Sense of coherence and health-related outcomes among patients with breast cancer: a systematic review

Patients with breast cancer frequently experience substantial psychological burden and persistent symptoms. Sense of coherence (SOC), a central construct of the salutogenic framework, has emerged as a key psychosocial resource for chronic illnesses. However, its association with diverse health-related outcomes in patients with breast cancer has not yet been systematically investigated. This systematic review examined the association between SOC and health-related outcomes in patients with breast cancer. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, and literature searches were conducted in PubMed, EMBASE, PsycINFO, and CINAHL from inception through October 2025. A total of 28 eligible studies were included. A higher SOC was consistently associated with greater psychological well-being and lower symptom burden, including pain, fatigue, and insomnia. SOC was also positively associated with quality of life (QoL), especially in the emotional, social, cognitive, and role-functioning domains. Some studies have suggested that a higher SOC is associated with more favorable QoL outcomes during the treatment phases. Evidence on the clinical prognosis is limited, with only one study examining survival outcomes reporting a positive association between SOC and survival. In conclusion, higher SOC was consistently associated with various health-related outcomes among patients with breast cancer, including psychological adjustment, symptom burden, and QoL. These findings suggest that higher SOC is associated with more favorable health-related functioning and overall well-being in this population.