The effects of lifestyle and behavioural interventions on cancer recurrence, overall survival and quality of life in breast cancer survivors: A systematic review and network meta-analysis

Ladan Yeganeh; Suzanne Willey; Ching Shan Wan; Mahnaz Bahri Khomami; Mohammad Chehrazi; Olivia Cook; Kate Webber

doi:10.1016/j.maturitas.2024.107977

The effects of lifestyle and behavioural interventions on cancer recurrence, overall survival and quality of life in breast cancer survivors: A systematic review and network meta-analysis

Maturitas. 2024 Jul:185:107977. doi: 10.1016/j.maturitas.2024.107977. Epub 2024 Mar 29.

Authors

Ladan Yeganeh¹, Suzanne Willey², Ching Shan Wan³, Mahnaz Bahri Khomami⁴, Mohammad Chehrazi⁵, Olivia Cook⁶, Kate Webber⁷

Affiliations

¹ Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia; Monash Centre for Health Research and Implementation, Monash University, VIC, Australia. Electronic address: ladan.yeganeh@monash.edu.
² Monash Nursing and Midwifery, Monash University, Peninsula Campus, VIC, Australia.
³ Nursing Research Institute, St Vincent's Health Network Sydney, St Vincent's Hospital Melbourne & Australian Catholic University, Melbourne, VIC, Australia.
⁴ Monash Centre for Health Research and Implementation, Monash University, VIC, Australia.
⁵ Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran.
⁶ Monash Nursing and Midwifery, Monash University, Clayton, VIC, Australia; McGrath Foundation, North Sydney, NSW, Australia.
⁷ Oncology Department, Monash Health, Clayton, VIC, Australia; School of Clinical Sciences, Monash University, Clayton, VIC, Australia.

PMID: 38574414
DOI: 10.1016/j.maturitas.2024.107977

Abstract

Lifestyle/behavioural interventions may improve breast cancer outcomes and quality of life (QoL); however, uncertainty remains about the most effective interventions due to limited evidence. This study aimed to assess and compare the effects of lifestyle/behavioural interventions on cancer recurrence, survival and QoL in breast cancer survivors. Electronic databases including Medline, EMBASE, PsycINFO, CINAHL and EBM Reviews were searched for relevant literature. Randomized controlled trials (RCTs) and quasi-RCTs comparing a lifestyle/behavioural intervention with a control condition in breast cancer survivors were included. Outcomes included cancer recurrence, overall survival and QoL. A network meta-analysis synthesized intervention effect. Studies not included in the analysis were reported narratively. Of 6251 identified articles, 38 studies met the selection criteria. Limited evidence exists on the impacts of lifestyle/behavioural interventions on breast cancer recurrence/survival. Exercise was identified as the most effective intervention in improving overall survival (HR 0.50, 95 % CI 0.36, 0.68). Lifestyle/behavioural interventions may improve QoL; psychosocial interventions (SMD 1.28, 95 % CI 0.80, 1.77) and aerobic-resistance exercise (SMD 0.33, 95 % CI -0.03, 0.69) were the most effective interventions to enhance QoL. This review highlights potential post-breast cancer benefits from lifestyle/behavioural interventions, notably exercise and psychosocial support for QoL and exercise for overall survival. Thus, encouraging active lifestyle, stress management and coping skills programs during and after cancer treatment may enhance physical wellbeing and QoL. However, the findings should be interpreted with caution due to the small number and sample sizes of studies. Future longer-term RCTs are required for conclusive recommendations.

Keywords: Behavioural intervention; Breast cancer; Life style intervention; Quality of life; Recurrence; Survival.

Publication types

Systematic Review
Meta-Analysis
Review

MeSH terms

Behavior Therapy / methods
Breast Neoplasms* / mortality
Breast Neoplasms* / psychology
Breast Neoplasms* / therapy
Cancer Survivors* / psychology
Exercise / psychology
Female
Humans
Life Style*
Neoplasm Recurrence, Local* / psychology
Network Meta-Analysis
Quality of Life*