The effects of lifestyle modifications including dietary and physical interventions with cognitive-behavioral therapy on quality of life and cancer-recurrence rate among patients with breast cancer and survivors: A protocol for a systematic review and meta-analysis of randomized controlled trial

Context: Lifestyle modifications consist of three components including diet, exercise, and cognitive-behavioral therapy which can reduce side effects of breast cancer. Cognitive-behavioral therapy is a complementary strategy that promotes new skills for any treatment. Published trials have investigated the co-efficacies of the two or three components of lifestyle modifications, especially dietary and cognitive-behavioral interventions in breast cancer survivors. Evidence Acquisition: This protocol is about a meta-analysis which will systematically report the simultaneous effects of dietary intervention or physical activity with cognitive-behavioral therapy, or three of them on quality of life, the recurrence levels and anthropometric measurements among patients with breast cancer and survivors. It was prepared in accordance with the PRISMAP checklist and will be performed in accordance with the Cochrane Handbook for Systematic reviews of intervention. Cochrane Central Register of Controlled trials, PubMed, EMBASE and ISI web of science will be searched for peer-reviewed literature using defined MeSH terms. Included randomized controlled trials on the combination effects of cognitive-behavioral therapy with either dietary or physical interventions will be assessed. Continuous data will be meta-analyzed using the STATA and will be gathered using random-effects models. The effect size will be reported as standardized mean difference with 95CIs. Heterogeneity assessment, publication bias, and sensitivity analysis will be performed. The heterogeneity between some trials may be a limitation of this study. Conclusions: This meta-analysis will provide beneficial guidance for healthcare providers and family members to improve the current understanding of the role of lifestyle modification on alleviating the important problems of patients with breast cancer. © 2020, Author(s)