Non-pharmacological Therapies for Depression in Women With Breast Cancer at Different Treatment Phases: A Systematic Review and Network Meta-Analysis

Various non-pharmacological therapies (NPTs) have been found to be helpful for depression in women with breast cancer (BC). However, the relative efficacy of different NPTs in women with BC during different treatment phases is unclear. To conduct a systematic review and network meta-analysis (NMA) to compare the relative efficacy of various NPTs for improving depression in women with BC during the inter-/post-treatment periods. We searched eight databases (Embase, PubMed, PsycINFO, The Cochrane Library, Chinese Biomedical Database, China National Knowledge Infrastructure, Chinese Scientific Journal Database, and WanFang Database) to identify relevant randomized controlled trials published in English and Chinese from their inception to 31 January 2024. We assessed the methodological quality of the included studies using the Cochrane Collaboration Risk of Bias Tool. NMA was conducted using a frequentist approach. The surface under the cumulative ranking (SUCRA) probabilities were used to rank the NPTs. A total of 41 articles involving 5408 participants studied 18 NPTs. Based on NMA, in the intertreatment phase, mindfulness-based cognitive therapy (MBCT), psychological education, virtual reality (VR) and yoga significantly improved depression in women with BC. MBCT, psychological education, and VR were the three most effective NPTs in this period. In the post-treatment phase, mindfulness-based stress reduction significantly improved depression in women with BC, which was the most effective NPTs in this period. Based on the GRADE framework, most results were rated as “high” to “very low” for the confidence of evidence. Our study confirmed the efficacy of several NPTs for depression in women with BC during inter-/post-treatment phases. These results should inform future clinical decisions and guidelines for depression in women with BC.