Effectiveness of self-management interventions in managing cancer therapy-induced cardiotoxicity in cancer survivors: a systematic review protocol.

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Learn more: PMC Disclaimer | PMC Copyright Notice Syst Rev . 2026 Apr 21;15:186. doi: 10.1186/s13643-026-03188-9 Effectiveness of self-management interventions in managing cancer therapy-induced cardiotoxicity in cancer survivors: a systematic review protocol Mubei Yang 1 , Agnes Y Lai 1 , Gary Tse 1 , Qiaohong Yang 2 , Wai Man Wong 1 , Xianliang Liu 1, ✉ Author information Article notes Copyright and License information 1 School of Nursing and Health Sciences, Hong Kong Metropolitan University, Hong Kong, China 2 School of Nursing, Jinan University, Guangzhou, Guangdong China ✉ Corresponding author. Received 2025 Apr 24; Accepted 2026 Apr 15; Collection date 2026. © The Author(s) 2026 Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/ . PMC Copyright notice PMCID: PMC13231534  PMID: 42015290 Abstract Background Advancements in cancer treatments, such as chemotherapy and radiotherapy, have increased survival rates. However, these treatments have side effects, such as cardiotoxicity, which significantly impact cancer survivors’ cardiovascular health and quality of life (QoL). Thus far, despite a limited amount of related literature, preliminary evidence suggests that patients can benefit from self-management. This systematic review aims to explore the effectiveness of self-management interventions in managing cancer therapy-induced cardiotoxicity and improving cardiovascular health and QoL. Methods Two reviewers will independently appraise, extract, and synthesize data from eligible studies published in the last 20 years (January 2004 to November 2024) obtained through comprehensive literature searches in databases, including CINAHL, PubMed, Web of Science, Cochrane CENTRAL, PsycINFO, and EMBASE. Only English-language studies will be included. Study quality will be assessed using the JBI appraisal tool. Studies will be pooled in a statistical meta-analysis using software R 4.3.3 or summarized in narrative format. The certainty of the evidence will be graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Discussion Despite the high risk of cardiovascular disease (CVD) associated with cancer treatment, little is known about the effectiveness of self-management strategies on improving cancer therapy-induced cardiotoxicity. Currently, there is no systematic review or structured guidance focused on self-management for cancer survivors. This review aims to evaluate the effectiveness of self-management interventions in managing cancer therapy-induced cardiotoxicity and improving cardiovascular health in cancer survivors. Systematic review registration PROSPERO CRD42024621854. Supplementary Information The online version contains supplementary material available at 10.1186/s13643-026-03188-9. Keywords: Cancer survivor, Self-management, Supportive care, Cardiovascular abnormalities, Cardiotoxicity Background Advancements in cancer treatments, including chemotherapy and radiotherapy, have significantly increased survival rates. However, these treatments come with adverse effects, particularly cardiotoxicity [ 1 ], that present challenges to the long-term health of cancer survivors. CVD is a prevalent health issue in cancer survivors, with studies showing that up to 26% of patients develop left ventricular dysfunction (LVD) after treatments such as doxorubicin, and the risk increases to 27% when combined with trastuzumab [ 2 ]. Moreover, the incidence of heart failure varies depending on the type and dosage of chemotherapy agents, especially anthracyclines, ranging from 0.14% to 48% [ 1 ]. Despite these risks, cardiovascular care is sometimes ignored during treatment, increasing the likelihood of severe cardiovascular complications in cancer survivors [ 3 ]. These risks are compounded by long-term cardiovascular complications that continually affect cancer survivors years after treatment. Cancer survivors who have lived more than five years after diagnosis have a 1.7- to 18.5-fold higher incidence of CVD risk factors (e.g., hypertension) and have up to a 3.6-fold increase in cardiovascular-specific mortality compared with their counterparts without a cancer history [ 4 ]. Studies have shown that cardiovascular abnormalities may take years to manifest after chemotherapy, from four to 20 years; for instance, 18% of patients showed cardiovascular dysfunction within the first decade, rising to 38% in those monitored longer, and around 5% of patients developed heart failure within 10 to 20 years after treatment [ 5 ]. Long-term cardiovascular effects, ranging from mild LVD to overt heart failure [ 3 ], impact survivors’ physical capacity and QoL, particularly in older people who may lack the physiological reserves to recover [ 6 ]. Given these risks, monitoring and managing cardiovascular health is crucial for improving survivors’ QoL. Cardioprotective therapies can be broadly categorized into pharmacologic and non-pharmacologic approaches. Pharmacologic options, such as dexrazoxane, and ACE inhibitors, can be administered at precise dosages, offering a more quantitative and controlled form of intervention. Despite their benefits, potential adverse effects—such as leukopenia—should be carefully considered [ 7 ], and their use may increase patients’ financial burden. Consequently, self-management has emerged as a potentially safer and more cost-effective alternative. Self-management refers to an individual’s ability to manage symptoms (e.g., fatigue), treatment, physical and psychosocial conditions, and lifestyle adjustments associated with chronic conditions, aiming to maintain a satisfactory QoL through cognitive, behavioral, and emotional adaptations [ 8 ]. Emotional support from family members and healthcare professionals is crucial to improving QoL, as it reduces patients’ insecurity and empowers them to manage their condition [ 9 ]. Furthermore, recent studies have highlighted the potential benefits of self-management exercise-based interventions. For instance, Dolan et al. [ 4 ] recruited 152 breast cancer survivors to participate in supervised aerobic and resistance exercise, which resulted in significant improvements in cardiorespiratory fitness ( p < 0.001), QoL ( p < 0.001), and fatigue ( p < 0.001). Kirkham et al. [ 10 ] conducted a randomized controlled trial (RCT) and found that aerobic exercise improved cardiovascular hemodynamics, including cardiac output, systemic vascular resistance, mean arterial pressure, and resting heart rate. Similarly, Lee et al. [ 11 ] reported a reduction in the Framingham Risk Score following a 16-week combined resistance and aerobic exercise program, indicating improved 10-year CVD risk. However, despite these promising findings, the effectiveness of self-management interventions for cancer-related cardiovascular health in breast cancer survivors is inconsistent. For instance, an RCT reported that an exercise-based cardio-oncology rehabilitation program mitigated a decline in left ventricular ejection fraction (LVEF) associated with anthracyclines treatment [ 12 ]. Conversely, a study conducted by Kirkham et al. [ 10 ] reported no impact of exercise interventions on reducing markers of cardiotoxicity. These mixed results highlight the complexity of effectively implementing self-management interventions as numerous barriers continue to hinder their success. Challenges such as the subtle presentation of early cardiotoxicity symptoms, infrequent symptom occurrence, inaccurate patient self-reports, and overloaded clinicians often hinder early cardiotoxicity symptom detection and risk prediction [ 13 ]. Barriers such as limited time, resources, and lack of useful information provided to patients further obstruct effective participation in self-management interventions [ 14 , 15 ]. This highlights the need for practical and structured support to assist cancer survivors in managing their cardiovascular health during and after cancer treatment. There are limited RCTs specifically focused on cancer therapy-induced cardiotoxicity. Existing systematic reviews have primarily examined how self-management may improve patients’ QoL [ 16 ] and identify barriers to effective self-management [ 6 ]. However, to date, no systematic review has specifically focused on evaluating the effectiveness of self-management interventions in managing cancer therapy-induced cardiotoxicity. This systematic review aims to evaluate the effectiveness of self-management interventions in managing cancer therapy-induced cardiotoxicity and improving cardiovascular health in cancer survivors. By synthesizing current relative research and bridging the gaps mentioned above, this systematic review seeks to present insights into designing self-management interventions that support cancer survivors in achieving better cardiovascular health and QoL. Inclusion criteria Participants This review will include studies involving cancer survivors, regardless of age, gender, race, cancer type, treatment type, or duration of treatment. Interventions and comparators This review will focus on studies that examined self-management interventions. Self-management interventions can be conducted under healthcare professionals’ supervision. Self-management encompasses several primary domains: lifestyle (e.g., exercising regularly), psychology (e.g., writing in a diary to track mental conditions), social support (e.g., participating in support groups), and knowledge (e.g., receiving educational guidance from healthcare professionals) [ 14 ]. Building on these domains, self-management interventions are structured programs designed to equip patients with the knowledge and skills to manage their cardiovascular health more effectively. These interventions can include various approaches, such as exercise-based self-management interventions, technology-based self-management interventions, and social support programs. Based on existing literature, self-management interventions can generally be divided into several key steps. First, a practical and measurable goal is set, such as a weekly exercise target. Second, patients receive health education and are encouraged to monitor and report symptoms regularly. Third, routines are developed to foster adherence to healthier behaviors. Eventually, interventions are adjusted based on patient feedback and health conditions. Comparators involve standard care, usual care, no intervention, or alternative interventions. Outcomes The review will examine two categories of outcomes. Primary outcome: The primary outcome of this systematic review will be cardiotoxicity, which manifests as clinical syndromes such as chest pain, myocardial infarction, heart failure, and arrhythmias [ 17 ]. Cardiotoxicity is categorized into three levels: mild, moderate, and severe [ 18 ]. Mild cardiotoxicity is defined as a reduction in LVEF of at least 10% to an absolute value below 53% and/or a decrease of over 15% in global longitudinal strain from baseline [ 12 ]. Emerging methods for cardiotoxicity detection include functional disability markers like VO 2 peak (≤ 18 mL·kg⁻ 1 ·min⁻ 1 ) [ 19 ]. Both cardiotoxicity definitions—imaging-based measures such as reductions in LVEF and GLS, and functional impairment measures such as VO₂peak—will be used to categorize cardiotoxicity where applicable. Studies will be included if they report on either definition. Recent research has categorized cardiotoxicity detection strategies into three main areas: myocardial strain imaging (e.g., echocardiography), cardiac biomarkers (e.g., troponin I), or a combination of imaging and biomarkers [ 17 ]. Secondary outcomes: The secondary outcomes of this systematic review will include various cardiovascular health outcomes (e.g., blood pressure, lipid profiles, and incidence of arrhythmias) [ 3 ], as well as measures of fatigue, psychological factors (e.g., levels of anxiety and depression), and overall QoL. Additionally, understanding the long-term effects of self-management on these dimensions is crucial as many patients shift their focus from treatment to improving QoL [ 14 ]. Studies will be included if they evaluated outcomes related to cancer therapy-induced cardiotoxicity or cardiovascular health. Studies focusing solely on general or patient-reported outcomes (e.g., QoL or psychological outcomes) without assessing cardiotoxicity-related outcomes will be excluded, as they do not align with the primary focus of this review. Types of studies This systematic review will include RCTs only to ensure the highest level of evidence in evaluating the effectiveness of self-management interventions. Other study designs, such as quasi-experimental studies or controlled before-and-after studies, will be excluded to maintain methodological rigor. Methods This systematic review will be conducted following the JBI methodology for systematic reviews of effectiveness [ 20 ] and the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. A completed PRISMA-P checklist is provided in Additional file 1. This review is registered in PROSPERO (registration number: CRD42024621854). Search strategy Two reviewers will independently conduct comprehensive research using tailored MeSH terms and keywords across databases and trial registers, including CINAHL, PubMed, Web of Science, Cochrane CENTRAL, PsycINFO, and EMBASE. Only studies published in English will be considered for inclusion. The research will include the following keywords for each database: cancer, cancer survivor, self-care, self-management, symptom, experience, supportive care, cardiovascular abnormalities, and cardiotoxicity. The search for studies will focus on published research from the last 20 years (January 2004 to November 2024), as more recent discoveries may have enhanced clinical knowledge and practice. For an example of the search strategy, see Table 1 . Clinical trial registries (e.g., ClinicalTrials.gov) will be searched to locate unpublished studies that could qualify for inclusion in this review. Reference lists from all included studies and similar systematic reviews will be scrutinized to identify additional eligible studies. Additionally, the reviewers will cooperate with a university librarian to develop a comprehensive search strategy. Table 1. Search strategy used in PubMed (search date: November 13, 2024) # Query Results retrieved S1 (((((((((((self-management[MeSH Terms]) OR (self care[MeSH Terms])) OR (Exercise[MeSH Terms])) OR (self-management[Title/Abstract])) OR (self care[Title/Abstract])) OR (supportive care[Title/Abstract])) OR (social support[Title/Abstract])) OR (health education[Title/Abstract])) OR (health promotion[Title/Abstract])) OR (exercise*[Title/Abstract])) OR (lifestyl*[Title/Abstract])) OR (psychosocial support*[Title/Abstract]) 900,320 S2 (((((((((((((cardiotoxicity[MeSH Terms]) OR (cardiovascular abnormality[MeSH Terms])) OR (cardiovascular disease[MeSH Terms])) OR (cardiotoxicit*[Title/Abstract])) OR (therapy-induced cardiotoxicit*[Title/Abstract])) OR (chemotherapy-induced cardiotoxicit*[Title/Abstract])) OR (cardiovascular toxicit*[Title/Abstract])) OR (cardiovascular abnormality[Title/Abstract])) OR (cardiovascular abnormaliti*[Title/Abstract])) OR (cardiovascular health[Title/Abstract])) OR (cardiovascular diseas*[Title/Abstract])) OR (heart health[Title/Abstract])) OR (cardiovascular effect*[Title/Abstract])) OR (cardiovascular function[Title/Abstract]) 2,961,866 S3 (((cancer survivors[MeSH Terms]) OR (Neoplasms[MeSH Terms])) OR (cancer survivor*[Title/Abstract])) OR (oncology patients[Title/Abstract]) 4,045,173 S4 S1 AND S2 AND S3 3965 S5 Filters applied: from 2004/1/1 to 2024/12/1, Randomized Controlled Trial 149 Open in a new tab Legend: MeSH , Medical Subject Headings; Title/Abstract = keywords searched in title or abstract fields only This review will follow the three-step search process recommended by the JBI methodology. First, an initial limited search of two appropriate databases (as two of those mentioned above) will be undertaken using keywords and index terms relevant to the topic. Second, a comprehensive search will be conducted across all included databases using all identified keywords and MeSH terms. Third, the reference lists of all included studies and relevant systematic reviews will be screened for additional studies. Clinical trial registries, including ClinicalTrials.gov, will also be searched to identify unpublished studies. Study selection Two reviewers will independently examine the titles and abstracts based on predefined inclusion criteria. If further appraisal is required, the full texts will be retrieved. Screening will be conducted using Covidence. Furthermore, the reasons for the exclusion of papers and the number of excluded studies will be recorded in a PRISMA flowchart. During this process, any disagreement between the two researchers will be resolved by discussion. Data extraction Two reviewers will independently extract the data for each eligible study using Covidence. Data elements will include study design, population, intervention details, comparators, outcomes, and follow-up period. Any disagreements will be resolved by discussion, with a third party involved if necessary. Quality appraisal of the included studies Two reviewers will independently conduct a methodological quality appraisal of included studies using a standardized critical appraisal instrument for RCTs from JBI [ 21 ]. Appraisal criteria will encompass study design, methodology, outcome measures, bias, and limitations. Any disagreements between the reviewers will be resolved by discussion, with a third party involved if necessary. Appraisal results will be presented in a table. All studies deemed eligible for inclusion will undergo data extraction and synthesis, irrespective of their assessed methodological quality. Furthermore, the methodological quality of all included studies will be factored into interpreting the results. Data synthesis Data synthesis will combine evidence on the effectiveness of self-management interventions in mitigating cancer therapy-induced cardiotoxicity and improving cardiovascular health in cancer survivors. Where studies are sufficiently homogeneous in terms of population, intervention, comparator, and outcomes, quantitative synthesis will be conducted using meta-analysis using R 4.3.3. For dichotomous outcomes, effect sizes will be expressed as risk ratios (RRs) with 95% confidence intervals (CIs). For continuous outcomes measured using the same scale, mean differences (MDs) with 95% CIs will be calculated; where different instruments are used to assess the same construct, standardized mean differences (SMDs) with 95% CIs will be used. Statistical heterogeneity will be assessed using the chi-squared test (with p < 0.05 indicating significant heterogeneity) and the I 2 statistic [ 22 ]. A fixed-effect model will be used when statistical heterogeneity is low ( I 2 ≤ 50%), while a random-effects model will be applied when heterogeneity is substantial ( I 2 > 50%) [ 22 ]. If meta-analysis is not appropriate due to substantial clinical, methodological, or statistical heterogeneity, findings will be presented using descriptive and narrative synthesis. If crossover trials are identified, only data from the first treatment period will be used where carryover effects cannot be excluded. If cluster randomized trials are identified, effect estimates will be adjusted for clustering using the reported intracluster correlation coefficient (ICC) or design effect, where available. To assess potential publication bias, funnel plots will be generated and Egger’s test for funnel plot asymmetry will be performed when at least 10 studies are available for a given outcome [ 23 ]. Assessing certainty in the findings The GRADE approach will be used to grade the certainty of evidence, and a Summary of Findings will be created using GRADEPro GDT software (McMaster University, ON, Canada) [ 22 ]. The Summary of Findings will provide comprehensive information, including absolute risk values, estimates of relative risk, and a ranking of the evidence quality, which will be based on considerations of bias risk, heterogeneity, and publication bias in the review results. The outcomes detailed in the Summary of Findings will focus on the impact of self-management interventions on cardiotoxicity and cardiovascular outcomes when compared with control groups. Discussion Despite the high risk of CVD associated with cancer therapy, there is a notable lack of systematic reviews specifically focused on self-management interventions for managing cancer therapy-induced cardiotoxicity and improving cardiovascular health in cancer survivors. Thus far, there is a lack of conceptual clarity, structured interventions, and limited focus on long-term outcomes. Bridging these gaps could provide valuable insights into the development of a systematic self-management framework. This review aims to provide comprehensive guidance for both patients and healthcare professionals in managing cardiovascular health after cancer therapy. Through identifying effective interventions, this review seeks to support cancer survivors in achieving better QoL and cardiovascular health outcomes. Supplementary Information Additional file 1: PRISMA-P Checklist. (32.7KB, docx) Acknowledgements Not applicable. Abbreviations QoL Quality of life GRADE Grading of Recommendations, Assessment, Development and Evaluation CVD Cardiovascular disease LVD Left ventricular dysfunction RCT Randomized controlled trial LVEF Left ventricular ejection fraction PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses PI Principal Investigator Authors’ contributions XLL contributed to the study design and drafted the manuscript with MBY. XLL and MBY conducted an initial search and a comprehensive search. AYL, GT, QHY, WMW, and XLL reviewed the manuscript and contributed guidance on methodological aspects. All authors read and approved the final version. Funding This work is supported by the Hong Kong Metropolitan University Faculty Research Startup Fund (Ref. no. FRSF/2024/01). Data availability All data generated or analyzed during this study will be included in the published article and supplementary information files. Declarations Ethics approval and consent to participate Not applicable. This study is a systematic review and does not involve collection of data from human participants. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Footnotes Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References 1. Conway A, McCarthy AL, Lawrence P, Clark RA. The prevention, detection and management of cancer treatment-induced cardiotoxicity: a meta-review. BMC Cancer. 2015;15:366. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 2. Narayan HK, Finkelman B, French B, Plappert T, Hyman D, Smith AM, et al. Detailed echocardiographic phenotyping in breast cancer patients: associations with ejection fraction decline, recovery, and heart failure symptoms over 3 years of follow-up. Circulation. 2017;135(15):1397–412. [ DOI ] [ PMC free article ] [ PubMed ] [ Google Scholar ] 3. Yeh ETH. 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Supplementary Materials Additional file 1: PRISMA-P Checklist. (32.7KB, docx) Data Availability Statement All data generated or analyzed during this study will be included in the published article and supplementary information files. Articles from Systematic Reviews are provided here courtesy of BMC ACTIONS View on publisher site PDF (809.8 KB) Cite Collections Permalink RESOURCES Similar articles Cited by other articles Links to NCBI Databases Follow NCBI NCBI on X (formerly known as Twitter) NCBI on Facebook NCBI on LinkedIn NCBI on GitHub NCBI RSS feed Connect with NLM NLM on X (formerly known as Twitter) NLM on Facebook NLM on YouTube National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894 Web Policies FOIA HHS Vulnerability Disclosure Help Accessibility Careers NLM NIH HHS USA.gov Back to Top

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