The potential benefits of internet-based cognitive behavioural therapy for improving psychosocial aspects, sexual functioning, and treatment-induced menopausal symptoms among breast cancer survivors: Systematic review and meta-analysis

ABSTRACT

Background: Breast cancer (BC) survivors must continue their treatments during the pandemic, include the psychotherapy, although limited due to the COVID-19 pandemic. Previous studies suggested inconclusive promising results of internet-based cognitive behavioural (iCBT) for breast cancer survivors. This study aims to compare the efficacies between iCBT and usual care (UC) for improving psychosocial aspects, sexual functioning, and treatment-induced menopausal symptoms (TIMS) among breast cancer survivors. Methods: We did comprehensive literature searching in several online databases to include all relevant studies from January 2000 until January 2021 then followed PRISMA guideline. We included all randomized controlled trials (RCTs) that compared the efficacies between iCBT and UC in BC survivors then accessed the changes of psychosocial aspects, sexual functioning, and TIMS. We used the Cochrane Risk-of-bias (RoB 2) tool for accessing bias risks. We performed analysis to provide standard mean difference (SMD) with 95% confidence interval (CI) using random-effect heterogeneity test. Results: We included 5 RCTs met our inclusion criteria. The iCBT shows non-inferiority compared with the UC group for improving seven psychosocial aspects in BC survivors. The iCBT improves sexual pleasure (SMD=0.26, 95% CI 0.04–0.48, p=0.02, I2=0%) and discomfort during sex (SMD=−0.40, 95% CI -0.79 to -0.01, p=0.04, I2=54%) significantly, but not statistically significant in improving intercourse frequency (SMD=0.15, 95% CI -0.49 to 0.80, p=0.65, I2=88%). The iCBT also shows significant improvements of sleep quality (SMD=−0.86, 95% CI -1.28 to -0.44, p<0.0001, I2=83%), hot flush frequency (SMD=−0.5, 95% CI -0.70 to -0.29, p<0.00001, I2=0%), night sweet frequency (SMD=−0.75, 95% CI -1.24 to -0.26, p=0.003, I2=81%), and the overall levels of TIMS (SMD=0.53, 95% CI 0.31–0.75, p<0.00001, I2=0%). Conclusions: The iCBT showed potential benefits for improving psychosocial aspects, sexual functioning, and TIMS among BC survivors compared with the UC. However, further studies are needed to establish the efficacies. Legal entity responsible for the study The authors. Funding: Has not received any funding. Disclosure All authors have declared no conflicts of interest.