Non-pharmacological interventions and quality of life in female survivors of hormone receptor-positive breast cancer receiving adjuvant endocrine therapy: A systematic review

Background Hormone receptor-positive breast cancer is treated with endocrine therapies to reduce recurrence and mortality. These therapies have side effects that negatively affect quality of life (QoL). We aim to synthesize the available evidence on the impact of non-pharmacological interventions on QoL and its specific domains (physical, psychological, social, and spiritual) in female breast cancer survivors undergoing endocrine therapies. Methods A systematic review following the Cochrane and PRISMA guidelines was registered in PROSPERO (CRD42024524238). Studies published from January 2013 to October 2025 were retrieved from PubMed, the Cochrane Library, Scopus, and Web of Science. Randomized controlled trials evaluating QoL in female with BC aged over 18 years, and undergoing endocrine therapies were included. Due to methodological and clinical heterogeneity, a narrative synthesis was performed instead of a meta-analysis. The RoB2 tool was used to assess the risk of bias. Results Seven studies (with 713 participants) were included. Non-pharmacological interventions such as physical exercise, hydrotherapy, physiotherapy, and health promotion programs were analysed. Physical exercise interventions showed significant improvement in overall QoL and specific domains. Conclusions Non-pharmacological interventions show variable effects on QoL in female breast cancer survivors undergoing endocrine therapies. While physical exercise appears promising, the high methodological heterogeneity and limited evidence preclude definitive conclusions. Future research should focus on standardized approaches.