Background
Methods
Definition
Search engines and time period
Search strategy
Selection criteria
Data synthesis
Results
Statistics
Overall outlook of reviews
Quality of life measurement
Authors [References] | Year | Main focus | Description/analysis | No. of databases | No. of included studies | Performed QA | Risk of bias assessment | Result(s) |
---|---|---|---|---|---|---|---|---|
Chen et al. [10] | 2010 | Patient-reported outcome measures for oncologic breast surgery | Systematic review | 8 | NA | No | No | Reliable and valid instruments exist, but even the best instruments do not address all important surgery‐specific and psychometric issues |
Winters et al. [11] | 2010 | Treatment recommendations in breast reconstruction based on patient-reported outcome measures and HRQOL | Systematic review | 4 | 34 | Yes | No | Sound scientific methodology in HRQOL is undermined by poorly designed and underpowered studies There is a pressing need for further longitudinal studies in breast reconstruction incorporating sensitive and condition-specific patient-report outcome measures; provide adequate sample sizes, and respect established guidelines for rigorous HRQOL methodology |
Lemieux et al. [12] | 2011 | QOL measurement in RCTs | An updated systematic review | PubMed | 190 | No | No | Reporting of QOL methodology should improve |
Reed et al. [13] | 2012 | QOL assessments in advanced breast cancer | Review | PubMed | 51 | No | No | There should be more consensuses on which QOL instruments are used |
Chopra and Kamal [14] | 2012 | QOL instruments in long-term BCS | Systematic review | 5 | 19 | No | No | The use of validated instruments will not only provide valid data but also help improve the quality of care in long-term BCS |
Adamowicz et al. [15] | 2012 | Assessment of HRQOL parameters as end points in phase III trials in advanced BC | Review | NA | 34 | No | No | HRQOL evaluation in clinical trials has the potential to predict patient prognosis and serves as a useful tool to assess patients’ experience during cancer therapy |
Pusic et al. [16] | 2013 | Patient-reported outcome instruments and outcomes in breast cancer patients with lymphedema | Systematic review | NA | 39 | Yes | No | 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 |
Niu HY et al. [17] | 2014 | Validity, reliability and responsiveness of breast cancer-specific HRQL instruments | Review | 3 | 4 | Yes | No | The EORTC QLQ-BR23, FACT-B, FACT-ES, and HFRDIS had fairly good psychometric properties to assess HRQOL |
Nguyen et al. [18] | 2015 | Effectiveness of EORTC QLQ-BR23 and FACT-B | Review | 3 | NA | No | No | Both questionnaires were effective in assessing QOL. Decision-making between the questionnaires depends on the study’s purpose and design |
Oliveira et al. [19] | 2015 | The procedures of translation, cross-cultural adaptation, and measurement properties of breast cancer-specific QOL questionnaires | Systematic review | 4 | 24 | Yes | No | Caution should be exercised when using breast cancer-specific QOL questionnaires that have been translated, adapted, and tested |
Maratia et al. [20] | 2016 | Evaluation of available specific and generic breast cancer HRQOL instruments | Systematic review | 2 | 32 | Yes | No | The EORTC BR-23, IBCSG, SF-36, and WHO-QOL BREF had good performance, depending on the purpose of the study |
Ghislain et al. [21] | 2016 | HRQOL in locally advanced and metastatic breast cancer: reporting of methodological and clinical issues in RCTs | Systematic review | PubMed | 49 | Yes | No | The absence of the HRQOL research hypotheses and the overemphasis on statistical rather than clinical significance was the main problem |
Turner-Bowker et al. [22] | 2016 | Patient-reported outcomes in advanced breast cancer clinical trials | Systematic review | 3 | 25 | No | No | Patient-reported outcomes may be used to provide a more comprehensive perspective of the benefits and risks from treatment |
Krohe et a l [23] | 2016 | PRO in metastatic breast cancer: a review of industry-sponsored clinical trials | Review | Clinicaltrial.gov | 38 | No | No | Stakeholders turn more attention to the patient perspective; one would expect PROs to increase as complementary measures to traditional endpoints and become an even more critical part of treatment evaluation |
Pe et al. [24] | 2018 | Patient-reported outcome data in randomized controlled trials of locally advanced and metastatic breast cancer | Review | PubMed | 66 | No | No | A need to improve standards in the analysis, interpretation, and reporting of Patient-reported outcome and quality of life data in cancer RCTs |
Liu et al. [25] | 2018 | BREAST-Q measurement of the patient perspective in oncoplastic breast surgery | Systematic review | 4 | 54 | Yes | No | BREAST-Q can effectively measure patient's satisfaction and HRQOL in relation to different type of breast oncoplastic surgeries. BREAST-Q captured meaningful and reliable information from the patients' perspective and may be useful for clinical decision-making |
Tevis et al. [26] | 2018 | Patient-reported outcomes for breast cancer | Review | Not specified | 123 | No | No | The implementation of PROs can be complex and challenging and care must be taken to minimize the potential for survey fatigue by patients and the potential financial burden for implementation, maintenance, and analyses of collected data |
Treatment
Authors [References] | Year | Main focus | Description/analysis | No. of databases | No. of included studies | Performed QA | Risk of bias assessment | Result(s) |
---|---|---|---|---|---|---|---|---|
Lemieux et al. [27] | 2008 | Effects of Chemotherapy-induced alopecia on QOL | Review | 5 | 38 | No | No | Hair loss consistently ranked amongst the most troublesome side effects, was described as distressing, and may affect the body image |
Cella and Fallowfiel [28] | 2008 | Side-effects of endocrine therapy and QOL | Review | NA | 6 | No | No | Starting with better QOL, which should lead to better adherence, will result in better patient outcomes |
Buijs et al. [29] | 2008 | Endocrine treatments for breast cancer and HRQOL | Review | NA | NA | No | No | HRQOL mostly is severely influenced by chemotherapy and part of these symptoms may be lasting, especially when associated with the induction of premature menopause. The varying side effect profiles of tamoxifen and aromatase inhibitors did not lead to significant difference in overall HRQOL |
Pockaj et al. [30] | 2009 | QOL after breast surgery | Review | NA | NA | No | No | Better preoperative counseling, informed decision-making, and appropriate interventions will lead to improved QOL |
Reimer and Gerber [31] | 2010 | Impact of local or systemic treatments on QOL in the elderly early-breast cancer patients | Review | PubMed | 18 | No | No | Overall QOL was maintained or improved |
Devi et al. [32] | 2011 | QOL of women during and up to ten years after treatment for breast cancer | Systematic review | 9 | 11 qualitative studies | Yes | No | Breast cancer diagnosis and its treatment can have a significant effect on several domains of women’s QOL |
Pinto and de Azambuja [33] | 2011 | Symptoms in BCS | Review | NA | NA | No | No | The most common symptoms affecting BCS were fatigue, insomnia, depression, cognitive dysfunction, reproductive and menopausal symptoms and lymphedema |
Howard-Anderson et al. [34] | 2012 | QOL, menopausal symptoms and fertility concerns, and behavioral health outcomes in younger patients | Systematic review | PubMed | 28 | No | No | Younger women experienced concerns on premature menopause, menopausal symptoms and infertility that had a role in the level of distress after treatment. Health outcomes in younger ones include weight gain and physical inactivity |
Kaviani et al. [35] | 2013 | Type of surgery and QOL | Narrative review | NA | NA | No | No | QOL had a better score for oncoplastic breast surgery in comparison with mastectomy or BCT |
Orsaria et al. [36] | 2014 | Nodal status assessment and QOL | Review | NA | NA | No | No | Quality results in breast cancer surgery need to generate oncological safety devoid of complications through renewed clinical experience |
Tsoi et al. [37] | 2014 | Tissue-expander/implant vs. autologous abdominal tissue breast reconstruction | Systematic review | 5 | 15 | Yes | Yes | There is some weak evidence that tissue-expander/implant reconstruction becomes a less favorable approach in terms of patient satisfaction after mastectomy |
Taghian et al. [38] | 2014 | Impact of lymphedema on QOL | Review | PubMed | NA | No | No | Lymphedema remains a significant QOL issue which affected woman’s physical, psychological, and emotional well-being |
Sodergren et al. [39] | 2015 | The side effects associated with targeted therapies used in the adjuvant and metastatic settings for HER2+ | Systematic review | 5 | 18 | No | No | Compared with conventional cytotoxics, targeted therapies are delivered over longer periods of time and present unique and often extensive side-effect profiles. Diarrhoea and skin rash as particularly prevalent anti-HER2 inhibitor side effects |
Kameo and Sawada [40] | 2016 | QOL and adverse reactions of chemotherapy | Integrative review | 5 | 50 | NA | NA | Multidisciplinary and thinking on the individual vulnerabilities should be considered when evaluating adverse reaction and QOL |
Mioranza et al. [41] | 2016 | The impact of adjuvant endocrine therapy in early breast cancer on QOL | Review | NA | NA | No | No | Impact of adjuvant endocrine therapies on HRQOL was not comparable since they used different QOL instruments |
Razdan et al. [42] | 2016 | Quality of life among patients after bilateral prophylactic mastectomy | Systematic review | 6 | 22 | Yes | No | Post-BPM, patients are satisfied with the outcomes and report high psychosocial well-being and positive body image. Sexual well-being and somatosensory function are most negatively affected. Vulnerability, psychological distress and preoperative cancer distress are significant negative predictors of quality of life and body image post-BPM |
Chalasani [43] | 2017 | Optimizing QOL in patients with hormone receptor-positive metastatic breast cancer | Review | NA | NA | No | No | Patients with HR-positive disease may receive maximum clinical benefit from endocrine therapy while optimizing QOL |
Garrido-Oyarzun and Castelo-Branco [44] | 2017 | Use of hormone therapy for menopausal symptoms and QOL in survivors | Review | NA | NA | No | No | The management of menopausal symptoms and QOL of patients treated for breast cancer remains an important problem without an optimal solution |
Marta et al. [45] | 2017 | QOL in patients treated with radiation therapy | Systematic review | PubMed | 353 | No | No | Significant benefit in HRQOL was often reported when a positive primary outcome was reported |
Zhou et al. [46] | 2017 | Impact of endocrine monotherapy and in combination with targeted therapy on QOL | Systematic review | 3 databases and key conferences | 11 | No | No | Users of both treatments experienced similar QOL in the first-line and ET-failure setting relative to patients on ET mono. Moreover, these users experienced better QOL outcomes in some domains in the ET-failure setting relative to ET mono users |
Mileski et al. [47] | 2017 | QOL considerations during cancer treatment in invasive ductal carcinoma patients | Systematic review | PubMed | 9 | No | No | The most prevalent positive QOL factors included patient expectations, decreased side effects, and increased survival rate. The most prevalent negative QOL factors included treatment, specific side effects and decreased quality of life |
Platt and Zhong [48] | 2017 | Patient-centered breast reconstruction based on health-related QOL evidence | Review | NA | NA | No | No | Both immediate and delayed breast reconstruction increased satisfaction and QOL after reconstruction, and both groups have reported similar satisfaction and QOL scores at long-term follow-up |
Rivera et al. [49] | 2018 | Chemotherapy-associated peripheral neuropathy | Systematic review | 4 | 60 | Yes | No | Neuropathic symptoms persisted in 11.0% to more than 80% of participants at one to three years following treatment. There is a paucity of data describing persistent PN in ESBC patients |
Xiao et al. [50] | 2018 | Effects of adjuvant endocrine therapy on the QOL of post-menopausal women with non-metastatic ER+ | Systematic review | 3 | 13 | Yes | No | Most studies found no differences between tamoxifen and aromatase inhibitor groups in terms of global QOL. The QOL of post-menopausal women is unlikely to be adversely affected by long-term use of adjuvant endocrine therapy |
Yee et al. [51] | 2018 | Radiation-induced skin toxicity in breast cancer patients | Systematic review | NA | 96 | Yes | No | Methods including simultaneous integrated boost, accelerated partial breast irradiation, and prone positioning may cause less radiation dermatitis than conventional treatments |
Cheng et al. [52] | 2018 | QOL of elderly patients with solid tumors undergoing adjuvant cancer therapy | Systematic review | 5 | 4 | Yes | Yes | Adjuvant chemotherapy and radiotherapy may not have detrimental effects on QOL in most elderly patients with solid tumors |
Muller et al. [53] | 2018 | Impact of manual lymphatic drainage on the HRQOL | Systematic review | 6 | 8 | Yes | Yes | No studies reported reductions in HRQOL, or severe adverse events after MLD |
Jeffs et al. [54] | 2018 | Effectiveness of decongestive treatments on excess arm volume and patient-centered outcomes in women with early breast cancer-related arm lymphedema | Systematic review | 3 | 7 | Yes | Yes | Weak evidence for the impact of decongestive lymphedema treatment did not allow any conclusions to be drawn about the most effective treatment to be offered when patients with early breast cancer first present for treatment |
Supportive care
Authors [References] | Year | Main focus | Description/analysis | No. of databases | No. of included studies | Performed QA | Risk of bias assessment | Result(s) |
---|---|---|---|---|---|---|---|---|
Bicego et al. [55] | 2009 | The effect of exercise on QOL | Systematic review | 4 | 9 | Yes | No | Exercise as an effective strategy can improve QOL in patients |
Bleakley and Stinson [56] | 2011 | CAM and QOL | Narrative review | 6 | 8 | Yes | No | There is great potential for complementary and alternative therapies to be increasingly integrated into clinical practice within breast cancer services |
Levine and Balk [57] | 2012 | Yoga and QOL improvement | Literature review | 7 | 71 | NA | NA | Participation in yoga programs appeared to benefit breast cancer patients |
Zhang, et al. [58] | 2012 | Effects of yoga on psychological function and QOL | Systematic review and meta-analysis | 5 | 6 | Yes | Yes | There is insufficient evidence to advocate that yoga should be offered routinely to women diagnosed with breast cancer. However, it may be an acceptable intervention to improve QOL for these women |
Boehm et al. [59] | 2014 | Arts therapies for anxiety, depression, and QOL | Systematic review and meta-analysis | 3 | 13 | Yes | Yes | Overall, the option of participation in arts therapies can be recommended and has shown to be significantly effective for the reduction of anxiety in patients |
Sawyer [60] | 2014 | Complementary exercise and QOL | Systematic review | 4 | 9 | No | No | Although complementary exercise improved QOL statistically in two-thirds of the research findings, further research is recommended |
Zeng Y et al. [61] | 2014 | Effects of exercise intervention on QOL in BCS | Systematic review and meta-analysis | 5 | 19 | Yes | Yes | Exercise interventions have statistically significant effects on overall QOL, as well as positive trends for breast and arm symptoms |
Yan et al. [62] | 2014 | Lack of Efficacy of Tai Chi in Improving QOL in BCS | Systematic review and meta-analysis | 4 | 9 | Yes | Yes | There is a lack of sufficient evidence to support Tai Chi benefiting the management of BCS in improving QOL and other important clinical outcomes |
Leggett et al. [63] | 2015 | Effects of CAM on cancer symptoms, treatment side effects, QOL, and survival | Systematic review | 5 | 22 | Yes | Yes | Guarana and Ganoderma lucidum may improve fatigue, whereas glutamine may also be effective in improving oral mucositis symptoms |
Van Dijck et al. [64] | 2016 | The effects of different physical self-management techniques on QOL | Systematic review | 4 | 13 | Yes | Yes | Physical self-management interventions during breast cancer treatment as well as after the primary treatment seem to generate beneficial effects on QOL |
Zhang et al. [65] | 2016 | Effects of mindfulness-based therapy on QOL | Systematic review and meta-analysis | 6 | 7 | Yes | Yes | There was limited that mindfulness-based therapy can improve QOL |
Cramer et al. [66] | 2017 | Yoga for improving HRQOL, mental health and cancer-related symptoms | Systematic review and meta-analysis | 6 | 23 | Yes | Yes | Moderate-quality evidence supported the recommendation of yoga for improving HRQOL and reducing fatigue and sleep disturbances when compared with no therapy, as well as for reducing depression, anxiety and fatigue, when compared with psychosocial/educational interventions |
D'Egidio et al. [67] | 2017 | Effect of counseling interventions on HRQOL | Systematic review | 2 | 35 | Yes | No | Exercise counseling as well as physical therapy are effective to improve shoulder mobility, healing wounds, and limb strength |
Husebo et al. [68] | 2017 | Mind–body exercise therapies and QOL | Review | 4 | 11 | Yes | Yes | Yoga was found to benefit patients’ psychological QOL, while less support was established concerning physical QOL elements |
Lipsett et al. [69] | 2017 | Exercise during adjuvant radiotherapy on fatigue and QOL | Systematic review and meta-analysis | 6 | 9 | Yes | No | Statistically significant benefits of supervised, combined aerobic resistance exercise on fatigue were achieved |
Pan et al. [70] | 2017 | Yoga practice improve treatment-related side effects and QOL | Systematic review and meta-analysis | 3 | 16 | Yes | No | Yoga was associated with enhanced overall HRQOL and relief of anxiety, depression and gastrointestinal adverse reactions in breast cancer patients and survivors |
Zaidi et al. [71] | 2018 | Effect of complementary therapies on survivors’ QOL | Review | NA | NA | No | No | There is a need for personalized physical activity plans to be developed to suit the individual and their circumstances |
Zhang et al. [72] | 2018 | Effectiveness of telephone- based interventions on HRQOL and prognostic outcomes | Systematic review and meta-analysis | 6 | 14 | Yes | Yes | Based on the insufficient evidence, the effects on depression, fatigue and physiological function were not statistically significant |
Psychological distress
Authors [References] | Year | Main focus | Description/analysis | No. of databases | No. of included studies | Performed QA | Risk of bias assessment | Result(s) |
---|---|---|---|---|---|---|---|---|
Reich et al. [73] | 2008 | Impact of depression on QOL | Review | NA | NA | No | No | Treatment of depression improves QOL and may increase longevity |
Duijts et al. [74] | 2011 | Effect of behavioral techniques and physical exercise on psychosocial functioning and HRQOL outcomes | Systematic review and meta-analysis | 6 | 56 | No | No | Behavioral techniques and physical exercise improve psychosocial functioning and HRQOL in breast cancer patients and survivors |
Paraskevi [75] | 2012 | QOL outcomes | Review | 4 | NA | No | No | Psychological distress-anxiety and depression were common among BC patients. Pain, fatigue, and insomnia were the most common symptoms reported |
Matsuda et al. [76] | 2014 | Effectiveness of psychoeducational support on quality of life | Systematic review and meta-analysis | CENTRAL | 8 | No | Yes | Psychosocial support in improving BC symptoms and in improving emotional well-being is effective within 6 months post-intervention |
Chow et al. [77] | 2016 | Body Image and QOL | Review | 5 | 13 | NA | NA | BC survivors were reported a poorer body image and deterioration in their QOL after treatment. There was not enough evidence of the correlation between body image and QOL |
Ye et al. [78] | 2018 | Efficacy of cognitive behavior therapy on QOL and psychological health of survivors | Meta-analysis | 4 | 10 | Yes | Yes | Due to the effectiveness of therapy for psychological symptoms, cognitive behavior therapy should be used as the intervention |
Abrahams et al. [79] | 2018 | Relationship of fatigue with QOL and factors that can be addressed in psychological interventions | Systematic review | 5 | 57 | Yes | No | Moderate to strong evidence appeared for a relationship of fatigue with depressive symptoms, anxiety, distress, sleep disturbances, lower physical activity levels, pain, difficulties with coping with cancer, and catastrophizing about symptoms |
Age-related reviews
Authors [References] | Year | Main focus | Description/analysis | No. of databases | No. of included studies | Performed QA | Risk of bias assessment | Result(s) |
---|---|---|---|---|---|---|---|---|
Ballinger and Fallowfield [80] | 2009 | Assessment of QOL in older patients | Review | NA | 25 | No | No | The long-term survivorship studies indicate that older patients are perhaps better equipped mentally to deal with treatments |
Munoz [81] | 2010 | Quality of life during treatment in young patients | Review | NA | NA | No | No | Patients who undergone mastectomy have worse body image and disturbances in their sexual life. Patients treated with mastectomy and adjuvant chemotherapy are those with the greatest impairment. Also, sexual activity is negatively affected by chemotherapy |
Rosenberg and Partridge [82] | 2013 | QOL related to physical and psychosocial functioning in young premature menopause patients | Review | NA | NA | No | No | Effective strategies as an intervention should be applied to relieve symptoms and improve QOL in younger age groups |
Samuel et al. [83] | 2016 | HRQOL in young black survivors | Systematic review | 5 | 6 | Yes | No | Young black BCS generally experience suboptimal HRQOL after breast cancer diagnosis |
Assessment of quality of life among nations/races
Authors [References] | Year | Main focus | Description/analysis | No. of databases | No. of included studies | Performed QA | Risk of bias assessment | Result(s) |
---|---|---|---|---|---|---|---|---|
Russell et al. [84] | 2008 | QOL of African American and white survivors | Review | 4 | 26 qualitative and quantitative | No | No | QOL was different in two groups. Overall global quality of life was favorable in both African American and white survivors |
Delgado-Sanz et al. [85] | 2011 | QOL in Spanish BC patients | Systematic review | 8 | 25 | Yes | No | Research into health-related quality of life of breast-cancer patients is a little developed |
Yanez et al. [86] | 2011 | QOL among Latina breast cancer patients | Systematic review | 2 | 22 qualitative and quantitative | No | No | Latina BCS on average experience worse QOL than non-Latina Whites |
Deshpande et al. [87] | 2013 | QOL outcomes in Indian | Review | NA | NA | No | No | Clinical pharmacists may give the major support to Indian healthcare system in future |
Mollica et al. [88] | 2015 | QOL in African American breast cancer survivors | Integrative literature review | 5 | 19 | Yes | No | Researchers must focus on factors from a multi-domain perspective to truly understand the varied dimensions influencing QOL |
Haddou Rahou et al. [89] | 2016 | QOL in Arab women | Systematic review | 5 | 13 qualitative and quantitative studies | Yes | No | Good scores of global health were recorded at Arab women compared to other countries. There was a difference in QOL scores and its associated factors among Arab women from different nations |
Ho et al. [90] | 2018 | QOL in Asian patients | Systematic review | 3 | 57 | Yes | No | Patients with comorbidities and those treated with chemotherapy, with less social support and with more unmet needs, have poorer HRQOL |
Bouya et al. [91] | 2018 | QOL of Iranian patients | Systematic review and Meta-analysis | 4 | 18 | Yes | No | Moderate level of QOL in patients was indicated |
Qualitative reviews
Achievements so far and a brief synthesis
Factors that might improve quality of life | Factors that might deteriorate quality of life |
---|---|
Reduction of radiation-induced skin toxicity using simultaneous integrated boost, accelerated partial breast irradiation, and prone positioning | Adjuvant endocrine therapy-related side effects including vasomotor symptoms such as hot flashes |
Adjuvant chemotherapy and radiotherapy in the elderly with solid tumors | Targeted therapy-related side effects: diarrhoea and skin rash in the adjuvant and metastatic settings for HER2+ breast cancer |
Oncoplastic breast surgery | Body image after mastectomy |
Both immediate and delayed breast reconstruction in long-term | Chemotherapy-induced alopecia |
Better preoperative counseling and informed decision-making | Disturbances in sexual life |
Physical activity interventions such as yoga, exercise, physical self-management, complementary exercise, art therapies, and mind–body exercise therapy | Less social support and unmet needs |
Treatment of lymphedema: manual lymphatic drainage | Lymphedema affecting woman’s physical, psychological, and emotional well-being |
Psychoeducational support or receiving social support in early stage breast cancer | Premature menopause, menopausal symptoms, and infertility |
Cognitive behavioral therapy | Comorbid depression which significantly increases the burden of distress and dysfunction |