A Cochrane review included 10 studies with a total of 1378 subjects. Of the 7 RCTs on group psychological interventions, 3 were on cognitive behavioural therapy and 4 were on supportive-expressive group therapy. The remaining 3 studies were individual based and the types of psychological interventions were not common to either cognitive behavioural or supportive-expressive therapy. A clear pattern of psychological outcomes could not be discerned as a wide variety of outcome measures and durations of follow-up were used in the included studies. The overall effect of the psychological interventions, on one-year survival, favoured the psychological intervention group (OR 1.46, 95% CI 1.07 to 1.99; 6 studies). Pooled data from four studies did not show any survival benefit at five-years follow-up (OR 1.03, 95% CI 0.42 to 2.52). There was evidence of a short-term benefit for some psychological outcomes and improvement in pain scores.
A technology assessment report on counselling for breast cancer patients was abstracted in the Health Technology Assessment Database. Overall, the trials showed that women with breast cancer derived benefit from the therapeutic intervention in terms of measures of emotional adjustment (depression, anxiety, locus of control) as well as general quality of life. These benefits lasted throughout the follow-up period, although one study found no significant effects after three months. Although the studies showed that counselling is effective, they do not provide a prescriptive model for service delivery: for instance, where counselling should be provided and by whom.
A Cochrane review included 28 studies with a total of 3940 women with non-metastatic breast cancer. 24 trials investigated a cognitive behavioural therapy and 4 trials investigating psychotherapy compared to control. Pooled standardised mean differences (SMD) from baseline indicated less depression (SMD -1.01, 95% CI -1.83 to -0.18; P = 0.02; 7 studies, n=637, I²=95%, low quality evidence), anxiety (SMD -0.48, 95% CI -0.76 to -0.21; P = 0.0006; 8 studies, n=776, I²=64%, low quality evidence) and mood disturbance (SMD -0.28, 95% CI -0.43 to -0.13; P = 0.0003; 8 studies, n=1536, I²=47%, moderate quality evidence) for the cognitive behavioural therapy group than the control group. For quality of life, only an individually-delivered cognitive behavioural intervention showed significantly better quality of life than the control with an SMD of 0.65 (95% CI 0.07 to 1.23; P = 0.03; 3 studies, n=141, I²=41%, very low quality evidence). Pooled data from two group-delivered studies showed a non-significant overall survival benefit favouring cognitive behavioural therapy compared to control.
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes).