Effectiveness of eHealth interventions in long-term follow-up care for breast and gynecological cancer survivors: a systematic review
Clinical Snapshot
PICO Framework
| P — Population | Adult breast and gynecological cancer survivors requiring long-term follow-up care |
| I — Intervention | eHealth interventions (digital health technologies for survivorship care) |
| C — Comparator | Usual care or standard follow-up protocols |
| O — Outcomes | Health-related quality of life, fatigue, psychological distress (anxiety/depression), self-management, treatment adherence, hospital readmissions, complications, infections, malnutrition |
Bottom Line
This systematic review of 41 studies suggests eHealth interventions may provide small to moderate benefits for psychological outcomes and quality of life in cancer survivors, particularly those with breast cancer. However, the evidence is limited by methodological heterogeneity, short follow-up periods, and significant underrepresentation of gynecological cancer populations. The finding that effect sizes diminished in higher-quality studies raises questions about the robustness of observed benefits. Key clinical outcomes including infections, malnutrition, and hospital readmissions were not evaluated in any included studies. While eHealth interventions show promise for scalable survivorship care, clinicians should interpret these findings cautiously. The current evidence is insufficient to support widespread implementation without further high-quality, long-term research across diverse cancer populations. Australian clinicians should consider these interventions as adjunctive rather than replacement therapy for standard survivorship care.
Key Findings
P Value: Not reported
Effect Size: Small to moderate (specific values not reported)
Primary Outcome: Small to moderate improvements in fatigue, anxiety, depression, health-related quality of life, and treatment adherence
Nnt Or Sensitivity: Effect sizes were smaller in studies with lower risk of bias
Confidence Interval: Not reported
Clinical Application
eHealth interventions offer scalable and accessible approach but require further validation Relevant to Australian cancer survivorship care given increasing survival rates and need for accessible follow-up. Could complement existing Cancer Council support services and align with TGA digital health framework Primarily breast cancer survivors; limited evidence for gynecological cancer survivors
Abstract
PURPOSE: As survival rates for breast and gynecological cancers improve, many survivors experience persistent long-term challenges, including fatigue, psychological distress, and reduced health-related quality of life (HRQoL). eHealth interventions may offer a scalable and accessible approach to support survivorship care. This systematic review aimed to evaluate the effectiveness of eHealth interventions in long-term follow-up care for breast and gynecological cancer survivors. METHODS: A systematic literature search was conducted across six databases (PubMed, PsycINFO, Web of Science, Cochrane Library, MedRxiv, and PsyArXiv) for studies published between January 2010 and February 2026. Eligible studies included adult breast or gynecological cancer survivors and evaluated eHealth interventions in follow-up care compared with usual care. Outcomes included outcomes such as burden of treatment, HRQoL, self-management, hospital readmissions, complications, infections, fatigue, or malnutrition. Data were extracted, synthesized narratively, and methodological quality was assessed using established risk-of-bias tools. RESULTS: A total of 41 studies were included, predominantly involving breast cancer survivors, with very limited representation of gynecological cancer populations. Overall, methodological quality ranged from low to moderate, with higher risk of bias observed in nonrandomized studies. eHealth interventions were associated with small to moderate improvements in fatigue, anxiety, depression, HRQoL, and treatment adherence, particularly among breast cancer survivors. However, effect sizes were generally smaller in studies with lower risk of bias. Evidence for gynecological cancer survivors was scarce and inconclusive, with only one study exclusively focusing on this population. Long-term outcomes were rarely assessed, and no studies evaluated the defined outcomes infections, malnutrition and unplanned hospital admissions. CONCLUSIONS: eHealth interventions show potential to support long-term survivorship care, particularly in improving psychological outcomes and quality of life among breast cancer survivors. However, the overall evidence base is limited by methodological heterogeneity, short follow-up periods, and the underrepresentation of gynecological cancer populations. Further high-quality, long-term, and cancer-specific research is needed to better establish the effectiveness and generalizability of these interventions in survivorship care. IMPLICATIONS FOR CANCER SURVIVORS: As survivorship care needs continue to increase, eHealth interventions may contribute to more accessible, scalable, and patient-centered models of follow-up care. However, their long-term effectiveness and applicability across diverse cancer populations remain unclear. More rigorous, long-term, and cancer-specific research is required to better define their role in survivorship care.
References
- 1.Kuhn, N. B. L., Maukel, L. M., & Tibubos, A. N. (2026). Effectiveness of eHealth interventions in long-term follow-up care for breast and gynecological cancer survivors: a systematic review. Supportive Care in Cancer. https://doi.org/10.2196/23304
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