Systematic review of clinical practice guidelines for long-term breast cancer survivorship: assessment of quality and evidence-based recommendations

Abstract

Background: Breast cancer is the most common cancer among women, with improved survival rates due to advances in early diagnosis and therapies. However, long-term survivors (≥5 years post-treatment, disease-free) face persistent physical, psychological, and social challenges requiring tailored, evidence-based care. Despite the growing survivor population, no systematic evaluation of Clinical Practice Guidelines (CPGs) for this group has been conducted. This study assesses the quality of CPGs and their evidence-based recommendations.

Methods: A systematic review was conducted in PubMed, CINAHL, and Cochrane Library (2015-2023), including guidelines from major oncology organisations. The AGREE II instrument evaluated CPG quality across six domains, and recommendations were classified using a Primary Care survivorship framework: prevention, surveillance, care coordination, and long-term effect management.

Results: Ten CPGs met inclusion criteria, with 7 classified as high quality. Most recommendations focused on prevention (adjuvant therapy, alcohol) and surveillance (follow-up, mammography), while gaps remained in lifestyle guidance, psychosocial support, and management of complications (lymphedema, osteoporosis, cognitive dysfunction). Care coordination and psychosocial interventions were inconsistently addressed.

Conclusions: Current CPGs inadequately cover the complex needs of long-term survivors, particularly in psychosocial care. Evidence-based, patient-centred guidelines are urgently needed to optimise long-term outcomes and quality of life.

Fig. 1. PRISMA flowchart of the study search and selection process.

^*Incorrect population: Palliative care population (n = 13), Population with other types of cancer (n = 8), Child and adolescent population (n = 1), Male population (n = 1).