Home-based multidimensional survivorship programmes for breast cancer survivors

Cheng, Karis Kin Fong; Lim, Yee Ting Ethel; Koh, Zhi Min; Tam, Wilson Wai San

doi:10.1002/14651858.cd011152.pub2

Cited by 114Cancer survivorship and careWomen's cancer prevention and managementChildhood Cancer Survivors' Quality of Life

Home-based multidimensional survivorship programmes for breast cancer survivors

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Cheng, Karis Kin Fong, Lim, Yee Ting Ethel, Koh, Zhi Min, Tam, Wilson Wai San·2017·Cochrane Database of Systematic Reviews

DOI 10.1002/14651858.cd011152.pub2PMC PMC6483678

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Abstract

BACKGROUND: The prognosis and survival rate of women with breast cancer have significantly improved worldwide. Effective home-based multidimensional programmes for breast cancer survivors have gained an ever greater emphasis in survivorship care to maximise women's quality of life for their successful transition to rehabilitation and normal life. It is important to summarise the best available evidence to evaluate the effects of home-based multidimensional survivorship programmes on quality of life in women within 10 years of the completion of surgery or adjuvant cancer therapy for breast cancer, or both. OBJECTIVES: To assess the effects of home-based, multidimensional survivorship (HBMS) programmes on maintaining or improving the quality of life in breast cancer survivors. SEARCH METHODS: In April 2016 we searched the Cochrane Breast Cancer Specialised Register, CENTRAL, PubMed, Embase, CINAHL Plus, PsycINFO, Web of Science, and the World Health Organization's International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov. We also screened reference lists of all identified studies and contacted study authors. SELECTION CRITERIA: Randomised controlled trials (RCTs) and quasi-RCTs assessing the effects of HBMS programmes in maintaining or improving quality of life in women with stages 0 to 3 breast cancer who completed primary cancer treatment (surgery or adjuvant cancer therapy, or both) up to 10 years earlier. We considered studies where the interventions included more than one of the following listed components: educational (such as information provision and self-management advice), physical (such as exercise training and resistance training) and psychological (such as counselling and cognitive therapies), to constitute a multidimensional programme. Interventions had to be allowed to be carried out at home. DATA COLLECTION AND ANALYSIS: Two authors independently assessed eligible studies for inclusion, and performed quality assessment and extracted relevant data of the included studies. Quality of life was the primary outcome of the review. MAIN RESULTS: We included 22 RCTs and four quasi-RCTs on 2272 participants. We categorised the intervention components into four groups: educational and psychological; educational and physical; physical and psychological; and educational, physical and psychological. Most of the studies used usual care (routine medical follow-up services) as the comparator. A few studies used a lower level or different type of intervention (e.g. stress management or exercise) or attention control as the comparator.We used the Functional Assessment of Cancer Therapy-Breast (FACT B), European Organisation for Research and Treatment of Cancer Quality of Life C30 (EORTC C30), Quality of Life (QoL) Breast Cancer, and SF36 questionnaires to assess quality of life. HBMS programmes may increase breast cancer-specific quality of life and global quality of life immediately after the intervention, as measured by FACT-B and EORTC C30 (FACT-B: mean difference (MD) 4.55, 95% confidence interval (CI) 2.33 to 6.78, 7 studies, 764 participants; EORTC: MD 4.38, 95% CI 0.11 to 8.64, 6 studies; 299 participants; moderate-quality evidence). There was no evidence of a difference in quality of life as measured by QoL-Breast Cancer or SF-36 (QoL-Breast Cancer: MD 0.42, 95% CI -0.02 to 0.85, 2 studies, 111 participants, very low-quality evidence; physical composite score SF36: MD 0.55, 95% CI -3.52 to 4.63, 2 studies, 308 participants, low-quality evidence).We observed a similar pattern at one to three months after the intervention: FACT-B (MD 6.10, 95% CI 2.48 to 9.72, 2 studies, 426 participants), EORTC-C30 (MD 6.32, 95% CI 0.61 to 12.04, 2 studies; 172 participants) and QoL-Breast Cancer (MD 0.45, 95% CI -0.19 to 1.09, 1 study, 61 participants). At four to six months and 12 months, there was no evidence of a difference in quality of life between groups (four to six months: EORTC - MD 0.08, 95% CI -7.28 to 7.44, 2 studies; 117 participants; SF-36 - MD -1.05, 95% CI -5.60 to 3.51, 2 studies, 308 participants; 12 months: EORTC - MD 2.04, 95% CI -9.91 to 13.99, 1 study; 57 participants).Functional status was incorporated into the quality of life subscale findings. HBMS programmes may decrease anxiety (MD of Hospital Anxiety and Depression Scale (HADS) -1.01, 95% CI -1.94 to -0.08, 5 studies, 253 participants, low-quality evidence) compared to control immediately after the intervention but the effect did not persist at four to six months. There was no evidence of improvements in depression immediately after HBMS (MD of HADS -1.36, 95% CI -2.94 to 0.22, 4 studies, 213 participants, low-quality evidence) or at follow-up. HBMS programmes may also decrease fatigue (MD -1.11, 95% CI -1.78 to -0.45, 3 studies, 127 participants; low-quality evidence) and insomnia (MD -1.81, 95% CI -3.34 to -0.27, 3 studies, 185 participants, low-quality evidence).None of the included studies reported service needs a

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A Cochrane Review reported a treatment effect of 4.38 points on the EORTC scale with an estimated standard deviation of 20 between intervention and control group.
“A Cochrane Review evaluating home-based multidimensional survivorship programmes for breast cancer survivors reported a treatment effect of 4.38 points on the EORTC scale with an estimated standard deviation of 20 between the intervention and control group [48].”
From The BrEasT cancer afTER-CARE (BETTER-CARE) programme to improve breast cancer follow-up: design and feasibility study results of a cluster-randomised complex intervention trial (2024) · cites this paper as [48]
The review’s EORTC-QLQ results (Analysis 2.1; page unavailable) report a post-intervention mean difference of 4.38 points between the home-based programme and control groups. The analysis tables list standard deviations for individual studies, but do not report an estimated standard deviation of 20 for the overall comparison. (LLM, conf=0.88)
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Authors: Cheng, K. K. F., Lim, Y. T. E., Koh, Z. M., & Tam, W. W. S.
Affiliations: National University of Singapore (SG)
ORCID: Cheng, Karis Kin Fong
Tam, Wilson Wai San
Venue: Cochrane Database of Systematic Reviews
Publisher: Wiley
Published: 2017-08-24
Volume: 2017
Issue: 8
Pages: CD011152-CD011152
ISSN: 1361-6137 (ISSN-L)
1465-1858
DOI: 10.1002/14651858.cd011152.pub2
PMC: PMC6483678
OpenAlex: W1919908001
Cited by: 114
References: 172
Citations by year: 2026: 5 · 2025: 13 · 2024: 12 · 2023: 17 · 2022: 15 · 2021: 12 · 2020: 16 · 2019: 12 · 2018: 8 · 2017: 2 · 2014: 1
FWCI: 1.09
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: doi.wiley.com/10.1002/tdm_license_1.1 (tdm)
onlinelibrary.wiley.com/termsAndConditions (vor)
Locations: Cochrane Database of Systematic Reviews (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Childhood Cancer Survivors' Quality of Life
Keywords: breast cancer survivors, home-based intervention, quality of life, survivorship care, exercise training, resistance training, self-management education, psychological intervention, cancer rehabilitation, FACT-B, EORTC QLQ-C30, SF-36, SF-6D, SF-12, SF-1000
MeSH terms: Anxiety, Breast Neoplasms, Depression, Fatigue, Female, Home Care Services, Humans, Sleep Initiation and Maintenance Disorders, Patient Education as Topic, Prognosis, Quality of Life, Program Evaluation, Exercise, Survival Rate, Randomized Controlled Trials as Topic, Survivors, Non-Randomized Controlled Trials as Topic

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