Abstract
Background
Higher survival rates for breast cancer patients have led to concerns in dealing with short- and long-term side effects. The most common complications are impairment of shoulder functions, pain, lymphedema, and dysesthesia of the injured arm; psychological consequences concern: emotional distress, anxiety, and depression, thereby, deeply impacting/affecting daily living activity, and health-related quality of life.
Objective
To perform a systematic review for assessing the efficacy or effectiveness of interventions aiming at improving health-related quality of life, return to daily activity, and correct lifestyles among breast cancer patients.
Methods
A literature search was conducted in December 2016 using the databases PubMed and Scopus. Search terms included: (counseling) AND (breast cancer) AND (quality of life). Articles on counseling interventions to improve quality of life, physical and psychological outcomes were included.
Results
Thirty-five articles met the inclusion criteria. The interventions were grouped in five main areas: concerning lifestyle counseling interventions, related to combined interventions (physical activity and nutritional counseling), physical therapy, peer counseling, multidisciplinary approach, included psychological, psycho-educational interventions, and cognitive-behavior therapy (CBT). Exercise counseling as well as physical therapy are effective to improve shoulder mobility, healing wounds, and limb strength. Psychological therapies such as psychoeducation and CBT may help to realize a social and psychological rehabilitation.
Conclusion
A multidisciplinary approach can help in sustaining and restoring impaired physical, psychosocial, and occupational outcomes of breast cancer patients.
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References
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The authors declare that they have no conflict of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
Appendices
Annex 1: PICOS inclusion and exclusion criteria
Inclusion criteria | Exclusion criteria | |
---|---|---|
Population | Women with diagnosis of breast cancer | Children and adolescents, patients with other solid cancer |
Interventions | 1. Lifestyle intervention counseling: nutritional—change in dietary habits, dietary regime, physical activity habits; physical exercise: home-based and instructed exercise, supervised training program by qualified exercise physiologist; group session of exercise, and diet 2. Comple—combined interventions, e.g., counseling and exercise 3. Physical therapy: manual lymph drainage (MLD), standard physiotherapy 4. Peer counseling, familiar counseling 5. Psychological intervention: cognitive-behavior therapy (CBT), psychoeducation, psychological counseling conducted face-to face or through telephone: telephone interpersonal counseling (TIP-C), telephone health education (THE), telephone psychosocial intervention (TTM Prochaska e Di Clemente, other complex protocols) | Alternative medicine—e.g., Chinese medicine herbal |
Comparator (e.g., control) | Usual care | No intervention applied |
Outcomes | Primary: HrQoL, Secondary: Physical (e.g., lymphedema, shoulder mobility) Psychosocial (e.g., anxiety, depression, psychological well-being, affect/mood,) Occupational (e.g., return to work, lifestyle) | Article not including HrQoL as outcome |
Study design | RCT, observational studies, narrative review, systematic review, review of systematic review, no restriction of language | None |
Annex 2 Prisma Statement Checklist
Section/topic | # | Checklist item | Reported on page # |
---|---|---|---|
Title | |||
Title | 1 | Identify the report as a systematic review, meta-analysis, or both | 1 |
Abstract | |||
Structured summary | 2 | Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number | 2 |
Introduction | |||
Rationale | 3 | Describe the rationale for the review in the context of what is already known | 3 |
Objectives | 4 | Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS) | 3 |
Methods | |||
Protocol and registration | 5 | Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number | 4 |
Eligibility criteria | 6 | Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale | 4 |
Information sources | 7 | Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched | 4 |
Search | 8 | Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated | 4 |
Study selection | 9 | State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis) | 4 |
Data collection process | 10 | Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators | 5 |
Data items | 11 | List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made | 4 |
Risk of bias in individual studies | 12 | Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis | n.a. |
Summary measures | 13 | State the principal summary measures (e.g., risk ratio, difference in means) | n.a. |
Synthesis of results | 14 | Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis | n.a. |
Section/topic | # | Checklist item | Reported on page # |
Risk of bias across studies | 15 | Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies) | n.a. |
Additional analyses | 16 | Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were prespecified | n.a. |
Results | |||
Study selection | 17 | Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram | 6;8 |
Study characteristics | 18 | For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations | 8–24 |
Risk of bias within studies | 19 | Present data on risk of bias of each study and, if available, any outcome level assessment (see item 12) | n.a. |
Results of individual studies | 20 | For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group, (b) effect estimates and confidence intervals, ideally with a forest plot | 8–24 |
Synthesis of results | 21 | Present results of each meta-analysis done, including confidence intervals and measures of consistency. | 8–24 |
Risk of bias across studies | 22 | Present results of any assessment of risk of bias across studies (see Item 15) | n.a. |
Additional analysis | 23 | Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item 16]) | n.a. |
Discussion | |||
Summary of evidence | 24 | Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers) | 25–28 |
Limitations | 25 | Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias) | 27 |
Conclusions | 26 | Provide a general interpretation of the results in the context of other evidence, and implications for future research | 28 |
Funding | |||
Funding | 27 | Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review | 28 |
Annex 3: Interventions included and main outcomes
Author | Interventions | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Nutritional | Physical activity | Combined | Physiotherapy | Peer counseling | Multidisciplinary | Psychological | Psychosocial | TIP-C | THE | CBT | |
Gellert [73] | x | ||||||||||
Marchioro [74] | x | ||||||||||
Marcus [63] | x | ||||||||||
Darga [40] | x | ||||||||||
Andersen [84] | x | x | |||||||||
Badger [69] | x | ||||||||||
Badger [70] | x | ||||||||||
Badger [70] | x | ||||||||||
Giese-Davis [61] | x | ||||||||||
Maeda [78] | x | ||||||||||
Demark-Wahnefried [45] | x | ||||||||||
Sharif [62] | x | ||||||||||
Hoving [79] | x | ||||||||||
Marcus [64] | x | ||||||||||
Lee [75] | x | ||||||||||
David [72] | x | ||||||||||
Gonçalves [76] | x | ||||||||||
Naumann [49] | x | ||||||||||
De Boer [80] | |||||||||||
Kim [66] | x | ||||||||||
Spector [48] | x | ||||||||||
Befort [43] | x | ||||||||||
McCarroll [25] | x | ||||||||||
Badger [37] | x | x | |||||||||
Arving [77] | x | ||||||||||
Carayol [46] | x | ||||||||||
Casla [51] | x | ||||||||||
Cho [41] | x | ||||||||||
Demark-Wahnefried [52] | x | ||||||||||
Rogers [53] | x | ||||||||||
Loh [58] | x | x | x | x | x | x | x | x | |||
Lahart [39] | x | ||||||||||
Badger [68] | x | ||||||||||
Giese-Davis [60] | x | ||||||||||
Gnagnarella [47] | x |
Author | Outcomes | ||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Physical activity | Diet | Weight loss | HRQoL | Anxiety and depression symptoms | Shoulder mobility, wound healing | Occupational outcome | Self-efficacy | Emotional function | Sexual functioning | Fatigue | Social support, | Psychological well-being | Adaptive coping | Physical function | |
Gellert [73] | x | x | |||||||||||||
Marchioro [74] | x | x | x | x | x | ||||||||||
Marcus [63] | x | x | x | x | |||||||||||
Darga [40] | x | ||||||||||||||
Andersen [84] | x | x | |||||||||||||
Badger [69] | x | x | x | ||||||||||||
Badger [70] | x | ||||||||||||||
Badger [70] | x | x | x | x | |||||||||||
Giese-Davis [61] | x | x | x | x | |||||||||||
Maeda [78] | x | x | x | x | |||||||||||
Demark-Wahnefried [45] | x | x | x | x | |||||||||||
Sharif (2009) | x | x | x | x | |||||||||||
Hoving [79] | x | x | x | ||||||||||||
Marcus [64] | x | x | x | ||||||||||||
Lee [75] | x | ||||||||||||||
David [72] | x | x | |||||||||||||
Gonçalves [76] | x | x | x | x | x | x | |||||||||
Naumann [49] | x | ||||||||||||||
De Boer [80] | x | ||||||||||||||
Kim [66] | x | x | x | x | x | x | |||||||||
Spector [48] | x | x | |||||||||||||
Befort [43] | x | x | x | x | |||||||||||
McCarroll [25] | x | x | x | ||||||||||||
Badger [37] | x | ||||||||||||||
Arving [77] | x | x | x | x | |||||||||||
Carayol [46] | x | x | x | x | |||||||||||
Casla [51] | x | x | x | ||||||||||||
Cho [41] | x | ||||||||||||||
Demark-Wahnefried [52] | x | ||||||||||||||
Rogers [53] | x | x | |||||||||||||
Loh [58] | x | x | x | ||||||||||||
Lahart [39] | x | x | x | ||||||||||||
Badger [37] | x | ||||||||||||||
Giese-Davis [60] | x | x | x | x | x | ||||||||||
Gnagnarella [47] | x | x |
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D’Egidio, V., Sestili, C., Mancino, M. et al. Counseling interventions delivered in women with breast cancer to improve health-related quality of life: a systematic review. Qual Life Res 26, 2573–2592 (2017). https://doi.org/10.1007/s11136-017-1613-6
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DOI: https://doi.org/10.1007/s11136-017-1613-6