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Review
. 2017 Aug 24;8(8):CD011152.
doi: 10.1002/14651858.CD011152.pub2.

Home-based multidimensional survivorship programmes for breast cancer survivors

Karis Kin Fong Cheng  1 , Yee Ting Ethel Lim, Zhi Min Koh, Wilson Wai San Tam
Affiliations
Review

Home-based multidimensional survivorship programmes for breast cancer survivors

Karis Kin Fong Cheng et al. Cochrane Database Syst Rev. .

Abstract

Background: The prognosis and survival rate of women with breast cancer have significantly improved worldwide. Effective home-based multidimensional programmes for breast cancer survivors have gained an ever greater emphasis in survivorship care to maximise women's quality of life for their successful transition to rehabilitation and normal life. It is important to summarise the best available evidence to evaluate the effects of home-based multidimensional survivorship programmes on quality of life in women within 10 years of the completion of surgery or adjuvant cancer therapy for breast cancer, or both.

Objectives: To assess the effects of home-based, multidimensional survivorship (HBMS) programmes on maintaining or improving the quality of life in breast cancer survivors.

Search methods: In April 2016 we searched the Cochrane Breast Cancer Specialised Register, CENTRAL, PubMed, Embase, CINAHL Plus, PsycINFO, Web of Science, and the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. We also screened reference lists of all identified studies and contacted study authors.

Selection criteria: Randomised controlled trials (RCTs) and quasi-RCTs assessing the effects of HBMS programmes in maintaining or improving quality of life in women with stages 0 to 3 breast cancer who completed primary cancer treatment (surgery or adjuvant cancer therapy, or both) up to 10 years earlier. We considered studies where the interventions included more than one of the following listed components: educational (such as information provision and self-management advice), physical (such as exercise training and resistance training) and psychological (such as counselling and cognitive therapies), to constitute a multidimensional programme. Interventions had to be allowed to be carried out at home.

Data collection and analysis: Two authors independently assessed eligible studies for inclusion, and performed quality assessment and extracted relevant data of the included studies. Quality of life was the primary outcome of the review.

Main results: We included 22 RCTs and four quasi-RCTs on 2272 participants. We categorised the intervention components into four groups: educational and psychological; educational and physical; physical and psychological; and educational, physical and psychological. Most of the studies used usual care (routine medical follow-up services) as the comparator. A few studies used a lower level or different type of intervention (e.g. stress management or exercise) or attention control as the comparator.We used the Functional Assessment of Cancer Therapy-Breast (FACT B), European Organisation for Research and Treatment of Cancer Quality of Life C30 (EORTC C30), Quality of Life (QoL) Breast Cancer, and SF36 questionnaires to assess quality of life. HBMS programmes may increase breast cancer-specific quality of life and global quality of life immediately after the intervention, as measured by FACT-B and EORTC C30 (FACT-B: mean difference (MD) 4.55, 95% confidence interval (CI) 2.33 to 6.78, 7 studies, 764 participants; EORTC: MD 4.38, 95% CI 0.11 to 8.64, 6 studies; 299 participants; moderate-quality evidence). There was no evidence of a difference in quality of life as measured by QoL-Breast Cancer or SF-36 (QoL-Breast Cancer: MD 0.42, 95% CI -0.02 to 0.85, 2 studies, 111 participants, very low-quality evidence; physical composite score SF36: MD 0.55, 95% CI -3.52 to 4.63, 2 studies, 308 participants, low-quality evidence).We observed a similar pattern at one to three months after the intervention: FACT-B (MD 6.10, 95% CI 2.48 to 9.72, 2 studies, 426 participants), EORTC-C30 (MD 6.32, 95% CI 0.61 to 12.04, 2 studies; 172 participants) and QoL-Breast Cancer (MD 0.45, 95% CI -0.19 to 1.09, 1 study, 61 participants). At four to six months and 12 months, there was no evidence of a difference in quality of life between groups (four to six months: EORTC - MD 0.08, 95% CI -7.28 to 7.44, 2 studies; 117 participants; SF-36 - MD -1.05, 95% CI -5.60 to 3.51, 2 studies, 308 participants; 12 months: EORTC - MD 2.04, 95% CI -9.91 to 13.99, 1 study; 57 participants).Functional status was incorporated into the quality of life subscale findings. HBMS programmes may decrease anxiety (MD of Hospital Anxiety and Depression Scale (HADS) -1.01, 95% CI -1.94 to -0.08, 5 studies, 253 participants, low-quality evidence) compared to control immediately after the intervention but the effect did not persist at four to six months. There was no evidence of improvements in depression immediately after HBMS (MD of HADS -1.36, 95% CI -2.94 to 0.22, 4 studies, 213 participants, low-quality evidence) or at follow-up. HBMS programmes may also decrease fatigue (MD -1.11, 95% CI -1.78 to -0.45, 3 studies, 127 participants; low-quality evidence) and insomnia (MD -1.81, 95% CI -3.34 to -0.27, 3 studies, 185 participants, low-quality evidence).None of the included studies reported service needs and utilisation and cost of care, and therefore the effect of HBMS programmes on healthcare utilisation and cost is unknown. Due to the variations in assessment methods of adherence among the eight studies, we could not combine the results for meta-analysis. We synthesised the results narratively, with the reported adherence rates of 58% to 100%.

Authors' conclusions: The results of this systematic review and meta-analysis revealed that HBMS programmes in breast cancer survivors appear to have a short-term beneficial effect of improving breast cancer-specific quality of life and global quality of life as measured by FACT-B and EORTC-C30, respectively. In addition, HBMS programmes are associated with a reduction in anxiety, fatigue and insomnia immediately after the intervention. We assessed the quality of evidence across studies as moderate for some outcomes, meaning that we are fairly confident about the results, while we assessed other outcomes as being low-quality, meaning that we are uncertain about the result.

PubMed Disclaimer

Conflict of interest statement

KC: nothing to declare EL: nothing to declare WT: nothing to declare ZMK: nothing to declare

Figures

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1
Study flow diagram
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Risk of bias summary
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Forest plot of comparison 1, quality of life by Functional Assessment of Cancer Therapy‐Breast (FACT‐B), outcome: 1.1 General
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Forest plot of comparison 1, quality of life by Functional Assessment of Cancer Therapy‐Breast (FACT‐B), outcome: 1.2 Breast cancer
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Funnel plot of comparison 1, quality of life by Functional Assessment of Cancer Therapy‐Breast (FACT‐B), outcome: 1.2 Breast cancer
6
6
Forest plot of comparison 2, quality of life measured by European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC‐QLQ), outcome: 2.1 General
See this image and copyright information in PMC

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    1. Lyons KD, Hull JG, Kaufman PA, Li Z, Seville JL, Ahles TA. Development and initial evaluation of a telephone‐delivered, behavioral activation, and problem‐solving treatment program to address functional goals of breast cancer survivors. Journal of Psychosocial Oncology 2015;33(2):199‐218. - PMC - PubMed
Mandelblatt 2008 {published data only}
    1. Mandelblatt JS, Cullen J, Lawrence WF, Stanton AL, Yi B, Kwan L, et al. Economic evaluation alongside a clinical trial of psycho‐educational interventions to improve adjustment to survivorship among patients with breast cancer. Journal of Clinical Oncology 2008;26(10):1684‐90. - PubMed
Manne 2005 {published data only}
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McKenzie 2003 {published data only}
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McKiernan 2010 {published data only}
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Milbury 2013 {published data only}
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Milne 2008 {published data only}
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Monti 2013 {published data only}
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Mustian 2004 {published data only}
    1. Mustian KM, Katula JA, Gill DL, Roscoe JA, Lang D, Murphy K. Tai Chi Chuan, health‐related quality of life and self‐esteem: a randomized trial with breast cancer survivors. Supportive Care in Cancer 2004;12(12):871‐6. - PubMed
Mustian 2008 {published data only}
    1. Mustian KM, Palesh OG, Flecksteiner SA. Tai Chi Chuan for breast cancer survivors. Medicine and Sport Science 2008;52:209‐17. - PMC - PubMed
Naumann 2012a {published data only}
    1. Naumann F, Martin E, Philpott M, Smith C, Groff D, Battaglini C. Can counseling add value to an exercise intervention for improving quality of life in breast cancer survivors? A feasibility study. Journal of Supportive Oncology 2012;10(5):188‐94. - PubMed
Naumann 2012b {published data only}
    1. Naumann F, Munro A, Martin E, Magrani P, Buchan J, Smith C, et al. An individual‐based versus group‐based exercise and counselling intervention for improving quality of life in breast cancer survivors. A feasibility and efficacy study. Psycho‐Oncology 2012;21(10):1136‐9. - PubMed
Neil 2013 {published data only}
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Park JH 2012 {published data only}
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Piland 2011 {published data only}
    1. Piland MN. Effectiveness of a cancer center based physical activity intervention in breast cancer survivors [Master's Thesis],. Greenville: East Carolina University. Retrieved from the Scholarship. (http://hdl.handle.net/10342/3740), 2011. [1505485]
Poorkiani 2010 {published data only}
    1. Poorkiani M, Abbaszadeh A, Hazrati M, Jafari P, Sadeghi M, Mohammadianpanah M. The effect of rehabilitation on quality of life in female breast cancer survivors in Iran. Indian Journal of Medical and Paediatric Oncology 2010;31(4):105‐9. - PMC - PubMed
Rowland 2009 {published data only}
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Schmitz 2009 {published data only}
    1. Schmitz KH, Troxel AB, Cheville A, Grant LL, Bryan CJ, Gross CR, et al. Physical Activity and Lymphedema (the PAL trial): assessing the safety of progressive strength training in breast cancer survivors. Contemporary Clinical Trials 2009;30(3):233‐45. - PMC - PubMed
Schover 2006 {published data only}
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Schover 2011 {published data only}
    1. Schover LR, Rhodes MM, Baum G, Adams JH, Jenkins R, Lewis P, et al. Sisters Peer Counseling in Reproductive Issues After Treatment (SPIRIT): a peer counseling program to improve reproductive health among African American breast cancer survivors. Cancer 2011;117(21):4983‐92. - PMC - PubMed
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References to ongoing studies

Abrahams 2015 {published data only}
    1. Abrahams HJG, Gielissen MFM, Goedendorp MM, Berends T, Peters MEWJ, Poort H, et al. A randomized controlled trial of web‐based cognitive behavioral therapy for severely fatigued breast cancer survivors (CHANGE‐study): study protocol. BMC Cancer 2015;15:765. - PMC - PubMed
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Rock 2013 {published data only}
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