Article

Quality of life, fertility concerns, and behavioral health outcomes in younger breast cancer survivors: A systematic review

David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA 90095-6900, USA.
CancerSpectrum Knowledge Environment (Impact Factor: 15.16). 03/2012; 104(5):386-405. DOI: 10.1093/jnci/djr541
Source: PubMed

ABSTRACT Breast cancer is the most common cancer in women younger than age 50 years. Cancer treatments in younger women may cause premature menopause, infertility, and negative psychosocial effects. In this systematic review, we examined three key domains of functioning that are particularly relevant for younger breast cancer survivors: health-related quality of life (QOL), menopausal symptoms and fertility concerns, and behavioral health outcomes.
We conducted a literature review using PubMed and secondary sources and examined 840 articles published between January 1990 and July 2010. Inclusion criteria for articles were 1) published in English after 1989; 2) exclusively analyzed female breast cancer survivors aged 50 years or younger or premenopausal at diagnosis, with baseline characteristics and/or quantitative or descriptive analyses for this age group; 3) investigated QOL (health-related QOL including physical functioning and mental health, depression, and anxiety), menopause- or fertility-related concerns, and weight gain or physical activity-related behavioral health outcomes. Data were extracted using a standardized table collecting the purpose, design, population, and results of each study. Extracted data were reviewed for accuracy by two investigators and presented as descriptive tables.
A total of 28 articles met the inclusion criteria (15 cross-sectional studies, eight longitudinal studies, and five randomized trials). Regarding data review, no discordance between investigators was noted. Standardized measures of QOL and depressive symptoms identified worse outcomes as being more frequent or severe in breast cancer survivors aged 50 years or younger when compared with the general age-matched population of women without cancer and to older women (aged >50 years) with breast cancer. Concerns about premature menopause, menopausal symptoms, and infertility were common in younger women (aged ≤ 50 years) and had a role in the level of distress after treatment. Weight gain and physical inactivity were common health outcomes in younger women.
Younger women with breast cancer were found to experience distinct psychosocial and menopause-related concerns, weight gain, and physical inactivity. A need for more longitudinal research, including efforts at intervention to manage these symptoms and adverse health outcomes, remains.

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    • "Further, there is evidence that there are Table 1 Levels of evidence grading system [16]. Grade of recommendation/ description Benefit vs. risk and burdens Methodological quality of supporting evidence Implications 1A/strong recommendation, high quality evidence Benefits clearly outweigh risk and burdens, or vice versa RCTs without important limitations or overwhelming evidence from observational studies Strong recommendation, can apply to most patients in most circumstances without reservation 1B/strong recommendation, moderate quality evidence Benefits clearly outweigh risk and burdens, or vice versa RCTs with important limitations (inconsistent results, methodological flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies Strong recommendation, can apply to most patients in most circumstances without reservation 1C/strong recommendation, low quality evidence Benefits clearly outweigh risk and burdens, or vice versa Observational studies or case series Strong recommendation, but may change when higher quality evidence becomes available 2A/weak recommendation, high quality evidence Benefits closely balanced with risks and burden RCTs without important limitations or overwhelming evidence from observational studies Weak recommendation, best action may differ depending on circumstances or patients' or societal values 2B/weak recommendation, moderate quality evidence Benefits closely balanced with risks and burden RCTs with important limitations (inconsistent results, methodological flaws, indirect, or imprecise) or exceptionally strong evidence from observational studies Weak recommendation, best action may differ depending on circumstances or patients' or societal values 2C/weak recommendation, low quality evidence Benefits closely balanced with risks and burden Observational studies or case series Very weak recommendation, other alternatives may be equally reasonable A.H. Partridge et al. / The Breast 23 (2014) 209e220 210 gaps in the care of young women after a diagnosis of breast cancer, particularly with regard to their unique needs including fertility, psychosocial and sexual health, as well as genetic issues [10]. Thus, the panel agreed that all young patients should be attended to in a multidisciplinary fashion and communication prior to beginning of therapy and attention to their unique issues are highly recommended . "
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