Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Effectiveness of eHealth interventions in long-term follow-up care for breast and gynecological cancer survivors: a systematic review
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.
27 May 2026
Read appraisal →JMIR formative research
Retrieval-Augmented Generation Versus GPT-4o for Patient-Facing Gynecological Cancer Information: Quality Evaluation
Retrieval-augmented generation improved overall quality scores for patient-facing gynecological cancer information mainly through better source attribution.
28 Apr 2026
Read appraisal →Physics in medicine and biology
Fraction-variant VMAT planning for patients with complex gynecological and head-and-neck cancer.
Objective. Increasing the number of arcs in volumetric modulated arc therapy (VMAT) allows for better intensity modulation and may improve plan quality. However, this leads to longer delivery times, which may cause patient discomfort and increase intra-fractional motion. In this study, it was investigated whether the delivery of different VMAT plans in different fractions may improve the dosimetric quality and delivery efficiency for the treatment of patients with complex tumor geometries.Approach. A direct aperture optimization algorithm was developed which allows for the simultaneous optimization of different VMAT plans to be delivered in different fractions, based on their cumulative physical dose. Each VMAT plan is constrained to deliver a uniform dose within the target volume, such that the entire treatment does not alter the fractionation scheme and is robust against inter-fractional setup errors. This approach was evaluated in-silico for five patients with gynecological and five patients with head-and-neck cancer.Main results. For all patients, fraction-variant treatments achieved significantly better target coverage and reduced the dose to critical organs-at-risk compared to fraction-invariant treatments that deliver the same plan in every fraction, where the dosimetric benefit was shown to increase with the number of different plans to be delivered. In addition, 1-arc and 2-arc fraction-variant treatments could approximate the dosimetric quality of 3-arc fraction-invariant treatments, while reducing the delivery time.Significance.Fraction-variant VMAT treatments may achieve excellent dosimetric quality for patients with complex tumor geometries, while keeping the delivery time per fraction viable.
9 Apr 2026
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