A systematic review of seven RCTs found that non-pharmacological interventions—particularly structured physical exercise—may improve overall quality of life and specific QoL domains in women with hormone receptor-positive breast cancer receiving adjuvant endocrine therapy, though high methodological heterogeneity limits definitive conclusions.
A PROSPERO-registered systematic review published in Anales del Sistema Sanitario de Navarra synthesized evidence from seven randomized controlled trials (n = 713) examining the impact of non-pharmacological interventions on quality of life (QoL) in female survivors of hormone receptor-positive (HR+) breast cancer undergoing adjuvant endocrine therapy. Interventions evaluated included structured physical exercise, hydrotherapy, physiotherapy, and health promotion programs, with outcomes assessed across physical, psychological, social, and spiritual QoL domains.
Adjuvant endocrine therapies—including aromatase inhibitors and selective estrogen receptor modulators—are foundational to reducing recurrence and mortality in HR+ breast cancer but carry a well-documented burden of adverse effects, including arthralgia, vasomotor symptoms, sexual dysfunction, and fatigue, all of which can substantially erode QoL and compromise long-term adherence. Non-pharmacological approaches represent an adjunctive strategy to mitigate these effects without introducing additional pharmacological burden.
Among the interventions reviewed, structured physical exercise demonstrated the most consistent improvements in overall QoL as well as in specific subdomains. Hydrotherapy and physiotherapy showed variable results across trials. However, the authors caution that substantial methodological and clinical heterogeneity across included studies precluded meta-analytic pooling, necessitating a narrative synthesis. Risk of bias was assessed using the RoB2 tool. The authors conclude that while physical exercise appears promising, the current evidence base is insufficient to support definitive clinical recommendations, and call for future research employing standardized intervention protocols and outcome measures.
Key points
- Seven RCTs involving 713 participants were included in this PRISMA/Cochrane-compliant systematic review of non-pharmacological QoL interventions in HR+ breast cancer survivors on adjuvant endocrine therapy.
- Structured physical exercise showed the most consistent improvements in overall QoL and domain-specific outcomes among all interventions evaluated.
- Hydrotherapy, physiotherapy, and health promotion programs demonstrated variable effects across trials.
- High methodological heterogeneity prevented meta-analysis; findings are based on narrative synthesis with RoB2 bias assessment.
- Authors emphasize the need for standardized trial designs before non-pharmacological interventions can be formally incorporated into clinical guidelines.
Why it matters
Adjuvant endocrine therapy-related side effects are a leading driver of non-adherence in HR+ breast cancer survivors, directly affecting recurrence risk and long-term outcomes. Identifying evidence-based non-pharmacological strategies to preserve QoL could meaningfully support treatment adherence and survivorship care planning.