Comment on ‘The Effectiveness of Telemedicine on Distress, Physical Function and Self‐Efficacy in Patients With Cancer: A Meta‐Analysis of Randomised Controlled Trials’

We read with considerable interest the meta-analysis by Su et al. (2026) evaluating the effectiveness of telemedicine on distress, physical function, and self-efficacy in patients with cancer. The authors are to be commended for synthesising evidence across randomised controlled trials and for addressing outcomes that are highly relevant to contemporary oncology nursing practice. Beyond confirming the potential benefits of telemedicine, this study provides an important opportunity to critically reflect on how digital interventions are conceptualised, evaluated, and integrated into nurse-led cancer care. A notable strength of this meta-analysis is its explicit focus on distress and self-efficacy outcomes that are particularly sensitive to nursing interventions and central to holistic cancer care. While much of the digital health literature has prioritised biomedical endpoints or service utilisation metrics, this study appropriately foregrounds psychosocial and functional domains. In doing so, it implicitly reinforces the role of nurses as key agents in delivering, monitoring, and sustaining telemedicine interventions that extend beyond symptom surveillance to address emotional coping and self-management capacity. However, the findings also raise important conceptual questions regarding intervention specificity. Telemedicine, as operationalised in the included trials, encompasses a heterogeneous set of modalities, including symptom monitoring platforms, mHealth applications, internet-based education, exercise rehabilitation, and psychological support. While this breadth reflects real-world practice, it complicates attribution of observed effects to specific intervention components. For example, reductions in distress may be driven primarily by improved clinician–patient communication and reassurance, whereas gains in self-efficacy may depend more heavily on educational content and self-monitoring features. Without disentangling these mechanisms, it remains difficult to determine which aspects of telemedicine are most effective and how nurses can prioritise or tailor digital strategies for individual patients. The modest effect size observed for physical function further underscores the need for greater conceptual clarity. Although statistically significant, the pooled improvement in physical function was small and sensitive to the inclusion of large trials. This suggests that telemedicine may function better as an enabling or adjunctive tool rather than a primary driver of physical rehabilitation. From a nursing perspective, this distinction is critical. Telemedicine platforms may facilitate adherence, monitoring, and motivation, but meaningful improvements in physical function likely require sustained behavioural engagement, structured exercise prescriptions, and contextual support that extend beyond digital interfaces. Future trials should therefore clarify whether telemedicine is intended to replace, supplement, or coordinate in-person rehabilitation efforts. Another important contribution of this meta-analysis lies in highlighting self-efficacy as a central outcome. The observed moderate improvement in self-efficacy aligns with nursing theories that emphasise empowerment, self-management, and patient engagement as core processes of care (Govindaraj et al. 2025). Telemedicine may enhance these processes by providing timely feedback, reinforcing goal-setting, and reducing barriers to information access. However, self-efficacy is not merely an individual trait but a dynamic construct shaped by relational and contextual factors. The extent to which telemedicine platforms support meaningful nurse–patient relationships, rather than transactional exchanges, may therefore be a critical determinant of effectiveness. Explicit examination of how nurses communicate, coach, and personalise care within digital systems would add depth to future evaluations. The study also invites reflection on outcome selection and measurement. Distress, physical function, and self-efficacy are interrelated constructs, yet they were analysed independently. In clinical practice, improvements in one domain may mediate or moderate changes in another. For example, enhanced self-efficacy may precede reductions in distress, or improvements in physical function may reinforce confidence and emotional well-being. Analytical approaches that explore these interdependencies, such as mediation or pathway analyses, could yield more nuanced insights into how telemedicine exerts its effects. Such approaches would be particularly valuable for nursing-led interventions, where outcomes often unfold through complex psychosocial pathways rather than linear cause–effect relationships. The limited reporting of adverse events and safety considerations also warrants attention. Although telemedicine is generally perceived as low risk, its rapid expansion raises important questions about digital fatigue, inequities in access, data privacy, and unintended psychological burdens. Older adults, socioeconomically disadvantaged populations, and those with limited digital literacy may experience telemedicine not as empowering but as alienating or stressful (Rabbani et al. 2025). Nurses are often the first to identify such challenges in practice, yet these experiences are rarely captured in outcome-focused trials. Incorporating qualitative or mixed-methods evaluations alongside RCTs could provide critical insight into patient experiences, acceptability, and unintended consequences. From an implementation perspective, the meta-analysis highlights telemedicine's potential efficiency benefits for nursing practice, including reduced travel demands and improved monitoring capacity. However, these advantages may be offset by increased cognitive and workload demands on nurses, who must manage digital platforms, respond to alerts, and maintain therapeutic relationships remotely. The sustainability of telemedicine interventions therefore depends not only on patient outcomes but also on workforce readiness, training, and organisational support. Future research would benefit from explicitly examining nursing workload, role adaptation, and professional satisfaction in telemedicine-enabled care models. The international scope of the included trials enhances the generalisability of the findings but also introduces cultural and systemic variability. Health system infrastructure, reimbursement policies, and cultural expectations of care differ substantially across settings and may influence both uptake and effectiveness of telemedicine. Moreover, the nursing role itself varies internationally in terms of autonomy, scope of practice, and digital competencies. Disaggregating results by context or explicitly analysing system-level moderators could help identify where and for whom telemedicine is most effective. Importantly, this meta-analysis positions telemedicine as a potentially sustainable approach to cancer care, yet long-term sustainability remains largely untested. The absence of extended follow-up data limits understanding of whether improvements in distress or self-efficacy are maintained once digital interventions conclude (Zhu et al. 2025). From a nursing perspective, sustainability is closely linked to continuity of care and ongoing relational support. Interventions that abruptly end may risk disengagement or rebound distress. Designing telemedicine programs with phased transitions or maintenance components could help address this gap. Finally, the study points toward future integration of telemedicine with artificial intelligence and advanced analytics. While such integration holds promise, it also raises questions about preserving the humanistic and relational dimensions of nursing care. As digital systems become more automated, ensuring that nursing judgement, empathy, and ethical oversight remain central will be essential. Telemedicine should augment, not eclipse, the relational foundations of cancer nursing. In summary, Su et al. provide valuable evidence that telemedicine can improve distress, physical function, and self-efficacy in patients with cancer. Beyond these findings, the study contributes to an evolving conversation about how digital health interventions intersect with nursing-sensitive outcomes and practice. Advancing this field will require greater specificity in intervention design, deeper exploration of mechanisms and contextual factors, and sustained attention to implementation and workforce implications. By addressing these dimensions, future research can more fully realise the potential of telemedicine as a nursing-led strategy for comprehensive, equitable, and person-centred cancer care. K.P.B. conceptualised the commentary, drafted the manuscript, and serves as the corresponding author. K.R. contributed to rehabilitation and clinical interpretation and manuscript review. P.S. provided microbiological and analytical contextualisation and critical evaluation. All authors reviewed, edited, and approved the final version of the manuscript. The authors have nothing to report. Generative AI Disclosure: Generative AI tools were used solely for language refinement and formatting assistance. All scientific interpretation, critique, and conceptual analysis were independently developed by the authors. The authors have nothing to report. The authors have nothing to report. The authors declare no conflicts of interest. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.