Breast Cancer, Disability, and Caregiving: An Evidence Mapping Review of Psychosocial Needs, Barriers to Care, and Support Interventions

Vollständiger Abstract

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Background: Women with pre-existing disabilities may experience substantial inequalities across the breast cancer care continuum, including barriers to screening, communication, diagnosis, treatment, and psychosocial support. Although disability-related disparities in breast cancer screening are increasingly recognized, evidence concerning psychosocial needs, caregiver involvement, and supportive adaptations remain fragmented. Objective: This evidence mapping review aimed to identify and conceptually organize research published between 2016 and 2026 addressing breast cancer among women with pre-existing disabilities, with particular attention to psychosocial needs, barriers to care, caregiving, and supportive interventions. Methods: A Focused evidence mapping approach was used to synthesize primary empirical studies relevant to four predefined domains: psychosocial and emotional needs; barriers across screening, diagnosis, treatment, and survivorship; caregiving, advocacy, and supported decision-making; and supportive interventions and person-centred adaptations. Studies were mapped according to disability population, stage of the breast cancer continuum, methodological characteristics, caregiver involvement, and principal findings. Results: The evidence was unevenly distributed across the breast cancer continuum, with research concentrated predominantly on breast awareness and screening and substantially less evidence addressing diagnosis, active treatment, and survivorship. Psychosocial concerns included fear, anxiety, uncertainty, inadequate preparation, communication difficulties, and threats to autonomy. Family members, caregivers, and support workers frequently facilitated access, communication, advocacy, and decision-making, yet their own psychosocial needs were rarely examined. Accessible information, individualized preparation, supported decision-making, navigation, and disability-responsive communication emerged as promising adaptations, although evaluated interventions remained limited. Conclusions: Disability-inclusive breast cancer care requires a shift from a predominantly screening-focused perspective toward accessible, psychologically informed, autonomy-supportive, and caregiver-aware care across the entire cancer trajectory. Future research should prioritize co-designed interventions, post-diagnosis experiences, psychosocial outcomes, and caregiver well-being.