Non-pharmacological therapies for depressive symptoms in breast cancer patients: Systematic review and meta-analysis of randomized clinical trials

• Published in: Breast (Edinburgh) Vol. 44; pp. 135 - 143
• Main Authors: Coutiño-Escamilla, Liliana, Piña-Pozas, Maricela, Tobías Garces, Aurelio, Gamboa-Loira, Brenda, López-Carrillo, Lizbeth
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01.04.2019
• Subjects: Breast cancer; Depressive symptoms; Non-pharmacological; Therapeutics; Depressive symptoms; Breast cancer; Non-pharmacological; Therapeutics
• ISSN: 0960-9776; 1532-3080
• DOI: 10.1016/j.breast.2019.01.006

Depressive symptoms are common comorbidities among breast cancer (BC) patients. Non-pharmacological therapies (NPTs) such as exercise and psychotherapy may reduce depressive symptoms; however, the evidence is inconclusive. The objective of this study is to evaluate if NPTs reduce depressive symptoms among BC patients. A systematic review and meta-analysis of randomized clinical trials (RCTs) of NPTs for BC patients were performed. A literature search was conducted from eight databases in English, Portuguese and Spanish from 2006 to 2017. Inclusion criteria were: RCTs that evaluated depressive symptoms as a primary or secondary outcome that did not include pharmacological interventions and did include a non-intervened control group, with at least 30 participants in non-terminal BC stage with no current psychiatric illness. A meta-analysis for each NPT was performed with DerSimonian and Laird's method for the random effects model. Sensitivity analyses were conducted. Heterogeneity and publication bias were assessed. A total of 41 eligible RCTs were identified. Overall, NPTs significantly reduced depressive symptoms (Summary standardized mean difference (SMD) = -0.516; 95%CI: -0.814, −0.218; I2 = 96.2). Of the types of NPTs, psychotherapy significantly reduced depressive symptoms (Summary SMD = −0.819; 95% CI: -1.608, −0.030; I2 = 91.53). A significant difference emerged for Mindfulness (Summary SMD = −0.241; 95% CI: -0.412, −0.070; I2 = 28.6%) and yoga (Summary SMD = −0.305; 95% CI: -0.602, −0.007; I2 = 41.0%) when the heterogeneity was reduced. No evidence of publication bias was observed. Psychotherapy and mind-body therapies may reduce depressive symptoms in women with BC. Laughter and couples therapy warrant attention in future studies. •Psychotherapy and yoga may reduce depressive symptoms in breast cancer patients.•MBSR and imagery reduce depressive symptoms in postmenopausal patients.•Further evidence is needed for laughter and couple therapies.