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Intervention Review

Psychological interventions for women with metastatic breast cancer

  1. Adrian GK Edwards1,*,
  2. Nicholas Hulbert-Williams2,
  3. Richard D Neal3

Editorial Group: Cochrane Breast Cancer Group

Published Online: 16 JUL 2008

Assessed as up-to-date: 17 SEP 2007

DOI: 10.1002/14651858.CD004253.pub3

How to Cite

Edwards AGK, Hulbert-Williams N, Neal RD. Psychological interventions for women with metastatic breast cancer. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD004253. DOI: 10.1002/14651858.CD004253.pub3.

Author Information

  1. 1

    Cardiff University, Department of Primary Care and Public Health, School of Medicine, Cardiff, Wales, UK

  2. 2

    University of Wolverhampton, Psychology Division, School of Applied Sciences, Wolverhampton, England, UK

  3. 3

    Cardiff University, Department of General Practice, Wrexham, UK

*Adrian GK Edwards, Department of Primary Care and Public Health, School of Medicine, Cardiff University, 2nd Floor Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS, UK. edwardsag@cardiff.ac.uk. adriangkedwards@btinternet.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 16 JUL 2008

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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. Plain language summary
  4. 摘要

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 methods

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.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

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.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

轉移性乳癌婦女的精神治療

癌症病人其精神治療的系統性文獻回顧是互相矛盾的,一些文獻顯示對病人有益,但其他文獻則否。先前的研究顯示對轉移性乳癌婦女施以精神治療在存活和心理上有顯著的益處。然而後來的研究顯示矛盾的結果。

目標

為了評估轉移性乳癌婦女精神治療(教育,個人認知行為或心理測驗,或群體支持)在心理和存活結果的影響

搜尋策略

搜尋Cochrane Breast Cancer Group Specialised Register(2007九月)以提供最新訊息。也搜尋MEDLINE (1966 – 2006九月), CINAHL (1982 – 2006九月), PsycInfo (1974 – 2006九月), 及SIGLE (1980 – 2006九月).

選擇標準

轉移性乳癌婦女其精神治療的隨機對照試驗(RCT)。由於研究的病人族群本質及可能高度遺失後續的資料,非 ‘intention to treat’ 的研究被納入

資料收集與分析

由兩位評論者各自獨立擷取資料。選用有關本質和干預設定的場所,關於干預結果和研究方法的品質資料。

主要結論

5個主要的研究 (511個婦女) 被定義為所有群體精神治療。其中兩個研究是認知行為的干預,另三個研究是評估支持表達群體療法。群體心理療法的五個研究顯示從這些干預成效有限。雖然一些心理的結果有短期助益的證據,然而後續追蹤一般沒有持續。由於納入的研究使用廣泛多樣的結果測量及持續的後續追蹤,因此不能歸納出一個更加清楚的心理結果模式。在早期研究中分配接受精神治療的婦女可能有較長的存活時間,然而在隨後四項研究中未有相同結果(包括一個第一研究小組的成員),並且整體干預作用對存活不具統計意義(例如,5年存活的odds ratio 0.83 (95% confidence interval [CI] 0.53 .28)。

作者結論

沒有足夠證據來主張群體心理治療(任一認知行為或支持表達)可用於所有診斷為轉移性乳癌的婦女。干預的所有助益只有在一些心理結果及短期上明顯。干預引起傷害的可能性也不能由所得資料來排除。

翻譯人

本摘要由中山醫學大學附設醫院楊嘉欣翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

對於轉移性乳癌的婦女(癌症蔓延到乳房之外)幾種精神治療可能有用。這些包括教育和精神治療干預、支持群體和個人認知行為的治療(治療幫助人測試和校正他們的想法、態度和行動)。在1989年進行的一有前瞻的研究顯示接受精神治療的轉移性乳癌的婦女其 存活率和心理皆有顯著的助益。儘管實施另外四次試驗,然而這些結果未曾重複(包括一個第一研究小組的成員)。對于這文獻回顧進行了全面搜尋。五項群體精神治療的主要研究被確認,包含511名婦女。二個研究是認知行為的干預,三個是評估支持表達群體療法。群體心理療法的五項研究顯示從這些干預出現助益的證據非常有限。雖然精神治療顯示提供一些短期心理助益,然而這助益未維持數月之久。這文獻回顧的研究都用廣泛的各種結果測量和試驗參加者後續追蹤期間可能造成缺乏決定性的結果。雖然一個試驗顯示支持群體參與在存活上的助益有上升,然而其他試驗皆沒有發現助益。所以此時沒有足夠的證據來主張群體心理治療(任一認知行為或支持表達)可用於所有診斷為轉移性乳癌的婦女。干預的所有助益只有在一些心理結果及短期上明顯。干預引起傷害的可能性也不能由所得資料來排除。