This scoping review followed the Joanna Briggs Institute scoping review framework [32] and adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines (Checklist 1) [33]. This protocol was registered on the Open Science Framework [34].

The literature search reporting adhered to the PRISMA-S (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Literature Search Extension) guidelines (Checklist 2) [35]. Comprehensive literature searches were conducted from inception to April 3, 2025, in the following English and Chinese electronic databases: (1) PubMed, (2) CINAHL (via EBSCOhost), (3) Cochrane Library, (4) Embase, (5) Scopus, (6) Web of Science, (7) PsycINFO, (8) CNKI, (9) WanFang, and (10) SinoMed. The search strategy was developed collaboratively by the research team and peer-reviewed by an experienced librarian at the institution. Given the broad scope and objectives of this scoping review, the key search terms selected were “lung cancer,” “symptom monitoring,” “electronic patient-reported outcome,” and “remote monitoring.” Of note, no limits were applied for date, time period, search filters, or study design to maximize comprehensiveness. Both MeSH terms and free-text searches were used to ensure a thorough search. Additionally, the reference lists of included studies were reviewed to ensure no relevant evidence was overlooked [33]. If any included articles were found to contain potentially relevant information not provided in the original publication, the research team planned to obtain it by contacting the corresponding authors. The detailed search strategy used in each database is presented in Multimedia Appendix 1. The literature search was rerun on October 16, 2025, to update results.

This study used the PCC (population, concept, and context) strategy to establish eligibility criteria in line with the Joanna Briggs Institute recommendations [32].

This review included peer-reviewed primary studies (quantitative or qualitative) published in English or Chinese. Conference abstracts, reviews, comments, letters, and case reports were excluded, as these types of studies typically provide insufficient methodological detail or lack the ability to extract outcomes relevant to this review. Studies involving populations with mixed cancers, where lung cancer–specific data could not be isolated, were also excluded.

All search results were exported to EndNote 2025 (Clarivate Analytics), where duplicates were removed by 2 reviewers independently (HH and TM). Titles and abstracts were thoroughly screened, followed by a full-text review to determine final inclusion or exclusion by 2 reviewers independently (HH and TM). Disagreements were discussed and resolved through consultation with 2 independent members of the team (NT and HA-O). The selection process is illustrated in a PRISMA-ScR flowchart [33].

Data relevant to the research questions were systematically extracted using a predesigned table developed by the research team. Specifically, the following details were extracted from each included study: (1) study characteristics (author, publication year, country, setting, sample size, and study design); (2) theoretical frameworks or models applied; (3) technology platforms for rSMS delivery and their key features (eg, accessibility, integration, and user interface); (4) clinical workflows for rSMS implementation (eg, with real-time clinician alerts and intervention, and automated responses to patients); (5) type of PROMs used and their symptom or health outcome domains; and (6) reported benefits and limitations of rSMS from patients, health care providers, and system perspectives.

For qualitative studies, thematic data on patients’ and health care providers’ experiences (eg, barriers, facilitators, and satisfaction) were also extracted.

Quantitative data, including study characteristics, the use of PROMs, and reported benefits and barriers, were summarized in tabular and narrative formats, with a narrative interpretation provided. Qualitative data, such as user experiences, were analyzed using content analysis and synthesized narratively [36].

A total of 495 articles were retrieved through the initial search, comprising 491 from English-language databases and 4 from Chinese-language databases. After screening titles and abstracts, followed by a thorough full-text review, 80 English-language articles were deemed eligible, while all Chinese-language articles were excluded due to irrelevant content or study designs that did not meet the inclusion criteria. Additionally, 3 studies were identified through citation searching. Ultimately, 41 studies were included in the final analysis. The search process is depicted in a PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flowchart (Figure 1; Checklist 3).

The 41 studies were published between 2007 and 2025. The majority of studies were conducted in the United States (n=19, 46%), followed by China (n=7, 17%), Denmark (n=3, 7%), the United Kingdom (n=3, 7%), and 1 (2%) study each from Australia, Germany, Spain, South Korea, Finland, France, Singapore, Italy, and Switzerland. The characteristics of the included studies are presented in Multimedia Appendix 2.

The majority of the included studies (n=19, 46%) used an RCT design, with 17 (41%) representing original RCTs [17,18,20-23,26,37-46] and 2 (5%) constituting secondary analyses derived from previously published RCTs [47,48]. The remaining publications encompassed prospective studies (n=8, 20%) [19,27,49-54], cohort studies (n=4, 10%) [55-57], mixed methods studies (n=4, 10%) [24,58-60], nonrandomized feasibility studies (n=4, 10%) [61-64], and qualitative studies (n=2, 5%) [65,66].

Among all the included studies, 5 (12%) enrolled health care providers as participants [49,50,58,60,63], whereas all others exclusively enrolled patients with lung cancer. Twelve (29%) studies focused exclusively on advanced-stage lung cancer [17,21,28,37,38,49,52,53,58,61,67], 7 (17%) included patients across all lung cancer stages [44,50,51,57,63,65,68], 3 (7%) targeted stages I to III [18,39,46], 1 (2%) concentrated on stages I to II [20], 1 (2%) focused on stage III [64], and 1 (2%) addressed stages II to IV [42]. Fifteen (37%) studies did not specify lung cancer stages [19,22-24,26,27,40,41,43,45,54-56,59,62].

Symptom monitoring across the included studies predominantly targeted respiratory complaints (cough, dyspnea, hemoptysis, voice changes, and chest pain), constitutional symptoms (fatigue, appetite loss, weight change, sleep disturbance, and cognitive difficulties), and gastrointestinal toxicities (nausea, vomiting, constipation, diarrhea, dysphagia, and sore mouth), as well as pain [17,18,20,21,39,42,46,51,55,61,62,64]. Psychological distress (anxiety, depression, and sadness) was less frequently assessed [21,42,45,46,55,64,67]. In addition, several research teams incorporated treatment-related adverse effects, such as side-effect bother, facial swelling, tumor growth sensation, and fever [17,42,45,61].

Three studies noted the application of established theoretical frameworks to guide the rSMS development or intervention implementation (Table 1).

The application of theoretical foundations varied across studies. Maguire et al [59] applied the holistic framework to improve the uptake and impact of eHealth technologies and to guide the development of their rSMS [69]. This framework includes 6 key foundational components, namely stakeholder engagement, iterative evaluation, intertwined development and implementation, transformation of health care organizations, persuasive design techniques, and advanced methods for impact assessment. The chronic care model [71], a patient-centered framework that emphasizes proactive, planned, and systematic interventions, was prospectively applied to design the rSMS intervention and evaluation strategies by Mooney et al [26].

Girgis et al [24] retrospectively applied the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) implementation science framework to guide and summarize successful intervention implementation, while concurrently identifying implementation barriers within this framework [70].

A total of 32 PROMs applied across the included studies were categorized into two groups: (1) PROMs integrated into rSMS for monitoring purposes and (2) outcome measures used to evaluate the effectiveness of the rSMS intervention (Multimedia Appendix 3). Specifically, 19 PROMs were integrated within rSMS as components to monitor 3 domains—symptom assessment, HRQL, and psychological well-being. Thirteen PROMs were used as outcome measures to assess the effectiveness of the rSMS (Figure 2). Among all the 32 PROMs, three were used as both outcome measures and as components within the rSMS, including the Edmonton Symptom Assessment Scale, MD Anderson Symptom Inventory for Lung Cancer, and EuroQoL 5D-5L. Consistent with this review’s focus on rSMS development and implementation within lung cancer care, detailed analysis is restricted to PROMs integrated within the rSMS, while those functioning solely as outcome measures are comprehensively cataloged in Multimedia Appendix 4.

The included studies used a variety of platforms for rSMS, including web-based systems, mobile phones, and wearable devices. Most studies (n=21, 51%) used web-based systems for rSMS implementation [9,17,19,22,24,27,28,43,44,51,52,54,56-58,61,62,65-67]. Mobile phones were the second most used digital platform (n=14, 34%), facilitating real-time responses and notifications between health care providers and patients [20,21,23,26,37-41,45,46,55,59,60]. Six (15%) additional studies implemented rSMS through personal electronic devices—encompassing personal computers, smartphones, or other specialized devices [18,49,50,53,63,64].

The functional modules of rSMS were categorized into 4 key stages: data collection, data analysis, care response, and patient support (Figure 3).

User experiences of both patients and health care providers were evaluated through semistructured interviews across 5 (12%) studies [45,59,60,63,66]. Questionnaire-based surveys were also used to measure satisfaction levels among patients and health care providers [62,63]. Additionally, qualitative interviews were conducted to examine the feasibility of interventions and to identify facilitating and hindering factors from the patients’ perspective [65]. The findings from the content analysis are detailed in Multimedia Appendix 5 and visually synthesized in Figure 4, which highlights the key benefits and concerns expressed by patients and health care professionals regarding rSMS use.

Health care providers expressed diverse benefits and barriers of rSMS. First, some health care providers in palliative care settings perceived that proactive monitoring could empower certain patients by granting them greater control over their conditions and enhancing their disease management abilities, as the system provided positive feedback that motivated patients and guided their next steps [60]. However, the same study included no patient outcome data, and most health care providers expressed doubts about implementing such interventions in palliative care settings. This aligns with the concerns voiced by clinicians in other research [63]. Additionally, the remote reporting feature allowed patients to report symptoms in familiar surroundings, potentially fostering a more relaxed reporting experience compared to hospital settings [66]. Second, for health care providers, patients’ previsit self-reports enabled the care teams to prepare more effectively and facilitated early identification of symptom changes [59]. Regular monitoring of symptom fluctuations also supported disease progression tracking, aiding timely adjustments to care strategies and clinical decision-making [63,66].

Concerns about rSMS implementation were also reported. Some physicians emphasized that rSMS should supplement rather than replace clinical judgment [60,66]. Similarly, other clinicians highlighted that traditional in-person consultations and hands-on experience should not be supplanted by remote reporting, as reliance solely on patient self-reports without clinical observation poses significant challenges [60,66]. Additional concerns included the selective applicability of rSMS, particularly regarding older patients’ unfamiliarity with or resistance to electronic systems, as well as its limited benefits for palliative care groups [60]. Regarding rSMS itself, some health care providers identified limitations in its ability to support rigorous clinical decisions, noting that symptom reports often lack contextual details such as frequency or type, necessitating further patient interaction [66]. Additionally, some health care providers reported that rSMS added to their existing workload, making timely responses challenging [59,66]. Furthermore, health care providers expressed concerns about alerts, questioning whether all alerts are necessary and effectively reflect patients’ actual symptom burdens, while also worrying that excessive alerts might increase workloads [63].

Patients reported that rSMS was generally user-friendly and easy to operate, enabling them to conveniently report their symptoms and functional status [59,65]. Timely response systems and tailored health advice were considered highly helpful [45,59,65]. Some patients felt that rSMS provided a sense of safety, encouragement, and support, making them feel attended to by health care providers outside clinical settings [45,59,65]. Additionally, patients reported feeling that they were not only receiving help during the intervention, but also contributing to helping others [45].

However, some patients expressed concerns about rSMS. System-related barriers included hardware issues (eg, unstable access in rural areas), a preference for paper-based surveys, and unfamiliarity with electronic systems [9,65]. Some perceived symptom assessments and advice as redundant with existing knowledge, reducing motivation to complete surveys [59,65]. Others questioned rSMS efficacy, describing it as “self-limited” [59,65]. High symptom burden was also cited as an engagement barrier [65].

The implementation of rSMS among patients with lung cancer has demonstrated substantial benefits, including symptom alleviation, improvements in HRQL, enhanced communication between patients and health care professionals, strengthened patient-centered care experiences, and broader health system advantages. Nevertheless, some studies have reported nonsignificant effects on clinical outcomes, underscoring the variability of evidence (Figure 5).

This scoping review provides an overview of how rSMS has been applied in lung cancer care, with particular attention to the integration of PROMs and functional modules. The synthesis of existing studies indicates that rSMS interventions show encouraging potential to improve symptom surveillance and support timely clinical responses; however, the current evidence remains fragmented and methodologically limited. Notably, few studies have adopted theory-driven approaches in the design, implementation, or evaluation of rSMS, leaving important conceptual and practical gaps. In addition, variability in patient and health care provider engagement highlights ongoing challenges related to usability and comprehension. These findings set the stage for a more detailed discussion of the opportunities and challenges in advancing rSMS, as well as directions for future research.

Only 3 (7%) studies incorporated theory-driven approaches in designing the intervention program or evaluating the outcomes [24,26,59]. Existing evidence from implementation science underscores that theory-driven approaches enhance methodological transparency, clarify intervention mechanisms, and promote sustainability [74,75]. The current limited application of theoretical frameworks may contribute to inconsistencies in intervention implementation and hinder the comparability and validity of outcome measurements across studies. Future studies should integrate theoretical guidance at both the design and evaluation stages to maximize the effectiveness and sustainability of interventions.

To ensure the reliability of patient-reported data and the validity of study outcomes, rSMS should incorporate PROMs that have undergone rigorous psychometric validation. However, as illustrated in Figure 2, the majority of PROMs used in rSMS studies were self-developed by research teams. Of the 9 self-developed tools identified, only 4 (10%) studies explicitly reported having conducted formal validation procedures [26,42,55]. The limited reporting of validation efforts may affect the interpretability and generalizability of findings derived from these tools, underscoring the need for greater emphasis on validated PROMs in future rSMS designs.

This review further delineates four key functional modules characterizing current rSMS applications in lung cancer care, including data collection, data analysis, the response system, and patient support. While most platforms offer real-time alert capabilities, more than half report limited clinical action in response to these alerts. This lack of action is primarily attributed to barriers such as competing clinical demands and unclear delineation of responsibilities [66]. This highlights a critical need for integration strategies that link real-time symptom alerts to actionable care pathways and effective feedback mechanisms, ensuring digital monitoring enables timely intervention rather than functioning as a passive data repository.

The qualitative findings identified in this review remain limited, with reported outcomes demonstrating variability [45,59,60,63,65,66]. While health care providers value rSMS for symptom monitoring, they noted limitations, including reduced effectiveness among patients with limited digital literacy—particularly older patients with lung cancer—and perceptions of data subjectivity, possibly due to misunderstandings about the system [60,66]. Patients acknowledge rSMS benefits but express notable concerns regarding the rSMS system’s trustworthiness [65]. A deeper understanding of these perceptions and experiences is needed to inform strategies for patient engagement and health care provider integration. Importantly, current evidence predominantly originates from Western high-income settings with advanced medical infrastructure, highlighting the need for research in diverse resource environments to comprehensively understand rSMS implementation.

Clinical outcomes associated with rSMS interventions were found to be heterogeneous. Several trials reported meaningful benefits, including reductions in symptom distress and improvements in pain, fatigue, or sleep disturbance [18,20,22,26,39,41,46,52]. In contrast, other studies observed limited or no impact on broader end points such as global quality of life, overall survival, or treatment satisfaction [21,22,37,63]. These discrepancies may be explained by heterogeneity in rSMS design and implementation, including differences in clinical context, monitoring frequency, patient reporting requirements, and the extent of clinician engagement. Context-related factors may also contribute to this variability, with effectiveness potentially differing across specific care settings. For example, prior work has highlighted that the use of rSMS in palliative care requires particular caution to avoid imposing additional burdens on patients receiving end-of-life care [60].

In the era of precision medicine, rSMS integration can be optimized through person-centered interventions tailored to the diverse disease trajectories of patients with lung cancer. Such a tailored approach could enhance symptom assessment and management efficacy. For example, identifying variations in symptom burden can enable the integration of personalized education and technical support into the intervention program. The color-coded system identified in this review exemplifies a tailored tool for assessing these variations, thereby optimizing the application of rSMS [50].

Improving patients’ understanding of rSMS implementation could facilitate its successful adoption. While the current exploratory evidence is limited, studies indicate that patients frequently hesitate to seek medical assistance despite receiving alerts [49,50]. The observed reluctance to seek medical help may reflect a limited comprehension of the intervention’s objectives and functionality. As patients’ understanding of rSMS can influence their adherence and engagement, future studies should prioritize preintervention education on rSMS features and clinical aims to reinforce engagement.

This review has several limitations. First, the included studies were predominantly published in English. Although Chinese literature underwent initial screening, no studies met the inclusion criteria. Second, consistent with the guidelines of scoping review methodology, no formal quality appraisal of the included studies was performed, and therefore, the methodological quality of the evidence could not be ascertained. Third, due to the considerable heterogeneity in study designs, interventions, and outcome measures, it was challenging to draw definitive conclusions regarding clinical effectiveness.

This review advances the field by offering a comprehensive synthesis of the landscape of rSMS in lung cancer care. Unlike previous reviews that focused primarily on clinical outcomes or technical feasibility, this review adds to prior work by summarizing the theoretical foundations guiding rSMS, integrating functional modules, and distinguishing PROMs used as embedded system components from those reported as outcome measures. Together, these contributions clarify the current landscape and highlight methodological gaps. This is innovative because it provides a theoretical lens for comparing rSMS, not only their outcomes. To ensure long-term sustainability and clinical relevance, future research should adopt theory-driven approaches, refine functional integration, and incorporate multistakeholder perspectives to develop rSMS platforms that are patient-centered, sustainable, and adaptable across diverse clinical contexts while minimizing clinician burden.