A systematic review of psychotherapeutic interventions for women with metastatic breast cancer: context matters

Abstract

Objectives: To summarise the evidence‐base of psychological interventions for women with metastatic breast cancer, by mode of delivery (group, individual, or low‐intensity interventions). To synthesise data regarding core intervention‐elements (eg, intervention duration) and context factors (trial setting, uptake and adherence, and demographic characteristics). Methods: Four databases were searched (inception‐May 2016): MEDLINE (OvidSP), PsycINFO (OvidSP), CINAHL (EBSCO), and SCOPUS; reference lists were examined for additional publications. Grey literature was excluded. Outcome data were extracted for survival, distress, quality of life, coping, sleep, fatigue, and/or pain and summarised through narrative synthesis. Results: Fifteen randomised clinical trials (RCTs), reported across 23 articles, met inclusion criteria: 7 groups, 4 individuals, and 4 low‐intensity interventions. Overall, interventions improved distress (8/13 RCTs), coping (4/5 RCTs), and pain (4/5 RCTs). No evidence of survival benefit was found. For remaining outcomes, evidence was either insufficient, or too mixed to draw conclusions. Group programs had the strongest evidence‐base for efficacy; individual and low‐intensity therapy had insufficient evidence to form conclusions. Group interventions had longest intervention durations and lowest uptake and adherence; low‐intensity interventions had shortest durations and highest uptake and adherence. Disparities in uptake, adherence, and reach were evident, with the demographic profile of participants polarised to young, Caucasian, English-speaking, partnered women. Conclusions: There remains a paucity of psychological interventions for women with metastatic breast cancer. Those that exist have an inconsistent evidence‐base across the range of patient‐reported outcomes. Further research is needed to evaluate accessible delivery formats that ensure efficacy as well as uptake.