A Cochrane review [Abstract] 1 included 10 studies with a total of 1378 subjects. Of the 7 RCTs on group psychological interventions, 3 were on cognitive behavioural therapy and 4 were on supportive-expressive group therapy. The remaining 3 studies were individual based and the types of psychological interventions were not common to either cognitive behavioural or supportive-expressive therapy. A clear pattern of psychological outcomes could not be discerned as a wide variety of outcome measures and durations of follow-up were used in the included studies. The overall effect of the psychological interventions, on one-year survival, favoured the psychological intervention group (OR 1.46, 95% CI 1.07 to 1.99; 6 studies). Pooled data from four studies did not show any survival benefit at five-years follow-up (OR 1.03, 95% CI 0.42 to 2.52). There was evidence of a short-term benefit for some psychological outcomes and improvement in pain scores.
A technology assessment report 2 on counselling for breast cancer patients was abstracted in the Health Technology Assessment Database. Overall, the trials showed that women with breast cancer derived benefit from the therapeutic intervention in terms of measures of emotional adjustment (depression, anxiety, locus of control) as well as general quality of life. These benefits lasted throughout the follow-up period, although one study found no significant effects after three months. Although the studies showed that counselling is effective, they do not provide a prescriptive model for service delivery: for instance, where counselling should be provided and by whom.
A Cochrane review [Abstract] 3 included 60 studies with a total of 7998 women with non-metastatic breast cancer. Most interventions were cognitive- or mindfulness-based, supportive-expressive, and educational. The interventions were mainly delivered face-to-face (56 studies) and in groups (50 studies). Pooled standardised mean differences (SMD) from baseline indicated less depression (SMD -0.27, 95% CI -0.52 to -0.02; P=0.04; 27 studies, n=3321, I²=91%), anxiety (SMD -0.43, 95% CI -0.68 to -0.17; P=0.0009; 22 studies, n=2702, I²=89%) and mood disturbance (SMD -0.18, 95% CI -0.31 to -0.04; P=0.009; 13 studies, n=2276, I²=56%), and stress (SMD -0.34, 95% CI -0.55 to -0.12; P =0.002; 8 studies, n=564 participants, I²=31%); all were low-certainty evidence. Quality of life was likely to improve (SMD 0.78, 95% CI 0.32 to 1.24; P=0.0008; 20 studies, n=1747, I²=95%, low-certainty evidence).
A meta-analysis 4 assessing patient education included 14 studies with a total of 1749 women. There were statistically significant short-term benefits for improved global quality-of-life (SMD 0.43, P = 0.05, 95% CI 0.00 to 0.85), emotional quality-of-life (SMD 0.32, P = 0.04, 95% CI 0.02 to 0.62) and fatigue (SMD 0.24, P = 0.0004, 95% CI 0.11 to 0.37). However, there were not statistically significant difference for pain severity and fear to recurrence.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes).
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