, experimental group showed significant increase in knowledge, attitude, self-efficacy, enabling factors, social supports, health promotion behaviors, patients' hope, and mental health compared to the control group. This study showed the effectiveness of intervention based on PRECEDE constructs in mentioned factors 6 months after intervention. Hence, this model can act as a framework for designing and implementing educational intervention for health promotion behaviors of cancer patients.

The effect of interpersonal psychotherapy on quality of life among breast cancer patients with common mental health disorder: a randomized control trial at Tikur Anbessa Specialized Hospital

PURPOSE

To determine the effect of interpersonal psychotherapy on anxiety, depression, and quality of life among breast cancer patients with mental health disorders at Tikur Anbessa Specialized Hospital, Ethiopia.

METHODS

A two-arm parallel randomized controlled trial study was conducted among 114 (n = 57 intervention, and n = 57 control group) breast cancer patients with common mental health disorder at the oncology center of Tikur Anbessa Specialized Hospital. The hospital anxiety and depression measurement scale was used to assess depression and anxiety disorder and a 30-item quality of life questionnaire was used to assess the quality of life. General linear model analysis was done, confounding factors were controlled, and p < 0.05 was used to declare statistical significance.

RESULTS

Patients in the intervention group showed a significant improvement in the anxiety (coefficient - 3.68; 95% CI - 5.67, - 1.69; p < 0.001), depression (coefficient - 3.22; 95% CI - 4.7, - 1.69; p < 0.001), physical functioning (coefficient 10.55; 95% CI 3.13, 17.98; p = 0.006), health-related quality of life (coefficient 21.85; 95% CI 14.1, 29.59; p < 0.001), insomnia (coefficient - 19.56; 95% CI - 31.87, - 7.25; p = 0.002), and fatigue (coefficient - 11.37; 95% CI - 21.49, - 1.24; p = 0.028) respectively.

CONCLUSIONS

The adapted Ethiopian version of interpersonal psychotherapy had improved anxiety, depression, and some domains of health-related quality of life. Hence, health programmers should consider incorporating it as a treatment option in oncology centers.

TRIAL REGISTRATION NUMBER

PACTR202011629348967 granted on 20 November 2020 which was retrospectively registered.

Study Protocol of CBT-AP Trial: A Randomized Controlled Trial of Cognitive Behavioral Therapy Integrated with Activity Pacing for Fatigued Breast Cancer Patients Undergoing Chemotherapy

PURPOSE

This paper reports the methodology for undertaking a randomized controlled trial to assess the combined effect of cognitive behavioral therapy (CBT) and activity pacing on fatigue experienced by breast cancer patients undergoing chemotherapy.

METHOD

Fifty-eight patients experiencing severe fatigue will be randomized to a CBT group or usual care group. The intervention will be given for 6 sessions by a trained oncology nurse. Primary and secondary outcome measures will be assessed at baseline, the sixth week of intervention and at the third month post intervention. The primary outcome measure is fatigue (Brief Fatigue Inventory) and secondary outcome measures include depression (Patient Health Questionnaire) and quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire). The protocol is designed using the SPIRIT guidelines which is one of the EQUATOR checklists.

DISCUSSION

This is the first RCT that will determine the efficacy of CBT by integrating with activity pacing to reduce fatigue among breast cancer patients receiving chemotherapy. The intervention design is novel in addressing multiple precipitating and perpetuating factors of fatigue and integrated with activity pacing in CBT.

CONCLUSION

If the intervention is effective, this therapeutic approach can be incorporated into a routine health care for breast cancer patients receiving chemotherapy.

TRIAL REGISTRATION

The study have been registered in Pan-African Clinical Trial Registry (website) on August 24, 2020. The trial registration number is PACTR202008881026130.

Effect of patient education on quality-of-life, pain and fatigue in breast cancer survivors: A systematic review and meta-analysis

OBJECTIVE

To synthesise the existing evidence about the effect of patient education, either used alone or as adjunctive therapy, on the improvement of quality of life, pain and fatigue in adult breast cancer survivors.

DATA SOURCES

We searched PubMed, Web of Science, CINAHL, SCOPUS, Cochrane Plus, PEDro, Dialnet and Clinicaltrials.gov databases.

METHODS

We conducted this systematic review in accordance with the PRISMA statement. Only randomised controlled trials with adult breast cancer survivors were included. We assessed the methodological quality of the studies using the PEDro scale and the Cochrane risk-of-bias tool. We synthesised evidence using the GRADE tool.

RESULTS

We included 14 studies (PEDro 4-8 points) comprising 1749 adult women who survived breast cancer, of which we included 12 in the quantitative analysis. There were statistically significant short-term benefits for improved global quality-of-life (standardised mean difference [SMD] = 0.43, P = 0.05, 95% CI [0.00, 0.85]; GRADE: low certainty; not important), emotional quality-of-life (SMD = 0.32, P = 0.04, 95% CI [0.02, 0.62]) and fatigue (SMD = 0.24, P = 0.0004, 95% CI [0.11, 0.37]; GRADE: low certainty; not important). However, there were not statistically significant for pain severity (SMD = -0.05, P = 0.67, 95% CI [-0.26, 0.17]; GRADE: low certainty; not important) and fear to recurrence (SMD = -0.05, P = 0.68, 95% CI [-0.31, 0.20]; GRADE: moderate certainty; not important).

CONCLUSION

Patient education have a significative effect in short-term global quality-of-life, emotional quality-of-life and fatigue, though all the results were classified as 'not important'.

The effectiveness of hope-fostering interventions in palliative care: A systematic review and meta-analysis

BACKGROUND

The concept of hope is an important theme in chronic illness and palliative care and has been associated with increased psycho-spiritual well-being and quality of life. Psycho-spiritual interventions have been described in this population, but no systematic review of hope-enhancing interventions or hopelessness-reducing interventions has been conducted for persons with palliative care diseases.

AIM

To describe and assess the effectiveness of interventions in palliative care that measure hope and/or hopelessness as an outcome.

DESIGN

This systematic review and meta-analysis was pre-registered (Prospero ID: CRD42019119956).

DATA SOURCES

Electronic databases, journals, and references were searched. We used the Cochrane criteria to assess the risk of bias within studies.

RESULTS

Thirty-five studies (24 randomized controlled trials, 5 quasi-experimental, 6 pre-post studies) involving a total of 3296 palliative care patients were included. Compared with usual/standard cancer care alone, interventions significantly increased hope levels at a medium effect size (g = 0.61, 95% confidence interval (CI) = 0.28-0.93) but did not significantly reduce hopelessness (g = -0.08, 95% CI = -0.18 to 0.02). It was found that interventions significantly increase spirituality (g = 0.70, 95% CI = 0.02-1.37) and decrease depression (g = -0.29, 95% CI = -0.51 to -0.07), but had no significant effect over anxiety, quality of life, and symptom burden. Overall, quality of evidence across the included studies was rated as low.

CONCLUSIONS

Evidence suggests that interventions can be effective in increasing hope in palliative care patients.

QualFatigue study: which factors influence the use of specific interventions for breast cancer survivors with fatigue? A cross-sectional exploratory study

PURPOSE

International guidelines recommend specific interventions to reduce cancer-related fatigue (CRF). Evidence suggests underutilization of these interventions among breast cancer survivors. The QualFatigue study aimed to explore the potential factors influencing the use of specific interventions, for relief, in patients with CRF through qualitative analyses.

METHODS

Patients with stage I-III breast cancer, and CRF ≥4 on a 10-point numerical scale were recruited within 6-24 months at the end of their primary treatment. Semi-structured interviews were performed. Emergent themes were identified using a stepped content analysis (QDA Miner software).

RESULTS

Data saturation was achieved with 15 interviews. Four main themes emerged as potential sources of influence in the participants' use of specific interventions: (1) expectations regarding the management of CRF, (2) representations of the benefits provided by the interventions, (3) individual physical and psychological conditions, and (4) social and environmental situations. Six key levers came out transversally to optimize the use of specific interventions to relieve CRF: (1) listening and recognition of the individual difficulties and needs; (2) individual and global health assessments; (3) information and advice on how to manage CRF; (4) discussion groups focused on the management of CRF; (5) group activities; and (6) professional and personalized guidance.

CONCLUSION

This study calls for multi-level action to address many persistent barriers and exploit levers in the management of CRF.

Assessment of Self-Efficacy as a Way to Help Identify Cancer Patients Who Might Benefit from Self-Help Group Attendance?

Participating in patient self-help groups is highly recommended to patients in cancer care. Yet, engagement is relatively rare. A total of 253 patients participated in our study conducted as a paper-and-pencil questionnaire. A binominal logistic regression, with interest in participation in self-help groups being the dependent variable, was run. General interest in self-help was high among the respondents. Female gender, higher age, higher education and low self-efficacy were found to significantly predict interest in self-help. Patients reported a lack of information provided by medical professionals. Self-efficacy as a predictor might contribute to characterizing patients who might benefit from self-help group participation.

The effect of cognitive behavioral therapy on the quality of life of breast cancer patients: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

Several lines of clinical research support the efficacy of Cognitive behavioral therapy (CBT) with a large number of population and various disease conditions, however, the true effects of CBT interventions on Quality of Life of breast cancer patients remain unknown. The aim of the study was to evaluate the effect of Cognitive Behavioral Therapy on the Quality of Life of breast cancer patients.

METHODS

A systematic review of articles published using Web of Science (1950-January 2020); Medline via EBSCO (1992-January 2020); Science direct via ELSEVIER (1996-January 2020); SCOPUS (2004-January 2020); and PubMed (1946-January 2020 excluding Medline from 1992-January 2020) were included. Additional studies were included after  checking reference lists of all relevant studies; searching ongoing trials and research registers and manual search. Data extraction was conducted by two independent authors and a third independent author checked the data extraction. The PRISMA statement was adopted.

RESULT

Eleven Randomized controlled trials (RCT) with 1690 breast cancer patients were included in this review. The overall effect size of cognitive behavioral therapy on QoL of breast cancer patients was medium 0.39 (95% CI 0.12-0.66, P < 0.00001, I² = 83%). Five studies had shown statistically significant improvement in functional and symptoms scales in the treatment group than the control group.

CONCLUSION

CBT is effective in improving the Quality of Life of breast cancer patients. In future research, further randomized controlled trials with adequate randomization, allocation concealment, and appropriate blinding may be needed.

The questionable efficacy of manualized psychological treatments for distressed breast cancer patients: An individual patient data meta-analysis

Previous meta-analyses conclude that psychological treatments are efficacious for emotional distress in breast cancer (BCa). However, the practical relevance of these meta-analyses is questionable; none focused specifically on clinically distressed patients or whether treatment effects were clinically significant. In a two-stage individual patient data (IPD) meta-analysis of 17 randomized controlled trials of manualized psychological treatments in BCa, we evaluated treatment efficacy in distressed BCa patients (n = 1591) using clinical significance and effect size analyses. Outcomes were anxiety, depression, and general distress, evaluated at post-treatment and follow-up. Moderators examined were treatment type, treatment format, therapists' profession, control condition, age, outcome measure, and trial quality. Treated patients were more likely than controls to recover from anxiety and general distress at post-treatment (14-15% more treated patients recovered), but not at mean 8-months follow-up. Overall recovery rates were low: across outcomes, at post-treatment, only 30-32% of treated patients and 15-25% of controls recovered; at follow-up, only 21-30% of treated patients and 18-35% of controls recovered. Small between-group effect sizes in favour of treatment were found across outcomes at post-treatment (g = 0.32-0.34) but not at follow-up. Across the different analysis methods, few moderator effects were found. More efficacious psychological treatments are needed for distressed BCa patients.

The Effectiveness of Psychological Treatments in Women with Breast Cancer: A Systematic Review and Meta-Analysis

Breast cancer is the most prevalent oncological disease among women, and it represents the second oncological cause of death. Many studies have considered the quality of life in people with breast cancer because this condition has high comorbidity with mental distress, anxiety, affective disorders and depression. Psychological interventions can reduce the stressful consequences of both the diagnosis and the medical treatments of breast cancer. However, different methods (e.g., group or individual therapy) and focus (e.g., improving personal skills or increasing emotional well-being) do not help to identify which type of psychological therapy can be more effective in improving quality of life in patients with breast cancer. This study was aimed to systematically review and compare, by means of a meta-analysis, the efficacy of cognitive behavioural, supportive-expressive or psycho-educational treatments in women with breast cancer, focusing on anxiety, depression, mood and quality of life as outcomes. The PRISMA statement was adopted. MEDLINE, PsycINFO, PUBMED and PsycArticles databases were used, and reference lists were examined for additional publications. In the selection of the articles were included studies considering women between 18 and 65 years who were diagnosed with breast cancer at any stage and under any treatment, and who underwent psychological group interventions. At the end of the systematic review, 45 studies met all inclusion criteria and were analysed in the meta-analysis. The overall effect size was medium, especially considering cognitive behavioural therapy and psycho-educational treatments. However, the studies are characterised by high methodological heterogeneity. Despite some limitations, this review and meta-analysis partially confirm the efficiency of cognitive-behavioural and psycho-educational therapies in the improvement of well-being in women with breast cancer.

A Retrospective Study Reviewing Interprofessional Advance Care Planning Group Discussions in Pulmonary Rehabilitation: A Proof-of-Concept and Feasibility Study

Background:

Advance care planning (ACP) is a process of reflection and discussion wherein a patient, in consultation with a health-care provider, family, and/or loved ones, clarifies values and treatment preferences and establishes goals, including a plan for end-of-life (EOL) care. Advance care planning encompasses appreciating and understanding illness and treatment options, elucidating patient values and beliefs, and identifying a substitute decision maker (SDM) or designating a power of attorney (POA) for personal care. These discussions have proven to be effective in improving patient–family satisfaction, reducing anxiety regarding EOL care in patients and family members, and improving patient-centered care by empowering patients to direct their care at EOL. However, ACP conversations are often difficult to have due to the sensitive nature of such discussions.

Objective:

The aim of this study was to determine whether group facilitation for teaching and discussing ACP enhances participants’ understanding of ACP and allows them to feel comfortable and supported when discussing these sensitive issues.

Methods:

Patients who were registered in North York General Hospital’s (NYGH) pulmonary rehabilitation program from June 2016 until August 2017 were given the opportunity to attend two 1-hour sessions related to ACP. The first session was dedicated to educating patients on ACP, explaining the hierarchy of the SDM and the role of the POA for personal care. The second session, provided a short time later, was devoted to discussions of values, wishes, fears, and trade-offs for future medical and EOL care. These discussions led by the supportive care nurse practitioner and a physician who are members of the NYGH Freeman Palliative Care Team were held in a group-facilitated format. Anonymous feedback forms, including both qualitative and quantitative feedback, were completed by the participants and analyzed.

Participants:

Analysis of a sample of 30 participants who attended 1 or 2 of the ACP sessions revealed that 21 identified as female and 9 identified as male. The average age of the participants was 76 years.

Findings:

Participants felt the content was relevant to their needs and were comfortable asking questions with all feedback averages ranging from good to very good. Participants appreciated the opportunity to share their thoughts in an open and interactive format.

Conclusion:

Discussing issues relevant to ACP, including providing information about ACP, sharing fears, wishes, and tradeoffs, were well-received in a group-support environment. Future studies should assess the impact of ACP group discussion on the individual, such as identifying a POA, having discussions regarding wishes and values with the SDM/POA, and examining the clinical impact of such sessions.

The effectiveness of psychological interventions for fatigue in cancer survivors: systematic review of randomised controlled trials

BACKGROUND

Fatigue is a common symptom in cancer patients that can persist beyond the curative treatment phase. This systematic review evaluated the effectiveness of psychological interventions for cancer-related fatigue in post-treatment cancer survivors.

METHODS

We searched relevant online databases and sources of grey literature. Randomised controlled trials (RCTs) evaluating psychological interventions in adult cancer patients after the completion of treatment, with fatigue as an outcome measure, were included. Two review authors extracted data independently from the selected studies and assessed the methodological quality using the Cochrane Collaboration Risk of Bias Tool.

RESULTS

Thirty-three psychological interventions were identified. The sample size of the included studies varied between 28 and 409, with 4525 participants overall. Twenty-three of the included studies reported a significant effect of the interventions on reducing fatigue in cancer survivors. Most interventions focused on psychoeducation, mindfulness, cognitive or behaviour therapy-oriented strategies. However, studies differed widely in terms of measurement tools used to assess fatigue, mode, duration and frequency of the intervention delivery.

CONCLUSIONS

This review showed some tentative support for psychological interventions for fatigue after cancer treatment. However, as the RCTs were heterogeneous in nature and the number of high-quality studies was limited, definitive conclusions are not yet possible. With the growing need for stage-specific research in cancer, this review sought to inform current practice and to summarise the existing evidence base of randomised controlled trials in the area.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration number: CRD42014015219.

The Effectiveness of Psychoeducational Support Groups for Women With Breast Cancer and Their Caregivers: A Mixed Methods Study

Background: Previous studies on the effectiveness of psychological interventions in oncology mainly used quantitative measures and no study was conducted with regard to both caregivers and patients.

Aim: This study evaluates the effectiveness of psychoeducational support groups, both for women with breast cancer, and for their informal caregivers through the use of quantitative and qualitative measures.

Methods: A longitudinal design was used comparing two psychoeducational support groups with other two groups in a standard care control condition. Participants were 28 women with a diagnosis of breast cancer in the care of a hospital in Northern Italy, and 21 family caregivers. The quantitative data were collected by Cognitive Behavioral Assessment for Outcome Evaluation (CBA-OE) and the qualitative data through the use of semi-structured interviews.

Results: The statistical analysis showed a significant change attributable to the psychological intervention that proves the effectiveness of such an intervention in the patients’ and caregivers’ group. The qualitative analysis allowed us to interpret the behavioral and psychological profile emerging from CBA-OE, by considering the subjective experience of the treatment groups. The group experience offered affective, relational and informative support, and allowed participants to create a network and to feel understood and reassured.

Conclusion: The results suggest the usefulness of psychoeducational support groups for women with breast cancer and for their caregivers. The value of this kind of intervention is not only at an individual level but also at a systems level, and family involvement ensures the best positive outcomes.

A randomized controlled trial of a group acceptance-based intervention for cancer survivors experiencing anxiety at re-entry ('Valued Living'): study protocol

Background

Anxiety is a common concern of cancer survivors during the transition from active cancer treatment to cancer survivorship (the re-entry phase). This paper presents the study protocol for a novel group-based behavioral intervention to improve mental health, well-being, and medical use outcomes among anxious cancer survivors at re-entry.

Methods/Design

This two-armed, prospective randomized controlled trial will randomize a minimum of 100 re-entry-phase cancer survivors with moderate to high anxiety to the intervention or a usual care control condition. The intervention is delivered in a group format over 7 weeks; content is based on Acceptance and Commitment Therapy (ACT), an acceptance, mindfulness, and values-based intervention. Participants will be recruited from community cancer care centers and the intervention will be led by the onsite clinical social workers. Participants will be assessed at baseline, mid-intervention, post-intervention, and 3- and 6-month follow-up. ACT participants will complete process measures before the beginning of group sessions 2, 4, and 6; all participants will complete the process measures during the regular assessments. The primary outcome is anxiety symptoms; secondary outcomes include anxiety disorder severity, fear of recurrence, depressive symptoms, cancer-related trauma symptoms, sense of life meaning, vitality/fatigue, and medical utilization.

Discussion

This clinical trial will provide valuable evidence regarding the efficacy of the group ACT intervention in community oncology settings.

Trial registration

Clinicaltrials.gov NCT02550925.

Intervenções Grupais para Mulheres com Câncer de Mama: Desafios e Possibilidades

Resumo Este estudo teve por objetivo analisar a produção científica nacional e internacional sobre os grupos de reabilitação psicossocial para mulheres com câncer de mama. O levantamento bibliográfico foi realizado a partir das bases indexadoras LILACS, PubMed, PsycINFO e CINAHL. Foram selecionados 28 artigos, publicados no período de 2000 a 2015, que constituíram o corpus do estudo. Os achados foram agrupados por meio de análise de conteúdo. Os resultados evidenciaram que os grupos de apoio podem resultar em benefícios psicossociais, como redução de estresse, incremento da qualidade de vida, melhora do humor e compartilhamento de informações sobre as diversas opções de tratamentos disponíveis. Conclui-se que participar de grupos de apoio está associado a melhores desfechos psicológicos, contudo, não há evidências que comprovem aumento na expectativa de vida das mulheres.

After the Psychoeducational Intervention: Turkish Breast Cancer Survivors' Experiences

OBJECTIVE

To explore breast cancer survivors' life experiences and perceptions about participating in a psychoeducational intervention that aimed at reducing psychological distress and in improvement of the quality of life.

MATERIALS AND METHODS

This study was a post-trial qualitative descriptive study. Data were collected at semi-structured interviews three months after the psychoeducational intervention. Interviews were conducted with 32 Turkish breast cancer survivors. Obtained data were analyzed with inductive content analysis.

RESULTS

The data were categorized into three themes: personal growth, unmet needs and recommendations about the quality of the psychoeducation. Survivors explained that they had positive changes in their self-concept, view of life and relationships after the psychoeducational intervention. In addition, they mentioned the unmet needs to join support groups and raise public awareness to decrease stigma over breast cancer patients in the society.

CONCLUSION

The results of the present study provide new insights into experiences of breast cancer survivors who participated a psychoeducational intervention and provide guidance for attempts to improve survivorship care via psychoeducation to professionals. Psychoeducational interventions should be continuously offered to provide psychosocial support for breast cancer survivors. Future research into psychoeducation for breast cancer survivors should be restructured to involve social support.

Exercise and Education Program After Breast Cancer: Benefits on Quality of Life and Symptoms at 3, 6, 12, and 24 Months' Follow-up

BACKGROUND

Various clinical trials have demonstrated the benefits of physical training offered during and/or after breast cancer treatments. However, given the variety of adverse events that may be encountered, physical training could be combined with psychologic, relational, and social guidance. This kind of multidisciplinary program, as well as its long-term effects, have been little studied so far. Therefore, the objective of our study was to determine the benefits at 3, 6, 12, and 24 months of a 3-month exercise and education program among women after breast cancer treatment.

PATIENTS AND METHODS

Two hundred nine outpatients treated for primary breast carcinoma were divided into a control group (n = 106) and an experimental group (n = 103) which underwent a 3-month rehabilitation program including physical training and psychoeducational sessions. The assessments, performed before the program and at 3, 6, 12, and 24 months after inclusion, included validated questionnaires on quality of life and symptoms.

RESULTS

The analyses revealed an improvement in quality of life and symptoms after the exercise and education program within the experimental group and a maintenance of these improvements during the 2 years of follow-up. These improvements were significantly better than those in the control group, clearly demonstrating that the program has benefits.

CONCLUSION

This trial identified the benefits of a well-detailed 3-month exercise and education program over 24 months' follow-up among women after breast cancer treatment.

A meta-analysis of the efficacy of cognitive behavior therapy on quality of life and psychological health of breast cancer survivors and patients

OBJECTIVE

The aim of this study was to examine the effect of cognitive behavior therapy (CBT) on quality of life (QOL) and psychological health of breast cancer survivors and patients.

METHODS

A total of 1289 references were examined from an overall literature search in PubMed, Embase, CINAHL, and the Cochrane Database of Systematic Reviews. Randomized controlled trials assessing the efficacy of CBT compared with a range of comparators in cancer survivors. We assessed the effect of CBT by using the standardized mean difference as effect size.

RESULTS

Among 1289 abstracts and 292 full-text articles reviewed, 10 studies were included. At the posttreatment period, the pooled effect size for CBT on QOL was 0.57 (95% CI, 0.44 to 0.69; P < .001), on depression was -1.11 (95% CI, -1.28 to -0.94; P < .001), on stress was -0.40 (95% CI, -0.53 to -0.26; P < .001), on anxiety was -1.10 (95% CI, -1.27 to -0.93; P < .001), and on hyperarousal cluster of symptoms was -0.18 (95% CI, -0.30 to -0.05; P < .001). The QOL was considered statistically medium effect sizes. The depression and anxiety were considered statistically large effect sizes.

CONCLUSIONS

Cognitive behavior therapy is an effective therapy for psychological symptoms of cancer survivors and patients, with meaningfully clinical effect sizes. These findings suggested that CBT should be used as the intervention for breast cancer survivors and patients when possible.

Web-Based Tailored Psychoeducation for Breast Cancer Patients at the Onset of the Survivorship Phase: A Multicenter Randomized Controlled Trial

CONTEXT

Many breast cancer patients have unmet informational and psychosocial needs after treatment completion. A psychoeducational intervention may be well suited to support these patients.

OBJECTIVES

The purpose of this multicenter randomized controlled trial was to examine the effectiveness of a web-based tailored psychoeducational program (ENCOURAGE) for breast cancer patients, which aims to empower patients to take control over prevailing problems.

METHODS

Female breast cancer patients from two hospitals in The Netherlands who recently completed (neo-)adjuvant chemotherapy were randomly assigned to standard care or 12-week access to the ENCOURAGE program providing fully automated information problem-solving strategies, resources, and services for reported problems. At six and 12 weeks, patients completed self-report questions on optimism and control over the future (primary outcome), feelings of being informed, and acceptance of the illness. At baseline and 12 weeks, distress and quality of life questionnaires were completed.

RESULTS

About 138 patients were included. Almost all patients (67 of 69) visited ENCOURAGE as requested. No differences between the control and intervention group were observed for primary and secondary outcomes. An unplanned subgroup analysis showed that in clinically distressed patients (N = 57 at baseline; 41%), use of the ENCOURAGE program increased optimism and control over the future at 12 weeks more than in patients in the control group (Cohen's d = 0.65).

CONCLUSION

Although the effectiveness was not demonstrated, a subgroup of women treated for breast cancer can probably be supported by the program. The results of the present study are a starting point for further development and use of the program.

Home-based multidimensional survivorship programmes for breast cancer survivors

BACKGROUND

The prognosis and survival rate of women with breast cancer have significantly improved worldwide. Effective home-based multidimensional programmes for breast cancer survivors have gained an ever greater emphasis in survivorship care to maximise women's quality of life for their successful transition to rehabilitation and normal life. It is important to summarise the best available evidence to evaluate the effects of home-based multidimensional survivorship programmes on quality of life in women within 10 years of the completion of surgery or adjuvant cancer therapy for breast cancer, or both.

OBJECTIVES

To assess the effects of home-based, multidimensional survivorship (HBMS) programmes on maintaining or improving the quality of life in breast cancer survivors.

SEARCH METHODS

In April 2016 we searched the Cochrane Breast Cancer Specialised Register, CENTRAL, PubMed, Embase, CINAHL Plus, PsycINFO, Web of Science, and the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. We also screened reference lists of all identified studies and contacted study authors.

SELECTION CRITERIA

Randomised controlled trials (RCTs) and quasi-RCTs assessing the effects of HBMS programmes in maintaining or improving quality of life in women with stages 0 to 3 breast cancer who completed primary cancer treatment (surgery or adjuvant cancer therapy, or both) up to 10 years earlier. We considered studies where the interventions included more than one of the following listed components: educational (such as information provision and self-management advice), physical (such as exercise training and resistance training) and psychological (such as counselling and cognitive therapies), to constitute a multidimensional programme. Interventions had to be allowed to be carried out at home.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed eligible studies for inclusion, and performed quality assessment and extracted relevant data of the included studies. Quality of life was the primary outcome of the review.

MAIN RESULTS

We included 22 RCTs and four quasi-RCTs on 2272 participants. We categorised the intervention components into four groups: educational and psychological; educational and physical; physical and psychological; and educational, physical and psychological. Most of the studies used usual care (routine medical follow-up services) as the comparator. A few studies used a lower level or different type of intervention (e.g. stress management or exercise) or attention control as the comparator.We used the Functional Assessment of Cancer Therapy-Breast (FACT B), European Organisation for Research and Treatment of Cancer Quality of Life C30 (EORTC C30), Quality of Life (QoL) Breast Cancer, and SF36 questionnaires to assess quality of life. HBMS programmes may increase breast cancer-specific quality of life and global quality of life immediately after the intervention, as measured by FACT-B and EORTC C30 (FACT-B: mean difference (MD) 4.55, 95% confidence interval (CI) 2.33 to 6.78, 7 studies, 764 participants; EORTC: MD 4.38, 95% CI 0.11 to 8.64, 6 studies; 299 participants; moderate-quality evidence). There was no evidence of a difference in quality of life as measured by QoL-Breast Cancer or SF-36 (QoL-Breast Cancer: MD 0.42, 95% CI -0.02 to 0.85, 2 studies, 111 participants, very low-quality evidence; physical composite score SF36: MD 0.55, 95% CI -3.52 to 4.63, 2 studies, 308 participants, low-quality evidence).We observed a similar pattern at one to three months after the intervention: FACT-B (MD 6.10, 95% CI 2.48 to 9.72, 2 studies, 426 participants), EORTC-C30 (MD 6.32, 95% CI 0.61 to 12.04, 2 studies; 172 participants) and QoL-Breast Cancer (MD 0.45, 95% CI -0.19 to 1.09, 1 study, 61 participants). At four to six months and 12 months, there was no evidence of a difference in quality of life between groups (four to six months: EORTC - MD 0.08, 95% CI -7.28 to 7.44, 2 studies; 117 participants; SF-36 - MD -1.05, 95% CI -5.60 to 3.51, 2 studies, 308 participants; 12 months: EORTC - MD 2.04, 95% CI -9.91 to 13.99, 1 study; 57 participants).Functional status was incorporated into the quality of life subscale findings. HBMS programmes may decrease anxiety (MD of Hospital Anxiety and Depression Scale (HADS) -1.01, 95% CI -1.94 to -0.08, 5 studies, 253 participants, low-quality evidence) compared to control immediately after the intervention but the effect did not persist at four to six months. There was no evidence of improvements in depression immediately after HBMS (MD of HADS -1.36, 95% CI -2.94 to 0.22, 4 studies, 213 participants, low-quality evidence) or at follow-up. HBMS programmes may also decrease fatigue (MD -1.11, 95% CI -1.78 to -0.45, 3 studies, 127 participants; low-quality evidence) and insomnia (MD -1.81, 95% CI -3.34 to -0.27, 3 studies, 185 participants, low-quality evidence).None of the included studies reported service needs and utilisation and cost of care, and therefore the effect of HBMS programmes on healthcare utilisation and cost is unknown. Due to the variations in assessment methods of adherence among the eight studies, we could not combine the results for meta-analysis. We synthesised the results narratively, with the reported adherence rates of 58% to 100%.

AUTHORS' CONCLUSIONS

The results of this systematic review and meta-analysis revealed that HBMS programmes in breast cancer survivors appear to have a short-term beneficial effect of improving breast cancer-specific quality of life and global quality of life as measured by FACT-B and EORTC-C30, respectively. In addition, HBMS programmes are associated with a reduction in anxiety, fatigue and insomnia immediately after the intervention. We assessed the quality of evidence across studies as moderate for some outcomes, meaning that we are fairly confident about the results, while we assessed other outcomes as being low-quality, meaning that we are uncertain about the result.

Small Group Process and Outcome Research Highlights: A 25-Year Perspective

We summarize major research findings from the past 25 years within the larger evolution of group psychotherapy. Small group process findings are highlighted from a group-as-a-whole, interpersonal relation, subgroup, individual member characteristics, and leader perspective. Special emphasis is given to cohesion and the significant correlation between cohesion and outcome. We note that group therapy is an empirically well-supported treatment for a large number of psychiatric disorders and describe evidence supporting the outcome of various theoretical orientations. Key studies showing outcome equivalence for group and individual therapy are reviewed, followed by a high-level summary of group therapy's efficacy research for depression, bipolar, social phobia, panic disorder, obsessive compulsive, bulimia nervosa, binge-eating, substance-related, trauma-related, HIV/AIDS, breast cancer, chronic pain, schizophrenia, and borderline personality. We conclude with the promise of recent advances for moving the field forward over the next 25 years.

Self-management education interventions for patients with cancer: a systematic review

PURPOSE

This systematic review was intended to identify the effectiveness and inclusion of essential components of self-management education interventions to support patients with cancer in developing the skills needed for effective self-management of their disease and the acute or immediate, long-term, and late harmful effects of treatments.

METHODS

Self-management education interventions were included if they were randomized controlled trials (RCTs) containing at least one of the eight core elements outlined by the research team. A systematic search was conducted in Ovid MEDLINE (2005 through April 2015), Embase (2005 to 2015, week 15), the Cochrane Database of Systematic Reviews (Issue 4, April 2015), CINAHL (2005 to 2015) and PsychINFO (2005 to 2015). Keywords searched include 'self-management patient education' or 'patient education'.

RESULTS

Forty-two RCTs examining self-management education interventions for patients with cancer were identified. Heterogeneity of interventions precluded meta-analysis, but narrative qualitative synthesis suggested that self-management education interventions improve symptoms of fatigue, pain, depression, anxiety, emotional distress and quality of life. Results for specific combinations of core elements were inconclusive. Very few studies used the same combinations of core elements, and among those that did, results were conflicting. Thus, conclusions as to the components or elements of self-management education interventions associated with the strength of the effects could not be assessed by this review.

CONCLUSION

Defining the core components of cancer self-management education and the fundamental elements for inclusion in supporting effective self-management will be critical to ensure consistent and effective provision of self-management support in the cancer system.

An evaluation of the effectiveness of 'Time to Adjust' a group-based cognitive-behavioural-therapy (CBT) programme for patients recovering from cancer

OBJECTIVES

'Time to Adjust' (TTA) is a 6-week group-based cognitive-behavioural-therapy programme for patients recovering from cancer. The TTA intervention is designed to facilitate patient's adjustment to life after cancer by enhancing existing coping skills, developing new coping skills and drawing on peer support within the context of group delivery of the programme. The study aims to explore patient psychological adjustment and to identify features of the intervention that patients find most beneficial.

METHODS

This retrospective repeated measures design study represents a clinical evaluation of a group-based intervention routinely delivered by the Cancer Psychology Service at University Hospital Limerick. TTA was open to patients with a cancer diagnosis who had completed their surgery, radiotherapy and chemotherapy treatment by the programme start date. Patients self-referred and suitability for the programme was assessed by pre-programme clinical interview. Pre- and post-intervention data from 59 participants was collected using self-report measures of stress and coping. A brief end-of-programme questionnaire provided descriptive feedback on patients' experience of the programme.

RESULTS

Findings revealed favourable trends in the psychological adjustment of patients. Self-reported depression, anxiety and negative adjustment was lower post-TTA.

CONCLUSIONS

This study indicates that TTA supports patients' psychological recovery from cancer with multiple components of the programme facilitating psychological adjustment. Findings support the delivery of group-based therapeutic interventions for this patient group. Future research could use in-depth post-intervention interviews for a richer understanding of the programme benefits. Longer-term follow-up in could examine the degree to which benefits are maintained over time.