Critique of Systematic Review

CRITIQUE OF SYSTEMATIC REVIEW 6

Critiqueof Systematic Review

Critiqueof Systematic Review

Asystematic research review is a rich source of high-quality data onexisting data in the healthcare industry. The reason is that itrepresents a critical review and analysis of healthcare studies thatare well designed and provide first level evidence regarding theeffectiveness of various healthcare interventions (Zeng et al.,2015). This paper will critique a systematic research review ofnon‐pharmacologicalinterventions for the problem of cognitive impairment resulting fromsystemic cancer treatment.

Relevanceof the Research Problem

About75% of all cancer survivors tend to experience cognitive impairmentdue to the treatment associated with condition. The problems vary inseverity among different survivors and usually make it difficult forone to handle the daily activities in their life. The symptoms of theimpairment include having trouble focusing, concentrating, or payingattention, mental disorientation, and issues with spatial orientation(Libert et al., 2016). Having about three-quarters of those affectedwith cancer having cognition issues is a proportion that is too highand worrisome especially given the increasing size of the populationof cancer survivors. Research on the real causes of the impairmentpoints to several factors. They include cancer, cancer treatments,side effects of the cancer treatments, treatment for some of the sideeffects of cancer, and hormone changes resulting from cancertreatment. The rate of new cancer infections keeps rising and is setto bring with it a high number of people with cognitive impairment.With such expectations, it is essential to identifynon-pharmacological interventions that are effective for themaintenance of cognitive functioning or the amelioration of cognitiveimpairment among those who have previously been diagnosed withcancer.

Critiqueof the Levels of Evidence of the Studies in the SRR

Therewere five studies used in the SRR, all of which fall into level II ofevidence. The reason is that they are RCTs. All the sources werepeer-reviewed as this was one of the criteria for consideration ofthe studies in the systematic research review. Given that studies areat level II of the evidence table, their validity is high (Berlin &ampGolub, 2014). The participants in the studies were chosen usingcriteria that could ensure the achievement of a competent outcome.The studies involved patients diagnosed during their adulthood (thoseaged 16 years and above) having any tumor, those who had previouslyundergone systemic treatment either in isolation or with othertherapies, and the ones who had received hormone therapy forprophylaxis purposes following their cancer treatment. Otherparticipants included patients from clinic or community settings. The SRR was willing to consider studies of cases of cancer survivorsfrom the onset of childhood or adulthood but found none. The effortsare commendable. The designs were broad in their coverage as theyconsidered six different types of interventions. Including severalinterventions in the design improved the quality of conclusions thatone is to draw from the outcome of the studies.

Critiqueof the Clarity of the SRR

Theauthors did well in their attempt to ensure the clarity of theirreview. They included in the review a section that summarizes theirSRR in simple language that a layperson can comprehend. The movehelps eliminate any confusion that one may be having regarding thenature of their review. On page 12, they present a flow diagram oftheir study which gives a summary of the search details and findings.For instance, one can see that the survey identified 13,618 recordsthrough database search while finding an additional 62 through othersources. The breakdown continues narrows down to the relevant sourcesand kind of data selected for use where only five studies werechosen. There was an assessment of the risk of bias of the studiesused in the SRR using the Cochrane tool. The risk assessmentaddressed selection bias, direction, performance bias, reportingbias, and attrition bias among other potential sources of bias usingthe items applicable to each type. Three review authors who wereworking in pairs independently applied the ‘risk of bias` tool(Treanor et al., 2016). Such a working arrangement helped in ensuringlow levels of bias. Discussions or further reviews were then soughtwhere there appeared to be differences. The move ensured the outcomeswere not clouded in suspicion.

OverallFindings of the SRR

Accordingto Treanor et al. (2016), compensatory strategy training had noimmediate or two months post-intervention beneficial effect onphysical well-being. The training was also found not to have anypositive impact two months later on the mental health of thoseaffected. The low certainty evidence suggested the existence of adirect relationship between the training and an immediate reductionin mental well-being. In the case of computerized cognitive training,the study found an improvement in some of the objectively assessedcognitive outcomes, mental well-being and self-reported cognitivefunction (Treanor et al., 2016). The compensative strategy was foundto result in better memory, improved self-reported cognitivefunction, as well as, an enhanced spiritual quality of life. Therewas also a depiction of benefits in relation to the participants`discernments of their quality of life and cognitive abilities. Sincethere is a tendency for repetition in practicing cognitive skills,interventions involving cognitive training can have such effectstransferred to other cognitive domains. The meditation and physicalactivity interventions did not find any effects that were beneficialon cognitive outcomes. Overall, there was impressive adherence tointerventions with interventions being held in high regard by theparticipants with respect to satisfaction.

Conclusionsand Implications

Thelimited evidence at present brings about a difficulty in drawingsolid recommendations for those tasked with the provision ofhealthcare that would place them in a position where they can helptheir patients to recover cognitive skills after chemotherapy. Thecurrent uncertainties regarding the effects of the interventions inuse calls for greater research. Evidence concerning the effectivenessof meditation intervention and physical activity on the outcomes ofcognitive function is too weak for one to develop any implicationfrom it for purposes of clinical practice. In the research, therewere only a few trials whose quality was however, wanting. There isroom for more rigorous research in the future. Firm conclusions onthe benefits of the interventions explored in the SRR will bepossible through larger multi-site studies and use of activeattentional control group. There is also need to cast the researchnet wider and conduct studies into cognitive impairment among othercancer patient groups as opposed to merely women with breast cancer.

References

Berlin,J. A., &amp Golub, R. M. (2014). Meta-analysis as evidence: Buildinga better pyramid. Jama,312(6),603-606.

Libert,Y., Dubruille, S., Borghgraef, C., Etienne, A., Merckaert, I.,Paesmans, M., &amp … Razavi, D. (2016). Vulnerabilities in olderpatients when cancer treatment is initiated: Does a cognitiveimpairment impact the two-year survival?. PlosONE,11(8),1-14.

Treanor,C. J., McMenamin, U. C., O`Neill, R. F., Cardwell, C. R., Clarke, M.J., Cantwell, M., &amp Donnelly, M. (2016). Non‐pharmacologicalinterventions for cognitive impairment due to systemic cancertreatment. TheCochrane Library,8. Retrieved from http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011325.pub2/full

Zeng,X., Zhang, Y., Kwong, J. S., Zhang, C., Li, S., Sun, F., &amp …Du, L. (2015). The methodological quality assessment tools forpreclinical and clinical studies, systematic review andmeta-analysis, and clinical practice guideline: a systematic review.Journalof Evidence-Based Medicine,8(1),2-10.