The Effect of E-Health Interventions on Fear of Recurrence in Breast Cancer Survivors: A Systematic Review and Meta-Analysis.

[INTRODUCTION] Fear of cancer recurrence (FCR) is among the most common and debilitating psychological issues affecting breast cancer survivors. With technological advances, e-health interventions have emerged as cost-effective tools to manage psychosocial challenges such as FCR.

[OBJECTIVES] This study aimed to systematically review and synthesize evidence from randomized controlled trials assessing the effectiveness of e-health interventions in reducing FCR among breast cancer survivors.

[METHODS] This systematic review and meta-analysis were conducted in accordance with PRISMA guidelines and registered in PROSPERO (CRD42025645734). Comprehensive searches were performed in Web of Science, PubMed, Scopus, Medline, and Taylor & Francis Online up to January 2025. Risk of bias was evaluated using the Cochrane RoB 2 tool. A random-effects model with Hedge's g effect sizes and I² statistics was applied in the meta-analysis.

[RESULTS] Ten randomized controlled trials involving 1,565 participants were included. Interventions included online cognitive behavioral therapy, mobile applications, tele-coaching, and online mindfulness-based interventions. Although some individual studies reported reductions in FCR, the overall pooled effect size was not statistically significant (Hedge's g = -0.076, 95% CI: -0.183 to 0.031, P = .163). Considerable heterogeneity was observed among studies (I² = 87.39%). No significant publication bias was detected.

[CONCLUSIONS] E-health interventions show promise in supporting the psychological well-being of breast cancer survivors. However, current evidence does not demonstrate a significant effect in reducing FCR. Future research should explore ways to enhance intervention design, improve user engagement, and examine how factors such as age, digital literacy, and adherence influence outcomes.

[IMPLICATIONS FOR NURSING PRACTICE] Nurses can play a key role in identifying patients receptive to digital interventions and supporting their engagement and adherence. Tailoring e-health content to individual needs, providing guidance on digital literacy, and integrating digital tools with face-to-face care approaches may enhance intervention effectiveness.