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JMIR Cancer
Patient-centered innovations, education, and technology for cancer care, cancer survivorship, and cancer research.
Background: Cervical cancer affects 570,000 women worldwide and is one of the leading causes of death. It is 35% higher in low-middle-income countries. The World Health Organization recommends early screening and vaccinations, with a 90-70-90 target that aims to treat 90% of precancerous lesions by age 15. Objective: The aim of this study was to identify factors influencing healthcare accessibility and social support to cervical cancer screening in Ethiopia. Methods: A facility-based cross-sectional study was conducted among eligible women attending health centers in Ethiopia. A systematic random sampling method was used to select 913 respondents. Data were collected using a structured interviewer-administered questionnaire. STATA Version 17 and Amos Version 21 were used for the analysis. Descriptive statistics were summarized using frequency, percentage, table, graph, chart, figure, and summary statistics. The generalized structural equation modelling was employed to assess the relationship. Results: The overall proportion of access to healthcare social support for cervical cancer screening among women aged 30-49 years was 46.11%. Factors significantly associated with increased healthcare access included: Good knowledge about cervical cancer (adjusted ???? = 0.07, 95% CI: 0.01, 0.14). Favorable attitude towards cervical cancer screening (adjusted ???? = 0.17, 95% CI: 0.08, 0.27). Being currently unmarried (adjusted ???? = -0.23, 95% CI: -0.39, -0.08). More than half of the participants (50.8%) had social support towards cervical cancer screening. Factors significantly associated with increased social support included: Good knowledge about cervical cancer (adjusted ???? = 0.36, 95% CI: 0.14, 0.59). Favorable attitude towards cervical cancer screening (adjusted ???? = 0.45, 95% CI: 0.23, 0.68). Facing barriers to cervical cancer screening (adjusted ???? = 1.93, 95% CI: 1.56, 2.31) Conclusions: This study found that knowledge, attitude, and facing barriers were significantly influence the healthcare accessibility and social support network toward cervical cancer screening. Policymakers and healthcare providers can use these findings to tailor interventions and programs that address these specific factors to improve cervical cancer screening rates in the country.
JMIR Publications is pleased to announce that JMIR Cancer,indexed inEmerging Sources Citation Index (ESCI), has been given an inaugural Journal Impact Factor (JIF) of 2.8 from the 2023 Journal Citation Reports™ (JCR). This is a great achievement for everyone involved and continues to demonstrate the importance of JMIR Cancer’s contribution to the scientific community and progressing open science and digital health.
Born and published open access since 2015, JMIR Cancer has been included among the world's best journals in the Oncology (ESCI) category. Journals receiving an inaugural Impact Factor in 2023 will not receive ranks, quartiles, or percentiles until 2024.
In total, 14 out of the 34 open access journals published by JMIR Publications now have a JIF. This represents a 133% increase compared to last year. Additionally, we have launched more journals in the past two years that are not yet eligible for metrics, such as JIF and CiteScore.
Our journals with inaugural Impact Factors include:
JMIR Cancer (JC, ISSN: 2369-1999, Impact Factor: 2.8) 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, case studies, 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: Make It Training is an e–mental health intervention designed for individuals with cancer that aims to reduce psychological distress and improve disease-related coping and quality of life.
Objective: This study evaluated the experienced usefulness and usability of the web-based Make It Training intervention using a qualitative approach.
Methods: In this study, semistructured interviews were conducted with participants at different cancer stages and with different cancer entities. All participants had previously taken part in the Reduct trial, a randomized controlled trial that assessed the efficacy of the Make It Training intervention. The data were coded deductively by 2 independent researchers and analyzed iteratively using thematic codebook analysis.
Results: Analysis of experienced usefulness resulted in 4 themes (developing coping strategies to reduce psychological distress, improvement in quality of life, Make It Training vs traditional psychotherapy, and integration into daily life) with 11 subthemes. Analysis of experienced usability resulted in 3 themes (efficiency and accessibility, user-friendliness, and recommendations to design the Make It Training intervention to be more appealing) with 6 subthemes. Make It Training was evaluated as a user-friendly intervention helpful for developing functional coping strategies to reduce psychological distress and improve quality of life. The consensus regarding Make It Training was that it was described as a daily companion that integrates well into daily life and that it has the potential to be routinely implemented within oncological health care either as a stand-alone intervention or in addition to psychotherapy.
Conclusions: e–Mental health interventions such as Make It Training can target both the prevention of mental health issues and health promotion. Moreover, they offer a cost-efficient and low-threshold option to receive psycho-oncological support.
Background: Trastuzumab has had a major impact on the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC). Anti-HER2 biosimilars such as Ogivri have demonstrated safety and clinical equivalence to trastuzumab (using Herceptin as the reference product) in clinical trials. To our knowledge, there has been no real-world report of the side effects and quality of life (QoL) in patients treated with biosimilars using electronic patient-reported outcomes (ePROs).
Objective: The primary objective of this prospective observational study (OGIPRO study) was to compare the ePRO data related to treatment side effects collected with the medidux app in patients with HER2-positive BC treated with the trastuzumab biosimilar Ogivri (prospective cohort) to those obtained from historical cohorts treated with Herceptin alone or combined with pertuzumab and/or chemotherapy (ClinicalTrials.gov NCT02004496 and NCT03578731).
Methods: Patients were treated with Ogivri alone or combined with pertuzumab and/or chemotherapy and hormone therapy in (neo)adjuvant and palliative settings. Patients used the medidux app to dynamically record symptoms (according to the Common Terminology Criteria for Adverse Events [CTCAE]), well-being (according to the Eastern Cooperative Oncology Group Performance Status scale), QoL (using the EQ-5D-5L questionnaire), cognitive capabilities, and vital parameters over 6 weeks. The primary endpoint was the mean CTCAE score. Key secondary endpoints included the mean well-being score. Data of this prospective cohort were compared with those of the historical cohorts (n=38 patients; median age 51, range 31-78 years).
Results: Overall, 53 female patients with a median age of 54 years (range 31-87 years) were enrolled in the OGIPRO study. The mean CTCAE score was analyzed in 50 patients with available data on symptoms, while the mean well-being score was evaluated in 52 patients with available data. The most common symptoms reported in both cohorts included fatigue, taste disorder, nausea, diarrhea, dry mucosa, joint discomfort, tingling, sleep disorder, headache, and appetite loss. Most patients experienced minimal (grade 0) or mild (grade 1) toxicities in both cohorts. The mean CTCAE score was comparable between the prospective and historical cohorts (29.0 and 30.3, respectively; mean difference –1.27, 95% CI –7.24 to 4.70; P=.68). Similarly, no significant difference was found for the mean well-being score between the groups treated with the trastuzumab biosimilar Ogivri and Herceptin (74.3 and 69.8, respectively; mean difference 4.45, 95% CI –3.53 to 12.44; P=.28).
Conclusions: Treatment of patients with HER2-positive BC with the trastuzumab biosimilar Ogivri resulted in equivalent symptoms, adverse events, and well-being as found for patients treated with Herceptin as determined by ePRO data. Hence, integration of an ePRO system into research and clinical practice can provide reliable information when investigating the real-world tolerability and outcomes of similar therapeutic compounds.
Trial Registration: ClinicalTrials.gov NCT05234021; https://clinicaltrials.gov/study/NCT05234021
Background: Medication nonadherence negatively impacts the health outcomes of people with cancer as well as health care costs. Digital technologies present opportunities to address this health issue. However, there is limited evidence on how to develop digital interventions that meet the needs of people with cancer, are perceived as useful, and are potentially effective in improving medication adherence.
Objective: The objective of this study was to co-design, develop, and preliminarily evaluate an innovative mobile health solution called Safety and Adherence to Medication and Self-Care Advice in Oncology (SAMSON) to improve medication adherence among people with cancer.
Methods: Using the 4 cycles and 6 processes of design science research methodology, we co-designed and developed a medication adherence solution for people with cancer. First, we conducted a literature review on medication adherence in cancer and a systematic review of current interventions to address this issue. Behavioral science research was used to conceptualize the design features of SAMSON. Second, we conducted 2 design phases: prototype design and final feature design. Last, we conducted a mixed methods study on patients with hematological cancer over 6 weeks to evaluate the mobile solution.
Results: The developed mobile solution, consisting of a mobile app, a web portal, and a cloud-based database, includes 5 modules: medication reminder and acknowledgment, symptom assessment and management, reinforcement, patient profile, and reporting. The quantitative study (n=30) showed that SAMSON was easy to use (21/27, 78%). The app was engaging (18/27, 67%), informative, increased user interactions, and well organized (19/27, 70%). Most of the participants (21/27, 78%) commented that SAMSON’s activities could help to improve their adherence to cancer treatments, and more than half of them (17/27, 63%) would recommend the app to their peers. The qualitative study (n=25) revealed that SAMSON was perceived as helpful in terms of reminding, supporting, and informing patients. Possible barriers to using SAMSON include the app glitches and users’ technical inexperience. Further needs to refine the solution were also identified. Technical improvements and design enhancements will be incorporated into the subsequent iteration.
Conclusions: This study demonstrates the successful application of behavioral science research and design science research methodology to design and develop a mobile solution for patients with cancer to be more adherent. The study also highlights the importance of applying rigorous methodologies in developing effective and patient-centered digital intervention solutions.
Background: Adolescents and young adults (AYAs) diagnosed with cancer experience physical, cognitive, and psychosocial effects from cancer treatment that can negatively affect their ability to remain engaged in education or work through cancer treatment and in the long term. Disengagement from education or work can have lasting implications for AYAs’ financial independence, psychosocial well-being, and quality of life. Australian AYAs with cancer lack access to adequate specialist support for their education and work needs and report a preference for web-based support that they can access from anywhere, in their own time. However, it remains unclear what web-based resources exist that are tailored to support AYAs with cancer in reaching their educational or work goals.
Objective: This study aimed to determine what web-based resources exist for Australian AYAs with cancer to (1) support return to education or work and (2) identify the degree to which existing resources are age-specific, cancer-specific, culturally inclusive, and evidence-based; are co-designed with AYAs; use age-appropriate language; and are easy to find.
Methods: We conducted an environmental scan by searching Google with English search terms in August 2022 to identify information resources about employment and education for AYAs ever diagnosed with cancer. Data extraction was conducted in Microsoft Excel, and the following were assessed: understandability and actionability (using the Patient Education and Materials Tool), readability (using the Sydney Health Literacy Laboratory Health Literacy Editor), and whether the resource was easy to locate, evidence-based, co-designed with AYAs, and culturally inclusive of Aboriginal and Torres Strait Islander peoples. The latter was assessed using 7 criteria previously developed by members of the research team.
Results: We identified 24 web-based resources, comprising 22 written text resources and 12 video resources. Most resources (21/24, 88%) were published by nongovernmental organizations in Australia, Canada, the United States, and the United Kingdom. A total of 7 resources focused on education, 8 focused on work, and 9 focused on both education and work. The evaluation of resources demonstrated poor understandability and actionability. Resources were rarely evidence-based or co-designed by AYAs, difficult to locate on the internet, and largely not inclusive of Aboriginal and Torres Strait Islander populations.
Conclusions: Although web-based resources for AYAs with cancer are often available through the websites of hospitals or nongovernmental organizations, this environmental scan suggests they would benefit from more evidence-based and actionable resources that are available in multiple formats (eg, text and audio-visual) and tailored to be age-appropriate and culturally inclusive.
Background: People with cancer frequently experience severe and distressing symptoms associated with cancer and its treatments. Predicting symptoms in patients with cancer continues to be a significant challenge for both clinicians and researchers. The rapid evolution of machine learning (ML) highlights the need for a current systematic review to improve cancer symptom prediction.
Objective: This systematic review aims to synthesize the literature that has used ML algorithms to predict the development of cancer symptoms and to identify the predictors of these symptoms. This is essential for integrating new developments and identifying gaps in existing literature.
Methods: We conducted this systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. We conducted a systematic search of CINAHL, Embase, and PubMed for English records published from 1984 to August 11, 2023, using the following search terms: cancer, neoplasm, specific symptoms, neural networks, machine learning, specific algorithm names, and deep learning. All records that met the eligibility criteria were individually reviewed by 2 coauthors, and key findings were extracted and synthesized. We focused on studies using ML algorithms to predict cancer symptoms, excluding nonhuman research, technical reports, reviews, book chapters, conference proceedings, and inaccessible full texts.
Results: A total of 42 studies were included, the majority of which were published after 2017. Most studies were conducted in North America (18/42, 43%) and Asia (16/42, 38%). The sample sizes in most studies (27/42, 64%) typically ranged from 100 to 1000 participants. The most prevalent category of algorithms was supervised ML, accounting for 39 (93%) of the 42 studies. Each of the methods—deep learning, ensemble classifiers, and unsupervised ML—constituted 3 (3%) of the 42 studies. The ML algorithms with the best performance were logistic regression (9/42, 17%), random forest (7/42, 13%), artificial neural networks (5/42, 9%), and decision trees (5/42, 9%). The most commonly included primary cancer sites were the head and neck (9/42, 22%) and breast (8/42, 19%), with 17 (41%) of the 42 studies not specifying the site. The most frequently studied symptoms were xerostomia (9/42, 14%), depression (8/42, 13%), pain (8/42, 13%), and fatigue (6/42, 10%). The significant predictors were age, gender, treatment type, treatment number, cancer site, cancer stage, chemotherapy, radiotherapy, chronic diseases, comorbidities, physical factors, and psychological factors.
Conclusions: This review outlines the algorithms used for predicting symptoms in individuals with cancer. Given the diversity of symptoms people with cancer experience, analytic approaches that can handle complex and nonlinear relationships are critical. This knowledge can pave the way for crafting algorithms tailored to a specific symptom. In addition, to improve prediction precision, future research should compare cutting-edge ML strategies such as deep learning and ensemble methods with traditional statistical models.
Cancer prevalence data for Black Americans is monolithic and fails to consider the diverse cultures and backgrounds within that community. For instance, African immigrants constitute a meaningful proportion of the foreign-born Black immigrants in the United States (42%), but the prevalence of cancer in the African immigrant community itself is unknown. Therefore, without accurate cancer prevalence data, it is impossible to identify trends and other key factors that are needed to support the health of African immigrants and their children. Moreover, it is impossible to understand how the culture and language of subgroups influence their cancer-related health behavior. While research in this area is limited, the existing literature articulates the need for culturally responsive and culturally tailored cancer education for African immigrants and their adolescent children, which is what we advocate for in this viewpoint paper. Existing projects demonstrate the feasibility of culturally responsive programming for adults; however, few projects include or focus on adolescents or children born to African immigrants. To best meet the needs of this understudied community, researchers must use culturally competent interventions alongside familiar, usable media. For adolescents, technology is ubiquitous thus, the creation of a culturally tailored digital intervention has immense potential to improve cancer awareness and prevention for youth and their community. More research is needed to address many of the existing research gaps and develop a rich understanding of the unique experience of cancer among African immigrant families that can be used to inform intervention development. Through this viewpoint, we review the current state of cancer-related research among African immigrant families in the United States. In this paper, we acknowledge the current knowledge gaps and issues surrounding measurement and then discuss the factors relevant to designing an educational intervention targeted at African immigrants and the role of African immigrant youth.
Background: Frequent sensor-assisted monitoring of changes in swallowing function may help improve detection of radiation-associated dysphagia before it becomes permanent. While our group has prototyped an epidermal strain/surface electromyography sensor that can detect minute changes in swallowing muscle movement, it is unknown whether patients with head and neck cancer would be willing to wear such a device at home after radiation for several months.
Objective: We iteratively assessed patients’ design preferences and perceived barriers to long-term use of the prototype sensor.
Methods: In study 1 (questionnaire only), survivors of pharyngeal cancer who were 3-5 years post treatment and part of a larger prospective study were asked their design preferences for a hypothetical throat sensor and rated their willingness to use the sensor at home during the first year after radiation. In studies 2 and 3 (iterative user testing), patients with and survivors of head and neck cancer attending visits at MD Anderson’s Head and Neck Cancer Center were recruited for two rounds of on-throat testing with prototype sensors while completing a series of swallowing tasks. Afterward, participants were asked about their willingness to use the sensor during the first year post radiation. In study 2, patients also rated the sensor’s ease of use and comfort, whereas in study 3, preferences were elicited regarding haptic feedback.
Results: The majority of respondents in study 1 (116/138, 84%) were willing to wear the sensor 9 months after radiation, and participant willingness rates were similar in studies 2 (10/14, 71.4%) and 3 (12/14, 85.7%). The most prevalent reasons for participants’ unwillingness to wear the sensor were 9 months being excessive, unwanted increase in responsibility, and feeling self-conscious. Across all three studies, the sensor’s ability to detect developing dysphagia increased willingness the most compared to its appearance and ability to increase adherence to preventive speech pathology exercises. Direct haptic signaling was also rated highly, especially to indicate correct sensor placement and swallowing exercise performance.
Conclusions: Patients and survivors were receptive to the idea of wearing a personalized risk sensor for an extended period during the first year after radiation, although this may have been limited to well-educated non-Hispanic participants. A significant minority of patients expressed concern with various aspects of the sensor’s burden and its appearance.
Trial Registration: ClinicalTrials.gov NCT03010150; https://clinicaltrials.gov/study/NCT03010150
In this 2-institution feasibility pilot, oncology fellows used and updated freely available web-based learning tools (scaffolds) in a constructivist fashion.
Background: Social support is essential to promoting optimal health outcomes for women with breast cancer. However, an estimated 12% of women with breast cancer simultaneously experience intimate partner violence (IPV; physical, psychological, or sexual abuse by an intimate partner). Women who experience IPV during breast cancer may lack traditional social support, and thus seek out alternative sources of support. Online community forums, such as Reddit, can provide accessible social connections within breast cancer–specific communities. However, it is largely unknown how women with breast cancer use Reddit to describe and seek support for experiences of IPV.
Objective: This study aims to explore how patients with breast cancer describe toxic relationships with their partners and immediate family members on Reddit.
Methods: This exploratory, cross-sectional, topic-modeling study analyzed textual data from 96 users in the r/breastcancer subreddit in February 2023. The meaning extraction method, inclusive of principal component analysis, was used to identify underlying components. Components were subjected to sentiment analysis and summative content analysis with emergent categorical development to articulate themes.
Results: Seven themes emerged related to toxic relationships: (1) contextualizing storytelling with lymph nodes, (2) toxic behavior and venting emotions, (3) abandonment and abuse following diagnosis, (4) toxic relationships and social-related fears, (5) inner strength and navigating breast cancer over time, (6) assessing social relationships and interactions, and (7) community advice and support. Toxic relationships were commonly characterized by isolation, abandonment, and emotional abuse, which had profound emotional consequences for patients. Reddit facilitated anonymous venting about toxic relationships that helped patients cope with intense feelings and stress. Exchanging advice and support about navigating toxic relationships during breast cancer were core functions of the r/breastcancer community.
Conclusions: Findings emphasized the value of Reddit as a source of social support for patients with breast cancer experiencing toxic relationships. Clinicians who understand that many patients with breast cancer experience toxic relationships and considerable psychological sequelae are better prepared to support their patients’ holistic well-being. Further investigation of Reddit as a possible resource for advice, information, and support has the potential to help inform clinical practice and subsequently, patient health outcomes.
Background: Australia’s bowel cancer prevention guidelines, following a recent revision, are among the most complex in the world. Detailed decision tables outline screening or surveillance recommendations for 230 case scenarios alongside cessation recommendations for older patients. While these guidelines can help better allocate limited colonoscopy resources, their increasing complexity may limit their adoption and potential benefits. Therefore, tools to support clinicians in navigating these guidelines could be essential for national bowel cancer prevention efforts. Digital applications (DAs) represent a potentially inexpensive and scalable solution but are yet to be tested for this purpose. Objective: This study aims to assess whether a DA could increase clinician adherence to Australia’s new colorectal cancer screening and surveillance guidelines and determine whether improved usability correlates with greater conformance to guidelines. Methods: As part of a randomized controlled crossover study, we created a clinical vignette quiz to evaluate the efficacy of a DA in comparison with the standard resource (SR) for making screening and surveillance decisions. Briefings were provided to study participants, which were tailored to their level of familiarity with the guidelines. We measured the adherence of clinicians according to their number of guideline-concordant responses to the scenarios in the quiz using either the DA or the SR. The maximum score was 18, with higher scores indicating improved adherence. We also tested the DA’s usability using the System Usability Scale. Results: Of 117 participants, 80 were included in the final analysis. Using the SR, the adherence of participants was rated a median (IQR) score of 10 (7.75-13) out of 18. The participants’ adherence improved by 40% (relative risk 1.4, P<.001) when using the DA, reaching a median (IQR) score of 14 (12-17) out of 18. The DA was rated highly for usability with a median (IQR) score of 90 (72.5-95) and ranked in the 96th percentile of systems. There was a moderate correlation between the usability of the DA and better adherence (rs=0.4; P<.001). No differences between the adherence of specialists and nonspecialists were found, either with the SR (10 vs 9; P=.47) or with the DA (13 vs 15; P=.24). There was no significant association between participants who were less adherent with the DA (n=17) and their age (P=.06), experience with decision support tools (P=.51), or academic involvement with a university (P=.39). Conclusions: DAs can significantly improve the adoption of complex Australian bowel cancer prevention guidelines. As screening and surveillance guidelines become increasingly complex and personalized, these tools will be crucial to help clinicians accurately determine the most appropriate recommendations for their patients. Additional research to understand why some practitioners perform worse with DAs is required. Further improvements in application usability may optimize guideline concordance further.
Background: Patients with cancer and their families often experience significant distress and deterioration in their quality of life. Psychosocial interventions were used to address patients’ and families’ psychosocial needs. Digital technology is increasingly being used to deliver psychosocial interventions to patients with cancer and their families.
Objective: A systematic review and meta-analysis were conducted to review the characteristics and effectiveness of digital health interventions on psychosocial outcomes in adult patients with cancer and their family members.
Methods: Databases (PubMed, Cochrane Library, Web of Science, Embase, CINAHL, PsycINFO, ProQuest Dissertations and Theses Global, and ClinicalTrials.gov) were searched for randomized controlled trials (RCTs) or quasi-experimental studies that tested the effects of a digital intervention on psychosocial outcomes. The Joanna Briggs Institute’s critical appraisal checklists for RCTs and quasi-experimental studies were used to assess quality. Standardized mean differences (ie, Hedges g) were calculated to compare intervention effectiveness. Subgroup analysis was planned to examine the effect of delivery mode, duration of the intervention, type of control, and dosage on outcomes using a random-effects modeling approach.
Results: A total of 65 studies involving 10,361 patients (mean 159, SD 166; range 9-803 patients per study) and 1045 caregivers or partners (mean 16, SD 54; range 9-244 caregivers or partners per study) were included in the systematic review. Of these, 32 studies were included in a meta-analysis of the effects of digital health interventions on quality of life, anxiety, depression, distress, and self-efficacy. Overall, the RCT studies’ general quality was mixed (applicable scores: mean 0.61, SD 0.12; range 0.38-0.91). Quasi-experimental studies were generally of moderate to high quality (applicable scores: mean 0.75, SD 0.08; range 0.63-0.89). Psychoeducation and cognitive-behavioral strategies were commonly used. More than half (n=38, 59%) did not identify a conceptual or theoretical framework. Most interventions were delivered through the internet (n=40, 62%). The median number of intervention sessions was 6 (range 1-56). The frequency of the intervention was highly variable, with self-paced (n=26, 40%) being the most common. The median duration was 8 weeks. The meta-analysis results showed that digital psychosocial interventions were effective in improving patients’ quality of life with a small effect size (Hedges g=0.05, 95% CI –0.01 to 0.10; I2=42.7%; P=.01). The interventions effectively reduced anxiety and depression symptoms in patients, as shown by moderate effect sizes on Hospital Anxiety and Depression Scale total scores (Hedges g=–0.72, 95% CI –1.89 to 0.46; I2=97.6%; P<.001).
Conclusions: This study demonstrated the effectiveness of digital health interventions on quality of life, anxiety, and depression in patients. Future research with a clear description of the methodology to enhance the ability to perform meta-analysis is needed. Moreover, this study provides preliminary evidence to support the integration of existing digital health psychosocial interventions in clinical practice.
Trial Registration: PROSPERO CRD42020189698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189698
Background: Breast cancer is a widespread disease, and its incidence is rapidly increasing in the Middle East and North Africa region. With the increasing availability of smartphone apps for various health purposes, breast cancer apps have emerged as tools for raising awareness, providing support, and empowering women affected by this disease. These apps offer many features, including information on breast cancer risk factors, self-examination guides, appointment reminders, and community support groups or hotlines. Using apps raises the risk of privacy and security issues, and we hope that examining these features of the apps will contribute to the understanding of how technology can be used to improve these apps and provide insights for future development and improvement of breast cancer apps.
Objective: This study aims to critically review the quality, privacy, and security of breast cancer apps available to Arabic speakers.
Methods: Similar to several recent studies, we used a systematic search for apps available in Google Play and Apple App stores using both the web interface and the built-in native stores installed on smartphones. The search was conducted in mid-December 2022 in Arabic using the following keywords: سرطان الثدي – فحص سرطان الثدي – علاج سرطان الثدي – مرض سرطان الثدي – أعراض سرطان الثدي – فحص الثدي (breast cancer, breast cancer treatment, breast cancer disease, breast cancer symptoms, breast cancer screening, and breast test). These preidentified search terms are based on earlier work concerning the top searched breast cancer topics by Arabic speakers through Google’s search engine. We excluded apps that did not have an Arabic interface, were developed for non-Arabic speakers, were paid, needed a subscription, or were directed toward health care workers. The Mobile App Rating Scale was used to evaluate the quality of the apps concerning their engagement, functionality, aesthetics, and information. A risk score was calculated for the apps to determine their security risk factors.
Results: Only 9 apps were included, with most (6/9, 67%) being supported by advertisements and categorized as informational. Overall, the apps had low numbers of downloads (>10 to >1000). The majority of the included apps (8/9, 89%) requested dangerous access permissions, including access to storage, media files, and the camera. The average security score of the included apps was 3.22, while only 2 apps provided information about data security and privacy. The included apps achieved an overall average quality score of 3.27, with individual dimension scores of 4.75 for functionality, 3.04 for information, 3.00 for aesthetics, and 2.32 for engagement.
Conclusions: The limited availability of breast cancer apps available to Arabic speakers should be a call to action and prompt health care organizations and developers to join forces and collaboratively develop information-rich, usable, functional, engaging, and secure apps.
Background: Cervical cancer affects 570,000 women worldwide and is one of the leading causes of death. It is 35% higher in low-middle-income countries. The World Health Organization recommends early s...
Background: Cervical cancer affects 570,000 women worldwide and is one of the leading causes of death. It is 35% higher in low-middle-income countries. The World Health Organization recommends early screening and vaccinations, with a 90-70-90 target that aims to treat 90% of precancerous lesions by age 15. Objective: The aim of this study was to identify factors influencing healthcare accessibility and social support to cervical cancer screening in Ethiopia. Methods: A facility-based cross-sectional study was conducted among eligible women attending health centers in Ethiopia. A systematic random sampling method was used to select 913 respondents. Data were collected using a structured interviewer-administered questionnaire. STATA Version 17 and Amos Version 21 were used for the analysis. Descriptive statistics were summarized using frequency, percentage, table, graph, chart, figure, and summary statistics. The generalized structural equation modelling was employed to assess the relationship. Results: The overall proportion of access to healthcare social support for cervical cancer screening among women aged 30-49 years was 46.11%. Factors significantly associated with increased healthcare access included: Good knowledge about cervical cancer (adjusted ???? = 0.07, 95% CI: 0.01, 0.14). Favorable attitude towards cervical cancer screening (adjusted ???? = 0.17, 95% CI: 0.08, 0.27). Being currently unmarried (adjusted ???? = -0.23, 95% CI: -0.39, -0.08). More than half of the participants (50.8%) had social support towards cervical cancer screening. Factors significantly associated with increased social support included: Good knowledge about cervical cancer (adjusted ???? = 0.36, 95% CI: 0.14, 0.59). Favorable attitude towards cervical cancer screening (adjusted ???? = 0.45, 95% CI: 0.23, 0.68). Facing barriers to cervical cancer screening (adjusted ???? = 1.93, 95% CI: 1.56, 2.31) Conclusions: This study found that knowledge, attitude, and facing barriers were significantly influence the healthcare accessibility and social support network toward cervical cancer screening. Policymakers and healthcare providers can use these findings to tailor interventions and programs that address these specific factors to improve cervical cancer screening rates in the country.
Background: The rising number of cancer survivors and the shortage of healthcare professionals challenge the accessibility of cancer care. Health technologies are necessary for sustaining optimal pati...
Background: The rising number of cancer survivors and the shortage of healthcare professionals challenge the accessibility of cancer care. Health technologies are necessary for sustaining optimal patient journeys. To understand individuals' daily life during their patient journey, qualitative studies are crucial. However, not all patients wish to share their story with researchers. Objective: To analyse colorectal cancer (CRC) patients' experiences, we used a novel machine learning-driven approach: 'patients community journey mapping.' Methods: The CRC patient forum posts from the Cancer Survivors Network USA was used. Topic modelling, as a part of machine learning, was used to recognise the topic patterns in the posts. Researchers read the most relevant 50 posts of each topic, dividing them into ‘home’ or ‘hospital’ contexts. A patient community journey map, derived from patient’s stories, was developed to illustrate patients’ experience. CRC medical doctors and a quality of life expert evaluated the map. Results: Based on 294.166 posts, 37 topics and 10 upper clusters were produced. Dominant clusters include ‘Daily activities while living with CRC (18.3%) and ‘Understanding treatment including alternatives and adjuvant therapy’ (14.9%). The topics discussed related to the home context have a more emotional content compared to the hospital context. The patient community journey map was constructed based on these findings. Conclusions: A machine learning-driven approach is a promising solution to analyse patients’ experiences. The innovative application of patient community journey mapping provides a unique perspective into the challenges of patients’ daily lives, essential for guiding the right support at the right moment.
Background: On February 28, 2023, the Facebook page of the United Nations Children's Fund (UNICEF) South Africa, announced the beginning of the HPV vaccination campaign for 2023. The announcement read...
Background: On February 28, 2023, the Facebook page of the United Nations Children's Fund (UNICEF) South Africa, announced the beginning of the HPV vaccination campaign for 2023. The announcement read: ‘‘Protect your daughter from cervical cancer and make sure she gets her HPV vaccine at school.” The post garnered several comments and reactions from Facebook users. Objective: The aim of this study was to examine the attitudes of Facebook users, who commented on the UNICEF South Africa post, towards HPV vaccination to inform the development and implementation of interventions that can increase HPV vaccine acceptance and uptake Methods: We used basic thematic analysis approach to analyse the content of the comments. Two authors (EJM and AJ) independently coded the responses through line-by-line readings as pro-vaccination, anti-vaccination or neutral. After labelling the data with the three main codes, we then used an inductive thematic analysis approach to extract emerging themes from the comments within each code. Results: Several comments were questions regarding the eligible criteria for vaccination, side effects, consent form, and vaccination strategies. Many Facebook users were hesitant towards HPV vaccination due to various reasons including concerns around side effects, religious beliefs, vaccine stock outs, and their distrust in the institutions or systems involved in vaccination programmes. Few users accepted HPV vaccination because they believed that it was a very important thing to do, beneficial for the children’s health, and they have vaccinated their children before. Conclusions: Our findings of the current study contribute to the promotion of acceptance and uptake of HPV vaccination by developing and implementing social media-based interventions tailored to address identified barriers that are associated with hesitant to HPV vaccination.
Background: There is paucity of data on the cardiovascular (CV) implications of monoclonal gammopathy of undetermined significance (MGUS), especially among hospitalized patients. Objective: To investi...
Background: There is paucity of data on the cardiovascular (CV) implications of monoclonal gammopathy of undetermined significance (MGUS), especially among hospitalized patients. Objective: To investigate the association between MGUS and cardiovascular outcomes in a hospital setting using the National Inpatient Sample database. Methods: MGUS patients were sampled using ICD-10 codes. Patients with concomitant plasma cell dyscrasias, lymphoma, or amyloidosis were excluded. Patients were stratified into two cohorts based on the presence or absence of MGUS. Comorbidities and CV outcomes were collected using ICD 10 DM codes. CV outcomes were evaluated before and after 1:1 matching for age, gender, and race. Furthermore, a sensitivity analysis was performed on matched population that excluded patients with diabetes mellitus, prior myocardial infarction, chronic kidney disease stage 3-5, dialysis, hypertension, obesity, metabolic syndrome, cancer (all-cause), antiplatelets, oral anticoagulants use, and adjusted for smoking, dyslipidemia, and aspirin use to evaluate CV outcomes. Results: MGUS patients had more heart failure, atrial fibrillation, venous thromboembolism, aortic aneurysm, aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, conduction disorder, cor pulmonale, and PVD. After matching, MGUS was associated with heart failure, atrial fibrillation, venous thromboembolism, aortic stenosis, mitral regurgitation, conduction disorder, cor pulmonale, and peripheral vascular disease. Conclusions: MGUS was linked to a wide spectrum of cardiovascular diseases in an inpatient setting. Further studies are needed to formulate appropriate recommendations for screening and management of cardiovascular complications in individuals with MGUS
