Telenursing to Improve Quality of Life in Women With Breast Cancer: A Systematic Review and Meta-Analysis.

BACKGROUND: Breast cancer is the most commonly diagnosed malignancy in women and a leading cause of cancer-related mortality. Beyond the physical burden, the disease significantly impacts emotional well-being and quality of life (QoL). Telenursing, as a nurse-led telemedicine intervention, has emerged as a promising strategy to support patients remotely. OBJECTIVE: To evaluate the effectiveness of nurse-led telenursing interventions on QoL in women with breast cancer and to compare the impact of different technological delivery modes. METHODS: A systematic review and meta-analysis was conducted following PRISMA 2020 and the Cochrane Handbook. Studies were identified through five databases. Randomized controlled trials (RCTs) and quasi-experimental studies comparing nurse-led telenursing to usual care were included. The primary outcome was QoL. Risk of bias was assessed using RoB 2.0 and ROBINS-I; GRADE was used to rate the certainty of evidence. RESULTS: Seventeen studies (n = 4199) were included in the systematic review. Seven studies provided sufficient quantitative data for meta-analysis. Overall, telenursing interventions showed a small to moderate pooled effect on quality of life (SMD = 0.40, 95% CI [0.09, 0.70]; p = 0.019); however, after trim-and-fill correction for potential publication bias, the adjusted estimate was attenuated and did not reach statistical significance (adjusted SMD = 0.14, 95% CI [-0.17, 0.45]; p = 0.376). Subgroup analyses-to be interpreted as exploratory-suggested a larger effect for mobile application-based interventions (SMD = 0.63, 95% CI [0.46, 0.80], I2 = 0%, k = 3) compared to telephone follow-up (SMD = 0.21, 95% CI [-0.34, 0.76], I2 = 85.2%, k = 4), though the small number of contributing studies limits the reliability of this comparison. CONCLUSIONS: These findings provide preliminary evidence that nurse-led telenursing may be associated with improvements in quality of life in women with breast cancer, though the certainty of the evidence is low (GRADE: Low). Results should be interpreted with caution given the attenuation of the pooled effect to non-significance after trim-and-fill adjustment, substantial methodological heterogeneity, and the exploratory nature of subgroup comparisons. High-quality randomized trials are needed to confirm these findings.