Psychological interventions for women with non‐metastatic breast cancer

Background Breast cancer is the most common cancer affecting women worldwide. It is a distressing diagnosis and, as a result, considerable research has examined the psychological sequelae of being diagnosed and treated for breast cancer. Breast cancer is associated with increased rates of depression and anxiety and reduced quality of life. As a consequence, multiple studies have explored the impact of psychological interventions on the psychological distress experienced after a diagnosis of breast cancer. This review is an update of a Cochrane Review first published in 2015. Objectives To assess the effect of psychological interventions on psychological morbidities and quality of life among women with non‐metastatic breast cancer. Search methods We searched the Cochrane Breast Cancer Group Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov up to 16 March 2021. We also scanned the reference lists of relevant articles. Selection criteria Randomised controlled trials that assessed the effectiveness of psychological interventions for women with non‐metastatic breast cancer. Data collection and analysis Two review authors independently appraised, extracted data from eligible trials, and assessed risk of bias and certainty of the evidence using the GRADE approach. Any disagreement was resolved by discussion. Extracted data included information about participants, methods, the intervention and outcomes. Main results We included 60 randomised controlled trials comprising 7998 participants. The most frequent reasons for exclusion were non‐randomised trials and the inclusion of women with metastatic disease. The updated review included 7998 randomised women; the original review included 3940 women. A wide range of interventions was evaluated. Most interventions were cognitive‐ or mindfulness‐based, supportive‐expressive, and educational. The interventions were mainly delivered face‐to‐face (56 studies) and in groups (50 studies) rather than individually (10 studies). Most intervention sessions were delivered on a weekly basis with an average duration of 14 hours. Follow‐up time ranged from two weeks to 24 months. Pooled standardised mean differences (SMD) from baseline indicated that the intervention may reduce depression (SMD ‐0.27, 95% confidence interval (CI) ‐0.52 to ‐0.02; P = 0.04; 27 studies, 3321 participants, I2 = 91%, low‐certai