Effects of electronic patient-reported outcome monitoring on symptom burden and health-related quality of life in patients with metastatic breast cancer: a systematic review and meta-analysis protocol.

Abstract

Metastatic breast cancer is increasingly managed as a long-term condition, yet symptom burden and health-related quality of life (HRQoL) remain major patient-centred concerns. Electronic patient-reported outcome (ePRO) monitoring has shown promise in improving symptom surveillance and supporting more responsive care in oncology; however, evidence specifically relating to metastatic breast cancer remains fragmented and has not yet been systematically synthesised. This review, therefore, aims to evaluate the effects of ePRO monitoring on symptom burden and HRQoL in patients with metastatic breast cancer. This systematic review and meta-analysis will include randomised controlled trials and non-randomised controlled studies involving adults with metastatic breast cancer. Eligible interventions will include ongoing ePRO monitoring delivered through digital systems or platforms during treatment or follow-up. Comparators will include usual care or non-ePRO-based follow-up. The primary outcomes will be symptom burden and HRQoL; secondary outcomes will include physical, role and social functioning, individual symptom domains, healthcare utilisation, treatment adherence or interruption, patient satisfaction and feasibility indicators. A comprehensive search will be conducted in PubMed, Embase, Web of Science, CINAHL and the Cochrane Library from database inception to the final search date, with the planned literature search to be conducted from July 2026 to December 2026. Additional searches of ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform will also be undertaken. Two reviewers will independently perform study selection, data extraction and risk-of-bias assessment. Where studies are sufficiently comparable, meta-analysis will be conducted using random-effects models; otherwise, findings will be synthesised narratively. Ethical approval is not required because this review will synthesise data from previously published studies and will not involve the collection of primary data from human participants. The findings will be disseminated through publication in a peer-reviewed journal and presentation at relevant academic conferences. CRD420261383449.