Journal Article Annotations
2023, 3rd Quarter


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

  1. Body image and cancer-related lymphedema: A systematic review.
  2. 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.


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.

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.


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.

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.