Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Clinical Practice Research Datalink (CPRD), Medicines and Healthcare Products Regulatory Agency, London, UK.
J Natl Cancer Inst. 2018 Dec 1;110(12):1311-1327. doi: 10.1093/jnci/djy177.
BACKGROUND: We aimed to systematically review the evidence on adverse mental health outcomes in breast cancer survivors (≥1 year) compared with women with no history of cancer. METHODS: Studies were identified by searching MEDLINE, PsycINFO, the Cumulative Index to Nursing and Allied Health Literature, and the Social Sciences Citation Index, and through backward citation tracking. Two researchers selected the studies, extracted data, and assessed the risk of bias. RESULTS: Sixty studies were included. Of 38 studies of depression, 33 observed more depression in breast cancer survivors; this was statistically significant in 19 studies overall, including six of seven where depression was ascertained clinically, three of four studies of antidepressants, and 13 of 31 that quantified depressive symptoms. Of 21 studies of anxiety, 17 observed more anxiety in breast cancer survivors, statistically significant in 11 studies overall, including two of four with clinical/prescription-based outcomes, and in eight of 17 of anxiety symptoms. Breast cancer survivors also had statistically significantly increased symptoms/frequency of neurocognitive dysfunction (18 of 24 studies), sexual dysfunctions (5 of 6 studies), sleep disturbance (5 of 5 studies), stress-related disorders/PTSD (2 of 3 studies), suicide (2 of 2 studies), somatisation (2 of 2 studies), and bipolar and obsessive-compulsive disorders (1 of 1 study each). Studies were heterogeneous in terms of participants' characteristics, time since diagnosis, ascertainment of outcomes, and measures reported. Approximately one-half of the studies were at high risk of selection bias and confounding by socio-economic status. CONCLUSIONS: There is compelling evidence of an increased risk of anxiety, depression and suicide, and neurocognitive and sexual dysfunctions in breast cancer survivors compared with women with no prior cancer. This information can be used to support evidence-based prevention and management strategies. Further population-based and longitudinal research would help to better characterize these associations.
背景：本研究旨在系统地综述乳腺癌幸存者（≥1 年）与无癌症史女性相比不良心理健康结局的证据。
方法：通过检索 MEDLINE、PsycINFO、护理学及相关健康学科累积索引和社会科学引文索引，并进行回溯引文追踪，确定研究。两位研究者选择研究、提取数据并评估偏倚风险。
结果：共纳入 60 项研究。在 38 项关于抑郁的研究中，有 33 项研究观察到乳腺癌幸存者的抑郁发生率更高；总体而言，19 项研究中有统计学意义，其中包括 7 项基于临床的研究中的 6 项、抗抑郁药的 4 项研究中的 3 项、31 项量化抑郁症状的研究中的 13 项。在 21 项焦虑研究中，17 项研究观察到乳腺癌幸存者的焦虑发生率更高，总体上有统计学意义的有 11 项，其中包括基于临床/处方的结局的 4 项研究中的 2 项、17 项焦虑症状研究中的 8 项。乳腺癌幸存者还存在神经认知功能障碍（24 项研究中的 18 项）、性功能障碍（6 项研究中的 5 项）、睡眠障碍（5 项研究中的 5 项）、应激相关障碍/创伤后应激障碍（3 项研究中的 2 项）、自杀（2 项研究中的 2 项）、躯体化（2 项研究中的 2 项）和双相情感障碍及强迫症（各 1 项研究）的症状/频率升高。这些研究在参与者特征、诊断后时间、结局确定和报告的测量方面存在异质性。大约一半的研究存在选择偏倚和社会经济地位混杂的高风险。
结论：与无癌症史女性相比，乳腺癌幸存者存在焦虑、抑郁和自杀风险增加，以及神经认知和性功能障碍的有力证据。这些信息可用于支持基于证据的预防和管理策略。进一步的人群和纵向研究将有助于更好地描述这些关联。
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