The Effect of E-Health Interventions on Fear of Recurrence in Breast Cancer Survivors: A Systematic Review and Meta-Analysis.

INTRODUCTION

Fear of cancer recurrence (FCR) is among the most common and debilitating psychological issues affecting breast cancer survivors. With technological advances, e-health interventions have emerged as cost-effective tools to manage psychosocial challenges such as FCR.

OBJECTIVES

This study aimed to systematically review and synthesize evidence from randomized controlled trials assessing the effectiveness of e-health interventions in reducing FCR among breast cancer survivors.

METHODS

This systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD42025645734). Comprehensive searches were performed in Web of Science, PubMed, Scopus, Medline, and Taylor & Francis Online up to January 2025. Risk of bias was evaluated using the Cochrane RoB 2 tool. A random-effects model with Hedge's g effect sizes and I² statistics was applied in the meta-analysis.

RESULTS

Ten randomized controlled trials involving 1,565 participants were included. Interventions included online cognitive behavioral therapy, mobile applications, tele-coaching, and online mindfulness-based interventions. Although some individual studies reported reductions in FCR, the overall pooled effect size was not statistically significant (Hedge's g = -0.076, 95% CI: -0.183 to 0.031, P = .163). Considerable heterogeneity was observed among studies (I² = 87.39%). No significant publication bias was detected.

CONCLUSIONS

E-health interventions show promise in supporting the psychological well-being of breast cancer survivors. However, current evidence does not demonstrate a significant effect in reducing FCR. Future research should explore ways to enhance intervention design, improve user engagement, and examine how factors such as age, digital literacy, and adherence influence outcomes.

IMPLICATIONS FOR NURSING PRACTICE: Nurses can play a key role in identifying patients receptive to digital interventions and supporting their engagement and adherence. Tailoring e-health content to individual needs, providing guidance on digital literacy, and integrating digital tools with face-to-face care approaches may enhance intervention effectiveness.