Cheng, K.K.F., Lim, Y.T.E., Koh, Z.M., & Tam, W.W.S. (2017). Home-based multidimensional survivorship programmes for breast cancer survivors. Cochrane Database of Systematic Reviews, 8, CD011152.

• STUDY PURPOSE: To determine if home-based, multidimensional survivorship (HBMS) programs help maintain or improve breast cancer survivors’ quality of life
• TYPE OF STUDY: Systematic review and meta-analysis

• DATABASES USED: Cochrane Breast Cancer Specialised Register, CENTRAL, PubMed, Embase, CINAHL Plus, PsycINFO, Web of Science, World Health Organization’s International Clinical Trials Registry Platform (WHO ICTRP), and ClinicalTrials.gov
• YEARS INCLUDED: (Overall for all databases) Final search results were 2006-2016
• INCLUSION CRITERIA: RCTs and quasi-RCTs using articles that appeared in peer-reviewed journal articles published in English, interventions with more than one of these components: educational, physical, and psychological interventions that were home-based, including delivery in-person, through telephone calls, Internet or multi-media, a validated instrument used to assess health related quality of life as an outcome
• EXCLUSION CRITERIA: Studies without a control group, women with stage IV breast cancer, lack of home-based component of intervention, lack of trained personnel or healthcare professional delivering intervention, lack of separate breast cancer survivors analysis, lack of quality-of-life assessments, lack of description of intervention

• TOTAL REFERENCES RETRIEVED: 29,198
• EVALUATION METHOD AND COMMENTS ON LITERATURE USED: 29,198 studies were originally found by electronic search, and 25,907 were left after duplication removal. 25,740 articles were removed after exclusion and inclusion criteria, leaving 174 articles for full-text assessment. Further screening using inclusion and exclusion left 26 studies; 25 journal articles and 1 dissertation (8 ongoing studies) (1998-2015).

• FINAL NUMBER STUDIES INCLUDED: 26
• TOTAL PATIENTS INCLUDED IN REVIEW: 2,272
• KEY SAMPLE CHARACTERISTICS: Women aged 18 years and older with a breast cancer diagnosis between stages 0-III and within 10 years of the completion of primary cancer treatment (surgery, chemotherapy, radiation therapy).

PHASE OF CARE: Survivorship

• Home-based multidimensional survivorship (HBMS) programs positively improve quality of life short-term, as measured by FACT-B and EORTC-C30 questionnaires (FACT-B: mean difference (MD) = 4.55, 95% CI [2.33, 6.78], 7 studies, 764 participants; EORTC: MD = 4.38, 95% CI [0.11, 8.64], 6 studies, 299 participants)
• HBMS may reduce anxiety, fatigue, and insomnia as measured by HADS, BFI, and ISI. HBMS programs may decrease anxiety (MD of Hospital Anxiety and Depression Scale (HADS) = -1.01, 95% CI [-1.94, -0.08], 5 studies, 253 participants). There was no evidence of improvements in depression after HBMS (MD of HADS = -1.36, 95% CI [-2.94, 0.22], 4 studies, 213 participants). HBMS programs may also decrease fatigue (MD = -1.11, 95% CI [-1.78, -0.45], 3 studies, 127 participants) and insomnia (MD = -1.81, 95% CI [-3.34, -0.27], 3 studies, 185 participants)
• Quality of life with educational, psychological, or physical intervention components showed no difference in improvement. 
• Improvement of physical, emotional, and functional quality of life was most effective with group-based intervention.

HBMS programs in breast cancer survivors were found to provide beneficial short-term improvement of breast cancer-specific quality of life and global quality of life. Also, immediately after the intervention, a reduction in anxiety, fatigue, and insomnia was assessed.

• Mostly low-quality/high-risk of bias studies
• High heterogeneity
• Low sample sizes
• Sample bias

Group-based intervention was shown to be the most effective mode of delivery toward improving physical, emotional, and functional quality of life