Remote, scalable weight-loss interventions after early-stage breast cancer: A systematic review and meta-analysis of randomized controlled trials.

Abstract

e12748 Background: Obesity is associated with worse breast cancer outcomes, but whether intentional weight loss improves recurrence or survival remains uncertain. Remote, scalable lifestyle interventions may broaden access to weight management after early-stage breast cancer. We conducted a systematic review and meta-analysis of randomized trials evaluating remote weight-loss interventions and their effects on weight and breast cancer outcomes. Methods: We searched PubMed and ScienceDirect for randomized controlled trials published through January 2026 evaluating telehealth/remote weight-loss interventions in patients with breast cancer and reporting weight-related outcomes and/or breast cancer endpoints. We followed PRISMA guidance and pooled outcomes using random-effects models in RevMan 5.4.1. Results: Of 638 records identified, 6 randomized controlled trials (n = 1,594) met inclusion criteria. Participants received weight-control interventions delivered via telehealth (48.9%), usual care (48.9%), or in-person programs (2.2%). In pooled analysis, telehealth interventions resulted in significantly greater weight reduction than usual care at 6 months (MD −3.17 kg; 95% CI −4.12 to −2.22; p < 0.0001; I² = 57%), 12 months (MD −3.94 kg; 95% CI −4.80 to −3.09; p < 0.00001; I² = 0%), and 18 months (MD −3.51 kg; 95% CI −4.50 to −2.53; p < 0.0001; I² = 0%). Waist circumference reduction was also significantly greater with telehealth at 6 months (MD −4.36 cm; 95% CI −7.09 to −1.63; p = 0.002; I² = 0%). Only one of the included trials had a follow-up period long enough to assess the impact of weight loss on survival outcomes and to evaluate oncologic outcomes; disease-free survival was not significantly different (HR 0.71; 95% CI 0.41–1.24; p = 0.23). A 5% weight reduction was associated with a non-significant improvement in overall survival (HR 0.72; 95% CI 0.47–1.12; p = 0.15). Conclusions: Remote/telehealth interventions produce clinically meaningful weight loss and reductions in waist circumference after early-stage breast cancer, underscoring their potential in patient management. Findings from the initial RCT to determine the impact of this weight loss on breast cancer survival suggest a possible benefit, though evidence remains limited. Larger RCTs with adequate follow-up are essential to confirm whether these interventions can improve breast cancer outcomes and inform clinical practice.