Journal Article Annotations
2023, 3rd Quarter

Psychooncology

Annotations by Christian Bjerre Real, MD, MMCI, Deepti Chopra, M.B.B.S., MPH, Daniel McFarland, MD, Marie Tobin, MD
October, 2023

Body image and cancer-related lymphedema: A systematic review.
Is digital intervention for fear of cancer recurrence beneficial to cancer patients?: A systematic review and meta-analysis.

PUBLICATION #1 — Psychooncology

Body image and cancer-related lymphedema: A systematic review.

Namgu Kang, Eun-Seung Yu.

Abstract: Psychooncology. 2023 Oct;32(10):1528-1538. doi: 10.1002/pon.6215. Epub 2023 Sep 8.

Abstract

Objective:
Cancer-related lymphoedema is a common side effect of cancer, affecting 24%–49% of people with cancer. Body image contributes to the well-being of individuals with this condition. This systematic review aimed to explore, for the first time, the state of the science concerning body image in cancer-related lymphoedema, including how body image is measured and variables associated with body image concerns.

Methods:
Six databases were systematically searched for peer-reviewed articles describing empirical quantitative studies where body image was measured with a reliable and valid measurement tool in adults with cancer-related lymphoedema.

Results:
Nine studies with 977 participants were included. The studies involved individuals who had experienced breast, head and neck, melanoma, and urogenital cancers and developed lymphoedema. There was considerable heterogeneity in body image measures used, precluding meta-analysis. The following variables were associated with increased body image concern: higher body integrity beliefs, experience of physical changes (e.g. pain) and differences in sensation and function, including changes in appearance related thoughts, feelings and emotions. Several studies described behavioural and psychological interventions which positively impacted body image outcomes in individuals with lymphoedema relating to specific cancers.

Conclusion:
Regular screening for body image concerns could encourage more positive body image awareness in individuals with cancer-related lymphoedema and lessen some of its associated negative consequences. Future longitudinal and individual differences research in this area is important to inform intervention development. There is also need for a more standardised approach to the study and measurement of body image in people with cancer-related lymphoedema.

Annotation

The finding:
Cancer-related lymphedema is an overlooked, progressive, and life-long condition with physical, psychological, and social consequences for survivors. In this systematic review of 9 studies examining body image disturbance among patients with cancer-related lymphedema, body image disturbance was associated with psychological distress, depression, and anxiety. Body image dissatisfaction mediated the relationship between pain and psychological distress in breast cancer-related lymphedema. Participants who experienced changes in physical appearance, pain, sensation, function, and body-image-related thoughts and emotions were more susceptible to body-image concerns. Interventions—including regular physical activity, liposuction, and therapeutic creative writing—appeared to improve positive body self-perception.

Strengths and weaknesses:
This study appears to be the first systematic review to address body image awareness among cancer-related lymphedema. It highlights the need for clinicians to address this issue among cancer survivors. A weakness of the study is the dearth of male participants. Additionally, in some of the included studies, body image was not the primary outcome or the focus of interventions.

Relevance:
Between 24-49% of cancer survivors experience related lymphedema. Despite its potential to cause deleterious effects on physical and emotional functioning, cancer-related lymphedema is frequently overlooked. The authors identify the need to develop a gold standard measurement for body image changes specifically in cancer-related lymphedema. Regular exercise, therapeutic creative writing, and liposuction may be helpful in specific cancer populations. Increased awareness of this clinical issue, its management, and standardized assessment tools can reduce suffering in the growing population of cancer survivors.

PUBLICATION #2 — Psychooncology

Is digital intervention for fear of cancer recurrence beneficial to cancer patients?: A systematic review and meta-analysis.

Margaret Heslin, Amelia Jewell, Sara Croxford, Cuong Chau, Shubulade Smith, Rudiger Pittrof, Elana Covshoff, Ann Sullivan, Valerie Delpech, Alison Brown, Helena P King, Mina Kakaiya, Lucy Campbell, Elizabeth Hughes, Robert Stewart.

Abstract: Psychooncology. 2023 Sep;32(9):1348-1358. doi: 10.1002/pon.6199. Epub 2023 Aug 12.

Abstract:

Objective:
This study aimed to compare the effectiveness of digital and face-to-face interventions in reducing fear of cancer recurrence (FCR) among individuals with cancer.

Methods:
This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for evaluating the efficacy of psychological interventions for FCR published between July 2018 and December 2021. We searched for research papers using PubMed, Embase, and Cochrane and assessed their quality using the Revised Cochrane risk-of-bias tool for randomized trials.

Results:
Of the 2113 identified studies, we analyzed 17 samples (N = 1482) from 14 studies, of which 13 were RCTs. The overall sample showed a moderate effect size (Hedges’ g = 0.607; 0.356 to 0.858; p < 0.001; I² = 81.29%) in FCR reduction. The overall effect size was 0.621 (95% CI, 0.276 to 0.966; p < 0.001; I² = 81.78%) for face-to-face interventions and 0.517 (95% CI, 0.093 to 0.941; p = 0.017; I² = 83.19%) for digital interventions. The difference between the two effect sizes was not statistically significant.

Conclusion:
Our meta-analysis suggests that digital interventions are moderately effective in reducing FCR, similar to face-to-face interventions. However, given the high degree of heterogeneity, this conclusion should be interpreted with caution. Further studies are required to identify the most effective digital interventions and the populations that may benefit from them.

Annotation

The finding:
In this meta-analysis and systematic review, digital interventions were just as effective as face-to-face interventions in reducing fear of cancer recurrence.

Strength and weaknesses:
Data were collected systematically, however, there was significant heterogeneity which means that the results may obscure the benefit of specific psychotherapies. The most common interventions were psychoeducation and psychotherapy. Data trended toward being more significant for face-to-face interventions, and more studies may demonstrate superiority of in-person interventions. A significant weakness was the study’s inability to compare efficacy across specific psychotherapeutic modalities used in these interventions.

Relevance:
Digital interventions appear efficacious for managing fear of cancer recurrence, but these interventions may not improve upon face-to-face interventions. C-L psychiatrists can feel confident in recommending either—so long as they are cognizant of the need to manage this impairing symptom among cancer survivors.