Digital supportive care in prostate cancer: a systematic review

Prostate cancer is the most commonly diagnosed cancer in men in many high-income countries, and while survival rates continue to improve, the disease and its treatments carry a heavy symptom burden. Men living with and beyond prostate cancer frequently report unmet supportive care needs despite regular reviews with healthcare professionals, ranging from anxiety and uncertainty about treatment choices to difficulties with urinary, bowel, and sexual function. A new systematic review published in Supportive Care in Cancer offers the most comprehensive picture yet of how digital health technologies might close this gap, synthesising the perspectives of nearly thirty thousand people affected by the disease.

The review, led by C. Paterson of Flinders University and the Central Adelaide Local Health Network together with colleagues at Cancer Council South Australia and the University of Canberra, set out to map and synthesise the existing evidence on people’s perspectives and requirements for patient-facing digital health technologies in prostate cancer care delivery. To the authors’ knowledge, it is the first systematic review to address this question comprehensively. The team searched four electronic databases, CINAHL, MEDLINE, SCOPUS, and Web of Science Core Collection, from database inception to July 2024, following PRISMA guidelines with a protocol registered on PROSPERO. All identified citations were imported into Covidence systematic review software, where two reviewers independently screened titles, abstracts, and full texts, resolving conflicts through discussion.

Of the 5,184 articles identified for screening, 4,943 were excluded and 88 primary studies were included, representing a total of 29,256 participants affected by prostate cancer. The studies were published between 1996 and July 2024, with most conducted in the United States, Canada, and Australia, and sample sizes ranging from 9 to 11,290. Methodological quality was appraised using the Mixed Methods Appraisal Tool, and findings were synthesised narratively using the Human, Organisation, and Technology-fit evaluation framework, a well-established model for evaluating health information systems that examines how well a technology aligns with its users and the care setting rather than judging it on technical sophistication alone.

Preferences for digital supportive care emerged across four interconnected domains: mode of delivery, type of content desired, factors enabling engagement, and barriers limiting use. Overall, there was clear willingness to engage with digital models due to their convenience, flexibility, and immediacy of access. Web-based platforms were the most commonly assessed and widely implemented delivery mode, valued for their flexibility, structured presentation of information, and ability to be accessed at home or in clinical settings. Mobile applications were highly regarded for real-time interactions, symptom tracking, medication and exercise reminders, and automated alerts to healthcare providers, particularly during active treatment phases. Phone-based models, including nurse-led counselling and postoperative follow-up, were preferred by older adults, individuals with limited internet access, and those living in rural or remote areas, being more accessible and less cognitively demanding than internet-dependent platforms.

Notably, models combining multiple modalities, such as web-based tools supplemented by phone support, print materials, videos, wearable fitness trackers, or face-to-face interactions, demonstrated the greatest acceptability and inclusivity. Twenty-eight studies reported that multimodal approaches allowed participants to engage with content aligned with their preferences and capabilities while supporting transitions across the cancer care continuum. Hybrid models also mitigated digital exclusion by offering alternatives for users unable or unwilling to engage with fully digital interventions. Simple SMS and email reminders were frequently cited as effective adjuncts, supporting adherence and reinforcing behaviour change in exercise, symptom monitoring, and follow-up activities, while wearable devices integrated into exercise interventions provided real-time feedback and motivational support.

The type of digital content people wanted was equally revealing. Educational information and decision-making support tools were consistently reported as highly valued, particularly when personalised to individual diagnosis and treatment context. Web-based patient decision aids designed to facilitate shared decision-making at key treatment junctures were preferred when they provided clear, side-by-side comparisons of treatment options, including anticipated benefits, risks, and side-effect profiles. Visual risk communication tools such as graphs and probability diagrams were particularly valued for clarifying trade-offs between oncological control and functional outcomes. Participants reported that decision aids enhanced decision confidence, reduced confusion and anxiety, improved understanding of diagnosis and treatment options, and reduced decisional regret. Symptom management content was described as practical and informative, with tailored self-management advice and structured symptom reporting enhancing engagement and confidence in recognising and managing treatment-related side effects.

Exercise and lifestyle content was among the most frequently accessed and positively evaluated components, with aerobic and resistance exercise interventions associated with improvements in physical and emotional wellbeing observed at three-month follow-up. Participants valued the flexibility of home-based exercise delivery, and video demonstrations improved confidence in completing exercises safely and independently. Psychosocial content, primarily delivered through web-based cognitive-behavioural therapy and stress management programmes, was associated with improvements in sexual satisfaction and reductions in anxiety and distress, with partners participating in these interventions demonstrating significant improvements in mental health-related quality of life and improved communication among couples. Couple-based and sexual health content was less frequently represented but addressed an important relational dimension, with sexual dysfunction content among the most frequently accessed educational resources by patient-partner dyads.

Several consistent enablers enhanced engagement and sustained use. Tailored content emerged as a central implementation facilitator, with interventions personalised to clinical characteristics, symptom profiles, or treatment stage perceived as more relevant and useful. Clinician endorsement and support significantly strengthened uptake and trust, with decision aids introduced or discussed during consultations associated with higher utilisation and improved shared decision-making outcomes. Symptom-monitoring platforms incorporating clinician alerts and feedback increased perceptions of safety, and remote supervision by exercise professionals improved adherence to home-based interventions. Video and interactive features were consistently preferred over text-only formats, and clear navigation and ease of use were critical, with participants prioritising simple, functional interfaces over aesthetic complexity, particularly among older adults and those with lower digital literacy.

Barriers to implementation were identified primarily relating to technology access, device compatibility, digital literacy, and emotional readiness. Technology access constraints, particularly among rural and lower-income populations, limited equitable participation, with inconsistent internet connectivity, technical difficulties, and limited access to reliable devices reducing feasibility for some users. Device exclusivity, where platforms require specific operating systems or smartphone ownership, posed barriers to participation for individuals without compatible devices. Low digital literacy, especially among older participants, was consistently identified as a barrier, with complex interfaces and multi-step navigation reducing usability and confidence. Emotional overwhelm and psychological distress also moderated uptake, with elevated anxiety, depression, or cancer-specific distress associated with reduced satisfaction and lower perceived benefit from digital decision-support tools, and stigma surrounding psychosocial support and discomfort discussing sensitive topics such as sexual health further reduced participation in some interventions.

Interpreted through the HOT-fit framework, the value of digital models depended on the fit between the technology, its users, and the care setting rather than on technological sophistication alone. The technical sophistication of a platform rarely determined its acceptability; rather, sustained engagement depended on the extent to which a technology suited its users’ capabilities and circumstances and the setting in which it was delivered. Interventions embedded within clinical workflows were perceived as more legitimate and more sustainably adopted, whereas those delivered in parallel to routine care showed declining engagement over time. The authors note that limited attention has been given to digital sexual wellbeing support, which could offer a more accessible and comfortable way for people to engage with this sensitive area given the stigma that can accompany sexual dysfunction after prostate cancer treatment. Further research is needed on engagement among people with low digital literacy, non-English speakers, and lower-income populations, and on the long-term sustainability of digital models so that initial investment is not futile. The review also highlights a distinct lack of artificial intelligence technologies across the included studies, pointing towards chatbots as a potential avenue to meet the strong preference for human interaction, though the authors caution that clinical evidence and standardised evaluation methods for AI-based tools in digital health remain lacking.

Subject of Research: Health

Article Title: Digital supportive care in prostate cancer: a systematic review

Article References: Paterson, C., Coro, D., Morris, J. N., Turner, M. R., Perrotta, N., Godfrey, M., Robertson, A., & Christina, J. (2026). Digital supportive care in prostate cancer: a systematic review. Supportive Care in Cancer, 34(11), Article 1117. https://doi.org/10.1007/s00520-026-11192-x

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11192-x

Keywords: prostate cancer, digital health, supportive care, systematic review, eHealth, patient preferences, telehealth, self-management, Digital, supportive, care, prostate