Effectiveness of self-management interventions in reducing cancer treatment-related cardiotoxicity in breast cancer survivors: A systematic review

Objective To evaluate the effectiveness of self-management interventions in reducing cancer therapy-induced cardiotoxicity among breast cancer survivors. Methods Six English-language databases were searched for studies from January 2004 to November 2024. JBI appraisal tools and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework were applied to assess the methodological quality and certainty of the evidence. Meta-analysis and descriptive qualitative synthesis were applied. Results A total of 11 randomised controlled trials (RCTs) involving 950 participants were included. A total of 516 participants (54%) were allocated to self-management intervention (e.g., aerobic and/or resistance exercise) groups, while 434 participants (46%) were assigned to control/usual care groups. The most frequently assessed cardiotoxicity-related parameters were cardiorespiratory fitness, cardiac function, and biomarkers, all of which may be attenuated by exercise. The meta-analysis indicated that exercise interventions significantly improved VO2peak (MD = 2.71, 95% CI 1.23 to 4.20, P < 0.001) and left ventricular ejection fraction (MD = 1.80, 95% CI 0.06 to 3.54, P = 0.043), although heterogeneity was substantial. However, the effectiveness of exercise on secondary outcomes remains uncertain, the GRADE framework rated the certainty of the evidence as very low. Conclusions Exercise has emerged as the most frequently employed self-management strategy for mitigating therapy-induced cardiotoxicity among breast cancer survivors. Evidence has indicated that structured exercise may help attenuate cancer therapy-induced cardiotoxicity, with VO2peak emerging as a more sensitive marker than left ventricular ejection fraction. Nonetheless, further rigorously designed RCTs are warranted to solidify the evidence base and evaluate exercise interventions' long-term sustainability and broader health benefits. Systematic review registration PROSPERO: CRD42024621854.