Effective interventions to improve well-being in breast cancer patients: A systematic review

In 2023, GreyBay Institute completed the commissioned report Effective interventions to improve well-being in breast cancer patients: a systematic review for Pfizer. The review synthesised 45 systematic reviews and meta-analyses and assessed the full intervention landscape for supportive care in breast cancer, including psychosocial care, physical activity, digital technology, and integrated programmes. The work was prepared to inform Pfizer's global patient-support strategy and local programme development in Japan.

1. Main findings

(1) Psychosocial interventions. Cognitive behavioural therapy and psychoeducation showed moderate benefits for anxiety, depression, and quality of life, especially over 6-12 week programmes. Nurse-delivered supportive-information packages produced small but reliable benefits in newly diagnosed patients. Studies involving minority groups suggested that culturally adapted peer-support models can improve coping, mood, and social well-being. Mindfulness, acceptance and commitment therapy, progressive muscle relaxation, guided imagery, and longer-term couple-based interventions also showed clear value.

(2) Physical-activity interventions. Exercise consistently improved pain management, quality of life, social functioning, physical functioning, and mental health. Session length was a key moderator: benefits were strongest for 45-60 minute and 60-90 minute sessions, while sessions shorter than 45 minutes were less effective. Moderate-or-higher intensity worked better than low intensity. Resistance training outperformed endurance training for fatigue and muscle endurance, while Baduanjin, Tai Chi, and yoga all showed benefits, with yoga having the most consistent evidence as a supportive therapy during treatment.

(3) Digital support. Virtual reality improved shoulder mobility, anxiety, depression, and pain. Mobile apps showed promise for symptom reporting, medication adherence, wound monitoring, and informational support. eHealth tools were effective for symptom management during active treatment and achieved high user satisfaction. Telephone-based interventions, often nurse-led, improved depression, anxiety, emotional distress, and fatigue. Online communities remained useful platforms for connection and support, even if effects on patient-reported outcomes were mixed.

(4) Integrated interventions. Multi-behaviour change programmes led by nurses or multidisciplinary teams improved physical activity and healthy eating, with longer programmes of four months or more working best. Cognitive training produced the clearest evidence for cancer-related cognitive impairment. Multimodal prehabilitation, combining exercise, education, psychological support, and relaxation, showed positive results for physical function, quality of life, and psychosocial outcomes, though maintenance support remained a major evidence gap.

2. Implications for Pfizer's patient-support strategy

(1) Extend the product mix from medicines to digital therapeutics. GreyBay recommended that Pfizer Japan build or adopt digital tools combining modular CBT content, self-guided ACT exercises, relaxation audio, home-based yoga/Baduanjin/Tai Chi video libraries connected to wearables, and digital delivery systems for peer-support volunteer training.

(2) Use health-technology assessment to support market access. The review provides an international benchmark for digital and supportive-care products in Japan. GreyBay recommended prioritising peer education, cognitive training, and prehabilitation for local effectiveness studies and economic evidence generation.

(3) Close the Japanese evidence gap. None of the 45 included reviews contained Japanese intervention studies. The report therefore recommended targeted funding for needs-and-preferences research among Japanese breast cancer patients, cultural adaptation of evidence-based Western interventions such as yoga, mindfulness, and CBT, and exploratory work on Japanese mind-body practices.

3. Summary

The review concludes that international evidence for well-being interventions in breast cancer is already substantial, but translation into products and clinical pathways remains incomplete. For Japan, the challenge and opportunity lie in adapting proven components to local care systems, patient preferences, and reimbursement conditions. For enquiries about the evidence synthesis, competitor benchmarking, or commercial assessment of specific intervention components, please contact contact@greybay.org.