Bibliometrics analysis of psychological intervention in breast cancer patients

Hong Chen,Ding-Yuan Wei

1Second breast surgery Department,Dongfang Hospital Beijing University of Chinese Medicine,Beijing 100078,China;2School of Nursing,Beijing University of Chinese Medicine,Beijing 100029,China.

Background:In order to provide some references and direction for further research on psychological intervention for breast cancer patients,we analyzed the breast cancer patients,learned its research status,and found out the existing problems.Methods:We retrieved relevant literatures on psychological intervention for breast cancer patients from databases such as CNKI,Wanfang data,VIP and CBM.Note Express 3.2 was used for bibliometric analysis.Results:A total of 60 articles were included.We found that the research institutions were mainly hospitals.There was a lack of attention to special breast cancer patients,efficacy comparison trials of different intervention and cooperation during institutions.Research design was not rigorous enough:lack of pertinence of populations,unclear and short intervention interval,low repeatability of research trials,low transparency of intervention,and defects in intervention quality control.Conclusion:Clinical trials on psychological intervention for breast cancer patients should pay more attention to special breast cancer populations.Researchers should correctly grasp related research trends,seek cooperation opportunities with other institutions,and improve the quality of their own research and ensure the innovation and scientificity of trial design.Meanwhile,researchers can further explore the psychological intervention methods for special breast cancer populations，and conduct comparative studies on the efficacy of different intervention measures.

Key words:Breast cancer,Psychological intervention,Bibliometrics,Literature analysis

Background

Breast cancer (BC) is one of the most common malignant tumors in women.It occurs most often in women aged 40-55,and is one of the major killers that take away women's lives in China.According to the 2019 National Cancer Report,the incidence of BC ranks first among all female malignancies in China,with an annual incidence of about 304,000.Obviously,BC has become the most common malignant tumors that seriously threaten Chinese women’s health.Routine treatment of BC includes surgery,chemotherapy,radiotherapy,endocrine therapy and so on.However,clinical practice shows that different psychological problems may occur after treatment,because clinical treatment can cause a strong psychological stress response [1].Besides,problems such as breast loss and breast morphology change caused by the disease and surgery will immerse the patients in different degrees of negative emotions and decline their quality of life.In recent years,a number of researches have shown that psychological intervention for BC patients can effectively reduce the negative emotions of patients,and improve patients’ treatment compliance,happiness and quality of life.Accordingly,in this study,a bibliometrics analysis of researches from January 1,2016 to December 31,2019 related to psychological intervention for BC patients was carried out.In order to provide some reference and direction for further research on psychological intervention for BC patients,we analyzed the patients,learned its research status,and found out the existing problems.

Materials and methods

Literature resources and retrieval strategies

The literatures related to psychological intervention for BC patients from CNKI,Wanfang data,VIP and CBM were searched by computer.The literatures retrieved was published between January 1,2016 and December 31,2019.The retrieval method is advanced retrieval.The search strategy was “subject = (breast cancer OR breast tumor) AND (psychological intervention OR psychology,society OR the quality of life OR mental process OR obsessive behavior OR anxiety OR clinical psychology OR affective symptoms OR mental health OR mental phenomena OR depression) AND (clinical observation OR clinical evaluation OR clinical trials OR clinical effect OR clinical research OR curative effect OR evaluation research OR prospective OR multicenter OR random OR contrast)”.

The inclusion and exclusion criteria of literatures

The inclusion criteria:a) articles which were related to psychological intervention for BC patients;b) study designs were randomized controlled trials;c) the implementers of psychological intervention were nursing staffs.

The exclusion criteria:a) dissertations and conference papers;b) the sample size of research was less than 90;c) non-randomized controlled trial researches;d) the full text was not available;e) review,systematic review,meta analysis,research plan and case studies.

Literature screening and data extraction

After reading the title and abstract of the literatures,screening according to the inclusion and exclusion criteria,the literatures that met the criteria was sorted out,and then the key information was extracted and the data were collected by reading the full text,including basic information of literatures include title,author,research institution,year of publication,source of research funding,etc and the main contents extracted from the literatures include intervention object,intervention period,intervention interval,sample size,intervention methods,observation indicators,evaluation tools,etc.

Outcomes

Outcomes of literature screening

One thousand six hundred and seventy-two relevant literatures were initially retrieved,and then duplicate literatures were eliminated with the help of Note Express 3.2.When filtrating the literatures,the titles and abstracts were first read to exclude irrelevant literatures,and then the full text was read.Finally,60 literatures were included according to the inclusion and exclusion criteria.

Research institution and fund support

A statistic analysis of the authors’ affiliations shows that 51 out of 60 researches were independently carried out by hospitals,and 9 were completed by hospitals in cooperation with universities.Among the 60 researches,30 (50%) were funded,including 8 national-level,15 provincial-level,5 municipal-level,1 college level and 1 school-level (Table 1).

Specific research contents

The contents of 60 clinical trials were extracted and analyzed.For researches with multiple populations and interventions,all of them were included after reading the full text.The statistical results of populations,intervention period,intervention methods,surgery type,and intervention interval are shown in Table 2.Patients’outcomes and its measurement tools are shown in Table 3.All the included researches indicate that psychological intervention for BC patients and/or their spouses could reduce their psychological stress to a certain extent,and improve their cognition of the disease,which had a positive impact on their treatment and life.

Table 1 Research institutions,sample size and fund support (n = 60)

Table 2 The intervention object,intervention period,intervention method,surgery,and intervention time

Discussion

More attention need to be paid to some special BC populations

In China,researches on psychological intervention for BC patients are mainly limited to female BC patients,while there are few researches on special BC populations.As is shown in Table 2,main populations of included researches are all female BC patients of the whole age group.There are only 5 researches on young,middle-aged and elderly women with BC,and only 1 research on unmarried women.From the perspective of gender,there are almost no large sample researches on psychological intervention for male BC patients in recent years,which may be related to the rarity of male BC.According to statistics,the incidence of male BC in Europe is 1 in 100,000,accounts for only 1% of all BCs,which is 1.4% in China [2].However,male BC tends to metastasize early,so the 5-year survival rate of male BC is much lower than women.In addition,male patients are more likely to face greater mental pressure [3],feeling depressed and embarrassed.Therefore,researches of psychological intervention for male BC patients have great clinical value.Furthermore,there are numerous special groups with BC such as the youth,women during pregnancy and breastfeeding,the ethnic minorities and the elderly that should be treated in different ways [3].Therefore,it is necessary to pay moreattention to these groups suffering from BC.Researches on psychological intervention for BC patients should be further targeted,and personalized psychological intervention plans should be made,considering the special needs of different groups.In recent years,people in some parts of the United States are beginning to appeal for medical equality for minorities.Due to differences in genes,dietary habits and cultural customs,different races also have differences in susceptibility to some kinds of diseases,and the psychological stress responses to diseases are also diverse.Therefore,clinical researches targeted at different races are necessary.In the United States,researches on psychological intervention for BC among ethnic minorities such as Chinese and Latino has become a hot topic.However,as a multi-ethnic country,researches on psychological intervention for BC patients of ethnic minorities in China is basically blank.A survey showed that the BC screening rate for women in Yunnan Province was 16.7%,and the screening rate for Han women was higher than that of Yi and other ethnic minorities.The influencing factors included age,education level,partner and so on [4].The culture and customs of ethnic minorities are quite different from those of the Han nationality.In the future,this direction is worthy of researching and exploring.

Table 3 Observation indicators and evaluation tools

There were a variety of intervention methods,but lack of comparative trials of different intervention methods

Researches on psychological intervention for BC patients have a long history.In recent years,the influential clinical trials mainly focus on the effect of different psychological intervention methods on patients,and pay more attention to the innovative the practice of psychological intervention methods under the guidance of different theories.The problem is that they mainly focus on proving the effect of certain psychological intervention for BC patients.Many researches have demonstrated that psychological intervention such as mindfulness-based stress reduction therapy,cognitive behavioral intervention,acceptance and commitment therapy can produce positive results for BC patients,however,these different interventions have rarely been compared directly.Of the included researches,only two compared the effects of 2 different psychological interventions.Therefore,how to apply different psychological intervention methods to patients with different psychological states,and how to combine these methods scientifically,so as to exert their maximum effect and promote the physical and mental health of patients to the greatest extent,are worthy of discussion.

Cooperation between institutions needs to be improved

What can be seen from the statistics is that the research institutions are mainly hospitals,and only 9 researches were conducted by hospital combined with colleges,which is consistent with the results of Lijing Lu’s research [5].Hospitals,as the direct practical contexts of nursing,can provide a large number of samples and space,manpower,material resources and financial support for research,that’s why most of the research were conducted in hospitals.But it does have disadvantages.On the one hand,it is difficult to obtain a large amount of samples when patients are recruited only in one hospital,so many researches recruited patients for as long as two or three years.Without a rigorous quality control,the reliability of the research results will be reduced.On the other hand,many clinical medical staffs lack experience in scientific research,resulting in low research quality.Therefore,clinical practitioners can seek cooperation with colleges,by virtue of the rich scientific research experience to make the research design more rigorous and the analysis of research results more scientific.

Problems of the research design

Did not eliminate the bias of different surgical methods.Among the included literatures,38 researches focused on women with BC,and none of the researches mentioned grouping the patients in terms of the type of surgery they underwent.Take patients undergoing radical mastectomy,modified radical mastectomy and breast conserving surgery as example,due to the differences of the excised tissue areas and integrity of the body,the patients' psychological responses and psychological needs are also different.If all female BC patients are taken as the research object,the bias will increase when the sample size is small and the patients are randomly grouped.

Some researches did not specify the duration of intervention,and most other researches showed a generally short intervention time.Of the 60 researches included,only 27 specified the duration of the whole intervention,and few specified the intervention times and duration of each time.Due to the differences of intervention methods,disease periods and treatment duration,there was no uniform standard of intervention duration and it was generally short.Of the researches that did address the duration of intervention,12 had a duration of 5 to 10 weeks,and only 3 researches had more than 14 weeks.Moreover,most researches only focused on a certain period of treatment,and the continuity of intervention isn’t very well.BC patients need to undergo a long period of treatment from diagnosis to recovery.The impact of disease and treatment on patients exists for a long time,not to mention that patients have different psychological status and needs at different stages of treatment.Psychological interventions didn’t work overnight,but need a planned,phased long-term intervention,in order to maximum the effect.Therefore,researches on psychological intervention should be extended from the hospital to patients' home,so as to see the maximum effect of these intervention methods.

Low repeatability.In the included researches,the description of the intervention methods and process was mainly vague and brief,which resulted in a great decrease in the reproducibility of the trials and the verifiability of the results.Scientific researches should follow the principle of repeatability and meet the requirements of verifiability in different contexts and at different time.Only in this way can the reliability of scientific researches be guaranteed,and the premise of verifiability is that the intervention methods are clearly described.In addition,the verifiability is guaranteed to avoid improper behaviors such as fabricating,tampering and screening the experimental data,which occurs when researchers are affected by economic interests or other utilitarian factors in order to obtain the expected experimental results [6].Therefore,researchers should have a detailed and accurate description of intervention methods to ensure that the research design is rigorous and that the results can be replicated.

Low transparency of operation.First of all,the included researches did not properly calculate the sample size,explain the calculation method and list the calculation process.Secondly,the included researches did not clarify the random allocation method and statistical method it used,or use random hiding or blind method to ensure the quality control in the research process,so as to avoid the subjective interference of researchers or research objects.As a result,various potential and subjective biases in researches have not been eliminated,which reduces the reliability of research results.Although adequate description of the experimental method does not fully represent the high value of researches,it can reflect the transparency of the experimental operation,and other researchers can also determine their confidence in the research.

Observation indexes and outcome measurement tools were limited.As can be seen from Table 3,a total of 38 observation indexes and 54 outcome measurement tools were used in the included researches.The observation indexes were relatively comprehensive,covering various aspects such as physiology,psychology and spirit.There were also a variety of outcome measurement tools,mainly objective indicators and scales.However,all included researches did not set the main and affiliated indicators,there were only 2-3 observation indicators in most researches.As for the types of outcome measurement tools,only one outcome measurement tool was used for each observation index in the included researches.No one considered the use of different tools to evaluate an observation indicator,which can make research results more reliable.

Lack of quality control.The effective implementation of psychological intervention needs the close cooperation of the implementer and patients.If the intervention provider is irresponsible,or he/she’s professional competence is insufficient,or the patient does not cooperate,the results will be affected.Most of the included researches,however,did not mention how to ensure quality control in the process of intervention,for example,have specialist supervision or record the video of the whole process,or to carry out the supervision meeting,use quality rating scales,etc.

Conclusion

Generally,as the included researches showed,a variety of clinical trials of psychological intervention for BC patients exist some deficiencies currently,such as less attention to special BC groups,lack of comparison of different intervention methods,low level of interinstitutions cooperation,and lack of rigorous trial design.Researchers should focus on the foreword and continue to innovate in psychological intervention methods for BC patients,seek cooperation with other institutions,and improve their own ability through continuous learning.At the same time,researchers should pay more attention to special BC groups and comparative researches of different intervention methods should be carried out.