A systematic review of psychotherapeutic interventions for women with metastatic breast cancer: Context matters

Lisa Beatty, Emma Kemp, Phyllis Butow, Afaf Girgis, Penelope Ellen Schofield, Jane Turner, Nicholas J. Hulbert-Williams, Janelle V. Levesque, Bogda Koczwara

Research output: Contribution to journalArticleResearchpeer-review

19 Citations (Scopus)

Abstract

Objectives: To summarise the evidence-base of psychological interventions for women with metastatic breast cancer, by mode of delivery (group, individual, or low-intensity interventions). To synthesise data regarding core intervention-elements (eg, intervention duration) and context factors (trial setting, uptake and adherence, and demographic characteristics). Methods: Four databases were searched (inception-May 2016): MEDLINE (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCO), and SCOPUS; reference lists were examined for additional publications. Grey literature was excluded. Outcome data were extracted for survival, distress, quality of life, coping, sleep, fatigue, and/or pain and summarised through narrative synthesis. Results: Fifteen randomised clinical trials (RCTs), reported across 23 articles, met inclusion criteria: 7 groups, 4 individuals, and 4 low-intensity interventions. Overall, interventions improved distress (8/13 RCTs), coping (4/5 RCTs), and pain (4/5 RCTs). No evidence of survival benefit was found. For remaining outcomes, evidence was either insufficient, or too mixed to draw conclusions. Group programs had the strongest evidence-base for efficacy; individual and low-intensity therapy had insufficient evidence to form conclusions. Group interventions had longest intervention durations and lowest uptake and adherence; low-intensity interventions had shortest durations and highest uptake and adherence. Disparities in uptake, adherence, and reach were evident, with the demographic profile of participants polarised to young, Caucasian, English-speaking, partnered women. Conclusions: There remains a paucity of psychological interventions for women with metastatic breast cancer. Those that exist have an inconsistent evidence-base across the range of patient-reported outcomes. Further research is needed to evaluate accessible delivery formats that ensure efficacy as well as uptake.

Original languageEnglish
Pages (from-to)34-42
Number of pages9
JournalPsycho-Oncology
Volume27
Issue number1
DOIs
Publication statusPublished - Jan 2018
Externally publishedYes

Keywords

  • Cancer
  • Metastatic breast cancer
  • Oncology
  • Psychological interventions
  • Systematic review
  • Treatment modality

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