The efficacy of interventions to improve psychosocial outcomes following surgical treatment for breast cancer: a systematic review and meta-analysis

Abstract

Objective: Breast cancer is the most commonly diagnosed cancer in women across the world. The majority of women diagnosed with the disease undergo surgery, which is often associated with significant psychosocial morbidity. The aim of this meta-analysis was to identify the efficacy of psychosocial interventions for women following breast cancer surgery.

Method: A comprehensive literature search was undertaken using keyword and subject headings within 7 databases. Included studies employed a quantitative methodology presenting empirical findings focusing on interventions for female breast cancer patients following surgery.

Results: Thirty-two studies were included and based on conventional values of effect sizes. Small effects emerged for the efficacy of psychosocial interventions in relation to anxiety (Hedges g = 0.31), depression (0.38), quality of life (0.40), mood disturbance (0.31), distress (0.27), body image (0.40), self-esteem (0.35), and sexual functioning (0.22). A moderate to large effect emerged for the efficacy of interventions in promoting improvements in sleep disturbance (0.67). Clear evidence emerged for the efficacy of cognitive behavioral therapy in promoting improvements in anxiety, depression, and quality of life.

Conclusion: This is the first meta-analysis to demonstrate the efficacy of interventions on a range of psychosocial outcomes following breast cancer surgery. The meta-analysis highlighted that cognitive behavioral therapy was consistently the most effective psychosocial intervention promoting improvements in anxiety, depression, and quality of life. However, there are shortcomings in existing studies; the length of the follow-up period is typically short and the generalizability of findings was limited by small samples, both of which should be addressed in future studies.

Keywords: cancer; mastectomy; meta-analysis; oncology; psychosocial interventions.