Self‐management interventions for cancer survivors: A systematic review and evaluation of intervention content and theories

Abstract

Objective Self‐management has been proposed as a strategy to help cancer patients optimize their health and well‐being during survivorship. Previous reviews have shown variable effects of self‐management on outcomes. The theoretical basis and psychoeducational components of these interventions have not been evaluated in detail. We aimed to evaluate the evidence for self‐management and provide a description of the components of these interventions. Methods We conducted a systematic review of self‐management interventions for adults who had completed primary cancer treatment by searching MEDLINE, EMBASE, PsychINFO, CINAHL, Scopus, Cochrane Database of Systematic Reviews, National Institutes of Health Clinical Trials Registry, and Cochrane CENTRAL Registry of Controlled Trials. We included experimental and quasiexperimental designs. Data synthesis included narrative and tabular summary of results; heterogeneity of interventions and outcomes precluded meta‐analysis. Study quality was evaluated using the Cochrane risk of bias tool or the risk of bias of nonrandomized studies tool. Results Forty‐one studies published between 1994 and 29 March 2018 were included. Studies were predominantly randomized controlled trials and targeted to breast cancer survivors. A variety of intervention designs, psychoeducational components, and outcomes were identified. Less than 50% of the studies included a theoretical framework. There was variability of effects across most outcomes. Risk of bias could not be fully assessed. Conclusions There are limitations in the design and research on self‐management interventions for cancer survivors that hinder their translation into clinical practice. Further research is needed to understand if these interventions are an important type of support for cancer survivors.

How patients experience endocrine therapy for breast cancer: an online survey of side effects, adherence, and medical team support

“…Patients and their medical team members might have differing perspectives on the definition of a “well-tolerated” medication and on measures of quality of life [ 52 , 53 ], but efforts must be made to better understand the patient’s point of view. There are a variety of conceptual framework models such as decision support and needs, symptom management, symptom experience, self-management, and patient activation [ 31 , 53 – 56 ] that can be applied to improve adherence [ 57 , 58 ]. For example, a recent pilot program demonstrated that patient activation did not improve oral oncolytic adherence; however, patients who completed the program did report increased confidence in their ability to self-manage symptoms and seek help when experiencing side effects [ 55 ].…”

Identifying and exploring the self-management strategies used by childhood cancer survivors

“…They may also indicate strategies that professionals could suggest to their patients. Interventions to encourage self-management are being developed for a range of adult cancers [16]. To inform such interventions for CCSs, it is essential to understand their views and needs and to develop a detailed understanding of why they behave in the way they do [52].…”

“…In addition, there is emerging evidence that self-management interventions have the potential to improve outcomes in cancer survivors [15]. However, results are difficult to interpret due to heterogeneity and methodological limitations with current interventions [16]. In addition, the provision of selfmanagement support in routine care for survivors lags behind that of chronic diseases [15].…”

Response to Letter to the Editor

“…We would like to thank you for the opportunity to respond to the comments raised by Dr Clare Foster et al in their letter to the editor about the publication “A Web‐based intervention (RESTORE) to support self‐management of cancer‐related fatigue following primary cancer treatment: a multi‐centre proof of concept randomised controlled trial” and clarify aspects in relation to the methodology and findings of our systematic review entitled “Self‐management interventions for cancer survivors: a systematic review and evaluation of intervention content and theories.” We would also like to thank Dr Foster and her colleagues for their interest in our paper and for taking the time to express their views. We respectfully disagree on several points.…”