The Singapore National University Hospital Centre for Evidence Based Nursing, Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore.
Int J Evid Based Healthc. 2011 Sep;9(3):215-35. doi: 10.1111/j.1744-1609.2011.00221.x.
Breast cancer is one of the most common cancers worldwide, and anxiety is a psychological morbidity that is inevitable. Many researchers have investigated the prevalence and detrimental effects of anxiety in breast cancer treatment, but little is known about differences in anxiety level among women receiving different breast cancer treatments. A systematic review of all available literature was needed to attain better understanding of anxiety in patients undergoing treatment for breast cancer.
This review aimed to determine the best available evidence on the level of anxiety among women with breast cancer who were undergoing cancer treatment(s), and the factor(s) contributing to anxiety in various treatment modalities.
The search sought to gather data from published and unpublished studies conducted between 1990 and 2010. An initial search on CINAHL and Medline was done to identify relevant search terms. A search strategy was then developed, using MeSH headings and key words. The following databases were searched: CINAHL, PubMed, ScienceDirect, PsycINFO, Cochrane Database of Systematic Review, Scopus, Wiley InterScience and PsycARTICLES. All papers are quantitative papers (randomised controlled trials and descriptive studies) that examined anxiety level in women with breast cancer of stage 0 to stage IIIA, over and equal to 21 and below 65 years of age, who were undergoing/had undergone treatment restricted to chemotherapy, radiotherapy and/or surgery, and these quantitative papers have made correlations between women's anxiety levels and contributing factors. The Hospital Anxiety and Depression Scale and State-Trait Anxiety Inventory were the two tools most frequently used by these papers to quantify the anxiety level. Two reviewers independently assessed the eligibility of the papers for inclusion. Eighteen papers were selected based on relevance, and assessed for methodological quality using MAStARI. Ten research papers that met our methodological standard were included in the review. Both reviewers agreed on the papers to be included and excluded. Due to the methodological heterogeneity of the included papers, a meta-analysis was not possible. The studies were hence presented in narrative summary.
Anxiety seems to be ubiquitous, presenting itself in all treatment types for breast cancer. Anxiety level in women who underwent chemotherapy was highest before the first chemotherapy infusion, mediated by age and trait anxiety. Radiotherapy regimes did not affect anxiety level in radiotherapy-treated patients, and most research concluded that anxiety level was higher among women who underwent mastectomy than those who underwent breast conservation therapy.
The prevalence and intensity of anxiety have been shown to be pronounced among breast cancer women who were undergoing/had undergone one or more of the three treatments. Chemotherapy, as compared to other treatments, is shown to be associated with a higher anxiety level. With the prevalence, intensity and correlated factors of anxiety identified through this review, future research may investigate the interventions that could help alleviate anxiety among these patients. Anxiety is prevalent in women with breast cancer undergoing treatment, especially those undergoing chemotherapy. Healthcare professionals should pay greater attention to identify signs of anxiety in patients and design interventions to help alleviate it earlier.
乳腺癌是全球最常见的癌症之一，焦虑是一种不可避免的心理疾病。许多研究人员已经研究了乳腺癌治疗中焦虑的患病率和不良影响，但对于接受不同乳腺癌治疗的女性焦虑水平的差异知之甚少。需要对所有现有文献进行系统综述，以更好地了解接受乳腺癌治疗的患者的焦虑情况。
本综述旨在确定有关正在接受癌症治疗的乳腺癌女性焦虑程度的最佳现有证据，以及各种治疗方式中导致焦虑的因素。
搜索旨在收集 1990 年至 2010 年期间发表和未发表的研究数据。在 CINAHL 和 Medline 上进行了初步搜索，以确定相关的搜索词。然后制定了搜索策略，使用了 MeSH 标题和关键词。搜索了以下数据库：CINAHL、PubMed、ScienceDirect、PsycINFO、Cochrane 系统评价数据库、Scopus、Wiley InterScience 和 PsycARTICLES。所有论文均为定量论文（随机对照试验和描述性研究），研究了 0 期至 IIIA 期乳腺癌女性的焦虑程度，年龄大于等于 21 岁且小于 65 岁，正在接受/已接受仅限于化疗、放疗和/或手术的治疗，这些定量论文已将女性的焦虑程度与致病因素进行了相关性分析。医院焦虑和抑郁量表和状态-特质焦虑量表是这些论文中最常用来量化焦虑程度的两种工具。两名评审员独立评估了论文的纳入资格。根据相关性，选择了 18 篇论文，并使用 MAStARI 评估其方法学质量。符合我们方法学标准的 10 篇研究论文被纳入综述。两名评审员均同意纳入和排除论文。由于纳入论文的方法学异质性，因此无法进行荟萃分析。研究结果以叙述性摘要的形式呈现。
焦虑似乎无处不在，出现在所有乳腺癌治疗类型中。接受化疗的女性在第一次化疗前焦虑程度最高，这与年龄和特质焦虑有关。放疗方案并未影响接受放疗的患者的焦虑程度，并且大多数研究得出的结论是，接受乳房切除术的女性比接受保乳治疗的女性焦虑程度更高。
通过本综述确定了乳腺癌女性在接受/已接受三种治疗方法之一或多种治疗方法后焦虑的发生率和强度。与其他治疗相比，化疗与更高的焦虑水平相关。通过本综述确定了焦虑的普遍性、强度和相关因素，未来的研究可以调查有助于减轻这些患者焦虑的干预措施。在接受治疗的乳腺癌女性中，焦虑症很常见，尤其是那些接受化疗的女性。医疗保健专业人员应更加注意识别患者的焦虑迹象，并设计干预措施以尽早帮助缓解焦虑。
