Effect of patient education on quality-of-life, pain and fatigue in breast cancer survivors: A systematic review and meta-analysis

Objective: To synthesise the existing evidence about the effect of patient education, either used alone or as adjunctive therapy, on the improvement of quality of life, pain and fatigue in adult breast cancer survivors. Data sources: We searched PubMed, Web of Science, CINAHL, SCOPUS, Cochrane Plus, PEDro, Dialnet and Clinicaltrials.gov databases. Methods: We conducted this systematic review in accordance with the PRISMA statement. Only randomised controlled trials with adult breast cancer survivors were included. We assessed the methodological quality of the studies using the PEDro scale and the Cochrane risk-of-bias tool. We synthesised evidence using the GRADE tool. Results: We included 14 studies (PEDro 4-8 points) comprising 1749 adult women who survived breast cancer, of which we included 12 in the quantitative analysis. There were statistically significant short-term benefits for improved global quality-of-life (standardised mean difference [SMD] = 0.43, P = 0.05, 95% CI [0.00, 0.85]; GRADE: low certainty; not important), emotional quality-of-life (SMD = 0.32, P = 0.04, 95% CI [0.02, 0.62]) and fatigue (SMD = 0.24, P = 0.0004, 95% CI [0.11, 0.37]; GRADE: low certainty; not important). However, there were not statistically significant for pain severity (SMD = -0.05, P = 0.67, 95% CI [-0.26, 0.17]; GRADE: low certainty; not important) and fear to recurrence (SMD = -0.05, P = 0.68, 95% CI [-0.31, 0.20]; GRADE: moderate certainty; not important). Conclusion: Patient education have a significative effect in short-term global quality-of-life, emotional quality-of-life and fatigue, though all the results were classified as 'not important'.