Purpose Lymphedema following breast cancer surgery remains a common and feared treatment complication. Accurate information on health-related quality of life (HRQOL) outcomes among patients with lymphedema is critically needed to inform shared medical decision making and evidence-based practice in oncologic breast surgery. Our systematic review aimed to (1) identify studies describing HRQOL outcomes in breast cancer-related lymphedema (BCRL) patients, (2) assess the quality of these studies, and (3) assess the quality and appropriateness of the patient-reported outcome (PRO) instruments used. Methods Using the PRISMA statement, we performed a systematic review including studies describing HRQOL outcomes among BCRL patients. Studies were classified by levels of evidence and fulfillment of the Efficace criteria. PRO instruments were assessed using the COSMIN criteria. Results Thirty-nine studies met inclusion criteria, including 8 level I and 14 level II studies. Sixteen of 39 studies were compliant with the Efficace criteria. Seventeen HRQOL instruments were used, two specific to lymphedema patients. Exercise and complex decongestive therapy treatment interventions were associated with improved HRQOL. Conclusions High-quality data on HRQOL outcomes is required to inform surgical decisions for breast cancer management and survivors. Of the lymphedema-specific PRO instruments, the Upper Limb Lymphedema 27 (ULL-27) was found to have strong psychometric properties. Future studies should strive to use high-quality condition-specific PRO instruments, follow existing guidelines for HRQOL measurement and to consider economic burdens of BCRL. Implications for Cancer Survivors As lymphedema may develop many years after breast cancer surgery, the ULL-27 may offer greater content validity for use in survivorship research.

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Objective To assess demographic, medical and psychological factors that are associated with fear of recurrence (FCR) in ovarian cancer patients. Methods We searched PubMed, EMBASE, Cochrane, CINAHL, and PsycINFO. For PubMed, a search using Medical Subject Headings (MeSH) was run, as well as a textword search from 1990 to July 2014. Search terms that were used consisted of ovarian terms, fear terms, and recurrence/progression themes. Title and abstract reviews were conducted by two independent reviewers to determine eligibility, and discrepancies were decided by a third reviewer. Full-text reviews of potentially eligible articles were conducted by the review team, which met regularly to ensure the reliability of eligibility ratings across all articles. Results Fifteen articles met our inclusion criteria. Nine were quantitative studies that utilized a cross-sectional design, and six studies consisted of three qualitative studies, two small intervention studies, and one study that utilized content analysis to explore written correspondence among ovarian cancer patients. FCR was reported as a significant concern for both older and younger women at both early and advanced stages. Women were distressed about recurrence at various times during their treatment and post-treatment. FCR was noted to be prevalent around cancer follow-up examinations. Many women report not receiving adequate support for recurrence. FCR was also shown to be linked in some way to hopelessness, faith/spirituality, and PTSD. FCR was also linked to patients’ anxiety about death and dying and the uncertainty of the future of their medical health. Conclusions This review demonstrates that FCR is prevalent in the ovarian cancer population. Cancer recurrence fears are not adequately assessed or treated. More information is needed on the factors that may be related to women’s fears about recurrence in the ovarian cancer population. In addition, a validated measure of FCR among ovarian cancer patients as well as a treatment intervention are needed.

This study aims to assess the current state of patient educational tools available for the purposes of educating women about postmastectomy breast reconstruction. A systematic review of the English language literature was conducted between the years 1966 and 2009 of all studies pertaining to the use of educational materials for breast reconstruction. MEDLINE, CINAHAL, PsycINFO, EMBASE, SCOPUS, and the Science Citation Index were searched. Only studies that both employed and evaluated a patient educational tool in the setting of postmastectomy reconstruction were selected for review. Qualifying studies were then evaluated with respect to their study design, sample size, and outcome measure evaluated. Each educational tool identified was similarly evaluated with respect to its development process, content, and educational medium. A total of 497 articles were retrieved. Of these, only seven met our inclusion criteria. These publications evaluated a total of seven educational tools. Among them were employed various mediums including written, visual, and audio materials. Detailed review revealed that the development of only one educational program included an educational needs assessment. Only two of the seven studies identified evaluated the efficacy of their educational tool using a randomized controlled trial study design. Outcome measures evaluated varied among the studies identified and included: knowledge gains (n = 4), the 'yes' or 'no' decision to undergo reconstruction (n = 3), satisfaction with decision regarding reconstruction (n = 1), decisional conflict (n = 3), and type of reconstruction (n = 3). This review highlights the need for well-designed, methodologically sound research into patient education regarding breast reconstruction. Such information is invaluable in developing patient education programs and decision aids that aim at patient empowerment.

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