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

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

doi:10.1002/pon.4445

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

Psychooncology. 2018 Jan;27(1):34-42. doi: 10.1002/pon.4445. Epub 2017 May 16.

Authors

Lisa Beatty^{1

2}, Emma Kemp^{1

2}, Phyllis Butow³, Afaf Girgis⁴, Penelope Schofield^{5

6

7}, Jane Turner⁸, Nicholas J Hulbert-Williams⁹, Janelle V Levesque⁴, Bogda Koczwara²

Affiliations

¹ Flinders University, Adelaide, South Austalia, Australia.
² Flinders Centre for Innovation in Cancer, Bedford Park, South Austalia, Australia.
³ University of Sydney, Sydney, New South Wales, Australia.
⁴ Ingham Institute for Applied Medical Research; South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
⁵ Department of Psychology, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia.
⁶ Department of Cancer Experiences Research, Peter MacCallum Cancer Center, East Melbourne, Victoria, Australia.
⁷ Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Parkville, Victoria, Australia.
⁸ University of Queensland, Brisbane, New South Wales, Australia.
⁹ Chester Research Unit for the Psychology of Health, University of Chester, Chester, UK.

PMID: 28432855
DOI: 10.1002/pon.4445

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.

Keywords: cancer; metastatic breast cancer; oncology; psychological interventions; systematic review; treatment modality.

Publication types

Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Adaptation, Psychological*
Breast Neoplasms / pathology
Breast Neoplasms / psychology*
Breast Neoplasms / therapy*
Fatigue
Female
Humans
Psychotherapy / methods*
Quality of Life / psychology*
Stress, Psychological / psychology*
Stress, Psychological / therapy