Breast cancer and its treatment commonly impair multiple domains of women’s well-being, including physical functioning, psychological health, and social roles. Increasingly, digital health interventions—websites, apps, text messaging, virtual reality, and email-based programs—have been deployed to provide supportive care. However, their effectiveness specifically for quality of life (QoL) and related psychosocial outcomes in women with breast cancer has been unclear.
This systematic review aimed to evaluate the effectiveness of digital health interventions on QoL in women treated for breast cancer and to assess effects on anxiety, depression (or emotional distress), and self-efficacy during or up to 1 year after active treatment.
The review was prospectively registered in PROSPERO (CRD420250578307) and performed following the PRISMA 2020 statement. The authors restricted eligibility to randomized controlled trials (RCTs) and controlled quasi-experimental studies that reported preintervention and postintervention assessments of QoL in women with breast cancer.
Databases searched in September 2025 included PsycINFO, Web of Science, Scopus, LILACS, and SciELO. Two reviewers independently screened records (interrater agreement >90%) and used a standardized extraction template; extracted data were verified independently by a second reviewer.
From 408 records identified, 15 studies met inclusion criteria: 14 RCTs and 1 quasi-experimental study. Sample sizes varied from 35 to 394 participants. Intervention modalities were heterogeneous:
Interventions ranged from primarily informational/supportive platforms to programs including active therapeutic components or professional support.
Primary outcome for inclusion was QoL. Secondary psychosocial outcomes reported across studies included anxiety, depression or broader emotional distress, and self-efficacy. Retention and acceptability measures were variably reported across the studies.
Data synthesis followed the Synthesis Without Meta-analysis (SWiM) guideline, with narrative reporting due to heterogeneity. Risk of bias for RCTs was assessed with the Cochrane RoB 2 tool; the quasi-experimental study was assessed with ROBINS-I. Among the 14 RCTs, 3 were judged at high overall risk of bias and 11 raised some concerns; none were at low risk. The single quasi-experimental study had a serious overall risk of bias.
Across the 15 included studies, the direction of effect favored the digital intervention for QoL in 8 studies. Improvements were characterized as modest and appeared to be primarily short-term in the reporting. The heterogeneity of interventions, outcome instruments, and participant samples precluded pooled quantitative estimation, so conclusions rely on direction-of-effect summaries and qualitative comparison across trials.
Thirteen studies assessed anxiety, depression, or emotional distress. Of these, 5 reported a favorable direction of effect associated with the digital intervention. The remaining studies showed no clear benefit or inconsistent results. The overall pattern did not provide consistent evidence for robust mental health benefits across interventions.
Self-efficacy was evaluated in 5 studies. Only one study favored the intervention on self-efficacy, and that observed effect was not maintained at follow-up according to the included reports. Overall, data on self-efficacy were sparse and effects were inconsistent.
Reported retention rates ranged from 68.6% to 100% across included studies. Reporting on acceptability was limited and insufficiently evaluated to draw conclusions about user engagement or broader feasibility in routine care.
The authors judged the certainty of evidence to be low for QoL and emotional outcomes and very low for self-efficacy. Risk of bias concerns across trials and heterogeneity in interventions, outcome measures, and timing of assessments limited confidence in effect estimates. Interventions that incorporated active therapeutic elements or professional support appeared more frequently to show favorable effects, but that observation arose from indirect comparisons across heterogeneous studies rather than head-to-head evidence.
Digital health interventions may yield modest, mostly short-term improvements in some QoL dimensions for women with breast cancer. Evidence for effects on anxiety, depression, and self-efficacy is inconsistent and of low certainty. Acceptability and longer-term outcomes were not well evaluated in the included trials. Overall, the review concludes that while digital interventions are promising, current evidence does not support strong or generalizable conclusions, and further higher-quality, well-reported trials with standardized outcomes and longer follow-up are needed.