Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Systematic Review.
Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Systematic Review.
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DOI：
10.1093/jnci/djy177
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发表时间：
2018-12-01
期刊：
影响因子：
--
通讯作者：
Bhaskaran K
中科院分区：
文献类型：
--
作者：
Carreira H;Williams R;Müller M;Harewood R;Stanway S;Bhaskaran K
我们的目的是系统地回顾与无癌症史的女性相比，乳腺癌幸存者（≥1年）不良心理健康结局的证据。通过检索MEDLINE、PsycINFO、护理和相关健康文献累积索引、社会科学引文索引以及反向引文跟踪来识别研究。两名研究人员选择了这些研究，提取了数据，并评估了偏倚的风险。纳入了60项研究。在38项抑郁症研究中，33项观察到乳腺癌幸存者的抑郁症更多;这在19项研究中具有统计学显著性，包括7项临床确定抑郁症的研究中的6项，4项抗抑郁药研究中的3项，以及31项量化抑郁症状的研究中的13项。在21项焦虑研究中，17项观察到乳腺癌幸存者的焦虑程度更高，总体上11项研究具有统计学显著性，其中包括四分之二的基于临床/处方的结果，以及17项焦虑症状中的八项。乳腺癌幸存者神经认知功能障碍的症状/频率也有统计学显著增加（24项研究中的18项），性功能障碍（6项研究中的5项），睡眠障碍（5/5项研究）、应激相关障碍/PTSD（2/3项研究）、自杀（2/2项研究）、躯体化（2/2项研究）以及双相和强迫症（各1/1项研究）。研究在参与者的特征、自诊断以来的时间、结果的确定和报告的测量方面是异质的。大约一半的研究存在选择偏倚和社会经济地位混杂的高风险。有令人信服的证据表明，与既往未患癌症的女性相比，乳腺癌幸存者的焦虑、抑郁和自杀以及神经认知和性功能障碍的风险增加。这些信息可用于支持循证预防和管理战略。进一步的基于人口的纵向研究将有助于更好地描述这些关联。
We aimed to systematically review the evidence on adverse mental health outcomes in breast cancer survivors (≥1 year) compared with women with no history of cancer. Studies were identified by searching MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Social Sciences Citation Index, and through backward citation tracking. Two researchers selected the studies, extracted data, and assessed the risk of bias. Sixty studies were included. Of 38 studies of depression, 33 observed more depression in breast cancer survivors; this was statistically significant in 19 studies overall, including six of seven where depression was ascertained clinically, three of four studies of antidepressants, and 13 of 31 that quantified depressive symptoms. Of 21 studies of anxiety, 17 observed more anxiety in breast cancer survivors, statistically significant in 11 studies overall, including two of four with clinical/prescription-based outcomes, and in eight of 17 of anxiety symptoms. Breast cancer survivors also had statistically significantly increased symptoms/frequency of neurocognitive dysfunction (18 of 24 studies), sexual dysfunctions (5 of 6 studies), sleep disturbance (5 of 5 studies), stress-related disorders/PTSD (2 of 3 studies), suicide (2 of 2 studies), somatisation (2 of 2 studies), and bipolar and obsessive-compulsive disorders (1 of 1 study each). Studies were heterogeneous in terms of participants’ characteristics, time since diagnosis, ascertainment of outcomes, and measures reported. Approximately one-half of the studies were at high risk of selection bias and confounding by socio-economic status. There is compelling evidence of an increased risk of anxiety, depression and suicide, and neurocognitive and sexual dysfunctions in breast cancer survivors compared with women with no prior cancer. This information can be used to support evidence-based prevention and management strategies. Further population-based and longitudinal research would help to better characterize these associations.
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