Abstract and Introduction
Purpose: Despite a large volume of research, breast cancer survivors continue to experience high levels of unmet need. To better understand the breadth of evidence, we mapped systematic review-level evidence across cancer survivorship domains and outcomes and conducted network analyses of breast cancer survivorship care interventions.
Methods: Umbrella review methodology was used to identify published systematic reviews reporting on survivorship care interventions for breast cancer survivors. Included reviews were mapped against domains and health care outcomes as specified by the Cancer Survivorship Quality Framework, and network analyses were conducted to determine the extent of clustering of reviews, and connectivity across domains and outcomes.
Results: Of 323 included reviews, most focused on management of physical (71.5%) or psychologic (65.3%) effects, health-related quality of life (55.1%), and physical activity (45.2%). Few focused on financial/employment effects, chronic conditions, health care delivery domains, or health service use or cost outcomes. Network analysis indicated 38.6% of reviews were connected to a single domain, 35.0% to two domains, and 16.5% to three domains, indicating a relatively siloed nature of research, with greater community clustering between health care delivery domains but limited connection between these and the other domains. Reviews published between 2011 and 2021 were more likely to examine financial toxicity and chronic conditions, but these domains remained under-represented compared with physical and psychologic effects.
Conclusion: Despite vast volume of breast cancer survivorship intervention research, systematic review-level research is unevenly distributed, siloed, and with significant gaps in key domains and outcomes. Assessment of evidence gaps in primary research and strategic planning of future research, in consultation with survivors, is needed.
Breast cancer is the most common type of cancer globally, and one most frequently researched. However, despite the large volume of evidence, breast cancer survivors continue to experience high levels of unmet needs,[3–5] highlighting a gap between research and improvement of outcomes, either because of interventions not addressing relevant needs or not being translated into practice. Survivorship interventions in prostate and colorectal cancers have been systematically reviewed against survivorship care guidelines, and have identified gaps and priorities for future research.[7,8] No such review has been conducted for breast cancer.
The large volume of research in breast cancer survivorship poses a challenge to data synthesis. The analysis needs to capture both the breadth and diversity of evidence across different interventions and outcomes, and to provide insights regarding connections between them and any gaps that may explain the evidence-translation gap. This study combined two approaches: mapping the existing systematic review-level evidence against the Quality of Cancer Survivorship Care Framework and network analysis. In combining these two approaches, the study aimed to (1) examine the evidence in a systematic way that aligns with best practice survivorship care, (2) assess distribution of and gaps in evidence, and (3) examine connections/overlap between domains and between outcomes.
J Clin Oncol. 2022;40(19):2083-2093. © 2022 American Society of Clinical Oncology