Effectiveness of cognitive-based interventions for improving body image of patients having breast cancer: A systematic review and meta-analysis

Wenqian Zhao; Yuen Yu Chong; Wai Tong Chien

doi:10.1016/j.apjon.2023.100213

Effectiveness of cognitive-based interventions for improving body image of patients having breast cancer: A systematic review and meta-analysis

Asia Pac J Oncol Nurs. 2023 Feb 23;10(4):100213. doi: 10.1016/j.apjon.2023.100213. eCollection 2023 Apr.

Authors

Wenqian Zhao¹, Yuen Yu Chong¹, Wai Tong Chien¹

Affiliation

¹ The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.

Abstract

Objective: Breast cancer patients often suffer from body image disturbance due to impairment of their body/appearance resulting from surgeries, other cancer treatments, and/or their complications. Cognitive-based interventions (CBIs) have recently been adopted for patients having breast cancer but their effects on improving body image are uncertain. This systematic review aimed to examine the effects of CBIs on body image in these patients, identify the optimal dose, characteristics, and/or component(s) of an effective intervention for these patients to inform future research and practice.

Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, ten online databases and five search engines were used to search for eligible studies. Quality appraisal of included studies and meta-analysis results were conducted using Rob 2 and Grading of Recommendations Assessment, Development and Evaluation profiler Guideline Development Tool, respectively. RevMan and comprehensive meta-analysis software were used to perform data analysis and synthesis.

Results: Eleven eligible randomized controlled trials (RCTs) examining the effects of cognitive behavioral, acceptance and commitment, mindfulness, and self-compassion therapies were reviewed. Results of the meta-analysis showed that CBIs significantly reduced negative body image perception (Standardised Mean Difference, SMD = -0.49, 95% confidence interval [CI], [-0.87, -0.11], I ² = 81%, 6 RCTs, 758 participants), when compared to the control groups (mainly usual care) at immediately post-intervention; in which, CBT-based (SMD = -0.37, 95% CI (-0.60, -0.13), I ² = 0%) and group-based (SMD = -0.38, 95% CI (-0.62, -0.13), I ² = 0%) programs had more consistent and significant effects.

Conclusions: In view of the highly heterogeneous and limited RCTs identified, high-quality controlled trials of CBIs for improving the body image of patients having breast cancer are suggested.

Systematic review registration: PROSPERO, CRD42021259173.

Keywords: Body image; Breast cancer; Cognitive-based interventions; Meta-analysis; Systematic review.

Publication types

Review