ObjectiveEndocrine therapy is an essential treatment to improve disease-free and overall survival in patients with hormone receptor-positive breast cancer. However, symptoms associated with endocrine therapy severely affect patients' quality of life and medication adherence. To inform symptom management strategies, this study systematically reviews research on patients' symptom experiences and coping strategies during endocrine therapy.MethodsThis study conducted a thematic synthesis of qualitative research, including patients' experiences with endocrine therapy-related symptoms and the coping strategies they employ. Systematic searches were conducted in nine databases, including six English-language databases (PsycINFO, PubMed, CINAHL, Cochrane Library, Embase, and Web of Science) and three Chinese-language databases (SinoMed, CNKI, and Weipu), with searches covering the period from database inception to May 2024. The PICoS (Population, Interest of phenomena, Context, Study design) search strategy was applied to include the required qualitative studies.ResultsA total of 1758 studies were screened, and 19 qualitative studies were ultimately included, comprising 584 female patients receiving endocrine therapy. Identified five main themes: (1) antecedent factors influence symptom perception and adaptation; (2) outcomes of symptom experiences; (3) the complexity and diversity of symptoms; (4) selection of coping strategies; (5) symptom management needs. Reveals the impact of antecedent factors on symptom perception and adaptation, provides recommendations for managing endocrine therapy-related symptoms, and indicate the clinical significance and limitations of the research.ConclusionsFindings indicate that information accessibility and individual differences influence symptom perception, while physiological changes, experiences, psychological states, and information affect symptom adaptation. After symptom onset, patients often face distress and daily life/work limitations. A major challenge in symptom management is the lack of a systematic approach that accounts for symptom complexity and dynamics. Additionally, patients' informational needs are unmet, and professional support is lacking.Trial RegistrationThis systematic review has been registered on PROSPERO (CRD:42023444435)