A comprehensive approach to rehabilitation interventions following breast cancer treatment - a systematic review of systematic reviews

Abstract

Background Breast cancer (BC) is the most common type of cancer in women worldwide. Post-treatment, patients suffer from side effects and have various rehabilitation needs, which means that individualization is fundamental for optimal rehabilitation. This systematic review (SR) of SRs aims to evaluate the current evidence on rehabilitation interventions in female patients following BC treatment. Methods Full-text SRs published in English from 2009 were searched in Embase, PubMed, Cinahl Complete, PsycINFO, AMED, SCOPUS, and Cochrane Library. Inclusion criteria: SRs of randomized or non-randomized controlled trials investigating the effects of rehabilitation interventions in women following BC treatment. All outcomes were considered. Methodological quality was evaluated using the AMSTAR 2 tool and interrater agreement was evaluated. Out of 1269 citations retrieved, 37 SRs were included. Results Five rehabilitation areas were identified: exercise and physical activity (PA), complementary and alternative medicine (CAM), yoga, lymphoedema treatment, and psychosocial interventions. The most solid evidence was found in exercise/PA and yoga. Exercise interventions improved outcomes such as shoulder mobility, lymphoedema, pain, fatigue and quality of life (QoL). Effects of yoga were shown on QoL, anxiety, depression, sleep disturbance, fatigue and gastrointestinal symptoms. The effect of CAM was shown on nausea, pain, fatigue, anger and anxiety but these results need to be interpreted with caution because of low methodological quality in included studies in the SRs. Among the lymphoedema treatments, positive effects were seen for resistance training on volume reduction and muscle strength and psychosocial interventions such as cognitive behavioural therapy had positive effects on QoL, anxiety, depression and mood disturbance. Conclusions This SR of SRs show solid positive effects of exercise/PA and yoga for women following BC treatment, and provides extended knowledge of the effects of CAM, yoga, lymphoedema treatment and psychosocial interventions. It is evident that more than one intervention could have positive effects on a specific symptom and that the effects depend not only on intervention type but also on how and when the intervention is provided. The results can be used as a foundation for individualized rehabilitation and aid health care professionals in meeting patients’ individual needs and preferences. Trial registration PROSPERO ( CRD42017060912 ). Electronic supplementary material The online version of this article (10.1186/s12885-019-5648-7) contains supplementary material, which is available to authorized users.

The quality of systematic reviews/meta‐analyses published in the field of bariatrics: A cross‐sectional systematic survey using AMSTAR 2 and ROBIS

“…Whereas in two studies, 50% of the included SR were assessed as “moderate” and “high” quality . Also, the results of our assessments of the quality and RoB of SR/MA are consistent with other studies using tools such as the AMSTAR, OQAQ, or PRISMA Checklist . In the bariatrics, in two overviews of the SR, the quality assessed in the AMSTAR was moderate, but it was based only on a few studies in comparison with our sample of 78 SR/MA.…”

The Physiotherapy Intervention for Shoulder Pain in Patients Treated for Breast Cancer: Systematic Review

“…In the same way, the use of myofascial inductions can be moderately effective [28]. However, the most solid positive effects are identified in therapeutic exercise for the reduction of the pain and in yoga with effects on the state of anxiety [29]. Active exercises show that the best results of joint recovery are achieved between the 28th and 42nd postoperative days [4].…”

Yoga for Chemotherapy-Induced Peripheral Neuropathy and Fall Risk: A Randomized Controlled Trial

“…Yoga is a meditative movement therapy that improves body conditioning, flexibility, and balance through mind-body awareness. A myriad of pilot and feasibility studies suggest that yoga may help improve quality of life ( 7–13 ), anxiety ( 9 , 14–16 ), depression ( 8 , 9 , 14–18 ), fatigue ( 13 , 17–20 ), and functional outcomes ( 13 , 21 , 22 ) in breast cancer patients and survivors who received chemotherapy ( 23 ). Although CIPN can substantially impact function and increase the risk of falls among cancer patients, only 2 small single arm (N = 10) and randomized controlled studies (N = 26, randomized to yoga, Reiki, meditation, or educational control) have evaluated the effects of yoga on improving CIPN symptoms and reducing CIPN-related falls in cancer patients ( 24 , 25 ).…”