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JMIR Cancer
Patient-centered innovations, education, and technology for cancer care, cancer survivorship, and cancer research.
Background: The latest WHO-GLOBOCAN data came out in October 2020. In India, approximately 1,78,361 i.e 13.3% new cases of breast cancer are detected per annum with 90,408 i.e. 10.6% deaths. With the 5-year overall survival, a study reported it to be 95% for stage I patients, 92% for stage II, 70% for stage III and only 21% for stage IV patients but with lifelong complications. There is evidence-based protocol for physiotherapy treatment in breast cancer but the lack of knowledge about the treatment and its benefits forms a barrier between patient and therapist. The lack of knowledge can be fulfilled by the app as it will give easy access to people while giving information about importance of physiotherapy in improving QOL and additional information about home-based exercises and prosthetics. Objective: To evaluate the awareness and knowledge of physiotherapy and evaluate Quality of life of breast cancer survivors after using the BRAVE App as intervention. Methods: 30 females suffering from breast cancer above the age 18 years were chosen. After the collection of baseline data and knowledge and awareness questionnaire the link to BRAVE App was provide. After 8 weeks post intervention data was collected. Results: Statistical analysis was done by using Chi-Square test for signifying the lack of knowledge and awareness about oncological rehabilitation in the breast cancer survivors. The pre and post intervention data was statistically analyzed by Wilcoxon Signed-Rank Test which gave significant improvement in post intervention functional score and quality of life. The overall mean for complete satisfaction usage of the BRAVE APP is near to 4.0 indicating higher satisfaction value. Conclusions: The pilot study is concluded as after the satisfied usage of BRAVE App there was improvement in functional score directly improving quality of life while addressing the lack of knowledge and awareness about physiotherapy with a cost-effective east to use intervention. Clinical Trial: The study was registered in the Clinical Trial Registry India with registration number CTRI/2025/05/086125.
(Toronto, February 15, 2026) JMIR Publications is pleased to announce that JMIR Cancer has been accepted and is now indexed in CABI’s Global Health database.
As a premier resource for international public health, CABI’s Global Health covers literature from 158 countries with a specialized focus on tropical diseases, nutrition, and community health. This inclusion ensures that research published in JMIR Cancerreaches a wider global audience of practitioners and researchers.
JMIR Cancer joins an elite group of JMIR journals in this database. You can view the full list in our Knowledge Base.
JMIR Cancer (JC, ISSN: 2369-1999) is a peer-reviewed journal focusing on education, innovation and technology in cancer care, cancer survivorship and cancer research, and participatory and patient-centred approaches. This journal also includes research on non-Internet approaches to improve cancer care and cancer research.
We invite submissions of original research, viewpoints, reviews, tutorials, and non-conventional articles (e.g. open patient education material and software resources that are not yet evaluated but are free for others to use/implement).
In our "Patients' Corner," we invite patients and survivors to submit short essays and viewpoints on all aspects of cancer. In particular, we are interested in suggestions on improving the health care system and suggestions for new technologies, applications and approaches (this section has no article processing fees).
Background: Endocrine therapy is a fundamental treatment for hormone receptor–positive breast cancer. However, treatment-related symptoms may lead to poor adherence and premature discontinuation, adversely affecting clinical outcomes. eHealth technology interventions have been widely applied as potential tools to support patient education, symptom management, and adherence.
Objective: This review aimed to evaluate the application, effectiveness, and limitations of eHealth technologies in symptom management among patients with breast cancer undergoing endocrine therapy.
Methods: A systematic literature search was conducted across 9 databases, including MEDLINE Complete, Academic Search Complete, PubMed, and CINAHL Ultimate, covering studies published between February 2015 and February 2025. Keywords included “breast cancer,” “endocrine therapy,” and “ehealth,” along with synonyms and related terms. Eligible studies examined the use of eHealth interventions in patients with breast cancer undergoing endocrine therapy. From 1352 records, 30 (2.2%) studies were included after screening and full-text review.
Results: The 30 included studies comprised 13 (43.3%) randomized controlled trials, 7 (23.3%) single-arm studies, 3 (10%) retrospective analyses, 2 (6.7%) observational studies, 3 (10%) mixed methods studies, and 2 (6.7%) qualitative studies. eHealth interventions, primarily mobile apps, telemonitoring systems, and SMS text messaging, demonstrated benefits in short-term symptom management, such as reductions in hot flashes, joint pain, anxiety, and sexual distress and improved medication adherence. However, evidence regarding long-term adherence and quality of life outcomes remains inconsistent. Considerable heterogeneity existed in study designs, adherence measures, and intervention components. Nurses were considered key contributors in implementing and monitoring eHealth interventions.
Conclusions: eHealth interventions show promise in improving symptom management and short-term adherence among patients with breast cancer receiving endocrine therapy. Methodological limitations and variability across studies restrict the strength of conclusions. Future research should prioritize long-term outcomes, standardized measures, and integration into routine clinical practice while incorporating perspectives from multiple stakeholders.
Background: Despite the human papillomavirus (HPV) vaccine being available to males for the past 12 years, adolescent males continue to lag in HPV vaccine uptake due to a variety of factors. With the ubiquitous nature of social media use among this population, further research is needed to improve HPV vaccine confidence among young adolescent males using these platforms.
Objective: Using the Elaboration Likelihood Model (ELM), this study sought to better understand knowledge, attitudes, and beliefs about HPV and HPV vaccination among male adolescents aged 14-17 years and examine how social media messaging influences vaccine perceptions and explore the characteristics of persuasion and trustworthiness of digital content narratives across age and vaccination status.
Methods: The study team recruited 18 adolescent males to participate in a series of online focus groups and interviews stratified by age (14-15 years and 16-17 years) and HPV vaccination status. The study team worked with our in-house national probability survey panel, AmeriSpeak Teen Panel, to recruit for the discussion groups and interviews. All discussions were recorded, transcribed, and coded using NVivo 14 (Lumivero). ELM was used to develop discussion guides, codebook, and analysis. Emergent themes were identified, and the full team participated in double-coding and analysis. Data were analyzed using rigorous thematic analysis to identify patterns across groups.
Results: Knowledge of HPV varied by age and vaccination status. Older, vaccinated adolescents were more likely to understand that HPV affects both genders and is sexually transmitted, whereas younger, unvaccinated adolescents often had little to no prior awareness. Parents—especially mothers—were the primary decision-makers for vaccinated adolescents, with older adolescents more likely to be engaged in that decision. Trust in social media health messages was low overall, with participants relying on perceived source credibility over content format or style. Trusted sources included parents, physicians, and well-known health organizations. Younger adolescents were more influenced by personal anecdotes, whereas older adolescents preferred statistics, facts, and reliable sources.
Conclusions: Our findings highlight the importance of tailoring HPV vaccine messaging by age and developmental stage. Trusted messengers, clear factual content, and platform appropriateness are critical for engaging adolescent males. ELM provides a useful lens for interpreting these findings: younger adolescents were more influenced by peripheral cues, personal stories, or visual appeal, whereas older adolescents engaged in more central processing, evaluating the credibility of the source and the factual content of the message. This underscores the need to match message strategies with adolescents’ cognitive and motivational readiness. Future interventions should consider dual strategies targeting both youth and parents, especially for younger adolescents. As the digital landscape continues to evolve, further research should also examine how generative artificial intelligence (AI) may serve as a trusted source or tool for communicating accurate, engaging health information to adolescent audiences.
Background: With increasing numbers of survivors with cancer, the importance of patient-centered information provision and communication to alleviate psychological burdens, such as anxiety and depression, is growing. However, substantial individual differences exist in patients with cancer information–seeking behaviors and use of support services, and few studies have comprehensively examined cognitive and psychological factors such as treatment status, sex, trust in information sources, and patient-provider relationships.
Objective: This study aimed to integrate the theory of planned behavior and the patient-provider relationship model to identify latent subgroups among Japanese survivors with cancer using information-seeking behaviors, difficulties in information seeking, trust in information sources, and intentions to use psychosocial support services recommended by medical institutions.
Methods: A CHERRIES (Checklist for Reporting Results of Internet E-Surveys)–compliant cross-sectional web survey was conducted in December 2024 with 350 Japanese survivors with cancer (at least 1 year post diagnosis, either undergoing treatment, or within 5 years after completing treatment). Exploratory factor analysis examined items such as difficulties in information seeking, trust in information sources, and assessment of relationships with physicians. Using the resulting factor structure and sociodemographic and clinical characteristics, latent class analysis was conducted. Differences between classes were examined using the chi-square test, Kruskal-Wallis test, and post hoc analyses.
Results: Latent class analysis classified participants into 3 groups: women under observation, men under observation, and patients under treatment. In the women under observation group, evaluation of the reliability of information from nonmedical institutions was significantly higher than in the male group (²=12.30; =.002). Although information-seeking behavior among men under observation was relatively limited, their evaluation of relationships with physicians was significantly higher than that of the treatment group (²=12.20; =.002). The proportion of men who regarded promoting communication with doctors and health care professionals as a benefit of using support services was also significantly higher than that of women (²=12.57; =.002 and Class 2 > Class 1; =.001). In the treatment group, searches for information on life during treatment (²=7.22; =.03), use of the Cancer Consultation Support Center (²=17.31; <.001), and use of the National Cancer Center website (²=7.59; =.02) were significantly higher than among men under observation. The treatment group also reported greater difficulty in seeking information (²=11.90; =.003).
Conclusions: Information-seeking behaviors, trusted sources, and perceived difficulties differed by sex and treatment stage among Japanese survivors with cancer. Patients undergoing treatment showed high information needs but greater difficulty in seeking information, suggesting reduced perceived behavioral control. Men under follow-up emphasized relationships with physicians, whereas women relied more on nonmedical information sources. These findings indicate that psychosocial support and information provision should be optimized according to patient-provider communication patterns.
Background: Despite a global decline in the incidence of gastric cancer (GC), the number of cases diagnosed among younger individuals continues to increase. Several studies have been conducted to develop predictive models of mortality in patients with GC.
Objective: We developed 3- and 5-year survival prediction models for young patients with GC based on machine learning–based survival modeling approaches.
Methods: Data from 813 young patients (≤50 years) diagnosed with GC between 2013 and 2015 were retrieved from the Gastric Cancer Public Staging Database. Among these 813 patients, data from 569 (70%) and 244 (30%) were allocated to the model training and testing datasets, respectively. Random survival forest, gradient boosting survival analysis, extra survival tree, and the Cox proportional hazards model were applied to predict survival outcomes at the 3- and 5-year time horizons. Model performance was assessed and quantified using the concordance index (C-index) metric. For the machine learning prediction models, the mean C-index values and corresponding 95% CIs were estimated across 100 repeated training iterations.
Results: For the random survival forest model, the C-index for predicting 3-year mortality was 95.89% (95% CI 95.80%‐95.97%), whereas the C-index for predicting 5-year mortality was 91.82% (95% CI 91.68%‐91.96%). In the gradient boosting survival analysis model, the C-index for predicting 3-year mortality was 95.32% (95% CI 95.31%‐95.33%), and the C-index for predicting 5-year mortality was 89.98% (95% CI 89.95%‐90.01%). For the extra survival tree model, the C-index for predicting 3-year mortality was 95.53% (95% CI 95.46%‐95.60%), whereas the C-index for predicting 5-year mortality was 94.60% (95% CI 94.50%‐94.70%). In addition, the Cox proportional hazards model showed a C-index of 94.15% for predicting 3-year mortality and 82.26% for predicting 5-year mortality. Tumor stage and tumor size were the primary predictive variables used to train the models for mortality prediction at different time points. Other variables exhibited varying levels of predictive contribution across different time points.
Conclusions: These findings may facilitate the identification of high-risk young patients with GC who may benefit from more aggressive treatment strategies by enabling the prediction of mortality risk at different time points.
Background: Consumer fitness tracker devices offer scalable opportunities to monitor real-world behavior and support health in cancer survivorship. However, adoption and sustained use outside structured research settings remain incompletely characterized, limiting their integration into survivorship care.
Objective: The primary objectives were to describe the prevalence of fitness tracker ownership and use patterns among cancer survivors and to identify sociodemographic, psychosocial, and usability-related correlates of device ownership and frequent use.
Methods: We conducted a cross-sectional survey of 893 cancer survivors enrolled in the Total Cancer Care protocol at a comprehensive cancer center. Participants completed an adapted online questionnaire assessing fitness tracker ownership, frequency of use, and perceived barriers and facilitators. Multivariable logistic regression models were used to identify sociodemographic, psychosocial, and usability-related correlates of device ownership and frequent use.
Results: More than half of the participants (506/893, 56.7%) reported owning a fitness tracker, and among owners, 82.2% (416/506) reported frequent use (most days or every day), including 71.3% (361/506) who wore the device every day. The most commonly used devices were the Apple iWatch (272/506, 53.8%) and Fitbit (147/506, 29.1%). In multivariable analyses, fitness tracker ownership was independently associated with sex, household income, and cancer site. Male participants had lower odds of ownership (adjusted odds ratio [aOR] 0.61, 95% CI 0.42-0.87; P=.006), while higher household income was associated with greater ownership (US $50,000-$99,999: aOR 1.70, 95% CI 1.13-2.57; P=.01; ≥US $100,000: aOR 3.64, 95% CI 2.41-5.50; P<.001). Ownership also differed by cancer site. Among owners, frequent use was concurrently and inversely associated with self-reported device discomfort (P<.001), low motivation (P<.001), information overload (P=.04), and limited app integration (P=.007).
Conclusions: In this single-center, predominantly White, higher-income sample of cancer survivors, fitness tracker ownership was common and patterned by demographic and socioeconomic characteristics, while sustained engagement among device owners was associated with psychosocial and usability factors. These findings suggest that scalable, fitness tracker–enabled survivorship care will need to address both structural disparities in ownership as well as behavioral readiness and user experience to ensure clinically meaningful implementation.
Background: Approximately 80% of breast cancers are estrogen receptor positive, and following initial tumor treatment, patients are prescribed hormone therapy (HT) drugs (tamoxifen, letrozole, anastrozole, and exemestane) for 5-10 years. These drugs are known to cause several side effects. Additionally, a small number of studies have identified that changing medication brands (generics) can negatively affect patients’ side effects, attitudes, and acceptance of HT. However, no effective intervention currently exists to address patients’ concerns about generic switching.
Objective: This study explores whether a symptom diary appears to be an acceptable approach for patients and pharmacists to address brand concerns, and provides a detailed report of the planning and development stages of a coproduced diary intervention.
Methods: This paper presents the studies conducted during the planning and development stages of the symptom diary, following the person-based approach, which combines theory-, evidence-, and person-based approaches to ensure interventions are acceptable and easy to implement. The study included the following stages: (1) the planning stage, which involved analysis of an online patient forum (n=277), interviews with patients (n=9), and interviews with pharmacists (n=7). Data triangulation was used to present an integrated set of findings. (2) The development stage, which involved a rapid scoping review of the literature on the use of diaries among patients with cancer, coproduction workshops with patients and pharmacists (n=17), pharmacist interviews (n=11), and consultation with our patient advisory group (n=5). Analysis was informed by evidence synthesis, behavior change analyses, and iterative stakeholder consultations.
Results: In the intervention planning stage, patients and pharmacists perceived community pharmacies as the ideal setting for HT medication consultations. Both groups proposed using a patient diary to support awareness and attribution of drug-related symptoms. Pharmacists described patients’ requests for specific brands as difficult to manage, whereas patients reported that switching brands undermined confidence in medication-taking. In the development stage, the scoping review (n=29 papers) identified barriers and facilitators related to diary use, and workshops explored diary format and content. These findings informed the intervention planning table and the first diary prototype. Pharmacist interviews and patient feedback informed the development of 2 further prototypes. The symptom diary is a self-monitoring tool designed to enhance self-efficacy in HT medication-taking behaviors. It includes recording side effects from brands alongside physical, psychological, and environmental factors; actions taken to manage symptoms; and problem-solving and planning before a medication consultation to facilitate personalized feedback from pharmacists.
Conclusions: We preliminarily developed an intervention that appears engaging, relevant, and acceptable for patients to self-monitor their symptoms. Further revisions informed by user feedback will be incorporated after testing ENABLE (Medication Brand Changes in Hormone Therapy for Breast Cancer: A Community Pharmacy Intervention Development to Improve Patients’ Adherence and Quality of Life) in community pharmacies.
Trial Registration: ISRCTN Registry ISRCTN15089342; http://www.isrctn.com/ISRCTN15089342
Background: Patients receiving systemic anticancer therapy (SACT) can deteriorate clinically between scheduled appointments; yet, acute oncology services often rely on reactive helplines with limited longitudinal symptom visibility.
Objective: The aim of this study was to evaluate the feasibility, safety, and workflow integration of OncsCare, a digital symptom triage platform mapping patient-reported symptoms to UK Oncology Nursing Society (UKONS) acuity tiers with episode-based clinician review.
Methods: This 10-week service evaluation (July to September 2025) implemented OncsCare within a UK tertiary acute oncology service. Patients completed daily symptom check-ins mapped to UKONS-informed green/amber/red tiers. Alerts were grouped into episode-level triage events using prespecified rules (48-hour window, symptom-domain continuity) to represent the operational workload. Outcomes included engagement, alert distribution, escalation pathways, timeliness of clinical response, and safety signals via structured case-finding.
Results: Thirty-two patients participated (none withdrew) in this study. Daily check-in completion rate was 91.7% (1444/1574 expected patient-days). From 362 amber/red alerts, 62 episodes were generated; 38.7% (24/62) were clinically actionable, resulting in telephone management (n=12, 50%), acute care assessment (n=9, 37.5%), emergency referral (n=2, 8.3%), or admission (n=1, 4.2%). Median time to first clinical response for in-hours red alerts was 47 minutes. Predefined safety case-finding identified no intervention-attributable safety signals. Patients reported increased home reassurance (n=17, 85%), and clinicians reported improved situational awareness without increased workload.
Conclusions: UKONS-informed digital triage with episode-based review demonstrated feasibility, with no intervention-attributable safety signals identified in this small single-center evaluation. This operational model addresses alert fragmentation and supports prospective multicenter evaluation.
Background: Lung cancer is one of the most commonly diagnosed cancers worldwide and the leading cause of cancer-related mortality. Global studies have highlighted the importance of awareness of lung cancer signs and symptoms, as it influences health care seeking, diagnosis timing, and treatment outcomes. Despite the high prevalence of both lung cancer and smoking in Jordan, no studies have assessed lung cancer awareness among the Jordanian population. This study is the first in Jordan to reveal the levels of awareness of lung cancer signs and symptoms, risk factors, and screening and to identify factors associated with the awareness level.
Objective: This study aimed to explore the awareness of lung cancer risk factors, signs and symptoms, and screening in the Jordanian population and the factors determining the levels of awareness.
Methods: A cross-sectional survey was conducted across all 12 governorates of Jordan, including 498 adult participants. Data were collected using a structured questionnaire covering sociodemographic characteristics and awareness about lung cancer signs, symptoms, risk factors, and screening. Items were derived from the Lung Cancer Awareness Measure Toolkit, version 2.1, 2011. Awareness scores for lung cancer risk factors, signs and symptoms, and overall lung cancer awareness were calculated. Multivariate linear regression was used to identify significant predictors of awareness scores. Multivariate logistic regression was used to determine significant predictors of lung cancer screening awareness.
Results: The mean lung cancer signs and symptoms awareness score was 5.4 (SD 4.9) out of 14, while the mean risk factor awareness score was 33.0 (SD 5.6) out of 45. The most recognized symptoms were coughing up blood (n=297, 59.6%) and pain upon breathing (n=237, 47.6%), while cigarette smoking (n=403, 80.9%) and exposure to air pollution (n=339, 68.1%) were the most recognized risk factors. Only 41.6% (n=207) of the participants had heard of lung cancer screening, while 79.3% (n=395) believed that screening improves survival. Being a smoker was predictive of lower awareness of lung cancer signs, symptoms, and risk factors, while a higher educational level and having a friend or relative previously diagnosed with lung cancer were associated with higher levels of awareness.
Conclusions: This study revealed a low level of awareness of lung cancer signs and symptoms, risk factors, and screening in the Jordanian population. Further studies are needed to identify effective strategies for improving awareness, especially among high-risk populations.
Trial Registration:
Background: About 4 in 10 people in Sweden get cancer during their lifetime, and approximately half of them will be diagnosed during their working life. As cancer survival rates improve, a growing number of individuals face challenges in returning to work following treatment. This increases the demand for effective return-to-work (RTW) strategies. Despite existing rehabilitation frameworks, cancer survivors often encounter barriers to sustainable work reintegration.
Objective: This study aimed to investigate stakeholders’ perceptions of facilitators and barriers to RTW among cancer survivors, including factors promoting work-related well-being during the RTW process.
Methods: During the development phase of a work-oriented rehabilitation intervention, semistructured interviews were conducted, with 25 stakeholders involved in the RTW process: health care professionals (n=12), social insurance officers (n=7), employers (n=5), and an employment service agency officer (n=1). Data were analyzed using qualitative content analysis.
Results: Five overarching themes were identified that influenced RTW: collaboration and clear division of responsibilities, balancing individual adaptations, reducing structural barriers through support, views and expectations of the individual regarding RTW, and the emotional significance of work. Key facilitators included flexible work arrangements, individualized adaptations, a strong desire to work, and the emotional value of work. Barriers comprised lack of collaboration among stakeholders, particularly the absence of a clear division of responsibilities, as well as structural barriers, such as sick leave bureaucracy and financial obstacles. The role of rehabilitation coordinators was highlighted as pivotal in bridging gaps between stakeholders and ensuring continuity in care.
Conclusions: RTW for cancer survivors is a complex, multifactorial process requiring coordinated efforts across health care, insurance, and employment sectors. Enhancing collaboration, clarifying stakeholder responsibilities, and implementing flexible, individualized support structures are essential to facilitating cancer survivors’ RTW. Additionally, including a designated coordinator in the process is proposed. More support during the early phase of RTW is necessary to reduce the risk of long-term labor market exclusion. To help cancer survivors’ RTW, clear role definitions and shared responsibilities among stakeholders are essential. Flexibility in the RTW process helps individuals reintegrate at their own pace, reduces isolation, and promotes social connection. These are key considerations for future policies and support measures.
Background: Wearable devices are becoming more ubiquitous and are capable of capturing health-relevant information that patients may be interested in sharing with their providers. However, limited research has been conducted on oncology provider perspectives on how these data could be used to inform cancer care.
Objective: The goal of this study was to understand oncology clinicians’ preferences about which data would be most clinically valuable and in what clinical scenarios, the benefits and barriers to integrating wearable device data into cancer care, and perspectives on how wearable device data could impact decision-making using 3 clinical vignettes.
Methods: A total of 13 oncology care clinicians completed an online questionnaire to assess the perceived value of different types of wearable device data in different clinical scenarios and participated in semistructured interviews to gather preferences around integrating these data into clinical workflows. During the interviews, providers were also presented with 3 clinical vignettes and asked for clinical recommendations both before and after seeing the patient’s wearable device data. Descriptive statistics were calculated to summarize quantitative data from questionnaires and structured interview questions, and interviews were transcribed and coded using an iterative thematic analysis approach.
Results: Survey responses indicated that providers were most interested in tracking vital sign metrics, followed by data related to falls and functioning, and then by data on sleep and activity. Clinicians thought that wearable device data might be especially useful for remotely monitoring patients at high-risk moments in their care trajectory, such as after an acute hospitalization or after starting a new outpatient treatment. Four main themes were discussed by providers in the interviews: (1) corroborating reports, (2) identifying new issues, (3) coordinating care, and (4) patient-provider communication. Although there were no statistically significant differences in clinical recommendations before and after viewing wearable device data for any vignette (all >.25), all clinicians reported that the wearable device data impacted their decision-making confidence, and most rated the wearable device data as helpful.
Conclusions: Oncology providers highlighted the potential clinical value of vital sign and physical functioning data from wearable devices, particularly when outpatients might be at risk for readmissions or other acute deteriorations between clinic visits. Providers noted that the objective data captured by consumer wearable devices can be helpful complements to patient and caregiver subjective reports and that this information could improve patient-provider communication and care coordination. During the interviews, most providers found wearable device data to be helpful when making decisions. While there are challenges to address on how to integrate this information into the clinical workflow and communicate alerts with patients, there is cautious enthusiasm among clinicians about how these data could inform and improve cancer care.
Background: Chronic myeloid leukemia (CML) has evolved into a chronic condition as a consequence of effective tyrosine kinase inhibitor (TKI) therapy, leading to an expanding demographic of patients necessitating lifelong monitoring. The use of eHealth solutions has the potential to facilitate sustainable and patient-centered care by enabling remote monitoring and enhancing guideline adherence. The Dutch CMyLife digital care platform incorporates a CML Dashboard intended for health care professionals (HCPs). This dashboard is designed to provide insight into real-world CML care and enable remote monitoring.
Objective: This study aimed to evaluate the feasibility of the CML Dashboard for remote monitoring of CML care, to assess the usefulness of dashboard-derived data, and to identify barriers and facilitators for its implementation in routine clinical practice.
Methods: We conducted a multimethods early-stage evaluation, determining the feasibility of the CML Dashboard and its barriers and facilitators. Quantitative data were generated through the CMyLife app and displayed in the CML Dashboard. These data were collected over a 2.5-year period and analyzed descriptively. Concurrently, semistructured interviews were conducted with HCPs treating patients with CML to explore barriers and facilitators for implementation. The analysis of interview transcripts was conducted using framework analysis, using established implementation models.
Results: Of the 199 patients who were registered, 177 provided data to the dashboard. The dashboard provided insight into patient characteristics, TKI treatment, BCR::ABL1 values, and monitoring intervals. However, the completeness and reliability of the data were limited, as the majority of the data were manually entered by the patients. The absence of complete data and the presence of inconsistencies in monitoring time points reduced the immediate usability of the dashboard for clinical decision-making and quality monitoring. A total of 8 HCPs participated in the interviews. The facilitators included an enhanced overview of patient data, support for consultation preparation, and the potential for remote monitoring and quality improvement. Key barriers identified were the lack of integration with electronic medical records, the necessity for additional log-in procedures, the limited adoption of the app by patients, and the perception of its added value as being inferior to existing systems.
Conclusions: The prospect of implementing a remote monitoring system for CML care holds promise. Such a system, using a digital dashboard, has the potential to enhance oversight and contribute to the enhancement of quality assurance. Nonetheless, the implementation of automated data exchange with electronic medical records, enhanced data completeness, and the augmentation of integration into clinical workflows are imperative prior to the large-scale implementation and the transition toward home-based CML care.
Background: Quality of life (QoL) questionnaires are used in many disease areas to measure the burden that a disease causes for patients, which help provide insights into disease impact, identify unmet medical needs, and inform patient-centered drug development and value assessment for treatments. The collection of data imposes both a significant burden on patients as well as effort on health care personnel, thus incurring high costs for the health care system. Given that patients share detailed information about their condition and treatment experiences on social media and patient forums, an important research question is to what extent information about QoL can be obtained from patients’ online forum posts to potentially complement information obtained from questionnaires.
Objective: This study aimed to assess how much QoL information can be gained from the analysis of posts by patients in online health care communities and whether this information is rich enough to estimate individual patient’s QoL based on their posts. We conducted this feasibility study in the context of breast cancer as it is the most prevalent cancer in the female population.
Methods: We recruited 134 female patients diagnosed with breast cancer on the Inspire patient online forum, who voluntarily participated in our feasibility study. They filled in the EORTC (European Organisation for Research and Treatment of Cancer) QLQ-C30 and QLQ-BR23 questionnaires consisting of 30 general questions and 23 additional breast cancer–specific questions and provided consent to analyze their posts and comments on the online forum (756 posts and 19,478 comments). Posts were coded manually to identify parts of the text providing answers to 1 of the aforementioned 53 questions.
Results: The data annotation yielded a substantial agreement (mean Fleiss κ of 0.5, SD 0.28). Overall, we found answers in the coded data for 50 out of 53 EORTC QLQ-C30 and QLQ-BR23 questions. The information coded in the posts reliably predicted the answers given in the questionnaires (-score=0.7), with even better results when grouping similar questions (-score=0.8 for fine-grained and 0.9 for coarse-grained grouping). The 5 questions that were most frequently answered on the basis of the coded posts were “Did you feel ill or unwell?” (304 of 2683 annotated posts and comments), “Did you worry?” (105 posts and comments), “Have you had pain?” (104 posts and comments), “Did you feel tense?” (85 posts and comments), and “Were you limited in doing either your work or other daily activities?” (77 posts and comments).
Conclusions: Our feasibility study shows that there is valuable QoL-related information in posts of online patient communities, which can potentially serve as an innovative low-burden QoL monitoring approach. Future research should consider how these insights can be used to complement existing QoL instruments and whether the process of extracting QoL-related information can be automated.
Background: The latest WHO-GLOBOCAN data came out in October 2020. In India, approximately 1,78,361 i.e 13.3% new cases of breast cancer are detected per annum with 90,408 i.e. 10.6% deaths. With the ...
Background: The latest WHO-GLOBOCAN data came out in October 2020. In India, approximately 1,78,361 i.e 13.3% new cases of breast cancer are detected per annum with 90,408 i.e. 10.6% deaths. With the 5-year overall survival, a study reported it to be 95% for stage I patients, 92% for stage II, 70% for stage III and only 21% for stage IV patients but with lifelong complications. There is evidence-based protocol for physiotherapy treatment in breast cancer but the lack of knowledge about the treatment and its benefits forms a barrier between patient and therapist. The lack of knowledge can be fulfilled by the app as it will give easy access to people while giving information about importance of physiotherapy in improving QOL and additional information about home-based exercises and prosthetics. Objective: To evaluate the awareness and knowledge of physiotherapy and evaluate Quality of life of breast cancer survivors after using the BRAVE App as intervention. Methods: 30 females suffering from breast cancer above the age 18 years were chosen. After the collection of baseline data and knowledge and awareness questionnaire the link to BRAVE App was provide. After 8 weeks post intervention data was collected. Results: Statistical analysis was done by using Chi-Square test for signifying the lack of knowledge and awareness about oncological rehabilitation in the breast cancer survivors. The pre and post intervention data was statistically analyzed by Wilcoxon Signed-Rank Test which gave significant improvement in post intervention functional score and quality of life. The overall mean for complete satisfaction usage of the BRAVE APP is near to 4.0 indicating higher satisfaction value. Conclusions: The pilot study is concluded as after the satisfied usage of BRAVE App there was improvement in functional score directly improving quality of life while addressing the lack of knowledge and awareness about physiotherapy with a cost-effective east to use intervention. Clinical Trial: The study was registered in the Clinical Trial Registry India with registration number CTRI/2025/05/086125.
Background: Preoperative assessment of lymph node metastasis (LNM) risk is needed to support risk stratification and individualized treatment planning in patients with colorectal cancer (CRC). However...
Background: Preoperative assessment of lymph node metastasis (LNM) risk is needed to support risk stratification and individualized treatment planning in patients with colorectal cancer (CRC). However, imaging-based nodal staging may be affected by image quality and readers’ experience, and its ability to detect microscopic metastatic disease remains limited. Machine learning models based on routinely available clinical data may provide an accessible and interpretable approach to support individualized preoperative decision-making. Objective: This study aimed to establish an interpretable machine learning–based model to estimate the preoperative risk of LNM risk in patients with CRC. The model incorporated preoperative variables that are routinely obtained in clinical practice and was further evaluated in an independent external validation set. Methods: We retrospectively analyzed data from 2725 patients diagnosed with CRC at two independent hospitals. The internal cohort was randomly split at a 7:3 ratio for model training and testing. The second-center cohort served as the independent external validation set. The outcome was pathologically confirmed regional LNM. Candidate variables included demographic characteristics, laboratory indicators, tumor markers, and tumor-related clinicopathological features available before surgery. Variables independently associated with LNM were identified using logistic regression analyses. Seven machine learning models were constructed using LightGBM, random forest, support vector machine, logistic regression, decision tree, XGBoost, and naive Bayes. Model performance was checked by discrimination, calibration, clinical utility, and classification metrics. We used the area under the receiver operating characteristic curve (AUC) to assess discrimination. Accuracy, sensitivity, specificity, F1 score, positive predictive value (PPV), and negative predictive value (NPV) described classification performance. Calibration curves compared predicted risks with observed outcomes. Decision curve analysis estimated the model’s net clinical benefit. SHapley Additive exPlanations (SHAP) analysis interpreted the selected model and assessed predictor contributions. Results: The final cohort included 2725 patients. There were 753 patients for model training, 321 for testing, and 1651 for external validation. In multivariable logistic regression, body mass index, preoperative carcinoembryonic antigen level, primary tumor site, clinical T stage, histological type, and tumor differentiation were independently associated with LNM. Among the seven models, random forest showed the most balanced performance. In the test set, this model had an AUC of 0.806. Its accuracy was 0.735, sensitivity was 0.737, and specificity was 0.734. In the external validation set, the AUC was 0.782. Accuracy, sensitivity, and specificity were 0.690, 0.661, and 0.708. Conclusions: An interpretable machine learning model estimated LNM risk in CRC with acceptable performance. Random forest showed stable discrimination in the independent external validation set. It may support individualized preoperative risk stratification, but prospective validation and implementation studies are still needed. Clinical Trial: Not applicable
Background: Each year, family caregivers help the 2 million newly-diagnosed patients with cancer manage symptoms; however few interventions have been developed and proven efficacious to enhance their ...
Background: Each year, family caregivers help the 2 million newly-diagnosed patients with cancer manage symptoms; however few interventions have been developed and proven efficacious to enhance their symptom support role. The recent expansion of electronic patient-reported outcomes (ePROs), including remote symptom monitoring, represents a potential opportunity to explore novel complementary caregiver symptom management support that leverages patient ePROs. Objective: The objective of this study was to elicit feedback on a theory-based intervention concept, called FamilyAWARE, consisting of one-on-one coaching on providing effective symptom support to patients and access to a web-based dashboard reporting summaries of their care recipient’s most recent ePRO symptom reports and tailored recommendations. Methods: This was a qualitative formative evaluation study (NIH Stage IA) where family caregivers (n=20), patients with stage I-IV cancer (n=20), and oncology clinicians (n=25) were recruited from a comprehensive cancer center in the U.S. South and participated in semi-structured, one-on-one interviews (January 2025-July 2025). Participants were shown an outline of the FamilyAWARE intervention concept and asked open-ended questions about the proposed content, format, and delivery of the intervention. Professionally transcribed interviews were analyzed using a thematic analysis approach. Results: Analysis yielded four primary themes: 1) First impressions and relevance: Participants’ initial impressions of FamilyAWARE were generally positive, with caregivers viewing it as highly relevant and potentially beneficial. Patients and clinicians expressed more cautious optimism, shaped by considerations of relevance and minimizing burden. 2) Key factors for acceptability and engagement: Caregivers showed strong interest in the intervention’s potential to increase confidence in symptom support; however, engagement was seen as contingent on the perceived value, minimal burden, and flexible delivery of the intervention, particularly given time and technology constraints. 3) Coaching content and delivery: The proposed format was widely viewed as feasible. Participants emphasized content that helps caregivers balance assisting patients with promoting independence, while also supporting them in deciding when to call for help and proactive symptom strategies. Opinions on delivery by phone, in-person, or videoconference varied. 4) Dashboard design and information access: Participants emphasized the importance of a simple, mobile-friendly dashboard designed for low digital literacy, with plain language and visual cues. Caregiver access to patient symptom data was broadly supported if patient permission was obtained. Conclusions: Findings highlight strong interest and insights into designing a caregiver-focused intervention that integrates one-on-one coaching with ePRO patient symptom reports and tailored recommendations. Participant insights from this study will directly inform refinement of the intervention’s content, format, and delivery, with the goal of advancing it to pilot testing. Clinical Trial: N/A
Background: Sedentary behavior (SB) is prevalent among early adolescents and young adults (eAYAs; ages 12–21 years) with acute lymphoblastic leukemia (ALL) and contributes to adverse cardiometabolic...
Background: Sedentary behavior (SB) is prevalent among early adolescents and young adults (eAYAs; ages 12–21 years) with acute lymphoblastic leukemia (ALL) and contributes to adverse cardiometabolic and health-related quality-of-life (HRQoL) outcomes. However, SB-focused interventions during active therapy are lacking. Objective: This trial aimed to evaluate the feasibility and acceptability of a 10-week, multi-component mobile health (mHealth) intervention among eAYAs receiving maintenance therapy for ALL. Methods: This 12-week, single-arm study enrolled 20 eAYAs with ALL receiving maintenance therapy. The 10-week intervention included a wearable activity tracker with inactivity-triggered prompts, individualized coaching sessions, and an app-based peer support group. The intervention was integrated into routine maintenance therapy by aligning the study timeline, visits, and procedures with a single maintenance therapy cycle. Primary endpoints were feasibility (defined by participant retention) and acceptability (via exit surveys and interviews). Secondary endpoints included pre-post intervention changes in device-measured and self-reported SB; exploratory analyses evaluated changes in cardiometabolic biomarkers and HRQoL. Results: Among the 20 participants, there was a 95% retention rate and a high level of intervention acceptability, with 95% reporting the intervention helped reduce SB and 100% recommending it to peers with cancer. Although statistically significant changes in device-measured sedentary time were not detected, there were notable decreases in prolonged sedentary bouts of 1 hour or more (−22.5 min/day, P=.59) and increases in daily steps (+49.5 steps/day, P=.39). Self-reported sitting time significantly decreased (−154 min/day, P=.006). No statistically significant changes were detected in cardiometabolic biomarkers; however, significant improvements were observed in HRQoL domains of physical functioning (+3.1, P=.04) and sleep/rest fatigue (+8.3, P=.05). Conclusions: This novel SB intervention met predetermined feasibility and acceptability criteria and demonstrated potential to reduce SB among eAYAs receiving ALL maintenance therapy, supporting further evaluation in larger trials. Clinical Trial: ClinicalTrials.gov: NCT06182163.
Background: What is a tumor, viz. how to define it? This seemingly naïve question has for years nagged at us as pathologists or other medical professionals who study cancer. This is because tumors ar...
Background: What is a tumor, viz. how to define it? This seemingly naïve question has for years nagged at us as pathologists or other medical professionals who study cancer. This is because tumors are defined differently in the literature from different viewpoints, such as from the slants of evolution, morphology, clinical manifestation, etc., and whether some outgrowths such as keloids are neoplastic or not are still debatable. Objective: This essay aims to present our definitions of outgrowths and cell deaths, and then to propound our idea that more researches should be put on benign neoplasms. Methods: We summarized key pathological features of cellular outgrowths to distinguish neoplastic lesions from non-neoplastic ones and summarized descriptions of cell deaths from the literature to bolster our viewpoint on apoptosis. We also present features of, and differences between, benign and malignant neoplasms, which lead to the inference that studies on tumorigenesis should first be focused on the benign neoplasms. Results: Benign neoplastic cells are immortal and autonomous, and autonomy can be manifested in either cellular replication or cellular function. Malignant cells have additional attributes, including decreased differentiation, more epigenetic and genetic alterations, invasiveness, metastatic potential, therapeutic refractoriness, etc. Of these traits, however, only cellular immortality and autonomy are unique and are indispensable criteria for rating a neoplasm, whereas the others can all be discerned in certain normal cells. the apoptosis originally defined by Kerr et al. is evolutionarily developed to remove obsolete or redundant cells like hyperplastic ones, but some neoplastic cells may also die of apoptosis because they retain certain stalwart to their parental organism. Efforts of the research fraternity have hitherto been put mainly on the malignancies, which have too many tangled alterations for researchers to disentangle. Conclusions: Tumorigenesis should probably be studied in two steps: The first is to Identify the cellular or molecular alterations that are the proximate causes for cellular immortality and autonomy, for which benign neoplasms or cell lines may be better models because they have many fewer alterations than their malignant counterparts. The second step is to study the malignant properties using malignant neoplasms or cell lines as model systems.
Background: Breast cancer remains a major public health problem globally and in Indonesia. Beyond diagnosis and treatment, increasing attention has been directed toward survivorship outcomes, quality ...
Background: Breast cancer remains a major public health problem globally and in Indonesia. Beyond diagnosis and treatment, increasing attention has been directed toward survivorship outcomes, quality of life (QoL), and patient-centered supportive oncology care. Self-efficacy may play an important role in how patients manage symptoms, cope with treatment-related challenges, communicate care needs, and maintain well-being during survivorship. Objective: This study aimed to identify demographic, clinical, and psychosocial factors associated with QoL among patients with breast cancer at Faisal Islamic Hospital, Makassar, Indonesia, with emphasis on implications for patient-centered supportive oncology care and self-efficacy–based survivorship support. Methods: This cross-sectional observational study included 38 adult women with breast cancer who were receiving treatment or follow-up care at Faisal Islamic Hospital, Makassar. Participants were recruited using purposive sampling. Demographic and clinical data were collected using structured questionnaires and medical record review. QoL was assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. Self-efficacy was assessed using a structured questionnaire evaluating patients’ confidence in managing treatment-related challenges, symptom control, emotional adaptation, and treatment adherence. Data were analyzed using descriptive statistics, bivariate analysis, and multivariable logistic regression. Results: The mean global health status/QoL score was 65.53 (SD 18.57), indicating moderate overall QoL. Emotional functioning had the highest mean functional-domain score, whereas physical functioning had the lowest. Fatigue and pain were the most prominent symptom burdens. In bivariate analysis, QoL was significantly associated with age (P=.027), cancer stage (P=.028), duration of illness (P=.026), and self-efficacy (P=.011). In the multivariable logistic regression model, self-efficacy remained independently associated with QoL (odds ratio 8.709; P=.024), whereas age and treatment type were not statistically significant. Conclusions: Self-efficacy was independently associated with better QoL among patients with breast cancer in this Indonesian hospital-based oncology setting. These findings suggest that survivorship outcomes are shaped not only by clinical characteristics but also by patients perceived ability to manage illness-related challenges. Integrating self-efficacy assessment, psychosocial counseling, patient education, and symptom self-management support into routine oncology services may strengthen patient-centered supportive care and survivorship support for patients with breast cancer in Indonesia.
