Symptoms Experienced by Breast Cancer Patients Before, During and After Chemotherapy: A Systematic Review

Yang Cao,1,2 Khuan Lee,1 Azlina Yusuf,3 Seong Ting Chen,4 Xue Dong,2 Lin Li,1 Poh Ying Lim5 1Department of Nursing, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia; 2Department of Nursing, Changchun University of Chinese Medicine, Changchun, Jilin, People’s Republic of China; 3Nursing Program, School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia; 4Division of Nutrition, Dietetics and Food Science, School of Health Sciences, IMU University, Bukit Jalil, Kuala Lumpur, Malaysia; 5Department of Community Health, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, MalaysiaCorrespondence: Poh Ying Lim, Email pohying_my@upm.edu.myIntroduction: Breast cancer is the most prevalent cancer among women worldwide. Chemotherapy remains a key element of treatment for a large proportion of breast cancer patients. Breast cancer patients undergoing chemotherapy often experience multiple symptoms that can impact their quality of life. This systematic review aimed to identify the symptoms experienced by breast cancer patients before, during and after chemotherapy treatment along with associated factors, to provide an evidence base for healthcare providers.Methods: Five electronic databases were searched from January 2015 to September 2025 encompassing observational studies. Two researchers independently screened the studies and extracted data. The Standard Quality Assessment Criteria for Evaluating Primary Research Papers was used to evaluate the quality of included studies.Results: Out of 5,588 records, 37 studies met the inclusion criteria. Majority of studies were conducted in Asia and the most common study type was cross-sectional studies (n=18, 48.6%). Anxiety, depression, chemotherapy-induced nausea and vomiting (CINV), fatigue and sleep problems were the most common symptoms observed in these studies. The factors reported were divided into non-modifiable factors (sociodemographic and disease related) and modifiable factors (physiological, psychological, lifestyle, nutritional and other related). Younger age was the most frequently reported risk factor for increased anxiety, depression, fatigue, nausea, and menopausal symptoms, followed by having children, greater number of chemotherapy cycles, higher BMI, lower performance status, and limited social support.Conclusion: Breast cancer patients undergoing chemotherapy experience a variety of symptoms. These findings underscore the importance of routine symptom screening and baseline risk assessment to enable early identification of high-risk patients and implementation of targeted interventions to optimize quality of life. Future research should prioritize identifying high-risk populations and implementing targeted early preventive interventions to enhance patient quality of life.Keywords: breast cancer, chemotherapy, symptoms, risk factors, systematic review