Educational programs for post-treatment breast cancer survivors: a systematic review

Objectives: The purpose of this systematic review was to identify the state of the scientific evidence related to educational programs for post-treatment breast cancer survivors (BCSs) during the last twenty years. Methods: A systematic search of PubMed/MEDLINE, CINAHL, EMBASE, Web of Science, and PsycINFO databases from January 2000 through May 2020 included keywords related to research on educational programs for BCSs. Inclusion criteria included: (1) focus on an educational program for post-treatment breast cancer survivors; (2) original research; (3) peer-review journals; (4) English language; and (5) published between January 2000 to May 2020. EndNote X9 (software version: X9, manufacturer: Clarivate, website location: endnote.com) was used as the reference management software package to manage citations from search results. A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) flowchart of the selection process is presented in this paper. Results: A total of 24 educational programs/interventions research studies include one mixed-method study, three qualitative studies, and twenty quantitative studies, were identified and analyzed. Three programs focused on BCSs’ self-management and self-efficacy, two programs focused on BCSs’ cognitive problems, seven programs focused on BCSs’ psychological distress, emotional support, and information seeking. In addition, one program focused on BCSs’ body image, body function, and sexual dysfunction issues, five programs focused on BCSs’ physical activities, nutritional levels, and normal body weight maintenance, two programs focused on BCSs’ supportive care and peer advocate support. Finally, one program focused on BCSs’ palliative care and end of life care, and three programs focused on BCSs’ post-treatment symptom clusters and overall quality of life. Conclusions: After breast cancer treatment ends, BCSs continue to suffer from long-term physical and psychological symptoms and report multiple unmet needs. Research on post-treatment breast cancer educational programs showed that programs assist BCSs with post-treatment symptom management and address their concerns while promoting supportive care and peer support to improve BCS’s overall quality of life.

education; program; post-treatment; breast cancer

[1] Miller KD, Nogueira L, Mariotto AB, Rowland JH, Yabroff KR, Alfano CM, et al. Cancer treatment and survivorship statistics, 2019. CA: a Cancer Journal for Clinicians. 2019; 69: 363–385.

[2] Chen K, Lu P, Beeraka NM, Sukocheva OA, Madhunapantula SV, Liu J, et al. Mitochondrial mutations and mitoepigenetics: Focus on regulation of oxidative stress-induced responses in breast cancers. Seminars in Cancer Biology. 2020. (in press)

[3] BreastCancer.org. U.S. Breast Cancer Statistics. 2020. Available at: https://www.breastcancer.org/symptoms/understand_bc/statistics (Accessed: 1 May 2020).

[4] Cancer.org. Breast Cancer Facts & Figures 2019–2020. 2019. Available at: https://www.cancer.org (Accessed: 20 March 2020).

[5] Janz NK, Mujahid M, Chung LK, Lantz PM, Hawley ST, Morrow M, et al. Symptom Experience and Quality of Life of Women Following Breast Cancer Treatment. Journal of Women’s Health. 2007; 16: 1348–1361.

[6] Song S, Ryu E. Posttraumatic Growth, Dyadic Adjustment, and Quality of Life in Breast Cancer Survivors and their Husbands. Journal of Korean Academy of Nursing. 2014; 44: 515–524. (In Ko)

[7] Bail J, Nolan TS, Vo JB, Gisiger-Camata S, Meneses K. Engaging an Urban African American Community to Deliver Cognitive Health Education to Breast Cancer Survivors. Journal of Cancer Education. 2018; 33: 870–874.

[8] Pauwels EEJ, Charlier C, De Bourdeaudhuij I, Lechner L, Van Hoof E. Care needs after primary breast cancer treatment. Survivors’ associated sociodemographic and medical characteristics. Psycho-Oncology. 2013; 22: 125–132.

[9] Reich RR, Lengacher CA, Alinat CB, Kip KE, Paterson C, Ramesar S, et al. Mindfulness-Based Stress Reduction in Post-treatment Breast Cancer Patients: Immediate and Sustained Effects across Multiple Symptom Clusters. Journal of Pain and Symptom Management. 2017; 53: 85–95.

[10] Xuan H, Gan C, Li W, Huang Z, Wang L, Jia Q, et al. Altered net-work efficiency of functional brain networks in patients with breast cancer after chemotherapy. Oncotarget. 2017; 8: 105648–105661.

[11] Boykoff N, Moieni M, Subramanian SK. Confronting chemobrain: an indepth look at survivors’ reports of impact on work, social net-works, and health care response. Journal of Cancer Survivorship. 2009; 3: 223–232.

[12] Lengacher CA, Reich RR, Kip KE, Paterson CL, Park HY, Ramesar S, et al. Moderating Effects of Genetic Polymorphisms on Improvements in Cognitive Impairment in Breast Cancer Survivors Participating in a 6-Week Mindfulness-Based Stress Reduction Program. Biological Research for Nursing. 2015; 17: 393–404.

[13] Staat K, Segatore M. The Phenomenon of Chemo Brain. Clinical Journal of Oncology Nursing. 2005; 9: 713–721.

[14] Paraska KK, Bender CM. Cognitive Dysfunction Following Adjuvant Chemotherapy for Breast Cancer: Two Case Studies. Oncology Nursing Forum. 2003; 30: 473–478.

[15] Jim HSL, Phillips KM, Chait S, Faul LA, Popa MA, Lee Y, et al. Meta-Analysis of Cognitive Functioning in Breast Cancer Survivors Previously Treated with Standard-Dose Chemotherapy. Journal of Clinical Oncology. 2012; 30: 3578–3587.

[16] Takahashi M, Kai I. Sexuality after breast cancer treatment: Changes and coping strategies among Japanese survivors. Social Science & Medicine. 2005; 61: 1278–1290.

[17] Teo I, Reece GP, Huang S, Mahajan K, Andon J, Khanal P, et al. Body image dissatisfaction in patients undergoing breast reconstruction: Examining the roles of breast symmetry and appearance investment. Psycho-Oncology. 2018; 27: 857–863.

[18] Paterson CL, Lengacher CA, Donovan KA, Kip KE, Tofthagen CS. Body Image in Younger Breast Cancer Survivors: A Systematic Review. Cancer Nursing. 2016; 39: E39–E58.

[19] Rezaei M, Elyasi F, Janbabai G, Moosazadeh M, Hamzehgardeshi Z. Factors Influencing Body Image in Women with Breast Cancer: A Comprehensive Literature Review. Iranian Red Crescent Medical Journal. 2016; 18: e39465.

[20] Collins B, Mackenzie J, Stewart A, Bielajew C, Verma S. Cognitive effects of hormonal therapy in early stage breast cancer patients: a prospective study. Psycho-Oncology. 2009; 18: 811–821.

[21] Liao M, Chen S, Lin Y, Chen M, Wang C, Jane S. Education and psychological support meet the supportive care needs of Taiwanese women three months after surgery for newly diagnosed breast cancer: a non-randomised quasi-experimental study. International Journal of Nursing Studies. 2014; 51: 390–399.

[22] Grunfeld E. Looking beyond Survival: how are we Looking at Sur-vivorship? Journal of Clinical Oncology. 2006; 24: 5166–5169.

[23] Hur HK. Information Needs of Women with Breast Cancer. Korean Journal of Academy Adult Nursing. 2000; 12: 286–295.

[24] Yi M, Kim J, Noh DY, Lee JL, Yoo KY, Hwang KT, et al. Evaluation of the satisfaction and usefulness of a web-based educational program for breast cancer patients. The Open Medical Informatics Journal. 2008; 2: 129–137.

[25] Rushton M, Morash R, Larocque G, Liska C, Stoica L, DeGrasse C, et al. Wellness Beyond Cancer Program: building an effective survivorship program. Current Oncology. 2015; 22: e419–e434.

[26] Sabiston CM, Fong AJ, O’Loughlin EK, Meterissian S. A mixed-methods evaluation of a community physical activity program for breast cancer survivors. Journal of Translational Medicine. 2019; 17: 206.

[27] Ellegaard MB, Jensen AB, Lomborg K. Development of a Cancer Self-management Education Programme for Women with Breast Cancer at the End of Primary Treatment. Journal of Cancer Education. 2018; 34: 882–889.

[28] Cimprich B, Janz NK, Northouse L, Wren PA, Given B, Given CW. Taking CHARGE: a self-management program for women follo-ing breast cancer treatment. Psycho-Oncology. 2005; 14: 704–717.

[29] Pelusi J. The Lived Experience of Surviving Breast Cancer. Oncology Nursing Forum. 1997; 24: 1343–1353.

[30] Cheon J, Bae J, Choi Y, Ko BK, Kim JS, Kim CR, et al. Effects of an Eduational Program on Knowledge and Quality of Life for Korean Breast Cancer Survivors: A Prospective Cohort Study. Annals of Oncology. 2019; 30: ix140–ix150.

[31] Ellegaard MB, Grau C, Zachariae R, Bonde Jensen A. Fear of cancer recurrence and unmet needs among breast cancer survivors in the first five years. a cross-sectional study. Acta Oncologica. 2017; 56: 314–320.

[32] Runowicz CD, Leach CR, Henry NL, Henry KS, Mackey HT, Cowens-Alvarado RL, et al. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. Journal of Clinical Oncology. 2016; 34: 611–635.

[33] O’Malley DM, Hudson SV, Ohman-Strickland PA, Bator A, Lee HS, Gundersen DA, et al. Follow-up Care Education and Information: Identifying Cancer Survivors in need of more Guidance. Journal of Cancer Education. 2016; 31: 63–69.

[34] Nho J, Kim S, Park M, Kweon S. Symptom clusters and quality of life in breast cancer survivors after cancer treatment in a tertiary hospital in Korea. European Journal of Cancer Care. 2016; 27: e12919.

[35] Esplen MJ, Warner E, Boquiren V, Wong J, Toner B. Restoring body image after cancer (ReBIC): a group therapy intervention. Psycho-Oncology. 2020; 29: 671–680.

[36] Mirrielees JA, Breckheimer KR, White TA, Denure DA, Schroeder MM, Gaines ME, et al. Breast Cancer Survivor Advocacy at a Uni-versity Hospital: Development of a Peer Support Program with Evaluation by Patients, Advocates, and Clinicians. Journal of Cancer Education. 2017; 32: 97–104.

[37] Wu P, Chen S, Huang W, Chang S, Hsu M. Effects of a Psychoe-ducational Intervention in Patients with Breast Cancer Undergoing Chemotherapy. Journal of Nursing Research. 2018; 26: 266–279.

[38] Lee MK, Yun YH, Park H, Lee ES, Jung KH, Noh D. A Web-based self-management exercise and diet intervention for breast cancer survivors: Pilot randomized controlled trial. International Journal of Nursing Studies. 2014; 51: 1557–1567.

[39] Meneses KD, McNees P, Loerzel VW, Su X, Zhang Y, Hassey LA. Transition from Treatment to Survivorship: Effects of a Psychoedu-cational Intervention on Quality of Life in Breast Cancer Survivors. Oncology Nursing Forum. 2007; 34: 1007–1016.

[40] Finocchiaro C, Ossola M, Monge T, Fadda M, Brossa L, Caudera V, et al. Effect of specific educational program on dietary change and weight loss in breast-cancer survivors. Clinical Nutrition. 2016; 35: 864–870.

[41] Spector D, Battaglini C, Alsobrooks A, Owen J, Groff D. Do Breast Cancer Survivors Increase their Physical Activity and Enhance their Health-Related Quality of Life after Attending Community-Based Wellness Workshops? Journal of Cancer Education. 2012; 27: 353–361.

[42] Stoutenberg M, Cutrono S, Perry AC. From Surviving to Thriving: a Health and Wellness Colloquium for Breast Cancer Survivors. Jour-nal of Cancer Education. 2011; 26: 694–700.

[43] Newman R, Lyons KD, Coster WJ, Wong J, Festa K, Ko NY. Feasibility, Acceptability and Potential Effectiveness of An Occupation-focused Cognitive Self-managemet Program for Breast Cancer Sur-vivors. British Journal of Occupational Therapy. 2019; 82: 604–611.

[44] Schulman-Green D, Jeon S. Managing Cancer Care: a psycho-educational intervention to improve knowledge of care options and breast cancer self-management. Psycho-Oncology. 2017; 26: 173–181.

[45] Rahmani S, Talepasand S, Ghanbary-Motlagh A. Comparison of effectiveness of the metacognition treatment and the mindfulness-based stress reduction treatment on global and specific life quality of women with breast cancer. Iranian Journal of Cancer Prevention. 2014; 7: 184–196.

[46] Ashing KT, George M. Exploring the efficacy of a paraprofessional delivered telephonic psychoeducational intervention on emotional wellbeing in African American breast cancer survivors. Supportive Care in Cancer. 2020; 28: 1163–1171.

[47] Lewis FM, Cochrane BB, Fletcher KA, Zahlis EH, Shands ME, Gralow JR, et al. Helping her Heal: a pilot study of an educational counseling intervention for spouses of women with breast cancer. Psycho-Oncology. 2008; 17: 131–137.

[48] Rowe J, Schapmire T. The Shady Pink Elephant: End of Life Education for Young Women Affected by Breast Cancer. Journal of Cancer Education. 2020; 35: 100–104.

[49] Ellegaard MBB, Jensen AB, Lomborg K. Developmen of a Cancer Self-management Education Programme for Wome with Breast Cancer at the End of Primary Treatment. Journal of Cancer Education. 2019; 34: 882–889.

[50] Boland L, Bennett K, Connolly D. Self-management interventions for cancer survivors: a systematic review. Supportive Care in Can-cer. 2018; 26: 1585–1595.

[51] McCorkle R, Ercolano E, Lazenby M, Schulman-Green D, Schilling LS, Lorig K, et al. Self-management: Enabling and empowering patients living with cancer as a chronic illness. CA: a Cancer Journal for Clinicians. 2011; 61: 50–62.

[52] Bandura A. Human agency in social cognitive theory. The American Psychologist. 1989; 44: 1175–1184.

[53] Bandura A. Self-efficacy: The exercise of control. Knowledge is necessary but insufficient to change behavior. Freeman: New York. 1997.

[54] Koppelmans V, Breteler MMB, Boogerd W, Seynaeve C, Gundy C, Schagen SB. Neuropsychological Performance in Survivors of Breast Cancer more than 20 Years after Adjuvant Chemotherapy. Journal of Clinical Oncology. 2012; 30: 1080–1086.

[55] Player L, Mackenzie L, Willis K, Loh SY. Women’s experiences of cognitive changes or ‘chemobrain’ following treatment for breast cancer: a role for occupational therapy? Australian Occupational Therapy Journal. 2014; 61: 230–240.

[56] Menning S, de Ruiter MB, Kieffer JM, Agelink van Rentergem J, Veltman DJ, Fruijtier A, et al. Cognitive Impairment in a Subset of Breast Cancer Patients after Systemic Therapy—Results from a Longitudinal Study. Journal of Pain and Symptom Management. 2016; 52: 560–569.e1.

[57] Yamanegi K, Yamane J, Kobayashi K, Kato-Kogoe N, Ohyama H, Nakasho K, et al. Sodium valproate, a histone deacetylase inhibitor, augments the expression of cell-surface NKG2D ligands, MICA/B, without increasing their soluble forms to enhance susceptibility of human osteosarcoma cells to NK cell-mediated cytotoxicity. Oncology Reports. 2010; 24: 1621–1627.

[58] Shapiro SL, Lopez AM, Schwartz GE, Bootzin R, Figueredo AJ, Braden CJ, et al. Quality of life and breast cancer: Relationship to psychosocial variables. Journal of Clinical Psychology. 2001; 57: 501–519.

[59] Burgess C, Cornelius V, Love S, Graham J, Richards M, Ramirez A. Depression and anxiety in women with early breast cancer: five year observational cohort study. British Medical Journal. 2005; 330: 702.

[60] Helgeson VS, Snyder P, Seltman H. Psychological and physical adjustment to breast cancer over 4 years: identifying distinct trajectories of change. Health Psychol. 2004. 23: 3–15.

[61] Beatty L, Koczwara B. An effectiveness study of a CBT group program for women with breast cancer. Clinical Psychologist. 2010; 14: 45–53.

[62] Siegel R, DeSantis C, Virgo K, Stein K, Mariotto A, Smith T, et al. Cancer treatment and survivorship statistics, 2012. CA: a Cancer Journal for Clinicians. 2012; 62: 220–241.

[63] Danhauer SC, Case LD, Tedeschi R, Russell G, Vishnevsky T, Triplett K, et al. Predictors of posttraumatic growth in women with breast cancer. Psycho-Oncology. 2013; 22: 2676–2683.

[64] Morse JMJ JL. The illness experience: Dimensions of suffering. Newbury Park. CA: Sage. 1991.

[65] Lee M, Kim K, Lim C, Kim J. Posttraumatic growth in breast cancer survivors and their husbands based on the actor-partner interdependence model. Psycho-Oncology. 2017; 26: 1586–1592.

[66] Begovic-Juhant A, Chmielewski A, Iwuagwu S, Chapman LA. Impact of Body Image on Depression and Quality of Life among Women with Breast Cancer. Journal of Psychosocial Oncology. 2012; 30: 446–460.

[67] Krychman ML, Pereira L, Carter J, Amsterdam A. Sexual Oncology: Sexual Health Issues in Women with Cancer. Oncology. 2006; 71: 18–25.

[68] Fobair P, Stewart SL, Chang S, D’Onofrio C, Banks PJ, Bloom JR. Body image and sexual problems in young women with breast cancer. Psycho-Oncology. 2006; 15: 579–594.

[69] Boquiren VM, Esplen MJ, Wong J, Toner B, Warner E. Exploring the influence of gender-role socialization and objectified body con-sciousness on body image disturbance in breast cancer survivors. Psycho-Oncology. 2013; 22: 2177–2185.

[70] Brédart A, Dolbeault S, Savignoni A, Besancenet C, This P, Giami A, et al. Prevalence and associated factors of sexual problems after early-stage breast cancer treatment: results of a French exploratory survey. Psycho-Oncology. 2011; 20: 841–850.

[71] Pillai-Friedman S, Ashline JL. Women, breast cancer survivorship, sexual losses, and disenfranchised grief – a treatment model for clinicians. Sexual and Relationship Therapy. 2014; 29: 436–453.

[72] Little M, Paul K, Jordens CFC, Sayers E. Survivorship and discourses of identity. Psycho-Oncology. 2002; 11: 170–178.

[73] Herman DR, Ganz PA, Petersen L, Greendale GA. Obesity and Cardiovascular Risk Factors in Younger Breast Cancer Survivors: the Cancer and Menopause Study (CAMS). Breast Cancer Research and Treatment. 2005; 93: 13–23.

[74] Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ. Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Co-hort of U.S. Adults. New England Journal of Medicine. 2003; 348: 1625–1638.

[75] Jones LW, Demark-Wahnefried W. Diet, exercise, and complementary therapies after primary treatment for cancer. The Lancet Oncology. 2006; 7: 1017–1026.

[76] Battaglini CL, Mills RC, Phillips BL, Lee JT, Story CE, Nascimento MG, et al. Twenty-five years of research on the effects of exercise training in breast cancer survivors: a systematic review of the literature. World Journal of Clinical Oncology. 2014; 5: 177–190.

[77] Nelson SH, Marinac CR, Patterson RE, Nechuta SJ, Flatt SW, Caan BJ, et al. Impact of very low physical activity, BMI, and comorbidities on mortality among breast cancer survivors. Breast Cancer Research and Treatment. 2016; 155: 551–557.

[78] Speck RM, Courneya KS, Mâsse LC, Duval S, Schmitz KH. An up-date of controlled physical activity trials in cancer survivors: a sys-tematic review and meta-analysis. Journal of Cancer Survivorship. 2010; 4: 87–100.

[79] Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Medicine and Science in Sports and Exercise. 2010; 42: 1409–1426.

[80] Hewitt M, Greenfield S, Stovall E. From cancer patient to cancer survivor: lost in transition. National Academies Press: Washington DC. 2005.

[81] McCabe MS, Bhatia S, Oeffinger KC, Reaman GH, Tyne C, Wollins DS, et al. American Society of Clinical Oncology State-ment: Achieving High-Quality Cancer Survivorship Care. Journal of Clinical Oncology. 2013; 31: 631–640.

[82] Morse JM. Analyzing and conceptualizing the theoretical fourndations of nursing. Springer: Berlin. 2017.

[83] Bauer-Wu S, Yeager K, Norris RL, Qin L, Habin KR, Hayes C, et al. Communication and Planning at The End of LIfe: A Survey with Women with Advanced Stage Breast Cancer. Journal of Communication in Healthcare. 2009; 2: 371–386.

[84] Wentlandt K, Burman D, Swami N, Hales S, Rydall A, Rodin G, et al. Preparation for the end of life in patients with advanced cancer and association with communication with professional caregivers. Psycho-Oncology. 2012; 21: 868–876.

[85] Mack JW, Cronin A, Taback N, Huskamp HA, Keating NL, Malin JL, et al. End-of-Life Care Discussions among Patients with Advanced Cancer: a cohort study. Annals of Internal Medicine. 2012; 156: 204–210.

[86] Medicine IO. Dying in America: improving quality and honoring individual preferences near hte end of life. The National Academies Press: Washington DC. 2014.

[87] Dodd M, Janson S, Facione N, Faucett J, Froelicher ES, Humphreys J, et al. Advancing the science of symptom management. Journal of Advanced Nursing. 2001; 33: 668–676.

[88] Dodd MJ, Cho MH, Cooper BA, Miaskowski C. The effect of symptom clusters on functional status and quality of life in women with breast cancer. European Journal of Oncology Nursing. 2010; 14: 101–110.

[89] Earle CC, Ganz PA. Cancer Survivorship Care: Don’t Let the Perfect be the Enemy of the Good. Journal of Clinical Oncology. 2012; 30: 3764–3768.

[90] Stricker CT, Jacobs LA, Risendal B, Jones A, Panzer S, Ganz PA, et al. Survivorship care planning after the Institute of Medicine recommendations: how are we faring? Journal of Cancer Survivorship. 2011; 5: 358–370.

[91] Parry C, Kent EE, Forsythe LP, Alfano CM, Rowland JH. Can’t See the Forest for the Care Plan: a Call to Revisit the Context of Care Planning. Journal of Clinical Oncology. 2013; 31: 2651–2653.

[92] Nicastro N, Mak E, Williams GB, Surendranathan A, Bevan-Jones WR, Passamonti L, et al. Correlation of microglial activation with white matter changes in dementia with Lewy bodies. NeuroImage: Clinical. 2020; 25: 102200.

[93] Stanton AL. Psychosocial concerns and interventions for cancer survivors. Journal of Clinical Oncology. 2006; 24: 5132–5137.