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Intervention Review

Psychological interventions for women with metastatic breast cancer

  1. AGK Edwards,
  2. N Hulbert-Williams,
  3. RD Neal

Editorial Group: Cochrane Breast Cancer Group

Published Online: 19 APR 2004

DOI: 10.1002/14651858.CD004253.pub2


How to Cite

Edwards AGK, Hulbert-Williams N, Neal RD. Psychological interventions for women with metastatic breast cancer. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004253. DOI: 10.1002/14651858.CD004253.pub2.

Author Information

*Prof Adrian Edwards, Research Professor in General Practice, Dept of Primary Care and Public Health, Centre for Health Sciences Research, Cardiff University, 2nd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4XN, UK. edwardsag@cardiff.ac.uk.

Publication History

  1. Publication Status: Edited
  2. Published Online: 19 APR 2004

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This is not the most recent version of the article. View current version (04 JUN 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Synopsis

Background

Systematic reviews of psychological interventions for patients with cancer are conflicting, some showing benefits for patients and others not. One early study appeared to show significant survival and psychological benefits from a psychological intervention given to women with metastatic breast cancer. Subsequent studies have however demonstrated conflicting results.

Objectives

To assess the effects of psychological interventions (educational, individual cognitive behavioural or psychotherapeutic, or group support) on psychological and survival outcomes for women with metastatic breast cancer.

Search strategy

For this update, the Cochrane Breast Cancer Group Specialised Register was searched (September 2007). Also searched were MEDLINE (1966-September 2006), CINAHL (1982-September 2006), PsycInfo (1974-September 2006), and SIGLE (1980-September 2006).

Selection criteria

Randomised controlled trials (RCTs) of psychological interventions for women with metastatic breast cancer. Studies which were not t 'intention to treat' were included owing to the nature of the patient group under study and the likely high loss of follow-up data.

Data collection and analysis

Data were extracted independently by two reviewers. Data about the nature and setting of the intervention, relevant outcome data and items relating to methodological quality were extracted.

Main results

Five primary studies (511 women) were identified all group psychological interventions. Two of these were cognitive behavioural interventions and three evaluated support-expressive group therapy. The five studies of group psychological therapies showed very limited evidence of benefit arising from these interventions. Although there was evidence of short-term benefit for some psychological outcomes, in general these were not sustained at follow-up. A clearer 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 possible longer survival times in women allocated to receive psychological intervention in the early study have not been replicated in the subsequent four studies (including one by members of the first study group), and overall the effects of these interventions on survival are not statistically significant (for example, odds ratio for 5 year survival 0.83 (95% confidence interval [CI] 0.53 - 1.28).

Authors' conclusions

There is insufficient evidence to advocate that group psychological therapies (either cognitive behavioural or supportive-expressive) should be made available to all women diagnosed with metastatic breast cancer. Any benefits of the interventions are only evident for some of the psychological outcomes and in the short term. The possibility of the interventions causing harm is not ruled out by the available data.

 

Synopsis

  1. Top of page
  2. Abstract
  3. Synopsis

Plain language summary

Psychological interventions for women with metastatic breast cancer

For women with metastatic breast cancer (cancer that has spread beyond the breast) several types of psychological interventions may be available. These include educational and psychotherapeutic interventions, support groups and individual cognitive behavioural treatment (treatment that helps people test and revise their thoughts, attitudes and actions). One promising study conducted in 1989 appeared to show significant survival benefits as well as psychological benefits from a psychological intervention given to women with metastatic breast cancer. These results however were never replicated despite another four trials being conducted (including one by members of the first study group).

For this review a comprehensive search was conducted. Five primary studies of group psychological interventions were identified involving 511 women. Two of these were cognitive behavioural interventions and three evaluated support-expressive group therapy. The five studies of group psychological therapies showed very limited evidence of benefit arising from these interventions. Although psychological interventions were shown to provide some short-term psychological benefits, this benefit was not sustained for longer than a few months. The studies in this review all used a wide variety of outcome measures and periods of follow-up for the trial participants which may have contributed to a lack of conclusive results. Although one trial showed an increase in survival from support group participation, all the other trials found no benefit. Therefore at this time there is insufficient evidence to advocate that group psychological therapies (either cognitive behavioural or supportive-expressive) should be made available to women diagnosed with metastatic breast cancer. Any benefits of the interventions are only evident for some of the psychological outcomes reviewed and in the short term. The possibility of the interventions causing harm is also not ruled out by the available data.