Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
Psychooncology. 2019 Nov;28(11):2119-2140. doi: 10.1002/pon.5215. Epub 2019 Oct 15.
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.
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.
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.
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.
自我管理被提议作为一种策略，以帮助癌症患者在生存期间优化其健康和福祉。先前的综述显示自我管理对结局的影响存在差异。这些干预措施的理论基础和心理教育组成部分尚未得到详细评估。我们旨在评估自我管理的证据，并对这些干预措施的组成部分进行描述。
我们通过搜索 MEDLINE、EMBASE、PsychINFO、CINAHL、Scopus、Cochrane 系统评价数据库、美国国立卫生研究院临床试验注册处和 Cochrane 对照试验中心注册处，对已完成主要癌症治疗的成年人的自我管理干预措施进行了系统评价。我们纳入了实验和准实验设计。数据综合包括结果的叙述性和表格总结；干预措施和结局的异质性排除了荟萃分析。使用 Cochrane 偏倚风险工具或非随机研究偏倚风险工具评估研究质量。
共纳入了 1994 年至 2018 年 3 月 29 日期间发表的 41 项研究。这些研究主要是随机对照试验，针对乳腺癌幸存者。确定了各种干预设计、心理教育组成部分和结局。不到 50%的研究包括理论框架。大多数结局的效果存在差异。偏倚风险无法全面评估。
癌症幸存者自我管理干预措施的设计和研究存在局限性，这阻碍了它们向临床实践的转化。需要进一步研究以了解这些干预措施是否是癌症幸存者的一种重要支持类型。
