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Impact of e-Health Interventions on Mental Health and Quality of Life in Breast Cancer Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
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Alexandros Mitsis
1, 
Panagiotis Filis
2,3,
Georgia Karanasiou
1,4,
Eleni I. Georga
1, 
Davide Mauri
3, 
Katerina K. Naka
5,
Anastasia Constantinidou
6,7,8,
Kalliopi Keramida
9,10,
Dorothea Tsekoura
11,
Ketti Mazzocco
12,13,
Alexia Alexandraki
14,
Effrosyni Kampouroglou
11,
Yorgos Goletsis
1,15,
Andri Papakonstantinou
16,
Athos Antoniades
17,
Cameron Brown
17,
Vasileios Bouratzis
5,
Erika Matos
18,
Kostas Marias
19,20
,
Manolis Tsiknakis
19
and
Dimitrios I. Fotiadis
1,4,*
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1
Unit of Medical Technology and Intelligent Information Systems, Department of Material Science and Engineering, University of Ioannina, 45110 Ioannina, Greece
2
Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, 45110 Ioannina, Greece
3
Department of Medical Oncology, University of Ioannina, 45110 Ioannina, Greece
4
Department of Biomedical Research, Institute of Molecular Biology and Biotechnology, FORTH, 45110 Ioannina, Greece
5
Second Department of Cardiology, University Hospital of Ioannina, Stavros Niarchos Avenue, 45500 Ioannina, Greece
6
Bank of Cyprus Oncology Centre, 2029 Nicosia, Cyprus
7
Cyprus Cancer Research Institute, 2109 Nicosia, Cyprus
8
Medical School, University of Cyprus, 2029 Nicosia, Cyprus
9
General Anti-Cancer Oncological Hospital, Agios Savvas, 11522 Athens, Greece
10
Department of Cardiology, University Hospital Attikon, National and Kapodistrian University of Athens, 12462 Athens, Greece
11
2nd Department of Surgery, Aretaieio University Hospital, National and Kapodistrian University of Athens, 76 Vas. Sofias Av., 11528 Athens, Greece
12
European Institute of Oncology IRCCS, 20141 Milan, Italy
13
Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
14
A.G. Leventis Clinical Trials Unit, Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, 2006 Nicosia, Cyprus
15
Laboratory of Business Economics and Decisions (LABED@UoI), Department of Economics, University of Ioannina, 45110 Ioannina, Greece
16
Department of Oncology-Pathology, Karolinska Institutet and University Hospital, 171 64 Stockholm, Sweden
17
Stremble Ventures Ltd., 59 Christaki Kranou, 4042 Limassol, Cyprus
18
Department of Medical Oncology, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
19
Department of Electrical and Computer Engineering, Hellenic Mediterranean University, 71410 Heraklion, Greece
20
Computational Biomedicine Laboratory, Institute of Computer Science, FORTH, 70013 Heraklion, Greece
*
Author to whom correspondence should be addressed.
Cancers 2025, 17(11), 1780; https://doi.org/10.3390/cancers17111780
Submission received: 1 April 2025
/
Revised: 16 May 2025
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Accepted: 23 May 2025
/
Published: 26 May 2025
(This article belongs to the Section Cancer Survivorship and Quality of Life)
Simple Summary
Breast cancer is widespread globally and significantly affects patients’ well being. e-Health solutions are rapidly increasing, offering support for patients’ mental health and quality of life. This systematic review includes 27 randomized studies with a total of 2,898 patients, which evaluated the effects of e-Health interventions on mental health and quality of life in breast cancer patients. The results show a significant reduction in anxiety and depression and an improvement in quality of life, but no significant effect on reducing distress.
Abstract
Background/Objectives: The prevalence of breast cancer (BC) is significant globally. The malignancy itself and the related treatments have a considerable impact on patients’ overall well-being. The adoption of e-health solutions for patients is increasing rapidly worldwide, since these innovative tools hold significant potential to positively impact the mental health and quality of life (QoL) of BC patients. However, their overall impact is still being explored, and further understanding and analysis are required. This review paper aims to present, quantify, and summarize the cumulative available randomized evidence on the state of the art of supportive interventions delivered via e-health applications for patients’ mental health and QoL before, during, and after BC treatment. Methods: A systematic review was conducted following the PRISMA guidelines in the Scopus and PubMed databases on 7 November 2024 to identify studies that utilized internet-based interventions in BC patients. The inclusion criteria were as follows: adult men and women (aged > 18 years) diagnosed with breast cancer (BC) who received patient-directed e-health interventions, compared to standard care or control interventions. The studies had to focus on outcomes such as quality of life (QoL), anxiety, depression, and distress, and be limited to randomized controlled trials (RCTs). The PRISMA-P guidelines were followed. Risk of bias was assessed using the Cochrane risk-of-bias (RoB) tool for randomized controlled trials. Results: A total of 27 randomized studies, involving 2898 patients, were included in this systematic review. The e-health interventions significantly affected patients’ anxiety (SMD = −0.80; 95% CI: −1.33 to −0.27; p < 0.01; and I2 = 94%), depression (SMD = −0.74; 95% CI: −1.40 to −0.09; p = 0.026; and I2 = 95%) and QoL (SMD = 0.65; 95% CI: 0.27 to 1.04; p < 0.01; and I2 = 90%) but had no significant effect on distress (SMD = −0.78; 95% CI: −1.93 to 0.37; p = 0.184; and I2 = 95%). Conclusions: This study showed that e-health interventions can improve QoL, reduce anxiety, and decrease depression in adult BC patients. However, no noticeable impact on reducing distress levels was observed. Additionally, given the diversity of interventions, these results should be interpreted with caution. To determine the optimum duration, validate different intervention approaches, and address methodological gaps in previous studies, more extensive clinical studies are needed.
Keywords:
e-health; breast cancer; anxiety; depression; quality of life
