Breast cancer is the most common type of cancer globally and in our country.¹ According to the GLOBOCAN 2020 data published by the International Agency for Research on Cancer (IARC), breast cancer has surpassed lung cancer as the most frequently diagnosed cancer with 2.3 million new cases globally, representing 11.7% of all new cancer diagnosis.² Over the past decade, breast cancer incidence has steadily risen worldwide, particularly in high and middle-income countries, where lifestyle changes and increased screening have contributed to earlier detection. However, global mortality rates show significant regional disparities, with higher death rates in low-income regions due to delayed diagnoses and limited access to treatment. In 2020, breast cancer incidence in our country increased to 47.7 per 100 000, up from 43.0 per 100 000 in 2014, following global trends of rising incidence.³,⁴

Breast cancer treatment is highly individualized, with numerous options available depending on the cancer stage, biological characteristics, patient preferences, and overall health. Treatment decisions are made collaboratively by the patient and the medical team, considering factors such as the cancer type and stage, biological characteristics, the patient’s age, menopausal status, genetic factors and preferences. Treatment typically involves a combination of surgical, radiotherapeutic, chemotherapeutic, hormonal and targeted therapies among the available options.⁵-⁶ Each option is carefully considered in terms of its risks and benefits, with the goal of reaching a shared decision between the patient and the healthcare team. Frequently, surgical procedures include breast-conserving and mastectomy surgeries. Despite equivalent survival rates when combined with radiation, patients eligible for breast-conserving surgery are increasingly opting for mastectomy due to various reasons, such as reluctance towards radiation therapy, fear of recurrence, and a desire for symmetry.⁶ A multicenter study conducted by the Turkish Federation of Breast Diseases Associations (2019) on twenty thousand women in our country indicated that 48.3% of cases were diagnosed with stage II, and 76.9% with invasive ductal carcinoma. The study reported that 60.7% underwent mastectomy, while 39.3% received breast-conserving surgery.⁷

These treatment options significantly influence postoperative recovery, including complications and long-term outcomes. Post-surgical complications, both early and late, are common and can adversely affect patients' quality of life. Early complications include seroma formation (3-85% incidence) ⁸,⁹, wound site infection (3-19% incidence)⁸,¹⁰,¹¹, pain (20-30% incidence)¹², and lymphedema (<10% incidence)⁸,¹¹,¹³. Late complications, such as shoulder dysfunction (15-65% incidence)⁸,¹⁰,¹⁴ and scar hypertrophy⁸,¹⁰,¹⁴, can develop long after surgery. These complications may adversely affect individuals' quality of life.¹⁵ To maintain independence in daily activities and improve the quality of life, patients require supportive care, treatment, and preventive health interventions.¹⁶ There is a need for education on issues related to late/long-term physical and psychosocial problems to address the challenges individuals face in their daily lives after breast surgery.¹⁷

Supportive care interventions, including patient education and preventive strategies, are crucial to mitigating these post-surgical complications. Patients who undergo mastectomy are now being educated not only through written, visual, and auditory materials but also with the use of mobile applications, thanks to technological advances. ¹⁸,¹⁹ Mobile health has grown rapidly, with apps now playing a key role in facilitating patient engagement, disease prevention, and management across various health conditions. ²⁰,²¹ Mobile health applications not only impact healthcare service providers but also influence the delivery of nursing care, enhancing the effectiveness of care. The use of technology in healthcare services not only improves the quality of life and healthcare service but also contributes economically. ²²

In recent years, mobile applications aimed at improving the quality of life in the postoperative period have gained significance for patients and market penetration of mobile health applications is increasing globally, with a growing number of breast cancer specific apps designed to support postoperative care. ²³-²⁶ For patients discharged home after surgery, in addition to daily monitoring of drainage, spirometry results, blood pressure, heart rate, oxygen saturation, blood glucose levels, and medication adherence, factors such as pain levels, sleep quality, daily life activities, exercise levels, and social issues can also be evaluated, and the continuity of nursing care practices and education through mobile applications enhances the quality of care. ²⁷

Despite the increasing use of mobile applications in the care of breast cancer patients, there remains a significant gap in understanding how these technologies specifically influence postoperative outcomes, such as pain management, anxiety levels, and overall quality of life. While the existing literature has documented the benefits of mobile health interventions for various cancer types, there is limited research focused on their effectiveness in the context of breast cancer surgery. ²⁸ Furthermore, the varying degrees of patient engagement and the qualitative aspects of their experiences with these applications are underexplored. This research is necessary to address these gaps by providing empirical evidence on the impact of mobile health technologies on the care outcomes of breast cancer patients after surgery focusing on both the physical and emotional needs throughout their recovery process. By identifying the specific features of mobile applications that enhance patient education, engagement, and self-management, this study aims to evaluate the impact of mobile applications on the care outcomes of patients undergoing surgery for breast cancer.

The findings from this systematic review demonstrate the significant role of mobile applications and e-mobile education in improving the quality of life, psychological well-being and physical health of breast cancer patients aged 18-65. These interventions not only alleviate disease symptoms, reduce anxiety, and boost self-esteem but also enhance symptom management, aligned with the existing literature. Studies like Cheng et al.³⁸ highlight the effectiveness of mobile-based symptom management programs, such as mindfulness training, while Zhu et al.³⁹ show improvements in self-efficacy and reduced symptom burden. Collectively, these randomized controlled trials emphasize the adaptability of digital interventions across various cultural contexts, supplementing traditional healthcare approaches.

A key strength of mobile applications is their adaptability and versatility. The applications in these studies primarily focused on educating patients about breast cancer diagnosis, treatment processes, and post surgical symptom management. These studies have shown that these apps improve quality of life by offering accessible information and ongoing support, allowing patients to take a more active role in their health. This is consistent with broader research findings. For example, a review by Nou, Arkes, Frances and Liyan⁴⁰ showed that mobile applications significantly improve quality of life and psychological well-being, especially for patients undergoing active treatment. Drawing on theoretical frameworks such as the self-determination theory, mobile applications empower patients by supporting autonomy, competence, and relatedness, which are essential for effective self-care and recovery. By offering easily accesible information and ongoing support, they extend care beyond the clinical setting, empowering patient to take an active role in their own health.

The applications, developed by the researchers themselves, reflect an increasing interest in leveraging technology to enhance patient support. For instance, the study by Çınar et al.²⁶ demonstrates how e-mobile education can significantly improve patients' quality of life by providing comprehensive content on breast cancer, stress management, and lifestyle factors such as diet and exercise. This holistic educational approach, addressing both physical and emotional recovery, plays a crucial role in improving overall patient well-being. Similar findings have been reported in other research. A systematic review by Saevarsdottir and Gudmundsdottir emphasizes that mobile health apps significantly enhance patients' mental and physical health by supporting behavioral interventions, such as physical activity and mindfulness.⁴¹ This growing body of evidence underscores the importance of digital tools in offering personalized and well-rounded support for breast cancer patients, ultimately improving their overall quality of life.

Similarly, Hou et al.'s findings regarding the long-term benefits of mobile applications in improving patient outcomes align with a growing body of literature on the effectiveness of mobile health interventions. For example, systematic reviews and studies on chronic disease management, including diabetes and cardiovascular conditions, have shown that mobile health tools not only offer immediate support but also promote sustained improvements in patient well-being.⁴²,⁴³ These tools facilitate self-management by providing tailored information, real-time monitoring, and continuous motivation, which collectively improve both physical and mental health outcomes over time.

The study by Dong et al.³⁰ brings a unique focus on physical rehabilitation, combining exercise programs delivered via mobile apps and social media platforms. Research shows that exercise programs delivered via mobile apps can significantly improve physical activity, reduce cancer-related fatigue, and enhance overall quality of life. Similarly, another exercise rehabilitation app aiming to improve the mental and physical health of breast cancer patients in postoperative period has been shown to improve mental health and fitness levels during recovery from chemotherapy or radiotherapy.⁴⁴ These findings underscore the effectiveness of integrating physical health interventions into digital platforms to support long-term recovery.

Furthermore, the study by Ghanbari et al.³⁷ on psychoeducational interventions through mobile apps and online group discussions demonstrates the significant psychosocial benefits for breast cancer patients, particularly in reducing anxiety and boosting self-esteem. This aligns with broader findings, such as those by Børøsund et al., who reported that mobile health interventions, especially those focused on stress management and peer support, can foster psychological well-being and emotional resilience in cancer patients.⁴⁵ These digital tools offer critical social support that reduces distress, as noted in several studies emphasizing the importance of psychoeducation and peer networks in improving mental health.

Health professionals should consider integrating these digital tools into the care plans of breast cancer patients, particularly in the post-operative phase, where symptom management and psychological support are critical. For health policy, these results highlight the importance of investing in digital health solutions as part of comprehensive cancer care strategies. Policymakers should focus on expanding access to mobile health platforms, ensuring that these technologies are affordable and accessible to a broader patient population.

However, despite these promising outcomes, several limitations must be considered. The relatively small number of included studies (four trials), variations in sample sizes, app content, study duration and the cultural contexts of the studies may influence the generalizability of the findings. For example, cultural factors may affect how patients engage with digital tools or perceive the support they provide. Furthermore, there may be publication and language biases, as only studies published in English were included. Additionally, while these studies suggest short- to medium-term benefits, further research is needed to assess the long-term effects of mobile applications on symptom management and psychological well-being. Long-term trials could help refine best practices for integrating these digital interventions into routine cancer care and ensure that they continue to meet the evolving needs of breast cancer patients. By comparing these findings with broader research on mobile health interventions in chronic illness management, it becomes clear that mobile applications hold significant potential, though more work is needed to optimize their use across diverse patient populations.

Future research should aim to address these limitations by conducting larger, multi-center randomized controlled trials that include diverse patient populations. Studies should also evaluate the long-term effectiveness of mobile health interventions and explore potential subgroup differences based on age, stage of cancer, or cultural factors. Additionally, future app development should prioritize user-centered designs that incorporate patient feedback to enhance usability and engagement. Researchers should also consider exploring other outcome measures, such as healthcare utilization, cost-effectiveness, and patient adherence, to provide a more comprehensive understanding of how mobile health tools can be integrated into routine cancer care.

This review highlights the significant potential of mobile applications in enhancing care outcomes for patients undergoing breast cancer surgery. The findings suggest that these digital interventions not only improve the quality of life but also aid in the effective management of symptoms during the postoperative period. Specifically, mobile applications can provide patients with personalized resourcces and support, thereby alleviating disease symptoms, facilitating better symptom management, and ultimateley reducing the preveleance of phychological disorders. While the positive outcomes are promising, this review also highlights key limitations, including the heterogeneity in study designs, variations in app content, and differing cultural contexts. These uncertainties call for caution in generalizing the results across diverse patient populations.

However, the studies examined in this review reveal notable methodological variations, highlighting the urgent need for standardized approaches in future research. To bolster the evidence base, it is crucial for further studies to identify and control for variables that could influence outcomes across diverse patient populations. Moreover, the selection of study samples should be informed by the existing literature, with a keen emphasis on the timing and duration of app usage to align with established follow-up protocols.

Healthcare providers should consider integrating mobile health applications into routine breast cancer care. Specifically, these tools can serve as adjuncts to traditional care by offering patients continuous access to educational resources, symptom-tracking features, and real-time support outside the clinical setting.

Further research should also focus on monitoring and addressing common postoperative complications, ensuring that mobile health applications offer comprehensive care tailored to the unique needs of breast cancer patients. The broader implications for the field of mobile health and cancer care are significant. In the short term, mobile applications can extend care beyond the hospital, promoting self-management and improving patient outcomes. In the long term, these digital tools have the potential to become integral components of cancer care, providing scalable, cost-effective solutions that address both physical and mental health.

In conclusion, while mobile applications represent a promising avenue for improving outcomes in breast cancer care, there is still much work to be done. The field must continue evolving, driven by evidence-based research and collaboration between healthcare providers, patients, and developers. By doing so, we can fully realize the potential of digital health interventions to improve the quality of life for breast cancer patients worldwide.

Not applicable.