Assessment effect on integrative supportive care in improving quality of life of breast cancer survivors: meta-analysis of randomized controlled trials 10.55131/jphd/2026/240125

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Published: Jan 29, 2026
DOI: https://doi.org/10.55131/jphd/2026/240125
Keywords:
breast cancer integrative supportive care palliative care quality of life

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Wahyu Tri Sudaryanto
Physiotherapy Department, Faculty of Health, Universitas Muhammadiyah Surakarta, Sukoharjo, Central Java 57169, Indonesia.
Ika Yuli Ayuningrum
Master’s Program in Public Health, Universitas Sebelas Maret, Surakarta, Central Java 57126, Indonesia.

Abstract

There is growing international recognition of the essential role of support for cancer patients’ well-being. Supportive care is an expected modality to manage side-effects of treatment, to maintain physical and psychological well-being, and to improve survivorship since the initial cancer diagnosis. The purpose of this study was to synthesize the evidence and assess the effect of integrative supportive care on quality of life (QoL) in breast cancer patients. A systematic review and meta-analysis on QoL in cancer patients was carried out under the guidance of PRISMA. Eligible studies were identified through a systematic literature search of PubMed and ScienceDirect databases using MeSH terms.Full text of randomized controlled trials comparing psychologically related supportive care vs. usual care in adult (≥18 years old) cancer patients, published from 2013 to 2023 were included. 10 RCTs reported that supportive care has been implemented in developed countries and 3 studies were conducted in developing countries. Supportive care had a higher impact on QoL in cancer patients than the standard care (SMD= 0.24; 95% CI= 0.08 to 0.40), with p<0.001. This study had high heterogeneity (I2= 74%). Integrative supportive care is increasingly being adopted in developed countries and has been shown to positively impact the QoL among cancer survivors.

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Sudaryanto WT, Ayuningrum IY. Assessment effect on integrative supportive care in improving quality of life of breast cancer survivors: meta-analysis of randomized controlled trials: 10.55131/jphd/2026/240125. J Public Hlth Dev [internet]. 2026 Jan. 29 [cited 2026 Feb. 2];24(1):353-74. available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/275481
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Vol. 24 No. 1 (2026): (January-April)
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Review articles
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Author Biographies

Wahyu Tri Sudaryanto, Physiotherapy Department, Faculty of Health, Universitas Muhammadiyah Surakarta, Sukoharjo, Central Java 57169, Indonesia.

Physiotherapy Department, Faculty of Health, Universitas Muhammadiyah Surakarta, Sukoharjo, Central Java 57169, Indonesia.

Ika Yuli Ayuningrum, Master’s Program in Public Health, Universitas Sebelas Maret, Surakarta, Central Java 57126, Indonesia.

Master’s Program in Public Health, Universitas Sebelas Maret, Surakarta, Central Java 57126, Indonesia.

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References

Fernando A, Tokell M, Ishak Y, Love J, Klammer M, Koh M. Mental health needs in cancer – a call for change. Future Healthcare J. 2023; 10(2): 112-116. https://doi.org/10.7861/fhj.2023-0059.

Mejareh ZN, Abdollahi B, Hoseinipalangi Z, et al. Global, regional, and national prevalence of depression among cancer patients: A systematic review and meta-analysis. Indian J Psychiatry 2021; 63: 527. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_77_21.

Pribadi DRA, Shih WM, Wu GH, Lin HR. Perspectives of Indonesian Muslim patients with advanced lung cancer on good death: A qualitative study. Eur J Oncol Nurs. 2023; 62:102251. https://doi.org/10.1016/j.ejon.2022.102251.

Arnout BA. The grief of loss among breast cancer patients during the COVID-19 pandemic: How can palliative care workers help?. Work. 2022; 74(4): 1299-1308. https://doi. org/10.3233/WOR-220400.

Guo Z, Tang HY, Li H, Tan SK, Feng KH, Huang YC, et al. The benefits of psychosocial interventions for cancer patients undergoing radiotherapy. Health Qual Life Outcomes. 2013; 11:121. https://doi.org/10.1186/1477-7525-11-121.

Ahlina FN, Nugraheni N, Salsabila IA, Haryanti S, Da'i M, Meiyanto E. Revealing the Reversal Effect of Galangal (Alpinia galanga L.) Extract Against Oxidative Stress in Metastatic Breast Cancer Cells and Normal Fibroblast Cells Intended as a Co- Chemotherapeutic and Anti-Ageing Agent. Asian Pac J Cancer Prev. 2020; 21(1):107-117. https://doi.org/ 10.31557/apjcp.2020.21.1.107.

Sulandari S, Coats RO, Miller A, Hodkinson A, Johnson J. A systematic review and meta-analysis of the association between physical capability, social support, loneliness, depression, anxiety, and life satisfaction in older adults. Gerontologist. 2024; 64(11):gnae128. https://doi.org/10.1093/geront/gnae128.

Jordan K, Feyer P, Höller U, Link H, Wörmann B, Jahn F. Supportive Treatments for Patients with Cancer. Dtsch Arztebl Int. 2017; 114(27-28): 481–487. https://doi.org/10.3238% 2Farztebl.2017.0481.

Papageorgiou L, Provost JBL, Palma MD, Langlois M, Salma I, Lopes M, Minvielle E, et al. Supportive care needs of newly diagnosed cancer patients in a comprehensive cancer center: Identifying care profiles and future perspectives. Cancers. 2024; 16(5): 1017. https://doi.org/10.3390/ cancers16051017.

Kaasa S, Knaul FM, Mwangi-Powell F, Rodin G. Supportive care in cancer: new directions to achieve universal access to psychosocial, palliative, and end-of-life care. The Lancet Global Health. 2018; 6: S11-S12. ttps:// doi.org/10.1016/S2214-109X(18) 30086-X.

Jasemi M, Valizadeh L, Zamanzadeh V, Keogh B. A concept analysis of holistic care by hybrid model. Indian J Palliat Care. 2017; 23(1): 71–80. https://doi.org/10.4103%2F0973-1075.197960.

Grimmett C, Heneka N, Chambers S. Psychological Interventions Prior to Cancer Surgery: a Review of Reviews. Curr Anesthesiol Rep. 2022; 12: 78–87. https://doi.org/10.1007/s40140-021-00505-x

Rahayu FN, Setyawati MB, Siwi AS, Suandika M. The Meaning of Support: A Husband Perspective of Women Cancer Survivor. Jurnal Berita Ilmu Keperawatan. 2022; 15(2): 173–184. https://doi.org/10.23917/bik.v15i2.18213.

Liu S, Huang R, Li A, Yu S, Yao S, Xu J, Tang L, et al. Effects of the CALM intervention on resilience in Chinese patients with early breast cancer: a randomized trial. J Cancer Res Clin Oncol. 2023; 149: 18005–18021. https://doi.org/10.1007/s00432-023-05498-0.

Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer, et al. PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews. BMJ. 2021; 372: n71. https://doi.org/10.1136¬/bmj.n71.

Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A. Rayyan — a web and mobile app for systematic reviews. Systematic Reviews. 2016; 5: 210. https://doi.org/10.1186/s13643-016-0384-4.

Barker TH, Stone JC, Sears K, Klugar M, Tufanaru C, Leonardi-Bee J, Aromataris E, Munn Z. The revised JBI critical appraisal tool for the assessment of risk of bias for randomized controlled trials. JBI Evidence Synthesis. 2024; 21(3):494-506. https://doi.org/¬10.11124/jbies-22-00430.

Ma LL, Wang YY, Yang ZH, Huang D, Weng H, Zeng XT. Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: What are they and which is better?. Mil Med Res. 2020; 7:7. https://doi.org/10.1186/s40779-020-00238-8.

Joanna Briggs Institute Levels of Evidence and Grades of Recommendation Working Party. Summary of Findings Tables for Joanna Briggs Institute Systematic Reviews. [Internet]. 2016. Retrieved from https://nursing.lsuhsc.¬edu/-JBI/docs/Grade/Summary_of_Findings_Ta¬bles_for_Joanna_Briggs_Insti-tute_Systematic_Reviews-V3.pdf.

Borenstein M. How to understand and report heterogeneity in a meta-analysis: The difference between I-squared and prediction intervals. Integr Med Res. 2023; 12(4): 101014. https://doi.org/10.1016/j.imr.2023.101014.

Simmonds, M. Quantifying the risk of error when interpreting funnel plots. Syst Rev. 2015; 4: 24. https:// doi.org/10.1186/s13643-015-0004-8.

Lin L, Chu H, Murad MH, Hong C, Qu Z, Cole SR, Chen Y. Empirical Comparison of Publication Bias Tests in Meta-Analysis. J Gen Intern Med. 2018; 33(8): 1260–1267. https://doi.org/10.1007%2Fs11606-018-4425-7.

Freeman S, Sutton A. Identifying publication bias in metaanalysis of continuous outcomes. Chochrane training. [Internet]. 2020. Accessed from https://training.cochrane.org/ sites/training.cochrane.org/files/public/uploads/Identifying%20publication%20bias%20in%20meta-analyses%20of%20continuous%20outcomes.pdf on June 2024.

Doleman B, Freeman SC, Lund JN, Williams JP, Sutton AJ. Funnel plots may show asymmetry in the absence of publication bias with continuous outcomes dependent on baseline risk: presentation of a new publication bias test. Research Synthesis Methods. 2020; 11(4): 522-534. https://doi.org/ 10.1002/jrsm.1414.

Chen S, Cao Z, Prettner K, Kuhn M, Yang J, Jiao L, Wang Z, et al. Estimates and Projections of the Global Economic Cost of 29 Cancers in 204 Countries and Territories From 2020 to 2050. JAMA Oncol. 2023; 9(4):465-472. https://doi.org/10.1001/ jamaoncol.2022.7826.

Çınar D, Karadakovan A, Erdogan AP. Effect of mobile phone app-based training on the quality of life for women with breast cancer. Eur J Oncol Nurs. 2021; 52: 101960. https://doi.org/10.1016/j.ejon.2021.101960.

Hummel SB, van Lankveld JJDM, Oldenburg HSA, Hahn DEE, Kieffer JM, Gerritsma MA, Kuenen MA, et al. Efficacy of Internet-Based Cognitive Behavioral Therapy in Improving Sexual Functioning of Breast Cancer Survivors: Results of a Randomized Controlled Trial. J Clin Oncol. 2017; 35(12):1328-1340. https://doi.org/ 10.1200/jco.2016.69.6021.

Johannsen M, O'Connor M, O'Toole MS, Jensen AB, Højris I, Zachariae R. Efficacy of Mindfulness-Based Cognitive Therapy on Late Post-Treatment Pain in Women Treated for Primary Breast Cancer: A Randomized Controlled Trial. J Clin Oncol. 2016; 34(28):3390-9. https://doi.org/ 10.1200/jco.2015.65.0770.

Kruizinga R, Scherer-Rath M, Schilderman JB, Hartog ID, Van Der Loos JP, Kotzé HP, Westermann AM, et al. An assisted structured reflection on life events and life goals in advanced cancer patients: Outcomes of a randomized controlled trial (Life InSight Application (LISA) study). Palliat Med. 2019; 33(2):221-231. https://doi.org/10.1177/0269216318816005.

Lengacher CA, Reich RR, Paterson CL, Ramesar S, Park JY, Alinat C, Johnson-Mallard V, et al. Examination of Broad Symptom Improvement Resulting From Mindfulness-Based Stress Reduction in Breast Cancer Survivors: A Randomized Controlled Trial. J Clin Oncol. 2016; 34(24):2827-34. https://doi.org/10.1200/jco.2015. 65.7874.

Park S, Sato Y, Takita Y, Tamura N, Ninomiya A, Kosugi T, Sado M, et al. Mindfulness-based cognitive therapy for psychological distress, fear of cancer recurrence, fatigue, spiritual well-being, and quality of life in patients with breast cancer-a randomized controlled trial. J Pain Symptom Manage. 2020; 60(2):381-389. https://doi.org/10.1016/ j.jpainsymman.2020.02.017.

Reich RR, Lengacher CA, Alinat CB, Kip KE, Paterson C, Ramesar S, Han HS, et al. Mindfulness-based stress reduction in post-treatment breast cancer patients: Immediate and sustained effects across multiple symptom clusters. J Pain Symptom Manage. 2017; 53(1): 85–95. https://doi.org/10.1016%2Fj.jpainsymman.2016.08.005.

Sarenmalm EK, Mårtensson LB, Andersson BA, Karlsson P, Bergh I. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer. Cancer Med. 2017; 6(5):1108-1122. https://doi.org/10.1002/cam4.1052.

van Amstel FKP, Peters MEWJ, Donders R, Schlooz-Vries MS, Polman LJM, van der Graaf WTA, Prins JB, Ottevanger PB. Does a regular nurse-led distress screening and discussion improve quality of life of breast cancer patients treated with curative intent? A randomized controlled trial. Psychooncology. 2020; 29(4):719-728. https://doi.org/ 10.1002/pon.5324.

van den Berg SW, Gielissen MFM, Custers JAE, van der Graaf WTA, Ottevanger PB, Prins JB. BREATH: Web-Based Self-Management for Psychological Adjustment After Primary Breast Cancer--Results of a Multicenter Randomized Controlled Trial. J Clin Oncol. 2015; 33(25):2763-71. https://doi.org/10.1200/jco.2013. 54.9386.

White V, Farrelly A, Pitcher M, Hill D. Does access to an information-based, breast cancer specific website help to reduce distress in young women with breast cancer? Results from a randomised trial. Eur J Cancer Care (Engl). 2018; 27(6):e12897. https:// doi.org/10.1111/ecc.12897.

Zhu J, Ebert L, Liu X, Wei D, Chan SWC. Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 2): Multicenter Randomized Controlled Trial. JMIR Mhealth Uhealth. 2018; 6(4): e104. https://doi.org/10.2196%2Fmhealth.9438.

de la Torre-Luque A, Gambara H, López E, Cruzado JA. Psychological treatments to improve quality of life in cancer contexts: A meta-analysis. Int J Clin Health Psychol. 2016; 16(2): 211–219. https://doi.org/10.1016%2Fj. ijchp.2015.07.005.

Peddireddy V. Psychological interventions to improve the quality of life in Indian lung cancer patients: A neglected area. J Health Psychol. 2019; 24(1): 100-112. https://doi.org/1 0.1177/1359105316650930.

Ghanbari E, Yektatalab S, Mehrabi M. Effects of psychoeducational interventions using mobile apps and mobile-based online group discussions on anxiety and self-esteem in women with breast cancer: Randomized controlled trial. JMIR Mhealth Uhealth. 2021; 9(5):e19262. https://doi.org/10.2196/19262.

Morris BB, Rossi B, Fuemmeler B. The role of digital health technology in rural cancer care delivery: A systematic review. J Rural Health. 2022; 38(3): 493–511. https://doi.org/ 10.1111%2Fjrh.12619.

Leslie M, Beatty L, Hulbert-Williams L, Pendrous R, Cartwright T, Jackson R, Hulbert-Williams NJ. Web-based psychological interventions for people living with and beyond cancer: Meta-review of what works and what does not for maximizing recruitment, engagement, and efficacy. JMIR Cancer. 2022; 8(3): e36255. https://doi.org/10.2196%2F36255.

Mumtaz H, Riaz MH, Wajid H, Saqib M, Zeeshan MH, Khan SE, Chauhan YR. et al. Current challenges and potential solutions to the use of digital health technologies in evidence generation: a narrative review. Front Digit Health. 2023; 5: 1203945. https://doi.org/10.3389%2Ffdgth.2023.1203945.

Cabanes A, Taylor C, Malburg C, Le PTD. Supportive care interventions for cancer patients in low- and middle-income countries (LMICs): a scoping review. Support Care Cancer. 2022; 30(11):9483-9496. https://doi.org/ 10.1007/¬s00520-022-07319-5.

Ward ZJ, Scott AM, Hricak H, Atun R. Global costs, health, and economic benefits of scaling up treatment and imaging modalities for survival of 11 cancers: a simulation-based analysis. Lancet Oncol. 2021; 22(3): 341–350. https://doi.org/10.1016%2FS1470-2045(20)30750-6.

Morris BB, Rossi B, Fuemmeler B. The role of digital health technology in rural cancer care delivery: A systematic review. J Rural Health. 2022; 38(3):493–511. https://doi.org/ 10.1111/jrh.12619.

Karanicolas KJ, Farrokhyar F, Bhandari M. Blinding: Who, what, when, why, how?. Can J Surg. 2010; 53(5): 345–348. https://pubmed.ncbi. nlm.nih.gov/20858381.

Lewis SC, Warlow CP. How to spot bias and other potential problems in randomised controlled trials. J Neurol Neurosurg Psychiatry. 2004; 75(2): 181–187. http://dx.doi.org/10.¬1136/ jnnp.2003.025833.

Matourypour P, Ghorbani A, Mahmoudi M, Binaei N, Manesh HJ, Nayeri ND, Bagheri I. Blinding and Its Quality in Clinical Trials Conducted on Patients with Breast Cancer: A Systematic Review. Iran J Nurs Midwifery Res. 2022; 27(1): 1–7. https://doi.¬org/10.4103%2Fijnmr. IJNMR_49_20.

Singer S, Janni W, Kühn T, Flock F, Felberbaum R, Schwentner L, Leinert E, et al. Awareness, offer, and use of psychosocial services by breast cancer survivors in Germany: a prospective multi-centre study. Arch Gynecol Obstet. 2023; 307(3): 945–956. https://doi.org/10.1007%2Fs00404-022-06665-3.