Elsevier

Clinical Oncology

Volume 28, Issue 5, May 2016, Pages 292-305
Clinical Oncology

Overview
The Effectiveness of Group-based Self-management Programmes to Improve Physical and Psychological Outcomes in Patients with Cancer: a Systematic Review and Meta-analysis of Randomised Controlled Trials

https://doi.org/10.1016/j.clon.2015.10.003Get rights and content

Abstract

The purpose of this study was to determine if patients with cancer who participate in group-based self-management programmes have better physical and psychological outcomes than patients with cancer who do not participate in group-based self-management programmes. A literature search was conducted in Ovid MEDLINE, Embase, PsycINFO, CINAHL, CENTRAL, Web of Science and ProQUEST using the terms ‘self-management’ OR ‘self-care’ AND ‘cancer’ OR ‘neoplasm’. Randomised controlled trials comparing outcomes for people with cancer participating in group-based self-management programmes with those not participating in these programmes were selected after screening by two reviewers. Initial searches yielded 563 articles. Two reviewers independently extracted data using piloted forms and assessed risk of bias using Cochrane's tool. Standard mean differences were calculated for continuous outcomes. The percentage of variability due to heterogeneity was assessed using I2. A subgroup analysis was carried out where possible. Six trials were included in the review after 141 full-text articles were screened. Group-based self-management programmes were found to improve physical function [standard mean difference (95% confidence interval) = 0.34 (0.02, 0.65), P = 0.04]. No significant results were found between groups for quality of life [0.48 (–0.16, 1.11), P = 0.14] and physical activity level [0.21 (–0.07, 0.5), P = 0.15] outcomes. Group-based self-management programmes for individuals with cancer resulted in improvements in physical outcomes. However, considerable heterogeneity was found between the included studies and the quality of evidence was very low for all main outcomes. Therefore the results should be viewed with caution.

Section snippets

Statement of Search Strategies Used and Sources of Information

Five databases were searched for studies to include in this systematic review. These included Ovid MEDLINE (In-Process and other Non-Indexed Citations 1946 to 11 February 2014), Embase (1974 to 11 February 2014), PsycINFO (1987 to Week 1 February 2014), CINAHL and the Cochrane Central Register for Controlled Trials (CENTRAL) up to 11 February 2014. Published literature with restricted distribution was searched through the ISI Web of Science and ProQuest for dissertations and theses. Authors of

Eligibility Criteria

The studies included in this review were randomised controlled trials involving adult patients (>18 years) with a primary diagnosis of any cancer, stages I–IV. Study intervention participants must have participated in a form of group-based self-management programme, whereas participants in the control group must not have participated in any form of group-based self-management programme. Control participants could receive non-group-based self-management education. Self-management programmes must

Study Selection

One hundred and forty-one full-text articles were screened of the 563 citations identified through initial searches. Of the full-text articles screened, only six fulfilled the eligibility criteria and were included in the analysis. See Figure 1 for a flow diagram of the study selection process with reasons for study exclusion.

Study Characteristics

The six English-language randomised controlled trials [41], [42], [43], [44], [45], [46], which consisted of a total of 617 participants, included in this systematic

Main Results

This systematic review provides a meta-analysis of the efficacy of group-based self-management programmes to improve physical, psychological and quality of life outcomes for patients with cancer. From the six studies included in this review the results show that these programmes lead to significant improvements in physical functioning. There were no significant differences found for physical activity level and quality of life. Interestingly, physical functioning, which is often measured as a

Conclusions

Based on the research presented in this systematic review it appears that group-based self-management programmes are effective in improving physical functioning in individuals with cancer. Although positive trends were found for quality of life, the results must be interpreted with caution due to the high risk of bias and very low quality of evidence of the outcomes assessed within the included studies.

Acknowledgements

The authors would like to thank Dr Shanil Ebrahim for his guidance during the writing of this manuscript.

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