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Review
Breast cancer nursing interventions and clinical effectiveness: a systematic review
  1. Raymond Javan Chan1,2,
  2. Laisa Teleni2,
  3. Suzanne McDonald2,
  4. Jaimon Kelly3,
  5. Jane Mahony4,
  6. Kerryn Ernst4,
  7. Kerry Patford4,
  8. James Townsend4,
  9. Manisha Singh4 and
  10. Patsy Yates2
  1. 1 Division of Cancer Services, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Queensland, Australia
  2. 2 School of Nursing and Cancer and Palliative Care Outcomes Centre, Queensland University of Technology, Brisbane, Queensland, Australia
  3. 3 School of Medicine, Griffith University, Brisbane, Queensland, Australia
  4. 4 McGrath Foundation, North Sydney, New South Wales, Australia
  1. Correspondence to Professor Raymond Javan Chan, Division of cancer Services, Princess Alexandra Hospital, Woolloongabba, QLD 4029, Australia; Raymond.Chan{at}qut.edu.au

Abstract

Objectives To examine the effects of nurse-led interventions on the health-related quality of life, symptom burden and self-management/behavioural outcomes in women with breast cancer.

Methods Cochrane Controlled Register of Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Embase databases were searched (January 1999 to May 2019) to identify randomised controlled trials (RCTs) and controlled before-and-after studies of interventions delivered by nurses with oncology experience for women with breast cancer. Risk of bias was evaluated using the revised Cochrane risk-of-bias tool for randomised trials. Intervention effects were synthesised by cancer trajectory using The Omaha System Intervention Classification Scheme.

Results Thirty-one RCTs (4651 participants) were included. All studies were at risk of bias mainly due to inherent limitations such as lack of blinding and self-report data. Most studies (71%; n=22) reported at least one superior intervention effect. There were no differences in all outcomes between those who receive nurse-led surveillance care versus those who received physical led or usual discharge care. Compared with control interventions, there were superior teaching, guidance and counselling (63%) and case management (100%) intervention effects on symptom burden during treatment and survivorship. Effects of these interventions on health-related quality of life and symptom self-management/behavioural outcomes were inconsistent.

Discussion There is consistent evidence from RCTs that nurse-led surveillance interventions are as safe and effective as physician-led care and strong evidence that nurse-led teaching, guidance and counselling and case management interventions are effective for symptom management. Future studies should ensure the incorporation of health-related quality of life and self-management/behavioural outcomes and consider well-designed attentional placebo controls to blind participants for self-report outcomes.

Protocol registration The International Prospective Register of Systematic Reviews (PROSPERO): CRD42020134914).

  • breast
  • quality of life
  • survivorship
  • symptoms and symptom management

https://doi.org/10.1136/bmjspcare-2019-002120

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    Footnotes

    • Contributors All authors planned the research. RC, JM, KE, KP, JT, MS and PY conceptualised the review and research questions. RC, LT and SM designed the protocol and conducted the research. SM conducted searches. SM, JK and LT screened and evaluated studies. LT extracted study data. All authors contributed to reporting the research. RC and LT synthesised study results and took lead on writing the manuscript and all authors discussed the results and provided critical feedback on the manuscript. RC is responsible for the overall content as guarantor.

    • Funding The McGrath Foundation provided funding for this project.

    • Competing interests This research was a collaboration between McGrath Foundation and Queensland University of Technology. RC received grant funding from McGrath Foundation to conduct this research. JM, KE, KP, MS and JT are employees of the McGrath Foundation but were not involved in the systematic review beyond scoping the research questions, interpreting the data synthesis and reviewing the manuscript.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.