Electronic Health Interventions for Patients With Breast Cancer: Systematic Review and Meta-Analyses

Abstract

Purpose: Ongoing supportive care using electronic health (eHealth) interventions has the potential to provide remote support and improve health outcomes for patients with breast cancer. This study aimed to evaluate the effectiveness of eHealth interventions on patient-reported outcomes (quality of life [QOL], self-efficacy, and mental or physical health) for patients during and after breast cancer treatment and patient-reported experience measures (acceptability and engagement).

Methods: Systematic review with meta-analyses (random-effects model) of randomized controlled trials was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Nine databases were searched using a prespecified search strategy. Patient-directed eHealth interventions for adult patients during or after active breast cancer treatment measuring QOL, self-efficacy, and mental (depressive, anxiety, and distress symptoms) or physical (physical activity, nutrition, and fatigue) health outcomes were included. Data from eligible full-text articles were independently extracted by six observers.

Results: Thirty-two unique studies (4,790 patients) were included. All were health self-management interventions, and most were multicomponent (videos, forums, and electronic reminder systems) websites. Meta-analyses revealed a significant effect of eHealth interventions on QOL (standardized mean difference [SMD], 0.20 [95% CI, 0.03 to 0.36]), self-efficacy (SMD, 0.45 [95% CI, 0.24 to 0.65]), distress (SMD, -0.41 [95% CI,-0.63 to -0.20]), and fatigue (SMD, -0.37 [95% CI, -0.61 to -0.13]). Twenty-five studies (78.1%) measured patient-reported experience measures. Acceptability (n = 9) was high, with high ratings for satisfaction (range, 71%-100%), usefulness (range, 71%-95%), and ease-of-use (range, 73%-92%). Engagement (n = 25) decreased over time, but disease-focused information and interactive support were most engaging.

Conclusion: eHealth interventions may provide an acceptable and effective strategy for improving QOL, distress, self-efficacy, and fatigue among patients with breast cancer.

FIG 1.

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020 flow diagram of included studies for meta-analyses. eHealth, electronic health; RCT, randomized controlled trial.

FIG 2.

Forest plot of (A) quality of life, (B) anxiety symptoms, (C) depressive symptoms, (D) psychologic distress, (E) self-efficacy, and (F) fatigue outcomes for electronic health randomized controlled trials. SD, standard deviation; SMD, standardized mean difference.

FIG 3.

Cochrane risk of bias scores (%low, unclear, and high risk) across bias domains (selective reporting, incomplete outcome data, blinding, allocation concealment, and random sequence generation) for the 18 included breast cancer electronic health studies. RoB, risk of bias.