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Psychological interventions for women with metastatic breast cancer

Mustafa M, Carson-Stevens A, Gillespie D, Edwards AGK
Published Online: 
4 June 2013

Cancer that has spread beyond the breast (metastatic breast cancer) is frightening and distressing and can lead women to experience psychological symptoms, such as depression. There is a belief that these psychological symptoms can make the cancer worse.

Treatment for psychological symptoms is sometimes offered to women with metastatic breast cancer, either individually or in a group. In 1989 one study examined the effect of this treatment, offered to a group of women, and it found that it led to them feeling psychologically better and living longer. Subsequent studies did not seem to replicate the findings from the 1989 study, causing uncertainty about the effects of psychological treatments for women with metastatic breast cancer. 

This review examined the studies to date to see what effect psychological treatments had on women with metastatic breast cancer. We found 10 studies with a total of 1378 women with metastatic breast cancer. Three of the studies used a psychological treatment known as cognitive behavioural therapy (CBT), four studies used supportive-expressive group therapy (SEGT), while the remaining three studies used treatments that were delivered on an individual basis and were neither CBT nor SEGT.

We performed statistical analysis and found that the odds ratio (a measure of association between an intervention and an outcome) for survival of women with metastatic breast cancer one year after receiving psychological treatment was 1.46, suggesting that there was an association between the psychological treatment and improved survival. This finding was not found when looking at the odds ratio of survival at five years. We also found some evidence that psychological treatments in the short term (for example, one year) may produce a small reduction in pain and improve some psychological symptoms. However, making comparisons across these studies was difficult as they differed in their conduct, treatments and measures used. Moreover, we cannot rule out that the psychological treatments could also cause psychological harm.

This record should be cited as: 
Mustafa M, Carson-Stevens A, Gillespie D, Edwards AGK. Psychological interventions for women with metastatic breast cancer. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD004253. DOI: 10.1002/14651858.CD004253.pub4
Assessed as up to date: 
30 June 2011