Abstract：
OBJECTIVE: Improvements in breast cancer management continue to increase survival and life expectancy after treatment. Yet the adverse effects of treatment may persist long term, threatening physical, psychological, and social wellbeing, leading to impaired quality of life (QOL). Upper-body morbidity (UBM) such as pain, lymphoedema, restricted shoulder range of motion (ROM), and impaired function are widely reported after breast cancer treatment, but evidence demonstrating its impact on QOL is inconsistent. Therefore, the aim of the study was to conduct a systematic review and meta-analysis evaluating the effect of UBM on QOL following primary breast cancer treatment.
METHODS: The study was prospectively registered on PROSPERO (CRD42020203445). CINAHL, Embase, Emcare, PsycInfo, PubMed/Medline, and SPORTDiscus databases were searched for studies reporting QOL in individuals with and without UBM following primary breast cancer treatment. Primary analysis determined the standardised mean difference (SMD) in physical, psychological, and social wellbeing scores between UBM + /UBM - groups. Secondary analyses identified differences in QOL scores between groups, according to questionnaire.
RESULTS: Fifty-eight studies were included, with 39 conducive to meta-analysis. Types of UBM included pain, lymphoedema, restricted shoulder ROM, impaired upper-body function, and upper-body symptoms. UBM + groups reported poorer physical (SMD = - 0.99; 95%CI = - 1.26, - 0.71; p < 0.00001), psychological (SMD = - 0.43; 95%CI = - 0.60, - 0.27; p < 0.00001), and social wellbeing (SMD = - 0.62; 95%CI = - 0.83, - 0.40; p < 0.00001) than UBM - groups. Secondary analyses according to questionnaire showed that UBM + groups rated their QOL poorer or at equal to, UBM - groups across all domains.
CONCLUSIONS: Findings demonstrate the significant, negative impact of UBM on QOL, pervading physical, psychological, and social domains.
CONCLUSIONS: Efforts to assess and minimise the multidimensional impact of UBM are warranted to mitigate impaired QOL after breast cancer.
METHODS: The study was prospectively registered on PROSPERO (CRD42020203445). CINAHL, Embase, Emcare, PsycInfo, PubMed/Medline, and SPORTDiscus databases were searched for studies reporting QOL in individuals with and without UBM following primary breast cancer treatment. Primary analysis determined the standardised mean difference (SMD) in physical, psychological, and social wellbeing scores between UBM + /UBM - groups. Secondary analyses identified differences in QOL scores between groups, according to questionnaire.
RESULTS: Fifty-eight studies were included, with 39 conducive to meta-analysis. Types of UBM included pain, lymphoedema, restricted shoulder ROM, impaired upper-body function, and upper-body symptoms. UBM + groups reported poorer physical (SMD = - 0.99; 95%CI = - 1.26, - 0.71; p < 0.00001), psychological (SMD = - 0.43; 95%CI = - 0.60, - 0.27; p < 0.00001), and social wellbeing (SMD = - 0.62; 95%CI = - 0.83, - 0.40; p < 0.00001) than UBM - groups. Secondary analyses according to questionnaire showed that UBM + groups rated their QOL poorer or at equal to, UBM - groups across all domains.
CONCLUSIONS: Findings demonstrate the significant, negative impact of UBM on QOL, pervading physical, psychological, and social domains.
CONCLUSIONS: Efforts to assess and minimise the multidimensional impact of UBM are warranted to mitigate impaired QOL after breast cancer.
摘要：
目的：乳腺癌治疗的改善可持续增加治疗后的生存率和预期寿命。然而，治疗的副作用可能会长期持续，威胁身体，心理,和社会福祉，导致生活质量（QOL）受损。上身发病率（UBM），如疼痛，淋巴水肿,限制肩部活动范围（ROM），乳腺癌治疗后功能受损被广泛报道，但证明其对生活质量影响的证据并不一致。因此,本研究的目的是进行系统评价和荟萃分析,评估UBM对原发性乳腺癌治疗后生活质量的影响.
方法：该研究在PROSPERO（CRD42020203445）上进行了前瞻性注册。CINAHL,Embase,Emcare,PsycInfo,PubMed/Medline,我们在SPORTDiscus数据库中搜索了报告原发性乳腺癌治疗后有UBM和无UBM个体生活质量的研究.初步分析确定了物理上的标准化平均差(SMD)，心理,UBM+/UBM-群体之间的社会福祉得分。次要分析确定了组间QOL得分的差异，根据问卷调查。
结果：纳入58项研究，39有利于荟萃分析。UBM的类型包括疼痛，淋巴水肿,限制肩部ROM，上身功能受损，和上身症状.UBM组报告身体较差（SMD=-0.99；95CI=-1.26，-0.71；p<0.00001），心理（SMD=-0.43；95CI=-0.60，-0.27；p<0.00001），和社会福利(SMD=-0.62；95CI=-0.83，-0.40；p<0.00001)比UBM组。根据问卷调查进行的二次分析显示，UBM组的QOL评分较差或等于，UBM-跨所有域的组。
结论：研究结果表明，UBM对QOL的负面影响，弥漫身体，心理,和社会领域。
结论：有必要努力评估和最小化UBM的多维影响，以减轻乳腺癌后QOL受损。
方法：该研究在PROSPERO（CRD42020203445）上进行了前瞻性注册。CINAHL,Embase,Emcare,PsycInfo,PubMed/Medline,我们在SPORTDiscus数据库中搜索了报告原发性乳腺癌治疗后有UBM和无UBM个体生活质量的研究.初步分析确定了物理上的标准化平均差(SMD)，心理,UBM+/UBM-群体之间的社会福祉得分。次要分析确定了组间QOL得分的差异，根据问卷调查。
结果：纳入58项研究，39有利于荟萃分析。UBM的类型包括疼痛，淋巴水肿,限制肩部ROM，上身功能受损，和上身症状.UBM组报告身体较差（SMD=-0.99；95CI=-1.26，-0.71；p<0.00001），心理（SMD=-0.43；95CI=-0.60，-0.27；p<0.00001），和社会福利(SMD=-0.62；95CI=-0.83，-0.40；p<0.00001)比UBM组。根据问卷调查进行的二次分析显示，UBM组的QOL评分较差或等于，UBM-跨所有域的组。
结论：研究结果表明，UBM对QOL的负面影响，弥漫身体，心理,和社会领域。
结论：有必要努力评估和最小化UBM的多维影响，以减轻乳腺癌后QOL受损。
