Table 3 Characteristics of included SRs

Exercise and physical activity

Juvet et al., 2017 [31]

25 RCTs

Endurance, strength, mobility exercises and coordination.

3418 (41–422). Non-metastatic invasive BC female patients who had undergone surgical procedures followed by chemotherapy or radiotherapy or both. Mostly studies that included early-stage BC patients recruited at least 12 months after diagnosis.

To investigate the efficacy of exercise intervention trials in BC patients during and after adjuvant cancer treatment with respect to HRQoL and with a focus on self-reported physical functioning and fatigue.

Inclusion: 1) RCTs; 2) female BC patients who had undergone surgery; 3) exercise interventions (endurance, strength, mobility exercises and coordination); 4) patient-reported outcomes such as HRQoL outcomes or fatigue; 5) at least 20 participants in each group. Exclusion: low-quality studies, studies with fewer than 20 participants in each group, studies involving patients with metastatic cancer and studies that do not present data separately for BC patients.

Fatigue, physical function.

Chan et al., 2010 [17]

7 RCTs

Upper limb exercise: posture correction, coordination, resistance machines, free weights, stretching.

429 (27–205). Women undergoing BC surgery with axillary lymph node dissection.

To assess the effectiveness of exercise programmes on shoulder mobility and lymphoedema in postoperative patients with BC having axillary lymph node dissection.

Inclusion: women undergoing BC treatment with axillary lymph node dissection. Various types of exercise programmes: weight training, aerobic and strengthening exercises, stretching and range of motion exercises. Range of shoulder motion, shoulder mobility, arm circumference and arm volume (at least one of these). RCTs published in English. Exclusion: men. No exercise intervention. Patients undergoing sentinel lymph node biopsy.

Range of shoulder motion, shoulder mobility, arm circumference and arm volume.

Zhu et al., 2016 [52]

33 RCTs

Aerobic, resistance, stretching, yoga, Tai Chi Chuan, dancing.

2659 (19–473). Adults diagnosed with BC, mostly during treatment or post-treatment.

To comprehensively summarize the effects of exercise intervention on BC patients based on the available data from RCTs.

Inclusion: studies that 1) were written in English; 2) had a RCT design, comparing an exercise intervention group with control group (usual care, maintain current activity level, or waiting list); 3) included adults diagnosed with BC; and 4) evaluated the effects of exercise in BC patients. Exclusion: 1) mixed cancer populations, including other types of cancer patients; 2) other types of intervention (exercise intervention combined with diet); and 3) exercise merely focused on upper limb or arm.

QoL, depression, anxiety, fatigue, muscle strength, body composition, physiological markers.

Meneses-Echavez et al., 2015 [38]

9 RCTs

Supervised exercise interventions defined as “any body movement causing an increase in energy expenditure that involves a planned or structured movement of the body performed in a systematic manner in terms of frequency, intensity, and duration and is designed to maintain or enhance health-related outcomes”.

1156 (22–500). BC survivors (women) stages I-IIIA.

To determine the pooled effects of supervised exercise interventions on cancer-related fatigue in BC survivors, via a meta-analysis of RCTs.

Inclusion: RCTs involving BC without restrictions regarding stage of disease. Supervised exercise interventions. Exclusion: systematic reviews, editorials, cross-sectional studies, case reports and case series studies, non-supervised exercise programmes, Tai Chi, manual therapy (joint mobilization techniques and therapeutic massage) and cognitive behavioral interventions. Studies that compared supervised exercise with pharmacological and surgical treatments.

Primary: fatigue. Secondary: depression; BMI as an indicator of body composition closely related to cancer progression; physical activity levels (minutes per week); QoL including physical, social, emotional and functional wellbeing.

Zeng et al., 2014 [50]

22 RCTs, 3 CTs

Any type of exercise (aerobic, anaerobic, or a combination of these).

2908 (18–573). Women who had completed active BC treatment.

To determine the effectiveness of exercise interventions on overall QoL and domain-specific QoL in BC survivors.

Inclusion: studies in English or Chinese. Participants were at least 18 years old, had a diagnosis of BC, and had completed active BC treatment. Any type of exercise (aerobic, anaerobic, or a combination) with BC surgery.

QoL outcomes measured by generic, cancer-specific, or cancer site-specific QoL scales.

Bluethmann et al., 2015 [16]

14 RCTs

Physical activity and behaviour change

2140 (36–500). BC surgery 5 years or less from completion of active cancer treatment. Most participants reported receiving an early cancer diagnosis at Stage I or Stage II of disease. Most studies excluded women diagnosed at Stage IV.

To 1) describe the characteristics of PA behaviour interventions for BC patients, including targeted populations, intervention features, and use of behavior theory; and 2) determine effect size estimates for behavior change from these PA interventions.

Inclusion: 5 years or less from completion of active treatment, including behaviour interventions; interventions targeting moderate to vigorous physical activity (MVPA) but not requiring access to exercise facilities or equipment.

Mean minutes of moderate to vigorous physical activity or mean hours of Metabolic Equivalent per week.

Duijts et al., 2011 [24]

56 RCTs

Behavioral techniques and/or physical exercise

7164 (24–558). Stages 0-IV. Mostly non-metastatic BC patients.

To evaluate the effect of behavioral techniques and physical exercise on psychosocial functioning and HRQoL outcomes in BC patients and survivors.

Inclusion: RCTs that addressed the effect of behavioral techniques or physical exercise on psychosocial functioning and HRQoL outcomes.

Psychosocial functioning, HRQoL, fatigue, depression, anxiety, body image, stress.

De Groef et al., 2015 [22]

18 RCTs

Passive mobilization, manual stretching, myofascial therapy, active exercises

1105 (61–439). Women who had undergone surgery for BC with axillary lymph node dissection and/or sentinelnode biopsy and/or modified radical mastectomy.

To investigate the effectiveness of four different physical therapy modalities on postoperative upper limb pain and impaired ROM after BC treatment.

Inclusion: women who had undergone surgery for BC. The physical therapy programme had to be started within 6 weeks of surgery.

Primary: pain and/or ROM of the shoulder. Secondary: e.g. decreased strength, arm lymphoedema, limitations in activities of daily living, QoL, wound drainage volume, seroma formation, punction volume.

McNeely et al., 2010 [37]

24 RCTs

Exercise for upper limb dysfunction: 1) active or active-assisted ROM exercises; 2) passive ROM/manual stretching exercises; 3) stretching exercises (including formal exercise interventions such as yoga and Tai Chi Chuan); 4) strengthening or resistance exercises.

2132 (21–344). Women who had undergone surgical removal of breast tumour (e.g. radical mastectomy, modified radical mastectomy, local wide excision and lumpectomy); axillary lymph node dissection (AND)/SNB/sentinel node dissection.

To examine RCTs for evidence of effectiveness of exercise interventions to prevent, minimize and/or improve upper limb dysfunction due to BC treatment.

Inclusion: RCTs; participants: 1) confirmed BC diagnosis; 2) surgical removal of breast tumour (e.g. radical mastectomy, modified radical mastectomy, local wide excision and lumpectomy);3) axillary lymph node dissection (AND)/SNB/sentinel node dissection; 4) adults: 17 years and older. Exclusion: cancer other than BC except BC subgroup.

Primary: upper extremity ROM, muscular strength, lymphoedema, pain. Secondary: upper extremity/shoulder function and QoL. Early post-operative complications (adverse events).

Short et al., 2013 [45]

10 RCTs

Behavioural change interventions for physical activity

1299 (36–404). Adult post-treatment (not including hormone therapy) BC survivors.

To examine the efficacy of behavioural interventions for promoting physical activity among post-treatment BC survivors.

Inclusion: studies that 1) examined the efficacy of at least one behaviour modification intervention designed to promote physical activity (i.e. aerobic activity and/or resistance training) among adult post-treatment (not including hormone therapy) BC patients; 2) included either self-reported or objectively assessed physical activity behaviour change as a study outcome; and 3) used an individual or cluster randomized controlled design. Exclusion: studies that 1) were published in a language other than English; 2) reported the efficacy of a physical activity intervention that did not involve behaviour change techniques (for example, a supervised exercise programme with no intervention component targeting increased knowledge or skills); 3) included mixed samples of cancer survivors (including BC survivors) and did not report intervention effects specifically by cancer type; 4) included BC survivors still undergoing active treatment (defined as: surgery, chemotherapy and radiotherapy); or 5) were available as a conference abstract only.

Physical activity (self-reported, using a pedometer or accelerometer).

Complementary and alternative medicine

Chao et al., 2009 [18]

26 RCTs

Acupoint stimulation

1548 (5–160). Adults with BC at any stage and undergoing treatments (surgery, radiotherapy, chemotherapy, hormonal therapy, or palliative treatment for metastatic BC), experiencing treatment-induced adverse events.

To scrutinize the evidence of using acupuncture point stimulation by any modality for managing adverse events related to anticancer therapies in patients with BC.

Inclusion: 1) study design: clinical trials including RCTs, CCTs, or single-group studies; 2) participants: adults who were diagnosed with BC at any stage and undergoing treatments such as surgery, radiotherapy, chemotherapy, hormonal therapy, or palliative treatment for metastatic BC, and experiencing treatment-induced adverse events; 3) intervention: stimulation of acupuncture points by any modality; 4) outcome measures: at least one clinically related outcome variable such as symptom scores; as well as condition-specific outcomes or generic health status outcomes. Exclusion: animal studies, case reports and anecdotal evidence, qualitative studies or descriptive surveys, and reports that were available only in abstract form; as well as diagnosis other than BC unless separate data were available for the BC subgroup.

Chemotherapy-induced nausea vomiting, vasomotor syndrome, post-operational pain, radiotherapy or chemotherapy-induced leukopenia, AI-induced arthralgia, and BC-related lymphoedema.

Pan et al., 2014 [40]

18 RCTs

Massage

950 (14–134). Female participants aged 18 years or older, history of BC, receiving active BC treatment. Mostly stage I-III.

To assess the efficacy of massage on treatment-related side effects and QoL in patients with BC.

Inclusion: participants: 1) aged 18 years or older and 2) with a history of BC and 3) receiving active BC treatments; studies: 4) RCTs which examined the effects of massage on treatment-related symptoms (pain, fatigue, sleep disturbances, gastrointestinal symptoms and/or negative mood).

Depression, anger, anxiety, fatigue, pain, upper limb lymphoedema, cortisol, HRQoL.

Lee et al., 2016 [34]

23 RCTs

Acupoint stimulation, massage therapy and expressive writing.

2346 (12–507). Female BC patients without any restrictions on age, race, status of severity, duration of cancer or clinical status. Mostly stage 0-IIIa.

To determine the effects on QoL, negative emotions and disease-related symptoms among women with BC.

Inclusion: all women with BC, without any restrictions on age, race, status of severity, and duration of cancer. There were no restrictions regarding patients’ clinical status (e.g. active treatment or post-treatment). Exclusion: studies involving interventions for people with a range of conditions (including people with cancers other than BC).

Primary: QoL and pain. Secondary: anxiety, depression, fatigue, sleep quality.

Lee et al., 2010 [33]

3 RCTs, 4 CTs

Tai Chi

201 (30–78). BC patients stage I-IV.

To critically evaluate the clinical trial evidence for or against the effectiveness of Tai Chi for providing supportive care in patients with BC.

Inclusion: prospective CCTs, Tai Chi alone or combined with other treatments. Exclusion: trials with designs that did not allow for an evaluation of the effectiveness of the intervention (e.g. by using treatments of unproven efficacy in the control group or comparing two different forms of Tai Chi).

Primary: symptoms. Secondary: survival rate, QoL.

Pan et al., 2015 [41]

9 RCTs

Tai Chi

273 (16–73). Female participants aged 18 years or older, history of BC, received active BC treatment. Mostly stage I-III.

To evaluate measures of pathology, physical activity, and overall wellbeing from the available RCTs.

Inclusion: participants: 1) aged 18 years or older; 2) had a history of BC; and 3) received active BC treatment; studies: 4) examined the effects of Tai Chi Chuan on psychological symptoms (stress, anxiety, and/or depression), treatment-related symptoms (e.g. pain and/or fatigue), or regulation of inflammatory responses and other biomarkers.

Pain, Interleukin 6, Insuline-like Growth Factor 1, Handgrip Dynamometer, Flexibility (degrees), BMI, physical, social or emotional well-being, general HRQoL.

Yan et al., 2014 [49]

9 RCTs

Tai Chi

407 (19–134). BC survivors.

To assess the effects of Tai Chi on QoL and other important clinical outcomes in BC survivors.

Inclusion: 1) participants: patients with diagnosed BC; 2) intervention: Tai Chi or TaiJi Chuan exercise with or without other treatments; 3) comparison: other treatments including standard support therapy, psychosocial support therapy, usual health care, or other forms of exercise.

Primary: QoL. Secondary: BMI, bone mineral density, muscle strength.

Yoga

Pan et al., 2017 [42]

16 RCTs

Yoga

930 (18–128). Patients with stage 0-III BC and patients with cancer of varying stages.

To determine whether yoga as a complementary and alternative medicine was associated with enhanced health and treatment-related side effects in patients with BC, and examine whether yoga practice provides any measurable benefit, both physically and psychologically, for women with BC.

Inclusion: female participants 1) aged 18 years or older; 2) with a history of BC; and 3) receiving active BC treatments. Studies: 1) RCTs if they examined the effects of yoga practices on psychological symptoms (stress, anxiety and/or depression) and treatment-related symptoms (pain, fatigue, sleep disturbances and/or gastrointestinal symptoms); 2) different control groups in RCTs examining clinical characteristics in parallel to yoga therapy.

Depression, anxiety, physical wellbeing, overall HRQoL, fatigue, sleep quality, gastrointestinal symptoms, and pain.

Cramer et al., 2012 [20]

12 RCTs

Yoga

742 (19–168). BC patients and survivors.

To assess and meta-analyse the evidence for effects of yoga on HRQoL and psychological health in BC patients and survivors.

Inclusion: 1) RCTs if published as full paper; 2) studies of adult (> 18 years) patients with a history of BC; 3) studies comparing yoga with no treatment or any active treatment. Studies were eligible if they assessed HRQoL or wellbeing (global HRQoL, mental, physical, functional, social, and/or spiritual wellbeing) and/or psychological health (depression, anxiety, perceived stress, and/or psychological distress). If available, safety data served as secondary outcome measures. Exclusion: if yoga was not the main intervention but part of a multimodal intervention.

Primary: short and long-term effect on HRQoL or wellbeing (global HRQoL, mental, physical, functional, social and/or spiritual wellbeing) and/or psychological health (depression, anxiety, perceived stress and/or psychological distress, mood). Secondary: safety data, i.e. reported adverse events.

Zhang et al., 2012 [51]

6 RCTs

Yoga

382 (18–164). Women with non-metastatic or metastatic BC.

To evaluate the effects of yoga on psychologic function and QoL in women with BC.

Inclusion: 1) RCTs, comparing yoga alone or a yoga-based intervention with a control group receiving no intervention, for psychological functioning and QoL in women with BC; 2) studies that examined yoga as a main intervention. Exclusion: 1) studies that included yoga as part of a larger intervention programme (e.g. mindfulness stress-reduction training), and those that did not provide findings specific to yoga.

Anxiety, depression, distress, perceived stress, fatigue, sleep and QoL.

Cramer et al., 2017 [21]

24 RCTs

Yoga

2166 (18–309). Women with non-metastatic BC (23 RCTs) and non-metastatic and metastatic carcinoma (1 RCT).

To assess effects of yoga on HRQoL, mental health and cancer-related symptoms.

Inclusion: RCTS assessing effects of yoga in women with BC (histologically confirmed diagnosis of non-metastatic or metastatic carcinoma) who were undergoing treatment or had completed treatment, or both. Exclusion: studies not providing measures of dispersion.

Primary: HRQoL, depression, anxiety, fatigue and sleep disturbances. Secondary: safety of the intervention, assessed as number of women with adverse events and number of women with severe adverse events.

Keilani et al., 2016 [32]

9 RCTs

Resistance exercise

957 (17–242). BC patients with or at risk of secondary lymphoedema (changes in BC survivors with pre-existing lymphoedema, the volume of the upper extremities in BC survivors at risk of lymphoedema, or included BC survivors both with or without pre-existing lymphoedema).

To investigate firstly, whether resistance exercise increases the risk/causes of development of BCRL and, secondly, whether patients with BCRL deteriorate, improve, or stay the same with resistance exercise.

Inclusion: prospective randomized controlled studies investigating the effect of a resistance exercise intervention on development of secondary lymphoedema in BC survivors.

Lymphoedema status, physical performance and function, body composition, QoL.

Singh Paramanandam et al., 2014 [46]

11 RCTs

Weight training or resistance exercises

1091 (40–204). Women of any age who had lymphoedema or were at risk of developing lymphoedema during or following BC treatment (modified radical mastectomy or breast conservationsurgery along with various axillary node management).

Research questions: 1) Is weight training exercise safe for women with lymphoedema or at risk of lymphoedema after BC? 2) Does weight training exercise improve muscle strength, QoL and BMI in this population?

Inclusion: 1) RTs conducted after 2001; 2) women with BC diagnosis with or at risk of developing lymphoedema; 3) weight training exercises.

Lymphoedema onset or exacerbation, limb strength, QoL, BMI.

Lymphoedema treatment

Cheema et al., 2014 [19]

15 RCTs

Progressive resistance training

1652 (21–232). Women surgically treated for primary tumour of the breast. Completion of all BC-related treatments (except hormonal therapy) or initiation of chemotherapy treatment for BC. Lymph node dissection (or SNB) and/or clinical diagnosis of lymphoedema by clinician.

To assess the safety and efficacy of progressive resistance training in BC.

Inclusion: 1) participants: women surgically treated for primary tumour of the breast; 2) intervention: PRT interventions at least 6 weeks in duration; 3) studies: studies including flexibility training plus PRT (PRT involving aspects of flexibility training, i.e. loaded movements throughout a complete ROM). Where multiple PRT interventions were tested, higher-intensity regimens were prioritized over lower-intensity regimens; published in English. Exclusion: Intervention studies that prescribed aerobic training plus PRT, unless a comparison group undertook the same dosage of aerobic training in isolation.

Primary: safety: 1) cases of BCRL incidence or exacerbation during the trial; 2) arm volume outcomes; and 3) BCRL symptom severity comparison between the treatment and the control group.Secondary: efficacy: 1) upper body strength; 2) lower body strength; 3) comparison of HRQoL after intervention (post-treatment) between the treatment and the control group.

Huang et al., 2013 [27]

10 RCTs

MLD

566 (24–158). Women who had undergone mastectomy with axillary lymph node dissection.

To evaluate the effectiveness of MLD in the prevention and treatment of BCRL.

Inclusion: 1) women who had undergone mastectomy with axillary lymph node dissection; inclusion criteria also concerned: 2) the MLD technique used; 3) the compression strategy used; 4) the definition of lymphoedema; and 5) evaluation of lymphoedema severity. Exclusion: 1) patients who had not received axillary lymph node dissection (e.g. in studies in which only sentinel node sampling was used); 2) studies in which the clinical outcomes had not been clearly stated; and 3) duplicate reporting of patient cohorts.

Incidence of lymphoedema, reduction in lymphoedema volume.

Devoogdt et al., 2010 [23]

10 RCTs, 5 CTs

Combined Physical Therapy, Intermittent Pneumatic Compression, arm elevation.

656 (14–80). Patients with arm lymphoedema, in the majority developed after axillary dissection for BC.

To review the available literature on different physical treatment modalities for lymphoedema.

Inclusion: RCTs, pseudo-randomised controlled trials and non-randomised experimental trials investigating the effectiveness of Combined Physical Therapy and its different parts, of Intermittent Pneumatic Compression and of arm elevation were included.

Arm volume, shoulder mobility, musclestrength, subjective symptoms, tissue elasticity, skinfold thickness and quality of life.

Omar et al., 2012 [39]

8 RCTs

Low-level laser therapy

230 (10–64). Women with unilateral lymphoedema secondary to BC surgery and/or radiotherapy.

To review the effect of low-level laser therapy on management of BCRL.

Inclusion: RCTs and uncontrolled trials. Women (greater than 18 years old) with unilateral lymphoedema secondary to BC surgery and/or radiotherapy. Exclusion: recurrent malignant disease.

Volume and/or circumference.

Shao et al., 2017 [44]

4 RCTs

MLD

234 (41–88). Patients undergoing treatment of breast carcinoma and having lymphoedema.

To compare the effectiveness of MLD for the management of BCRL.

Inclusion: patients undergoing treatment of breast carcinoma and having lymphoedema defined as a minimum of 10% or 2 cm or 150 mL volume difference between the affected and the unaffected arm.

Primary: volume reduction. Secondary: improvement of symptoms and arm function.

Ezzo et al., 2015 [25]

6 RCTs

MLD

426 (52–95). Women diagnosed with BCRL in any body area (i.e. arm, hand, trunk).

To assess the efficacy and safety of MLD in treating BCRL.

Inclusion: randomized or quasi-randomized (i.e. allocated by alternate assignment, date of birth, etc) trials in any language.

Primary: 1) volumetric changes in arm, hand, breast or trunk; 2) adverse events. Secondary: functional measures, subjective sensations, QoL and other psychosocial outcomes, cost of care, any other outcome reported by the trial.

Rogan et al., 2016 [43]

32 RCTs

Lymphatic drainage or lymph tape or compression bandage or sleeve or intermittent pneumatic compression or exercise.

1337 (14–141). Female BC patients with lymphoedema.

To study the effects of compression (bandages) and active exercise during the intensive phase of therapy on the reduction of lymphoedema in BC patients.

Inclusion: 1) RCTs; 2) adequate statistics for a meta-analysis; 3) written in English or German. Exclusion: 1) effects of drugs, hormonal therapy, or radiation and surgical procedures; 2) studies in children; 3) non-BCs, lower-extremity oedema; 4) impact on fatigue only; 5) diet, or sexually transmitted diseases; 6) cost analysis only; and 7) non-carcinogenic syndromes or 8) prevention of BC.

Volume or oedema reduction.

Stuiver et al., 2015 [47]

10 RCTs

Conservative lymphatic interventions

1205 (48–205). Participants of both sexes and all ages at risk of developing lymphoedema in the upper limb after treatment for BC (surgical treatment for BC with axillary lymph node dissection, SNB or axillary sampling, with or without radiotherapy to the axilla or the supraclavicular fossa or both, or radiotherapy alone).

To assess the effects of conservative (non-surgical and non-pharmacological) interventions for preventing clinically detectable upper limb lymphoedema after BC treatment.

Inclusion: 1) studies: RCTs that reported secondary lymphoedema as the primary outcome, and that compared a conservative intervention to either usual care, placebo intervention, or some other intervention. No language or publication date restrictions were imposed. We only considered research published in peer-reviewed scientific journals; 2) participants: persons of both sexes and all ages at risk of developing lymphoedema in the upper limb after treatment for BC; 3) intervention: surgical treatment for BC with axillary lymph node dissection, SNB or axillary sampling, with or without radiotherapy to the axilla or the supraclavicular fossa or both; or radiotherapy alone. Exclusion: persons diagnosed with lymphoedema/cancer recurrence.

Primary: lymphoedema (circumference measurements, water displacement methods, bioimpedance measurements, laser scanning, perimetry and dual-energy X-ray absorptiometry scanning), time to event. Secondary: infection, ROM of the upper limb, activities of daily living, pain, HRQoL.

Psychosocial interventions

Fors et al., 2011 [26]

18 RCTs

Psychoeducational information

3272 (27–303). Women with BC undergoing surgery and adjuvant treatment.

To determine the effectiveness of psychoeducation, CBT and social support interventions used in the rehabilitation of BC patients.

Inclusion: RCTs studying the effect of psychosocial interventions on BC rehabilitation in ≥20 female BC patients after undergoing surgery and adjuvant treatment in groups. Exclusion: studies with metastatic BC patients and studies including other cancer types; data not presented separately for BC; low-quality studies; < 20 participants in each group.

QoL, fatigue, mood, health behaviours and social function.

Matsuda et al., 2014 [35]

8 RCTs

Psychoeducation and psychosocial support

1159 (49–256). Early-stage BC patients.

To evaluate the effectiveness of psychosocial and especially psycho-educational support interventions to improve QoL for early-stage BC patients, with a follow-up of up to 6 months after completing the intervention.

Inclusion: RCTs on BC comparing a group receiving social support with a control group. Exclusion: 1) patients with metastatic or advanced-stage cancer; 2) intervention studies that included exercise as social suport; 3) studies not reporting adequate information on the randomization process and not reporting HRQoL data using a QoL questionnaire.

Global QoL, BC symptoms, emotional wellbeing.

Johanssen et al., 2013 [30]

16 RCTs, 10 CTs

Patient education, supportive group therapy, relaxation therapies

2193 (8–309). Women with BC, stage 0 to IV, most of whom completed treatment.

To systematically review and quantify the existing research on the effect of psychosocial interventions on pain in BC patients and survivors.

Inclusion: Studies that presented data on a psychosocial interventions, including both baseline and post-intervention measures of pain, and that reported data on BC populations and used a quantitative research approach.

Pain.

Matthews et al., 2017 [36]

22 RCTs, 10 CTs

CBT, psychoeducational interventions, support groups, counselling, supportive-expressive group therapy, mindfulness-based stress reduction programme, psychosexual intervention, music therapy and progressive music relaxation training

4148 (20–442). Women after BC surgery.

To identify the efficacy of psychosocial interventions for women following BC surgery.

Inclusion: 1) participants: female adult BC survivors following any type of primary BC surgery; 2) intervention: psychological, psychoeducational, and/or psychosocial intervention; 3) studies: written in English; using quantitative methodology; presenting empirical findings. Exclusion: 1) interventions with focus on physical rehabilitation, physiological outcomes, and palliative and/or metastatic BC; 2) research published as a conference abstract or a case study.

Anxiety, depression, QoL, mood disturbance, distess, body image, sleep disturbance, self-esteem, sexual function.

Huang et al., 2016 [28]

3 RCTs, 5 CTs

Mindfulness-based stress reduction programme

964 (13–336). Women with BC.

To evaluate the benefits of mindfulness-based stress reduction programme on psychological distress among BC survivors.

Inclusion: RCT and before-and-after intervention study comparing mindfulness-based stress reduction programme with standard/usual care in women diagnosed with BC. Outcomes: QoL and psychological domains. Exclusion: mixed cancers; unpublished or duplicate data, insufficient raw data.

Primary: psychological domains such as depression, anxiety, stress. Secondary: effects on QoL.

Xiao et al., 2017 [48]

13 RCTs

Psychological education, relaxation training, psychological counselling, CBT

966 (−). Women who had been diagnosed with BC and had undergone BC surgery.

To assess the efficacy of individually delivered CBT in improving the depressive symptoms of women with BC.

Inclusion: RCTs comparing individually delivered CBT or CBT-based interventions with a control group receiving no intervention for depression disorders in women after BC surgery.

Depression and anxiety.

Jassim et al., 2015 [29]

28 RCTs

Cognitive behavioral interventions, psychotherapy counselling and informational and psycho-educational therapy

3940 (14–575). Women witth non-metastatic BC.

To assess the effects of psychological interventions on psychologicalmorbidities, QoL and survival among women with non-metastatic BC.

Inclusion: 1) RCTs comparing any form of psychological or behavioural intervention with a placebo, waiting list controls or an alternative form of psychological intervention; 2) women with a histologically confirmed diagnosis of breast carcinoma of an early non-metastatic stage.

Primary: depression, anxiety, stress and mood disturbance. Secondary: effects on QoL, coping, adjustment and survival.