Findings from a systematic review to explore the patient and societal impacts of disease progression in women who were treated for early breast cancer

Implications for future research, policy and practice

by Natasha L. Elmore, Sarah King, Josephine Exley, Daniela Rodriguez-Rincon, Jody Larkin, Molly Morgan Jones, Catriona Manville

Download eBook for Free

FormatFile SizeNotes
PDF file 1.7 MB

Use Adobe Acrobat Reader version 10 or higher for the best experience.

Research Questions

  1. What is the psychosocial well-being of women with early breast cancer who have relapsed, and what monetary costs may they experience?
  2. What are the psychosocial and out-of-pocket monetary costs for carers and families of women who had early breast cancer who have relapsed?
  3. What are the costs to society in resource use for women who had early breast cancer who have relapsed?

RAND Europe conducted a study on the societal impact of early breast cancer. This study was divided into three interconnected phases, which together aim to enrich the evidence base on the broader health, societal and economic impacts of treatment of early breast cancer, using a mixed methods approach. In the second phase of our programme we undertook a systematic review of the non-clinical burden of a recurrence event following treatment for early breast cancer. The systematic review sought to address the psychosocial and broader economic costs of women with early breast cancer who have recurred, their carers, families and broader society. We found that the majority of evidence available in the literature on the impact of breast cancer recurrence following treatment for early breast cancer focused on the psychosocial well-being of women who have experienced a recurrence of breast cancer, following initial treatment. There was a limited body of evidence of the impact of recurrence on the patient's relationship with their spouse, and even less of the impact of breast cancer on the spouse — other than fatigue. There was a limited number of studies presenting the impact of early breast cancer on the wider health system and society overall. Surprisingly, there was a lack of qualitative research on psychosocial well-being in patients and carers, or on time off work and out-of-pocket expenses for both groups. These results highlight that there is a multifaceted psychological burden for women treated for early breast cancer who go on to experience a recurrence, and there is some evidence of psychological burden on spouses and wider society.

Key Findings

  • There are inconsistencies in the measurement and definitions for many of the non-clinical outcomes of breast cancer recurrence following treatment for early breast cancer.
  • Recurrence of breast cancer results in significantly greater cancer-specific stress, greater use of antidepressants, higher levels of self-esteem and lower frequency of sexual intercourse than in women who were also treated for early breast cancer but remain disease-free.
  • The evidence did not demonstrate a difference in mood, body image, social distress, social support, emotional functioning, mental health, fatigue, sexual satisfaction, insomnia or quality of life between women with breast cancer recurrence and women who remained disease-free.
  • There was conflicting evidence on the outcomes of depression and anxiety, dyadic satisfaction and financial difficulties experienced by women who had a breast cancer recurrence compared with those who remained disease-free.
  • Quality of life scores were higher in women undergoing breast-conserving treatment than in healthy women.
  • Body image, breast sexual functioning and social functioning were all found to be lower in women who underwent a mastectomy than in those who had breast-conserving treatment.
  • When undergoing treatment, fatigue and depression were greater, and quality of life and sexual enjoyment lower, than in those who had finished treatment.
  • There is a lack of evidence of outcomes for carers of patients who experience a recurrence following treatment for early breast cancer.
  • Patients who experienced recurrent breast cancer had significantly higher total healthcare costs than patients where the breast cancer did not recur, as a result of costs of treating breast cancer recurrence.

Table of Contents

  • Chapter One


  • Chapter Two


  • Chapter Three


  • Chapter Four


  • Chapter Five


  • Annex A

    Search terms

  • Annex B

    Data extraction table template

  • Annex C

    Quality and risk of bias assessments

  • Annex D

    Detailed outcome tables for results

  • Annex E

    Studies excluded at full text review stage

  • Annex F

    Overview of included studies

Research conducted by

The research described in this report was sponsored by F. Hoffmann-La Roche Ltd and conducted by RAND Europe.

This report is part of the RAND Corporation Research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of this publication online is prohibited; linking directly to this product page is encouraged. Permission is required from RAND to reproduce, or reuse in another form, any of its research documents for commercial purposes. For information on reprint and reuse permissions, please visit

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.