1963

UCD: 618.19-006.6-089 616.89-008.454 DOI: 10.24411/1995-5871-2020-10128

THE PREVALENCE OF ANXIETY AMONG ADVANCED BREAST CANCER PATIENTS:

A SYSTEMATIC REVIEW AND META-ANALYSIS

*1
I. Karibayeva, 2 B.Turdaliyeva, 3 Nor Zuraida Zainal, 4 F. Bagiyarova
Kazakh medical university of continuing education, Almaty
1, 2

3
University of Malaya, Kuala Lumpur, Malaysia
4
S.D. Asfendiyarov Kazakh National medical university, Almaty

SUMMARY

Background. Anxiety in patients with metastatic or recurrent breast cancer is a common

psychological comorbidity. This study aims to systematically review the current literature
on observational studies with data on the prevalence of anxiety in metastatic and recurrent
breast cancer patients, examine the pooled mean prevalence of anxiety and potential sources of
heterogeneity.
Methods. An extensive systematic review of PubMed, Web of Science, ScienceDirect,
Google Scholar, and Open Grey databases, and following hand-search of the reference list of
the included studies was performed.
Results. We identified 16 eligible studies that assessed 1284 patients on the presence of
anxiety using structured interviews and two self-report inventories. In total, 371 patients met
the criteria for anxiety. According to the random-effects model, the pooled mean prevalence of
anxiety was 29.93% (95% CI [23.22; 37.09]; I2= 86%). Studies that reported the prevalence of
anxiety in the last fifteen years had the same rate as the studies that were published in the fifteen
years before that.
Limitations. Only studies in English were included; no studies from African and South-
East Asia regions met the criteria; we did not have enough data on the time between diagnosis
of breast cancer to the time of the anxiety evaluation; the heterogeneity of the included studies
was high. Conclusions. Around one-third of patients with advanced breast cancer are diagnosed
with anxiety. Breast cancer patients’ high psychological needs have to be recognized and met
not only at primary diagnosis but also at recurrence and progression of the disease.
Key words: Breast cancer, anxiety, metastatic, recurrent, systematic review.

Background. As cancer, regardless diagnosis include anxiety, confusion,

of its localization, is a chronic disease that depression, and stress, and some studies show
requires constant monitoring and complex that patients who experience psychological
treatment, and even then can significantly limit distress have a higher rate of cancer related
Наука о жизни и здоровье №4, 2020

the longevity of a person, there is a certain
amount of fear and concern about getting
cancer in the general population [1]. Fear of
being diagnosed with cancer is one of the main
reasons why people delay seeking medical
help in time [2]. Understandably, patients
with cancer experience a high psychological
burden as they have to accept their diagnosis,
prognosis and prepare themselves for the
treatment strategy, and deal with the change
in their normal life [3]. Often the emotional
experiences of patients about their cancer
mortality [4]. Because breast cancer is one
of the most prevalent oncological diseases
affecting women [5], and women are more
likely to have higher levels of psychological
symptoms [6], a huge number of studies have
been devoted to investigating the psychological
needs of breast cancer patients and long-term
survivors, and factors associated with them.
According to a systematic review of the
descriptive studies that assessed depression
among Iranian breast cancer patients,
the prevalence of severe and very severe

*indira.karibayeva@gmail.com
80
depression varied from 10% to 69.4% [7].
Significant variation in depression prevalence
among breast cancer patients was also shown
in a study that combined results of 72 non-
intervention studies, where the depression
prevalence ranged from 3% to 95.9% [8].
A study that reviewed 27 articles with the
assessment of the anxiety prevalence among
breast cancer patients also found that the
presence of anxiety of any degree stretched
from 4.1% to 97.5% [9]. Those variations
make the investigation of the impact of the
psychological experiences on the quality of
life and overall survival of the patients crucial,
as some studies show that underdiagnosed
depression and anxiety can reduce the quality
of life and cause higher economical loss [10].
In 2013, a review of the literature showed
that among long-term breast cancer survivors
the depression prevalence varied from 1% to
56% [11]. Breast cancer survivors regardless
of the time since diagnosis experience high
levels of anxiety and unmet psychological
care needs [12]. A study among long-term
cancer survivors showed that less than 50% of
the survivors received psycho-social care after
diagnosis [13]
We have yet to understand the patterns
of anxiety duration and severity among breast
cancer patients, and its impact on the quality
of life, treatment efficacy, and overall survival
of the patients. Important questions that arise
are: how effective is the regular screening
for psychological needs; what approach for
regular screening should be implemented;
does the prevalence of psychological disorders
vary in recurrent and metastatic breast cancer
patients versus non-advanced breast cancer
patients.
To the authors’ best knowledge, a
systematic review of the articles that assessed
the prevalence of anxiety among metastatic
and recurrent breast cancer patients has not
been published. It is important to determine,
whether advanced breast cancer patients
experience a high psychological burden,
and whether special policies should be
implemented to address their unmet needs.
This study aims to systematically review
the current literature on observational studies
with data on the prevalence of anxiety in
metastatic and recurrent breast cancer patients,
examine the pooled mean prevalence of
anxiety and potential sources of heterogeneity.
Methods. The study protocol is
registered with the PROSPERO International
prospective register of systematic reviews (ID:
CRD42020153960).
Search strategy. The PROSPERO
database was searched to identify the
registration of studies that assessed the
prevalence of anxiety among metastatic
and recurrent breast cancer patients, and
similar studies were not found. Therefore,
for this review, PubMed, Web of Science,
ScienceDirect, Google Scholar, and Open
Grey databases were searched from January
1990 till May 2020. The full search strategy
of the databases is presented in supplemental
materials. After the initial selection of the
studies from the database search, we performed
a hand search of the literature based on the list
of references of the selected articles from the
database search.
Eligibility criteria. In this review, we
used methods from the Preferred Reporting
Items for Systematic Reviews and Meta-
Analyses (PRISMA). The inclusion criteria for
the studies: 1) included adults (aged ≥18); 2)
patients had a primary diagnosis of metastatic
(stage IV) or recurrent (local, regional, or
distant) breast cancer; 3) reported either
proportion or number of patients with anxiety
using standard evaluation methods; 4) were
observational; 5) published in English from
January 1990 to May 2020. The exclusion
criteria: 1) publications that lacked required
information; 2) publications that duplicated
previously reported study results; 3) had a
high risk of bias; 4) focused specifically on
younger or older patient groups;
Selection of studies and data extraction.
Following the PRISMA guidelines, the
database search, selection of studies based
on their inclusion/exclusion criteria, and
Наука о жизни и здоровье №4, 2020
data extraction were performed by two
independent researchers (IK and FB) [14].
Up to two contacts via email were made to
authors to obtain missing data. The required
information list was created and approved by
all authors, and included: first author, year,
country, study design, sampling, number of
eligible and approached patients, number of
responded patients, number of patients with
anxiety, anxiety evaluation scale, mean age,
the proportion of married patients, number of
patients with depression and risk of bias.
Quality assessment. The nine-
81
 1963
item Hoy quality assessment checklist for
prevalence studies was used to evaluate the
risk of bias of the included studies [15]. The
risk of bias is low if the study Hoy score is
≤3. Each researcher evaluated the risk of bias
independently for every included article, and
disagreements, when present, were resolved
through consensus of three authors.
Data analysis. Data analysis was
performed using R-studio statistical
software. The outcome of interest was
the number of patients with anxiety. Data
were combined using a forest plot. The
pooled average prevalence of anxiety was
calculated with Freeman-Tukey double
arcsine transformation using random-effects
restricted maximum likelihood estimator
to handle small sample sizes and extreme
proportions. To account for some level
of between-study variability and identify
potential influential studies for the meta-
analysis results we calculated the studentized
residuals, performed a leave-one-out analysis,
and calculated the pooled mean prevalence
of anxiety when the influential studies were
removed. To examine whether clinical and
sociodemographic factors account for the
heterogeneity in the prevalence of anxiety
among metastatic and recurrent breast cancer
Наука о жизни и здоровье №4, 2020
Figure №1. The PRISMA flowchart of study selection
82
patients, we performed the univariable meta-
regression analysis. To further explore the
sources of heterogeneity, several subgroup
analyses were performed. For the subgroup
analysis, because of the different sample
sizes, we assumed a common between-study
variance component and pooled within-group
estimates of between-study variance.
Assessment of risk of bias across
studies. To detect the risk of publication
bias, we plotted the proportion of patients
with anxiety in each included study by the
inverse of its standard error, and then by the
inverse of the sample size. Visually examined
the funnel plots, and performed the Egger’s
unweighted regression test for funnel plot
asymmetry.
Results. The initial search of PubMed,
Web of Science, ScienceDirect, Google Scholar,
and Open Grey retrieved 2 814 articles. After
eliminating duplicates, not relevant articles,
systematic reviews, letters to the editor, 94
studies were screened for their eligibility
criteria, and thirteen studies met the criteria.
The reference search included 421 references
listed in the included articles, where three
articles met the inclusion criteria. A secondary
reference search included 112 articles, but no
additional studies were selected (Figure №1).
 Characteristics of included studies.
The proportion or number of patients with
anxiety was reported in sixteen studies, using
three different diagnostic methods, such as
structured interview, Beck Anxiety Inventory
(BAI), and Hospital Anxiety and Depression
Scale (HADS). HADS was the most frequently
used anxiety inventory, as it was used in nine
studies. Studies were conducted in eight
countries, with seven studies taking place in
the United Kingdom (UK), and three in Japan.
In all included papers the sampling method
was consecutive. Twelve studies employed the
cross-sectional design, two studies employed
the cohort design, one study employed the
descriptive design and one study used the
prospective design. The sample size ranged
from 22 to 211 participants, with a mean
sample size of 80 participants. All included
articles had a low risk of bias and scored three
Table №1. Demographic characteristics of the included studies
or below on the Hoy scale.
1 373 patients were eligible and
approached, and 1 284 (93.52%) patients
agreed to participate in the prevalence studies.
The mean age of participants was 55.35 (range:
47-65). In total, 371 patients met the criteria
for anxiety. The lowest prevalence of anxiety
of 12% according to the structured interview
results was reported among 25 recurrent breast
cancer patients in Egypt [16]. The highest
prevalence of anxiety of 66% was reported
among 44 metastatic breast cancer patients in
the UK [17]. In a study by El Missiry and
colleagues, the prevalence of anxiety was
reported according to the structured interview
(DSM-IV) and BAI results, only the number
of patients with anxiety according to the
structured interview results was included to
the present count and meta-analysis of patients
with anxiety [16] (Table №1)

Наука о жизни и здоровье №4, 2020

Abbreviations: BAI, Beck Anxiety Inventory; HADS, Hospital Anxiety and Depression
Scale; mts, metastasis; n, number; Pts, patients; SD, standard deviation; UK, the United
Kingdom; USA, the United States of America; WHO, World Health Organization

Pooled mean prevalence of anxiety. 86%). Test for heterogeneity suggests

Based on the random-effects model, the high heterogeneity in the anxiety
pooled mean prevalence of anxiety was prevalence: Q (df = 15) = 104.59, p-val <
29.93% (95% CI [23.22; 37.09]; I2= 0.0001 (Figure №2).

83
 1963

Figure №2. Prevalence of anxiety based on the random-effects model among advanced breast
cancer patients

(Abbreviations: CI, confidence interval; I2, percentage of variability in the effect sizes
which is not caused by sampling error; Tau2, between-study variance in the meta-analysis; Chi2,
(Q-statistic) difference between the observed effect sizes and the fixed-effect model estimate of
the effect size).

According to the analysis that identifies
the most influential studies, studentized
residuals that are larger than “2” were identified
in two studies with the highest prevalence of
anxiety of more than 60% [17] [18]. When
those studies were removed, the pooled mean
prevalence of anxiety based on the random-
effects model was lower at 25.72% (95% CI
[20.89; 30.84].
Assessment of risk of bias across
studies. On the funnel plot with the standard
error on the y-axis and the proportion of
Наука о жизни и здоровье №4, 2020
clear evidence of the funnel plot asymmetry.
To examine, if the method of funnel plot
construction can induce the asymmetry, we
plotted the sample size of the included studies
on the y-axis, and the proportion of patients
with anxiety on the x-axis. The second plot also
did not have clear evidence of the asymmetry.
The Egger’s unweighted regression tests for
both plots were not statistically significant,
and returned z = 0.29, p = 0.77 for the first plot,
and z = -0.96, p = 0.34 for the second plot. Our
findings suggest that the risk of publication

patients with anxiety on the x-axis, two studies
that we previously identified as the most
influential studies were further away from the
pooled mean prevalence line. Several studies
were located outside of the 95% CI limit lines,
which is indicative of the high heterogeneity of
the included studies. Visually we did not find
bias across included studies was low.
Meta-regression finding. According to
the meta-regression findings, the publication
year, mean age of participants, being married,
being depressed and sample size did not
significantly account for the heterogeneity in
the effect sizes between studies (Table №2).

84
 Table №2. Meta-regression model results

Coefficient Estimate Standard z-value p-value
error
Publication year 0.84 0.004 0.005 0.92 0.36
(year)
Mean age (years) 0.27 -0.005 0.01 -0.52 0.61
Married patients 0.37 0.004 0.006 0.60 0.55
(%)
Depressed patients 3.02 0.005 0.003 1.74 0.08
(%)
Sample size (n) 0.93 -0.0008 0.0008 -0.96 0.34

Subgroup analysis of studies that the previous fifteen years at 30.35% (95%
reported the number of patients with CI [20.07; 41.68], I2=83%, p<0.01) and
anxiety. Subgroup analysis based on the 29.55% (95% CI [19.30; 40.91], I2=87%,
years that the studies were conducted, showed p<0.01) respectively (Figure №3). The test
that the pooled prevalence of anxiety in the for subgroup differences was not statistically
last fifteen years was almost the same as in significant, p=0.92.
Figure №3. Subgroup analysis of the depression prevalence based on the random-effects
model among advanced breast cancer patients by the years that the studies were conducted

Наука о жизни и здоровье №4, 2020

(Abbreviations: Chi2, (Q-statistic) difference between the observed effect sizes and the
fixed-effect model estimate of the effect size; CI, confidence interval; I2, percentage of variability
in the effect sizes which is not caused by sampling error; Tau2, between-study variance in the
meta-analysis).
Subgroup analysis based on the anxiety according to the HADS results at 32.15%
evaluation method showed that the pooled (95% CI [24.41; 40.40], I2=85%, p<0.01)
prevalence of anxiety among advanced breast (k=9) compared to the pooled prevalence of
cancer patients was higher when reported anxiety reported according to the interview

85
 1963

results at 20.75% (95% CI [11.98; 31.03], test for subgroup differences was statistically
I2=59%, p<0.03) (k=6) (Figure №4). The significant, p=0.01.

Figure 4. Subgroup analysis of the depression prevalence based on the random-effects model
among advanced breast cancer patients by the anxiety evaluation method

(Abbreviations: BAI, Beck Anxiety Inventory; Chi2, (Q-statistic) difference between

the observed effect sizes and the fixed-effect model estimate of the effect size; CI, confidence
interval; HADS, Hospital Anxiety and Depression scale; I2, percentage of variability in the
effect sizes which is not caused by sampling error; Tau2, between-study variance in the meta-
analysis).

Sub-group analyses based on the cancer
type showed that the combined prevalence
of anxiety was higher in studies that focused
only on metastatic breast cancer patients, and
lower in studies with recurrent (local, regional
or distant) breast cancer patients at 35.51%
Наука о жизни и здоровье №4, 2020
was not statistically significant, p=0.33.
Subgroup analysis based on the World
Health Organization (WHO) regions showed
that the pooled prevalence of anxiety was
higher in the European and in the Americas
regions at 33.07% (95% CI [23.45; 43.42],

(95% CI [25.23; 46.50], I2=92%, p<0.01)
and 23.47% (95% CI [12.60; 36.31], I2=54%,
p=0.06). The pooled prevalence of anxiety in
mixed studies that focused on recurrent and
metastatic breast cancer patients was closer
to the pooled mean prevalence of anxiety at
25.73% (95% CI [09.29; 46.72]; I2=80%,
p=0.02). The test for subgroup differences
I2=90%, p<0.01) and 32.46% (95% CI [13.69;
54.71], I2=47%, p=0.17) respectively. The
lowest prevalence of anxiety was detected in
the Eastern Mediterranean region at 12% (95%
CI [0; 45.00]). Unfortunately, we only had one
study from the Eastern Mediterranean region
(Figure №5). The test for subgroup differences
was not statistically significant, p=0.53.

86
 Figure №5. Subgroup analysis of the depression prevalence based on the random-effects
model among advanced breast cancer patients by WHO regions

(Abbreviations: Chi2, (Q-statistic) difference between the observed effect sizes and the
fixed-effect model estimate of the effect size; CI, confidence interval; I2, percentage of variability
in the effect sizes which is not caused by sampling error; Tau2, between-study variance in the
meta-analysis; WHO, World Health Organization).

Subgroup analysis based on the income
level of the country where a study was
conducted, showed that the pooled prevalence
of anxiety in upper-middle-income countries
was the highest at 48.20% (95% CI [28.69;
68.00]; I2=90%; p<0.01). The test for subgroup
differences was not statistically significant,
p=0.08.
The graphical representation of the
subgroup analysis results is presented in the
supplemental materials.
Discussion. The prevalence of anxiety
in advanced breast cancer patients varies from
could be attributable to the specific focus of
the present analysis on the advanced stage,
methodological variations, and a smaller
number of studies analyzed. A previous study
that investigated the relationship between
anxiety and depression after diagnosis and
cancer stage showed that advanced stage did
not predict higher levels of anxiety among
breast cancer patients [19].
Some authors argue that the prevalence of
anxiety in breast cancer patients has increased
in recent years [9]. In the present meta-analysis,
this factor was not analyzed, as only studies that
Наука о жизни и здоровье №4, 2020

12% to 66% according to the papers that were
included in the present analysis. Based on
the results of our meta-analysis, the global
prevalence of anxiety among 1284 advanced
breast cancer patients was 29.93% (95%
CI [23.22; 37.09]). According to the meta-
analysis of anxiety prevalence among breast
cancer patients which included twenty-seven
articles, the range of anxiety prevalence was
wider at 4.1% to 97.5%, and pooled mean
prevalence of anxiety was also higher at 41.9%
(95% CI [30.7; 53.2]) [9]. This difference
were published up to 2016 met the eligibility
criteria. Studies that reported the prevalence of
anxiety in the last fifteen years group (2005 –
2020) had the same rate as the studies that were
published in the fifteen years before that (1990
– 2014) at 30.35% (95% CI [20.07; 41.68]) and
29.55% (95% CI [19.30; 40.91]) respectively.
Exploring whether the anxiety rate of breast
patients has increased in the last five years, and
if it could be explained with the wider range of
therapeutic options presented to a patient is an
interesting topic for further research.

87
 1963
The methodology of anxiety diagnosis
has been a significant factor that could
influence the number of patients with
anxiety. Some studies show that the anxiety
diagnosis rate was higher when self-
assessment inventories were used compared
to the structured interview results [20], and
the results of the present meta-analysis
confirm previous findings. The prevalence
of anxiety reported according to the results
of the structured interview was significantly
lower than the prevalence rate reported
with the HADS inventory at 20.75% (95%
CI [11.98; 31.03]) and 32.15% (95% CI
[24.41; 40.40]) respectively. Generally,
most of the self-report scales were reported
to be designed as a screening instrument,
but not as a diagnostic tool [21] [22] [23]
[24]. Nevertheless, some authors argue that
the combined use of self-report inventories
and structured interview is the best way to
identify patients with psychological needs
[20]. Another topic for further research could
be to look at the influence of underdiagnosed
anxiety on the survival rate of breast cancer
patients.
Among clinical factors that were
explored as the potential sources of
heterogeneity, subgroup difference for cancer
type was not statistically significant, although
the metastatic group had a higher prevalence
of anxiety than the recurrent group at 35.51%
(95% CI [25.23; 46.50]) and 23.47% (95% CI
[12.60; 36.31]) respectively. Further research
is needed to explore whether the anxiety rate
of the de novo metastatic breast cancer patients
is different from the patients with recurrent
breast cancer and whether those patients
Наука о жизни и здоровье №4, 2020
require different approaches to manage their
high psychological needs. Meta-regression
analysis based on the depression prevalence
among breast cancer patients was also not
statistically significant. Nevertheless, the
correlation between the number of depressed
patients and the number of patients with
anxiety was positive.
Among sociodemographic factors that
were explored as the potential sources of
heterogeneity, we found that the European and
88
the Americas region had a higher prevalence
of anxiety (33.07% (95% CI [23.45; 43.42])
and 32.46% (95% CI [13.69; 54.71])
respectively) than the Eastern Mediterranean
region at 12% (95% CI [0; 45.00]). Previously
reported studies show that patients with breast
cancer in the Eastern Mediterranean region
have a higher prevalence of psychological
comorbidities that are attributed to the younger
age of patients, and a later stage of the disease
at diagnosis [8].
The limitations of the present systematic
review and meta-analysis are the following:
1) We only included published studies in
English, and acknowledge that we could not
eliminate the publication bias; 2) No studies
from African and South-East Asia regions
met the eligibility criteria of the present meta-
analysis; 3) We did not have enough data on
the time between diagnosis of breast cancer
to the time of the anxiety evaluation. To
make results more homogenous, we excluded
studies that reported anxiety prevalence
among long term survivors with metastatic
breast cancer [25]; 4) The heterogeneity of
the included studies was high, although we
excluded studies that: a) focused only on
geriatric or young advanced breast cancer
patients [26] [27] [28] [29]; b) had stage III
and stage IV breast cancer patients, if they did
not define their stage III patients as recurrent
[30] [31] [32] [33] or reported anxiety before
recurrence [34].
Clinical implications of our findings:
breast cancer patients’ high psychological
needs have to be recognized and met not only
at primary diagnosis but also at recurrence
and progression of the disease.
Conclusion. Our findings show that
every third patient with metastatic and
recurrent breast cancer is at risk of having
anxiety. Healthcare providers must implement
special policies to address the timely
diagnosis of the presence of psychological
disorders, initiation, and maintenance of the
adequate psycho-social care and support of
the breast cancer patients throughout the entire
course of the treatment and beyond during
their survivorsh
 REFERENCES

1. Vrinten C., McGregor L.M., Heinrich M., von Wagner C., Waller J., Wardle J., et al.
What do people fear about cancer? A systematic review and meta-synthesis of cancer fears in
the general population. Psychooncology. 2017;26:1070–9. doi:10.1002/pon.4287.
2. Cipora E., Konieczny M., Czerw A., Mikos M., Budzik M.P., Deptała A, et al. Causes
of delays in breast cancer diagnosis in Poland. Pol Merkur Lekarski. 2019;47:85–90.
3. Hack T.F., Degner L.F. Coping responses following breast cancer diagnosis predict
psychological adjustment three years later. Psychooncology. 2004;13:235–47. doi:10.1002/
pon.739.
4. Lu D., Andrae B., Valdimarsdóttir U., Sundström K., Fall K., Sparén P., et al.
Psychological distress is associated with cancer-specific mortality among patients with cervical
cancer. Cancer Res. 2019.
5. Bray F., Ferlay J., Soerjomataram I., Siegel R.L., Torre L.A., Jemal A. Global cancer
statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in
185 countries. CA Cancer J Clin. 2018;68:394–424.
6. Ahmad S, Bangash H, Khan SA. Emotional intelligence and gender differences. Sarhad
J Agric. 2009;25:127–30.
7. Jafari A., Goudarzian A.H., Bagheri Nesami M. Depression in Women with Breast
Cancer: A Systematic Review of Cross-Sectional Studies in Iran. Asian Pac J Cancer Prev.
2018;19:1–7.
8. Pilevarzadeh M., Amirshahi M., Afsargharehbagh R., Rafiemanesh H., Hashemi S.M.,
Balouchi A. Global prevalence of depression among breast cancer patients: a systematic review
and meta-analysis. Breast Cancer Res Treat. 2019;176:519–33. doi:10.1007/s10549-019-
05271-3.
9. Hashemi S.M., Rafiemanesh H., Aghamohammadi T., Badakhsh M., Amirshahi M.,
Sari M., et al. Prevalence of anxiety among breast cancer patients: a systematic review and
meta-analysis. Breast Cancer. 2019;:1–13.
10. Williams S.Z., Chung G.S., Muennig P.A. Undiagnosed depression: A community
diagnosis. SSM - Popul Heal. 2017;3:633–8. doi:10.1016/j.ssmph.2017.07.012.
11. Zainal N.Z., Nik-Jaafar N.R., Baharudin A., Sabki Z.A., Ng C.G. Prevalence of
depression in breast cancer survivors: a systematic review of observational studies. Asian
Pacific J Cancer Prev. 2013;14:2649–56.
12. Hodgkinson K., Butow P., Hunt G.E., Pendlebury S., Hobbs K.M., Wain G. Breast
cancer survivors’ supportive care needs 2–10 years after diagnosis. Support Care Cancer.
2007;15:515–23. doi:10.1007/s00520-006-0170-2.
13. Forsythe L.P., Kent E.E., Weaver K.E., Buchanan N., Hawkins N.A., Rodriguez J.L.,
et al. Receipt of psychosocial care among cancer survivors in the United States. J Clin Oncol.
Наука о жизни и здоровье №4, 2020

2013;31:1961–9. doi:10.1200/JCO.2012.46.2101.
14. Liberati A., Altman D.G., Tetzlaff J., Mulrow C., Gøtzsche P.C., Ioannidis JPA, et
al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies
that evaluate healthcare interventions: explanation and elaboration. BMJ. 2009;339:b2700.
doi:10.1136/bmj.b2700.
15. Hoy D., Brooks P., Woolf A., Blyth F., March L., Bain C., et al. Assessing risk of bias
in prevalence studies: modification of an existing tool and evidence of interrater agreement. J
Clin Epidemiol. 2012;65:934–9.
16. El Missiry A. Psychiatric Morbidity, Pattern of Coping among sample of Egyptian
Women in Early Versus Recurrent Stage of Cancer Breast. Arab J Psychiatry. 2011;Vol. 22:Page
(36-44).
17. Fulton C.L. The physical and psychological symptoms experienced by patients with

89
 1963

metastatic breast cancer before death. Eur J Cancer Care (Engl). 1997;6:262–6. doi:10.1046/
j.1365-2354.1997.00057.x.
18. Dragomir B-I, Fodoreanu L. Correlations between state anxiety and quality of life in
metastatic breast cancer patients. Medical-Surgical J. 2013;117:610–5.
19. Vodermaier A., Linden W., MacKenzie R., Greig D., Marshall C. Disease stage
predicts post-diagnosis anxiety and depression only in some types of cancer. Br J Cancer.
2011;105:1814–7. doi:10.1038/bjc.2011.503.
20. Hopwood C.J., Morey L.C., Edelen M.O., Shea M.T., Grilo C.M., Sanislow C.A., et al.
A comparison of interview and self-report methods for the assessment of borderline personality
disorder criteria. Psychological Assessment. 2008;20:81–5.
21. Mitchell A.J., Meader N., Symonds P. Diagnostic validity of the Hospital Anxiety and
Depression Scale (HADS) in cancer and palliative settings: a meta-analysis. J Affect Disord.
2010;126:335–48.
22. Wang G., Hsu S., Feng A., Chiu C., Shen J., Lin Y., et al. The HADS and the DT for
screening psychosocial distress of cancer patients in Taiwan. Psycho-oncology. 2011;20:639–46.
23. Warmenhoven F., van Rijswijk E., Engels Y., Kan C., Prins J., Van Weel C., et al.
The Beck Depression Inventory (BDI-II) and a single screening question as screening tools for
depressive disorder in Dutch advanced cancer patients. Support care cancer. 2012;20:319–24.
24. Hann D., Winter K., Jacobsen P. Measurement of depressive symptoms in cancer
patients: evaluation of the Center for Epidemiological Studies Depression Scale (CES-D). J
Psychosom Res. 1999;46:437–43.
25. Meisel J.L., Domchek S.M., Vonderheide R.H., Giobbie-Hurder A., Lin N.U., Winer
EP, et al. Quality of Life in Long-Term Survivors of Metastatic Breast Cancer. Clin Breast
Cancer. 2012;12:119–26. doi:https://doi.org/10.1016/j.clbc.2012.01.010.
26. Park E.M., Gelber S., Rosenberg S.M., Seah DSE, Schapira L., Come S.E., et al.
Anxiety and Depression in Young Women With Metastatic Breast Cancer: A Cross-Sectional
Study. Psychosomatics. 2018;59:251–8. doi:https://doi.org/10.1016/j.psym.2018.01.007.
27. Mehmood T. Evaluation of depression and anxiety in young women with metastatic
breast cancer. The Breast. 2018;41:S28–9.
28. Hamaker M.E., Seynaeve C., Wymenga ANM, van Tinteren H., Nortier JWR,
Maartense E., et al. Baseline comprehensive geriatric assessment is associated with toxicity
and survival in elderly metastatic breast cancer patients receiving single-agent chemotherapy:
Results from the OMEGA study of the Dutch Breast Cancer Trialists’ Group. The Breast.
2014;23:81–7. doi:https://doi.org/10.1016/j.breast.2013.11.004.
29. Aaldriks A.A., Giltay E.J., Le Cessie S., van der Geest LGM, Portielje JEA, Tanis
B.C., et al. Prognostic value of geriatric assessment in older patients with advanced breast
cancer receiving chemotherapy. The Breast. 2013;22:753–60.
30. Hamash K.I., Umberger W., Aktas A., Walsh D., Cheruvu V.K. The Effect of the Pain
Наука о жизни и здоровье №4, 2020

Symptom Cluster on Performance in Women Diagnosed with Advanced Breast Cancer: The
Mediating Role of the Psychoneurological Symptom Cluster. Pain Manag Nurs. 2018;19:627–
36. doi:https://doi.org/10.1016/j.pmn.2018.05.002.
31. Au A., Lam W., Tsang J., Yau T., Soong I., Yeo W., et al. Supportive care needs in Hong
Kong Chinese women confronting advanced breast cancer. Psychooncology. 2013;22:1144–51.
32. Valderrama Rios MC, Sanchez Pedraza R., Rios MCV, Pedraza R.S. Anxiety and
depression disorders in relation to the quality of life of breast cancer patients with locally
advanced or disseminated stage. Rev Colomb Psiquiatr (English ed). 2018;47:211–20.
doi:https://doi.org/10.1016/j.rcpeng.2018.10.001.
33. Akechi T., Nakano T., Okamura H., Ueda S., Akizuki N., Nakanishi T., et al. Association
Between Self-Reported Sleep Disturbance and Other Symptoms in Patients with Advanced
Cancer. Support CARE CANCER. 2018;14:549–55. doi:10.1007/s00520-016-3207-1.

90
 34. Thornton L.M., Andersen B.L., Carson W.E. 3rd. Immune, endocrine, and behavioral
precursors to breast cancer recurrence: a case-control analysis. Cancer Immunol Immunother.
2008;57:1471–81.
35. Alfano ACC, Paiva C.E., Rugno F.C., da Silva R.H., Paiva BSR. Biologically based
therapies are commonly self-prescribed by Brazilian women for the treatment of advanced
breast cancer or its symptoms. Support Care Cancer. 2014;22:1303–11. doi:10.1007/s00520-
013-2087-x.
36. Fulton C. The prevalence and detection of psychiatric morbidity in patients with
metastatic breast cancer. Eur J Cancer Care (Engl). 1998;7:232–9.
37. Hall A., Fallowfield LJ, A’Hern RP. When Breast Cancer Recurs: A 3-Year Prospective
Study of Psychological Morbidity. Breast J. 1996;2:197–203. doi:10.1111/j.1524-4741.1996.
tb00095.x.
38. Hopwood P., Howell A., Maguire P. Psychiatric morbidity in patients with advanced
cancer of the breast - prevalence measured by 2 self-rating questionnaires. Br J Cancer.
1991;64:349–52.
39. Hopwood P., Howell A., Maguire P. Screening for psychiatric morbidity in patients
with advanced breast cancer: validation of two self-report questionnaires. Br J Cancer.
1991;64:353–6.
40. Jehn C.F., Flath B., Strux A., Krebs M., Possinger K., Pezzutto A., et al. Influence of
age, performance status, cancer activity, and IL-6 on anxiety and depression in patients with
metastatic breast cancer. Breast Cancer Res Treat. 2012;136:789–94. doi:10.1007/s10549-012-
2311-2.
41. Jenkins P.L., May V.E., Hughes L.E. Psychological morbidity associated with local
recurrence of breast cancer. Int J Psychiatry Med. 1991;21:149–55.
42. Okamura M., Yamawaki S., Akechi T., Taniguchi K., Uchitomi Y. Psychiatric disorders
following first breast cancer recurrence: Prevalence, associated factors and relationship to
quality of life. Jpn J Clin Oncol. 2005;35:302–9.
43. Okamura H., Watanabe T., Narabayashi M., Katsumata N., Ando M., Adachi I., et
al. Psychological distress following first recurrence of disease in patients with breast cancer:
prevalence and risk factors. Breast Cancer Res Treat. 2000;61:131–7.
44. Pinder K.L., Ramírez A.J., Black M.E., Richards M.A., Gregory W.M., Rubens R.D.
Psychiatric disorder in patients with advanced breast cancer: prevalence and associated factors.
Eur J Cancer. 1993;29A:524–7. doi:10.1016/s0959-8049(05)80144-3.
45. Kenne Sarenmalm E., Öhlén J., Jonsson T., Gaston-Johansson F. Coping with Recurrent
Breast Cancer: Predictors of Distressing Symptoms and Health-Related Quality of Life. J Pain
Symptom Manage. 2007; 34:24–39. doi:https://doi.org/10.1016/j.jpainsymman.2006.10.017.
46. Shin J.A., El-Jawahri A., Parkes A., Schleicher S.M., Knight H.P., Temel J.S. Quality
of life, mood, and prognostic understanding in patients with metastatic breast cancer. J Palliat
Наука о жизни и здоровье №4, 2020

Med. 2016;19:863–9.
47. Uchida M., Akechi T., Okuyama T., Sagawa R., Nakaguchi T., Endo C., et al. Patients’
Supportive Care Needs and Psychological Distress in Advanced Breast Cancer Patients in
Japan. Jpn J Clin Oncol. 2011;41:530–6.

Indira Karibayeva https://orcid.org/0000-0003-1796-2604

Botagoz Turdaliyeva https://orcid.org/0000-0001-9884-0777
Nor Zuraida Zainal https://orcid.org/0000-0002-3519-711X
Fatima Bagiyarova https://orcid.org/0000-0003-0000-1321

91
 1963

List of abbreviations (used in the text)

BAI - Beck Anxiety Inventory
HADS - Hospital Anxiety and Depression Scale
PRISMA - Preferred Reporting Items for Systematic Reviews and Meta-Analyses
UK - United Kingdom
WHO - World Health Organization

СҮТ БЕЗІ ҚАТЕРЛІ ІСІГІ АУРУЫ БАР НАУҚАСТАР АРАСЫНДА МАЗАСЫЗДЫҚТЫҢ

ТАРАЛУЫ: ЖҮЙЕЛІ ШОЛУ ЖӘНЕ МЕТА-АНАЛИЗ

*1
И. Карибаева, 2Б.Турдалиева, 3 Нор Зураида Зайнал, 4 Ф. Багиярова
Қазақ медициналық үздіксіз білім беру университеті, Алматы қ-сы
1, 2

3
Малай университеті, Куала-Лумпур, Малайзия
4
С.Д. Асфендияров атындағы Қазақ Ұлттық медициналық университеті, Алматы қ-сы

ТҮЙІНДІ

Кіріспе. Метастатикалық немесе қайта пайда болған сүт безінің қатерлі ісігі бар
науқастардағы мазасыздық - бұл жалпы психологиялық ілеспе ауру. Бұл зерттеудің мақсаты
- метастатикалық және қайта пайда болған сүт безінің қатерлі ісігі бар науқастардағы
мазасыздықтың таралуы туралы мәліметтері бар обсервациялық зерттеулерді жүйелі
түрде қарастыру, мазасыздықтың жинақталған орташа таралуы мен потенциалды
гетерогенділігін зерттеу.
Әдістер. PubMed, Web of Science, ScienceDirect, Google Scholar және Open Grey
дерекқорларына кең жүйелі шолу жасап, бірінші кезекте таңдалып алынған зерттеулердің
сілтімілеріне қайта шолу жасау.
Нәтижелер. Ұсынылып отырғын жүйелі қарастыруға біз құрастырылған сұхбат
пен екі түрлі сауалнаманы қолдана отырып 1284 пациентте мазасыздықты зерттеген 16
лайықты зерттеуді қостық. Барлығы 371 науқас мазасыздық критерийлеріне сай бол-
ды. Кездейсоқ эффекттер моделіне сәйкес мазасыздықтың жинақталған орташа тара-
луы 29.93% құрады (95% CI [23.22; 37.09]; I2 = 86%). Соңғы он бес жылда баяндалған
мазасыздықтың таралуы осыдан он бес жыл бұрын шыққан зерттеулердегі мазасыздықтың
таралуына тең келді.
Шектеулер. Тек ағылшын тіліндегі зерттеулер енгізілді; Африка және Оңтүстік-
Шығыс Азия аймақтарында жүргізілген зерттеулер зерттеуге қосу критерийлерге сәйкес
келмеді; бізде сүт безі қатерлі ісігінің диагнозы мен мазасыздықты бағалау уақытына
дейінгі уақыт туралы мәліметтер жеткіліксіз болды; енгізілген зерттеулердің әртектілігі
жоғары болды.
Наука о жизни и здоровье №4, 2020

Қорытынды. Сүт безі қатерлі ісігі бар науқастардың шамамен үштен бір бөлігінде
мазасыздық бар. Сүт безі қатерлі ісігі бар науқастардың жоғары психологиялық
қажеттіліктерін алғашқы диагноз қою кезінде ғана емес, сонымен қатар аурудың
қайталануы мен өршуі кезінде де мойындау және қанағаттандыру қажет.
Кілт сөздер: сүт безінің қатерлі ісігі, мазасыздық, метастатикалық,
қайталанатын, жүйелік шолу.

92
РАСПРОСТРАНЕННОСТЬ ТРЕВОГИ СРЕДИ ПАЦИЕНТОВ С РАСПРОСТРАНЕННЫМ
РАКОМ МОЛОЧНОЙ ЖЕЛЕЗЫ: СИСТЕМАТИЧЕСКИЙ ОБЗОР И МЕТААНАЛИЗ

И. Карибаева, 2Б.Турдалиева, 3 Нор Зураида Зайнал, 4Ф. Багиярова

*1

1, 2
Казахский медицинский университет непрерывного образования, г. Алматы
3
Малайский университет, Куала-Лумпур, Малайзия
4
Казахский Национальный медицинский университет им.С.Д. Асфендиярова, г. Алматы

АННОТАЦИЯ

Введение. Тревожность у пациентов с метастатическим или рецидивирующим ра-

ком молочной железы является частой психологической коморбидностью. Это исследо-
вание направлено на систематический обзор литературы по обсервационным исследова-
ниям с данными о распространенности тревожности у пациентов с метастатическим и
рецидивирующим раком молочной железы, изучение объединенной средней распростра-
ненности тревожности и потенциальных источников неоднородности.
Методы. Был проведен обширный систематический обзор баз данных PubMed,
Web of Science, ScienceDirect, Google Scholar и Open Grey, а также последующий ручной
поиск литературы по списку ссылок включенных исследований.
Результаты. Мы определили 16 подходящих исследований, в которых было оце-
нено наличие тревожности у 1284 пациентов, используя структурированное интервью и
два вида опросников для само-заполнения. Всего критериям тревожности соответство-
вал 371 пациент. Согласно модели случайных эффектов, объединенное среднее значение
распространенности тревожности составило 29,93% (95% ДИ [23,22; 37,09]; I2 = 86%).
Исследования, в которых сообщалось о распространенности тревожности за последние
пятнадцать лет, имели такой же уровень, как и исследования, опубликованные за пятнад-
цать лет до этого.
Ограничения. Были включены только исследования на английском языке; ни одно
исследование из регионов Африки и Юго-Восточной Азии не соответствовало крите-
риям включения в систематический обзор; у нас не было достаточно данных о времени
между постановкой диагноза рака молочной железы и оценкой тревожности; гетероген-
ность включенных исследований была высокой.
Выводы. Примерно у одной трети пациентов с распространенным раком молочной
железы диагностируется тревожность. Высокие психологические потребности пациен-
тов с раком молочной железы должны быть адресованы не только при первичной диа-
гностике, но также при рецидиве и прогрессировании заболевания.
Ключевые слова: рак молочной железы, тревожность, метастатический, реци-
дивирующий, систематический обзор.
Наука о жизни и здоровье №4, 2020

93