Skip to main content

Advertisement

Log in

The effect of cognitive behavioral therapy on the quality of life of breast cancer patients: a systematic review and meta-analysis of randomized controlled trials

  • Review
  • Published:
Quality of Life Research Aims and scope Submit manuscript

A Correction to this article was published on 16 August 2022

This article has been updated

Abstract

Purpose

Several lines of clinical research support the efficacy of Cognitive behavioral therapy (CBT) with a large number of population and various disease conditions, however, the true effects of CBT interventions on Quality of Life of breast cancer patients remain unknown. The aim of the study was to evaluate the effect of Cognitive Behavioral Therapy on the Quality of Life of breast cancer patients.

Methods

A systematic review of articles published using Web of Science (1950–January 2020); Medline via EBSCO (1992–January 2020); Science direct via ELSEVIER (1996–January 2020); SCOPUS (2004–January 2020); and PubMed (1946–January 2020 excluding Medline from 1992–January 2020) were included. Additional studies were included after  checking reference lists of all relevant studies; searching ongoing trials and research registers and manual search. Data extraction was conducted by two independent authors and a third independent author checked the data extraction. The PRISMA statement was adopted.

Result

Eleven Randomized controlled trials (RCT) with 1690 breast cancer patients were included in this review. The overall effect size of cognitive behavioral therapy on QoL of breast cancer patients was medium 0.39 (95% CI 0.12–0.66, P < 0.00001, I2 = 83%). Five studies had shown statistically significant improvement in functional and symptoms scales in the treatment group than the control group.

Conclusion

CBT is effective in improving the Quality of Life of breast cancer patients. In future research, further randomized controlled trials with adequate randomization, allocation concealment, and appropriate blinding may be needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9

Similar content being viewed by others

Data availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Change history

References

  1. World Health Organization. What is fatigue and weakness [Internet]. 2020. Retrieved January 6, 2020, from https://www.who.int/cancer/prevention/diagnosis-screening/breast-cancer/en/.

  2. American Cancer Society. (2019). Breast Cancer Facts and Figures 2019–2020. Am cancer Soc Inc.

  3. Sosnowski, R., Kulpa, M., Ziętalewicz, U., Wolski, J. K., Nowakowski, R., Bakuła, R., et al. (2017). Basic issues concerning health-related quality of life. Central European Journal of Urology, 70, 206–211.

    PubMed  PubMed Central  Google Scholar 

  4. Perry, S., Kowalski, T. L., & Chang, C. H. (2007). Quality of life assessment in women with breast cancer: Benefits, acceptability and utilization. Health and Quality of Life Outcomes, 5, 1–14.

    Article  Google Scholar 

  5. Ho, P. J., Gernaat, S. A. M., Hartman, M., & Verkooijen, H. M. (2018). Health-related quality of life in Asian patients with breast cancer: A systematic review. Biomedical Journal, 8, 1–28.

    Google Scholar 

  6. Hashemi, S. (2019). Mediterranean region: A systematic review and meta-analysis Health-related quality of life of breast cancer patients in the Eastern Mediterranean region: A systematic review and meta-analysis. Breast Cancer Research and Treatment. https://doi.org/10.1007/s10549-019-05131-0

    Article  PubMed  Google Scholar 

  7. Paraskevi, T. (2012). Quality of life outcomes in patients with breast cancer. Oncology Reviews, 6, 7–10.

    Article  Google Scholar 

  8. Seidman, A. D., Portenoy, R., Yao, T. J., Lepore, J., Mont, E. K., Kortmansky, J., et al. (1995). Quality of life in phase II trials: A study of methodology and predictive value in patients with advanced breast cancer treated with paclitaxel plus granulocyte colony-stimulating factor. Journal of the National Cancer Institute, 87(17), 1316–1322.

    Article  CAS  Google Scholar 

  9. Yan, B., Yang, L. M., Hao, L. P., Yang, C., Quan, L., Wang, L. H., et al. (2016). Determinants of quality of life for breast cancer patients in Shanghai, China. PLoS ONE, 11, e0153714.

    Article  Google Scholar 

  10. Rothbaum BO, MEA, RP, & FDW. (2000). Cognitive-behavioral therapy [Internet]. In: E. B. Foa TMK& MJF, editor. Guilford Press. pp. 320–325. Retrieved February 15, 2020, from https://psycnet.apa.org/record/2000-02102-015.

  11. Craske, M. G. (2010). Theories of psychotherapy. Cognitive–behavioral therapy [Internet]. Washington: American Psychological Association. Retrieved February 15, 2020, from https://psycnet.apa.org/record/2009-08916-000.

  12. Dobson, K. S. (ed.) (2010). Handbook of cognitive-behavioral therapies [Internet]. The Guilford Press. Retrieved February 15, 2020, from https://pdfs.semanticscholar.org/7494/7b0effdaf89bb039c22776c4b77835837c5e.pdf#page=292.

  13. Ren, W., Qiu, H., Yang, Y., Zhu, X., Zhu, C., Mao, G., & Xie, X. (2019). Randomized controlled trial of cognitive behavioural therapy for depressive and anxiety symptoms in Chinese women with breast cancer. Psychiatry Research, 271, 52–59.

    Article  Google Scholar 

  14. Ga, J., Dl, W., Hickey, A., & Carter, B. (2015). Psychological interventions for women with non-metastatic breast cancer ( Review ). Cochrane Database of Systematic Reviews, 5, CD008729.

    Google Scholar 

  15. Aricò, D., Raggi, A., & Ferri, R. (2016). Cognitive behavioral therapy for insomnia in breast cancer survivors: A review of the literature. Frontiers in Psychology, 7(August), 1–10.

    Google Scholar 

  16. Quesnel, C., Ivers, H., Morin, C. M., & Quesnel, C. (2003). Efficacy of cognitive – behavioral therapy for insomnia in women treated for nonmetastatic breast cancer. Journal of Consulting and Clinical Psychology, 71(1), 189–200.

    Article  Google Scholar 

  17. Abrahams, J. G., Gielissen, M. F. M., Donders, R. R. T., & Goedendorp, M. M. (2017). The efficacy of internet-based cognitive behavioral therapy for severely fatigued survivors of breast cancer compared with care as usual: A randomized controlled trial. Cancer, 123, 1–10.

    Article  Google Scholar 

  18. Hunter, M. S., Coventry, S., Hamed, H., Fentiman, I., & Grunfeld, E. A. (2009). Evaluation of a group cognitive behavioural intervention for women suffering from menopausal symptoms following breast cancer treatment. Psycho-Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 18(5), 560–563.

    Article  Google Scholar 

  19. Wojtyna, E., Jolanta, Ż, & Patrycja, S. (2007). The influence of cognitive-behaviour therapy on quality of life and self-esteem in women suffering from breast cancer. Reports of Practical Oncology and Radiotherapy, 12(2), 109–117. https://doi.org/10.1016/S1507-1367(10)60047-8

    Article  Google Scholar 

  20. Glaser, R., Rice, J., Sheridan, J., Fertel, R., Stout, J., Speicher, C., et al. (1987). Stress-related immune suppression: Health implications. Brain, Behavior, and Immunity, 1(1), 7–20.

    Article  CAS  Google Scholar 

  21. Courtois, C. A., & Sonis, J. (2017). Guideline: What is Cognitive Behavioral Therapy? Am Psychol Assoc [Internet]. pp. 1–119. Retrieved from www.apa.org/ptsd-guideline

  22. Wojtyna, E., Życińska, J., & Stawiarska, P. (2007). The influence of cognitive-behaviour therapy on quality of life and self-esteem in women suffering from breast cancer. Reports of Practical Oncology & Radiotherapy, 12(2), 109–117. https://doi.org/10.1016/S1507-1367(10)60047-8

    Article  Google Scholar 

  23. Gielissen, M. F. M., Verhagen, S., Witjes, F., & Bleijenberg, G. (2006). Effects of cognitive behavior therapy in severely fatigued disease-free cancer patients compared with patients waiting for cognitive behavior therapy: A randomized controlled trial. Journal of Clinical Oncology, 24(30), 4882–4887.

    Article  Google Scholar 

  24. Ye, M., Du, K., Zhou, J., Zhou, Q., Shou, M., & Hu, B. (2018). A meta-analysis of the efficacy of cognitive behavior therapy on quality of life and psychological health of breast cancer survivors and patients. Psychooncology, 27(7), 1695–1703.

    Article  Google Scholar 

  25. Xu, Y., Zhu, F., & Wu, J. (2019). The efficacy of cognitive behavioral therapy to treat depression and anxiety and improve quality of life among early- stage breast cancer patients. Integrative Cancer Therapies, 18(1), 1–9.

    Google Scholar 

  26. Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C., Gøtzsche, P. C., Ioannidis, J. P. A., et al. (2009). The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. PLoS Medicine, 6(7), 1–34.

    Article  Google Scholar 

  27. Higgins, J. P., Altman, D. G., Gøtzsche, P. C., Jüni, P., Moher, D., Oxman, A. D., et al. (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 343, 5928.

    Article  Google Scholar 

  28. Cohen, J. (1988). statistical power analysis for the behavioral sciences (2nd ed.). New Jersey: Lawrence Erlbaum Associates.

    Google Scholar 

  29. Qiu, J., Chen, W., Gao, X., Xu, Y., Tong, H., Yang, M., et al. (2013). A randomized controlled trial of group cognitive behavioral therapy for Chinese breast cancer patients with major depression. Journal of Psychosomatic Obstetrics & Gynecology, 8942, 60–67.

    Article  Google Scholar 

  30. Lechner, S. C., Whitehead, N. E., Vargas, S., Annane, D. W., Robertson, B. R., Carver, C. S., et al. (2014). Does a community-based stress management intervention affect psychological adaptation among underserved black breast cancer survivors? Journal of the National Cancer Institute. Monographs, 50, 315–322.

    Article  Google Scholar 

  31. Qiu, H., Ren, W., Yang, Y., Zhu, X., Mao, G., Mao, S., et al. (2018). Effects of cognitive behavioral therapy for depression on improving insomnia and quality of life in Chinese women with breast cancer: Results of a randomized, controlled, multicenter trial. Neuropsychiatric Disease and Treatment, 14, 2665–2673. https://doi.org/10.2147/NDT.S171297

    Article  PubMed  PubMed Central  Google Scholar 

  32. Dirksen, S. R., & Epstein, D. R. (2008). Efficacy of an insomnia intervention on fatigue, mood and quality of life in breast cancer survivors. Journal of Advanced Nursing, 61(6), 664–675.

    Article  Google Scholar 

  33. Arving, C., Sjode, P. O., Bergh, J., Hellbom, M., Johansson, B., Glimelius, B., & Brandberg, Y. (2007). Individual psychosocial support for breast cancer patients: A randomized study of nurse versus psychologist interventions and standard care. Cancer Nursing, 30(3), E10–E19.

    Article  Google Scholar 

  34. Wu, P., Chen, S., Huang, W., Chang, S., & Hsu, M. (2018). Effects of a psychoeducational intervention in patients with breast cancer undergoing chemotherapy. Journal of Nursing Research, 26(4), 266–279.

    Article  Google Scholar 

  35. Boesen, E. H., Karlsen, R., Christensen, J., Paaschburg, B., Nielsen, D., Seier, I., et al. (2011). Psychosocial group intervention for patients with primary breast cancer: A randomised trial. European Journal of Cancer, 47(9), 1363–1372. https://doi.org/10.1016/j.ejca.2011.01.002

    Article  PubMed  Google Scholar 

  36. Bordeleau, B. L., Szalai, J. P., Ennis, M., Leszcz, M., Speca, M., Sela, R., et al. (2003). Quality of life in a randomized trial of group psychosocial support in metastatic breast cancer: Overall effects of the intervention and an exploration of missing data. Journal of Clinical Oncology, 21(10), 1944–1951.

    Article  Google Scholar 

  37. Dolbeault, S., Cayrou, S., Viala, A. L., Desclaux, B., Saltel, P., Hardy, P., et al. (2009). The effectiveness of a psycho-educational group after early-stage breast cancer treatment: Results of a randomized French study. Psychooncology., 18, 647–656.

    Article  CAS  Google Scholar 

  38. Holzner, B., Bode, R. K., Hahn, E. A., Cella, D., Kopp, M., Sperner-Unterweger, B., & Kemmler, G. (2006). Equating EORTC QLQ-C30 and FACT-G scores and its use in oncological research. European Journal of Cancer, 42(18), 3169–3177.

    Article  CAS  Google Scholar 

  39. Guarino, A., Polini, C., Forte, G., Favieri, F., Boncompagni, I., & Casagrande, M. (2020). The effectiveness of psychological treatments in women with breast cancer: A systematic review and meta-analysis. Journal of Clinical Medicine, 9(1), 209.

    Article  Google Scholar 

  40. Duncan, M., Moschopoulou, E., Herrington, E., Deane, J., Roylance, R., Jones, L., et al. (2017). Review of systematic reviews of non- pharmacological interventions to improve quality of life in cancer survivors. Biomedical Journal, 7, 1–21.

    Google Scholar 

  41. Ye, M., Du, K., Zhou, J., Zhou, Q., Shou, M., Hu, B., & Yu, C. (2018). A meta-analysis of the efficacy of cognitive behavior therapy on quality of life and psychological health of breast cancer survivors and patients. Psycho-oncology, 27(7), 1695–1703.

    Article  Google Scholar 

  42. Rehse, B., & Pukrop, R. (2003). Effects of psychosocial interventions on quality of life in adult cancer patients: Meta analysis of 37 published controlled outcome studies. Patient Education Counsling, 50, 179–186.

    Article  Google Scholar 

  43. Raingruber, B. (2011). The effectiveness of psychosocial interventions with cancer patients: An integrative review of the literature (2006–2011). ISRN Nursing, 2011.

  44. Corbett, T. K., Groarke, A., Devane, D., Carr, E., Walsh, J. C., & Mcguire, B. E. (2019). The effectiveness of psychological interventions for fatigue in cancer survivors: Systematic review of randomised controlled trials. BMC, 8(324), 1–30.

    Google Scholar 

  45. Peppone, L., Innominato, P. F., Janelsins, M., Jeong, M., Sprod, L., Savard, J., et al. (2012). Prevalence, putative mechanisms, and current management of sleep problems during chemotherapy for cancer. Nature and Science of Sleep, 4, 151–163.

    PubMed  PubMed Central  Google Scholar 

  46. Rute, A., Fontes, F., Pereira, S., Gonçalves, M., Azevedo, A., & Lunet, N. (2014). Impact of breast cancer treatments on sleep disturbances: A systematic review. The Breast, 23(6), 697–709. https://doi.org/10.1016/j.breast.2014.09.003

    Article  Google Scholar 

  47. Axelsson, E., & Hedman-Lagerlöf, E. (2019). Cognitive behavior therapy for health anxiety: Systematic review and meta-analysis of clinical efficacy and health economic outcomes. Expert Review of Pharmacoeconomics & Outcomes Research, 19(6), 663–676.

    Article  Google Scholar 

  48. Agk, E., & Rd, N. (2008). Psychological interventions for women with metastatic breast cancer (Review). Cochrane Database of Systematic Reviews (2).

  49. Anderson, W. F., Althuis, M. D., Brinton, L. A., & Devesa, S. S. (2004). Is male breast cancer similar or different than female breast cancer? Breast Cancer Research and Treatment, 83(1), 77–86.

    Article  Google Scholar 

  50. Taso, C., Lin, H., Lin, W., Chen, S., Huang, W., & Chen, S. (2014). The effect of yoga exercise on improving depression, anxiety, and fatigue in women with breast cancer: A randomized controlled trial. Journal of Nursing Research, 22(3), 155–164.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Contributions

MAG had the idea of the study, performed literature search, and data synthesis. MAG, WP, JFM, KD, and DR performed data selection, data extraction, and risk of bias assessment. MAG performed the data synthesis and prepared manuscript CC and critically revised the manuscript.

Corresponding author

Correspondence to Mikiyas Amare Getu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by the authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

The original online version of this article was revised: The duplication sentences along with the subtitle "Assessment of risk of bias in included studies" were removed.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Getu, M.A., Chen, C., Panpan, W. et al. The effect of cognitive behavioral therapy on the quality of life of breast cancer patients: a systematic review and meta-analysis of randomized controlled trials. Qual Life Res 30, 367–384 (2021). https://doi.org/10.1007/s11136-020-02665-5

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-020-02665-5

Keywords

Navigation