Counseling interventions delivered in women with breast cancer to improve health-related quality of life: a systematic review

Abstract

Background

Higher survival rates for breast cancer patients have led to concerns in dealing with short- and long-term side effects. The most common complications are impairment of shoulder functions, pain, lymphedema, and dysesthesia of the injured arm; psychological consequences concern: emotional distress, anxiety, and depression, thereby, deeply impacting/affecting daily living activity, and health-related quality of life.

Objective

To perform a systematic review for assessing the efficacy or effectiveness of interventions aiming at improving health-related quality of life, return to daily activity, and correct lifestyles among breast cancer patients.

Methods

A literature search was conducted in December 2016 using the databases PubMed and Scopus. Search terms included: (counseling) AND (breast cancer) AND (quality of life). Articles on counseling interventions to improve quality of life, physical and psychological outcomes were included.

Results

Thirty-five articles met the inclusion criteria. The interventions were grouped in five main areas: concerning lifestyle counseling interventions, related to combined interventions (physical activity and nutritional counseling), physical therapy, peer counseling, multidisciplinary approach, included psychological, psycho-educational interventions, and cognitive-behavior therapy (CBT). Exercise counseling as well as physical therapy are effective to improve shoulder mobility, healing wounds, and limb strength. Psychological therapies such as psychoeducation and CBT may help to realize a social and psychological rehabilitation.

Conclusion

A multidisciplinary approach can help in sustaining and restoring impaired physical, psychosocial, and occupational outcomes of breast cancer patients.

Appendices

Annex 1: PICOS inclusion and exclusion criteria

	Inclusion criteria	Exclusion criteria
Population	Women with diagnosis of breast cancer	Children and adolescents, patients with other solid cancer
Interventions	1. Lifestyle intervention counseling: nutritional—change in dietary habits, dietary regime, physical activity habits; physical exercise: home-based and instructed exercise, supervised training program by qualified exercise physiologist; group session of exercise, and diet 2. Comple—combined interventions, e.g., counseling and exercise 3. Physical therapy: manual lymph drainage (MLD), standard physiotherapy 4. Peer counseling, familiar counseling 5. Psychological intervention: cognitive-behavior therapy (CBT), psychoeducation, psychological counseling conducted face-to face or through telephone: telephone interpersonal counseling (TIP-C), telephone health education (THE), telephone psychosocial intervention (TTM Prochaska e Di Clemente, other complex protocols)	Alternative medicine—e.g., Chinese medicine herbal
Comparator (e.g., control)	Usual care	No intervention applied
Outcomes	Primary: HrQoL, Secondary: Physical (e.g., lymphedema, shoulder mobility) Psychosocial (e.g., anxiety, depression, psychological well-being, affect/mood,) Occupational (e.g., return to work, lifestyle)	Article not including HrQoL as outcome
Study design	RCT, observational studies, narrative review, systematic review, review of systematic review, no restriction of language	None

Annex 2 Prisma Statement Checklist

Section/topic	#	Checklist item	Reported on page #
Title
Title	1	Identify the report as a systematic review, meta-analysis, or both	1
Abstract
Structured summary	2	Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions and implications of key findings; systematic review registration number	2
Introduction
Rationale	3	Describe the rationale for the review in the context of what is already known	3
Objectives	4	Provide an explicit statement of questions being addressed with reference to participants, interventions, comparisons, outcomes, and study design (PICOS)	3
Methods
Protocol and registration	5	Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide registration information including registration number	4
Eligibility criteria	6	Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, language, publication status) used as criteria for eligibility, giving rationale	4
Information sources	7	Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify additional studies) in the search and date last searched	4
Search	8	Present full electronic search strategy for at least one database, including any limits used, such that it could be repeated	4
Study selection	9	State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, included in the meta-analysis)	4
Data collection process	10	Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any processes for obtaining and confirming data from investigators	5
Data items	11	List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and simplifications made	4
Risk of bias in individual studies	12	Describe methods used for assessing risk of bias of individual studies (including specification of whether this was done at the study or outcome level), and how this information is to be used in any data synthesis	n.a.
Summary measures	13	State the principal summary measures (e.g., risk ratio, difference in means)	n.a.
Synthesis of results	14	Describe the methods of handling data and combining results of studies, if done, including measures of consistency (e.g., I2) for each meta-analysis	n.a.
Section/topic	#	Checklist item	Reported on page #
Risk of bias across studies	15	Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective reporting within studies)	n.a.
Additional analyses	16	Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, indicating which were prespecified	n.a.
Results
Study selection	17	Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for exclusions at each stage, ideally with a flow diagram	6;8
Study characteristics	18	For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) and provide the citations	8–24
Risk of bias within studies	19	Present data on risk of bias of each study and, if available, any outcome level assessment (see item 12)	n.a.
Results of individual studies	20	For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each intervention group, (b) effect estimates and confidence intervals, ideally with a forest plot	8–24
Synthesis of results	21	Present results of each meta-analysis done, including confidence intervals and measures of consistency.	8–24
Risk of bias across studies	22	Present results of any assessment of risk of bias across studies (see Item 15)	n.a.
Additional analysis	23	Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item 16])	n.a.
Discussion
Summary of evidence	24	Summarize the main findings including the strength of evidence for each main outcome; consider their relevance to key groups (e.g., healthcare providers, users, and policy makers)	25–28
Limitations	25	Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval of identified research, reporting bias)	27
Conclusions	26	Provide a general interpretation of the results in the context of other evidence, and implications for future research	28
Funding
Funding	27	Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders for the systematic review	28

Annex 3: Interventions included and main outcomes

Author	Interventions
	Nutritional	Physical activity	Combined	Physiotherapy	Peer counseling	Multidisciplinary	Psychological	Psychosocial	TIP-C	THE	CBT
Gellert [73]							x
Marchioro [74]											x
Marcus [63]								x
Darga [40]	x
Andersen [84]							x	x
Badger [69]									x
Badger [70]							x
Badger [70]									x
Giese-Davis [61]					x
Maeda [78]							x
Demark-Wahnefried [45]			x
Sharif [62]					x
Hoving [79]							x
Marcus [64]							x
Lee [75]											x
David [72]								x
Gonçalves [76]											x
Naumann [49]			x
De Boer [80]
Kim [66]			x
Spector [48]							x
Befort [43]			x
McCarroll [25]			x
Badger [37]									x	x
Arving [77]							x
Carayol [46]	x
Casla [51]			x
Cho [41]	x
Demark-Wahnefried [52]			x
Rogers [53]		x
Loh [58]	x	x	x	x		x	x	x			x
Lahart [39]		x
Badger [68]								x
Giese-Davis [60]					x
Gnagnarella [47]			x

Author	Outcomes
	Physical activity	Diet	Weight loss	HRQoL	Anxiety and depression symptoms	Shoulder mobility, wound healing	Occupational outcome	Self-efficacy	Emotional function	Sexual functioning	Fatigue	Social support,	Psychological well-being	Adaptive coping	Physical function
Gellert [73]				x											x
Marchioro [74]				x	x				x			x			x
Marcus [63]				x	x			x		x
Darga [40]				x
Andersen [84]				x									x
Badger [69]				x									x		x
Badger [70]				x
Badger [70]				x	x						x		x
Giese-Davis [61]				x				x	x				x
Maeda [78]				x					x				x	x
Demark-Wahnefried [45]	x	x		x											x
Sharif (2009)				x								x	x		x
Hoving [79]				x									x		x
Marcus [64]				x	x					x
Lee [75]				x
David [72]				x									x
Gonçalves [76]	x			x	x				x			x	x
Naumann [49]				x
De Boer [80]				x
Kim [66]	x	x		x	x				x		x
Spector [48]	x			x
Befort [43]	x	x		x											x
McCarroll [25]	x		x	x
Badger [37]				x
Arving [77]				x	x						x		x
Carayol [46]			x	x	x		x
Casla [51]	x			x	x
Cho [41]				x
Demark-Wahnefried [52]				x
Rogers [53]	x			x
Loh [58]				x			x								x
Lahart [39]	x			x	x
Badger [37]				x
Giese-Davis [60]				x	x			x	x				x
Gnagnarella [47]				x									x