JMIR Publications

ABSTRACT

Background:

The International Agency for Research on Cancer (IARC) estimates that female breast cancer will account for 11.6% of nearly 20 million new cancer cases worldwide in 2022, resulting in 670,000 deaths [1]. Breast cancer is heterogeneous, comprising various solid tumours with distinct clinical and pathological characteristics; approximately 80% of patients exhibit positive hormone receptor (HR) tumours [2-3]. The primary treatment for HR-positive breast cancer involves anti-estrogenic endocrine therapy, mainly through selective estrogenic receptor modulators (SERMS) and aromatase inhibitors (AIS) [4]. Adjuvant endocrine treatment significantly reduces distant metastases, recurrence risk, and mortality in early-stage HR-positive breast cancer patients [5-6]. According to breast cancer treatment guidelines, adjuvant endocrine therapy (AET) with treatment durations of 5-10 years is advised [7-9]. Studies indicate that by the fifth year, nearly one-third of patients discontinue therapy [10]. This is related to patients' accurate access to treatment information, adverse drug reaction symptoms, age, comorbidities, previous chemotherapy experience, patient preference and other factors [10-12]. Previous research has identified various adverse reactions to endocrine therapy for breast cancer, such as hot flashes, joint pain, osteoporosis, sexual dysfunction, weight gain, sleep disorders, depression, anxiety, and cognitive dysfunction [7,13]. These symptoms can affect the quality of life and adherence of breast cancer patients [14]. Therefore, taking steps to help breast cancer patients recognise, assess, and alleviate symptoms during endocrine therapy is critical to ultimate clinical outcomes. As technology advances, the World Health Organisation (WHO, 2020) has introduced the "Global Digital Health Strategy," outlining a roadmap that integrates innovation and digital health advancement to enhance hygiene outcomes. Over the last two decades, a wide range of technologies, including voice recognition, information systems, mobile phones, telemedicine, mobile medical applications, medical information systems, virtual medical care, and other innovations, have been extensively utilised in the healthcare sector under the overarching framework of electronic health [15-17]. Research has validated the utilisation and significance of eHealth in individuals with chronic illnesses and cancer, including symptom monitoring, medication tracking and reminders, patient education, remote communication, disease information dissemination, patient-reported outcomes, and enhancement of self-management capabilities [18-19]. Breast cancer patients commonly utilise eHealth applications to address various issues such as sleep disorders, pain management, lymphatic oedema, weight control, psychological support, chemotherapy side effects, and screening [20-24]. Due to the specific characteristics of breast cancer patients during endocrine therapy, symptom management is an essential component. To date, there is no comprehensive review summarising the use of eHealth in symptom management in such patients. Therefore, this review will provide a thorough assessment and synthesis based on the latest evidence to understand the effectiveness, strengths and weaknesses of existing eHealth tools in symptom management, combined with the researchers' personal values to provide a reference point for clinical practice, and to help healthcare professionals better use modern technological tools to reduce patients' symptom burden and improve clinical outcomes.

Objective:

Endocrine therapy is a fundamental treatment approach in hormone receptor-positive breast cancer. Treating related symptoms may cause patients to discontinue treatment prematurely, affecting clinical prognosis. E-health technology has been widely applied in symptom monitoring, patient education, and support, among other areas. This review aims to evaluate the application, current status and limitations of e-health in managing symptoms among breast cancer patients undergoing endocrine therapy.

Methods:

A literature search was conducted using such databases as MEDLINE Complete, Academic Search Complete, PubMed, and CINAHL Ultimate, utilising the primary keywords 'breast cancer,' 'endocrine therapy,' and 'e-health,' supplemented with synonyms, academic terms, abbreviations, and related terminology. The search reviewed studies from February 2015 to February 2025. From a total of 1352 retrieved manuscripts, 30 studies were included for analysis

Results:

This review demonstrated eHealth's efficacy in symptom monitoring and management for breast cancer patients on endocrine therapy. Electronic health tools have played a positive role in short-term symptom management and improving patient compliance, and patients generally have a high acceptance and satisfaction rate. However, patients' compliance with medication and its impact on their quality of life vary. And found that Nurses play an indispensable and crucial role in the application of electronic health tools.

Conclusions:

By focusing on the individualised needs of patients and integrating the experiences and feelings of multiple stakeholders, such as patients, doctors, and nurses, when using electronic health tools, significant improvements and hope have been brought to the symptom management of breast cancer patients. Clinical Trial: NO