Background <p>Patients with cancer face a high symptom burden, but traditional care models often lack timely, personalized support during home recovery. Nurse-led mobile health (mHealth) interventions show promise in bridging this gap. However, evidence on their effectiveness and reporting quality remains limited. This study evaluated the impact of nurse-led mHealth interventions on symptom outcomes in adult patients with cancer and assessed reporting completeness using the WHO mERA framework.</p> Methods <p>A systematic search of 10 electronic databases included studies published before January 27, 2025. Eligible studies were randomized controlled trials (RCTs) evaluating nurse-led mHealth interventions for cancer symptom outcomes. The risk of bias was assessed via the Cochrane Risk of Bias 2.0 tool. The meta-analyses were conducted via random-effects models, with effect sizes expressed as standardized mean differences (SMDs) with 95% confidence intervals (CIs). Sensitivity analyses explored sources of heterogeneity. Intervention characteristics were categorized using the Omaha System, and reporting quality was evaluated with the mHealth Evidence Reporting and Assessment (mERA) checklist.</p> Results <p>A total of 14 RCTs involving 1,972 participants were included. Pooled results from high-certainty evidence revealed that nurse-led mHealth interventions significantly improved depression (SMD = − 0.42, 95% <i>CI</i> [− 0.57, − 0.27], <i>p</i> &lt; 0.001). There was low-certainty evidence suggesting potential benefits for quality of life (SMD = 0.49, 95% <i>CI</i> [0.17, 0.81], <i>p</i> = 0.003). Very low-certainty evidence indicated possible effects on symptom severity (SMD = − 0.49, 95% <i>CI</i> [− 0.81, − 0.17], <i>p</i> = 0.003) and anxiety (SMD = − 0.47, 95% <i>CI</i> [− 0.74, − 0.20], <i>p</i> &lt; 0.001). No significant effects were observed for physical health, pain, or mental health. Interventions vary widely in platform, duration, and theoretical underpinnings. Most emphasized education and psychosocial support, with fewer studies targeting surveillance or treatment. mERA assessment revealed substantial reporting gaps, particularly regarding user feedback, cost, and data security.</p> Conclusions <p>On the basis of high-certainty evidence, nurse-led mHealth interventions appear to benefit depression management. However, the evidence for their effects on quality of life, symptom severity, anxiety, and other outcomes is of low or very low certainty, limiting confidence in these findings. Moreover, variability in intervention design and inadequate reporting transparency may hinder broader adoption. Future research should prioritize theory-based, cancer specific, and multidisciplinary approaches while adhering to standardized reporting frameworks to support effective implementation and scalability.</p> Registration <p>This systematic review was registered with the International Prospective Register of Systematic Reviews (PROSPERO); Registration number: CRD420251024506.</p>