Understanding the intent of our narrative review on psychological challenges in breast cancer survivorship

We appreciate the thoughtful comments provided in response to our publication, “Is cancer back?—psychological issues faced by survivors of breast cancer” (1). We value the insights shared and would like to address some of the concerns raised, particularly regarding our methodological approach and the intent of our review.

First and foremost, it is important to clarify that our main goal was not to conduct a systematic review but rather a narrative review. Understanding the distinction between these two approaches is crucial to contextualizing the intent and scope of our article.

A systematic review is a research methodology that aims to answer a specific research question by systematically identifying, selecting, and critically evaluating all relevant research on the topic. It is characterized by a well-defined protocol, explicit inclusion and exclusion criteria, and often includes a meta-analysis to synthesize quantitative data. Systematic reviews are valuable for providing a comprehensive and unbiased summary of the evidence, particularly when addressing well-defined clinical questions.

In contrast, a narrative review is a more flexible and descriptive approach that allows for the exploration of broader topics, often integrating findings from various sources to provide a cohesive narrative. Narrative reviews do not typically follow the rigid protocols of systematic reviews, as they are designed to offer a more interpretative and conceptual synthesis of the literature. This approach is particularly valuable when dealing with complex, multifaceted issues—such as the psychological challenges faced by breast cancer survivors—where the goal is to explore and discuss the breadth of knowledge, rather than to systematically aggregate quantitative data.

In our review (2), we deliberately chose the narrative approach to offer a holistic understanding of the psychological issues encountered by breast cancer survivors. Our intention was to highlight the complexities of their experiences, drawing from a diverse array of sources, including PubMed and personal files, to provide a nuanced discussion of risk factors, vulnerable moments, and unmet needs. We aimed to illuminate areas that may not be fully captured by quantitative studies alone, emphasizing the importance of resilience-building interventions and comprehensive support systems.

Regarding the concerns about the lack of explicit criteria for article selection and the absence of quantitative data, we acknowledge that these are limitations inherent to the narrative review format. However, we believe that our approach allowed us to address a wide range of psychological aspects that may have been overlooked in more narrowly focused systematic reviews. The goal was not to generalize findings to all survivors but to provoke thoughtful consideration of the varied psychological experiences and the necessity for ongoing research in this field.

We agree that future research could benefit from incorporating multi-method techniques, including longitudinal studies and diverse demographic representation, to further deepen our understanding of the psychological well-being of cancer survivors. We also concur that interdisciplinary collaborations and innovative digital solutions hold promise for advancing survivorship care.

In conclusion, our narrative review was intended to foster a broad discussion about the psychological complexities of breast cancer survivorship. While it does not replace the need for systematic reviews, it serves as a complementary approach that emphasizes the importance of understanding the lived experiences of survivors and the multifaceted nature of their psychological challenges.

Thank you once again for the opportunity to respond to the letter, and we hope this clarification enhances the understanding of the purpose and scope of our review.

Acknowledgments

Funding: None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, Annals of Palliative Medicine. The article did not undergo external peer review.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://apm.amegroups.com/article/view/10.21037/apm-24-140/coif). P.T. reports serving as advisor/consultant for AstraZeneca, Daiichi-Sankyo, Gilead, Lilly, Novartis, and Roche/Genentech. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Daungsupawong H, Wiwanitkit V. Re: psychological challenges for breast cancer survivors. Ann Palliat Med 2024; [Crossref]
2. Bergerot C, Bergerot PG, Maués J, et al. Is cancer back?—psychological issues faced by survivors of breast cancer. Ann Palliat Med 2024;13:1229-34. [Crossref] [PubMed]