Saudi Cultural Missions Theses & Dissertations
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Item Restricted Breast Cancer Treatment Disparities in Patients with Severe Mental Illness: A Systematic Review and Meta-Analysis(Queensland University of Technology, 2024) Alotiby, Meshary; Protani, Melinda; Kisely, Steve; Siskind, DanBackground Disparities in breast cancer treatment for people with pre-existing severe mental illness (SMI) have not been well studied compared to disparities in cancer screening and stage at diagnosis. Aims To conduct a systematic review of the available evidence and investigate whether female breast cancer patients with pre-existing SMI had equitable access to guideline recommended breast cancer treatment compare to those without SMI. Methods We conducted systematic review and meta-analysis of observational studies that were retrieved from PubMed, EMBASE, CINAHL and PsycINFO databases from 22 February 2021 to 26 March 2021. Female breast cancer patients with SMI were included in the analyses. SMI was defined as Schizophrenia, Bipolar disorder, and major depression. Guideline recommended treatment was defined as surgery, chemotherapy, radiotherapy and adjuvant endocrine therapy. Pooled odds ratios, and other estimates, such as hazard ratios and risk ratios were presented. Risk of bias was assessed using Newcasle-Ottawa scale. DerSimonian-Laird random effects models were used. Results 3,325 citations were identified; 10 studies were included, and 4 studies were meta-analysed. Pooled analyses suggested that people with SMI were less likely to receive guideline recommended breast cancer treatment than those without SMI (OR: 0.83; 95% CI: 0.77 to 0.90). Breast cancer patients with schizophrenia had a reduced likelihood for receiving adjuvant radiotherapy (Crude RR: 0.81, 95% CI: 0.77 to 0.85), while those with major depression and bipolar I disorder had lower likelihood of receiving adjuvant chemotherapy (Crude RR: 0.71, 95% CI: 0.60 to 0.84). Conclusions This review identified disparities in breast cancer care for individuals with pre-existing SMI, which contributed to poorer prognosis and excess mortality. Improving collaboration between psycho-oncology teams is advised to address patients’ needs for treatment. Future research is necessary for identifying disparities in primary and systemic treatments and investigating the reasons for treatment inequity.9 0Item Restricted The Effect of Physical Exercise as an Adjunctive Treatment to the Usual Treatment for Major Depressive Disorder: An Integrative Review(Saudi Digital Library, 2017) Alsolami, Eman; West, Sandra; Betihavas, VasilikiMajor depressive disorder (MDD) is a leading cause of disability around the world. The current treatment approach for MDD is limited. Physical exercise is a suggested treatment for depression and the use of exercise as an adjunctive therapy to the usual treatment of depression has received significant attention. The aim of this thesis is to evaluate whether physical exercise as an adjunctive therapy leads to an extra reduction in depressive symptoms compared with using the usual treatments alone. An integrative review was conducted by a systematic search in Scopus and PsycINFO databases. The search yielded 100articles, which were narrowed to 15 articles based on inclusion and exclusion criteria. The review found that using exercise as an adjunctive therapy to the usual treatment of depression decreased depressive symptoms more than using the usual treatment alone. It also found that this effect is not influenced by factors such as type of exercise, as aerobic and resistance exercise lead to the same effect. In addition, it found that exercise programs of short- and medium-duration were more effective than programs of a longer duration, and that hospital- and public-based exercise were more effective than home-based exercise. However, this review cannot determine whether the effect of using exercise as an adjunctive therapy to the usual treatments might be different based on the severity of depression and the patient’s age. This review suggests that using short and moderate programs of exercise as an adjunctive therapy to the usual treatment of depression can be an effective way to improve the depressive symptoms among adult patients with MDD.20 0