Beatty, L., Kemp, E., Butow, P., Girgis, A., Schofield, P., Turner, J., . . . Koczwara, B. (2018). A systematic review of psychotherapeutic interventions for women with metastatic breast cancer: Context matters. Psycho-Oncology, 27, 34–42.

STUDY PURPOSE: To summarize the evidence-base of psychological interventions for women with metastatic breast cancer by mode of delivery and to synthesize data regarding core intervention elements and context factors.

TYPE OF STUDY: Systematic review

DATABASES USED: Medline, PsycINFO, CINAHL, SCOPUS

YEARS INCLUDED: Inception to May 2016

INCLUSION CRITERIA: Articles published or in press in a peer-reviewed journal between database inception to May 2016. Intervention targeted adult woman with a diagnosis of MBC or recurrent breast cancer. Studies including woman with MBC as part of a larger sample with other cancers if data could be extracted about MBC patients. The therapies were psychotherapeutic. Outcomes included survival, distress, coping, QOL, or somatic symptoms. All studies were RCT, quasi-RCT, or feasibility RCT in English.

EXCLUSION CRITERIA: Grey literature

TOTAL REFERENCES RETRIEVED: 740

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Meta-analysis (PRISMA) and a review protocol was developed.

FINAL NUMBER STUDIES INCLUDED: 15 RCTs across 23 articles

TOTAL PATIENTS INCLUDED IN REVIEW: 1,638

SAMPLE RANGE ACROSS STUDIES: 37 to 235

KEY SAMPLE CHARACTERISTICS: Age, years since MBC diagnosis, English speaking, race, partnership, education, employment

PHASE OF CARE: Multiple phases of care     

APPLICATIONS: Palliative care

Overall interventions improved distress in 8 of 13 RCTs, coping in 4 of 5 RCTs, and pain in 4 of 5 RCTs. No evidence of survival benefit was found. For remaining outcomes the 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 duration and lowest uptake and adherence. Low-intensity interventions had shortest duration and highest uptake and adherence. Disparities in uptake, adherence, and reach were evident with demographic profiles of age, race, language, and partnered woman (young, White, English-speaking, married women).

There remains a parity of psychological interventions for women with MBC. 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 ensue efficacy as well as uptake and adherence. There were only five new articles from the last systematic review in 2013.

• Limited number of studies included
• High heterogeneity
• Outcomes varied between studies and used multiple different follow-up assessment tools.

More research is needed on the psychological therapies used in MBC patients in regards to survival, distress, coping, QOL, pain, fatigue, and sleeping, all of which contribute to depression. There is little research on this population and their psychologic concerns, particularly in minority populations. It is important that nurses reach a broader range of women with MBC. Research is also needed on how to deliver more accessible evidence-based interventions.