Jassim, G.A., Whitford, D.L., Hickey, A., & Carter, B. (2015). Psychological interventions for women with non-metastatic breast cancer. Cochrane Database of Systematic Reviews, 5, CD008729.

DOI Link

Purpose

STUDY PURPOSE: To evaluate evidence for psychological interventions in women with breast cancer

TYPE OF STUDY: Meta analysis and systematic review

Search Strategy

DATABASES USED: MEDLINE, EMBASE, CINAHL, PsycINFO, World Health Organization International Clinical Trials Registry, Cochrane Collaboration
 
KEYWORDS: psychological interventions, early breast cancer, cognitive behavioral technique, psychotherapy, psychoeducational therapy, CBT, psychotherapeutic, acceptance, and commitment therapy
 
INCLUSION CRITERIA: RCT in which any type of psychotherapy intervention was compared to controls or an alternative psychotherapeutic interventions; women with stage I-III breast cancer
 
EXCLUSION CRITERIA: metastatic disease, studies in other types of cancer, studies in caregivers of women with breast cancer

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 2,859
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane Handbook methods

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED  =  28 in qualitative review, 16 in meta analysis
  • TOTAL PATIENTS INCLUDED IN REVIEW = 3,940
  • SAMPLE RANGE ACROSS STUDIES: 14-575
  • KEY SAMPLE CHARACTERISTICS: All had early-stage breast cancer, age ranged from 18-80 years old

 

Phase of Care and Clinical Applications

PHASE OF CARE:  Multiple phases of care

Results

In 24 of 28 trials, cognitive behavioral therapy was the basis of the intervention. Most studies had unclear risk of bias, and for studies aimed at anxiety and depression, quality of the evidence was graded as low. Comparison of CBT versus control across multiple studies for depression showed an overall standard mean difference (SMD) of -1.01 (p = 0.02) in favor of the CBT intervention. Only two studies examined CBT delivered individually, showing no significant benefit and high heterogeneity. Examined separately, group CBT also did not consistently show significant benefit for depression. Eight studies looked at change in anxiety. Both individual- and group-delivered CBT showed significant benefit, with an overall SMD -10.48 (p = 0.0006). CBT showed a significant positive effect for stress, and only marginal effect on quality of life.

Conclusions

Findings showed overall benefit of CBT for anxiety and depression in women with early-stage breast cancer

Limitations

Although studies have shown that psychological interventions are more effective for individuals with psychological problems, the studies included here excluded women with psychological morbidity.  There was high heterogeneity, and most studies were of low quality.

Nursing Implications

CBT delivered in a group or individual setting has been shown to have a positive effect on depression and anxiety among women with early-stage breast cancer. The strength of these results is limited by the relatively low quality of studies included in this review.

Legacy ID

5669