The Effects of Pharmacological and Non-Pharmacological Interventions on Symptom Management and Quality of Life among Breast Cancer Survivors Undergoing Adjuvant Endocrine Therapy: A Systematic Review

Abstract

Breast cancer survivors need to undergo adjuvant endocrine therapy after completion of curative treatments to prevent disease recurrence. These individuals often experience symptoms which are detrimental to their quality of life (QOL). Implementation of interventions for effective symptom management among these survivors is warranted. This review provides an overview of studies on the effectiveness of the previously developed interventions for breast cancer survivors undergoing adjuvant endocrine therapy on symptom alleviation and enhancement of QOL or health-related QOL (HRQOL). Five electronic databases were employed in the literature search. Study selection, data extraction and critical appraisal of the included studies were conducted by three authors independently. Twenty-four studies were included. Both pharmacological and non-pharmacological interventions are effective in addressing the symptoms associated with adjuvant endocrine therapy among the breast cancer survivors, and in improving their QOL, although discrepancies were noted between the studies in terms of the significance of these effects. Pharmacological and non-pharmacological interventions can be effective for symptom management among breast cancer survivors. Their implementation is recommended for effective survivorship care for these individuals. Further research on intervention development for breast cancer survivors is recommended to provide further evidence for the utility of the explored interventions in survivorship care for these patients.

Strategies to self-manage side-effects of adjuvant endocrine therapy among breast cancer survivors: an umbrella review of empirical evidence and clinical guidelines

“…The quality of the systematic reviews was mixed. Four systematic reviews had critically low quality [27][28][29][30], nine were low quality [31][32][33][34][35][36][37][38][39], 13 moderate quality [40][41][42][43][44][45][46][47][48][49][50][51][52], and seven high quality [53][54][55][56][57][58][59] (Table 1). There were consistent weaknesses within the reviews.…”

“…Eight systematic reviews [28,33,39,[47][48][49][50]59] and three clinical guidelines [61,72,73] reported on physical activity as a self-management strategy for arthralgia. One systematic review [59] and one clinical guideline [61] were rated as high quality.…”

“…One systematic review [59] and one clinical guideline [61] were rated as high quality. Activities reported included yoga [28,33,39,47,48,72], walking [28, 33, 47-49, 59, 72], Nordic walking [33,48], aerobic and resistance training [28, 33, 39, 47-50, 59, 61, 73], aquatic exercise [33,49,72], and Tai-Chi [33]. A high-quality review reported no clear evidence of benefit for exercise therapy to address arthralgia [59].…”

“…This finding was supported by most evidence from the lower quality reviews, particularly those focussed on low intensity interventions such as yoga and Tai-Chi. One large randomised controlled trial was included in all systematic reviews [28,33,39,[47][48][49][50]59] and one of the clinical guidelines [72], and reported supervised aerobic and resistance training could improve arthralgia in this population.…”

Association of single nucleotide polymorphisms of cytochrome P450 enzymes with experience of vasomotor, vaginal and musculoskeletal symptoms among breast cancer patients: a systematic review

“…Adjuvant endocrine therapies that involve the use of drugs such as tamoxifen and aromatase inhibitors (AIs), are often administered to breast cancer patients who have completed curative treatments [1]. These therapies serve to prevent the recurrence of oestrogen receptor (ER)-positive breast cancer, potentially via inhibition of oestrogen production or suppression of the tumourinducing effects of oestrogen via its interaction with ER [2][3][4].…”