Mapping Systematic Reviews of Breast Cancer Survivorship Interventions: A Network Analysis

Abstract

PURPOSE Despite a large volume of research, breast cancer survivors continue to experience high levels of unmet need. To better understand the breadth of evidence, we mapped systematic review-level evidence across cancer survivorship domains and outcomes and conducted network analyses of breast cancer survivorship care interventions. METHODS Umbrella review methodology was used to identify published systematic reviews reporting on survivorship care interventions for breast cancer survivors. Included reviews were mapped against domains and health care outcomes as specified by the Cancer Survivorship Quality Framework, and network analyses were conducted to determine the extent of clustering of reviews, and connectivity across domains and outcomes. RESULTS Of 323 included reviews, most focused on management of physical (71.5%) or psychologic (65.3%) effects, health-related quality of life (55.1%), and physical activity (45.2%). Few focused on financial/employment effects, chronic conditions, health care delivery domains, or health service use or cost outcomes. Network analysis indicated 38.6% of reviews were connected to a single domain, 35.0% to two domains, and 16.5% to three domains, indicating a relatively siloed nature of research, with greater community clustering between health care delivery domains but limited connection between these and the other domains. Reviews published between 2011 and 2021 were more likely to examine financial toxicity and chronic conditions, but these domains remained under-represented compared with physical and psychologic effects. CONCLUSION Despite vast volume of breast cancer survivorship intervention research, systematic review-level research is unevenly distributed, siloed, and with significant gaps in key domains and outcomes. Assessment of evidence gaps in primary research and strategic planning of future research, in consultation with survivors, is needed.

Co-morbidities and their management in women with breast cancer. An Australian survey of breast cancer survivors

“…A recent umbrella review of reviews related to interventions for breast cancer survivors identi ed that out of 323 reviews only seven (2%) addressed the management of chronic conditions. [15] To better understand the pattern of comorbid conditions experienced by breast cancer survivors, their impact, and the quality of their care, we conducted a survey of Australian cancer survivors using validated measures of comorbidity and chronic condition management. Speci cally, the survey aimed to address the following objectives: 1) examine the self-reported prevalence of co-morbidity in women with history of breast cancer; 2) evaluate the impact of comorbidities on self-perceived health status; and 3) assess the quality of care delivered for management of comorbid chronic conditions as compared to care delivered for cancer.…”

Moving the Translational Needle in Breast Cancer Survivorship: Connecting Intervention Research to Clinical Practice

“…In general, findings from the network analyses were consistent with other recent efforts in identifying evidence gaps and setting cancer survivorship research priorities. 6 Another important point by Kemp et al 4 was the singleproblem/single-symptom approach used in most reviews, as evidenced by the low level of connectivity between domains and outcomes. Of note, these analyses were based on purely topical information and did not incorporate actual findings or strength of evidence from individual reviews in considering network connectivity, modularity, or other features.…”

“…In their analyses, Kemp et al 4 report that the majority of systematic reviews focused on physical or psychological effects and health-related quality of life, whereas the remaining domains and outcomes were studied much less frequently. Although this provides a high-level overview of the uneven distribution of research activity, it lacks information on gaps within specific domains.…”

“…High-level intervention research evidence for survivors of breast cancer exists, but many effective interventions are still underutilized and do not reach patients who could benefit from them. Kemp et al 4 demonstrate that interventions with the potential to prevent, mitigate, or manage physical and psychological long-term effects and enhance quality of life have been rigorously studied. However, they also highlight the need for generation of more foundational knowledge related to the framework's contextual domains of health care delivery, such as clinical structure, communication, and coordination of care.…”

“…These strategies include shared care and risk stratification approaches to help offset the burden of survivorship care delivery on oncologists and promote a team-based approach. In a shared care model, a patient's survivorship care is delivered by different clinical teams in coordination THE TAKEAWAY In the article that accompanies this editorial, Kemp et al 4 5 with each other and patients and their families. [17][18][19][20] For example, survivors may receive care from oncology and primary care but also appropriate specialists such as endocrinology or cardiology to manage chronic cancerrelated issues or comorbid conditions.…”