Academic Edi o : Thomas Lich
Recei ed: 1 Ap il 2025
Re ised: 16 May 2025
Accep ed: 23 May 2025
Published: 26 May 2025
Ci a ion: Mi sis, A.; Filis, P.;
Ka anasiou, G.; Geo ga, E.I.; Mau i, D.;
Naka, K.K.; Cons an inidou, A.;
Ke amida, K.; Tsekou a, D.; Mazzocco,
K.; e al. Impac o e-Heal h
In e en ions on Men al Heal h and
Quali y o Li e in B eas Cance
Pa ien s: A Sys ema ic Re iew and
Me a-Analysis o Randomized
Con olled T ials. Cance s 2025,17,
1780. h ps://doi.o g/10.3390/
cance s17111780
Copy igh : © 2025 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
This a icle is an open access a icle
dis ibu ed unde he e ms and
condi ions o he C ea i e Commons
A ibu ion (CC BY) license
(h ps://c ea i ecommons.o g/
licenses/by/4.0/).
Sys ema ic Re iew
Impac o e-Heal h In e en ions on Men al Heal h and Quali y
o Li e in B eas Cance Pa ien s: A Sys ema ic Re iew
and Me a-Analysis o Randomized Con olled T ials
Alexand os Mi sis 1, Panagio is Filis 2,3 , Geo gia Ka anasiou 1,4 , Eleni I. Geo ga 1, Da ide Mau i 3,
Ka e ina K. Naka 5, Anas asia Cons an inidou 6,7,8, Kalliopi Ke amida 9,10, Do o hea Tsekou a 11 ,
Ke i Mazzocco 12,13 , Alexia Alexand aki 14 , E osyni Kampou oglou 11 , Yo gos Gole sis 1,15 ,
And i Papakons an inou 16
, A hos An oniades
17
, Came on B own
17
, Vasileios Bou a zis
5
, E ika Ma os
18
,
Kos as Ma ias 19,20 , Manolis Tsiknakis 19 and Dimi ios I. Fo iadis 1,4,*
1Uni o Medical Technology and In elligen In o ma ion Sys ems, Depa men o Ma e ial Science and
Enginee ing, Uni e si y o Ioannina, 45110 Ioannina, G eece; [email p o ec ed] (A.M.);
[email p o ec ed] (G.K.); [email p o ec ed] (E.I.G.); [email p o ec ed] (Y.G.)
2Depa men o Hygiene and Epidemiology, Uni e si y o Ioannina School o Medicine,
45110 Ioannina, G eece; [email p o ec ed]
3Depa men o Medical Oncology, Uni e si y o Ioannina, 45110 Ioannina, G eece; [email p o ec ed]
4Depa men o Biomedical Resea ch, Ins i u e o Molecula Biology and Bio echnology, FORTH,
45110 Ioannina, G eece
5Second Depa men o Ca diology, Uni e si y Hospi al o Ioannina, S a os Nia chos A enue,
45500 Ioannina, G eece; [email p o ec ed] (K.K.N.); [email p o ec ed] (V.B.)
6Bank o Cyp us Oncology Cen e, Nicosia 2029, Cyp us; [email p o ec ed]
7Cyp us Cance Resea ch Ins i u e, Nicosia 2109, Cyp us
8Medical School, Uni e si y o Cyp us, Nicosia 2029, Cyp us
9Gene al An i-Cance Oncological Hospi al, Agios Sa as, 11522 A hens, G eece;
[email p o ec ed]
10 Depa men o Ca diology, Uni e si y Hospi al A ikon, Na ional and Kapodis ian Uni e si y o A hens,
12462 A hens, G eece
11
2nd Depa men o Su ge y, A e aieio Uni e si y Hospi al, Na ional and Kapodis ian Uni e si y o A hens,
76 Vas. So ias A ., 11528 A hens, G eece; [email p o ec ed] (D.T.);
e osini.kampou [email p o ec ed] (E.K.)
12 Eu opean Ins i u e o Oncology IRCCS, 20141 Milan, I aly; [email p o ec ed]
13 Depa men o Oncology and Hema o-Oncology, Uni e si y o Milan, 20122 Milan, I aly
14 A.G. Le en is Clinical T ials Uni , Bank o Cyp us Oncology Cen e, 32 Ac opoleos A enue,
Nicosia 2006, Cyp us; [email p o ec ed]g.cy
15 Labo a o y o Business Economics and Decisions (LABED@UoI), Depa men o Economics,
Uni e si y o Ioannina, 45110 Ioannina, G eece
16 Depa men o Oncology-Pa hology, Ka olinska Ins i u e and Uni e si y Hospi al, 171 64 S ockholm,
Sweden; [email p o ec ed]
17
S emble Ven u es L d., 59 Ch is aki K anou, Limassol 4042, Cyp us; a hos.an oniades@s emble.com (A.A.);
came on.b own@s emble.com (C.B.)
18
Depa men o Medical Oncology, Ins i u e o Oncology Ljubljana, 1000 Ljubljana, Slo enia; [email p o ec ed]
19 Depa men o Elec ical and Compu e Enginee ing, Hellenic Medi e anean Uni e si y,
71410 He aklion, G eece; [email p o ec ed] (K.M.); [email p o ec ed] (M.T.)
20 Compu a ional Biomedicine Labo a o y, Ins i u e o Compu e Science, FORTH, 70013 He aklion, G eece
*Co espondence: [email p o ec ed]
Simple Summa y: B eas cance is widesp ead globally and signi ican ly a ec s pa ien s’
well being. e-Heal h solu ions a e apidly inc easing, o e ing suppo o pa ien s’ men al
heal h and quali y o li e. This sys ema ic e iew includes 27 andomized s udies wi h
a o al o 2898 pa ien s, which e alua ed he e ec s o e-Heal h in e en ions on men al
heal h and quali y o li e in b eas cance pa ien s. The esul s show a signi ican educ ion
in anxie y and dep ession and an imp o emen in quali y o li e, bu no signi ican e ec
on educing dis ess.
Cance s 2025,17, 1780 h ps://doi.o g/10.3390/cance s17111780
Cance s 2025,17, 1780 2 o 19
Abs ac : Backg ound/Objec i es: The p e alence o b eas cance (BC) is signi ican
globally. The malignancy i sel and he ela ed ea men s ha e a conside able impac on
pa ien s’ o e all well-being. The adop ion o e-heal h solu ions o pa ien s is inc easing
apidly wo ldwide, since hese inno a i e ools hold signi ican po en ial o posi i ely
impac he men al heal h and quali y o li e (QoL) o BC pa ien s. Howe e , hei o e -
all impac is s ill being explo ed, and u he unde s anding and analysis a e equi ed.
This e iew pape aims o p esen , quan i y, and summa ize he cumula i e a ailable
andomized e idence on he s a e o he a o suppo i e in e en ions deli e ed ia
e-heal h applica ions o pa ien s’ men al heal h and QoL be o e, du ing, and a e BC
ea men . Me hods: A sys ema ic e iew was conduc ed ollowing he PRISMA guide-
lines in he Scopus and PubMed da abases on 7 No embe 2024 o iden i y s udies ha
u ilized in e ne -based in e en ions in BC pa ien s. The inclusion c i e ia we e as ollows:
adul men and women (aged > 18 yea s) diagnosed wi h b eas cance (BC) who ecei ed
pa ien -di ec ed e-heal h in e en ions, compa ed o s anda d ca e o con ol in e en ions.
The s udies had o ocus on ou comes such as quali y o li e (QoL), anxie y, dep ession,
and dis ess, and be limi ed o andomized con olled ials (RCTs). The PRISMA-P guide-
lines we e ollowed. Risk o bias was assessed using he Coch ane isk-o -bias (RoB) ool
o andomized con olled ials. Resul s: A o al o 27 andomized s udies, in ol ing
2898 pa ien s, we e included in his sys ema ic e iew. The e-heal h in e en ions sig-
ni ican ly a ec ed pa ien s’ anxie y (
SMD = −0.80
; 95% CI:
−
1.33 o
−
0.27; p< 0.01;
and I2= 94%
), dep ession (SMD =
−
0.74; 95% CI:
−
1.40 o
−
0.09; p= 0.026;
and I2= 95%
)
and QoL (SMD = 0.65; 95% CI: 0.27 o 1.04; p< 0.01; and I
2
= 90%) bu had no signi ican
e ec on dis ess (SMD =
−
0.78;
95% CI: −1.93 o 0.37
;p= 0.184; and I
2
= 95%). Conclu-
sions: This s udy showed ha e-heal h in e en ions can imp o e QoL, educe anxie y,
and dec ease dep ession in adul BC pa ien s. Howe e , no no iceable impac on educing
dis ess le els was obse ed. Addi ionally, gi en he di e si y o in e en ions, hese
esul s should be in e p e ed wi h cau ion. To de e mine he op imum du a ion, alida e
di e en in e en ion app oaches, and add ess me hodological gaps in p e ious s udies,
mo e ex ensi e clinical s udies a e needed.
Keywo ds: e-heal h; b eas cance ; anxie y; dep ession; quali y o li e
1. In oduc ion
B eas cance (BC) is he mos common ype o cance , commonly diagnosed in women,
al hough i can occu in men [
1
]. I poses a signi ican heal h bu den globally, wi h o e
2 million new cases diagnosed in 2022 [
2
]. I is also one o he leading causes o dea h in
women wo ldwide, despi e i s downwa d end, pa icula ly in de eloped coun ies. This
highligh s he impo ance o ad ancing BC managemen , wi h a ocus on enhancing ea ly
de ec ion me hods and de eloping mo e e ec i e ea men op ions [3].
Cu en ly, he apeu ic op ions o BC encompass su gical in e en ions, chemo he apy,
endoc ine he apy, adio he apy, a ge ed he apy, and immuno he apy [
4
]. The e olu ion
o no el ea men s and he apies has no ably imp o ed he su i al o BC pa ien s. Ap-
p oxima ely 70% o pa ien s expe ience an inc ease in li e expec ancy o mo e han i e
yea s, while 40% expe ience an inc ease o mo e han en yea s. Mo eo e , o 15% o pa-
ien s, li e expec ancy ex ends by o e wen y yea s [
5
]. Howe e , i is well ecognized ha
pa ien s’ men al heal h and QoL a e ypically impac ed by BC ea men and i s sequelae,
and some o hem can be li elong [
6
]. Thus, he ansi ion om he “cance s uggle” o
“ egula li e” o su i o s manda es ha hey i s deal wi h he ad e se e ec s o cance
Cance s 2025,17, 1780 3 o 19
he apy [
7
]. The e o e, as su i al a es ha e imp o ed conside ably [
5
], he mi iga ion
o cance he apy- ela ed ad e se e ec s is c ucial o imp o ing QoL. The managemen
o QoL, in i s physical and psychological componen s, will esul in imp o ed ea men
e icacy and p ognosis [8].
E-heal h e e s o he use and applica ion o digi al echnologies (e.g., in e ne , mobile
de ices, wea ables, so wa e ools, e c.) ha suppo heal hca e deli e y o imp o ed
disease moni o ing, managemen , and QoL [
9
]. The apid imp o emen s and inc easing
accessibili y o hese echnologies ha e d i en he widesp ead adop ion o e-heal h in e -
en ions in cance ca e, enabling, among o he s, pa ien engagemen and communica ion
wi h heal hca e expe s h oughou he heal hca e deli e y con inuum [
10
]. Cu en ly, he e
a e se e al s udies showing ha e-heal h in e en ions may ha e a posi i e e ec on cance
pa ien s’ physical, psychological, and social unc ioning, as well as hei sel -e icacy, QoL,
men al well-being, dep ession, and anxie y [
5
,
11
–
13
]. None heless, he o e all impac o
e-heal h in e en ions on pa ien s’ men al heal h and QoL is no ye clea , la gely due o
he a iabili y in s udy designs, in e en ion ypes, and ou come measu es used in exis ing
esea ch, and his a iabili y p esen s a signi ican challenge in conduc ing comp ehensi e
e iews o accu a ely es ima e hei o e all e ec i eness.
To add ess his challenge, we pe o med a sys ema ic e iew wi h he aim o quan-
i ying and summa izing he a ailable andomized e idence on he use o suppo i e
in e en ions deli e ed ia e-heal h on pa ien s’ men al heal h and QoL.
2. Ma e ials and Me hods
2.1. Sea ch S a egy
The PubMed and Scopus da abases we e sys ema ically sc u inized om incep ion
up o 7 No embe 2024 o eligible s udies. This s udy was egis e ed in he In e na ional
P ospec i e Regis e o Sys ema ic Re iews.
To iden i y ele an s udies o his e iew, a Boolean s ing consis ing o se e al
ele an keywo ds was gene a ed. The ollowing s ing was applied: “((quali y o li e)
AND (men al heal h AND ((men al OR emo ional OR psychological OR social) AND
well-being) OR men al diso de OR dep ession OR anxie y) AND (b eas cance ) AND
(e-heal h OR elec onic heal h OR in o ma ion and communica ion echnolog* OR ICT OR
m-heal h OR mobile heal h OR digi al heal h OR mobile OR in e ne OR web OR online OR
digi al OR emo e OR sma phone OR applica ion OR app OR e-coach))”. This s ing was
de eloped so ha he sea ch o each da abase only iden i ied s udies ele an o he opic,
he eby ensu ing consis ency and comp ehensi eness in he sea ch p ocess. Fo a s udy o
be conside ed o inclusion in ou analysis, i had o mee he p ede ined inclusion c i e ia
lis ed in Table 1. In addi ion, he s udy had o be published in English, and he ull ex had
o be a ailable. The inclusion c i e ia we e de e mined using he PICOS amewo k [14].
Table 1. Inclusion c i e ia o s udies.
Pa ame e Inclusion C i e ia
Popula ion Adul men o women (aged > 18 yea s old) diagnosed wi h BC
In e en ion Pa ien -di ec ed e-heal h in e en ion
Compa a o
S udies in which pa ien s ecei ed s anda d ca e o con ol in e en ion
Ou comes QoL, anxie y, dep ession, dis ess
S udy Design Randomized con olled ials
Cance s 2025,17, 1780 4 o 19
2.2. Da a Ex ac ion
The pape s e ie ed we e subsequen ly handled wi h an au oma ed ool (Zo e o 6.0.36,
Co po a ion o Digi al Schola ship, Vienna, VA, USA), which was used o emo e duplica e
en ies. The emaining a icles we e hen independen ly sc eened o i le and abs ac
by each o he wo e iewe s who pa icipa ed in he s udy selec ion p ocess. Po en ially
eligible a icles we e hen assessed in ull ex by he same e iewe s independen ly once
again. Any disag eemen s we e esol ed h ough discussion o , i necessa y, wi h he
in ol emen o a hi d e iewe .
The da a om he emaining s udies we e ex ac ed by wo independen e iewe s
acco ding o he PRISMA guidelines.
A p ede ined da a ex ac ion shee was used o collec in o ma ion om each s udy.
The ocus was on e alua ing changes in anxie y, dep ession, quali y o li e, and dis ess
be o e and a e he in e en ion in ol ing e-heal h applica ions. S udies ha did no
epo ou comes o any o hese ca ego ies we e excluded om he cu en analysis. Da a
ex ac ion was pe o med independen ly by wo au ho s, and he accu acy o he ex ac ed
da a was e i ied by a hi d au ho . Fo each s udy, we ex ac ed in o ma ion ega ding he
au ho s, publica ion yea , ID, sample size, cance and he apy in o ma ion, in e en ion
ype, du a ion o he in e en ion, s udy design, ou comes o in e es , and a summa y o
he esul s.
2.3. Risk o Bias and Quali y Assessmen
Two independen e iewe s assessed he quali y o he included s udies using he
Coch ane isk-o -bias ool, a commonly used me hod o assessing he isk o bias in a ious
s udy designs, including andomized con olled ials (RCTs) [
15
]. The quali y o each
s udy was e alua ed in he ollowing domains: adequa e sequence gene a ion, alloca ion
concealmen , adequa e blinding o pa ien s and pe sonnel, adequa e blinding o ou come
assesso s, incomple e ou come da a assessmen , and selec i e epo ing bias [16].
2.4. S a is ical Analysis
We pe o med a me a-analysis using RS udio so wa e ( e sion 4.3.1; R Co e Team,
2023) wi h he ‘me a’ and ‘me a o ’ packages. S anda dized mean di e ences (SMDs) and
95% con idence in e als we e used o he ou comes, measu ed as he mean and s anda d
de ia ion. A andom-e ec s model was employed o accoun o po en ial di e ences in
samples and in e en ions ac oss he included s udies. A p- alue o <0.05 was conside ed
s a is ically signi ican . S a is ical he e ogenei y was assessed using he I
2
s a is ic [
17
].
Values o 0–25%, 25–50%, and 50–100% we e conside ed o indica e low, mode a e, and
subs an ial he e ogenei y, espec i ely [
18
]. Mo eo e , subg oup analyses we e pe o med
based on he mode o e-heal h in e en ion (Web, mobile applica ions, o he ), as well as
he du a ion o he in e en ion (less han 12 weeks and 12 weeks o mo e). Small s udy
e ec s, indica i e o publica ion bias, we e assessed by isual inspec ion o unnel plo s
and Egge ’s es [
19
]. This assessmen was pe o med only o analyses ha included 10 o
mo e s udies, and a p- alue < 0.1 was conside ed indica i e o small s udy e ec s.
3. Resul s
A o al o 1488 eco ds we e iden i ied ollowing he sea ch o Scopus and PubMed.
A e i le and abs ac sc eening, 109 publica ions we e iden i ied as po en ially eligible
(Figu e 1). Following de ailed sc eening, ou sys ema ic e iew e ained a o al o 27 s udies
ocusing on e-heal h in e en ions a ge ing men al heal h and QoL in BC pa ien s.
Cance s 2025,17, 1780 5 o 19
3.1. Cha ac e is ics o Included S udies
All he s udies included in he inal analysis ocused on adul pa ien s and cance
su i o s aged 18 yea s o olde . All he s udies included we e RCTs speci ically a ge ing
pa ien s diagnosed wi h BC. The sample size anged om 35 o 363 pa ien s. Fi e s udies
had a sample size o less han 50 pa ien s, wel e be ween 50 and 100 pa ien s, while he
emaining s udies had a sample size o mo e han 100 pa ien s. In o al, (i) pa ien s in
10 s udies had a mean age be ween 50 and 60 yea s, pa ien s in 1 s udy had a mean age o
o e 60 yea s, and pa ien s in he emaining s udies had a mean age o 50 yea s o younge ;
(ii) he publica ions we e om 2018 onwa d: nine s udies we e published in 2024, wo
s udies in 2023, h ee s udies in 2022, wo s udies in 2021, ou s udies in 2020, h ee s udies
in 2019, and ou s udies in 2018; and (iii) he majo i y (13/27) we e conduc ed in Asia,
ollowed by se en, ou , and h ee in Eu ope, Ame ica, and Aus alia, espec i ely.
The included s udies had di e en in e en ion du a ions, anging om 3 o 24 weeks,
and di e en e-heal h ools we e used. No ably, he majo i y o s udies (16/27) used
mHeal h apps [20–37], while he emaining s udies used web applica ions [38–46].
Figu e 1. PRISMA low diag am.
The main cha ac e is ics and indings o he s udies included a e summa ized in
Tables 2–4.
Cance s 2025,17, 1780 6 o 19
Table 2. S udies on e-heal h in e en ions in cance pa ien s.
Au ho s PMID/DOI Numbe o Pa ien s S age/S a us The apy Expe imen al
In e en ion Compa ison Du a ion o
In e en ion (Weeks)
S udy Ou comes
(Compa ed o
Con ol G oup)
Akkol-Solakoglu, e al.
[46]36635249 To al = 72
(I = 49, C = 23), Mean
age: 47.8 0, I, II, III, IV
Chemo he apy,
Radio he apy,
Ho monal he apy,
Su ge y
Web-based cogni i e
beha io al he apy Usual ca e 8 No signi ican e ec on
anxie y, dep ession, ea
o ecu ence, and QoL.
A ema e al. [38] 30763176 To al = 169
(I = 85, C = 85), Mean
age: 47.4 I, II, III, IV
Su ge y, Chemo he apy,
Radia ion he apy,
Immuno he apy,
Endoc ine he apy,
Oopho ec omy
In e ne -based cogni i e
beha io al he apy Wai ing lis 24
Imp o emen s in ho
lushes, sleep quali y,
and menopausal
symp oms.
Chen e al. [20] 38889503 To al = 94
(I = 47, C = 47), Mean
age: 49.3 I, II Chemo he apy Phone-based suppo
p og am Usual ca e 7
Highe sel -ca e e icacy,
be e QoL, less
symp om dis ess,
educed anxie y and
dep ession.
Dong e al. [21] 31242926 To al = 60
(I = 30, C = 30), Mean
age: 49.7 I, II, III Chemo he apy In e ne and social
media so wa e
(CEIBISMS) T adi ional ehab ca e 12 Imp o emen s in
i ali y, men al heal h,
and heal h ansi ion.
Ghanba i e al. [22] 34003138 To al = 82
(I = 41, C = 41), Mean
age: 46.4 Nonme as a ic No epo ed mHeal h
psychoeduca ional
in e en ion Wai ing lis 5 Lowe anxie y and
highe sel -es eem.
G aham e al. [39] 38752788 To al = 79
(I = 40, C = 39), Mean
age: 59.4 I, II, III Su ge y, Chemo he apy,
Radia ion he apy,
Ho mone he apy
Remo ely deli e ed
one- o-one he apy Usual ca e 24
Imp o emen s in
medica ion adhe ence,
QoL, dis ess,
and lexibili y.
Handa e al. [23] 32201165 To al = 102
(I = 52, C = 50), Mean
age: 49.9
ER+, ER-, PR+, PR-,
HER2+, HER2- Chemo he apy
Sma phone app du ing
chemo he apy Usual ca e 12
No signi ican
anxie y/dep ession
change; possible
enhanced ca e ia
in o sha ing.
Hein ich e al. [24] 39439014 To al = 70
(I = 32, C = 38), Mean
age: 57.6 P ima y b eas cance Su ge y, Chemo he apy,
Radia ion he apy mHeal h cogni i e
beha io al he apy Usual ca e 12 Imp o ed anxie y,
HRQoL, and illness
pe cep ion.
Hol di k e al. [40] 33961667 To al = 363
(I = 181, C = 182), Mean
age: 49.9 No epo ed Su ge y, Chemo he apy,
Radia ion ea men Websi e wi h CBT Usual ca e 12 Imp o ed QoL and die ;
no change in exe cise.
Jacobs e al. [41] 35924869 To al = 100
(I = 50, C = 50), Mean
age: 56.1 0, I, II, III Su ge y, Chemo he apy,
Radia ion he apy,
Endoc ine he apy
Teleheal h o symp om
managemen Medica ion moni o ing 12 Less dis ess, be e
sel -managemen ,
coping, mood, and QoL.
Kim e al. [35] 30578205 To al = 76
(I = 36, C = 40), Mean
age: 51.0 IV
Chemo he apy ( axanes,
an h acyclines,
capeci abine, pla inum
compounds)
mHeal h game o educe
chemo he apy side
e ec s
Con en ional educa ion
g oup 3
Be e d ug adhe ence,
ewe chemo he apy
ad e se e ec s, be e
QoL, no signi ican
di e ence in dep ession
o anxie y.
Cance s 2025,17, 1780 7 o 19
Table 3. S udies on e-heal h in e en ions in cance pa ien s.
Au ho s PMID/DOI Numbe o Pa ien s S age/S a us The apy Expe imen al
In e en ion Compa ison Du a ion o
In e en ion (Weeks)
S udy Ou comes
(Compa ed o
Con ol G oup)
Ko kmaz e al. [42] 31119709 To al = 48
(I = 24, C = 24), Mean
age: 47.7 II, III Su ge y Web-based educa ion
p og am on anxie y and
QoL Rou ine educa ion 4 Lowe le els o anxie y
and imp o emen s
in QoL.
Lally e al. [43] 31414245 To al = 100
(I = 57, C = 43), Mean
age: 54.2 0, I, II Su ge y, Chemo he apy,
Radia ion he apy
Tailo ed
sel -managemen
psychoeduca ional
p og am
Usual ca e 12 No signi ican
ou comes.
Li e al. [25] 39363984 To al = 44
(I = 23, C = 21), Mean
age: 47.9 I, II, III Chemo he apy
Wea able de ice-based
ae obic exe cise o
physical and men al
heal h
Wai ing lis 12
Imp o emen s in
physical i ness, men al
heal h, sleep quali y,
QoL, and ewe
ad e se e ec s.
Okuyama e al. [26] 38796818 To al = 125
(I = 61, C = 64), Mean
age: 63.5 I, II, III
Chemo he apy,
Radio he apy,
endoc ine he apy,
Combina ion he apy
Elec onic
pa ien - epo ed
ou come app Usual ca e 12
No imp o emen s in BC
pa ien s’ QoL.
Philips e al. [27] 39014267 To al = 49
(I = 25, C = 24), Mean
age: 54.8 IV
Chemo he apy,
Radia ion he apy,
Immuno he apy,
Ta ge ed he apy,
Ho mone he apy
Physical ac i i y
p omo ion ia mHeal h
in e en ion Heal hy li es yle con ol 12
Imp o emen s in
ac i i y, QoL, some
PROs, social cogni i e
heo y cons uc s, and
unc ional pe o mance.
Peng e al. [28] 36347151 To al = 60
(I = 30, C = 30), Mean
age: 41.8 I, II, III, IV
mas ec omy,
conse a i e he apy,
mas ec omy + b eas
cons uc ion
Online
mind ulness-based
in e en ion on ea o
cance ecu ence and
quali y o li e
Usual ca e 6
Lowe le el o ea o
cance ecu ence (FCR)
and an imp o emen in
quali y o li e
Rigg e al. [44] 39438337 To al = 35
(I = 17, C = 18), Mean
age: 57.4 IV
Su ge y, Chemo he apy,
Radio he apy,
Ho monal he apy,
O he ea men
Web-based sel -guided
psychosocial p og am Usual ca e 6
Small imp o emen s in
ea o p og ession and
global QoL, alongside
some de e io a ions in
dis ess and
men al QoL.
Rosen e al. [29] 10.1002/pon.4764 To al = 112
(I = 57, C = 55), Mean
age: 52.2 No epo ed No epo ed mHeal h mind ulness
aining Wai ing lis 8 Imp o emen s in QoL.
Sa ac e al. [30] 39257013 To al = 82
(I = 42, C = 40), Mean
age: 49.0 No epo ed
Adju an , Neoadju an ,
Su ge y (BCS + SLNB,
Mas ec omy + SLNB,
MRM)
In o ma i e mobile app
use on anxie y, dis ess,
and QoL Usual ca e 4
Lowe anxie y and
dis ess le els, bu no
di e ence in
o e all QoL.
Single on e al. [31] 35460441 To al = 156
(I = 78, C = 78), Mean
age: 55.1 No epo ed
Su ge y, Radio he apy,
Chemo he apy,
Endoc ine he apy,
Ta ge ed he apy
Suppo ing women’s
heal h ou comes
h ough ex messages. Usual ca e 24
No signi ican di e ences
be ween g oups o
sel -e icacy, adjus ed
mean di e ence, QoL,
men al heal h, physical
ac i i y, o BMI.
Cance s 2025,17, 1780 8 o 19
Table 4. S udies on e-heal h in e en ions in cance pa ien s.
Au ho s PMID/DOI Numbe o Pa ien s S age/S a us The apy Expe imen al
In e en ion Compa ison Du a ion o
In e en ion (Weeks)
S udy Ou comes
(Compa ed o
Con ol G oup)
Whi e e al. [45] 30137657 To al = 337
(I = 202, C = 177), Mean
age: 43.7 I, II
Su ge y, Chemo he apy,
Radio he apy, Ta ge ed
he apy, Ho monal
he apy
In o ma ion-based
b eas cance -speci ic
websi e Usual ca e 24 Mean le el o QoL
sco es did no di e
be ween g oups.
Zhang e al. [36] 38418478 To al = 36
(I = 19, C = 17), Mean
age: 47.2 IV No epo ed
Vi ual eali y
in e en ion o
managing cance and
li ing meaning ully.
Wai ing lis 12
CALM he apy led o
educ ions in
dep ession, dis ess, and
a achmen a oidance,
as well as imp o emen s
in quali y o li e.
Zhang e al. [37] 35712124 To al = 90
(I = 45, C = 45), Mean
age: 51.6 I, II, III, IV Su ge y, Chemo he apy
Vi ual eali y
in e en ion o
psychological dis ess
and symp om
managemen .
Usual ca e 12 VR-CALM imp o es
well-being in su i o s.
Zhou e al. [32] 32272281 To al = 111
(I = 56, C = 55), Mean
age: 49.9 I, II, III Su ge y, Chemo he apy,
Radio he apy,
Endoc ine he apy
WeCha -based nu sing
p og am o
pos ope a i e BC
ehabili a ion
Usual ca e 24 Signi ican
imp o emen
in HRQoL.
Zhou e al. [34] 31342310 To al = 132
(I = 66, C = 66), Mean
age: 44.5 I, II, III Su ge y, Chemo he apy,
Radio he apy,
Endoc ine he apy
Mobile-based aining
on esilience,
dep ession, and anxie y
managemen
Usual ca e 12
Imp o emen s we e
obse ed in
psychological esilience,
anxie y, and
dep ession sco es.
Zhu e al. [33] 29712622 To al = 114
(I = 57, C = 57), Mean
age: 47.2 I, II, III, IV Su ge y, Chemo he apy Mobile b eas cance
e-suppo p og am Usual ca e 12
E-suppo + ca e
imp o ed sel -e icacy,
symp om in e e ence,
and QoL bu no social
suppo , symp om
se e i y, anxie y, o
dep ession.
Cance s 2025,17, 1780 9 o 19
3.2. Risk o Bias Wi hin S udies
We used he Coch ane isk-o -bias ool o assess he quali y o he included s udies.
O he 27 included s udies, only h ee RCTs me all he equi emen s o be conside ed as
ha ing a low isk o bias. O he 27 included s udies, 24 (89%) had an app op ia e sequence
gene a ion p ocess, while only 13 used alloca ion concealmen . Mos o he s udies (81.5%)
did no blind hei pa ien s o p o essionals, o i was unclea whe he blinding was used,
esul ing in a high o unclea isk o bias. Thi een s udies (48%) implemen ed blinding o
ou come assesso s. Twen y s udies (74%) we e judged as posing a low isk o incomple e
ou come da a.
Al oge he , 21 (78%) s udies we e conside ed as ha ing a low isk o epo ing bias.
Figu es 2and 3show he esul s o he quali y assessmen o he included s udies using he
Coch ane Collabo a ion’s ool.
Figu e 2. Risk-o -bias g aph.
Figu e 3. Risk-o -bias summa y [20–46].
Cance s 2025,17, 1780 16 o 19
The e o e, o de ine he op imal ype and egimen o e-heal h in e en ion, high-quali y
RCTs a e needed.
5. Conclusions
E-heal h suppo has been shown o signi ican ly imp o e QoL and educe anxie y
and dep ession in BC pa ien s. These esul s imply ha e-heal h in e en ions ha e been a
leas o some ex en success ul and bene icial. Conside ing he decades-long dominance o
adi ional ea men s and suppo i e ca e managemen , hese e-heal h in e en ion ou -
comes a e mo e han encou aging o he u u e o medical ca e. Addi ionally, he easons
o he mode a e e ec i eness o some e-heal h in e en ions need o be u he analyzed,
including po en ial biases, implemen a ion issues, and me hodological weaknesses ha
may impac he esul s.
Supplemen a y Ma e ials: The ollowing suppo ing in o ma ion can be downloaded a h ps:
//www.mdpi.com/a icle/10.3390/cance s17111780/s1, Figu e S1: Fo es plo s showing he e ec s
o e-Heal h in e en ions on anxie y, p esen ed by in e en ion du a ion (less han 12 weeks: p= 0.011;
12 weeks o mo e: p= 0.033); Figu e S2: Fo es plo s showing he e ec s o e-Heal h in e en ions
on dep ession, p esen ed by in e en ion du a ion (less han 12 weeks: p= 0.278; 12 weeks o
mo e:
p= 0.065
); Figu e S3: Fo es plo s showing he e ec s o e-Heal h in e en ions on quali y
o li e (QoL), p esen ed by in e en ion du a ion (less han 12 weeks: p= 0.022; 12 weeks o mo e:
p= 0.012
);
Figu e S4
: Fo es plo s showing he e ec s o e-Heal h in e en ions on dis ess, p esen ed
by in e en ion du a ion (less han 12 weeks: p= 0.52; 12 weeks o mo e: p= 0.011); Figu e S5: Funnel
plo o publica ion bias on anxie y. The esul o Egge ’s es (p= 0.003) indica es he p esence o
small s udy e ec s, as sugges ed by he asymme y in he plo ; Figu e S6: unnel plo o publica ion
bias on dep ession. The esul o Egge ’s es (p= 0.037) indica es he p esence o small s udy e ec s,
as sugges ed by he asymme y in he plo ; Figu e S7: Funnel plo o publica ion bias on QoL. The
esul o Egge ’s es (p= 0.032) indica es he p esence o small s udy e ec s, as sugges ed by he
asymme y in he plo .
Au ho Con ibu ions: Concep ualiza ion: A.M., P.F., E.I.G., G.K. and K.M. (Kos as Ma ias); Me hod-
ology: A.M., P.F. and E.I.G.; Valida ion: A.M. and E.I.G.; Fo mal Analysis: A.M. and P.F.; In es iga ion:
A.M. and E.I.G.; Da a Cu a ion: A.M., P.F. and E.I.G.; W i ing—O iginal D a : A.M. and P.F.; Vi-
sualiza ion: A.M.; Supe ision: K.K.N. and D.I.F.; W i ing—Re iew and Edi ing: P.F., G.K., E.I.G.,
D.M., K.K.N., A.C., K.K., D.T., K.M. (Ke i Mazzocco), A.A. (Alexia Alexand aki), E.K., Y.G., A.P., A.A.
(A hos An oniades), C.B., V.B., E.M., K.M. (Kos as Ma ias), M.T. and D.I.F. All au ho s ha e ead and
ag eed o he published e sion o he manusc ip .
Funding: This esea ch ecei ed no ex e nal unding.
Da a A ailabili y S a emen : The da a p esen ed in his s udy a e a ailable in his a icle and
Supplemen a y Ma e ials.
Con lic s o In e es : Au ho s A hos An oniades and Came on B own we e employed by he company
S emble Ven u es L d. The emaining au ho s decla e ha he esea ch was conduc ed in he absence
o any comme cial o inancial ela ionships ha could be cons ued as a po en ial con lic o in e es .
Abb e ia ions
The ollowing abb e ia ions a e used in his manusc ip :
Abb e ia ion De ini ion
App Applica ion
BC B eas cance
E-heal h Elec onic heal h
HRQoL Heal h- ela ed quali y o li e
IARC In e na ional Agency o Resea ch on Cance
Cance s 2025,17, 1780 17 o 19
PICOS Popula ion, In e en ion, Compa a o , Ou comes, S udy Design
PRISMA P e e ed Repo ing I ems o Sys ema ic Re iews and Me a-Analysis
QoL Quali y o li e
RCT Randomized con olled ial
AI A i icial in elligence
PGHD Pa ien -gene a ed heal h da a
EHRs Elec onic heal h eco ds
Re e ences
1.
“B eas Cance | B eas Cance In o ma ion & O e iew”. A ailable online: h ps://www.cance .o g/cance / ypes/b eas -
cance .h ml (accessed on 21 No embe 2024).
2.
Zahwe, M.; Bendahhou, K.; Ese , S.; Mukhe ji, D.; Fouad, H.; Fadhil, I.; Soe joma a am, I.; Znao , A. Cu en and u u e bu den o
emale b eas cance in he Middle Eas and No h A ica egion using es ima es om GLOBOCAN 2022. In . J. Cance 2025,
156, 2320–2329. [C ossRe ]
3.
Sung, H.; Fe lay, J.; Siegel, R.L.; La e sanne, M.; Soe joma a am, I.; Jemal, A.; B ay, F. Global Cance S a is ics 2020: GLOBOCAN
Es ima es o Incidence and Mo ali y Wo ldwide o 36 Cance s in 185 Coun ies. CA Cance J. Clin. 2021,71, 209–249. [C ossRe ]
[PubMed]
4.
Wang, S.; Liu, Y.; Feng, Y.; Zhang, J.; Swinnen, J.; Li, Y.; Ni, Y. A Re iew on Cu abili y o Cance s: Mo e E o s o No el
The apeu ic Op ions A e Needed. Cance s 2019,11, 11782. [C ossRe ] [PubMed]
5.
Chen, M.; Gong, J.; Li, Q. The applica ion o eHeal h in cance su i o ship ca e: A e iew o web-based dyadic in e en ions o
pos - ea men cance su i o s and ca egi e s. Asia-Pac. J. Oncol. Nu s. 2022,9, 100109. [C ossRe ] [PubMed]
6.
Em e, N.; Yılmaz, S. Sleep quali y, men al heal h, and quali y o li e in women wi h b eas cance . Indian J. Cance 2024,61, 299.
[C ossRe ]
7.
Nayak, M.G.; Geo ge, A.; Vidyasaga , M.S.; Ma hew, S.; Nayak, S.; Nayak, B.S.; Shashidha a, Y.; Kama h, A. Quali y o Li e among
Cance Pa ien s. Indian J. Pallia . Ca e 2017,23, 445–450. [C ossRe ]
8.
Zeng, Y.; Hu, C.-H.; Li, Y.-Z.; Zhou, J.-S.; Wang, S.-X.; Liu, M.-D.; Qiu, Z.-H.; Deng, C.; Ma, F.; Xia, C.-F.; e al. Associa ion
be ween p e ea men emo ional dis ess and immune checkpoin inhibi o esponse in non-small-cell lung cance . Na . Med.
2024,30, 1680–1688. [C ossRe ]
9.
Booge d, E.A.; A s, T.; Engelen, L.J.; an de Bel , T.H. ‘Wha Is eHeal h’: Time o An Upda e? JMIR Res. P o oc. 2015,4, e29.
[C ossRe ]
10.
Penedo, F.J.; Oswald, L.B.; K onen eld, J.P.; Ga cia, S.F.; Cella, D.; Yanez, B. The inc easing alue o eHeal h in he deli e y o
pa ien -cen ed cance ca e. Lance Oncol. 2020,21, e240–e251. [C ossRe ]
11.
Gi onga, I.; Desmond, D.; Duda, N.; Magui e, R. Impac o connec ed heal h in e en ions on psychological wellbeing and quali y
o li e in pa ien s wi h cance : A sys ema ic e iew and me a-analysis. Psychooncology 2022,31, 1621–1636. [C ossRe ]
12.
Luo, X.; Gao, L.; Li, J.; Lin, Y.; Zhao, J.; Li, Q. A c i ical li e a u e e iew o dyadic web-based in e en ions o suppo cance
pa ien s and hei ca egi e s, and di ec ions o u u e esea ch. Psychooncology 2020,29, 38–48. [C ossRe ] [PubMed]
13.
Xiao, K.; Tang, L.; Chen, Y.; Zhou, J.; Yang, Q.; Wang, R. The e ec i eness o E-heal h in e en ions p omo ing physical ac i i y in
cance su i o s: A sys ema ic e iew and me a-analysis o andomized con olled ials. J. Cance Res. Clin. Oncol. 2024,150, 72.
[C ossRe ]
14.
Mohe , D.; Libe a i, A.; Te zla , J.; Al man, D.G.; PRISMA G oup. P e e ed epo ing i ems o sys ema ic e iews and
me a-analyses: The PRISMA s a emen . PLoS Med. 2009,6, e1000097. [C ossRe ] [PubMed]
15.
Chap e 8: Assessing Risk o Bias in a Randomized T ial. A ailable online: h ps:// aining.coch ane.o g/handbook/a chi e/ 6
.2/chap e -08 (accessed on 22 No embe 2024).
16.
Risk o Bias 2 (RoB 2) Tool | Coch ane Me hods. A ailable online: h ps://me hods.coch ane.o g/ isk-bias-2 (accessed on
22 No embe 2024).
17. De Simonian, R.; Lai d, N. Me a-analysis in clinical ials. Con ol. Clin. T ials 1986,7, 177–188. [C ossRe ]
18.
Higgins, J.P.T.; Thompson, S.G.; Deeks, J.J.; Al man, D.G. Measu ing inconsis ency in me a-analyses. BMJ 2003,327, 557–560.
[C ossRe ] [PubMed]
19.
S e ne, J.A.C.; Su on, A.J.; Ioannidis, J.P.A.; Te in, N.; Jones, D.R.; Lau, J.; Ca pen e , J.; Rücke , G.; Ha bo d, R.M.; Schmid, C.H.;
e al. Recommenda ions o examining and in e p e ing unnel plo asymme y in me a-analyses o andomised con olled ials.
BMJ 2011,343, d4002. [C ossRe ]
20.
Chen, X.; Qin, Y.; Chaimongkol, N. E ec i eness o a phone-based suppo p og am on sel -ca e sel -e icacy, psychological
dis ess, and quali y o li e among women newly diagnosed wi h b eas cance : A andomized con olled ial. Eu . J. Oncol. Nu s.
2024,71, 102643. [C ossRe ]
Cance s 2025,17, 1780 18 o 19
21.
Dong, X.; Yi, X.; Gao, D.; Gao, Z.; Huang, S.; Chao, M.; Chen, W.; Ding, M. The e ec s o he combined exe cise in e en ion based
on in e ne and social media so wa e (CEIBISMS) on quali y o li e, muscle s eng h and ca dio espi a o y capaci y in Chinese
pos ope a i e b eas cance pa ien s: A andomized con olled ial. Heal h Qual. Li e Ou comes 2019,17, 109. [C ossRe ]
22.
Ghanba i, E.; Yek a alab, S.; Meh abi, M. E ec s o Psychoeduca ional In e en ions Using Mobile Apps and Mobile-Based Online
G oup Discussions on Anxie y and Sel -Es eem in Women wi h B eas Cance : Randomized Con olled T ial. JMIR Mheal h
Uheal h 2021,9, e19262. [C ossRe ]
23.
Handa, S.; Okuyama, H.; Yamamo o, H.; Nakamu a, S.; Ka o, Y. E ec i eness o a Sma phone Applica ion as a Suppo Tool
o Pa ien s Unde going B eas Cance Chemo he apy: A Randomized Con olled T ial. Clin. B eas Cance 2020,20, 201–208.
[C ossRe ]
24.
Hein ich, R.; Schilling, G.; Woj yna, E.; A nold, D.; Geisle , M.; Kley, S.; G udzinski, P.; Ksi˛e˙
zak, M.; Schoen elde , T. E ec s o
Mobile Applica ion-Based Cogni i e Beha io al The apy on Psychological Ou comes in Women T ea ed o B eas Cance : A
Randomized Con olled Pilo T ial in Ge many. Psycho-Oncology 2024,33, 10. [C ossRe ] [PubMed]
25.
Li, H.; Sang, D.; Gong, L.; Wang, B.; Wang, Y.; Jia, X.; Yu, J.; Kong, Z.; Liu, H.; Zhang, Y. Imp o ing physical and men al heal h in
women wi h b eas cance unde going an h acycline-based chemo he apy h ough wea able de ice-based ae obic exe cise: A
andomized con olled ial. F on . Public Heal h 2024,12, 1451101. [C ossRe ]
26.
Okuyama, H.; Takada, F.; Tai a, N.; Nakamu a, S. A andomized ial o he impac o symp om moni o ing using an elec onic
pa ien - epo ed ou come app on heal h- ela ed quali y o li e in pos menopausal b eas cance pa ien s ecei ing adju an
endoc ine he apy. B eas Cance 2024,31, 787–797. [C ossRe ]
27.
Phillips, S.M.; S a iko sky, J.; Solk, P.; Desai, R.; Reading, J.M.; Hasanaj, K.; Wang, S.D.; Culla he , E.; Lee, J.; Song, J.; e al.
Feasibili y and p elimina y e ec s o he Fi 2Th i eMB pilo physical ac i i y p omo ion in e en ion on physical ac i i y and
pa ien epo ed ou comes in indi iduals wi h me as a ic b eas cance . B eas Cance Res. T ea . 2024,208, 391–403. [C ossRe ]
[PubMed]
28.
Peng, L.; Yang, Y.; Chen, M.; Xu, C.; Chen, Y.; Liu, R.; Cao, X.; Li, M. E ec s o an online mind ulness-based in e en ion on Fea
o Cance Recu ence and quali y o li e among Chinese b eas cance su i o s. Complemen The . Clin. P . 2022,49, 101686.
[C ossRe ] [PubMed]
29.
Rosen, K.D.; Paniagua, S.M.; Kazanis, W.; Jones, S.; Po e , J.S. Quali y o li e among women diagnosed wi h b eas Cance : A
andomized wai lis con olled ial o comme cially a ailable mobile app-deli e ed mind ulness aining. Psycho-Oncology 2018,
27, 2023–2030. [C ossRe ]
30. Sa aç, F.S.; ˙
Ilhan, S.E.; Ku un, S.; Ku lu ü kan, S. The E ec o In o ma i e Mobile App Use on Anxie y, Dis ess, and Quali y o
Li e o Women wi h B eas Cance . Eu . J. B eas Heal h 2024,20, 207–214. [C ossRe ]
31.
Single on, A.C.; Raeside, R.; Pa idge, S.R.; Hyun, K.K.; Ta -Ko, J.; Sum, S.C.M.; Hayes, M.; Chow, C.K.; Thiagalingam, A.; Maka,
K.; e al. Suppo ing women’s heal h ou comes a e b eas cance ea men compa ing a ex message in e en ion o usual ca e:
The EMPOWER-SMS andomised clinical ial. J. Cance Su i . 2023,17, 1533–1545. [C ossRe ]
32.
Zhou, K.; Wang, W.; Zhao, W.; Li, L.; Zhang, M.; Guo, P.; Zhou, C.; Li, M.; An, J.; Li, J.; e al. Bene i s o a WeCha -based
mul imodal nu sing p og am on ea ly ehabili a ion in pos ope a i e women wi h b eas cance : A clinical andomized con olled
ial. In . J. Nu s. S ud. 2020,106, 103565. [C ossRe ]
33.
Zhu, J.; Ebe , L.; Liu, X.; Wei, D.; Chan, S.W.-C. Mobile b eas cance e-suppo p og am o chinese women wi h b eas cance
unde going chemo he apy (Pa 2): Mul icen e andomized con olled ial. JMIR MHeal h UHeal h 2018,6, 9438. [C ossRe ]
34.
Zhou, K.; Li, J.; Li, X. E ec s o cyclic adjus men aining deli e ed ia a mobile de ice on psychological esilience, dep ession,
and anxie y in Chinese pos -su gical b eas cance pa ien s. B eas Cance Res. T ea . 2019,178, 95–103. [C ossRe ]
35.
Kim, H.J.; Kim, S.M.; Shin, H.; Jang, J.-S.; Kim, Y.I.; Han, D.H. A Mobile Game o Pa ien s wi h B eas Cance o Chemo he apy
Sel -Managemen and Quali y-o -Li e Imp o emen : Randomized Con olled T ial. J. Med. In e ne Res. 2018,20, e273. [C ossRe ]
36.
Zhang, Y.; Pang, Y.; He, Y.; You, M.; Tang, L. Feasibili y o online managing cance and li ing meaning ully (CALM) in Chinese pa ien s
wi h me as a ic b eas cance : A pilo andomized con ol ial. Sci. Rep. 2024,14, 1. [C ossRe ]
37.
Zhang, X.; Yao, S.; Wang, M.; Yin, X.; Bi, Z.; Jing, Y.; Cheng, H. The Impac o VR-CALM In e en ion Based on VR on Psychological
Dis ess and Symp om Managemen in B eas Cance Su i o s. J. Oncol. 2022,2022, 1–10. [C ossRe ] [PubMed]
38.
A ema, V.; an Leeuwen, M.; Kie e , J.M.; Oldenbu g, H.S.; an Beu den, M.; Ge i sma, M.A.; Kuenen, M.A.; Plaisie , P.W.;
Ca dozo, A.M.L.; an Rie , Y.E.; e al. E icacy o In e ne -Based Cogni i e Beha io al The apy o T ea men -Induced Menopausal
Symp oms in B eas Cance Su i o s: Resul s o a Randomized Con olled T ial. J. Clin. Oncol. 2019,37, 809–822. [C ossRe ]
[PubMed]
39.
G aham, C.D.; Ellison, R.; Hall, L.H.; Cla k, J.; McNaugh , E.; G een, S.M.C.; Wilkes, H.; Robson, G.; Lo en z, I.; Holmes, L.; e al.
A pilo andomised con olled ial o accep ance and commi men he apy o medica ion decision-making and quali y o li e in
women wi h b eas cance : The ACTION ial. Psycho-Oncology 2024,33, 5. [C ossRe ]
40.
Hol di k, F.; Mehne , A.; Weiss, M.; Maye , J.; Meye , B.; B öde, P.; Claus, M.; Wa zl, C. Resul s o he Op imune ial: A
andomized con olled ial e alua ing a no el In e ne in e en ion o b eas cance su i o s. PLoS ONE 2021,16, 5. [C ossRe ]
Cance s 2025,17, 1780 19 o 19
41.
Jacobs, J.M.; Pos , K.; Massad, K.; Ho ick, N.K.; Walsh, E.A.; Cohn, J.; Rapopo , C.S.; Cla a, A.J.; An oni, M.H.; Sa en, S.A.; e
al. A eleheal h in e en ion o symp om managemen , dis ess, and adhe ence o adju an endoc ine he apy: A andomized
con olled ial. Cance 2022,128, 3541–3551. [C ossRe ] [PubMed]
42.
Ko kmaz, S.; Iyigun, E.; Tas an, S. An E alua ion o he In luence o Web-Based Pa ien Educa ion on he Anxie y and Li e Quali y
o Pa ien s Who Ha e Unde gone Mammaplas y: A Randomized Con olled S udy. J. Cance Educ. 2020,35, 912–922. [C ossRe ]
43.
Lally, R.M.; Kupzyk, K.A.; Bella ia, G.; Hydeman, J.; Gallo, S.; Helgeson, V.S.; E win, D.; Mills, A.C.; B own, J.K. Ca ingGuid-
anceTM a e b eas cance diagnosis eHeal h psychoeduca ional in e en ion o educe ea ly pos -diagnosis dis ess. Suppo
Ca e Cance 2020,28, 2163–2174. [C ossRe ]
44.
Rigg, A.; Kemp, E.; Koczwa a, B.; Bu ow, P.; Gi gis, A.; Hulbe -Williams, N.J.; Kaambwa, B.; Long, R.; Scho ield, P.; Tu ne ,
J.; e al. Feasibili y, accep abili y, and p elimina y e icacy o a sel -di ec ed online psychosocial in e en ion o women wi h
me as a ic b eas cance : Finding My Way-Ad anced. Suppo Ca e Cance 2024,32, 744. [C ossRe ] [PubMed]
45.
Whi e, V.; Fa elly, A.; Pi che , M.; Hill, D. Does access o an in o ma ion-based, b eas cance speci ic websi e help o educe dis ess in
young women wi h b eas cance ? Resul s om a andomised ial. Eu . J. Cance Ca e 2018,27, 6. [C ossRe ] [PubMed]
46.
Akkol-Solakoglu, S.; He ey, D. In e ne -deli e ed cogni i e beha iou al he apy o dep ession and anxie y in b eas cance
su i o s: Resul s om a andomised con olled ial. Psycho-Oncology 2023,32, 446–456. [C ossRe ]
47.
Jacobs, J.M.; Ream, M.E.; Pensak, N.; Niso el, L.E.; Fishbein, J.N.; MacDonald, J.J.; Buzaglo, J.; Lennes, I.T.; Sa en, S.A.; Pi l, W.F.;
e al. Pa ien expe iences wi h o al chemo he apy: Adhe ence, symp oms, and quali y o li e. JNCCN J. Na l. Comp . Cance Ne w.
2019,17, 221–228. [C ossRe ]
48.
Doyle-Lind ud, S. S a e o eHeal h in Cance Ca e: Re iew o he Bene i s and Limi a ions o eHeal h Tools. CJON 2020,24, 10–15.
[C ossRe ] [PubMed]
49.
Wosik, J.; Fudim, M.; Came on, B.; Gellad, Z.F.; Cho, A.; Phinney, D.; Cu is, S.; Roman, M.; Poon, E.G.; Fe an i, J.; e al. Teleheal h
ans o ma ion: COVID-19 and he ise o i ual ca e. J. Am. Med. In o m. Assoc. 2020,27, 957–962. [C ossRe ]
50.
Pan, L.; Wu, X.; Lu, Y.; Zhang, H.; Zhou, Y.; Liu, X.; Liu, S.; Yan, Q. A i icial in elligence empowe ed digi al heal h echnologies in
cance su i o ship ca e: A scoping e iew. Asia-Pac. J. Oncol. Nu s. 2022,9, 100127. [C ossRe ]
51.
Ye, D.; Woods, N.; Jo dan; S a en, J. The ole o a i icial in elligence o he applica ion o in eg a ing elec onic heal h eco ds
and pa ien -gene a ed da a in clinical decision suppo . AMIA J . Summi s T ansl. Sci. P oc. 2024,2024, 459–467.
52.
Sun, F.; Zhang, L.; Tong, Z. Applica ion p og ess o a i icial in elligence in umo diagnosis and ea men . F on . A i . In ell.
2025,7, 1487207. [C ossRe ]
53.
Ruiz Sa ias, O.; Ma ínez del P ado, M.P.; Sala Gonzalez, M.Á.; Azcuna Saga duy, J.; Casado Cues a, P.; Figa edo Be jano,
C.; Gal e-Cal o, E.; López de San Vicen e He nández, B.; López-San illán, M.; Nuño Escolás ico, M.; e al. Le e aging La ge
Language Models o P ecision Moni o ing o Chemo he apy-Induced Toxici ies: A Pilo S udy wi h Expe Compa isons and
Fu u e Di ec ions. Cance s 2024,16, 2830. [C ossRe ]
54.
Deepa, R.; A unkuma , S.; Jaya aj, V.; Si asamy, A. Heal hca e’s new F on ie : AI-d i en ea ly cance de ec ion o imp o ed
well-being. AIP Ad . 2023,13, 115331. [C ossRe ]
55.
No i, L.P.; Lohi ha, M.; Vadapalli, R.R.; Bon haga ala, B.; Nagineni, S.R.; Kalidindi, V.R. Re olu ionizing Heal hca e: The Impac
o AI on P ecision Medicine. In . J. Pha m. In es ig. 2025,15, 2. [C ossRe ]
56.
Khos a i, M.; Aza , G. A sys ema ic e iew o e iews on he ad an ages o mHeal h u iliza ion in men al heal h se ices: A iable
op ion o la ge popula ions in low- esou ce se ings. Camb. P ism. Glob. Men . Heal h 2024,11, e43. [C ossRe ]
57.
Güle , K.G.; Uzun, S.; Emi za, E.G. The e ec i eness o elemedicine applica ions in men al heal h se ices: A me a-analysis
s udy. I . J. Med. Sci. 2025,194, 233–245. [C ossRe ]
58. Dis ess- he 6 h Vi al Sign-PubMed. A ailable online: h ps://pubmed.ncbi.nlm.nih.go /21980246/ (accessed on 5 Feb ua y 2025).
59.
Nelson, H.D.; Pappas, M.; Can o , A.; Haney, E.; Holmes, R. Risk Assessmen , Gene ic Counseling, and Gene ic Tes ing o
BRCA-Rela ed Cance in Women: Upda ed E idence Repo and Sys ema ic Re iew o he US P e en i e Se ices Task Fo ce.
JAMA 2019,322, 666–685. [C ossRe ] [PubMed]
60.
Yang, Y.; Huang, Y.; Dong, N.; Zhang, L.; Zhang, S. E ec o eleheal h in e en ions on anxie y and dep ession in cance pa ien s:
A sys ema ic e iew and me a-analysis o andomized con olled ials. J. Telemed. Teleca e 2024,30, 1053–1064. [C ossRe ]
61.
Wen, T.; Chen, C.; Ren, W.; Hu, S.; Zhao, X.; Zhao, F.; Zhao, Q. E ec o elec onic heal h (eHeal h) on quali y o li e in women
wi h b eas cance : A sys ema ic e iew and me a-analysis o andomized con olled ials. Cance Med. 2023,12, 14252–14263.
[C ossRe ]
Disclaime /Publishe ’s No e: The s a emen s, opinions and da a con ained in all publica ions a e solely hose o he indi idual
au ho (s) and con ibu o (s) and no o MDPI and/o he edi o (s). MDPI and/o he edi o (s) disclaim esponsibili y o any inju y o
people o p ope y esul ing om any ideas, me hods, ins uc ions o p oduc s e e ed o in he con en .
