Web-Based Interventions Effective in Improving Quality of Life for Patients With Breast Cancer

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Patients with breast cancer often experience a decrease in their quality of life because of multiple psychosocial and physical challenges. Because of the COVID-19 pandemic, web-based intervention methods are becoming more accessible, convenient, and cost-effective for patients who want to improve their quality of life. Authors of a systemic review published in Cancer Medicine evaluated whether web-based interventions could help enhance the quality of life of patients who have breast cancer.

The authors included only randomized controlled trials (RCTs) with clear evidence as part of their analysis. For this systemic review and meta-analysis, the investigators searched the PubMed, Embase, Cochrane Library, CINAHL Web of Science, and PsycINFO databases for breast cancer, web-based interventions, and quality of life from their inception to October 16, 2023.

Studies were included if they included the following criteria: participants were adults 18 years of age who had received a diagnosis of breast cancer; all treatment modalities (such as surgery, adjuvant chemotherapy, and radiotherapy) and stages of cancer were included; web-based intervention using computer, internet-based mobile phone, and tablets; usual care, standard care, waiting list, standard care, and basic care (eg, general information) provided identically when compared with the intervention group; quality of life measures; and were RCTs. Studies were not included if they used an app, text message, or telephone call, combined a web-based intervention with other methods, lacked sufficient statistical values for a meta-analysis, and materials were unpublished.

The final analysis included 16 articles, with years of publication ranging from 2005 to 2023. Of these studies, about 73.68% were published after 2015 and most (n = 10) were conducted in Europe. Settings included hospitals (n = 11), community (n = 7), and a combination of community and hospital settings (n = 1). The intervention groups’ sample sizes ranged from 19 to 171 patients, and control groups ranged from 20 to 165 patients. The mean age of study participants ranged from 41.5 to 55.57 years.

According to the authors, web-based interventions across the studies included a variety of content that encompassed psychosocial interventions (such as mindfulness, cognitive behavioral therapy; n = 14), self-management interventions (such as educative information, exercise programs; n = 5), and support groups (n = 2). Intervention durations ranged from 1 to 9 months, and the EORTC Core Quality of Life questionnaire (n = 8) was used most frequently, followed by the Functional Assessment of Cancer Therapy-Breast (n = 6).

The meta-analysis of 21 RCTs from 19 studies found that the overall effect of web-based interventions on the quality of life in patients with breast cancer showed a small effect size (SMD = 0.27, 95% CI = 0.15–0.38, p = 0.03). When evaluating the effects of web-based interventions on physical, cognitive, emotional, role, and social domains of the quality of life of patients with breast cancer, web-based interventions demonstrated a moderate effect size on physical functioning (SMD = 0.71, 95% CI = 0.19–1.23, p < 0.01, I2 = 95%) compared with the control group. Additionally, small effect sizes were also observed on cognitive (SMD = 0.45, 95% CI = 0.21–0.69, p = 0.27, I2 = 23%) and emotional functioning (SMD = 0.34, 95% CI = 0.13–0.55, p = 0.03, I2 = 53%); however, there were no significant effects observed on role and social functioning when compared with the control group.

Further, subgroup analyses demonstrated that web-based intervention methods were more effective when the study was conducted in a hospital setting (SMD = 0.30, 95% CI = 0.15–0.45, I2 = 61.1%) rather than a community setting, the interventions lasted less than 3 months (SMD = 0.30, 95% CI = 0.14–0.47, I2 = 60.0%), cancer-specific measurement tools were utilized (SMD = 0.29, 95% CI = 0.08–0.50), and self-management interventions were included (SMD = 0.43, 95% CI = 0.18–0.67). Additionally, the analysis showed that the effect size of web-based interventions were not significantly impacted by participants’ mean age, completion rate, or sample size.

Limitations of the study are the inclusion of RCTs only, published studies were included (which can restrict the generalizability), and both measurement tool and intervention method subgroups showed uncertain results within subgroup analyses. The authors noted that future research will be needed to enhance the robustness of their findings.

REFERENCE

Coombs LA, Kim M. Effects of web-based interventions on quality of life among patients with breast cancer: A systematic review and meta-analysis of randomized controlled trials. Cancer Med. 2024; 13:e70230. doi:10.1002/cam4.70230