Article type
Year
Abstract
Background: Women recently diagnosed with early breast cancer have been found to have high rates of psychiatric and psychological disturbance, which was also found to affect quality of life [1]. Psycho-oncology is a relatively young scientific discipline concerned with the psychological aspects that both stem from and affect a cancer diagnosis and its related treatments. It has been responsible for the burgeoning of clinical trials examining the efficacy of a multitude of psychological interventions (e.g., cognitive behavioural therapy, group psychotherapy) on a wide array of variables including emotional and functional adjustment. With the exception of two meta-analytic investigation conducted by [2] and [3] examining the effects of psychosocial interventions with adult cancer patients, the literature seems to be characterized by a conspicuous absence of systematic reviews that address the breast cancer population.
Objectives: The objective of this review was to assess the overall efficacy of psychological interventions (compared to wait-list controls) in alleviating psychological/psychiatric morbidity in breast cancer patients of all stages. Three outcome variables were identified at the outset; depression, anxiety and quality of life. The following moderator variables were also identified a priori; quality of trial, publication bias, patient prognosis, treatment type and duration and level of clinician training.
Methods: A systematic search strategy was applied to 11 relevant databases, including the Cochrane Central Register of Controlled Trials Medline, EMBASE and PSYCLIT from January 1966 to December 2003. Reference lists of articles were reviewed and unpublished theses were identified from the literature. Two independent reviewers (i) assessed the quality of each trial and (ii) extracted data. Where information was missing, study authors were contacted.
Results: Seventeen trials were included the review. For anxiety, 13 trials involving 1180 patients were identified yielding a standardized mean difference of -0.16 in favor of treatment against no treatment (95% CI 0.64 to 0.32). For depression, 13 trials involving 1226 patients yielded a standardized mean difference of 0.69 in favor of treatment (95% CI 1.23 to 0.15). Seven trials were included in the assessment of treatment efficacy on QOL. These involved 623 and yielded a standardized mean difference of 0.93 in favor of treatment compared to no treatment (95% CI -0.08 to 1.94).
Conclusions: Psychological interventions appear to impact psychological morbidity in breast cancer patients differentially. Psychological interventions seem to have the most pronounced effects on QOL, followed by depression and anxiety.
Aknowledgements : The authors would like to thank Dr. Dean Ferguson and Dwayne Schindler for statistical consultation for this project.
References : 1. Kissane DW, Clarke D, Bloch S, Miach P, Ikin, JF, Smith, G, McKenzie D. Australian randomized controlled trial of cognitive-existential therapy for women with breast cancer. Proceedings of the 151st Anuual Meeting of the American Psychiatric Association; 1998; Toronto, Canada. 2. Meyer M, Mark M. Effects of Psychosocial Interventions with Adult Cancer patients: A meta-analysis of randomized experiments. Health Psychol. 1995;14(2):101-108. 3. Sheard T, Maguire P. The effect of psychological interventions on anxiety and depression in cancer patients: the results of two meta-analyses. Br J Cancer. 1999;80(11):1770-1780.
Objectives: The objective of this review was to assess the overall efficacy of psychological interventions (compared to wait-list controls) in alleviating psychological/psychiatric morbidity in breast cancer patients of all stages. Three outcome variables were identified at the outset; depression, anxiety and quality of life. The following moderator variables were also identified a priori; quality of trial, publication bias, patient prognosis, treatment type and duration and level of clinician training.
Methods: A systematic search strategy was applied to 11 relevant databases, including the Cochrane Central Register of Controlled Trials Medline, EMBASE and PSYCLIT from January 1966 to December 2003. Reference lists of articles were reviewed and unpublished theses were identified from the literature. Two independent reviewers (i) assessed the quality of each trial and (ii) extracted data. Where information was missing, study authors were contacted.
Results: Seventeen trials were included the review. For anxiety, 13 trials involving 1180 patients were identified yielding a standardized mean difference of -0.16 in favor of treatment against no treatment (95% CI 0.64 to 0.32). For depression, 13 trials involving 1226 patients yielded a standardized mean difference of 0.69 in favor of treatment (95% CI 1.23 to 0.15). Seven trials were included in the assessment of treatment efficacy on QOL. These involved 623 and yielded a standardized mean difference of 0.93 in favor of treatment compared to no treatment (95% CI -0.08 to 1.94).
Conclusions: Psychological interventions appear to impact psychological morbidity in breast cancer patients differentially. Psychological interventions seem to have the most pronounced effects on QOL, followed by depression and anxiety.
Aknowledgements : The authors would like to thank Dr. Dean Ferguson and Dwayne Schindler for statistical consultation for this project.
References : 1. Kissane DW, Clarke D, Bloch S, Miach P, Ikin, JF, Smith, G, McKenzie D. Australian randomized controlled trial of cognitive-existential therapy for women with breast cancer. Proceedings of the 151st Anuual Meeting of the American Psychiatric Association; 1998; Toronto, Canada. 2. Meyer M, Mark M. Effects of Psychosocial Interventions with Adult Cancer patients: A meta-analysis of randomized experiments. Health Psychol. 1995;14(2):101-108. 3. Sheard T, Maguire P. The effect of psychological interventions on anxiety and depression in cancer patients: the results of two meta-analyses. Br J Cancer. 1999;80(11):1770-1780.