@Article{info:doi/10.2196/66847,
author="Kochashvili, Mariam
and Guttoo, Parishma
and Sezgin, Emre
and Pai, Ahna
and Bajwa, Rajinder
and Landier, Wendy
and Gerhardt, Cynthia
and Skeens, Micah",
title="Supporting Medication Adherence in Pediatric Patients Undergoing Hematopoietic Stem Cell Transplant Using the BMT4me mHealth App: Mixed Methods Usability Study",
journal="JMIR Cancer",
year="2025",
month="May",
day="29",
volume="11",
pages="e66847",
keywords="mHealth",
keywords="pediatric transplant",
keywords="digital health",
keywords="medication adherence",
keywords="usability",
keywords="hematopoietic stem cell transplant",
keywords="bone marrow transplant",
keywords="pediatric",
keywords="children",
keywords="hematopoietic stem cell",
keywords="HSC",
keywords="smartphone",
keywords="mobile health",
keywords="BMT4me",
keywords="digital health intervention",
keywords="descriptive statistics",
keywords="thematic analysis",
keywords="usability study",
keywords="mixed method",
keywords="social support",
keywords="health outcomes",
keywords="medication management",
keywords="symptom tracking",
keywords="electronic medical records",
keywords="user-friendly",
abstract="Background: Due to multifaceted outpatient regimens, children receiving hematopoietic stem cell transplants (HCTs) are at high risk of medication nonadherence, leading to life-threatening complications. Mobile health (mHealth) interventions have proven effective in improving adherence in various pediatric conditions; however, adherence intervention literature on HCT is limited. Objective: This study aimed to assess the usability of a mHealth intervention (BMT4me) designed to serve as a real-time, personalized tool for medication management or adherence, symptom tracking, and journal keeping. Methods: Following a mixed methods approach, 14 caregivers (n=11, 79\% female; n=10, 71\% White) of children aged 2?18 (mean age 8.51, SD 5.18) years in the acute phase (first 100 d) post-HCT were recruited. Caregivers were asked to use the BMT4me app for 100 days or until weaning of the immunosuppressant medications to measure usability. The System Usability Scale (assessing functionality and acceptability), reaction cards (assessing desirability), caregiver satisfaction (assessing satisfaction) with the app, and semistructured interviews (assessing participant experience using the app and feedback regarding features) were conducted at two time points, at enrollment and study completion. Results: The mean System Usability Scale score was 86.15 (SD 12.81) at enrollment and 73.13 (SD 16.13) at study completion, with most participants reporting the app easy to use and accepable during both time points. At enrollment, 80\% (n=12) of caregivers reported that the app was effective in motivating them to stay on schedule, and 87\% (n=13) indicated they would recommend it to others. At study completion, 75\% (n=6) of caregivers found the app helpful for tracking their child's medication schedule, and 64\% (n=5) would recommend it to others. Caregivers described the app as ``accessible,'' ``useful,'' and ``valuable.'' Qualitative interviews during both time points revealed caregivers' positive reactions to the app, particularly regarding medication reminders, tracking symptoms, and notes features, while also providing suggestions for improvements, such as integrating the BMT4me app with electronic medical records, incorporating educational content, adding fields for recording vital signs, and important phone numbers. Conclusions: The BMT4me app demonstrated promising usability as a mHealth intervention among pediatric patients undergoing HCT. Caregivers considered the app user-friendly and valuable, with positive feedback on its features, such as medication reminders and symptom tracking. Despite minor reported issues with app functionality, the overall acceptance of the app suggests its potential to support families in managing complex treatment. The findings from this study will inform the feasibility of testing in larger randomized controlled trials. Trial Registration: ClinicalTrials.gov NCT04976933; https://clinicaltrials.gov/ct2/show/NCT04976933 International Registered Report Identifier (IRRID): RR2-10.2196/39098 ",
doi="10.2196/66847",
url="https://cancer.jmir.org/2025/1/e66847"
}


@Article{info:doi/10.2196/69855,
author="Deutsch, M. Thomas
and Volmer, L. L{\'e}a
and Feisst, Manuel
and Bodenbeck, Laura
and Hassdenteufel, Kathrin
and Tretschock, Lara
and Breit, Christiane
and Stefanovic, Stefan
and Bauer, Armin
and Anders, Carolin
and Weinert, Lina
and Engler, Tobias
and Hartkopf, D. Andreas
and Pfeifer, Nico
and Escher, Pascal
and Mausch, Marc
and Heinze, Oliver
and Suetterlin, Marc
and Brucker, Y. Sara
and Schneeweiss, Andreas
and Wallwiener, Markus",
title="ENABLE---App-Based Digital Capture and Intervention of Patient-Reported Quality of Life, Adverse Events, and Treatment Satisfaction in Breast Cancer: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2025",
month="May",
day="26",
volume="14",
pages="e69855",
keywords="breast cancer",
keywords="electronic patient-reported outcomes",
keywords="ePRO",
keywords="health-related quality of life",
keywords="HRQoL",
keywords="eHealth apps",
abstract="Background: In recent years, breast cancer treatment has taken the path toward personalized medicine. Based on individual tumor biology, therapy tailored to the particular subtype of cancer is increasingly being used. The aim here is to find the most suitable therapy for the disease. However, the success of therapy depends to a large extent on the patient's adherence to treatment. This, in turn, depends on how the therapy is tolerated and how the treatment team cares for the patient. Patient-centered care seeks to identify and address the individual needs of each patient and to find the best form of care for that person. Objective: In order to improve comprehensive oncological care of patients with breast cancer, the ENABLE trial digitally recorded the health-related quality of life (HRQoL), adverse events (AEs), and patient satisfaction using a mobile smartphone app. The trial provided individualized responses to reported AEs and offered assistance. Additionally, it assessed the impact of a patient-reported outcome--based intervention across various therapy settings. Methods: Patients with breast cancer were eligible to participate in the study before neoadjuvant, adjuvant, postneoadjuvant, or palliative systemic therapy against breast cancer was initiated at the Heidelberg, Mannheim, and Tuebingen, Germany, university hospitals. After 1:1 randomization into an intervention and a control group, HRQoL assessments were performed at six fixed time points during the therapy using validated questionnaires. In the intervention group, HRQoL was also assessed briefly every week using a visual analog scale (EQ-VAS). In cases of significant deterioration, therapy-associated side effects were assessed in a graduated manner, recommendations were sent to the patient, and the treatment team was informed. Additionally, the app served as an ``eHealth companion'' for education, training, and organizational support during therapy. Results: Recruitment started in March 2021; follow-up was completed in February 2024. In total, 606 patients were enrolled, and 592 patients participated in the study. Enrollment was completed in September 2023, and the last visit was in February 2024. The first results are expected to be published in Q2 2025. Conclusions: Participation in the intervention group is expected to improve treatment satisfaction, adherence, detection, and timely treatment of critical AEs. The close-meshed, weekly, brief HRQoL assessment will also be tested as a screening tool to detect relevant side effects during therapy. The study offers a more objective HRQoL assessment across treatment strategies. Trial Registration: Deutsches Register Klinischer Studien DRKS00025611; https://drks.de/search/en/trial/DRKS00025611 International Registered Report Identifier (IRRID): DERR1-10.2196/69855 ",
doi="10.2196/69855",
url="https://www.researchprotocols.org/2025/1/e69855"
}


@Article{info:doi/10.2196/53690,
author="Kalla, Mahima
and Bradford, Ashleigh
and Schadewaldt, Verena
and Burns, Kara
and Bray, E. Sarah C.
and Cain, Sarah
and McAlpine, Heidi
and Dhillon, S. Rana
and Chapman, Wendy
and Whittle, R. James
and J Drummond, Katharine
and Krishnasamy, Meinir",
title="Co-Designing a User-Centered Digital Health Tool for Supportive Care Needs of Patients With Brain Tumors and Their Caregivers: Interview Analysis",
journal="JMIR Cancer",
year="2025",
month="May",
day="23",
volume="11",
pages="e53690",
keywords="brain cancer",
keywords="unmet needs",
keywords="supportive care",
keywords="psychosocial support",
keywords="digital health",
keywords="qualitative research",
keywords="brain tumor",
keywords="user-centered",
keywords="patients",
keywords="caregivers",
keywords="interview analysis",
keywords="quality of life",
keywords="effectiveness",
keywords="co-design paradigm",
keywords="ideas",
keywords="concepts",
keywords="emotional support",
keywords="information sharing",
keywords="social connectedness",
keywords="health care professionals",
abstract="Background: Brain tumors are characterized by the high burden of disease that profoundly impacts the quality of life in patients and their families. Digital health tools hold tremendous potential to enhance supportive care and quality of life for patients with brain tumors and their caregivers. Objective: This study aims to generate ideas and concepts, through a co-design paradigm, to inform the development of a digital health tool to address the unmet needs of people affected by brain tumors. Methods: Patients with brain tumors, caregivers, and health professionals from 2 large public tertiary hospitals in Victoria, Australia, were invited to complete a qualitative interview discussing their unmet needs of care. Overall, 35 qualitative interviews focusing on unmet needs and concepts for a digital health tool were conducted with 13 patients, 11 caregivers, and 11 health professionals. Interviews were audio recorded and transcribed, and a 5-step framework analysis approach was used to analyze data. Results: Four themes of unmet supportive care needs emerged: (1) emotional and psychological, (2) information, (3) physical and practical, and (4) social connectedness. Participants expressed the desire for early and proactive mental health intervention, noted the importance of providing mental health support to caregivers, and emphasized the need for positive stories and affirmative language. From an information perspective, participants noted a sense of information overload, especially at the beginning. They also underscored the variety of information needed on an ongoing basis, including life after treatment, and comprehensive care assistance to maintain quality of life. Participants also described unmet supportive care needs relating to symptom burden, and practical and administrative support to facilitate the logistics of accessing treatment and accomplishing daily life tasks. Finally, they expressed the desire for greater social connectedness and safe spaces to engage with other people in a similar situation. Our findings are consistent with previous research on this subject and were integrated into the development of a web-based platform. Conclusions: Participants' perspectives informed the development of content for a web-based digital health platform called ``Brain Tumours Online.'' The platform comprises three pillars---(1) ``LEARN'': a repository of vetted information about a range of biomedical and psychosocial care topics; (2) ``CONNECT'': a digital peer support community with a health care professional interface; and (3) ``TOOLBOX'': an emerging library of validated digital therapeutics for symptom management. ",
doi="10.2196/53690",
url="https://cancer.jmir.org/2025/1/e53690"
}


@Article{info:doi/10.2196/67462,
author="Bai, Xuexue
and Wang, Shiyong
and Zhao, Yuanli
and Feng, Ming
and Ma, Wenbin
and Liu, Xiaomin",
title="Application of AI Chatbot in Responding to Asynchronous Text-Based Messages From Patients With Cancer: Comparative Study",
journal="J Med Internet Res",
year="2025",
month="May",
day="21",
volume="27",
pages="e67462",
keywords="artificial intelligence, chatbot, telemedicine",
keywords="oncology",
keywords="comparative study",
abstract="Background: Telemedicine, which incorporates artificial intelligence such as chatbots, offers significant potential for enhancing health care delivery. However, the efficacy of artificial intelligence chatbots compared to human physicians in clinical settings remains underexplored, particularly in complex scenarios involving patients with cancer and asynchronous text-based interactions. Objective: This study aimed to evaluate the performance of the GPT-4 (OpenAI) chatbot in responding to asynchronous text-based medical messages from patients with cancer by comparing its responses with those of physicians across two clinical scenarios: patient education and medical decision-making. Methods: We collected 4257 deidentified asynchronous text-based medical consultation records from 17 oncologists across China between January 1, 2020, and March 31, 2024. Each record included patient questions, demographic data, and disease-related details. The records were categorized into two scenarios: patient education (eg, symptom explanations and test interpretations) and medical decision-making (eg, treatment planning). The GPT-4 chatbot was used to simulate physician responses to these records, with each session conducted in a new conversation to avoid cross-session interference. The chatbot responses, along with the original physician responses, were evaluated by a medical review panel (3 oncologists) and a patient panel (20 patients with cancer). The medical panel assessed completeness, accuracy, and safety using a 3-level scale, whereas the patient panel rated completeness, trustworthiness, and empathy on a 5-point ordinal scale. Statistical analyses included chi-square tests for categorical variables and Wilcoxon signed-rank tests for ordinal ratings. Results: In the patient education scenario (n=2364), the chatbot scored higher than physicians in completeness (n=2301, 97.34\% vs n=2213, 93.61\% for fully complete responses; P=.002), with no significant differences in accuracy or safety (P>.05). In the medical decision-making scenario (n=1893), the chatbot exhibited lower accuracy (n=1834, 96.88\% vs n=1855, 97.99\% for fully accurate responses; P<.001) and trustworthiness (n=860, 50.71\% vs n=1766, 93.29\% rated as ``Moderately trustworthy'' or higher; P<.001) compared with physicians. Regarding empathy, the medical review panel rated the chatbot as demonstrating higher empathy scores across both scenarios, whereas the patient review panel reached the opposite conclusion, consistently favoring physicians in empathetic communication. Errors in chatbot responses were primarily due to misinterpretations of medical terminology or the lack of updated guidelines, with 3.12\% (59/1893) of its responses potentially leading to adverse outcomes, compared with 2.01\% (38/1893) for physicians. Conclusions: The GPT-4 chatbot performs comparably to physicians in patient education by providing comprehensive and empathetic responses. However, its reliability in medical decision-making remains limited, particularly in complex scenarios requiring nuanced clinical judgment. These findings underscore the chatbot's potential as a supplementary tool in telemedicine while highlighting the need for physician oversight to ensure patient safety and accuracy. ",
doi="10.2196/67462",
url="https://www.jmir.org/2025/1/e67462"
}


@Article{info:doi/10.2196/63964,
author="Mushcab, Hayat
and Al Ramis, Mohammed
and AlRujaib, Abdulrahman
and Eskandarani, Rawan
and Sunbul, Tamara
and AlOtaibi, Anwar
and Obaidan, Mohammed
and Al Harbi, Reman
and Aljabri, Duaa",
title="Application of Artificial Intelligence in Cardio-Oncology Imaging for Cancer Therapy--Related Cardiovascular Toxicity: Systematic Review",
journal="JMIR Cancer",
year="2025",
month="May",
day="9",
volume="11",
pages="e63964",
keywords="artificial intelligence",
keywords="cardiology",
keywords="oncology",
keywords="cancer therapy--induced",
keywords="cardiotoxicity",
keywords="cardiovascular toxicity",
keywords="machine learning",
keywords="imaging",
keywords="radiology",
abstract="Background: Artificial intelligence (AI) is a revolutionary tool yet to be fully integrated into several health care sectors, including medical imaging. AI can transform how medical imaging is conducted and interpreted, especially in cardio-oncology. Objective: This study aims to systematically review the available literature on the use of AI in cardio-oncology imaging to predict cardiotoxicity and describe the possible improvement of different imaging modalities that can be achieved if AI is successfully deployed to routine practice. Methods: We conducted a database search in PubMed, Ovid MEDLINE, Cochrane Library, CINAHL, and Google Scholar from inception to 2023 using the AI research assistant tool (Elicit) to search for original studies reporting AI outcomes in adult patients diagnosed with any cancer and undergoing cardiotoxicity assessment. Outcomes included incidence of cardiotoxicity, left ventricular ejection fraction, risk factors associated with cardiotoxicity, heart failure, myocardial dysfunction, signs of cancer therapy--related cardiovascular toxicity, echocardiography, and cardiac magnetic resonance imaging. Descriptive information about each study was recorded, including imaging technique, AI model, outcomes, and limitations. Results: The systematic search resulted in 7 studies conducted between 2018 and 2023, which are included in this review. Most of these studies were conducted in the United States (71\%), included patients with breast cancer (86\%), and used magnetic resonance imaging as the imaging modality (57\%). The quality assessment of the studies had an average of 86\% compliance in all of the tool's sections. In conclusion, this systematic review demonstrates the potential of AI to enhance cardio-oncology imaging for predicting cardiotoxicity in patients with cancer. Conclusions: Our findings suggest that AI can enhance the accuracy and efficiency of cardiotoxicity assessments. However, further research through larger, multicenter trials is needed to validate these applications and refine AI technologies for routine use, paving the way for improved patient outcomes in cancer survivors at risk of cardiotoxicity. Trial Registration: PROSPERO CRD42023446135; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023446135 ",
doi="10.2196/63964",
url="https://cancer.jmir.org/2025/1/e63964"
}


@Article{info:doi/10.2196/65960,
author="Le D{\^u}, Katell
and Chauchet, Adrien
and Sadot-Lebouvier, Sophie
and Fitoussi, Olivier
and Fontanet, Bijou
and Saint-Lezer, Arnaud
and Maloisel, Fr{\'e}d{\'e}ric
and Rossi, C{\'e}dric
and Carras, Sylvain
and Parcelier, Anne
and Balavoine, Magali
and Septans, Anne-Lise",
title="Comparison of Electronic Surveillance With Routine Monitoring for Patients With Lymphoma at High Risk of Relapse: Prospective Randomized Controlled Phase 3 Trial (Sentinel Lymphoma)",
journal="JMIR Cancer",
year="2025",
month="May",
day="6",
volume="11",
pages="e65960",
keywords="patient-reported outcome measures",
keywords="lymphoma",
keywords="risk of relapse",
keywords="relapse",
keywords="randomized trial",
keywords="web-based",
keywords="quality of life",
keywords="survival",
keywords="detection",
keywords="progression",
keywords="T-cell lymphoma",
keywords="Hodgkin lymphoma",
abstract="Background: Relapse is a major event in patients with lymphoma. Therefore, early detection may have an impact on quality of life and overall survival. Patient-reported outcome measures have demonstrated clinical benefits for patients with lung cancer; however, evidence is lacking in patients with lymphoma. We evaluated the effect of a web-mediated follow-up application for patients with lymphoma at high risk of relapse. Objective: This study aims to demonstrate that monitoring patients via a web application enables the detection of at least 30\% more significant events occurring between 2 systematic follow-up consultations with the specialist using an electronic questionnaire. Methods: We conducted a prospective, randomized phase 3 trial comparing the impact of web-based follow-up (experimental arm) with a standard follow-up (control arm). The trial was based on a 2-step triangular test and was designed to have a power of 90\% to detect a 30\% improvement in the detection of significant events. A significant event was defined as a relapse, progression, or a serious adverse event. The study covered the follow-up period after completion of first-line treatment or relapse (24 months). Eligible patients were aged 18 years and older and had lymphoma at a high risk of relapse. In the experimental arm, patients received a 16-symptom questionnaire by email every 2 weeks. An email alert was sent to the medical team based on a predefined algorithm. The primary objective was assessed after the inclusion of the 40th patient. The study was continued for the duration of the analysis. Results: A total of 52 patients were included between July 12, 2017, and April 7, 2020, at 11 centers in France, with 27 in the experimental arm and 25 in the control arm. The median follow-up was 21.3 (range 1.3?25.6) months, and 121 events were reported during the study period. Most events occurred in the experimental arm (83/119, 69.7\%) compared with 30.2\% (36/119) in the control arm. A median number of 3.5 (range 1-8) events per patient occurred in the experimental arm, and 1.8 (range 1-6) occurred in the control arm (P=.01). Progression and infection were the most frequently reported events. Further, 19 patients relapsed during follow-up: 6 in the experimental arm and 13 in the control arm (P<.001), with a median follow-up of 7.7 (range 2.8?20.6) months and 6.7 (range 1.9?16.4) months (P=.94), respectively. Statistical analysis was conducted after including the 40th patient, which showed no superiority of the experimental arm over the control arm. The study was therefore stopped after the 52nd patient was enrolled. Conclusions: The primary objective was not reached; however, patient-reported outcome measures remain essential for detecting adverse events in patients with cancer, and the electronic monitoring method needs to demonstrate its effectiveness and comply with international safety guidelines. Trial Registration: ClinicalTrials.gov NCT03154710; https://clinicaltrials.gov/ct2/show/NCT03154710 ",
doi="10.2196/65960",
url="https://cancer.jmir.org/2025/1/e65960"
}


@Article{info:doi/10.2196/64083,
author="Huebner, Hanna
and Wurmthaler, A. Lena
and Goossens, Chlo{\"e}
and Ernst, Mathias
and Mocker, Alexander
and Kr{\"u}ckel, Annika
and Kallert, Maximilian
and Geck, J{\"u}rgen
and Limpert, Milena
and Seitz, Katharina
and Ruebner, Matthias
and Kreis, Philipp
and Heindl, Felix
and H{\"o}rner, Manuel
and Volz, Bernhard
and Roth, Eduard
and Hack, C. Carolin
and Beckmann, W. Matthias
and Uhrig, Sabrina
and Fasching, A. Peter",
title="A Digital Home-Based Health Care Center for Remote Monitoring of Side Effects During Breast Cancer Therapy: Prospective, Single-Arm, Monocentric Feasibility Study",
journal="JMIR Cancer",
year="2025",
month="May",
day="2",
volume="11",
pages="e64083",
keywords="breast cancer",
keywords="digital medicine",
keywords="telehealth",
keywords="remote monitoring",
keywords="cyclin-dependent kinase 4/6 inhibitor",
keywords="CDK4/6 inhibitor",
keywords="mobile phone",
abstract="Background: The introduction of oral anticancer therapies has, at least partially, shifted treatment from clinician-supervised hospital care to patient-managed home regimens. However, patients with breast cancer receiving oral cyclin-dependent kinase 4/6 inhibitor therapy still require regular hospital visits to monitor side effects. Telemonitoring has the potential to reduce hospital visits while maintaining quality care. Objective: This study aims to develop a digital home-based health care center (DHHC) for acquiring electrocardiograms (ECGs), white blood cell (WBC) counts, side effect photo documentation, and patient-reported quality of life (QoL) data. Methods: The DHHC was set up using an Apple Watch Series 6 (ECG measurements), a HemoCue WBC DIFF Analyzer (WBC counts), an iPhone SE (QoL assessments and photo documentation), a TP-Link M7350-4G Wi-Fi router, and a Raspberry Pi 4 Model B. A custom-built app stored and synchronized remotely collected data with the clinic. The feasibility and acceptance of the DHHC among patients with breast cancer undergoing cyclin-dependent kinase 4/6 inhibitor therapy were evaluated in a prospective, single-arm, monocentric study. Patients (n=76) monitored side effects---ECGs, WBC counts, photo documentation, and QoL---at 3 predefined time points: study inclusion (on-site), day 14 (remote), and day 28 (remote). After the study completion, patients completed a comprehensive questionnaire on user perception and feasibility. Adherence to scheduled visits, the success rate of the data transfer, user perception and feasibility, and the clinical relevance of remote measurements were evaluated. Results: Mean adherence to the planned remote visits was 63\% on day 14 and 37\% on day 28. ECG measurements were performed most frequently (day 14: 57/76, 75\%; day 28: 31/76, 41\%). The primary patient-reported reason for nonadherence was device malfunction. The expected versus the received data transfer per patient was as follows: ECGs: 3 versus 3.04 (SD 1.9); WBC counts: 3 versus 2.14 (SD 1.14); QoL questionnaires: 3 versus 2.5 (SD 1.14); and photo documentation: 6 versus 4.4 (SD 3.36). Among patients, 81\% (55/68) found ECG measurements easy, 82\% (55/67) found photo documentation easy, and 48\% (33/69) found WBC measurements easy. Additionally, 61\% (40/66) of patients felt comfortable with self-monitoring and 79\% (54/68) were willing to integrate remote monitoring into their future cancer care. Therapy-induced decreased neutrophil count was successfully detected (P<.001; mean baseline: 4.3, SD 2.2, {\texttimes}109/L; on-treatment: 1.8, SD 0.8, {\texttimes}109/L). All-grade neutropenia and corrected QT interval prolongations were detected in 80\% (55/68) and 2\% (1/42) of patients, respectively. Conclusions: Adherence to scheduled remote visits was moderate, with nonadherence primarily attributed to device-related complications, which may have also affected the success rate of data transfer. Overall, patients considered remote monitoring useful and feasible. The prevalence of reported adverse events was comparable to existing literature, suggesting clinical potential. This initial feasibility study highlights the potential of the DHHC. ",
doi="10.2196/64083",
url="https://cancer.jmir.org/2025/1/e64083"
}


@Article{info:doi/10.2196/69398,
author="Hubel, J. Niclas
and Vorbach, M. Samuel
and de Ligt, M. Kelly
and Rathgeber, S. Ines
and Beyer, Katharina
and Wintner, M. Lisa
and Faller, Barbara
and Nemec, Jasmin
and Holzner, Bernhard
and Sztankay, Monika
and Lehmann, Jens",
title="Sustainability and Time Trends in Electronic Patient-Reported Outcome Assessment in Routine Cancer Care: Systematic Scoping Review and Follow-Up Survey",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="25",
volume="27",
pages="e69398",
keywords="patient-reported outcome measures",
keywords="cancer, clinical routine",
keywords="health-related quality of life",
keywords="quality of care",
keywords="mobile applications",
keywords="digital technology",
abstract="Background: Routine electronic assessment of patient-reported outcomes (ePROs) can improve cancer care; yet, its implementation in routine practice and long-term sustainability remain unclear. Understanding these aspects is critical to advancing the field. Objective: To review and describe the past and current status, time trends, and long-term sustainability of clinical ePRO applications in routine oncology care. Methods: We conducted a systematic review of publications on ePRO use in oncology care up to December 31, 2023, searching PubMed and Web of Science and extracting data on clinical ePRO applications. We included peer-reviewed studies including patients with cancer using ePRO assessments in clinical practice, excluding research letters and conference abstracts. Data from the review were analyzed using descriptive statistics and univariate regression models to evaluate time trends, with year of publication as the predictor. A follow-up survey was sent to authors of published ePRO applications to assess their current use of the application or reasons for discontinuation. Responses from the follow-up survey were analyzed descriptively. Results: For the review, we screened 2933 references, and 303 met inclusion criteria. Results showed that Europe was the most common region (n=141, 46.5\%), and study populations consisted mostly of adult patients (n=276, 91.1\%) under chemotherapy treatment (n=124, 40.9\%) assessed in an outpatient setting (n=261, 86.1\%). The EORTC (European Organisation for Research and Treatment of Cancer; n=77, 25.4\%) and PRO-CTCAE (Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events) questionnaires (n=65, 21.5\%) were most frequently integrated into ePRO applications. In the univariate analysis, we found that publications increased significantly over time (2003-2023, P<.001). Trends showed a rise in mobile app use (odds ratio [OR] 1.211, P<.001), remote assessments (OR 1.094, P=.002), and feedback provided to patients (OR 1.060, P=.04). Of the 303 studies, 221 unique clinical ePRO applications were identified, merging publications at the application level. The follow-up survey had a 35.3\% response rate (78/221), with 61.1\% of ePRO applications still in use, lasting a median of 5 years. The most common reason for discontinuation was a lack of funding and resources (42.9\%, 12/28). Conclusions: The field of ePRO assessment in oncology is rapidly evolving, with a shift toward remote, app-based tools and a growing emphasis on providing feedback to patients. We present, for the first time, data on the sustainability of ePRO use in routine care. While our findings offer valuable insights, they should be interpreted in light of potential response bias in the follow-up survey. Several ePRO applications remain in active use, highlighting potential for long-term integration into clinical practice. However, financial constraints, limited reimbursement models, and challenges with workflow integration continue to hinder broader and more sustainable adoption. Addressing these barriers will be essential to support the continued use of ePROs in clinical care. ",
doi="10.2196/69398",
url="https://www.jmir.org/2025/1/e69398"
}


@Article{info:doi/10.2196/57834,
author="Hou, J. Sharon H.
and Henry, Brianna
and Drummond, Rachelle
and Forbes, Caitlin
and Mendon{\c{c}}a, Kyle
and Wright, Holly
and Rahamatullah, Iqra
and Tutelman, R. Perri
and Zwicker, Hailey
and Stokoe, Mehak
and Duong, Jenny
and Drake, K. Emily
and Erker, Craig
and Taccone, S. Michael
and Sutherland, Liam
and Nathan, Paul
and Spavor, Maria
and Goddard, Karen
and Reynolds, Kathleen
and Schulte, M. Fiona S.",
title="Co-Designing Priority Components of an mHealth Intervention to Enhance Follow-Up Care in Young Adult Survivors of Childhood Cancer and Health Care Providers: Qualitative Descriptive Study",
journal="JMIR Cancer",
year="2025",
month="Apr",
day="25",
volume="11",
pages="e57834",
keywords="mobile health",
keywords="mHealth",
keywords="pediatric oncology",
keywords="cancer survivorship",
keywords="qualitative research",
keywords="patient-oriented research",
keywords="co-design",
keywords="intervention development",
abstract="Background: Survivors of childhood cancer are at risk of medical, psychological, and social late effects. To screen for their risks, receipt of consistent, cancer-specific follow-up care is crucial. However, <50\% of survivors attend their aftercare, and only 35\% of them recognize that they could have a serious health problem. The use of mobile health (mHealth) is a promising form of intervention to educate, connect, and empower survivors of childhood cancer on the importance of follow-up care. Objective: This study aimed to use co-design to identify the priority components to include in an mHealth intervention with young adult (aged between 18 and 39 years) survivors of childhood cancer and health care providers. Methods: This study was conducted between January and November 2022 in Canada and used patient-oriented research methods. Participants were recruited through local or provincial long-term follow-up clinics, using convenience sampling from patient partners who assisted in recruiting survivors across geographical areas in western, central, and eastern Canada, and social media outreach (X, formally known as Twitter; Facebook; and Instagram). Qualitative descriptive data (focus group interviews) from survivors of childhood cancer and health care providers (individual interviews) were gathered. We analyzed the collected data using reflexive thematic analysis and verified it through member checking techniques through an online community engagement event. Results: We conducted with patient partners 5 online (Zoom) focus groups with 22 survivors of childhood cancer (mean age 29.19, SD 4.78 y). We conducted individual telephone interviews with 7 health care providers. Participants identified five priority areas to be included in an mHealth intervention: (1) connections, (2) education and information, (3) engagement, (4) personalization, and (5) resources. Results were shared with and validated by survivors of childhood cancer, their families, health care providers, and academic researchers as part of a community engagement event. Small and large group discussions were facilitated to allow participants to review and discuss the accuracy of the themes derived regarding the core components to be included in mHealth. A graphic recording artist visually captured key ideas from the event. A subset of the participants also completed a web-based satisfaction survey, and responses indicated that the community engagement event was generally well received. Conclusions: Results from this study have provided the necessary foundation to progress in intervention development. The next step of this multiphased project is to build an innovative and accessible mHealth intervention prototype that is based on the identified core components and is grounded in an established conceptual framework for co-design of mHealth. ",
doi="10.2196/57834",
url="https://cancer.jmir.org/2025/1/e57834"
}


@Article{info:doi/10.2196/64208,
author="Liao, Wan-Chuen
and Angus, Fiona
and Conley, Jane
and Chen, Li-Chia",
title="The Efficacy of Digital Interventions on Adherence to Oral Systemic Anticancer Therapy Among Patients With Cancer: Systematic Review and Meta-Analysis",
journal="JMIR Cancer",
year="2025",
month="Apr",
day="16",
volume="11",
pages="e64208",
keywords="efficacy",
keywords="digital interventions",
keywords="oral systemic anticancer therapy",
keywords="medication adherence",
keywords="cancer",
keywords="oral",
keywords="patients with cancer",
keywords="therapy",
keywords="systematic review",
keywords="meta-analysis",
keywords="care plans",
keywords="medication",
keywords="treatments",
keywords="mobile app",
keywords="mobile applications",
keywords="mHealth",
keywords="multimedia platforms",
keywords="digital technology",
keywords="self-reported",
keywords="mobile phone",
abstract="Background: Digital interventions have been increasingly applied in multidisciplinary care plans to improve medication adherence to oral systemic anticancer therapy (SACT), the crucial lifesaving treatments for many cancers. However, there is still a lack of consensus on the efficacy of those digital interventions. Objectives: This systematic review and meta-analysis aimed to investigate the efficacy of digital interventions in improving adherence to oral SACTs in patients with cancer. Methods: This systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement guidelines. The protocol has been registered at PROSPERO (no. CRD42024550203). Fully published, randomized controlled trials (RCTs) in English on adults with cancer assessing digital interventions for improving adherence to oral SACTs were retrieved from MEDLINE, Embase, APA PsycINFO, and CINAHL Plus up to May 31, 2024. Adherence measures compared between digital intervention users and nonusers were extracted. The proportions of poor adherence were synthesized using a random-effects model. The pooled results were reported as the odds ratio and 95\% CI. The heterogeneity was assessed with the I2 test (\%). The mean difference and 95\% CI were calculated from the mean adherence score and SD. A risk of bias assessment was conducted using version 2 of the Cochrane Risk of Bias Assessment Tool (RoB 2) for RCTs, which ensured that a quality assessment of all included studies was conducted as recommended by the Cochrane Collaboration. Results: This study included 13 RCTs on digital interventions for improving adherence to oral SACTs in patients with cancer. The 13 RCTs, published between 2016 and 2024, were conducted in the United States, South Korea, France, Egypt, Finland, Australia, Colombia, Singapore, and Turkey. The technologies used were mobile apps (n=4), reminder systems (n=4), telephone follow-ups (n=3), and interactive multimedia platforms (n=2). Adherence was measured by surveys (n=8), relative dose intensity (n=2), pill count (n=1), self-reported missed doses (n=1), a smart pill bottle (n=1), and urine aromatase inhibitor metabolite assays (n=1). Concerns regarding risk of bias primarily involved randomization, missing outcome data, and outcome measurement, including nonblinded randomization, subjective patient-reported data, and difficulties in distinguishing between missed appointments and actual medication nonadherence. Pooled results from 11 trials showed that digital technology users had significantly lower risk of poor adherence (odds ratio 0.60, 95\% CI 0.47?0.77). Two studies reported positive mean differences in adherence scores comparing digital intervention users and nonusers. However, due to considerable heterogeneity (I{\texttwosuperior}=73.1\%), it is difficult to make a definitive conclusion from the pooled results about the effect of digital interventions upon adherence to oral anticancer therapy. Conclusions: Digital intervention users exhibited significantly lower risk of poor oral SACTs adherence than nonusers. Acknowledging individual variation and tailoring digital technologies to prioritize patient needs is essential. Trial Registration: PROSPERO CRD42024550203; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024550203 ",
doi="10.2196/64208",
url="https://cancer.jmir.org/2025/1/e64208"
}


@Article{info:doi/10.2196/63677,
author="Grilo, Ana
and Marques, Catarina
and Corte-Real, Maria
and Carolino, Elisabete
and Caetano, Marco",
title="Assessing the Quality and Reliability of ChatGPT's Responses to Radiotherapy-Related Patient Queries: Comparative Study With GPT-3.5 and GPT-4",
journal="JMIR Cancer",
year="2025",
month="Apr",
day="16",
volume="11",
pages="e63677",
keywords="artificial intelligence",
keywords="ChatGPT",
keywords="large language model",
keywords="radiotherapy",
keywords="patient information",
keywords="quality",
keywords="internet access",
keywords="health information",
keywords="cancer awareness",
keywords="accuracy",
keywords="readability",
keywords="chatbot",
keywords="patient query",
keywords="chat generative pretrained transformer",
keywords="OpenAI",
keywords="natural language processing",
keywords="patients with cancer",
abstract="Background: Patients frequently resort to the internet to access information about cancer. However, these websites often lack content accuracy and readability. Recently, ChatGPT, an artificial intelligence--powered chatbot, has signified a potential paradigm shift in how patients with cancer can access vast amounts of medical information, including insights into radiotherapy. However, the quality of the information provided by ChatGPT remains unclear. This is particularly significant given the general public's limited knowledge of this treatment and concerns about its possible side effects. Furthermore, evaluating the quality of responses is crucial, as misinformation can foster a false sense of knowledge and security, lead to noncompliance, and result in delays in receiving appropriate treatment. Objective: This study aims to evaluate the quality and reliability of ChatGPT's responses to common patient queries about radiotherapy, comparing the performance of ChatGPT's two versions: GPT-3.5 and GPT-4. Methods: We selected 40 commonly asked radiotherapy questions and entered the queries in both versions of ChatGPT. Response quality and reliability were evaluated by 16 radiotherapy experts using the General Quality Score (GQS), a 5-point Likert scale, with the median GQS determined based on the experts' ratings. Consistency and similarity of responses were assessed using the cosine similarity score, which ranges from 0 (complete dissimilarity) to 1 (complete similarity). Readability was analyzed using the Flesch Reading Ease Score, ranging from 0 to 100, and the Flesch-Kincaid Grade Level, reflecting the average number of years of education required for comprehension. Statistical analyses were performed using the Mann-Whitney test and effect size, with results deemed significant at a 5\% level (P=.05). To assess agreement between experts, Krippendorff $\alpha$ and Fleiss $\kappa$ were used. Results: GPT-4 demonstrated superior performance, with a higher GQS and a lower number of scores of 1 and 2, compared to GPT-3.5. The Mann-Whitney test revealed statistically significant differences in some questions, with GPT-4 generally receiving higher ratings. The median (IQR) cosine similarity score indicated substantial similarity (0.81, IQR 0.05) and consistency in the responses of both versions (GPT-3.5: 0.85, IQR 0.04; GPT-4: 0.83, IQR 0.04). Readability scores for both versions were considered college level, with GPT-4 scoring slightly better in the Flesch Reading Ease Score (34.61) and Flesch-Kincaid Grade Level (12.32) compared to GPT-3.5 (32.98 and 13.32, respectively). Responses by both versions were deemed challenging for the general public. Conclusions: Both GPT-3.5 and GPT-4 demonstrated having the capability to address radiotherapy concepts, with GPT-4 showing superior performance. However, both models present readability challenges for the general population. Although ChatGPT demonstrates potential as a valuable resource for addressing common patient queries related to radiotherapy, it is imperative to acknowledge its limitations, including the risks of misinformation and readability issues. In addition, its implementation should be supported by strategies to enhance accessibility and readability. ",
doi="10.2196/63677",
url="https://cancer.jmir.org/2025/1/e63677"
}


@Article{info:doi/10.2196/68179,
author="Rades, Dirk
and K{\"u}ter, Jan-Dirk
and von Staden, Michael
and Al-Salool, Ahmed
and Janssen, Stefan
and Timke, Carmen
and Duma, Nona Marciana
and Bartscht, Tobias
and Vesterg{\aa}rd Madsen, Christine
and Kristiansen, Charlotte
and Cremers, Florian",
title="A Reminder App to Optimize Bladder Filling During Radiotherapy for Patients With  Prostate Cancer (REFILL-PAC): Protocol for a Prospective Trial",
journal="JMIR Res Protoc",
year="2025",
month="Apr",
day="8",
volume="14",
pages="e68179",
keywords="prostate cancer",
keywords="external beam radiation therapy",
keywords="radiation toxicity",
keywords="bladder filling",
keywords="mobile app",
abstract="Background: Many patients with nonmetastatic prostate cancer receive radiotherapy, which may be associated with acute cystitis, particularly if the volume of the urinary bladder is small. Three studies showed bladder volumes <200 ml or <180 ml to be associated with increased urinary toxicity. Therefore, it is important to maintain bladder volumes greater than 200 ml during as many radiation fractions as possible. Several studies investigated drinking protocols, where patients were asked to drink a certain amount of water prior to radiotherapy sessions. This may require considerable discipline from the patients, who are predominantly older adults. Adherence to a drinking protocol may be facilitated by a mobile app that reminds patients to drink water prior to each radiation session. This study investigates the effect of such an app on bladder filling status in patients with prostate cancer undergoing external beam radiotherapy (EBRT) alone. Objective: The primary goal of this study is to evaluate the impact of an app that reminds patients irradiated for prostate cancer to drink 300 ml of water prior to each radiotherapy session on the number of fractions with bladder volumes <200 ml during the radiotherapy course. Methods: This ongoing phase 2 aims to recruit 28 patients treated with EBRT alone for nonmetastatic prostate cancer. Radiotherapy will be administered using normo-fractionation, with doses ranging from 70 to 80 Gy in 35 to 40 fractions of 2 Gy, preferably with volumetric-modulated arc therapy (VMAT). Treatment volumes include the prostate with or without the seminal vesicles. Results: Recruitment for this trial will start in March 2025 and is planned to be completed in October 2026. The study is scheduled to conclude in December 2026. Conclusions: This trial is the first to evaluate the impact of a reminder app on the number of radiotherapy fractions with bladder volumes <200 ml in patients undergoing irradiation for localized prostate cancer. Trial Registration: Clinicaltrials.gov NCT06653751; https://clinicaltrials.gov/show/NCT06653751 International Registered Report Identifier (IRRID): PRR1-10.2196/68179 ",
doi="10.2196/68179",
url="https://www.researchprotocols.org/2025/1/e68179"
}


@Article{info:doi/10.2196/67914,
author="Liu, Darren
and Hu, Xiao
and Xiao, Canhua
and Bai, Jinbing
and Barandouzi, A. Zahra
and Lee, Stephanie
and Webster, Caitlin
and Brock, La-Urshalar
and Lee, Lindsay
and Bold, Delgersuren
and Lin, Yufen",
title="Evaluation of Large Language Models in Tailoring Educational Content for Cancer Survivors and Their Caregivers: Quality Analysis",
journal="JMIR Cancer",
year="2025",
month="Apr",
day="7",
volume="11",
pages="e67914",
keywords="large language models",
keywords="GPT-4",
keywords="cancer survivors",
keywords="caregivers",
keywords="education",
keywords="health equity",
abstract="Background: Cancer survivors and their caregivers, particularly those from disadvantaged backgrounds with limited health literacy or racial and ethnic minorities facing language barriers, are at a disproportionately higher risk of experiencing symptom burdens from cancer and its treatments. Large language models (LLMs) offer a promising avenue for generating concise, linguistically appropriate, and accessible educational materials tailored to these populations. However, there is limited research evaluating how effectively LLMs perform in creating targeted content for individuals with diverse literacy and language needs. Objective: This study aimed to evaluate the overall performance of LLMs in generating tailored educational content for cancer survivors and their caregivers with limited health literacy or language barriers, compare the performances of 3 Generative Pretrained Transformer (GPT) models (ie, GPT-3.5 Turbo, GPT-4, and GPT-4 Turbo; OpenAI), and examine how different prompting approaches influence the quality of the generated content. Methods: We selected 30 topics from national guidelines on cancer care and education. GPT-3.5 Turbo, GPT-4, and GPT-4 Turbo were used to generate tailored content of up to 250 words at a 6th-grade reading level, with translations into Spanish and Chinese for each topic. Two distinct prompting approaches (textual and bulleted) were applied and evaluated. Nine oncology experts evaluated 360 generated responses based on predetermined criteria: word limit, reading level, and quality assessment (ie, clarity, accuracy, relevance, completeness, and comprehensibility). ANOVA (analysis of variance) or chi-square analyses were used to compare differences among the various GPT models and prompts. Results: Overall, LLMs showed excellent performance in tailoring educational content, with 74.2\% (267/360) adhering to the specified word limit and achieving an average quality assessment score of 8.933 out of 10. However, LLMs showed moderate performance in reading level, with 41.1\% (148/360) of content failing to meet the sixth-grade reading level. LLMs demonstrated strong translation capabilities, achieving an accuracy of 96.7\% (87/90) for Spanish and 81.1\% (73/90) for Chinese translations. Common errors included imprecise scopes, inaccuracies in definitions, and content that lacked actionable recommendations. The more advanced GPT-4 family models showed better overall performance compared to GPT-3.5 Turbo. Prompting GPTs to produce bulleted-format content was likely to result in better educational content compared with textual-format content. Conclusions: All 3 LLMs demonstrated high potential for delivering multilingual, concise, and low health literacy educational content for cancer survivors and caregivers who face limited literacy or language barriers. GPT-4 family models were notably more robust. While further refinement is required to ensure simpler reading levels and fully comprehensive information, these findings highlight LLMs as an emerging tool for bridging gaps in cancer education and advancing health equity. Future research should integrate expert feedback, additional prompt engineering strategies, and specialized training data to optimize content accuracy and accessibility. International Registered Report Identifier (IRRID): RR2-10.2196/48499 ",
doi="10.2196/67914",
url="https://cancer.jmir.org/2025/1/e67914"
}


@Article{info:doi/10.2196/62749,
author="Iivanainen, Sanna
and Arokoski, Reetta
and Mentu, Santeri
and Lang, Laura
and Ekstr{\"o}m, Jussi
and Virtanen, Henri
and Kataja, Vesa
and Koivunen, Pekka Jussi",
title="Development of a Comprehensive Decision Support Tool for Chemotherapy-Cycle Prescribing: Initial Usability Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="31",
volume="9",
pages="e62749",
keywords="cancer",
keywords="chemotherapy",
keywords="ePRO",
keywords="electronic patient-reported outcome",
keywords="decision support system",
abstract="Background: Chemotherapy cycle prescription is generally carried out through a multistep manual process that is prone to human error. Clinical decision support tools can provide patient-specific assessments that support clinical decisions, improve prescribing practices, and reduce medication errors. Objective: We hypothesized that a knowledge-based, patient-derived, evidence-directed decision support tool consisting of multiple modules focusing on the core duties preceding chemotherapy-cycle prescription could result in a more cost-effective and error-free approach and streamline the workflow. Methods: A 1-arm, multicenter, prospective clinical trial (``Follow-up of Cancer Patients Receiving Chemotherapy or Targeted Therapy by Electronic Patient Reported Outcomes-tool'' [ECHO] 7/2019-1/2021; NCT04081558) was initiated to investigate the tool. The most important inclusion criteria were the presence of colorectal cancer (CRC) treated with oxaliplatin-based chemotherapy, age ?18 years, Eastern Cooperative Oncology Group [ECOG] performance score of 0 to 2, and internet access. A decision support tool that included digital symptom monitoring, a laboratory value interface, and treatment schedule integration for semiautomated chemotherapy cycle prescribing was integrated into the care pathway. Performance was assessed by the percentage of chemotherapy cycles with sent and completed symptom questionnaires, while perceptions of health care professionals (HCPs) on the feasibility of the approach were collected through a 1-time semistructured interview. Results: The ECHO trial included 43 patients with CRC treated with doublet or triplet chemotherapy in an adjuvant or metastatic setting. Altogether, 843 electronic patient-reported outcome (ePRO) symptom questionnaires were completed. Of the 15 recorded symptoms, fatigue (n=446, 52.9\%) and peripheral neuropathy (n=429, 50.9\%) were reported most often, while 137 grade 3 to 4 symptoms were recorded, of which diarrhea (n=5, 4\%) and peripheral neuropathy (n=4, 3\%) were the most common. During the study, 339 chemotherapy cycles were prescribed, and for the 77\% (n=262) of new chemotherapy cycles, ePRO questionnaire data were available within preset limits (completed within 3 days prior to chemotherapy scheduling) while 65\% of the cycles (n=221) had symptom questionnaire grading at ?1\%, and 67\% of the cycles (n=228) had laboratory values in a preset range. The recommendations by the tool for a new chemotherapy cycle were tier 1 (green; meaning ``go'') in 145 (42.8\%) of the cycles, tier 2 (yellow; ``evaluate'') in 83 (25\%), and tier 3 (red; ``hold'') in 111 (32.7\%). HCPs (n=3) were interviewed with a questionnaire (comprising 8 questions), revealing that they most valued the improved workflow, faster patient evaluation, and direct messaging option. Conclusions: In this study, we investigated the feasibility of a decision support system for chemotherapy-cycle pre-evaluation and prescription that was developed for the prospective ECHO trial. The study showed that the functionalities of the investigated tool were feasible and that an automated approach to chemotherapy-cycle prescription was possible for nearly half of the cycles. Trial Registration: ClinicalTrials.gov NCT04081558; https://clinicaltrials.gov/study/NCT04081558 ",
doi="10.2196/62749",
url="https://formative.jmir.org/2025/1/e62749"
}


@Article{info:doi/10.2196/66275,
author="Minvielle, Etienne
and Perez-Torrents, Joel
and Salma, Israa
and Aegerter, Philippe
and Ferrua, Marie
and Fert{\'e}, Charles
and Leleu, Henri
and Mathivon, Delphine
and Sicotte, Claude
and Di Palma, Mario
and Scott{\'e}, Florian",
title="The Effect of Nurse Navigators in Digital Remote Monitoring in Cancer Care: Case Study Using Structural Equation Modeling",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="28",
volume="27",
pages="e66275",
keywords="digital remote monitoring",
keywords="nurse navigators",
keywords="patient care",
keywords="oncology",
keywords="toxicity",
keywords="patient satisfaction",
keywords="hospitalization",
abstract="Background: The purpose of digital remote monitoring (DRM) is improving cancer care management. However, its effectiveness largely depends on the role of nurse navigators (NNs) within these systems to process data and lead action. Objective: This study aims to fill gaps in our understanding of the role of NNs within a specific system, drawing on the Canc{\'e}rologie parcours r{\'e}gion Ile-de-France (CAPRI) DRM program applied to oncology patients. Methods: The CAPRI DRM, targeting patients taking oral anticancer agents, combines digital interfaces with NN interventions. A phase 3 randomized controlled trial involving 559 patients assessed its safety and efficacy, with the primary end point being the relative dose intensity. This report focuses on patients in the CAPRI arm, evaluating the impact of NN interventions on outcomes such as toxicity, hospitalization, and emergency visits. Data on patient characteristics, NN interventions, and patient satisfaction surveys were analyzed using structural equation modeling. Results: The study included 187 patients. Patient characteristics were significantly correlated with outcomes. Across all the models we used, the quality of NN interventions was consistently associated with higher patient satisfaction, with correlation coefficients ranging from 0.332 (95\% CI 0.154-0.510; P<.001) to 0.366 (95\% CI 0.182-0.550; P<.001). The number of grade ?3 toxicity events correlated positively with NN referrals to oncologists. Hospitalization length was positively related to NN referral (coefficient 0.102, 95\% CI 0.051-0.153; P<.001) and inversely to NN advice (coefficient --0.045, 95\% CI --0.096 to 0.006; P=.08). Emergency visits showed a negative correlation with NN actions (coefficient --0.478, 95\% CI --0.923 to 0.033; P=.04) and a positive correlation with NN calls and referrals (coefficient 0.516, 95\% CI 0.069-0.963; P=.02). Conclusions: This study shows the central role of NNs in making DRM effective. Despite the study's limitations, these results support the design of DRM as a hybrid model of automated digital tools and human support. Future research should explore the applicability of such a DRM model in various clinical settings to clarify the optimal association between automated systems and NN expertise. Trial Registration: ClinicalTrials.gov NCT02828462; https://www.clinicaltrials.gov/study/NCT02828462 ",
doi="10.2196/66275",
url="https://www.jmir.org/2025/1/e66275"
}


@Article{info:doi/10.2196/67922,
author="Xu, He-Li
and Li, Xiao-Ying
and Jia, Ming-Qian
and Ma, Qi-Peng
and Zhang, Ying-Hua
and Liu, Fang-Hua
and Qin, Ying
and Chen, Yu-Han
and Li, Yu
and Chen, Xi-Yang
and Xu, Yi-Lin
and Li, Dong-Run
and Wang, Dong-Dong
and Huang, Dong-Hui
and Xiao, Qian
and Zhao, Yu-Hong
and Gao, Song
and Qin, Xue
and Tao, Tao
and Gong, Ting-Ting
and Wu, Qi-Jun",
title="AI-Derived Blood Biomarkers for Ovarian Cancer Diagnosis: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="24",
volume="27",
pages="e67922",
keywords="artificial intelligence",
keywords="AI",
keywords="blood biomarker",
keywords="ovarian cancer",
keywords="diagnosis",
keywords="PRISMA",
abstract="Background: Emerging evidence underscores the potential application of artificial intelligence (AI) in discovering noninvasive blood biomarkers. However, the diagnostic value of AI-derived blood biomarkers for ovarian cancer (OC) remains inconsistent. Objective: We aimed to evaluate the research quality and the validity of AI-based blood biomarkers in OC diagnosis. Methods: A systematic search was performed in the MEDLINE, Embase, IEEE Xplore, PubMed, Web of Science, and the Cochrane Library databases. Studies examining the diagnostic accuracy of AI in discovering OC blood biomarkers were identified. The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies--AI tool. Pooled sensitivity, specificity, and area under the curve (AUC) were estimated using a bivariate model for the diagnostic meta-analysis. Results: A total of 40 studies were ultimately included. Most (n=31, 78\%) included studies were evaluated as low risk of bias. Overall, the pooled sensitivity, specificity, and AUC were 85\% (95\% CI 83\%-87\%), 91\% (95\% CI 90\%-92\%), and 0.95 (95\% CI 0.92-0.96), respectively. For contingency tables with the highest accuracy, the pooled sensitivity, specificity, and AUC were 95\% (95\% CI 90\%-97\%), 97\% (95\% CI 95\%-98\%), and 0.99 (95\% CI 0.98-1.00), respectively. Stratification by AI algorithms revealed higher sensitivity and specificity in studies using machine learning (sensitivity=85\% and specificity=92\%) compared to those using deep learning (sensitivity=77\% and specificity=85\%). In addition, studies using serum reported substantially higher sensitivity (94\%) and specificity (96\%) than those using plasma (sensitivity=83\% and specificity=91\%). Stratification by external validation demonstrated significantly higher specificity in studies with external validation (specificity=94\%) compared to those without external validation (specificity=89\%), while the reverse was observed for sensitivity (74\% vs 90\%). No publication bias was detected in this meta-analysis. Conclusions: AI algorithms demonstrate satisfactory performance in the diagnosis of OC using blood biomarkers and are anticipated to become an effective diagnostic modality in the future, potentially avoiding unnecessary surgeries. Future research is warranted to incorporate external validation into AI diagnostic models, as well as to prioritize the adoption of deep learning methodologies. Trial Registration: PROSPERO CRD42023481232; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023481232 ",
doi="10.2196/67922",
url="https://www.jmir.org/2025/1/e67922",
url="http://www.ncbi.nlm.nih.gov/pubmed/40126546"
}


@Article{info:doi/10.2196/66273,
author="Gyrard, Amelie
and Abedian, Somayeh
and Gribbon, Philip
and Manias, George
and van Nuland, Rick
and Zatloukal, Kurt
and Nicolae, Emilia Irina
and Danciu, Gabriel
and Nechifor, Septimiu
and Marti-Bonmati, Luis
and Mallol, Pedro
and Dalmiani, Stefano
and Autexier, Serge
and Jendrossek, Mario
and Avramidis, Ioannis
and Garcia Alvarez, Eva
and Holub, Petr
and Blanquer, Ignacio
and Boden, Anna
and Hussein, Rada",
title="Lessons Learned From European Health Data Projects With Cancer Use Cases: Implementation of Health Standards and Internet of Things Semantic Interoperability",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="24",
volume="27",
pages="e66273",
keywords="artificial intelligence",
keywords="cancer",
keywords="European Health Data Space",
keywords="health care standards",
keywords="interoperability",
keywords="AI",
keywords="health data",
keywords="cancer use cases",
keywords="IoT",
keywords="Internet of Things",
keywords="primary data",
keywords="diagnosis",
keywords="prognosis",
keywords="decision-making",
doi="10.2196/66273",
url="https://www.jmir.org/2025/1/e66273",
url="http://www.ncbi.nlm.nih.gov/pubmed/40126534"
}


@Article{info:doi/10.2196/63347,
author="{\vS}uto Pavi{\v c}i{\'c}, Jelena
and Maru{\vs}i{\'c}, Ana
and Buljan, Ivan",
title="Using ChatGPT to Improve the Presentation of Plain Language Summaries of Cochrane Systematic Reviews About Oncology Interventions: Cross-Sectional Study",
journal="JMIR Cancer",
year="2025",
month="Mar",
day="19",
volume="11",
pages="e63347",
keywords="health literacy",
keywords="patient education",
keywords="health communication",
keywords="ChatGPT",
keywords="neoplasms",
keywords="Cochrane",
keywords="oncology",
keywords="plain language",
keywords="medical information",
keywords="decision-making",
keywords="large language model",
keywords="artificial intelligence",
keywords="AI",
abstract="Background: Plain language summaries (PLSs) of Cochrane systematic reviews are a simple format for presenting medical information to the lay public. This is particularly important in oncology, where patients have a more active role in decision-making. However, current PLS formats often exceed the readability requirements for the general population. There is still a lack of cost-effective and more automated solutions to this problem. Objective: This study assessed whether a large language model (eg, ChatGPT) can improve the readability and linguistic characteristics of Cochrane PLSs about oncology interventions, without changing evidence synthesis conclusions. Methods: The dataset included 275 scientific abstracts and corresponding PLSs of Cochrane systematic reviews about oncology interventions. ChatGPT-4 was tasked to make each scientific abstract into a PLS using 3 prompts as follows: (1) rewrite this scientific abstract into a PLS to achieve a Simple Measure of Gobbledygook (SMOG) index of 6, (2) rewrite the PLS from prompt 1 so it is more emotional, and (3) rewrite this scientific abstract so it is easier to read and more appropriate for the lay audience. ChatGPT-generated PLSs were analyzed for word count, level of readability (SMOG index), and linguistic characteristics using Linguistic Inquiry and Word Count (LIWC) software and compared with the original PLSs. Two independent assessors reviewed the conclusiveness categories of ChatGPT-generated PLSs and compared them with original abstracts to evaluate consistency. The conclusion of each abstract about the efficacy and safety of the intervention was categorized as conclusive (positive/negative/equal), inconclusive, or unclear. Group comparisons were conducted using the Friedman nonparametric test. Results: ChatGPT-generated PLSs using the first prompt (SMOG index 6) were the shortest and easiest to read, with a median SMOG score of 8.2 (95\% CI 8?8.4), compared with the original PLSs (median SMOG score 13.1, 95\% CI 12.9?13.4). These PLSs had a median word count of 240 (95\% CI 232?248) compared with the original PLSs' median word count of 364 (95\% CI 339?388). The second prompt (emotional tone) generated PLSs with a median SMOG score of 11.4 (95\% CI 11.1?12), again lower than the original PLSs. PLSs produced with the third prompt (write simpler and easier) had a median SMOG score of 8.7 (95\% CI 8.4?8.8). ChatGPT-generated PLSs across all prompts demonstrated reduced analytical tone and increased authenticity, clout, and emotional tone compared with the original PLSs. Importantly, the conclusiveness categorization of the original abstracts was unchanged in the ChatGPT-generated PLSs. Conclusions: ChatGPT can be a valuable tool in simplifying PLSs as medically related formats for lay audiences. More research is needed, including oversight mechanisms to ensure that the information is accurate, reliable, and culturally relevant for different audiences. ",
doi="10.2196/63347",
url="https://cancer.jmir.org/2025/1/e63347"
}


@Article{info:doi/10.2196/66801,
author="Pozzar, A. Rachel
and Tulsky, A. James
and Berry, L. Donna
and Batista, Jeidy
and Barwick, Paige
and Lindvall, J. Charlotta
and Dykes, C. Patricia
and Manni, Michael
and Matulonis, A. Ursula
and McCleary, J. Nadine
and Wright, A. Alexi",
title="Usability, Acceptability, and Barriers to Implementation of a Collaborative Agenda-Setting Intervention (CASI) to Promote Person-Centered Ovarian Cancer Care: Development Study",
journal="JMIR Cancer",
year="2025",
month="Mar",
day="10",
volume="11",
pages="e66801",
keywords="ovarian neoplasm",
keywords="ovarian cancer",
keywords="cancer",
keywords="oncology",
keywords="oncologist",
keywords="metastases",
keywords="communication",
keywords="physician-patient relations",
keywords="electronic health record",
keywords="EHR",
keywords="electronic medical record",
keywords="EMR",
keywords="implementation science",
keywords="digital",
keywords="digital health",
keywords="digital technology",
keywords="digital intervention",
keywords="mobile phone",
abstract="Background: People with advanced ovarian cancer and their caregivers report unmet supportive care needs. We developed a Collaborative Agenda-Setting Intervention (CASI) to elicit patients' and caregivers' needs through the patient portal before a clinic visit and to communicate these needs to clinicians using the electronic health record. Objective: We aimed to assess the usability and acceptability of the CASI and identify barriers to and facilitators of its implementation. Methods: We recruited English- and Spanish-speaking patients, caregivers, and clinicians from the gynecologic oncology program at a comprehensive cancer center. Participants used the CASI prototype and then completed individual cognitive interviews and surveys. We assessed usability with the System Usability Scale (scores range 0?100, scores ?70 indicate acceptable usability) and acceptability with the Acceptability of Intervention Measure and Intervention Appropriateness Measure (scores for both measures range from 1 to 5, higher scores indicate greater acceptability). Interviews were audio recorded, transcribed, and analyzed using directed content analysis. Domains and constructs from the Consolidated Framework for Implementation Research comprised the initial codebook. We analyzed survey data using descriptive statistics and compared usability and acceptability scores across patients, caregivers, and clinicians using analyses of variance. Results: We enrolled 15 participants (5 patients, 5 caregivers, and 5 clinicians). The mean System Usability Scale score was 72 (SD 16). The mean Acceptability of Intervention Measure and Intervention Appropriateness Measure scores were 3.9 (SD 1.0) and 4.1 (SD 0.8), respectively. Participants viewed the CASI content and format positively overall. Several participants appreciated the CASI's integration into the clinical workflow and its potential to increase attention to psychosocial concerns. Suggestions to refine the CASI included removing redundant items, simplifying item language, and adding options to request a conversation or opt out of supportive care referrals. Key barriers to implementing the CASI include its complexity and limited resources available to address patients' and caregivers' needs. Conclusions: The CASI is usable and acceptable to patients with advanced ovarian cancer, caregivers, and clinicians. We identified several barriers to and facilitators of implementing the CASI. In future research, we will apply these insights to a pilot randomized controlled trial to assess the feasibility of comparing the CASI to usual care in a parallel group-randomized efficacy trial. ",
doi="10.2196/66801",
url="https://cancer.jmir.org/2025/1/e66801"
}


@Article{info:doi/10.2196/63486,
author="Lyhne, Dam Johanne
and Smith, `Ben' Allan
and Carstensen, Wisbech Tina Birgitte
and Beatty, Lisa
and Bamgboje-Ayodele, Adeola
and Klein, Britt
and Jensen, Henrik Lars
and Frostholm, Lisbeth",
title="Adapting a Self-Guided eHealth Intervention Into a Tailored Therapist-Guided eHealth Intervention for Survivors of Colorectal Cancer",
journal="JMIR Cancer",
year="2025",
month="Mar",
day="5",
volume="11",
pages="e63486",
keywords="fear of cancer recurrence",
keywords="therapist-guided",
keywords="self-guided",
keywords="online intervention",
keywords="colorectal cancer",
keywords="digital health",
keywords="psychosocial intervention",
keywords="survivorship",
keywords="eHealth",
keywords="adaptation",
keywords="survivors",
keywords="oncologists",
keywords="therapists",
keywords="acceptability",
keywords="mobile phone",
abstract="Trial Registration: ClinicalTrials.gov NCT04287218; https://clinicaltrials.gov/study/NCT04287218 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-020-06731-6 ",
doi="10.2196/63486",
url="https://cancer.jmir.org/2025/1/e63486"
}


@Article{info:doi/10.2196/66636,
author="Werts-Pelter, J. Samantha
and Chen, Zhao
and Bea, W. Jennifer
and Sokan, E. Amanda
and Thomson, A. Cynthia",
title="Analysis of the Relationship Between Rural-Urban Status and Use of Digital Health Technology Among Older Cancer Survivors Based on the Health Information National Trends Survey: Cross-Sectional Analysis",
journal="JMIR Cancer",
year="2025",
month="Mar",
day="4",
volume="11",
pages="e66636",
keywords="cancer",
keywords="non-metropolitan",
keywords="disparities",
keywords="digital divide",
keywords="health research",
keywords="aging",
keywords="rural-urban",
keywords="digital health technology",
keywords="cross-sectional",
keywords="health behaviors",
keywords="mobile phone",
abstract="Background: Though telehealth has been a promising avenue for engaging cancer survivors with health care and lifestyle programming, older and rural-dwelling cancer survivors may have additional challenges in accessing digital devices and tools that have not yet been described. This study aimed to use a robust, nationally representative sample collected in 2022 to provide an updated view of digital technology use and the use of technology for health in this population. Objective: This study aimed to examine the prevalence of digital technology use for health-related activities among older cancer survivors in both rural and urban settings. The primary outcomes of interest included (1) internet access and use for health-related activities, (2) digital device ownership and use as a tool for health behaviors, (3) use of social media for health, and (4) use of telehealth. Methods: A cross-sectional analysis of the National Cancer Institute's Health Information National Trends Survey Cycle 6 (HINTS 6) was completed to examine the prevalence of digital technology use among older cancer survivors. For analysis, the sample was restricted to cancer survivors over the age of 60 years (n=710). Unadjusted and adjusted logistic regression models were used to test the association between rurality and digital health tool use. Results: Overall, 17\% (125/710) of the sample lived in a rural area of the United States and the mean sample age was 73 (SD 8.2) years. Older cancer survivors, regardless of rural-urban status, reported a high prevalence of internet usage (n=553, 79.9\%), digital device ownership (n=676, 94.9\%), and social media use (n=448, 66.6\%). In unadjusted models, rural survivors were less likely than urban survivors to report that they had used a health or wellness application in the previous year (odds ratio [OR] 0.56, 95\% CI 0.32-0.97; P=.04). In adjusted models, rural survivors were more likely to report that they had shared personal health information on social media (OR 2.64, 95\% CI 1.13-6.19; P=.03). There were no differences in the proportion of rural and urban respondents who reported receiving health services through telehealth in the previous year. Conclusions: Regardless of the residential status, older cancer survivors report high internet and technology use for health-related activities. These results show promise for the feasibility of using digital technologies to implement supportive care and wellness programming with older cancer survivors. ",
doi="10.2196/66636",
url="https://cancer.jmir.org/2025/1/e66636"
}


@Article{info:doi/10.2196/54625,
author="Tang, Wen-Zhen
and Mo, Shu-Tian
and Xie, Yuan-Xi
and Wei, Tian-Fu
and Chen, Guo-Lian
and Teng, Yan-Juan
and Jia, Kui",
title="Predicting Overall Survival in Patients with Male Breast Cancer: Nomogram Development and External Validation Study",
journal="JMIR Cancer",
year="2025",
month="Mar",
day="4",
volume="11",
pages="e54625",
keywords="male breast cancer",
keywords="specific survival",
keywords="prediction model",
keywords="nomogram",
keywords="Surveillance, Epidemiology, and End Results database",
keywords="SEER database",
abstract="Background: Male breast cancer (MBC) is an uncommon disease. Few studies have discussed the prognosis of MBC due to its rarity. Objective: This study aimed to develop a nomogram to predict the overall survival of patients with MBC and externally validate it using cases from China. Methods: Based on the Surveillance, Epidemiology, and End Results (SEER) database, male patients who were diagnosed with breast cancer between January 2010, and December 2015, were enrolled. These patients were randomly assigned to either a training set (n=1610) or a validation set (n=713) in a 7:3 ratio. Additionally, 22 MBC cases diagnosed at the First Affiliated Hospital of Guangxi Medical University between January 2013 and June 2021 were used for external validation, with the follow-up endpoint being June 10, 2023. Cox regression analysis was performed to identify significant risk variables and construct a nomogram to predict the overall survival of patients with MBC. Information collected from the test set was applied to validate the model. The concordance index (C-index), receiver operating characteristic (ROC) curve, decision curve analysis (DCA), and a Kaplan-Meier survival curve were used to evaluate the accuracy and reliability of the model. Results: A total of 2301 patients with MBC in the SEER database and 22 patients with MBC from the study hospital were included. The predictive model included 7 variables: age (hazard ratio [HR] 1.89, 95\% CI 1.50?2.38), surgery (HR 0.38, 95\% CI 0.29?0.51), marital status (HR 0.75, 95\% CI 0.63?0.89), tumor stage (HR 1.17, 95\% CI 1.05?1.29), clinical stage (HR 1.41, 95\% CI 1.15?1.74), chemotherapy (HR 0.62, 95\% CI 0.50?0.75), and HER2 status (HR 2.68, 95\% CI 1.20?5.98). The C-index was 0.72, 0.747, and 0.981 in the training set, internal validation set, and external validation set, respectively. The nomogram showed accurate calibration, and the ROC curve confirmed the advantage of the model in clinical validity. The DCA analysis indicated that the model had good clinical applicability. Furthermore, the nomogram classification allowed for more accurate differentiation of risk subgroups, and patients with low-risk MBC demonstrated substantially improved survival outcomes compared with medium- and high-risk patients (P<.001). Conclusions: A survival prognosis prediction nomogram with 7 variables for patients with MBC was constructed in this study. The model can predict the survival outcome of these patients and provide a scientific basis for clinical diagnosis and treatment. ",
doi="10.2196/54625",
url="https://cancer.jmir.org/2025/1/e54625"
}


@Article{info:doi/10.2196/59391,
author="Newton, Lorelei
and Monkman, Helen
and Fullerton, Claire",
title="Exploring Older Adult Cancer Survivors' Digital Information Needs: Qualitative Pilot Study",
journal="JMIR Cancer",
year="2025",
month="Feb",
day="27",
volume="11",
pages="e59391",
keywords="older adults",
keywords="cancer survivors",
keywords="digital health literacy",
keywords="digital health technologies",
keywords="aging",
keywords="qualitative",
keywords="pilot study",
keywords="semistructured interview",
abstract="Background: Older adults (aged >65 years) are disproportionately affected by cancer at a time when Canadians are surviving cancer in an unprecedented fashion. Contrary to persistent ageist assumptions, not only do the majority of older adult cancer survivors use digital health technologies (DHTs) regularly, such technologies also serve as important sources of their health information. Although older adults' transition to cancer survivorship is connected to the availability and provision of relevant and reliable information, little evidence exists as to how they use DHTs to supplement their understanding of their unique situation to manage, and make decisions about, their ongoing cancer-related concerns. Objective: This pilot study, which examined older adult cancer survivors' use of DHTs, was conducted to support a larger study designed to explore how digital health literacy dimensions might affect the management of cancer survivorship sequelae. Understanding DHT use is also an important consideration for digital health literacy. Thus, we sought to investigate older adult cancer survivors' perceptions of DHTs in the context of accessing information about their health, health care systems, and health care providers. Methods: A qualitative pilot study, which involved semistructured interviews with older adult cancer survivors (N=5), was conducted to explore how participants interacted with, accessed, and searched for information, as well as how DHT use related to their cancer survivorship. Institutional ethics approval (\#21?0421) was obtained. Interpretive description inquiry---a practice-based approach suitable for generating applied knowledge---supported exploration of the research question. Thematic analysis was used to examine the transcripts for patterns of meaning (themes). Results: Assessing the credibility of digital information remains challenging for older adult cancer survivors. Identified benefits of DHTs included improved access to meet health information needs, older adult cancer survivors feeling empowered to make informed decisions regarding their health trajectory, and the ability to connect with interdisciplinary teams for care continuity. Additionally, participants described feeling disconnected when DHTs seemed to be used as substitutes for human interaction. The results of this pilot study were used to create 12 additional questions to supplement a digital health literacy survey, through which we will seek a more fulsome account of the relationship between digital health literacy and DHTs for older adult cancer survivors. Conclusions: Overall, this pilot study confirmed the utility of DHTs in enhancing the connection of older adult cancer survivors to their health care needs. Importantly, this connection exists on a continuum, and providing greater access to technologies, in combination with human support, leads to feelings of empowerment. DHTs are an important aspect of contemporary health care; yet, these technologies must be seen as complementary and not as replacements for human interaction. Otherwise, we risk dehumanizing patients and disconnecting them from the care that they need and deserve. ",
doi="10.2196/59391",
url="https://cancer.jmir.org/2025/1/e59391"
}


@Article{info:doi/10.2196/65302,
author="Dang, Ha Thu
and Wickramasinghe, Nilmini
and Jayaraman, Prakash Prem
and Burbury, Kate
and Alexander, Marliese
and Whitechurch, Ashley
and Dyer, Mitchell
and Quinn, Stephen
and Forkan, Mohammad Abdur Rahim
and Schofield, Penelope",
title="Digital Solution to Support Medication Adherence and Self-Management in Patients with Cancer (SAMSON): Pilot Randomized Controlled Trial",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="19",
volume="9",
pages="e65302",
keywords="home-based cancer treatment",
keywords="smartphone app",
keywords="oral chemotherapy",
keywords="patient safety",
keywords="SAMSON",
keywords="mobile phone",
keywords="digital solution",
keywords="medication adherence",
keywords="self-management",
keywords="cancer",
keywords="randomized controlled trial",
keywords="RCT",
keywords="pilot study",
keywords="oncology",
keywords="mobile health",
keywords="mHealth",
keywords="quality of life",
keywords="eHealth",
abstract="Background: Medication nonadherence is a serious problem in cancer, potentially impacts patients' health outcomes and health care costs. Although technology-based medication adherence (MA) interventions have emerged, evidence supporting their quality and effectiveness remains limited. Objective: This study tested the acceptability, feasibility, and potential effects of Safety and Adherence to Medications and Self-care Advice in Oncology (SAMSON), a digital solution designed to support MA and self-management in cancer. Methods: A 12-week, 2-arm, unblinded, pragmatic pilot randomized controlled trial was conducted. Adults with hematological malignancies who started oral cancer medicines within the last 12 months were recruited from a metropolitan specialized hospital and randomized 1:1 to SAMSON or control (usual care). The SAMSON solution included a smartphone app with tailored alerts and real-time self-care advice, a web-based dashboard for health care professionals (HCPs) to monitor patients' adherence and symptoms, and motivational interviewing (MI) teleconsultations delivered by oncology nurses and pharmacists at baseline and weeks 1, 4, 8, and 12. Primary outcomes were the patients' acceptance of SAMSON, measured by the Unified Theory of Acceptance and Use of Technology at 12 weeks, and study feasibility, measured by predefined rates of recruitment, randomization, retention, intervention adherence, and outcome assessment completion. Secondary outcomes were comparison of MA and clinical self-assessments through online questionnaires, including adherence, toxicity self-management, anxiety and depression symptoms, and quality of life, measured at baseline and 12 weeks between the 2 arms. Data retrieved from the SAMSON app (Swinburne University of Technology) was analysed for task completion. Results: A total of 33 patients (79\% of those who were approached) consented to participate in the trial. Of those, 31/33 (94\%) completed baseline surveys and were randomized to SAMSON (15/31) and control arms (16/31). Of 31 patients, 28 (90\%) completed the 12-week surveys (12 SAMSON and 16 control). Overall, patients rated the SAMSON solution as highly acceptable (13/15, 87\% app usage; 14/15, 93\% MI teleconsultation delivery). They reported that SAMSON was easy to use (10/12, 83\%) and helpful in improving their MA (6/12, 50\%). All study HCPs reported the SAMSON solution was helpful in supporting patients' MA. Patients completed an average of 99 tasks over the 12-week study period (71\% of scheduled tasks). Most patients (10/12, 83\%) completed all 5 scheduled consultations. All study feasibility measures were higher than the predefined upper thresholds, except the rate of patients' responses to medication reminders. Conclusions: The results demonstrated that the SAMSON solution is acceptable, usable, and useful for oncology HCPs and patients with cancer. The SAMSON solution is feasible in real-life oncology settings. Our next steps involve refining the SAMSON solution based on participants' feedback, conducting a large-scale randomized controlled trial to evaluate its clinical and economic effectiveness, and exploring potential commercialization. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000472673; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385728 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-079122 ",
doi="10.2196/65302",
url="https://formative.jmir.org/2025/1/e65302",
url="http://www.ncbi.nlm.nih.gov/pubmed/39969972"
}


@Article{info:doi/10.2196/64145,
author="Bargas-Ochoa, Miguel
and Zulbaran-Rojas, Alejandro
and Finco, G. M.
and Costales, B. Anthony
and Flores-Camargo, Areli
and Bara, O. Rasha
and Pacheco, Manuel
and Phan, Tina
and Khichi, Aleena
and Najafi, Bijan",
title="Development and Implementation of a Personal Virtual Assistant for Patient Engagement and Communication in Postsurgical Cancer Care: Feasibility Cohort Study",
journal="JMIR Cancer",
year="2025",
month="Feb",
day="18",
volume="11",
pages="e64145",
keywords="digital health",
keywords="personal virtual assistant",
keywords="remote patient monitoring",
keywords="surgical oncology",
keywords="posthospital discharge",
keywords="postoperative support",
keywords="medication adherence postsurgery",
keywords="patient engagement",
keywords="mHealth",
keywords="mobile health",
abstract="Background: Cancer-care complexity heightens communication challenges between health care providers and patients, impacting their treatment adherence. This is especially evident upon hospital discharge in patients undergoing surgical procedures. Digital health tools offer potential solutions to address communication challenges seen in current discharge protocols. We aim to explore the usability and acceptability of an interactive health platform among discharged patients who underwent oncology-related procedures. Methods: A 4-week exploratory cohort study was conducted. Following hospital discharge, a tablet equipped with an integrated Personal Virtual Assistant (PVA) system was provided to patients who underwent oncology-related procedures. The PVA encompasses automated features that provide personalized care plans, developed through collaboration among clinicians, researchers, and engineers from various disciplines. These plans include guidance on daily specific assignments that were divided into 4 categories: medication intake, exercise, symptom surveys, and postprocedural specific tasks. The aim was to explore the acceptability of the PVA by quantification of dropout rate and assessing adherence to each care plan category throughout the study duration. The secondary aim assessed acceptability of the PVA through a technology acceptance model (TAM) questionnaire that examined ease of use, usefulness, attitude toward use, and privacy concerns. Results: In total, 17 patients were enrolled. However, 1 (5.8\%) patient dropped out from the study after 3 days due to health deterioration, leaving 16/17 (94.2\%) completing the study (mean age 54.5, SD 12.7, years; n=9, 52\% Caucasian; n=14, 82\% with a gynecological disease; n=3, 18\% with a hepatobiliary disease). At the study end point, adherence to care plan categories were 78\% (SD 25\%) for medications, 81\% (SD 24\%) for exercises, 61\% (SD 30\%) for surveys, and 58\% (SD 44\%) for specific tasks such as following step-by step wound care instructions, managing drains, administering injectable medications independently, and performing pelvic baths as instructed. There was an 80\% patient endorsement (strongly agree or agree) across all TAM categories. Conclusion: This study suggests the potential acceptability of the PVA among patients discharged after oncology-related procedures, with a dropout rate of less than 6\% and fair-to-good adherence to tasks such as medication intake and exercise. However, these findings are preliminary due to the small sample size and highlight the need for further research with larger cohorts to validate and refine the system. ",
doi="10.2196/64145",
url="https://cancer.jmir.org/2025/1/e64145"
}


@Article{info:doi/10.2196/66269,
author="Shan, Rui
and Li, Xin
and Chen, Jing
and Chen, Zheng
and Cheng, Yuan-Jia
and Han, Bo
and Hu, Run-Ze
and Huang, Jiu-Ping
and Kong, Gui-Lan
and Liu, Hui
and Mei, Fang
and Song, Shi-Bing
and Sun, Bang-Kai
and Tian, Hui
and Wang, Yang
and Xiao, Wu-Cai
and Yao, Xiang-Yun
and Ye, Jing-Ming
and Yu, Bo
and Yuan, Chun-Hui
and Zhang, Fan
and Liu, Zheng",
title="Interpretable Machine Learning to Predict the Malignancy Risk of Follicular Thyroid Neoplasms in Extremely Unbalanced Data: Retrospective Cohort Study and Literature Review",
journal="JMIR Cancer",
year="2025",
month="Feb",
day="10",
volume="11",
pages="e66269",
keywords="follicular thyroid neoplasm",
keywords="machine learning",
keywords="prediction model",
keywords="malignancy",
keywords="unbalanced data",
keywords="literature review",
abstract="Background: Diagnosing and managing follicular thyroid neoplasms (FTNs) remains a significant challenge, as the malignancy risk cannot be determined until after diagnostic surgery. Objective: We aimed to use interpretable machine learning to predict the malignancy risk of FTNs preoperatively in a real-world setting. Methods: We conducted a retrospective cohort study at the Peking University Third Hospital in Beijing, China. Patients with postoperative pathological diagnoses of follicular thyroid adenoma (FTA) or follicular thyroid carcinoma (FTC) were included, excluding those without preoperative thyroid ultrasonography. We used 22 predictors involving demographic characteristics, thyroid sonography, and hormones to train 5 machine learning models: logistic regression, least absolute shrinkage and selection operator regression, random forest, extreme gradient boosting, and support vector machine. The optimal model was selected based on discrimination, calibration, interpretability, and parsimony. To address the highly imbalanced data (FTA:FTC ratio>5:1), model discrimination was assessed using both the area under the receiver operating characteristic curve and the area under the precision-recall curve (AUPRC). To interpret the model, we used Shapley Additive Explanations values and partial dependence and individual conditional expectation plots. Additionally, a systematic review was performed to synthesize existing evidence and validate the discrimination ability of the previously developed Thyroid Imaging Reporting and Data System for Follicular Neoplasm scoring criteria to differentiate between benign and malignant FTNs using our data. Results: The cohort included 1539 patients (mean age 47.98, SD 14.15 years; female: n=1126, 73.16\%) with 1672 FTN tumors (FTA: n=1414; FTC: n=258; FTA:FTC ratio=5.5). The random forest model emerged as optimal, identifying mean thyroid-stimulating hormone (TSH) score, mean tumor diameter, mean TSH, TSH instability, and TSH measurement levels as the top 5 predictors in discriminating FTA from FTC, with the area under the receiver operating characteristic curve of 0.79 (95\% CI 0.77?0.81) and AUPRC of 0.40 (95\% CI 0.37-0.44). Malignancy risk increased nonlinearly with larger tumor diameters and higher TSH instability but decreased nonlinearly with higher mean TSH scores or mean TSH levels. FTCs with small sizes (mean diameter 2.88, SD 1.38 cm) were more likely to be misclassified as FTAs compared to larger ones (mean diameter 3.71, SD 1.36 cm). The systematic review of the 7 included studies revealed that (1) the FTA:FTC ratio varied from 0.6 to 4.0, lower than the natural distribution of 5.0; (2) no studies assessed prediction performance using AUPRC in unbalanced datasets; and (3) external validations of Thyroid Imaging Reporting and Data System for Follicular Neoplasm scoring criteria underperformed relative to the original study. Conclusions: Tumor size and TSH measurements were important in screening FTN malignancy risk preoperatively, but accurately predicting the risk of small-sized FTNs remains challenging. Future research should address the limitations posed by the extreme imbalance in FTA and FTC distributions in real-world data. ",
doi="10.2196/66269",
url="https://cancer.jmir.org/2025/1/e66269"
}


@Article{info:doi/10.2196/64747,
author="Kennedy, Fiona
and Smith, Susan
and Beeken, J. Rebecca
and Buck, Caroline
and Williams, Sarah
and Martin, Charlene
and Lally, Phillippa
and Fisher, Abi",
title="An App-Based Intervention With Behavioral Support to Promote Brisk Walking in People Diagnosed With Breast, Prostate, or Colorectal Cancer (APPROACH): Process Evaluation Study",
journal="JMIR Cancer",
year="2025",
month="Feb",
day="10",
volume="11",
pages="e64747",
keywords="cancer",
keywords="physical activity",
keywords="process evaluation",
keywords="randomized controlled trial",
keywords="intervention",
keywords="app",
keywords="habit",
abstract="Background: The APPROACH pilot study explored the feasibility and acceptability of an app (NHS Active 10) with brief, habit-based, behavioral support calls and print materials intended to increase brisk walking in people diagnosed with cancer. Objective: Following UK Medical Research Council guidelines, this study assessed the implementation of the intervention, examined the mechanisms of impact, and identified contextual factors influencing engagement. Methods: Adults (aged ?18 y) with breast, prostate, or colorectal cancer who reported not meeting the UK guidelines for moderate-to-vigorous physical activity (?150 min/wk) were recruited from a single hospital site in Yorkshire, United Kingdom. They were randomly assigned to the intervention or control (usual care) arm and assessed via quantitative surveys at baseline (time point 0 [T0]) and 3-month follow-up (time point 1 [T1]) and qualitative exit interviews (36/44, 82\%) at T1. The process evaluation included intervention participants only (n=44). Implementation was assessed using data from the T1 questionnaire exploring the use of the intervention components. The perceived usefulness of the app, leaflet, and behavioral support call was rated from 0 to 5. Behavioral support calls were recorded, and the fidelity of delivery of 25 planned behavior change techniques was rated from 0 to 5 using an adapted Dreyfus scale. Mechanisms of impact were identified by examining T0 and T1 scores on the Self-Reported Behavioural Automaticity Index and feedback on the leaflet, app, call, and planner in the T1 questionnaire and qualitative interviews. Contextual factors influencing engagement were identified through qualitative interviews. Results: The implementation of the intervention was successful: 98\% (43/44) of the participants received a behavioral support call, 78\% (32/41) reported reading the leaflet, 95\% (39/41) reported downloading the app, and 83\% (34/41) reported using the planners. The mean perceived usefulness of the app was 4.3 (SD 0.8) in participants still using the app at T1 (n=33). Participants rated the leaflet (mean 3.9, SD 0.6) and the behavioral support call (mean 4.1, SD 1) as useful. The intended behavior change techniques in the behavioral support calls were proficiently delivered (overall mean 4.2, SD 1.2). Mechanisms of impact included habit formation, behavioral monitoring, and support and reassurance from the intervention facilitator. Contextual factors impacting engagement included barriers, such as the impact of cancer and its treatment, and facilitators, such as social support. Conclusions: The APPROACH intervention was successfully implemented and shows promise for increasing brisk walking, potentially through promoting habit formation and enabling self-monitoring. Contextual factors will be important to consider when interpreting outcomes in the larger APPROACH randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-022-01028-w ",
doi="10.2196/64747",
url="https://cancer.jmir.org/2025/1/e64747"
}


@Article{info:doi/10.2196/50124,
author="Jonnalagedda-Cattin, Magali
and Moukam Datchoua, Mano{\"e}la Alida
and Yakam, Flore Virginie
and Kenfack, Bruno
and Petignat, Patrick
and Thiran, Jean-Philippe
and Sch{\"o}nenberger, Klaus
and Schmidt, C. Nicole",
title="Barriers and Facilitators to the Preadoption of a Computer-Aided Diagnosis Tool for Cervical Cancer: Qualitative Study on Health Care Providers' Perspectives in Western Cameroon",
journal="JMIR Cancer",
year="2025",
month="Feb",
day="5",
volume="11",
pages="e50124",
keywords="qualitative research",
keywords="technology acceptance",
keywords="cervical cancer",
keywords="diagnosis",
keywords="computer-assisted",
keywords="decision support systems",
keywords="artificial intelligence",
keywords="health personnel attitudes",
keywords="Cameroon",
keywords="mobile phone",
abstract="Background: Computer-aided detection and diagnosis (CAD) systems can enhance the objectivity of visual inspection with acetic acid (VIA), which is widely used in low- and middle-income countries (LMICs) for cervical cancer detection. VIA's reliance on subjective health care provider (HCP) interpretation introduces variability in diagnostic accuracy. CAD tools can address some limitations; nonetheless, understanding the contextual factors affecting CAD integration is essential for effective adoption and sustained use, particularly in resource-constrained settings. Objective: This study investigated the barriers and facilitators perceived by HCPs in Western Cameroon regarding sustained CAD tool use for cervical cancer detection using VIA. The aim was to guide smooth technology adoption in similar settings by identifying specific barriers and facilitators and optimizing CAD's potential benefits while minimizing obstacles. Methods: The perspectives of HCPs on adopting CAD for VIA were explored using a qualitative methodology. The study participants included 8 HCPs (6 midwives and 2 gynecologists) working in the Dschang district, Cameroon. Focus group discussions were conducted with midwives, while individual interviews were conducted with gynecologists to comprehend unique perspectives. Each interview was audio-recorded, transcribed, and independently coded by 2 researchers using the ATLAS.ti (Lumivero, LLC) software. The technology acceptance lifecycle framework guided the content analysis, focusing on the preadoption phases to examine the perceived acceptability and initial acceptance of the CAD tool in clinical workflows. The study findings were reported adhering to the COREQ (Consolidated Criteria for Reporting Qualitative Research) and SRQR (Standards for Reporting Qualitative Research) checklists. Results: Key elements influencing the sustained use of CAD tools for VIA by HCPs were identified, primarily within the technology acceptance lifecycle's preadoption framework. Barriers included the system's ease of use, particularly challenges associated with image acquisition, concerns over confidentiality and data security, limited infrastructure and resources such as the internet and device quality, and potential workflow changes. Facilitators encompassed the perceived improved patient care, the potential for enhanced diagnostic accuracy, and the integration of CAD tools into routine clinical practices, provided that infrastructure and training were adequate. The HCPs emphasized the importance of clinical validation, usability testing, and iterative feedback mechanisms to build trust in the CAD tool's accuracy and utility. Conclusions: This study provides practical insights from HCPs in Western Cameroon regarding the adoption of CAD tools for VIA in clinical settings. CAD technology can aid diagnostic objectivity; however, data management, workflow adaptation, and infrastructure limitations must be addressed to avoid ``pilotitis''---the failure of digital health tools to progress beyond the pilot phase. Effective implementation requires comprehensive technology management, including regulatory compliance, infrastructure support, and user-focused training. Involving end users can ensure that CAD tools are fully integrated and embraced in LMICs to aid cervical cancer screening. ",
doi="10.2196/50124",
url="https://cancer.jmir.org/2025/1/e50124"
}


@Article{info:doi/10.2196/65974,
author="Villain, Patricia
and Downham, Laura
and Le Bonniec, Alice
and Bauquier, Charlotte
and Mandrik, Olena
and Nadarzynski, Tom
and Donelle, Lorie
and Murillo, Ra{\'u}l
and Tolma, L. Eleni
and Johnson, Sonali
and Soler-Michel, Patricia
and Smith, Robert",
title="Impact of Online Interactive Decision Tools on Women's Decision-Making Regarding Breast Cancer Screening: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="29",
volume="27",
pages="e65974",
keywords="breast cancer screening",
keywords="decision-making",
keywords="online interactive",
keywords="decision aid",
keywords="average risk",
keywords="shared decision-making",
keywords="screening participation",
keywords="cognitive determinants",
keywords="women",
abstract="Background: The online nature of decision aids (DAs) and related e-tools supporting women's decision-making regarding breast cancer screening (BCS) through mammography may facilitate broader access, making them a valuable addition to BCS programs. Objective: This systematic review and meta-analysis aims to evaluate the scientific evidence on the impacts of these e-tools and to provide a comprehensive assessment of the factors associated with their increased utility and efficacy. Methods: We followed the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted a search of MEDLINE, PsycINFO, Embase, CINAHL, and Web of Science databases from August 2010 to April 2023. We included studies reporting on populations at average risk of breast cancer, which utilized DAs or related e-tools, and assessed women's participation in BCS by mammography or other key cognitive determinants of decision-making as primary or secondary outcomes. We conducted meta-analyses on the identified randomized controlled trials, which were assessed using the revised Cochrane Risk of Bias 2 (RoB 2) tool. We further explored intermediate and high heterogeneity between studies to enhance the validity of our results. Results: In total, 22 different e-tools were identified across 31 papers. The degree of tailoring in the e-tools, specifically whether the tool was fully tailored or featured with tailoring, was the most influential factor in women's decision-making regarding BCS. Compared with control groups, tailored e-tools significantly increased women's long-term participation in BCS (risk ratio 1.14, 95\% CI 1.07-1.23, P<.001, I2=0\%). Tailored-to-breast-cancer-risk e-tools increased women's level of worry (mean difference 0.31, 95\% CI 0.13-0.48, P<.001, I2=0\%). E-tools also improved women's adequate knowledge of BCS, with features-with-tailoring e-tools designed and tested with the general population being more effective than tailored e-tools designed for or tested with non-BCS participants ($\chi$21=5.1, P=.02). Features-with-tailoring e-tools increased both the rate of women who intended not to undergo BCS (risk ratio 1.88, 95\% CI 1.43-2.48, P<.001, I2=0\%) and the rate of women who had made an informed choice regarding their intention to undergo BCS (risk ratio 1.60, 95\% CI 1.09-2.33, P=.02, I2=91\%). Additionally, these tools decreased the proportion of women with decision conflict (risk ratio 0.77, 95\% CI 0.65-0.91, P=.002, I2=0\%). Shared decision-making was not formally evaluated. This review is limited by small sample sizes, including only a few studies in the meta-analysis, some with a high risk of bias, and high heterogeneity between the studies and e-tools. Conclusions: Features-with-tailoring e-tools could potentially negatively impact BCS programs by fostering negative intentions and attitudes toward BCS participation. Conversely, tailored e-tools may increase women's participation in BCS but, when tailored to risk, they may elevate their levels of worry. To maximize the effectiveness of e-tools while minimizing potential negative impacts, we advocate for an ``on-demand'' layered approach to their design. ",
doi="10.2196/65974",
url="https://www.jmir.org/2025/1/e65974"
}


@Article{info:doi/10.2196/60585,
author="Mazzella-Ebstein, Marie Ann
and Daly, Robert
and Huang, Jennie
and Bernal, Camila
and Wilhelm, Clare
and Panageas, S. Katherine
and Holland, Jessie
and Salvaggio, Rori
and Ackerman, Jill
and Cracchiolo, Jennifer
and Kuperman, Gilad
and Mao, Jun
and Begue, Aaron
and Barton-Burke, Margaret",
title="Oncology Clinicians' Perspectives of a Remote Patient Monitoring Program: Multi-Modal Case Study Approach",
journal="JMIR Hum Factors",
year="2025",
month="Jan",
day="24",
volume="12",
pages="e60585",
keywords="cancer",
keywords="oncology",
keywords="clinician end users",
keywords="remote patient monitoring",
keywords="digital health",
keywords="implementation science",
keywords="patient monitoring",
keywords="patient access",
keywords="care",
keywords="communication",
keywords="usability",
keywords="functionality",
keywords="survey",
keywords="interview",
keywords="efficiency",
keywords="workflow",
keywords="user",
keywords="clinician support",
abstract="Background: Remote patient monitoring (RPM) aims to improve patient access to care and communication with clinical providers. Overall, understanding the usability of RPM applications and their influence on clinical care workflows is limited from the perspectives of clinician end users at a cancer center in the Northeastern United States. Objective: This study aims to explore the usability and functionality of RPM and elicit the perceptions and experiences of oncology clinicians using RPM for oncology patients after hospital discharge. Methods: The sample included 30 of 98 clinicians (31\% response rate) managing at least 5 patients in the RPM program and responding to the mHealth usability between March 2021 and October 2021. Overall, clinicians responded positively to the survey. Item responses with the highest proportion of disagreement were explored further. A nested sample of 5 clinicians who responded to the study survey (30\% response rate) participated in interview sessions conducted from November 2021 to February 2022, averaging 60 minutes each. Results: Survey responses highlighted that RPM was easy to use and learn and verified symptom alerts during follow-up phone calls. Areas to improve identified practice changes from reporting RPM alerts through digital portals and its influence on clinicians' workload burden. Interview sessions revealed 3 main themes: clinician understanding and usability constraints, patient constraints, and suggestions for improving the program. Subthemes for each theme were explored, characterizing technical and functional limitations that could be addressed to enhance efficiency, workflow, and user experience. Conclusions: Clinicians support the value of RPM for improving symptom management and engaging with providers. Improvements to address RPM challenges include functional changes to enhance the program's utility, such as input from patients about temporal changes in their symptoms and technical resources for home monitoring devices. ",
doi="10.2196/60585",
url="https://humanfactors.jmir.org/2025/1/e60585"
}


@Article{info:doi/10.2196/56625,
author="Brunelli, Cinzia
and Alfieri, Sara
and Zito, Emanuela
and Spelta, Marco
and Arba, Laura
and Lombi, Linda
and Caselli, Luana
and Caraceni, Augusto
and Borreani, Claudia
and Roli, Anna
and Miceli, Rosalba
and Tine', Gabriele
and Zecca, Ernesto
and Platania, Marco
and Procopio, Giuseppe
and Nicolai, Nicola
and Battaglia, Luigi
and Lozza, Laura
and Shkodra, Morena
and Massa, Giacomo
and Loiacono, Daniele
and Apolone, Giovanni",
title="Patient Voices: Multimethod Study on the Feasibility of Implementing Electronic Patient-Reported Outcome Measures in a Comprehensive Cancer Center",
journal="JMIR Cancer",
year="2025",
month="Jan",
day="22",
volume="11",
pages="e56625",
keywords="feasibility",
keywords="oncology",
keywords="patient-reported outcomes",
keywords="PROMs",
keywords="quality of life",
keywords="mixed methods study",
keywords="cancer",
keywords="electronic patient-reported outcomes",
keywords="patient compliance",
keywords="barrier",
keywords="implementation",
keywords="usability scale",
keywords="semistructured interview",
keywords="questionnaire",
keywords="clinical management",
keywords="eHealth",
abstract="Background: ``Patient Voices'' is a software developed to promote the systematic collection of electronic patient-reported outcome measures (ePROMs) in routine oncology clinical practice. Objective: This study aimed to assess compliance with and feasibility of the Patient Voices ePROM system and analyze patient-related barriers in an Italian comprehensive cancer center. Methods: Consecutive patients with cancer attending 3 outpatient clinics and 3 inpatient wards were screened for eligibility (adults, native speakers, and being able to fill in the ePROMs) and enrolled in a quantitative and qualitative multimethod study. Compliance, reasons for not administering the ePROMs, patients' interaction needs, and patient-perceived System Usability Scale (range 0-100) were collected; semistructured interviews were carried out in a subsample of patients. Results: From June 2020 to September 2021, a total of 435 patients were screened, 421 (96.7\%) were eligible, and 309 completed the ePROMs (309/421, 73.4\%; 95\% CI 69.8\%-77.5\%; mean age 63.3, SD 13.7 years). Organization problems and patient refusal were the main reasons for not administering the ePROMs (outpatients: 40/234, 17.1\% and inpatients: 44/201, 21.9\%). Help for tablet use was needed by 27.8\% (47/169) of outpatients and 10.7\% (15/140) of inpatients, while the support received for item interpretation was similar in the 2 groups (outpatients: 36/169, 21.3\% and inpatients: 26/140, 18.6\%). Average System Usability Scale scores indicated high usability in both groups (outpatients: mean 86.8, SD 15.8 and inpatients: mean 83.9, SD 18.8). Overall, repeated measurement compliance was 76.9\% (173/225; outpatients only). Interviewed patients showed positive attitudes toward ePROMs. However, there are barriers to implementation related to the time and cognitive effort required to complete the questionnaires. There is also skepticism about the usefulness of ePROMs in interactions with health care professionals. Conclusions: This study provides useful information for future ePROM implementation strategies, aimed at effectively supporting the routine clinical management and care of patients with cancer. In addition, these findings may be relevant to other organizations willing to systematically collect PROMs or ePROMs in their clinical routines. Trial Registration: ClinicalTrials.gov NCT03968718; https://clinicaltrials.gov/study/NCT03968718 ",
doi="10.2196/56625",
url="https://cancer.jmir.org/2025/1/e56625"
}


@Article{info:doi/10.2196/54609,
author="Kumar, Naresh
and Hui, Jian Si
and Lee, Renick
and Athia, Sahil
and Tan, Hao Joel Yong
and Tan, Hao Jonathan Jiong",
title="Evaluation of the Feasibility of Transfusing Leukocyte Depletion Filter--Processed Intraoperative Cell Salvage Blood in Metastatic Spine Tumor Surgery: Protocol for a Non--Randomized Study",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="17",
volume="14",
pages="e54609",
keywords="blood transfusion",
keywords="autologous blood transfusion",
keywords="operative blood salvage",
keywords="leukocyte reduction filtration",
keywords="intraoperative blood cell salvage",
keywords="extramedullary spinal cord compression",
keywords="metastases",
keywords="tumors",
keywords="leukocytes",
abstract="Background: Metastatic spine tumor surgery (MSTS) is often complex and extensive leading to significant blood loss. Allogeneic blood transfusion (ABT) is the mainstay of blood replenishment but with immune-mediated postoperative complications. Alternative blood management techniques (salvaged blood transfusion [SBT]) allow us to overcome such complications. Despite widespread use of intraoperative cell salvage (IOCS) in oncological and nononcological surgical procedures, surgeons remain reluctant to use IOCS in MSTS. Objective: This study aims to analyze safety of IOCS-leukocyte depletion filter (LDF)--processed blood transfusion for patients undergoing MSTS by assessing clinical outcomes---disease progression: tumor progression and overall survival. This study evaluates whether reinfusion of IOCS-LDF--processed blood reduces ABT rates in patients undergoing MSTS by sorting patients undergoing MSTS who require ABT into patients who consent to receive or not receive SBT. Methods: We aim to recruit a minimum of 90 patients---30 patients for SBT, 30 patients for ABT, and 30 patients with no blood transfusion. SBT and ABT form the 2 experimental arms, whereas no blood transfusion forms the control cohort. Available patient data will be reviewed to determine tumor burden secondary to metastasis and postoperative survival and disease progression, improvement in pain, and neurological and ambulatory status. Data collected will be studied postoperatively at 3, 6, 12, 24, 36, and 48 months or until demise, whichever occurs first. Outcomes of the experimental groups will be compared with those of the control group. Outcomes will be analyzed using 1-way ANOVA and Fisher exact test. The Kaplan-Meier curve and a log-rank test will be used to study overall survival. A multivariate and competing risk analysis will be used to study the association between blood transfusion type and tumor progression. All statistical analyses will be done using Stata Special Edition 14.0 (StataCorp LP). Results: This is the largest clinical study on use of IOCS in MSTS from various primary malignancies to date. It will provide significant clinical evidence regarding the safety and applicability of IOCS in MSTS. It will help reduce use of ABT, improving overall blood management of patients undergoing MSTS. A limitation of this study is that not all patients undergoing MSTS will survive for the follow-up period (4 years), theoretically leading to underreporting of disease progression. Study commenced in 2016 and patient recruitment continued till 2019. As of September 2019, we have collected operative data on 140 patients. However, the 2-year outcomes of about 40.0\% (56/140) of patients are in the process of collection. The study is aimed to be published in the years 2023-2024. Conclusions: Results will be disseminated via peer-reviewed publications, paving the way for future studies. International Registered Report Identifier (IRRID): DERR1-10.2196/54609 ",
doi="10.2196/54609",
url="https://www.researchprotocols.org/2025/1/e54609"
}


@Article{info:doi/10.2196/57715,
author="Fong, Allan
and Boxley, Christian
and Schubel, Laura
and Gallagher, Christopher
and AuBuchon, Katarina
and Arem, Hannah",
title="Identifying Complex Scheduling Patterns Among Patients With Cancer With Transportation and Housing Needs: Feasibility Pilot Study",
journal="JMIR Cancer",
year="2025",
month="Jan",
day="17",
volume="11",
pages="e57715",
keywords="patient scheduling",
keywords="scheduling complexities",
keywords="temporal data mining",
keywords="dataset",
keywords="breast cancer",
keywords="social determinant of health",
keywords="oncology",
keywords="metastasis",
keywords="cancer patient",
keywords="social support",
keywords="community health worker",
keywords="housing need",
keywords="care",
keywords="transportation",
keywords="algorithm",
abstract="Background: Patients with cancer frequently encounter complex treatment pathways, often characterized by challenges with coordinating and scheduling appointments at various specialty services and locations. Identifying patients who might benefit from scheduling and social support from community health workers or patient navigators is largely determined on a case-by-case basis and is resource intensive. Objective: This study aims to propose a novel algorithm to use scheduling data to identify complex scheduling patterns among patients with transportation and housing needs. Methods: We present a novel algorithm to calculate scheduling complexity from patient scheduling data. We define patient scheduling complexity as an aggregation of sequence, resolution, and facility components. Schedule sequence complexity is the degree to which appointments are scheduled and arrived to in a nonchronological order. Resolution complexity is the degree of no shows or canceled appointments. Location complexity reflects the proportion of appointment dates at 2 or more different locations. Schedule complexity captures deviations from chronological order, unresolved appointments, and coordination across multiple locations. We apply the scheduling complexity algorithm to scheduling data from 38 patients with breast cancer enrolled in a 6-month comorbidity management intervention at an urban hospital in the Washington, DC area that serves low-income patients. We compare the scheduling complexity metric with count-based metrics: arrived ratio, rescheduled ratio, canceled ratio, and no-show ratio. We defined an aggregate count-based adjustment metric as the harmonic mean of rescheduled ratio, canceled ratio, and no-show ratio. A low count-based adjustment metric would indicate that a patient has fewer disruptions or changes in their appointment scheduling. Results: The patients had a median of 88 unique appointments (IQR 60.3), 62 arrived appointments (IQR 47.8), 13 rescheduled appointments (IQR 13.5), 9 canceled appointments (IQR 10), and 1.5 missed appointments (IQR 5). There was no statistically significant difference in count-based adjustments and scheduling complexity bins ($\chi$24=6.296, P=.18). In total, 5 patients exhibited high scheduling complexity with low count-based adjustments. A total of 2 patients exhibited high count-based adjustments with low scheduling complexity. Out of the 15 patients that indicated transportation or housing insecurity issues in conversations with community health workers, 86.7\% (13/15) patients were identified as medium or high scheduling complexity while 60\% (9/15) were identified as medium or high count-based adjustments. Conclusions: Scheduling complexity identifies patients with complex but nonchronological scheduling behaviors who would be missed by traditional count-based metrics. This study shows a potential link between transportation and housing needs with schedule complexity. Scheduling complexity can complement count-based metrics when identifying patients who might need additional care coordination support especially as it relates to transportation and housing needs. Trial Registration: ClinicalTrials.gov NCT04836221; https://clinicaltrials.gov/study/NCT04836221 ",
doi="10.2196/57715",
url="https://cancer.jmir.org/2025/1/e57715"
}


@Article{info:doi/10.2196/59478,
author="Marker, J. Ryan
and Kittelson, J. Andrew
and Scorsone, J. Jared
and Moran, A. Ian
and Quindry, C. John
and Leach, J. Heather",
title="A Novel Telehealth Exercise Program Designed for Rural Survivors of Cancer With Cancer-Related Fatigue: Single-Arm Feasibility Trial",
journal="JMIR Cancer",
year="2025",
month="Jan",
day="10",
volume="11",
pages="e59478",
keywords="cancer-related fatigue",
keywords="telehealth",
keywords="physical activity",
keywords="survivorship",
keywords="digital health",
keywords="lifestyle intervention",
keywords="videoconference",
keywords="symptom burden",
keywords="symptom monitoring",
keywords="geographic disparities",
keywords="mHealth",
abstract="Background: Exercise interventions are among the best-known interventions for cancer-related fatigue (CRF). Rural survivors of cancer, however, report specific barriers to engaging in exercise programs and lack overall access to effective programs. Objective: The purpose of this investigation was to assess the feasibility of a novel telehealth exercise program designed specifically for rural survivors of cancer with CRF. Methods: A single-arm clinical trial of the BfitBwell Telehealth Program was performed. Based on an established clinical program, this adapted 12-week program addressed barriers previously reported by rural survivors by providing synchronous videoconference exercise sessions (2 per program), asynchronous exercise sessions using a personal training smartphone or internet app (3-5 per week), and regular symptom (CRF) monitoring using automated emailed surveys (every 2 weeks). Personalized exercise prescriptions containing aerobic and resistance activities were implemented by cancer exercise specialists. Symptom-triggered synchronous sessions were initiated for participants failing to improve in CRF, as identified by a reference chart of CRF improvements observed during a supervised exercise program. Eligible participants were adult survivors of any cancer diagnosis who had completed treatment with curative intent in the past 12 months or had no planned changes in treatment for the duration of the study, lived in a rural area, and were currently experiencing CRF. Feasibility was assessed by objective measures of recruitment, data collection, intervention acceptability and suitability, and preliminary evaluations of participant responses. CRF was the primary clinical outcome (assessed using the Functional Assessment of Chronic Illness Therapy---Fatigue Scale [FACIT-Fatigue]) and was measured before, after, and 6 months after program completion. Results: In total, 19 participants enrolled in the study, 16 initiated the exercise program, and 15 completed the program. A total of 14 participants were recruited through internet advertisements, and the total recruitment rate peaked at 5 participants per month. Participants completed 100\% of initial and final assessments (30 assessments across all participants) and 93\% (70/75 possible surveys across all participants) of emailed surveys and attended 97\% (29/30 possible sessions across all participants) of synchronous exercise sessions. In total, 6 participants initiated symptom-triggered sessions, with 6 of 7 initiated sessions attended. The mean FACIT-Fatigue scores significantly improved (P=.001) by 11.2 (SD 6.8) points following the completion of the program. A total of 13 participants demonstrated at least a minimal clinically important difference in FACIT-Fatigue scores (? +3 points) at this time. FACIT-Fatigue scores did not significantly change from program completion to 6-month follow-up (n=13; mean change --1.1, SD 3.4 points; P=.29). Conclusions: Results from this investigation support the feasibility of the BfitBwell Telehealth Program and a subsequent efficacy trial. Novel program components also provide potential models for improving exercise program efficacy and efficiency through asynchronous exercise prescription and symptom monitoring. Trial Registration: ClinicalTrials.gov NCT04533165; https://clinicaltrials.gov/study/NCT04533165 ",
doi="10.2196/59478",
url="https://cancer.jmir.org/2025/1/e59478"
}


@Article{info:doi/10.2196/65148,
author="Scruton, Sarah
and Wong, Geoff
and Babinski, Stephanie
and Squires, R. Lauren
and Berlin, Alejandro
and Easley, Julie
and McGee, Sharon
and Noel, Ken
and Rodin, Danielle
and Sussman, Jonathan
and Urquhart, Robin
and Bender, L. Jacqueline",
title="Optimizing Virtual Follow-Up Care: Realist Evaluation of Experiences and Perspectives of Patients With Breast and Prostate Cancer",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="3",
volume="27",
pages="e65148",
keywords="cancer",
keywords="follow-up",
keywords="virtual",
keywords="outcomes",
keywords="realist evaluation",
keywords="survivorship",
abstract="Background: Virtual follow-up (VFU) has the potential to enhance cancer survivorship care. However, a greater understanding is needed of how VFU can be optimized. Objective: This study aims to examine how, for whom, and in what contexts VFU works for cancer survivorship care. Methods: We conducted a realist evaluation of VFU among patients with breast cancer and prostate cancer at an urban cancer center during the COVID-19 pandemic. Realist evaluations examine how underlying causal processes of an intervention (mechanisms) in specific circumstances (contexts) interact to produce results (outcomes). Semistructured interviews were conducted with a purposive sample of patients ?5 years after diagnosis. Interviews were audio-recorded and analyzed using a realist logic of analysis. Results: Participants (N=24; n=12, 50\% with breast cancer and n=12, 50\% with prostate cancer) had an average age of 59.6 (SD 10.7) years. Most participants (20/24, 83\%) were satisfied with VFU and wanted VFU options to continue after the COVID-19 pandemic. However, VFU impacted patient perceptions of the quality of their care, particularly in terms of its effectiveness and patient centeredness. Whether VFU worked well for patients depended on patient factors (eg, needs, psychosocial well-being, and technological competence), care provider factors (eg, socioemotional behaviors and technological competence), and virtual care system factors (eg, modality, functionality, usability, virtual process of care, and communication workflows). Key mechanisms that interacted with contexts to produce positive outcomes (eg, satisfaction) were visual cues, effective and empathetic communication, and a trusting relationship with their provider. Conclusions: Patients value VFU; however, VFU is not working as well as it could for patients. To optimize VFU, it is critical to consider contexts and mechanisms that impact patient perceptions of the patient centeredness and effectiveness of their care. Offering patients the choice of in-person, telephone, or video visits when possible, coupled with streamlined access to in-person care when required, is important. Prioritizing and addressing patient needs; enhancing physician virtual socioemotional behaviors and technology competency; and enhancing VFU functionality, usability, and processes of care and communication workflows will improve patient perceptions of the patient centeredness and effectiveness of virtual care. ",
doi="10.2196/65148",
url="https://www.jmir.org/2025/1/e65148"
}


@Article{info:doi/10.2196/48170,
author="Lally, Phillippa
and May, N. Christine
and Mitchell, Siobhan E.
and McCallum, Meaghan
and Michaelides, Andreas
and Fisher, Abigail",
title="Prototype of an App Designed to Support Self-Management for Health Behaviors and Weight in Women Living With Breast Cancer: Qualitative User Experience Study",
journal="JMIR Cancer",
year="2024",
month="Dec",
day="20",
volume="10",
pages="e48170",
keywords="breast cancer",
keywords="self-management",
keywords="app",
keywords="health behaviors",
keywords="weight",
keywords="prototype",
keywords="user experience",
keywords="development",
keywords="application",
keywords="coaching",
keywords="peer support",
keywords="oncology",
abstract="Background: Accessible self-management interventions are required to support people living with breast cancer. Objective: This was an industry-academic partnership study that aimed to collect qualitative user experience data of a prototype app with built-in peer and coach support designed to support the management of health behaviors and weight in women living with breast cancer. Methods: Participants were aged ?18 years, were diagnosed with breast cancer of any stage within the last 5 years, had completed active treatment, and were prescribed oral hormone therapy. Participants completed demographic surveys and were asked to use the app for 4 weeks. Following this, they took part in in-depth qualitative interviews about their experiences. These were analyzed using thematic analysis. Results: Eight participants (mean age, 45 years; mean time since diagnosis, 32 months) were included. Of the 8 participants, 7 (88\%) were white, 6 (75\%) had a graduate degree or above, and 6 (75\%) had stage I-III breast cancer. Four overarching themes were identified: (1) Support for providing an app earlier in the care pathway; (2) Desire for more weight-focused content tailored to the breast cancer experience; (3) Tracking of health behaviors that are generally popular; and (4) High value of in-app social support. Conclusions: This early user experience work showed that women with breast cancer found an app with integrated social and psychological support appealing to receive support for behavior change and weight management or self-management. However, many features were recommended for further development. This work is the first step in an academic-industry collaboration that would ultimately aim to develop and empirically test a supportive app that could be integrated into the cancer care pathway. ",
doi="10.2196/48170",
url="https://cancer.jmir.org/2024/1/e48170"
}


@Article{info:doi/10.2196/51536,
author="Jones, Tamara
and Edbrooke, Lara
and Rawstorn, C. Jonathan
and Denehy, Linda
and Hayes, Sandra
and Maddison, Ralph
and Sverdlov, L. Aaron
and Koczwara, Bogda
and Kiss, Nicole
and Short, E. Camille",
title="Demographics and Health Characteristics Associated With the Likelihood of Participating in Digitally Delivered Exercise Rehabilitation for Improving Heart Health Among Breast Cancer Survivors: Cross-Sectional Survey Study",
journal="JMIR Cancer",
year="2024",
month="Dec",
day="16",
volume="10",
pages="e51536",
keywords="digital health",
keywords="breast cancer",
keywords="exercise",
keywords="rehabilitation",
keywords="cardiotoxicity",
keywords="demographic",
keywords="cancer survivor",
keywords="exercise rehabilitation",
keywords="home-based program",
keywords="pathologic process",
keywords="radiation",
keywords="physical phenomena",
keywords="heart care",
keywords="cardiovascular disease",
keywords="diagnosis",
keywords="cross-sectional study",
keywords="chronic disease",
keywords="statistics",
abstract="Background: Strong evidence supports the benefits of exercise following both cardiovascular disease and cancer diagnoses. However, less than one-third of Australians who are referred to exercise rehabilitation complete a program following a cardiac diagnosis. Technological advances make it increasingly possible to embed real-time supervision, tailored exercise prescription, behavior change, and social support into home-based programs. Objective: This study aimed to explore demographic and health characteristics associated with the likelihood of breast cancer survivors uptaking a digitally delivered cardiac exercise rehabilitation program and to determine whether this differed according to intervention timing (ie, offered generally, before, during, or after treatment). Secondary aims were to explore the knowledge of cardiac-related treatment side-effects, exercise behavior, additional intervention interests (eg, diet, fatigue management), and service fee capabilities. Methods: This cross-sectional study involved a convenience sample of breast cancer survivors recruited via social media. A self-reported questionnaire was used to collect outcomes of interests, including the likelihood of uptaking a digitally delivered cardiac exercise rehabilitation program, and demographic and health characteristics. Descriptive statistics were used to summarize sample characteristics and outcomes. Ordered logistic regression models were used to examine associations between demographic and health characteristics and likelihood of intervention uptake generally, before, during, and after treatment, with odds ratios (ORs) <0.67 or >1.5 defined as clinically meaningful and statistical significance a priori set at P?.05. Results: A high proportion (194/208, 93\%) of the sample (mean age 57, SD 11 years; median BMI=26, IQR 23?31 kg/m2) met recommended physical activity levels at the time of the survey. Living in an outer regional area (compared with living in a major city) was associated with higher odds of uptake in each model (OR 3.86?8.57, 95\% CI 1.04-68.47; P=.01?.04). Receiving more cardiotoxic treatments was also associated with higher odds of general uptake (OR 1.42, 95\% CI 1.02-1.96; P=.04). There was some evidence that a higher BMI, more comorbid conditions, and lower education (compared with university education) were associated with lower odds of intervention uptake, but findings differed according to intervention timing. Respondents identified the need for better education about the cardiotoxic effects of breast cancer treatment, and the desire for multifaceted rehabilitation interventions that are free or low cost (median Aus \$10, IQR 10-15 per session; Aus \$1=US \$0.69 at time of study). Conclusions: These findings can be used to better inform future research and the development of intervention techniques that are critical to improving the delivery of a digital service model that is effective, equitable, and accessible, specifically, by enhancing digital inclusion, addressing general exercise barriers experienced by chronic disease populations, incorporating multidisciplinary care, and developing affordable delivery models. ",
doi="10.2196/51536",
url="https://cancer.jmir.org/2024/1/e51536"
}


@Article{info:doi/10.2196/63892,
author="Cho, Seungbeom
and Lee, Mangyeong
and Yu, Jaewook
and Yoon, Junghee
and Choi, Jae-Boong
and Jung, Kyu-Hwan
and Cho, Juhee",
title="Leveraging Large Language Models for Improved Understanding of Communications With Patients With Cancer in a Call Center Setting: Proof-of-Concept Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="11",
volume="26",
pages="e63892",
keywords="large language model",
keywords="cancer",
keywords="supportive care",
keywords="LLMs",
keywords="patient communication",
keywords="natural language processing",
keywords="NLP",
keywords="self-management",
keywords="teleconsultation",
keywords="triage services",
keywords="telephone consultations",
abstract="Background: Hospital call centers play a critical role in providing support and information to patients with cancer, making it crucial to effectively identify and understand patient intent during consultations. However, operational efficiency and standardization of telephone consultations, particularly when categorizing diverse patient inquiries, remain significant challenges. While traditional deep learning models like long short-term memory (LSTM) and bidirectional encoder representations from transformers (BERT) have been used to address these issues, they heavily depend on annotated datasets, which are labor-intensive and time-consuming to generate. Large language models (LLMs) like GPT-4, with their in-context learning capabilities, offer a promising alternative for classifying patient intent without requiring extensive retraining. Objective: This study evaluates the performance of GPT-4 in classifying the purpose of telephone consultations of patients with cancer. In addition, it compares the performance of GPT-4 to that of discriminative models, such as LSTM and BERT, with a particular focus on their ability to manage ambiguous and complex queries. Methods: We used a dataset of 430,355 sentences from telephone consultations with patients with cancer between 2016 and 2020. LSTM and BERT models were trained on 300,000 sentences using supervised learning, while GPT-4 was applied using zero-shot and few-shot approaches without explicit retraining. The accuracy of each model was compared using 1,000 randomly selected sentences from 2020 onward, with special attention paid to how each model handled ambiguous or uncertain queries. Results: GPT-4, which uses only a few examples (a few shots), attained a remarkable accuracy of 85.2\%, considerably outperforming the LSTM and BERT models, which achieved accuracies of 73.7\% and 71.3\%, respectively. Notably, categories such as ``Treatment,'' ``Rescheduling,'' and ``Symptoms'' involve multiple contexts and exhibit significant complexity. GPT-4 demonstrated more than 15\% superior performance in handling ambiguous queries in these categories. In addition, GPT-4 excelled in categories like ``Records'' and ``Routine,'' where contextual clues were clear, outperforming the discriminative models. These findings emphasize the potential of LLMs, particularly GPT-4, for interpreting complicated patient interactions during cancer-related telephone consultations. Conclusions: This study shows the potential of GPT-4 to significantly improve the classification of patient intent in cancer-related telephone oncological consultations. GPT-4's ability to handle complex and ambiguous queries without extensive retraining provides a substantial advantage over discriminative models like LSTM and BERT. While GPT-4 demonstrates strong performance in various areas, further refinement of prompt design and category definitions is necessary to fully leverage its capabilities in practical health care applications. Future research will explore the integration of LLMs like GPT-4 into hybrid systems that combine human oversight with artificial intelligence--driven technologies. ",
doi="10.2196/63892",
url="https://www.jmir.org/2024/1/e63892"
}


@Article{info:doi/10.2196/52542,
author="Montalescot, Lucile
and Baussard, Louise
and Charbonnier, Elodie",
title="Factors Associated With Digital Intervention Engagement and Adherence in Patients With Cancer: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="11",
volume="26",
pages="e52542",
keywords="adherence",
keywords="engagement",
keywords="eHealth",
keywords="mHealth",
keywords="cancer",
keywords="mobile health",
keywords="app",
keywords="eHealth interventions",
keywords="patient",
keywords="cancer care",
keywords="digital health",
keywords="health-related",
keywords="intervention-related",
keywords="sociodemographic",
keywords="behavior",
keywords="systematic review",
abstract="Background: Digital interventions offer vital support for patients with cancer through education, behavior change, and monitoring. Despite their potential, patient adherence to and engagement with these self-help interventions is challenging. Factors like user characteristics, technology, and intervention design influence adherence and engagement. Existing reviews have gaps in exploring diverse factors associated with adherence in cancer care. Objective: This systematic review aims to identify factors influencing adherence to and engagement with digital interventions with self-help components in cancer care. It examined sociodemographic, psychosocial, health-related, and intervention-related factors that affect patients' adherence to and engagement with these digital health solutions. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a search was conducted across PubMed, Embase, Cochrane Library, and PsycINFO to find studies published from January 2010 to September 2021. The studies included in this review focused on adult patients with cancer using digital interventions with self-help features. Data were extracted and synthesized using a standardized approach. Factors associated with adherence were synthesized according to their type---sociodemographic factors, psychosocial factors, health-related factors, technology-related factors, and intervention-related factors. Results: Among 9386 studies initially screened, 61 (0.6\%) were eligible for analysis. These studies covered diverse eHealth intervention types, cancer types, and outcome measures. Investigating the determinants of adherence to and engagement with digital interventions was the main objective for 43\% (26/61) of the included studies. Adherence and engagement were gauged using varied measures, such as dropout rates, log-ins, and self-reported measures. Results regarding factors associated with adherence and engagement were inconsistent across studies. Most sociodemographic (eg, age) and health-related factors (eg, cancer stage) yielded mixed outcomes. However, comorbidity consistently predicted lower adherence and engagement. Results regarding psychosocial factors were more stable across studies. Specifically, higher social support was associated with lower adherence and engagement. Finally, intervention-related factors like intervention type or human support showed conflicting results. Adopting an intersectional perspective revealed that specificities vary according to intervention goals and the operationalization of adherence versus engagement, with women being more adherent and engaged than men in interventions targeting distress. When focusing on adherence rather than engagement, older patients were more adherent than younger patients. Conclusions: This review highlights the complexity of adherence to and engagement with digital interventions in cancer care. While some factors, notably comorbidities and low social support, were consistently linked to adherence and engagement, others displayed mixed associations. The review underscores the need for standardizing measures, investigating specific intervention features, and enhancing study quality to optimize digital interventions for patients with cancer. Further research is crucial to better understand and improve adherence to digital health solutions in cancer care. Trial Registration: PROSPERO CRD42021281028; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=281028 ",
doi="10.2196/52542",
url="https://www.jmir.org/2024/1/e52542"
}


@Article{info:doi/10.2196/53834,
author="McCann, Lisa
and Lewis, Liane
and Oduntan, Olubukola
and Harris, Jenny
and Darley, Andrew
and Berg, V. Geir
and Lubowitzki, Simone
and Cheevers, Katy
and Miller, Morven
and Armes, Jo
and Ream, Emma
and Fox, Patricia
and Furlong, Patricia Eileen
and Gaiger, Alexander
and Kotronoulas, Grigorios
and Patiraki, Elisabeth
and Katsaragakis, Stylianos
and McCrone, Paul
and Miaskowski, Christine
and Cardone, Antonella
and Orr, Dawn
and Flowerday, Adrian
and Skene, Simon
and Moore, Margaret
and De Souza, Nicosha
and Donnan, Peter
and Maguire, Roma",
title="Patients' and Clinicians' Experiences Using a Real-Time Remote Monitoring System for Chemotherapy Symptom Management (ASyMS): Qualitative Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="3",
volume="26",
pages="e53834",
keywords="cancer",
keywords="clinician experiences",
keywords="digital interventions",
keywords="patient experiences",
keywords="remote monitoring",
keywords="qualitative methods",
abstract="Background: Patients receiving chemotherapy require ongoing symptom monitoring and management to optimize their outcomes. In recent years, digital remote monitoring interventions have emerged to provide enhanced cancer care delivery experiences to patients and clinicians. However, patient and clinician experiential evaluations of these technologies are rare. Therefore, we explored user experiences and perceptions of one such intervention---Advanced Symptom Management System (ASyMS)---after its scaled deployment in the context of the Electronic Symptom Management System Remote Technology (eSMART) trial. The eSMART trial was a large, multicenter randomized controlled trial to evaluate the efficacy of ASyMS in 12 clinical sites in 5 European countries. Objective: In this qualitative study, both patients' and clinicians' experiences of using ASyMS for up to 6 cycles of chemotherapy were explored to understand the impact of ASyMS on patients' experiences, clinical practice, and supportive care delivery. Methods: For this analysis, individual, semistructured, one-to-one interviews with 29 patients with breast, colorectal, and hematological cancers and 18 clinicians from Austria, Greece, Ireland, Norway, and the United Kingdom were conducted. Interviews focused on patients' and clinicians' experiences of using ASyMS, care organization and changes in practice following the introduction of ASyMS, perceived changes in care associated with the use of ASyMS, and its potential for future integration into routine chemotherapy care pathways. Results: Thematic analysis identified several themes that describe patients' and clinicians' experiences using ASyMS. One central orienting theme---ASyMS as a facilitator of change---was supported by 5 key themes associated with human and technology monitoring: reassurance, enhanced communications and relationships, knowing what is ``normal'' and what is to be expected, enhancing cancer care experiences, and informing future cancer care. Conclusions: This study is the first to evaluate both patients' and clinicians' experiences of using a digital health intervention to remotely monitor chemotherapy symptoms across 5 countries. Experiences with ASyMS were positive from both patients' and clinicians' perspectives, although some improvements to support the wider-scale rollout and sustained implementation were identified. Overall, this study demonstrates that real-time remote monitoring systems can help patients feel more reassured during their chemotherapy treatments and can help clinicians provide the right care, at the right time, and in the right place. Trial Registration: ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2016-015016 ",
doi="10.2196/53834",
url="https://www.jmir.org/2024/1/e53834"
}


@Article{info:doi/10.2196/47856,
author="Baxter-King, Ryan
and Naeim, Arash
and Huang, Q. Tina
and Sepucha, Karen
and Stanton, Annette
and Rudkin, Aaron
and Ryu, Rita
and Sabacan, Leah
and Vavreck, Lynn
and Esserman, Laura
and Stover Fiscalini, Allison
and Wenger, S. Neil",
title="Relationship Between Perceived COVID-19 Risk and Change in Perceived Breast Cancer Risk: Prospective Observational Study",
journal="JMIR Cancer",
year="2024",
month="Dec",
day="2",
volume="10",
pages="e47856",
keywords="breast cancer",
keywords="COVID-19 risk perception",
keywords="cancer screening",
keywords="anxiety",
keywords="cancer",
keywords="COVID-19",
keywords="prevention",
keywords="medical care",
keywords="screening",
keywords="survey",
abstract="Background: Whether COVID-19 is associated with a change in risk perception about other health conditions is unknown. Because COVID-19 occurred during a breast cancer study, we evaluated the effect of COVID-19 risk perception on women's breast cancer risk perception. Objective: This study aims to evaluate the relationship between perceived risk of COVID-19 and change in perceived breast cancer risk. We hypothesized that women who perceived greater COVID-19 risk would evidence increased perceived breast cancer risk and this risk would relate to increased anxiety and missed cancer screening. Methods: Women aged 40-74 years with no breast cancer history were enrolled in a US breast cancer prevention trial in outpatient settings. They had provided breast cancer risk perception and general anxiety before COVID-19. We performed a prospective observational study of the relationship between the perceived risk of COVID-19 and the change in perceived breast cancer risk compared to before the pandemic. Each woman was surveyed up to 4 times about COVID-19 and breast cancer risk perception, general anxiety, and missed medical care early in COVID-19 (May to December 2020). Results: Among 13,002 women who completed a survey, compared to before COVID-19, anxiety was higher during COVID-19 (mean T score 53.5 vs 49.7 before COVID-19; difference 3.8, 95\% CI 3.6-4.0; P<.001) and directly related to perceived COVID-19 risk. In survey wave 1, anxiety increased by 2.3 T score points for women with very low perceived COVID-19 risk and 5.2 points for those with moderately or very high perceived COVID-19 risk. Despite no overall difference in breast cancer risk perception (mean 32.5\% vs 32.5\% before COVID-19; difference 0.24, 95\% CI --0.47 to 0.52; P=.93), there was a direct relationship between change in perceived breast cancer risk with COVID-19 risk perception, ranging in survey wave 4 from a 2.4\% decrease in breast cancer risk perception for those with very low COVID-19 risk perception to a 3.4\% increase for women with moderately to very high COVID-19 risk perception. This was not explained by the change in anxiety or missed cancer screening. After adjustment for age, race, education, and survey wave, compared to women with very low perceived COVID-19 risk, perceived breast cancer risk increased by 1.54\% (95\% CI 0.75\%-2.33\%; P<.001), 4.28\% (95\% CI 3.30\%-5.25\%; P<.001), and 3.67\% (95\% CI 1.94\%-5.40\%; P<.001) for women with moderately low, neither high nor low, and moderately or very high perceived COVID-19 risk, respectively. Conclusions: Low perceived COVID-19 risk was associated with reduced perceived breast cancer risk, and higher levels of perceived COVID-19 risk were associated with increased perceived breast cancer risk. This natural experiment suggests that a threat such as COVID-19 may have implications beyond the pandemic. Preventive health behaviors related to perceived risk may need attention as COVID-19 becomes endemic. ",
doi="10.2196/47856",
url="https://cancer.jmir.org/2024/1/e47856"
}


@Article{info:doi/10.2196/59152,
author="Hu, Chao
and Fu, Qiang
and Gao, Fei Fei
and Zeng, Jian
and Xiao, Wei
and Li, Hui
and Peng, Li
and Huang, Xi
and Yang, Li
and Chen, Zhi Wen
and Jiang, Yan Ming",
title="Ultrasound-Guided High-Intensity Focused Ultrasound Combined With PD-1 Blockade in Patients With Liver Metastases From Lung Cancer: Protocol for a Single-Arm Phase 2 Trial",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="29",
volume="13",
pages="e59152",
keywords="high-intensity focused ultrasound",
keywords="programmed cell death protein",
keywords="PD-1 blockade",
keywords="liver metastases",
keywords="lung cancer",
keywords="immunotherapy",
keywords="treatment efficacy",
keywords="quality of life",
keywords="HILL study",
abstract="Background: While immunotherapy has revolutionized oncological management, its efficacy in lung cancer patients with liver metastases remains limited, potentially due to the unique immunosuppressive microenvironment of the liver. Local liver treatment has been shown to enhance the immunotherapy response, and high-intensity focused ultrasound (HIFU), a minimally invasive local treatment, has demonstrated promising results in combination with immunotherapy. However, clinical data regarding HIFU in lung cancer with liver metastases are limited. Objective: We designed the HILL (Ultrasound-Guided High-Intensity Focused Ultrasound Combined With PD-1 Blockade in Patients With Liver Metastases From Lung Cancer) study to investigate the effectiveness and safety of HIFU in combination with immunotherapy for lung cancer with liver metastases. Methods: The HILL study is a single-armed, single-center, phase 2 clinical trial that will enroll 30 patients with lung cancer and liver metastases. The treatment regimen involves administering HIFU to liver metastases 1 week before the first dose of a programmed cell death protein (PD)--1 blockade, which is then administered every 3 weeks. The primary aim is to determine the overall response rate based on immune-related response criteria. Secondary aims include safety, progression-free survival, overall response, overall survival, and quality of life. Exploratory studies will also be conducted using whole blood, plasma, archival cancer tissue, and tumor biopsies during progression or relapse to identify potential biomarkers. Results: The study was funded on March 14, 2022, and received ethical approval on April 27, 2022. Clinical trial registration was completed by June 10, 2022, with participant recruitment beginning on July 10, 2022. Data collection commenced on July 14, 2022, with the enrollment of the first patient. By April 2024, 6 participants had been recruited. The results are expected to be published in December 2026. Conclusions: This study seeks to improve treatment outcomes for lung cancer patients with liver metastases by combining HIFU and PD-1 inhibition. The study also aims to identify potential biomarkers through exploratory research that can aid in selecting patients for optimized outcomes in the future. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200061076; https://www.chictr.org.cn/showproj.html?proj=170967 International Registered Report Identifier (IRRID): DERR1-10.2196/59152 ",
doi="10.2196/59152",
url="https://www.researchprotocols.org/2024/1/e59152"
}


@Article{info:doi/10.2196/57415,
author="Malandrone, Francesca
and Urru, Sara
and Berchialla, Paola
and Rossini, Gilbert Pierre
and Oliva, Francesco
and Bianchi, Silvia
and Ottaviano, Manuel
and Gonzalez-Martinez, Sergio
and Carli, Vladimir
and Valenza, Gaetano
and Scilingo, Pasquale Enzo
and Carletto, Sara
and Ostacoli, Luca",
title="Exploring the Effects of Variety and Amount of Mindfulness Practices on Depression, Anxiety, and Stress Symptoms: Longitudinal Study on a Mental Health--Focused eHealth System for Patients With Breast or Prostate Cancer",
journal="JMIR Ment Health",
year="2024",
month="Nov",
day="21",
volume="11",
pages="e57415",
keywords="depression",
keywords="anxiety",
keywords="stress",
keywords="internet-based",
keywords="mental health",
keywords="mindfulness",
keywords="breast cancer",
keywords="prostate cancer",
keywords="cancer-related mental distress",
keywords="emotional distress",
keywords="psychological distress",
keywords="mindfulness-based interventions",
keywords="MBI",
keywords="e-MBI",
keywords="dispositional mindfulness",
keywords="self-compassion",
keywords="mental wellbeing",
keywords="mobile phone",
abstract="Background: Patients with cancer often face depression and anxiety, and mindfulness-based interventions, including internet-based versions, can effectively reduce these symptoms and improve their quality of life. This study aims to investigate the impact of internet-based mindfulness-based interventions (e-MBIs) on anxiety, depression, and stress symptoms in patients with prostate or breast cancer. Objective: The primary aims are to assess the association between the amount and variety of e-MBI practices and symptom reduction. Second, this study aims to examine how baseline information such as sociodemographic characteristics, dispositional mindfulness (DM), and dispositional self-compassion (DSC) correlate with both app usage and symptom reduction. Methods: Participants included 107 patients with cancer (68 women with breast cancer and 38 men with prostate cancer) enrolled in a hospital setting. They were assigned to the intervention group of the NEVERMIND project, using the e-BMI module via the NEVERMIND app. A longitudinal design involved Pearson correlation analysis to determine the relationship between the amount and duration of e-MBI practices. Linear regression analysis was conducted to gauge the dose-response effect, evaluating the impact of DM and DSC on depression, anxiety, and stress. Negative binomial regression was conudcted to study sociodemographic factors' influence on the amount of practice in e-MBIs. Results: The participants with more diverse and sustained mindfulness practices experienced significant reductions in depression, anxiety, and stress. A high correlation (0.94) between e-MBI practices and symptom reduction was also highlighted. Male, married, and highly educated patients were more likely to engage in mindfulness. Even if DM and DSC did not impact the amount or variety of practices correlated, they were correlated with symptom reduction, showing that higher levels were associated with significant reductions in depression, anxiety, and stress. Conclusions: While more e-MBI practice is linked to reduced anxiety, depression, and stress, this study emphasizes the crucial role of variety of practice over amount. DM and DSC are key in shaping intervention effectiveness and may act as protectors against psychological distress. Using app log data, our research provides a unique perspective on e-MBI impact, contributing to cancer care understanding and guiding future studies. ",
doi="10.2196/57415",
url="https://mental.jmir.org/2024/1/e57415"
}


@Article{info:doi/10.2196/51477,
author="Ji, Lu
and Yao, Yifan
and Yu, Dandan
and Chen, Wen
and Yin, Shanshan
and Fu, Yun
and Tang, Shangfeng
and Yao, Lan",
title="Performance of a Full-Coverage Cervical Cancer Screening Program Using on an Artificial Intelligence-- and Cloud-Based Diagnostic System: Observational Study of an Ultralarge Population",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="20",
volume="26",
pages="e51477",
keywords="full coverage",
keywords="cervical cancer screening",
keywords="artificial intelligence",
keywords="primary health institutions",
keywords="accessibility",
keywords="efficiency",
abstract="Background: The World Health Organization has set a global strategy to eliminate cervical cancer, emphasizing the need for cervical cancer screening coverage to reach 70\%. In response, China has developed an action plan to accelerate the elimination of cervical cancer, with Hubei province implementing China's first provincial full-coverage screening program using an artificial intelligence (AI) and cloud-based diagnostic system. Objective: This study aimed to evaluate the performance of AI technology in this full-coverage screening program. The evaluation indicators included accessibility, screening efficiency, diagnostic quality, and program cost. Methods: Characteristics of 1,704,461 individuals screened from July 2022 to January 2023 were used to analyze accessibility and AI screening efficiency. A random sample of 220 individuals was used for external diagnostic quality control. The costs of different participating screening institutions were assessed. Results: Cervical cancer screening services were extended to all administrative districts, especially in rural areas. Rural women had the highest participation rate at 67.54\% (1,147,839/1,699,591). Approximately 1.7 million individuals were screened, achieving a cumulative coverage of 13.45\% in about 6 months. Full-coverage programs could be achieved by AI technology in approximately 1 year, which was 87.5 times more efficient than the manual reading of slides. The sample compliance rate was as high as 99.1\%, and compliance rates for positive, negative, and pathology biopsy reviews exceeded 96\%. The cost of this program was CN {\textyen}49 (the average exchange rate in 2022 is as follows: US \$1=CN {\textyen}6.7261) per person, with the primary screening institution and the third-party testing institute receiving CN {\textyen}19 and {\textyen}27, respectively. Conclusions: AI-assisted diagnosis has proven to be accessible, efficient, reliable, and low cost, which could support the implementation of full-coverage screening programs, especially in areas with insufficient health resources. AI technology served as a crucial tool for rapidly and effectively increasing screening coverage, which would accelerate the achievement of the World Health Organization's goals of eliminating cervical cancer. ",
doi="10.2196/51477",
url="https://www.jmir.org/2024/1/e51477"
}


@Article{info:doi/10.2196/53780,
author="Almashmoum, Maryam
and Cunningham, James
and Ainsworth, John",
title="Evaluating Factors Affecting Knowledge Sharing Among Health Care Professionals in the Medical Imaging Departments of 2 Cancer Centers: Concurrent Mixed Methods Study",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="13",
volume="11",
pages="e53780",
keywords="knowledge management",
keywords="knowledge sharing",
keywords="medical imaging departments",
keywords="cancer centers",
keywords="The Christie",
keywords="Kuwait Cancer Control Center",
keywords="concurrent mixed methods",
keywords="factors",
keywords="challenges",
keywords="definition",
keywords="mechanisms",
keywords="practices",
abstract="Background: Knowledge sharing is a crucial part of any knowledge management implementation. It refers to sharing skills and experience among team members in an organization. In a health care setting, sharing knowledge, whether tacit or explicit, is important and can lead to better health care services. In medical imaging departments, knowledge sharing can be of particular importance. There are several factors that affect knowledge-sharing practices in medical imaging departments: individual, departmental, and technological. Evaluating the importance of these factors and understanding their use can help with improving knowledge-sharing practices in medical imaging departments. Objective: We aimed to assess the level of motivation, identify current knowledge-sharing tools, and evaluate factors affecting knowledge sharing in the medical imaging departments of 2 cancer centers, The Christie, United Kingdom, and the Kuwait Cancer Control Center (KCCC). Methods: A concurrent mixed methods study was conducted through nonprobability sampling techniques between February 1, 2023, and July 30, 2023. Semistructured interviews were used to validate the results of the quantitative analysis. Data were collected using an electronic questionnaire that was distributed among health care professionals in both cancer centers using Qualtrics. Semistructured interviews were conducted online using Microsoft Teams. The quantitative data were analyzed using the Qualtrics MX software to report the results for each question, whereas the qualitative data were analyzed using a thematic approach with codes classified through NVivo. Results: In total, 56 respondents from the KCCC and 29 from The Christie participated, with a 100\% response rate (56/56, 100\% and 29/29, 100\%, respectively) based on the Qualtrics survey tool. A total of 59\% (17/29) of health care professionals from The Christie shared their knowledge using emails and face-to-face communication as their main tools on a daily basis, and 57\% (32/56) of health care professionals from the KCCC used face-to-face communication for knowledge sharing. The mean Likert-scale score of all the components that assessed the factors that affected knowledge-sharing behaviors fell between ``somewhat agree'' and ``strongly agree'' in both centers, excepting extrinsic motivation, which was rated as ``neither agree nor disagree.'' This was similar to the results related to incentives. It was shown that 52\% (15/29) of health care professionals at The Christie had no incentives to encourage knowledge-sharing practices. Therefore, establishing clear policies to manage incentives is important to increase knowledge-sharing practices. Conclusions: This study offered an evaluation of factors that affect knowledge sharing in 2 cancer centers. Most health care professionals were aware of the importance of knowledge-sharing practices in enhancing health care services. Several challenges were identified, such as time constraints, a lack of staff, and the language barrier, which limit knowledge-sharing practices. Therefore, establishing a clear policy for knowledge sharing is vital to practicing knowledge-sharing behaviors and facing any challenges that limit this practice. ",
doi="10.2196/53780",
url="https://humanfactors.jmir.org/2024/1/e53780"
}


@Article{info:doi/10.2196/56795,
author="Lu, Taiping
and Deng, Ting
and Long, Yangyang
and Li, Jin
and Hu, Anmei
and Hu, Yufan
and Ouyang, Li
and Wang, Huiping
and Ma, Junliang
and Chen, Shaolin
and Hu, Jiale",
title="Effectiveness and Feasibility of Digital Pulmonary Rehabilitation in Patients Undergoing Lung Cancer Surgery: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="11",
volume="26",
pages="e56795",
keywords="app-based",
keywords="digital rehabilitation",
keywords="internet-based intervention",
keywords="lung cancer",
keywords="perioperative pulmonary rehabilitation",
keywords="systematic review",
keywords="telerehabilitation",
abstract="Background: Pulmonary rehabilitation (PR) has been shown to effectively support postsurgical recovery in patients with lung cancer (LC) at various stages. While digital PR programs offer a potential solution to traditional challenges, such as time and space constraints, their efficacy and feasibility for patients undergoing LC surgery remain unclear. Objective: This systematic review aims to assess the feasibility and effectiveness of digital PR programs for individuals undergoing LC surgery. Methods: A systematic review was conducted, retrieving data from 6 English and 4 Chinese databases from their inception to January 1, 2024. References in related studies were also manually reviewed. The primary outcomes assessed were physical capacity, lung function, and the incidence of postoperative pulmonary complications (PPCs). The secondary outcomes were compliance, hospital stay, chest tube duration, anxiety, depression, and quality of life. Where applicable, recruitment and withdrawal rates were also evaluated. Meta-analysis and descriptive analysis were used to assess the outcomes. Results: A total of 5 randomized controlled trials and 6 quasi-experimental studies (n=1063) were included, with 4 studies being included in the meta-analyses. Our meta-analyses revealed that digital PR reduced the decline in 6-minute walk distance (6-MWD) by an average of 15 m compared with routine PR programs from admission to discharge, demonstrating a clinically significant improvement in physical capacity (mean difference --15.00, 95\% CI --25.65 to --4.34, P=.006). Additionally, digital PR was associated with a reduction (26/58, 45\%) in the likelihood of PPCs (risk ratio 0.45, 95\% CI 0.30-0.66, P<.001) and a reduction of 1.53 days in chest tube duration (mean difference --1.53, 95\% CI --2.95 to --0.12, P=.03), without a statistically significant effect on postoperative hospital stay (mean difference --1.42, 95\% CI --3.45 to 0.62, P=.17). Descriptive analyses suggested that digital PR has the potential to improve knowledge, lung function, quality of life, and self-efficacy, while reducing depression and anxiety. Notably, digital PR was found to be a safe, feasible, and acceptable supplementary intervention. Despite challenges with low recruitment, digital PR enhanced exercise compliance, increased patient satisfaction, and lowered dropout rates. Conclusions: This systematic review is the first comprehensive analysis to suggest that digital PR is a safe, feasible, acceptable, and effective intervention for promoting recovery in patients with LC after surgery. Digital PR has the potential to be a valuable supplement, expanding access to traditional PR programs. Future research should prioritize the development of interactive and inclusive digital solutions tailored to diverse age groups and educational backgrounds. Rigorous studies, including large-scale, high-quality randomized controlled trials with detailed protocols and robust methodologies, are needed to assess the short-, medium-, and long-term efficacy of digital PR, ensuring reproducibility in future research. Trial Registration: PROSPERO CRD42023430271; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=430271 ",
doi="10.2196/56795",
url="https://www.jmir.org/2024/1/e56795"
}


@Article{info:doi/10.2196/64406,
author="Chow, L. James C.
and Li, Kay",
title="Ethical Considerations in Human-Centered AI: Advancing Oncology Chatbots Through Large Language Models",
journal="JMIR Bioinform Biotech",
year="2024",
month="Nov",
day="6",
volume="5",
pages="e64406",
keywords="artificial intelligence",
keywords="humanistic AI",
keywords="ethical AI",
keywords="human-centered AI",
keywords="machine learning",
keywords="large language models",
keywords="natural language processing",
keywords="oncology chatbot",
keywords="transformer-based model",
keywords="ChatGPT",
keywords="health care",
doi="10.2196/64406",
url="https://bioinform.jmir.org/2024/1/e64406",
url="http://www.ncbi.nlm.nih.gov/pubmed/39321336"
}


@Article{info:doi/10.2196/57510,
author="Geeraerts, Joran
and Pivodic, Lara
and Rosquin, Lise
and Naert, Eline
and Crombez, Geert
and De Ridder, Mark
and Van den Block, Lieve",
title="Uncovering the Daily Experiences of People Living With Advanced Cancer Using an Experience Sampling Method Questionnaire: Development, Content Validation, and Optimization Study",
journal="JMIR Cancer",
year="2024",
month="Nov",
day="5",
volume="10",
pages="e57510",
keywords="cancer",
keywords="quality of life",
keywords="ecological momentary assessment",
keywords="experience sampling method",
keywords="telemedicine",
keywords="mHealth",
keywords="eHealth",
keywords="patient outcome assessment",
keywords="validated instruments",
abstract="Background: The experience sampling method (ESM), a self-report method that typically uses multiple assessments per day, can provide detailed knowledge of the daily experiences of people with cancer, potentially informing oncological care. The use of the ESM among people with advanced cancer is limited, and no validated ESM questionnaires have been developed specifically for oncology. Objective: This study aims to develop, content validate, and optimize the digital Experience Sampling Method for People Living With Advanced Cancer (ESM-AC) questionnaire, covering multidimensional domains and contextual factors. Methods: A 3-round mixed methods study was designed in accordance with the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) and the European Organization for Research and Treatment of Cancer guidelines. The study included semistructured interviews with 43 people with stage IV breast cancer or stage III to IV lung cancer and 8 health care professionals. Round 1 assessed the appropriateness, relative importance, relevance, and comprehensiveness of an initial set of ESM items that were developed based on the existing questionnaires. Round 2 tested the comprehensibility of ESM items. Round 3 tested the usability of the digital ESM-AC questionnaire using the m-Path app. Analyses included descriptive statistics and qualitative content analysis. Results: Following the first round, we developed an initial core set of 68 items (to be used with all patients) and a supplementary set (optional; patients select items), both covering physical, psychological, social, spiritual-existential, and global well-being domains and concurrent contexts in which experiences occur. We categorized items to be assessed multiple times per day as momentary items (eg, ``At this moment, I feel tired''), once a day in the morning as morning items (eg, ``Last night, I slept well''), or once a day in the evening as evening items (eg, ``Today, I felt hopeful''). We used participants' evaluations to optimize the questionnaire items, the digital app, and its onboarding manual. This resulted in the ESM-AC questionnaire, which comprised a digital core questionnaire containing 31 momentary items, 2 morning items, and 7 evening items and a supplementary set containing 39 items. Participants largely rated the digital questionnaire as ``easy to use,'' with an average score of 4.5 (SD 0.5) on a scale from 1 (``completely disagree'') to 5 (``completely agree''). Conclusions: We developed the ESM-AC questionnaire, a content-validated digital questionnaire for people with advanced breast or lung cancer. It showed good usability when administered on smartphone devices. Future research should evaluate the potential of this ESM tool to uncover daily experiences of people with advanced breast or lung cancer, explore its clinical utility, and extend its validation to other populations with advanced diseases. ",
doi="10.2196/57510",
url="https://cancer.jmir.org/2024/1/e57510"
}


@Article{info:doi/10.2196/59061,
author="Zhu, Siying
and Dong, Yan
and Li, Yumei
and Wang, Hong
and Jiang, Xue
and Guo, Mingen
and Fan, Tiantian
and Song, Yalan
and Zhou, Ying
and Han, Yuan",
title="Experiences of Patients With Cancer Using Electronic Symptom Management Systems: Qualitative Systematic Review and Meta-Synthesis",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="28",
volume="26",
pages="e59061",
keywords="electronic symptom management systems",
keywords="oncology care",
keywords="access to care",
keywords="symptom monitoring",
keywords="self-management",
keywords="patient-reported outcomes",
keywords="health-related outcomes",
keywords="quality of life",
abstract="Background: There are numerous symptoms related to cancer and its treatments that can affect the psychosomatic health and quality of life of patients with cancer. The use of electronic symptom management systems (ESMSs) can help patients with cancer monitor and manage their symptoms effectively, improving their health-related outcomes. However, patients' adhesion to ESMSs decreases over time, and little is known about their real experiences with them. Therefore, it is necessary to gain a deep understanding of patients' experiences with ESMSs. Objective: The purpose of this systematic review was to synthesize qualitative studies on the experiences of patients with cancer using ESMSs. Methods: A total of 12 electronic databases, including PubMed, Web of Science, Cochrane Library, EBSCOhost, Embase, PsycINFO, ProQuest, Scopus, Wanfang database, CNKI, CBM, and VIP, were searched to collect relevant studies from the earliest available record until January 2, 2024. Qualitative and mixed methods studies published in English or Chinese were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement checklist) and the ENTREQ (Enhancing Transparency in Reporting the Synthesis of Qualitative Research) statement were used to improve transparency in reporting the synthesis of the qualitative research. The Critical Appraisal Skills Program (CASP) checklist was used to appraise the methodological quality of the included studies, and a meta-synthesis was conducted to interpret and synthesize the findings. Results: A total of 21 studies were included in the meta-synthesis. The experiences of patients with cancer using ESMSs were summarized into three major categories: (1) perceptions and attitudes toward ESMSs; (2) the value of ESMSs; and (3) barriers, requirements, and suggestions for ESMSs. Subsequently, 10 subcategories emerged from the 3 major categories. The meta-synthesis revealed that patients with cancer had both positive and negative experiences with ESMSs. In general, patients recognized the value of ESMSs in symptom assessment and management and were willing to use them, but they still encountered barriers and wanted them to be improved. Conclusions: This systematic review provides implications for developing future ESMSs that improve health-related outcomes for patients with cancer. Future research should focus on strengthening electronic equipment and technical support for ESMSs, improving their functional contents and participation forms, and developing personalized applications tailored to the specific needs and characteristics of patients with cancer. Trial Registration: PROSPERO CRD42023421730; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=421730 ",
doi="10.2196/59061",
url="https://www.jmir.org/2024/1/e59061",
url="http://www.ncbi.nlm.nih.gov/pubmed/39466301"
}


@Article{info:doi/10.2196/53825,
author="Li, Mengdan
and Yu, Zhifu
and Li, Hui
and Cao, Li
and Yu, Huihui
and Deng, Ning
and Liu, Yunyong",
title="Effects of Virtual Reality Therapy for Patients With Breast Cancer During Chemotherapy: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2024",
month="Oct",
day="17",
volume="12",
pages="e53825",
keywords="virtual reality",
keywords="breast neoplasms",
keywords="quality of life",
keywords="psychological distress",
keywords="longitudinal studies",
abstract="Background: Patients with breast cancer endure high levels of psychological and physical pain. Virtual reality (VR) may be an acceptable, safe intervention to alleviate the negative emotions and pain of patients with cancer. Objective: We aimed to test the long-term effects of VR on psychological distress and quality of life (QOL) with traditional care in Chinese patients with breast cancer. We also explored the intervention mechanism and the acceptability of VR. Methods: A total of 327 eligible participants were randomly assigned to a VR intervention group or a control group. The Distress Thermometer, QLQ-C30 (Quality of Life Questionnaire version 3.0), and Virtual Reality Symptom Questionnaire were assessed at baseline, postintervention (3 mo), and follow-up (6 mo). Analysis followed the intention-to-treat (ITT) principle. The generalized estimating equations model was used to analyze the longitudinal data, and the PROCESS macro was used to analyze the mediating effect. Results: Compared with the control group, patients with breast cancer in the VR group had lower distress scores (P=.007), and higher health-related QOL scores (physical, role, emotional, cognitive, and social functioning) after 6 months (P<.05). Psychological distress had mediating effects on the longitudinal association between VR and the health-related QOL (indirect effect=4.572?6.672, all P<.05). Conclusions: VR intervention technology may help reduce distress and improve QOL for patients with breast cancer over time. By incorporating a mediating analysis, we showed that the QOL benefits of VR intervention was manifested through positive effects on psychological distress risk factors. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000035049; https://www.chictr.org.cn/showproj.html?proj=53648 ",
doi="10.2196/53825",
url="https://games.jmir.org/2024/1/e53825"
}


@Article{info:doi/10.2196/57183,
author="Bertolaccini, Luca
and Ciani, Oriana
and Lucchi, Marco
and Zaraca, Francesco
and Bertani, Alessandro
and Crisci, Roberto
and Spaggiari, Lorenzo
and ",
title="Outcomes of Patients With Early and Locally Advanced Lung Cancer: Protocol for the Italian Lung Cancer Observational Study (LUCENT)",
journal="JMIR Res Protoc",
year="2024",
month="Oct",
day="8",
volume="13",
pages="e57183",
keywords="lung cancer",
keywords="quality of life",
keywords="observational study",
keywords="economic aspects",
keywords="multicenter study",
abstract="Background: Lung cancer, predominantly non-small cell lung cancer (NSCLC), remains a formidable challenge, necessitating an in-depth understanding of evolving treatment paradigms. The Italian Lung Cancer Observational Study (LUCENT) addresses this need by investigating the outcomes of patients with early and locally advanced lung cancer in Italy. Objective: With a focus on real-world data and patient registries, this study aims to provide comprehensive insights into clinical, psychosocial, and economic impacts, contributing to informed decision-making in health care. Methods: LUCENT is a prospective observational multicenter cohort study enrolling patients eligible for minimally invasive manual, robot-assisted, or traditional open surgery. The study will develop a web-based registry to collect longitudinal surgical, oncological, and socioeconomic outcome data. The primary objectives include performance assessment through the establishment of national benchmarks based on risk-adjusted outcomes and processes of care indicators. The secondary objectives encompass economic and psychosocial impact assessments of innovative technologies and treatment pathways. The multicenter design ensures a diverse and representative study population. Results: The evolving landscape of NSCLC treatment necessitates a nuanced approach with consideration of the dynamic shifts in therapeutic strategies. LUCENT strives to fill existing knowledge gaps by providing a platform for collecting and analyzing real-world data, emphasizing the importance of patient-reported outcomes in enhancing the understanding of the disease. By developing a web-based registry, the study not only facilitates efficient data collection but also addresses the limitations of traditional methods, such as suboptimal response rates and costs associated with paper-and-pencil questionnaires. Recruitment will be conducted from January 01, 2024, to December 31, 2026. Follow-up will be performed for a minimum of 2 years. The study will be completed in the year 2028. Conclusions: LUCENT's potential implications are substantial. Establishing national benchmarks will enable a thorough evaluation of outcomes and care processes, guiding clinicians and policymakers in optimizing patient management. Furthermore, the study's secondary objectives, focusing on economic and psychosocial impacts, align with the contemporary emphasis on holistic cancer care. Insights gained from this study may influence treatment strategies, resource utilization, and patient well-being, thereby contributing to the ongoing refinement of lung cancer management. Trial Registration: ClinicalTrials.gov NCT05851755; https://clinicaltrials.gov/study/NCT05851755. ISRCTN 67197140; https://www.isrctn.com/ISRCTN67197140 International Registered Report Identifier (IRRID): PRR1-10.2196/57183 ",
doi="10.2196/57183",
url="https://www.researchprotocols.org/2024/1/e57183"
}


@Article{info:doi/10.2196/64673,
author="Loerzel, Victoria
and Alamian, Arsham
and Clochesy, John
and Geddie, I. Patricia",
title="Serious Gaming for Chemotherapy-Induced Nausea and Vomiting in Older Adults With Cancer: Protocol for a Randomized Clinical Trial",
journal="JMIR Res Protoc",
year="2024",
month="Oct",
day="2",
volume="13",
pages="e64673",
keywords="chemotherapy-induced nausea and vomiting",
keywords="aged",
keywords="serious game",
keywords="symptom self-management",
keywords="mobile phone",
keywords="neoplasms",
keywords="self-care",
abstract="Background: Older adults are at high risk for toxicity due to cancer treatment and increased risk for adverse events related to chemotherapy-induced nausea and vomiting (CINV). Unfortunately, older adults report multiple treatment-related symptoms but use few strategies to self-manage these symptoms due to erroneous beliefs related to the effectiveness of commonly taught self-management strategies. We developed a novel serious game, Managing at Home (MAH), to help older adults learn how to effectively self-manage CINV at home. Objective: This study has 2 aims. Aim 1 is to examine changes in CINV severity, self-management behaviors, functioning, quality of life, cognitive representation, and health care use within the intervention group from baseline (T1) to completion of the study (T6). Aim 2 is to determine the efficacy of the MAH intervention by comparing differences in primary outcomes (CINV severity and health care use) and secondary outcomes (self-management behaviors, functioning, and quality of life) between the intervention and control groups at each follow-up visit (T2-T6) and completion of the study (T6). Methods: This is a longitudinal randomized clinical trial. We will collect data from 500 older adults receiving cancer-related chemotherapy at baseline (T1) and at each treatment cycle until cycle 6 (T6). Participants will be enrolled if they are 60 years or older of age, are newly diagnosed with cancer, being treated with any chemotherapy agent with moderate or high emetic potential, are on a 2-, 3-, or 4-week treatment cycle, are proficient in English, and have a telephone. Previous diagnosis or treatment for cancer, end-stage disease with less than 6 months to live, and uncorrected visual or hearing impairment are exclusion criteria. Results: This study was funded in September 2022 and received institutional review board approval in October 2022. As of July 2023, the enrollment of participants is ongoing and currently has 130 enrolled participants. Data collection and analysis will be complete in 2027. Conclusions: This study addresses self-management of CINV in older adults using an innovative serious game. The MAH intervention uses simulation and gaming technology to engage older adults in active learning in order to reframe erroneous perceptions about symptom self-management. If shown to be effective, it can easily be adapted to include other cancer-related symptoms or other chronic illnesses. Trial Registration: ClinicalTrials.gov NCT05838638; https://clinicaltrials.gov/study/NCT05838638 International Registered Report Identifier (IRRID): DERR1-10.2196/64673 ",
doi="10.2196/64673",
url="https://www.researchprotocols.org/2024/1/e64673"
}


@Article{info:doi/10.2196/59587,
author="Ortiz, L. Bengie
and Gupta, Vibhuti
and Kumar, Rajnish
and Jalin, Aditya
and Cao, Xiao
and Ziegenbein, Charles
and Singhal, Ashutosh
and Tewari, Muneesh
and Choi, Won Sung",
title="Data Preprocessing Techniques for AI and Machine Learning Readiness: Scoping Review of Wearable Sensor Data in Cancer Care",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Sep",
day="27",
volume="12",
pages="e59587",
keywords="machine learning",
keywords="artificial intelligence",
keywords="preprocessing",
keywords="wearables",
keywords="mobile phone",
keywords="cancer care",
abstract="Background: Wearable sensors are increasingly being explored in health care, including in cancer care, for their potential in continuously monitoring patients. Despite their growing adoption, significant challenges remain in the quality and consistency of data collected from wearable sensors. Moreover, preprocessing pipelines to clean, transform, normalize, and standardize raw data have not yet been fully optimized. Objective: This study aims to conduct a scoping review of preprocessing techniques used on raw wearable sensor data in cancer care, specifically focusing on methods implemented to ensure their readiness for artificial intelligence and machine learning (AI/ML) applications. We sought to understand the current landscape of approaches for handling issues, such as noise, missing values, normalization or standardization, and transformation, as well as techniques for extracting meaningful features from raw sensor outputs and converting them into usable formats for subsequent AI/ML analysis. Methods: We systematically searched IEEE Xplore, PubMed, Embase, and Scopus to identify potentially relevant studies for this review. The eligibility criteria included (1) mobile health and wearable sensor studies in cancer, (2) written and published in English, (3) published between January 2018 and December 2023, (4) full text available rather than abstracts, and (5) original studies published in peer-reviewed journals or conferences. Results: The initial search yielded 2147 articles, of which 20 (0.93\%) met the inclusion criteria. Three major categories of preprocessing techniques were identified: data transformation (used in 12/20, 60\% of selected studies), data normalization and standardization (used in 8/20, 40\% of the selected studies), and data cleaning (used in 8/20, 40\% of the selected studies). Transformation methods aimed to convert raw data into more informative formats for analysis, such as by segmenting sensor streams or extracting statistical features. Normalization and standardization techniques usually normalize the range of features to improve comparability and model convergence. Cleaning methods focused on enhancing data reliability by handling artifacts like missing values, outliers, and inconsistencies. Conclusions: While wearable sensors are gaining traction in cancer care, realizing their full potential hinges on the ability to reliably translate raw outputs into high-quality data suitable for AI/ML applications. This review found that researchers are using various preprocessing techniques to address this challenge, but there remains a lack of standardized best practices. Our findings suggest a pressing need to develop and adopt uniform data quality and preprocessing workflows of wearable sensor data that can support the breadth of cancer research and varied patient populations. Given the diverse preprocessing techniques identified in the literature, there is an urgency for a framework that can guide researchers and clinicians in preparing wearable sensor data for AI/ML applications. For the scoping review as well as our research, we propose a general framework for preprocessing wearable sensor data, designed to be adaptable across different disease settings, moving beyond cancer care. ",
doi="10.2196/59587",
url="https://mhealth.jmir.org/2024/1/e59587",
url="http://www.ncbi.nlm.nih.gov/pubmed/38626290"
}


@Article{info:doi/10.2196/57801,
author="Donawa, Alyssa
and Powell, Christian
and Wang, Rong
and Chih, Ming-Yuan
and Patel, Reema
and Zinner, Ralph
and Aronoff-Spencer, Eliah
and Baker, E. Corey",
title="Designing Survey-Based Mobile Interfaces for Rural Patients With Cancer Using Apple's ResearchKit and CareKit: Usability Study",
journal="JMIR Form Res",
year="2024",
month="Sep",
day="26",
volume="8",
pages="e57801",
keywords="usability",
keywords="usability testing",
keywords="digital literacy",
keywords="ehealth literacy",
keywords="digital divide",
keywords="mobile health",
keywords="mHealth",
keywords="patients with cancer",
keywords="rural health",
keywords="distress",
keywords="apps",
keywords="ehealth adoption",
keywords="HealthKit",
keywords="CareKit",
abstract="Background: Despite the increased accessibility and availability of technology in recent years, equality and access to health-related technology remain limited to some demographics. In particular, patients who are older or from rural communities represent a large segment of people who are currently underusing mobile health (mHealth) solutions. System usability continues to hinder mHealth adoption among users with nontraditional digital literacy. Objective: This study aims to investigate if state-of-the-art mobile app interfaces from open-source libraries provide sufficient usability for rural patients with cancer, with minimal design changes and forgoing the co-design process. Methods: We developed Assuage (Network Reconnaissance Lab) as a research platform for any mHealth study. We conducted a pilot study using Assuage to assess the usability of 4 mobile user interfaces (UIs) based on open-source libraries from Apple's ResearchKit and CareKit. These UIs varied in complexity for reporting distress symptoms. Patients with cancer were recruited at the Markey Cancer Center, and all research procedures were conducted in person. Participants completed the distress assessment using a randomly selected UI in Assuage with little to no assistance. Data were collected on participant age, location, mobile app use, and familiarity with mHealth apps. Participants rated usability with the System Usability Scale (SUS), and usability issues were documented and compared. A one-way ANOVA was used to compare the effect of the UIs on the SUS scores. Results: We recruited 30 current or postsurgery patients with cancer for this pilot study. Most participants were aged >50 years (24/30, 80\%), from rural areas (25/30, 83\%), had up to a high school education (19/30, 63\%), and were unfamiliar with mHealth apps (21/30, 70\%). General mobile app use was split, with 43\% (14/30) of the patients not regularly using mobile apps. The mean SUS score across the UIs was 75.8 (SD 22.2), with UI 3 and UI 4 achieving an SUS score ?80, meeting the industry standard for good usability of 80. Critical usability issues were related to data input and navigation with touch devices, such as scale-format questions, vertical scrolling, and traversing multiple screens. Conclusions: The findings from this study show that most patients with cancer (20/30, 67\%) who participated in this study rated the different interfaces of Assuage as above-average usability (SUS score >68). This suggests that Apple's ResearchKit and CareKit libraries can provide usable UIs for older and rural users with minimal interface alterations. When resources are limited, the design stage can be simplified by omitting the co-design process while preserving suitable usability for users with nontraditional technical proficiency. Usability comparable to industry standards can be achieved by considering heuristics for interface and electronic survey design, specifically how to segment and navigate surveys, present important interface elements, and signal gestural interactions. ",
doi="10.2196/57801",
url="https://formative.jmir.org/2024/1/e57801"
}


@Article{info:doi/10.2196/60323,
author="Janbain, Ali
and Farolfi, Andrea
and Guenegou-Arnoux, Armelle
and Romengas, Louis
and Scharl, Sophia
and Fanti, Stefano
and Serani, Francesca
and Peeken, C. Jan
and Katsahian, Sandrine
and Strouthos, Iosif
and Ferentinos, Konstantinos
and Koerber, A. Stefan
and Vogel, E. Marco
and Combs, E. Stephanie
and Vrachimis, Alexis
and Morganti, Giuseppe Alessio
and Spohn, KB Simon
and Grosu, Anca-Ligia
and Ceci, Francesco
and Henkenberens, Christoph
and Kroeze, GC Stephanie
and Guckenberger, Matthias
and Belka, Claus
and Bartenstein, Peter
and Hruby, George
and Emmett, Louise
and Omerieh, Afshar Ali
and Schmidt-Hegemann, Nina-Sophie
and Mose, Lucas
and Aebersold, M. Daniel
and Zamboglou, Constantinos
and Wiegel, Thomas
and Shelan, Mohamed",
title="A Machine Learning Approach for Predicting Biochemical Outcome After PSMA-PET--Guided Salvage Radiotherapy in Recurrent Prostate Cancer After Radical Prostatectomy: Retrospective Study",
journal="JMIR Cancer",
year="2024",
month="Sep",
day="20",
volume="10",
pages="e60323",
keywords="cancer",
keywords="oncologist",
keywords="metastases",
keywords="prostate",
keywords="prostate cancer",
keywords="prostatectomy",
keywords="salvage radiotherapy",
keywords="PSMA-PET",
keywords="prostate-specific membrane antigen--positron emission tomography",
keywords="prostate-specific membrane antigen",
keywords="PET",
keywords="positron emission tomography",
keywords="radiotherapy",
keywords="radiology",
keywords="radiography",
keywords="machine learning",
keywords="ML",
keywords="artificial intelligence",
keywords="AI",
keywords="algorithm",
keywords="algorithms",
keywords="predictive model",
keywords="predictive models",
keywords="predictive analytics",
keywords="predictive system",
keywords="practical model",
keywords="practical models",
keywords="deep learning",
abstract="Background: Salvage radiation therapy (sRT) is often the sole curative option in patients with biochemical recurrence after radical prostatectomy. After sRT, we developed and validated a nomogram to predict freedom from biochemical failure. Objective: This study aims to evaluate prostate-specific membrane antigen--positron emission tomography (PSMA-PET)--based sRT efficacy for postprostatectomy prostate-specific antigen (PSA) persistence or recurrence. Objectives include developing a random survival forest (RSF) model for predicting biochemical failure, comparing it with a Cox model, and assessing predictive accuracy over time. Multinational cohort data will validate the model's performance, aiming to improve clinical management of recurrent prostate cancer. Methods: This multicenter retrospective study collected data from 13 medical facilities across 5 countries: Germany, Cyprus, Australia, Italy, and Switzerland. A total of 1029 patients who underwent sRT following PSMA-PET--based assessment for PSA persistence or recurrence were included. Patients were treated between July 2013 and June 2020, with clinical decisions guided by PSMA-PET results and contemporary standards. The primary end point was freedom from biochemical failure, defined as 2 consecutive PSA rises >0.2 ng/mL after treatment. Data were divided into training (708 patients), testing (271 patients), and external validation (50 patients) sets for machine learning algorithm development and validation. RSF models were used, with 1000 trees per model, optimizing predictive performance using the Harrell concordance index and Brier score. Statistical analysis used R Statistical Software (R Foundation for Statistical Computing), and ethical approval was obtained from participating institutions. Results: Baseline characteristics of 1029 patients undergoing sRT PSMA-PET--based assessment were analyzed. The median age at sRT was 70 (IQR 64-74) years. PSMA-PET scans revealed local recurrences in 43.9\% (430/979) and nodal recurrences in 27.2\% (266/979) of patients. Treatment included dose-escalated sRT to pelvic lymphatics in 35.6\% (349/979) of cases. The external outlier validation set showed distinct features, including higher rates of positive lymph nodes (47/50, 94\% vs 266/979, 27.2\% in the learning cohort) and lower delivered sRT doses (<66 Gy in 57/979, 5.8\% vs 46/50, 92\% of patients; P<.001). The RSF model, validated internally and externally, demonstrated robust predictive performance (Harrell C-index range: 0.54-0.91) across training and validation datasets, outperforming a previously published nomogram. Conclusions: The developed RSF model demonstrates enhanced predictive accuracy, potentially improving patient outcomes and assisting clinicians in making treatment decisions. ",
doi="10.2196/60323",
url="https://cancer.jmir.org/2024/1/e60323"
}


@Article{info:doi/10.2196/51061,
author="Jin, William
and Montoya, Christopher
and Rich, James Benjamin
and Taswell, Seldon Crystal
and Noy, Miguel
and Kwon, Deukwoo
and Spieler, Benjamin
and Mahal, Brandon
and Abramowitz, Matthew
and Yechieli, Raphael
and Pollack, Alan
and Dal Pra, Alan",
title="A Smart Water Bottle and Companion App (HidrateSpark 3) to Improve Bladder-Filling Compliance in Patients With Prostate Cancer Receiving Radiotherapy: Nonrandomized Trial of Feasibility and Acceptability",
journal="JMIR Cancer",
year="2024",
month="Sep",
day="10",
volume="10",
pages="e51061",
keywords="digital therapeutics",
keywords="behavioral intervention",
keywords="digital health",
keywords="prostate cancer",
keywords="radiation",
keywords="smart water bottle",
keywords="companion app",
keywords="oncology",
keywords="prostate",
keywords="privacy",
keywords="radiation therapy",
keywords="bladder",
keywords="compliance",
keywords="smartphone-based behavioral intervention",
keywords="mobile phone",
abstract="Background: Patients with prostate cancer undergoing radiation therapy (RT) need comfortably full bladders to reduce toxicities during treatment. Poor compliance is common with standard of care written or verbal instructions, leading to wasted patient value (PV) and clinic resources via poor throughput efficiency (TE). Objective: Herein, we assessed the feasibility and acceptability of a smartphone-based behavioral intervention (SBI) to improve bladder-filling compliance and methods for quantifying PV and TE. Methods: In total, 36 patients with prostate cancer were enrolled in a single-institution, closed-access, nonrandomized feasibility trial. The SBI consists of a fully automated smart water bottle and smartphone app. Both pieces alert the patient to empty his bladder and drink a personalized volume goal, based on simulation bladder volume, 1.25 hours before his scheduled RT. Patients were trained to adjust their volume goal and notification times to achieve comfortably full bladders. The primary end point was met if qualitative (QLC) and quantitative compliance (QNC) were >80\%. For QLC, patients were asked if they prepared their bladders before daily RT. QNC was met if bladder volumes on daily cone-beam tomography were >75\% of the simulation's volume. The Service User Technology Acceptability Questionnaire (SUTAQ) was given in person pre- and post-SBI. Additional acceptability and engagement end points were met if >3 out of 5 across 4 domains on the SUTAQ and >80\% (15/18) of patients used the device >50\% of the time, respectively. Finally, the impact of SBI on PV and TE was measured by time spent in a clinic and on the linear accelerator (linac), respectively, and contrasted with matched controls. Results: QLC was 100\% in 375 out of 398 (94.2\%) total treatments, while QNC was 88.9\% in 341 out of 398 (85.7\%) total treatments. Of a total score of 5, patients scored 4.33 on privacy concerns, 4 on belief in benefits, 4.56 on satisfaction, and 4.24 on usability via SUTAQ. Further, 83\% (15/18) of patients used the SBI on >50\% of treatments. Patients in the intervention arm spent less time in a clinic (53.24, SEM 1.71 minutes) compared to the control (75.01, SEM 2.26 minutes) group (P<.001). Similarly, the intervention arm spent less time on the linac (10.67, SEM 0.40 minutes) compared to the control (14.19, SEM 0.32 minutes) group (P<.001). Conclusions: This digital intervention trial showed high rates of bladder-filling compliance and engagement. High patient value and TE were feasibly quantified by shortened clinic times and linac usage, respectively. Future studies are needed to evaluate clinical outcomes, patient experience, and cost-benefit. Trial Registration: ClinicalTrials.gov NCT04946214; https://www.clinicaltrials.gov/study/NCT04946214 ",
doi="10.2196/51061",
url="https://cancer.jmir.org/2024/1/e51061"
}


@Article{info:doi/10.2196/55841,
author="Roberts, Anne Natasha
and Pelecanos, Anita
and Alexander, Kimberly
and Wyld, David
and Janda, Monika",
title="Implementation of Patient-Reported Outcomes in a Medical Oncology Setting (the iPROMOS Study): Type II Hybrid Implementation Study",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="27",
volume="26",
pages="e55841",
keywords="implementation science",
keywords="iPARIHS",
keywords="clinical practice",
keywords="intervention",
keywords="implementation",
keywords="facilitator",
keywords="facilitation",
keywords="patient-reported outcomes, patient-reported outcome measures",
keywords="oncology",
keywords="symptom",
keywords="symptoms",
keywords="detection",
keywords="investigate",
keywords="service",
keywords="services",
keywords="clinic",
keywords="clinics",
keywords="Australia",
keywords="binary logistic models",
keywords="regression model",
keywords="regression models",
keywords="patient",
keywords="patients",
keywords="supportive care",
abstract="Background: Clinical trials have demonstrated that patient-reported outcome measures (PROMs) can improve mortality and morbidity outcomes when used in clinical practice. Objective: This study aimed to prospectively investigate the implementation of PROMs in routine oncology. Outcomes measured included improved symptom detection, clinical response to symptom information, and health service outcomes. Methods: Two of 12 eligible clinics were randomized to implement symptom PROMs in a medical oncology outpatient department in Australia. Randomization was carried out at the clinic level. Patients in control clinics continued with usual care; those in intervention clinics completed a symptom PROM at presentation. This was a pilot study investigating symptom detection, using binary logistic models, and clinical response to PROMs investigated using multiple regression models. Results: A total of 461 patient encounters were included, consisting of 242 encounters in the control and 222 in the intervention condition. Patients in these clinics most commonly had head and neck, lung, prostate, breast, or colorectal cancer and were seen in the clinic for surveillance and oral or systemic treatments for curative, metastatic, or palliative cancer care pathways. Compared with control encounters, the proportion of symptoms detected increased in intervention encounters (odds ratio 1.05, 95\% CI 0.99-1.11; P=.08). The odds of receiving supportive care, demonstrated by nonroutine allied health review, increased in the intervention compared with control encounters (odds ratio 3.54, 95\% CI 1.26-9.90; P=.02). Conclusions: Implementation of PROMs in routine care did not significantly improve symptom detection but increased the likelihood of nonroutine allied health reviews for supportive care. Larger studies are needed to investigate health service outcomes. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000398202; https://tinyurl.com/3cxbemy4 ",
doi="10.2196/55841",
url="https://www.jmir.org/2024/1/e55841",
url="http://www.ncbi.nlm.nih.gov/pubmed/39190468"
}


@Article{info:doi/10.2196/52841,
author="Franzoi, Alice Maria
and Pages, Arnaud
and Papageorgiou, Loula
and Di Meglio, Antonio
and Laparra, Ariane
and Martin, Elise
and Barbier, Aude
and Renvoise, Nathalie
and Arvis, Johanna
and Scotte, Florian
and Vaz-Luis, Ines",
title="Evaluating the Implementation of Integrated Proactive Supportive Care Pathways in Oncology: Master Protocol for a Cohort Study",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="26",
volume="13",
pages="e52841",
keywords="care delivery",
keywords="pathway of care",
keywords="oncology",
keywords="supportive care",
keywords="quality of life",
keywords="cohort study",
abstract="Background: Supportive care (SC) refers to the prevention and management of complications of cancer and its treatment. While it has long been recognized as an important cancer care delivery component, a high proportion of patients face unaddressed SC needs, calling for innovative approaches to deliver SC. Objective: The objective of this master protocol is to evaluate the implementation of different integrated proactive SC pathways across the cancer care continuum in our institution (Gustave Roussy, Villejuif, France). Pathways studied in this master protocol may occur shortly after diagnosis to prevent treatment-related burden; during treatment to monitor the onset of toxicities and provide timely symptom management; and after treatment to improve rehabilitation, self-management skills, and social reintegration. Methods: This study is guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. The primary objective is to evaluate the impact of SC pathways on patients' distress and unmet needs after 12 weeks, measured by the National Comprehensive Cancer Network's Distress Thermometer and Problem List. Secondary objectives will focus on the pathways (macrolevel) and each SC intervention (microlevel), evaluating their reach (administrative data review of the absolute number and proportion of clinical and sociodemographic characteristics of patients included in the pathways); short-term and long-term efficacy through their impact on quality of life (EQ-5D-5L and the 30-item European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire) and symptom burden (MD Anderson Symptom Inventory, Hospital Anxiety and Depression Scale, Insomnia Severity Index, and 22-item European Organization for Research and Treatment of Cancer Sexual Health Questionnaire); adoption by patients and providers (administrative data review of SC referrals and attendance or use of SC strategies); barriers to and leverage for implementation (surveys and focus groups with patients, providers, and the hospital organization); and maintenance (cost-consequence analysis). Pilot evaluations with a minimum of 70 patients per pathway will be performed to generate mean Distress Thermometer scores and SDs informing the calculation of formal sample size needed for efficacy evaluation (cohorts will be enriched accordingly). Results: The study was approved by the ethics committee, and as of February 2024, a total of 12 patients were enrolled. Conclusions: This study will contribute toward innovative models of SC delivery and will inform the implementation of integrated SC pathways of care. Trial Registration: ClinicalTrials.gov NCT06479057; https://clinicaltrials.gov/study/NCT06479057 International Registered Report Identifier (IRRID): PRR1-10.2196/52841 ",
doi="10.2196/52841",
url="https://www.researchprotocols.org/2024/1/e52841"
}


@Article{info:doi/10.2196/54785,
author="Bourne, E. Jessica
and Kelly, Paul
and Armstrong, G. Miranda E.",
title="A Theory and Evidence-Informed e-Cycling Intervention for Individuals Diagnosed With Cancer: Development Study",
journal="JMIR Cancer",
year="2024",
month="Aug",
day="16",
volume="10",
pages="e54785",
keywords="prostate cancer",
keywords="breast cancer",
keywords="electrically assisted cycling",
keywords="physical activity promotion",
keywords="behavior change techniques",
keywords="BCTs",
keywords="Behaviour Change Wheel",
keywords="Medical Research Council",
keywords="Theoretical Domains Framework",
keywords="TDF",
keywords="physical activity",
keywords="e-cycling intervention",
keywords="e-cycling",
keywords="cancer",
keywords="risk of disease",
keywords="all-cause mortality",
keywords="behavioral health",
keywords="instructor",
keywords="instructors",
keywords="cancer survivor",
keywords="patient with cancer",
keywords="healthy lifestyle",
keywords="intervention",
keywords="physical fitness",
keywords="exercise",
abstract="Background: Physical activity engagement following a cancer diagnosis is positively associated with survival, reduced risk of disease recurrence, and reduced cancer-specific and all-cause mortality. However, rates of physical activity engagement are low among individuals diagnosed with and being treated for breast cancer or prostate cancer. Objective: The purpose of this study was to describe the systematic process of developing an e-cycling intervention aimed at increasing physical activity among individuals living with prostate cancer or breast cancer and outline the key components to be implemented. Methods: The Medical Research Council guidance for developing complex interventions and the Behaviour Change Wheel were used to guide intervention development. Information was gathered from the literature and through discussions with end users to understand factors influencing e-cycling. These factors were mapped onto the Theoretical Domains Framework to identify potential mechanisms of action. Behavior change techniques were selected from theory and evidence to develop intervention content. Interested parties, including cycling instructors, end users, and behavior change experts, reviewed and refined the intervention. Results: Anticipated barriers and facilitators to e-cycling engagement were mapped onto 11 of the 14 domains of the Theoretical Domains Framework. A total of 23 behavior change techniques were selected to target these domains over 4 one-to-one e-cycling sessions delivered by trained cycling instructors in the community. Cycling instructors were provided a 3-hour classroom training session on delivering the intervention and a 3-hour practical session with feedback. The outcome of this work is a theory and evidence-informed intervention aimed at promoting e-cycling behavior among individuals being treated for breast cancer or prostate cancer, which is currently being implemented and evaluated. Conclusions: Transparent intervention development and reporting of content is important for comprehensively examining intervention implementation. The implementation of this intervention package is currently being evaluated in a pilot randomized controlled trial. If the intervention is found to be effective and the content and delivery are acceptable, this intervention will form a basis for the development of e-cycling interventions in other survivors of cancer. Trial Registration: ISRCTN Registry ISRCTN39112034 https://www.isrctn.com/ISRCTN39112034; and IRSCTN Registry ISRCTN42852156;https://www.isrctn.com/ISRCTN42852156 ",
doi="10.2196/54785",
url="https://cancer.jmir.org/2024/1/e54785"
}


@Article{info:doi/10.2196/55252,
author="Hudson, Peter
and Francis, Jill
and Cohen, Joachim
and Kapp, Suzanne
and De Abreu Lourenco, Richard
and Beatty, Lisa
and Gray, Kathleen
and Jefford, Michael
and Juraskova, Ilona
and Northouse, Laurel
and de Vleminck, Aline
and Chang, Sungwon
and Yates, Patsy
and Athan, Sophy
and Baptista, Shaira
and Klaic, Marlena
and Philip, Jennifer",
title="Improving the Well-Being of People With Advanced Cancer and Their Family Caregivers: Protocol for an Effectiveness-Implementation Trial of a Dyadic Digital Health Intervention (FOCUSau)",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="13",
volume="13",
pages="e55252",
keywords="advanced cancer",
keywords="clinical trial",
keywords="digital health intervention",
keywords="palliative care",
keywords="health economics",
keywords="implementation science",
keywords="wellbeing",
keywords="well-being",
keywords="cancer",
keywords="family caregiver",
keywords="family caregivers",
keywords="caregivers",
keywords="caregiver",
keywords="digital health",
keywords="quality of life",
keywords="dyad",
keywords="self-administered",
keywords="web-based intervention",
keywords="web-based",
keywords="Australian",
keywords="Australia",
keywords="efficacy",
keywords="cost-effectiveness",
keywords="psychoeducation",
abstract="Background: Advanced cancer significantly impacts patients' and family caregivers' quality of life. When patients and caregivers are supported concurrently as a dyad, the well-being of each person is optimized. Family, Outlook, Communication, Uncertainty, Symptom management (FOCUS) is a dyadic, psychoeducational intervention developed in the United States, shown to improve the well-being and quality of life of patients with advanced cancer and their primary caregivers. Originally, a nurse-delivered in-person intervention, FOCUS has been adapted into a self-administered web-based intervention for European delivery. Objective: The aims of this study are to (1) adapt FOCUS to the Australian context (FOCUSau); (2) evaluate the effectiveness of FOCUSau in improving the emotional well-being and self-efficacy of patients with advanced cancer and their primary caregiver relative to usual care control group; (3) compare health care use between the intervention and control groups; and (4) assess the acceptability, feasibility, and scalability of FOCUSau in order to inform future maintainable implementation of the intervention within the Australian health care system. Methods: FOCUS will be adapted prior to trial commencement, using an iterative stakeholder feedback process to create FOCUSau. To examine the efficacy and cost-effectiveness of FOCUSau and assess its acceptability, feasibility, and scalability, we will undertake a hybrid type 1 implementation study consisting of a phase 3 (clinical effectiveness) trial along with an observational implementation study. Participants will include patients with cancer who are older than 18 years, able to access the internet, and able to identify a primary support person or caregiver who can also be approached for participation. The sample size consists of 173 dyads in each arm (ie, 346 dyads in total). Patient-caregiver dyad data will be collected at 3 time points---baseline (T0) completed prerandomization; first follow-up (T1; N=346) at 12 weeks post baseline; and second follow-up (T2) at 24 weeks post baseline. Results: The study was funded in March 2022. Recruitment commenced in July 2024. Conclusions: If shown to be effective, this intervention will improve the well-being of patients with advanced cancer and their family caregivers, regardless of their location or current level of health care support. Trial Registration: ClinicalTrials.gov NCT06082128; https://clinicaltrials.gov/study/NCT06082128 International Registered Report Identifier (IRRID): PRR1-10.2196/55252 ",
doi="10.2196/55252",
url="https://www.researchprotocols.org/2024/1/e55252"
}


@Article{info:doi/10.2196/57276,
author="Garcia-Saiso, Sebastian
and Marti, Myrna
and Pesce, Karina
and Luciani, Silvana
and Mujica, Oscar
and Hennis, Anselm
and D'Agostino, Marcelo",
title="Artificial Intelligence as a Potential Catalyst to a More Equitable Cancer Care",
journal="JMIR Cancer",
year="2024",
month="Aug",
day="12",
volume="10",
pages="e57276",
keywords="digital health",
keywords="public health",
keywords="cancer",
keywords="artificial intelligence",
keywords="AI",
keywords="catalyst",
keywords="cancer care",
keywords="cost",
keywords="costs",
keywords="demographic",
keywords="epidemiological",
keywords="change",
keywords="changes",
keywords="healthcare",
keywords="equality",
keywords="health system",
keywords="mHealth",
keywords="mobile health",
doi="10.2196/57276",
url="https://cancer.jmir.org/2024/1/e57276",
url="http://www.ncbi.nlm.nih.gov/pubmed/39133537"
}


@Article{info:doi/10.2196/49089,
author="Perry, Betty Melissa
and Taylor, Sally
and Khatoon, Binish
and Vercell, Amy
and Faivre-Finn, Corinne
and Velikova, Galina
and Marsden, Antonia
and Heal, Calvin
and Yorke, Janelle",
title="Examining the Effectiveness of Electronic Patient-Reported Outcomes in People With Cancer: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Jul",
day="31",
volume="26",
pages="e49089",
keywords="telemedicine",
keywords="patient-reported outcome measure",
keywords="neoplasms",
keywords="quality of life",
keywords="systematic review",
keywords="meta-analysis",
keywords="randomized controlled trial",
abstract="Background: Electronic patient-reported outcomes (ePROs) are commonly used in oncology clinical practice and have shown benefits for patients and health resource use. Objective: The aim of this study was to compare the isolated effect of administering ePROs to patients with cancer versus a control condition. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Randomized controlled trials evaluating ePRO interventions that aimed to improve health-related outcomes among patients with cancer were included. The primary outcome was health-related quality of life (HRQOL), and the secondary outcomes were symptoms, hospital admissions, unplanned visits, chemotherapy completion, survival, and satisfaction with care. The effect sizes of ePROs on health-related outcomes were analyzed as standardized mean differences (SMDs) with 95\% CIs using a random effects model. Results: The search identified 10,965 papers, of which 19 (0.17\%) from 15 studies were included. The meta-analysis showed an improvement in HRQOL at 3 months, measured by the Functional Assessment of Cancer Therapy--General (SMD 0.29, 95\% CI 0.19 to 0.39), and at 6 months, assessed using various HRQOL measures (SMD 0.21, 95\% CI 0.11 to 0.30). Of the 15 studies, 9 (60\%) reported a positive signal on HRQOL, with two-thirds of the studies (n=6, 67\%) including tailored patient advice and two-thirds (n=6, 67\%) using clinician alert systems. Conclusions: The meta-analysis showed an improvement in HRQOL at 6 months and in Functional Assessment of Cancer Therapy--General scores at 3 months for studies that included tailored advice and clinician alerts, suggesting that these elements may improve ePRO effectiveness. The findings will provide guidance for future use and help health care professionals choose the most suitable ePRO features for their patients. Trial Registration: PROSPERO CRD42020175007; https://tinyurl.com/5cwmy3j6 ",
doi="10.2196/49089",
url="https://www.jmir.org/2024/1/e49089"
}


@Article{info:doi/10.2196/58886,
author="Weile, Synne Kathrine
and Mathiasen, Ren{\'e}
and Winther, Falck Jeanette
and Hasle, Henrik
and Henriksen, Tram Louise",
title="Hjernetegn.dk---The Danish Central Nervous System Tumor Awareness Initiative Digital Decision Support Tool: Design and Implementation Report",
journal="JMIR Med Inform",
year="2024",
month="Jul",
day="25",
volume="12",
pages="e58886",
keywords="digital health initiative",
keywords="digital health initiatives",
keywords="clinical decision support",
keywords="decision support",
keywords="decision support system",
keywords="decision support systems",
keywords="decision support tool",
keywords="decision support tools",
keywords="diagnostic delay",
keywords="awareness initiative",
keywords="pediatric neurology",
keywords="pediatric CNS tumors",
keywords="CNS tumor",
keywords="CNS tumour",
keywords="CNS tumours",
keywords="co-creation",
keywords="health systems and services",
keywords="communication",
keywords="central nervous system",
abstract="Background: Childhood tumors in the central nervous system (CNS) have longer diagnostic delays than other pediatric tumors. Vague presenting symptoms pose a challenge in the diagnostic process; it has been indicated that patients and parents may be hesitant to seek help, and health care professionals (HCPs) may lack awareness and knowledge about clinical presentation. To raise awareness among HCPs, the Danish CNS tumor awareness initiative hjernetegn.dk was launched. Objective: This study aims to present the learnings from designing and implementing a decision support tool for HCPs to reduce diagnostic delay in childhood CNS tumors. The aims also include decisions regarding strategies for dissemination and use of social media, and an evaluation of the digital impact 6 months after launch. Methods: The phases of developing and implementing the tool include participatory co-creation workshops, designing the website and digital platforms, and implementing a press and media strategy. The digital impact of hjernetegn.dk was evaluated through website analytics and social media engagement. Implementation (Results): hjernetegn.dk was launched in August 2023. The results after 6 months exceeded key performance indicators. The analysis showed a high number of website visitors and engagement, with a plateau reached 3 months after the initial launch. The LinkedIn campaign and Google Search strategy also generated a high number of impressions and clicks. Conclusions: The findings suggest that the initiative has been successfully integrated, raising awareness and providing a valuable tool for HCPs in diagnosing childhood CNS tumors. The study highlights the importance of interdisciplinary collaboration, co-creation, and ongoing community management, as well as broad dissemination strategies when introducing a digital support tool. ",
doi="10.2196/58886",
url="https://medinform.jmir.org/2024/1/e58886"
}


@Article{info:doi/10.2196/54817,
author="Jackson, Walton Riley
and Cao-Nasalga, Ann
and Chieng, Amy
and Pirkl, Amy
and Jagielo, D. Annemarie
and Xu, Cindy
and Goldenhersch, Emilio
and Rosencovich, Nicolas
and Waitman, Cristian
and Prochaska, J. Judith",
title="Adding Virtual Reality Mindful Exposure Therapy to a Cancer Center's Tobacco Treatment Offerings: Feasibility and Acceptability Single-Group Pilot Study",
journal="JMIR Form Res",
year="2024",
month="Jul",
day="23",
volume="8",
pages="e54817",
keywords="tobacco cessation",
keywords="virtual reality",
keywords="exposure therapy",
keywords="cancer care",
keywords="mobile phone",
abstract="Background: Smoking contributes to 1 in 3 cancer deaths. At the Stanford Cancer Center, tobacco cessation medication management and counseling are provided as a covered benefit. Patients charted as using tobacco are contacted by a tobacco treatment specialist and offered cessation services. As a novel addition, this study examined the acceptability of a virtual reality (VR) mindful exposure therapy app for quitting smoking called MindCotine. Objective: The objective of this study was to determine the feasibility and acceptability of offering 6 weeks of MindCotine treatment as a part of Stanford's Tobacco Treatment Services for patients seen for cancer care. Methods: As part of a single-group pilot study, the MindCotine VR program was offered to English- or Spanish-speaking patients interested in quitting smoking. Given the visual interface, epilepsy was a medical exclusion. Viewed from a smartphone with an attachable VR headset, MindCotine provides a digital environment with audiovisual content guiding mindfulness exercises (eg, breathing techniques, body awareness, and thought recognition), text-based coaching, and cognitive behavioral therapy-based self-reflections for quitting smoking. Interested patients providing informed consent were mailed a MindCotine headset and asked to use the app for 10+ minutes a day. At the end of 6 weeks, participants completed a feedback survey. Results: Of the 357 patients reached by the tobacco treatment specialist, 62 (17.3\%) were ineligible, 190 (53.2\%) were not interested in tobacco treatment services, and 78 (21.8\%) preferred other tobacco treatment services. Among the 105 eligible and interested in assistance with quitting, 27 (25.7\%) were interested in MindCotine, of whom 20 completed the informed consent, 9 used the program, and 8 completed their end-of-treatment survey. Participants using MindCotine completed, on average, 13 (SD 20.2) program activities, 19 (SD 26) journal records, and 11 (SD 12.3) coaching engagements. Of the 9 participants who used MindCotine, 4 (44\%) reported some dizziness with app use that resolved and 7 (78\%) would recommend MindCotine to a friend. In total, 2 participants quit tobacco (22.2\% reporting, 10\% overall), 2 others reduced their smoking by 50\% or more, and 2 quit for 24 hours and then relapsed. Conclusions: In a feasibility and acceptability pilot study of a novel VR tobacco treatment app offered to patients at a cancer center, 4 of 9 (44\%) reporting and 4 of 20 (20\%) overall substantially reduced or quit using tobacco after 6 weeks and most would recommend the app to others. Further testing on a larger sample is warranted. Trial Registration: ClinicalTrials.gov NCT05220254; https://clinicaltrials.gov/study/NCT05220254 ",
doi="10.2196/54817",
url="https://formative.jmir.org/2024/1/e54817"
}


@Article{info:doi/10.2196/43070,
author="Leung, W. Yvonne
and Wouterloot, Elise
and Adikari, Achini
and Hong, Jinny
and Asokan, Veenaajaa
and Duan, Lauren
and Lam, Claire
and Kim, Carlina
and Chan, P. Kai
and De Silva, Daswin
and Trachtenberg, Lianne
and Rennie, Heather
and Wong, Jiahui
and Esplen, Jane Mary",
title="Artificial Intelligence--Based Co-Facilitator (AICF) for Detecting and Monitoring Group Cohesion Outcomes in Web-Based Cancer Support Groups: Single-Arm Trial Study",
journal="JMIR Cancer",
year="2024",
month="Jul",
day="22",
volume="10",
pages="e43070",
keywords="group cohesion",
keywords="LIWC",
keywords="online support group",
keywords="natural language processing",
keywords="NLP",
keywords="emotion analysis",
keywords="machine learning",
keywords="sentiment analysis",
keywords="emotion detection",
keywords="integrating human knowledge",
keywords="emotion lining",
keywords="cancer",
keywords="oncology",
keywords="support group",
keywords="artificial intelligence",
keywords="AI",
keywords="therapy",
keywords="online therapist",
keywords="emotion",
keywords="affect",
keywords="speech tagging",
keywords="speech tag",
keywords="topic modeling",
keywords="named entity recognition",
keywords="spoken language processing",
keywords="focus group",
keywords="corpus",
keywords="language",
keywords="linguistic",
abstract="Background: Commonly offered as supportive care, therapist-led online support groups (OSGs) are a cost-effective way to provide support to individuals affected by cancer. One important indicator of a successful OSG session is group cohesion; however, monitoring group cohesion can be challenging due to the lack of nonverbal cues and in-person interactions in text-based OSGs. The Artificial Intelligence--based Co-Facilitator (AICF) was designed to contextually identify therapeutic outcomes from conversations and produce real-time analytics. Objective: The aim of this study was to develop a method to train and evaluate AICF's capacity to monitor group cohesion. Methods: AICF used a text classification approach to extract the mentions of group cohesion within conversations. A sample of data was annotated by human scorers, which was used as the training data to build the classification model. The annotations were further supported by finding contextually similar group cohesion expressions using word embedding models as well. AICF performance was also compared against the natural language processing software Linguistic Inquiry Word Count (LIWC). Results: AICF was trained on 80,000 messages obtained from Cancer Chat Canada. We tested AICF on 34,048 messages. Human experts scored 6797 (20\%) of the messages to evaluate the ability of AICF to classify group cohesion. Results showed that machine learning algorithms combined with human input could detect group cohesion, a clinically meaningful indicator of effective OSGs. After retraining with human input, AICF reached an F1-score of 0.82. AICF performed slightly better at identifying group cohesion compared to LIWC. Conclusions: AICF has the potential to assist therapists by detecting discord in the group amenable to real-time intervention. Overall, AICF presents a unique opportunity to strengthen patient-centered care in web-based settings by attending to individual needs. International Registered Report Identifier (IRRID): RR2-10.2196/21453 ",
doi="10.2196/43070",
url="https://cancer.jmir.org/2024/1/e43070",
url="http://www.ncbi.nlm.nih.gov/pubmed/39037754"
}


@Article{info:doi/10.2196/49703,
author="Baik, H. Sharon
and Clark, Karen
and Sanchez, Marisol
and Loscalzo, Matthew
and Celis, Ashley
and Razavi, Marianne
and Yang, Dershung
and Dale, William
and Haas, Niina",
title="Usability and Preliminary Efficacy of an Adaptive Supportive Care System for Patients With Cancer: Pilot Randomized Controlled Trial",
journal="JMIR Cancer",
year="2024",
month="Jul",
day="10",
volume="10",
pages="e49703",
keywords="cancer",
keywords="distress screening",
keywords="eHealth",
keywords="supportive care",
keywords="mobile phone",
abstract="Background: Using an iterative user-centered design process, our team developed a patient-centered adaptive supportive care system, PatientCareAnywhere, that provides comprehensive biopsychosocial screening and supportive cancer care to patients across the continuum of care adaptively. The overarching goal of PatientCareAnywhere is to improve health-related quality of life (HRQOL) and self-efficacy of patients with cancer by empowering them with self-management skills and bringing cancer care support directly to them at home. Such support is adaptive to the patient's needs and health status and coordinated across multiple sources in the forms of referrals, education, engagement of community resources, and secure social communication. Objective: This study aims to assess the usability of the new web-based PatientCareAnywhere system and examine the preliminary efficacy of PatientCareAnywhere to improve patient-reported outcomes compared with usual care. Methods: For phase 1, usability testing participants included patients with cancer (n=4) and caregivers (n=7) who evaluated the software prototype and provided qualitative (eg, interviews) and quantitative (eg, System Usability Scale) feedback. For phase 2, participants in the 3-month pilot randomized controlled trial were randomized to receive the PatientCareAnywhere intervention (n=36) or usual care control condition (n=36). HRQOL and cancer-relevant self-efficacy were assessed at baseline (preintervention assessment) and 12 weeks from baseline (postintervention assessment); mean differences between pre- and postintervention scores were compared between the 2 groups. Results: Participants were highly satisfied with the prototype and reported above-average acceptable usability, with a mean System Usability Scale score of 84.09 (SD 10.02). Qualitative data supported the overall usability and perceived usefulness of the intervention, with a few design features (eg, ``help request'' function) added based on participant feedback. With regard to the randomized controlled trial, patients in the intervention group reported significant improvements in HRQOL from pre- to postintervention scores (mean difference 6.08, SD 15.26) compared with the control group (mean difference ?2.95, SD 10.63; P=.01). In contrast, there was no significant between-group difference in self-efficacy (P=.09). Conclusions: Overall, PatientCareAnywhere represents a user-friendly, functional, and acceptable supportive care intervention with preliminary efficacy to improve HRQOL among patients diagnosed with cancer. Future studies are needed to further establish the efficacy of PatientCareAnywhere as well as explore strategies to enhance user engagement and investigate the optimal intensity, frequency, and use of the intervention to improve patient outcomes. Trial Registration: ClinicalTrials.gov NCT02408406; https://clinicaltrials.gov/study/NCT02408406 ",
doi="10.2196/49703",
url="https://cancer.jmir.org/2024/1/e49703"
}


@Article{info:doi/10.2196/58724,
author="Kim, Sunghak
and Wilson, Paije
and Abraham, Olufunmilola",
title="Investigating the Use of Serious Games for Cancer Control Among Children and Adolescents: Scoping Review",
journal="JMIR Serious Games",
year="2024",
month="Jul",
day="10",
volume="12",
pages="e58724",
keywords="serious games",
keywords="cancer control",
keywords="children",
keywords="adolescents",
keywords="scoping review",
keywords="game",
keywords="games",
keywords="gaming",
keywords="cancer",
keywords="oncology",
keywords="pediatric",
keywords="pediatrics",
keywords="paediatric",
keywords="paediatrics",
keywords="child",
keywords="youth",
keywords="adolescent",
keywords="teen",
keywords="teens",
keywords="teenager",
keywords="teenagers",
keywords="synthesis",
keywords="review methods",
keywords="review methodology",
keywords="search",
keywords="searches",
keywords="searching",
keywords="scoping",
abstract="Background: Effective health care services that meet the diverse needs of children and adolescents with cancer are required to alleviate their physical, psychological, and social challenges and improve their quality of life. Previous studies showed that serious games help promote people's health. However, the potential for serious games to be used for successful cancer control for children and adolescents has received less attention. Objective: This scoping review aimed to map the use of serious games in cancer prevention and cancer care for children and adolescents, and provide future directions for serious games' development and implementation within the context of cancer control for children and adolescents. Methods: This study followed a combination of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and the JBI (Joanna Briggs Institute) framework for the conduct of scoping reviews. PubMed, CINAHL Plus Full Text, Scopus, Web of Science Core Collection, and American Psychological Association (APA) PsycINFO databases were used for the search. Results: From the initial 2750 search results, 63 papers were included in the review, with 28 quantitative, 14 qualitative, and 21 mixed method studies. Most of the studies were cancer care serious game papers (55/63, 87\%) and a small number of studies were cancer prevention serious game papers (8/63, 13\%). The majority of the included studies were published between 2019 and 2023 (cancer prevention: 5/8, 63\%; cancer care: 35/55, 64\%). The majority of the studies were conducted in Europe (cancer prevention: 3/8, 38\%; cancer care: 24/55, 44\%) and North America (cancer prevention: 4/8, 50\%; cancer care: 17/55, 31\%). Adolescents were the most represented age group in the studies' participants (cancer prevention: 8/8, 100\%; cancer care: 46/55, 84\%). All (8/8, 100\%) cancer prevention serious game papers included healthy people as participants, and 45 out of 55 (82\%) cancer care serious game papers included patients with cancer. The majority of cancer prevention serious game papers addressed game preference as a target outcome (4/8, 50\%). The majority of cancer care serious game papers addressed symptom management as a target outcome (28/55, 51\%). Of the cancer care studies examining serious games for symptom management, the majority of the studies were conducted to treat psychological (13/55, 24\%) and physical symptoms (10/55, 18\%). Conclusions: This review shows both the growth of interest in the use of serious games for cancer control among children and adolescents and the potential for bias in the relevant literature. The diverse characteristics of the included papers suggest that serious games can be used in various ways for cancer control among children and adolescents while highlighting the need to develop and implement serious games in underrepresented areas. ",
doi="10.2196/58724",
url="https://games.jmir.org/2024/1/e58724",
url="http://www.ncbi.nlm.nih.gov/pubmed/38985502"
}


@Article{info:doi/10.2196/51072,
author="Yeung, Y. Nelson C.
and Lau, Y. Stephanie T.
and Mak, S. Winnie W.
and Cheng, Cecilia
and Chan, Y. Emily Y.
and Siu, M. Judy Y.
and Cheung, Y. Polly S.",
title="Applying the  Unified Theory of Acceptance and Use of Technology to Identify Factors Associated With Intention to Use Teledelivered Supportive Care Among Recently Diagnosed Breast Cancer Survivors During COVID-19 in Hong Kong: Cross-Sectional Survey",
journal="JMIR Cancer",
year="2024",
month="Jun",
day="27",
volume="10",
pages="e51072",
keywords="telehealth",
keywords="tele-delivered supportive cancer care",
keywords="breast cancer",
keywords="COVID-19",
keywords="technology acceptance",
keywords="UTAUT",
abstract="Background: Many supportive cancer care (SCC) services were teledelivered during COVID-19, but what facilitates patients' intentions to use teledelivered SCC is unknown. Objective: The study aimed to use the unified theory of acceptance and use of technology to investigate the factors associated with the intentions of breast cancer survivors (BCS) in Hong Kong to use various types of teledelivered SCC (including psychosocial care, medical consultation, complementary care, peer support groups). Favorable telehealth-related perceptions (higher performance expectancy, lower effort expectancy, more facilitating conditions, positive social influences), less technological anxiety, and greater fear of COVID-19 were hypothesized to be associated with higher intentions to use teledelivered SCC. Moreover, the associations between telehealth-related perceptions and intentions to use teledelivered SCC were hypothesized to be moderated by education level, such that associations between telehealth-related perceptions and intentions to use teledelivered SCC would be stronger among those with a higher education level. Methods: A sample of 209 (209/287, 72.8\% completion rate) women diagnosed with breast cancer since the start of the COVID-19 outbreak in Hong Kong (ie, January 2020) were recruited from the Hong Kong Breast Cancer Registry to complete a cross-sectional survey between June 2022 and December 2022. Participants' intentions to use various types of teledelivered SCC (dependent variables), telehealth-related perceptions (independent variables), and sociodemographic variables (eg, education, as a moderator variable) were measured using self-reported, validated measures. Results: Hierarchical regression analysis results showed that greater confidence using telehealth, performance expectancy (believing telehealth helps with daily tasks), social influence (important others encouraging telehealth use), and facilitating conditions (having resources for telehealth use) were associated with higher intentions to use teledelivered SCC (range: $\beta$=0.16, P=.03 to $\beta$=0.34, P<.001). Moreover, 2-way interactions emerged between education level and 2 of the telehealth perception variables. Education level moderated the associations between (1) performance expectancy and intention to use teledelivered complementary care ($\beta$=0.34, P=.04) and (2) facilitating conditions and intention to use teledelivered peer support groups ($\beta$=0.36, P=.03). The positive associations between those telehealth perceptions and intentions were only significant among those with a higher education level. Conclusions: The findings of this study implied that enhancing BCS' skills at using telehealth, BCS' and their important others' perceived benefits of telehealth, and providing assistance for telehealth use could increase BCS' intentions to use teledelivered SCC. For intentions to use specific types of SCC, addressing relevant factors (performance expectancy, facilitating conditions) might be particularly beneficial for those with a higher education level. ",
doi="10.2196/51072",
url="https://cancer.jmir.org/2024/1/e51072"
}


@Article{info:doi/10.2196/58503,
author="LoCastro, Marissa
and Wang, Ying
and Yu, Tristan
and Mortaz-Hedjri, Soroush
and Mendler, Jason
and Norton, Sally
and Bernacki, Rachelle
and Carroll, Thomas
and Klepin, Heidi
and Wedow, Lucy
and Goonan, Sean
and Erdos, Hannah
and Bagnato, Brenda
and Liesveld, Jane
and Huselton, Eric
and Kluger, Benzi
and Loh, Poh Kah",
title="Clinicians' Perspectives on the Telehealth Serious Illness Care Program for Older Adults With Myeloid Malignancies: Single-Arm Pilot Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="27",
volume="8",
pages="e58503",
keywords="serious illness conversations",
keywords="serious illness conversation",
keywords="SIC",
keywords="Serious Illness Care Program",
keywords="SICP",
keywords="hematologic malignancy",
keywords="geriatric oncology",
keywords="acute myeloid leukemia",
keywords="AML",
keywords="myelodysplastic syndrome",
keywords="MDS",
keywords="cancer",
keywords="oncology",
keywords="oncologist",
keywords="oncologists",
keywords="metastases",
keywords="telemedicine",
keywords="telehealth",
keywords="tele-medicine",
keywords="tele-health",
abstract="Background: Serious illness conversations may help patients avoid unwanted treatments. We previously piloted the telehealth Serious Illness Care Program (SICP) for older adults with acute myeloid leukemia and myelodysplastic syndrome. Objective: In this study, we aimed to understand the experience of the telehealth SICP from the clinician's perspective. Methods: We studied 10 clinicians who delivered the telehealth SICP to 20 older adults with acute myeloid leukemia or myelodysplastic syndrome. Quantitative outcomes included confidence and acceptability. Confidence was measured using a 22-item survey (range 1-7; a higher score is better). Acceptability was measured using an 11-item survey (5-point Likert scale). Hypothesis testing was performed at $\alpha$=.10 (2-tailed) due to the pilot nature and small sample size. Clinicians participated in audio-recorded qualitative interviews at the end of the study to discuss their experience. Results: A total of 8 clinicians completed the confidence measure and 7 clinicians completed the acceptability measure. We found a statistically significant increase in overall confidence (mean increase of 0.5, SD 0.6; P=.03). The largest increase in confidence was in helping families with reconciliation and goodbye (mean 1.4, SD 1.5; P=.04). The majority of clinicians agreed that the format was simple (6/7, 86\%) and easy to use (6/7, 86\%). Clinicians felt that the telehealth SICP was effective in understanding their patients' values about end-of-life care (7/7, 100\%). A total of three qualitative themes emerged: (1) the telehealth SICP deepened relationships and renewed trust; (2) each telehealth SICP visit felt unique and personal in a positive way; and (3) uninterrupted, unrushed time optimized the visit experience. Conclusions: The telehealth SICP increased confidence in having serious illness conversations while deepening patient-clinician relationships. Trial Registration: ClinicalTrials.gov NCT04745676; https://www.clinicaltrials.gov/study/NCT04745676 ",
doi="10.2196/58503",
url="https://formative.jmir.org/2024/1/e58503",
url="http://www.ncbi.nlm.nih.gov/pubmed/38935428"
}


@Article{info:doi/10.2196/47704,
author="Wang, Ting
and Tang, Chulei
and Jiang, Xiaoman
and Guo, Yinning
and Zhu, Shuqin
and Xu, Qin",
title="Effectiveness of Web-Based Mindfulness-Based Interventions for Patients With Cancer: Systematic Review and Meta-Analyses",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="25",
volume="26",
pages="e47704",
keywords="cancer",
keywords="mindfulness-based interventions",
keywords="mental health",
keywords="randomized controlled trial",
keywords="systematic review",
keywords="meta-analysis",
keywords="mindfulness",
keywords="web-based intervention",
keywords="oncology",
keywords="delivery mode",
keywords="efficacy",
keywords="quality of life",
keywords="program",
keywords="adherence",
keywords="mobile phone",
abstract="Background: Cancer has emerged as a considerable global health concern, contributing substantially to both morbidity and mortality. Recognizing the urgent need to enhance the overall well-being and quality of life (QOL) of cancer patients, a growing number of researchers have started using online mindfulness-based interventions (MBIs) in oncology. However, the effectiveness and optimal implementation methods of these interventions remain unknown. Objective: This study evaluates the effectiveness of online MBIs, encompassing both app- and website-based MBIs, for patients with cancer and provides insights into the potential implementation and sustainability of these interventions in real-world settings. Methods: Searches were conducted across 8 electronic databases, including the Cochrane Library, Web of Science, PubMed, Embase, SinoMed, CINAHL Complete, Scopus, and PsycINFO, until December 30, 2022. Randomized controlled trials involving cancer patients aged ?18 years and using app- and website-based MBIs compared to standard care were included. Nonrandomized studies, interventions targeting health professionals or caregivers, and studies lacking sufficient data were excluded. Two independent authors screened articles, extracted data using standardized forms, and assessed the risk of bias in the studies using the Cochrane Bias Risk Assessment Tool. Meta-analyses were performed using Review Manager (version 5.4; The Cochrane Collaboration) and the meta package in R (R Foundation for Statistical Computing). Standardized mean differences (SMDs) were used to determine the effects of interventions. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was used to assess the potential implementation and sustainability of these interventions in real-world settings. Results: Among 4349 articles screened, 15 (0.34\%) were included. The total population comprised 1613 participants, of which 870 (53.9\%) were in the experimental conditions and 743 (46.1\%) were in the control conditions. The results of the meta-analysis showed that compared with the control group, the QOL (SMD 0.37, 95\% CI 0.18-0.57; P<.001), sleep (SMD ?0.36, 95\% CI ?0.71 to ?0.01; P=.04), anxiety (SMD ?0.48, 95\% CI ?0.75 to ?0.20; P<.001), depression (SMD ?0.36, 95\% CI ?0.61 to ?0.11; P=.005), distress (SMD ?0.50, 95\% CI ?0.75 to ?0.26; P<.001), and perceived stress (SMD ?0.89, 95\% CI ?1.33 to ?0.45; P=.003) of the app- and website-based MBIs group in patients with cancer was significantly alleviated after the intervention. However, no significant differences were found in the fear of cancer recurrence (SMD ?0.30, 95\% CI ?1.04 to 0.44; P=.39) and posttraumatic growth (SMD 0.08, 95\% CI ?0.26 to 0.42; P=.66). Most interventions were multicomponent, website-based health self-management programs, widely used by international and multilingual patients with cancer. Conclusions: App- and website-based MBIs show promise for improving mental health and QOL outcomes in patients with cancer, and further research is needed to optimize and customize these interventions for individual physical and mental symptoms. Trial Registration: PROSPERO CRD42022382219; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=382219 ",
doi="10.2196/47704",
url="https://www.jmir.org/2024/1/e47704"
}


@Article{info:doi/10.2196/49309,
author="Miller, Morven
and McCann, Lisa
and Lewis, Liane
and Miaskowski, Christine
and Ream, Emma
and Darley, Andrew
and Harris, Jenny
and Kotronoulas, Grigorios
and V Berg, Geir
and Lubowitzki, Simone
and Armes, Jo
and Patiraki, Elizabeth
and Furlong, Eileen
and Fox, Patricia
and Gaiger, Alexander
and Cardone, Antonella
and Orr, Dawn
and Flowerday, Adrian
and Katsaragakis, Stylianos
and Skene, Simon
and Moore, Margaret
and McCrone, Paul
and De Souza, Nicosha
and Donnan, T. Peter
and Maguire, Roma",
title="Patients' and Clinicians' Perceptions of the Clinical Utility of Predictive Risk Models for Chemotherapy-Related Symptom Management: Qualitative Exploration Using Focus Groups and Interviews",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="20",
volume="26",
pages="e49309",
keywords="chemotherapy",
keywords="digital health",
keywords="education",
keywords="predictive risk models",
keywords="qualitative research methods",
keywords="symptoms",
keywords="symptom cluster",
keywords="tailored information",
abstract="Background: Interest in the application of predictive risk models (PRMs) in health care to identify people most likely to experience disease and treatment-related complications is increasing. In cancer care, these techniques are focused primarily on the prediction of survival or life-threatening toxicities (eg, febrile neutropenia). Fewer studies focus on the use of PRMs for symptoms or supportive care needs. The application of PRMs to chemotherapy-related symptoms (CRS) would enable earlier identification and initiation of prompt, personalized, and tailored interventions. While some PRMs exist for CRS, few were translated into clinical practice, and human factors associated with their use were not reported. Objective: We aim to explore patients' and clinicians' perspectives of the utility and real-world application of PRMs to improve the management of CRS. Methods: Focus groups (N=10) and interviews (N=5) were conducted with patients (N=28) and clinicians (N=26) across 5 European countries. Interactions were audio-recorded, transcribed verbatim, and analyzed thematically. Results: Both clinicians and patients recognized the value of having individualized risk predictions for CRS and appreciated how this type of information would facilitate the provision of tailored preventative treatments or supportive care interactions. However, cautious and skeptical attitudes toward the use of PRMs in clinical care were noted by both groups, particularly in relationship to the uncertainty regarding how the information would be generated. Visualization and presentation of PRM information in a usable and useful format for both patients and clinicians was identified as a challenge to their successful implementation in clinical care. Conclusions: Findings from this study provide information on clinicians' and patients' perspectives on the clinical use of PRMs for the management of CRS. These international perspectives are important because they provide insight into the risks and benefits of using PRMs to evaluate CRS. In addition, they highlight the need to find ways to more effectively present and use this information in clinical practice. Further research that explores the best ways to incorporate this type of information while maintaining the human side of care is warranted. Trial Registration: ClinicalTrials.gov NCT02356081; https://clinicaltrials.gov/study/NCT02356081 ",
doi="10.2196/49309",
url="https://www.jmir.org/2024/1/e49309"
}


@Article{info:doi/10.2196/53159,
author="Stang, S. Garrett
and Tanner, T. Nichole
and Hatch, Ashley
and Godbolt, Jakarri
and Toll, A. Benjamin
and Rojewski, M. Alana",
title="Development of an Electronic Health Record Self-Referral Tool for Lung Cancer Screening: One-Group Posttest Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="12",
volume="8",
pages="e53159",
keywords="lung cancer screening",
keywords="LCS",
keywords="electronic health records",
keywords="EHR",
keywords="Health Belief Model",
keywords="HBM",
keywords="self-refer",
keywords="tobacco treatment",
keywords="cancer screening",
keywords="development",
keywords="self-referral tool",
keywords="electronic health record",
keywords="decision-making",
abstract="Background: Approximately 14 million individuals in the United States are eligible for lung cancer screening (LCS), but only 5.8\% completed screening in 2021. Given the low uptake despite the potential great health benefit of LCS, interventions aimed at increasing uptake are warranted. The use of a patient-facing electronic health record (EHR) patient portal direct messaging tool offers a new opportunity to both engage eligible patients in preventative screening and provide a unique referral pathway for tobacco treatment. Objective: This study sought to develop and pilot an EHR patient-facing self-referral tool for an established LCS program in an academic medical center. Methods: Guided by constructs of the Health Belief Model associated with LCS uptake (eg, knowledge and self-efficacy), formative development of an EHR-delivered engagement message, infographic, and self-referring survey was conducted. The survey submits eligible self-reported patient information to a scheduler for the LCS program. The materials were pretested using an interviewer-administered mixed methods survey captured through venue-day-time sampling in 5 network-affiliated pulmonology clinics. Materials were then integrated into the secure patient messaging feature in the EHR system. Next, a one-group posttest quality improvement pilot test was conducted. Results: A total of 17 individuals presenting for lung screening shared-decision visits completed the pretest survey. More than half were newly referred for LCS (n=10, 60\%), and the remaining were returning patients. When asked if they would use a self-referring tool through their EHR messaging portal, 94\% (n=16) reported yes. In it, 15 participants provided oral feedback that led to refinement in the tool and infographic prior to pilot-testing. When the initial application of the tool was sent to a convenience sample of 150 random patients, 13\% (n=20) opened the self-referring survey. Of the 20 who completed the pilot survey, 45\% (n=9) were eligible for LCS based on self-reported smoking data. A total of 3 self-referring individuals scheduled an LCS. Conclusions: Pretest and initial application data suggest this tool is a positive stimulus to trigger the decision-making process to engage in a self-referral process to LCS among eligible patients. This self-referral tool may increase the number of patients engaging in LCS and could also be used to aid in self-referral to other preventative health screenings. This tool has implications for clinical practice. Tobacco treatment clinical services or health care systems should consider using EHR messaging for LCS self-referral. This approach may be cost-effective to improve LCS engagement and uptake. Additional referral pathways could be built into this EHR tool to not only refer patients who currently smoke to LCS but also simultaneously trigger a referral to clinical tobacco treatment. ",
doi="10.2196/53159",
url="https://formative.jmir.org/2024/1/e53159",
url="http://www.ncbi.nlm.nih.gov/pubmed/38865702"
}


@Article{info:doi/10.2196/45331,
author="Zheng, Di
and Shang, Yanhong
and Ni, Jian
and Peng, Ling
and Tan, Xiaoming
and Dai, Zhaoxia
and Zhao, Yizhuo
and Gu, Aiqin
and Wang, Jiying
and Song, Yanyan
and Li, Xiaofeng
and Zhang, Junping
and Heng, Wei
and Zhang, Cuiying
and Liu, Chunling
and Li, Hui
and Du, Yingying
and Xu, Jianfang
and Wu, Dan
and Cai, Xuwei
and Meng, Rui
and Dong, Xiaorong
and Ruan, Yaoping
and Jiang, Liyan",
title="Telehealth With Comprehensive Live-Fed Real-World Data as a Patient Care Platform for Lung Cancer: Implementation and Evaluation Study",
journal="JMIR Cancer",
year="2024",
month="Jun",
day="5",
volume="10",
pages="e45331",
keywords="telehealth",
keywords="real-world data",
keywords="patient engagement",
keywords="lung carcinoma",
keywords="patient-reported outcomes",
abstract="Background: Telehealth has emerged as a popular channel for providing outpatient services in many countries. However, the majority of telehealth systems focus on operational functions and offer only a sectional patient journey at most. Experiences with incorporating longitudinal real-world medical record data into telehealth are valuable but have not been widely shared. The feasibility and usability of such a telehealth platform, with comprehensive, real-world data via a live feed, for cancer patient care are yet to be studied. Objective: The primary purpose of this study is to understand the feasibility and usability of cancer patient care using a telehealth platform with longitudinal, real-world data via a live feed as a supplement to hospital electronic medical record systems specifically from physician's perspective. Methods: A telehealth platform was constructed and launched for both physicians and patients. Real-world data were collected and curated using a comprehensive data model. Physician activities on the platform were recorded as system logs and analyzed. In February 2023, a survey was conducted among the platform's registered physicians to assess the specific areas of patient care and to quantify their before and after experiences, including the number of patients managed, time spent, dropout rate, visit rate, and follow-up data. Descriptive and inferential statistical analyses were performed on the data sets. Results: Over a period of 15 months, 16,035 unique users (13,888 patients, 1539 friends and family members, and 174 physician groups with 608 individuals) registered on the platform. More than 382,000 messages including text, reminders, and pictures were generated by physicians when communicating with patients. The survey was completed by 78 group leaders (45\% of the 174 physician groups). Of the participants, 84\% (65.6/78; SD 8.7) reported a positive experience, with efficient communication, remote supervision, quicker response to questions, adverse event prevention, more complete follow-up data, patient risk reduction, cross-organization collaboration, and a reduction in in-person visits. The majority of the participants (59/78, 76\% to 76/78, 97.4\%) estimated improvements in time spent, number of patients managed, the drop-off rate, and access to medical history, with the average ranging from 57\% to 105\%. When compared with prior platforms, responses from physicians indicated better experiences in terms of time spent, the drop-off rate, and medical history, while the number of patients managed did not significantly change. Conclusions: This study suggests that a telehealth platform, equipped with comprehensive, real-world data via a live feed, is feasible and effective for cancer patient care. It enhances inpatient management by improving time efficiencies, reducing drop-off rates, and providing easy access to medical history. Moreover, it fosters a positive experience in physician-patient interactions. ",
doi="10.2196/45331",
url="https://cancer.jmir.org/2024/1/e45331",
url="http://www.ncbi.nlm.nih.gov/pubmed/38838304"
}


@Article{info:doi/10.2196/56916,
author="Albright, Liam
and Ko, Woojin
and Buvanesh, Meyhaa
and Haraldsson, Harald
and Polubriaginof, Fernanda
and Kuperman, J. Gilad
and Levy, Michelle
and Sterling, R. Madeline
and Dell, Nicola
and Estrin, Deborah",
title="Opportunities and Challenges for Augmented Reality in Family Caregiving: Qualitative Video Elicitation Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="30",
volume="8",
pages="e56916",
keywords="augmented reality",
keywords="extended reality",
keywords="family caregiver",
keywords="home care",
keywords="virtual care",
keywords="telemedicine",
keywords="telehealth",
keywords="oncology",
keywords="artificial intelligence",
keywords="mobile phone",
abstract="Background: Although family caregivers play a critical role in care delivery, research has shown that they face significant physical, emotional, and informational challenges. One promising avenue to address some of caregivers' unmet needs is via the design of digital technologies that support caregivers' complex portfolio of responsibilities. Augmented reality (AR) applications, specifically, offer new affordances to aid caregivers as they perform care tasks in the home. Objective: This study explored how AR might assist family caregivers with the delivery of home-based cancer care. The specific objectives were to shed light on challenges caregivers face where AR might help, investigate opportunities for AR to support caregivers, and understand the risks of AR exacerbating caregiver burdens. Methods: We conducted a qualitative video elicitation study with clinicians and caregivers. We created 3 video elicitations that offer ways in which AR might support caregivers as they perform often high-stakes, unfamiliar, and anxiety-inducing tasks in postsurgical cancer care: wound care, drain care, and rehabilitative exercise. The elicitations show functional AR applications built using Unity Technologies software and Microsoft Hololens2. Using elicitations enabled us to avoid rediscovering known usability issues with current AR technologies, allowing us to focus on high-level, substantive feedback on potential future roles for AR in caregiving. Moreover, it enabled nonintrusive exploration of the inherently sensitive in-home cancer care context. Results: We recruited 22 participants for our study: 15 clinicians (eg, oncologists and nurses) and 7 family caregivers. Our findings shed light on clinicians' and caregivers' perceptions of current information and communication challenges caregivers face as they perform important physical care tasks as part of cancer treatment plans. Most significant was the need to provide better and ongoing support for execution of caregiving tasks in situ, when and where the tasks need to be performed. Such support needs to be tailored to the specific needs of the patient, to the stress-impaired capacities of the caregiver, and to the time-constrained communication availability of clinicians. We uncover opportunities for AR technologies to potentially increase caregiver confidence and reduce anxiety by supporting the capture and review of images and videos and by improving communication with clinicians. However, our findings also suggest ways in which, if not deployed carefully, AR technologies might exacerbate caregivers' already significant burdens. Conclusions: These findings can inform both the design of future AR devices, software, and applications and the design of caregiver support interventions based on already available technology and processes. Our study suggests that AR technologies and the affordances they provide (eg, tailored support, enhanced monitoring and task accuracy, and improved communications) should be considered as a part of an integrated care journey involving multiple stakeholders, changing information needs, and different communication channels that blend in-person and internet-based synchronous and asynchronous care, illness, and recovery. ",
doi="10.2196/56916",
url="https://formative.jmir.org/2024/1/e56916",
url="http://www.ncbi.nlm.nih.gov/pubmed/38814705"
}


@Article{info:doi/10.2196/52274,
author="Aumaitre, Albane
and Gagnayre, R{\'e}mi
and Foucaut, Aude-Marie",
title="Determinants and Factors of Physical Activity After Oncology Treatments (DEFACTO) in Metropolitan France: Protocol of a Mixed Methods Study and Intervention",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="16",
volume="13",
pages="e52274",
keywords="socioecological model",
keywords="mixed methods",
keywords="cancer survivorship",
keywords="physical activity",
keywords="sedentary behavior",
keywords="individualized health education program",
keywords="feasibility",
abstract="Background: While the scientific community widely recognizes the benefits of physical activity (PA) in oncology supportive care, cancer survivors who have undergone chemo- or radio-immunotherapy treatments struggle to meet PA recommendations. This underscores the importance of identifying factors influencing active lifestyle adoption and maintenance and proposing a multilevel model (micro-, meso-, and macrolevel) to better understand facilitators and barriers. Currently, no socioecological model explains an active lifestyle in the posttreatment phase of breast, colorectal, prostate, and lung cancers. Objective: The objective is to identify factors influencing an active lifestyle in cancer survivorship and assess the feasibility of an individualized program targeting an active lifestyle. The objectives will be addressed in 3 stages. Stage 1 aims to elucidate factors associated with the active lifestyle of cancer survivors. Stage 2 involves developing an explanatory model based on previously identified factors to create a tailored health education program for an active lifestyle after oncology treatments. Stage 3 aims to evaluate the feasibility and potential effects of this personalized health education program after its national implementation. Methods: First, the exploration of factors influencing PA (stage 1) will be based on a mixed methods approach, using an explanatory sequential design and multilevel analysis. The quantitative phase involves completing a questionnaire from a socioecological perspective. Subsequently, a subset of respondents will engage in semistructured interviews to aid in interpreting the quantitative results. This phase aims to construct a model of the factors influencing an active lifestyle and develop an individualized 12-week program based on our earlier findings (stage 2). In stage 3, we will implement our multicenter, multimodal program for 150 physically inactive and sedentary cancer survivors across metropolitan France. Program feasibility will be evaluated. Measured PA level by connected device and multidimensional variables such as declared PA and sedentary behaviors, PA readiness, motivation, PA preferences, PA knowledge and skills, and barriers and facilitators will be assessed before and during the program and 52 weeks afterward. Results: The institutional review board approved the mixed methods study (phase 1) in April 2020, and the intervention (phase 3) was approved in March 2022. Recruitment and data collection commenced in April 2022, with intervention implementation concluded in May 2023. Data collection and full analysis are expected to be finalized by July 2024. Conclusions: The Determinants and Factors of Physical Activity After Oncology Treatments (DEFACTO) study seeks to enhance our understanding, within our socioecological model, of factors influencing an active lifestyle among cancer survivors and to assess whether a tailored intervention based on this model can support an active lifestyle. Trial Registration: ClinicalTrials.gov NCT05354882; https://www.clinicaltrials.gov/study/NCT05354882 International Registered Report Identifier (IRRID): DERR1-10.2196/52274 ",
doi="10.2196/52274",
url="https://www.researchprotocols.org/2024/1/e52274",
url="http://www.ncbi.nlm.nih.gov/pubmed/38753415"
}


@Article{info:doi/10.2196/53163,
author="Sien, Sang-Wha
and Kobekyaa, Kyerepagr Francis
and Puts, Martine
and Currie, Leanne
and Tompson, Margaret
and Hedges, Penelope
and McGrenere, Joanna
and Mariano, Caroline
and Haase, R. Kristen",
title="Tailored Self-Management App to Support Older Adults With Cancer and Multimorbidity: Development and Usability Testing",
journal="JMIR Aging",
year="2024",
month="May",
day="8",
volume="7",
pages="e53163",
keywords="cancer",
keywords="aging",
keywords="self-management",
keywords="usability testing",
keywords="design thinking",
keywords="design",
keywords="oncology",
keywords="develop",
keywords="development",
keywords="usability",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="ageing",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="symptom",
keywords="symptoms",
keywords="comorbidity",
keywords="comorbidities",
keywords="comorbid",
keywords="multimorbidity",
keywords="multimorbidities",
keywords="co-design",
abstract="Background: Globally, cancer predominates in adults aged older than 60 years, and 70\% of older adults have ?1 chronic condition. Cancer self-management interventions can improve symptom management and confidence, but few interventions target the complex needs of older adults with cancer and multimorbidity. Despite growing evidence of digital health tools in cancer care, there is a paucity of theoretically grounded digital self-management supports for older adults. Many apps for older adults have not been co-designed with older adults to ensure that they are tailored to their specific needs, which would increase usability and uptake. Objective: We aim to report on the user evaluations of a self- and symptom-management app to support older adults living with cancer and multimorbidity. Methods: This study used Grey's self-management framework, a design thinking approach, and involved older adults with lived experiences of cancer to design a medium-fidelity app prototype. Older adults with cancer or caregivers were recruited through community organizations or support groups to participate in co-designing or evaluations of the app. Data from interviews were iteratively integrated into the design process and analyzed using descriptive statistics and thematic analyses. Results: In total, 15 older adults and 3 caregivers (n=18) participated in this study: 10 participated (8 older adults and 2 caregivers) in the design of the low-fidelity prototype, and 10 evaluated (9 older adults and 1 caregiver) the medium-fidelity prototype (2 older adults participated in both phases). Participants emphasized the importance of tracking functions to make sense of information across physical symptoms and psychosocial aspects; a clear display; and the organization of notes and reminders to communicate with care providers. Participants also emphasized the importance of medication initiation or cessation reminders to mitigate concerns related to polypharmacy. Conclusions: This app has the potential to support the complex health care needs of older adults with cancer, creating a ``home base'' for symptom management and support. The findings from this study will position the researchers to conduct feasibility testing and real-world implementation. ",
doi="10.2196/53163",
url="https://aging.jmir.org/2024/1/e53163",
url="http://www.ncbi.nlm.nih.gov/pubmed/38717806"
}


@Article{info:doi/10.2196/52061,
author="Lau, Nancy
and Zhao, Xin
and O'Daffer, Alison
and Weissman, Hannah
and Barton, Krysta",
title="Pediatric Cancer Communication on Twitter: Natural Language Processing and Qualitative Content Analysis",
journal="JMIR Cancer",
year="2024",
month="May",
day="7",
volume="10",
pages="e52061",
keywords="cancer",
keywords="COVID-19",
keywords="Twitter",
keywords="communication",
keywords="child health",
keywords="caregivers",
keywords="social media",
keywords="tweet",
keywords="tweets",
keywords="sentiment",
keywords="oncology",
keywords="cancers",
keywords="pediatric",
keywords="pediatrics",
keywords="child",
keywords="children' youth",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="opinions",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
abstract="Background: During the COVID-19 pandemic, Twitter (recently rebranded as ``X'') was the most widely used social media platform with over 2 million cancer-related tweets. The increasing use of social media among patients and family members, providers, and organizations has allowed for novel methods of studying cancer communication. Objective: This study aimed to examine pediatric cancer--related tweets to capture the experiences of patients and survivors of cancer, their caregivers, medical providers, and other stakeholders. We assessed the public sentiment and content of tweets related to pediatric cancer over a time period representative of the COVID-19 pandemic. Methods: All English-language tweets related to pediatric cancer posted from December 11, 2019, to May 7, 2022, globally, were obtained using the Twitter application programming interface. Sentiment analyses were computed based on Bing, AFINN, and NRC lexicons. We conducted a supplemental nonlexicon-based sentiment analysis with ChatGPT (version 3.0) to validate our findings with a random subset of 150 tweets. We conducted a qualitative content analysis to manually code the content of a random subset of 800 tweets. Results: A total of 161,135 unique tweets related to pediatric cancer were identified. Sentiment analyses showed that there were more positive words than negative words. Via the Bing lexicon, the most common positive words were support, love, amazing, heaven, and happy, and the most common negative words were grief, risk, hard, abuse, and miss. Via the NRC lexicon, most tweets were categorized under sentiment types of positive, trust, and joy. Overall positive sentiment was consistent across lexicons and confirmed with supplemental ChatGPT (version 3.0) analysis. Percent agreement between raters for qualitative coding was 91\%, and the top 10 codes were awareness, personal experiences, research, caregiver experiences, patient experiences, policy and the law, treatment, end of life, pharmaceuticals and drugs, and survivorship. Qualitative content analysis showed that Twitter users commonly used the social media platform to promote public awareness of pediatric cancer and to share personal experiences with pediatric cancer from the perspective of patients or survivors and their caregivers. Twitter was frequently used for health knowledge dissemination of research findings and federal policies that support treatment and affordable medical care. Conclusions: Twitter may serve as an effective means for researchers to examine pediatric cancer communication and public sentiment around the globe. Despite the public mental health crisis during the COVID-19 pandemic, overall sentiments of pediatric cancer--related tweets were positive. Content of pediatric cancer tweets focused on health and treatment information, social support, and raising awareness of pediatric cancer. ",
doi="10.2196/52061",
url="https://cancer.jmir.org/2024/1/e52061",
url="http://www.ncbi.nlm.nih.gov/pubmed/38713506"
}


@Article{info:doi/10.2196/50620,
author="Steen-Olsen, Balch Emma
and Pappot, Helle
and Hjerming, Maiken
and Hanghoej, Signe
and Holl{\"a}nder-Mieritz, Cecilie",
title="Monitoring Adolescent and Young Adult Patients With Cancer via a Smart T-Shirt: Prospective, Single-Cohort, Mixed Methods Feasibility Study (OncoSmartShirt Study)",
journal="JMIR Mhealth Uhealth",
year="2024",
month="May",
day="1",
volume="12",
pages="e50620",
keywords="smart T-shirt",
keywords="AYA",
keywords="oncology",
keywords="home monitoring",
keywords="patients' perspective",
keywords="perspective",
keywords="perspectives",
keywords="experiences",
keywords="experience",
keywords="youth",
keywords="adolescent",
keywords="adolescents",
keywords="smart",
keywords="monitoring",
keywords="biometric",
keywords="sensor",
keywords="sensors",
keywords="young adult",
keywords="young adults",
keywords="feasibility",
keywords="cancer",
keywords="cancers",
keywords="electrode",
keywords="electrodes",
keywords="adherence",
keywords="mobile phone",
abstract="Background: Wearables that measure vital parameters can be potential tools for monitoring patients at home during cancer treatment. One type of wearable is a smart T-shirt with embedded sensors. Initially, smart T-shirts were designed to aid athletes in their performance analyses. Recently however, researchers have been investigating the use of smart T-shirts as supportive tools in health care. In general, the knowledge on the use of wearables for symptom monitoring during cancer treatment is limited, and consensus and awareness about compliance or adherence are lacking. Objectives: The aim of this study was to evaluate adherence to and experiences with using a smart T-shirt for the home monitoring of biometric sensor data among adolescent and young adult patients undergoing cancer treatment during a 2-week period. Methods: This study was a prospective, single-cohort, mixed methods feasibility study. The inclusion criteria were patients aged 18 to 39 years and those who were receiving treatment at Copenhagen University Hospital - Rigshospitalet, Denmark. Consenting patients were asked to wear the Chronolife smart T-shirt for a period of 2 weeks. The smart T-shirt had multiple sensors and electrodes, which engendered the following six measurements: electrocardiogram (ECG) measurements, thoracic respiration, abdominal respiration, thoracic impedance, physical activity (steps), and skin temperature. The primary end point was adherence, which was defined as a wear time of >8 hours per day. The patient experience was investigated via individual, semistructured telephone interviews and a paper questionnaire. Results: A total of 10 patients were included. The number of days with wear times of >8 hours during the study period (14 d) varied from 0 to 6 (mean 2 d). Further, 3 patients had a mean wear time of >8 hours during each of their days with data registration. The number of days with any data registration ranged from 0 to 10 (mean 6.4 d). The thematic analysis of interviews pointed to the following three main themes: (1) the smart T-shirt is cool but does not fit patients with cancer, (2) the technology limits the use of the smart T-shirt, and (3) the monitoring of data increases the feeling of safety. Results from the questionnaire showed that the patients generally had confidence in the device. Conclusions: Although the primary end point was not reached, the patients' experiences with using the smart T-shirt resulted in the knowledge that patients acknowledged the need for new technologies that improve supportive cancer care. The patients were positive when asked to wear the smart T-shirt. However, technical and practical challenges in using the device resulted in low adherence. Although wearables might have potential for home monitoring, the present technology is immature for clinical use. Trial Registration: ClinicalTrials.gov NCT05235594; https://clinicaltrials.gov/study/NCT05235594 International Registered Report Identifier (IRRID): RR2-10.2196/37626 ",
doi="10.2196/50620",
url="https://mhealth.jmir.org/2024/1/e50620"
}


@Article{info:doi/10.2196/51949,
author="Springer, Franziska
and Maier, Ayline
and Friedrich, Michael
and Raue, Simon Jan
and Finke, Gandolf
and Lordick, Florian
and Montgomery, Guy
and Esser, Peter
and Brock, Hannah
and Mehnert-Theuerkauf, Anja",
title="Digital Therapeutic (Mika) Targeting Distress in Patients With Cancer: Results From a Nationwide Waitlist Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="25",
volume="26",
pages="e51949",
keywords="digital therapeutic",
keywords="digital health",
keywords="mobile health",
keywords="app",
keywords="cancer",
keywords="randomized controlled trial",
keywords="supportive care",
keywords="oncology",
keywords="access to care",
keywords="distress",
keywords="depression",
keywords="anxiety",
keywords="fatigue",
keywords="mobile phone",
abstract="Background: Distress is highly prevalent among patients with cancer, but supportive care needs often go unmet. Digital therapeutics hold the potential to overcome barriers in cancer care and improve health outcomes. Objective: This study conducted a randomized controlled trial to investigate the efficacy of Mika, an app-based digital therapeutic designed to reduce distress across the cancer trajectory. Methods: This nationwide waitlist randomized controlled trial in Germany enrolled patients with cancer across all tumor entities diagnosed within the last 5 years. Participants were randomized into the intervention (Mika plus usual care) and control (usual care alone) groups. The participants completed web-based assessments at baseline and at 2, 6, and 12 weeks. The primary outcome was the change in distress from baseline to week 12, as measured by the National Comprehensive Cancer Network Distress Thermometer. Secondary outcomes included depression, anxiety (Hospital Anxiety and Depression Scale), fatigue (Functional Assessment of Chronic Illness Therapy-Fatigue), and quality of life (Clinical Global Impression-Improvement Scale). Intention-to-treat and per-protocol analyses were performed. Analyses of covariance were used to test for outcome changes over time between the groups, controlling for baseline. Results: A total of 218 patients (intervention: n=99 and control: n=119) were included in the intention-to-treat analysis. Compared with the control group, the intervention group reported greater reductions in distress (P=.03; $\eta$p{\texttwosuperior}=0.02), depression (P<.001; $\eta$p{\texttwosuperior}=0.07), anxiety (P=.03; $\eta$p{\texttwosuperior}=0.02), and fatigue (P=.04; $\eta$p{\texttwosuperior}=0.02). Per-protocol analyses revealed more pronounced treatment effects, with the exception of fatigue. No group difference was found for quality of life. Conclusions: Mika effectively diminished distress in patients with cancer. As a digital therapeutic solution, Mika offers accessible, tailored psychosocial and self-management support to address the unmet needs in cancer care. Trial Registration: German Clinical Trials Register (DRKS) DRKS00026038; https://drks.de/search/en/trial/DRKS00026038 ",
doi="10.2196/51949",
url="https://www.jmir.org/2024/1/e51949",
url="http://www.ncbi.nlm.nih.gov/pubmed/38663007"
}


@Article{info:doi/10.2196/53668,
author="Shalaby, Reham
and Vuong, Wesley
and Agyapong, Belinda
and Gusnowski, April
and Surood, Shireen
and Agyapong, Vincent",
title="Cancer Care Supportive Text Messaging Program (Text4Hope) for People Living With Cancer and Their Caregivers During the COVID-19 Pandemic: Longitudinal Observational Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="24",
volume="8",
pages="e53668",
keywords="Text4Hope Cancer Care",
keywords="COVID-19",
keywords="cancer",
keywords="caregivers",
keywords="mental health",
keywords="anxiety",
keywords="depression",
keywords="cancer care",
keywords="Canada",
keywords="Canadian",
keywords="treatment",
keywords="stress",
abstract="Background: Cancer is the leading cause of death in Canada, and living with cancer generates psychological demands, including depression and anxiety among cancer survivors and caregivers. Text4Hope-Cancer Care SMS text messaging--based service was provided to people with cancer and caregivers during the COVID-19 pandemic to support their mental health. Objective: The aim of this study is to examine the clinical effectiveness of and satisfaction with Text4Hope-Cancer Care in addressing mental health conditions among people living with cancer and caregivers. Methods: The study was conducted in Alberta, Canada. People who were diagnosed or receiving cancer treatment and caregivers self-subscribed to receive 3-months daily supportive cognitive behavioral therapy--based SMS text messages and a web-based survey was sent at designated time points to collect clinical and nonclinical data. The Hospital Anxiety and Depression scale (HADS) was used to examine changes in anxiety and depression symptoms after receiving the service. Satisfaction with the service was assessed using a survey with a Likert scale. Descriptive and inferential statistics were used, and test significance was considered with P?.05. Results: Overall, 107 individuals subscribed to the service, and 93 completed the program (completion rate 93/107, 86.9\%). A significant improvement in the anxiety symptoms (HADS-Anxiety [HADS-A] subscale) was reported after 3 months of Text4Hope-Cancer Care (t11=2.62; P=.02), with medium effect size (Hedges g=0.7), but not depression symptoms (HADS-Depression [HADS-D] subscale). Subscribers expressed high satisfaction and agreed that the service has helped them to cope with mental health symptoms and improve their quality of life. Most subscribers read the SMS text messages more than once (30/30, 100\%); took time to reflect or took a beneficial action after reading the messages (27/30, 90\%); and highly agreed (27/30, >80\%) with the value of the received supportive SMS text messages as being relevant, succinct, affirmative, and positive. All subscribers recommended SMS text messaging for stress, anxiety, and depression and for cancer care support (30/30, 100\%). Conclusions: Text4Hope-Cancer Care was well-perceived and effectively addressed anxiety symptoms among people living with cancer and caregivers during the peak of the COVID-19 pandemic. This study provides evidence-based support and insight for policy and stakeholders to implement similar convenient, economic, and accessible mental health services that support vulnerable populations during crises. International Registered Report Identifier (IRRID): RR2-10.2196/20240 ",
doi="10.2196/53668",
url="https://formative.jmir.org/2024/1/e53668",
url="http://www.ncbi.nlm.nih.gov/pubmed/38657234"
}


@Article{info:doi/10.2196/53053,
author="Elkefi, Safa
and Asan, Onur",
title="Validating the Effectiveness of the Patient-Centered Cancer Care Framework by Assessing the Impact of Work System Factors on Patient-Centered Care and Quality of Care: Interview Study With Newly Diagnosed Cancer Patients",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="24",
volume="11",
pages="e53053",
keywords="cancer",
keywords="communication",
keywords="trust",
keywords="satisfaction",
keywords="technology",
keywords="workload",
keywords="work system factors",
abstract="Background: Patients with cancer who have recently been diagnosed have distinct requirements compared to cancer survivors. It is crucial to take into account their unique needs to ensure that they make informed decisions and are receptive to the care provided. Objective: This study suggested a framework titled Effectiveness of Patient-Centered Cancer Care that considers the needs of newly diagnosed patients with cancer and related work system factors. This study investigated how work system factors influence the perceptions of patient-centered care, quality of care, and associated outcomes among newly diagnosed patients with cancer. Patient-centered care is defined in terms of workload and communication considerations, whereas the quality of care is assessed through indicators such as trust in physicians, satisfaction with care, and perceptions of technology. Methods: This study used qualitative data collected through interviews with newly diagnosed patients with cancer (N=20) right after their first visits with their physicians. Thematic analysis was conducted to validate the 5 hypotheses of the framework, mapping the interactions among quality of care, patient-centered care, and work system factors. Results: We found that workload and patient-centered communication impact the quality of care and that the work system elements impact the patient-centeredness (workload and communication) and the quality of care (trust in physicians, satisfaction with care, and perception of technology use). Conclusions: Qualitatively validating the proposed Effectiveness of Patient-Centered Cancer Care framework, this study demonstrated its efficacy in elucidating the interplay of various factors. The framework holds promise for informing interventions geared toward enhancing patients' experiences during their initial visits after diagnosis. There is a pressing need for heightened attention to the organizational design, patient processes, and collaborative efforts among diverse stakeholders and providers to optimize the overall patient experience. ",
doi="10.2196/53053",
url="https://humanfactors.jmir.org/2024/1/e53053",
url="http://www.ncbi.nlm.nih.gov/pubmed/38656776"
}


@Article{info:doi/10.2196/53307,
author="Cho, Dalnim
and Roth, Michael
and Peterson, K. Susan
and Jennings, Kristofer
and Kim, Seokhun
and Weathers, Shiao-Pei
and Ahmed, Sairah
and Livingston, Andrew J.
and Barcenas, Carlos
and You, Nancy Y.
and Milbury, Kathrin",
title="Associations Between Stress, Health Behaviors, and Quality of Life in Young Couples During the Transition to Survivorship: Protocol for a Measurement Burst Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="23",
volume="13",
pages="e53307",
keywords="young adult survivors",
keywords="caregivers",
keywords="dyadic",
keywords="couple-based",
keywords="stress",
keywords="health behaviors",
keywords="quality of life",
keywords="transition to survivorship",
keywords="measurement-burst",
abstract="Background: Cancer is a life-threatening, stressful event, particularly for young adults due to delays and disruptions in their developmental transitions. Cancer treatment can also cause adverse long-term effects, chronic conditions, psychological issues, and decreased quality of life (QoL) among young adults. Despite numerous health benefits of health behaviors (eg, physical activity, healthy eating, no smoking, no alcohol use, and quality sleep), young adult cancer survivors report poor health behavior profiles. Determining the associations of stress (either cancer-specific or day-to-day stress), health behaviors, and QoL as young adult survivors transition to survivorship is key to understanding and enhancing these survivors' health. It is also crucial to note that the effects of stress on health behaviors and QoL may manifest on a shorter time scale (eg, daily within-person level). Moreover, given that stress spills over into romantic relationships, it is important to identify the role of spouses or partners (hereafter partners) in these survivors' health behaviors and QoL. Objective: This study aims to investigate associations between stress, health behaviors, and QoL at both within- and between-person levels during the transition to survivorship in young adult cancer survivors and their partners, to identify the extent to which young adult survivors' and their partners' stress facilitates or hinders their own and each other's health behaviors and QoL. Methods: We aim to enroll 150 young adults (aged 25-39 years at the time of cancer diagnosis) who have recently completed cancer treatment, along with their partners. We will conduct a prospective longitudinal study using a measurement burst design. Participants (ie, survivors and their partners) will complete a daily web-based survey for 7 consecutive days (a ``burst'') 9 times over 2 years, with the bursts spaced 3 months apart. Participants will self-report their stress, health behaviors, and QoL. Additionally, participants will be asked to wear an accelerometer to assess their physical activity and sleep during the burst period. Finally, dietary intake (24-hour diet recalls) will be assessed during each burst via telephone by research staff. Results: Participant enrollment began in January 2022. Recruitment and data collection are expected to conclude by December 2024 and December 2026, respectively. Conclusions: To the best of our knowledge, this will be the first study that determines the interdependence of health behaviors and QoL of young adult cancer survivors and their partners at both within- and between-person levels. This study is unique in its focus on the transition to cancer survivorship and its use of a measurement burst design. Results will guide the creation of a developmentally appropriate dyadic psychosocial or behavioral intervention that improves both young adult survivors' and their partners' health behaviors and QoL and potentially their physical health. International Registered Report Identifier (IRRID): DERR1-10.2196/53307 ",
doi="10.2196/53307",
url="https://www.researchprotocols.org/2024/1/e53307",
url="http://www.ncbi.nlm.nih.gov/pubmed/38652520"
}


@Article{info:doi/10.2196/50032,
author="Kim, J. Jacqueline H.
and Kagawa Singer, Marjorie
and Bang, Lisa
and Ko, Amy
and Nguyen, Becky
and Chen Stokes, Sandy
and Lu, Qian
and Stanton, L. Annette",
title="Supportive Care Needs in Chinese, Vietnamese, and Korean Americans With Metastatic Cancer: Mixed Methods Protocol for the DAWN Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="22",
volume="13",
pages="e50032",
keywords="Asian American",
keywords="disparities",
keywords="metastatic cancer",
keywords="psychosocial",
keywords="supportive care",
keywords="unmet needs",
keywords="well-being",
abstract="Background: Asian Americans with metastatic cancer are an understudied population. The Describing Asian American Well-Being and Needs in Cancer (DAWN) Study was designed to understand the supportive care needs of Chinese-, Vietnamese-, and Korean-descent (CVK) patients with metastatic cancer. Objective: This study aims to present the DAWN Study protocol involving a primarily qualitative, convergent, mixed methods study from multiple perspectives (patients or survivors, caregivers, and health care professionals). Methods: CVK Americans diagnosed with solid-tumor metastatic cancer and their caregivers were recruited nationwide through various means (registries, community outreach newsletters, newspapers, radio advertisements, etc). Potentially eligible individuals were screened and consented on the web or through a phone interview. The study survey and interview for patients or survivors and caregivers were provided in English, traditional/simplified Chinese and Cantonese/Mandarin, Vietnamese, and Korean, and examined factors related to facing metastatic cancer, including quality of life, cultural values, coping, and cancer-related symptoms. Community-based organizations assisted in recruiting participants, developing and translating study materials, and connecting the team to individuals for conducting interviews in Asian languages. Health care professionals who have experience working with CVK patients or survivors with metastatic solid cancer were recruited through referrals from the DAWN Study community advisory board and were interviewed to understand unmet supportive care needs. Results: Recruitment began in November 2020; data collection was completed in October 2022. A total of 66 patients or survivors, 13 caregivers, and 15 health care professionals completed all portions of the study. We completed data management in December 2023 and will submit results for patients or survivors and caregivers to publication outlets in 2024. Conclusions: Future findings related to this protocol will describe and understand the supportive care needs of CVK patients or survivors with metastatic cancer and will help develop culturally appropriate psychosocial interventions that target known predictors of unmet supportive care needs in Chinese, Vietnamese, and Korean Americans with metastatic cancer. International Registered Report Identifier (IRRID): DERR1-10.2196/50032 ",
doi="10.2196/50032",
url="https://www.researchprotocols.org/2024/1/e50032",
url="http://www.ncbi.nlm.nih.gov/pubmed/38648633"
}


@Article{info:doi/10.2196/55601,
author="Lammers, J. Eline M.
and Zijlstra, M. Jos{\'e}e
and Ret{\`e}l, P. Valesca
and Aleman, P. Berthe M.
and van Leeuwen, E. Flora
and Nijdam, Annelies
and ",
title="Effectiveness and Cost-Effectiveness of Survivorship Care for Survivors of Hodgkin Lymphoma (INSIGHT Study): Protocol for a Multicenter Retrospective Cohort Study With a Quasi-Experimental Design",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="18",
volume="13",
pages="e55601",
keywords="research design",
keywords="Hodgkin lymphoma",
keywords="late effects of cancer treatment",
keywords="survivorship care",
keywords="screening",
keywords="cost-effectiveness analysis",
abstract="Background: Hodgkin lymphoma (HL) occurs at young ages, with the highest incidence between 20 and 40 years. While cure rates have improved to 80\%-90\% over the past decades, survivors of HL are at substantial risk of late treatment--related complications, such as cardiovascular diseases, breast cancer, severe infections, and hypothyroidism. To reduce morbidity and mortality from late treatment effects, the Dutch Better care after lymphoma, Evaluation of long-term Treatment Effects and screening Recommendations (BETER) consortium developed a survivorship care program for 5-year survivors of HL that includes risk-based screening for and treatment of (risk factors for) late adverse events. Even though several cancer survivorship care programs have been established worldwide, there is a lack of knowledge about their effectiveness in clinical practice. Objective: The Improving Nationwide Survivorship care Infrastructure and Guidelines after Hodgkin lymphoma Treatment (INSIGHT) study evaluates whether Dutch BETER survivorship care for survivors of HL decreases survivors' burden of disease from late adverse events after HL treatment and associated health care costs and improves their quality of life. Methods: The INSIGHT study is a multicenter retrospective cohort study with a quasi-experimental design and prospective follow-up, embedded in the national BETER survivorship care infrastructure. The first BETER clinics started in 2013-2016 and several other centers started or will start BETER clinics in 2019-2024. This allows us to compare survivors who did and those who did not receive BETER survivorship care in the last decade. Survivors in the intervention group are matched to controls (n=450 per group) based on sex, age at diagnosis ({\textpm}5 years), age in 2013 ({\textpm}5 years), and treatment characteristics. The primary outcome is the burden of disease in disability-adjusted life years from cardiovascular disease, breast cancer, severe infections, and hypothyroidism. In a cost-effectiveness analysis, we will assess the cost of BETER survivorship care per averted or gained disability-adjusted life year and quality-adjusted life year. Secondary outcomes are BETER clinic attendance, adherence to screening guidelines, and knowledge and distress about late effects among survivors of HL. Study data are collected from a survivor survey, a general practitioner survey, medical records, and through linkages with national disease registries. Results: The study was funded in November 2020 and approved by the institutional review board of the Netherlands Cancer Institute in July 2021. We expect to finalize recruitment by October 2024, data collection by early 2025, and data analysis by May 2025. Conclusions: INSIGHT is the first evaluation of a comprehensive survivorship program using real-world data; it will result in new information on the (cost-)effectiveness of survivorship care in survivors of HL in clinical practice. The results of this study will be used to improve the BETER program where necessary and contribute to more effective evidence-based long-term survivorship care for lymphoma survivors. International Registered Report Identifier (IRRID): PRR1-10.2196/55601 ",
doi="10.2196/55601",
url="https://www.researchprotocols.org/2024/1/e55601",
url="http://www.ncbi.nlm.nih.gov/pubmed/38635308"
}


@Article{info:doi/10.2196/54086,
author="Jain, Rishabh
and Kumar, Akash
and Sharma, Atul
and Sahoo, Kumar Ranjit
and Sharma, Aparna
and Seth, Amlesh
and Nayak, Brusabhanu
and Shamim, A. Shamim
and Kaushal, Seema
and KP, Haresh
and Das, J. Chandan
and Batra, Atul",
title="Carboplatin in Patients With Metastatic Castration-Resistant Prostate Cancer Harboring Somatic or Germline Homologous Recombination Repair Gene Mutations: Phase II Single-Arm Trial",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="18",
volume="13",
pages="e54086",
keywords="carboplatin",
keywords="mCRPC",
keywords="prostate cancer",
keywords="homologous recombinant gene repair",
keywords="metastatic castration-resistant prostate cancer",
keywords="incurable",
keywords="deleterious mutation",
keywords="synthetic lethality",
keywords="tumor",
keywords="DNA",
keywords="low-income",
keywords="middle-income",
keywords="chemotherapeutic",
keywords="drug",
keywords="retrospective study",
keywords="taxane",
keywords="novel antiandrogen",
keywords="single-arm study",
keywords="health-related",
keywords="quality of life",
keywords="bone lesion",
abstract="Background: Approximately 20\%-25\% of patients with metastatic castration-resistant prostate cancer (mCRPC) harbor a deleterious germline or somatic mutation in the homologous recombination repair (HRR) pathway genes, which is involved in the repair of double-stranded DNA damage. Half of these mutations are germline, while the remaining are exclusively somatic. While polyadenosine 5'diphosphoribose [poly (ADP-ribose)] polymerase inhibitors, such as olaparib and rucaparib, are effective in this subgroup, their widespread use is limited due to the associated high cost, especially in resource-constrained settings. Notably, platinum agents like carboplatin have exquisite sensitivity to cells with defective DNA repair machinery. Carboplatin, a conventional, inexpensive chemotherapeutic agent, offers a potential alternative treatment in such patients. Several retrospective small case series support this hypothesis. However, there are no prospective clinical trials of carboplatin in patients with mCRPC with HRR mutations. Objective: The primary objective is to assess the objective response rate of 3 weekly carboplatin treatments in patients with mCRPC harboring deleterious mutations in the HRR pathway genes and previously treated with a taxane or a novel antiandrogen agent. The secondary objectives include progression-free survival, health-related quality of life, and safety profile of carboplatin. Methods: Patients diagnosed with mCRPC harboring HRR pathway mutations previously treated with docetaxel or novel antiandrogen agents (abiraterone, enzalutamide, apalutamide, or darolutamide) or both will be eligible. Genes involved directly or indirectly in the HRR pathway will be tested. In this single-arm phase II study, we will screen approximately 200 patients to enroll 49 patients, and carboplatin (dosing at the area under curve=5) will be administered every 3 weeks until progression or intolerable side effects. The primary end point will be assessed as the proportion of patients with a reduction of serum prostate-specific antigen by more than 50\% from enrollment. Secondary outcomes include progression-free survival---soft-tissue disease progression (by response evaluation criteria in solid tumors, version 1.1, and bone lesion progression using Prostate Cancer Clinical Trials Working Group 3 criteria), health-related quality of life during carboplatin treatment using the Functional Assessment of Cancer Therapy---Prostate questionnaire and the European Organisation for Research and Treatment of Cancer questionnaire and safety profile of carboplatin (National Cancer Institute's Common Terminology Criteria for Adverse Events version 5.0). Results: The trial started enrollment in September 2023. This trial is ongoing, and 12 patients have been recruited to date. All 49 participants will be enrolled according to plan. Conclusions: This prospective phase II trial represents a critical step toward addressing the therapeutic gap in patients with mCRPC harboring HRR pathway mutations, particularly in demographic regions with limited access to poly (ADP-ribose) polymerase inhibitors. Outcomes from this study will inform clinical practice and guide future phase III randomized trials, ultimately improving patient outcomes globally. Trial Registration: Clinical Trials Registry of India CTRI/2023/04/051507; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=Njc0NjU=\&Enc=\&userName= International Registered Report Identifier (IRRID): DERR1-10.2196/54086 ",
doi="10.2196/54086",
url="https://www.researchprotocols.org/2024/1/e54086",
url="http://www.ncbi.nlm.nih.gov/pubmed/38453159"
}


@Article{info:doi/10.2196/50118,
author="Laidsaar-Powell, Rebekah
and Giunta, Sarah
and Butow, Phyllis
and Keast, Rachael
and Koczwara, Bogda
and Kay, Judy
and Jefford, Michael
and Turner, Sandra
and Saunders, Christobel
and Schofield, Penelope
and Boyle, Frances
and Yates, Patsy
and White, Kate
and Miller, Annie
and Butt, Zoe
and Bonnaudet, Melanie
and Juraskova, Ilona",
title="Development of Web-Based Education Modules to Improve Carer Engagement in Cancer Care: Design and User Experience Evaluation of the e-Triadic Oncology (eTRIO) Modules for Clinicians, Patients, and Carers",
journal="JMIR Med Educ",
year="2024",
month="Apr",
day="17",
volume="10",
pages="e50118",
keywords="family carers",
keywords="patient education",
keywords="health professional education",
keywords="web-based intervention",
keywords="mobile phone",
abstract="Background: Carers often assume key roles in cancer care. However, many carers report feeling disempowered and ill?equipped to support patients. Our group published evidence-based guidelines (the Triadic Oncology [TRIO] Guidelines) to improve oncology clinician engagement with carers and the management of challenging situations involving carers. Objective: To facilitate implementation of the TRIO Guidelines in clinical practice, we aimed to develop, iteratively refine, and conduct user testing of a suite of evidence-based and interactive web-based education modules for oncology clinicians (e-Triadic Oncology [eTRIO]), patients with cancer, and carers (eTRIO for Patients and Carers [eTRIO?pc]). These were designed to improve carer involvement, communication, and shared decision-making in the cancer management setting. Methods: The eTRIO education modules were based on extensive research, including systematic reviews, qualitative interviews, and consultation analyses. Guided by the person-based approach, module content and design were reviewed by an expert advisory group comprising academic and clinical experts (n=13) and consumers (n=5); content and design were continuously and iteratively refined. User experience testing (including ``think-aloud'' interviews and administration of the System Usability Scale [SUS]) of the modules was completed by additional clinicians (n=5), patients (n=3), and carers (n=3). Results: The final clinician module comprises 14 sections, requires approximately 1.5 to 2 hours to complete, and covers topics such as carer-inclusive communication and practices; supporting carer needs; and managing carer dominance, anger, and conflicting patient-carer wishes. The usability of the module was rated by 5 clinicians, with a mean SUS score of 75 (SD 5.3), which is interpreted as good. Clinicians often desired information in a concise format, divided into small ``snackable'' sections that could be easily recommenced if they were interrupted. The carer module features 11 sections; requires approximately 1.5 hours to complete; and includes topics such as the importance of carers, carer roles during consultations, and advocating for the patient. The patient module is an adaptation of the relevant carer module sections, comprising 7 sections and requiring 1 hour to complete. The average SUS score as rated by 6 patients and carers was 78 (SD 16.2), which is interpreted as good. Interactive activities, clinical vignette videos, and reflective learning exercises are incorporated into all modules. Patient and carer consumer advisers advocated for empathetic content and tone throughout their modules, with an easy-to-read and navigable module interface. Conclusions: The eTRIO suite of modules were rigorously developed using a person-based design methodology to meet the unique information needs and learning requirements of clinicians, patients, and carers, with the goal of improving effective and supportive carer involvement in cancer consultations and cancer care. ",
doi="10.2196/50118",
url="https://mededu.jmir.org/2024/1/e50118",
url="http://www.ncbi.nlm.nih.gov/pubmed/38630531"
}


@Article{info:doi/10.2196/44025,
author="Wu, Shih-Chung
and Chuang, Chia-Wen
and Liao, Wen-Chun
and Li, Chung-Fang
and Shih, Hsin-Hsin",
title="Using Virtual Reality in a Rehabilitation Program for Patients With Breast Cancer: Phenomenological Study",
journal="JMIR Serious Games",
year="2024",
month="Apr",
day="16",
volume="12",
pages="e44025",
keywords="breast cancer",
keywords="rehabilitation",
keywords="virtual reality",
keywords="VR",
keywords="virtual reality design process",
keywords="VR design process",
keywords="feasibility",
keywords="accessibility",
abstract="Background: Surgery is an essential treatment for early-stage breast cancer. However, various side effects of breast cancer surgery, such as arm dysfunction and lymphedema, remain causes for concern. Rehabilitation exercises to prevent such side effects should be initiated within 24 hours after surgery. Virtual reality (VR) can assist the process of rehabilitation; however, the feasibility of applying VR for rehabilitation must be explored, in addition to experiences of this application. Objective: This study explored patients' attitudes toward and experiences of using VR for their rehabilitation to determine the feasibility of such VR use and to identify potential barriers. Methods: A phenomenological qualitative study was conducted from September to December 2021. A total of 18 patients with breast cancer who had undergone surgical treatment were interviewed using open-ended questions. The Colaizzi 7-step procedure for phenomenological analysis was used for data analysis. To ensure high study reliability, this study followed previously reported quality criteria for trustworthiness. Results: Three themes were identified: (1) VR was powerful in facilitating rehabilitation, (2) early and repetitive upper limb movements were an advantage of VR rehabilitation, and (3) extensive VR use had challenges to be overcome. Most of the interviewed patients reported positive experiences of using VR for rehabilitation. Specifically, VR helped these patients identify appropriate motion and angle limits while exercising; in other words, knowledge gained through VR can play a key role in the rehabilitation process. In addition, the patients reported that the use of VR provided them company, similar to when a physiotherapist is present. Finally, the gamified nature of the VR system seemed to make VR-based rehabilitation more engaging than traditional rehabilitation, particularly with respect to early rehabilitation; however, the high cost of VR equipment made VR-based rehabilitation difficult to implement at home. Conclusions: The interviewed patients with breast cancer had positive experiences in using VR for rehabilitation. The high cost of both VR equipment and software development presents a challenge for applying VR-based rehabilitation. ",
doi="10.2196/44025",
url="https://games.jmir.org/2024/1/e44025"
}


@Article{info:doi/10.2196/55794,
author="Nishioka, Satoshi
and Watabe, Satoshi
and Yanagisawa, Yuki
and Sayama, Kyoko
and Kizaki, Hayato
and Imai, Shungo
and Someya, Mitsuhiro
and Taniguchi, Ryoo
and Yada, Shuntaro
and Aramaki, Eiji
and Hori, Satoko",
title="Adverse Event Signal Detection Using Patients' Concerns in Pharmaceutical Care Records: Evaluation of Deep Learning Models",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="16",
volume="26",
pages="e55794",
keywords="cancer",
keywords="anticancer drug",
keywords="adverse event",
keywords="side effect",
keywords="patient-reported outcome",
keywords="patients' voice",
keywords="patient-oriented",
keywords="patient narrative",
keywords="natural language processing",
keywords="deep learning",
keywords="pharmaceutical care record",
keywords="SOAP",
abstract="Background: Early detection of adverse events and their management are crucial to improving anticancer treatment outcomes, and listening to patients' subjective opinions (patients' voices) can make a major contribution to improving safety management. Recent progress in deep learning technologies has enabled various new approaches for the evaluation of safety-related events based on patient-generated text data, but few studies have focused on the improvement of real-time safety monitoring for individual patients. In addition, no study has yet been performed to validate deep learning models for screening patients' narratives for clinically important adverse event signals that require medical intervention. In our previous work, novel deep learning models have been developed to detect adverse event signals for hand-foot syndrome or adverse events limiting patients' daily lives from the authored narratives of patients with cancer, aiming ultimately to use them as safety monitoring support tools for individual patients. Objective: This study was designed to evaluate whether our deep learning models can screen clinically important adverse event signals that require intervention by health care professionals. The applicability of our deep learning models to data on patients' concerns at pharmacies was also assessed. Methods: Pharmaceutical care records at community pharmacies were used for the evaluation of our deep learning models. The records followed the SOAP format, consisting of subjective (S), objective (O), assessment (A), and plan (P) columns. Because of the unique combination of patients' concerns in the S column and the professional records of the pharmacists, this was considered a suitable data for the present purpose. Our deep learning models were applied to the S records of patients with cancer, and the extracted adverse event signals were assessed in relation to medical actions and prescribed drugs. Results: From 30,784 S records of 2479 patients with at least 1 prescription of anticancer drugs, our deep learning models extracted true adverse event signals with more than 80\% accuracy for both hand-foot syndrome (n=152, 91\%) and adverse events limiting patients' daily lives (n=157, 80.1\%). The deep learning models were also able to screen adverse event signals that require medical intervention by health care providers. The extracted adverse event signals could reflect the side effects of anticancer drugs used by the patients based on analysis of prescribed anticancer drugs. ``Pain or numbness'' (n=57, 36.3\%), ``fever'' (n=46, 29.3\%), and ``nausea'' (n=40, 25.5\%) were common symptoms out of the true adverse event signals identified by the model for adverse events limiting patients' daily lives. Conclusions: Our deep learning models were able to screen clinically important adverse event signals that require intervention for symptoms. It was also confirmed that these deep learning models could be applied to patients' subjective information recorded in pharmaceutical care records accumulated during pharmacists' daily work. ",
doi="10.2196/55794",
url="https://www.jmir.org/2024/1/e55794",
url="http://www.ncbi.nlm.nih.gov/pubmed/38625718"
}


@Article{info:doi/10.2196/53117,
author="Krakowczyk, Barbara Julia
and Truijens, Femke
and Teufel, Martin
and Lalgi, Tania
and Heinen, Jana
and Schug, Caterina
and Erim, Yesim
and Pantf{\"o}rder, Michael
and Graf, Johanna
and B{\"a}uerle, Alexander",
title="Evaluation of the e--Mental Health Intervention Make It Training From Patients' Perspectives: Qualitative Analysis Within the Reduct Trial",
journal="JMIR Cancer",
year="2024",
month="Apr",
day="9",
volume="10",
pages="e53117",
keywords="psycho-oncology",
keywords="eHealth",
keywords="digital health",
keywords="cancer",
keywords="Reduct trial",
keywords="oncology",
abstract="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. ",
doi="10.2196/53117",
url="https://cancer.jmir.org/2024/1/e53117",
url="http://www.ncbi.nlm.nih.gov/pubmed/38592764"
}


@Article{info:doi/10.2196/49574,
author="S{\'a}nchez-Qui{\~n}ones, Beatriz
and Ant{\'o}n-Maldonado, Cristina
and Ibarra Vega, Nataly
and Martorell Marin{\'e}, Isabel
and Santamaria, Amparo",
title="Development and Implementation of an eHealth Oncohematonootric Program: Descriptive, Observational, Prospective Cohort Pilot Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="8",
volume="8",
pages="e49574",
keywords="Nootric app",
keywords="oncohematology patient",
keywords="physical-nutritional well-being",
keywords="multidisciplinary team",
abstract="Background: In oncohematology, both the development of the disease and the side effects of antineoplastic treatment often take a toll on patients' physical and nutritional well-being. In this era of digital transformation, we launched a pioneering project for oncohematologic patients to promote adherence to a healthy lifestyle and improve their physical and nutritional well-being. We aim to achieve this goal by involving doctors and nutritionists through the Nootric app. Objective: This study aims to assess the impact of the use of eHealth tools to facilitate nutrition and well-being in oncohematologic patients. We also aim to determine the usefulness of physical-nutritional management in improving tolerance to chemotherapy treatments within routine clinical practice. Methods: We designed a descriptive, observational, longitudinal, prospective cohort pilot study that included a total of 22 patients from March to May 2022 in the Vinalop{\'o} University Hospital. The inclusion criteria were adults over 18 years of age diagnosed with oncohematological pathology in active chemotherapy treatment. An action plan was created to generate alerts between the doctor and the nutritionist. In the beginning, the patients were trained to use the app and received education highlighting the importance of nutrition and physical exercise. Sociodemographic, clinical-biological-analytical (eg, malnutrition index), health care impact, usability, and patient adherence data were collected. Tolerance to chemotherapy treatment and its health care impact were evaluated. Results: We included 22 patients, 11 (50\%) female and 11 (50\%) male, ranging between 42 and 84 years of age. Among them, 13 (59\%) were adherents to the program. The most frequent diseases were lymphoproliferative syndromes (13/22, 59\%) and multiple myeloma (4/22, 18\%). Moreover, 15 (68\%) out of 22 patients received immunochemotherapy, while 7 (32\%) out of 22 patients received biological treatment. No worsening of clinical-biological parameters was observed. Excluding dropouts and abandonments (n=9/22, 41\%), the adherence rate was 81\%, established by calculating the arithmetic mean of the adherence rates of 13 patients. No admission was observed due to gastrointestinal toxicity or discontinuation of treatment related to alterations in physical and nutritional well-being. In addition, only 5.5\% of unscheduled consultations were increased due to incidents in well-being, mostly telematic (n=6/103 consultation are unscheduled). Additionally, 92\% of patients reported an improvement in their nutritional habits (n=12/13), and up to 45\% required adjustment of medical supportive treatment (n=5/11). There were no cases of grade 3 or greater gastrointestinal toxicity. All of this reflects improved tolerance to treatments. Patients reported a satisfaction score of 4.3 out of 5, while professionals rated their satisfaction at 4.8 out of 5. Conclusions: We demonstrated the usefulness of integrating new technologies through a multidisciplinary approach. The Nootric app facilitated collaboration among the medical team, nutritionists, and patients. It enabled us to detect health issues related to physical-nutritional well-being, anticipate major complications, and mitigate potentially avoidable risks. Consequently, there was a decrease in unscheduled visits and admissions related to this condition. ",
doi="10.2196/49574",
url="https://formative.jmir.org/2024/1/e49574",
url="http://www.ncbi.nlm.nih.gov/pubmed/38588522"
}


@Article{info:doi/10.2196/54178,
author="Trojan, Andreas
and Roth, Sven
and Atassi, Ziad
and Kiessling, Michael
and Zenhaeusern, Reinhard
and Kadvany, Yannick
and Schumacher, Johannes
and Kullak-Ublick, A. Gerd
and Aapro, Matti
and Eniu, Alexandru",
title="Comparison of the Real-World Reporting of Symptoms and Well-Being for the HER2-Directed Trastuzumab Biosimilar Ogivri With Registry Data for Herceptin in the Treatment of Breast Cancer: Prospective Observational Study (OGIPRO) of Electronic Patient-Reported Outcomes",
journal="JMIR Cancer",
year="2024",
month="Apr",
day="4",
volume="10",
pages="e54178",
keywords="breast cancer",
keywords="biosimilar",
keywords="trastuzumab",
keywords="electronic patient-reported outcome",
keywords="ePRO",
keywords="medidux",
keywords="app",
abstract="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 ",
doi="10.2196/54178",
url="https://cancer.jmir.org/2024/1/e54178",
url="http://www.ncbi.nlm.nih.gov/pubmed/38573759"
}


@Article{info:doi/10.2196/51338,
author="Bhyat, Fatima
and Makkink, Andrew
and Henrico, Karien",
title="Holistic Person-Centered Care in Radiotherapy: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="3",
volume="13",
pages="e51338",
keywords="cancer patient",
keywords="cancer",
keywords="cancer care",
keywords="holistic care",
keywords="person-centered care",
keywords="person-centered",
keywords="radiologist",
keywords="radiology",
keywords="radiotherapist",
keywords="radiotherapy",
keywords="scoping review",
abstract="Background: Several types of health care professionals are responsible for the care of patients with cancer throughout their engagement with the health care system. One such type is the radiotherapist. The radiotherapist not only administers treatment but is also directly involved with the patient during treatment. Despite this direct contact with the patient, the narrative tends to focus more on technical tasks than the actual patient. This task-focused interaction is often due to the highly sophisticated equipment and complex radiotherapy treatment processes involved. This often results in not meeting the psychosocial needs of the patient, and patients have acknowledged noncompliance and delayed treatment as a result. Objective: The scoping review aims to explore, chart, and map the available literature on holistic person-centered care in radiotherapy and to identify and present key concepts, definitions, methodologies, knowledge gaps, and evidence related to holistic person-centered care in radiotherapy. Methods: This protocol was developed using previously described methodological frameworks for scoping studies. The review will include both peer-reviewed and gray literature regarding holistic, person-centered care in radiotherapy. A comprehensive search strategy has been developed for MEDLINE (Ovid), which will be translated into the other included databases: Scopus, CINAHL (EBSCO), MEDLINE (PubMed), Embase (Elsevier), Cochrane Library, and the Directory of Open Access Journals. Gray literature searching will include Google (Google Books and Google Scholar), ProQuest, the WorldWideScience website, the OpenGrey website, and various university dissertation and thesis repositories. The title and abstract screening, full-text review, and relevant data extraction will be performed independently by all 3 reviewers using the Covidence (Veritas Health Innovation) software, which will also be used to guide the resolution of conflicts. Sources selected will be imported into ATLAS.ti (ATLAS.ti Scientific Software Development GmbH) for analysis, which will consist of content analysis, narrative analysis, and descriptive synthesis. Results will be presented using narrative, diagrammatic, and tabular formats. Results: The review is expected to identify research gaps that will inform current and future holistic, person-centered care in radiotherapy. The review commenced in November 2023, and the formal literature search was completed by the end of February 2024. Final results are expected to be published in a peer-reviewed journal by 2025. Conclusions: The findings of this review are expected to provide a wide variety of strategies aimed at providing holistic, person-centered care in radiotherapy, as well as to identify some gaps in the literature. These findings will be used to inform future studies aimed at designing, developing, evaluating, and implementing strategies toward improved holistic, person-centered care in radiotherapy. International Registered Report Identifier (IRRID): DERR1-10.2196/51338 ",
doi="10.2196/51338",
url="https://www.researchprotocols.org/2024/1/e51338",
url="http://www.ncbi.nlm.nih.gov/pubmed/38569177"
}


@Article{info:doi/10.2196/46979,
author="Dang, Ha Thu
and Wickramasinghe, Nilmini
and Forkan, Mohammad Abdur Rahim
and Jayaraman, Prakash Prem
and Burbury, Kate
and O'Callaghan, Clare
and Whitechurch, Ashley
and Schofield, Penelope",
title="Co-Design, Development, and Evaluation of a Mobile Solution to Improve Medication Adherence in Cancer: Design Science Research Approach",
journal="JMIR Cancer",
year="2024",
month="Apr",
day="3",
volume="10",
pages="e46979",
keywords="cancer",
keywords="behavioral science",
keywords="design science research",
keywords="digital",
keywords="medication adherence",
keywords="mobile solution",
keywords="Safety and Adherence to Medication and Self-Care Advice in Oncology",
keywords="SAMSON",
keywords="mobile phone",
abstract="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. ",
doi="10.2196/46979",
url="https://cancer.jmir.org/2024/1/e46979",
url="http://www.ncbi.nlm.nih.gov/pubmed/38569178"
}


@Article{info:doi/10.2196/51145,
author="von Wolff, Michael
and Germeyer, Ariane
and B{\"o}ttcher, Bettina
and Magaton, Martha Isotta
and Marcu, Irene
and Pape, Janna
and S{\"a}nger, Nicole
and Nordhoff, Verena
and Roumet, Marie
and Weidlinger, Susanna",
title="Evaluation of the Gonadotoxicity of Cancer Therapies to Improve Counseling of Patients About Fertility and Fertility Preservation Measures: Protocol for a Retrospective Systematic Data Analysis and a Prospective Cohort Study",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="20",
volume="13",
pages="e51145",
keywords="fertility",
keywords="fertility preservation",
keywords="cancer",
keywords="gonadotoxicity",
keywords="FertiPROTEKT",
keywords="FertiTOX",
keywords="data analysis",
keywords="cohort study",
keywords="internet",
keywords="platform",
keywords="internet-based",
keywords="data",
abstract="Background: Cytotoxic treatments such as chemo- and radiotherapy and immune therapies are required in cancer diseases. These therapies have the potential to cure patients but may also have an impact on gonadal function and, therefore, on fertility. Consequently, fertility preservation treatments such as freezing of gametes and gonadal tissue might be required. However, as detailed data about the necessity to perform fertility preservation treatment are very limited, this study was designed to fill this data gap. Objective: Primary objective of this study is to analyze the impact of cancer therapies and chemotherapies on the ovarian reserve and sperm quality. Secondary objectives are to analyze the (1) impact of cancer therapies and chemotherapies on other fertility parameters and (2) probability of undergoing fertility preservation treatments in relation to specific cancer diseases and treatment protocols and the probability to use the frozen gametes and gonadal tissue to achieve pregnancies. Methods: First, previously published studies on the gonadotoxicity of chemo- and radiotherapies among patients with cancer will be systematically analyzed. Second, a prospective cohort study set up by approximately 70 centers in Germany, Switzerland, and Austria will collect the following data: ovarian function by analyzing anti-M{\"u}llerian hormone (AMH) concentrations and testicular function by analyzing sperm parameters and total testosterone immediately before and around 1 year after gonadotoxic therapies (short-term fertility). A follow-up of these fertility parameters, including history of conceptions, will be performed 5 and 10 years after gonadotoxic therapies (long-term fertility). Additionally, the proportion of patients undergoing fertility-preserving procedures, their satisfaction with these procedures, and the amount of gametes and gonadal tissue and the children achieved by using the frozen material will be analyzed. Third, the data will be merged to create the internet-based data platform FertiTOX. The platform will be structured in accordance with the ICD (International Classification of Diseases) classification of cancer diseases and will be easily be accessible using a specific App. Results: Several funding bodies have funded this study. Ten systematic reviews are in progress and the first one has been accepted for publication. All Swiss and many German and Austrian ethics committees have provided their approval for the prospective cohort study. The study registry has been set up, and a study website has been created. In total, 50 infertility centers have already been prepared for data collection, which started on December 1, 2023. Conclusions: The study can be expected to bridge the data gap regarding the gonadotoxicity of cancer therapies to better counsel patients about their infertility risk and their need to undergo fertility preservation procedures. Initial data are expected to be uploaded on the FertiTOX platform in 2026. Trial Registration: ClinicalTrials.gov NCT05885048; https://clinicaltrials.gov/study/NCT05885048 International Registered Report Identifier (IRRID): DERR1-10.2196/51145 ",
doi="10.2196/51145",
url="https://www.researchprotocols.org/2024/1/e51145",
url="http://www.ncbi.nlm.nih.gov/pubmed/38506900"
}


@Article{info:doi/10.2196/52322,
author="Zeinali, Nahid
and Youn, Nayung
and Albashayreh, Alaa
and Fan, Weiguo
and Gilbertson White, St{\'e}phanie",
title="Machine Learning Approaches to Predict Symptoms in People With Cancer: Systematic Review",
journal="JMIR Cancer",
year="2024",
month="Mar",
day="19",
volume="10",
pages="e52322",
keywords="machine learning",
keywords="ML",
keywords="deep learning",
keywords="DL",
keywords="cancer symptoms",
keywords="prediction model",
abstract="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. ",
doi="10.2196/52322",
url="https://cancer.jmir.org/2024/1/e52322",
url="http://www.ncbi.nlm.nih.gov/pubmed/38502171"
}


@Article{info:doi/10.2196/47685,
author="Jiang, Yun
and Hwang, Misun
and Cho, Youmin
and Friese, R. Christopher
and Hawley, T. Sarah
and Manojlovich, Milisa
and Krauss, C. John
and Gong, Yang",
title="The Acceptance and Use of Digital Technologies for Self-Reporting Medication Safety Events After Care Transitions to Home in Patients With Cancer: Survey Study",
journal="J Med Internet Res",
year="2024",
month="Mar",
day="8",
volume="26",
pages="e47685",
keywords="digital technology",
keywords="patient safety",
keywords="patient participation",
keywords="patient-reported outcomes",
keywords="drug-related side effects and adverse reactions",
abstract="Background: Actively engaging patients with cancer and their families in monitoring and reporting medication safety events during care transitions is indispensable for achieving optimal patient safety outcomes. However, existing patient self-reporting systems often cannot address patients' various experiences and concerns regarding medication safety over time. In addition, these systems are usually not designed for patients' just-in-time reporting. There is a significant knowledge gap in understanding the nature, scope, and causes of medication safety events after patients' transition back home because of a lack of patient engagement in self-monitoring and reporting of safety events. The challenges for patients with cancer in adopting digital technologies and engaging in self-reporting medication safety events during transitions of care have not been fully understood. Objective: We aim to assess oncology patients' perceptions of medication and communication safety during care transitions and their willingness to use digital technologies for self-reporting medication safety events and to identify factors associated with their technology acceptance. Methods: A cross-sectional survey study was conducted with adult patients with breast, prostate, lung, or colorectal cancer (N=204) who had experienced care transitions from hospitals or clinics to home in the past 1 year. Surveys were conducted via phone, the internet, or email between December 2021 and August 2022. Participants' perceptions of medication and communication safety and perceived usefulness, ease of use, attitude toward use, and intention to use a technology system to report their medication safety events from home were assessed as outcomes. Potential personal, clinical, and psychosocial factors were analyzed for their associations with participants' technology acceptance through bivariate correlation analyses and multiple logistic regressions. Results: Participants reported strong perceptions of medication and communication safety, positively correlated with medication self-management ability and patient activation. Although most participants perceived a medication safety self-reporting system as useful (158/204, 77.5\%) and easy to use (157/204, 77\%), had a positive attitude toward use (162/204, 79.4\%), and were willing to use such a system (129/204, 63.2\%), their technology acceptance was associated with their activation levels (odds ratio [OR] 1.83, 95\% CI 1.12-2.98), their perceptions of communication safety (OR 1.64, 95\% CI 1.08-2.47), and whether they could receive feedback after self-reporting (OR 3.27, 95\% CI 1.37-7.78). Conclusions: In general, oncology patients were willing to use digital technologies to report their medication events after care transitions back home because of their high concerns regarding medication safety. As informed and activated patients are more likely to have the knowledge and capability to initiate and engage in self-reporting, developing a patient-centered reporting system to empower patients and their families and facilitate safety health communications will help oncology patients in addressing their medication safety concerns, meeting their care needs, and holding promise to improve the quality of cancer care. ",
doi="10.2196/47685",
url="https://www.jmir.org/2024/1/e47685",
url="http://www.ncbi.nlm.nih.gov/pubmed/38457204"
}


@Article{info:doi/10.2196/41657,
author="Klein, M. Colleen
and Sivesind, E. Torunn
and Dellavalle, P. Robert",
title="From the Cochrane Library: Visual Inspection and Dermoscopy, Alone or in Combination, for Diagnosing Keratinocyte Skin Cancers in Adults",
journal="JMIR Dermatol",
year="2024",
month="Mar",
day="7",
volume="7",
pages="e41657",
keywords="nonmelanoma skin cancer",
keywords="dermoscopy",
keywords="dermatoscopy",
keywords="teledermatology",
keywords="dermascopic",
keywords="dermatoscope",
keywords="oncology",
keywords="skin",
keywords="cancer",
keywords="basal cell carcinoma",
keywords="dermatology",
keywords="cutaneous squamous cell carcinoma",
keywords="diagnostic odds ratio",
keywords="lesion",
keywords="diagnostic",
keywords="diagnosis",
keywords="keratinocyte carcinoma",
doi="10.2196/41657",
url="https://derma.jmir.org/2024/1/e41657",
url="http://www.ncbi.nlm.nih.gov/pubmed/38451581"
}


@Article{info:doi/10.2196/53627,
author="Boehm, Dominik
and Strantz, Cosima
and Christoph, Jan
and Busch, Hauke
and Ganslandt, Thomas
and Unberath, Philipp",
title="Data Visualization Support for Tumor Boards and Clinical Oncology: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="5",
volume="13",
pages="e53627",
keywords="clinical oncology",
keywords="tumor board",
keywords="cancer conference",
keywords="multidisciplinary",
keywords="visualization",
keywords="software",
keywords="tool",
keywords="scoping review",
keywords="tumor",
keywords="malignant",
keywords="benign",
keywords="data sets",
keywords="oncology",
keywords="interactive visualization",
keywords="data",
keywords="patient",
keywords="patients",
keywords="physicians",
keywords="medical practitioners",
keywords="medical practitioner",
keywords="conference",
abstract="Background: Complex and expanding data sets in clinical oncology applications require flexible and interactive visualization of patient data to provide the maximum amount of information to physicians and other medical practitioners. Interdisciplinary tumor conferences in particular profit from customized tools to integrate, link, and visualize relevant data from all professions involved. Objective: The scoping review proposed in this protocol aims to identify and present currently available data visualization tools for tumor boards and related areas. The objective of the review will be to provide not only an overview of digital tools currently used in tumor board settings, but also the data included, the respective visualization solutions, and their integration into hospital processes. Methods: The planned scoping review process is based on the Arksey and O'Malley scoping study framework. The following electronic databases will be searched for articles published in English: PubMed, Web of Knowledge, and SCOPUS. Eligible articles will first undergo a deduplication step, followed by the screening of titles and abstracts. Second, a full-text screening will be used to reach the final decision about article selection. At least 2 reviewers will independently screen titles, abstracts, and full-text reports. Conflicting inclusion decisions will be resolved by a third reviewer. The remaining literature will be analyzed using a data extraction template proposed in this protocol. The template includes a variety of meta information as well as specific questions aiming to answer the research question: ``What are the key features of data visualization solutions used in molecular and organ tumor boards, and how are these elements integrated and used within the clinical setting?'' The findings will be compiled, charted, and presented as specified in the scoping study framework. Data for included tools may be supplemented with additional manual literature searches. The entire review process will be documented in alignment with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) flowchart. Results: The results of this scoping review will be reported per the expanded PRISMA-ScR guidelines. A preliminary search using PubMed, Web of Knowledge, and Scopus resulted in 1320 articles after deduplication that will be included in the further review process. We expect the results to be published during the second quarter of 2024. Conclusions: Visualization is a key process in leveraging a data set's potentially available information and enabling its use in an interdisciplinary setting. The scoping review described in this protocol aims to present the status quo of visualization solutions for tumor board and clinical oncology applications and their integration into hospital processes. International Registered Report Identifier (IRRID): DERR1-10.2196/53627 ",
doi="10.2196/53627",
url="https://www.researchprotocols.org/2024/1/e53627",
url="http://www.ncbi.nlm.nih.gov/pubmed/38441925"
}


@Article{info:doi/10.2196/50528,
author="Ni, Chenxu
and Wang, Yi-fu
and Zhang, Yun-ting
and Yuan, Min
and Xu, Qing
and Shen, Fu-ming
and Li, Dong-Jie
and Huang, Fang",
title="A Mobile Applet for Assessing Medication Adherence and Managing Adverse Drug Reactions Among Patients With Cancer: Usability and Utility Study",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="29",
volume="8",
pages="e50528",
keywords="WeChat applet",
keywords="usability testing",
keywords="utility testing",
keywords="cancer patients",
keywords="patients",
keywords="cancer",
keywords="qualitative study",
abstract="Background: Medication adherence and the management of adverse drug reactions (ADRs) are crucial to the efficacy of antitumor drugs. A WeChat applet, also known as a ``Mini Program,'' is similar to the app but has marked advantages. The development and use of a WeChat applet makes follow-up convenient for patients with cancer. Objective: This study aimed to assess the usability and utility of a newly developed WeChat applet, ``DolphinCare,'' among patients with cancer in Shanghai. Methods: A qualitative methodology was used to obtain an in-depth understanding of the experiences of patients with cancer when using DolphinCare from the usability and utility aspects. The development phase consisted of 2 parts: alpha and beta testing. Alpha testing combined the theory of the Fogg Behavior Model and the usability model. Alpha testing also involved testing the design of DolphinCare using a conceptual framework, which included factors that could affect medication adherence and ADRs. Beta testing was conducted using in-depth interviews. In-depth interviews allowed us to assist the patients in using DolphinCare and understand whether they liked or disliked DolphinCare and found it useful. Results: We included participants who had an eHealth Literacy Scale (eHEALS) score of ?50\%, and a total of 20 participants were interviewed consecutively. The key positive motivators described by interviewers were to be reminded to take their medications and to alleviate their ADRs. The majority of the patients were able to activate and use DolphinCare by themselves. Most patients indicated that their trigger to follow-up DolphinCare was the recommendation of their known and trusted health care professionals. All participants found that labels containing the generic names of their medication and the medication reminders were useful, including timed pop-up push notifications and text alerts. The applet presented the corresponding information collection forms of ADRs to the patient to fill out. The web-based consultation system enables patients to consult pharmacists or physicians in time when they have doubts about medications or have ADRs. The applet had usabilities and utilities that could improve medication adherence and the management of ADRs among patients with cancer. Conclusions: This study provides preliminary evidence regarding the usability and utility of this type of WeChat applet among patients with cancer, which is expected to be promoted for managing follow-up among other patients with other chronic disease. ",
doi="10.2196/50528",
url="https://formative.jmir.org/2024/1/e50528",
url="http://www.ncbi.nlm.nih.gov/pubmed/38421700"
}


@Article{info:doi/10.2196/47359,
author="Shinn, H. Eileen
and Garden, S. Adam
and Peterson, K. Susan
and Leupi, J. Dylan
and Chen, Minxing
and Blau, Rachel
and Becerra, Laura
and Rafeedi, Tarek
and Ramirez, Julian
and Rodriquez, Daniel
and VanFossen, Finley
and Zehner, Sydney
and Mercier, P. Patrick
and Wang, Joseph
and Hutcheson, Kate
and Hanna, Ehab
and Lipomi, J. Darren",
title="Iterative Patient Testing of a Stimuli-Responsive Swallowing Activity Sensor to Promote Extended User Engagement During the First Year After Radiation: Multiphase Remote and In-Person Observational Cohort Study",
journal="JMIR Cancer",
year="2024",
month="Feb",
day="28",
volume="10",
pages="e47359",
keywords="user-centered design",
keywords="patients with head and neck cancer",
keywords="dysphagia throat sensor",
abstract="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 ",
doi="10.2196/47359",
url="https://cancer.jmir.org/2024/1/e47359",
url="http://www.ncbi.nlm.nih.gov/pubmed/38416544"
}


@Article{info:doi/10.2196/49312,
author="Su, Zhenzhen
and Zhang, Liyan
and Lian, Xuemin
and Guan, Miaomiao",
title="Virtual Reality--Based Exercise Rehabilitation in Cancer-Related Dysfunctions: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Feb",
day="26",
volume="26",
pages="e49312",
keywords="virtual reality",
keywords="cancer",
keywords="virtual reality--based exercise rehabilitation",
keywords="cancer-related dysfunction",
keywords="rehabilitation",
keywords="scoping review",
abstract="Background: Virtual reality--based exercise rehabilitation (VRER) is a promising intervention for patients with cancer-related dysfunctions (CRDs). However, studies focusing on VRER for CRDs are lacking, and the results are inconsistent. Objective: We aimed to review the application of VRER in patients with CRDs. Methods: This scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist framework. Publications were included from the time of database establishment to October 14, 2023. The databases were PubMed, Embase, Scopus, Cochrane, Web of Science, ProQuest, arXiv, IEEE Xplore, MedRxiv, CNKI, Wanfang Data, VIP, and SinoMed. The population included patients with cancer. A virtual reality (VR) system or device was required to be provided in exercise rehabilitation as an intervention. Eligible studies focused on VRER used for CRDs. Study selection and data extraction were performed by 2 reviewers independently. Extracted data included authors, year, country, study type, groups, sample size, participant age, cancer type, existing or potential CRDs, VR models and devices, intervention programs and durations, effectiveness, compliance, satisfaction, and safety. Results: We identified 25 articles, and among these, 12 (48\%) were randomized clinical trials, 11 (44\%) were other experimental studies, and 2 (8\%) were observational studies. The total sample size was 1174 (range 6-136). Among the 25 studies, 22 (88\%), 2 (8\%), and 1 (4\%) included nonimmersive VR, immersive VR, and augmented reality, respectively, which are models of VRER. Commercial game programs (17/25, 68\%) were the most popular interventions of VRER, and their duration ranged from 3 to 12 weeks. Using these models and devices, VRER was mostly applied in patients with breast cancer (14/25, 56\%), leukemia (8/25, 32\%), and lung cancer (3/25, 12\%). Furthermore, 6 CRDs were intervened by VRER, and among these, postmastectomy syndromes were the most common (10/25, 40\%). Overall, 74\% (17/23) of studies reported positive results, including significant improvements in limb function, joint range of motion, edema rates, cognition, respiratory disturbance index, apnea, activities of daily living, and quality of life. The compliance rate ranged from 56\% to 100\%. Overall, 32\% (8/25) of studies reported on patient satisfaction, and of these, 88\% (7/8) reported satisfaction with VRER. Moreover, 13\% (1/8) reported mild sickness as an adverse event. Conclusions: We found that around half of the studies reported using VRER in patients with breast cancer and postmastectomy dysfunctions through nonimmersive models and commercial game programs having durations of 3-12 weeks. In addition, most studies showed that VRER was effective owing to virtualization and interaction. Therefore, VRER may be an alternate intervention for patients with CRDs. However, as the conclusions were drawn from data with acknowledged inconsistencies and limited satisfaction reports, studies with larger sample sizes and more outcome indictors are required. ",
doi="10.2196/49312",
url="https://www.jmir.org/2024/1/e49312",
url="http://www.ncbi.nlm.nih.gov/pubmed/38407951"
}


@Article{info:doi/10.2196/46625,
author="Ow, Tsai-Wing
and Sukocheva, Olga
and Bampton, Peter
and Iyngkaran, Guruparan
and Rayner, K. Christopher
and Tse, Edmund",
title="Improving Concordance Between Clinicians With Australian Guidelines for Bowel Cancer Prevention Using a Digital Application: Randomized Controlled Crossover Study",
journal="JMIR Cancer",
year="2024",
month="Feb",
day="22",
volume="10",
pages="e46625",
keywords="colorectal cancer",
keywords="guidelines",
keywords="colorectal cancer screening",
keywords="digital application",
keywords="questionnaire",
keywords="application",
keywords="cancer prevention",
keywords="prevention",
keywords="cancer",
keywords="bowel cancer",
keywords="surveillance",
keywords="clinical vignette quiz",
keywords="usability",
keywords="Australia",
abstract="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. ",
doi="10.2196/46625",
url="https://cancer.jmir.org/2024/1/e46625",
url="http://www.ncbi.nlm.nih.gov/pubmed/38238256"
}


@Article{info:doi/10.2196/52338,
author="Badaghi, Nasim
and van Kruijsbergen, Mette
and Speckens, Anne
and Vil{\'e}, Jo{\"e}lle
and Prins, Judith
and Kelders, Saskia
and Kwakkenbos, Linda",
title="Group, Blended and Individual, Unguided Online Delivery of Mindfulness-Based Cognitive Therapy for People With Cancer: Feasibility Uncontrolled Trial",
journal="JMIR Form Res",
year="2024",
month="Feb",
day="21",
volume="8",
pages="e52338",
keywords="cancer",
keywords="eHeath",
keywords="online interventions",
keywords="mindfulness",
keywords="psycho-oncology",
keywords="qualitative research",
keywords="oncology",
keywords="CBT",
keywords="blended",
keywords="eMBCT",
keywords="iCBT",
keywords="cognitive therapy",
keywords="unguided",
keywords="psychotherapy",
keywords="MBCT",
keywords="co-creation",
keywords="therapist",
keywords="self-guided",
keywords="peer-support",
keywords="co-design",
keywords="participatory",
abstract="Background: Online mindfulness based cognitive therapy (eMBCT) has been shown to reduce psychological distress in people with cancer. However, this population has reported lack of support and asynchronous communication as barriers to eMBCT, resulting in higher nonadherence rates than with face-to-face MBCT. Using a co-creation process, we developed 2 formats of eMBCT: group, blended (combination of therapist-guided group and individual online sessions) and individual, unguided (individual, unguided online sessions only). Group, blended eMBCT offers peer support and guidance, whereas individual, unguided eMBCT offers flexibility and the possibility of large-scale implementation. Objective: The objective of this nonrandomized feasibility study was to assess aspects of feasibility of the group, blended and individual, unguided eMBCT interventions. Methods: Participants were people with cancer who chose between group, blended and individual, unguided eMBCT. Both intervention conditions followed the same 8-week eMBCT program, including an introductory session and a silent day (10 sessions total). All sessions for individual, unguided eMBCT occurred via the platform Minddistrict, whereas group, blended eMBCT consisted of 3 online videoconference sessions guided by a mindfulness teacher and 5 sessions via Minddistrict. We assessed the feasibility of the intervention quantitatively and qualitatively by evaluating its acceptability among participants. Additionally, we assessed limited efficacy by looking at the number of questionnaires participants completed pre- and postintervention. Results: We included 12 participants for each eMBCT condition. Participants in group, blended eMBCT completed, on average, 9.7 of 10 sessions, compared with an average 8.3 sessions for individual, unguided eMBCT (excluding dropouts). Of the 24 participants, 13 (54\%) agreed to be interviewed (5 unguided and 8 blended). Participants in both conditions reported positive experiences, including the convenience of not having to travel and the flexibility to choose when and where to participate. However, among the barriers for participation, participants in the group, blended condition reported a preference for more group sessions, and participants in the individual, unguided condition reported a lack of guidance. Additionally, for the group, blended condition, the effect sizes were small for all outcome measures (Hedges g range=0.01-0.36), except for fatigue, which had a moderate effect size (Hedges g=0.57). For the individual, unguided condition, the effect sizes were small for all outcome measures (Hedges g range=0.24-0.46), except for mindfulness skills (Hedges g=0.52) and engagement with the intervention (Hedges g=1.53). Conclusions: Participants in this study had a positive experience with group, blended and individual, unguided eMBCT. Based on the results from this study, we will adjust the intervention prior to conducting a full-scale randomized controlled trial to evaluate effectiveness; we will add 1 group session to the group, blended eMBCT using Zoom as the platform for the group sessions; and we will send reminders to participants to complete questionnaires. Trial Registration: ClinicalTrials.gov NCT05336916; https://clinicaltrials.gov/ct2/show/NCT05336916 ",
doi="10.2196/52338",
url="https://formative.jmir.org/2024/1/e52338",
url="http://www.ncbi.nlm.nih.gov/pubmed/38381493"
}


@Article{info:doi/10.2196/52689,
author="Manne, Sharon
and Heckman, J. Carolyn
and Frederick, Sara
and Schaefer, A. Alexis
and Studts, R. Christina
and Khavjou, Olga
and Honeycutt, Amanda
and Berger, Adam
and Liu, Hao",
title="A Digital Intervention to Improve Skin Self-Examination Among Survivors of Melanoma: Protocol for a Type-1 Hybrid Effectiveness-Implementation Randomized Trial",
journal="JMIR Res Protoc",
year="2024",
month="Feb",
day="12",
volume="13",
pages="e52689",
keywords="melanoma",
keywords="cancer survivorship",
keywords="skin self-examinations",
keywords="digital interventions",
abstract="Background: Although melanoma survival rates have improved in recent years, survivors remain at risk of recurrence, second primary cancers, and keratinocyte carcinomas. The National Comprehensive Cancer Network recommends skin examinations by a physician every 3 to 12 months. Regular thorough skin self-examinations (SSEs) are recommended for survivors of melanoma to promote the detection of earlier-stage, thinner melanomas, which are associated with improved survival and lower treatment costs. Despite their importance, less than a quarter of survivors of melanoma engage in SSEs. Objective: Previously, our team developed and evaluated a web-based, fully automated intervention called mySmartSkin (MSS) that successfully improved SSE among survivors of melanoma. Enhancements were proposed to improve engagement with and outcomes of MSS. The purpose of this paper is to describe the rationale and methodology for a type-1 hybrid effectiveness-implementation randomized trial evaluating the enhanced MSS versus control and exploring implementation outcomes and contextual factors. Methods: This study will recruit from state cancer registries and social media 300 individuals diagnosed with cutaneous malignant melanoma between 3 months and 5 years after surgery who are currently cancer free. Participants will be randomly assigned to either enhanced MSS or a noninteractive educational web page. Surveys will be collected from both arms at baseline and at 3, 6, 12, and 18 months to assess measures of intervention engagement, barriers, self-efficacy, habit, and SSE. The primary outcome is thorough SSE. The secondary outcomes are the diagnosis of new or recurrent melanomas and sun protection practices. Results: Multilevel modeling will be used to examine whether there are significant differences in survivor outcomes between MSS and the noninteractive web page over time. Mixed methods will evaluate reach, adoption, implementation (including costs), and potential for maintenance of MSS, as well as contextual factors relevant to those outcomes and future scale-up. Conclusions: This trial has the potential to improve outcomes in survivors of melanoma. If MSS is effective, the results could guide its implementation in oncology care and nonprofit organizations focused on skin cancers. International Registered Report Identifier (IRRID): RR1-10.2196/52689 ",
doi="10.2196/52689",
url="https://www.researchprotocols.org/2024/1/e52689",
url="http://www.ncbi.nlm.nih.gov/pubmed/38345836"
}


@Article{info:doi/10.2196/48069,
author="Kvale, Elizabeth
and Phillips, Farya
and Ghosh, Samiran
and Lea, Jayanthi
and Hoppenot, Claire
and Costales, Anthony
and Sunde, Jan
and Badr, Hoda
and Nwogu-Onyemkpa, Eberechi
and Saleem, Nimrah
and Ward, Rikki
and Balasubramanian, Bijal",
title="Survivorship Care for Women Living With Ovarian Cancer: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Feb",
day="9",
volume="13",
pages="e48069",
keywords="chronic survivorship",
keywords="metastatic survivor",
keywords="metavivor",
keywords="ovarian cancer",
keywords="persons living with cancer",
keywords="quality of life",
keywords="survivor",
keywords="survivorship care",
keywords="survivorship transition",
abstract="Background: Ovarian cancer ranks 12th in cancer incidence among women in the United States and 5th among causes of cancer-related death. The typical treatment of ovarian cancer focuses on disease management, with little attention given to the survivorship needs of the patient. Qualitative work alludes to a gap in survivorship care; yet, evidence is lacking to support the delivery of survivorship care for individuals living with ovarian cancer. We developed the POSTCare survivorship platform with input from survivors of ovarian cancer and care partners as a means of delivering patient-centered survivorship care. This process is framed by the chronic care model and relevant behavioral theory. Objective: The overall goal of this study is to test processes of care that support quality of life (QOL) in survivorship. The specific aims are threefold: first, to test the efficacy of the POSTCare platform in supporting QOL, reducing depressive symptom burden, and reducing recurrence worry. In our second aim, we will examine factors that mediate the effect of the intervention. Our final aim focuses on understanding aspects of care platform design and delivery that may affect the potential for dissemination. Methods: We will enroll 120 survivors of ovarian cancer in a randomized controlled trial and collect data at 12 and 24 weeks. Each participant will be randomized to either the POSTCare platform or the standard of care process for survivorship. Our population will be derived from 3 clinics in Texas; each participant will have received some combination of treatment modalities; continued maintenance therapy is not exclusionary. Results: We will examine the impact of the POSTCare-O platform on QOL at 12 weeks after intervention as the primary end point. We will look at secondary outcomes, including depressive symptom burden, recurrence anxiety, and physical symptom burden. We will identify mediators important to the impact of the intervention to inform revisions of the intervention for subsequent studies. Data collection was initiated in November 2023 and will continue for approximately 2 years. We expect results from this study to be published in early 2026. Conclusions: This study will contribute to the body of survivorship science by testing a flexible platform for survivorship care delivery adapted for the specific survivorship needs of patients with ovarian cancer. The completion of this project will contribute to the growing body of science to guide survivorship care for persons living with cancer. Trial Registration: ClinicalTrials.gov NCT05752448; https://clinicaltrials.gov/study/NCT05752448 International Registered Report Identifier (IRRID): PRR1-10.2196/48069 ",
doi="10.2196/48069",
url="https://www.researchprotocols.org/2024/1/e48069",
url="http://www.ncbi.nlm.nih.gov/pubmed/38335019"
}


@Article{info:doi/10.2196/53853,
author="Zhao, Sunyan
and Zhang, Jing
and Wan, Haijun
and Tao, Chenjie
and Hu, Meng
and Liang, Wei
and Xu, Zhi
and Xu, Bingguo
and Zhang, Jiaying
and Wang, Guoxin
and Li, Ping
and Lyu, Guangmei
and Gong, Yongling",
title="Role of Chinese Acupuncture in the Treatment for Chemotherapy-Induced Cognitive Impairment in Older Patients With Cancer: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Feb",
day="8",
volume="13",
pages="e53853",
keywords="older patients with cancer",
keywords="cognitive impairment",
keywords="chemobrain",
keywords="Chinese medicine",
keywords="electroacupuncture",
abstract="Background: Older patients with cancer experience cognitive impairment and a series of neurocognitive symptoms known as chemobrain due to chemotherapy. Moreover, older populations are disproportionately affected by chemobrain and heightened negative mental health outcomes after cytotoxic chemical drug therapy. Chinese acupuncture is an emerging therapeutic option for chemotherapy-induced cognitive impairment in older patients with cancer, despite limited supporting evidence. Objective: Our study aims to directly contribute to the existing knowledge of this novel Chinese medicine mode in older patients with cancer enrolled at the Department of Oncology/Chinese Medicine, Nanjing First Hospital, China, thereby establishing the basis for further research. Methods: This study involves a 2-arm, prospective, randomized, assessor-blinded clinical trial in older patients with cancer experiencing chemobrain-related stress and treated with Chinese acupuncture from September 30, 2023, to December 31, 2025. We will enroll 168 older patients with cancer with clinically confirmed chemobrain. These participants will be recruited through screening by oncologists for Chinese acupuncture therapy and evaluation. Electroacupuncture will be performed by a registered practitioner of Chinese medicine. The electroacupuncture intervention will take about 30 minutes every session (2 sessions per week over 8 weeks). For the experimental group, the acupuncture points are mainly on the head, limbs, and abdomen, with a total of 6 pairs of electrically charged needles on the head, while for the control group, the acupuncture points are mainly on the head and limbs, with only 1 pair of electrically charged needles on the head. Results: Eligible participants will be randomized to the control group or the experimental group in 1:1 ratio. The primary outcome of this intervention will be the scores of the Montreal Cognitive Assessment. The secondary outcomes, that is, attentional function and working memory will be determined by the Digit Span Test scores. The quality of life of the patients and multiple functional assessments will also be evaluated. These outcomes will be measured at 2, 4, 6, and 8 weeks after the randomization. Conclusions: This efficacy trial will explore whether Chinese electroacupuncture can prevent chemobrain, alleviate the related symptoms, and improve the quality of life of older patients with cancer who are undergoing or are just going to begin chemotherapy. The safety of this electroacupuncture intervention for such patients will also be evaluated. Data from this study will be used to promote electroacupuncture application in patients undergoing chemotherapy and support the design of further real-world studies. Trial Registration: ClinicalTrials.gov NCT05876988; https://clinicaltrials.gov/ct2/show/NCT05876988 International Registered Report Identifier (IRRID): DERR1-10.2196/53853 ",
doi="10.2196/53853",
url="https://www.researchprotocols.org/2024/1/e53853",
url="http://www.ncbi.nlm.nih.gov/pubmed/38329790"
}


@Article{info:doi/10.2196/46116,
author="Zhang, Yingzi
and Flannery, Marie
and Zhang, Zhihong
and Underhill-Blazey, Meghan
and Bobry, Melanie
and Leblanc, Natalie
and Rodriguez, Darcey
and Zhang, Chen",
title="Digital Health Psychosocial Intervention in Adult Patients With Cancer and Their Families: Systematic Review and Meta-Analysis",
journal="JMIR Cancer",
year="2024",
month="Feb",
day="5",
volume="10",
pages="e46116",
keywords="cancer",
keywords="anxiety",
keywords="decision-making",
keywords="depression",
keywords="digital health",
keywords="distress",
keywords="family",
keywords="mental health",
keywords="mortality",
keywords="psychosocial intervention",
keywords="quality of life",
abstract="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 ",
doi="10.2196/46116",
url="https://cancer.jmir.org/2024/1/e46116",
url="http://www.ncbi.nlm.nih.gov/pubmed/38315546"
}


@Article{info:doi/10.2196/51925,
author="de Hond, Anne
and van Buchem, Marieke
and Fanconi, Claudio
and Roy, Mohana
and Blayney, Douglas
and Kant, Ilse
and Steyerberg, Ewout
and Hernandez-Boussard, Tina",
title="Predicting Depression Risk in Patients With Cancer Using Multimodal Data: Algorithm Development Study",
journal="JMIR Med Inform",
year="2024",
month="Jan",
day="18",
volume="12",
pages="e51925",
keywords="natural language processing",
keywords="machine learning",
keywords="artificial intelligence",
keywords="oncology",
keywords="depression",
keywords="clinical decision support",
keywords="decision support",
keywords="cancer",
keywords="patients with cancer",
keywords="chemotherapy",
keywords="mental health",
keywords="prediction model",
keywords="depression risk",
keywords="cancer treatment",
keywords="radiotherapy",
keywords="diagnosis",
keywords="validation",
keywords="cancer care",
keywords="care",
abstract="Background: Patients with cancer starting systemic treatment programs, such as chemotherapy, often develop depression. A prediction model may assist physicians and health care workers in the early identification of these vulnerable patients. Objective: This study aimed to develop a prediction model for depression risk within the first month of cancer treatment. Methods: We included 16,159 patients diagnosed with cancer starting chemo- or radiotherapy treatment between 2008 and 2021. Machine learning models (eg, least absolute shrinkage and selection operator [LASSO] logistic regression) and natural language processing models (Bidirectional Encoder Representations from Transformers [BERT]) were used to develop multimodal prediction models using both electronic health record data and unstructured text (patient emails and clinician notes). Model performance was assessed in an independent test set (n=5387, 33\%) using area under the receiver operating characteristic curve (AUROC), calibration curves, and decision curve analysis to assess initial clinical impact use. Results: Among 16,159 patients, 437 (2.7\%) received a depression diagnosis within the first month of treatment. The LASSO logistic regression models based on the structured data (AUROC 0.74, 95\% CI 0.71-0.78) and structured data with email classification scores (AUROC 0.74, 95\% CI 0.71-0.78) had the best discriminative performance. The BERT models based on clinician notes and structured data with email classification scores had AUROCs around 0.71. The logistic regression model based on email classification scores alone performed poorly (AUROC 0.54, 95\% CI 0.52-0.56), and the model based solely on clinician notes had the worst performance (AUROC 0.50, 95\% CI 0.49-0.52). Calibration was good for the logistic regression models, whereas the BERT models produced overly extreme risk estimates even after recalibration. There was a small range of decision thresholds for which the best-performing model showed promising clinical effectiveness use. The risks were underestimated for female and Black patients. Conclusions: The results demonstrated the potential and limitations of machine learning and multimodal models for predicting depression risk in patients with cancer. Future research is needed to further validate these models, refine the outcome label and predictors related to mental health, and address biases across subgroups. ",
doi="10.2196/51925",
url="https://medinform.jmir.org/2024/1/e51925",
url="http://www.ncbi.nlm.nih.gov/pubmed/38236635"
}


@Article{info:doi/10.2196/50550,
author="Fridriksdottir, Nanna
and Ingadottir, Brynja
and Skuladottir, Kristin
and Zo{\"e}ga, Sigridur
and Gunnarsdottir, Sigridur",
title="Supportive Digital Health Service During Cancer Chemotherapy: Single-Arm Before-and-After Feasibility Study",
journal="JMIR Form Res",
year="2023",
month="Dec",
day="22",
volume="7",
pages="e50550",
keywords="web portal for patients with cancer",
keywords="supportive digital health service",
keywords="symptom monitoring",
keywords="self-management support",
keywords="feasibility",
keywords="usability",
keywords="acceptability",
keywords="patient education",
keywords="health engagement",
keywords="patient-reported outcomes",
keywords="digital health service",
keywords="patient portal",
keywords="electronic health records",
keywords="mobile phone",
abstract="Background: Digital supportive cancer care is recommended to improve patient outcomes. A portal was designed and embedded within the electronic medical record and public health portal of Iceland, consisting of symptom and needs monitoring, educational material, and messaging. Objective: This study aims to assess (1) portal feasibility (adoption, engagement, usability, and acceptability), (2) potential predictors of usability and acceptability, and (3) the potential impact of the portal on patient-reported outcomes. Methods: This was a single-arm, before-and-after feasibility study at a university hospital among patients with cancer who were undergoing chemotherapy. Participation included filling out the Edmonton Symptom Assessment System--Revised (ESASr) weekly and the Distress Thermometer and Problem List (DT\&PL) 3 times; reading educational material and messaging; and completing study questionnaires. Clinical and portal engagement data were collected from medical records. Data from patients were collected electronically at baseline and 7 to 10 days after the third chemotherapy round. Usability was assessed using the System Usability Scale (score 0-100), and acceptability was assessed using a 35-item survey (score 1-5). Patient-reported outcome measures included ESASr and DT\&PL; a single-item scale for quality of life, family support, and quality of care; and multi-item scales for health literacy (Brief Health Literacy Screener), health engagement (Patient Health Engagement Scale), self-care self-efficacy (Self-Care Self-Efficacy scale), symptom interference (MD Anderson Symptom Inventory), knowledge expectations (Hospital Patients' Knowledge Expectations), and received knowledge (Hospital Patients' Received Knowledge). Health care professionals were interviewed regarding portal feasibility. Results: The portal adoption rate was 72\% (103/143), and the portal use rate was 76.7\% (79/103) over a mean 8.6 (SD 2.7) weeks. The study completion rate was 67\% (69/103). The combined completion rate of the ESASr and DT\&PL was 78.4\% (685/874). Patients received a mean 41 (SD 13) information leaflets; 33\% (26/79) initiated messaging, 73\% (58/79) received messages, and 85\% (67/79) received follow-up phone calls. The mean System Usability Scale score was 72.3 (SD 14.7), indicating good usability. Usability was predicted by age ($\beta$=?.45), ESASr engagement ($\beta$=.5), symptom interference ($\beta$=.4), and received knowledge ($\beta$=.41). The mean acceptability score, 3.97 (SD 0.5), was above average and predicted by age ($\beta$=?.31), ESASr engagement ($\beta$=.37), symptom interference ($\beta$=.60), self-care self-efficacy ($\beta$=.37), and received knowledge ($\beta$=.41). ESASr scores improved for total symptom distress (P=.003; Cohen d=0.36), physical symptoms (P=.01; Cohen d=0.31), and emotional symptoms (P=.01; Cohen d=0.31). Daily symptom interference increased (P=.03; Cohen d=0.28), quality of life improved (P=.03; Cohen d=0.27) and health engagement (P=.006; Cohen d=0.35) improved, while knowledge expectations decreased (P?.001; Cohen d=2.57). Health care professionals were positive toward the portal but called for clearer role delineation and follow-up. Conclusions: This study supports the feasibility of a support portal and the results indicate the possibility of improving patient outcomes, but further developments are warranted. ",
doi="10.2196/50550",
url="https://formative.jmir.org/2023/1/e50550",
url="http://www.ncbi.nlm.nih.gov/pubmed/38015268"
}


@Article{info:doi/10.2196/48296,
author="Dunlop, Emma
and Ferguson, Aimee
and Mueller, Tanja
and Baillie, Kelly
and Laskey, Jennifer
and Clarke, Julie
and Kurdi, Amanj
and Wales, Ann
and Connolly, Thomas
and Bennie, Marion",
title="Involving Patients and Clinicians in the Design of Wireframes for Cancer Medicines Electronic Patient Reported Outcome Measures in Clinical Care: Mixed Methods Study",
journal="JMIR Form Res",
year="2023",
month="Dec",
day="21",
volume="7",
pages="e48296",
keywords="cancer",
keywords="clinicians",
keywords="mHealth",
keywords="mixed methods study",
keywords="patient reported outcome measures",
keywords="patients",
keywords="technology acceptance model",
abstract="Background: Cancer treatment is a key component of health care systems, and the increasing number of cancer medicines is expanding the treatment landscape. However, evidence of the impact on patients has been focused more on chemotherapy toxicity and symptom control and less on the effect of cancer medicines more broadly on patients' lives. Evolving electronic patient-reported outcome measures (ePROMs) presents the opportunity to secure early engagement of patients and clinicians in shaping the collection of quality-of-life metrics and presenting these data to better support the patient-clinician decision-making process. Objective: The aim of this study was to obtain initial feedback from patients and clinicians on the wireframes of a digital solution (patient app and clinician dashboard) for the collection and use of cancer medicines ePROMs. Methods: We adopted a 2-stage, mixed methods approach. Stage 1 (March to June 2019) consisted of interviews and focus groups with cancer clinicians and patients with cancer to explore the face validity of the wireframes, informed by the technology acceptance model constructs (perceived ease of use, perceived usefulness, and behavioral intention to use). In stage 2 (October 2019 to February 2020), the revised wireframes were assessed through web-based, adapted technology acceptance model questionnaires. Qualitative data (stage 1) underwent a framework analysis, and descriptive statistics were performed on quantitative data (stage 2). Clinicians and patients with cancer were recruited from NHS Greater Glasgow \& Clyde, the largest health board in Scotland. Results: A total of 14 clinicians and 19 patients participated in a combination of stage 1 interviews and focus groups. Clinicians and patients indicated that the wireframes of a patient app and clinician dashboard for the collection of cancer medicines ePROMs would be easy to use and could focus discussions, and they would be receptive to using such tools in the future. In stage 1, clinicians raised the potential impact on workload, and both groups identified the need for adequate IT skills to use each technology. Changes to the wireframes were made, and in stage 2, clinicians (n=8) and patients (n=16) indicated it was ``quite likely'' that the technologies would be easy to use and they would be ``quite likely'' to use them in the future. Notably, clinicians indicated that they would use the dashboard to enable treatment decisions ``with around half'' of their patients. Conclusions: This study emphasizes the importance of consulting both patients and clinicians in the design of digital solutions. The wireframes were perceived positively by patients and clinicians who were willing to use such technologies if available in the future as part of routine care. However, challenges were raised, and some differences were identified between participant groups, which warrant further research. ",
doi="10.2196/48296",
url="https://formative.jmir.org/2023/1/e48296",
url="http://www.ncbi.nlm.nih.gov/pubmed/38127422"
}


@Article{info:doi/10.2196/48852,
author="Masiero, Marianna
and Spada, Elena Gea
and Sanchini, Virginia
and Munzone, Elisabetta
and Pietrobon, Ricardo
and Teixeira, Lucas
and Valencia, Mirtha
and Machiavelli, Aline
and Fragale, Elisa
and Pezzolato, Massimo
and Pravettoni, Gabriella",
title="A Machine Learning Model to Predict Patients' Adherence Behavior and a Decision Support System for Patients With Metastatic Breast Cancer: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Dec",
day="14",
volume="12",
pages="e48852",
keywords="adherence",
keywords="metastatic breast cancer",
keywords="decision-making",
keywords="personality",
keywords="risk-predictive model",
keywords="decision support system",
keywords="oral therapies",
keywords="machine learning",
keywords="behavior",
keywords="cancer",
keywords="breast cancer",
abstract="Background: Adherence to oral anticancer treatments is critical in the disease trajectory of patients with breast cancer. Given the impact of nonadherence on clinical outcomes and the associated economic burden for the health care system, finding ways to increase treatment adherence is particularly relevant. Objective: The primary end point is to evaluate the effectiveness of a decision support system (DSS) and a machine learning web application in promoting adherence to oral anticancer treatments among patients with metastatic breast cancer. The secondary end point is to collect a set of new physical, psychological, social, behavioral, and quality of life predictive variables that could be used to refine the preliminary version of the machine learning model to predict patients' adherence behavior. Methods: This prospective, randomized controlled study is nested in a large-scale international project named ``Enhancing therapy adherence among metastatic breast cancer patients'' (Pfizer 65080791), aimed to develop a predictive model of nonadherence and associated DSS and guidelines to foster patients' engagement and therapy adherence. A web-based DSS named TREAT (treatment adherence support) was developed using a patient-driven approach, with 4 sections, that is, Section A: Metastatic Breast Cancer; Section B: Adherence to Cancer Therapies; Section C: Promoting Adherence; and Section D: My Adherence Diary. Moreover, a machine learning--based web application was developed to predict patients' risk factors of adherence to anticancer treatment, specifically pertaining to physical status and comorbid conditions, as well as short and long-term side effects. Overall, 100 patients consecutively admitted at the European Institute of Oncology (IEO) at the Division of Medical Senology will be enrolled; 50 patients with metastatic breast cancer will be exposed to the DSS and machine learning web application for 3 months (experimental group), and 50 patients will not be exposed to the intervention (control group). Each participant will fill a weekly medication diary and a set of standardized self-reports evaluating psychological and quality of life variables (Adherence Attitude Inventory, Beck Depression Inventory-II, Brief Pain Inventory, 13-item Sense of Coherence scale, Brief Italian version of Cancer Behavior Inventory, European Organization for Research and Treatment of Cancer Quality of Life 23-item Breast Cancer-specific Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, 8-item Morisky Medication Adherence Scale, State-Trait Anxiety Inventory forms I and II, Big Five Inventory, and visual analogue scales evaluating risk perception). The 3 assessment time points are T0 (baseline), T1 (1 month), T2 (2 months), and T3 (3 months). This study was approved by the IEO ethics committee (R1786/22-IEO 1907). Results: The recruitment process started in May 2023 and is expected to conclude on December 2023. Conclusions: The contribution of machine learning techniques through risk-predictive models integrated into DSS will enable medication adherence by patients with cancer. Trial Registration: ClinicalTrials.gov NCT06161181; https://clinicaltrials.gov/study/NCT06161181 International Registered Report Identifier (IRRID): DERR1-10.2196/48852 ",
doi="10.2196/48852",
url="https://www.researchprotocols.org/2023/1/e48852",
url="http://www.ncbi.nlm.nih.gov/pubmed/38096002"
}


@Article{info:doi/10.2196/51089,
author="Zhang, Xupin
and Wang, Jingjing
and Lane, M. Jamil
and Xu, Xin
and S{\"o}rensen, Silvia",
title="Investigating Racial Disparities in Cancer Crowdfunding: A Comprehensive Study of Medical GoFundMe Campaigns",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="12",
volume="25",
pages="e51089",
keywords="crowdfunding",
keywords="racial discrimination",
keywords="GoFundMe",
abstract="Background: In recent years, there has been growing concern about prejudice in crowdfunding; however, empirical research remains limited, particularly in the context of medical crowdfunding. This study addresses the pressing issue of racial disparities in medical crowdfunding, with a specific focus on cancer crowdfunding on the GoFundMe platform. Objective: This study aims to investigate racial disparities in cancer crowdfunding using average donation amount, number of donations, and success of the fundraising campaign as outcomes. Methods: Drawing from a substantial data set of 104,809 campaigns in the United States, we used DeepFace facial recognition technology to determine racial identities and used regression models to examine racial factors in crowdfunding performance. We also examined the moderating effect of the proportion of White residents on crowdfunding bias and used 2-tailed t tests to measure the influence of racial anonymity on crowdfunding success. Owing to the large sample size, we set the cutoff for significance at P<.001. Results: In the regression and supplementary analyses, the racial identity of the fundraiser significantly predicted average donations (P<.001), indicating that implicit bias may play a role in donor behavior. Gender (P=.04) and campaign description length (P=.62) did not significantly predict the average donation amounts. The race of the fundraiser was not significantly associated with the number of donations (P=.42). The success rate of cancer crowdfunding campaigns, although generally low (11.77\%), showed a significant association with the race of the fundraiser (P<.001). After controlling for the covariates of the fundraiser gender, fundraiser age, local White proportion, length of campaign description, and fundraising goal, the average donation amount to White individuals was 17.68\% higher than for Black individuals. Moreover, campaigns that did not disclose racial information demonstrated a marginally higher average donation amount (3.92\%) than those identified as persons of color. Furthermore, the racial composition of the fundraiser's county of residence was found to exert influence (P<.001); counties with a higher proportion of White residents exhibited reduced racial disparities in crowdfunding outcomes. Conclusions: This study contributes to a deeper understanding of racial disparities in cancer crowdfunding. It highlights the impact of racial identity, geographic context, and the potential for implicit bias in donor behavior. As web-based platforms evolve, addressing racial inequality and promoting fairness in health care financing remain critical goals. Insights from this research suggest strategies such as maintaining racial anonymity and ensuring that campaigns provide strong evidence of deservingness. Moreover, broader societal changes are necessary to eliminate the financial distress that drives individuals to seek crowdfunding support. ",
doi="10.2196/51089",
url="https://www.jmir.org/2023/1/e51089",
url="http://www.ncbi.nlm.nih.gov/pubmed/38085562"
}


@Article{info:doi/10.2196/46481,
author="Gregory, E. Megan
and Cao, Weidan
and Rahurkar, Saurabh
and Jonnalagadda, Pallavi
and Stock, C. James
and Ghazi, M. Sanam
and Reid, Endia
and Berk, L. Abigail
and Hebert, Courtney
and Li, Lang
and Addison, Daniel",
title="Exploring the Incorporation of a Novel Cardiotoxicity Mobile Health App Into Care of Patients With Cancer: Qualitative Study of Patient and Provider Perspectives",
journal="JMIR Cancer",
year="2023",
month="Dec",
day="12",
volume="9",
pages="e46481",
keywords="cancer, cardiology, implementation science, mobile app, oncology",
keywords="mobile phone",
keywords="cancer patient",
keywords="patient care",
keywords="mobile health application",
keywords="application",
keywords="implementation",
keywords="design",
keywords="development",
keywords="symptom tracking",
keywords="cardiotoxicity",
keywords="cancer therapy",
keywords="symptom",
keywords="primary care",
abstract="Background: Cardiotoxicity is a limitation of several cancer therapies and early recognition improves outcomes. Symptom-tracking mobile health (mHealth) apps are feasible and beneficial, but key elements for mHealth symptom-tracking to indicate early signs of cardiotoxicity are unknown. Objective: We explored considerations for the design of, and implementation into a large academic medical center, an mHealth symptom-tracking tool for early recognition of cardiotoxicity in patients with cancer after cancer therapy initiation. Methods: We conducted semistructured interviews of >50\% of the providers (oncologists, cardio-oncologists, and radiation oncologists) who manage cancer treatment-related cardiotoxicity in the participating institution (n=11), and either interviews or co-design or both with 6 patients. Data were coded and analyzed using thematic analysis. Results: Providers indicated that there was no existing process to enable early recognition of cardiotoxicity and felt the app could reduce delays in diagnosis and lead to better patient outcomes. Signs and symptoms providers recommended for tracking included chest pain or tightness, shortness of breath, heart racing or palpitations, syncope, lightheadedness, edema, and excessive fatigue. Implementation barriers included determining who would receive symptom reports, ensuring all members of the patient's care team (eg, oncologist, cardiologist, and primary care) were informed of the symptom reports and could collaborate on care plans, and how to best integrate the app data into the electronic health record. Patients (n=6, 100\%) agreed that the app would be useful for enhanced symptom capture and education and indicated willingness to use it. Conclusions: Providers and patients agree that a patient-facing, cancer treatment-related cardiotoxicity symptom-tracking mHealth app would be beneficial. Additional studies evaluating the role of mHealth as a potential strategy for targeted early cardioprotective therapy initiation are needed. ",
doi="10.2196/46481",
url="https://cancer.jmir.org/2023/1/e46481",
url="http://www.ncbi.nlm.nih.gov/pubmed/38085565"
}


@Article{info:doi/10.2196/50017,
author="Renner, Christopher
and Reimer, Niklas
and Christoph, Jan
and Busch, Hauke
and Metzger, Patrick
and Boerries, Melanie
and Ustjanzew, Arsenij
and Boehm, Dominik
and Unberath, Philipp",
title="Extending cBioPortal for Therapy Recommendation Documentation in Molecular Tumor Boards: Development and Usability Study",
journal="JMIR Med Inform",
year="2023",
month="Dec",
day="11",
volume="11",
pages="e50017",
keywords="molecular tumor board",
keywords="documentation platform",
keywords="usability evaluation",
keywords="cBioPortal",
keywords="precision medicine",
keywords="genomics",
keywords="health information interoperability",
keywords="tumor",
keywords="implementation",
keywords="cancer",
keywords="tool",
keywords="platform",
keywords="development",
keywords="precision",
keywords="use",
keywords="user-centered",
abstract="Background: In molecular tumor boards (MTBs), patients with rare or advanced cancers are discussed by a multidisciplinary team of health care professionals. Software support for MTBs is lacking; in particular, tools for preparing and documenting MTB therapy recommendations need to be developed. Objective: We aimed to implement an extension to cBioPortal to provide a tool for the documentation of therapy recommendations from MTB sessions in a secure and standardized manner. The developed extension should be embedded in the patient view of cBioPortal to enable easy documentation during MTB sessions. The resulting architecture for storing therapy recommendations should be integrable into various hospital information systems. Methods: On the basis of a requirements analysis and technology analysis for authentication techniques, a prototype was developed and iteratively refined through a user-centered development process. In conclusion, the tool was evaluated via a usability evaluation, including interviews, structured questionnaires, and the System Usability Scale. Results: The patient view of cBioPortal was extended with a new tab that enables users to document MTB sessions and therapy recommendations. The role-based access control was expanded to allow for a finer distinction among the rights to view, edit, and delete data. The usability evaluation showed overall good usability and a System Usability Scale score of 83.57. Conclusions: This study demonstrates how cBioPortal can be extended to not only visualize MTB patient data but also be used as a documentation platform for therapy recommendations. ",
doi="10.2196/50017",
url="https://medinform.jmir.org/2023/1/e50017",
url="http://www.ncbi.nlm.nih.gov/pubmed/38079196"
}


@Article{info:doi/10.2196/53124,
author="Odeh, Yousra
and Al-Balas, Mahmoud",
title="Implications of Agile Values in Software Engineering for Agility in Breast Cancer Treatment: Protocol for a Comparative Study",
journal="JMIR Res Protoc",
year="2023",
month="Dec",
day="5",
volume="12",
pages="e53124",
keywords="agile breast cancer treatment",
keywords="breast cancer",
keywords="breast cancer treatment",
keywords="agile",
keywords="software engineering",
keywords="agile software engineering",
keywords="oncology",
keywords="agile values",
keywords="multidisciplinary research",
keywords="agility in health care",
keywords="agile oncology practice",
abstract="Background: Breast cancer treatment has been described as a dynamic and patient-centered approach that emphasizes adaptability and flexibility throughout the treatment process. Breast cancer is complex, with varying subtypes and stages, making it important to tailor treatment plans to each patient's unique circumstances. Breast cancer treatment delivery relies on a multidisciplinary team of health care professionals who collaborate to provide personalized care and quick adaptation to changing conditions to optimize outcomes while minimizing side effects and maintaining the patient's quality of life. However, agility in breast cancer treatment has not been defined according to common agile values and described in language comprehensible to breast cancer professionals. In the rapidly evolving landscape of breast cancer treatment, the incorporation of agile values from software engineering promises to enhance patient care. Objective: Our objective is to propose agile values for breast cancer treatment adopted and adapted from software engineering. We also aim to validate how these values conform to the concept of agility in the breast cancer context through referencing past work. Methods: We applied a structured research methodology to identify and validate 4 agile values for breast cancer treatment. In the elicitation phase, through 2 interviews, we identified 4 agile values and described them in language that resonates with breast cancer treatment professionals. The values were then validated by a domain expert and discussed in the context of supporting work from the literature. Final validation entailed a domain expert conducting a walkthrough of the 4 identified agile values to adjust them as per the reported literature. Results: Four agile values were identified for breast cancer treatment, and among them, we validated 3 that conformed to the concept of agility. The fourth value, documentation and the quality of documentation, is vital for breast cancer treatment planning and management. This does not conform to agility. However, its nonagility is vital for the agility of the other values. None of the identified agile values were validated as partially conforming to the concept of agility. Conclusions: This work makes a novel contribution to knowledge in identifying the first set of agile values in breast cancer treatment through multidisciplinary research. Three of these values were evaluated as conforming to the concept of agility, and although 1 value did not meet the concept of agility, it enhanced the agility of the other values. It is anticipated that these 4 agile values can drive oncology practice, strategies, policies, protocols, and procedures to enhance delivery of care. Moreover, the identified values contribute to identifying quality assurance and control practices to assess the concept of agility in oncology practice and breast cancer treatment and adjust corresponding actions. We conclude that breast cancer treatment agile values are not limited to 4. International Registered Report Identifier (IRRID): RR1-10.2196/53124 ",
doi="10.2196/53124",
url="https://www.researchprotocols.org/2023/1/e53124",
url="http://www.ncbi.nlm.nih.gov/pubmed/38051558"
}


@Article{info:doi/10.2196/49735,
author="Bentsen, Line
and Hangh{\o}j, Signe
and Hjerming, Maiken
and Bergmann, Buur Mette
and Thycosen, Marianne
and Borup, Anette
and Larsen, Camilla
and Pappot, Helle",
title="Development of Quality of Life in Adolescents and Young Adults With Cancer Using a Patient Support Smartphone App: Prepost Interventional Study",
journal="JMIR Cancer",
year="2023",
month="Dec",
day="4",
volume="9",
pages="e49735",
keywords="adolescent",
keywords="young adult",
keywords="cancer",
keywords="quality of life",
keywords="eHealth",
keywords="smartphone application",
keywords="application",
keywords="development",
keywords="interventional study",
keywords="youth",
keywords="grief",
keywords="symptom tracker",
keywords="social community",
keywords="Denmark",
keywords="physical functioning",
keywords="treatment",
keywords="mobile phone",
abstract="Background: Adolescents and young adults often experience existential concerns in addition to side effects during a cancer trajectory, which they often carry alone. Thus, cohesion with other adolescents and young adults with cancer is essential but difficult due to the relatively small, widely dispersed nationwide population. In cocreation, a smartphone app has been developed and includes an information bank, a symptom tracker, and a social community platform, aiming to improve the quality of life (QoL) in this patient group. Objective: This nationwide, multicenter study aimed to investigate the QoL in adolescents and young adults undergoing a cancer trajectory as they used the app for 6 weeks. Methods: Via youth support initiatives, participants were recruited from hospitals in all regions of Denmark. Inclusion criteria were patients with cancer aged 15-29 years who either initiated any cancer treatment or started follow-up after cancer treatment within 30 days. Participants used the adolescents and young adults cancer app for 6 weeks. Before and after the 6 weeks of app use, they completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The participants were divided into a treatment and a follow-up group for analysis. A high score for a functional scale or the global health or overall QoL represents a high or healthy level of functioning or high QoL, respectively; however, a high score for a symptom scale or item represents a high level of symptomatology. Results: Overall, 81 participants were recruited. However, 4 participants did not answer the questionnaire and 6 participants did not use the app. In the treatment group (n=36), significant improvement was found in 2 domains: ``Role functioning'' (baseline median 33.33, IQR 16.67-83.33 vs 6 weeks median 66.67, IQR 33.33-83.33;?P=.04) and ``Pain'' (baseline median 33.33, IQR 16.67-50.00 vs 6 weeks median 16.67, IQR 0.00-33.33;?P=.04). The ``Global health/Overall QoL'' scale remained stable (baseline median 58.33, IQR 45.83-77.08 vs 6 weeks median 62.50, IQR 41.67-75.00;?P=.25). In the follow-up group (n=35), significant improvement was found in 3 domains: ``Physical functioning'' (baseline median 79.23, IQR 73.33-93.33 vs 6 weeks median 82.86, IQR 73.33-100.00;?P=.03), ``Cognitive functioning'' (baseline median 62.38, IQR 50.00-83.33 vs 6 weeks median 69.52, IQR 50.00-100.00;?P=.02), and ``Social functioning'' (baseline median 76.19, IQR 50.00-100.00 vs 6 weeks median 85.71, IQR 83.33-100.00;?P=.05), as well as in the ``Global health/Overall QoL'' scale (baseline median 57.14, IQR 83.33-100.00 vs 6 weeks median 75.0, IQR 62.91-85.73;?P<.001). Conclusions: In this study, we found an improvement in specific QoL scales for both participants in treatment and follow-up when using the app for 6 weeks. The global health or overall QoL score improved significantly in the follow-up group. In the treatment group, it remained stable. International Registered Report Identifier (IRRID): RR2-10.2196/10098 ",
doi="10.2196/49735",
url="https://cancer.jmir.org/2023/1/e49735",
url="http://www.ncbi.nlm.nih.gov/pubmed/38048144"
}


@Article{info:doi/10.2196/46242,
author="Kim, Sunghak
and Jung, Timothy
and Sohn, Kyung Dae
and Chae, Yoon
and Kim, Ae Young
and Kang, Hyun Seung
and Park, Yujin
and Chang, Jung Yoon",
title="The Multidomain Metaverse Cancer Care Digital Platform: Development and Usability Study",
journal="JMIR Serious Games",
year="2023",
month="Nov",
day="30",
volume="11",
pages="e46242",
keywords="metaverse",
keywords="virtual reality",
keywords="cancer education",
keywords="cancer care",
keywords="digital health",
keywords="cancer treatment",
keywords="patient care",
keywords="cross-sectional survey",
keywords="digital health intervention",
abstract="Background: As cancer treatment methods have diversified and the importance of self-management, which lowers the dependence rate on direct hospital visits, has increased, effective cancer care education and management for health professionals and patients have become necessary. The metaverse is in the spotlight as a means of digital health that allows users to engage in cancer care education and management beyond physical constraints. However, it is difficult to find a multipurpose medical metaverse that can not only be used in the field but also complements current cancer care. Objective: This study aimed to develop an integrated metaverse cancer care platform, Dr. Meta, and examine its usability. Methods: We conducted a multicenter, cross-sectional survey between November and December 2021. A descriptive analysis was performed to examine users' experiences with Dr. Meta. In addition, a supplementary open-ended question was used to ask users for their suggestions and improvements regarding the platform. Results: Responses from 70 Korean participants (male: n=19, 27\% and female: n=51, 73\%) were analyzed. More than half (n=37, 54\%) of the participants were satisfied with Dr. Meta; they responded that it was an interesting and immersive platform (n=50, 72\%). Less than half perceived no discomfort when using Dr. Meta (n=34, 49\%) and no difficulty in wearing and operating the device (n=30, 43\%). Furthermore, more than half (n=50, 72\%) of the participants reported that Dr. Meta would help provide non--face-to-face and noncontact services. More than half also wanted to continue using this platform in the future (n=41, 59\%) and recommended it to others (n=42, 60\%). Conclusions: We developed a multidomain metaverse cancer care platform that can support both health professionals and patients in non--face-to-face cancer care. The platform was uniquely disseminated and implemented in multiple regional hospitals and showed the potential to perform successful cancer care. ",
doi="10.2196/46242",
url="https://games.jmir.org/2023/1/e46242",
url="http://www.ncbi.nlm.nih.gov/pubmed/38032697"
}


@Article{info:doi/10.2196/48483,
author="Govindaraj, Ramkumar
and Agar, Meera
and Currow, David
and Luckett, Tim",
title="Assessing Patient-Reported Outcomes in Routine Cancer Clinical Care Using Electronic Administration and Telehealth Technologies: Realist Synthesis of Potential Mechanisms for Improving Health Outcomes",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="28",
volume="25",
pages="e48483",
keywords="patient-reported outcome measure",
keywords="PROM",
keywords="PROMs",
keywords="realist synthesis",
keywords="oncology",
keywords="eHealth",
keywords="patient reported",
keywords="outcome measure",
keywords="outcome measures",
keywords="realist",
keywords="literature review",
keywords="narrative review",
keywords="search strategy",
keywords="review methods",
keywords="review methodology",
keywords="electronic patient-reported outcome measure",
keywords="ePROM",
keywords="cancer",
keywords="self-reporting",
keywords="mobile phone",
abstract="Background: The routine measurement of patient-reported outcomes in cancer clinical care using electronic patient-reported outcome measures (ePROMs) is gaining momentum worldwide. However, a deep understanding of the mechanisms underpinning ePROM interventions that could inform their optimal design to improve health outcomes is needed. Objective: This study aims to identify the implicit mechanisms that underpin the effectiveness of ePROM interventions and develop program theories about how and when ePROM interventions improve health outcomes. Methods: A realist synthesis of the literature about ePROM interventions in cancer clinical care was performed. A conceptual framework of ePROM interventions was constructed to define the scope of the review and frame the initial program theories. Literature searches of Ovid MEDLINE, Ovid Embase, Scopus, and CINAHL, supplemented by citation tracking, were performed to identify relevant literature to develop, refine, and test program theories. Quality appraisal of relevant studies was performed using the Mixed Methods Appraisal Tool. Results: Overall, 61 studies were included in the realist synthesis: 15 (25\%) mixed methods studies, 9 (15\%) qualitative studies, 13 (21\%) descriptive studies, 21 (34\%) randomized controlled trials, and 3 (5\%) quasi-experimental studies. In total, 3 initial program theories were developed regarding the salient components of ePROM interventions---remote self-reporting, real-time feedback to clinicians, and clinician-patient telecommunication. The refined theories posit that remote self-reporting enables patients to recognize and report symptoms accurately and empowers them to communicate these to clinicians, real-time feedback prompts clinicians to manage symptoms proactively, and clinician-patient telephone interactions and e-interactions between clinic encounters improve symptom management by reshaping how clinicians and patients communicate. However, the intervention may not achieve the intended benefit if ePROMs become a reminder to patients of their illness and are not meaningful to them and when real-time feedback to clinicians lacks relevance and increases the workload. Conclusions: The key to improving health outcomes through ePROM interventions is enabling better symptom reporting and communication through remote symptom self-reporting, promoting proactive management of symptoms through real-time clinician feedback, and facilitating clinician-patient interactions. Patient engagement with self-reporting and clinician engagement in responding to feedback are vital and may reinforce each other in improving outcomes. Effective ePROM interventions might fundamentally alter how clinicians and patients interact between clinic encounters. ",
doi="10.2196/48483",
url="https://www.jmir.org/2023/1/e48483",
url="http://www.ncbi.nlm.nih.gov/pubmed/38015606"
}


@Article{info:doi/10.2196/48040,
author="Mallafr{\'e}-Larrosa, Meritxell
and Papi, Ginevra
and Trilla, Antoni
and Ritchie, David",
title="Development and Promotion of an mHealth App for Adolescents Based on the European Code Against Cancer: Retrospective Cohort Study",
journal="JMIR Cancer",
year="2023",
month="Nov",
day="28",
volume="9",
pages="e48040",
keywords="adolescent health",
keywords="cancer prevention",
keywords="digital health",
keywords="ECAC",
keywords="European Code Against Cancer",
keywords="health promotion",
keywords="mHealth",
keywords="mobile app",
keywords="mobile health",
keywords="NCD",
keywords="noncommunicable disease",
keywords="primary prevention",
abstract="Background: Mobile health technologies, underpinned by scientific evidence and ethical standards, exhibit considerable promise and potential in actively engaging consumers and patients while also assisting health care providers in delivering cancer prevention and care services. The WASABY mobile app was conceived as an innovative, evidence-based mobile health tool aimed at disseminating age-appropriate messages from the European Code Against Cancer (ECAC) to adolescents across Europe. Objective: This study aims to assess the outcomes of the design, development, and promotion of the WASABY app through a 3-pronged evaluation framework that encompasses data on social media promotion, app store traffic, and user engagement. Methods: The WASABY app's content, cocreated with cancer-focused civil society organizations across 6 European countries, drew upon scientific evidence from the ECAC. The app's 10 modules were designed using the health belief model and a gamification conceptual framework characterized by spaced repetition learning techniques, refined through 2 rounds of testing. To evaluate the effectiveness of the app, we conducted a retrospective cohort study using the WASABY app's user database registered from February 4 to June 30, 2021, using a 3-pronged assessment framework: social media promotion,?app store traffic, and user engagement. Descriptive statistics and association analyses explored the relationship between sociodemographic variables and user performance analytics. Results: After extensive promotion on various social media platforms and subsequent traffic to the Apple App and Google Play stores, a sample of 748 users aged between 14 and 19 years was included in the study cohort. The selected sample exhibited a mean age of 16.08 (SD 1.28) years and was characterized by a predominant representation of female users (499/748, 66.7\%). Most app users identified themselves as nonsmokers (689/748, 92.1\%), reported either no or infrequent alcohol consumption (432/748, 57.8\% and 250/748, 33.4\%, respectively), and indicated being physically active for 1 to 5 hours per week (505/748, 67.5\%). In aggregate, the app's content garnered substantial interest, as evidenced by 40.8\% (305/748) of users visiting each of the 10 individual modules. Notably, sex and smoking habits emerged as predictors of app completion rates; specifically, male and smoking users demonstrated a decreased likelihood of successfully completing the app's content (odds ratio 0.878, 95\% CI 0.809-0.954 and odds ratio 0.835, 95\% CI 0.735-0.949, respectively). Conclusions: The development and promotion of the WASABY app presents a valuable case study, illustrating the effective dissemination of evidence-based recommendations on cancer prevention within the ECAC through an innovative mobile app aimed at European adolescents. The data derived from this study provide insightful findings for the implementation of Europe's Beating Cancer Plan, particularly the creation of the EU Mobile App for Cancer Prevention. ",
doi="10.2196/48040",
url="https://cancer.jmir.org/2023/1/e48040",
url="http://www.ncbi.nlm.nih.gov/pubmed/38015612"
}


@Article{info:doi/10.2196/45145,
author="Lim, Chun Dwight Su
and Kwok, Benedict
and Williams, Patricia
and Koczwara, Bogda",
title="The Impact of Digital Technology on Self-Management in Cancer: Systematic Review",
journal="JMIR Cancer",
year="2023",
month="Nov",
day="22",
volume="9",
pages="e45145",
keywords="self-management",
keywords="self-management support",
keywords="self-management core skills",
keywords="digital technology",
keywords="digital health",
keywords="mHealth",
keywords="mobile health",
keywords="eHealth",
keywords="cancer",
keywords="theoretical frameworks",
keywords="predictors of effect",
keywords="chronic disease",
keywords="skills",
keywords="decision-making",
keywords="cancer treatment",
abstract="Background: Self-management (SM) plays an important role in supporting patients' adaptation to and management of the symptoms of chronic diseases. Cancer is a chronic disease that requires patients to have responsibility in management. Digital technology has the potential to enhance SM support, but there is little data on what SM skills are most commonly supported by digital technology. Objective: This review aimed to examine the SM core skills that were enabled and supported by digital interventions in people with cancer and identify any predictors of the effect of digital health intervention on SM core skills. Methods: Three electronic databases (MEDLINE, Scopus, and CINAHL) were searched for papers, published from January 2010 to February 2022, that reported randomized controlled trials (RCTs) involving patients with cancer or survivors of cancer where a digital technology intervention was evaluated and change in 1 or more SM core skills was a measured outcome. Results: This systematic review resulted in 12 studies that were eligible to identify which SM core skills were enabled and supported by digital intervention. The total number of participants in the 12 studies was 2627. The most common SM core skills targeted by interventions were decision-making, goal setting, and partnering with health professionals. A total of 8 (67\%) out of 12 RCTs demonstrated statistically significant improvement in outcomes including self-efficacy, survivorship care knowledge and attitude, quality of life, increased knowledge of treatment, and emotional and social functioning. A total of 5 (62\%) out of 8 positive RCTs used theoretical considerations in their study design; whereas in 1 (25\%) out of 4 negative RCTs, theoretical considerations were used. In 3 studies, some factors were identified that were associated with the development of SM core skills, which included younger age (regression coefficient [RC]=--0.06, 95\% CI --0.10 to --0.02; P=.002), computer literacy (RC=--0.20, 95\% CI --0.37 to --0.03; P=.02), completing cancer treatment (Cohen d=0.31), male sex (SD 0.34 in social functioning; P=.009), higher education (SD 0.19 in social functioning; P=.04), and being a recipient of chemotherapy (SD 0.36 in depression; P=.008). In all 3 studies, there were no shared identical factors that supported the development of SM core skills, whereby each study had a unique set of factors that supported the development of SM core skills. Conclusions: Digital technology for patients with cancer appears to improve SM core skills including decision-making, goal setting, and partnering with health care partners. This effect is greater in people who are younger, male, educated, highly computer literate, completing cancer treatment, or a recipient of chemotherapy. Future research should focus on targeting multiple SM core skills and identifying predictors of the effect of digital technology intervention. Trial Registration: PROSPERO CRD42021221922; https://tinyurl.com/mrx3pfax ",
doi="10.2196/45145",
url="https://cancer.jmir.org/2023/1/e45145",
url="http://www.ncbi.nlm.nih.gov/pubmed/37991831"
}


@Article{info:doi/10.2196/49100,
author="Oakley-Girvan, Ingrid
and Yunis, Reem
and Fonda, J. Stephanie
and Longmire, Michelle
and Veuthey, L. Tess
and Shieh, Jennifer
and Aghaee, Sara
and Kubo, Ai
and Davis, W. Sharon
and Liu, Raymond
and Neeman, Elad",
title="Correlation Between Remote Symptom Reporting by Caregivers and Adverse Clinical Outcomes: Mixed Methods Study",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="21",
volume="25",
pages="e49100",
keywords="adverse events",
keywords="cancer",
keywords="decentralized clinical trials",
keywords="electronic patient-reported outcomes",
keywords="ePROs",
keywords="mobile health app",
keywords="observer-reported outcomes",
keywords="Patient-Reported Outcomes Measurement Information System Patient-Reported Outcome Common Terminology Criteria for Adverse Events",
keywords="patient-reported outcomes",
keywords="PRO-CTCAE",
keywords="PROMIS",
keywords="remote clinical trials",
keywords="remote monitoring",
keywords="smartphone",
abstract="Background: Timely collection of patient-reported outcomes (PROs) decreases emergency department visits and hospitalizations and increases survival. However, little is known about the outcome predictivity of unpaid informal caregivers' reporting using similar clinical outcome assessments. Objective: The aim of this study is to assess whether caregivers and adults with cancer adhered to a planned schedule for electronically collecting patient-reported outcomes (PROs) and if PROs were associated with future clinical events. Methods: We developed 2 iPhone apps to collect PROs, one for patients with cancer and another for caregivers. We enrolled 52 patient-caregiver dyads from Kaiser Permanente Northern California in a nonrandomized study. Participants used the apps independently for 4 weeks. Specific clinical events were obtained from the patients' electronic health records up to 6 months following the study. We used logistic and quasi-Poisson regression analyses to test associations between PROs and clinical events. Results: Participants completed 97\% (251/260) of the planned Patient-Reported Outcomes Common Terminology Criteria for Adverse Events (PRO-CTCAE) surveys and 98\% (254/260) of the Patient-Reported Outcomes Measurement Information System (PROMIS) surveys. PRO-CTCAE surveys completed by caregivers were associated with patients' hospitalizations or emergency department visits, grade 3-4 treatment-related adverse events, dose reductions (P<.05), and hospice referrals (P=.03). PROMIS surveys completed by caregivers were associated with hospice referrals (P=.02). PRO-CTCAE surveys completed by patients were not associated with any clinical events, but their baseline PROMIS surveys were associated with mortality (P=.03), while their antecedent or final PROMIS surveys were associated with all clinical events examined except for total days of treatment breaks. Conclusions: In this study, caregivers and patients completed PROs using smartphone apps as requested. The association of caregiver PRO-CTCAE surveys with patient clinical events suggests that this is a feasible approach to reducing patient burden in clinical trial data collection and may help provide early information about increasing symptom severity. ",
doi="10.2196/49100",
url="https://www.jmir.org/2023/1/e49100",
url="http://www.ncbi.nlm.nih.gov/pubmed/37988151"
}


@Article{info:doi/10.2196/46474,
author="Hj{\"a}rtstr{\"o}m, Malin
and Dihge, Looket
and Bendahl, P{\"a}r-Ola
and Skarping, Ida
and Ellbrant, Julia
and Ohlsson, Mattias
and Ryd{\'e}n, Lisa",
title="Noninvasive Staging of Lymph Node Status in Breast Cancer Using Machine Learning: External Validation and Further Model Development",
journal="JMIR Cancer",
year="2023",
month="Nov",
day="20",
volume="9",
pages="e46474",
keywords="breast neoplasm",
keywords="sentinel lymph node biopsy",
keywords="SLNB",
keywords="noninvasive lymph node staging",
keywords="NILS",
keywords="prediction model",
keywords="multilayer perceptron",
keywords="MLP",
keywords="register data",
keywords="breast cancer",
keywords="cancer",
keywords="validation study",
keywords="machine learning",
keywords="model development",
keywords="therapeutic",
keywords="feasibility",
keywords="diagnostic",
keywords="lymph node",
keywords="mammography images",
abstract="Background: Most patients diagnosed with breast cancer present with a node-negative disease. Sentinel lymph node biopsy (SLNB) is routinely used for axillary staging, leaving patients with healthy axillary lymph nodes without therapeutic effects but at risk of morbidities from the intervention. Numerous studies have developed nodal status prediction models for noninvasive axillary staging using postoperative data or imaging features that are not part of the diagnostic workup. Lymphovascular invasion (LVI) is a top-ranked predictor of nodal metastasis; however, its preoperative assessment is challenging. Objective: This paper aimed to externally validate a multilayer perceptron (MLP) model for noninvasive lymph node staging (NILS) in a large population-based cohort (n=18,633) and develop a new MLP in the same cohort. Data were extracted from the Swedish National Quality Register for Breast Cancer (NKBC, 2014-2017), comprising only routinely and preoperatively available documented clinicopathological variables. A secondary aim was to develop and validate an LVI MLP for imputation of missing LVI status to increase the preoperative feasibility of the original NILS model. Methods: Three nonoverlapping cohorts were used for model development and validation. A total of 4 MLPs for nodal status and 1 LVI MLP were developed using 11 to 12 routinely available predictors. Three nodal status models were used to account for the different availabilities of LVI status in the cohorts and external validation in NKBC. The fourth nodal status model was developed for 80\% (14,906/18,663) of NKBC cases and validated in the remaining 20\% (3727/18,663). Three alternatives for imputation of LVI status were compared. The discriminatory capacity was evaluated using the validation area under the receiver operating characteristics curve (AUC) in 3 of the nodal status models. The clinical feasibility of the models was evaluated using calibration and decision curve analyses. Results: External validation of the original NILS model was performed in NKBC (AUC 0.699, 95\% CI 0.690-0.708) with good calibration and the potential of sparing 16\% of patients with node-negative disease from SLNB. The LVI model was externally validated (AUC 0.747, 95\% CI 0.694-0.799) with good calibration but did not improve the discriminatory performance of the nodal status models. A new nodal status model was developed in NKBC without information on LVI (AUC 0.709, 95\% CI: 0.688-0.729), with excellent calibration in the holdout internal validation cohort, resulting in the potential omission of 24\% of patients from unnecessary SLNBs. Conclusions: The NILS model was externally validated in NKBC, where the imputation of LVI status did not improve the model's discriminatory performance. A new nodal status model demonstrated the feasibility of using register data comprising only the variables available in the preoperative setting for NILS using machine learning. Future steps include ongoing preoperative validation of the NILS model and extending the model with, for example, mammography images. ",
doi="10.2196/46474",
url="https://cancer.jmir.org/2023/1/e46474",
url="http://www.ncbi.nlm.nih.gov/pubmed/37983068"
}


@Article{info:doi/10.2196/49016,
author="Zhang, Jinghui
and Ma, Guiyuan
and Peng, Sha
and Hou, Jianmei
and Xu, Ran
and Luo, Lingxia
and Hu, Jiaji
and Yao, Nian
and Wang, Jiaan
and Huang, Xin",
title="Risk Factors and Predictive Models for Peripherally Inserted Central Catheter Unplanned Extubation in Patients With Cancer: Prospective, Machine Learning Study",
journal="J Med Internet Res",
year="2023",
month="Nov",
day="16",
volume="25",
pages="e49016",
keywords="cancer",
keywords="PICC",
keywords="unplanned extubation",
keywords="predictive model",
keywords="logistic",
keywords="support vector machine",
keywords="random forest",
abstract="Background: Cancer indeed represents a significant public health challenge, and unplanned extubation of peripherally inserted central catheter (PICC-UE) is a critical concern in patient safety. Identifying independent risk factors and implementing high-quality assessment tools for early detection in high-risk populations can play a crucial role in reducing the incidence of PICC-UE among patients with cancer. Precise prevention and treatment strategies are essential to improve patient outcomes and safety in clinical settings. Objective: This study aims to identify the independent risk factors associated with PICC-UE in patients with cancer and to construct a predictive model tailored to this group, offering a theoretical framework for anticipating and preventing PICC-UE in these patients. Methods: Prospective data were gathered from January to December 2022, encompassing patients with cancer with PICC at Xiangya Hospital, Central South University. Each patient underwent continuous monitoring until the catheter's removal. The patients were categorized into 2 groups: the UE group (n=3107) and the non-UE group (n=284). Independent risk factors were identified through univariate analysis, the least absolute shrinkage and selection operator (LASSO) algorithm, and multivariate analysis. Subsequently, the 3391 patients were classified into a train set and a test set in a 7:3 ratio. Utilizing the identified predictors, 3 predictive models were constructed using the logistic regression, support vector machine, and random forest algorithms. The ultimate model was selected based on the receiver operating characteristic (ROC) curve and TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) synthesis analysis. To further validate the model, we gathered prospective data from 600 patients with cancer at the Affiliated Hospital of Qinghai University and Hainan Provincial People's Hospital from June to December 2022. We assessed the model's performance using the area under the curve of the ROC to evaluate differentiation, the calibration curve for calibration capability, and decision curve analysis (DCA) to gauge the model's clinical applicability. Results: Independent risk factors for PICC-UE in patients with cancer were identified, including impaired physical mobility (odds ratio [OR] 2.775, 95\% CI 1.951-3.946), diabetes (OR 1.754, 95\% CI 1.134-2.712), surgical history (OR 1.734, 95\% CI 1.313-2.290), elevated D-dimer concentration (OR 2.376, 95\% CI 1.778-3.176), targeted therapy (OR 1.441, 95\% CI 1.104-1.881), surgical treatment (OR 1.543, 95\% CI 1.152-2.066), and more than 1 catheter puncture (OR 1.715, 95\% CI 1.121-2.624). Protective factors were normal BMI (OR 0.449, 95\% CI 0.342-0.590), polyurethane catheter material (OR 0.305, 95\% CI 0.228-0.408), and valved catheter (OR 0.639, 95\% CI 0.480-0.851). The TOPSIS synthesis analysis results showed that in the train set, the composite index (Ci) values were 0.00 for the logistic model, 0.82 for the support vector machine model, and 0.85 for the random forest model. In the test set, the Ci values were 0.00 for the logistic model, 1.00 for the support vector machine model, and 0.81 for the random forest model. The optimal model, constructed based on the support vector machine, was obtained and validated externally. The ROC curve, calibration curve, and DCA curve demonstrated that the model exhibited excellent accuracy, stability, generalizability, and clinical applicability. Conclusions: In summary, this study identified 10 independent risk factors for PICC-UE in patients with cancer. The predictive model developed using the support vector machine algorithm demonstrated excellent clinical applicability and was validated externally, providing valuable support for the early prediction of PICC-UE in patients with cancer. ",
doi="10.2196/49016",
url="https://www.jmir.org/2023/1/e49016",
url="http://www.ncbi.nlm.nih.gov/pubmed/37971792"
}


@Article{info:doi/10.2196/49508,
author="Conti, Lorenzo
and Marzorati, Chiara
and Grasso, Roberto
and Ferrucci, Roberta
and Priori, Alberto
and Mameli, Francesca
and Ruggiero, Fabiana
and Pravettoni, Gabriella",
title="Home-Based Treatment for Chronic Pain Combining Neuromodulation, Computer-Assisted Training, and Telemonitoring in Patients With Breast Cancer: Protocol for a Rehabilitative Study",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="16",
volume="12",
pages="e49508",
keywords="telemedicine",
keywords="chronic pain",
keywords="breast cancer",
keywords="tDCS",
keywords="transcranial direct current stimulation",
keywords="home care treatment",
keywords="home care",
keywords="care",
keywords="training",
keywords="pain",
keywords="cancer",
keywords="quality of life",
keywords="rehabilitation",
keywords="telemonitoring",
keywords="web platform",
keywords="exercise",
keywords="therapy",
abstract="Background: Chronic pain is a disabling symptom frequently reported in patients with breast cancer with a prevalence ranging from 25\% to 60\%, representing a major health issue. It has negative consequences on health status, causing psychological distress and affecting quality of life. Furthermore, the clinical management of chronic pain is often inadequate, and many patients do not benefit from the administration of pharmacological treatments. Alternative therapeutic options have been implemented to improve the psychophysical well-being of patients, including neuromodulation and complementary interventions. Objective: We aimed to investigate the effectiveness of a home care strategy combining computerized rehabilitation, transcranial direct current stimulation (tDCS), and remote telemonitoring via a web-based platform in patients with breast cancer suffering for chronic pain. Methods: A web-based structured survey aimed at monitoring chronic pain and its effect on psychological functions will be delivered to patients with breast cancer through social media and email. In total, 42 patients with breast cancer affected by chronic pain will be recruited during the medical screening visit. The patients will be randomly divided into 3 treatment groups that will carry out either tDCS only, exercise therapy only, or a combination of both over a 3-week period. All the treatments will be delivered at the patients' home through the use of a system including a tablet, wearable inertial sensors, and a tDCS programmable medical device. Using web-based questionnaires, the perception of pain (based on the pain self-efficacy questionnaire, visual analogue scale, pain catastrophizing scale, and brief pain inventory) and psychological variables (based on the hospital and anxiety depression scale and 12-item short form survey) will be assessed at the beginning of treatment, 1 week after the start of treatment, at the end of treatment, 1 month after the start of treatment, and 3 months after the start of treatment. The system's usability (based on the mobile app rating scale and system usability scale) and its involvement in the decision-making process (based on the 9-item shared decision-making questionnaire) will be also evaluated. Finally, at the end of the treatment, a digital focus group will be conducted with the 42 patients to explore their unexpressed needs and preferences concerning treatment. Results: The study project is scheduled to start in June 2023, and it is expected to be completed by August 2025. Conclusions: We expect that the combination of tDCS and telemedicine programs will reduce pain perceived by patients with breast cancer and improve their mental well-being more effectively than single interventions. Furthermore, we assume that this home-based approach will also improve patients' participation in routine clinical care, reducing disparities in accessing health care processes. This integrated home care strategy could be useful for patients with breast cancer who cannot find relief from chronic pain with pharmacological treatments or for those who have limited access to care due to poor mobility or geographical barriers, thus increasing the patients' empowerment and reducing health care costs. International Registered Report Identifier (IRRID): PRR1-10.2196/49508 ",
doi="10.2196/49508",
url="https://www.researchprotocols.org/2023/1/e49508",
url="http://www.ncbi.nlm.nih.gov/pubmed/37971805"
}


@Article{info:doi/10.2196/47646,
author="Straczkiewicz, Marcin
and Keating, L. Nancy
and Thompson, Embree
and Matulonis, A. Ursula
and Campos, M. Susana
and Wright, A. Alexi
and Onnela, Jukka-Pekka",
title="Open-Source, Step-Counting Algorithm for Smartphone Data Collected in Clinical and Nonclinical Settings: Algorithm Development and Validation Study",
journal="JMIR Cancer",
year="2023",
month="Nov",
day="15",
volume="9",
pages="e47646",
keywords="accelerometer",
keywords="cancer",
keywords="open-source",
keywords="smartphone",
keywords="step count",
keywords="validation",
keywords="wearable",
abstract="Background: Step counts are increasingly used in public health and clinical research to assess well-being, lifestyle, and health status. However, estimating step counts using commercial activity trackers has several limitations, including a lack of reproducibility, generalizability, and scalability. Smartphones are a potentially promising alternative, but their step-counting algorithms require robust validation that accounts for temporal sensor body location, individual gait characteristics, and heterogeneous health states. Objective: Our goal was to evaluate an open-source, step-counting method for smartphones under various measurement conditions against step counts estimated from data collected simultaneously from different body locations (``cross-body'' validation), manually ascertained ground truth (``visually assessed'' validation), and step counts from a commercial activity tracker (Fitbit Charge 2) in patients with advanced cancer (``commercial wearable'' validation). Methods: We used 8 independent data sets collected in controlled, semicontrolled, and free-living environments with different devices (primarily Android smartphones and wearable accelerometers) carried at typical body locations. A total of 5 data sets (n=103) were used for cross-body validation, 2 data sets (n=107) for visually assessed validation, and 1 data set (n=45) was used for commercial wearable validation. In each scenario, step counts were estimated using a previously published step-counting method for smartphones that uses raw subsecond-level accelerometer data. We calculated the mean bias and limits of agreement (LoA) between step count estimates and validation criteria using Bland-Altman analysis. Results: In the cross-body validation data sets, participants performed 751.7 (SD 581.2) steps, and the mean bias was --7.2 (LoA --47.6, 33.3) steps, or --0.5\%. In the visually assessed validation data sets, the ground truth step count was 367.4 (SD 359.4) steps, while the mean bias was --0.4 (LoA --75.2, 74.3) steps, or 0.1\%. In the commercial wearable validation data set, Fitbit devices indicated mean step counts of 1931.2 (SD 2338.4), while the calculated bias was equal to --67.1 (LoA --603.8, 469.7) steps, or a difference of 3.4\%. Conclusions: This study demonstrates that our open-source, step-counting method for smartphone data provides reliable step counts across sensor locations, measurement scenarios, and populations, including healthy adults and patients with cancer. ",
doi="10.2196/47646",
url="https://cancer.jmir.org/2023/1/e47646",
url="http://www.ncbi.nlm.nih.gov/pubmed/37966891"
}


@Article{info:doi/10.2196/46128,
author="Gomaa, Sameh
and Posey, James
and Bashir, Babar
and Basu Mallick, Atrayee
and Vanderklok, Eleanor
and Schnoll, Max
and Zhan, Tingting
and Wen, Kuang-Yi",
title="Feasibility of a Text Messaging--Integrated and Chatbot-Interfaced Self-Management Program for Symptom Control in Patients With Gastrointestinal Cancer Undergoing Chemotherapy: Pilot Mixed Methods Study",
journal="JMIR Form Res",
year="2023",
month="Nov",
day="10",
volume="7",
pages="e46128",
keywords="chemotherapy",
keywords="gastrointestinal cancer",
keywords="digital health",
keywords="text messaging",
keywords="chatbot",
keywords="side effect management",
abstract="Background: Outpatient chemotherapy often leaves patients to grapple with a range of complex side effects at home. Leveraging tailored evidence-based content to monitor and manage these symptoms remains an untapped potential among patients with gastrointestinal (GI) cancer. Objective: This study aims to bridge the gap in outpatient chemotherapy care by integrating a cutting-edge text messaging system with a chatbot interface. This approach seeks to enable real-time monitoring and proactive management of side effects in patients with GI cancer undergoing intravenous chemotherapy. Methods: Real-Time Chemotherapy-Associated Side Effects Monitoring Supportive System (RT-CAMSS) was developed iteratively, incorporating patient-centered inputs and evidence-based information. It synthesizes chemotherapy knowledge, self-care symptom management skills, emotional support, and healthy lifestyle recommendations. In a single-arm 2-month pilot study, patients with GI cancer undergoing chemotherapy received tailored intervention messages thrice a week and a weekly Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events--based symptom assessment via a chatbot interface. Baseline and postintervention patient surveys and interviews were conducted. Results: Out of 45 eligible patients, 34 were enrolled (76\% consent rate). The mean age was 61 (SD 12) years, with 19 (56\%) being females and 21 (62\%) non-Hispanic White. The most common cancer type was pancreatic (n=18, 53\%), followed by colon (n=12, 35\%) and stomach (n=4, 12\%). In total, 27 (79\% retention rate) participants completed the postintervention follow-up. In total, 20 patients texted back at least once to seek additional information, with the keyword ``chemo'' or ``support'' texted the most. Among those who used the chatbot system checker, fatigue emerged as the most frequently reported symptom (n=15), followed by neuropathy (n=7). Adjusted for multiple comparisons, patients engaging with the platform exhibited significantly improved Patient Activation Measure (3.70, 95\% CI --6.919 to --0.499; P=.02). Postintervention interviews and satisfaction surveys revealed that participants found the intervention was user-friendly and were provided with valuable information. Conclusions: Capitalizing on mobile technology communication holds tremendous scalability for enhancing health care services. This study presents initial evidence of the engagement and acceptability of RT-CAMSS, warranting further evaluation in a controlled clinical trial setting. ",
doi="10.2196/46128",
url="https://formative.jmir.org/2023/1/e46128",
url="http://www.ncbi.nlm.nih.gov/pubmed/37948108"
}


@Article{info:doi/10.2196/46077,
author="O'Neill, Linda
and Brennan, Louise
and Sheill, Grainne
and Connolly, Deirdre
and Guinan, Emer
and Hussey, Juliette",
title="Moving Forward With Telehealth in Cancer Rehabilitation: Patient Perspectives From a Mixed Methods Study",
journal="JMIR Cancer",
year="2023",
month="Nov",
day="9",
volume="9",
pages="e46077",
keywords="telehealth",
keywords="telemedicine",
keywords="cancer rehabilitation",
keywords="oncology",
keywords="qualitative",
keywords="mixed methods",
keywords="mobile phone",
abstract="Background: The COVID-19 pandemic accelerated the use of telehealth in cancer care and highlighted the potential of telehealth as a means of delivering the much-needed rehabilitation services for patients living with the side effects of cancer and its treatments. Objective: This mixed methods study aims to explore patients' experiences of telehealth and their preferences regarding the use of telehealth for cancer rehabilitation to inform service development. Methods: The study was completed in 2 phases from October 2020 to November 2021. In phase 1, an anonymous survey (web- and paper-based) exploring the need, benefits, barriers, facilitators, and preferences for telehealth cancer rehabilitation was distributed to survivors of cancer in Ireland. In phase 2, survivors of cancer were invited to participate in semistructured interviews exploring their experiences of telehealth and its role in cancer rehabilitation. Interviews were conducted via telephone or video call following an interview guide informed by the results of the survey and transcribed verbatim, and reflexive thematic analysis was performed using a qualitative descriptive approach. Results: A total of 48 valid responses were received. The respondents were at a median of 26 (range 3-256) months after diagnosis, and 23 (48\%) of the 48 participants had completed treatment. Of the 48 respondents, 31 (65\%) reported using telehealth since the start of the pandemic, 15 (31\%) reported having experience with web-based cancer rehabilitation, and 43 (90\%) reported a willingness for web-based cancer rehabilitation. A total of 26 (54\%) of the 48 respondents reported that their views on telehealth had changed positively since the start of the pandemic. Semistructured interviews were held with 18 survivors of cancer. The mean age of the participants was 58.9 (SD 8.24) years, 56\% (10/18) of the participants were female, and 44\% (8/18) of the participants were male. Reflexive thematic analysis identified 5 key themes: telehealth improves accessibility to cancer rehabilitation for some but is a barrier for others, lived experiences of the benefits of telehealth in survivorship, the value of in-person health care, telehealth in cancer care and COVID-19 (from novelty to normality), and the future of telehealth in cancer rehabilitation. Conclusions: Telehealth is broadly welcomed as a mode of cancer rehabilitation for patients living with and beyond cancer in Ireland. However, issues regarding accessibility and the importance of in-person care must be acknowledged. Factors of convenience, time savings, and cost savings indicate that telehealth interventions are a desirable patient-centered method of delivering care when performed in suitable clinical contexts and with appropriate populations. ",
doi="10.2196/46077",
url="https://cancer.jmir.org/2023/1/e46077",
url="http://www.ncbi.nlm.nih.gov/pubmed/37943595"
}


@Article{info:doi/10.2196/48761,
author="Marks, Asher
and Garbatini, Amanda
and Hieftje, Kimberly
and Puthenpura, Vidya
and Weser, Veronica
and Fernandes, F. Claudia-Santi",
title="Use of Immersive Virtual Reality Spaces to Engage Adolescent and Young Adult Patients With Cancer in Therapist-Guided Support Groups: Protocol for a Pre-Post Study",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="9",
volume="12",
pages="e48761",
keywords="cancer",
keywords="virtual reality",
keywords="support groups",
keywords="peer support",
keywords="adolescent",
keywords="young adult",
keywords="resilience",
keywords="adolescents and young adults",
keywords="oncology",
keywords="therapist-guided support",
keywords="social isolation",
keywords="support system",
keywords="psychosocial support",
keywords="barrier",
keywords="quality of life",
abstract="Background: For adolescents and young adults, a cancer diagnoses can magnify feelings of social isolation at an inherently vulnerable developmental stage. Prior studies have highlighted the importance of peer groups during cancer treatment. Support groups help foster connection and resilience, but patients find in-person participation difficult due to a variety of factors. Additionally, physical changes brought on by cancer makes these patients hesitant to meet in person. The COVID-19 pandemic magnified these difficulties. Virtual reality (VR) allows for the creation of a therapist-curated, computer-generated social space that potentially enables support groups for this population. Objective: This protocol describes a pilot study examining the efficacy, feasibility, and acceptability of a social VR support group intervention for adolescent and young adult patients with cancer. Methods: We approached 20 participants aged 17-20 years, and 16 agreed to participate. Moreover, 1 participant dropped out due to hospitalization. Participants attended virtual, professionally facilitated support groups using Meta Quest VR headsets. The groups consisted of 4 participants and 1 facilitator, amounting to a total of 22 individual sessions. Each session lasted 45-60 minutes and took place weekly for 4-6 weeks. The primary aim of this study was to collect quantitative and qualitative data on the feasibility and acceptability of the intervention. Feasibility was measured through session participation rates and overall retention rates. The acceptability of the intervention was explored through brief in-person interviews with participants at the end of the final intervention session. The secondary aim of this study was to collect data on the preliminary efficacy of the intervention in decreasing symptoms of participant depression and anxiety and increasing positive affect and resiliency. Results: In total, 15 patients aged 17-20 years participated in 22 sessions between November 5, 2019, and July 8, 2021. The median age was 19 (IQR 17-20) years. Overall, 10 (62\%) participants identified as male, 5 (31\%) as female, and 1 (6\%) as transgender female. Furthermore, 5 (31\%) participants identified as Hispanic, 1 (6\%) identified as non-Hispanic Asian, 3 (19\%) identified as non-Hispanic Black, 6 (38\%) identified as non-Hispanic White, and 1 (6\%) identified as other race or ethnicity. Hematologic malignancies or bone marrow failure was the most common diagnosis (8/16, 50\%). The mean attendance rate was 72.8\% (SD 25.7\%) and retention was 86.7\% (SD 0.35\%). Moreover, 45\% (10/22) of sessions had to be postponed by a week or more due to unexpected participant scheduling issues. Conclusions: The use of VR to deliver psychosocial support for adolescents and young adults with cancer may reduce common barriers associated with attending in-person peer support groups while improving quality-of-life measures. The data from this study will inform future studies focused on conducting VR support groups in other rare disease populations, including older adults with cancer. International Registered Report Identifier (IRRID): DERR1-10.2196/48761 ",
doi="10.2196/48761",
url="https://www.researchprotocols.org/2023/1/e48761",
url="http://www.ncbi.nlm.nih.gov/pubmed/37943596"
}


@Article{info:doi/10.2196/45518,
author="Marks, A. Victoria
and Hsiang, R. Walter
and Nie, James
and Umer, Waez
and Haleem, Afash
and Galal, Bayan
and Pak, Irene
and Kim, Dana
and Salazar, C. Michelle
and Pantel, Haddon
and Berger, R. Elizabeth
and Boffa, J. Daniel
and Cavallo, A. Jaime
and Leapman, S. Michael",
title="Telehealth Availability for Cancer Care During the COVID-19 Pandemic: Cross-Sectional Study",
journal="JMIR Cancer",
year="2023",
month="Nov",
day="2",
volume="9",
pages="e45518",
keywords="telehealth",
keywords="colorectal cancer",
keywords="breast cancer",
keywords="melanoma",
keywords="access to care",
keywords="COVID-19 pandemic",
keywords="telemedicine",
keywords="national survey",
keywords="cross-sectional",
keywords="cancer",
keywords="oncology",
abstract="Background: Telehealth was an important strategy for maintaining continuity of cancer care during the coronavirus pandemic and has continued to play a role in outpatient care; however, it is unknown whether services are equally available across cancer hospitals. Objective: This study aimed to assess telehealth availability at cancer hospitals for new and established patients with common cancers to contextualize the impact of access barriers to technology on overall access to health care. Methods: We conducted a national cross-sectional secret shopper study from June to November 2020 to assess telehealth availability at cancer hospitals for new and established patients with colorectal, breast, and skin (melanoma) cancer. We examined facility-level factors to determine predictors of telehealth availability. Results: Of the 312 investigated facilities, 97.1\% (n=303) provided telehealth services for at least 1 cancer site. Telehealth was less available to new compared to established patients (n=226, 72\% vs n=301, 97.1\%). The surveyed cancer hospitals more commonly offered telehealth visits for breast cancer care (n=266, 85\%) and provided lower access to telehealth for skin (melanoma) cancer care (n=231, 74\%). Most hospitals (n=163, 52\%) offered telehealth for all 3 cancer types. Telehealth availability was weakly correlated across cancer types within a given facility for new (r=0.16, 95\% CI 0.09-0.23) and established (r=0.14, 95\% CI 0.08-0.21) patients. Telehealth was more commonly available for new patients at National Cancer Institute--designated facilities, medical school--affiliated facilities, and major teaching sites, with high total admissions and below-average timeliness of care. Telehealth availability for established patients was highest at Academic Comprehensive Cancer Programs, nongovernment and nonprofit facilities, medical school--affiliated facilities, Accountable Care Organizations, and facilities with a high number of total admissions. Conclusions: Despite an increase in telehealth services for patients with cancer during the COVID-19 pandemic, we identified differences in access across cancer hospitals, which may relate to measures of clinical volume, affiliation, and infrastructure. ",
doi="10.2196/45518",
url="https://cancer.jmir.org/2023/1/e45518",
url="http://www.ncbi.nlm.nih.gov/pubmed/37917149"
}


@Article{info:doi/10.2196/47624,
author="Longacre, L. Margaret
and Chwistek, Marcin
and Keleher, Cynthia
and Siemon, Mark
and Egleston, L. Brian
and Collins, Molly
and Fang, Y. Carolyn",
title="Patient-Caregiver Portal System in Palliative Oncology: Assessment of Usability and Perceived Benefit",
journal="JMIR Hum Factors",
year="2023",
month="Nov",
day="2",
volume="10",
pages="e47624",
keywords="caregiving",
keywords="patient portal, health policy",
keywords="palliative oncology",
keywords="oncology",
keywords="engagement",
keywords="family caregiver",
keywords="caregiver",
keywords="communication",
keywords="usage",
keywords="usability",
keywords="clinical care",
keywords="cancer",
abstract="Background: The engagement of family caregivers in oncology is not universal or systematic. Objective: We implemented a process intervention (ie, patient-caregiver portal system) with an existing patient portal system to (1) allow a patient to specify their caregiver and communication preferences with that caregiver, (2) connect the caregiver to a unique caregiver-specific portal page to indicate their needs, and (3) provide an electronic notification of the dyad's responses to the care team to inform clinicians and connect the caregiver to resources as needed. Methods: We assessed usability and satisfaction with this patient-caregiver portal system among patients with cancer receiving palliative care, their caregivers, and clinicians. Results: Of 31 consented patient-caregiver dyads, 20 patients and 19 caregivers logged in. Further, 60\% (n=12) of patients indicated a preference to communicate equally or together with their caregiver. Caregivers reported high emotional (n=9, 47.3\%), financial (n=6, 31.6\%), and physical (n=6, 31.6\%) caregiving-related strain. The care team received all patient-caregiver responses electronically. Most patients (86.6\%, 13/15 who completed the user experience interview) and caregivers (94\%, 16/17 who completed the user experience interview) were satisfied with the system, while, of the 6 participating clinicians, 66.7\% agreed ``quite a bit'' (n=1, 16.7\%) or ``very much'' (n=3, 50\%) that the system allowed them to provide better care. Conclusions: Our findings demonstrate system usability, including a systematic way to identify caregiver needs and share with the care team in a way that is acceptable to patients and caregivers and perceived by clinicians to benefit clinical care. Integration of a patient-caregiver portal system may be an effective approach for systematically engaging caregivers. These findings highlight the need for additional research among caregivers of patients with less advanced cancer or with different illnesses. ",
doi="10.2196/47624",
url="https://humanfactors.jmir.org/2023/1/e47624",
url="http://www.ncbi.nlm.nih.gov/pubmed/37917129"
}


@Article{info:doi/10.2196/49051,
author="Li, Yufei
and Chen, Weihong
and Liang, Yanjing
and Yang, Ling
and Hou, Lili",
title="Evaluation of Mobile Health Technology Interventions for the Postdischarge Management of Patients With Head and Neck Cancer: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Oct",
day="23",
volume="11",
pages="e49051",
keywords="head and neck cancer",
keywords="mobile health technology",
keywords="postdischarge",
keywords="self-management",
keywords="rehabilitation",
abstract="Background: Patients with head and neck cancer (HNC) often experience various types and degrees of complications and functional impairment following surgery or radiotherapy. Consequently, these patients require extensive postdischarge rehabilitation, either at home or in the community. Numerous studies have shown the advantages of mobile Health (mHealth) technology in assisting patients with cancer with self-management and rehabilitation during the postdischarge period. However, few reviews have focused on the intervention, management, and evaluation of mHealth technology in postdischarge patients with HNC. Objective: This study aimed to conduct a scoping review of mHealth technology apps and interventions currently available to patients discharged from hospitals after receiving treatment for HNC. This study sought to identify and summarize the types and effectiveness of existing mHealth interventions as well as the differences in their outcome assessments. Methods: The PubMed, Embase, Web of Science, and CINAHL databases were used to identify studies with no publication time limits. The keywords ``mobile health technology'' and ``head and neck cancer'' were combined to address the main concepts of the research questions. Results: Of the 1625 papers identified, 13 (0.8\%) met the inclusion and exclusion criteria. Most studies (n=8, 61.5\%) were randomized controlled trials (RCTs) and cohort studies. These studies were conducted in 6 countries. The main aims of the mHealth interventions in these studies are as follows: (1) symptom monitoring and assessment, (2) rehabilitation training, (3) access to medical health information, (4) telehealth advisers, (5) peer communication and support, and (6) follow-up/review reminders. The outcome evaluations of the 13 included studies were grouped into 4 categories: (1) technology usability and patient satisfaction, (2) self-management of symptoms and patient-reported outcome--related indicators, (3) adherence, and (4) health-related quality of life. Conclusions: A limited number of studies have investigated the use of mHealth technology in the postdischarge self-management of patients with HNC. The existing literature suggests that mHealth technology can effectively assist patients with HNC in self-management and postdischarge interventions. It plays an important role in addressing patients' health information needs, reducing both their somatic and psychological burdens, and improving their overall quality of life. Future research should prioritize conducting additional high-quality RCTs to evaluate the usability and analyze the cost-effectiveness of mHealth technology. ",
doi="10.2196/49051",
url="https://mhealth.jmir.org/2023/1/e49051",
url="http://www.ncbi.nlm.nih.gov/pubmed/37870887"
}


@Article{info:doi/10.2196/46189,
author="Sprave, Tanja
and Pfaffenlehner, Michelle
and Stoian, Raluca
and Christofi, Eleni
and R{\"u}hle, Alexander
and Z{\"o}ller, Daniela
and Fabian, Alexander
and Fahrner, Harald
and Binder, Harald
and Sch{\"a}fer, Henning
and Gkika, Eleni
and Grosu, Anca-Ligia
and Heinemann, Felix
and Nicolay, Henrik Nils",
title="App-Controlled Treatment Monitoring and Support for Patients With Head and Neck Cancer Undergoing Radiotherapy: Results From a Prospective Randomized Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="19",
volume="25",
pages="e46189",
keywords="mHealth",
keywords="head and neck cancer",
keywords="head and neck squamous cell carcinoma",
keywords="HNSCC",
keywords="radiotherapy",
keywords="mobile app",
keywords="quality of life",
keywords="patient-reported outcome measure",
keywords="PROM",
keywords="mobile health",
keywords="head",
keywords="neck",
keywords="cancer",
keywords="oncology",
keywords="radiation",
keywords="randomized controlled trial",
keywords="RCT",
keywords="satisfaction",
keywords="treatment surveillance",
keywords="patient surveillance",
keywords="feasibility",
keywords="patient reported",
keywords="outcome measure",
keywords="app-based",
abstract="Background: Head and neck cancers (HNCs) are very common malignancies, and treatment often requires multimodal approaches, including radiotherapy and chemotherapy. Patients with HNC often display a high symptom burden, both due to the disease itself and the adverse effects of the multimodal therapy. Close telemonitoring of symptoms and quality of life during the course of treatment may help to identify those patients requiring early medical support. Objective: The App-Controlled Treatment Monitoring and Support for Patients With Head and Neck Cancer (APCOT) trial aimed to investigate the feasibility of integrating electronic patient-reported outcomes (ePROs) in the treatment surveillance pathway of patients with HNC during the course of their radiotherapy. Additionally, the influence of app-based ePRO monitoring on global and disease-specific quality of life and patient satisfaction with treatment was assessed. Methods: Patients undergoing radiotherapy for histologically proven HNCs at the Department of Radiation Oncology, University Medical Center Freiburg, Germany, were enrolled in this trial and monitored by weekly physician appointments. Patients were randomized between additional ePRO monitoring on each treatment day or standard-of-care monitoring. Feasibility of ePRO monitoring was defined as ?80\% of enrolled patients answering ?80\% of their daily app-based questions. Quality of life and patient satisfaction were assessed by the European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ-C30), the head and neck cancer module (H\&N35), and the validated Patient Satisfaction Questionnaire Short Form (PSQ-18) at the completion of treatment and compared between trial arms. Results: A total of 100 patients were enrolled in this trial, and 93 patients were evaluable. All patients (100\%) in the experimental arm answered ?80\% of the ePRO questions during treatment, reaching the predefined threshold for the feasibility of ePRO monitoring (P<.001 in the binomial test). No clinical or patient-specific factor was found to influence feasibility. Global health and most domains of the general quality of life were comparable between trial arms, but an increased HNC-specific symptom burden was reported by patients undergoing ePRO surveillance. ePRO monitoring resulted in improved patient satisfaction regarding interpersonal manners (P=.01), financial aspects (P=.01), and time spent with a doctor (P=.01). Conclusions: This trial demonstrated the feasibility of incorporating daily app-based ePRO surveillance for patients with HNC undergoing radiotherapy. Our data, for the first time, demonstrate that telemonitoring in this setting led to increased reporting of HNC-specific symptom burden and significantly improved several domains of patient satisfaction. Further analyses are needed to assess whether our findings hold true outside the context of a clinical trial. Trial Registration: German Clinical Trials Register DRKS00020491; https://drks.de/search/en/trial/DRKS00020491 ",
doi="10.2196/46189",
url="https://www.jmir.org/2023/1/e46189",
url="http://www.ncbi.nlm.nih.gov/pubmed/37856185"
}


@Article{info:doi/10.2196/46765,
author="Raff, Christian
and D{\"o}rr-Harim, Colette
and Otto, Stephanie
and Thiele, Johanna
and Mihaljevic, Andre
and Kramer, Klaus",
title="Prehabilitation in an Integrative Medicine Day Clinic for Patients Undergoing Neoadjuvant Treatment: Single-Center Feasibility Pilot Study",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="18",
volume="12",
pages="e46765",
keywords="supportive care",
keywords="prehabilitation",
keywords="neoadjuvant treatment",
keywords="integrative medicine",
keywords="multimodal prehabilitation",
keywords="cancer",
keywords="oncology",
keywords="surgery",
keywords="preoperative",
keywords="feasibility",
keywords="integrative",
keywords="naturopathy",
keywords="naturopathic",
keywords="diet",
keywords="nutrition",
abstract="Background: Patients with cancer receiving neoadjuvant treatment prior to surgery are in a very stressful situation. Chemotherapy and radiation therapy put a strain on the quality of life and the pending surgery poses a relevant burden for many patients. Preparation of these patients for the intervention in terms of prehabilitation has great potential to reduce the burden of postoperative complications and may improve the clinical outcome. A prehabilitation approach also yields the possibility to address unmet patients' needs and to help them modify their lifestyle in a maintainable way. Therefore, a multimodal approach is mandatory during this critical period. Objective: The aim of this study is to assess the feasibility of prehabilitation in an integrative medicine day clinic (PRIME-DC) prior to cancer surgery at a major university clinic. PRIME-DC is considered feasible if 80\% of enrolled patients are willing and able to complete at least 6 out of the 8 weekly meetings, each lasting 6.5 hours, at such a clinic. Secondary end points aim to evaluate this multimodal program. Methods: The PRIME-DC intervention combines mind-body medicine, exercise therapy, nutrition therapy, naturopathic counseling, and the application of a yarrow liver compress. Adult patients with cancer, with a primary tumor in the abdomen (including intraperitoneal cancer, stomach cancer, and extraperitoneal cancers such as pancreatic, bladder, rectal, esophageal, endometrial, ovarian, and cervical cancer) or the breast requiring a neoadjuvant oncological treatment setting are eligible to participate. The addressed cancer entities imply either an extensive surgical intervention with an expected need for prehabilitation (eg, abdominal surgery) or a neoadjuvant treatment of several months with a high burden of treatment-associated side effects (breast cancer). Adherence to the day clinic program is the primary end point being defined as presence during the day clinic session. Secondary end points are physical assessment and quality of life, together with a structured assessment of neoadjuvant treatment-associated side effects. Furthermore, to collect qualitative data voluntary participants of the day clinic will be interviewed in a semistructured way after completion of the day clinic program on each component of the study (mind-body intervention, exercise, nutrition, naturopathic counseling, and a yarrow liver compress). Results: The procedures used in this study adhere to the tenets of the Declaration of Helsinki. As of February 2023, we enrolled 23 patients; the dominant cancer entity is breast cancer (18 enrolled patients). Conclusions: The presented protocol combines prehabilitation, lifestyle modification, naturopathic counseling, dietary assistance, and naturopathic treatment in an innovative and integrative way. Trial Registration: Deutsches Register Klinischer Studien German Clinical Trials Register DRKS00028126; https://drks.de/search/de/trial/DRKS00028126 International Registered Report Identifier (IRRID): DERR1-10.2196/46765 ",
doi="10.2196/46765",
url="https://www.researchprotocols.org/2023/1/e46765",
url="http://www.ncbi.nlm.nih.gov/pubmed/37851493"
}


@Article{info:doi/10.2196/49731,
author="Hinneburg, Jana
and Zacher, Sandro
and Berger-H{\"o}ger, Birte
and Berger-Th{\"u}rmel, Karin
and Kratzer, Vanessa
and Steckelberg, Anke
and L{\"u}hnen, Julia
and ",
title="Enhancing Transsectoral Interdisciplinary Patient-Centered Care for Patients With Rare Cancers: Protocol for a Mixed Methods Process Evaluation",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="12",
volume="12",
pages="e49731",
keywords="process evaluation",
keywords="study protocol",
keywords="logic model",
keywords="complex intervention",
keywords="coordination of care",
keywords="rare cancer",
keywords="mobile phone",
abstract="Background: Rare cancers account for approximately 24\% of all new cancers. The category of rare tumor diseases includes almost 200 different entities. In particular, the treatment of patients with extensive care needs requires cooperation between service providers, both between sectors (outpatient and inpatient) and within sectors (eg, between different medical disciplines). The treatment pathway is associated with a high need for coordination and information sharing between providers. When crossing sectoral boundaries in the German health care system, interface problems between the outpatient and inpatient sectors can lead to gaps in care delivery. The multicomponent program Trans-sectoral Personalised Care Concept for Patients with Rare Cancers aims to optimize transsectoral cooperation and coordination of care to enhance patient involvement and the medical care coordination of patients with rare cancers. Objective: This process evaluation will contribute to answering questions about intervention fidelity and the implementation of transsectoral communication, identifying and describing the intended and nonintended effects of the intervention, and exploring the barriers to and facilitators of the implementation. Methods: We will include patients who participate in the intervention phase; all persons and staff involved in the development and implementation of the intervention (Onco Coach, psychologists, physicians on the contact platform, IT staff, and staff of the Bavarian Association of Statutory Health Insurance Physicians); physicians from the Ludwig-Maximilians-University Hospital Munich and the hospital of the Technical University Munich who are involved in the treatment of patients during the course of the project; and participating office--based hematologists and oncologists. Data collection will be conducted at the beginning, during, and at the end of the intervention using mixed methods. Data will be collected from questionnaires, document analyses, semistructured interviews, and structured observations and will cover different aspects of process evaluation. These include examining the context to explore existing patterns, changes in patterns, attitudes, and interactions; analyzing the implementation of intervention elements; and exploring the complex causal pathways and mediators of the intervention. Qualitative data will be analyzed using thematic analysis. The data will then be combined using between-methods triangulation. Results: This project received funding on March 1, 2022. The intervention phase and recruitment for the process evaluation began on March 1, 2023, and the recruitment is expected to end on September 30, 2025. At the time of protocol submission in June 2023, a total of 8 doctors from hematology and oncology practices were enrolled. Data collection began on March 14, 2023. Conclusions: The Trans-sectoral Personalised Care Concept for Patients with Rare Cancers project is a complex intervention that is to be implemented in an equally complex health care context. The process evaluation will help understand the influence of contextual factors and assess the mechanisms of change. Trial Registration: ISRCTN registry ISRCTN16441179; https://doi.org/10.1186/ISRCTN16441179 International Registered Report Identifier (IRRID): DERR1-10.2196/49731 ",
doi="10.2196/49731",
url="https://www.researchprotocols.org/2023/1/e49731",
url="http://www.ncbi.nlm.nih.gov/pubmed/37824180"
}


@Article{info:doi/10.2196/49096,
author="Jenci?t?, Gabriel?
and Kasputyt?, Gabriel?
and Bunevi{\v c}ien?, Inesa
and Korobeinikova, Erika
and Vaitiekus, Domas
and In{\v c}i?ra, Arturas
and Jaru{\vs}evi{\v c}ius, Laimonas
and Bunevi{\v c}ius, Romas
and Krik{\vs}tolaitis, Ri{\v c}ardas
and Krilavi{\v c}ius, Tomas
and Juozaityt?, Elona
and Bunevi{\v c}ius, Adomas",
title="Digital Phenotyping for Monitoring and Disease Trajectory Prediction of Patients With Cancer: Protocol for a Prospective Observational Cohort Study",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="10",
volume="12",
pages="e49096",
keywords="cancer",
keywords="digital phenotyping",
keywords="biomarkers",
keywords="oncology",
keywords="digital phenotype",
keywords="biomarker",
keywords="data collection",
keywords="data generation",
keywords="monitor",
keywords="monitoring",
keywords="predict",
keywords="prediction",
keywords="model",
keywords="models",
keywords="mobile phone",
abstract="Background: Timely recognition of cancer progression and treatment complications is important for treatment guidance. Digital phenotyping is a promising method for precise and remote monitoring of patients in their natural environments by using passively generated data from sensors of personal wearable devices. Further studies are needed to better understand the potential clinical benefits of digital phenotyping approaches to optimize care of patients with cancer. Objective: We aim to evaluate whether passively generated data from smartphone sensors are feasible for remote monitoring of patients with cancer to predict their disease trajectories and patient-centered health outcomes. Methods: We will recruit 200 patients undergoing treatment for cancer. Patients will be followed up for 6 months. Passively generated data by sensors of personal smartphone devices (eg, accelerometer, gyroscope, GPS) will be continuously collected using the developed LAIMA smartphone app during follow-up. We will evaluate (1) mobility data by using an accelerometer (mean time of active period, mean time of exertional physical activity, distance covered per day, duration of inactive period), GPS (places of interest visited daily, hospital visits), and gyroscope sensors and (2) sociability indices (frequency of duration of phone calls, frequency and length of text messages, and internet browsing time). Every 2 weeks, patients will be asked to complete questionnaires pertaining to quality of life (European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire [EORTC QLQ-C30]), depression symptoms (Patient Health Questionnaire-9 [PHQ-9]), and anxiety symptoms (General Anxiety Disorder-7 [GAD-7]) that will be deployed via the LAIMA app. Clinic visits will take place at 1-3 months and 3-6 months of the study. Patients will be evaluated for disease progression, cancer and treatment complications, and functional status (Eastern Cooperative Oncology Group) by the study oncologist and will complete the questionnaire for evaluating quality of life (EORTC QLQ-C30), depression symptoms (PHQ-9), and anxiety symptoms (GAD-7). We will examine the associations among digital, clinical, and patient-reported health outcomes to develop prediction models with clinically meaningful outcomes. Results: As of July 2023, we have reached the planned recruitment target, and patients are undergoing follow-up. Data collection is expected to be completed by September 2023. The final results should be available within 6 months after study completion. Conclusions: This study will provide in-depth insight into temporally and spatially precise trajectories of patients with cancer that will provide a novel digital health approach and will inform the design of future interventional clinical trials in oncology. Our findings will allow a better understanding of the potential clinical value of passively generated smartphone sensor data (digital phenotyping) for continuous and real-time monitoring of patients with cancer for treatment side effects, cancer complications, functional status, and patient-reported outcomes as well as prediction of disease progression or trajectories. International Registered Report Identifier (IRRID): PRR1-10.2196/49096 ",
doi="10.2196/49096",
url="https://www.researchprotocols.org/2023/1/e49096",
url="http://www.ncbi.nlm.nih.gov/pubmed/37815850"
}


@Article{info:doi/10.2196/44332,
author="Pfisterer, J. Kaylen
and Lohani, Raima
and Janes, Elizabeth
and Ng, Denise
and Wang, Dan
and Bryant-Lukosius, Denise
and Rendon, Ricardo
and Berlin, Alejandro
and Bender, Jacqueline
and Brown, Ian
and Feifer, Andrew
and Gotto, Geoffrey
and Saha, Shumit
and Cafazzo, A. Joseph
and Pham, Quynh",
title="An Actionable Expert-System Algorithm to Support Nurse-Led Cancer Survivorship Care: Algorithm Development Study",
journal="JMIR Cancer",
year="2023",
month="Oct",
day="4",
volume="9",
pages="e44332",
keywords="prostate cancer",
keywords="patient-reported outcomes",
keywords="nurse-led model of care",
keywords="expert system",
keywords="artificial intelligence--powered decision support",
keywords="digital health",
keywords="nursing",
keywords="algorithm development",
keywords="cancer treatment",
keywords="AI",
keywords="survivorship",
keywords="cancer",
abstract="Background: Comprehensive models of survivorship care are necessary to improve access to and coordination of care. New models of care provide the opportunity to address the complexity of physical and psychosocial problems and long-term health needs experienced by patients following cancer treatment. Objective: This paper presents our expert-informed, rules-based survivorship algorithm to build a nurse-led model of survivorship care to support men living with prostate cancer (PCa). The algorithm is called No Evidence of Disease (Ned) and supports timelier decision-making, enhanced safety, and continuity of care. Methods: An initial rule set was developed and refined through working groups with clinical experts across Canada (eg, nurse experts, physician experts, and scientists; n=20), and patient partners (n=3). Algorithm priorities were defined through a multidisciplinary consensus meeting with clinical nurse specialists, nurse scientists, nurse practitioners, urologic oncologists, urologists, and radiation oncologists (n=17). The system was refined and validated using the nominal group technique. Results: Four levels of alert classification were established, initiated by responses on the Expanded Prostate Cancer Index Composite for Clinical Practice survey, and mediated by changes in minimal clinically important different alert thresholds, alert history, and clinical urgency with patient autonomy influencing clinical acuity. Patient autonomy was supported through tailored education as a first line of response, and alert escalation depending on a patient-initiated request for a nurse consultation. Conclusions: The Ned algorithm is positioned to facilitate PCa nurse-led care models with a high nurse-to-patient ratio. This novel expert-informed PCa survivorship care algorithm contains a defined escalation pathway for clinically urgent symptoms while honoring patient preference. Though further validation is required through a pragmatic trial, we anticipate the Ned algorithm will support timelier decision-making and enhance continuity of care through the automation of more frequent automated checkpoints, while empowering patients to self-manage their symptoms more effectively than standard care. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-045806 ",
doi="10.2196/44332",
url="https://cancer.jmir.org/2023/1/e44332",
url="http://www.ncbi.nlm.nih.gov/pubmed/37792435"
}


@Article{info:doi/10.2196/49476,
author="Riedl, David
and Lehmann, Jens
and Rothmund, Maria
and Dejaco, Daniel
and Grote, Vincent
and Fischer, J. Michael
and Rumpold, Gerhard
and Holzner, Bernhard
and Licht, Thomas",
title="Usability of Electronic Patient-Reported Outcome Measures for Older Patients With Cancer: Secondary Analysis of Data from an Observational Single Center Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="21",
volume="25",
pages="e49476",
keywords="patient-reported outcomes",
keywords="completion rate",
keywords="geriatric",
keywords="age",
keywords="patient reported",
keywords="elderly",
keywords="older adults",
keywords="older adult",
keywords="cancer",
keywords="oncology",
keywords="survivor",
keywords="survivors",
keywords="questionnaire",
keywords="questionnaires",
keywords="self-reported",
keywords="geriatrics",
keywords="gerontology",
keywords="survey",
keywords="surveys",
keywords="mobile phone",
abstract="Background: Patient-reported outcomes are considered the gold standard for assessing subjective health status in oncology patients. Electronic assessment of patient-reported outcomes (ePRO) has become increasingly popular in recent years in both clinical trials and practice. However, there is limited evidence on how well older patients with cancer can complete ePRO assessments. Objective: We aimed to investigate how well adult patients with cancer of different age ranges could complete ePRO assessments at home and in a treatment facility and to identify factors associated with the ability to complete questionnaires electronically. Methods: This retrospective longitudinal single-center study involved survivors of cancer who participated in inpatient rehabilitation. Patients completed ePRO assessments before rehabilitation at home (T1) and after rehabilitation at the facility (T2). We analyzed the rate of patients who could complete the ePRO assessment at T1 and T2, the proportion of patients who required assistance, and the time it took patients to complete standardized questionnaires. Multivariate logistic regression analyses were conducted to identify predictors of ePRO completion rate and the need for assistance. Results: Between 2017 and 2022, a total of 5571 patients were included in this study. Patients had a mean age of 60.3 (SD 12.2) years (range 18 to 93 years), and 1135 (20.3\%) of them were classified as geriatric patients (>70 years). While more than 90\% (5060/5571) of all patients completed the ePRO assessment, fewer patients in the age group of >70 years (924/1135, 81.4\% at T1 vs 963/1135, 84.8\% at T2) completed the assessment. Approximately 19\% (1056/5571) of patients reported a need for assistance with the ePRO assessment at home, compared to 6.8\% (304/4483) at the institution. Patients older than 70 years had a significantly higher need for assistance than those in younger age groups. Moreover, a gender difference was observed, with older women reporting a higher need for assistance than men (71-80 years: women requiring assistance 215/482, 44.6\% vs men 96/350, 27.4\%; P<.001 and >80 years: women 102/141, 72.3\% vs men 57/112, 50.9\%; P<.001). On average, patients needed 4.9 (SD 3.20) minutes to remotely complete a 30-item questionnaire (European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire) and patients in the older age groups took significantly longer compared to younger age groups. Lower age and higher physical functioning were the clearest predictors for both the ePRO completion rate and the need for assistance in the multivariate regression analysis. Conclusions: This study's results indicate that ePRO assessment is feasible in older individuals with cancer, but older patients may require assistance (eg, from relatives) to complete home-based assessments. It may be more feasible to conduct assessments in-house in this population. Additionally, it is crucial to carefully consider which resources are necessary and available to support patients in using ePRO devices. ",
doi="10.2196/49476",
url="https://www.jmir.org/2023/1/e49476",
url="http://www.ncbi.nlm.nih.gov/pubmed/37733409"
}


@Article{info:doi/10.2196/48737,
author="Oyedele, K. Natasha
and Lansey, G. Dina
and Chiew, Calvin
and Chan, Cupid
and Quon, Harry
and Dean, T. Lorraine",
title="Development and Testing of a Mobile App to Collect Social Determinants of Health Data in Cancer Settings: Interview Study",
journal="JMIR Form Res",
year="2023",
month="Sep",
day="14",
volume="7",
pages="e48737",
keywords="social determinants of health",
keywords="mobile apps",
keywords="medical oncology",
keywords="mobile phone",
abstract="Background: Social determinants of health (SDOH) such as lack of basic resources, housing, transportation, and social isolation play an important role for patients on the cancer care continuum. Health systems' current technological solutions for identifying and managing patients' SDOH data largely focus on information recorded in the electronic health record by providers, which is often inaccessible to patients to contribute to or modify. Objective: We developed and tested a patient-centric SDOH screening tool designed for use on patients' personal mobile phone that preserves patient privacy and confidentiality, collects information about the unmet social needs of patients with cancer, and communicates them to the provider. Methods: We interviewed 22 patients with cancer, oncologists, and social workers associated with a US-based comprehensive cancer center to better understand how patients' SDOH information is collected and reported. After triangulating data obtained from thematic analysis of interviews, an environmental scan, and a literature search of validated tools to collect SDOH data, we developed an SDOH screening tool mobile app and conducted a pilot study of 16 dyadic pairs of patients and cancer care team members at the same cancer center. We collected patient SDOH data using 36 survey items covering 7 SDOH domains and used validated scales and follow-up interviews to assess the app's usability and acceptability among patients and cancer care team members. Results: Formative interviews with patients and care team members revealed that transportation, financial challenges, food insecurity, and low health literacy were common SDOH challenges and that a mobile app that collected those data, shared those data with care team members, and offered supportive resources could be useful and valuable. In the pilot study, 25\% (4/16) of app-using patients reported having at least one of the abovementioned social needs; the most common social need was social isolation (7/16, 44\%). Patients rated the mobile app as easy to use, accurately capturing their SDOH, and preserving their privacy but suggested that the app could be more helpful by connecting patients to actual resources. Providers reported high acceptability and usability of the app. Conclusions: Use of a brief, patient-centric, mobile app--based SDOH screening tool can effectively capture SDOH of patients with cancer for care team members in a way that preserves patient privacy and that is acceptable and usable for patients and care team members. However, only collecting SDOH information is not sufficient; usefulness can be increased by connecting patients directly to resources to address their unmet social needs. ",
doi="10.2196/48737",
url="https://formative.jmir.org/2023/1/e48737",
url="http://www.ncbi.nlm.nih.gov/pubmed/37707880"
}


@Article{info:doi/10.2196/49775,
author="Petros, Gebrewold Nuhamin
and Alvarsson-Hjort, Jesper
and Hadlaczky, Gerg{\"o}
and Wasserman, Danuta
and Ottaviano, Manuel
and Gonzalez-Martinez, Sergio
and Carletto, Sara
and Scilingo, Pasquale Enzo
and Valenza, Gaetano
and Carli, Vladimir",
title="Predictors of the Use of a Mental Health--Focused eHealth System in Patients With Breast and Prostate Cancer: Bayesian Structural Equation Modeling Analysis of a Prospective Study",
journal="JMIR Cancer",
year="2023",
month="Sep",
day="12",
volume="9",
pages="e49775",
keywords="mental health",
keywords="eHealth system",
keywords="perceived usefulness",
keywords="structural equation modeling",
keywords="cancer",
keywords="NEVERMIND system",
keywords="usability",
keywords="digital health",
keywords="Technology Acceptance Model",
abstract="Background: eHealth systems have been increasingly used to manage depressive symptoms in patients with somatic illnesses. However, understanding the factors that drive their use, particularly among patients with breast and prostate cancer, remains a critical area of research. Objective: This study aimed to determine the factors influencing use of the NEVERMIND eHealth system among patients with breast and prostate cancer over 12 weeks, with a focus on the Technology Acceptance Model. Methods: Data from the NEVERMIND trial, which included 129 patients with breast and prostate cancer, were retrieved. At baseline, participants completed questionnaires detailing demographic data and measuring depressive and stress symptoms using the Beck Depression Inventory--II and the Depression, Anxiety, and Stress Scale--21, respectively. Over a 12-week period, patients engaged with the NEVERMIND system, with follow-up questionnaires administered at 4 weeks and after 12 weeks assessing the system's perceived ease of use and usefulness. Use log data were collected at the 2- and 12-week marks. The relationships among sex, education, baseline depressive and stress symptoms, perceived ease of use, perceived usefulness (PU), and system use at various stages were examined using Bayesian structural equation modeling in a path analysis, a technique that differs from traditional frequentist methods. Results: The path analysis was conducted among 100 patients with breast and prostate cancer, with 66\% (n=66) being female and 81\% (n=81) having a college education. Patients reported good mental health scores, with low levels of depression and stress at baseline. System use was approximately 6 days in the initial 2 weeks and 45 days over the 12-week study period. The results revealed that PU was the strongest predictor of system use at 12 weeks ($\beta$use at 12 weeks is predicted by PU at 12 weeks=.384), whereas system use at 2 weeks moderately predicted system use at 12 weeks ($\beta$use at 12 weeks is predicted by use at 2 weeks=.239). Notably, there were uncertain associations between baseline variables (education, sex, and mental health symptoms) and system use at 2 weeks, indicating a need for better predictors for early system use. Conclusions: This study underscores the importance of PU and early engagement in patient engagement with eHealth systems such as NEVERMIND. This suggests that, in general eHealth implementations, caregivers should educate patients about the benefits and functionalities of such systems, thus enhancing their understanding of potential health impacts. Concentrating resources on promoting early engagement is also essential given its influence on sustained use. Further research is necessary to clarify the remaining uncertainties, enabling us to refine our strategies and maximize the benefits of eHealth systems in health care settings. ",
doi="10.2196/49775",
url="https://cancer.jmir.org/2023/1/e49775",
url="http://www.ncbi.nlm.nih.gov/pubmed/37698900"
}


@Article{info:doi/10.2196/50993,
author="Lai, Jin-Shei
and Jensen, E. Sally
and Peipert, Devin John
and Mitchell, A. Sandra
and Garcia, F. Sofia
and Cella, David
and Goldman, Stewart
and Lenzen, Alicia",
title="Using IT to Improve Outcomes for Children Living With Cancer (SyMon-SAYS): Protocol for a Single-Institution Waitlist Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Sep",
day="8",
volume="12",
pages="e50993",
keywords="pediatric, cancer",
keywords="symptom monitoring",
keywords="randomized controlled trial",
keywords="protocol, electronic health record",
keywords="health-related quality of life",
abstract="Background: Children and adolescents with cancer may experience multiple disease- and treatment-related symptoms that negatively affect health-related quality of life. Routine symptom surveillance thus constitutes an important component of supportive care in pediatric oncology. The Symptom Monitoring and Systematic Assessment and Reporting System in Young Survivors (SyMon-SAYS) system will administer, score, interpret, and display the results of symptom assessments captured weekly using patient-reported outcomes presented via the electronic health record (EHR) portal between clinic visits in oncology ambulatory settings, when patients are likely to be more symptomatic. This study is testing a digital system for routine symptom surveillance that includes EHR-based reports to clinicians and alerts for severe symptoms. Objective: In this randomized trial, we are examining the effects of the SyMon-SAYS system on perceived barriers to symptom management, self-efficacy, and symptom severity. Better self-management and timely clinical intervention to address symptoms promote adherence to treatment plans, strengthen child and parent self-efficacy, improve interactions between children, parents, and their clinical providers, and optimize clinical outcomes. Methods: The SyMon-SAYS system is integrated into the EHR to streamline the presentation of symptom scores and delivery of alerts for severe symptoms to clinicians using EHR (Epic) messaging functionalities. Children (aged 8 to 17 years) complete the weekly symptom assessment and review the symptom report by logging into the patient portal (Epic MyChart). This single-institution waitlist randomized controlled trial is recruiting 200 children (aged 8-17 years) with cancer and their parents, guardians, or caregivers. Participating dyads are randomly assigned to receive the intervention over 16 weeks (Group A: 16-week SyMon-SAYS intervention; Group B: 8-week usual care and then an 8-week SyMon-SAYS intervention). Analyses will (1) evaluate the efficacy of SyMon-SAYS at week 8 and the maintenance of those effects at week 16; (2) evaluate factors associated with those efficacy outcomes, including contextual factors, adherence to the SyMon-SAYS intervention, demographic characteristics, and clinical factors; and (3) evaluate predictors of adherence to the SyMon-SAYS intervention and preference of SyMon-SAYS versus usual care. Results: Data collection is currently in progress. We hypothesize that at 8 weeks, those receiving the SyMon-SAYS intervention will report decreased parent-perceived barriers to managing their children's symptoms, increased parent and child self-efficacy, decreased child symptom burden, and ultimately better child health-related quality of life, compared to waitlist controls. Feasibility, acceptability, and engagement from the perspectives of the children with cancer, their parents, and their clinicians will be examined using mixed methods. Conclusions: We anticipate that this system will facilitate prompt identification of problematic symptoms. Additionally, we hypothesize that with the availability of graphical symptom reports over time, and timely provider responses, children or parents will become better informed and take an active role in managing their symptoms, which will further improve clinical outcomes. Trial Registration: ClinicalTrials.gov NCT04789720; https://clinicaltrials.gov/study/NCT04789720 International Registered Report Identifier (IRRID): DERR1-10.2196/50993 ",
doi="10.2196/50993",
url="https://www.researchprotocols.org/2023/1/e50993",
url="http://www.ncbi.nlm.nih.gov/pubmed/37682593"
}


@Article{info:doi/10.2196/42044,
author="Kanodia, Sweekrity
and Thalabard, Christophe Jean
and Lhoste, Kevin",
title="Categorization and Analysis of Primary Care mHealth Apps Related to Breast Health and Breast Cancer: Systematic Search in App Stores and Content Analysis",
journal="JMIR Cancer",
year="2023",
month="Sep",
day="7",
volume="9",
pages="e42044",
keywords="breast cancer",
keywords="breast self-examination",
keywords="BSE",
keywords="primary care",
keywords="mobile applications",
keywords="mobile apps",
keywords="breast health",
keywords="early diagnosis",
abstract="Background: Breast cancer is the most common cause of cancer mortality among women globally. The use of mobile health tools such as apps and games is increasing rapidly, even in low- and middle-income countries, to promote early diagnosis and to manage care and support of survivors and patients. Objective: The primary objective of this review was to categorize selected mobile health apps related to breast health and prevention of breast cancer, based on features such as breast self-examination (BSE) training and reminders, and to analyze their current dissemination. An ancillary objective was to highlight the limitations of existing tools and suggest ways to improve them. Methods: We defined strict inclusion and exclusion criteria, which required apps to have titles or descriptions that suggest that they were designed for the general public, and not for patients with breast cancer or health workers. Apps that focused on awareness and primary care via self-check were included, while those that focused on topics such as alternative treatments and medical news were excluded. Apps that were not specifically related to breast cancer were also excluded. Apps (in any language) that appeared in the search with keywords were included. The database consisted of apps from AppAgg and Google Play Store. Only 85 apps met the inclusion criteria. Selected apps were categorized on the basis of their alleged interactive features. Descriptive statistics were obtained, and available language options, the number of downloads, and the cost of the apps were the main parameters reviewed. Results: The selected apps were categorized on the basis of the following features: education, BSE training, reminders, and recording. Of the 85 selected apps, 72 (84.7\%) focused on disseminating breast cancer information. BSE training was provided by only 47\% (n=40) of the apps, and very few had reminder (n=26, 30.5\%) and recording (n=11, 12.9\%) features. The median number of downloads was the highest for apps with recording features (>1000 downloads) than those with education, BSE training, reminder, and recording features (>5000 downloads). Most of these apps (n=74, 83.5\%) were monolingual, and around 80.3\% (n=49) of these apps were in English. Almost all the apps on Google Play Store were free of charge. Conclusions: Although there exist several apps on Google Play Store to promote awareness about breast health and cancer, the usefulness of most of them appears debatable. To provide a complete breast health package to the users, such apps must have all of the following features: reminders or notifications and symptom recording and tracking. There is still an urgent need to scientifically evaluate existing apps in the target populations in order to make them more functional and user-friendly. ",
doi="10.2196/42044",
url="https://cancer.jmir.org/2023/1/e42044",
url="http://www.ncbi.nlm.nih.gov/pubmed/37676704"
}


@Article{info:doi/10.2196/47187,
author="Ester, Manuel
and Wagoner, W. Chad
and Dreger, Julianna
and Chen, Guanmin
and McDonough, H. Meghan
and McNeely, L. Margaret
and Culos-Reed, Nicole S.",
title="Effectiveness of a Self-Monitoring App in Supporting Physical Activity Maintenance Among Rural Canadians With Cancer After an Exercise Oncology Program: Cluster Randomized Controlled Trial",
journal="JMIR Cancer",
year="2023",
month="Sep",
day="7",
volume="9",
pages="e47187",
keywords="eHealth",
keywords="mHealth",
keywords="mobile health",
keywords="mobile apps",
keywords="self-monitoring",
keywords="cancer",
keywords="oncology",
keywords="physical activity",
keywords="exercise",
keywords="randomized controlled trial",
keywords="intervention",
keywords="mobile phone",
abstract="Background: Despite the benefits of physical activity (PA) for individuals with cancer, most remain insufficiently active. Exercise oncology interventions can improve PA levels. Individuals struggle to maintain PA levels after interventions because of persistent psychological and environmental PA barriers. Health technology (eHealth) may address some PA barriers and deliver effective, scalable PA interventions in oncology, yet its effectiveness for changing PA levels remains mixed. Using eHealth to support PA maintenance among rural populations with cancer, who may need greater PA support given lower PA levels and worse health outcomes, remains under-studied. Objective: This study examined the effectiveness of an app-based self-monitoring intervention in supporting PA maintenance among rural populations with cancer after a supervised web-based exercise oncology program. Methods: This 2-arm, cluster randomized controlled trial was embedded within the Exercise for Cancer to Enhance Living Well (EXCEL) effectiveness-implementation study. Upon consent, participants were randomized 1:1 by EXCEL class clusters to the intervention (24 weeks of app-based PA self-monitoring) or waitlist control (app access after 24 weeks). Both groups completed a 12-week supervised web-based exercise oncology program followed by a 12-week self-directed PA maintenance period. Baseline demographics, eHealth literacy, and patient-reported outcomes were compared using chi-square and 2-tailed t tests. App use was measured throughout the intervention. The primary outcome---self-reported moderate-to-vigorous PA (MVPA) minutes---and secondary outcomes---objective MVPA minutes and steps and app usability ratings---were collected at baseline, 12 weeks, and 24 weeks. Intervention effects on self-report MVPA maintenance were assessed via linear mixed modeling, with secondary outcomes explored descriptively. Results: Of the 359 eligible EXCEL participants, 205 (57.1\%) consented, 199 (55.4\%; intervention: 106/199, 53.3\%; control: 93/199, 46.7\%) started the study, and 183 (51\%; intervention: 100/183, 54.6\%; control: 83/183, 45.4\%) and 141 (39.3\%; intervention: 69/141, 48.9\%; control: 72/141, 51.1\%) completed 12- and 24-week measures, respectively. Mean age was 57.3 (SD 11.5) years. Most participants were female (174/199, 87.4\%), White (163/199, 81.9\%), and diagnosed with breast cancer (108/199, 54.3\%). Median baseline self-report weekly MVPA minutes were 60.0 (IQR 0-180) and 40.0 (IQR 0-135) for the intervention and waitlist control groups, respectively (P=.74). Median app use duration was 10.3 (IQR 1.3-23.9) weeks, with 9.6 (IQR 4.4-17.8) self-monitoring entries/week. Both groups increased their weekly MVPA minutes significantly at 12 weeks (P<.001) and maintained the increases at 24 weeks (P<.001), relative to baseline, with no between-group differences (P=.87). The intervention group had significantly higher step counts for 7 of the 12 weeks during the PA maintenance period (P=.048 to <.001). Conclusions: The app-based self-monitoring intervention did not improve MVPA maintenance but may have contributed to increased step counts during the PA maintenance period. More work is needed to realize the full potential of eHealth in exercise oncology. Trial Registration: ClinicalTrials.gov NCT04790578; https://clinicaltrials.gov/study/NCT04790578 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2021.106474 ",
doi="10.2196/47187",
url="https://cancer.jmir.org/2023/1/e47187",
url="http://www.ncbi.nlm.nih.gov/pubmed/37676714"
}


@Article{info:doi/10.2196/44320,
author="Wennerberg, Camilla
and Hellstr{\"o}m, Amanda
and Schildmeijer, Kristina
and Ekstedt, Mirjam",
title="Effects of Web-Based and Mobile Self-Care Support in Addition to Standard Care in Patients After Radical Prostatectomy: Randomized Controlled Trial",
journal="JMIR Cancer",
year="2023",
month="Sep",
day="6",
volume="9",
pages="e44320",
keywords="eHealth",
keywords="linear mixed model",
keywords="prostatic neoplasms",
keywords="radical prostatectomy",
keywords="randomized controlled trial",
keywords="self-care",
keywords="telemedicine",
keywords="mobile health",
keywords="mHealth",
keywords="prostate cancer",
keywords="sexual dysfunction",
keywords="urinary incontinence",
keywords="web-based",
keywords="pelvic exercise",
keywords="physical activity",
abstract="Background: Prostate cancer is a common form of cancer that is often treated with radical prostatectomy, which can leave patients with urinary incontinence and sexual dysfunction. Self-care (pelvic floor muscle exercises and physical activity) is recommended to reduce the side effects. As more and more men are living in the aftermath of treatment, effective rehabilitation support is warranted. Digital self-care support has the potential to improve patient outcomes, but it has rarely been evaluated longitudinally in randomized controlled trials. Therefore, we developed and evaluated the effects of digital self-care support (electronic Patient Activation in Treatment at Home [ePATH]) on prostate-specific symptoms. Objective: This study aimed to investigate the effects of web-based and mobile self-care support on urinary continence, sexual function, and self-care, compared with standard care, at 1, 3, 6, and 12 months after radical prostatectomy. Methods: A multicenter randomized controlled trial with 2 study arms was conducted, with the longitudinal effects of additional digital self-care support (ePATH) compared with those of standard care alone. ePATH was designed based on the self-determination theory to strengthen patients' activation in self-care through nurse-assisted individualized modules. Men planned for radical prostatectomy at 3 county hospitals in southern Sweden were included offline and randomly assigned to the intervention or control group. The effects of ePATH were evaluated for 1 year after surgery using self-assessed questionnaires. Linear mixed models and ordinal regression analyses were performed. Results: This study included 170 men (85 in each group) from January 2018 to December 2019. The participants in the intervention and control groups did not differ in their demographic characteristics. In the intervention group, 64\% (53/83) of the participants used ePATH, but the use declined over time. The linear mixed model showed no substantial differences between the groups in urinary continence ($\beta$=?5.60; P=.09; 95\% CI ?12.15 to ?0.96) or sexual function ($\beta$=?.12; P=.97; 95\% CI ?7.05 to ?6.81). Participants in the intervention and control groups did not differ in physical activity (odds ratio 1.16, 95\% CI 0.71-1.89; P=.57) or pelvic floor muscle exercises (odds ratio 1.51, 95\% CI 0.86-2.66; P=.15). Conclusions: ePATH did not affect postoperative side effects or self-care but reflected how this support may work in typical clinical conditions. To complement standard rehabilitation, digital self-care support must be adapted to the context and individual preferences for use and effect. Trial Registration: ISRCTN Registry ISRCTN18055968; https://www.isrctn.com/ISRCTN18055968 International Registered Report Identifier (IRRID): RR2-10.2196/11625 ",
doi="10.2196/44320",
url="https://cancer.jmir.org/2023/1/e44320",
url="http://www.ncbi.nlm.nih.gov/pubmed/37672332"
}


@Article{info:doi/10.2196/41999,
author="Qiu, Hang
and Wang, Liya
and Zhou, Li
and Wang, Xiaodong",
title="Comorbidity Patterns in Patients Newly Diagnosed With Colorectal Cancer: Network-Based Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Sep",
day="5",
volume="9",
pages="e41999",
keywords="colorectal cancer",
keywords="comorbidity patterns",
keywords="prevalence",
keywords="health status disparities",
keywords="network analysis",
keywords="routinely collected health data",
abstract="Background: Patients with colorectal cancer (CRC) often present with multiple comorbidities, and many of these can affect treatment and survival. However, previous comorbidity studies primarily focused on diseases in commonly used comorbidity indices. The comorbid status of CRC patients with respect to the entire spectrum of chronic diseases has not yet been investigated. Objective: This study aimed to systematically analyze all chronic diagnoses and diseases co-occurring, using a network-based approach and large-scale administrative health data, and provide a complete picture of the comorbidity pattern in patients newly diagnosed with CRC from southwest China. Methods: In this retrospective observational study, the hospital discharge records of 678 hospitals from 2015 to 2020 in Sichuan Province, China were used to identify new CRC cases in 2020 and their history of diseases. We examined all chronic diagnoses using ICD-10 (International Classification of Diseases, 10th Revision) codes at 3 digits and focused on chronic diseases with >1\% prevalence in at least one subgroup (1-sided test, P<.025), which resulted in a total of 66 chronic diseases. Phenotypic comorbidity networks were constructed across all CRC patients and different subgroups by sex, age (18-59, 60-69, 70-79, and ?80 years), area (urban and rural), and cancer site (colon and rectum), with comorbidity as a node and linkages representing significant correlations between multiple comorbidities. Results: A total of 29,610 new CRC cases occurred in Sichuan, China in 2020. The mean patient age at diagnosis was 65.6 (SD 12.9) years, and 75.5\% (22,369/29,610) had at least one comorbidity. The most prevalent comorbidities were hypertension (8581/29,610, 29.0\%; 95\% CI 28.5\%-29.5\%), hyperplasia of the prostate (3816/17,426, 21.9\%; 95\% CI 21.3\%-22.5\%), and chronic obstructive pulmonary disease (COPD; 4199/29,610, 14.2\%; 95\% CI 13.8\%-14.6\%). The prevalence of single comorbidities was different in each subgroup in most cases. Comorbidities were closely associated, with disorders of lipoprotein metabolism and hyperplasia of the prostate mediating correlations between other comorbidities. Males and females shared 58.3\% (141/242) of disease pairs, whereas male-female disparities occurred primarily in diseases coexisting with COPD, cerebrovascular diseases, atherosclerosis, heart failure, or renal failure among males and with osteoporosis or gonarthrosis among females. Urban patients generally had more comorbidities with higher prevalence and more complex disease coexistence relationships, whereas rural patients were more likely to have co-existing severe diseases, such as heart failure comorbid with the sequelae of cerebrovascular disease or COPD. Conclusions: Male-female and urban-rural disparities in the prevalence of single comorbidities and their complex coexistence relationships in new CRC cases were not due to simple coincidence. The results reflect clinical practice in CRC patients and emphasize the importance of measuring comorbidity patterns in terms of individual and coexisting diseases in order to better understand comorbidity patterns. ",
doi="10.2196/41999",
url="https://publichealth.jmir.org/2023/1/e41999",
url="http://www.ncbi.nlm.nih.gov/pubmed/37669093"
}


@Article{info:doi/10.2196/45547,
author="Bae, Kideog
and Jeon, Seok Young
and Hwangbo, Yul
and Yoo, Woo Chong
and Han, Nayoung
and Feng, Mengling",
title="Data-Efficient Computational Pathology Platform for Faster and Cheaper Breast Cancer Subtype Identifications: Development of a Deep Learning Model",
journal="JMIR Cancer",
year="2023",
month="Sep",
day="5",
volume="9",
pages="e45547",
keywords="deep learning",
keywords="self-supervised learning",
keywords="immunohistochemical staining",
keywords="machine learning",
keywords="histology",
keywords="pathology",
keywords="computation",
keywords="predict",
keywords="diagnosis",
keywords="diagnose",
keywords="carcinoma",
keywords="cancer",
keywords="oncology",
keywords="breast cancer",
abstract="Background: Breast cancer subtyping is a crucial step in determining therapeutic options, but the molecular examination based on immunohistochemical staining is expensive and time-consuming. Deep learning opens up the possibility to predict the subtypes based on the morphological information from hematoxylin and eosin staining, a much cheaper and faster alternative. However, training the predictive model conventionally requires a large number of histology images, which is challenging to collect by a single institute. Objective: We aimed to develop a data-efficient computational pathology platform, 3DHistoNet, which is capable of learning from z-stacked histology images to accurately predict breast cancer subtypes with a small sample size. Methods: We retrospectively examined 401 cases of patients with primary breast carcinoma diagnosed between 2018 and 2020 at the Department of Pathology, National Cancer Center, South Korea. Pathology slides of the patients with breast carcinoma were prepared according to the standard protocols. Age, gender, histologic grade, hormone receptor (estrogen receptor [ER], progesterone receptor [PR], and androgen receptor [AR]) status, erb-B2 receptor tyrosine kinase 2 (HER2) status, and Ki-67 index were evaluated by reviewing medical charts and pathological records. Results: The area under the receiver operating characteristic curve and decision curve were analyzed to evaluate the performance of our 3DHistoNet platform for predicting the ER, PR, AR, HER2, and Ki67 subtype biomarkers with 5-fold cross-validation. We demonstrated that 3DHistoNet can predict all clinically important biomarkers (ER, PR, AR, HER2, and Ki67) with performance exceeding the conventional multiple instance learning models by a considerable margin (area under the receiver operating characteristic curve: 0.75-0.91 vs 0.67-0.8). We further showed that our z-stack histology scanning method can make up for insufficient training data sets without any additional cost incurred. Finally, 3DHistoNet offered an additional capability to generate attention maps that reveal correlations between Ki67 and histomorphological features, which renders the hematoxylin and eosin image in higher fidelity to the pathologist. Conclusions: Our stand-alone, data-efficient pathology platform that can both generate z-stacked images and predict key biomarkers is an appealing tool for breast cancer diagnosis. Its development would encourage morphology-based diagnosis, which is faster, cheaper, and less error-prone compared to the protein quantification method based on immunohistochemical staining. ",
doi="10.2196/45547",
url="https://cancer.jmir.org/2023/1/e45547",
url="http://www.ncbi.nlm.nih.gov/pubmed/37669090"
}


@Article{info:doi/10.2196/46571,
author="Siglen, Elen
and Vetti, H{\o}berg Hildegunn
and Augestad, Mirjam
and Steen, M. Vidar
and Lunde, {\AA}shild
and Bjorvatn, Cathrine",
title="Evaluation of the Rosa Chatbot Providing Genetic Information to Patients at Risk of Hereditary Breast and Ovarian Cancer: Qualitative Interview Study",
journal="J Med Internet Res",
year="2023",
month="Sep",
day="1",
volume="25",
pages="e46571",
keywords="chatbot",
keywords="chatbots",
keywords="genetic",
keywords="trust",
keywords="acceptability",
keywords="perception",
keywords="perceived",
keywords="genetic counseling",
keywords="hybrid health care",
keywords="digital health tool",
keywords="digital information tool",
keywords="digital health technology",
keywords="virtual assistant",
keywords="hereditary breast and ovarian cancer",
keywords="hereditary",
keywords="genetic testing",
keywords="technology",
keywords="genetic clinic",
keywords="digital tool",
keywords="ovarian cancer",
keywords="breast cancer",
keywords="information retrieval",
keywords="women's health",
keywords="breast",
keywords="ovarian",
keywords="cancer",
keywords="oncology",
keywords="mobile phone",
abstract="Background: Genetic testing has become an integrated part of health care for patients with breast or ovarian cancer, and the increasing demand for genetic testing is accompanied by an increasing need for easy access to reliable genetic information for patients. Therefore, we developed a chatbot app (Rosa) that is able to perform humanlike digital conversations about genetic BRCA testing. Objective: Before implementing this new information service in daily clinical practice, we wanted to explore 2 aspects of chatbot use: the perceived utility and trust in chatbot technology among healthy patients at risk of hereditary cancer and how interaction with a chatbot regarding sensitive information about hereditary cancer influences patients. Methods: Overall, 175 healthy individuals at risk of hereditary breast and ovarian cancer were invited to test the chatbot, Rosa, before and after genetic counseling. To secure a varied sample, participants were recruited from all cancer genetic clinics in Norway, and the selection was based on age, gender, and risk of having a BRCA pathogenic variant. Among the 34.9\% (61/175) of participants who consented for individual interview, a selected subgroup (16/61, 26\%) shared their experience through in-depth interviews via video. The semistructured interviews covered the following topics: usability, perceived usefulness, trust in the information received via the chatbot, how Rosa influenced the user, and thoughts about future use of digital tools in health care. The transcripts were analyzed using the stepwise-deductive inductive approach. Results: The overall finding was that the chatbot was very welcomed by the participants. They appreciated the 24/7 availability wherever they were and the possibility to use it to prepare for genetic counseling and to repeat and ask questions about what had been said afterward. As Rosa was created by health care professionals, they also valued the information they received as being medically correct. Rosa was referred to as being better than Google because it provided specific and reliable answers to their questions. The findings were summed up in 3 concepts: ``Anytime, anywhere''; ``In addition, not instead''; and ``Trustworthy and true.'' All participants (16/16) denied increased worry after reading about genetic testing and hereditary breast and ovarian cancer in Rosa. Conclusions: Our results indicate that a genetic information chatbot has the potential to contribute to easy access to uniform information for patients at risk of hereditary breast and ovarian cancer, regardless of geographical location. The 24/7 availability of quality-assured information, tailored to the specific situation, had a reassuring effect on our participants. It was consistent across concepts that Rosa was a tool for preparation and repetition; however, none of the participants (0/16) supported that Rosa could replace genetic counseling if hereditary cancer was confirmed. This indicates that a chatbot can be a well-suited digital companion to genetic counseling. ",
doi="10.2196/46571",
url="https://www.jmir.org/2023/1/e46571",
url="http://www.ncbi.nlm.nih.gov/pubmed/37656502"
}


@Article{info:doi/10.2196/44612,
author="Ni, Chen-Xu
and Lu, Wen-Jie
and Ni, Min
and Huang, Fang
and Li, Dong-Jie
and Shen, Fu-Ming",
title="Advanced Messaging Intervention for Medication Adherence and Clinical Outcomes Among Patients With Cancer: Randomized Controlled Trial",
journal="JMIR Cancer",
year="2023",
month="Aug",
day="31",
volume="9",
pages="e44612",
keywords="5G messaging",
keywords="fifth-generation",
keywords="medication adherence",
keywords="patients with cancer",
keywords="clinical pharmacists",
keywords="randomized controlled trial",
abstract="Background: Medication adherence is crucial for improving clinical outcomes in the treatment of patients with cancer. The lack of adherence and adverse drug reactions can reduce the effectiveness of cancer therapy including the quality of life. The commonly used intervention methods for medication adherence continue to evolve, and the age of fifth-generation (5G) messaging has arrived. Objective: In this study, we conducted a prospective, pilot randomized controlled trial to evaluate the effect of 5G messaging on medication adherence and clinical outcomes among patients with cancer in China. Methods: The research population was patients with nonsmall cell lung cancer undergoing pemetrexed chemotherapy who require regular folic acid (FA) and vitamin B12 supplements. The intervention and control groups were assigned to 5G messaging and second-generation (2G) messaging, respectively. The patients' medication adherence and quality of life were assessed at baseline and 1-month and 3-month time points. Moreover, the chemotherapy-related hematologic or nonhematologic toxicities, as well as the serum levels of FA and vitamin B12, were measured. Results: Of the 567 patients assessed for eligibility between January and May 2021, a total of 154 (27.2\%) patients were included. Overall, 80 were randomized to the control group and 74 to the intervention group. The odds of adherence in the 5G messaging intervention group were significantly higher than the control group at the 1-month (62/69, 90\% vs 56/74, 76\%; adjusted odds ratio 2.67, 95\% CI 1.02-7.71) and 3-month (50/60, 83\% vs 48/64, 75\%; adjusted odds ratio 2.36, 95\% CI 1.00-5.23) time points. Correspondingly, the FA and vitamin B12 serum levels of patients in the 5G messaging group were higher than those of the control group. Regarding hematologic toxicities, only the incidence of leukopenia in the intervention group was lower than that in the control group (25/80, 31\% in the control group vs 12/74, 16\% in the intervention group; P=.04). There were no differences in nonhematologic toxicities and quality of life between the 2 groups. Conclusions: In summary, we conclude that compared with conventional 2G text-based messaging, a 5G messaging intervention can better improve medication adherence and clinical outcome among patients with cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200058188; https://www.chictr.org.cn/showproj.html?proj=164489 ",
doi="10.2196/44612",
url="https://cancer.jmir.org/2023/1/e44612",
url="http://www.ncbi.nlm.nih.gov/pubmed/37651170"
}


@Article{info:doi/10.2196/38515,
author="Meinlschmidt, Gunther
and Grossert, Astrid
and Meffert, Cornelia
and Roemmel, Noa
and Hess, Viviane
and Rochlitz, Christoph
and Pless, Miklos
and Hunziker, Sabina
and W{\"o}ssmer, Brigitta
and Geuter, Ulfried
and Schaefert, Rainer",
title="Smartphone-Based Psychotherapeutic Interventions in Blended Care of Cancer Survivors: Nested Randomized Clinical Trial",
journal="JMIR Cancer",
year="2023",
month="Aug",
day="28",
volume="9",
pages="e38515",
keywords="digital therapeutics",
keywords="ecological momentary assessment (EMA)",
keywords="ecological momentary intervention (EMI)",
keywords="internet- and mobile-based intervention",
keywords="microintervention",
keywords="neoplasm",
keywords="smartphone-based intervention",
keywords="postcancer treatment",
keywords="body psychotherapy",
keywords="mobile phone",
abstract="Background: Cancer is related to not only physical but also mental suffering. Notably, body image disturbances are highly relevant to cancer-related changes often persisting beyond recovery from cancer. Scalable and low-barrier interventions that can be blended with face-to-face psychotherapy for cancer survivors are highly warranted. Objective: The aim of the study is to investigate whether smartphone-based bodily interventions are more effective to improve the mood of patients with cancer than smartphone-based fairy tale interventions (control intervention). Methods: We recruited patients with cancer in 2 Swiss hospitals and conducted daily, fully automated smartphone-based interventions 6 times a week for 5 consecutive weeks, blended with weekly face-to-face group body psychotherapy. We applied 2 types of smartphone-based interventions using a within-subject design, randomly assigning patients daily to either bodily interventions or fairy tales. Each intervention type was presented 3 times a week. For this secondary analysis, 3-level mixed models were estimated with mood assessed by the 3 Multidimensional Mood Questionnaire subscales for good-bad mood, wakefulness, and calmness as key indicators. In addition, the effects on experience of presence, vitality, and burden assessed with visual analog scales were investigated. Results: Based on the data from s=732 interventions performed by 36 participants, good-bad mood improved ($\beta$=.27; 95\% CI 0.062-0.483), and participants became calmer ($\beta$=.98; 95\% CI 0.740-1.211) following smartphone-based interventions. Wakefulness did not significantly change from pre- to postsmartphone--based intervention ($\beta$=.17; 95\% CI --0.081 to 0.412). This was true for both intervention types. There was no interaction effect of intervention type with change in good-bad mood ($\beta$=--.01; 95\% CI --0.439 to 0.417), calmness ($\beta$=.22; 95\% CI --0.228 to 0.728), or wakefulness ($\beta$=.14; 95\% CI --0.354 to 0.644). Experience of presence ($\beta$=.34; 95\% CI 0.271-0.417) and vitality ($\beta$=.35; 95\% CI 0.268-0.426) increased from pre- to postsmartphone--based intervention, while experience of burden decreased ($\beta$=--0.40; 95\% CI --0.481 to 0.311). Again, these effects were present for both intervention types. There were no significant interaction effects of intervention type with pre- to postintervention changes in experience of presence ($\beta$=.14; 95\% CI --0.104 to 0.384), experience of vitality ($\beta$=.06; 95\% CI --0.152 to 0.265), and experience of burden ($\beta$=--.16; 95\% CI --0.358 to 0.017). Conclusions: Our results suggest that both smartphone-based audio-guided bodily interventions and fairy tales have the potential to improve the mood of cancer survivors. Trial Registration: ClinicalTrials.gov NCT03707548; https://clinicaltrials.gov/study/NCT03707548 International Registered Report Identifier (IRRID): RR2-10.1186/s40359-019-0357-1 ",
doi="10.2196/38515",
url="https://cancer.jmir.org/2023/1/e38515",
url="http://www.ncbi.nlm.nih.gov/pubmed/37639296"
}


@Article{info:doi/10.2196/45212,
author="Kang, Danbee
and Kim, Hyunsoo
and Cho, Juhee
and Kim, Zero
and Chung, Myungjin
and Lee, Eon Jeong
and Nam, Jin Seok
and Kim, Won Seok
and Yu, Jonghan
and Chae, Joo Byung
and Ryu, Min Jai
and Lee, Kyung Se",
title="Prediction Model for Postoperative Quality of Life Among Breast Cancer Survivors Along the Survivorship Trajectory From Pretreatment to 5 Years: Machine Learning--Based Analysis",
journal="JMIR Public Health Surveill",
year="2023",
month="Aug",
day="24",
volume="9",
pages="e45212",
keywords="breast cancer survivor",
keywords="quality of life",
keywords="machine learning",
keywords="trajectory",
keywords="predict",
keywords="develop",
keywords="breast cancer",
keywords="survivor",
keywords="cancer",
keywords="oncology",
keywords="algorithm",
keywords="model",
keywords="QoL",
abstract="Background: Breast cancer is the most common cancer and the most common cause of cancer death in women. Although survival rates have improved, unmet psychosocial needs remain challenging because the quality of life (QoL) and QoL-related factors change over time. In addition, traditional statistical models have limitations in identifying factors associated with QoL over time, particularly concerning the physical, psychological, economic, spiritual, and social dimensions. Objective: This study aimed to identify patient-centered factors associated with QoL among patients with breast cancer using a machine learning (ML) algorithm to analyze data collected along different survivorship trajectories. Methods: The study used 2 data sets. The first data set was the cross-sectional survey data from the Breast Cancer Information Grand Round for Survivorship (BIG-S) study, which recruited consecutive breast cancer survivors who visited the outpatient breast cancer clinic at the Samsung Medical Center in Seoul, Korea, between 2018 and 2019. The second data set was the longitudinal cohort data from the Beauty Education for Distressed Breast Cancer (BEST) cohort study, which was conducted at 2 university-based cancer hospitals in Seoul, Korea, between 2011 and 2016. QoL was measured using European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 questionnaire. Feature importance was interpreted using Shapley Additive Explanations (SHAP). The final model was selected based on the highest mean area under the receiver operating characteristic curve (AUC). The analyses were performed using the Python 3.7 programming environment (Python Software Foundation). Results: The study included 6265 breast cancer survivors in the training data set and 432 patients in the validation set. The mean age was 50.6 (SD 8.66) years and 46.8\% (n=2004) had stage 1 cancer. In the training data set, 48.3\% (n=3026) of survivors had poor QoL. The study developed ML models for QoL prediction based on 6 algorithms. Performance was good for all survival trajectories: overall (AUC 0.823), baseline (AUC 0.835), within 1 year (AUC 0.860), between 2 and 3 years (AUC 0.808), between 3 and 4 years (AUC 0.820), and between 4 and 5 years (AUC 0.826). Emotional and physical functions were the most important features before surgery and within 1 year after surgery, respectively. Fatigue was the most important feature between 1 and 4 years. Despite the survival period, hopefulness was the most influential feature on QoL. External validation of the models showed good performance with AUCs between 0.770 and 0.862. Conclusions: The study identified important factors associated with QoL among breast cancer survivors across different survival trajectories. Understanding the changing trends of these factors could help to intervene more precisely and timely, and potentially prevent or alleviate QoL-related issues for patients. The good performance of our ML models in both training and external validation sets suggests the potential use of this approach in identifying patient-centered factors and improving survivorship care. ",
doi="10.2196/45212",
url="https://publichealth.jmir.org/2023/1/e45212",
url="http://www.ncbi.nlm.nih.gov/pubmed/37309655"
}


@Article{info:doi/10.2196/44707,
author="Luetke Lanfer, Hanna
and Reifegerste, Doreen
and Berg, Annika
and Memenga, Paula
and Baumann, Eva
and Weber, Winja
and Geulen, Julia
and M{\"u}ller, Anne
and Hahne, Andrea
and Weg-Remers, Susanne",
title="Understanding Trust Determinants in a Live Chat Service on Familial Cancer: Qualitative Triangulation Study With Focus Groups and Interviews in Germany",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="23",
volume="25",
pages="e44707",
keywords="trust",
keywords="live chat",
keywords="web-based health seeking",
keywords="qualitative research",
keywords="cancer",
abstract="Background: In dealing with familial cancer risk, seeking web-based health information can be a coping strategy for different stakeholder groups (ie, patients, relatives, and those suspecting an elevated familial cancer risk). In the vast digital landscape marked by a varied quality of web-based information and evolving technologies, trust emerges as a pivotal factor, guiding the process of health information seeking and interacting with digital health services. This trust formation in health information can be conceptualized as context dependent and multidimensional, involving 3 key dimensions: information seeker (trustor), information provider (trustee), and medium or platform (application). Owing to the rapid changes in the digital context, it is critical to understand how seekers form trust in new services, given the interplay among these different dimensions. An example of such a new service is a live chat operated by physicians for the general public with personalized cancer-related information and a focus on familial cancer risk. Objective: To gain a comprehensive picture of trust formation in a cancer-related live chat service, this study investigates the 3 dimensions of trust---trustor, trustee, and application---and their respective relevant characteristics based on a model of trust in web-based health information. In addition, the study aims to compare these characteristics across the 3 different stakeholder groups, with the goal to enhance the service's trustworthiness for each group. Methods: This qualitative study triangulated the different perspectives of medical cancer advisers, advisers from cancer support groups, and members of the public in interviews and focus group discussions to explore the 3 dimensions of trust---trustor, trustee, and application---and their determinants for a new live chat service for familial cancer risk to be implemented at the German Cancer Information Service. Results: The results indicate that experience with familial cancer risk is the key trustor characteristic to using, and trusting information provided by, the live chat service. The live chat might also be particularly valuable for people from minority groups who have unmet needs from physician-patient interactions. Participants highlighted trustee characteristics such as ability, benevolence, integrity, and humanness (ie, not a chatbot) as pivotal in a trustworthy cancer live chat service. Application-related characteristics, including the reputation of the institution, user-centric design, modern technology, and visual appeal, were also deemed essential. Despite the different backgrounds and sociodemographics of the 3 stakeholder groups, many overlaps were found among the 3 trust dimensions and their respective characteristics. Conclusions: Trust in a live chat for cancer information is formed by different dimensions and characteristics of trust. This study underscores the importance of understanding trust formation in digital health services and suggests potential enhancements for effective, trustworthy interactions in live chat services (eg, by providing biographies of the human medical experts to differentiate them from artificial intelligence chatbots). ",
doi="10.2196/44707",
url="https://www.jmir.org/2023/1/e44707",
url="http://www.ncbi.nlm.nih.gov/pubmed/37610815"
}


@Article{info:doi/10.2196/46017,
author="Lehmann, Jens
and de Ligt, M. Kelly
and Tipelius, Stefanie
and Giesinger, M. Johannes
and Sztankay, Monika
and Voigt, Sandra
and van de Poll-Franse, V. Lonneke
and Rumpold, Gerhard
and Weger, Roman
and Willenbacher, Ella
and Willenbacher, Wolfgang
and Holzner, Bernhard",
title="Adherence to Patient-Reported Symptom Monitoring and Subsequent Clinical Interventions for Patients With Multiple Myeloma in Outpatient Care: Longitudinal Observational Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="22",
volume="25",
pages="e46017",
keywords="neoplasms",
keywords="patient-reported outcome measures",
keywords="quality of life",
keywords="ambulatory care",
keywords="multiple myeloma",
keywords="symptom monitoring",
keywords="symptoms",
keywords="monitoring",
keywords="myeloma",
keywords="cancer patient",
keywords="therapy",
keywords="application",
keywords="treatment",
keywords="web-based assessment",
keywords="clinical care",
abstract="Background: The use of software to monitor patient-reported outcome measures (PROMs) can improve outcomes for patients with cancer receiving anticancer therapy; however, evidence from applications used in routine clinical practice is lacking. Objective: We aimed to investigate adherence to and patient perceptions of a weekly, web-based PROM symptom monitoring program in routine clinical practice for patients with Multiple Myeloma. Moreover, we aimed to capture how clinical alerts prompted by the system influenced clinical care. Methods: We conducted a single-center longitudinal observational study to evaluate patient adherence to and perceptions of the PROM monitoring software in routine practice. Patients with Multiple Myeloma remotely completed weekly treatment-specific PROMs to monitor key symptoms via a dedicated web-based platform. Alarming symptoms triggered clinical alerts in the application for the treatment team, which could initiate clinical interventions. The primary outcomes were the web-based assessment completion rate and patients' perceptions of the monitoring program, as assessed by an evaluation questionnaire. Moreover, clinical alerts prompted by the system and consequential clinical interventions were analyzed. Results: Between July 2021 and June 2022, a total of 55 patients were approached for participation; 39 patients participated (24, 61\% male, mean age 63.2, SD 9.2 years). The median assessment completion rate out of all weekly scheduled assessments was 70.3\% (IQR 41.2\%-89.6\%). Most patients (77\%) felt that the health care team was better informed about their health status due to the web-based assessments. Clinical alerts were triggered for 1758 of 14,639 (12\%) reported symptoms. For 548 of 1758 (31.2\%) alerts, the symptom had been registered before and no further action was required; for 348 of 1758 (19.9\%) alerts, telephone consultation and self-management advice sufficed. Higher-level interventions were seldom needed in response to alerts: referral to a doctor or specialist (88/1758, 5\% alerts), medication changes (22/1758, 1.3\%), scheduling additional diagnostics (9/1758, 0.5\%), or unplanned emergency visits (7/1758, 0.4\%). Most patients (55\%) reported the calls in response to alerts gave them ``quite a bit'' or ``very much'' of an added feeling of security during therapy. Conclusions: Our study shows that high adherence to regular and tailored PROM monitoring can be achieved in routine clinical care. The findings provide valuable insight into how the PROM monitoring program and the clinical alerts and resulting interventions shaped clinical practice. Trial Registration: ClinicalTrials.gov NCT05036863; https://clinicaltrials.gov/study/NCT05036863 ",
doi="10.2196/46017",
url="https://www.jmir.org/2023/1/e46017",
url="http://www.ncbi.nlm.nih.gov/pubmed/37606979"
}


@Article{info:doi/10.2196/47366,
author="Liu, Jen-Hsuan
and Shih, Chih-Yuan
and Huang, Hsien-Liang
and Peng, Jen-Kuei
and Cheng, Shao-Yi
and Tsai, Jaw-Shiun
and Lai, Feipei",
title="Evaluating the Potential of Machine Learning and Wearable Devices in End-of-Life Care in Predicting 7-Day Death Events Among Patients With Terminal Cancer: Cohort Study",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="18",
volume="25",
pages="e47366",
keywords="artificial intelligence",
keywords="end-of-life care",
keywords="machine learning",
keywords="palliative care",
keywords="survival prediction",
keywords="terminal cancer",
keywords="wearable device",
abstract="Background: An accurate prediction of mortality in end-of-life care is crucial but presents challenges. Existing prognostic tools demonstrate moderate performance in predicting survival across various time frames, primarily in in-hospital settings and single-time evaluations. However, these tools may fail to capture the individualized and diverse trajectories of patients. Limited evidence exists regarding the use of artificial intelligence (AI) and wearable devices, specifically among patients with cancer at the end of life. Objective: This study aimed to investigate the potential of using wearable devices and AI to predict death events among patients with cancer at the end of life. Our hypothesis was that continuous monitoring through smartwatches can offer valuable insights into the progression of patients at the end of life and enable the prediction of changes in their condition, which could ultimately enhance personalized care, particularly in outpatient or home care settings. Methods: This prospective study was conducted at the National Taiwan University Hospital. Patients diagnosed with cancer and receiving end-of-life care were invited to enroll in wards, outpatient clinics, and home-based care settings. Each participant was given a smartwatch to collect physiological data, including steps taken, heart rate, sleep time, and blood oxygen saturation. Clinical assessments were conducted weekly. The participants were followed until the end of life or up to 52 weeks. With these input features, we evaluated the prediction performance of several machine learning--based classifiers and a deep neural network in 7-day death events. We used area under the receiver operating characteristic curve (AUROC), F1-score, accuracy, and specificity as evaluation metrics. A Shapley additive explanations value analysis was performed to further explore the models with good performance. Results: From September 2021 to August 2022, overall, 1657 data points were collected from 40 patients with a median survival time of 34 days, with the detection of 28 death events. Among the proposed models, extreme gradient boost (XGBoost) yielded the best result, with an AUROC of 96\%, F1-score of 78.5\%, accuracy of 93\%, and specificity of 97\% on the testing set. The Shapley additive explanations value analysis identified the average heart rate as the most important feature. Other important features included steps taken, appetite, urination status, and clinical care phase. Conclusions: We demonstrated the successful prediction of patient deaths within the next 7 days using a combination of wearable devices and AI. Our findings highlight the potential of integrating AI and wearable technology into clinical end-of-life care, offering valuable insights and supporting clinical decision-making for personalized patient care. It is important to acknowledge that our study was conducted in a relatively small cohort; thus, further research is needed to validate our approach and assess its impact on clinical care. Trial Registration: ClinicalTrials.gov NCT05054907; https://classic.clinicaltrials.gov/ct2/show/NCT05054907 ",
doi="10.2196/47366",
url="https://www.jmir.org/2023/1/e47366",
url="http://www.ncbi.nlm.nih.gov/pubmed/37594793"
}


@Article{info:doi/10.2196/43345,
author="Xing, Zhaoquan
and Ji, Meng
and Shan, Yi
and Dong, Zhaogang
and Xu, Xiaofei",
title="Using the Multidimensional Health Locus of Control Scale Form C to Investigate Health Beliefs About Bladder Cancer Prevention and Treatment Among Male Patients: Cross-Sectional Study",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="16",
volume="7",
pages="e43345",
keywords="health beliefs",
keywords="Multidimensional Health Locus of Control",
keywords="Chinese translation",
keywords="bladder cancer prevention and treatment",
keywords="male patients",
keywords="latent class analysis",
abstract="Background: Bladder cancer is a leading cause of death among Chinese male populations in recent years. The health locus of control construct can mediate health status and outcomes, and it has proven helpful in predicting and explaining specific health-related behaviors. However, it has never been used to investigate health beliefs about bladder cancer prevention and treatment. Objective: This study aimed to classify male patients into different latent groups according to their beliefs about bladder cancer prevention and treatment and to identify associated factors to provide implications for the delivery of tailored education and interventions and the administration of targeted prevention and treatment. Methods: First, we designed a four-section questionnaire to solicit data: section 1---age, gender, and education; section 2---the communicative subscale of the All Aspects of Health Literacy Scale; section 3---the eHealth Literacy Scale; and section 4---health beliefs about bladder cancer prevention and treatment measured by the Multidimensional Health Locus of Control Scale Form C. We hypothesized that the participants' health beliefs about bladder cancer prevention and treatment measured in section 4 could be closely associated with information collected through sections 1 to 3. We recruited 718 Chinese male patients from Qilu Hospital of Shandong University, China, and invited them to participate in a web-based questionnaire survey. Finally, we used latent class analysis to identify subgroups of men based on their categorical responses to the items on the Multidimensional Health Locus of Control Scale Form C and ascertained factors contributing to the low self-efficacy group identified. Results: We identified 2 subgroups defined as low and moderate self-efficacy groups representing 75.8\% (544/718) and 24.2\% (174/718) of the total sample, respectively. Men in the low self-efficacy cluster (cluster 1: 544/718, 75.8\%) were less likely to believe in their own capability or doctors' advice to achieve optimal outcomes in bladder cancer prevention and treatment. Men in the moderate self-efficacy cluster (cluster 2: 174/718, 24.2\%) had distinct psychological traits. They had stronger beliefs in their own capability to manage their health with regard to bladder cancer prevention and treatment and moderate to high levels of trust in health and medical professionals and their advice to achieve better prevention and treatment outcomes. Four factors contributing to low self-efficacy were identified, including limited education (Year 6 to Year 12), aged ?44 years, limited communicative health literacy, and limited digital health literacy. Conclusions: This was the first study investigating beliefs about bladder cancer prevention and treatment among Chinese male patients. Given that bladder cancer represents a leading cause of death among Chinese male populations in recent years, the low self-efficacy cluster and associated contributing factors identified in this study can provide implications for clinical practice, health education, medical research, and health policy-making. ",
doi="10.2196/43345",
url="https://formative.jmir.org/2023/1/e43345",
url="http://www.ncbi.nlm.nih.gov/pubmed/37585255"
}


@Article{info:doi/10.2196/45693,
author="Wu, Chao-Yi
and Tibbitts, Deanne
and Beattie, Zachary
and Dodge, Hiroko
and Shannon, Jackilen
and Kaye, Jeffrey
and Winters-Stone, Kerri",
title="Using Continuous Passive Assessment Technology to Describe Health and Behavior Patterns Preceding and Following a Cancer Diagnosis in Older Adults: Proof-of-Concept Case Series Study",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="10",
volume="7",
pages="e45693",
keywords="sensor",
keywords="quality of life",
keywords="physical activity",
keywords="medication",
keywords="monitoring",
keywords="function",
keywords="mobile phone",
abstract="Background: Describing changes in health and behavior that precede and follow a sentinel health event, such as a cancer diagnosis, is challenging because of the lack of longitudinal, objective measurements that are collected frequently enough to capture varying trajectories of change leading up to and following the event. A continuous passive assessment system that continuously monitors older adults' physical activity, weight, medication-taking behavior, pain, health events, and mood could enable the identification of more specific health and behavior patterns leading up to a cancer diagnosis and whether and how patterns change thereafter. Objective: In this study, we conducted a proof-of-concept retrospective analysis, in which we identified new cancer diagnoses in older adults and compared trajectories of change in health and behaviors before and after cancer diagnosis. Methods: Participants were 10 older adults (mean age 71.8, SD 4.9 years; 3/10, 30\% female) with various self-reported cancer types from a larger prospective cohort study of older adults. A technology-agnostic assessment platform using multiple devices provided continuous data on daily physical activity via wearable sensors (actigraphy); weight via a Wi-Fi--enabled digital scale; daily medication-taking behavior using electronic Bluetooth-enabled pillboxes; and weekly pain, health events, and mood with online, self-report surveys. Results: Longitudinal linear mixed-effects models revealed significant differences in the pre- and postcancer trajectories of step counts (P<.001), step count variability (P=.004), weight (P<.001), pain severity (P<.001), hospitalization or emergency room visits (P=.03), days away from home overnight (P=.01), and the number of pillbox door openings (P<.001). Over the year preceding a cancer diagnosis, there were gradual reductions in step counts and weight and gradual increases in pain severity, step count variability, hospitalization or emergency room visits, and days away from home overnight compared with 1 year after the cancer diagnosis. Across the year after the cancer diagnosis, there was a gradual increase in the number of pillbox door openings compared with 1 year before the cancer diagnosis. There was no significant trajectory change from the pre-- to post--cancer diagnosis period in terms of low mood (P=.60) and loneliness (P=.22). Conclusions: A home-based, technology-agnostic, and multidomain assessment platform could provide a unique approach to monitoring different types of behavior and health markers in parallel before and after a life-changing health event. Continuous passive monitoring that is ecologically valid, less prone to bias, and limits participant burden could greatly enhance research that aims to improve early detection efforts, clinical care, and outcomes for people with cancer. ",
doi="10.2196/45693",
url="https://formative.jmir.org/2023/1/e45693",
url="http://www.ncbi.nlm.nih.gov/pubmed/37561574"
}


@Article{info:doi/10.2196/42153,
author="Haniuda, Yu
and Tsubaki, Michihiro
and Ito, Yoshiyasu",
title="Evaluating the Usability of Electronic Patient-Reported Outcome Apps: Comment on a Symptom Management Platform for Outpatients With Advanced Cancer",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="7",
volume="7",
pages="e42153",
keywords="electronic patient-reported outcome",
keywords="symptom management",
keywords="advanced cancer",
keywords="outpatient",
keywords="follow-up",
keywords="cancer",
doi="10.2196/42153",
url="https://formative.jmir.org/2023/1/e42153",
url="http://www.ncbi.nlm.nih.gov/pubmed/37548992"
}


@Article{info:doi/10.2196/45164,
author="Singleton, C. Anna
and Raeside, Rebecca
and Hyun, K. Karice
and Hayes, Molly
and Sherman, A. Kerry
and Elder, Elisabeth
and Redfern, Julie
and Partridge, R. Stephanie",
title="A National Health and Wellness SMS Text Message Program for Breast Cancer Survivors During COVID-19 (EMPOWER-SMS COVID-19): Mixed Methods Evaluation Using the RE-AIM Framework",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="25",
volume="25",
pages="e45164",
keywords="digital health",
keywords="telemedicine",
keywords="SMS text messaging",
keywords="breast cancer",
keywords="implementation science",
keywords="cancer survivorship",
keywords="supportive care",
keywords="public health",
keywords="COVID-19",
abstract="Background: COVID-19 lockdowns caused widespread closures of supportive care services for breast cancer survivors in Australia. In a randomized controlled trial, our team's lifestyle-focused, evidence-based SMS text message support program (EMPOWER-SMS COVID-19) was found to be acceptable and useful for breast cancer survivors, and it was ready for rapid widespread delivery. Objective: This study aims to evaluate the reach (uptake) of an adapted 3-month lifestyle-focused SMS text message program (EMPOWER-SMS COVID-19) and barriers and enablers to implementation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Methods: A mixed methods pre-post study was conducted to evaluate the EMPOWER-SMS COVID-19 program. The study evaluated the following aspects: (1) reach/representativeness, which refers to the proportion of participant enrollment (ie, number enrolled/number that visited the study website) and demographics (eg, age, sex, ethnicity, time since completing treatment, Index of Relative Socio-economic Advantage and Disadvantage [IRSAD; quintile 1, which refers to most disadvantaged areas, to quintile 5, which refers to least disadvantaged areas, and remoteness); (2) effectiveness, in which participant engagement and acceptability were evaluated using SMS text message reply data and a feedback survey (5-point Likert scale and free-text responses); (3) adoption, which corresponds to the proportion of organizations or health professionals who agreed to promote the program; (4) implementation fidelity and maintenance, which evaluated SMS text message delivery data, opt-outs, costs, and adaptations. Quantitative data were summarized using means and SDs or frequencies and percentages, while qualitative data were analyzed thematically. Results: With regard to the reach/representativeness of the program, 841/1340 (62.8\%) participants enrolled and provided electronic consent. Participants had a mean age of 58.8 (SD 9.8; range 30-87) years. According to the data collected, most participants identified as female (837/840, 99.6\%) and White (736/840, 87.6\%) and nearly half (418/841, 49.7\%) finished treatment ?18 months ago. Most resided in major cities (574/838, 68.5\%) and 30\% (251/838) in IRSAD quintile 1 or 2. In terms of effectiveness, 852 replies were received from 511 unique participants (median 1; range 1-26). The most common replies were participants stating how they heard about the program (467/852, 54.8\%) or ``thank you'' (131/852, 15.4\%). None of the replies contained urgent safety concerns. Among participants who provided feedback (449/841, 53.4\%), most ``(strongly) agreed'' the SMS text messages were easy to understand (445/448, 99.3\%), useful (373/440, 84.8\%), helped participants feel supported (388/448, 86.6\%), and motivated participants to be physically active (312/445, 70.1\%) and eat healthier (313/457, 68.5\%). Free-text responses revealed 5 factors influencing engagement: (1) feeling supported and less alone, (2) motivation and reassurance for health self-management, (3) the variety of information, (4) weblinks to information and resources, and (5) the option to save the SMS text messages. Concerning adoption, 50\% (18/36) of organizations/health professionals agreed to promote the program. With regard to implementation/maintenance, SMS text messages were delivered as planned (97.43\% [41,257/42,344] of SMS text messages were successfully delivered) with minimal opt-outs (62/838, 7.4\%) and low cost (Aus \$15.40/participant; Aus \$1=US \$0.67). No adaptations were made during the intervention period. Postintervention adaptations included adding weblinks and participant-selected customizations. Conclusions: EMPOWER-SMS COVID-19 was implemented quickly, had a broad reach, and had high engagement and acceptability among socioeconomically diverse participants. The program had high fidelity, low cost, and required minimal staff oversight, which may facilitate future implementation. However, further research is needed to evaluate barriers and enablers to adoption and implementation for health professionals and strategies for long-term maintenance. ",
doi="10.2196/45164",
url="https://www.jmir.org/2023/1/e45164",
url="http://www.ncbi.nlm.nih.gov/pubmed/37490319"
}


@Article{info:doi/10.2196/44914,
author="Howell, Doris
and Bryant Lukosius, Denise
and Avery, Jonathan
and Santaguida, Athina
and Powis, Melanie
and Papadakos, Tina
and Addario, Vincenzo
and Lovas, Mike
and Kukreti, Vishal
and Haase, Kristen
and Mayo, J. Samantha
and Papadakos, Janet
and Moradian, Saeed
and Krzyzanowska, K. Monika",
title="A Web-Based Cancer Self-Management Program (I-Can Manage) Targeting Treatment Toxicities and Health Behaviors: Human-Centered Co-design Approach and Cognitive Think-Aloud Usability Testing",
journal="JMIR Cancer",
year="2023",
month="Jul",
day="21",
volume="9",
pages="e44914",
keywords="web-based program",
keywords="self-management",
keywords="cancer treatment",
keywords="digital technology",
keywords="co-design",
keywords="usability",
abstract="Background: Patients with cancer require adequate preparation in self-management of treatment toxicities to reduce morbidity that can be achieved through well-designed digital technologies that are developed in co-design with patients and end users. Objective: We undertook a user-centered co-design process in partnership with patients and other knowledge end users to develop and iteratively test an evidence-based and theoretically informed web-based cancer self-management program (I-Can Manage). The specific study aims addressed in 2 phases were to (1) identify from the perspective of patients with cancer and clinicians the desired content, features, and functionalities for an online self-management education and support (SMES) program to enable patient self-management of treatment toxicities (phase 1); (2) develop the SMES prototype based on human-centered, health literate design principles and co-design processes; and (3) evaluate usability of the I-Can Manage prototype through user-centered testing (phase 2). Methods: We developed the I-Can Manage program using multiperspective data sources and based on humanistic and co-design principles with end users engaged through 5 phases of development. We recruited adult patients with lung, colorectal, and lymphoma cancer receiving systemic treatments from ambulatory clinics in 2 regional cancer programs for the qualitative inquiry phase. The design of the program was informed by data from qualitative interviews and focus groups, persona and journey mapping, theoretical underpinnings of social cognitive learning theory, and formalized usability testing using a cognitive think-aloud process and user satisfaction survey. A co-design team comprising key stakeholders (human design experts, patients/caregiver, clinicians, knowledge end users, and e-learning and digital design experts) was involved in the developmental process. We used a cognitive think-aloud process to test usability and participants completed the Post-Study System Usability Questionnaire (PSSUQ). Results: In the initial qualitative inquiry phase, 16 patients participated in interviews and 19 clinicians participated in interviews or focus groups and 12 key stakeholders participated in a persona journey mapping workshop to inform development of the program prototype. The I-Can Manage program integrates evidence-based information and strategies for the self-management of treatment toxicities and health-promoting behaviors in 6 e-learning modules (lay termed ``chapters''), starting with an orientation to self-management. Behavioral exercises, patient written and video stories, downloadable learning resources, and online completion of goals and action plans were integrated across chapters. Patient participants (n=5) with different cancers, gender, and age worked through the program in the human factors laboratory using a cognitive think-aloud process and all key stakeholders reviewed each chapter of the program and approved revisions. Results of the PSSUQ (mean total score: 3.75) completed following the cognitive think-aloud process (n=5) suggest patient satisfaction with the usability of I-Can Manage. Conclusions: The I-Can Manage program has the potential for activating patients in self-management of cancer and treatment toxicities but requires testing in a larger randomized controlled trial. ",
doi="10.2196/44914",
url="https://cancer.jmir.org/2023/1/e44914",
url="http://www.ncbi.nlm.nih.gov/pubmed/37477968"
}


@Article{info:doi/10.2196/45872,
author="Bujak, Joanna
and K??k, Stanis?aw
and Balawejder, Martyna
and Kociniak, Aleksandra
and Wilkus, Kinga
and Szatanek, Rafa?
and Orzeszko, Zofia
and Welanyk, Joanna
and Torbicz, Grzegorz
and J?ckowski, Mateusz
and Kucharczyk, Tomasz
and Wohadlo, ?ukasz
and Borys, Maciej
and Stadnik, Honorata
and Wysocki, Micha?
and Kayser, Magdalena
and S?omka, Ewa Marta
and Kosmowska, Anna
and Horbacka, Karolina
and Gach, Tomasz
and Markowska, Beata
and Kowalczyk, Tomasz
and Karo?, Jacek
and Karczewski, Marek
and Szura, Miros?aw
and Sanecka-Duin, Anna
and Blum, Agnieszka",
title="Creating an Innovative Artificial Intelligence--Based Technology (TCRact) for Designing and Optimizing T Cell Receptors for Use in Cancer Immunotherapies: Protocol for an Observational Trial",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="13",
volume="12",
pages="e45872",
keywords="AI",
keywords="artificial intelligence",
keywords="colorectal cancer",
keywords="HLA",
keywords="human leukocyte antigen",
keywords="immunotherapy",
keywords="neoantigen",
keywords="T cell receptors",
keywords="TCR",
abstract="Background: Cancer continues to be the leading cause of mortality in high-income countries, necessitating the development of more precise and effective treatment modalities. Immunotherapy, specifically adoptive cell transfer of T cell receptor (TCR)-engineered T cells (TCR-T therapy), has shown promise in engaging the immune system for cancer treatment. One of the biggest challenges in the development of TCR-T therapies is the proper prediction of the pairing between TCRs and peptide-human leukocyte antigen (pHLAs). Modern computational immunology, using artificial intelligence (AI)-based platforms, provides the means to optimize the speed and accuracy of TCR screening and discovery. Objective: This study proposes an observational clinical trial protocol to collect patient samples and generate a database of pHLA:TCR sequences to aid the development of an AI-based platform for efficient selection of specific TCRs. Methods: The multicenter observational study, involving 8 participating hospitals, aims to enroll patients diagnosed with stage II, III, or IV colorectal cancer adenocarcinoma. Results: Patient recruitment has recently been completed, with 100 participants enrolled. Primary tumor tissue and peripheral blood samples have been obtained, and peripheral blood mononuclear cells have been isolated and cryopreserved. Nucleic acid extraction (DNA and RNA) has been performed in 86 cases. Additionally, 57 samples underwent whole exome sequencing to determine the presence of somatic mutations and RNA sequencing for gene expression profiling. Conclusions: The results of this study may have a significant impact on the treatment of patients with colorectal cancer. The comprehensive database of pHLA:TCR sequences generated through this observational clinical trial will facilitate the development of the AI-based platform for TCR selection. The results obtained thus far demonstrate successful patient recruitment and sample collection, laying the foundation for further analysis and the development of an innovative tool to expedite and enhance TCR selection for precision cancer treatments. Trial Registration: ClinicalTrials.gov NCT04994093; https://clinicaltrials.gov/ct2/show/NCT04994093 International Registered Report Identifier (IRRID): DERR1-10.2196/45872 ",
doi="10.2196/45872",
url="https://www.researchprotocols.org/2023/1/e45872",
url="http://www.ncbi.nlm.nih.gov/pubmed/37440307"
}


@Article{info:doi/10.2196/40875,
author="Laitio, Anna-Mari
and Giunti, Guido
and Halonen, Raija",
title="Perceived Barriers and Facilitators in Using Patient-Reported Outcome Systems for Cancer Care: Systematic Mapping Study",
journal="JMIR Cancer",
year="2023",
month="Jun",
day="28",
volume="9",
pages="e40875",
keywords="patient-reported outcome system",
keywords="barriers",
keywords="facilitators",
keywords="cancer",
keywords="health care professionals",
abstract="Background: Cancer is a major global health problem. Patient-reported outcome (PRO) systems have been developed to support the treatment of patients with cancer. Although clear evidence of the benefits of the routine use of electronic patient-reported outcomes (ePROs) exists, engaging physicians in using these systems has been challenging. Objective: This study aims to identify and analyze what is currently known about health care professionals' (HCPs) perceived barriers and facilitators that exist and influence the use of ePRO systems for cancer care. Methods: We carried out a systematic mapping study by conducting searches of 3 databases (Association for Computing Machinery, PubMed, and Scopus). Eligible papers were published between 2010 and 2021, and they described HCPs' perspectives on using ePROs. The data on the included papers were extracted, a thematic meta-synthesis was performed, and 7 themes were summarized into 3 categories. Results: A total of 17 papers were included in the study. The HCPs' perceived barriers and facilitators of using ePROs can be summarized into 7 themes: clinical workflow, organization and infrastructure, value to patients, value to HCPs, digital health literacy, usability, and data visualization and perceived features. These themes can be further summarized into 3 categories: work environment, value to users, and suggested features. According to the study, ePROs should be interoperable with hospital electronic health records and adapted to the hospital workflow. HCPs should get appropriate support for their use. Additional features are needed for ePROs, and special attention should be paid to data visualization. Patients should have the option to use web-based ePROs at home and complete it at the time most valuable to the treatment. Patients' ePRO notes need attention during clinical visits, but ePRO use should not limit patient-clinician face-to-face communication. Conclusions: The study revealed that several aspects need improvement in ePROs and their operating environments. By improving these aspects, HCPs' experience with ePROs will enhance, and thus, there will be more facilitating factors for HCPs to use ePROs than those available today. More national and international knowledge about using ePROs is still needed to cover the need for information to develop them and their operating environments to meet the needs of HCPs. ",
doi="10.2196/40875",
url="https://cancer.jmir.org/2023/1/e40875",
url="http://www.ncbi.nlm.nih.gov/pubmed/37379076"
}


@Article{info:doi/10.2196/46734,
author="Mendes-Santos, Cristina
and Quinta-Gomes, Lu{\'i}sa Ana
and Pereira, Raquel
and Vasconcelos, Priscila
and Nobre, Pedro
and Couto, Joana
and Correia de Barros, Ana",
title="A Smartphone-Delivered Program (Anathema) to Promote the Sexual Health of Older Adults, Colorectal Cancer Survivors, and Stroke Survivors: Protocol for a Feasibility Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="27",
volume="12",
pages="e46734",
keywords="colorectal cancer",
keywords="internet interventions",
keywords="smartphone",
keywords="older adults",
keywords="participatory design",
keywords="randomized controlled trial",
keywords="stroke",
keywords="survivors",
abstract="Background: Despite the prevalence of sexual distress and dysfunction in older adults in general and stroke and colorectal cancer survivors in particular, access to specialized care is limited by organizational barriers and stigma, embarrassment, and discrimination. The internet allows reaching services that would otherwise be difficult or impossible to reach, and as smartphones are personal (intimate) technologies, they are a promising vehicle to close this gap. However, research focusing on smartphone-delivered sexual health promotion programs is scarce. Objective: This study aims to assess the acceptability, feasibility, and preliminary efficacy of Anathema, an 8-week, iOS/Android smartphone--delivered, individually tailored, cognitive-behavioral sexual health promotion program developed to improve relationship and sexual satisfaction, sexual functioning, sexual distress, sexual pleasure, and health-related quality of life (HRQoL) in older adults, colorectal cancer survivors, and stroke survivors compared to treatment as usual in a waiting-list control condition. Methods: Two-arm, parallel, open-label, waiting list, feasibility, pilot randomized controlled trials (RCTs) will be conducted involving older adults, stroke survivors, and colorectal cancer survivors. The primary outcomes are the acceptability, usability, and feasibility of Anathema. Sexual function, relationship and sexual satisfaction, sexual pleasure, sexual distress, anxiety, depression, and HRQoL are the secondary outcomes. This study has been reviewed and approved by the ethics committees of Instituto Portugu{\^e}s de Oncologia do Porto Francisco Gentil, Europacolon Portugal, Faculty of Psychology and Educational Sciences, University of Porto, and Sigmund Freud University (approval numbers: CES218R/021, CES19/023, and 2022/01-05b). Results: This project is funded by the European Commission through the Active and Assisted Living (AAL) Programme (reference: AAL-2020-7-133-CP) from April 2021 to December 2023. Recruitment for the pilot RCTs started on January 2023 in Portugal, Austria, and the Netherlands and is currently ongoing. As of May 2023, we randomized 49 participants in the trials. We expect to complete the RCTs in September 2023. The results on the acceptability, feasibility, and preliminary efficacy of Anathema are expected in the second semester of 2023. We expect Anathema to be highly accepted by the populations under study; to prove feasible to scale up to parent RCTs; and to be potentially efficacious in improving sexual functioning, relationship and sexual satisfaction, sexual distress, sexual pleasure, and HRQoL in older adults, colorectal cancer survivors, and stroke survivors compared to treatment as usual in a waiting-list control condition. The study results will be published in open-access venues according to COREQ (Consolidated Criteria for Reporting Qualitative Research) and CONSORT EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) guidelines. Conclusions: The study results will inform the refinement and scale-up of Anathema. Anathema's wider-scale implementation can potentially promote the sexual health of largely neglected user groups such as older adults, colorectal cancer survivors, and stroke survivors. International Registered Report Identifier (IRRID): DERR1-10.2196/46734 ",
doi="10.2196/46734",
url="https://www.researchprotocols.org/2023/1/e46734",
url="http://www.ncbi.nlm.nih.gov/pubmed/37368469"
}


@Article{info:doi/10.2196/41876,
author="Diefenbach, A. Michael
and Marziliano, Allison
and Siembida, J. Elizabeth
and Mistretta, Thomas
and Pfister, Halie
and Yacoub, Andrea
and Aibel, Kelli
and Patel, Priya
and Lapitan, Emmanuel
and Tagai, K. Erin
and Smaldone, Marc
and Miller, M. Suzanne",
title="Cancer Resource and Information Support (CRIS) for Bladder Cancer Survivors and Their Caregivers: Development and Usability Testing Study",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="22",
volume="7",
pages="e41876",
keywords="muscle invasive bladder cancer",
keywords="behavioral intervention development",
keywords="ORBIT model",
keywords="usability testing",
keywords="web-based intervention",
abstract="Background: Bladder cancer survivors and their caregivers face profound practical (eg, use of stoma appliances and care for urinary diversion methods) and psychosocial (eg, depression and anxiety) challenges after surgical treatment with cystectomy. Objective: To improve the health-related quality of life and postsurgical outcomes of both bladder cancer survivors and their caregivers, the team, in collaboration with Sourcetop, Inc (software design) and Dappersmith (graphic design), developed the Cancer Resource and Information Support (CRIS) software. The purpose of this manuscript is to report on the development and usability testing of the CRIS software. Methods: The development of the CRIS software was guided by the Obesity-Related Behavioral Intervention Trials (ORBIT) model for developing behavioral treatments for chronic diseases. The ORBIT model is unique in that it proposes a flexible and progressive process with prespecific clinically significant milestones for forward movement and returns to earlier stages for refinement, and it facilitates communication among diverse groups by using terminology from the drug development model. This paper focuses on 2 phases of the ORBIT model: phase IA: define and IB: refine. During phase IA, the study team developed solutions for the stated clinical problem---adjustment to life post cystectomy---by reviewing the literature and collecting feedback from clinicians, professional organizations, bladder cancer survivors, and their caregivers. During Phase IB, the study team focused on tailoring content in the CRIS software to the user as well as usability testing with 7 participants. Results: The finished product is CRIS, a web-based software for survivors of bladder cancer and their caregivers to serve as a health management and lifestyle resource after surgery. Overarching themes from phase IA (participant feedback) included how to use new medical equipment, tips and tricks for easier living with new medical equipment, questions about health maintenance, and questions about lifestyle modifications. To accommodate our target population, we also incorporated recommendations from the Americans with Disabilities Act for website design, such as large text size, large paragraph spacing, highly contrasting text and background colors, use of headings and labels to describe the purpose of the content, portrait orientation without the need for horizontal scrolling, multiple ways to access a web page within a set of pages, ability to navigate web pages in sequential order, and in-text links that are descriptive. Usability participants evaluated CRIS very positively, indicating that it was easy to use, the functions were well-integrated, and if available, they would use CRIS frequently. Conclusions: CRIS, developed over the course of 18 months by integrating feedback from experts, literature reviews, and usability testing, is the first web-based software developed for bladder cancer survivors and their caregivers to help them adjust to life following cystectomy. The efficacy of CRIS in improving patients' and caregivers' quality of life is currently being evaluated in a randomized controlled trial. ",
doi="10.2196/41876",
url="https://formative.jmir.org/2023/1/e41876",
url="http://www.ncbi.nlm.nih.gov/pubmed/37347533"
}


@Article{info:doi/10.2196/40113,
author="Leung, W. Yvonne
and Ng, Steve
and Duan, Lauren
and Lam, Claire
and Chan, Kenith
and Gancarz, Mathew
and Rennie, Heather
and Trachtenberg, Lianne
and Chan, P. Kai
and Adikari, Achini
and Fang, Lin
and Gratzer, David
and Hirst, Graeme
and Wong, Jiahui
and Esplen, Jane Mary",
title="Therapist Feedback and Implications on Adoption of an Artificial Intelligence--Based Co-Facilitator for Online Cancer Support Groups: Mixed Methods Single-Arm Usability Study",
journal="JMIR Cancer",
year="2023",
month="Jun",
day="9",
volume="9",
pages="e40113",
keywords="cancer",
keywords="recommender system",
keywords="natural language processing",
keywords="LIWC",
keywords="emotion analysis",
keywords="therapist adoption",
keywords="therapist attitudes",
keywords="legal implications of AI",
keywords="therapist liability",
abstract="Background: The recent onset of the COVID-19 pandemic and the social distancing requirement have created an increased demand for virtual support programs. Advances in artificial intelligence (AI) may offer novel solutions to management challenges such as the lack of emotional connections within virtual group interventions. Using typed text from online support groups, AI can help identify the potential risk of mental health concerns, alert group facilitator(s), and automatically recommend tailored resources while monitoring patient outcomes. Objective: The aim of this mixed methods, single-arm study was to evaluate the feasibility, acceptability, validity, and reliability of an AI-based co-facilitator (AICF) among CancerChatCanada therapists and participants to monitor online support group participants' distress through a real-time analysis of texts posted during the support group sessions. Specifically, AICF (1) generated participant profiles with discussion topic summaries and emotion trajectories for each session, (2) identified participant(s) at risk for increased emotional distress and alerted the therapist for follow-up, and (3) automatically suggested tailored recommendations based on participant needs. Online support group participants consisted of patients with various types of cancer, and the therapists were clinically trained social workers. Methods: Our study reports on the mixed methods evaluation of AICF, including therapists' opinions as well as quantitative measures. AICF's ability to detect distress was evaluated by the patient's real-time emoji check-in, the Linguistic Inquiry and Word Count software, and the Impact of Event Scale-Revised. Results: Although quantitative results showed only some validity of AICF's ability in detecting distress, the qualitative results showed that AICF was able to detect real-time issues that are amenable to treatment, thus allowing therapists to be more proactive in supporting every group member on an individual basis. However, therapists are concerned about the ethical liability of AICF's distress detection function. Conclusions: Future works will look into wearable sensors and facial cues by using videoconferencing to overcome the barriers associated with text-based online support groups. International Registered Report Identifier (IRRID): RR2-10.2196/21453 ",
doi="10.2196/40113",
url="https://cancer.jmir.org/2023/1/e40113",
url="http://www.ncbi.nlm.nih.gov/pubmed/37294610"
}


@Article{info:doi/10.2196/44339,
author="Kim, Jiyeong
and Linos, Eleni
and Fishman, A. Debra
and Dove, S. Melanie
and Hoch, S. Jeffrey
and Keegan, H. Theresa",
title="Factors Associated With Online Patient-Provider Communications Among Cancer Survivors in the United States During COVID-19: Cross-sectional Study",
journal="JMIR Cancer",
year="2023",
month="May",
day="22",
volume="9",
pages="e44339",
keywords="online patient-provider communication",
keywords="cancer survivor",
keywords="COVID-19",
keywords="telehealth",
keywords="eHealth activities",
keywords="telemedicine",
keywords="eHealth",
keywords="e-health",
keywords="patient provider",
keywords="online communication",
keywords="patient-physician",
keywords="national survey",
keywords="sociodemographic",
keywords="oncology",
keywords="cancer",
abstract="Background: Online patient-provider communication (OPPC) is crucial in enhancing access to health information, self-care, and related health outcomes among cancer survivors. The necessity of OPPC increased during SARS-CoV-2/COVID-19, yet investigations in vulnerable subgroups have been limited. Objective: This study aims to assess the prevalence of OPPC and sociodemographic and clinical characteristics associated with OPPC among cancer survivors and adults without a history of cancer during COVID-19 versus pre--COVID-19. Methods: Nationally representative cross-sectional survey data (Health Information National Trends Survey 5, 2017-2020) were used among cancer survivors (N=1900) and adults without a history of cancer (N=13,292). COVID-19 data included data from February to June 2020. We calculated the prevalence of 3 types of OPPC, defined as using the email/internet, tablet/smartphone, or electronic health record (EHR) for patient-provider communication, in the past 12 months. To investigate the associations of sociodemographic and clinical factors with OPPC, multivariable-adjusted weighted logistic regression was performed to obtain odds ratios (ORs) and 95\% CIs. Results: The average prevalence of OPPC increased from pre-COVID to COVID among cancer survivors (39.7\% vs 49.7\%, email/internet; 32.2\% vs 37.9\%, tablet/smartphone; 19.0\% vs 30.0\%, EHR). Cancer survivors (OR 1.32, 95\% CI 1.06-1.63) were slightly more likely to use email/internet communications than adults without a history of cancer prior to COVID-19. Among cancer survivors, the email/internet (OR 1.61, 95\% CI 1.08-2.40) and EHRs (OR 1.92, 95\% CI 1.22-3.02) were more likely to be used during COVID-19 than pre--COVID-19. During COVID-19, subgroups of cancer survivors, including Hispanics (OR 0.26, 95\% CI 0.09-0.71 vs non-Hispanic Whites) or those with the lowest income (US \$50,000-<US \$75,000: OR 6.14, 95\% CI 1.99-18.92; ?US \$75,000: OR 0.42, 95\% CI 1.56-11.28 vs <US \$20,000), with no usual source of care (OR 6.17, 95\% CI 2.12-17.99), or reporting depression (OR 0.33, 95\% CI 0.14-0.78) were less likely to use email/internet, and those who were the oldest (age 35-49 years: OR 9.33, 95\% CI 2.18-40.01; age 50-64 years: OR 3.58, 95\% CI 1.20-10.70; age 65-74 years: OR 3.09, 95\% CI 1.09-8.76 vs age?75 years), were unmarried (OR 2.26, 95\% CI 1.06-4.86), or had public/no health insurance (Medicare, Medicaid, or other: ORs 0.19-0.21 vs private) were less likely to use a tablet/smartphone to communicate with providers. Cancer survivors with a usual source of care (OR 6.23, 95\% CI 1.66-23.39) or health care office visits in a year (ORs 7.55-8.25) were significantly more likely to use EHRs to communicate. Although it was not observed in cancer survivors, a lower education level was associated with lower OPPC among adults without a history of cancer during COVID-19. Conclusions: Our findings identified vulnerable subgroups of cancer survivors who were left behind in OPPC, which is increasingly becoming part of health care. These vulnerable subgroups of cancer survivors with lower OPPC should be helped through multidimensional interventions to prevent further inequities. ",
doi="10.2196/44339",
url="https://cancer.jmir.org/2023/1/e44339",
url="http://www.ncbi.nlm.nih.gov/pubmed/37074951"
}


@Article{info:doi/10.2196/39072,
author="Hodroj, Khalil
and Pellegrin, David
and Menard, Cindy
and Bachelot, Thomas
and Durand, Thierry
and Toussaint, Philippe
and Dufresne, Armelle
and Mery, Benoite
and Tredan, Olivier
and Goulvent, Thibaut
and Heudel, Pierre",
title="A Digital Solution for an Advanced Breast Tumor Board: Pilot Application Cocreation and Implementation Study",
journal="JMIR Cancer",
year="2023",
month="May",
day="18",
volume="9",
pages="e39072",
keywords="digital health",
keywords="multidisciplinary meeting",
keywords="advanced breast cancer",
keywords="cancer",
keywords="breast cancer",
keywords="tumor",
keywords="clinician",
keywords="confidence",
keywords="treatment",
keywords="pathology",
keywords="genomic",
keywords="care",
keywords="patient",
keywords="software",
keywords="data",
keywords="neoplastic",
keywords="pain",
keywords="follow-up",
keywords="electronic medical records",
keywords="records",
abstract="Background: Cancer treatment is constantly evolving toward a more personalized approach based on clinical features, imaging, and genomic pathology information. To ensure the best care for patients, multidisciplinary teams (MDTs) meet regularly to review cases. Notwithstanding, the conduction of MDT meetings is challenged by medical time restrictions, the unavailability of critical MDT members, and the additional administrative work required. These issues may result in members missing information during MDT meetings and postponed treatment. To explore and facilitate improved approaches for MDT meetings in France, using advanced breast cancers (ABCs) as a model, Centre L{\'e}on B{\'e}rard (CLB) and ROCHE Diagnostics cocreated an MDT application prototype based on structured data. Objective: In this paper, we want to describe how an application prototype was implemented for ABC MDT meetings at CLB to support clinical decisions. Methods: Prior to the initiation of cocreation activities, an organizational audit of ABC MDT meetings identified the following four key phases for the MDT: the instigation, preparation, execution, and follow-up phases. For each phase, challenges and opportunities were identified that informed the new cocreation activities. The MDT application prototype became software that integrated structured data from medical files for the visualization of the neoplastic history of a patient. The digital solution was assessed via a before-and-after audit and a survey questionnaire that was administered to health care professionals involved in the MDT. Results: The ABC MDT meeting audit was carried out during 3 MDT meetings, including 70 discussions of clinical cases before and 58 such discussions after the implementation of the MDT application prototype. We identified 33 pain points related to the preparation, execution, and follow-up phases. No issues were identified related to the instigation phase. Difficulties were grouped as follows: process challenges (n=18), technological limitations (n=9), and the lack of available resources (n=6). The preparation of MDT meetings was the phase in which the most issues (n=16) were seen. A repeat audit, which was undertaken after the implementation of the MDT application, demonstrated that (1) the discussion times per case remained comparable (2 min and 22 s vs 2 min and 14 s), (2) the capture of MDT decisions improved (all cases included a therapeutic proposal), (3) there was no postponement of treatment decisions, and (4) the mean confidence of medical oncologists in decision-making increased. Conclusions: The introduction of the MDT application prototype at CLB to support the ABC MDT seemed to improve the quality of and confidence in clinical decisions. The integration of an MDT application with the local electronic medical record and the utilization of structured data conforming to international terminologies could enable a national network of MDTs to support sustained improvements to patient care. ",
doi="10.2196/39072",
url="https://cancer.jmir.org/2023/1/e39072",
url="http://www.ncbi.nlm.nih.gov/pubmed/37200077"
}


@Article{info:doi/10.2196/41216,
author="Masiero, Marianna
and Filipponi, Chiara
and Pizzoli, Maria Silvia Francesca
and Munzone, Elisabetta
and Guido, Luca
and Guardamagna, Andrea Vittorio
and Marceglia, Sara
and Caruso, Annamaria
and Prandin, Roberto
and Prenassi, Marco
and Manzelli, Vania
and Savino, Chiara
and Conti, Costanza
and Rizzi, Federica
and Casalino, Alice
and Candiani, Giulia
and Memini, Francesca
and Chiveri, Luca
and Vitali, Luigi Andrea
and Corbo, Massimo
and Milani, Alessandra
and Grasso, Roberto
and Traversoni, Silvia
and Fragale, Elisa
and Didier, Florence
and Pravettoni, Gabriella",
title="Usability Testing of a New Digital Integrated Health Ecosystem (PainRELife) for the Clinical Management of Chronic Pain in Patients With Early Breast Cancer: Protocol for a Pilot Study",
journal="JMIR Res Protoc",
year="2023",
month="May",
day="12",
volume="12",
pages="e41216",
keywords="decision-making",
keywords="decision aid",
keywords="chronic pain",
keywords="eHealth",
keywords="patient electronic health record",
keywords="clinical",
keywords="technology",
keywords="mobile application",
keywords="pilot study",
keywords="breast cancer",
keywords="chronic",
keywords="patient",
keywords="cancer",
keywords="pain",
abstract="Background: Chronic pain (CP) and its management are critical issues in the care pathway of patients with breast cancer. Considering the complexity of CP experience in cancer, the international scientific community has advocated identifying cutting-edge approaches for CP management. Recent advances in the field of health technology enable the adoption of a novel approach to care management by developing integrated ecosystems and mobile health apps. Objective: The primary end point of this pilot study is to evaluate patients' usability experience at 3 months of a new digital and integrated technological ecosystem, PainRELife, for CP in a sample of patients with breast cancer. The PainRELife ecosystem is composed of 3 main technological assets integrated into a single digital ecosystem: Fast Healthcare Interoperability Resources--based cloud platform (Nu platform) that enables care pathway definition and data collection; a big data infrastructure connected to the Fast Healthcare Interoperability Resources server that analyzes data and implements dynamic dashboards for aggregate data visualization; and an ecosystem of personalized applications for patient-reported outcomes collection, digital delivery of interventions and tailored information, and decision support of patients and caregivers (PainRELife app). Methods: This is an observational, prospective pilot study. Twenty patients with early breast cancer and chronic pain will be enrolled at the European Institute of Oncology at the Division of Medical Senology and the Division of Pain Therapy and Palliative Care. Each patient will use the PainRELife mobile app for 3 months, during which data extracted from the questionnaires will be sent to the Nu Platform that health care professionals will manage. This pilot study is nested in a large-scale project named ``PainRELife,'' which aims to develop a cloud technology platform to interoperate with institutional systems and patients' devices to collect integrated health care data. The study received approval from the Ethical Committee of the European Cancer Institute in December 2021 (number R1597/21-IEO 1701). Results: The recruitment process started in May 2022 and ended in October 2022. Conclusions: The new integrated technological ecosystems might be considered an encouraging affordance to enhance a patient-centered approach to managing patients with cancer. This pilot study will inform about which features the health technological ecosystems should have to be used by cancer patients to manage CP. International Registered Report Identifier (IRRID): DERR1-10.2196/41216 ",
doi="10.2196/41216",
url="https://www.researchprotocols.org/2023/1/e41216",
url="http://www.ncbi.nlm.nih.gov/pubmed/37171843"
}


@Article{info:doi/10.2196/40917,
author="Hwang, Soohyun
and Lazard, J. Allison
and Reffner Collins, K. Meredith
and Brenner, T. Alison
and Heiling, M. Hillary
and Deal, M. Allison
and Crockett, D. Seth
and Reuland, S. Daniel
and Elston Lafata, Jennifer",
title="Exploring the Acceptability of Text Messages to Inform and Support Shared Decision-making for Colorectal Cancer Screening: Online Panel Survey",
journal="JMIR Cancer",
year="2023",
month="May",
day="5",
volume="9",
pages="e40917",
keywords="text messages",
keywords="shared decision-making",
keywords="colorectal cancer",
keywords="cancer screening",
keywords="mHealth",
keywords="cancer",
keywords="health care",
keywords="marginalized groups",
abstract="Background: While online portals may be helpful to engage patients in shared decision-making at the time of cancer screening, because of known disparities in patient portal use, sole reliance on portals to support cancer screening decision-making could exacerbate well-known disparities in this health care area. Innovative approaches are needed to engage patients in health care decision-making and to support equitable shared decision-making. Objective: We assessed the acceptability of text messages to engage sociodemographically diverse individuals in colorectal cancer (CRC) screening decisions and support shared decision-making in practice. Methods: We developed a brief text message program offering educational information consisting of components of shared decision-making regarding CRC screening (eg, for whom screening is recommended, screening test options, and pros/cons of options). The program and postprogram survey were offered to members of an online panel. The outcome of interest was program acceptability measured by observed program engagement, participant-reported acceptability, and willingness to use similar programs (behavioral intent). We evaluated acceptability among historically marginalized categories of people defined by income, literacy, and race. Results: Of the 289 participants, 115 reported having a low income, 146 were Black/African American, and 102 had less than extreme confidence in their health literacy. With one exception, we found equal or greater acceptability, regardless of measure, within each of the marginalized categories of people compared to their counterparts. The exception was that participants reporting an income below US \$50,000 were less likely to engage with sufficient content of the program to learn that there was a choice among different CRC screening tests (difference --10.4\%, 95\% CI --20.1 to --0.8). Of note, Black/African American participants reported being more likely to sign up to receive text messages from their doctor's office compared to white participants (difference 18.7\%, 95\% CI 7.0-30.3). Conclusions: Study findings demonstrate general acceptance of text messages to inform and support CRC screening shared decision-making. ",
doi="10.2196/40917",
url="https://cancer.jmir.org/2023/1/e40917",
url="http://www.ncbi.nlm.nih.gov/pubmed/37145859"
}


@Article{info:doi/10.2196/46259,
author="Garc{\'i}a Abejas, Abel
and Serra Trull{\'a}s, Adri{\`a}
and Sobral, Ana Maria
and Canelas, Daniel
and Leite Costa, F{\'a}bio
and Salvador Verges, {\`A}ngels",
title="Improving the Understanding and Managing of the Quality of Life of Patients With Lung Cancer With Electronic Patient-Reported Outcome Measures: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="May",
day="3",
volume="25",
pages="e46259",
keywords="lung cancer",
keywords="electronic patient-reported outcome measures",
keywords="ePROMs",
keywords="health-related quality of life",
keywords="sickness impact profile",
keywords="quality improvement",
keywords="review",
abstract="Background: Electronic patient-reported outcome measures (ePROMs) are essential to clinical practice and research. The growth of eHealth technologies has provided unprecedented opportunities to collect information systematically through ePROMs. Although they are widely used in scientific research, more evidence is needed to determine their use and implementation in daily clinical practice. For example, when diagnosed, patients with lung cancer are at an advanced stage of the disease. This entails tremendous burden because of high mortality and losses in the different dimensions of the human being. In this case, monitoring symptoms and other outcomes help improve the patient's quality of life. Objective: ePROMs offered unprecedented opportunities to collect information systematically. Our goal was to demonstrate that ePROMs are more useful in controlling patient symptoms, lung cancer, and overall survival than their alternatives, such as nonelectronic PROMs. Methods: This exploratory review considered articles published between 2017 and 2022 identified through searches of PubMed, Scopus, Cochrane, CINAHL, and PsycINFO. We found 5097 articles; after removing the duplicates, we reduced them to 3315. After reading the summary, we were left with 56. Finally, after applying the exclusion criteria, we reviewed 12. The 5-step framework by Arksey and O'Malley was used to refine the initial search results with the following research questions: Do ePROMs help physician-patient communication? To what extent do they improve decision-making? Are institutions and their digitization policies barriers to or facilitators of this process? and What else is needed for routine implementation? Results: This review included 12 articles. We found that ePROMs are an integrative and facilitative communication tool, highlighting their importance in the relationship between palliative care and medical oncology. ePROMs help assess patient symptoms and functionality more accurately and facilitate clinical decision-making. In addition, it allows for more precise predictions of overall patient survival and the adverse effects of their treatments. The main institutional obstacles are the initial investment, which can be costly, and the data protection policy. However, enablers included better funding through the development of telemedicine, support from institutional leaders to overcome resistance to change, and transparent policies to ensure the safe and secure use of ePROMs. Conclusions: Routine collection of remote ePROMs is an effective and valuable strategy for providing real-time clinical feedback. In addition, it provides satisfaction to patients and professionals. Optimizing ePROMs in patients with lung cancer leads to a more accurate view of health outcomes and ensures quality patient follow-up. It also allows us to stratify patients based on their morbidity, creating specific follow-ups for their needs. However, data privacy and security are concerns when using ePROMs to ensure compliance with local entities. At least four barriers were identified: cost, complex programming within health systems, safety, and social and health literacy. ",
doi="10.2196/46259",
url="https://www.jmir.org/2023/1/e46259",
url="http://www.ncbi.nlm.nih.gov/pubmed/37021695"
}


@Article{info:doi/10.2196/39852,
author="Crawford, Rebecca
and Sikirica, Slaven
and Morrison, Ross
and Cappelleri, C. Joseph
and Russell-Smith, Alexander
and Shah, Richa
and Chadwick, Helen
and Doward, Lynda",
title="The Patient Experience of Acute Lymphoblastic Leukemia and Its Treatment: Social Media Review",
journal="JMIR Cancer",
year="2023",
month="May",
day="1",
volume="9",
pages="e39852",
keywords="acute lymphoblastic leukemia",
keywords="health-related quality of life",
keywords="qualitative research",
keywords="social media",
keywords="leukemia",
keywords="lymphoblastic",
keywords="adult",
keywords="disease",
keywords="treatment",
keywords="therapy",
keywords="symptoms",
keywords="independence",
keywords="functioning",
keywords="social",
keywords="well-being",
keywords="emotional",
abstract="Background: Adult patients with acute lymphoblastic leukemia (ALL) report substantial disease- and treatment-related impacts on their health-related quality of life (HRQOL). Patient-reported information (PRI) shared on social media may provide a distinct opportunity to understand the patient experience outside of formal research contexts and help inform the development of novel therapies. Objective: This qualitative social media review aimed to assess PRI shared on social media websites to gain a better understanding of the symptom, HRQOL, and treatment impacts on individuals with ALL. Methods: We identified English-language posts on 3 patient advocacy websites (Patient Power, The Patient Story, and Leukaemia Care) and YouTube that included PRI about experiences with ALL or ALL treatments shared by adults (aged ?18 years) with a self-reported ALL diagnosis. Patients' demographic and disease characteristics were extracted from posts (where available), and the posts were analyzed thematically. A network analysis was conducted to delineate possible associations among ALL symptoms, HRQOL impacts, and treatment-related symptoms and impacts. Results: Of the 935 social media posts identified, 63 (7\%) met the review criteria, including 40 (63\%) videos, 5 (8\%) comments posted in response to videos, and 18 (29\%) blog posts. The 63 posts were contributed by 41 patients comprised of 21 (51\%) males, 18 females (44\%), and 2 (5\%) whose gender was not reported. Among the patients, 13 (32\%) contributed >1 source of data. Fatigue (n=20, 49\%), shortness of breath (n=13, 32\%), and bruising (n=12, 29\%) were the symptoms prior to treatment most frequently discussed by patients. Patients also reported impacts on personal relationships (n=26, 63\%), psychological and emotional well-being (n=25, 61\%), and work (n=16, 39\%). Although inpatient treatment reportedly restricted patients' independence and social functioning, it also provided a few patients with a sense of safety. Patients frequently relied on their doctors to drive their treatment decisions but were also influenced by family members. The network analysis indicated that disease-related symptoms were primarily associated with patients' physical functioning, activities of daily living, and ability to work, while treatment-related symptoms were primarily associated with emotional well-being. Conclusions: This social media review explored PRI through a thematic analysis of patient-contributed content on patient advocacy websites and YouTube to identify and contextualize emergent themes in patient experiences with ALL and its treatments. To our knowledge, this is the first study to leverage this novel tool to generate new insights into patients' experiences with ALL. Patients' social media posts suggest that inpatient care for ALL is associated with restricted independence and social functioning. However, inpatient care also provided a sense of safety for some patients. Studies such as this one that capture patients' experiences in their own words are valuable tools to further our knowledge of patient outcomes with ALL. ",
doi="10.2196/39852",
url="https://cancer.jmir.org/2023/1/e39852",
url="http://www.ncbi.nlm.nih.gov/pubmed/37126376"
}


@Article{info:doi/10.2196/37330,
author="Vaffis, Shannon
and Whaley, Soluna
and Axon, Rhys David
and Hall-Lipsy, Elizabeth
and Hincapie, Ana
and Slack, Marion
and Warholak, Terri",
title="Features of Cancer mHealth Apps and Evidence for Patient Preferences: Scoping Literature Review",
journal="JMIR Cancer",
year="2023",
month="Apr",
day="28",
volume="9",
pages="e37330",
keywords="scoping review",
keywords="mHealth",
keywords="mobile health",
keywords="health app",
keywords="cancer",
keywords="oncology",
keywords="disease self-management",
keywords="self-management",
keywords="chronic disease",
keywords="tablet",
keywords="smartphone",
keywords="digital health",
keywords="eHealth",
keywords="feature",
abstract="Background: Cancer is increasingly being treated as a chronic disease rather than an acute one-time illness. Additionally, oral anticancer therapies, as opposed to intravenous chemotherapy, are now available for an increasing number of cancer indications. Mobile health (mHealth) apps for use on mobile devices (eg, smartphones or tablets) are designed to help patients with medication adherence, symptom tracking, and disease management. Several previous literature reviews have been conducted regarding mHealth apps for cancer. However, these studies did not address patient preferences for the features of cancer mHealth apps. Objective: The primary aim was to review the scientific literature that describes the features and functions of mHealth apps designed for cancer self-management. Methods: As the purpose of this review was to explore the depth and breadth of research on mHealth app features for cancer self-management, a scoping review methodology was adopted. Four databases were used for this review: PubMed/MEDLINE, Embase, CINAHL, and PsycINFO. Citation and reference searches were conducted for manuscripts meeting the inclusion criteria. A gray literature search was also conducted. Data?extracted from manuscripts?included author, title, publication date, study type, sampling type, cancer type, treatment, age of participants, features, availability (free or subscription), design input, and patient preferences. Finally, the features listed for each app were compared, highlighting similarities across platforms as well as features unique to each app. Results: After the removal of duplicates, 522 manuscripts remained for the title and abstract review, with 51 undergoing full-text review. A total of 7 manuscripts (referred to as studies hereafter) were included in the final scoping review. App features described in each study varied from 2 to 11, with a median of 4 features per app. The most reported feature was a symptom or side effect tracker, which was reported in 6 studies. Two apps specified the inclusion of patients and health care providers during the design, while 1 app noted that IT and communications experts provided design input. The utility of the apps for end users was measured in several ways, including acceptability (measuring the end users' experience), usability (assessing the functionality and performance by observing real users completing tasks), or qualitative data (reports from end users collected from interviews or focus groups). Conclusions: This review explored the literature on cancer mHealth apps. Popular features within these mHealth apps include symptom trackers, cancer education, and medication trackers. However, these apps and features are often developed with little input from patients. Additionally, there is little information regarding patient preferences for the features of existing apps. While the number of cancer-related apps available for download continues to increase, further exploration of patient preferences for app features could result in apps that better meet patient disease self-management needs. ",
doi="10.2196/37330",
url="https://cancer.jmir.org/2023/1/e37330",
url="http://www.ncbi.nlm.nih.gov/pubmed/37115587"
}


@Article{info:doi/10.2196/41179,
author="Speiser, Dorothee
and Heibges, Maren
and Besch, Laura
and Hilger, Caren
and Keinert, Marie
and Klein, Katharina
and Rauwolf, Gudrun
and Schmid, Christine
and Schulz-Niethammer, Sven
and Stegen, Steffi
and Westfal, Viola
and Witzel, Isabell
and Zang, Benedikt
and Kendel, Friederike
and Feufel, A. Markus",
title="Paradigmatic Approach to Support Personalized Counseling With Digital Health (iKNOW)",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="21",
volume="7",
pages="e41179",
keywords="hereditary breast and ovarian cancer",
keywords="BRCA",
keywords="genetic counseling",
keywords="digital health",
keywords="online counseling tool",
keywords="user-centered design principles",
keywords="risk communication",
keywords="cancer risk",
keywords="hereditary cancer",
keywords="breast cancer",
keywords="ovarian cancer",
doi="10.2196/41179",
url="https://formative.jmir.org/2023/1/e41179",
url="http://www.ncbi.nlm.nih.gov/pubmed/37083496"
}


@Article{info:doi/10.2196/45475,
author="Reis, Joaquim
and Travado, Luzia
and Scherrer, Alexander
and Kosmidis, Thanos
and Venios, Stefanos
and Laras, Emmanouil Paris
and Oestreicher, Gabrielle
and Moehler, Markus
and Parolini, Margherita
and Passardi, Alessandro
and Meggiolaro, Elena
and Martinelli, Giovanni
and Petracci, Elisabetta
and Zingaretti, Chiara
and Diamantopoulos, Sotiris
and Plakia, Maria
and Vassiliou, Charalampos
and Mousa, Suheib
and Zifrid, Robert
and Sullo, Giulio Francesco
and Gallio, Chiara",
title="Digital Guardian Angel Supported by an Artificial Intelligence System to Improve Quality of Life, Well-being, and Health Outcomes of Patients With Cancer (ONCORELIEF): Protocol for a Single Arm Prospective Multicenter Pilot Study",
journal="JMIR Res Protoc",
year="2023",
month="Apr",
day="21",
volume="12",
pages="e45475",
keywords="eHealth",
keywords="artificial intelligence",
keywords="quality of life and well-being",
keywords="supportive cancer care",
keywords="mobile phone",
keywords="cancer support",
keywords="artificial intelligence--based recommendations",
abstract="Background: According to Europe's Beating Cancer Plan, the number of cancer survivors is growing every year and is now estimated at over 12 million in Europe. A main objective of the European Commission is to ensure that cancer survivors can enjoy a high quality of life, underlining the role of digital technology and eHealth apps and tools to achieve this. Objective: The main objective of this study is the development of a user-centered artificial intelligence system to facilitate the input and integration of patient-related biopsychosocial data to improve posttreatment quality of life, well-being, and health outcomes and examine the feasibility of this digitally assisted workflow in a real-life setting in patients with colorectal cancer and acute myeloid leukemia. Methods: A total of 60 patients with colorectal cancer and 30 patients with acute myeloid leukemia will be recruited from 2 clinical centers: Universit{\"a}tsmedizin der Johannes Gutenberg-Universit{\"a}t Mainz (Mainz, Germany) and IRCCS Istituto Romagnolo per lo Studio dei Tumori ``Dino Amadori'' (IRST, Italy). Psychosocial data (eg, emotional distress, fatigue, quality of life, subjective well-being, sleep problems, and appetite loss) will be collected by questionnaires via a smartphone app, and physiological data (eg, heart rate, skin temperature, and movement through step count) will be collected by a customizable smart wrist-worn sensor device. Each patient will be assessed every 2 weeks over their 3-month participation in the ONCORELIEF study. Inclusion criteria include patients with the diagnosis of acute myeloid leukemia or colorectal cancer, adult patients aged 18 years and older, life expectancy greater than 12 months, Eastern Cooperative Oncology Group performance status ?2, and patients who have a smartphone and agree to use it for the purpose of the study. Exclusion criteria include patients with a reduced cognitive function (such as dementia) or technological illiteracy and other known active malignant neoplastic diseases (patients with a medical history of treated neoplastic disease are included). Results: The pilot study started on September 1, 2022. As of January 2023, we enrolled 33 patients with colorectal cancer and 7 patients with acute myeloid leukemia. As of January 2023, we have not yet started the data analysis. We expect to get all data in June 2023 and expect the results to be published in the second semester of 2023. Conclusions: Web-based and mobile apps use methods from mathematical decision support and artificial intelligence through a closed-loop workflow that connects health professionals and patients. The ONCORELIEF system has the potential of continuously identifying, collecting, and processing data from diverse patient dimensions to offer health care recommendations, support patients with cancer to address their unmet needs, and optimize survivorship care. Trial Registration: German Clinical Trials Register (DRKS) 00027808; https://drks.de/search/en/trial/DRKS00027808 International Registered Report Identifier (IRRID): DERR1-10.2196/45475 ",
doi="10.2196/45475",
url="https://www.researchprotocols.org/2023/1/e45475",
url="http://www.ncbi.nlm.nih.gov/pubmed/37083563"
}


@Article{info:doi/10.2196/44695,
author="Florensa, Didac
and Mateo-Fornes, Jordi
and Lopez Sorribes, Sergi
and Torres Tuca, Anna
and Solsona, Francesc
and Godoy, Pere",
title="Exploring Cancer Incidence, Risk Factors, and Mortality in the Lleida Region: Interactive, Open-source R Shiny Application for Cancer Data Analysis",
journal="JMIR Cancer",
year="2023",
month="Apr",
day="20",
volume="9",
pages="e44695",
keywords="R Shiny",
keywords="cloud computing",
keywords="microservices",
keywords="Docker",
keywords="decision support system",
keywords="cancer incidence",
keywords="cancer risk factors, cancer mortality",
abstract="Background: The cancer incidence rate is essential to public health surveillance. The analysis of this information allows authorities to know the cancer situation in their regions, especially to determine cancer patterns, monitor cancer trends, and help prioritize the allocation of health resource. Objective: This study aimed to present the design and implementation of an R Shiny application to assist cancer registries conduct rapid descriptive and predictive analytics in a user-friendly, intuitive, portable, and scalable way. Moreover, we wanted to describe the design and implementation road map to inspire other population registries to exploit their data sets and develop similar tools and models. Methods: The first step was to consolidate the data into the population registry cancer database. These data were cross validated by ASEDAT software, checked later, and reviewed by experts. Next, we developed an online tool to visualize the data and generate reports to assist decision-making under the R Shiny framework. Currently, the application can generate descriptive analytics using population variables, such as age, sex, and cancer type; cancer incidence in region-level geographical heat maps; line plots to visualize temporal trends; and typical risk factor plots. The application also showed descriptive plots about cancer mortality in the Lleida region. This web platform was built as a microservices cloud platform. The web back end consists of an application programming interface and a database, which NodeJS and MongoDB have implemented. All these parts were encapsulated and deployed by Docker and Docker Compose. Results: The results provide a successful case study in which the tool was applied to the cancer registry of the Lleida region. The study illustrates how researchers and cancer registries can use the application to analyze cancer databases. Furthermore, the results highlight the analytics related to risk factors, second tumors, and cancer mortality. The application shows the incidence and evolution of each cancer during a specific period for gender, age groups, and cancer location, among other functionalities. The risk factors view permitted us to detect that approximately 60\% of cancer patients were diagnosed with excess weight at diagnosis. Regarding mortality, the application showed that lung cancer registered the highest number of deaths for both genders. Breast cancer was the lethal cancer in women. Finally, a customization guide was included as a result of this implementation to deploy the architecture presented. Conclusions: This paper aimed to document a successful methodology for exploiting the data in population cancer registries and propose guidelines for other similar records to develop similar tools. We intend to inspire other entities to build an application that can help decision-making and make data more accessible and transparent for the community of users. ",
doi="10.2196/44695",
url="https://cancer.jmir.org/2023/1/e44695",
url="http://www.ncbi.nlm.nih.gov/pubmed/37079353"
}


@Article{info:doi/10.2196/45382,
author="Choudhury, Avishek",
title="Impact of Social Isolation, Physician-Patient Communication, and Self-perception on the Mental Health of Patients With Cancer and Cancer Survivors: National Survey Analysis",
journal="Interact J Med Res",
year="2023",
month="Apr",
day="7",
volume="12",
pages="e45382",
keywords="cancer communication",
keywords="cancer stigma",
keywords="mental health",
keywords="social isolation",
keywords="cancer survivorship",
keywords="patient-centeredness",
abstract="Background: Cancer is perceived as a life-threatening, fear-inducing, and stigmatized disease. Most patients with cancer and cancer survivors commonly experience social isolation, negative self-perception, and psychological distress. The heavy toll that cancer takes on patients continues even after treatment. It is common for many patients with cancer to feel uncertain about their future. Some undergo anxiety, loneliness, and fear of getting cancer again. Objective: This study examined the impact of social isolation, self-perception, and physician-patient communication on the mental health of patients with cancer and cancer survivors. The study also explored the impact of social isolation and physician-patient communication on self-perception. Methods: This retrospective study used restricted data from the 2021 Health Information National Trends Survey (HINTS), which collected data from January 11, 2021, to August 20, 2021. We used the partial least squares structural equation modeling (PLS-SEM) method for data analysis. We checked for quadratic effects among all the paths connecting social isolation, poor physician-patient communication, mental health (measured using the 4-item Patient Health Questionnaire [PHQ-4]), and negative self-perception. The model was controlled for confounding factors such as respondents' annual income, education level, and age. Bias-corrected and accelerated (BCA) bootstrap methods were used to estimate nonparametric CIs. Statistical significance was tested at 95\% CI (2-tailed). We also conducted a multigroup analysis in which we created 2 groups. Group A consisted of newly diagnosed patients with cancer who were undergoing cancer treatment during the survey or had received cancer treatment within the last 12 months (receipt of cancer treatment during the COVID-19 pandemic). Group B consisted of respondents who had received cancer treatment between 5 and 10 years previously (receipt of cancer treatment before the COVID-19 pandemic). Results: The analysis indicated that social isolation had a quadratic effect on mental health, with higher levels of social isolation associated with worse mental health outcomes up to a certain point. Self-perception positively affected mental health, with higher self-perception associated with better mental health outcomes. In addition, physician-patient communication significantly indirectly affected mental health via self-perception. Conclusions: The findings of this study provide important insights into the factors that affect the mental health of patients with cancer. Our results suggest that social isolation, negative self-perception, and communication with care providers are significantly related to mental health in patients with cancer. ",
doi="10.2196/45382",
url="https://www.i-jmr.org/2023/1/e45382",
url="http://www.ncbi.nlm.nih.gov/pubmed/37027201"
}


@Article{info:doi/10.2196/42704,
author="Jenkinson, P. George
and Houghton, Natasha
and van Zalk, Nejra
and Waller, Jo
and Bello, Fernando
and Tzemanaki, Antonia",
title="Acceptability of Automated Robotic Clinical Breast Examination: Survey Study",
journal="J Particip Med",
year="2023",
month="Apr",
day="3",
volume="15",
pages="e42704",
keywords="breast cancer detection",
keywords="automated diagnosis",
keywords="breast examination",
keywords="health care robotics",
keywords="patient and public involvement",
keywords="participatory design",
keywords="user acceptability",
keywords="mammography",
keywords="breast cancer",
abstract="Background: In the United Kingdom, women aged 50 to 70 years are invited to undergo mammography. However, 10\% of invasive breast cancers occur in women aged ?45 years, representing an unmet need for young women. Identifying a suitable screening modality for this population is challenging; mammography is insufficiently sensitive, whereas alternative diagnostic methods are invasive or costly. Robotic clinical breast examination (R-CBE)---using soft robotic technology and machine learning for fully automated clinical breast examination---is a theoretically promising screening modality with early prototypes under development. Understanding the perspectives of potential users and partnering with patients in the design process from the outset is essential for ensuring the patient-centered design and implementation of this technology. Objective: This study investigated the attitudes and perspectives of women regarding the use of soft robotics and intelligent systems in breast cancer screening. It aimed to determine whether such technology is theoretically acceptable to potential users and identify aspects of the technology and implementation system that are priorities for patients, allowing these to be integrated into technology design. Methods: This study used a mixed methods design. We conducted a 30-minute web-based survey with 155 women in the United Kingdom. The survey comprised an overview of the proposed concept followed by 5 open-ended questions and 17 closed questions. Respondents were recruited through a web-based survey linked to the Cancer Research United Kingdom patient involvement opportunities web page and distributed through research networks' mailing lists. Qualitative data generated via the open-ended questions were analyzed using thematic analysis. Quantitative data were analyzed using 2-sample Kolmogorov-Smirnov tests, 1-tailed t tests, and Pearson coefficients. Results: Most respondents (143/155, 92.3\%) indicated that they would definitely or probably use R-CBE, with 82.6\% (128/155) willing to be examined for up to 15 minutes. The most popular location for R-CBE was at a primary care setting, whereas the most accepted method for receiving the results was an on-screen display (with an option to print information) immediately after the examination. Thematic analysis of free-text responses identified the following 7 themes: women perceive that R-CBE has the potential to address limitations in current screening services; R-CBE may facilitate increased user choice and autonomy; ethical motivations for supporting R-CBE development; accuracy (and users' perceptions of accuracy) is essential; results management with clear communication is a priority for users; device usability is important; and integration with health services is key. Conclusions: There is a high potential for the acceptance of R-CBE in its target user group and a high concordance between user expectations and technological feasibility. Early patient participation in the design process allowed the authors to identify key development priorities for ensuring that this new technology meets the needs of users. Ongoing patient and public involvement at each development stage is essential. ",
doi="10.2196/42704",
url="https://jopm.jmir.org/2023/1/e42704",
url="http://www.ncbi.nlm.nih.gov/pubmed/37010907"
}


@Article{info:doi/10.2196/37141,
author="Dolan, H. Elizabeth
and Goulding, James
and Tata, J. Laila
and Lang, R. Alexandra",
title="Using Shopping Data to Improve the Diagnosis of Ovarian Cancer: Computational Analysis of a Web-Based Survey",
journal="JMIR Cancer",
year="2023",
month="Mar",
day="31",
volume="9",
pages="e37141",
keywords="carcinoma",
keywords="ovarian epithelial",
keywords="ovarian neoplasms",
keywords="self-medication",
keywords="diagnostic errors",
keywords="symptom assessment",
keywords="machine learning",
keywords="nonprescription drugs",
keywords="over-the-counter",
keywords="pharmaceutical",
keywords="symptom",
keywords="ovary",
keywords="ovarian cancer",
keywords="oncology",
keywords="cancer",
abstract="Background: Shopping data can be analyzed using machine learning techniques to study population health. It is unknown if the use of such methods can successfully investigate prediagnosis purchases linked to self-medication of symptoms of ovarian cancer. Objective: The aims of this study were to gain new domain knowledge from women's experiences, understand how women's shopping behavior relates to their pathway to the diagnosis of ovarian cancer, and inform research on computational analysis of shopping data for population health. Methods: A web-based survey on individuals' shopping patterns prior to an ovarian cancer diagnosis was analyzed to identify key knowledge about health care purchases. Logistic regression and random forest models were employed to statistically examine how products linked to potential symptoms related to presentation to health care and timing of diagnosis. Results: Of the 101 women surveyed with ovarian cancer, 58.4\% (59/101) bought nonprescription health care products for up to more than a year prior to diagnosis, including pain relief and abdominal products. General practitioner advice was the primary reason for the purchases (23/59, 39\%), with 51\% (30/59) occurring due to a participant's doctor believing their health problems were due to a condition other than ovarian cancer. Associations were shown between purchases made because a participant's doctor believing their health problems were due to a condition other than ovarian cancer and the following variables: health problems for longer than a year prior to diagnosis (odds ratio [OR] 7.33, 95\% CI 1.58-33.97), buying health care products for more than 6 months to a year (OR 3.82, 95\% CI 1.04-13.98) or for more than a year (OR 7.64, 95\% CI 1.38-42.33), and the number of health care product types purchased (OR 1.54, 95\% CI 1.13-2.11). Purchasing patterns are shown to be potentially predictive of a participant's doctor thinking their health problems were due to some condition other than ovarian cancer, with nested cross-validation of random forest classification models achieving an overall in-sample accuracy score of 89.1\% and an out-of-sample score of 70.1\%. Conclusions: Women in the survey were 7 times more likely to have had a duration of more than a year of health problems prior to a diagnosis of ovarian cancer if they were self-medicating based on advice from a doctor rather than having made the decision to self-medicate independently. Predictive modelling indicates that women in such situations, who are self-medicating because their doctor believes their health problems may be due to a condition other than ovarian cancer, exhibit distinct shopping behaviors that may be identifiable within purchasing data. Through exploratory research combining women sharing their behaviors prior to diagnosis and computational analysis of these data, this study demonstrates that women's shopping data could potentially be useful for early ovarian cancer detection. ",
doi="10.2196/37141",
url="https://cancer.jmir.org/2023/1/e37141",
url="http://www.ncbi.nlm.nih.gov/pubmed/37000495"
}


@Article{info:doi/10.2196/42092,
author="Ardito, Vittoria
and Golubev, Georgi
and Ciani, Oriana
and Tarricone, Rosanna",
title="Evaluating Barriers and Facilitators to the Uptake of mHealth Apps in Cancer Care Using the Consolidated Framework for Implementation Research: Scoping Literature Review",
journal="JMIR Cancer",
year="2023",
month="Mar",
day="30",
volume="9",
pages="e42092",
keywords="mobile health",
keywords="mHealth",
keywords="smartphones",
keywords="mobile",
keywords="oncology",
keywords="cancer",
keywords="implementation science",
keywords="consolidated framework for implementation research",
keywords="CFIR",
keywords="mobile phones",
abstract="Background: Mobile health (mHealth) solutions have proven to be effective in a wide range of patient outcomes and have proliferated over time. However, a persistent challenge of digital health technologies, including mHealth, is that they are characterized by early dropouts in clinical practice and struggle to be used outside experimental settings or on larger scales. Objective: This study aimed to explore barriers and enablers to the uptake of mHealth solutions used by patients with cancer undergoing treatment, using a theory-guided implementation science model, that is, the Consolidated Framework for Implementation Research (CFIR). Methods: A scoping literature review was conducted using PubMed (MEDLINE), Web of Science, and ScienceDirect databases in March 2022. We selected studies that analyzed the development, evaluation, and implementation of mHealth solutions for patients with cancer that were used in addition to the standard of care. Only empirical designs (eg, randomized controlled trials, observational studies, and qualitative studies) were considered. First, information on the study characteristics, patient population, app functionalities, and study outcomes was extracted. Then, the CFIR model was used as a practical tool to guide data collection and interpretation of evidence on mHealth uptake. Results: Overall, 91 papers were included in the data synthesis. The selected records were mostly randomized controlled trials (26/91, 29\%) and single-arm, noncomparative studies (52/91, 57\%). Most of the apps (42/73, 58\%) were designed for both patients and clinicians and could be used to support any type of cancer (29/73, 40\%) and a range of oncological treatments. Following the CFIR scheme (intervention, outer setting, inner setting, individuals, process), multistakeholder co-design, codevelopment, and testing of mHealth interventions were identified as key enablers for later uptake. A variety of external drivers emerged, although the most relevant outer incentive fostering mHealth use was addressing patient needs. Among organizational factors likely to influence technology uptake, interoperability was the most prominent, whereas other providers' dimensions such as managerial attitudes or organizational culture were not systematically discussed. Technology-related impediments that could hamper the use of mHealth at the individual level were considered least often. Conclusions: The hype surrounding mHealth in cancer care is hindered by several factors that can affect its use in real world and nonexperimental settings. Compared with the growing evidence on mHealth efficacy, knowledge to inform the uptake of mHealth solutions in clinical cancer care is still scarce. Although some of our findings are supported by previous implementation research, our analysis elaborates on the distinguishing features of mHealth apps and provides an integrated perspective on the factors that should be accounted for implementation efforts. Future syntheses should liaise these dimensions with strategies observed in successful implementation initiatives. ",
doi="10.2196/42092",
url="https://cancer.jmir.org/2023/1/e42092",
url="http://www.ncbi.nlm.nih.gov/pubmed/36995750"
}


@Article{info:doi/10.2196/41441,
author="McCann, Lisa
and Hewitt, Christopher
and McMillan, A. Kathryn",
title="Developing an e-Prehabilitation System of Care for Young Adults Diagnosed With Cancer: User-Centered Design Study",
journal="JMIR Cancer",
year="2023",
month="Mar",
day="30",
volume="9",
pages="e41441",
keywords="digital health",
keywords="human factors",
keywords="user-centered",
keywords="prehabilitation",
keywords="young adults",
keywords="cancer",
abstract="Background: A diagnosis of cancer in adolescence or young adulthood can pose many different and unique challenges for individuals, as well as their families and friends. Drawing on the concept of prehabilitation, the provision of high-quality, accessible, timely, reliable, and appropriate information, care, and support for young adults with cancer and their families is critical to ensure that they feel equipped and empowered to make informed decisions relating to their treatment and care. Increasingly, digital health interventions offer opportunities to augment current health care information and support provision. Co-designing these digital health interventions can help to ensure that they are meaningful and relevant to the patient cohort, thereby maximizing their accessibility and acceptability. Objective: This study had 4 primary interlinked objectives: understand the support needs of young adults with cancer at the time of diagnosis, understand the potential role of a digital health solution to assist in the delivery of prehabilitation for young adults with cancer, identify appropriate technologies and technological platforms for a digital prehabilitation system of care, and develop a prototype for a digital prehabilitation system of care. Methods: This was a qualitative study using interviews and surveys. Young adults aged 16 to 26 years diagnosed with cancer within the last 3 years were invited to participate in individual user-requirement interviews or surveys. Health care professionals specializing in the treatment and care of young adults with cancer and digital health professionals working in the industry were also interviewed or completed a survey. Consensus feedback interviews were conducted with 3 young adults and 2 health care professionals after the development of the first generation of the prototype app. Results: In total, 7 individual interviews and 8 surveys were completed with young adults with a range of cancer diagnoses. Moreover, 6 individual interviews and 9 surveys were completed with health care professionals, and 3 digital health professionals participated in one-on-one interviews. A prototype app with the working name of Cancer Helpmate was developed based on these collective participant data. Overall, feedback from participants across the data collection activities suggests that the concept for the app was positive during these developmental stages. Further insightful ideas for the app's future development were also identified. Conclusions: Young adults with cancer and health care professionals are responsive to the need for more digitally driven services to be developed. Further development of an app such as Cancer Helpmate, which incorporates key features and functionalities directly informed by users, could help to augment the support provided to young adults with cancer. ",
doi="10.2196/41441",
url="https://cancer.jmir.org/2023/1/e41441",
url="http://www.ncbi.nlm.nih.gov/pubmed/36995740"
}


@Article{info:doi/10.2196/45011,
author="Renner, Simon
and Loussikian, Paul
and Foulqui{\'e}, Pierre
and Marrel, Alexia
and Barbier, Valentin
and Mebarki, Adel
and Sch{\"u}ck, St{\'e}phane
and Bharmal, Murtuza",
title="Patient and Caregiver Perceptions of Advanced Bladder Cancer Systemic Treatments: Infodemiology Study Based on Social Media Data",
journal="JMIR Cancer",
year="2023",
month="Mar",
day="27",
volume="9",
pages="e45011",
keywords="bladder cancer",
keywords="social media",
keywords="patient",
keywords="caregiver",
keywords="chemotherapy",
keywords="immunotherapy",
keywords="qualitative research",
keywords="cancer treatment",
keywords="first-line therapy",
keywords="patient support",
keywords="adverse event",
keywords="peer support",
keywords="cancer",
keywords="oncology",
keywords="perception",
keywords="pharmacotherapy",
keywords="opinion",
keywords="attitude",
abstract="Background: In 2022, it was estimated that more than 80,000 new cases of bladder cancer (BC) were diagnosed in the United States, 12\% of which were locally advanced or metastatic BC (advanced BC). These forms of cancer are aggressive and have a poor prognosis, with a 5-year survival rate of 7.7\% for metastatic BC. Despite recent therapeutic advances for advanced BC, little is known about patient and caregiver perceptions of different systemic treatments. To further explore this topic, social media can be used to collect the perceptions of patients and caregivers when they discuss their experiences on forums and online communities. Objective: The aim of this study was to assess patient and caregiver perceptions of chemotherapy and immunotherapy for treating advanced BC from social media--posted data. Methods: Public posts on social media in the United States between January 2015 and April 2021 from patients with advanced BC and their caregivers were collected. The posts included in this analysis were geolocalized to the United States; collected from publicly available domains and sites, including social media sites such as Twitter and forums such as patient association forums; and were written in English. Posts mentioning any line of chemotherapy or immunotherapy were qualitatively analyzed by two researchers to classify perceptions of treatments (positive, negative, mixed, or without perception). Results: A total of 80 posts by 69 patients and 142 posts by 127 caregivers mentioning chemotherapy, and 42 posts by 31 patients and 35 posts by 32 caregivers mentioning immunotherapy were included for analysis. These posts were retrieved from 39 public social media sites. Among patients with advanced BC and their caregivers, treatment perceptions of chemotherapy were more negative (36\%) than positive (7\%). Most of the patients' posts (71\%) mentioned chemotherapy factually without expressing a perception of the treatment. The caregivers' perceptions of treatment were negative in 44\%, mixed in 8\%, and positive in 7\% of posts. In combined patient and caregiver posts, immunotherapy was perceived positively in 47\% of posts and negatively in 22\% of posts. Caregivers also posted more negative perceptions (37\%) of immunotherapy than patients (9\%). Negative perceptions of both chemotherapy and immunotherapy were mainly due to side effects and perceived lack of effectiveness. Conclusions: Despite chemotherapy being standard first-line therapy for advanced BC, negative perceptions were identified on social media, particularly among caregivers. Addressing these negative perceptions of treatment may improve treatment adoption. Strengthening support for patients receiving chemotherapy and their caregivers to help them manage side effects and understand the role of chemotherapy in the treatment of advanced BC would potentially enable a more positive experience. ",
doi="10.2196/45011",
url="https://cancer.jmir.org/2023/1/e45011",
url="http://www.ncbi.nlm.nih.gov/pubmed/36972135"
}


@Article{info:doi/10.2196/41101,
author="Raso, Kristy-Lee
and Suen, Michael
and Turner, Jane
and Khatri, Sonia
and Lin, Yanlan
and Wildbore, Carolyn
and Becerril-Martinez, Guillermo
and Le Page, Philip
and Tan, Yee Sim
and Egger, Sam
and Vardy, Janette",
title="Prehabilitation Before Gastrointestinal Cancer Surgery: Protocol for an Implementation Study",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="27",
volume="12",
pages="e41101",
keywords="prehabilitation",
keywords="gastrointestinal",
keywords="cancer",
keywords="surgery",
keywords="exercise",
keywords="nutrition",
keywords="telehealth",
keywords="colorectal",
keywords="psychological",
abstract="Background: Surgery remains the standard curative treatment for early-stage colorectal and upper gastrointestinal cancer. Reduced preoperative functional capacity, nutritional status, and psychological well-being are associated with poor postoperative outcomes. Prehabilitation aims to improve preoperative functional reserves through physical, nutritional, and psychological interventions. Yet, how it transitions from a trial setting to being integrated into a real-world health setting is unknown. Objective: The primary aim is to evaluate the implementation of a multimodal (supervised exercise, nutrition, and nursing support) prehabilitation program into standard care for patients with gastrointestinal cancer (colorectal and upper gastrointestinal cancer) scheduled for curative intent surgery. The secondary aim is to determine the impact of a multimodal prehabilitation program on functional capacity, nutritional and psychological status, and surgical outcomes. Methods: This is an implementation study that will investigate a multimodal prehabilitation intervention, in a nonblinded, nonrandomized, single-group, pre-post design. Patients diagnosed with colorectal and upper gastrointestinal cancer scheduled for potentially curative intent surgery at Concord Repatriation General Hospital, with ?14 intervention days prior to surgery and are medically cleared to exercise will be eligible. The study will be evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance Evaluation Framework. Results: The protocol was approved in December 2019 by the Concord Repatriation General Hospital Human Research Ethics Committee (reference number 2019/PID13679). Recruitment commenced in January 2020. In response to the COVID-19 pandemic, recruitment was paused in March 2020 and reopened in August 2020 with remote or telehealth intervention adaptations. Recruitment ended on December 31, 2021. Over the 16-month recruitment period, a total of 77 participants were recruited. Conclusions: Prehabilitation represents an opportunity to maximize functional capacity and improve surgical outcomes. The study will provide guidance and contribute to the evidence on the integration of prehabilitation into standard care using adaptive models of health care delivery including telehealth. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTR 12620000409976; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378974\&isReview=true International Registered Report Identifier (IRRID): RR1-10.2196/41101 ",
doi="10.2196/41101",
url="https://www.researchprotocols.org/2023/1/e41101",
url="http://www.ncbi.nlm.nih.gov/pubmed/36972114"
}


@Article{info:doi/10.2196/43586,
author="Wang, Le
and Wang, Youqing
and Wang, Fei
and Gao, Yumeng
and Fang, Zhimei
and Gong, Weiwei
and Li, Huizhang
and Zhu, Chen
and Chen, Yaoyao
and Shi, Lei
and Du, Lingbin
and Li, Ni",
title="Disparity in Lung Cancer Screening Among Smokers and Nonsmokers in China: Prospective Cohort Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Mar",
day="14",
volume="9",
pages="e43586",
keywords="lung cancer",
keywords="screening",
keywords="smoker",
keywords="nonsmoker",
abstract="Background: Low-dose computed tomography (LDCT) screening is effective in reducing lung cancer mortality in smokers; however, the evidence in nonsmokers is scarce. Objective: This study aimed to evaluate the participant rate and effectiveness of one-off LDCT screening for lung cancer among smokers and nonsmokers. Methods: A population-based prospective cohort study was performed to enroll participants aged between 40 and 74 years from 2013 to 2019 from 4 cities in Zhejiang Province, China. Participants who were evaluated as having a high risk of lung cancer from an established risk score model were recommended to undergo LDCT screening. Follow-up outcomes were retrieved on June 30, 2020. The uptake rate of LDCT screening for evaluated high-risk participants and the detection rate of early-stage lung cancer (stage 0-I) were calculated. The lung cancer incidence, lung cancer mortality, and all-cause mortality were compared between the screened and nonscreened groups. Results: At baseline, 62.56\% (18,818/30,079) of smokers and 6\% (5483/91,455) of nonsmokers were identified as high risk (P<.001), of whom 41.9\% (7885/18,818) and 66.31\% (3636/5483) underwent LDCT screening (P<.001), respectively. After a median follow-up of 5.1 years, 1100 lung cancer cases and 456 all-cause death cases (116 lung cancer death cases) were traced. The proportion of early-stage lung cancer among smokers was 60.3\% (173/287), which was lower than the proportion of 80.3\% (476/593) among nonsmokers (P<.001). Among smokers, a higher proportion was found in the screened group (72/106, 67.9\%) than the nonscreened group (56/114, 49.1\%; P=.005), whereas no significance was found (42/44, 96\% vs 10/12, 83\%; P=.20) among nonsmokers. Compared with participants who were not screened, LDCT screening in smokers significantly increased lung cancer incidence (hazard ratio [HR] 1.39, 95\% CI 1.09-1.76; P=.007) but reduced lung cancer mortality (HR 0.52, 95\% CI 0.28-0.96; P=.04) and all-cause mortality (HR 0.47, 95\% CI 0.32-0.69; P<.001). Among nonsmokers, no significant results were found for lung cancer incidence (P=.06), all-cause mortality (P=.89), and lung cancer mortality (P=.17). Conclusions: LDCT screening effectively reduces lung cancer and all-cause mortality among high-risk smokers. Further efforts to define high-risk populations and explore adequate lung cancer screening modalities for nonsmokers are needed. ",
doi="10.2196/43586",
url="https://publichealth.jmir.org/2023/1/e43586",
url="http://www.ncbi.nlm.nih.gov/pubmed/36917151"
}


@Article{info:doi/10.2196/39645,
author="Levitz, E. Carly
and Kuo, Elena
and Guo, Monica
and Ruiz, Esmeralda
and Torres-Ozadali, Evelyn
and Brar Prayaga, Rena
and Escaron, Anne",
title="Using Text Messages and Fotonovelas to Increase Return of Home-Mailed Colorectal Cancer Screening Tests: Mixed Methods Evaluation",
journal="JMIR Cancer",
year="2023",
month="Mar",
day="7",
volume="9",
pages="e39645",
keywords="colorectal cancer screening",
keywords="texting campaign",
keywords="patient navigation",
keywords="fotonovela",
keywords="fecal immunochemical test kit",
keywords="FIT kit",
keywords="screening",
keywords="cancer",
keywords="colorectal cancer",
keywords="CRC",
keywords="bidirectional texting",
keywords="health text messaging",
keywords="health promotion",
keywords="participation",
keywords="comics",
abstract="Background: Colorectal cancer (CRC) is currently the second leading cause of cancer-related deaths in the United States; however, it is mostly preventable with appropriate screening and is often treatable when detected at early stages. Many patients enrolled in an urban Federally Qualified Health Center (FQHC) clinic were found to be past due for CRC screening. Objective: This study described a quality improvement (QI) project to improve CRC screening rates. This project used bidirectional texting with fotonovela comics and natural language understanding (NLU) to encourage patients to mail fecal immunochemical test (FIT) kits back to the FQHC. Methods: The FQHC mailed FIT kits to 11,000 unscreened patients in July 2021. Consistent with the usual care, all patients received 2 text messages and a patient navigator call within the first month of mailing. As part of a QI project, 5241 patients who did not return their FIT kit within 3 months, aged 50-75 years, and spoke either English or Spanish were randomized to either usual care (no further intervention) or intervention (4-week texting campaign with a fotonovela comic and remailing kits if requested) groups. The fotonovela was developed to address known barriers to CRC screening. The texting campaign used NLU to respond to patients' texts. A mixed methods evaluation used data from SMS text messages and electronic medical records to understand the impact of the QI project on CRC screening rates. Open-ended text messages were analyzed for themes, and interviews were completed with a convenience sample of patients to understand barriers to screening and impact of the fotonovela. Results: Of the 2597 participants, 1026 (39.5\%) in the intervention group engaged with bidirectional texting. Participating in bidirectional texting was related to language preference ($\chi$22=11.0; P=.004) and age group ($\chi$22=19.0; P<.001). Of the 1026 participants who engaged bidirectionally, 318 (31\%) clicked on the fotonovela. Furthermore, 54\% (32/59) of the patients clicked on the fotonovela and responded that they loved it, and 36\% (21/59) of patients responded that they liked it. The intervention group was more likely to get screened (487/2597, 18.75\%) than those in usual care (308/2644, 11.65\%; P<.001), and this pattern held, regardless of demographic subgroup (sex, age, screening history, preferred language, and payer type). Interview data (n=16) indicated that the text messages, navigator calls, and fotonovelas were well received and not unduly invasive. Interviewees noted several important barriers to CRC screening and offered suggestions for reducing barriers and increasing screening. Conclusions: Texting using NLU and fotonovela is valuable in increasing CRC screening as observed by the FIT return rate for patients in the intervention group. There were patterns in which patients did not engage bidirectionally; future work should investigate how to ensure that populations are not left out of screening campaigns. ",
doi="10.2196/39645",
url="https://cancer.jmir.org/2023/1/e39645",
url="http://www.ncbi.nlm.nih.gov/pubmed/36881466"
}


@Article{info:doi/10.2196/44197,
author="Zhang, Xupin
and Tao, Xinqi
and Ji, Bingxiang
and Wang, Renwu
and S{\"o}rensen, Silvia",
title="The Success of Cancer Crowdfunding Campaigns: Project and Text Analysis",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="3",
volume="25",
pages="e44197",
keywords="cancer",
keywords="GoFundme",
keywords="fundraising",
keywords="emotional content",
keywords="sentiment analysis",
keywords="campaign features",
keywords="crowdfunding",
keywords="gender",
abstract="Background: Recent studies have analyzed the factors that contribute to variations in the success of crowdfunding campaigns for a specific cancer type; however, little is known about the influential factors among crowdfunding campaigns for multiple cancers. Objective: The purpose of this study was to examine the relationship between project features and the success of cancer crowdfunding campaigns and to determine whether text features affect campaign success for various cancers. Methods: Using cancer-related crowdfunding projects on the GoFundMe website, we transformed textual descriptions from the campaigns into structured data using natural language processing techniques. Next, we used penalized logistic regression and correlation analyses to examine the influence of project and text features on fundraising project outcomes. Finally, we examined the influence of campaign description sentiment on crowdfunding success using Linguistic Inquiry and Word Count software. Results: Campaigns were significantly more likely to be successful if they featured a lower target amount (Goal amount, $\beta$=?1.949, z score=?82.767, P<.001) for fundraising, a higher number of previous donations, agency (vs individual) organizers, project pages containing updates, and project pages containing comments from readers. The results revealed an inverted U-shaped relationship between the length of the text and the amount of funds raised. In addition, more spelling mistakes negatively affected the funds raised (Number of spelling errors, $\beta$=?1.068, z score=?38.79, P<.001). Conclusions: Difficult-to-treat cancers and high-mortality cancers tend to trigger empathy from potential donors, which increases the funds raised. Gender differences were observed in the effects of emotional words in the text on the amount of funds raised. For cancers that typically occur in women, links between emotional words used and the amount of funds raised were weaker than for cancers typically occurring among men. ",
doi="10.2196/44197",
url="https://www.jmir.org/2023/1/e44197",
url="http://www.ncbi.nlm.nih.gov/pubmed/36692283"
}


@Article{info:doi/10.2196/43832,
author="Xue, Peng
and Si, Mingyu
and Qin, Dongxu
and Wei, Bingrui
and Seery, Samuel
and Ye, Zichen
and Chen, Mingyang
and Wang, Sumeng
and Song, Cheng
and Zhang, Bo
and Ding, Ming
and Zhang, Wenling
and Bai, Anying
and Yan, Huijiao
and Dang, Le
and Zhao, Yuqian
and Rezhake, Remila
and Zhang, Shaokai
and Qiao, Youlin
and Qu, Yimin
and Jiang, Yu",
title="Unassisted Clinicians Versus Deep Learning--Assisted Clinicians in Image-Based Cancer Diagnostics: Systematic Review With Meta-analysis",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="2",
volume="25",
pages="e43832",
keywords="deep learning",
keywords="cancer diagnosis",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: A number of publications have demonstrated that deep learning (DL) algorithms matched or outperformed clinicians in image-based cancer diagnostics, but these algorithms are frequently considered as opponents rather than partners. Despite the clinicians-in-the-loop DL approach having great potential, no study has systematically quantified the diagnostic accuracy of clinicians with and without the assistance of DL in image-based cancer identification. Objective: We systematically quantified the diagnostic accuracy of clinicians with and without the assistance of DL in image-based cancer identification. Methods: PubMed, Embase, IEEEXplore, and the Cochrane Library were searched for studies published between January 1, 2012, and December 7, 2021. Any type of study design was permitted that focused on comparing unassisted clinicians and DL-assisted clinicians in cancer identification using medical imaging. Studies using medical waveform-data graphics material and those investigating image segmentation rather than classification were excluded. Studies providing binary diagnostic accuracy data and contingency tables were included for further meta-analysis. Two subgroups were defined and analyzed, including cancer type and imaging modality. Results: In total, 9796 studies were identified, of which 48 were deemed eligible for systematic review. Twenty-five of these studies made comparisons between unassisted clinicians and DL-assisted clinicians and provided sufficient data for statistical synthesis. We found a pooled sensitivity of 83\% (95\% CI 80\%-86\%) for unassisted clinicians and 88\% (95\% CI 86\%-90\%) for DL-assisted clinicians. Pooled specificity was 86\% (95\% CI 83\%-88\%) for unassisted clinicians and 88\% (95\% CI 85\%-90\%) for DL-assisted clinicians. The pooled sensitivity and specificity values for DL-assisted clinicians were higher than for unassisted clinicians, at ratios of 1.07 (95\% CI 1.05-1.09) and 1.03 (95\% CI 1.02-1.05), respectively. Similar diagnostic performance by DL-assisted clinicians was also observed across the predefined subgroups. Conclusions: The diagnostic performance of DL-assisted clinicians appears better than unassisted clinicians in image-based cancer identification. However, caution should be exercised, because the evidence provided in the reviewed studies does not cover all the minutiae involved in real-world clinical practice. Combining qualitative insights from clinical practice with data-science approaches may improve DL-assisted practice, although further research is required. Trial Registration: PROSPERO CRD42021281372; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=281372 ",
doi="10.2196/43832",
url="https://www.jmir.org/2023/1/e43832",
url="http://www.ncbi.nlm.nih.gov/pubmed/36862499"
}


@Article{info:doi/10.2196/38758,
author="Moradian, Saeed
and Maguire, Roma
and Liu, Geoffrey
and Krzyzanowska, K. Monika
and Butler, Marcus
and Cheung, Chantal
and Signorile, Marisa
and Gregorio, Nancy
and Ghasemi, Shiva
and Howell, Doris",
title="Promoting Self-management and Patient Activation Through eHealth: Protocol for a Systematic Literature Review and Meta-analysis",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="2",
volume="12",
pages="e38758",
keywords="digital health",
keywords="cancer supportive care",
keywords="cancer-related symptoms",
keywords="self-efficacy",
keywords="supported self-management",
abstract="Background: Major advances in different cancer treatment modalities have been made, and people are now living longer with cancer. However, patients with cancer experience a range of physical and psychological symptoms during and beyond cancer treatment. New models of care are needed to combat this rising challenge. A growing body of evidence supports the effectiveness of eHealth interventions in the delivery of supportive care to people living with the complexities of chronic health conditions. However, reviews on the effects of eHealth interventions are scarce in the field of cancer-supportive care, particularly for interventions with the aim of empowering patients to manage cancer treatment--related symptoms. For this reason, this protocol has been developed to guide a systematic review and meta-analysis to assess the effectiveness of eHealth interventions for supporting patients with cancer in managing cancer-related symptoms. Objective: This systematic review with meta-analysis is conducted with the aim of identifying eHealth-based self-management intervention studies for adult patients with cancer and evaluating the efficacy of eHealth-based self-management tools and platforms in order to synthesize the empirical evidence on self-management and patient activation through eHealth. Methods: A systematic review with meta-analysis and methodological critique of randomized controlled trials is conducted following Cochrane Collaboration methods. Multiple data sources are used to identify all potential research sources for inclusion in the systematic review: (1) electronic databases such as MEDLINE, (2) forward reference searching, and (3) gray literature. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for conducting the review were followed. The PICOS (Population, Interventions, Comparators, Outcomes, and Study Design) framework is used to identify relevant studies. Results: The literature search yielded 10,202 publications. The title and abstract screening were completed in May 2022. Data will be summarized, and if possible, meta-analyses will be performed. It is expected to finalize this review by Winter 2023. Conclusions: The results of this systematic review will provide the latest data on leveraging eHealth interventions and offering effective and sustainable eHealth care, both of which have the potential to improve quality and efficiency in cancer-related symptoms. Trial Registration: PROSPERO 325582; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=325582 International Registered Report Identifier (IRRID): DERR1-10.2196/38758 ",
doi="10.2196/38758",
url="https://www.researchprotocols.org/2023/1/e38758",
url="http://www.ncbi.nlm.nih.gov/pubmed/36862481"
}


@Article{info:doi/10.2196/42250,
author="Ayyoubzadeh, Mohammad Seyed
and Baniasadi, Tayebeh
and Shirkhoda, Mohammad
and Rostam Niakan Kalhori, Sharareh
and Mohammadzadeh, Niloofar
and Roudini, Kamran
and Ghalehtaki, Reza
and Memari, Fereidoon
and Jalaeefar, Amirmohsen",
title="Remote Monitoring of Colorectal Cancer Survivors Using a Smartphone App and Internet of Things--Based Device: Development and Usability Study",
journal="JMIR Cancer",
year="2023",
month="Feb",
day="15",
volume="9",
pages="e42250",
keywords="eHealth",
keywords="telemedicine",
keywords="colorectal cancer",
keywords="cancer survivor",
keywords="IoT",
keywords="mHealth",
keywords="patient monitoring",
keywords="remote monitoring",
keywords="postdischarge care",
keywords="cancer",
keywords="patient care",
keywords="cancer care",
keywords="postoperative complications",
abstract="Background: Patients with colorectal cancer who undergo surgery face many postoperative problems. These problems include the risk of relapse, side effects, and long-term complications. Objective: This study sought to design and develop a remote monitoring system as a technological solution for the postdischarge care of these patients. Methods: This research was conducted in 3 main steps: system feature extraction, system design, and evaluation. After feature extraction from a systematic review, the necessary features were defined by 18 clinical experts in Iran. In the next step, the architecture of the system was designed based on the requirements; the software and hardware parts of the system were embedded in the architecture, then the software system components were drawn using the unified modeling language diagrams, and the details of software system implementation were identified. Regarding the hardware design, different accessible hardware modules were evaluated, and suitable ones were selected. Finally, the usability of the system was evaluated by demonstrating it over a Skype virtual meeting session and using Nilsen's usability principles. Results: A total of 21 mandatory features in 5 main categories, including patient information registration, periodic monitoring of health parameters, education, reminders, and assessments, were defined and validated for the system. The software was developed using an ASP.Net core backend, a Microsoft SQL Server database, and an Ionic frontend alongside the Angular framework, to build an Android app. The user roles of the system included 3 roles: physicians, patients, and the system administrator. The hardware was designed to contain an Esp8266 as the Internet of Things module, an MLX90614 infrared temperature sensor, and the Maxim Integrated MAX30101 sensor for sensing the heartbeat. The hardware was designed in the shape of a wristband device using SolidWorks 2020 and printed using a 3D printer. The firmware of the hardware was developed in Arduino with the capability of firmware over the air. In evaluating the software system from the perspective of usability, the system received an average score of 3.8 out of 5 from 4 evaluators. Conclusions: Sensor-based telemonitoring systems for patients with colorectal cancer after surgery are possible solutions that can make the process automatic for patients and caregivers. The apps for remote colorectal patient monitoring could be designed to be useful; however, more research regarding the developed system's implementation in clinic settings and hospitals is required to understand the probable barriers and limitations. ",
doi="10.2196/42250",
url="https://cancer.jmir.org/2023/1/e42250",
url="http://www.ncbi.nlm.nih.gov/pubmed/36790851"
}


@Article{info:doi/10.2196/39988,
author="Singh, Rohan
and McCain, Sarah
and Feldman, R. Steven",
title="Refusal of Retreatment With Topical 5-Fluorouracil Among Patients With Actinic Keratosis: Qualitative Analysis",
journal="JMIR Dermatol",
year="2023",
month="Feb",
day="15",
volume="6",
pages="e39988",
keywords="actinic keratosis",
keywords="solar keratosis",
keywords="topical 5-fluorouracil",
keywords="fluorouracil",
keywords="topical treatment",
keywords="cancer",
keywords="carcinoma",
keywords="neoplasm",
keywords="oncology",
keywords="pharmacotherapy",
keywords="pharmacological",
keywords="malignant",
keywords="malignancy",
keywords="tolerability",
keywords="adherence",
keywords="preference",
keywords="opinion",
keywords="attrition",
keywords="attitude",
keywords="perception",
keywords="qualitative",
keywords="skin",
keywords="dermatology",
keywords="lesion",
abstract="Background: Actinic keratosis (AK) is a common premalignant skin lesion, and topical 5-fluorouracil (5-FU) is commonly used in field-directed therapy. However, 5-FU is associated with frequent local skin reactions. Objective: This study aimed to qualitatively assess experiences among patients with AK who refuse retreatment with 5-FU. Methods: Semistructured interviews were conducted with 10 adult participants who had received treatment with 5-FU for AK between January 1, 2017, and January 1, 2020, and refused future treatment with 5-FU. Results were analyzed using qualitative research methods. Results: Although most participants had low concern upon having received a diagnosis of AK, most felt that treatment is very important. When initiating treatment with 5-FU, most cited recommendation by their health care professionals as the primary motivator and initially had low concern regarding treatment. The side effects associated with treatment were physically and psychosocially burdensome for most participants and led to temporary lifestyle adjustments. After treatment, most did not believe that their health care provider prepared them for treatment or were unsure. While half of the participants felt that 5-FU helped treat AKs, half were either unsure, due to premature discontinuation, or did not think that 5-FU treated their AKs. Conclusions: 5-FU is one of the most commonly prescribed treatments for AKs, yet most patients experienced both a physical and psychosocial burden with the treatment. Inability to assess efficacy due to premature discontinuation secondary to 5-FU--related reactions is common, and shared decision-making, navigating treatment options, and taking into account patient preferences may be critical to help assure better adherence and outcomes. Although our study was limited by input from participants who refused future treatment with 5-FU, most stated that they would still continue to seek treatment for AKs in the future and would consider other topical treatments, especially if associated with a milder tolerability profile. ",
doi="10.2196/39988",
url="https://derma.jmir.org/2023/1/e39988",
url="http://www.ncbi.nlm.nih.gov/pubmed/37632916"
}


@Article{info:doi/10.2196/35601,
author="Duong, Thien Huong
and Hopfer, Suellen",
title="Exploring Intergenerational Communication on Social Media Group Chats as a Cancer Prevention Intervention Opportunity Among Vietnamese American Families: Qualitative Study",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="15",
volume="7",
pages="e35601",
keywords="cancer prevention",
keywords="Vietnamese",
keywords="family communication",
keywords="intervention",
keywords="colorectal cancer",
keywords="human papillomavirus vaccine",
keywords="HPV vaccine",
keywords="Papanicolaou test",
keywords="mobile phone",
abstract="Background: Families use social media group chats to connect with each other about daily life and to share information. Although cancer is not a frequent topic of conversation in family settings, the adoption of mobile technology in the family context presents a novel opportunity to promote cancer prevention information. To the best of our knowledge, few studies have used private social media group chats to promote cancer prevention information to family members. Objective: In this formative study, we investigated how family group chat platforms can be leveraged to encourage colorectal cancer screening, human papillomavirus vaccination, and cervical cancer screening among intergenerational Vietnamese American families. This study aimed to cocreate a family-based communication intervention for introducing cancer screening information in family group chats. We sought to understand family members' motivations for using group chats, family dynamics and conversation patterns, and group chat experiences and cultural norms for interacting with family members. Methods: Overall, 20 audio-recorded and semistructured interviews were conducted with young Vietnamese adults. The study was conducted between August and October 2018. Participants were Vietnamese Americans; aged between 18 and 44 years; living in Orange County, California; had an existing family group chat; and expressed an interest in becoming family health advocates. Data were analyzed using a framework analysis. Results: In total, 13 (65\%) of the 20 young adults reported having >1 group chat with their immediate and extended family. Preventive health was not a typical topic of family conversations, but food, family announcements, personal updates, humorous videos or photos, and current events were. Young adults expressed openness to initiating conversations with family members about cancer prevention; however, they also raised concerns that may influence family members' receptivity to the messages. Themes that could potentially impact family members' willingness to accept cancer prevention messages included family status and hierarchy, gender dynamics, relational closeness in the family, and source trust and credibility. These considerations may impact whether families will be open to receiving cancer screening information and acting on it. The participants also mentioned practical considerations for intervention and message design, which included the Vietnamese cultural conversation etiquette of h?i th?m, respect for a physician's recommendation, prevention versus symptom orientation, the family health advocate's bilingual capacity, and the busy lives of family members. In response to exemplar messages, participants mentioned that they preferred to personalize template messages to accommodate conversational norms in their family group chats. Conclusions: The findings of this study inform the development of a social media intervention for increasing preventive cancer screening in Vietnamese American families. ",
doi="10.2196/35601",
url="https://formative.jmir.org/2023/1/e35601",
url="http://www.ncbi.nlm.nih.gov/pubmed/36790844"
}


@Article{info:doi/10.2196/42783,
author="Sanger, Sally
and Duffin, Suzanne
and Gough, E. Rosemarie
and Bath, A. Peter",
title="Use of Online Health Forums by People Living With Breast Cancer During the COVID-19 Pandemic: Thematic Analysis",
journal="JMIR Cancer",
year="2023",
month="Feb",
day="7",
volume="9",
pages="e42783",
keywords="online health forum",
keywords="breast cancer",
keywords="COVID-19",
keywords="pandemic",
keywords="discussion forum",
keywords="coronavirus",
keywords="web-based communities",
keywords="information use",
abstract="Background: At the time of the UK COVID-19 lockdowns, online health forums (OHFs) were one of the relatively few remaining accessible sources of peer support for people living with breast cancer. Cancer services were heavily affected by the pandemic in many ways, including the closure of many of the customary support services. Previous studies indicate that loneliness, anxiety, distress, and depression caused by COVID-19 were common among people living with breast cancer, and this suggests that the role of OHFs in providing users with support, information, and empathy could have been of increased importance at that time. Objective: This study aimed to examine how people living with breast cancer shared information, experiences, and emotions in an OHF during the COVID-19 pandemic. Methods: This qualitative study thematically analyzed posts from the discussion forums of an OHF provided by the UK charity, Breast Cancer Now. We selected 1053 posts from the time of 2 UK lockdowns: March 16, 2020, to June 15, 2020 (lockdown 1), and January 6, 2021, to March 8, 2021 (lockdown 3), for analysis, from 2 of the forum's boards (for recently diagnosed people and for those undergoing chemotherapy). We analyzed the data using the original 6 steps for thematic analysis by Braun and Clarke but by following a codebook approach. Descriptive statistics for posts were also derived. Results: We found that COVID-19 amplified the forum's value to its users. As patients with cancer, participants were in a situation that was ``bad enough already,'' and the COVID-19 pandemic heightened this difficult situation. The forum's value, which was already high for the information and peer support it provided, increased because COVID-19 caused some special information needs that forum users were uniquely well placed to fulfill as people experiencing the combined effects of having breast cancer during the pandemic. The forum also met the emotional needs generated by the COVID-19 pandemic and was valued as a place where loneliness during the pandemic may be relieved and users' spirits lifted in a variety of ways specific to this period. We found some differences in use between the 2 periods and the 2 boards---most noticeable was the great fear and anxiety expressed at the beginning of lockdown 1. Both the beginning and end of lockdown periods were particularly difficult for participants, with the ends seen as potentially increasing isolation. Conclusions: The forums were an important source of support and information to their users, with their value increasing during the lockdowns for a variety of reasons. Our findings will be helpful to organizations offering OHFs and to health care workers advising people living with breast cancer about sources of support. ",
doi="10.2196/42783",
url="https://cancer.jmir.org/2023/1/e42783",
url="http://www.ncbi.nlm.nih.gov/pubmed/36473015"
}


@Article{info:doi/10.2196/39391,
author="Wathne, Hege
and Morken, Margreta Ingvild
and Storm, Marianne
and Huseb{\o}, Lunde Anne Marie",
title="Designing a Future eHealth Service for Posthospitalization Self-management Support in Long-term Illness: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2023",
month="Feb",
day="6",
volume="10",
pages="e39391",
keywords="colorectal cancer",
keywords="eHealth service",
keywords="heart failure",
keywords="noncommunicable diseases",
keywords="self-management",
keywords="qualitative research",
keywords="mobile phone",
abstract="Background: For patients with noncommunicable diseases (NCDs; eg, heart failure [HF] and colorectal cancer [CRC]), eHealth interventions could meet their posthospital discharge needs and strengthen their ability to self-manage. However, inconclusive evidence exists regarding how to design eHealth services to meet the complex needs of patients. To foster patient acceptability and ensure the successful development and implementation of eHealth solutions, it is beneficial to include different stakeholders (ie, patients and health care professionals) in the design and development phase of such services. The involvement of different stakeholders could contribute to ensuring feasible, acceptable, and usable solutions and that eHealth services are developed in response to users' supportive care needs when transitioning to home after hospitalization. This study is the first step of a larger complex intervention study aimed at meeting the postdischarge needs of 2 NCD populations. Objective: This study aimed to explore the perspectives of patients with HF and CRC and health care professionals on patient self-management needs following hospital discharge and investigate how a future nurse-assisted eHealth service could be best designed to foster patient acceptability, support self-management, and smooth the transition from hospital to home. Methods: A qualitative, explorative, and descriptive approach was used. We conducted 38 semistructured interviews with 10 patients with HF, 9 patients surgically treated for CRC with curative intent, 6 registered nurses recruited as nurse navigators of a planned eHealth service, and 13 general practitioners experienced in HF and CRC treatment and follow-up care. Patients were recruited conveniently from HF and CRC outpatient clinics, and the nurses were recruited from the cardiology and gastro-surgical departments at a university hospital in the southwest of Norway. The general practitioners were recruited from primary care in surrounding municipalities. Semistructured interview guides were used for data collection, and the data were analyzed using thematic analysis. Results: In total, 3 main themes were derived from the data analysis: expecting information, reassurance, and guidance when using eHealth for HF and CRC self-management; expecting eHealth to be comprehensible, supportive, and knowledge promoting; and recognizing both the advantages and disadvantages of eHealth for HF and CRC self-management. The data generated from this interview study depicted the diverse needs for self-management support of patients with CRC and HF after hospital discharge. In addition, valuable suggestions were identified regarding the design and content of the eHealth service. However, participants described both possible advantages and disadvantages of a remote eHealth service. Conclusions: This study is the first step in the development of an eHealth service for posthospitalization self-management support for long-term illnesses. It concerns patients' supportive care needs and user requirements of an eHealth service. The findings of this study may add value to the planning and development of eHealth interventions for patients with NCDs. ",
doi="10.2196/39391",
url="https://humanfactors.jmir.org/2023/1/e39391",
url="http://www.ncbi.nlm.nih.gov/pubmed/36745492"
}


@Article{info:doi/10.2196/42334,
author="Yu, Liyang
and Liu, You-Chi
and Cornelius, L. Sarah
and Scodari, T. Bruno
and Brooks, A. Gabriel
and O'Malley, James Alistair
and Onega, Tracy
and Moen, L. Erika",
title="Telehealth Use Following COVID-19 Within Patient-Sharing Physician Networks at a Rural Comprehensive Cancer Center: Cross-sectional Analysis",
journal="JMIR Cancer",
year="2023",
month="Jan",
day="17",
volume="9",
pages="e42334",
keywords="telehealth",
keywords="rural cancer care",
keywords="patient-sharing networks",
keywords="network analysis",
keywords="COVID-19",
keywords="cancer care",
keywords="telemedicine",
keywords="oncology",
keywords="oncologist",
keywords="electronic health record data",
keywords="health system",
keywords="patient network",
abstract="Background: In response to the COVID-19 pandemic, cancer centers rapidly adopted telehealth to deliver care remotely. Telehealth will likely remain a model of care for years to come and may not only affect the way oncologists deliver care to their own patients but also the physicians with whom they share patients. Objective: This study aimed to examine oncologist characteristics associated with telehealth use and compare patient-sharing networks before and after the COVID-19 pandemic in a rural catchment area with a particular focus on the ties between physicians at the comprehensive cancer center and regional facilities. Methods: In this retrospective observational study, we obtained deidentified electronic health record data for individuals diagnosed with breast, colorectal, or lung cancer at Dartmouth Health in New Hampshire from 2018-2020. Hierarchical logistic regression was used to identify physician factors associated with telehealth encounters post COVID-19. Patient-sharing networks for each cancer type before and post COVID-19 were characterized with global network measures. Exponential-family random graph models were performed to estimate homophily terms for the likelihood of ties existing between physicians colocated at the hub comprehensive cancer center. Results: Of the 12,559 encounters between patients and oncologists post COVID-19, 1228 (9.8\%) were via telehealth. Patient encounters with breast oncologists who practiced at the hub hospital were over twice as likely to occur via telehealth compared to encounters with oncologists who practiced in regional facilities (odds ratio 2.2, 95\% CI 1.17-4.15; P=.01). Patient encounters with oncologists who practiced in multiple locations were less likely to occur via telehealth, and this association was statistically significant for lung cancer care (odds ratio 0.26, 95\% CI 0.09-0.76; P=.01). We observed an increase in ties between oncologists at the hub hospital and oncologists at regional facilities in the lung cancer network post COVID-19 compared to before COVID-19 (93/318, 29.3\%, vs 79/370, 21.6\%, respectively), which was also reflected in the lower homophily coefficients post COVID-19 compared to before COVID-19 for physicians being colocated at the hub hospital (estimate: 1.92, 95\% CI 1.46-2.51, vs 2.45, 95\% CI 1.98-3.02). There were no significant differences observed in breast cancer or colorectal cancer networks. Conclusions: Telehealth use and associated changes to patient-sharing patterns associated with telehealth varied by cancer type, suggesting disparate approaches for integrating telehealth across clinical groups within this health system. The limited changes to the patient-sharing patterns between oncologists at the hub hospital and regional facilities suggest that telehealth was less likely to create new referral patterns between these types of facilities and rather replace care that would otherwise have been delivered in person. However, this study was limited to the 2 years immediately following the initial outbreak of COVID-19, and longer-term follow-up may uncover delayed effects that were not observed in this study period. ",
doi="10.2196/42334",
url="https://cancer.jmir.org/2023/1/e42334",
url="http://www.ncbi.nlm.nih.gov/pubmed/36595737"
}


@Article{info:doi/10.2196/36401,
author="Ahmed, Anam
and Mewes, C. Janne
and Boot, A. Iris W.
and Vrijhoef, M. Hubertus J.",
title="New Heat and Moisture Exchangers for Laryngectomized Patients in Germany: Mixed Methods Study on the Expected Effectiveness",
journal="JMIR Form Res",
year="2023",
month="Jan",
day="11",
volume="7",
pages="e36401",
keywords="heat and moisture exchanger",
keywords="HME",
keywords="laryngectomy",
keywords="device",
keywords="laryngeal cancer",
keywords="mixed methods",
keywords="review",
keywords="interview",
keywords="structured expert elicitation",
abstract="Background: Notwithstanding the benefits of heat and moisture exchangers (HMEs) in both clinical research and practice, a gap exists between the optimal physiological humidification created through the nasal function and the humidification capacity of HMEs for patients after total laryngectomy. In this study, 5 new HMEs (Provox Life) specialized for situational use with improved humidification capacities were evaluated. Objective: This study aims to evaluate the effectiveness of the existing HMEs, assess the potential effectiveness of the new HMEs, and elicit expert judgments on the new HMEs' expected effectiveness and impact on health care use. Methods: First, a rapid literature review (RLR) was performed to identify evidence on the clinical outcomes, health outcomes, and complications of HMEs in patients who underwent laryngectomy. Second, semistructured interviews with German experts (n=4) were conducted to validate the findings of the RLR and identify reasonable expectations regarding the potential of the new HMEs. Third, a structured expert elicitation among German experts (n=19) was used to generate quantitative evidence on the expected effectiveness of the new HMEs in clinical and health outcomes. Results: The RLR (n=10) demonstrated that HME use by patients has advantages compared with no HME use concerning breathing resistance, tracheal dryness and irritation, mucus production and plugging, frequency of cough and forced expectorations, sleep quality, voice quality, use of physiotherapy, tracheobronchitis or pneumonia episodes, quality of life, and patient satisfaction. From the expert interviews and structured expert elicitation, it was found that, on average, experts expect that compared with the second-generation HMEs, the new HMEs will lead to a decrease in tracheal dryness or irritation (51\%, SD 24\%, of patients), mucus plug events (33\%, SD 32\%, of patients), mucus production (53\%, SD 22\%, of patients), physiotherapy (0.74, SD 0.70, days) and pulmonary infections (34\%, SD 32\%) and an increase or improvement in speech quality (25\%, SD 23\%, of patients), social contacts (13\%, SD 18\%), quality of life (33\%, SD 30\%), and patient satisfaction (44\%, SD 30\%). An improvement in breathing (53\%, SD 28\%, of patients) and shortness of breath (48\%, SD 25\%, of patients) was expected. The average number of daily cough periods and forced expectorations was expected to be 2.95 (SD 1.61) and 2.46 (SD 1.42), respectively. Experts expect that, on average, less than half of the patients will experience sleeping problems (48\%, SD 22\%) and psychosocial problems (24\%, SD 20\%). Conclusions: According to German experts, it is expected that the new HMEs with improved humidification levels will lead to additional (clinical) effectiveness on pulmonary health and an improved overall quality of life of patients compared with the currently available HMEs. ",
doi="10.2196/36401",
url="https://formative.jmir.org/2023/1/e36401",
url="http://www.ncbi.nlm.nih.gov/pubmed/36630171"
}


@Article{info:doi/10.2196/38333,
author="Lee, Kyunghwa
and Kim, Sanghee
and Kim, Hyun Soo
and Yoo, Sung-Hee
and Sung, Hyun Ji
and Oh, Geum Eui
and Kim, Nawon
and Lee, Jiyeon",
title="Digital Health Interventions for Adult Patients With Cancer Evaluated in Randomized Controlled Trials: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="6",
volume="25",
pages="e38333",
keywords="digital health",
keywords="adult",
keywords="neoplasms",
keywords="randomized controlled trial",
keywords="mobile phone",
abstract="Background: Digital care has become an essential component of health care. Interventions for patients with cancer need to be effective and safe, and digital health interventions must adhere to the same requirements. Objective: The purpose of this study was to identify currently available digital health interventions developed and evaluated in randomized controlled trials (RCTs) targeting adult patients with cancer. Methods: A scoping review using the JBI methodology was conducted. The participants were adult patients with cancer, and the concept was digital health interventions. The context was open, and sources were limited to RCT effectiveness studies. The PubMed, CINAHL, Embase, Cochrane Library, Research Information Sharing Service, and KoreaMed databases were searched. Data were extracted and analyzed to achieve summarized results about the participants, types, functions, and outcomes of digital health interventions. Results: A total of 231 studies were reviewed. Digital health interventions were used mostly at home (187/231, 81\%), and the web-based intervention was the most frequently used intervention modality (116/231, 50.2\%). Interventions consisting of multiple functional components were most frequently identified (69/231, 29.9\%), followed by those with the self-manage function (67/231, 29\%). Web-based interventions targeting symptoms with the self-manage and multiple functions and web-based interventions to treat cognitive function and fear of cancer recurrence consistently achieved positive outcomes. More studies supported the positive effects of web-based interventions to inform decision-making and knowledge. The effectiveness of digital health interventions targeting anxiety, depression, distress, fatigue, health-related quality of life or quality of life, pain, physical activity, and sleep was subject to their type and function. A relatively small number of digital health interventions specifically targeted older adults (6/231, 2.6\%) or patients with advanced or metastatic cancer (22/231, 9.5\%). Conclusions: This scoping review summarized digital health interventions developed and evaluated in RCTs involving adult patients with cancer. Systematic reviews of the identified digital interventions are strongly recommended to integrate digital health interventions into clinical practice. The identified gaps in digital health interventions for cancer care need to be reflected in future digital health research. ",
doi="10.2196/38333",
url="https://www.jmir.org/2023/1/e38333",
url="http://www.ncbi.nlm.nih.gov/pubmed/36607712"
}


@Article{info:doi/10.2196/43404,
author="Patel, Smit
and Goldsack, C. Jennifer
and Cordovano, Grace
and Downing, Andrea
and Fields, K. Karen
and Geoghegan, Cindy
and Grewal, Upinder
and Nieva, Jorge
and Patel, Nikunj
and Rollison, E. Dana
and Sah, Archana
and Said, Maya
and Van De Keere, Isabel
and Way, Amanda
and Wolff-Hughes, L. Dana
and Wood, A. William
and Robinson, J. Edmondo",
title="Advancing Digital Health Innovation in Oncology: Priorities for High-Value Digital Transformation in Cancer Care",
journal="J Med Internet Res",
year="2023",
month="Jan",
day="4",
volume="25",
pages="e43404",
keywords="digital health",
keywords="innovation",
keywords="oncology",
keywords="cancer care",
keywords="cancer",
keywords="patient journey",
keywords="digital transformation",
keywords="digital divide",
keywords="health care delivery",
keywords="service delivery",
keywords="equity",
keywords="patient-reported outcome",
keywords="PROM",
keywords="biomarker",
keywords="digital innovation",
doi="10.2196/43404",
url="https://www.jmir.org/2023/1/e43404",
url="http://www.ncbi.nlm.nih.gov/pubmed/36598811"
}


@Article{info:doi/10.2196/42908,
author="Beuken, M. Maik J.
and Kanera, M. Iris
and Ezendam, Maria Nicole Paulina
and Braun, Susy
and Zoet, Martijn",
title="Identification and Potential Use of Clusters of Patients With Colorectal Cancer and Patients With Prostate Cancer in Clinical Practice: Explorative Mixed Methods Study",
journal="JMIR Cancer",
year="2022",
month="Dec",
day="27",
volume="8",
number="4",
pages="e42908",
keywords="colorectal cancer",
keywords="prostate cancer",
keywords="referral to aftercare",
keywords="patient clusters",
keywords="cluster analysis",
keywords="K-means cluster algorithm",
keywords="multiple-factor analysis",
keywords="expert panel group interviews",
keywords="interview",
keywords="cancer",
keywords="patient",
keywords="usability",
keywords="clinical",
keywords="colorectal",
keywords="recovery",
abstract="Background: A steady increase in colorectal and prostate cancer survivors and patients with these cancers is expected in the upcoming years. As a result of primary cancer treatments, patients have numerous additional complaints, increasing the need for cancer aftercare. However, referrals to appropriate cancer aftercare remain inadequate, despite a wide range of aftercare options. Caregivers and patients often do not know which aftercare is the most appropriate for the individual patient. Since characteristics and complaints of patients within a diagnosis group may differ, predefined patient clusters could provide substantive and efficient support for professionals in the conversation about aftercare. By using advanced data analysis methods, clusters of patients who are different from one another within a diagnosis group can be identified. Objective: This study had a 2-fold objective: (1) to identify, visualize, and describe potential patient clusters within the colorectal and prostate cancer population and (2) to explore the potential usability of these clusters in clinical practice. Methods: First, we used cross-sectional data from patients with colorectal cancer and patients with prostate cancer provided by the population-based PROFILES (Patient-Reported Outcomes Following Initial Treatment and Long-Term Evaluation of Survivorship) registry, which were originally collected between 2008 and 2012. To identify and visualize different clusters among the 2 patient populations, we conducted cluster analyses by applying the K-means algorithm and multiple-factor analyses. Second, in a qualitative study, we presented the patient clusters to patients with prostate, patients with colorectal cancer, and oncology professionals. To assess the usability of these clusters, we held expert panel group interviews. The interviews were video recorded and transcribed. Three researchers independently performed content-directed data analyses to understand and describe the qualitative data. Quotes illustrate the most important results. Results: We identified 3 patient clusters among colorectal cancer cases (n=3989) and 5 patient clusters among prostate cancer cases (n=696), which were described in tabular form. Patient experts (6/8, 75\%) and professional experts (17/20, 85\%) recognized the patient clustering based on distinguishing variables. However, the tabular form was evaluated as less applicable in clinical practice. Instead, the experts suggested the development of a conversation tool (eg, decision tree) to guide professionals through the hierarchy of variables. In addition, participants suggested that information about possible aftercare initiatives should be offered and integrated. This would also ensure a good overview and seemed to be a precondition for finding suitable aftercare. Conclusions: This study demonstrates that a fully data-driven approach can be used to identify distinguishable and recognizable (ie, in routine care) patient clusters in large data sets within cancer populations. Patient clusters can be a source of support for health professionals in the aftercare conversation. These clusters, when integrated into a smart digital conversation and referral tool, might be an opportunity to improve referral to cancer aftercare. Trial Registration: Netherlands Trial Register NL9226; https://trialsearch.who.int/Trial2.aspx?TrialID=NL9226 ",
doi="10.2196/42908",
url="https://cancer.jmir.org/2022/4/e42908",
url="http://www.ncbi.nlm.nih.gov/pubmed/36574281"
}


@Article{info:doi/10.2196/39271,
author="Skiba, B. Meghan
and Harker, Graham
and Guidarelli, Carolyn
and El-Gohary, Mahmoud
and Horak, Fay
and Roeland, J. Eric
and Silbermann, Rebecca
and Hayes-Lattin, Brandon
and Winters-Stone, Kerri",
title="Using Wearable Inertial Sensors to Assess Mobility of Patients With Hematologic Cancer and Associations With Chemotherapy-Related Symptoms Before Autologous Hematopoietic Stem Cell Transplant: Cross-sectional Study",
journal="JMIR Cancer",
year="2022",
month="Dec",
day="8",
volume="8",
number="4",
pages="e39271",
keywords="wearable inertial sensor",
keywords="mobility",
keywords="gait",
keywords="induction chemotherapy",
keywords="autologous hematopoietic stem cell transplant",
keywords="autoHSCT",
keywords="chemotherapy-related symptoms",
abstract="Background: Wearable sensors could be a simple way to quantify and characterize mobility in patients with hematologic cancer scheduled to receive autologous hematopoietic stem cell transplant (autoHSCT) and how they may be related to common treatment-related symptoms and side effects of induction chemotherapy. Objective: We aimed to conduct a cross-sectional study comparing mobility in patients scheduled to receive autoHSCT with that in healthy, age-matched adult controls and determine the relationships between patient mobility and chemotherapy-related symptoms. Methods: Patients scheduled to receive autoHSCT (78/156, 50\%) and controls (78/156, 50\%) completed the prescribed performance tests using wearable inertial sensors to quantify mobility including turning (turn duration and number of steps), gait (gait speed, stride time, stride time variability, double support time, coronal trunk range of motion, heel strike angle, and distance traveled), and balance (coronal sway, coronal range, coronal velocity, coronal centroidal frequency, sagittal sway, sagittal range, sagittal velocity, and sagittal centroidal frequency). Patients completed the validated patient-reported questionnaires to assess symptoms common to chemotherapy: chemotherapy-induced peripheral neuropathy (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group--Neurotoxicity subscale), nausea and pain (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), fatigue (Patient-Reported Outcomes Measurement Information System Fatigue Short Form 8a), vertigo (Vertigo Symptom Scale--short form), and depression (Center for Epidemiological Studies--Depression). Paired, 2-sided t tests were used to compare mobility between patients and controls. Stepwise multivariable linear regression models were used to evaluate associations between patient mobility and symptoms. Results: Patients aged 60.3 (SD 10.3) years had significantly worse turning (turn duration; P<.001), gait (gait speed, stride time, stride time variability, double support time, heel strike angle, stride length, and distance traveled; all P<.001), and balance (coronal sway; P<.001, range; P<.001, velocity; P=.02, and frequency; P=.02; and sagittal range; P=.008) than controls. In patients, high nausea was associated with worse stride time variability ({\ss}=.001; P=.005) and heel strike angle ({\ss}=?.088; P=.02). Pain was associated with worse gait speed ({\ss}=?.003; P=.003), stride time variability ({\ss}=.012; P=.02), stride length ({\ss}=?.002; P=.004), and distance traveled ({\ss}=?.786; P=.005). Nausea and pain explained 17\% to 33\% and 14\% to 36\% of gait variance measured in patients, respectively. Conclusions: Patients scheduled to receive autoHSCT demonstrated worse mobility in multiple turning, gait, and balance domains compared with controls, potentially related in part to nausea and pain. Wearable inertial sensors used in the clinic setting could provide granular information about mobility before further treatment, which may in turn benefit from rehabilitation or symptom management. Future longitudinal studies are needed to better understand temporal changes in mobility and symptoms across the treatment trajectory to optimally time, design, and implement strategies, to preserve functioning in patients with hematologic cancer in the long term. ",
doi="10.2196/39271",
url="https://cancer.jmir.org/2022/4/e39271",
url="http://www.ncbi.nlm.nih.gov/pubmed/36480243"
}


@Article{info:doi/10.2196/42245,
author="Basch, H. Corey
and Hillyer, C. Grace
and Yalamanchili, Bhavya
and Morris, Aldean",
title="How TikTok Is Being Used to Help Individuals Cope With Breast Cancer: Cross-sectional Content Analysis",
journal="JMIR Cancer",
year="2022",
month="Dec",
day="6",
volume="8",
number="4",
pages="e42245",
keywords="TikTok",
keywords="breast cancer",
keywords="social media",
keywords="short video apps",
keywords="social support",
keywords="content analysis",
keywords="video",
keywords="patient support",
keywords="medical information",
keywords="health information",
keywords="peer support",
keywords="online conversation",
keywords="online health information",
abstract="Background: Acknowledging the popularity of TikTok, how quickly medical information can spread, and how users seek support on social media, there is a clear lack of research on breast cancer conversations on TikTok. There is a paucity of information on how these videos can advocate for those impacted by breast cancer as a means to provide support and information as well as raise awareness. Objective: The purpose of this cross-sectional content analysis was to describe the content of videos from the hashtag \#breastcancer on TikTok. Content related to breast cancer support and coping, cancer education, and heightening the awareness of breast cancer early detection, prevention, and treatment was evaluated. Methods: This study included 100 of the most viewed TikTok videos related to breast cancer through June 30, 2022. Videos were excluded if they were not in the English language or relevant to the topic being studied. Content was deductively coded into categories related to video characteristics and content topics using a screener based on expert breast cancer information sheets. Univariable analyses were conducted to evaluate differences in video characteristics and content when stratified as advocating or not advocating for breast cancer (yes or no) support, education, and awareness. Results: The cumulative number of views of the videos included in this study was 369,504,590. The majority (n=81, 81\%) of videos were created by patients and loved ones of individuals with breast cancer, and the most commonly discussed topic was breast cancer support (n=88, 88\%), followed by coping with the myriad issues surrounding breast cancer (n=79, 79\%). Overall, <50\% of the videos addressed important issues such as body image (n=48, 48\%), surgery (n=46, 46\%), medication and therapy (n=41, 41\%), or the stigma associated with a breast cancer diagnosis (n=44, 44\%); however, in videos that were advocacy oriented, body image (40/62, 64\% vs 8/38, 21\%; P<.001), stigma associated with breast cancer (33/62, 53\% vs 11/38, 29\%; P=.02), and breast cancer surgery (36/62, 58\% vs 10/38, 26\%; P=.002) were discussed significantly more often than in videos that did not specifically advocate for breast cancer. Conclusions: The use of videos to display health journeys can facilitate engagement by patients, family members, and loved ones interested in information about challenging conditions. Collectively, these findings highlight the level of peer-to-peer involvement on TikTok and may provide insights for designing breast cancer educational campaigns. ",
doi="10.2196/42245",
url="https://cancer.jmir.org/2022/4/e42245",
url="http://www.ncbi.nlm.nih.gov/pubmed/36472899"
}


@Article{info:doi/10.2196/39012,
author="Lima, Souza Vivian Cristina Gama
and Soares, Souza Raquel de
and Santos, dos Willian Alves
and Alves, Paulo
and Fuly, Claro Patricia dos Santos",
title="Scientific Publications on Nursing for COVID-19 in Patients With Cancer: Scoping Review",
journal="JMIR Cancer",
year="2022",
month="Nov",
day="25",
volume="8",
number="4",
pages="e39012",
keywords="COVID-19",
keywords="review",
keywords="nursing",
keywords="coronavirus infection",
keywords="oncology nursing",
abstract="Background: The needs of patients with cancer must be met, especially in times of crisis. The advent of the pandemic triggered a series of strategic actions by the nursing team to preserve the health of patients and professionals---hence the importance of studies on nursing care actions provided to patients with cancer during the COVID-19 pandemic. It is known that these patients are susceptible to severe COVID-19. However, no previous review has summarized the findings of scientific studies on nursing for COVID-19 in patients with cancer. Objective: This study aims to map the topics addressed in scientific studies on nursing for COVID-19 in patients with cancer. Methods: A scoping review was conducted using the methodology described in the Joanna Briggs Institute Reviewers' Manual 2015. The research question was elaborated using the population, concept, and context framework: What topics have been studied in nursing publications about COVID-19 in adult patients with cancer? The searches were carried out in 8 databases between April and November 2021 without time restrictions. Results: In total, 973 publications were identified using the search strategies in the databases, and 12 papers were retrieved by consulting the references. A total of 31 (3.2\%) publications were included in the final analysis, generating 4 thematic categories on the subject: ``restructuring the services: how oncology nursing was adapted during the pandemic,'' ``experiences of patients and performance of the nursing team during the COVID-19 pandemic,'' ``protocols and recommendations for dealing with the COVID-19 pandemic,'' and ``challenges and the role of oncology nurses facing the COVID-19 pandemic.'' Conclusions: Several strategies used by oncology nurses to face the COVID-19 pandemic in the international scenario were identified. Reports about the restructuring of services and the team's reactions to the pandemic predominated. However, there is a lack of reports regarding emotional support strategies for health care professionals. Another gap identified was the scarcity of clinical studies on the activities developed by oncology nurses. Therefore, there is a need for clinical research in the oncology area and emotional coping strategies to support oncology nurses. ",
doi="10.2196/39012",
url="https://cancer.jmir.org/2022/4/e39012",
url="http://www.ncbi.nlm.nih.gov/pubmed/36219752"
}


@Article{info:doi/10.2196/37371,
author="Scher, Nathaniel
and Guetta, Liath
and Draghi, Cl{\'e}ment
and Yahiaoui, Safia
and Terzioglu, Mathilde
and Butaye, Emilie
and Henriques, Kathy
and Alavoine, Marie
and Elharar, Ayala
and Guetta, Andre
and Toledano, Alain",
title="Sleep Disorders and Quality of Life in Patients With Cancer: Prospective Observational Study of the Rafael Institute",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="24",
volume="6",
number="11",
pages="e37371",
keywords="cancer",
keywords="sleep disorder",
keywords="sleep",
keywords="fatigue",
keywords="nocturnal",
keywords="oncology",
keywords="cancer care",
keywords="patient-centred approach",
keywords="patient-centered",
keywords="personalized",
keywords="personalization",
keywords="customized",
keywords="customization",
keywords="care plan",
keywords="quality of life",
keywords="mood",
keywords="pain",
keywords="cancer treatment",
keywords="overweight",
keywords="obese",
keywords="hormone therapy",
keywords="breast",
keywords="prostate",
abstract="Background: Sleep disorders are a common occurrence in the general population. Yet today, it is clearly agreed that sleep disorders represent both a cancer risk factor and a biological consequence of the of the activation of the immuno-inflammatory system induced by cancer itself. Objective: The aim of this study was to assess the impact of sleep disorders on quality of life and identify the type of disorder and its causes in order to offer an adapted and personalized care plan. Methods: In a survey completed during the COVID-19 lockdown, 2000 hours of interviews were collected by remote consultations. During these calls, we administered a sleep questionnaire. This questionnaire was inspired by the STOP-BANG questionnaire and enquired about 6 items. The demographic details of each patient (eg, age and sex), the nature of the pathology, their past treatments, the ongoing cancer treatment, the mood, whether or not the patient is anxious or depressed, and the use of sleeping drug pills were analyzed. A univariate analysis was performed according to the presence or absence of fatigue. Chi-square test was applied to assess possible differences of variables' link to sleep disturbance between patients complaining of fatigue and those without fatigue. The same test was then used to analyze patients on hormone therapy and those with no hormone therapy for 2 types of cancer---breast cancer and prostate cancer. Results: A total of 905 patients were prospectively included in this study. The average age was 66.7 (5 SD) years, and 606 (67\%) patients were women; 142 patients declared being overweight. Breast cancer was the most frequently reported cancer. Nocturnal awakening was reported by 70\% (n=633), fatigue by 50\% (n=452), difficulty falling asleep by 38\% (n=343), snoring reported by an independent observer in 38\% (n=343), and apnea reported by an independent observer in 9\% (n=81) of the patients. The univariate analysis showed that the feeling of tiredness was significantly greater in patients reporting difficulty falling asleep (P?.99), pain (P<.001), and frequent awakening (P<.001), as well as in patients who were not receiving cancer treatment (P<.001). The univariate analysis showed that patients who were receiving breast cancer treatment and were under hormone therapy reported difficulty falling asleep (P=.04) and pain (P=.05). In a univariate analysis of patients treated for prostate cancer, being overweight was the only factor reported that had a statistically significant value. Conclusions: Our preliminary data support and are consistent with data in the literature regarding the importance of sleep disorders in oncology. This justifies the usefulness of a diagnosis and early treatment of sleep disorders in patients with cancer. The Rafael Institute sleep observatory will enable patients to be identified and treated. ",
doi="10.2196/37371",
url="https://formative.jmir.org/2022/11/e37371",
url="http://www.ncbi.nlm.nih.gov/pubmed/36422866"
}


@Article{info:doi/10.2196/40059,
author="Wang, Luyao
and Chen, Xing
and Peng, Yueyang
and Zhang, Kun
and Ma, Jun
and Xu, Lin
and Liu, Zixuan
and Liu, Li
and Luo, Yang
and Gu, Can",
title="Effect of a 4-Week Internet-Delivered Mindfulness-Based Cancer Recovery Intervention on the Symptom Burden and Quality of Life of Patients With Breast Cancer: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="22",
volume="24",
number="11",
pages="e40059",
keywords="mindfulness-based cancer recovery",
keywords="mindfulness-based intervention",
keywords="cancer-related symptom",
keywords="quality of life",
keywords="breast cancer",
keywords="internet-delivered intervention",
keywords="mobile phone",
abstract="Background: Mindfulness-based interventions (MBIs) can improve the symptoms and psychological well-being of patients with breast cancer. However, standard MBIs are an 8-week program delivered face-to-face, which may be inconvenient for patients with cancer. Many attempts have been made to adapt MBIs to increase their accessibility for patients with cancer while maintaining their therapeutic components and efficacy. Objective: This study aimed to investigate the effectiveness of a 4-week internet-delivered mindfulness-based cancer recovery (iMBCR) program in reducing symptom burden and enhancing the health-related quality of life (HRQoL) of patients with breast cancer. Methods: A total of 103 postoperative patients with breast cancer (stages 0 to IV) were randomly assigned to an iMBCR group (4-week iMBCR; n=51, 49.5\%) or a control group (usual care and 4-week program of health education information; n=52, 50.5\%). The study outcomes included symptom burden and HRQoL, as measured by the MD Anderson Symptom Inventory and the Functional Assessment of Cancer Therapy-Breast scale. All data were collected at baseline (T0), after the intervention (T1), and at 1-month follow-up (T2). Data analysis followed the intention-to-treat principle. Linear mixed models were used to assess the effects over time of the iMBCR program. Results: Participants in the iMBCR group had significantly larger decreases in symptom burden than those in the control group at T1 (mean difference --11.67, 95\% CI --16.99 to --6.36), and the decreases were maintained at T2 (mean difference --11.83, 95\% CI --18.19 to --5.46). The HRQoL score in the iMBCR group had significantly larger improvements than that in the control group at T1 and T2 (mean difference 6.66, 95\% CI 3.43-9.90 and mean difference 11.94, 95\% CI 7.56-16.32, respectively). Conclusions: Our preliminary findings suggest that the iMBCR program effectively improved the symptom burden and HRQoL of patients with breast cancer, and the participants in the iMBCR group demonstrated good adherence and completion rates. These results indicate that the iMBCR intervention might be a promising way to reduce symptom burden and improve HRQoL of patients with cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000038980; http://www.chictr.org.cn/showproj.aspx?proj=62659 ",
doi="10.2196/40059",
url="https://www.jmir.org/2022/11/e40059",
url="http://www.ncbi.nlm.nih.gov/pubmed/36413385"
}


@Article{info:doi/10.2196/38088,
author="Ankersmid, Wies Jet
and Siesling, Sabine
and Strobbe, A. Luc J.
and Meulepas, M. Johanna
and van Riet, A. Yvonne E.
and Engels, Noel
and Prick, M. Janine C.
and The, Regina
and Takahashi, Asako
and Velting, Mirjam
and van Uden-Kraan, F. Cornelia
and Drossaert, C. Constance H.",
title="Supporting Shared Decision-making About Surveillance After Breast Cancer With Personalized Recurrence Risk Calculations: Development of a Patient Decision Aid Using the International Patient Decision AIDS Standards Development Process in Combination With a Mixed Methods Design",
journal="JMIR Cancer",
year="2022",
month="Nov",
day="14",
volume="8",
number="4",
pages="e38088",
keywords="patient decision aid",
keywords="PtDA",
keywords="breast cancer",
keywords="surveillance",
keywords="risk information",
keywords="shared decision-making",
keywords="SDM",
abstract="Background: Although the treatment for breast cancer is highly personalized, posttreatment surveillance remains one-size-fits-all: annual imaging and physical examination for at least five years after treatment. The INFLUENCE nomogram is a prognostic model for estimating the 5-year risk for locoregional recurrences and second primary tumors after breast cancer. The use of personalized outcome data (such as risks for recurrences) can enrich the process of shared decision-making (SDM) for personalized surveillance after breast cancer. Objective: This study aimed to develop a patient decision aid (PtDA), integrating personalized risk calculations on risks for recurrences, to support SDM for personalized surveillance after curative treatment for invasive breast cancer. Methods: For the development of the PtDA, the International Patient Decision Aids Standards development process was combined with a mixed methods design inspired by the development process of previously developed PtDAs. In the development, 8 steps were distinguished: establishing a multidisciplinary steering group; definition of the end users, scope, and purpose of the PtDA; assessment of the decisional needs of end users; defining requirements for the PtDA; determining the format and implementation strategy for the PtDA; prototyping; alpha testing; and beta testing. The composed steering group convened during regular working-group sessions throughout the development process. Results: The ``Breast Cancer Surveillance Decision Aid'' consists of 3 components that support the SDM process: a handout sheet on which personalized risks for recurrences, calculated using the INFLUENCE-nomogram, can be visualized and which contains an explanation about the decision for surveillance and a login code for a web-based deliberation tool; a web-based deliberation tool, including a patient-reported outcome measure on fear of cancer recurrence; and a summary sheet summarizing patient preferences and considerations. The PtDA was assessed as usable and acceptable during alpha testing. Beta testing is currently ongoing. Conclusions: We developed an acceptable and usable PtDA that integrates personalized risk calculations for the risk for recurrences to support SDM for surveillance after breast cancer. The implementation and effects of the use of the ``Breast Cancer Surveillance Decision Aid'' are being investigated in a clinical trial. ",
doi="10.2196/38088",
url="https://cancer.jmir.org/2022/4/e38088",
url="http://www.ncbi.nlm.nih.gov/pubmed/36374536"
}


@Article{info:doi/10.2196/39725,
author="Conduit, Ciara
and Guo, Christina
and Smith, B. Allan
and Rincones, Orlando
and Baenziger, Olivia
and Thomas, Benjamin
and Goad, Jeremy
and Lenaghan, Dan
and Lawrentschuk, Nathan
and Wong, Lih-Ming
and Corcoran, M. Niall
and Ross, Margaret
and Gibbs, Peter
and O'Haire, Sophie
and Anton, Angelyn
and Liow, Elizabeth
and Lewin, Jeremy
and Tran, Ben",
title="Role for a Web-Based Intervention to Alleviate Distress in People With Newly Diagnosed Testicular Cancer: Mixed Methods Study",
journal="JMIR Cancer",
year="2022",
month="Oct",
day="28",
volume="8",
number="4",
pages="e39725",
keywords="testicular germ cell tumor",
keywords="cancer survivors",
keywords="emotional distress",
keywords="anxiety disorders",
keywords="depression",
abstract="Background: Distress is common immediately after diagnosis of testicular cancer. It has historically been difficult to engage people in care models to alleviate distress because of complex factors, including differential coping strategies and influences of social gender norms. Existing support specifically focuses on long-term survivors of testicular cancer, leaving an unmet need for age-appropriate and sex-sensitized support for individuals with distress shortly after diagnosis. Objective: We evaluated a web-based intervention, Nuts \& Bolts, designed to provide support and alleviate distress after diagnosis of testicular cancer. Methods: Using a mixed methods design to evaluate the acceptability, feasibility, and impact of Nuts \& Bolts on distress, we randomly assigned participants with recently diagnosed testicular cancer (1:1) access to Nuts \& Bolts at the time of consent (early) or alternatively, 1 week later (day 8; delayed). Participants completed serial questionnaires across a 4- to 5-week period to evaluate levels of distress (measured by the National Comprehensive Cancer Network Distress Thermometer [DT]; scored 0-10), anxiety, and depression (Hospital Anxiety and Depression Score [HADS]--Anxiety and HADS-Depression; each scored 0-21). The primary end point was change in distress between consent and day 8. Secondary end points of distress, anxiety, and depression were assessed at defined intervals during follow-up. Optional, semistructured interviews occurring after completion of quantitative assessments were thematically analyzed. Results: Overall, 39 participants were enrolled in this study. The median time from orchidectomy to study consent was 14.8 (range 3-62) days. Moderate or high levels of distress evaluated using DT were reported in 58\% (23/39) of participants at consent and reduced to 13\% (5/38) after 1 week of observation. Early intervention with Nuts \& Bolts did not significantly decrease the mean DT score by day 8 compared with delayed intervention (early: 4.56-2.74 vs delayed: 4.47-2.74; P=.85), who did not yet have access to the website. A higher baseline DT score was significantly predictive of reduction in DT score during this period (P<.001). Median DT, HADS-Anxiety, and HADS-Depression scores reduced between orchidectomy and 3 weeks postoperatively and then remained stable throughout the observation period. Thematic analysis of 16 semistructured interviews revealed 4 key themes, ``Nuts \& Bolts is a helpful tool,'' ``Maximizing benefits of the website,'' ``Whirlwind of diagnosis and readiness for treatment,'' and ``Primary stressors and worries,'' as well as multiple subthemes. Conclusions: Distress is common following the diagnosis of testicular cancer; however, it decreases over time. Nuts \& Bolts was considered useful, acceptable, and relevant by individuals diagnosed with testicular cancer, with strong support for the intervention rendered by thematic analyses of semistructured interviews. The best time to introduce support, such as Nuts \& Bolts, is yet to be determined; however, it may be most beneficial as soon as testicular cancer is strongly suspected or diagnosed. ",
doi="10.2196/39725",
url="https://cancer.jmir.org/2022/4/e39725",
url="http://www.ncbi.nlm.nih.gov/pubmed/36306156"
}


@Article{info:doi/10.2196/39764,
author="Gudmundsson, Haukur G.
and M{\'e}sz{\'a}ros, Judit
and Bj{\"o}rnsd{\'o}ttir, E. {\'A}g{\'u}sta
and {\'A}mundad{\'o}ttir, L. Mar{\'i}a
and Thorvardardottir, E. Gudrun
and Magnusdottir, Erna
and Helgadottir, Halla
and Oddsson, Saemundur",
title="Evaluating the Feasibility of a Digital Therapeutic Program for Patients With Cancer During Active Treatment: Pre-Post Interventional Study",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="13",
volume="6",
number="10",
pages="e39764",
keywords="cancer",
keywords="lifestyle",
keywords="quality of life",
keywords="mobile app",
keywords="digital therapeutics",
keywords="self-management",
keywords="physical activity",
keywords="mobile phone",
abstract="Background: Increasing evidence shows that lifestyle interventions can improve the symptoms, quality of life (QoL), and even overall survival of patients with cancer. Digital therapeutics (DTx) can help implement behavioral modifications and empower patients through education, lifestyle support, and remote symptom monitoring. Objective: We aimed to test the feasibility of a DTx program for patients with cancer, as measured by engagement, retention, and acceptability. In addition, we explored the effects of the program on cancer-related QoL. Methods: We conducted a 4-week single-arm trial in Iceland, where DTx was delivered through a smartphone app. The intervention consisted of patient education about mindfulness, sleep, stress, and nutrition; lifestyle coaching; and the completion of daily missions for tracking physical activity and exercise, reporting patient-reported outcomes (PROs), practicing mindfulness, and logging healthy food intake. Information on program engagement and retention, step goal attainment, as well as PROs were collected throughout the study. QoL was measured using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C30 at baseline and follow-up. Results: In total, 30 patients with cancer undergoing active therapy were enrolled, and 29 registered in the app (23 female, 18 with breast cancer; mean age 52.6, SD 11.5 years). Overall, 97\% (28/29) of participants were active in 3 of the 4 weeks and completed the pre- and postprogram questionnaires. The weekly active days (median) were 6.8 (IQR 5.8-6.8), and 72\% (21/29) of participants were active at least 5 days a week. Users interacted with the app on average 7.7 (SD 1.9) times per day. On week 1, all 29 participants used the step counter and logged an average of 20,306 steps; 21 (72\%) participants reached their step goals of at least 3000 steps per day. On week 4, of the 28 active users, 27 (96\%) were still logging their steps, with 19 (68\%) reaching their step goals. Of the 28 participants who completed the satisfaction questionnaire, 25 (89\%) were likely to recommend the program, 23 (82\%) said the program helped them deal with the disease, and 24 (86\%) said it helped them remember their medication. QoL assessment showed that the average global health status, functioning, and symptom burden remained stable from baseline to follow-up. In all, 50\% (14/28) of participants reported less pain, and the average pain score decreased from 31 (SD 20.1) to 22.6 (SD 23.2; P=.16). There was no significant change in PROs on the quality of sleep, energy, and stress levels from the first to the last week. Conclusions: The high retention, engagement, and acceptability found in this study demonstrate that multidisciplinary DTx is feasible for patients with cancer. A longer, full-scale randomized controlled trial is currently being planned to evaluate the efficacy of the intervention. ",
doi="10.2196/39764",
url="https://formative.jmir.org/2022/10/e39764",
url="http://www.ncbi.nlm.nih.gov/pubmed/36227639"
}


@Article{info:doi/10.2196/37626,
author="Steen-Olsen, Balch Emma
and Pappot, Helle
and Green, Allan
and Langberg, Henning
and Holl{\"a}nder-Mieritz, Cecilie",
title="Feasibility of Monitoring Patients Who Have Cancer With a Smart T-shirt: Protocol for the OncoSmartShirt Study",
journal="JMIR Res Protoc",
year="2022",
month="Oct",
day="3",
volume="11",
number="10",
pages="e37626",
keywords="biometric sensor technology",
keywords="cancer",
keywords="home monitoring",
keywords="patient-generated health data",
keywords="sensor",
keywords="smart t-shirt",
keywords="remote monitoring",
keywords="adolescent",
keywords="protocol",
keywords="patient",
keywords="youth",
keywords="health care professional",
keywords="cancer treatment",
abstract="Background: Studies have shown that there may be dissimilar perceptions on symptoms or side effects between patients with cancer and health care professionals. This may lead to symptomatic patients notifying the clinic irregularly or not telling the clinic at all. Wearables could help identify symptoms earlier. Patients with low socioeconomic status and less self-awareness of their health may benefit from this. A new design of wearables is a smart t-shirt that, with embedded sensors, provides measurement flows such as electrocardiogram, thoracic and abdominal respiration, and temperature. Objective: This study evaluates the feasibility of using a smart t-shirt for home monitoring of biometric sensor data in adolescent and young adult and elderly patients during cancer treatment. Methods: The OncoSmartShirt study is an explorative study investigating the feasibility of using the Chronolife smart t-shirt during cancer treatment. This smart t-shirt is designed with multiple fully embedded sensors and electrodes that engender 6 different measurement flows continuously. A total of 20 Danish patients with cancer ?18 years old in antineoplastic treatment at Department of Oncology Rigshospitalet Denmark will be recruited from all cancer wards, whether patients are in curative or palliative care. Of these 20 patients, 10 (50\%) will be <39 years old, defined as adolescent and young adult, and 10 (50\%) will be patients >65 years old, defined as elderly. Consenting patients will be asked to wear a smart t-shirt daily for 2 weeks during their treatment course. Results: The primary outcome is to determine if it is feasible to wear a smart t-shirt throughout the day (preferably 8 hours per day) for 2 weeks. Inclusion of patients started in March 2022. Conclusions: The study will assess the feasibility of using the Chronolife smart t-shirt for home monitoring of vital parameters in patients with cancer during their treatment and bring new insights into how wearables and biometric data can be used as part of symptom or side-effect recognition in patients with cancer during treatment, with the aim to increase patients' quality of life. Trial Registration: ClinicalTrials.gov NCT05235594; https://beta.clinicaltrials.gov/study/NCT05235594 International Registered Report Identifier (IRRID): PRR1-10.2196/37626 ",
doi="10.2196/37626",
url="https://www.researchprotocols.org/2022/10/e37626",
url="http://www.ncbi.nlm.nih.gov/pubmed/36190744"
}


@Article{info:doi/10.2196/36714,
author="Vasquez, S. Taylor
and Bylund, L. Carma
and Alpert, Jordan
and Close, Julia
and Le, Tien
and Markham, Jennifer Merry
and Taylor, B. Greenberry
and Paige, R. Samantha",
title="Comparing Transactional eHealth Literacy of Individuals With Cancer and Surrogate Information Seekers: Mixed Methods Study",
journal="JMIR Form Res",
year="2022",
month="Sep",
day="28",
volume="6",
number="9",
pages="e36714",
keywords="eHealth literacy",
keywords="cancer communication",
keywords="individuals with cancer",
keywords="surrogate seekers",
keywords="web-based information credibility appraisal",
abstract="Background: The number of adults entering higher-risk age groups for receiving a cancer diagnosis is rising, with predicted numbers of cancer cases expected to increase by nearly 50\% by 2050. Living with cancer puts exceptional burdens on individuals and families during treatment and survivorship, including how they navigate their relationships with one another. One role that a member of a support network may enact is that of a surrogate seeker, who seeks information in an informal capacity on behalf of others. Individuals with cancer and surrogate seekers often use the internet to learn about cancer, but differences in their skills and strategies have received little empirical attention. Objective: This study aimed to examine the eHealth literacy of individuals with cancer and surrogate information seekers, including an investigation of how each group evaluates the credibility of web-based cancer information. As a secondary aim, we sought to explore the differences that exist between individuals with cancer and surrogate seekers pertaining to eHealth literacies and sociodemographic contexts. Methods: Between October 2019 and January 2020, we conducted a web-based survey of 282 individuals with cancer (n=185) and surrogate seekers (n=97). We used hierarchical linear regression analyses to explore differences in functional, communicative, critical, and translational eHealth literacy between individuals with cancer and surrogate seekers using the Transactional eHealth Literacy Instrument. Using a convergent, parallel mixed methods design, we also conducted a thematic content analysis of an open-ended survey response to qualitatively examine how each group evaluates web-based cancer information. Results: eHealth literacy scores did not differ between individuals with cancer and surrogate seekers, even after adjusting for sociodemographic variables. Individuals with cancer and surrogate seekers consider the credibility of web-based cancer information based on its channel (eg, National Institutes of Health). However, in evaluating web-based information, surrogate seekers were more likely than individuals with cancer to consider the presence and quality of scientific references supporting the information. Individuals with cancer were more likely than surrogate seekers to cross-reference other websites and web-based sources to establish consensus. Conclusions: Web-based cancer information accessibility and evaluation procedures differ among individuals with cancer and surrogate seekers and should be considered in future efforts to design web-based cancer education interventions. Future studies may also benefit from more stratified recruitment approaches and account for additional contextual factors to better understand the unique circumstances experienced within this population. ",
doi="10.2196/36714",
url="https://formative.jmir.org/2022/9/e36714",
url="http://www.ncbi.nlm.nih.gov/pubmed/36170007"
}


@Article{info:doi/10.2196/39068,
author="Lyall, Matthew
and Crawford, Rebecca
and Bell, Timothy
and Mamolo, Carla
and Neuhof, Alexander
and Levy, Courtney
and Heyes, Anne",
title="Characterizing the Patient Journey in Multiple Myeloma: Qualitative Review",
journal="JMIR Cancer",
year="2022",
month="Sep",
day="22",
volume="8",
number="3",
pages="e39068",
keywords="multiple myeloma",
keywords="literature review",
keywords="patient-centered insights",
keywords="patient experience",
keywords="patient perspectives",
keywords="patient-reported information",
keywords="social media",
keywords="YouTube",
abstract="Background: The patient experience of multiple myeloma (MM) is multifaceted and varies substantially between individuals. Current published information on the patient perspective and treatment of MM is limited, making it difficult to gain insights into patient needs regarding the condition. Objective: In this review, a combined research method approach (ie, the review of published literature and social media posts) was undertaken to provide insight into patients' perspectives on the burden and treatment of MM, the impact of the COVID-19 pandemic, and the impact of MM on caregivers of patients with MM. Methods: Targeted searches of PubMed and PsycINFO were conducted from November 16, 2010, to November 16, 2020; in parallel, patient-reported information derived from social media posts from 6 patient advocacy websites and YouTube were searched. The review of patient advocacy websites and YouTube targeted patient-reported information from patients with a self-reported diagnosis of MM who discussed their experience of MM and its treatments. Results: A total of 27 articles and 138 posts were included (patient-reported information included data from 76 individuals), and results from both sources showed that patients experienced a variety of symptoms and treatment side effects, including neuropathy, fatigue, nausea, and back pain. These can affect areas of health-related quality of life (HRQOL), including physical functioning; emotional, psychological, and social well-being; the ability to work; and relationships. Patients valued involvement in treatment decision-making, and both the patient-reported information and the literature indicated that efficacy and tolerability strongly influence treatment decision-making. For patients, caregivers, and physicians, the preference for treatments was strongest when associated with increased survival. Caregivers can struggle to balance care responsibilities and jobs, and their HRQOL is affected in several areas, including emotional-, role-, social-, and work-related aspects of life. The COVID-19 pandemic has challenged patients' ability to manage MM because of limited hospital access and restrictions that negatively affected their lives, psychological well-being, and HRQOL. Unmet patient needs identified in the literature and patient-reported information were for more productive appointments with health care professionals, better-tolerated therapies, and more support for themselves and their caregivers. Conclusions: The combination of published literature and patient-reported information provides valuable and rich details on patient experiences and perceptions of MM and its treatment. The data highlighted that patients' HRQOL is impeded not only by the disease but also by treatment-related side effects. Patients in the literature and patient-reported information showed a strong preference for treatments that prolong life, and patients appeared to value participation in treatment decisions. However, there remain unmet needs and areas for further research, including treatment, caregiver burden, and how to conduct appointments with health care professionals. This may help improve the understanding of the journey of patients with MM. Plain Language Summary: Multiple Myeloma (MM) is the second most common cancer that affects blood cells. In this study, researchers wanted to know patients' views on the effects of MM and the treatments they received. Researchers also looked at the impact of the COVID-19 pandemic on patients' treatment and the impact of MM on caregivers. To this end, the researchers reviewed information from 27 published studies and 138 social media posts by 76 patients with MM. Patients commonly reported nerve pain, tiredness, feeling sick, and back pain caused by MM and the treatments they received. The effects of MM and treatments affected patients' physical function; emotional, psychological, and social well-being; ability to work; and relationships. The researchers found that patients wanted to be involved in decisions related to their treatment. The effectiveness against MM and known negative effects strongly influenced the choice of treatments for patients. Increased survival was the strongest factor in the choice of treatment for patients, caregivers, and doctors. Researchers found that the emotional-, role-, social-, and work-related aspects of caregivers' lives were affected by caring for patients with MM. The COVID-19 pandemic also affected the ability of patients to manage their MM because of limited hospital access and the effects of restrictions that impacted their lives and psychological well-being. Finally, the researchers identified some areas requiring improvement, including unproductive appointments with health care professionals, the need for treatments with fewer negative effects, and more support for patients with MM and their caregivers. This information may be useful to improve and understand the experience of patients with MM. ",
doi="10.2196/39068",
url="https://cancer.jmir.org/2022/3/e39068",
url="http://www.ncbi.nlm.nih.gov/pubmed/36136395"
}


@Article{info:doi/10.2196/37757,
author="Adams, J. Elizabeth
and Tallman, David
and Haynam, L. Marcy
and Nekhlyudov, Larissa
and Lustberg, B. Maryam",
title="Psychosocial Needs of Gynecological Cancer Survivors: Mixed Methods Study",
journal="J Med Internet Res",
year="2022",
month="Sep",
day="20",
volume="24",
number="9",
pages="e37757",
keywords="mixed methods",
keywords="quantitative",
keywords="qualitative",
keywords="cancer survivorship",
keywords="gynecological cancer",
keywords="uterine cancer",
keywords="ovarian cancer",
keywords="cancer informatics",
keywords="patient discussion",
keywords="social media",
abstract="Background: Internet and social media platforms offer insights into the lived experiences of survivors of cancer and their caregivers; however, the volume of narrative data available is often cumbersome for thorough analysis. Survivors of gynecological cancer have unique needs, such as those related to a genetic predisposition to future cancers, impact of cancer on sexual health, the advanced stage at which many are diagnosed, and the influx of new therapeutic approaches. Objective: This study aimed to present a unique methodology to leverage large amounts of data from internet-based platforms for mixed methods analysis. We analyzed discussion board posts made by survivors of gynecological cancer on the American Cancer Society website with a particular interest in evaluating the psychosocial aspects of survivorship. Methods: All posts from the ovarian, uterine, and gynecological cancers (other than ovarian and uterine) discussion boards on the American Cancer Society Cancer Survivors Network were included. Posts were web scraped using Python and organized by psychosocial themes described in the Quality of Cancer Survivorship Care Framework. Keywords related to each theme were generated and verified. Keywords identified posts related to the predetermined psychosocial themes. Quantitative analysis was completed using Python and R Foundation for Statistical Computing packages. Qualitative analysis was completed on a subset of posts as a proof of concept. Themes discovered through latent Dirichlet allocation (LDA), an unsupervised topic modeling technique, were assessed and compared with the predetermined themes of interest. Results: A total of 125,498 posts made by 6436 survivors of gynecological cancer and caregivers between July 2000 and February 2020 were evaluated. Of the 125,489 posts, 23,458 (18.69\%) were related to the psychosocial experience of cancer and were included in the mixed methods psychosocial analysis. Quantitative analysis (23,458 posts) revealed that survivors across all gynecological cancer discussion boards most frequently discussed the role of friends and family in care, as well as fatigue, the effect of cancer on interpersonal relationships, and health insurance status. Words related to psychosocial aspects of survivorship most often used in posts included ``family,'' ``hope,'' and ``help.'' Qualitative analysis (20 of the 23,458 posts) similarly demonstrated that survivors frequently discussed coping strategies, distress and worry, the role of family and caregivers in their cancer care, and the toll of managing financial and insurance concerns. Using LDA, we discovered 8 themes, none of which were directly related to psychosocial aspects of survivorship. Of the 56 keywords identified by LDA, 2 (4\%), ``sleep'' and ``work,'' were included in the keyword list that we independently devised. Conclusions: Web-based discussion platforms offer a great opportunity to learn about patient experiences of survivorship. Our novel methodology expedites the quantitative and qualitative analyses of such robust data, which may be used for additional patient populations. ",
doi="10.2196/37757",
url="https://www.jmir.org/2022/9/e37757",
url="http://www.ncbi.nlm.nih.gov/pubmed/36125848"
}


@Article{info:doi/10.2196/37518,
author="Renner, Simon
and Loussikian, Paul
and Foulqui{\'e}, Pierre
and Arnould, Benoit
and Marrel, Alexia
and Barbier, Valentin
and Mebarki, Adel
and Sch{\"u}ck, St{\'e}phane
and Bharmal, Murtuza",
title="Perceived Unmet Needs in Patients Living With Advanced Bladder Cancer and Their Caregivers: Infodemiology Study Using Data From Social Media in the United States",
journal="JMIR Cancer",
year="2022",
month="Sep",
day="20",
volume="8",
number="3",
pages="e37518",
keywords="real-world evidence",
keywords="unmet needs",
keywords="quality of life",
keywords="social media",
keywords="bladder cancer",
keywords="caregivers",
abstract="Background: Locally advanced or metastatic bladder cancer (BC), which is generally termed advanced BC (aBC), has a very poor prognosis, and in addition to its physical symptoms, it is associated with emotional and social challenges. However, few studies have assessed the unmet needs and burden of aBC from patient and caregiver perspectives. Infodemiology, that is, epidemiology based on internet health-related content, can help obtain more insights on patients' and caregivers' experiences with aBC. Objective: The study aimed to identify the main discussion themes and the unmet needs of patients with aBC and their caregivers through a mixed methods analysis of social media posts. Methods: Social media posts were collected between January 2015 and April 2021 from US geolocalized sites using specific keywords for aBC. Automatic natural language processing (regular expressions and machine learning) methods were used to filter out irrelevant content and identify verbatim posts from patients and caregivers. The verbatim posts were analyzed to identify main discussion themes using biterm topic modeling. Difficulties or unmet needs were further explored using qualitative research methods by 2 independent annotators until saturation of concepts. Results: A total of 688 posts from 262 patients and 1214 posts from 679 caregivers discussing aBC were identified. Analysis of 340 randomly selected patient posts and 423 randomly selected caregiver posts uncovered 33 unique unmet need categories among patients and 36 among caregivers. The main unmet patient needs were related to challenges regarding adverse events (AEs; 28/95, 29\%) and the psychological impact of aBC (20/95, 21\%). Other patient unmet needs identified were prognosis or diagnosis errors (9/95, 9\%) and the need for better management of aBC symptoms (9/95, 9\%). The main unmet caregiver needs were related to the psychological impacts of aBC (46/177, 26.0\%), the need for support groups and to share experiences between peers (28/177, 15.8\%), and the fear and management of patient AEs (22/177, 12.4\%). Conclusions: The combination of manual and automatic methods allowed the extraction and analysis of several hundreds of social media posts from patients with aBC and their caregivers. The results highlighted the emotional burden of cancer for both patients and caregivers. Additional studies on patients with aBC and their caregivers are required to quantitatively explore the impact of this disease on quality of life. ",
doi="10.2196/37518",
url="https://cancer.jmir.org/2022/3/e37518",
url="http://www.ncbi.nlm.nih.gov/pubmed/36125861"
}


@Article{info:doi/10.2196/37606,
author="Shuldiner, Jennifer
and Shah, Nida
and Reis, Catherine
and Chalmers, Ian
and Ivers, Noah
and Nathan, Paul",
title="Developing a Provincial Surveillance and Support System for Childhood Cancer Survivors: Multiphase User-Centered Design Study",
journal="JMIR Hum Factors",
year="2022",
month="Sep",
day="13",
volume="9",
number="3",
pages="e37606",
keywords="design",
keywords="cancer screening",
keywords="childhood cancer survivor",
keywords="late effects",
keywords="surveillance",
keywords="cancer",
keywords="cancer survivor",
keywords="morbidity",
keywords="mortality",
keywords="cancer treatment",
keywords="mammogram",
keywords="echocardiogram",
abstract="Background: Survivors of childhood cancer are at lifelong risk of morbidity (such as new cancers or heart failure) and premature mortality due to their cancer treatment. These are termed late effects. Therefore, they require lifelong, risk-tailored surveillance. However, most adult survivors of childhood cancer do not complete recommended surveillance tests such as mammograms or echocardiograms. Objective: In partnership with survivors, family physicians, and health system partners, we are designing a provincial support system for high-priority tests informed by principles of implementation science, behavioral science, and design thinking. Methods: Our multiphase process was structured as follows. Step 1 consisted of a qualitative study to explore intervention components essential to accessing surveillance tests. Step 2 comprised a workshop with childhood cancer survivors, family physicians, and health system stakeholders that used the Step 1 findings and ``personas'' (a series of fictional but data-informed characters) to develop and tailor the intervention for different survivor groups. Step 3 consisted of intervention prototype development, and Step 4 involved iterative user testing. Results: The qualitative study of 30 survivors and 7 family physicians found a high desire for information on surveillance for late effects. Respondents indicated that the intervention should help patients book appointments when they are due in addition to providing personalized information. Insights from the workshop included the importance of partnering with both family physicians and survivorship clinics and providing emotional support for survivors who may experience distress upon learning of their risk for late effects. In our user-testing process, prototypes went through iterations that incorporated feedback from users regarding acceptability, usability, and functionality. We sought to address the needs of survivors and physicians while balancing the capacity and infrastructure available for a lifelong intervention via our health system partners. Conclusions: In partnership with childhood cancer survivors, family physicians, and health system partners, we elucidated the barriers and enablers to accessing guideline-recommended surveillance tests and designed a multifaceted solution that will support survivors and their family physicians. The next step is to evaluate the intervention in a pragmatic randomized controlled trial. ",
doi="10.2196/37606",
url="https://humanfactors.jmir.org/2022/3/e37606",
url="http://www.ncbi.nlm.nih.gov/pubmed/36099013"
}


@Article{info:doi/10.2196/39643,
author="Chi, Yu
and Thaker, Khushboo
and He, Daqing
and Hui, Vivian
and Donovan, Heidi
and Brusilovsky, Peter
and Lee, Ji Young",
title="Knowledge Acquisition and Social Support in Online Health Communities: Analysis of an Online Ovarian Cancer Community",
journal="JMIR Cancer",
year="2022",
month="Sep",
day="13",
volume="8",
number="3",
pages="e39643",
keywords="online health community",
keywords="ovarian cancer",
keywords="health information needs",
keywords="social support",
keywords="knowledge acquisition",
abstract="Background: Patients and caregivers widely use online health communities (OHCs) to acquire knowledge from peers. Questions posed in OHCs reflect participants' learning objectives and differ in their level of cognitive complexity. However, little is known about the topics and levels of participants' learning objectives and the corresponding support they receive from members of OHCs. Objective: This study aimed to investigate the knowledge acquisition of patients and caregivers in an OHC. Specifically, we investigated the distribution and topics of posts with learning objectives at different cognitive complexity levels, the type and amount of social support provided to meet users' learning objectives at different cognitive complexity levels, and the influence of social support on the change in learning objectives. Methods: We collected 10 years of discussion threads from one of the most active ovarian cancer (OvCa) OHCs. A mixed methods approach was used, including qualitative content analysis and quantitative statistical analysis. Initial posts with questions were manually classified into 1 of the 3 learning objectives with increasing cognitive complexity levels, from low to high, based on the Anderson and Krathwohl taxonomy: understand, analyze, and evaluate. Manual content analysis and automatic classification models were used to identify the types of social support in the comments, including emotional support and 5 types of informational support: advice, referral, act, personal experience, and opinion. Results: The original data set contained 909 initial posts and 14,816 comments, and the final data set for the analysis contained 560 posts with questions and 3998 comments. Our results showed that patients with OvCa and their caregivers mainly used OHCs to acquire knowledge for low- to medium-level learning objectives. Of the questions, 82.3\% (461/560) were either understand- or analyze-level questions, in which users were seeking to learn basic facts and medical concepts or draw connections among different situations and conditions. Only 17.7\% (99/560) of the questions were at the evaluate level, in which users asked other OHC members to help them make decisions or judgments. Notably, OvCa treatment was the most popular topic of interest among all the questions, regardless of the level of learning objectives. Regarding the social support received for different levels of learning objectives, significant differences were found in the advice (F2437.84=9.69; P<.001), opinion (F2418.18=11.56; P<.001), and emotional support (F2395.88=3.24; P=.01), as determined by one-way ANOVA, whereby questions at the evaluate level were more likely to receive advice, opinion, and emotional support than questions at the lower levels. Additionally, receiving social support tends to drive users to increase the cognitive complexity of the learning objective in the next post. Conclusions: Our study establishes that OHCs are promising resources for acquiring knowledge of OvCa. Our findings have implications for designing better OHCs that serve the growing OvCa community. ",
doi="10.2196/39643",
url="https://cancer.jmir.org/2022/3/e39643",
url="http://www.ncbi.nlm.nih.gov/pubmed/36099015"
}


@Article{info:doi/10.2196/39920,
author="Koppel, D. Paula
and De Gagne, C. Jennie
and Docherty, Sharron
and Smith, Sophia
and Prose, S. Neil
and Jabaley, Terri",
title="Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Qualitative Descriptive Study",
journal="J Med Internet Res",
year="2022",
month="Sep",
day="8",
volume="24",
number="9",
pages="e39920",
keywords="clinician-patient relationship",
keywords="nursing",
keywords="oncology ambulatory care",
keywords="rapport",
keywords="telehealth",
keywords="videoconferencing visits",
keywords="videoconferencing",
keywords="telemedicine",
keywords="ambulatory care",
keywords="cancer care",
keywords="oncology nurse",
abstract="Background: Although videoconferencing between oncology patients and nurses became routine during the pandemic, little is known about the development of clinician-patient rapport in this care environment. Evidence that virtual visits may challenge nurses' ability to form connections with patients, demonstrate empathy, and provide support suggests that videoconferencing may not ensure optimal care for persons with cancer. Establishing rapport during videoconferencing visits (VCVs) is important in oncology nursing, as rapport enables the nurse to provide emotional support and assistance to patients as they navigate their cancer journey. Objective: This study investigated the nature of nurse-patient rapport in ambulatory cancer care videoconferencing telehealth visits. Objectives included exploring (1) how patients with cancer and nurses describe experiences of and strategies for cultivating rapport and (2) similarities and differences between rapport in videoconferencing and in-person visits (IPVs). Methods: In this qualitative descriptive study, interviews were conducted from October 2021 to March 2022 with 22 participants, including patients with cancer (n=10, 45\%) and oncology nurses (n=12, 55\%), about their experiences of rapport building during VCVs. All interviews were analyzed using conventional content analysis. Data from nurses and patients were analyzed separately using identical procedures, with a comparative analysis of patient and nurse results performed in the final analysis. Results: Most patients in the study had experienced 3-5 video visits within the past 12 months (n=7, 70\%). Half of the nurse participants (n=6, 50\%) reported having participated in over 100 VCVs, and all had experiences with videoconferencing (ranging from 3 to 960 visits) over the past 12 months. In total, 3 themes and 6 categories were derived from the patient data, and 4 themes and 13 categories were derived from the nurse data. Comparisons of themes derived from participant interviews identified similarities in how nurses and patients described experiences of rapport during VCVs. Three themes fit the collective data: (1) person-centered and relationship-based care is valued and foundational to nurse-patient rapport in oncology ambulatory care regardless of how care is delivered, (2) adapting a bedside manner to facilitate rapport during VCVs is feasible, and (3) nurses and patients can work together to create person-centered options across the care trajectory to ensure quality care outcomes. Barriers to relationship building in VCVs included unexpected interruptions from others, breaks in the internet connection, concerns about privacy, and limitations associated with not being physically present. Conclusions: Person-centered and relationship-based approaches can be adapted to support nurse-patient rapport in VCVs, including forming a personal connection with the patient and using active listening techniques. Balancing the challenges and limitations with the benefits of videoconferencing is an essential competency requiring additional research and guidelines. International Registered Report Identifier (IRRID): RR2-10.2196/27940 ",
doi="10.2196/39920",
url="https://www.jmir.org/2022/9/e39920",
url="http://www.ncbi.nlm.nih.gov/pubmed/36074558"
}


@Article{info:doi/10.2196/37539,
author="Murchie, Peter
and Constable, Lynda
and Hall, Susan
and Brant, William
and Allan, Julia
and Johnston, Marie
and Masthoff, Judith
and Lee, Amanda
and Treweek, Shaun
and Ayansina, Dolapo
and Proby, Charlotte
and Rahman, Kaz
and Walter, Fiona
and Burrows, Nigel
and Durrani, Amer
and Maclennan, Graeme",
title="The Achieving Self-directed Integrated Cancer Aftercare Intervention for Detection of Recurrent and Second Primary Melanoma in Survivors of Melanoma: Pilot Randomized Controlled Trial",
journal="JMIR Cancer",
year="2022",
month="Sep",
day="8",
volume="8",
number="3",
pages="e37539",
keywords="primary care",
keywords="melanoma",
keywords="cancer",
keywords="randomized controlled trial",
keywords="survivorship",
keywords="self-directed care",
keywords="eHealth",
keywords="Achieving Self-directed Integrated Cancer Aftercare",
keywords="ASICA",
keywords="well-being",
keywords="quality of life",
keywords="mobile phone",
abstract="Background: Melanoma is common with increasing incidence. Guidelines recommend monthly total skin self-examinations (TSSEs) by survivors to detect recurrent and new primary melanomas. TSSE is underperformed despite evidence of benefit. Objective: This study compares the effect on psychological well-being and TSSE practice of a self-directed digital intervention with treatment as usual in patients treated for a first stage 0 to IIC primary cutaneous melanoma within the preceding 60 months. Methods: This randomized clinical trial was conducted at 2 UK National Health Service hospitals (Aberdeen Royal Infirmary, Grampian, and Addenbrooke's, Cambridge). Adults (?18 years) diagnosed with a first 0 to IIC primary cutaneous melanoma were randomized to receive Achieving Self-directed Integrated Cancer Aftercare (ASICA), a tablet-based intervention prompting and supporting TSSE in survivors of melanoma, or to usual care. The hypothesis was that ASICA would increase TSSE practice in users affected by melanoma and compared with controls without affecting psychological well-being. The main primary outcomes were melanoma worry (Melanoma Worry Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and quality of life (EQ-5D-5L) as well as secondary outcomes collected using postal questionnaires 3, 6, and 12 months following randomization. Results: A total of 240 recruits were randomized (1:1) into the ASICA (n=121, 50.4\%) or control (n=119, 49.6\%) groups. There were no significant differences between groups for melanoma worry at 12 months (mean difference: 0.12, 95\% CI ?0.6 to 0.84; P=.74), 3 months (0.23, 95\% CI ?0.31 to 0.78; P=.40), or 6 months (?0.1, 95\% CI ?0.7 to 0.51; P=.76). The ASICA group had lower anxiety scores at 12 months (?0.54, 95\% CI ?1.31 to 0.230; P=.17), 3 months (?0.13, 95\% CI ?0.79 to 0.54; P=.71), and significantly at 6 months (?1.00, 95\% CI ?1.74 to ?0.26; P=.009). Depression scores were similar, being lower at 12 months (?0.44, 95\% CI ?1.11 to 0.23; P=.20) and 3 months (?0.24, 95\% CI ?0.84 to 0.35; P=.42) but only significantly lower at 6 months (?0.77, 95\% CI ?1.41 to ?0.12; P=.02). The ASICA group had significantly higher quality of life scores at 12 months (0.044, 95\% CI 0.003-0.085; P=.04) and 6 months (0.070, 95\% CI 0.032-0.107; P<.001) and nonsignificantly at 3 months (0.024, 95\% CI ?0.006 to 0.054; P=.11). ASICA users reported significantly more regular (>5) TSSEs during the study year and significantly higher levels of self-efficacy in conducting TSSE. They also reported significantly higher levels of planning and intention to perform TSSE in the future. Conclusions: Using ASICA for 12 months does not increase melanoma worry, can reduce anxiety and depression, and may improve quality of life. ASICA has the potential to improve the well-being and vigilance of survivors of melanoma and enable the benefits of regular TSSE. Trial Registration: ClinicalTrials.gov NCT03328247; https://clinicaltrials.gov/ct2/show/NCT03328247 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3453-x ",
doi="10.2196/37539",
url="https://cancer.jmir.org/2022/3/e37539",
url="http://www.ncbi.nlm.nih.gov/pubmed/36074560"
}


@Article{info:doi/10.2196/34471,
author="Obro, Faurholt Louise
and Osther, Sloth Palle J{\"o}rn
and Ammentorp, Jette
and Pihl, Thybo Gitte
and Heiselberg, Kvols Kasper
and Krogh, Gall Peter
and Handberg, Charlotte",
title="An Intervention Offering Self-management Support Through mHealth and Health Coaching to Patients With Prostate Cancer: Interpretive Description of Patients' Experiences and Perspectives",
journal="JMIR Form Res",
year="2022",
month="Sep",
day="8",
volume="6",
number="9",
pages="e34471",
keywords="mobile phone",
keywords="mobile health",
keywords="mHealth",
keywords="prostate cancer",
keywords="self-management",
keywords="health coaching",
keywords="coaching",
abstract="Background: Observational management strategies such as active surveillance and watchful waiting are considered to be acceptable approaches in patients with low-risk localized prostate cancer and a safe alternative to aggressive treatment. During observational management, treatment is postponed until the disease progresses, which often never occurs. However, approximately 90\% of patients with a low-risk disease choose aggressive treatment owing to anxiety. Strategies to address anxiety are needed for optimal management of this population and to improve the quality of life of patients with low-risk localized prostate cancer. A review highlighted that mobile health (mHealth) in tandem with health coaching can support patients' self-management of health behaviors and improve well-being. Objective: This study aims to explore patients' experiences with and perspectives on an intervention offering self-management support through the use of mHealth devices and health coaching to identify supportive features that enable patients to perform sustainable changes that improve well-being. Methods: We used an interpretive description approach, combining semistructured interviews with 13 purposively selected patients with prostate cancer and participant observations of patient-coach interactions in coaching sessions. The interviews were transcribed and analyzed. The self-determination theory was used as a theoretical lens. Field notes and coaching notes from each session were used to orient data generation and confirm or challenge the analysis. Results: Our analysis suggested that patients' self-awareness and psychological identity influenced their experiences with and perspectives on the self-management support offered by mHealth and health coaching in clinical practice. The patients' individual experiences and perspectives indicated that they placed themselves in a dynamic continuum of sustaining or repressing their identity, self-awareness, and individual qualities. Our analysis revealed 4 interacting themes, all related to the psychological identity of the patients. Conclusions: For the group of patients with prostate cancer to experience well-being, we found it important for them to sustain their self-image when offered a self-management intervention. Motivation and autonomy were important aspects for the individual patients to sustain their self-image throughout the intervention. In contrast, demotivation and a sense of paternalism could result in fostering an experience of having to repress self-awareness. ",
doi="10.2196/34471",
url="https://formative.jmir.org/2022/9/e34471",
url="http://www.ncbi.nlm.nih.gov/pubmed/35925751"
}


@Article{info:doi/10.2196/34264,
author="Dodd, H. Rachael
and Zhang, Chenyue
and Sharman, R. Ashleigh
and Carlton, Julie
and Tang, Ruijin
and Rankin, M. Nicole",
title="Assessing Information Available for Health Professionals and Potential Participants on Lung Cancer Screening Program Websites: Cross-sectional Study",
journal="JMIR Cancer",
year="2022",
month="Aug",
day="30",
volume="8",
number="3",
pages="e34264",
keywords="lung cancer screening",
keywords="communication",
keywords="recommendation",
keywords="lung cancer",
keywords="cancer",
keywords="cross-sectional study",
keywords="cancer screening",
keywords="screening program",
keywords="screening",
abstract="Background: Lung cancer is the leading cause of cancer death worldwide. The US Preventive Services Task Force (USPSTF) updated recommendations for lung cancer screening in 2021, adjusting the age of screening to 50 years (from 55 years) and reducing the number of pack-years used to estimate total firsthand cigarette smoke exposure to 20 (from 30). With many individuals using the internet to find health care information, it is important to understand what information is available for individuals contemplating lung cancer screening. Objective: This study aimed to assess the eligibility criteria and information available on lung cancer screening program websites for both health professionals and potential screening participants. Methods: A descriptive cross-sectional analysis of 151 lung cancer screening program websites of academic (n=76) and community medical centers (n=75) in the United States with information for health professionals and potential screening participants was conducted in March 2021. Presentation of eligibility criteria for potential screening participants and presence of information available specific to health professionals about lung cancer screening were the primary outcomes. Secondary outcomes included presentation of information about cost and smoking cessation, inclusion of an online risk assessment tool, mention of any clinical guidelines, and use of multimedia to present information. Results: Eligibility criteria for lung cancer screening was included in nearly all 151 websites (n=142, 94\%), as well as age range (n=139, 92.1\%) and smoking history (n=141, 93.4\%). Age was only consistent with the latest recommendations in 14.5\% (n=22) of websites, and no websites had updated smoking history. Half the websites (n=76, 50.3\%) mentioned screening costs as related to the type of insurance held. A total of 23 (15.2\%) websites featured an online assessment tool to determine eligibility. The same proportion (n=23, 15.2\%) hosted information specifically for health professionals. In total, 44 (29.1\%) websites referred to smoking cessation, and 46 (30.5\%) websites used multimedia to present information, such as short videos or podcasts. Conclusions: Most websites of US lung cancer screening programs provide information about eligibility criteria, but this is not consistent and has not been updated across all websites following the latest USPSTF recommendations. Online resources require updating to present standardized information that is accessible for all. ",
doi="10.2196/34264",
url="https://cancer.jmir.org/2022/3/e34264",
url="http://www.ncbi.nlm.nih.gov/pubmed/36040773"
}


@Article{info:doi/10.2196/38514,
author="Higgins, A. Kristin
and Thomas, Alexandra
and Soto, Nancy
and Paulus, Rebecca
and George, J. Thomas
and Julian, B. Thomas
and Hartson Stine, Sharon
and Markham, Jennifer Merry
and Werner-Wasik, Maria",
title="Creating and Implementing a Principal Investigator Tool Kit for Enhancing Accrual to Late Phase Clinical Trials: Development and Usability Study",
journal="JMIR Cancer",
year="2022",
month="Aug",
day="25",
volume="8",
number="3",
pages="e38514",
keywords="clinical trial accrual",
keywords="social media tools",
keywords="principal investigator",
keywords="PI toolkit",
keywords="oncology",
keywords="clinical trial",
keywords="tool",
keywords="resources",
keywords="patient",
keywords="investigators",
keywords="accrual",
keywords="development",
keywords="engagement",
keywords="study",
keywords="community",
keywords="planning",
keywords="activation",
keywords="social media",
abstract="Background: Accrual to oncology clinical trials remains a challenge, particularly during the COVID-19 pandemic. For late phase clinical trials funded by the National Cancer Institute, the development of these research protocols is a resource-intensive process; however, mechanisms to optimize patient accrual after trial activation are underdeveloped across the National Clinical Trial Network (NCTN). Low patient accrual can lead to the premature closure of clinical trials and can ultimately delay the availability of new, potentially life-saving therapies in oncology. Objective: The purpose of this study is to formally create an easily implemented tool kit of resources for investigators of oncology clinical trials within the NCTN, specifically the NRG Oncology cooperative group, in order to optimize patient accrual. Methods: NRG Oncology sought to formally develop a tool kit of resources to use at specific time points during the lifetime of NRG Oncology clinical trials. The tools are clearly described and involve the facilitation of engagement of the study principal investigator with the scientific and patient advocate community during the planning, activation, and accrual periods. Social media tools are also leveraged to enhance such engagement. The principal investigator (PI) tool kit was created in 2019 and thereafter piloted with the NRG Oncology/Alliance NRG-LU005 phase II or III trial in small-cell lung cancer. The PI tool kit was developed by the NRG Oncology Protocol Operations Management committee and was tested with the NRG/Alliance LU005 randomized trial within the NCTN. Results: NRG Oncology/Alliance NRG-LU005 has seen robust enrollment, currently 127\% of the projected accrual. Importantly, many of the tool kit elements are already being used in ongoing NRG Oncology trials, with 56\% of active NRG trials using at least one element of the PI tool kit and all in-development trials offered the resource. This underscores the feasibility and potential benefits of deploying the PI tool kit across all NRG Oncology trials moving forward. Conclusions: While clinical trial accrual can be challenging, the PI tool kit has been shown to augment accrual in a low-cost and easily implementable fashion. It could be widely and consistently deployed across the NCTN to improve accrual in oncology clinical trials. Trial Registration: ClinicalTrials.gov NCT03811002; https://clinicaltrials.gov/ct2/show/NCT03811002 ",
doi="10.2196/38514",
url="https://cancer.jmir.org/2022/3/e38514",
url="http://www.ncbi.nlm.nih.gov/pubmed/36006678"
}


@Article{info:doi/10.2196/37526,
author="Neil, M. Jordan
and Senecal, Christian
and Ballini, Lauren
and Chang, Yuchiao
and Goshe, Brett
and Flores, Efren
and Ostroff, S. Jamie
and Park, R. Elyse",
title="A Multimethod Evaluation of Tobacco Treatment Trial Recruitment Messages for Current Smokers Recently Diagnosed With Cancer: Pilot Factorial Randomized Controlled Trial",
journal="JMIR Cancer",
year="2022",
month="Aug",
day="24",
volume="8",
number="3",
pages="e37526",
keywords="teachable moment",
keywords="cancer",
keywords="tobacco treatment trial",
keywords="smoking",
keywords="message framing",
keywords="recruitment",
abstract="Background: A cancer diagnosis can catalyze motivation to quit smoking. Tobacco treatment trials offer cessation resources but have low accrual rates. Digital outreach may improve accrual, but knowledge of how best to recruit smokers with recent diagnoses is limited. Objective: This study aims to identify the message frames that were most effective in promoting intent to talk to a physician about participating in a tobacco treatment trial for smokers recently diagnosed with cancer. Methods: From February to April 2019, current smokers diagnosed within the past 24 months were recruited from a national web-based panel for a multimethod pilot randomized trial (N=99). Participants were randomized to a 2{\texttimes}3 plus control factorial design that tested 3 unique message frames: proximal versus distal threats of smoking, costs of continued smoking versus benefits of quitting, and gains of participating versus losses of not participating in a tobacco treatment trial. The primary outcome was intent to talk to a physician about participating in a tobacco treatment trial. In phase 1, the main effect within each message factor level was examined using ANOVA and compared with the control condition. Other message evaluation and effectiveness measures were collected and explored in a multivariable model predicting intent to talk to a physician. In phase 2, open-text evaluations of the messages were analyzed using natural language processing software (Leximancer) to generate a thematic concept map and Linguistic Inquiry Word Count to identify and compare the prevalence of linguistic markers among message factors. Results: Of the 99 participants, 76 (77\%) completed the intervention. Participants who received the cost of continued smoking frame were significantly more likely to intend to talk to their physician about participating in a tobacco treatment trial than those who received the benefits of the quitting frame (mean costs 5.13, SD 1.70 vs mean benefits 4.23, SD 1.86; P=.04). Participants who received the proximal risks of continued smoking frame were significantly more likely to seek more information about participating (mean distal 4.83, SD 1.61 vs mean proximal 5.55, SD 1.15; P=.04), and those who received the losses of not participating frame reported significantly improved perceptions of smoking cessation research (mean gain 3.98, SD 0.83 vs mean loss 4.38, SD 0.78; P=.01). Male participants (P=.006) and those with greater message relevancy (P=.001) were significantly more likely to intend to talk to their physician. Participants' perceptions of their smoking habits, as well as their motivation to quit smoking, were prevalent themes in the open-text data. Differences in the percentages of affective words across message frames were identified. Conclusions: Multimethod approaches are needed to develop evidence-based recruitment messages for patients recently diagnosed with cancer. Future tobacco treatment trials should evaluate the effectiveness of different message frames on smoker enrollment rates. Trial Registration: Clinicaltrials.gov NCT05471284; https://clinicaltrials.gov/ct2/show/NCT05471284 ",
doi="10.2196/37526",
url="https://cancer.jmir.org/2022/3/e37526",
url="http://www.ncbi.nlm.nih.gov/pubmed/36001378"
}


@Article{info:doi/10.2196/36244,
author="Herbert, S. Amber
and Hassan, Naeemul
and Malik, D. Rena
and Loeb, Stacy
and Myrie, Akya",
title="Exploring Urological Malignancies on Pinterest: Content Analysis",
journal="JMIR Cancer",
year="2022",
month="Aug",
day="22",
volume="8",
number="3",
pages="e36244",
keywords="bladder cancer",
keywords="Pinterest",
keywords="prostate cancer",
keywords="kidney cancer",
keywords="testicular cancer",
keywords="urological cancer",
keywords="misinformation",
keywords="genitourinary",
keywords="malignancy",
keywords="oncology",
keywords="content",
keywords="information",
keywords="social media",
keywords="accuracy",
keywords="quality",
abstract="Background: Pinterest is a visually oriented social media platform with over 250 million monthly users. Previous studies have found misinformative content on genitourinary malignancies to be broadly disseminated on YouTube; however, no study has assessed the quality of this content on Pinterest. Objective: Our objective was to evaluate the quality, understandability, and actionability of genitourinary malignancy content on Pinterest. Methods: We examined 540 Pinterest posts or pins, using the following search terms: ``bladder cancer,'' ``kidney cancer,'' ``prostate cancer,'' and ``testicular cancer.'' The pins were limited to English language and topic-specific content, resulting in the following exclusions: bladder (n=88), kidney (n=4), prostate (n=79), and testicular cancer (n=10), leaving 359 pins as the final analytic sample. Pinterest pins were classified based on publisher and perceived race or ethnicity. Content was assessed using 2 validated grading systems: DISCERN quality criteria and the Patient Education Materials Assessment Tool. The presence of misinformation was evaluated using a published Likert scale ranging from 1=none to 5=high. Results: Overall, 359 pins with a total of 8507 repins were evaluated. The primary publisher of genitourinary malignancy pins were health and wellness groups (n=162, 45\%). Across all genitourinary malignancy pins with people, only 3\% (n=7) were perceived as Black. Additionally, Asian (n=2, 1\%) and Latinx (n=1, 0.5\%) individuals were underrepresented in all pins. Nearly 75\% (n=298) of the pins had moderate- to poor-quality information. Misinformative content was apparent in 4\%-26\% of all genitourinary cancer pins. Understandability and actionability were poor in 55\% (n=198) and 100\% (n=359) of the pins, respectively. Conclusions: On Pinterest, the majority of the urological oncology patient-centric content is of low quality and lacks diversity. This widely used, yet unregulated platform has the ability to influence consumers' health knowledge and decision-making. Ultimately, this can lead to consumers making suboptimal medical decisions. Moreover, our findings demonstrate underrepresentation across many racial and ethnic groups. Efforts should be made to ensure the dissemination of diverse, high-quality, and accurate health care information to the millions of users on Pinterest and other social media platforms. ",
doi="10.2196/36244",
url="https://cancer.jmir.org/2022/3/e36244",
url="http://www.ncbi.nlm.nih.gov/pubmed/35994318"
}


@Article{info:doi/10.2196/34851,
author="Vachon, Eric
and Robb, W. Bruce
and Haggstrom, A. David",
title="Impact of a Personal Health Record Intervention Upon Surveillance Among Colorectal Cancer Survivors: Feasibility Study",
journal="JMIR Cancer",
year="2022",
month="Aug",
day="11",
volume="8",
number="3",
pages="e34851",
keywords="personal health record",
keywords="colorectal cancer survivors",
keywords="surveillance",
keywords="health record",
keywords="survivor",
keywords="cancer",
keywords="oncology",
keywords="colorectal",
keywords="United States",
keywords="North America",
keywords="feasibility",
keywords="web-based",
keywords="patient belief",
keywords="patient attitude",
keywords="survival",
abstract="Background: There are currently an estimated 1.5 million individuals living in the United States with colorectal cancer (CRC), and although the 5-year survival rate has increased, survivors are at risk for recurrence, particularly within the first 2-3 years after treatment. National guidelines recommend continued surveillance after resection to identify recurrence early on. Adherence among survivors ranges from 23\% to 94\%. Novel interventions are needed to increase CRC survivors' knowledge and confidence in managing their cancer and thus to increase adherence to follow-up surveillance. Objective: The objective of this study is to develop and test the feasibility and efficacy of a stand-alone, web-based personal health record (PHR) to increase surveillance adherence among CRC survivors, with patient beliefs about surveillance as secondary outcomes. Methods: A pre- and postintervention feasibility trial was conducted testing the efficacy of the colorectal cancer survivor (CRCS)--PHR, which had been previously developed using an iterative, user-centered design approach. Results: The average age of the sample was 58 (SD 9.9) years, with 57\% (16/28) male and the majority married (20/28, 71\%) and employed full-time (15/28, 54\%). We observed a significant increase in adherence to colonoscopy (before: 11/21, 52\% vs after: 18/21, 86\%; P=.005) and CEA (14/21, 67\% vs 20/21, 95\%; P=.01), as well as a slight increase in CT scans (14/21, 67\% vs 18/21, 86\%; P=.10). The only significant impact on secondary outcome (patient beliefs) was benefits of CEA test (P=.04), as most of the beliefs were high at baseline. Conclusions: This feasibility study lays the groundwork for continued development of the CRCS-PHR to increase CRC surveillance. Patient-centered technologies, such as the CRCS-PHR, represent an important potential approach to improving the receipt of guideline-concordant care and follow-up surveillance, and not just for CRC survivors. Researchers should continue to develop patient-centered health technologies with clinician implementation in mind to increase patient self-efficacy and surveillance adherence. ",
doi="10.2196/34851",
url="https://cancer.jmir.org/2022/3/e34851",
url="http://www.ncbi.nlm.nih.gov/pubmed/35969424"
}


@Article{info:doi/10.2196/37368,
author="Lamaj, Ganimete
and Pablo-Trinidad, Alberto
and Butterworth, Ian
and Bell, Nolan
and Benasutti, Ryan
and Bourquard, Aurelien
and Sanchez-Ferro, Alvaro
and Castro-Gonzalez, Carlos
and Jim{\'e}nez-Ubieto, Ana
and Baumann, Tycho
and Rodriguez-Izquierdo, Antonia
and Pottier, Elizabeth
and Shelton, Anthony
and Martinez-Lopez, Joaquin
and Sloan, Mark John",
title="Usability Evaluation of a Noninvasive Neutropenia Screening Device (PointCheck) for Patients Undergoing Cancer Chemotherapy: Mixed Methods Observational Study",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="9",
volume="24",
number="8",
pages="e37368",
keywords="digital health",
keywords="usability",
keywords="patient-centered care",
keywords="remote monitoring",
keywords="decision support systems",
keywords="white blood cells",
keywords="diagnosis",
keywords="medical device",
keywords="cancer",
keywords="chemotherapy",
keywords="infection",
keywords="white blood cell",
keywords="technology",
abstract="Background: Patients with cancer undergoing cytotoxic chemotherapy face an elevated risk of developing serious infection as a consequence of their treatment, which lowers their white blood cell count and, more specifically, their absolute neutrophil count. This condition is known as neutropenia. Neutropenia accompanied by a fever is referred to as febrile neutropenia, a common side effect of chemotherapy with a high mortality rate. The timely detection of severe neutropenia (<500 absolute neutrophil count/$\mu$L) is critical in detecting and managing febrile neutropenia. Current methods rely on blood draws, which limit them to clinical settings and do not allow frequent or portable monitoring. In this study, we demonstrated the usability of PointCheck, a noninvasive device for neutropenia screening, in a simulated home environment without clinical supervision. PointCheck automatically performs microscopy through the skin of the finger to image the blood flowing through superficial microcapillaries and enables the remote monitoring of neutropenia status, without requiring venipuncture. Objective: This study aimed to evaluate the usability of PointCheck, a noninvasive optical technology for screening severe neutropenia, with the goal of identifying potential user interface, functionality, and design issues from the perspective of untrained users. Methods: We conducted a multicenter study using quantitative and qualitative approaches to evaluate the usability of PointCheck across 154 untrained participants. We used a mixed method approach to gather usability data through user testing observations, a short-answer qualitative questionnaire, and a standardized quantitative System Usability Scale (SUS) survey to assess perceived usability and satisfaction. Results: Of the 154 participants, we found that 108 (70.1\%) scored above 80.8 on the SUS across all sites, with a mean SUS score of 86.1 across all sites. Furthermore, the SUS results indicated that, out of the 151 users who completed the SUS survey, 145 (96\%) found that they learned how to use PointCheck very quickly, and 141 (93.4\%) felt very confident when using the device. Conclusions: We have shown that PointCheck, a novel technology for noninvasive, home-based neutropenia detection, can be safely and effectively operated by first-time users. In a simulated home environment, these users found it easy to use, with a mean SUS score of 86.1, indicating an excellent perception of usability and placing this device within the top tenth percentile of systems evaluated for usability by the SUS. Trial Registration: ClinicalTrials.gov NCT04448314; https://clinicaltrials.gov/ct2/show/NCT04448314 (Hospital Universitario 12 de Octubre registration) and NCT04448301; https://clinicaltrials.gov/ct2/show/NCT04448301 (Boston Medical Center registration) ",
doi="10.2196/37368",
url="https://www.jmir.org/2022/8/e37368",
url="http://www.ncbi.nlm.nih.gov/pubmed/35943786"
}


@Article{info:doi/10.2196/36879,
author="LeBaron, Virginia
and Alam, Ridwan
and Bennett, Rachel
and Blackhall, Leslie
and Gordon, Kate
and Hayes, James
and Homdee, Nutta
and Jones, Randy
and Lichti, Kathleen
and Martinez, Yudel
and Mohammadi, Sahar
and Ogunjirin, Emmanuel
and Patel, Nyota
and Lach, John",
title="Deploying the Behavioral and Environmental Sensing and Intervention for Cancer Smart Health System to Support Patients and Family Caregivers in Managing Pain: Feasibility and Acceptability Study",
journal="JMIR Cancer",
year="2022",
month="Aug",
day="9",
volume="8",
number="3",
pages="e36879",
keywords="mobile health",
keywords="mHealth",
keywords="smart health",
keywords="cancer",
keywords="pain",
keywords="palliative care",
keywords="family caregiver",
keywords="remote monitoring",
keywords="feasibility and acceptability",
keywords="rural",
abstract="Background: Distressing cancer pain remains a serious symptom management issue for patients and family caregivers, particularly within home settings. Technology can support home-based cancer symptom management but must consider the experience of patients and family caregivers, as well as the broader environmental context. Objective: This study aimed to test the feasibility and acceptability of a smart health sensing system---Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C)---that was designed to support the monitoring and management of cancer pain in the home setting. Methods: Dyads of patients with cancer and their primary family caregivers were recruited from an outpatient palliative care clinic at an academic medical center. BESI-C was deployed in each dyad home for approximately 2 weeks. Data were collected via environmental sensors to assess the home context (eg, light and temperature); Bluetooth beacons to help localize dyad positions; and smart watches worn by both patients and caregivers, equipped with heart rate monitors, accelerometers, and a custom app to deliver ecological momentary assessments (EMAs). EMAs enabled dyads to record and characterize pain events from both their own and their partners' perspectives. Sensor data streams were integrated to describe and explore the context of cancer pain events. Feasibility was assessed both technically and procedurally. Acceptability was assessed using postdeployment surveys and structured interviews with participants. Results: Overall, 5 deployments (n=10 participants; 5 patient and family caregiver dyads) were completed, and 283 unique pain events were recorded. Using our ``BESI-C Performance Scoring Instrument,'' the overall technical feasibility score for deployments was 86.4 out of 100. Procedural feasibility challenges included the rurality of dyads, smart watch battery life and EMA reliability, and the length of time required for deployment installation. Postdeployment acceptability Likert surveys (1=strongly disagree; 5=strongly agree) found that dyads disagreed that BESI-C was a burden (1.7 out of 5) or compromised their privacy (1.9 out of 5) and agreed that the system collected helpful information to better manage cancer pain (4.6 out of 5). Participants also expressed an interest in seeing their own individual data (4.4 out of 5) and strongly agreed that it is important that data collected by BESI-C are shared with their respective partners (4.8 out of 5) and health care providers (4.8 out of 5). Qualitative feedback from participants suggested that BESI-C positively improved patient-caregiver communication regarding pain management. Importantly, we demonstrated proof of concept that seriously ill patients with cancer and their caregivers will mark pain events in real time using a smart watch. Conclusions: It is feasible to deploy BESI-C, and dyads find the system acceptable. By leveraging human-centered design and the integration of heterogenous environmental, physiological, and behavioral data, the BESI-C system offers an innovative approach to monitor cancer pain, mitigate the escalation of pain and distress, and improve symptom management self-efficacy. International Registered Report Identifier (IRRID): RR2-10.2196/16178 ",
doi="10.2196/36879",
url="https://cancer.jmir.org/2022/3/e36879",
url="http://www.ncbi.nlm.nih.gov/pubmed/35943791"
}


@Article{info:doi/10.2196/34745,
author="Zaidi, Maryum
and Amante, J. Daniel
and Anderson, Ekaterina
and Ito Fukunaga, Mayuko
and Faro, M. Jamie
and Frisard, Christine
and Sadasivam, S. Rajani
and Lemon, C. Stephenie",
title="Association Between Patient Portal Use and Perceived Patient-Centered Communication Among Adults With Cancer: Cross-sectional Survey Study",
journal="JMIR Cancer",
year="2022",
month="Aug",
day="9",
volume="8",
number="3",
pages="e34745",
keywords="health information technology",
keywords="informatics",
keywords="cancer care",
keywords="patient-centered communication",
keywords="patient portal",
keywords="patient communication",
keywords="cancer",
keywords="oncology",
keywords="health information",
keywords="information seeking",
keywords="patient-centered care",
keywords="patient perception",
abstract="Background: Patient-centered communication (PCC) plays a vital role in effective cancer management and care. Patient portals are increasingly available to patients and hold potential as a valuable tool to facilitate PCC. However, whether more frequent use of patient portals is associated with increased perceived PCC and which mechanisms might mediate this relationship have not been fully studied. Objective: The goal of this study was to investigate the association between the frequency of access of patient portals and perceived PCC in patients diagnosed with cancer. We further sought to examine whether this association was mediated by patients' self-efficacy in health information--seeking. Methods: We used data from the Health Information National Trend Survey 5 (HINTS 5) cycle 3 (2019) and cycle 4 (2020). This analysis includes 1222 individuals who self-reported having a current or past diagnosis of cancer. Perceived PCC was measured with a 7-item HINTS 5--derived scale and classified as low, medium, or high. Patient portal use was measured by a single item assessing the frequency of use. Self-efficacy about health information--seeking was assessed with a 1-item measure assessing confidence in obtaining health information. We used adjusted multinomial logistic regression models to estimate relative risk ratios (RRRs)/effect sizes of the association between patient portal use and perceived PCC. Mediation by health information self-efficacy was investigated using the Baron and Kenny and Karlson-Holm-Breen methods. Results: A total of 54.5\% of the sample reported that they had not accessed their patient portals in the past 12 months, 12.6\% accessed it 1 to 2 times, 24.8\% accessed it 3 to 9 times, and 8.2\% accessed it 10 or more times. Overall, the frequency of accessing the patient portal was marginally associated (P=.06) with perceived PCC in an adjusted multinominal logistic regression model. Patients who accessed their patient portal 10 or more times in the previous 12 months were almost 4 times more likely (RRR 3.8, 95\% CI 1.6-9.0) to report high perceived PCC. In mediation analysis, the association between patient portal use and perceived PCC was attenuated adjusting for health information--seeking self-efficacy, but those with the most frequent patient portal use (10 or more times in the previous 12 months) were still almost 2.5 times more likely to report high perceived PCC (RRR 2.4, 95\% CI 1.1-5.6) compared to those with no portal use. Conclusions: Increased frequency of patient portal use was associated with higher PCC, and an individual's health information--seeking self-efficacy partially mediated this association. These findings emphasize the importance of encouraging patients and providers to use patient portals to assist in patient-centeredness of cancer care. Interventions to promote the adoption and use of patient portals could incorporate strategies to improve health information self-efficacy. ",
doi="10.2196/34745",
url="https://cancer.jmir.org/2022/3/e34745",
url="http://www.ncbi.nlm.nih.gov/pubmed/35943789"
}


@Article{info:doi/10.2196/37502,
author="Austin, Judith
and Drossaert, C. Constance H.
and van Dijk, Jelle
and Sanderman, Robbert
and B{\o}r{\o}sund, Elin
and Mirkovic, Jelena
and Schotanus-Dijkstra, Marijke
and Peeters, J. Nienke
and Van 't Klooster, R. Jan-Willem J.
and Schroevers, J. Maya
and Bohlmeijer, T. Ernst",
title="Integrating Top-down and Bottom-up Requirements in eHealth Development: The Case of a Mobile Self-compassion Intervention for People With Newly Diagnosed Cancer",
journal="JMIR Cancer",
year="2022",
month="Aug",
day="1",
volume="8",
number="3",
pages="e37502",
keywords="eHealth",
keywords="cancer",
keywords="self-compassion",
keywords="co-design",
keywords="requirements",
keywords="evidence-based",
keywords="mobile phone",
abstract="Background: Psychosocial eHealth interventions for people with cancer are promising in reducing distress; however, their results in terms of effects and adherence rates are quite mixed. Developing interventions with a solid evidence base while still ensuring adaptation to user wishes and needs is recommended to overcome this. As most models of eHealth development are based primarily on examining user experiences (so-called bottom-up requirements), it is not clear how theory and evidence (so-called top-down requirements) may best be integrated into the development process. Objective: This study aims to investigate the integration of top-down and bottom-up requirements in the co-design of eHealth applications by building on the development of a mobile self-compassion intervention for people with newly diagnosed cancer. Methods: Four co-design tasks were formulated at the start of the project and adjusted and evaluated throughout: explore bottom-up experiences, reassess top-down content, incorporate bottom-up and top-down input into concrete features and design, and synergize bottom-up and top-down input into the intervention context. These tasks were executed iteratively during a series of co-design sessions over the course of 2 years, in which 15 people with cancer and 7 nurses (recruited from 2 hospitals) participated. On the basis of the sessions, a list of requirements, a final intervention design, and an evaluation of the co-design process and tasks were yielded. Results: The final list of requirements included intervention content (eg, major topics of compassionate mind training such as psychoeducation about 3 emotion systems and main issues that people with cancer encounter after diagnosis such as regulating information consumption), navigation, visual design, implementation strategies, and persuasive elements. The final intervention, Compas-Y, is a mobile self-compassion training comprising 6 training modules and several supportive functionalities such as a mood tracker and persuasive elements such as push notifications. The 4 co-design tasks helped overcome challenges in the development process such as dealing with conflicting top-down and bottom-up requirements and enabled the integration of all main requirements into the design. Conclusions: This study addressed the necessary integration of top-down and bottom-up requirements into eHealth development by examining a preliminary model of 4 co-design tasks. Broader considerations regarding the design of a mobile intervention based on traditional intervention formats and merging the scientific disciplines of psychology and design research are discussed. ",
doi="10.2196/37502",
url="https://cancer.jmir.org/2022/3/e37502",
url="http://www.ncbi.nlm.nih.gov/pubmed/35916691"
}


@Article{info:doi/10.2196/35893,
author="Leung, W. Yvonne
and Park, Bomi
and Heo, Rachel
and Adikari, Achini
and Chackochan, Suja
and Wong, Jiahui
and Alie, Elyse
and Gancarz, Mathew
and Kacala, Martyna
and Hirst, Graeme
and de Silva, Daswin
and French, Leon
and Bender, Jacqueline
and Mishna, Faye
and Gratzer, David
and Alahakoon, Damminda
and Esplen, Jane Mary",
title="Providing Care Beyond Therapy Sessions With a Natural Language Processing--Based Recommender System That Identifies Cancer Patients Who Experience Psychosocial Challenges and Provides Self-care Support: Pilot Study",
journal="JMIR Cancer",
year="2022",
month="Jul",
day="29",
volume="8",
number="3",
pages="e35893",
keywords="artificial intelligence",
keywords="natural language processing",
keywords="online support groups",
keywords="supportive care in cancer",
keywords="recommender system",
abstract="Background: The negative psychosocial impacts of cancer diagnoses and treatments are well documented. Virtual care has become an essential mode of care delivery during the COVID-19 pandemic, and online support groups (OSGs) have been shown to improve accessibility to psychosocial and supportive care. de Souza Institute offers CancerChatCanada, a therapist-led OSG service where sessions are monitored by an artificial intelligence--based co-facilitator (AICF). The AICF is equipped with a recommender system that uses natural language processing to tailor online resources to patients according to their psychosocial needs. Objective: We aimed to outline the development protocol and evaluate the AICF on its precision and recall in recommending resources to cancer OSG members. Methods: Human input informed the design and evaluation of the AICF on its ability to (1) appropriately identify keywords indicating a psychosocial concern and (2) recommend the most appropriate online resource to the OSG member expressing each concern. Three rounds of human evaluation and algorithm improvement were performed iteratively. Results: We evaluated 7190 outputs and achieved a precision of 0.797, a recall of 0.981, and an F1 score of 0.880 by the third round of evaluation. Resources were recommended to 48 patients, and 25 (52\%) accessed at least one resource. Of those who accessed the resources, 19 (75\%) found them useful. Conclusions: The preliminary findings suggest that the AICF can help provide tailored support for cancer OSG members with high precision, recall, and satisfaction. The AICF has undergone rigorous human evaluation, and the results provide much-needed evidence, while outlining potential strengths and weaknesses for future applications in supportive care. ",
doi="10.2196/35893",
url="https://cancer.jmir.org/2022/3/e35893",
url="http://www.ncbi.nlm.nih.gov/pubmed/35904877"
}


@Article{info:doi/10.2196/37706,
author="Adler, F. Rachel
and Morales, Paulina
and Sotelo, Jocelyn
and Magasi, Susan",
title="Developing an mHealth App for Empowering Cancer Survivors With Disabilities: Co-design Study",
journal="JMIR Form Res",
year="2022",
month="Jul",
day="26",
volume="6",
number="7",
pages="e37706",
keywords="user-centered design",
keywords="co-design",
keywords="mobile health",
keywords="mHealth",
keywords="cancer survivors",
keywords="disabilities",
abstract="Background: The transition from active treatment to long-term cancer survivorship leaves the needs of many cancer survivors unaddressed as they struggle with physical, cognitive, psychological, and social consequences of cancer and its treatment. The lack of guidance after treatment has forced cancer survivors to manage long-term effects on their own, which has an impact on their overall health, quality of life, and social participation. Mobile health (mHealth) interventions can be used to promote self-management and evidence-informed education. Objective: This study aims to design an mHealth app for cancer survivors with disabilities that will offer interventions to improve their quality of life and increase their self-efficacy to manage cancer as a chronic condition. Methods: We organized 3 co-design workshops with cancer survivors (n=5). These workshops included persona development based on data from 25 interviews with cancer survivors with disabilities; prototype ideation, where we sketched ideas for the prototype; and prototype development, where participants critiqued, and suggested improvements for, the wireframes. Results: These workshops helped us to define the challenges that cancer survivors with disabilities face as well as important considerations when designing an mHealth app for cancer survivors with disabilities, such as the need for including flexibility, engagement, socialization, and a minimalistic design. We also outline guidelines for other researchers to follow when planning their own co-design workshops, which include allowing more time for discussion among participants, having small participant groups, keeping workshops engaging and inclusive, and letting participants dream big. Conclusions: Using a co-design process aided us in developing a prototype of an mHealth app for cancer survivors with disabilities as well as a list of guidelines that other researchers can use to develop their own co-design workshops and design their app. Furthermore, working together with cancer survivors ensured that the design team had a deeper sense of empathy toward the target users and kept the focus on our ultimate goal: creating something that cancer survivors would want to use and benefit from. Future work will include usability testing of a high-fidelity prototype based on the results of these workshops. ",
doi="10.2196/37706",
url="https://formative.jmir.org/2022/7/e37706",
url="http://www.ncbi.nlm.nih.gov/pubmed/35881439"
}


@Article{info:doi/10.2196/38300,
author="Chin, Stanley
and Cavadino, Alana
and Akroyd, Amelia
and Tennant, Geraldine
and Dobson, Rosie
and Gautier, Adele
and Reynolds, Lisa",
title="An Investigation of Virtual Reality Nature Experiences in Patients With Metastatic Breast Cancer: Secondary Analysis of a Randomized Controlled Trial",
journal="JMIR Cancer",
year="2022",
month="Jul",
day="22",
volume="8",
number="3",
pages="e38300",
keywords="metastatic breast cancer",
keywords="virtual reality",
keywords="nature connectedness",
keywords="intervention",
keywords="quality of life",
abstract="Background: Connection with nature has well-established physical and psychological benefits. However, women with metastatic breast cancer (MBC) are often unable to access nature because of physical limitations, psychological barriers, and treatment demands. Virtual reality (VR) nature experiences offer an alternative means of connecting with nature and may be of particular benefit to patients with cancer who are house- or hospital-bound. Objective: This study aims to explore whether VR nature experiences are associated with physical and psychological benefits for women with MBC who are disconnected with nature. Methods: This secondary analysis of a previous randomized controlled crossover trial recruited participants from the emailing lists of breast cancer support organizations. Participants were provided VR headsets for daily use in their homes for over 3 weeks. In the first week, participants used 1 of 2 VR nature experiences (Ripple or Happy Place) daily, followed by a 1-week washout period, before using the other VR experience every day for the final week. Outcomes assessed changes between baseline and postintervention scores in quality of life (EQ-5D-5L), pain (Brief Pain Inventory Short Form), fatigue (Functional Assessment of Chronic Illness Therapy-fatigue), depression (Depression, Anxiety, and Stress Scale-depression), anxiety (Depression, Anxiety, and Stress Scale-anxiety), and spiritual well-being (Functional Assessment of Chronic Illness Therapy- Spiritual Well-being) and investigated whether benefits were greater in participants who were not strongly connected with nature at baseline. Results: A total of 38 women with MBC completed the VR interventions and were included in the analyses. Participants reported significantly less fatigue (P=.001), less depression (P<.001), and greater quality of life (P=.02) following the interventions than at baseline. Women with a weaker connection to nature reported greater fatigue (P=.03), depression (P=.006), and anxiety (P=.001), and poorer spirituality (P=.004) than their strongly connected counterparts. Only those with a weaker baseline connection with nature showed improvements in depression following the intervention (P=.03), with similar trends observed in fatigue (P=.07) and quality of life (P=.10). Conclusions: This study provides preliminary evidence that feeling connected with nature is associated with better physical and psychological status in patients with MBC and that VR nature interventions might be beneficial for this clinical population. Future studies should focus on activities that encourage connection with nature (rather than simply exposure to nature) and investigate the aspects of VR nature interventions that have the greatest therapeutic potential. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001480178; https://tinyurl.com/et6z3vac ",
doi="10.2196/38300",
url="https://cancer.jmir.org/2022/3/e38300",
url="http://www.ncbi.nlm.nih.gov/pubmed/35867398"
}


@Article{info:doi/10.2196/29056,
author="Florensa, D{\'i}dac
and Mateo-Forn{\'e}s, Jordi
and Solsona, Francesc
and Pedrol Aige, Teresa
and Mesas Juli{\'o}, Miquel
and Pi{\~n}ol, Ramon
and Godoy, Pere",
title="Use of Multiple Correspondence Analysis and K-means to Explore Associations Between Risk Factors and Likelihood of Colorectal Cancer: Cross-sectional Study",
journal="J Med Internet Res",
year="2022",
month="Jul",
day="19",
volume="24",
number="7",
pages="e29056",
keywords="colorectal cancer",
keywords="cancer registry",
keywords="multiple correspondence analysis",
keywords="k-means",
keywords="risk factors",
abstract="Background: Previous works have shown that risk factors are associated with an increased likelihood of colorectal cancer. Objective: The purpose of this study was to detect these associations in the region of Lleida (Catalonia) by using multiple correspondence analysis (MCA) and k-means. Methods: This cross-sectional study was made up of 1083 colorectal cancer episodes between 2012 and 2015, extracted from the population-based cancer registry for the province of Lleida (Spain), the Primary Care Centers database, and the Catalan Health Service Register. The data set included risk factors such as smoking and BMI as well as sociodemographic information and tumor details. The relations between the risk factors and patient characteristics were identified using MCA and k-means. Results: The combination of these techniques helps to detect clusters of patients with similar risk factors. Risk of death is associated with being elderly and obesity or being overweight. Stage III cancer is associated with people aged ?65 years and rural/semiurban populations, while younger people were associated with stage 0. Conclusions: MCA and k-means were significantly useful for detecting associations between risk factors and patient characteristics. These techniques have proven to be effective tools for analyzing the incidence of some factors in colorectal cancer. The outcomes obtained help corroborate suspected trends and stimulate the use of these techniques for finding the association of risk factors with the incidence of other cancers. ",
doi="10.2196/29056",
url="https://www.jmir.org/2022/7/e29056",
url="http://www.ncbi.nlm.nih.gov/pubmed/35852835"
}


@Article{info:doi/10.2196/38553,
author="Dennett, M. Amy
and Harding, E. Katherine
and Peiris, L. Casey
and Shields, Nora
and Barton, Christian
and Lynch, Lauren
and Parente, Phillip
and Lim, David
and Taylor, F. Nicholas",
title="Efficacy of Group Exercise--Based Cancer Rehabilitation Delivered via Telehealth (TeleCaRe): Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Jul",
day="18",
volume="11",
number="7",
pages="e38553",
keywords="telehealth",
keywords="exercise",
keywords="telerehabilitation",
keywords="physical activity",
keywords="supportive care",
keywords="cancer",
abstract="Background: Access to rehabilitation to support cancer survivors to exercise is poor. Group exercise--based rehabilitation may be delivered remotely, but no trials have currently evaluated their efficacy. Objective: We aimed to evaluate the efficacy of a group exercise--based cancer rehabilitation program delivered via telehealth compared to usual care for improving the quality of life of cancer survivors. Methods: A parallel, assessor-blinded, pragmatic randomized controlled trial with embedded cost and qualitative analysis will be completed. In total, 116 cancer survivors will be recruited from a metropolitan health network in Melbourne, Victoria, Australia. The experimental group will attend an 8-week, twice-weekly, 60-minute exercise group session supervised via videoconferencing supplemented by a web-based home exercise program and information portal. The comparison group will receive usual care including standardized exercise advice and written information. Assessments will be completed at weeks 0 (baseline), 9 (post intervention), and 26 (follow-up). The primary outcome will be health-related quality of life measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire at week 9. Secondary measures include walking capacity (6-minute walk test), physical activity (activPAL accelerometer), self-efficacy (Health Action Process Approach Questionnaire), and adverse events. Health service data including hospital length of stay, hospital readmissions, and emergency department presentations will be recorded. Semistructured interviews will be completed within an interpretive description framework to explore the patient experience. The primary outcome will be analyzed using linear mixed effects models. A cost-effectiveness analysis will also be performed. Results: The trial commenced in April 2022. As of June 2022, we enrolled 14 participants. Conclusions: This trial will inform the future implementation of cancer rehabilitation by providing important data about efficacy, safety, cost, and patient experience. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001417875; https://tinyurl.com/yc5crwtr International Registered Report Identifier (IRRID): PRR1-10.2196/38553 ",
doi="10.2196/38553",
url="https://www.researchprotocols.org/2022/7/e38553",
url="http://www.ncbi.nlm.nih.gov/pubmed/35849441"
}


@Article{info:doi/10.2196/36490,
author="El Alaoui, Yousra
and Elomri, Adel
and Qaraqe, Marwa
and Padmanabhan, Regina
and Yasin Taha, Ruba
and El Omri, Halima
and EL Omri, Abdelfatteh
and Aboumarzouk, Omar",
title="A Review of Artificial Intelligence Applications in Hematology Management: Current Practices and Future Prospects",
journal="J Med Internet Res",
year="2022",
month="Jul",
day="12",
volume="24",
number="7",
pages="e36490",
keywords="cancer",
keywords="oncology",
keywords="hematology",
keywords="machine learning",
keywords="deep learning",
keywords="artificial intelligence",
keywords="prediction",
keywords="malignancy",
keywords="management",
abstract="Background: Machine learning (ML) and deep learning (DL) methods have recently garnered a great deal of attention in the field of cancer research by making a noticeable contribution to the growth of predictive medicine and modern oncological practices. Considerable focus has been particularly directed toward hematologic malignancies because of the complexity in detecting early symptoms. Many patients with blood cancer do not get properly diagnosed until their cancer has reached an advanced stage with limited treatment prospects. Hence, the state-of-the-art revolves around the latest artificial intelligence (AI) applications in hematology management. Objective: This comprehensive review provides an in-depth analysis of the current AI practices in the field of hematology. Our objective is to explore the ML and DL applications in blood cancer research, with a special focus on the type of hematologic malignancies and the patient's cancer stage to determine future research directions in blood cancer. Methods: We searched a set of recognized databases (Scopus, Springer, and Web of Science) using a selected number of keywords. We included studies written in English and published between 2015 and 2021. For each study, we identified the ML and DL techniques used and highlighted the performance of each model. Results: Using the aforementioned inclusion criteria, the search resulted in 567 papers, of which 144 were selected for review. Conclusions: The current literature suggests that the application of AI in the field of hematology has generated impressive results in the screening, diagnosis, and treatment stages. Nevertheless, optimizing the patient's pathway to treatment requires a prior prediction of the malignancy based on the patient's symptoms or blood records, which is an area that has still not been properly investigated. ",
doi="10.2196/36490",
url="https://www.jmir.org/2022/7/e36490",
url="http://www.ncbi.nlm.nih.gov/pubmed/35819826"
}


@Article{info:doi/10.2196/39003,
author="Leis, Angela
and Casadevall, David
and Albanell, Joan
and Posso, Margarita
and Maci{\`a}, Francesc
and Castells, Xavier
and Ram{\'i}rez-Anguita, Manuel Juan
and Mart{\'i}nez Rold{\'a}n, Jordi
and Furlong, I. Laura
and Sanz, Ferran
and Ronzano, Francesco
and Mayer, A. Miguel",
title="Exploring the Association of Cancer and Depression in Electronic Health Records: Combining Encoded Diagnosis and Mining Free-Text Clinical Notes",
journal="JMIR Cancer",
year="2022",
month="Jul",
day="11",
volume="8",
number="3",
pages="e39003",
keywords="cancer",
keywords="depression",
keywords="electronic health records",
keywords="text mining",
keywords="natural language processing",
abstract="Background: A cancer diagnosis is a source of psychological and emotional stress, which are often maintained for sustained periods of time that may lead to depressive disorders. Depression is one of the most common psychological conditions in patients with cancer. According to the Global Cancer Observatory, breast and colorectal cancers are the most prevalent cancers in both sexes and across all age groups in Spain. Objective: This study aimed to compare the prevalence of depression in patients before and after the diagnosis of breast or colorectal cancer, as well as to assess the usefulness of the analysis of free-text clinical notes in 2 languages (Spanish or Catalan) for detecting depression in combination with encoded diagnoses. Methods: We carried out an analysis of the electronic health records from a general hospital by considering the different sources of clinical information related to depression in patients with breast and colorectal cancer. This analysis included ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis codes and unstructured information extracted by mining free-text clinical notes via natural language processing tools based on Systematized Nomenclature of Medicine Clinical Terms that mentions symptoms and drugs used for the treatment of depression. Results: We observed that the percentage of patients diagnosed with depressive disorders significantly increased after cancer diagnosis in the 2 types of cancer considered---breast and colorectal cancers. We managed to identify a higher number of patients with depression by mining free-text clinical notes than the group selected exclusively on ICD-9-CM codes, increasing the number of patients diagnosed with depression by 34.8\% (441/1269). In addition, the number of patients with depression who received chemotherapy was higher than those who did not receive this treatment, with significant differences (P<.001). Conclusions: This study provides new clinical evidence of the depression-cancer comorbidity and supports the use of natural language processing for extracting and analyzing free-text clinical notes from electronic health records, contributing to the identification of additional clinical data that complements those provided by coded data to improve the management of these patients. ",
doi="10.2196/39003",
url="https://cancer.jmir.org/2022/3/e39003",
url="http://www.ncbi.nlm.nih.gov/pubmed/35816382"
}


@Article{info:doi/10.2196/32370,
author="Ramos Herrera, Mart{\'i}n Igor
and Lemus Flores, Guadalupe Mar{\'i}a
and Reyna Sevilla, Antonio
and Gonz{\'a}lez Casta{\~n}eda, Ernesto Miguel
and Torres Guti{\'e}rrez, Adolfo Fernando
and Crocker Sagastume, Crist{\'o}bal Ren{\'e}
and Robles Pastrana, Dios Juan De
and V{\'a}zquez Castellanos, Luis Jos{\'e}",
title="Public Policies and Programs for the Prevention and Control of Breast Cancer in Latin American Women: Scoping Review",
journal="JMIR Cancer",
year="2022",
month="Jul",
day="6",
volume="8",
number="3",
pages="e32370",
keywords="breast cancer",
keywords="scoping review",
keywords="public policy",
keywords="prevention programs",
keywords="systematic review",
abstract="Background: Breast cancer has positioned itself worldwide as one of the main public health problems, especially in Latin America. In some countries, several programs for the prevention and control of breast cancer in women have been developed and implemented on a permanent basis, but there are no public reports on the policies that originated such programs. Objective: A scoping review of scientific publications that identify the type, extent, and scope of policies and programs for the prevention and control of breast cancer in Latin American women was performed, and the main results were presented in this paper. Methods: This scoping review was carried out according to the method by Arksey and O'Malley based on 3 fundamental questions about breast cancer prevention and control policies in Latin America: their type, extent and scope, and reference framework. The search period was from 2000 to 2019, and the search was carried out in the following databases: MEDLINE (PubMed), MEDLINE (EbscoHost), CINAHL (EbscoHost), Academic Search Complete (EbscoHost), ISI Web of Science (Science Citation Index), and Scopus in English, Spanish, and Portuguese, and Scielo, Cochrane, and MEDES-MEDicina in Spanish and Portuguese. Of the 743 studies found, 20 (2.7\%) were selected, which were analyzed using descriptive statistics and qualitative content analysis. Results: The selected studies identified several Latin American countries that have generated policies and programs to prevent and control breast cancer in women, focusing mainly on risk communication, prevention and timely detection, effective access to health services, improvement of the screening process, and evaluation of screening programs. Evaluation criteria and greater participation of civil society in policy design and program execution are still lacking. This could undoubtedly help eliminate existing barriers to effective action. Conclusions: Although several Latin American countries have generated public policies and action programs for the prevention and control of breast cancer, a pending issue is the evaluation of the results to analyze the effectiveness and impact of their implementation given the magnitude of the public health problem it represents and because women and civil society play an important role in its prevention and control. International Registered Report Identifier (IRRID): RR2-10.2196/12624 ",
doi="10.2196/32370",
url="https://cancer.jmir.org/2022/3/e32370",
url="http://www.ncbi.nlm.nih.gov/pubmed/35793130"
}


@Article{info:doi/10.2196/37212,
author="Rillamas-Sun, Eileen
and Schattenkerk, Liza
and Cobos, Sofia
and Ueland, Katherine
and Gaffney, Ogden Ann
and Greenlee, Heather",
title="Characteristics of Users of the Cook for Your Life Website, an Online Nutrition Resource for Persons Affected by Cancer: Descriptive Study",
journal="JMIR Cancer",
year="2022",
month="Jul",
day="5",
volume="8",
number="3",
pages="e37212",
keywords="oncology nutrition",
keywords="eHealth",
keywords="website use",
keywords="bilingual",
abstract="Background: Accessible nutrition resources tailored to patients with cancer, caregivers of cancer survivors, and people interested in cancer prevention are limited. Cook for Your Life is a bilingual (ie, English and Spanish) website providing science-based, nutrition information for people affected by cancer. Objective: The aim of this study was to describe the characteristics of Cook for Your Life website users. Methods: In December 2020, Cook for Your Life website visitors at least 18 years old were invited to participate in an online English-language survey. A Spanish version was offered in April 2021. Demographic, health, and cooking characteristics were collected. Persons with a cancer history were asked about treatment and side effects. Data were analyzed through December 2021 on those completing over half of the survey. Three groups were compared: people with a history of cancer diagnosis, caregivers of cancer survivors, and the general public (ie, people without a cancer history). Website use data were also compared. Results: Among English-language respondents, 3346 initiated the survey and 2665 (79.65\%) completed over half of the questions.  Of these, 54.82\% (n=1461) had a cancer diagnosis, 8.26\% (n=220) were caregivers, and 36.92\% (n=984) were from the general public. English-language respondents were US residents (n=2054, 77.07\%), with some from Europe (n=285, 10.69\%) and Canada (n=170, 6.38\%). Cancer survivors were most likely 55 years of age or older, female, non-Hispanic White, with incomes over US \$100,000, and college educated. Caregivers and the general public were younger and more racially and geographically diverse. The most common cancer malignancies among English-language cancer survivors were breast (629/1394, 45.12\%) and gastrointestinal (209/1394, 14.99\%). For Spanish-language respondents, 942 initiated the survey; of these, 681 (72.3\%) were analyzed. Of the 681 analyzed, 13.5\% (n=92) were cancer survivors, 6.8\% (n=46) were caregivers, and 79.7\% (n=543) were from the general public. Spanish-language respondents were also more likely to be female and highly educated, but were younger, were from South or Latin America, and had incomes less than US \$30,000. Among Spanish-language cancer survivors, breast cancer (27/81, 33\%) and gastrointestinal cancer (15/81, 19\%) were the most common diagnoses. Website use data on over 2.2 million users from December 2020 to December 2021 showed that 52.29\% of traffic was in English and 43.44\% was in Spanish. Compared to survey respondents, a higher proportion of website users were male, younger, and from South or Central America and Europe. Conclusions: Cook for Your Life website users were demographically, socioeconomically, and geographically diverse, especially English-language respondents without a cancer history and all Spanish-language respondents. Improvements on website user diversity and reach for all patients with cancer and research on effective strategies for using this digital platform to support cancer prevention, treatment, and survivorship will continue. Trial Registration: ClinicalTrials.gov NCT04200482; https://www.clinicaltrials.gov/ct2/show/NCT04200482 ",
doi="10.2196/37212",
url="https://cancer.jmir.org/2022/3/e37212",
url="http://www.ncbi.nlm.nih.gov/pubmed/35788100"
}


@Article{info:doi/10.2196/36258,
author="Katsaros, Dimos
and Hawthorne, James
and Patel, Jay
and Pothier, Kaitlin
and Aungst, Timothy
and Franzese, Chris",
title="Optimizing Social Support in Oncology with Digital Platforms",
journal="JMIR Cancer",
year="2022",
month="Jun",
day="24",
volume="8",
number="2",
pages="e36258",
keywords="social support",
keywords="chronic disease",
keywords="social networks",
keywords="oncology",
keywords="cancer",
keywords="digital biomarkers",
keywords="digital health",
keywords="caregiver support",
doi="10.2196/36258",
url="https://cancer.jmir.org/2022/2/e36258",
url="http://www.ncbi.nlm.nih.gov/pubmed/35749161"
}


@Article{info:doi/10.2196/35694,
author="de Leeuwerk, Elizabeth Marijke
and Botjes, Martine
and van Vliet, Vincent
and Geleijn, Edwin
and de Groot, Vincent
and van Wegen, Erwin
and van der Schaaf, Marike
and Tuynman, Jurriaan
and Dickhoff, Chris
and van der Leeden, Marike",
title="Self-monitoring of Physical Activity After Hospital Discharge in Patients Who Have Undergone Gastrointestinal or Lung Cancer Surgery: Mixed Methods Feasibility Study",
journal="JMIR Cancer",
year="2022",
month="Jun",
day="24",
volume="8",
number="2",
pages="e35694",
keywords="mobile phone",
keywords="physical activity",
keywords="self-monitoring",
keywords="fitness trackers",
keywords="telemedicine",
keywords="cancer",
keywords="physical therapy",
abstract="Background: Self-monitoring of physical activity (PA) using an accelerometer is a promising intervention to stimulate PA after hospital discharge. Objective: This study aimed to evaluate the feasibility of PA self-monitoring after discharge in patients who have undergone gastrointestinal or lung cancer surgery. Methods: A mixed methods study was conducted in which 41 patients with cancer scheduled for lobectomy, esophageal resection, or hyperthermic intraperitoneal chemotherapy were included. Preoperatively, patients received an ankle-worn accelerometer and the corresponding mobile health app to familiarize themselves with its use. The use was continued for up to 6 weeks after surgery. Feasibility criteria related to the study procedures, the System Usability Scale, and user experiences were established. In addition, 6 patients were selected to participate in semistructured interviews. Results: The percentage of patients willing to participate in the study (68/90, 76\%) and the final participation rate (57/90, 63\%) were considered good. The retention rate was acceptable (41/57, 72\%), whereas the rate of missing accelerometer data was relatively high (31\%). The mean System Usability Scale score was good (77.3). Interviewed patients mentioned that the accelerometer and app were easy to use, motivated them to be more physically active, and provided postdischarge support. The technical shortcomings and comfort of the ankle straps should be improved. Conclusions: Self-monitoring of PA after discharge appears to be feasible based on good system usability and predominantly positive user experiences in patients with cancer after lobectomy, esophageal resection, or hyperthermic intraperitoneal chemotherapy. Solving technical problems and improving the comfort of the ankle strap may reduce the number of dropouts and missing data in clinical use and follow-up studies. ",
doi="10.2196/35694",
url="https://cancer.jmir.org/2022/2/e35694",
url="http://www.ncbi.nlm.nih.gov/pubmed/35749165"
}


@Article{info:doi/10.2196/34753,
author="Chekin, Nasrin
and Ayatollahi, Haleh
and Karimi Zarchi, Mojgan",
title="A Clinical Decision Support System for Assessing the Risk of Cervical Cancer: Development and Evaluation Study",
journal="JMIR Med Inform",
year="2022",
month="Jun",
day="22",
volume="10",
number="6",
pages="e34753",
keywords="cervical cancer",
keywords="clinical decision support system",
keywords="risk assessment",
keywords="medical informatics",
keywords="cancer",
keywords="oncology",
keywords="decision support",
keywords="risk",
keywords="CDSS",
keywords="cervical",
keywords="prototype",
keywords="evaluation",
keywords="testing",
abstract="Background: Cervical cancer has been recognized as a preventable type of cancer. As the assessment of all the risk factors of a disease is challenging for physicians, information technology and risk assessment models have been used to estimate the degree of risk. Objective: The aim of this study was to develop a clinical decision support system to assess the risk of cervical cancer. Methods: This study was conducted in 2 phases in 2021. In the first phase of the study, 20 gynecologists completed a questionnaire to determine the essential parameters for assessing the risk of cervical cancer, and the data were analyzed using descriptive statistics. In the second phase of the study, the prototype of the clinical decision support system was developed and evaluated. Results: The findings revealed that the most important parameters for assessing the risk of cervical cancer consisted of general and specific parameters. In total, the 8 parameters that had the greatest impact on the risk of cervical cancer were selected. After developing the clinical decision support system, it was evaluated and the mean values of sensitivity, specificity, and accuracy were 85.81\%, 93.82\%, and 91.39\%, respectively. Conclusions: The clinical decision support system developed in this study can facilitate the process of identifying people who are at risk of developing cervical cancer. In addition, it can help to increase the quality of health care and reduce the costs associated with the treatment of cervical cancer. ",
doi="10.2196/34753",
url="https://medinform.jmir.org/2022/6/e34753",
url="http://www.ncbi.nlm.nih.gov/pubmed/35731549"
}


@Article{info:doi/10.2196/35324,
author="Tripathi, D. Sanidhya
and Parker, D. Pearman
and Prabhu, V. Arpan
and Thomas, Kevin
and Rodriguez, Analiz",
title="An Examination of Patients and Caregivers on Reddit Navigating Brain Cancer: Content Analysis of the Brain Tumor Subreddit",
journal="JMIR Cancer",
year="2022",
month="Jun",
day="22",
volume="8",
number="2",
pages="e35324",
keywords="brain tumor",
keywords="internet",
keywords="social media",
keywords="Reddit",
keywords="cancer",
keywords="emotional support",
keywords="self-management",
abstract="Background: Occurring in up to 40\% of all patients with cancer, the incidence of brain tumors has caused limited survival, a high psychosocial burden, and an increase in the loss of decision-making capability for the unique population. Although specific symptoms depend on the type of brain tumor, a clinical team of physicians, nurses, and other individuals commonly assist patients and their caregivers with how to tackle the upcoming challenges of their diagnosis. Despite the support from clinical team members, many patients and caregivers may still seek outside support through social media to process their emotions and seek comfort outside of the clinical setting. Specifically, online resources such as Reddit are used where users are provided with the anonymity they need to show their true behavior without fear of judgment. In this study, we aimed to examine trends from Reddit discussion threads on brain tumors to identify areas of need in patient care. Objective: Our primary aims were to determine the type of Reddit user posting, classify the specific brain tumors that were the subject of the posts, and examine the content of the original posts. Methods: We used a qualitative descriptive design to understand patients' and caregivers' unmet and met needs. We selected posts from the top-rated 100 posts from the r/braincancer subreddit from February 2017 to June 2020 to identify common themes using content analysis. Results: The qualitative content analysis revealed how Reddit users primarily used the forum as a method to understand and process the emotions surrounding a brain tumor diagnosis. Three major topic areas from content analysis emerged as prominent themes, including (1) harnessing hope, (2) moving through the grief process, and (3) expressing gratitude toward other Reddit users. Most of the authors of the posts were patients with brain tumors (32/88, 36\%) who used Reddit as a reflective journaling tool to process the associated emotions of a challenging diagnosis. Conclusions: This study shows the potential of Reddit to serve as a unique group therapy platform for patients affected by brain tumors. Our results highlight the support provided by the Reddit community members as a unique mechanism to assist cancer survivors and caregivers with the emotional processing of living with brain tumors. Additionally, the results highlight the importance of recommending Reddit as a therapeutic virtual community and the need for implementing online resources as a part of a health care professional's repertoire to understand the level of support they can give their patients. ",
doi="10.2196/35324",
url="https://cancer.jmir.org/2022/2/e35324",
url="http://www.ncbi.nlm.nih.gov/pubmed/35731559"
}


@Article{info:doi/10.2196/37093,
author="van Deursen, Liza
and Versluis, Anke
and van der Vaart, Rosalie
and Standaar, Lucille
and Struijs, Jeroen
and Chavannes, Niels
and Aardoom, J. Jiska",
title="eHealth Interventions for Dutch Cancer Care: Systematic Review Using the Triple Aim Lens",
journal="JMIR Cancer",
year="2022",
month="Jun",
day="14",
volume="8",
number="2",
pages="e37093",
keywords="cancer",
keywords="eHealth",
keywords="digital care",
keywords="Triple Aim",
keywords="population health",
keywords="quality of care",
keywords="costs",
keywords="systematic review",
keywords="psychosocial",
keywords="intervention",
keywords="mobile phone",
abstract="Background: Globally, the burden of cancer on population health is growing. Recent trends such as increasing survival rates have resulted in a need to adapt cancer care to ensure a good care experience and manageable expenditures. eHealth is a promising way to increase the quality of cancer care and support patients and survivors. Objective: The aim of this systematic review was 2-fold. First, we aimed to provide an overview of eHealth interventions and their characteristics for Dutch patients with and survivors of cancer. Second, we aimed to provide an overview of the empirical evidence regarding the impact of eHealth interventions in cancer care on population health, quality of care, and per capita costs (the Triple Aim domains). Methods: The electronic databases Web of Science, PubMed, Cochrane, and Ovid PsycINFO were searched using 3 key search themes: eHealth interventions, cancer care, and the Netherlands. The identified interventions were classified according to predetermined criteria describing the intervention characteristics (eg, type, function, and target population). Their impact was subsequently examined using the Triple Aim framework. Results: A total of 38 interventions were identified. Most of these were web portals or web applications functioning to inform and self-manage, and target psychosocial factors or problems. Few interventions have been tailored to age, disease severity, or gender. The results of this study indicate that eHealth interventions could positively affect sleep quality, fatigue, and physical activity of patients with and survivors of cancer. Inconclusive results were found regarding daily functioning and quality of life, psychological complaints, and psychological adjustment to the disease. Conclusions: eHealth can improve outcomes in the Triple Aim domains, particularly in the population health and quality of care domains. Cancer-related pain and common symptoms of active treatment were not targeted in the included interventions and should receive more attention. Further research is needed to fully understand the impact of eHealth interventions in cancer care on participation, accessibility, and costs. The latter can be examined in economic evaluations by comparing eHealth interventions with care as usual. ",
doi="10.2196/37093",
url="https://cancer.jmir.org/2022/2/e37093",
url="http://www.ncbi.nlm.nih.gov/pubmed/35699991"
}


@Article{info:doi/10.2196/35020,
author="Ullah, Shahid
and Ullah, Farhan
and Rahman, Wajeeha
and Karras, A. Dimitrios
and Ullah, Anees
and Ahmad, Gulzar
and Ijaz, Muhammad
and Gao, Tianshun",
title="The Cancer Research Database (CRDB): Integrated Platform to Gain Statistical Insight Into the Correlation Between Cancer and COVID-19",
journal="JMIR Cancer",
year="2022",
month="Jun",
day="10",
volume="8",
number="2",
pages="e35020",
keywords="cancer database",
keywords="COVID-19",
keywords="CRDB",
keywords="genomics",
keywords="PHP",
keywords="cancer and COVID-19",
keywords="cancer statistics",
keywords="cancer research",
keywords="health database",
keywords="research platform",
abstract="Background: The advancement of cancer research has been facilitated through freely available cancer literature, databases, and tools. The age of genomics and big data has given rise to the need for cooperation and data sharing in order to make efficient use of this new information in the COVID-19 pandemic. Although there are many databases for cancer research, their access is not easy owing to different ways of processing and managing the data. There is an absence of a unified platform to manage all of them in a transparent and more comprehensible way. Objective: In this study, an improved integrated cancer research database and platform is provided to facilitate a deeper statistical insight into the correlation between cancer and the COVID-19 pandemic, unifying the collection of almost all previous published cancer databases and defining a model web database for cancer research, and scoring databases on the basis of the variety types of cancer, sample size, completeness of omics results, and user interface. Methods: Databases examined and integrated include the Data Portal database, Genomic database, Proteomic database, Expression database, Gene database, and Mutation database; and it is expected that this launch will sort, save, advance the understanding and encourage the use of these resources in the cancer research environment. Results: To make it easy to search valuable information, 85 cancer databases are provided in the form of a table, and a database of databases named the Cancer Research Database (CRDB) has been built and presented herein. Furthermore, the CRDB has been herein equipped with unique navigation tools in order to be explored by three methods; that is, any single database can be browsed by typing the name in the given search bar, while all categories can be browsed by clicking on the name of the category or image expression icon, thus serving as a facility that could provide all the category databases on a single click. Conclusions: The computational platform (PHP, HTML, CSS, and MySQL) used to build CRDB for the cancer scientific community can be freely investigated and browsed on the internet and is planned to be updated in a timely manner. In addition, based on the proposed platform, the status and diagnoses statistics of cancer during the COVID-19 pandemic have been thoroughly investigated herein using CRDB, thus providing an easy-to-manage, understandable framework that mines knowledge for future researchers. ",
doi="10.2196/35020",
url="https://cancer.jmir.org/2022/2/e35020",
url="http://www.ncbi.nlm.nih.gov/pubmed/35430561"
}


@Article{info:doi/10.2196/35500,
author="Baertsch, Marc-Andrea
and Decker, Sarah
and Probst, Leona
and Joneleit, Stefan
and Salwender, Hans
and Frommann, Franziska
and Buettner, Hartwig",
title="Convenient Access to Expert-Reviewed Health Information via an Alexa Voice Assistant Skill for Patients With Multiple Myeloma: Development Study",
journal="JMIR Cancer",
year="2022",
month="Jun",
day="9",
volume="8",
number="2",
pages="e35500",
keywords="Alexa voice assistant",
keywords="Alexa",
keywords="voice assistant",
keywords="virtual assistant",
keywords="multiple myeloma",
keywords="cancer",
keywords="oncology",
keywords="medical education",
keywords="patient support group",
keywords="digital health",
keywords="patient support",
keywords="support group",
keywords="Europe",
keywords="German",
keywords="mobile phone",
abstract="Background: Patients with multiple myeloma (MM) have high information needs due to the complexity of the disease and variety of treatments. Digital voice assistants provide support in daily life and can be a convenient tool that even older patients can use to access health information. Voice assistants may therefore be useful in providing digital health services to meet the information needs of patients with MM. Objective: We aim to describe and report on the development, content, and functionality of the first Amazon Alexa voice assistant skill for patients with MM in Germany with the goal of empowering and educating patients. Further, we share data on skill usage and first learnings. Methods: In a cocreation workshop with MM patient organizations and MM medical experts in Germany, Takeda Oncology discussed the development and content of the Alexa skill Multiple Myeloma. Patient information on MM disease, diagnostics, and therapy was presented in a question-and-answer format, reviewed by experts, and programmed into the skill. Additionally, a search function for finding patient support groups within a perimeter of 200 km around the users and a myeloma quiz functionality with multiple-choice questions were integrated into the skill. Aggregated retrospective data on the total number of skill installations and skill usage were retrieved from an Amazon Alexa developer account, and a web-based patient survey was conducted on the Takeda Oncology website. Results: The Alexa skill Multiple Myeloma was launched in September 2019. It was available free of charge on the German Amazon Alexa skill store between September 2019 and March 2022 and could be used with devices featuring the Amazon Alexa voice assistant. Since the launch in September 2019 and up to July 2021, a total of 141 users have installed the skill. Between July 2020 and July 2021, a total of 189 skill sessions with 797 utterances were analyzed. The most popular inquiries were searches for patient support groups near the users (58/797, 7.3\%), followed by inquiries about information on MM disease (53/797, 6.6\%) and the quiz (43/797, 5.4\%). The web-based survey on voice assistant usage and the feedback on the Alexa skill Multiple Myeloma were collected from 24 participants and showed that 46\% (11/24) of participants would recommend the Alexa skill. Nonusers of voice assistants (11/24, 46\%) stated that data protection concerns (7/11, 64\%) and a lack of need (6/11, 55\%) were the most important factors of not using voice assistants. Conclusions: The Alexa skill Multiple Myeloma offers patient-friendly and expert-reviewed answers and explanations for medical terms related to MM disease, diagnostics, and therapy, as well as connections to patient support groups and a quiz functionality. In the future, the skill can be extended with new content and functionalities, such as medication adherence support. ",
doi="10.2196/35500",
url="https://cancer.jmir.org/2022/2/e35500",
url="http://www.ncbi.nlm.nih.gov/pubmed/35679096"
}


@Article{info:doi/10.2196/33734,
author="Petros, Gebrewold Nuhamin
and Hadlaczky, Gergo
and Carletto, Sara
and Martinez, Gonzalez Sergio
and Ostacoli, Luca
and Ottaviano, Manuel
and Meyer, Bj{\"o}rn
and Scilingo, Pasquale Enzo
and Carli, Vladimir",
title="Sociodemographic Characteristics Associated With an eHealth System Designed to Reduce Depressive Symptoms Among Patients With Breast or Prostate Cancer: Prospective Study",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="8",
volume="6",
number="6",
pages="e33734",
keywords="mental health",
keywords="depression",
keywords="eHealth",
keywords="usability",
keywords="breast cancer",
keywords="prostate cancer",
keywords="System Usability Scale",
keywords="SUS",
keywords="the user version of the Mobile App Rating Scale",
keywords="uMARS",
keywords="Neurobehavioural Predictive and Personalised Modelling of Depressive Symptoms During Primary Somatic Diseases",
keywords="NEVERMIND system",
abstract="Background: eHealth interventions have become a topic of interest in the field of mental health owing to their increased coordination and integration of different elements of care, in treating and preventing mental ill health in patients with somatic illnesses. However, poor usability, learnability, and user engagement might affect the effectiveness of an eHealth intervention. Identifying different sociodemographic characteristics that might be associated with higher perceived usability can help improve the usability of eHealth interventions. Objective: This study aimed to identify the sociodemographic characteristics that might be associated with the perceived usability of the NEVERMIND (Neurobehavioural Predictive and Personalised Modelling of Depressive Symptoms During Primary Somatic Diseases) eHealth system, comprising a mobile app and a sensorized shirt, in reducing comorbid depressive symptoms in patients with breast or prostate cancer. Methods: The study included a total of 129 patients diagnosed with breast (n=80, 62\%) or prostate (n=49, 38\%) cancer, who received a fully automated mobile app and sensorized shirt (NEVERMIND system). Sociodemographic data on age, sex, marital status, education level, and employment status were collected at baseline. Usability outcomes included the System Usability Scale (SUS), a subjective measure that covers different aspects of system usability; the user version of the Mobile App Rating Scale (uMARS), a user experience questionnaire; and a usage index, an indicator calculated from the number of days patients used the NEVERMIND system during the study period. Results: The analysis was based on 108 patients (n=68, 63\%, patients with breast cancer and n=40, 37\%, patients with prostate cancer) who used the NEVERMIND system for an average of 12 weeks and completed the study. The overall mean SUS score at 12 weeks was 73.4 (SD 12.5), which indicates that the NEVERMIND system has good usability, with no statistical differences among different sociodemographic characteristics. The global uMARS score was 3.8 (SD 0.3), and women rated the app higher than men ($\beta$=.16; P=.03, 95\% CI 0.02-0.3), after adjusting for other covariates. No other sociodemographic characteristics were associated with higher uMARS scores. There was a statistical difference in the use of the NEVERMIND system between women and men. Women had significantly lower use ($\beta$=--0.13; P=.04, 95\% CI ?0.25 to ?0.01), after adjusting for other covariates. Conclusions: The findings suggest that the NEVERMIND system has good usability according to the SUS and uMARS scores. There was a higher favorability of mobile apps among women than among men. However, men had significantly higher use of the NEVERMIND system. Despite the small sample size and low variability, there is an indication that the NEVERMIND system does not suffer from the digital divide, where certain sociodemographic characteristics are more associated with higher usability. Trial Registration: German Clinical Trials Register RKS00013391; https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00013391 ",
doi="10.2196/33734",
url="https://formative.jmir.org/2022/6/e33734",
url="http://www.ncbi.nlm.nih.gov/pubmed/35675116"
}


@Article{info:doi/10.2196/34183,
author="Peterson, John
and Wilson, Trevor
and Gruhl, Joshua
and Davis, Sydney
and Olsen, Jaxon
and Parsons, Matthew
and Kann, Benjamin
and Fagerlin, Angela
and Watt, Melissa
and Johnson, Skyler",
title="Timing and Motivations for Alternative Cancer Therapy With Insights From a Crowdfunding Platform: Cross-sectional Mixed Methods Study",
journal="JMIR Cancer",
year="2022",
month="Jun",
day="7",
volume="8",
number="2",
pages="e34183",
keywords="internet",
keywords="health misinformation",
keywords="online crowdfunding",
keywords="alternative medicine",
keywords="internet research ethics",
abstract="Background: Alternative cancer therapy is associated with increased mortality, but little is known about those who pursue it. Objective: We aimed to describe individuals' motivations for using alternative cancer therapies and determine whether motivations differ based on individuals' timing of seeking alternative therapies. Methods: We used data from 649 campaigns posted on the website GoFundMe between 2011 and 2019 for beneficiaries with cancer pursuing alternative therapy. The data were analyzed using a mixed methods approach. Campaigns were categorized by timing of alternative therapy (either before or after experiencing conventional therapy). Qualitative analysis identified motivational themes. Chi-square tests of independence and Fisher tests (all 2-sided) determined significant differences in the presence of motivational themes between groups. Results: The expression of concerns about the efficacy of conventional therapy was significantly more likely in campaigns for individuals who used conventional therapy first than in campaigns for individuals who started with alternative therapy (63.3\% vs 41.7\%; P<.001). Moreover, on comparing those who started with alternative therapy and those who switched from conventional to alternative therapy, those who started with alternative therapy more often expressed natural and holistic values (49.3\% vs 27.0\%; P<.001), expressed an unorthodox understanding of cancer (25.5\% vs 16.4\%; P=.004), referenced religious or spiritual beliefs (15.1\% vs 8.9\%; P=.01), perceived alternative treatment as efficacious (19.1\% vs 10.2\%; P=.001), and distrusted pharmaceutical companies (3.2\% vs 0.5\%; P=.04). Conclusions: Individuals sought treatments that reflected their values and beliefs, even if scientifically unfounded. Many individuals who reported prior conventional cancer therapy were motivated to pursue alternative treatments because they perceived the conventional treatments to be ineffective. ",
doi="10.2196/34183",
url="https://cancer.jmir.org/2022/2/e34183",
url="http://www.ncbi.nlm.nih.gov/pubmed/35671074"
}


@Article{info:doi/10.2196/29004,
author="Moens, Katrien
and Peeters, Marc
and Van den Bulcke, Marc
and Leys, Mark
and Horlait, Melissa",
title="Development, Testing, and Implementation of the Belgian Patient Reported Experience Measure for Pancreatic Cancer Care (PREPARE) Project: Protocol for a Multi-Method Research Project",
journal="JMIR Res Protoc",
year="2022",
month="Jun",
day="6",
volume="11",
number="6",
pages="e29004",
keywords="patient-centered care",
keywords="quality of health care",
keywords="interdisciplinary research",
keywords="decision-making",
keywords="pancreatic cancer",
keywords="quality",
keywords="outcome",
keywords="assessment",
keywords="cancer",
keywords="pancreas",
keywords="development",
keywords="testing",
keywords="implementation",
keywords="patient-reported",
keywords="experience",
keywords="protocol",
keywords="participatory medicine",
abstract="Background: Patients with pancreatic cancer do not feel involved in the development of their treatment and care plans. In Belgium, these plans are decided on during multidisciplinary team meetings. However, limited time is spent on the discussion of the preferences of the patient during these meetings. This research project aims to develop a patient-reported experience measure (PREM) for pancreatic cancer and assess if its use can support collaborative treatment decision-making. Objective: This paper aims to outline the protocol for a multi-method research project to improve person-centered pancreatic cancer care in Belgium. Three subobjectives are pursued: (1) to develop a PREM to assess the experiences of care-related aspects in pancreatic cancer care, (2) to validate the PREM, and (3) to develop and evaluate an educational intervention to support the use of the PREM's results. Methods: For the development of the PREM, an exploratory mixed methods study design will be used. The study will start with a survey followed by a telephone interview involving patients with pancreatic cancer and digestive oncology health care professionals. Study two is the testing of the content and construct validity of the PREM. Study three involves the implementation study according to the Medical Research Council framework of a complex intervention introducing the PREM in practice. The effectiveness of the intervention will be investigated using a pragmatic randomized controlled trial study design. Results: The protocol presents the entire structure of the research project. Ethics approval to conduct the exploratory mixed methods study (objective 1) has been obtained, and recruitment has started since January 2022. Conclusions: The poor prognosis of patients with pancreatic cancer should not be considered a hurdle to not study this patient population group. Involving patients in the research and decision-making processes early on is key. This project aims to realize a scientifically sound research process providing research outputs that can easily and timely be implemented in the care trajectory of patients with pancreatic cancer. This research project will also lead to recommendations on how to involve patients with pancreatic cancer and how the methodology of this research project can be translated to other patient groups. International Registered Report Identifier (IRRID): PRR1-10.2196/29004 ",
doi="10.2196/29004",
url="https://www.researchprotocols.org/2022/6/e29004",
url="http://www.ncbi.nlm.nih.gov/pubmed/35666559"
}


@Article{info:doi/10.2196/34828,
author="Kesler, R. Shelli
and Henneghan, M. Ashley
and Thurman, Whitney
and Rao, Vikram",
title="Identifying Themes for Assessing Cancer-Related Cognitive Impairment: Topic Modeling and Qualitative Content Analysis of Public Online Comments",
journal="JMIR Cancer",
year="2022",
month="May",
day="25",
volume="8",
number="2",
pages="e34828",
keywords="cognitive",
keywords="natural language processing",
keywords="cancer",
keywords="oncology",
abstract="Background: Cancer-related cognitive impairment (CRCI) is a common and significant adverse effect of cancer and its therapies. However, its definition and assessment remain difficult due to limitations of currently available measurement tools. Objective: This study aims to evaluate qualitative themes related to the cognitive effects of cancer to help guide development of assessments that are more specific than what is currently available. Methods: We applied topic modeling and inductive qualitative content analysis to 145 public online comments related to cognitive effects of cancer. Results: Topic modeling revealed 2 latent topics that we interpreted as representing internal and external factors related to cognitive effects. These findings lead us to hypothesize regarding the potential contribution of locus of control to CRCI. Content analysis suggested several major themes including symptoms, emotional/psychological impacts, coping, ``chemobrain'' is real, change over time, and function. There was some conceptual overlap between the 2 methods regarding internal and external factors related to patient experiences of cognitive effects. Conclusions: Our findings indicate that coping mechanisms and locus of control may be important themes to include in assessments of CRCI. Future directions in this field include prospective acquisition of free-text responses to guide development of assessments that are more sensitive and specific to cognitive function in patients with cancer. ",
doi="10.2196/34828",
url="https://cancer.jmir.org/2022/2/e34828",
url="http://www.ncbi.nlm.nih.gov/pubmed/35612878"
}


@Article{info:doi/10.2196/33859,
author="Kalra, Maitri
and Henry, Elizabeth
and McCann, Kelly
and Karuturi, S. Meghan
and Bustamante Alvarez, G. Jean
and Parkes, Amanda
and Wesolowski, Robert
and Wei, Mei
and Mougalian, S. Sarah
and Durm, Gregory
and Qin, Angel
and Schonewolf, Caitlin
and Trivedi, Meghna
and Armaghani, J. Avan
and Wilson, H. Frederick
and Iams, T. Wade
and Turk, A. Anita
and Vikas, Praveen
and Cecchini, Michael
and Lubner, Sam
and Pathak, Priyadarshini
and Spencer, Kristen
and Koshkin, S. Vadim
and Labriola, K. Matthew
and Marshall, H. Catherine
and Beckermann, E. Katy
and 
and Sharifi, N. Marina
and Bejjani, C. Anthony
and Hotchandani, Varsha
and Housri, Samir
and Housri, Nadine",
title="Making National Cancer Institute--Designated Comprehensive Cancer Center Knowledge Accessible to Community Oncologists via an Online Tumor Board: Longitudinal Observational Study",
journal="JMIR Cancer",
year="2022",
month="May",
day="19",
volume="8",
number="2",
pages="e33859",
keywords="National Cancer Institute--designated Comprehensive Cancer Centers",
keywords="NCI-CCC",
keywords="tumor boards",
keywords="TBs",
keywords="knowledge sharing",
keywords="cancer",
keywords="digital health",
keywords="oncology",
keywords="health websites",
keywords="health education",
abstract="Background: Expert knowledge is often shared among multidisciplinary academic teams at tumor boards (TBs) across the country, but these conversations exist in silos and do not reach the wider oncology community. Objective: Using an oncologist-only question and answer (Q\&A) website, we sought to document expert insights from TBs at National Cancer Institute--designated Comprehensive Cancer Centers (NCI-CCCs) to provide educational benefits to the oncology community. Methods: We designed a process with the NCI-CCCs to document and share discussions from the TBs focused on areas of practice variation on theMednet, an interactive Q\&A website of over 13,000 US oncologists. The faculty translated the TB discussions into concise, non--case-based Q\&As on theMednet. Answers were peer reviewed and disseminated in email newsletters to registered oncologists. Reach and engagement were measured. Following each Q\&A, a survey question asked how the TB Q\&As impacted the readers' practice. Results: A total of 23 breast, thoracic, gastrointestinal, and genitourinary programs from 16 NCI-CCC sites participated. Between December 2016 and July 2021, the faculty highlighted 368 questions from their TBs. Q\&As were viewed 147,661 times by 7381 oncologists at 3515 institutions from all 50 states. A total of 277 (75\%) Q\&As were viewed every month. Of the 1063 responses to a survey question on how the Q\&A affected clinicians' practices, 646 (61\%) reported that it confirmed their current practice, 163 (20\%) indicated that a Q\&A would change their future practice, and 214 (15\%) reported learning something new. Conclusions: Through an online Q\&A platform, academics at the NCI-CCCs share knowledge outside the walls of academia with oncologists across the United States. Access to up-to-date expert knowledge can reassure clinicians' practices, significantly impact patient care in community practices, and be a source of new knowledge and education. ",
doi="10.2196/33859",
url="https://cancer.jmir.org/2022/2/e33859",
url="http://www.ncbi.nlm.nih.gov/pubmed/35588361"
}


@Article{info:doi/10.2196/27694,
author="Chen, Pei-Chin
and Lu, Yun-Ru
and Kang, Yi-No
and Chang, Chun-Chao",
title="The Accuracy of Artificial Intelligence in the Endoscopic Diagnosis of Early Gastric Cancer: Pooled Analysis Study",
journal="J Med Internet Res",
year="2022",
month="May",
day="16",
volume="24",
number="5",
pages="e27694",
keywords="artificial intelligence",
keywords="early gastric cancer",
keywords="endoscopy",
abstract="Background: Artificial intelligence (AI) for gastric cancer diagnosis has been discussed in recent years. The role of AI in early gastric cancer is more important than in advanced gastric cancer since early gastric cancer is not easily identified in clinical practice. However, to our knowledge, past syntheses appear to have limited focus on the populations with early gastric cancer. Objective: The purpose of this study is to evaluate the diagnostic accuracy of AI in the diagnosis of early gastric cancer from endoscopic images. Methods: We conducted a systematic review from database inception to June 2020 of all studies assessing the performance of AI in the endoscopic diagnosis of early gastric cancer. Studies not concerning early gastric cancer were excluded. The outcome of interest was the diagnostic accuracy (comprising sensitivity, specificity, and accuracy) of AI systems. Study quality was assessed on the basis of the revised Quality Assessment of Diagnostic Accuracy Studies. Meta-analysis was primarily based on a bivariate mixed-effects model. A summary receiver operating curve and a hierarchical summary receiver operating curve were constructed, and the area under the curve was computed. Results: We analyzed 12 retrospective case control studies (n=11,685) in which AI identified early gastric cancer from endoscopic images. The pooled sensitivity and specificity of AI for early gastric cancer diagnosis were 0.86 (95\% CI 0.75-0.92) and 0.90 (95\% CI 0.84-0.93), respectively. The area under the curve was 0.94. Sensitivity analysis of studies using support vector machines and narrow-band imaging demonstrated more consistent results. Conclusions: For early gastric cancer, to our knowledge, this was the first synthesis study on the use of endoscopic images in AI in diagnosis. AI may support the diagnosis of early gastric cancer. However, the collocation of imaging techniques and optimal algorithms remain unclear. Competing models of AI for the diagnosis of early gastric cancer are worthy of future investigation. Trial Registration: PROSPERO CRD42020193223; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=193223 ",
doi="10.2196/27694",
url="https://www.jmir.org/2022/5/e27694",
url="http://www.ncbi.nlm.nih.gov/pubmed/35576561"
}


@Article{info:doi/10.2196/36654,
author="Mangsbacka, Maria
and Gustavell, Tina",
title="Nurses' Experiences Using an Interactive System to Assess and Manage Treatment-Related Symptoms of Patients With Pancreatic Cancer: Interview Study",
journal="JMIR Nursing",
year="2022",
month="May",
day="16",
volume="5",
number="1",
pages="e36654",
keywords="app",
keywords="health care professionals",
keywords="mobile health",
keywords="mHealth",
keywords="nurses",
keywords="pancreatic cancer",
keywords="person-centered care",
keywords="symptom-management",
keywords="qualitative interview",
keywords="nursing",
keywords="interview",
abstract="Background: Treatment for pancreatic cancer entails symptom distress and a high burden of self-care. Patient-reported outcomes, collected with the support of mobile health (mHealth), have shown positive effects on symptom management, patient satisfaction, and quality of life for patients with cancer. For mHealth tools to become an integral part of clinical routine, experiences from health care professionals are needed. Objective: The aim of this paper is to describe nurses' experiences of integrating an interactive system (Interaktor) for symptom assessment and management into daily practice, when caring for patients following pancreaticoduodenectomy and during chemotherapy treatment due to pancreatic cancer. Methods: Patients reported symptoms via the Interaktor app daily for 6 months. In the event of alarming symptoms, an alert was triggered to the patient's nurse who then called the patient to offer advice and support. All nurses (n=8) who assessed patients were interviewed either individually or in a group. Transcribed interviews were analyzed using qualitative thematic analysis. Results: mHealth can facilitate person-centered care by offering nurses a way to gain knowledge about patients and to build relationships. Further, obstacles to implementation could be seen due to a lack of structural prerequisites and uncertainty about multiple ways to interact with patients. Conclusions: The Interaktor system can provide person-centered care. However, to implement mHealth tools as a clinical routine, focus needs to be placed on creating the necessary organizational conditions. ",
doi="10.2196/36654",
url="https://nursing.jmir.org/2022/1/e36654",
url="http://www.ncbi.nlm.nih.gov/pubmed/35576577"
}


@Article{info:doi/10.2196/35033,
author="Spector-Bagdady, Kayte
and Kent, Madison
and Krenz, D. Chris
and Brummel, Collin
and Swiecicki, L. Paul
and Brenner, Chad J.
and Shuman, G. Andrew",
title="Patient and Provider Perspectives on Enrollment in Precision Oncology Research: Qualitative Ethical Analysis",
journal="JMIR Cancer",
year="2022",
month="May",
day="3",
volume="8",
number="2",
pages="e35033",
keywords="oncology research platform",
keywords="precision oncology",
keywords="head and neck oncology",
keywords="academic cancer center",
keywords="semistructured interview",
keywords="patient-provider dyads",
keywords="oncology",
keywords="interview",
keywords="ethical analysis",
keywords="patient",
keywords="provider",
abstract="Background: The genomic frontier continues to revolutionize the practice of oncology. Advances in cancer biology from tumorigenesis to treatment resistance are driven by the molecular underpinnings of malignancy. The framing of precision oncology as both a clinical and research tool is constantly evolving and directly influences conversations between oncologists and their patients. Prior research has shown that patient-participants often have unmet or unrealistic expectations regarding the clinical utility of oncology research and genomic sequencing. This indicates the need for more in-depth investigation of how and why patients choose to participate in such research. Objective: This study presents a qualitative ethical analysis to better understand patient and provider perspectives on enrollment in precision oncology research. Methods: Paired semistructured interviews were conducted with patient-participants enrolled in a prospective head and neck precision oncology research platform, along with their oncology providers, at a National Cancer Institute--designated academic cancer center. Results: There were three major themes that emerged from the analysis. (1) There are distinct and unique challenges with informed consent to precision medicine, chiefly involving the ability of both patient-participants and providers to effectively understand the science underlying the research. (2) The unique benefits of precision medicine enrollment are of paramount importance to patients considering enrollment. (3) Patient-participants have little concern for the risks of research enrollment, particularly in the context of a low-burden protocol. Conclusions: Patient-participants and their providers offer complementary and nuanced perspectives on their motivation to engage in precision oncology research. This reflects both the inherent promise and enthusiasm within the field, as well as the limitations and challenges of ensuring that both patient-participants and clinicians understand the complexities of the science involved. ",
doi="10.2196/35033",
url="https://cancer.jmir.org/2022/2/e35033",
url="http://www.ncbi.nlm.nih.gov/pubmed/35503525"
}


@Article{info:doi/10.2196/36788,
author="Yazdanian, Azade
and Mehdizadeh, Hamed
and Balaghafari, Azita
and Kahouei, Mahdi
and Masoudinezhad, Maede",
title="Mobile-Based Self-management Application Requirements for Patients With Gastric Cancer: Quantitative Descriptive Study of Specialist and Patient Perspectives",
journal="JMIR Cancer",
year="2022",
month="Apr",
day="27",
volume="8",
number="2",
pages="e36788",
keywords="digital health, eHealth",
keywords="telehealth",
keywords="mHealth",
keywords="mobile app",
keywords="self-management",
keywords="patient education",
keywords="needs assessment, requirements analysis, stomach neoplasm, gastric cancer",
abstract="Background: Gastric cancer is one of the most common gastrointestinal cancers. Patients with gastric cancer experience disabilities and complications that lead to reduced quality of life. Empowering these patients by providing them with information and self-management skills can help reduce side effects and improve their quality of life. Objective: The aim of this study was to identify the user requirements for developing a mobile-based self-management app to support patients with gastric cancer. Methods: Data were analyzed using descriptive statistics and frequency distribution reports using IBM SPSS Statistics software. Results: All of the data elements and functional requirements except ``data recording times'' and ``weight changes in graphs'' were identified as essential by clinical experts and patients. Among the functional requirements required in a gastric cancer self-management app, the capabilities related to informing, announcing warnings, and reminders are included. In the demographic data section, most patients (14/26, 53\%) did not comment on the importance of recording data such as name, surname, and place of residence, and the demographic data section was met with less agreement from patients than clinicians. Conclusions: Applying the requirements mentioned in this study can improve the self-management of patients with gastric cancer. Such apps can play an important role in empowering patients and improving their quality of life. However, the apps need to be designed and implemented to see how they can meet users' requirements. ",
doi="10.2196/36788",
url="https://cancer.jmir.org/2022/2/e36788",
url="http://www.ncbi.nlm.nih.gov/pubmed/35475920"
}


@Article{info:doi/10.2196/37009,
author="Bilodeau, Karine
and Gouin, Marie-Michelle
and Lecours, Alexandra
and Lederer, Val{\'e}rie
and Durand, Marie-Jos{\'e}
and Kilpatrick, Kelley
and Lepage, David
and Ladouceur-Deslauriers, Lauriane
and Dorta, Tomas",
title="Acceptability and Feasibility of a Return-to-Work Intervention for Posttreatment Breast Cancer Survivors: Protocol for a Co-design and Development Study",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="22",
volume="11",
number="4",
pages="e37009",
keywords="co-design",
keywords="breast cancer",
keywords="intervention",
keywords="return-to-work",
keywords="primary care",
keywords="qualitative",
abstract="Background: The mortality rate from breast cancer has been declining for many years, and the population size of working-age survivors is steadily increasing. However, the recurrent side effects of cancer and its treatment can result in multiple disabilities and disruptions to day-to-day life, including work disruptions. Despite the existing knowledge of best practices regarding return to work (RTW) for breast cancer survivors, only a few interdisciplinary interventions have been developed to address the individualized needs and multiple challenges of breast cancer survivors, health care professionals, and employer and insurer representatives. Thus, it seems appropriate to develop RTW interventions collaboratively by using a co-design approach with these specific stakeholders. Objective: This paper presents a protocol for developing and testing an innovative, interdisciplinary pilot intervention based on a co-design approach to better support RTW and job retention after breast cancer treatment. Methods: First, a participatory research approach will be used to develop the intervention in a co-design workshop with 12 to 20 participants, including people affected by cancer, employer and insurer representatives, and health care professionals. Next, a pilot intervention will be tested in a primary care setting with 6 to 8 women affected by breast cancer. The acceptability and feasibility of the pilot intervention will be pretested through semistructured interviews with participants, health care professionals, and involved patient partners. The transcribed data will undergo an iterative content analysis. Results: The first phase of the project---the co-design workshop---was completed in June 2021. The pilot test of the intervention will begin in spring 2022. The results from the test will be available in late 2022. Conclusions: The project will offer novel data regarding the use of the co-design approach for the development of innovative, co-designed interventions. In addition, it will be possible to document the acceptability and feasibility of the pilot intervention with a primary care team. Depending on the results obtained, the intervention could be implemented on a larger scale. International Registered Report Identifier (IRRID): DERR1-10.2196/37009 ",
doi="10.2196/37009",
url="https://www.researchprotocols.org/2022/4/e37009",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451972"
}


@Article{info:doi/10.2196/34903,
author="Dennett, M. Amy
and Tang, Y. Clarice
and Chiu, April
and Osadnik, Christian
and Granger, L. Catherine
and Taylor, F. Nicholas
and Campbell, L. Kristin
and Barton, Christian",
title="A Cancer Exercise Toolkit Developed Using Co-Design: Mixed Methods Study",
journal="JMIR Cancer",
year="2022",
month="Apr",
day="21",
volume="8",
number="2",
pages="e34903",
keywords="cancer",
keywords="website",
keywords="online learning",
keywords="professional development",
keywords="physiotherapy",
keywords="exercise",
keywords="cancer survivorship",
keywords="cancer survivor",
keywords="digital health",
keywords="online health",
keywords="online toolkit",
abstract="Background: Access to exercise therapy for cancer survivors is poor. Professional development to support exercise professionals in delivering these interventions is needed. Few online resources exist for exercise professionals to address this issue. Objective: To develop and evaluate a freely available online toolkit to support exercise professionals working with cancer survivors. Methods: A 2-phase, experience-based co-design approach was used to develop and evaluate the online toolkit. The two phases were as follows: 1) needs identification and co-design of resources and platform and 2) pilot evaluation. Four co-design workshops were conducted, transcribed, and thematically analyzed to identify key elements for the toolkit. For the pilot evaluation, a customized survey (the Determinants of Implementation Behavior Questionnaire) was distributed to exercise professionals at baseline and 3 months after launch of the online toolkit to determine its usability, utility, and effectiveness in improving their knowledge, confidence, and behavior. Results were reported as the median and interquartile range and changes were calculated using non-parametric tests. Website analytics described site usage after the initial evaluation. Results: Twenty-five exercise professionals participated in co-designing 8 key elements of the online Cancer Exercise Toolkit: the homepage and pages for getting started, screening and safety, assessment, exercise prescription, education, locations, and resources. For the pilot evaluation, 277/320 respondents (87\% of whom were physiotherapists) from 26 countries completed the survey at baseline, with 58 exercise professionals completing follow-up surveys at 3 months. Exercise professionals' knowledge, skills, and confidence in delivering exercise therapy to cancer survivors increased 3 months after baseline (items 1, 6, and 8: median score 5, IQR 3 to 6) to follow-up (items 1 and 6: median score 6, IQR 5 to 6; item 8: median score 5, IQR 5 to 7; P<.001) on a 1 to 7 Likert scale. Most participants (35/44, 80\%) agreed or strongly agreed they would recommend the toolkit to colleagues. In the 6 months following the pilot evaluation, the toolkit received an average of 866 views per month. Conclusions: The co-designed online Cancer Exercise Toolkit was a useful resource for exercise professionals that may increase their knowledge, skills, and confidence in providing exercise therapy to cancer survivors. ",
doi="10.2196/34903",
url="https://cancer.jmir.org/2022/2/e34903",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451966"
}


@Article{info:doi/10.2196/31887,
author="Borgonovo, Giulia
and Vettus, Elen
and Greco, Alessandra
and Leo, Anna Laura
and Faletra, Fulvio Francesco
and Klersy, Catherine
and Curti, Moreno
and Valli, Mariacarla",
title="Early Detection of Cardiotoxicity From Systemic and Radiation Therapy in Patients With Breast Cancer: Protocol for a Multi-Institutional Prospective Study",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="21",
volume="11",
number="4",
pages="e31887",
keywords="breast cancer",
keywords="cardiotoxicity",
keywords="cardiac diagnostic imaging",
keywords="radiotherapy",
keywords="chemotherapy",
abstract="Background: The incidence of breast cancer is rising worldwide. Recent advances in systemic and local treatments have significantly improved survival rates of patients having early breast cancer. In the last decade, great attention has been paid to the prevention and early detection of cardiotoxicity induced by breast cancer treatments. Systemic therapy-related cardiac toxicities have been extensively studied. Radiotherapy, an essential component of breast cancer treatment, can also increase the risk of heart diseases. Consequently, it is important to balance the expected benefits of cancer treatment with cardiovascular risk and to identify strategies to prevent cardiotoxicity and improve long-term outcomes and quality of life for these patients. Objective: This CardioTox Breast study aims to investigate the use of cardiac imaging, based on cardiac magnetic resonance and echocardiography, and to identify associated circulating biomarkers to assess early tissue changes in chemo-induced and radiation-induced cardiotoxicity in the time window of 12 months after the end of radiotherapy in patients with breast cancer. Methods: The CardioTox Breast trial is a multicenter observational prospective longitudinal study. We aim to enroll 150 women with stage I-III unilateral breast cancer, treated with breast conserving surgery, who planned to receive radiotherapy with or without systemic therapy. Baseline and follow-up data include cardiac measurements based on cardiac magnetic resonance imaging, echocardiography, and circulating biomarkers of cardiac toxicity. Results: This study details the protocol of the CardioTox Breast trial. Recruitment started in September 2020. The results of this study will not be published until data are mature for the final analysis of the primary study end point. Conclusions: The CardioTox Breast study is designed to investigate the effects of systemic and radiation therapy on myocardial function and structure, thus providing additional evidence on whether cardiac magnetic resonance is the optimal screening imaging for cardiotoxicity. Trial Registration: ClinicalTrials.gov NCT04790266; https://clinicaltrials.gov/ct2/show/NCT04790266 International Registered Report Identifier (IRRID): DERR1-10.2196/31887 ",
doi="10.2196/31887",
url="https://www.researchprotocols.org/2022/4/e31887",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451989"
}


@Article{info:doi/10.2196/33799,
author="Yang, Xinyu
and Mu, Dongmei
and Peng, Hao
and Li, Hua
and Wang, Ying
and Wang, Ping
and Wang, Yue
and Han, Siqi",
title="Research and Application of Artificial Intelligence Based on Electronic Health Records of Patients With Cancer: Systematic Review",
journal="JMIR Med Inform",
year="2022",
month="Apr",
day="20",
volume="10",
number="4",
pages="e33799",
keywords="electronic health records",
keywords="artificial intelligence",
keywords="neoplasms",
keywords="machine learning",
abstract="Background: With the accumulation of electronic health records and the development of artificial intelligence, patients with cancer urgently need new evidence of more personalized clinical and demographic characteristics and more sophisticated treatment and prevention strategies. However, no research has systematically analyzed the application and significance of artificial intelligence based on electronic health records in cancer care. Objective: The aim of this study was to conduct a review to introduce the current state and limitations of artificial intelligence based on electronic health records of patients with cancer and to summarize the performance of artificial intelligence in mining electronic health records and its impact on cancer care. Methods: Three databases were systematically searched to retrieve potentially relevant papers published from January 2009 to October 2020. Four principal reviewers assessed the quality of the papers and reviewed them for eligibility based on the inclusion criteria in the extracted data. The summary measures used in this analysis were the number and frequency of occurrence of the themes. Results: Of the 1034 papers considered, 148 papers met the inclusion criteria. Cancer care, especially cancers of female organs and digestive organs, could benefit from artificial intelligence based on electronic health records through cancer emergencies and prognostic estimates, cancer diagnosis and prediction, tumor stage detection, cancer case detection, and treatment pattern recognition. The models can always achieve an area under the curve of 0.7. Ensemble methods and deep learning are on the rise. In addition, electronic medical records in the existing studies are mainly in English and from private institutional databases. Conclusions: Artificial intelligence based on electronic health records performed well and could be useful for cancer care. Improving the performance of artificial intelligence can help patients receive more scientific-based and accurate treatments. There is a need for the development of new methods and electronic health record data sharing and for increased passion and support from cancer specialists. ",
doi="10.2196/33799",
url="https://medinform.jmir.org/2022/4/e33799",
url="http://www.ncbi.nlm.nih.gov/pubmed/35442195"
}


@Article{info:doi/10.2196/29455,
author="Tardini, Elisa
and Zhang, Xinhua
and Canahuate, Guadalupe
and Wentzel, Andrew
and Mohamed, R. Abdallah S.
and Van Dijk, Lisanne
and Fuller, D. Clifton
and Marai, Elisabeta G.",
title="Optimal Treatment Selection in Sequential Systemic and Locoregional Therapy of Oropharyngeal Squamous Carcinomas: Deep Q-Learning With a Patient-Physician Digital Twin Dyad",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="20",
volume="24",
number="4",
pages="e29455",
keywords="digital twin dyad",
keywords="reinforcement learning",
keywords="head and neck cancer",
abstract="Background: Currently, selection of patients for sequential versus concurrent chemotherapy and radiation regimens lacks evidentiary support and it is based on locally optimal decisions for each step. Objective: We aim to optimize the multistep treatment of patients with head and neck cancer and predict multiple patient survival and toxicity outcomes, and we develop, apply, and evaluate a first application of deep Q-learning (DQL) and simulation to this problem. Methods: The treatment decision DQL digital twin and the patient's digital twin were created, trained, and evaluated on a data set of 536 patients with oropharyngeal squamous cell carcinoma with the goal of, respectively, determining the optimal treatment decisions with respect to survival and toxicity metrics and predicting the outcomes of the optimal treatment on the patient. Of the data set of 536 patients, the models were trained on a subset of 402 (75\%) patients (split randomly) and evaluated on a separate set of 134 (25\%) patients. Training and evaluation of the digital twin dyad was completed in August 2020. The data set includes 3-step sequential treatment decisions and complete relevant history of the patient cohort treated at MD Anderson Cancer Center between 2005 and 2013, with radiomics analysis performed for the segmented primary tumor volumes. Results: On the test set, we found mean 87.35\% (SD 11.15\%) and median 90.85\% (IQR 13.56\%) accuracies in treatment outcome prediction, matching the clinicians' outcomes and improving the (predicted) survival rate by +3.73\% (95\% CI --0.75\% to 8.96\%) and the dysphagia rate by +0.75\% (95\% CI --4.48\% to 6.72\%) when following DQL treatment decisions. Conclusions: Given the prediction accuracy and predicted improvement regarding the medically relevant outcomes yielded by this approach, this digital twin dyad of the patient-physician dynamic treatment problem has the potential of aiding physicians in determining the optimal course of treatment and in assessing its outcomes. ",
doi="10.2196/29455",
url="https://www.jmir.org/2022/4/e29455",
url="http://www.ncbi.nlm.nih.gov/pubmed/35442211"
}


@Article{info:doi/10.2196/29492,
author="Aronoff-Spencer, Eliah
and McComsey, Melanie
and Chih, Ming-Yuan
and Hubenko, Alexandra
and Baker, Corey
and Kim, John
and Ahern, K. David
and Gibbons, Christopher Michael
and Cafazzo, A. Joseph
and Nyakairu, Pia
and Vanderpool, C. Robin
and Mullett, W. Timothy
and Hesse, W. Bradford",
title="Designing a Framework for Remote Cancer Care Through Community Co-design: Participatory Development Study",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="12",
volume="24",
number="4",
pages="e29492",
keywords="cancer care",
keywords="distress screening",
keywords="human-centered design",
keywords="participatory design",
keywords="Appalachia",
keywords="mobile phone",
abstract="Background: Recent shifts to telemedicine and remote patient monitoring demonstrate the potential for new technology to transform health systems; yet, methods to design for inclusion and resilience are lacking. Objective: The aim of this study is to design and implement a participatory framework to produce effective health care solutions through co-design with diverse stakeholders. Methods: We developed a design framework to cocreate solutions to locally prioritized health and communication problems focused on cancer care. The framework is premised on the framing and discovery of problems through community engagement and lead-user innovation with the hypothesis that diversity and inclusion in the co-design process generate more innovative and resilient solutions. Discovery, design, and development were implemented through structured phases with design studios at various locations in urban and rural Kentucky, including Appalachia, each building from prior work. In the final design studio, working prototypes were developed and tested. Outputs were assessed using the System Usability Scale as well as semistructured user feedback. Results: We co-designed, developed, and tested a mobile app (myPath) and service model for distress surveillance and cancer care coordination following the LAUNCH (Linking and Amplifying User-Centered Networks through Connected Health) framework. The problem of awareness, navigation, and communication through cancer care was selected by the community after framing areas for opportunity based on significant geographic disparities in cancer and health burden resource and broadband access. The codeveloped digital myPath app showed the highest perceived combined usability (mean 81.9, SD 15.2) compared with the current gold standard of distress management for patients with cancer, the paper-based National Comprehensive Cancer Network Distress Thermometer (mean 74.2, SD 15.8). Testing of the System Usability Scale subscales showed that the myPath app had significantly better usability than the paper Distress Thermometer (t63=2.611; P=.01), whereas learnability did not differ between the instruments (t63=--0.311; P=.76). Notable differences by patient and provider scoring and feedback were found. Conclusions: Participatory problem definition and community-based co-design, design-with methods, may produce more acceptable and effective solutions than traditional design-for approaches. ",
doi="10.2196/29492",
url="https://www.jmir.org/2022/4/e29492",
url="http://www.ncbi.nlm.nih.gov/pubmed/35412457"
}


@Article{info:doi/10.2196/33110,
author="Thaker, Khushboo
and Chi, Yu
and Birkhoff, Susan
and He, Daqing
and Donovan, Heidi
and Rosenblum, Leah
and Brusilovsky, Peter
and Hui, Vivian
and Lee, Ji Young",
title="Exploring Resource-Sharing Behaviors for Finding Relevant Health Resources: Analysis of an Online Ovarian Cancer Community",
journal="JMIR Cancer",
year="2022",
month="Apr",
day="12",
volume="8",
number="2",
pages="e33110",
keywords="online health community",
keywords="resource sharing",
keywords="link sharing",
keywords="topical relevance",
keywords="information seeking",
keywords="ovarian cancer",
keywords="user behavior modeling",
abstract="Background: Online health communities (OHCs) provide patients and survivors of ovarian cancer (OvCa) and their caregivers with help beyond traditional support channels, such as health care providers and clinicians. OvCa OHCs promote connections and exchanges of information among users with similar experiences. Users often exchange information, which leads to the sharing of resources in the form of web links. Although OHCs are important platforms for health management, concerns exist regarding the quality and relevance of shared resources. Previous studies have examined different aspects of resource-sharing behaviors, such as the purpose of sharing, the type of shared resources, and peer user reactions to shared resources in OHCs to evaluate resource exchange scenarios. However, there is a paucity of research examining whether resource-sharing behaviors can ultimately determine the relevance of shared resources. Objective: This study aimed to examine the association between OHC resource-sharing behaviors and the relevance of shared resources. We analyzed three aspects of resource-sharing behaviors: types of shared resources, purposes of sharing resources, and OHC users' reactions to shared resources. Methods: Using a retrospective design, data were extracted from the National Ovarian Cancer Coalition discussion forum. The relevance of a resource was classified into three levels: relevant, partially relevant, and not relevant. Resource-sharing behaviors were identified through manual content analysis. A significance test was performed to determine the association between resource relevance and resource-sharing behaviors. Results: Approximately 48.3\% (85/176) of the shared resources were identified as relevant, 29.5\% (52/176) as partially relevant, and 22.2\% (39/176) as irrelevant. The study established a significant association between the types of shared resources ($\chi$218=33.2; P<.001) and resource relevance (through chi-square tests of independence). Among the types of shared resources, health consumer materials such as health news (P<.001) and health organizations (P=.02) exhibited significantly more relevant resources. Patient educational materials (P<.001) and patient-generated resources (P=.01) were more significantly associated with partially relevant and irrelevant resources, respectively. Expert health materials, including academic literature, were only shared a few times but had significantly (P<.001) more relevant resources. A significant association ($\chi$210=22.9; P<.001) was also established between the purpose of resource sharing and overall resource relevance. Resources shared with the purpose of providing additional readings (P=.01) and pointing to resources (P=.03) had significantly more relevant resources, whereas subjects for discussion and staying connected did not include any relevant shared resources. Conclusions: The associations found between resource-sharing behaviors and the relevance of these resources can help in collecting relevant resources, along with the corresponding information needs from OvCa OHCs, on a large scale through automation. The results from this study can be leveraged to prioritize the resources required by survivors of OvCa and their caregivers, as well as to automate the search for relevant shared resources in OvCa OHCs. ",
doi="10.2196/33110",
url="https://cancer.jmir.org/2022/2/e33110",
url="http://www.ncbi.nlm.nih.gov/pubmed/35258465"
}


@Article{info:doi/10.2196/31461,
author="Emani, Srinivas
and Rui, Angela
and Rocha, Lima Hermano Alexandre
and Rizvi, F. Rubina
and Jua{\c{c}}aba, Ferreira Sergio
and Jackson, Purcell Gretchen
and Bates, W. David",
title="Physicians' Perceptions of and Satisfaction With Artificial Intelligence in Cancer Treatment: A Clinical Decision Support System Experience and Implications for Low-Middle--Income Countries",
journal="JMIR Cancer",
year="2022",
month="Apr",
day="7",
volume="8",
number="2",
pages="e31461",
keywords="artificial intelligence",
keywords="cancer",
keywords="low-middle--income countries",
keywords="physicians",
keywords="perceptions",
keywords="Watson for Oncology",
keywords="implementation",
keywords="local context",
doi="10.2196/31461",
url="https://cancer.jmir.org/2022/2/e31461",
url="http://www.ncbi.nlm.nih.gov/pubmed/35389353"
}


@Article{info:doi/10.2196/36364,
author="Smith, Jazzine
and Essery, Rosie
and Yardley, Lucy
and Richardson, Alison
and Slodkowska-Barabasz, Joanna
and Foster, Claire
and Watson, Eila
and Grimmett, Chloe
and Geraghty, A. Adam W.
and Little, Paul
and Bradbury, Katherine",
title="Implementing a Health Care Professional--Supported Digital Intervention for Survivors of Cancer in Primary Care: Qualitative Process Evaluation of the Renewed Intervention",
journal="JMIR Cancer",
year="2022",
month="Apr",
day="1",
volume="8",
number="2",
pages="e36364",
keywords="process evaluation",
keywords="digital intervention",
keywords="primary care",
keywords="health care professional",
keywords="web-based",
keywords="quality of life",
keywords="posttreatment",
keywords="oncology",
abstract="Background: Primary care plays an important role in supporting survivors of cancer; however, support is limited because of practitioners' perceived lack of expertise and time. A digital intervention for survivors of cancer could provide an efficient way for primary care staff to support survivors of cancer without the need to accumulate expertise and skills to help patients make behavior changes; providing very brief support alongside this could maximize adherence to digital interventions. Renewed is a digital intervention that combines web-based behavior change advice with brief health care practitioner support from a nurse or health care assistant. Knowledge about the views and experiences of primary care staff providing support alongside a digital intervention for survivors of cancer is sparse, limiting the understanding of the acceptability and feasibility of this type of intervention. Objective: This study aims to explore supporters' experiences of providing support to survivors of cancer using Renewed, understand potential barriers to and facilitators of the implementation of Renewed in practice, and investigate the strengths and weaknesses of the intervention from the perspective of health care professionals. Methods: This was a qualitative process evaluation nested within a large trial evaluating Renewed. A total of 28 semistructured telephone interviews were conducted with nurses and health care assistants. Data were analyzed using inductive thematic analysis. Results: Four themes were developed during the analysis, which reflected the factors that supporters identified as hindering or enabling them to provide support alongside Renewed Online: Renewed Online as an acceptable digital tool with some improvements, confidence in enacting the supporter role, practicalities of delivering support alongside a digital intervention, and managing a patient-led approach. The analysis suggests that supporters perceived that a digital intervention such as Renewed would be beneficial in supporting survivors of cancer in primary care and fit within current practices. However, barriers to providing support alongside the intervention were also identified, including concerns about how to facilitate rapport building and, in a minority, concerns about using a nondirective approach, in which most advice and support is provided through digital interventions, with brief additional support provided by primary care staff. Conclusions: These findings add to the literature on how best to provide support alongside digital interventions, suggesting that although most practitioners cope well with a nondirective approach, a minority requires more training to feel confident in implementing this. This study suggests that the barriers to providing formal support to survivors of cancer in primary care could be successfully overcome with an approach such as Renewed, where a digital intervention provides most of the support and expertise, and health care practitioners provide additional brief human support to maximize engagement. Strategies to maximize the chances of successful implementation for this type of intervention are also discussed. ",
doi="10.2196/36364",
url="https://cancer.jmir.org/2022/2/e36364",
url="http://www.ncbi.nlm.nih.gov/pubmed/35363143"
}


@Article{info:doi/10.2196/28724,
author="Pang, Ning-Qi
and Lau, Jerrald
and Fong, Si-Ying
and Wong, Yu-Hui Celine
and Tan, Ker-Kan",
title="Telemedicine Acceptance Among Older Adult Patients With Cancer: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="29",
volume="24",
number="3",
pages="e28724",
keywords="older adult patients",
keywords="cancer",
keywords="telemedicine",
keywords="acceptability",
keywords="satisfaction",
abstract="Background: Cancer is likely to remain the most prevalent noncommunicable disease in high-income countries with an older population. Interestingly, no review of attitudes toward telemedicine among older adults has been performed. This is likely to be the group most affected by both cancer and the increasing use of technology in health care. Objective: We aimed to map research on the acceptance of telemedicine among older adults who are cancer patients. Methods: We conducted a scoping review. PubMed, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials were systematically searched from inception to September 2020. Articles were included if the study population had a mean or median age ?65 years, with cancer diagnoses and if the study assessed patients' acceptance of a telemedicine intervention. Quantitative, qualitative, and mixed method studies were included. Results: Out of a total of 887 articles that were identified, 19 were included in the review. Interventions were delivered via telephone, videoconference, web portal, mobile app, wearable technology, and text messaging and included teleconsultation, monitoring and follow-up, psychosocial support and nursing care, and prompts. The most often cited facilitating factor was convenience. Other facilitators included an increase in telemedicine care accessibility, previous positive experiences of telemedicine, appropriate technical knowledge and support, decreased cost, physician recommendations, and privacy conferred by the telemedicine intervention. Barriers include a preference for conventional care along with negative perceptions of telemedicine, concerns about technical difficulties, and confidentiality concerns in the adoption of telemedicine. Conclusions: None of the studies explored the ability of tailored interventions to address facilitators and barriers of the acceptance of telemedicine in order to increase its adoption by older adults. Facilitators and barriers will likely differ across different cultural contexts and by type of telemedicine; however, this is a gap in current knowledge. In-depth studies are necessary to determine if interventions could potentially address the barriers identified in this review, to increase acceptability. ",
doi="10.2196/28724",
url="https://www.jmir.org/2022/3/e28724",
url="http://www.ncbi.nlm.nih.gov/pubmed/35348462"
}


@Article{info:doi/10.2196/33239,
author="Micaux, Claire
and Wiklander, Maria
and Eriksson, E. Lars
and Wettergren, Lena
and Lampic, Claudia",
title="Efficacy of a Web-Based Psychoeducational Intervention for Young Adults With Fertility-Related Distress Following Cancer (Fex-Can): Randomized Controlled Trial",
journal="JMIR Cancer",
year="2022",
month="Mar",
day="29",
volume="8",
number="1",
pages="e33239",
keywords="cancer",
keywords="fertility distress",
keywords="psychoeducation",
keywords="randomized controlled trial",
keywords="web-based",
abstract="Background: Threatened fertility following cancer diagnosis in the reproductive age may severely impact emotional and psychosocial well-being in survivorship. Effective web-based interventions for fertility-related distress have been lacking. Objective: This study aims to test whether the Fertility and Sexuality following Cancer (Fex-Can) intervention is superior to standard care in reducing fertility-related distress and related psychosocial outcomes in young adults with cancer. Methods: This randomized controlled trial evaluated a 12-week, web-based, automated self-help intervention for fertility-related distress following cancer---Fex-Can Fertility. Individuals were identified via Swedish national quality registries, and those reporting fertility-related distress 1.5 years after diagnosis were invited. A total of 100 women and 24 men (aged 19-40 years) answered self-administered surveys at baseline (T0), directly after the intervention (T1), and 3 months later (T2). The main outcome was fertility-related distress, which was measured by using the 6-dimension Reproductive Concerns After Cancer (RCAC) scale. The secondary outcomes were health-related quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), emotional distress (Hospital Anxiety and Depression Scale), fertility-related knowledge, and fertility self-efficacy. In addition, the intervention group (IG) reported self-perceived changes in problems related to fertility after cancer (T1). 2-tailed t tests and linear mixed models, including intention-to-treat and subgroup analyses, were performed to compare the effects of the intervention with those of standard care. Results: Although 62\% (31/50) of the participants in the IG stated that their concerns about fertility were fewer after the intervention, there were few statistically significant group differences in the main outcome (RCAC) at T1 and T2. Compared with controls, the IG rated lower distress concerning the dimension child's health at T2 (P=.003; effect size [ES]=0.64). This difference was maintained when adding group and time interactions (intention-to-treat: P=.003; ES=0.58). The IG also had better self-perceived cancer-related fertility knowledge at T1 (P=.05; ES=0.35) and T2 (P=.01; ES=0.42) than the control group. Subgroup analyses based on dose or adherence and baseline RCAC scores did not substantially alter these results. Overall, the use of the web-based program was low. Conclusions: The Fex-Can intervention had small to moderate positive effects on cancer-related fertility knowledge and distress related to child's health. The lack of group differences in other dimensions of fertility distress and related secondary outcomes contrasted with reports on self-perceived improvement after the intervention. The Fex-Can Fertility program may be a useful complement to routine psychosocial support in the clinical care of young women and men with cancer. Trial Registration: ISRCTN Registry 36621459; https://www.isrctn.com/ISRCTN36621459 ",
doi="10.2196/33239",
url="https://cancer.jmir.org/2022/1/e33239",
url="http://www.ncbi.nlm.nih.gov/pubmed/35348459"
}


@Article{info:doi/10.2196/31388,
author="Grewal, Singh Udhayvir
and Gupta, Arjun
and Doggett, Jamie
and Lou, Emil
and Gusani, J. Niraj
and Maitra, Anirban
and Beg, Shaalan Muhammad
and Ocean, J. Allyson",
title="Twitter Conversations About Pancreatic Cancer by Health Care Providers and the General Public: Thematic Analysis",
journal="JMIR Cancer",
year="2022",
month="Mar",
day="24",
volume="8",
number="1",
pages="e31388",
keywords="pancreatic cancer",
keywords="Twitter",
keywords="general public",
keywords="health care providers",
keywords="social media",
keywords="Creation Pinpoint",
keywords="thematic analysis",
abstract="Background: ?There is a growing interest in the pattern of consumption of health-related information on social media platforms. Objective: We evaluated the content of discussions around pancreatic cancer on Twitter to identify subtopics of greatest interest to health care providers and the general public.? Methods: ?We used an online analytical tool (Creation Pinpoint) to quantify Twitter mentions (tweets and retweets) related to pancreatic cancer between January 2018 and December 2019. Keywords, hashtags, word combinations, and phrases were used to identify mentions. Health care provider profiles were identified using machine learning and then verified by a human analyst. Remaining user profiles were classified as belonging to the general public. Data from conversations were stratified qualitatively into 5 domains: (1) prevention, (2) survivorship, (3) treatment, (4) research, and (5) policy. We compared the themes of conversations initiated by health care providers and the general public and analyzed the impact of the Pancreatic Cancer Awareness Month and announcements by public figures of pancreatic cancer diagnoses on the overall volume of conversations.? Results: ?Out of 1,258,028 mentions of pancreatic cancer, 313,668 unique mentions were classified into the 5 domains. We found that health care providers most commonly discussed pancreatic cancer research (10,640/27,031 mentions, 39.4\%), while the general public most commonly discussed treatment (154,484/307,449 mentions, 50.2\%). Health care providers were found to be more likely to initiate conversations related to research (odds ratio [OR] 1.75, 95\% CI 1.70-1.79, P<.001) and prevention (OR 1.49, 95\% CI 1.41-1.57, P<.001) whereas the general public took the lead in the domains of treatment (OR 1.63, 95\% CI 1.58-1.69, P<.001) and survivorship (OR 1.17, 95\% CI 1.13-1.21, P<.001). Pancreatic Cancer Awareness Month did not increase the number of mentions by health care providers in any of the 5 domains, but general public mentions increased temporarily in all domains except prevention and policy. Health care provider mentions did not increase with announcements by public figures of pancreatic cancer diagnoses. After Alex Trebek, host of the television show Jeopardy, received his diagnosis, general public mentions of survivorship increased, while Justice Ruth Bader Ginsburg's diagnosis increased conversations on treatment.? Conclusions: Health care provider conversations on Twitter are not aligned with the general public. Pancreatic Cancer Awareness Month temporarily increased general public conversations about treatment, research, and survivorship, but not prevention or policy. Future studies are needed to understand how conversations on social media platforms can be leveraged to increase health care awareness among the general public. ",
doi="10.2196/31388",
url="https://cancer.jmir.org/2022/1/e31388",
url="http://www.ncbi.nlm.nih.gov/pubmed/35323123"
}


@Article{info:doi/10.2196/31118,
author="Vollmer Dahlke, Deborah
and Yoshikawa, Aya
and McAdam, Molly
and Malatok, Sharyn
and Gonzales, D. Elaine",
title="An Analysis of Health Care Team Communication Needs Among Younger vs Older Breast Cancer Survivors: Web-Based Survey",
journal="JMIR Cancer",
year="2022",
month="Mar",
day="18",
volume="8",
number="1",
pages="e31118",
keywords="breast cancer",
keywords="breast cancer survivorship",
keywords="patient-physician communications",
keywords="patient-centric communication",
keywords="younger breast cancer patients",
keywords="patient communication",
abstract="Background: Prior studies indicate that the age of onset of breast cancer is an important element in considering communication between patients and the health care team. Younger women aged 45 and under diagnosed with breast cancer are often at a higher risk of being more vulnerable to psychosocial issues compared to older women aged 46 years and above. Few studies have examined age differences in patient perceptions of treatment-related discussion and communication during transition with their health care team. Objective: The aims of this survey were (1) to better understand breast cancer survivors' perspectives regarding communication with health care providers during treatment and during transition to posttreatment care; and (2) to determine the differences between younger women with breast cancer (?45 years of age) and older women (?46 years of age). It was hypothesized that (1) breast cancer survivors' psychosocial and finance-related communications with health care providers may lack effectiveness; (2) younger women experience greater needs for patient-centered communication with physicians and health care providers, especially about psychosocial care and transition to posttreatment care; and (3) younger breast cancer patients (?45 years of age) need more information on survivorship and follow-up care. Methods: An internet-based survey was conducted with 143 women in Central Texas with 35\% (n=50) aged 45 years or under and 65\% (n=93) aged 46 years and above. The Mann-Whitney U test was performed to assess differences in participants' perceptions about communication with health care providers by age group: younger (?45 years of age) and older (?46 years of age) women. Results: Statistically significant results pertained to rating health care team and patient discussions about transition from treatment to posttreatment using scores of 0 as ``no discussion'' and 100 as ``in-depth discussion.'' For the questions about management of posttreatment care, the overall mean score of the groups was 56.26 and that of the younger group was 43.96; the mean score of the older group was 61.96 (P=.02). For the question about the timing of follow-up appointments, the overall mean score was 64.29; the mean score of the younger group was 54.44, and that of the older group was 68.88 (P=.05). All the group scores related to psychosocial and financial support discussions with health care providers were low, with a rollup average of only 30.02 out of 100, suggesting that this is an important area for improving patient-centered communication. Conclusions: For all patients, transition from treatment to posttreatment requires a greater level of engagement and communication with the health care team. It appears that younger patients aged ?45 years require more in-depth and personalized messaging to better understand their posttreatment care requirements. ",
doi="10.2196/31118",
url="https://cancer.jmir.org/2022/1/e31118",
url="http://www.ncbi.nlm.nih.gov/pubmed/35302499"
}


@Article{info:doi/10.2196/33152,
author="Mueller, L. Emily
and Cochrane, R. Anneli
and Campbell, E. Madison
and Nikkhah, Sarah
and Miller, D. Andrew",
title="An mHealth App to Support Caregivers in the Medical Management of Their Child With Cancer: Co-design and User Testing Study",
journal="JMIR Cancer",
year="2022",
month="Mar",
day="16",
volume="8",
number="1",
pages="e33152",
keywords="child",
keywords="adolescent",
keywords="oncology",
keywords="supportive care",
keywords="mHealth",
keywords="mobile health",
keywords="cancer",
keywords="pediatrics",
keywords="children",
keywords="digital health",
keywords="health applications",
keywords="parent",
keywords="caregiver",
abstract="Background: Caregivers face new challenges and tasks when their child is diagnosed with cancer, which can be overwhelming. Mobile technology has the capacity to provide immediate support at their fingertips to aid in tracking symptoms, managing medication, and planning for emergencies. Objective: The objective of this study is to engage directly with end users and proxies to co-design and create a mobile technology app to support caregivers in the medical management of their child with cancer. Methods: We engaged directly with caregivers of children with cancer and pediatric oncology nurse coordinators (proxy end users) to co-design and create the prototype of the Cope 360 mobile health app. Alpha testing was accomplished by walking the users through a series of predetermined tasks that encompassed all aspects of the app including tracking symptoms, managing medications, and planning or practicing for a medical emergency that required seeking care in the emergency department. Evaluation was accomplished through recorded semistructured interviews and quantitative surveys to capture demographic information and measure the system usability score. Interviews were transcribed and analyzed iteratively using NVivo (version 12; QSR International). Results: This study included 8 caregivers (aged 33-50 years) of children with cancer, with most children receiving chemotherapy, and 6 nurse coordinators, with 3 (50\%) of them having 11 to 20 years of nursing experience. The mean system usability score given by caregivers was 89.4 (95\% CI 80-98.8). Results were grouped by app function assessed with focus on specific attributes that were well received and those that required refinement. The major issues requiring refinement included clarity in the medical information and terminology, improvement in design of tasks, tracking of symptoms including adjusting the look and feel of certain buttons, and changing the visual graph used to monitor symptoms to include date anchors. Conclusions: The Cope 360 app was well received by caregivers of children with cancer but requires further refinement for clarity and visual representation. After refinement, testing among caregivers in a real-world environment is needed to finalize the Cope 360 app before its implementation in a randomized controlled trial. ",
doi="10.2196/33152",
url="https://cancer.jmir.org/2022/1/e33152",
url="http://www.ncbi.nlm.nih.gov/pubmed/35293867"
}


@Article{info:doi/10.2196/33182,
author="Lu, Sheng-Chieh
and Xu, Cai
and Nguyen, H. Chandler
and Geng, Yimin
and Pfob, Andr{\'e}
and Sidey-Gibbons, Chris",
title="Machine Learning--Based Short-Term Mortality Prediction Models for Patients With Cancer Using Electronic Health Record Data: Systematic Review and Critical Appraisal",
journal="JMIR Med Inform",
year="2022",
month="Mar",
day="14",
volume="10",
number="3",
pages="e33182",
keywords="machine learning",
keywords="cancer mortality",
keywords="artificial intelligence",
keywords="clinical prediction models",
keywords="end-of-life care",
abstract="Background: In the United States, national guidelines suggest that aggressive cancer care should be avoided in the final months of life. However, guideline compliance currently requires clinicians to make judgments based on their experience as to when a patient is nearing the end of their life. Machine learning (ML) algorithms may facilitate improved end-of-life care provision for patients with cancer by identifying patients at risk of short-term mortality. Objective: This study aims to summarize the evidence for applying ML in ?1-year cancer mortality prediction to assist with the transition to end-of-life care for patients with cancer. Methods: We searched MEDLINE, Embase, Scopus, Web of Science, and IEEE to identify relevant articles. We included studies describing ML algorithms predicting ?1-year mortality in patients of oncology. We used the prediction model risk of bias assessment tool to assess the quality of the included studies. Results: We included 15 articles involving 110,058 patients in the final synthesis. Of the 15 studies, 12 (80\%) had a high or unclear risk of bias. The model performance was good: the area under the receiver operating characteristic curve ranged from 0.72 to 0.92. We identified common issues leading to biased models, including using a single performance metric, incomplete reporting of or inappropriate modeling practice, and small sample size. Conclusions: We found encouraging signs of ML performance in predicting short-term cancer mortality. Nevertheless, no included ML algorithms are suitable for clinical practice at the current stage because of the high risk of bias and uncertainty regarding real-world performance. Further research is needed to develop ML models using the modern standards of algorithm development and reporting. ",
doi="10.2196/33182",
url="https://medinform.jmir.org/2022/3/e33182",
url="http://www.ncbi.nlm.nih.gov/pubmed/35285816"
}


@Article{info:doi/10.2196/29063,
author="Guilabert, Mercedes
and Prades, Joan
and Borras, M. Josep
and Maestu, Inmaculada
and Guerra, Antonio Juan
and Fumad{\'o}, Llu{\'i}s
and Mira, Joaquin Jos{\'e}
and ",
title="A Web-Based Self-assessment Model for Evaluating Multidisciplinary Cancer Teams in Spain: Development and Validation Pilot Study",
journal="J Med Internet Res",
year="2022",
month="Mar",
day="10",
volume="24",
number="3",
pages="e29063",
keywords="web-based tool",
keywords="multidisciplinary care",
keywords="cancer",
keywords="evaluation",
keywords="quality assurance",
abstract="Background: Tumor boards constitute the main consensus and clinical decision--making body of multidisciplinary teams (MDTs) in cancer care. With the increasing clinical complexity of treatment options (eg, targeted therapies, multimodal treatments) and the progressive incorporation of new areas of intervention (eg, survivorship care), tumor boards are now required to play a central role in all cancer processes. However, although frameworks are in place to evaluate MDT quality, only few web-based tools are available for this purpose; indeed, no web-based MDT evaluation tools have been developed for or adapted to the Spanish National Health System. Objective: The first aim of this study was to develop a web-based self-assessment model (Autoevaluaci{\'o}n de Equipos Multidisciplinares de Atenci{\'o}n al C{\'a}ncer [AEMAC]) for evaluating multidisciplinary cancer teams in Spain and the second aim was to validate this tool by testing its metric properties, acceptability, and usability. Methods: We designed and validated the AEMAC program in 3 stages. In the first stage (research), we reviewed the available scientific evidence and performed a qualitative case study of good practice in multidisciplinary care within the Spanish National Health System (n=4 centers and 28 health care professionals). The results were used to define the thematic areas and quality criteria for the self-evaluation model, which were then discussed and validated by a group of experts. The second stage (development) involved the technological development of a web app that would be accessible from any mobile device. In the third stage (piloting and validation), we conducted 4 pilot tests (n=15 tumor boards, 243 professionals) and used the results to analyze the acceptability and usefulness of the tool. Results: We designed a self-assessment model based on 5 thematic areas encompassing a total of 25 quality components, which users rated on a 3-option development scale. The evaluation process, which was managed entirely from the web app, consisted of individual self-assessment, group prioritization, and creation of an improvement plan. Cronbach alpha (.86), McDonald's omega (0.88), and various fit indices (comparative fit index between 0.95 and 1 and goodness-of-fit index between 0.97 and 0.99 for all 5 aspects) confirmed internal consistency. The mean rating for overall satisfaction with the tool and for consistency between the content of the tool and the reality of tumor boards was 7.6 out of 10. Conclusions: The results obtained during the period of research and piloting of the AEMAC program showed that it has an appropriate structure and metric properties and could therefore be implemented in a real context and generalized to other hospitals. As a virtual tool, it helps to measure the key aspects of MDT quality, such as effectiveness of collaboration and communication, leadership, and the organizational environment. ",
doi="10.2196/29063",
url="https://www.jmir.org/2022/3/e29063",
url="http://www.ncbi.nlm.nih.gov/pubmed/35266870"
}


@Article{info:doi/10.2196/19379,
author="van Eenbergen, C. Mies
and Vromans, D. Ruben
and Tick, W. Lidwine
and Vreugdenhil, Gerard
and Krahmer, J. Emiel
and Mols, Floortje
and van de Poll-Franse, V. Lonneke",
title="Comparing Survivors of Cancer in Population-Based Samples With Those in Online Cancer Communities: Cross-sectional Questionnaire Study",
journal="JMIR Cancer",
year="2022",
month="Mar",
day="8",
volume="8",
number="1",
pages="e19379",
keywords="internet use",
keywords="breast cancer",
keywords="prostate cancer",
keywords="lymphoma",
keywords="gynecological cancer",
keywords="cancer survivors",
keywords="online health community",
abstract="Background: Most Western countries have websites that provide information on cancer and the opportunity to participate in online cancer communities (OCCs). The number of patients with cancer that participate in these OCCs is growing. These patients are relatively easy to approach for research purposes. Objective: The objective of this study is to determine the differences and similarities between survivors of cancer in population-based samples and survivors participating in OCCs who use the internet in relation to their illness. Methods: In 2017, we drew a sample of 539 population-based patients and 531 OCC patients. The population-based patients were sent a paper-based questionnaire, and the OCC patients were sent the same questionnaire on the web. In the questionnaire, we asked patients about their sociodemographics, internet use, sources of information, media use, and wishes regarding future internet use for health care--related purposes, and the effect of internet use on their health care consumption. Results: The response rate of population-based internet users was 47\% (233/496), and that of the OCC group was 40.3\% (214/531). The OCC group had a significantly higher education level (P<.001), was younger (P<.001), had more survivors that were employed (P<.001), and attached greater importance to the internet (171/214, 79.9\% vs 126/233, 54.1\%; P<.001) and fellow survivors (107/214, 50\% vs 60/233, 25.8\%; P<.001). Compared with the population-based group, the OCC group reported more intensive internet use immediately after diagnosis, during treatment, and during follow-up (P<.001 in each case). There were similarities in terms of the relative importance that survivors attach to the various sources of information, the topics on which they seek information, and their wishes for future eHealth possibilities. The OCC group reported a greater need to participate in a web-based class or chat with others (92/214, 43\% vs 44/233, 18.9\%). Conclusions: We conclude that survivors who are members of an OCC are not representative of survivors of cancer in general. There are significant differences in sociodemographic characteristics, internet use during their treatment journey, internet search frequency during their cancer journey, and participation wishes. Using web-based information and communication can support shared decision-making and may facilitate the active participation of patients during their treatment. For research purposes, it is important to take the bias in OCC groups into account. ",
doi="10.2196/19379",
url="https://cancer.jmir.org/2022/1/e19379",
url="http://www.ncbi.nlm.nih.gov/pubmed/35258460"
}


@Article{info:doi/10.2196/34895,
author="Alpert, M. Jordan
and Taylor, Greenberry
and Hampton, N. Chelsea
and Paige, Samantha
and Markham, Jennifer Merry
and Bylund, L. Carma",
title="Clinicians' Perceptions of the Benefits and Challenges of Teleoncology as Experienced Through the COVID-19 Pandemic: Qualitative Study",
journal="JMIR Cancer",
year="2022",
month="Feb",
day="24",
volume="8",
number="1",
pages="e34895",
keywords="teleoncology",
keywords="telemedicine",
keywords="qualitative",
keywords="COVID-19",
keywords="telehealth",
keywords="cancer care",
keywords="cancer",
keywords="oncology",
keywords="digital health",
keywords="pandemic",
abstract="Background: COVID-19 thrust both patients and clinicians to use telemedicine in place of traditional in-person visits. Prepandemic, limited research had examined clinician-patient communication in telemedicine visits. The shift to telemedicine in oncology, or teleoncology, has placed attention on how the technology can be utilized to provide care for patients with cancer. Objective: Our objective was to describe oncology clinicians' experiences with teleoncology and to uncover its benefits and challenges during the first 10 months of the COVID-19 pandemic. Methods: In-depth, semistructured qualitative interviews were conducted with oncology clinicians. Using an inductive, thematic approach, the most prevalent themes were identified. Results: In total, 21 interviews with oncology clinicians revealed the following themes: benefits of teleoncology, such as (1) reducing patients' travel time and expenses, (2) limiting COVID-19 exposure, and (3) enabling clinicians to ``see'' a patients' lifestyle and environment, and challenges, such as (1) technological connection difficulties, (2) inability to physically examine patients, and (3) patients' frustration related to clinicians being late to teleoncology appointments. Conclusions: Teleoncology has many benefits and is well suited for specific types of appointments. Challenges could be addressed through improved communication when scheduling appointments to make patients aware about what to expect. Ensuring patients have the proper technology to participate in teleoncology and an understanding about how it functions are necessary. ",
doi="10.2196/34895",
url="https://cancer.jmir.org/2022/1/e34895",
url="http://www.ncbi.nlm.nih.gov/pubmed/35142622"
}


@Article{info:doi/10.2196/33083,
author="Skiba, B. Meghan
and Lopez-Pentecost, Melissa
and Werts, J. Samantha
and Ingram, Maia
and Vogel, M. Rosi
and Enriquez, Tatiana
and Garcia, Lizzie
and Thomson, A. Cynthia",
title="Health Promotion Among Mexican-Origin Survivors of Breast Cancer and Caregivers Living in the United States--Mexico Border Region: Qualitative Analysis From the Vida Plena Study",
journal="JMIR Cancer",
year="2022",
month="Feb",
day="24",
volume="8",
number="1",
pages="e33083",
keywords="Mexican-origin Hispanics",
keywords="breast cancer",
keywords="survivorship",
keywords="caregivers",
keywords="border health",
keywords="lifestyle",
keywords="diet",
keywords="physical activity",
keywords="health promotion",
keywords="mobile phone",
abstract="Background: Hispanic survivors of cancer experience increased cancer burden. Lifestyle behaviors, including diet and physical activity, may reduce the cancer burden. There is limited knowledge about the posttreatment lifestyle experiences of Hispanic survivors of cancer living on the United States--Mexico border. Objective: This study aims to support the development of a stakeholder-informed, culturally relevant, evidence-based lifestyle intervention for Mexican-origin Hispanic survivors of cancer living in a border community to improve their dietary quality and physical activity. Methods: Semistructured interviews with 12 Mexican-origin Hispanic survivors of breast cancer and 7 caregivers were conducted through internet-based teleconferencing. The interviews explored the impact of cancer on lifestyle and treatment-related symptoms, perception of lifestyle as an influence on health after cancer, and intervention content and delivery preferences. Interviews were analyzed using a deductive thematic approach grounded in the Quality of Cancer Survivorship Care Framework. Results: Key survivor themes included perception of Mexican diet as unhealthy, need for reliable diet-related information, perceived benefits of physical activity after cancer treatment, family support for healthy lifestyles (physical and emotional), presence of cancer-related symptoms interfering with lifestyle, and financial barriers to living a healthy lifestyle. Among caregivers, key themes included effects of the cancer caregiving experience on caregivers' lifestyle and cancer-preventive behaviors and gratification in providing support to the survivors. Conclusions: The interviews revealed key considerations to the adaptation, development, and implementation of a theory-informed, evidence-based, culturally relevant lifestyle program to support lifestyle behavior change among Mexican-origin Hispanic survivors of cancer living in border communities. Our qualitative findings highlight specific strategies that can be implemented in health promotion programming aimed at encouraging cancer protective behaviors to reduce the burden of cancer and comorbidities in Mexican-origin survivors of cancer living in border communities. ",
doi="10.2196/33083",
url="https://cancer.jmir.org/2022/1/e33083",
url="http://www.ncbi.nlm.nih.gov/pubmed/35200150"
}


@Article{info:doi/10.2196/35346,
author="Bogdanowicz, Les
and Fidaner, Onur
and Ceres, Donato
and Grycuk, Alexander
and Guidetti, Martina
and Demos, David",
title="The Cole Relaxation Frequency as a Parameter to Identify Cancer in Lung Tissue: Preliminary Animal and Ex Vivo Patient Studies",
journal="JMIR Biomed Eng",
year="2022",
month="Feb",
day="21",
volume="7",
number="1",
pages="e35346",
keywords="Cancer",
keywords="Detection",
keywords="Lung Cancer",
keywords="Non Small Cell Lung Cancer",
keywords="Spectral Impedance",
keywords="Cole Relaxation Frequency",
keywords="biomedical engineering",
keywords="medical device",
keywords="scan",
keywords="testing",
keywords="identify",
keywords="lungs",
keywords="respiratory",
keywords="diagnosis",
keywords="model",
keywords="animal testing",
keywords="in-vivo",
keywords="human testing",
abstract="Background: Lung cancer is the world's leading cause of cancer deaths, and diagnosis remains challenging. Lung cancer starts as small nodules; early and accurate diagnosis allows timely surgical resection of malignant nodules while avoiding unnecessary surgery in patients with benign nodules. Objective: The Cole relaxation frequency (CRF) is a derived electrical bioimpedance signature, which may be utilized to distinguish cancerous tissues from normal tissues. Methods: Human testing ex vivo was conducted with NoduleScan in freshly resected lung tissue from 30 volunteer patients undergoing resection for nonsmall cell lung cancer. The CRF of the tumor and the distant normal lung tissue relative to the tumor were compared to histopathology specimens to establish a potential algorithm for point-of-care diagnosis. For animal testing in vivo, 20 mice were implanted with xenograft human lung cancer tumor cells injected subcutaneously into the right flank of each mouse. Spectral impedance measurements were taken on the tumors on live animals transcutaneously and on the tumors after euthanasia. These CRF measurements were compared to healthy mouse lung tissue. For porcine lung testing ex vivo, porcine lungs were received with the trachea. After removal of the vocal box, a ventilator was attached to pressurize the lung and simulate breathing. At different locations of the lobes, the lung's surface was cut to produce a pocket that could accommodate tumors obtained from in vivo animal testing. The tumors were placed in the subsurface of the lung, and the electrode was placed on top of the lung surface directly over the tumor but with lung tissue between the tumor and the electrode. Spectral impedance measurements were taken when the lungs were in the deflated state, inflated state, and also during the inflation-deflation process to simulate breathing. Results: Among 60 specimens evaluated in 30 patients, NoduleScan allowed ready discrimination in patients with clear separation of CRF in tumor and distant normal tissue with a high degree of sensitivity (97\%) and specificity (87\%). In the 25 xenograft small animal model specimens measured, the CRF aligns with the separation observed in the human in vivo measurements. The CRF was successfully measured of tumors implanted into ex vivo porcine lungs, and CRF measurements aligned with previous tests for pressurized and unpressurized lungs. Conclusions: As previously shown in breast tissue, CRF in the range of 1kHz-10MHz was able to distinguish nonsmall cell lung cancer versus normal tissue. Further, as evidenced by in vivo small animal studies, perfused tumors have the same CRF signature as shown in breast tissue and human ex vivo testing. Inflation and deflation of the lung have no effect on the CRF signature. With additional development, CRF derived from spectral impedance measurements may permit point-of-care diagnosis guiding surgical resection. ",
doi="10.2196/35346",
url="https://biomedeng.jmir.org/2022/1/e35346"
}


@Article{info:doi/10.2196/33355,
author="Goodman, William
and Bagnall, Anne-Marie
and Ashley, Laura
and Azizoddin, Desiree
and Muehlensiepen, Felix
and Blum, David
and Bennett, I. Michael
and Allsop, Matthew",
title="The Extent of Engagement With Telehealth Approaches by Patients With Advanced Cancer: Systematic Review",
journal="JMIR Cancer",
year="2022",
month="Feb",
day="17",
volume="8",
number="1",
pages="e33355",
keywords="systematic review",
keywords="advanced cancer",
keywords="engagement",
keywords="digital health",
keywords="telehealth",
keywords="mobile phone",
abstract="Background: Telehealth approaches are increasingly being used to support patients with advanced diseases, including cancer. Evidence suggests that telehealth is acceptable to most patients; however, the extent of and factors influencing patient engagement remain unclear. Objective: The aim of this review is to characterize the extent of engagement with telehealth interventions in patients with advanced, incurable cancer reported in the international literature. Methods: This systematic review was registered with PROSPERO (International Prospective Register of Systematic Reviews) and is reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. A comprehensive search of databases was undertaken for telehealth interventions (communication between a patient with advanced cancer and their health professional via telehealth technologies), including MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Sociological Abstracts, and Web of Science, from the inception of each electronic database up until December 31, 2020. A narrative synthesis was conducted to outline the design, population, and context of the studies. A conceptual framework of digital engagement comprising quantitative behavioral measures (frequency, amount, duration, and depth of use) framed the analysis of engagement with telehealth approaches. Frequency data were transformed to a percentage (actual patient engagement as a proportion of intended engagement), and the interventions were characterized by intensity (high, medium, and low intended engagement) and mode of delivery for standardized comparisons across studies. Results: Of the 19,676 identified papers, 40 (0.2\%) papers covering 39 different studies were eligible for inclusion, dominated by US studies (22/39, 56\%), with most being research studies (26/39, 67\%). The most commonly reported measure of engagement was frequency (36/39, 92\%), with substantial heterogeneity in the way in which it was measured. A standardized percentage of actual patient engagement was derived from 17 studies (17/39, 44\%; n=1255), ranging from 51\% to 100\% with a weighted average of 75.4\% (SD 15.8\%). A directly proportional relationship was found between intervention intensity and actual patient engagement. Higher engagement occurred when a tablet, computer, or smartphone app was the mode of delivery. Conclusions: Understanding engagement for people with advanced cancer can guide the development of telehealth approaches from their design to monitoring as part of routine care. With increasing telehealth use, the development of meaningful and context- and condition-appropriate measures of telehealth engagement is needed to address the current heterogeneity in reporting while improving the understanding of optimal implementation of telehealth for oncology and palliative care. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42018117232; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42018117232 ",
doi="10.2196/33355",
url="https://cancer.jmir.org/2022/1/e33355",
url="http://www.ncbi.nlm.nih.gov/pubmed/35175205"
}


@Article{info:doi/10.2196/33550,
author="Mendes-Santos, Cristina
and Nunes, Francisco
and Weiderpass, Elisabete
and Santana, Rui
and Andersson, Gerhard",
title="Development and Evaluation of the Usefulness, Usability, and Feasibility of iNNOV Breast Cancer: Mixed Methods Study",
journal="JMIR Cancer",
year="2022",
month="Feb",
day="15",
volume="8",
number="1",
pages="e33550",
keywords="acceptance and commitment therapy",
keywords="anxiety",
keywords="breast cancer survivors",
keywords="cognitive behavioral therapy",
keywords="depression",
keywords="digital mental health",
keywords="e-mental health",
keywords="user-centered design",
keywords="internet interventions",
keywords="usability",
keywords="mobile phone",
abstract="Background: Despite the efficacy of psychosocial interventions in minimizing psychosocial morbidity in breast cancer survivors (BCSs), intervention delivery across survivorship is limited by physical, organizational, and attitudinal barriers, which contribute to a mental health care treatment gap in cancer settings. Objective: The aim of this study is to develop iNNOV Breast Cancer (iNNOVBC), a guided, internet-delivered, individually tailored, acceptance and commitment therapy--influenced cognitive behavioral intervention program aiming to treat mild to moderate anxiety and depression in BCSs as well as to improve fatigue, insomnia, sexual dysfunction, and health-related quality of life in this group. This study also aims to evaluate the usefulness, usability, and preliminary feasibility of iNNOVBC. Methods: iNNOVBC was developed using a user-centered design approach involving its primary and secondary end users, that is, BCSs (11/24, 46\%) and mental health professionals (13/24, 54\%). We used mixed methods, namely in-depth semistructured interviews, laboratory-based usability tests, short-term field trials, and surveys, to assess iNNOVBC's usefulness, usability, and preliminary feasibility among these target users. Descriptive statistics were used to characterize the study sample, evaluate performance data, and assess survey responses. Qualitative data were recorded, transcribed verbatim, and thematically analyzed. Results: Overall, participants considered iNNOVBC highly useful, with most participants reporting on the pertinence of its scope, the digital format, the relevant content, and the appropriate features. However, various usability issues were identified, and participants suggested that the program should be refined by simplifying navigation paths, using a more dynamic color scheme, including more icons and images, displaying information in different formats and versions, and developing smartphone and tablet versions. In addition, participants suggested that tables should be converted into plain textboxes and data visualization dashboards should be included to facilitate the tracking of progress. The possibility of using iNNOVBC in a flexible manner, tailoring it according to BCSs' changing needs and along the cancer care continuum, was another suggestion that was identified. Conclusions: The study results suggest that iNNOVBC is considered useful by both BCSs and mental health professionals, configuring a promising point-of-need solution to bridge the psychological supportive care gap experienced by BCSs across the survivorship trajectory. We believe that our results may be applicable to other similar programs. However, to fulfill their full supportive role, such programs should be comprehensive, highly usable, and tailorable and must adopt a flexible yet integrated structure capable of evolving in accordance with survivors' changing needs and the cancer continuum. ",
doi="10.2196/33550",
url="https://cancer.jmir.org/2022/1/e33550",
url="http://www.ncbi.nlm.nih.gov/pubmed/35166682"
}


@Article{info:doi/10.2196/32291,
author="Yeary, Kim Karen H.
and Clark, Nikia
and Saad-Harfouche, Frances
and Erwin, Deborah
and Kuliszewski, Gates Margaret
and Li, Qiang
and McCann, E. Susan
and Yu, Han
and Lincourt, Catherine
and Zoellner, Jamie
and Tang, Li",
title="Cruciferous Vegetable Intervention to Reduce the Risk of Cancer Recurrence in Non--Muscle-Invasive Bladder Cancer Survivors: Development Using a Systematic Process",
journal="JMIR Cancer",
year="2022",
month="Feb",
day="15",
volume="8",
number="1",
pages="e32291",
keywords="non--muscle invasive bladder cancer survivors",
keywords="dietary intervention",
keywords="cruciferous vegetable",
keywords="cancer survivorship",
keywords="cancer recurrence",
abstract="Background: Bladder cancer is one of the top 10 most common cancers in the United States. Most bladder cancers (70\%-80\%) are diagnosed at early stages as non--muscle-invasive bladder cancer (NMIBC), which can be removed surgically. However, 50\% to 80\% of NMIBC cases recur within 5 years, and 15\% to 30\% progress with poor survival. Current treatments are limited and expensive. A wealth of preclinical and epidemiological evidence suggests that dietary isothiocyanates in cruciferous vegetables (Cruciferae) could be a novel, noninvasive, and cost-effective strategy to control NMIBC recurrence and progression. Objective: The aim of this study is to develop a scalable dietary intervention that increases isothiocyanate exposure through Cruciferae intake in NMIBC survivors. Methods: We worked with a community advisory board (N=8) to identify relevant factors, evidence-based behavior change techniques, and behavioral theory constructs used to increase Cruciferae intake in NMIBC survivors; use the PEN-3 Model focused on incorporating cultural factors salient to the group's shared experiences to review the intervention components (eg, the saliency of behavioral messages); administer the revised intervention to community partners for their feedback; and refine the intervention. Results: We developed a multicomponent intervention for NMIBC survivors consisting of a magazine, tracking book, live telephone call script, and interactive voice messages. Entitled POW-R Health: Power to Redefine Your Health, the intervention incorporated findings from our adaptation process to ensure saliency to NMIBC survivors. Conclusions: This is the first evidence-based, theoretically grounded dietary intervention developed to reduce bladder cancer recurrence in NMIBC survivors using a systematic process for community adaptation. This study provides a model for others who aim to develop behavioral, community-relevant interventions for cancer prevention and control with the overall goal of wide-scale implementation and dissemination. ",
doi="10.2196/32291",
url="https://cancer.jmir.org/2022/1/e32291",
url="http://www.ncbi.nlm.nih.gov/pubmed/35166681"
}


@Article{info:doi/10.2196/29289,
author="Ritchie, B. Jordon
and Frey, J. Lewis
and Lamy, Jean-Baptiste
and Bellcross, Cecelia
and Morrison, Heath
and Schiffman, D. Joshua
and Welch, M. Brandon",
title="Automated Clinical Practice Guideline Recommendations for Hereditary Cancer Risk Using Chatbots and Ontologies: System Description",
journal="JMIR Cancer",
year="2022",
month="Jan",
day="31",
volume="8",
number="1",
pages="e29289",
keywords="service-oriented architecture",
keywords="restful API",
keywords="hereditary cancer",
keywords="risk assessment",
keywords="clinical practice guidelines",
keywords="consumer health informatics",
abstract="Background: Identifying patients at risk of hereditary cancer based on their family health history is a highly nuanced task. Frequently, patients at risk are not referred for genetic counseling as providers lack the time and training to collect and assess their family health history. Consequently, patients at risk do not receive genetic counseling and testing that they need to determine the preventive steps they should take to mitigate their risk. Objective: This study aims to automate clinical practice guideline recommendations for hereditary cancer risk based on patient family health history. Methods: We combined chatbots, web application programming interfaces, clinical practice guidelines, and ontologies into a web service--oriented system that can automate family health history collection and assessment. We used Owlready2 and Prot{\'e}g{\'e} to develop a lightweight, patient-centric clinical practice guideline domain ontology using hereditary cancer criteria from the American College of Medical Genetics and Genomics and the National Cancer Comprehensive Network. Results: The domain ontology has 758 classes, 20 object properties, 23 datatype properties, and 42 individuals and encompasses 44 cancers, 144 genes, and 113 clinical practice guideline criteria. So far, it has been used to assess >5000 family health history cases. We created 192 test cases to ensure concordance with clinical practice guidelines. The average test case completes in 4.5 (SD 1.9) seconds, the longest in 19.6 seconds, and the shortest in 2.9 seconds. Conclusions: Web service--enabled, chatbot-oriented family health history collection and ontology-driven clinical practice guideline criteria risk assessment is a simple and effective method for automating hereditary cancer risk screening. ",
doi="10.2196/29289",
url="https://cancer.jmir.org/2022/1/e29289",
url="http://www.ncbi.nlm.nih.gov/pubmed/35099392"
}


@Article{info:doi/10.2196/31255,
author="Meghiref, Yasmine
and Parnot, Charles
and Duverger, Claire
and Difoum, Lilly Fran{\c{c}}oise
and Gourden, Audrey
and Yssaad, Halima
and Leiterer, Caroline
and Bedekovic, Caroline
and Blanchard, Julien
and Nait Ammar, Houria
and Schernberg, Antoine
and Vanquaethem, H{\'e}l{\`e}ne
and Helissey, Carole",
title="The Use of Telemedicine in Cancer Clinical Trials: Connect-Patient-to-Doctor Prospective Study",
journal="JMIR Cancer",
year="2022",
month="Jan",
day="27",
volume="8",
number="1",
pages="e31255",
keywords="telemedicine",
keywords="clinical trial",
keywords="neoplasms",
keywords="patient-reported outcome measures",
abstract="Background: Telemedicine is currently being adopted for the management of patients in routine care. However, its use remains limited in the context of clinical trials. Objective: This study aimed to demonstrate the feasibility of telemonitoring and patient-reported outcomes collection in the context of clinical trials. Methods: The patients who were included in an interventional oncology clinical trial were eligible. The patients were registered with a digital tool to respond to a patient-reported outcomes questionnaire (ePRO) based on CTCAE (The Common Terminology Criteria for Adverse Events, National Cancer Institute), version 5.0, personalized to their pathology and treatment. An algorithm evaluated the health status of the patient based on the reported adverse events, with a classification in 4 different states (correct, compromise, state to be monitored, or critical state). The main objective was to evaluate the feasibility of remote monitoring via a connected platform of patients included in a clinical trial. Results: From July 1, 2020, to March 31, 2021, 39 patients were included. The median age was 71 years (range 41-94); 74\% (n=29) were male, and 59\% (n=23) had metastatic disease. Out of the 969 ePRO questionnaires completed over the course of the study, 77.0\% (n=746) were classified as ``correct,'' 10.9\% (n=106) as ``compromised,'' and 12.1\% (n=117) as ``to be monitored'' or ``critical.'' The median response time was 7 days (IQR 7-15.5), and 76\% (25/33) of the patients were compliant. Out of the 35 patients who answered a satisfaction questionnaire, 95\% (n=33) were satisfied or very satisfied with the tool, and 85\% (n=30) were satisfied with their relationship with the health care team. There were 5 unscheduled hospitalizations during the study period. Conclusions: Remote monitoring in clinical trials is feasible, with a high level of patient participation and satisfaction. It benefits patients, but it also ensures the high quality of the trial through the early management of adverse events and better knowledge of the tolerance profile of experimental treatments. This e-technology will likely be deployed more widely in our clinical trials. ",
doi="10.2196/31255",
url="https://cancer.jmir.org/2022/1/e31255",
url="http://www.ncbi.nlm.nih.gov/pubmed/34921544"
}


@Article{info:doi/10.2196/34616,
author="Lama, Yuki
and Davidoff, J. Amy
and Vanderpool, C. Robin
and Jensen, E. Roxanne",
title="Telehealth Availability and Use of Related Technologies Among Medicare-Enrolled Cancer Survivors: Cross-sectional Findings From the Onset of the COVID-19 Pandemic",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="25",
volume="24",
number="1",
pages="e34616",
keywords="cancer survivor",
keywords="Medicare",
keywords="telehealth",
keywords="COVID-19",
keywords="availability",
keywords="use",
keywords="elderly",
keywords="older adults",
keywords="cancer",
keywords="sociodemographic",
keywords="internet",
keywords="communication",
keywords="population",
keywords="access",
abstract="Background: There has been rapid integration of telehealth into care delivery during the COVID-19 pandemic. However, little is known about technology ownership, internet access and use for communication, and telehealth availability among cancer survivors, particularly those enrolled in Medicare. Objective: This study aims to identify sociodemographic associations with technology ownership, internet access and use for communication, and telehealth availability in a population-based sample of Medicare-enrolled cancer survivors. Methods: Data are from the Medicare Current Beneficiary Survey COVID-19 Summer 2020 Supplement administered between June 10 and July 15, 2020. Analyses were restricted to beneficiaries who reported a prior (nonskin) cancer diagnosis and a usual source of care (N=2044). Dichotomous outcomes included technology ownership, internet access, internet use for communication, and telehealth availability from providers. Sociodemographic correlates included sex, age, race/ethnicity, Medicare/Medicaid dual enrollment, rurality, census region, and self-reported comorbidities. Results: Over half (957/2044, 53\%) of cancer survivors reported using the internet for communication purposes, and 62\% (1218/2044) reported that their usual provider had telehealth services available. Using the internet for communication purposes was reported less frequently for rural compared to urban survivors (adjusted probability of 28\% vs 46\%; P<.001) and for Hispanic and Black survivors compared to non-Hispanic White survivors (29\%, 31\%, and 44\%, respectively; all P<.01). Rural survivors reported lower telehealth availability (53\% vs 63\%; P<.001); no significant differences in telehealth availability were identified by race/ethnicity. Conclusions: During the COVID-19 pandemic, study findings highlight a complex digital divide among Medicare beneficiaries with a history of cancer related to device ownership necessary for telehealth, internet access and use for communication, and reports of providers having telehealth available. Multilevel approaches are needed to increase equitable telehealth availability and use for cancer survivors. Suggested strategies include increasing broadband internet access to providers and patients in at-risk communities, supporting telehealth implementation among providers that serve populations with known health disparities, raising awareness of providers' available telehealth services among patients, and screening for technology use and provision of telehealth-related technical assistance among older and historically underserved cancer survivors. ",
doi="10.2196/34616",
url="https://www.jmir.org/2022/1/e34616",
url="http://www.ncbi.nlm.nih.gov/pubmed/34978531"
}


@Article{info:doi/10.2196/29635,
author="Turner, Kea
and Bobonis Babilonia, Margarita
and Naso, Cristina
and Nguyen, Oliver
and Gonzalez, D. Brian
and Oswald, B. Laura
and Robinson, Edmondo
and Elston Lafata, Jennifer
and Ferguson, J. Robert
and Alishahi Tabriz, Amir
and Patel, B. Krupal
and Hallanger-Johnson, Julie
and Aldawoodi, Nasrin
and Hong, Young-Rock
and Jim, L. Heather S.
and Spiess, E. Philippe",
title="Health Care Providers' and Professionals' Experiences With Telehealth Oncology Implementation During the COVID-19 Pandemic: A Qualitative Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="19",
volume="24",
number="1",
pages="e29635",
keywords="telehealth",
keywords="telemedicine",
keywords="teleoncology",
keywords="digital health",
keywords="remote monitoring",
keywords="cancer",
keywords="oncology",
keywords="coronavirus disease",
keywords="COVID-19",
abstract="Background: Rapid implementation of telehealth for cancer care during COVID-19 required innovative and adaptive solutions among oncology health care providers and professionals (HPPs). Objective: The aim of this qualitative study was to explore oncology HPPs' experiences with telehealth implementation during the COVID-19 pandemic. Methods: This study was conducted at Moffitt Cancer Center (Moffitt), an NCI (National Cancer Institute)-Designated Comprehensive Cancer Center. Prior to COVID-19, Moffitt piloted telehealth visits on a limited basis. After COVID-19, Moffitt rapidly expanded telehealth visits. Telehealth visits included real-time videoconferencing between HPPs and patients and virtual check-ins (ie, brief communication with an HPP by telephone only). We conducted semistructured interviews with 40 oncology HPPs who implemented telehealth during COVID-19. The interviews were recorded, transcribed verbatim, and analyzed for themes using Dedoose software (version 4.12). Results: Approximately half of the 40 participants were physicians (n=22, 55\%), and one-quarter of the participants were advanced practice providers (n=10, 25\%). Other participants included social workers (n=3, 8\%), psychologists (n=2, 5\%), dieticians (n=2, 5\%), and a pharmacist (n=1, 3\%). Five key themes were identified: (1) establishing and maintaining patient-HPP relationships, (2) coordinating care with other HPPs and informal caregivers, (3) adapting in-person assessments for telehealth, (4) developing workflows and allocating resources, and (5) future recommendations. Participants described innovative strategies for implementing telehealth, such as coordinating interdisciplinary visits with multiple HPPs and inviting informal caregivers (eg, spouse) to participate in telehealth visits. Health care workers discussed key challenges, such as workflow integration, lack of physical exam and biometric data, and overcoming the digital divide (eg, telehealth accessibility among patients with communication-related disabilities). Participants recommended policy advocacy to support telehealth (eg, medical licensure policies) and monitoring how telehealth affects patient outcomes and health care delivery. Conclusions: To support telehealth growth, implementation strategies are needed to ensure that HPPs and patients have the tools necessary to effectively engage in telehealth. At the same time, cancer care organizations will need to engage in advocacy to ensure that policies are supportive of oncology telehealth and develop systems to monitor the impact of telehealth on patient outcomes, health care quality, costs, and equity. ",
doi="10.2196/29635",
url="https://www.jmir.org/2022/1/e29635",
url="http://www.ncbi.nlm.nih.gov/pubmed/34907900"
}


@Article{info:doi/10.2196/29485,
author="Fu, Rosemary Mei
and Axelrod, Deborah
and Guth, A. Amber
and Scagliola, Joan
and Rampertaap, Kavita
and El-Shammaa, Nardin
and Qiu, M. Jeanna
and McTernan, L. Melissa
and Frye, Laura
and Park, S. Christopher
and Yu, Gary
and Tilley, Charles
and Wang, Yao",
title="A Web- and Mobile-Based Intervention for Women Treated for Breast Cancer to Manage Chronic Pain and Symptoms Related to Lymphedema: Results of a Randomized Clinical Trial",
journal="JMIR Cancer",
year="2022",
month="Jan",
day="17",
volume="8",
number="1",
pages="e29485",
keywords="pain",
keywords="lymphatic exercises",
keywords="symptoms",
keywords="lymphedema",
keywords="breast cancer",
keywords="health behavior",
keywords="mHealth",
abstract="Background: The-Optimal-Lymph-Flow (TOLF) is a patient-centered, web- and mobile-based mHealth system that delivers safe, easy, and feasible digital therapy of lymphatic exercises and limb mobility exercises. Objective: The purpose of this randomized clinical trial (RCT) was to evaluate the effectiveness of the web- and mobile-based TOLF system for managing chronic pain and symptoms related to lymphedema. The primary outcome includes pain reduction, and the secondary outcomes focus on symptom relief, limb volume difference measured by infrared perometer, BMI, and quality of life (QOL) related to pain. We hypothesized that participants in the intervention group would have improved pain and symptom experiences, limb volume difference, BMI, and QOL. Methods: A parallel RCT with a control--experimental, pre- and posttest, and repeated-measures design were used. A total of 120 patients were recruited face-to-face at the point of care during clinical visits. Patients were randomized according to pain in a 1:1 ratio into either the arm precaution (AP) control group to improve limb mobility and arm protection or The-Optimal-Lymph flow (TOLF) intervention group to promote lymph flow and limb mobility. Trial outcomes were evaluated at baseline and at week 12 after the intervention. Descriptive statistics, Fisher exact tests, Wilcoxon rank-sum tests, t test, and generalized linear mixed effects models were performed for data analysis. Results: At the study endpoint of 12 weeks, significantly fewer patients in the TOLF intervention group compared with the AP control group reported chronic pain (45\% [27/60] vs 70\% [42/60]; odds ratio [OR] 0.39, 95\% CI 0.17-0.90; P=.02). Patients who received the TOLF intervention were significantly more likely to achieve a complete reduction in pain (50\% [23/46] vs 22\% [11/51]; OR 3.56, 95\% CI 1.39-9.76; P=.005) and soreness (43\% [21/49] vs 22\% [11/51]; OR 2.60, 95\% CI 1.03-6.81; P=.03). Significantly lower median severity scores were found in the TOLF group for chronic pain (MedTOLF=0, IQR 0-1 vs MedAP=1, IQR 0-2; P=.02) and general bodily pain (MedTOLF=1, IQR=0-1.5 vs MedAP=1, IQR 1-3; P=.04). Compared with the AP control group, significantly fewer patients in the TOLF group reported arm/hand swelling (P=.04), heaviness (P=.03), redness (P=.03), and limited movement in shoulder (P=.02) and arm (P=.03). No significant differences between the TOLF and AP groups were found in complete reduction of aching (P=.12) and tenderness (P=.65), mean numbers of lymphedema symptom reported (P=.11), ?5\% limb volume differences (P=.48), and BMI (P=.12). Conclusions: The TOLF intervention had significant benefits for breast cancer survivors to manage chronic pain, soreness, general bodily pain, arm/hand swelling, heaviness, and impaired limb mobility. The intervention resulted in a 13\% reduction (from 40\% [24/60] to 27\% [16/60]) in proportions of patients who took pain medications compared with the AP control group, which had a 5\% increase (from 40\% [24/60] to 45\% [27/60]). A 12\% reduction (from 27\% [16/60] to 15\% [9/60]) in proportions of patients with ?5\% limb volume differences was found in the TOLF intervention, while a 5\% increase in the AP control group (from 40\% [24/60] to 45\% [27/60]) was found. In conclusion, the TOLF intervention can be a better choice for breast cancer survivors to reduce chronic pain and limb volume. Trial Registration: Clinicaltrials.gov NCT02462226; https://clinicaltrials.gov/ct2/show/NCT02462226 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.5104 ",
doi="10.2196/29485",
url="https://cancer.jmir.org/2022/1/e29485",
url="http://www.ncbi.nlm.nih.gov/pubmed/35037883"
}


@Article{info:doi/10.2196/31576,
author="Van Blarigan, L. Erin
and Dhruva, Anand
and Atreya, E. Chloe
and Kenfield, A. Stacey
and Chan, M. June
and Milloy, Alexandra
and Kim, Iris
and Steiding, Paige
and Laffan, Angela
and Zhang, Li
and Piawah, Sorbarikor
and Fukuoka, Yoshimi
and Miaskowski, Christine
and Hecht, M. Frederick
and Kim, Mi-Ok
and Venook, P. Alan
and Van Loon, Katherine",
title="Feasibility and Acceptability of a Physical Activity Tracker and Text Messages to Promote Physical Activity During Chemotherapy for Colorectal Cancer: Pilot Randomized Controlled Trial (Smart Pace II)",
journal="JMIR Cancer",
year="2022",
month="Jan",
day="11",
volume="8",
number="1",
pages="e31576",
keywords="exercise",
keywords="treatment",
keywords="colon cancer",
keywords="rectal cancer",
keywords="digital health",
keywords="wearables",
keywords="SMS",
abstract="Background: We conducted a pilot 2-arm randomized controlled trial to assess the feasibility of a digital health intervention to increase moderate-to-vigorous physical activity in patients with colorectal cancer (CRC) during chemotherapy. Objective: This study aimed to determine whether a digital health physical activity intervention is feasible and acceptable during chemotherapy for CRC. Methods: Potentially eligible patients with CRC expected to receive at least 12 weeks of chemotherapy were identified in person at the University of California, San Francisco, and on the web through advertising. Eligible patients were randomized 1:1 to a 12-week intervention (Fitbit Flex, automated SMS text messages) versus usual care. At 0 and 12 weeks, patients wore an Actigraph GT3X+ accelerometer for 7 days and completed surveys, body size measurements, and an optional 6-minute walk test. Participants could not be masked to their intervention arm, but people assessing the body size and 6-minute walk test outcomes were masked. The primary outcomes were adherence (eg, Fitbit wear and text response rate) and self-assessed acceptability of the intervention. The intervention would be considered feasible if we observed at least 80\% complete follow-up and 70\% adherence and satisfaction, a priori. Results: From 2018 to 2020, we screened 240 patients; 53.3\% (128/240) of patients were ineligible and 26.7\% (64/240) declined to participate. A total of 44 patients (44/240, 18\%) were randomized to the intervention (n=22) or control (n=22) groups. Of these, 57\% (25/44) were women; 68\% (30/44) identified as White and 25\% (11/44) identified as Asian American or Pacific Islander; and 77\% (34/44) had a 4-year college degree. The median age at enrollment was 54 years (IQR 45-62 years). Follow-up at 12 weeks was 91\% (40/44) complete. In the intervention arm, patients wore Fitbit devices on a median of 67 out of 84 (80\%) study days and responded to a median of 17 out of 27 (63\%) questions sent via SMS text message. Among 19 out of 22 (86\%) intervention patients who completed the feedback survey, 89\% (17/19) were satisfied with the Fitbit device; 63\% (12/19) were satisfied with the SMS text messages; 68\% (13/19) said the SMS text messages motivated them to exercise; 74\% (14/19) said the frequency of SMS text messages (1-3 days) was ideal; and 79\% (15/19) said that receiving SMS text messages in the morning and evening was ideal. Conclusions: This pilot study demonstrated that many people receiving chemotherapy for CRC are interested in participating in digital health physical activity interventions. Fitbit adherence was high; however, participants indicated a desire for more tailored SMS text message content. Studies with more socioeconomically diverse patients with CRC are required. Trial Registration: ClinicalTrials.gov NCT03524716; https://clinicaltrials.gov/ct2/show/NCT03524716 ",
doi="10.2196/31576",
url="https://cancer.jmir.org/2022/1/e31576",
url="http://www.ncbi.nlm.nih.gov/pubmed/35014958"
}


@Article{info:doi/10.2196/19750,
author="Flippo, Brittany
and Stone, Bradley
and Stahr, Shelbie
and Khalil, Mahmoud
and Davis, Rodney
and Kamel, Mohamed
and Singh, Manisha",
title="Short-Term and Long-Term Renal Outcomes in Patients With Obesity After Minimally Invasive Versus Open Partial Nephrectomy for the Treatment of Renal Cancer: Retrospective Study",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="10",
volume="6",
number="1",
pages="e19750",
keywords="renal outcomes",
keywords="renal cell carcinoma",
keywords="minimally invasive vs open partial nephrectomy",
keywords="obesity",
keywords="kidney",
keywords="cancer",
keywords="surgery",
keywords="retrospective",
keywords="outcome",
keywords="short-term",
keywords="long-term",
abstract="Background: Obesity is significantly associated with renal cell carcinoma. Surgery is the preferred treatment for demarcated lesions of renal cell carcinoma; however, obesity increases the complexity of surgical outcomes. Minimally invasive surgical techniques are preferred over open partial nephrectomy (OPN), but controversy remains regarding the most efficacious technique in patients with obesity. Objective: This study aims to determine whether minimally invasive partial nephrectomy (MIPN) or OPN better preserves renal function and investigate short- and long-term renal outcomes in patients with obesity undergoing a partial nephrectomy. Methods: We conducted a retrospective chart review of 242 adult patients aged ?18 years who underwent MIPN or OPN between January 1, 2005, and December 31, 2016, at the University of Arkansas for Medical Sciences. Using creatinine as a measure of kidney function, patients' preoperative levels were compared with their postoperative levels in 2-time frames: short (3-6 months postsurgery) or long (>6 months). The primary outcome was the change in creatinine values from preoperative to >6 months postoperatively in patients with obesity. Secondary outcomes included the change in creatinine values from preoperative to 3 to 6 months postoperatively in patients with obesity who underwent MIPN versus OPN. We also analyzed the creatinine values of nonobese patients (BMI <30) who underwent partial nephrectomy using the same time frames. Unconditional logistic regression was used to estimate crude and multivariable-adjusted odds ratios (ORs) and 95\% CI to observe associations between surgery type and changes in creatinine values from while stratifying for obesity. Results: A total of 140 patients were included in the study, of whom 75 were obese and 65 were nonobese. At >6 months after MIPN (n=20), the odds of patients with obesity having a decrease or no change in creatinine values was 1.24 times higher than those who had OPN (n=13; OR 1.24, 95\% CI 0.299-6.729; P=.80). At 3 to 6 months after MIPN (n=27), the odds were 0.62 times lower than those after OPN (n=17; OR 0.62, 95\% CI 0.140-2.753; P=.56). In the nonobese group, at 3 to 6 months after undergoing minimally invasive surgery (n=18), the odds of having a decrease or no change in creatinine values was 4.86 times higher than those who had open surgery (n=21; OR 4.86, 95\% CI 1.085-21.809; P=.04). At more than 6 months after MIPN (n=14), the odds were 4.13 times higher than those after OPN (n=11; OR 4.13, 95\% CI 0.579-29.485; P=.16). Conclusions: We observed a nonstatistically significant preservation of renal function in patients with obesity who underwent OPN at 3 to 6 months postoperatively. Conversely, after 6 months, the same was true for MIPN, indicating the long-term benefit of MIPN. In the nonobese group, MIPN was favored over OPN.? ",
doi="10.2196/19750",
url="https://formative.jmir.org/2022/1/e19750",
url="http://www.ncbi.nlm.nih.gov/pubmed/35006078"
}


@Article{info:doi/10.2196/18083,
author="Ayyoubzadeh, Mohammad Seyed
and Shirkhoda, Mohammad
and R Niakan Kalhori, Sharareh
and Mohammadzadeh, Niloofar
and Zakerabasali, Somayyeh",
title="A Smartphone Remote Monitoring App to Follow Up Colorectal Cancer Survivors: Requirement Analysis",
journal="JMIR Cancer",
year="2022",
month="Jan",
day="5",
volume="8",
number="1",
pages="e18083",
keywords="eHealth",
keywords="app",
keywords="colorectal cancer",
keywords="survivors",
keywords="requirements analysis",
keywords="MoSCoW",
abstract="Background: Colorectal cancer survivors face multiple challenges after discharge. eHealth may potentially support them by providing tools such as smartphone apps. They have lots of capabilities to exchange information and could be used for remote monitoring of these patients. Objective: In this study, we addressed the required features for apps designed to follow up colorectal cancer patients based on survivors' and clinical experts' views. Methods: A mixed methods study was conducted. Features of related apps were extracted through the literature; the features were categorized, and then, they were modified. A questionnaire was designed containing the features listed and prioritized based on the MoSCoW (Must have, Should have, Could have, Won't have) technique and an open question for each category. The link to the questionnaire was shared among clinical experts in Iran. The answers were analyzed using the content validity ratio (CVR), and based on the value of this measure, the minimum feature set of a monitoring app to follow up patients with colorectal cancer was addressed. In addition, a telephone interview with colorectal cancer survivors was conducted to collect their viewpoints regarding a remote monitoring system for colorectal cancer cases. Results: The questionnaire contained 10 sections evaluating 9 categories of features. The questionnaire was completed by 18 experts. The minimum set of features in the app was identified as patient information registration, sign and symptom monitoring, education, reminders, and patient evaluation (0.42 < CVR < 0.85). Features including physical activity, personalized advice, and social network did not achieve the minimum score (--0.11 < CVR < 0.39). We interviewed 9 colorectal cancer survivors. Information registration, sign and symptom monitoring, education, and personalized advice were the features with high priority from the survivors' perspectives. Scheduling, shopping, and financial support features were emphasized by survivors in the interview. Conclusions: The requirement set could be used to design an app for the targeted population or patients affected by other cancers. As the views from both survivors and clinical experts were considered in this study, the remote system may more adequately fulfill the need for follow-up of survivors. This eases the patients' and health care providers' communication and interaction. ",
doi="10.2196/18083",
url="https://cancer.jmir.org/2022/1/e18083",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989685"
}


@Article{info:doi/10.2196/34502,
author="Jones, R. Sarah
and Vidrine, J. Damon
and Wetter, W. David
and Shih, Tina Ya-Chen
and Sutton, K. Steven
and Ramondetta, M. Lois
and Elting, S. Linda
and Walker, L. Joan
and Smith, M. Katie
and Frank-Pearce, G. Summer
and Li, Yisheng
and Simmons, N. Vani
and Vidrine, I. Jennifer",
title="Evaluation of the Efficacy of a Smoking Cessation Intervention for Cervical Cancer Survivors and Women With High-Grade Cervical Dysplasia: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="30",
volume="10",
number="12",
pages="e34502",
keywords="smoking cessation",
keywords="cervical cancer",
keywords="cancer survivor",
keywords="motivation",
keywords="tobacco treatment",
keywords="cancer",
keywords="smoking",
keywords="RCT",
keywords="randomized controlled trial",
keywords="cognitive behavior",
keywords="intervention",
abstract="Background: The prevalence of smoking among cervical cancer survivors is strikingly high, yet no smoking cessation interventions to date have specifically targeted this population. This paper describes the study design, methods, and data analysis plans for a randomized clinical trial designed to evaluate the efficacy of a theoretically and empirically based Motivation And Problem Solving (MAPS) approach for promoting and facilitating smoking cessation among cervical cancer survivors. MAPS is a comprehensive, dynamic, and holistic intervention that incorporates empirically supported cognitive behavioral and social cognitive theory--based treatment strategies within an overarching motivational framework. MAPS is designed to be appropriate for all smokers regardless of their motivation to change and views motivation as dynamically fluctuating from moment to moment throughout the behavior change process. Objective: This 2-group randomized controlled trial compares the efficacy of standard treatment to MAPS in facilitating smoking cessation among women with a history of high-grade cervical dysplasia or cervical cancer. Methods: Participants (N=202) are current smokers with a history of high-grade cervical dysplasia or cervical cancer recruited nationally and randomly assigned to one of two treatment conditions: (1) standard treatment (ST) or (2) MAPS. ST consists of repeated letters referring participants to their state's tobacco cessation quitline, standard self-help materials, and free nicotine replacement therapy when ready to quit. MAPS has all ST components along with 6 proactive telephone counseling sessions delivered over 12 months. The primary outcome is abstinence from tobacco at 18 months. Secondary outcomes include abstinence over time across all assessment points, abstinence at other individual assessment time points, quit attempts, cigarettes per day, and use of state quitlines. Hypothesized treatment mechanisms and cost-effectiveness will also be evaluated. Results: This study was approved by the institutional review boards at the University of Texas MD Anderson Cancer Center, the University of Oklahoma Health Sciences Center, and Moffitt Cancer Center. Participant enrollment concluded at Moffitt Cancer Center in January 2020, and follow-up data collection was completed in July 2021. Data analysis is ongoing. Conclusions: This study will yield crucial information regarding the efficacy and cost-effectiveness of a MAPS approach for smoking cessation tailored to the specific needs of women with a history of high-grade cervical dysplasia or cervical cancer. Findings indicating that MAPS has substantially greater efficacy than existing evidence-based tobacco cessation treatments would have tremendous public health significance. Trial Registration: ClinicalTrials.gov NCT02157610; https://clinicaltrials.gov/ct2/show/NCT02157610 International Registered Report Identifier (IRRID): DERR1-10.2196/34502 ",
doi="10.2196/34502",
url="https://www.researchprotocols.org/2021/12/e34502",
url="http://www.ncbi.nlm.nih.gov/pubmed/34967755"
}


@Article{info:doi/10.2196/33130,
author="Dennett, Amy
and Harding, E. Katherine
and Reimert, Jacoba
and Morris, Rebecca
and Parente, Phillip
and Taylor, F. Nicholas",
title="Telerehabilitation's Safety, Feasibility, and Exercise Uptake in Cancer Survivors: Process Evaluation",
journal="JMIR Cancer",
year="2021",
month="Dec",
day="21",
volume="7",
number="4",
pages="e33130",
keywords="telehealth",
keywords="exercise",
keywords="telerehabilitation",
keywords="physical activity",
keywords="supportive care",
keywords="COVID-19",
keywords="feasibility",
keywords="cancer",
keywords="cancer survivor",
keywords="evaluation",
keywords="rehabilitation",
keywords="impact",
keywords="development",
keywords="implementation",
abstract="Background: Access to exercise for cancer survivors is poor despite global recognition of its benefits. Telerehabilitation may overcome barriers to exercise for cancer survivors but is not routinely offered. Objective: Following the rapid implementation of an exercise-based telerehabilitation program in response to COVID-19, a process evaluation was conducted to understand the impact on patients, staff, and the health service with the aim of informing future program development. Methods: A mixed methods evaluation was completed for a telerehabilitation program for cancer survivors admitted between March and December 2020. Interviews were conducted with patients and staff involved in implementation. Routinely collected hospital data (adverse events, referrals, admissions, wait time, attendance, physical activity, and quality of life) were also assessed. Patients received an 8-week telerehabilitation intervention including one-on-one health coaching via telehealth, online group exercise and education, information portal, and home exercise prescription. Quantitative data were reported descriptively, and qualitative interview data were coded and mapped to the Proctor model for implementation research. Results: The telerehabilitation program received 175 new referrals over 8 months. Of those eligible, 123 of 150 (82\%) commenced the study. There were no major adverse events. Adherence to health coaching was high (674/843, 80\% of scheduled sessions), but participation in online group exercise classes was low (n=36, 29\%). Patients improved their self-reported physical activity levels by a median of 110 minutes per week (IQR 90-401) by program completion. Patients were satisfied with telerehabilitation, but clinicians reported a mixed experience of pride in rapid care delivery contrasting with loss of personal connections. The average health service cost per patient was Aus \$1104 (US \$790). Conclusions: Telerehabilitation is safe, feasible, and improved outcomes for cancer survivors. Learnings from this study may inform the ongoing implementation of cancer telerehabilitation. ",
doi="10.2196/33130",
url="https://cancer.jmir.org/2021/4/e33130",
url="http://www.ncbi.nlm.nih.gov/pubmed/34854817"
}


@Article{info:doi/10.2196/31128,
author="Shahzadi, Kiran Syeda
and Karuvantevida, Noushad
and Banerjee, Yajnavalka",
title="A Venomics Approach to the Identification and Characterization of Bioactive Peptides From Animal Venoms for Colorectal Cancer Therapy: Protocol for a Proof-of-Concept Study",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="21",
volume="10",
number="12",
pages="e31128",
keywords="animal venoms",
keywords="colorectal cancer",
keywords="bioactive peptides",
keywords="high-throughput screening",
keywords="venom",
keywords="cancer",
keywords="colorectal",
keywords="peptide",
keywords="screening",
keywords="treatment",
keywords="conceptual",
keywords="characterize",
keywords="development",
keywords="therapy",
abstract="Background: Cancer is the third leading cause of death in the United Arab Emirates (UAE), after cardiovascular diseases and accidents. In the UAE, colorectal cancer (CRC) is the first and fourth most common cancer in males and females, respectively. Several treatment modalities have been employed for cancer treatment, such as surgery, radiotherapy, chemotherapy, hormone replacement therapy, and immunotherapy. These treatment modalities often elicit adverse effects on normal cells, causing toxic side effects. To circumvent these toxicities, there has been an increased impetus towards the identification of alternate treatment strategies. Animal venoms are rich sources of pharmacologically active polypeptides and proteins. Objective: In this proof-of-concept study, we will apply a high-throughput venomics strategy to identify and characterize anticancer bioactive peptides (BAPs) from 20 different animal venoms, specifically targeting CRC. We chose to focus on CRC because it is one of the foremost health issues in the UAE. Methods: In the initial study, we will screen 2500 different peptides derived from 20 different animal venoms for anticancer activity specifically directed against 3 CRC cell lines and two control cell lines employing the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) colorimetric assay for cytotoxicity. Of the 20 venoms, 3 that exhibit specific and potent anticancer activity directed against the 3 CRC cell lines will be selected; and from these 3 venoms, the specific peptides with anti-CRC activity will be isolated and characterized. Results: This study is at the protocol development stage only, and as such, no results are available. However, we have initiated the groundwork required to disseminate the proposed study, which includes culturing of colorectal cancer cell lines and preparation of venom screens. Conclusions: In summary, the proposed study will generate therapeutic leads to manage and treat one of the leading health issues in the UAE, namely, CRC. International Registered Report Identifier (IRRID): PRR1-10.2196/31128 ",
doi="10.2196/31128",
url="https://www.researchprotocols.org/2021/12/e31128",
url="http://www.ncbi.nlm.nih.gov/pubmed/34932002"
}


@Article{info:doi/10.2196/29912,
author="Abdulkarim, S. Louay
and Motley, J. Richard",
title="First-line Advanced Cutaneous Melanoma Treatments: Where Do We Stand?",
journal="JMIR Cancer",
year="2021",
month="Dec",
day="15",
volume="7",
number="4",
pages="e29912",
keywords="advanced cutaneous melanoma",
keywords="first-line treatments",
keywords="immunotherapy",
keywords="targeted therapy",
keywords="combinational therapy",
keywords="dermatologic adverse events",
keywords="cutaneous side effects",
doi="10.2196/29912",
url="https://cancer.jmir.org/2021/4/e29912",
url="http://www.ncbi.nlm.nih.gov/pubmed/34914610"
}


@Article{info:doi/10.2196/27639,
author="Luo, Yuanhui
and Xia, Wei
and Cheung, Tan Ankie
and Ho, Kwan Laurie Long
and Zhang, Jingping
and Xie, Jianhui
and Xiao, Pin
and Li, William Ho Cheung",
title="Effectiveness of a Mobile Device--Based Resilience Training Program in Reducing Depressive Symptoms and Enhancing Resilience and Quality of Life in Parents of Children With Cancer: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="29",
volume="23",
number="11",
pages="e27639",
keywords="depressive symptoms",
keywords="pediatric cancer",
keywords="parents",
keywords="quality of life",
keywords="resilience",
keywords="mobile phone",
abstract="Background: Caring for children with cancer can be a stressful experience for parents and may have negative effects on their physical and psychological well-being. Although evidence has shown that resilience is associated with positive psychological well-being, few interventions have been specifically designed to enhance the resilience of parents of children with cancer. Objective: The aim of this study is to examine the effectiveness of a mobile device--based resilience training program in reducing depressive symptoms and enhancing resilience and quality of life (QoL) in parents of children with cancer. Methods: Parents of children diagnosed with cancer were recruited from the pediatric oncology wards of 3 tertiary hospitals in China. The participants were randomly assigned to either the experimental group (52/103, 50.5\%) to undergo an 8-week mobile device--based resilience training program or to the control group (51/103, 49.5\%) to receive an 8-week program of placebo information. The study outcomes included resilience, depressive symptoms, and QoL, as measured by the Connor--Davidson Resilience Scale, the Self-Rating Depression Scale, and the Short Form of the 6-Dimension Health Survey, respectively. All data were collected at baseline and at 2 and 6 months of follow-up. The data analysis followed the intention-to-treat principle. A generalized estimating equation was used to examine the effects of the intervention. Results: The participants were mostly female (72/103, 69.9\%), and their mean age was 33.6 (SD 5.2) years. The participants in the experimental group showed significantly higher levels of resilience (mean 67.96, SD 15.8 vs mean 58.27, SD 19.0; P<.001) and lower levels of depressive symptoms (mean 40.17, SD 9.9 vs mean 46.04, SD 10.9; P<.001) than those in the control group at 6 months of follow-up. The intervention showed statistically significant effects in improving resilience ($\beta$=6.082; P=.01) and decreasing depressive symptoms ($\beta$=?2.772; P=.04) relative to the control group. The QoL score in the experimental group was higher than that in the control group at 6 months of follow-up (mean 0.79, SD 0.2 vs mean 0.76, SD 0.3; P=.07); however, no statistically significant intervention effect was detected ($\beta$=.020; P=.38). Conclusions: The mobile device--based resilience training program effectively enhanced resilience and alleviated depressive symptoms in parents of children with cancer. It is highly recommended that health care professionals incorporate this resilience training program when providing psychological care to parents of children with cancer. Trial Registration: Clinical.Trials.gov NCT04038242; http://clinicaltrials.gov/ct2/show/NCT04038242 ",
doi="10.2196/27639",
url="https://www.jmir.org/2021/11/e27639",
url="http://www.ncbi.nlm.nih.gov/pubmed/34847060"
}


@Article{info:doi/10.2196/27850,
author="Xu, Lu
and Sanders, Leslie
and Li, Kay
and Chow, L. James C.",
title="Chatbot for Health Care and Oncology Applications Using Artificial Intelligence and Machine Learning: Systematic Review",
journal="JMIR Cancer",
year="2021",
month="Nov",
day="29",
volume="7",
number="4",
pages="e27850",
keywords="chatbot",
keywords="artificial intelligence",
keywords="machine learning",
keywords="health",
keywords="medicine",
keywords="communication",
keywords="diagnosis",
keywords="cancer therapy",
keywords="ethics",
keywords="medical biophysics",
keywords="mobile phone",
abstract="Background: Chatbot is a timely topic applied in various fields, including medicine and health care, for human-like knowledge transfer and communication. Machine learning, a subset of artificial intelligence, has been proven particularly applicable in health care, with the ability for complex dialog management and conversational flexibility. Objective: This review article aims to report on the recent advances and current trends in chatbot technology in medicine. A brief historical overview, along with the developmental progress and design characteristics, is first introduced. The focus will be on cancer therapy, with in-depth discussions and examples of diagnosis, treatment, monitoring, patient support, workflow efficiency, and health promotion. In addition, this paper will explore the limitations and areas of concern, highlighting ethical, moral, security, technical, and regulatory standards and evaluation issues to explain the hesitancy in implementation. Methods: A search of the literature published in the past 20 years was conducted using the IEEE Xplore, PubMed, Web of Science, Scopus, and OVID databases. The screening of chatbots was guided by the open-access Botlist directory for health care components and further divided according to the following criteria: diagnosis, treatment, monitoring, support, workflow, and health promotion. Results: Even after addressing these issues and establishing the safety or efficacy of chatbots, human elements in health care will not be replaceable. Therefore, chatbots have the potential to be integrated into clinical practice by working alongside health practitioners to reduce costs, refine workflow efficiencies, and improve patient outcomes. Other applications in pandemic support, global health, and education are yet to be fully explored. Conclusions: Further research and interdisciplinary collaboration could advance this technology to dramatically improve the quality of care for patients, rebalance the workload for clinicians, and revolutionize the practice of medicine. ",
doi="10.2196/27850",
url="https://cancer.jmir.org/2021/4/e27850",
url="http://www.ncbi.nlm.nih.gov/pubmed/34847056"
}


@Article{info:doi/10.2196/22931,
author="Ghods, Alireza
and Shahrokni, Armin
and Ghasemzadeh, Hassan
and Cook, Diane",
title="Remote Monitoring of the Performance Status and Burden of Symptoms of Patients With Gastrointestinal Cancer Via a Consumer-Based Activity Tracker: Quantitative Cohort Study",
journal="JMIR Cancer",
year="2021",
month="Nov",
day="26",
volume="7",
number="4",
pages="e22931",
keywords="step count",
keywords="performance status",
keywords="symptom",
keywords="wearable",
keywords="activity tracker",
keywords="gastrointestinal cancer",
keywords="monitoring",
keywords="cancer",
keywords="gastrointestinal",
keywords="burden",
abstract="Background: The number of older patients with gastrointestinal cancer is increasing due to an aging global population. Minimizing reliance on an in-clinic patient performance status test to determine a patient's prognosis and course of treatment can improve resource utilization. Further, current performance status measurements cannot capture patients' constant changes. These measurements also rely on self-reports, which are subjective and subject to bias. Real-time monitoring of patients' activities may allow for a more accurate assessment of patients' performance status while minimizing resource utilization. Objective: This study investigates the validity of consumer-based activity trackers for monitoring the performance status of patients with gastrointestinal cancer. Methods: A total of 27 consenting patients (63\% male, median age 58 years) wore a consumer-based activity tracker 7 days before chemotherapy and 14 days after receiving their first treatment. The provider assessed patients using the Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scale and Memorial Symptom Assessment Scale-Short Form (MSAS-SF) before and after chemotherapy visits. The statistical correlations between ECOG-PS and MSAS-SF scores and patients' daily step counts were assessed. Results: The daily step counts yielded the highest correlation with the patients' ECOG-PS scores after chemotherapy (P<.001). The patients with higher ECOG-PS scores experienced a higher fluctuation in their step counts. The patients who walked more prechemotherapy (mean 6071 steps per day) and postchemotherapy (mean 5930 steps per day) had a lower MSAS-SF score (lower burden of symptoms) compared to patients who walked less prechemotherapy (mean 5205 steps per day) and postchemotherapy (mean 4437 steps per day). Conclusions: This study demonstrates the feasibility of using inexpensive, consumer-based activity trackers for the remote monitoring of performance status in the gastrointestinal cancer population. The findings need to be validated in a larger population for generalizability. ",
doi="10.2196/22931",
url="https://cancer.jmir.org/2021/4/e22931",
url="http://www.ncbi.nlm.nih.gov/pubmed/34842527"
}


@Article{info:doi/10.2196/32609,
author="Santos, D. Amanda
and Caine, Vera
and Robson, J. Paula
and Watson, Linda
and Easaw, C. Jacob
and Petrovskaya, Olga",
title="Oncology Patients' Experiences With Novel Electronic Patient Portals to Support Care and Treatment: Qualitative Study With Early Users and Nonusers of Portals in Alberta, Canada",
journal="JMIR Cancer",
year="2021",
month="Nov",
day="24",
volume="7",
number="4",
pages="e32609",
keywords="patient portal",
keywords="MyChart",
keywords="health information and communication technology",
keywords="eHealth",
keywords="personal health information",
keywords="oncology",
keywords="cancer care",
keywords="Canada",
keywords="qualitative",
keywords="context of technology implementation",
abstract="Background: With the current proliferation of clinical information technologies internationally, patient portals are increasingly being adopted in health care. Research, conducted mostly in the United States, shows that oncology patients have a keen interest in portals to gain access to and track comprehensive personal health information. In Canada, patient portals are relatively new and research into their use and effects is currently emerging. There is a need to understand oncology patients' experiences of using eHealth tools and to ground these experiences in local sociopolitical contexts of technology implementation, while seeking to devise strategies to enhance portal benefits. Objective: The purpose of this study was to explore the experiences of oncology patients and their family caregivers when using electronic patient portals to support their health care needs. We focused on how Alberta's unique, 2-portal context shapes experiences of early portal adopters and nonadopters, in anticipation of a province-wide rollout of a clinical information system in oncology facilities. Methods: This qualitative descriptive study employed individual semistructured interviews and demographic surveys with 11 participants. Interviews were audio-recorded and transcribed verbatim. Data were analyzed thematically. The study was approved by the University of Alberta Human Research Ethics Board. Results: Participants currently living with nonactive cancer discussed an online patient portal as one among many tools (including the internet, phone, videoconferencing, print-out reports) available to make sense of their diagnosis and treatment, maintain connections with health care providers, and engage with information. In the Fall of 2020, most participants had access to 1 of 2 of Alberta's patient portals and identified ways in which this portal was supportive (or not) of their ongoing health care needs. Four major themes, reflecting the participants' broader concerns within which the portal use was occurring, were generated from the data: (1) experiencing doubt and the desire for transparency; (2) seeking to become an informed and active member of the health care team; (3) encountering complexity; and (4) emphasizing the importance of the patient--provider relationship. Conclusions: Although people diagnosed with cancer and their family caregivers considered an online patient portal as beneficial, they identified several areas that limit how portals support their oncology care. Providers of health care portals are invited to recognize these limitations and work toward addressing them. ",
doi="10.2196/32609",
url="https://cancer.jmir.org/2021/4/e32609",
url="http://www.ncbi.nlm.nih.gov/pubmed/34822338"
}


@Article{info:doi/10.2196/31966,
author="Lo, Jonathon
and Ballurkar, Kieran
and Fox, Simonie
and Tynan, Kate
and Luu, Nghiep
and Boyer, Michael
and Murali-Ganesh, Raghav",
title="A Digital Coaching Intervention for Cancer Survivors With Job Loss: Retrospective Study",
journal="JMIR Cancer",
year="2021",
month="Nov",
day="23",
volume="7",
number="4",
pages="e31966",
keywords="cancer survivors",
keywords="employment",
keywords="absenteeism",
keywords="mobile app",
keywords="software",
keywords="return to work",
abstract="Background: Returning to work is a key unmet need for working-age cancer survivors. Objective: This study sought to evaluate return-to-work outcomes of a multidisciplinary intervention provided as routine employee support. Methods: In a retrospective cohort analysis, patients with cancer and more than 3 months of absence from work were provided with an intervention consisting of digital resources and calls with a health coach. Propensity score matching was used to define a similar cohort of cancer patients absent from work, who were not offered the coaching intervention. The return-to-work rate as a percentage of all participants and secondary outcomes, such as the rate of death, were measured. The median time to return to work was compared between the cohorts using the Kaplan-Meier method. Results: A total of 220 participants were enrolled in the intervention, of which 125 met the criteria for analysis. The median follow-up from cancer diagnosis was 79 weeks (IQR 60-106 weeks). In the matched control group, 22 (17.6\%) participants returned to work compared with 38 (30.4\%) in the intervention group (P=.02). Additionally, 19 (15.2\%) matched controls died prior to claim closure compared with 13 (10.4\%) in the intervention group (P=.26). The Kaplan-Meier estimated median time for the first 15\% of the cohort to return to work was 87.1 weeks (95\% CI 60.0-109.1 weeks) for the matched control group compared with 70.6 weeks (95\% CI 52.6-79.6 weeks; P=.08) for the intervention group. Conclusions: Patients receiving a remotely delivered coaching program in a real-world setting returned to work at a higher frequency than did control participants receiving usual care. ",
doi="10.2196/31966",
url="https://cancer.jmir.org/2021/4/e31966",
url="http://www.ncbi.nlm.nih.gov/pubmed/34710853"
}


@Article{info:doi/10.2196/27893,
author="El Haidari, Rana
and Anota, Amelie
and Abou-Abbas, Linda
and Nerich, Virginie",
title="Health-Related Quality of Life of Lebanese Women With Breast Cancer: Protocol for a Prospective Cohort Study",
journal="JMIR Res Protoc",
year="2021",
month="Nov",
day="23",
volume="10",
number="11",
pages="e27893",
keywords="breast cancer",
keywords="cohort",
keywords="health-related quality of life",
keywords="Lebanese women",
keywords="prospective",
abstract="Background: In the past few decades, Lebanon has witnessed a significant increase in the incidence rates of women diagnosed with breast cancer. This increase, which is associated with the advancements in treatment modalities, emphasizes the need to evaluate the health-related quality of life (HRQoL) of women with breast cancer and to compare its patterns before and after breast-conserving surgery (BCS). Objective: This study aims to describe changes in HRQoL according to body image pre- and post-BCS and just before initiation of adjuvant therapy in newly diagnosed patients with breast cancer in Lebanon. Methods: A prospective cohort study targeting Lebanese women newly diagnosed with breast cancer and who have an indication for BCS will be conducted in 2 health care facilities. Baseline characteristics and clinical data will be collected. The European Organization for Research and Treatment of Cancer Quality-of-Life cancer-specific and breast cancer--specific questionnaires will be used to assess HRQoL. The outcomes will be measured at baseline and 1 day after breast surgery. The primary outcome will be the body image dimensions of the Quality-of-Life breast cancer--specific questionnaire. Statistical analyses will include descriptive statistics, paired 2-tailed t test, and stepwise multiple regression. A total of 120 patients will be required. Results: A total of 120 patients were enrolled in the study. Future outcomes will be published in professional peer-reviewed health-related research journals. Conclusions: This study is strengthened by its follow-up nature, allowing us to draw conclusions about causality. The results of this study will identify the most affected components of HRQoL, as well as the factors that could play a role in improving HRQoL among women undergoing BCS. The findings of this study will help decision makers, physicians, and social workers to design a comprehensive program with multidisciplinary components for the management and care of patients with breast cancer in Lebanon. International Registered Report Identifier (IRRID): DERR1-10.2196/27893 ",
doi="10.2196/27893",
url="https://www.researchprotocols.org/2021/11/e27893",
url="http://www.ncbi.nlm.nih.gov/pubmed/34817382"
}


@Article{info:doi/10.2196/22140,
author="Su, Zhaohui
and Li, Xiaoshan
and McDonnell, Dean
and Fernandez, A. Andrea
and Flores, E. Bertha
and Wang, Jing",
title="Technology-Based Interventions for Cancer Caregivers: Concept Analysis",
journal="JMIR Cancer",
year="2021",
month="Nov",
day="16",
volume="7",
number="4",
pages="e22140",
keywords="concept analysis",
keywords="caregivers",
keywords="cancer",
keywords="oncology",
keywords="technology-based interventions",
keywords="mobile phone",
abstract="Background: Cancer is a taxing chronic disease that demands substantial care, most of which is shouldered by informal caregivers. As a result, cancer caregivers often have to manage considerable challenges that could result in severe physical and psychological health consequences. Technology-based interventions have the potential to address many, if not all, of the obstacles caregivers encounter while caring for patients with cancer. However, although the application of technology-based interventions is on the rise, the term is seldom defined in research or practice. Considering that the lack of conceptual clarity of the term could compromise the effectiveness of technology-based interventions for cancer caregivers, timely research is needed to bridge this gap. Objective: This study aims to clarify the meaning of technology-based interventions in the context of cancer caregiving and provide a definition that can be used by cancer caregivers, patients, clinicians, and researchers to facilitate evidence-based research and practice. Methods: The 8-step concept analysis method by Walker and Avant was used to analyze the concept of technology-based interventions in the context of cancer caregiving. PubMed, PsycINFO, CINAHL, and Scopus were searched for studies that examined technology-based interventions for cancer caregivers. Results: The defining attributes of technology-based interventions were recognized as being accessible, affordable, convenient, and user-friendly. On the basis of insights gained on the defining attributes, antecedents to, and consequences of technology-based interventions through the concept analysis process, technology-based interventions were defined as the use of technology to design, develop, and deliver health promotion contents and strategies aimed at inducing or improving positive physical or psychological health outcomes in cancer caregivers. Conclusions: This study clarified the meaning of technology-based interventions in the context of cancer caregiving and provided a clear definition that can be used by caregivers, patients, clinicians, and researchers to facilitate evidence-based oncology practice. A clear conceptualization of technology-based interventions lays foundations for better intervention design and research outcomes, which in turn have the potential to help health care professionals address the needs and preferences of cancer caregivers more cost-effectively. ",
doi="10.2196/22140",
url="https://cancer.jmir.org/2021/4/e22140",
url="http://www.ncbi.nlm.nih.gov/pubmed/34783664"
}


@Article{info:doi/10.2196/27073,
author="Elsamany, Shereef
and Elbaiomy, Mohamed
and Zeeneldin, Ahmed
and Tashkandi, Emad
and Hassanin, Fayza
and Abdelhafeez, Nafisa
and O Al-Shamsi, Humaid
and Bukhari, Nedal
and Elemam, Omima",
title="Suggested Modifications to the Management of Patients With Breast Cancer During the COVID-19 Pandemic: Web-Based Survey Study",
journal="JMIR Cancer",
year="2021",
month="Nov",
day="15",
volume="7",
number="4",
pages="e27073",
keywords="breast cancer",
keywords="COVID-19",
keywords="pandemic",
keywords="web-based survey",
keywords="treatment modification",
keywords="oncology",
keywords="treatment",
keywords="modification",
keywords="risk",
keywords="infection",
abstract="Background: Management of patients with cancer in the current era of the COVID-19 pandemic poses a significant challenge to health care systems. Breast cancer is the most common cancer internationally. Breast cancer is a disease that involves surgery, chemotherapy, hormonal therapy, targeted therapy, radiotherapy, and, more recently, immunotherapy in its management plan. The immune system requires months to recover from these medications, and this condition is even worse in patients with metastatic breast cancer who need ongoing treatment with these drugs. Some of these drugs, such as inhibitors of cyclin-dependent kinases 4 and 6, can cause rare but life-threating lung inflammation. Patients with breast cancer who have metastatic disease to the lungs can experience deterioration of disease symptoms with COVID-19 infection. Oncologists treating patients with breast cancer are facing a difficult situation regarding treatment choice. The impact that COVID-19 has had on breast cancer care is unknown, including how to provide the best care possible without compromising patient and community safety. Objective: The aim of this study was to explore the views of oncologists regarding the management of patients with breast cancer during the COVID-19 pandemic. Methods: A web-based SurveyMonkey questionnaire was submitted to licensed oncologists involved in breast cancer management in Saudi Arabia, Egypt, and United Arab Emirates. The survey focused on characteristics of the participants, infection risk among patients with cancer, and possible treatment modifications related to different types of breast cancer. Results: The survey was completed by 82 participants. For early hormone receptor (HR)--positive, human epidermal growth factor receptor 2 (HER2)--negative breast cancer, 61 of the 82 participants (74\%) supported using neoadjuvant hormonal therapy in selected patients, and 58\% (48/82) preferred giving 6 over 8 cycles of adjuvant chemotherapy when indicated. Only 43\% (35/82) preferred inhibitors of cyclin-dependent kinases 4 and 6 with hormonal therapy as the first-line treatment in all patients with metastatic HR-positive disease. A total of 55 of the 82 participants (67\%) supported using adjuvant trastuzumab for 6 instead of 12 months in selected patients with HER2-positive breast cancer. For metastatic HER2-positive, HR-positive breast cancer, 80\% of participants (66/82) supported the use of hormonal therapy with dual anti-HER2 blockade in selected patients. The preferred choice of first-line treatment in metastatic triple negative patients with BRCA mutation and programmed cell death 1 ligand 1 (PD-L1) <1\% was poly(adenosine diphosphate--ribose) polymerase inhibitor according to 41\% (34/82) of the participants, and atezolizumab with nab-paclitaxel was preferred for PD-L1 >1\% according to 71\% (58/82) of the participants. Conclusions: Several modifications in breast cancer management were supported by the survey participants. These modifications need to be discussed on a local basis, taking into account the local infrastructure and available resources. ",
doi="10.2196/27073",
url="https://cancer.jmir.org/2021/4/e27073",
url="http://www.ncbi.nlm.nih.gov/pubmed/34726611"
}


@Article{info:doi/10.2196/24722,
author="Marthick, Michael
and McGregor, Deborah
and Alison, Jennifer
and Cheema, Birinder
and Dhillon, Haryana
and Shaw, Tim",
title="Supportive Care Interventions for People With Cancer Assisted by Digital Technology: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="29",
volume="23",
number="10",
pages="e24722",
keywords="digital health",
keywords="telehealth",
keywords="eHealth",
keywords="neoplasm",
keywords="supportive care",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Although relatively new, digital health interventions are demonstrating rapid growth because of their ability to facilitate access and overcome issues of location, time, health status, and most recently, the impact of a major pandemic. With the increased uptake of digital technologies, digital health has the potential to improve the provision of supportive cancer care. Objective: This systematic review aims to evaluate digital health interventions for supportive cancer care. Methods: Published literature between 2000 and 2020 was systematically searched in MEDLINE, PubMed, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, and Scopus. Eligible publications were randomized controlled trials of clinician-led digital health interventions to support adult cancer patients. The interventions included were determined by applying a digital health conceptual model. Studies were appraised for quality using the revised Cochrane risk of bias tool. Results: Twenty randomized controlled trials met the inclusion criteria for the analysis. Interventions varied by duration, frequency, degree of technology use, and applied outcome measures. Interventions targeting a single tumor stream, predominantly breast cancer, and studies involving the implementation of remote symptom monitoring have dominated the results. In most studies, digital intervention resulted in significant positive outcomes in patient-reported symptoms, levels of fatigue and pain, health-related quality of life, functional capacity, and depression levels compared with the control. Conclusions: Digital health interventions are helpful and effective for supportive care of patients with cancer. There is a need for high-quality research. Future endeavors could focus on the use of valid, standardized outcome measures, maintenance of methodological rigor, and strategies to improve patient and health professional engagement in the design and delivery of supportive digital health interventions. Trial Registration: PROSPERO CRD42020149730; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=149730 ",
doi="10.2196/24722",
url="https://www.jmir.org/2021/10/e24722",
url="http://www.ncbi.nlm.nih.gov/pubmed/34714246"
}


@Article{info:doi/10.2196/31616,
author="Yung, Alan
and Kay, Judy
and Beale, Philip
and Gibson, A. Kathryn
and Shaw, Tim",
title="Computer-Based Decision Tools for Shared Therapeutic Decision-making in Oncology: Systematic Review",
journal="JMIR Cancer",
year="2021",
month="Oct",
day="26",
volume="7",
number="4",
pages="e31616",
keywords="oncology",
keywords="cancer",
keywords="computer-based",
keywords="decision support",
keywords="decision-making",
keywords="system",
keywords="tool",
keywords="machine learning",
keywords="artificial intelligence",
keywords="uncertainty",
keywords="shared decision-making",
abstract="Background: Therapeutic decision-making in oncology is a complex process because physicians must consider many forms of medical data and protocols. Another challenge for physicians is to clearly communicate their decision-making process to patients to ensure informed consent. Computer-based decision tools have the potential to play a valuable role in supporting this process. Objective: This systematic review aims to investigate the extent to which computer-based decision tools have been successfully adopted in oncology consultations to improve patient-physician joint therapeutic decision-making. Methods: This review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist and guidelines. A literature search was conducted on February 4, 2021, across the Cochrane Database of Systematic Reviews (from 2005 to January 28, 2021), the Cochrane Central Register of Controlled Trials (December 2020), MEDLINE (from 1946 to February 4, 2021), Embase (from 1947 to February 4, 2021), Web of Science (from 1900 to 2021), Scopus (from 1969 to 2021), and PubMed (from 1991 to 2021). We used a snowball approach to identify additional studies by searching the reference lists of the studies included for full-text review. Additional supplementary searches of relevant journals and gray literature websites were conducted. The reviewers screened the articles eligible for review for quality and inclusion before data extraction. Results: There are relatively few studies looking at the use of computer-based decision tools in oncology consultations. Of the 4431 unique articles obtained from the searches, only 10 (0.22\%) satisfied the selection criteria. From the 10 selected studies, 8 computer-based decision tools were identified. Of the 10 studies, 6 (60\%) were conducted in the United States. Communication and information-sharing were improved between physicians and patients. However, physicians did not change their habits to take advantage of computer-assisted decision-making tools or the information they provide. On average, the use of these computer-based decision tools added approximately 5 minutes to the total length of consultations. In addition, some physicians felt that the technology increased patients' anxiety. Conclusions: Of the 10 selected studies, 6 (60\%) demonstrated positive outcomes, 1 (10\%) showed negative results, and 3 (30\%) were neutral. Adoption of computer-based decision tools during oncology consultations continues to be low. This review shows that information-sharing and communication between physicians and patients can be improved with the assistance of technology. However, the lack of integration with electronic health records is a barrier. This review provides key requirements for enhancing the chance of success of future computer-based decision tools. However, it does not show the effects of health care policies, regulations, or business administration on physicians' propensity to adopt the technology. Nevertheless, it is important that future research address the influence of these higher-level factors as well. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021226087; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42021226087 ",
doi="10.2196/31616",
url="https://cancer.jmir.org/2021/4/e31616",
url="http://www.ncbi.nlm.nih.gov/pubmed/34544680"
}


@Article{info:doi/10.2196/24865,
author="Cruz, da Fl{\'a}via Oliveira de Almeida Marques
and Faria, Tostes Edison
and Ghobad, Cardelino Pabblo
and Alves, Mano Leandro Yukio
and Reis, dos Paula Elaine Diniz",
title="A Mobile App (AMOR Mama) for Women With Breast Cancer Undergoing Radiation Therapy: Functionality and Usability Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="13",
volume="23",
number="10",
pages="e24865",
keywords="mobile applications",
keywords="health education",
keywords="nursing care",
keywords="oncology nursing",
keywords="educational technology",
keywords="breast neoplasms",
keywords="radiation therapy",
abstract="Background: Mobile apps targeting women with breast cancer can facilitate access to information, improve well-being, and record reports of treatment-related symptoms. However, it is important to confirm the benefits of these apps before they are used as a tool in clinical care. Objective: The aim of this study was to evaluate the functionality and the usability of a mobile app created to guide and monitor patients with breast cancer undergoing radiation therapy. Methods: The evaluation process of the mobile app was performed in 2 steps with 8 professionals, including nurses, physician, medical physicists, and communication networks engineer. The first step was the focus group, which allowed obtaining suggestions proposed by the participants regarding the improvement of the mobile app. The second step was the individual filling in of an evaluation tool to obtain objective measures about the mobile app. A minimum concordance index of 80\% was considered to ensure the adequacy of the material. Results: After the mobile app was evaluated by 8 professionals, only 1 item of the evaluation tool, that is, concerning the potentiality of the app to be used by users of different educational levels, obtained a concordance index <80\%. Conclusions: The mobile app titled ``AMOR Mama'' was considered suitable, which suggests its contribution to an educational health technology to guide and monitor patients with breast cancer undergoing radiation therapy. More studies with this target population should be carried out to assess the performance and quality of the mobile app during its use. ",
doi="10.2196/24865",
url="https://www.jmir.org/2021/10/e24865",
url="http://www.ncbi.nlm.nih.gov/pubmed/34643531"
}


@Article{info:doi/10.2196/31150,
author="Alshammari, O. Fatemah O. F.
and Al-saraireh, M. Yousef
and Youssef, M. Ahmed M.
and Al-Sarayra, M. Yahya
and Alrawashdeh, Mohammad Hamzeh",
title="Cytochrome P450 1B1 Overexpression in Cervical Cancers: Cross-sectional Study",
journal="Interact J Med Res",
year="2021",
month="Oct",
day="12",
volume="10",
number="4",
pages="e31150",
keywords="cancer",
keywords="cervical cancer",
keywords="cytochrome P450",
keywords="cytochrome 1B1",
keywords="immunohistochemistry",
keywords="toxicity",
keywords="therapies",
keywords="molecular",
keywords="tumor",
keywords="cytochrome",
keywords="cervix",
abstract="Background: Current standard treatments for patients with recurrent cervical cancer are not very effective and are associated with severe toxicity. Recently, the rational approach for the discovery of new therapies for cervical cancer is based on the alterations in the molecular biology of cancer cells. One of the emerging molecular changes in cancer cells is the aberrant expression of cytochrome P450 1B1 (CYP1B1). This unique enzyme has been reported to be selectively overexpressed in several cancers. Objective: The aim of this study was to examine CYP1B1 expression in cervical cancers and to assess the enzyme's relationship with several clinicopathological features. Methods: Immunohistochemistry was performed to examine CYP1B1 expression in 100 patient samples with cervical cancer and 10 patient samples with normal healthy cervical tissues. Results: CYP1B1 was expressed in the majority of the cervical cancer samples (91/100, 91.0\%) but not in normal healthy cervical samples. The difference in the expression of CYP1B1 between healthy and tumorous cervical tissues was significant (P=.01). Moreover, the frequency of CYP1B1 expression was found to be significantly higher in patients with advanced grades of the disease (P=.03) and in patients having metastasis to the lymph nodes (P=.01). Surprisingly, there was a significantly higher expression of CYP1B1 in patients with a high prevalence of human papilloma virus 16/18 (P=.04). Conclusions: The differential profile of CYP1B1 expression between cervical cancer tissues and normal cervical tissues suggests that CYP1B1 may be used as a target for future therapeutic exploitations. ",
doi="10.2196/31150",
url="https://www.i-jmr.org/2021/4/e31150",
url="http://www.ncbi.nlm.nih.gov/pubmed/34636736"
}


@Article{info:doi/10.2196/25776,
author="Brusniak, Katharina
and Feisst, Manuel
and Sebesteny, Linda
and Hartkopf, Andreas
and Graf, Joachim
and Engler, Tobias
and Schneeweiss, Andreas
and Wallwiener, Markus
and Deutsch, Maximilian Thomas",
title="Measuring the Time to Deterioration for Health-Related Quality of Life in Patients With Metastatic Breast Cancer Using a Web-Based Monitoring Application: Longitudinal Cohort Study",
journal="JMIR Cancer",
year="2021",
month="Oct",
day="12",
volume="7",
number="4",
pages="e25776",
keywords="eHealth",
keywords="breast cancer",
keywords="health-related quality of life",
keywords="quality of life",
keywords="time to deterioration",
keywords="EQ-VAS",
keywords="EQ-5D-5L",
keywords="EORTC QLQ-C30",
abstract="Background: Health-related quality of life (HRQoL) is used to evaluate the treatment of metastatic breast cancer. In a long-term therapy setting, HRQoL can be used as an important benchmark for treatment success. With the help of digital apps, HRQoL monitoring can be extended to more remote areas and be administered on a more frequent basis. Objective: This study aims to evaluate 3 common HRQoL questionnaires in metastasized breast cancer in terms of TTD in a digital, web-based setting. We further aim to examine the development of the HRQoL in different systemic treatment groups in each of these evaluation instruments. Methods: A total of 192 patients with metastatic breast cancer were analyzed in this bicentric prospective online cohort study at two German university hospitals. Patients completed questionnaires on HRQoL (EuroQol Visual Analog Scale [EQ-VAS], EuroQol 5 Dimension 5 Level [EQ-5D-5L], European Organization for Research and Treatment of Cancer Quality of Life Questionnaire--Core 30 item [EORTC QLQ-C30]) via an online platform over a 6-month period. Treatment schedules and medical history were retrieved from medical records. Unadjusted Cox regression analysis on treatment-related factors was performed. We conducted subgroup analyses in regard to TTD events between different treatments. Results: The EQ-VAS showed a higher rate of deterioration after 8 weeks (84/179, 46.9\%) than the EQ-5D-5L (47/163, 28.8\%) and EORTC QLQ-C30 (65/176, 36.9\%). Unadjusted Cox regression revealed significant connections between known metastases in the liver (P=.03, HR 1.64, 95\% CI 1.06-2.52) and pleura (P=.04, HR 0.42, 95\% CI 0.18-0.96) in the EQ-VAS. Significant relations between EQ-VAS events and single EQ-5D-5L items and the EQ-5D-5L summary score were demonstrated. All treatment groups significantly differed from the CDK4/6 inhibition subgroup in the EQ-VAS. Conclusions: Compared to the EQ-5D-5L and QLQ-C30, the EQ-VAS showed a higher rate of deterioration after 8 weeks. Significant connections to certain metastatic locations were only detected in the EQ-VAS. The EQ-VAS is capable of reflecting the distinctive HRQoL profiles of different systemic treatments as well as the different aspects of HRQoL presented in the EQ-5D-5L. TTD with the EQ-VAS is an adequate mean of examining longitudinal development of HRQoL among breast cancer patients. ",
doi="10.2196/25776",
url="https://cancer.jmir.org/2021/4/e25776",
url="http://www.ncbi.nlm.nih.gov/pubmed/34636732"
}


@Article{info:doi/10.2196/31212,
author="Rebelo, Artur
and Ukkat, J{\"o}rg
and Klose, Johannes
and Ronellenfitsch, Ulrich
and Kleeff, J{\"o}rg",
title="Surgery With Arterial Resection for Hilar Cholangiocarcinoma: Protocol for a Systematic Review and Meta-analysis",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="5",
volume="10",
number="10",
pages="e31212",
keywords="meta-analysis",
keywords="cholangiocarcinoma",
keywords="arterial resection",
keywords="surgery",
keywords="vascular resections",
keywords="cardiology",
keywords="outcomes",
keywords="mortality",
keywords="morbidity",
keywords="perioperative",
keywords="cancer",
keywords="tumor",
keywords="liver",
keywords="liver cancer",
abstract="Background: In light of recent advances in multimodality treatment, an analysis of vascular resection outcomes in surgery for hilar cholangiocarcinoma is lacking. Objective: The aim of this meta-analysis is to summarize the currently available evidence on outcomes of patients undergoing arterial resection for the treatment of hilar cholangiocarcinoma. Methods: A systematic literature search in the databases PubMed/MEDLINE, Cochrane Library, and CINAHL, and the trial registries ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform will be carried out. Predefined outcomes are mortality (100-day and in-hospital), morbidity (Clavien-Dindo classification, any type of complication), vascular complications (thrombosis or stenosis of the portal vein or hepatic artery, pseudoaneurysms), liver failure, postoperative bleeding, duration of surgery, reoperation rate, length of hospital stay, survival time, actuarial survival (2-, 3-, and 5-year survival), complete/incomplete resection rates, histologic arterial invasion, and lymph node positivity (number of positive lymph nodes and lymph node ratio). Results: Database searches will commence in December 2020. The meta-analysis will be completed by December 2021. Conclusions: Our findings will enable us to present the current evidence on the feasibility, safety, and oncological effectiveness of surgery for hilar cholangiocarcinoma with arterial resection. Our data will support health care professionals and patients in their clinical decision-making. Trial Registration: PROSPERO 223396; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=223396 International Registered Report Identifier (IRRID): DERR1-10.2196/31212 ",
doi="10.2196/31212",
url="https://www.researchprotocols.org/2021/10/e31212",
url="http://www.ncbi.nlm.nih.gov/pubmed/34609321"
}


@Article{info:doi/10.2196/28869,
author="Hopstaken, S. Jana
and Verweij, Lynn
and van Laarhoven, M. Cees J. H.
and Blijlevens, A. Nicole M.
and Stommel, J. Martijn W.
and Hermens, G. Rosella P. M.",
title="Effect of Digital Care Platforms on Quality of Care for Oncological Patients and Barriers and Facilitators for Their Implementation: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="24",
volume="23",
number="9",
pages="e28869",
keywords="digital care platforms",
keywords="cancer care",
keywords="eHealth",
keywords="telemedicine",
keywords="health care services",
keywords="fragmentation of care",
keywords="health care fragmentation",
keywords="oncology",
keywords="quality of care",
keywords="barriers",
keywords="facilitators",
keywords="patient experience",
abstract="Background: Oncological health care services are challenged by the increasing number of cancer survivors, long-term follow-up care, and fragmentation of care. Digital care platforms are potential tools to deliver affordable, patient-centered oncological care. Previous reviews evaluated only one feature of a digital care platform or did not evaluate the effect on enhancement of information, self-efficacy, continuity of care, or patient- and health care provider--reported experiences. Additionally, they have not focused on the barriers and facilitators for implementation of a digital care platform in oncological care. Objective: The aim of this systematic review was to collect the best available evidence of the effect of a digital care platform on quality of care parameters such as enhancement of available information, self-efficacy, continuity of care, and patient- and health care provider--reported experiences. Additionally, barriers and facilitators for implementation of digital care platforms were analyzed. Methods: The PubMed (Medline), Embase, CINAHL, and Cochrane Library databases were searched for the period from January 2000 to May 2020 for studies assessing the effect of a digital care platform on the predefined outcome parameters in oncological patients and studies describing barriers and facilitators for implementation. Synthesis of the results was performed qualitatively. Barriers and facilitators were categorized according to the framework of Grol and Wensing. The Mixed Methods Appraisal Tool was used for critical appraisal of the studies. Results: Seventeen studies were included for final analysis, comprising 8 clinical studies on the effectiveness of the digital care platform and 13 studies describing barriers and facilitators. Usage of a digital care platform appeared to enhance the availability of information and self-efficacy. There were no data available on the effect of a digital care platform on the continuity of care. However, based on focus group interviews, digital care platforms could potentially improve continuity of care by optimizing the exchange of patient information across institutes. Patient-reported experiences such as satisfaction with the platform were considerably positive. Most barriers for implementation were identified at the professional level, such as the concern for increased workload and unattended release of medical information to patients. Most facilitators were found at the patient and innovation levels, such as improved patient-doctor communication and patient empowerment. There were few barriers and facilitators mentioned at the economic and political levels. Conclusions: The use of digital care platforms is associated with better quality of care through enhancement of availability of information and increased self-efficacy for oncological patients. The numerous facilitators identified at the patient level illustrate that patients are positive toward a digital care platform. However, despite these favorable results, robust evidence concerning the effectiveness of digital care platforms, especially from high-quality studies, is still lacking. Future studies should therefore aim to further investigate the effectiveness of digital care platforms, and the barriers and facilitators to their implementation at the economic and political levels. ",
doi="10.2196/28869",
url="https://www.jmir.org/2021/9/e28869",
url="http://www.ncbi.nlm.nih.gov/pubmed/34559057"
}


@Article{info:doi/10.2196/28524,
author="Hauth, Franziska
and Gehler, Barbara
and Nie{\ss}, Michael Andreas
and Fischer, Katharina
and Toepell, Andreas
and Heinrich, Vanessa
and Roesel, Inka
and Peter, Andreas
and Renovanz, Mirjam
and Hartkopf, Andreas
and Stengel, Andreas
and Zips, Daniel
and Gani, Cihan",
title="An Activity Tracker--Guided Physical Activity Program for Patients Undergoing Radiotherapy: Protocol for a Prospective Phase III Trial (OnkoFit I and II Trials)",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="22",
volume="10",
number="9",
pages="e28524",
keywords="cancer",
keywords="fatigue",
keywords="physical activity",
keywords="quality of life",
keywords="activity tracker",
keywords="exercise program",
keywords="radiotherapy",
keywords="digital health",
abstract="Background: The positive impact that physical activity has on patients with cancer has been shown in several studies over recent years. However, supervised physical activity programs have several limitations, including costs and availability. Therefore, our study proposes a novel approach for the implementation of a patient-executed, activity tracker--guided exercise program to bridge this gap. Objective: Our trial aims to investigate the impact that an activity tracker--guided, patient-executed exercise program for patients undergoing radiotherapy has on cancer-related fatigue, health-related quality of life, and preoperative health status. Methods: Patients receiving postoperative radiotherapy for breast cancer (OnkoFit I trial) or neoadjuvant, definitive, or postoperative treatment for other types of solid tumors (OnkoFit II trial) will be randomized (1:1:1) into 3-arm studies. Target accrual is 201 patients in each trial (50 patients per year). After providing informed consent, patients will be randomized into a standard care arm (arm A) or 1 of 2 interventional arms (arms B and C). Patients in arms B and C will wear an activity tracker and record their daily step count in a diary. Patients in arm C will receive personalized weekly targets for their physical activity. No further instructions will be given to patients in arm B. The target daily step goals for patients in arm C will be adjusted weekly and will be increased by 10\% of the average daily step count of the past week until they reach a maximum of 6000 steps per day. Patients in arm A will not be provided with an activity tracker. The primary end point of the OnkoFit I trial is cancer-related fatigue at 3 months after the completion of radiotherapy. This will be measured by the Functional Assessment of Chronic Illness Therapy-Fatigue questionnaire. For the OnkoFit II trial, the primary end point is the overall quality of life, which will be assessed with the Functional Assessment of Cancer Therapy-General sum score at 6 months after treatment to allow for recovery after possible surgery. In parallel, blood samples from before, during, and after treatment will be collected in order to assess inflammatory markers. Results: Recruitment for both trials started on August 1, 2020, and to date, 49 and 12 patients have been included in the OnkoFit I and OnkoFit II trials, respectively. Both trials were approved by the institutional review board prior to their initiation. Conclusions: The OnkoFit trials test an innovative, personalized approach for the implementation of an activity tracker--guided training program for patients with cancer during radiotherapy. The program requires only a limited amount of resources. Trial Registration: ClinicalTrials.gov NCT04506476; https://clinicaltrials.gov/ct2/show/NCT04506476. ClinicalTrials.gov NCT04517019; https://clinicaltrials.gov/ct2/show/NCT04517019. International Registered Report Identifier (IRRID): DERR1-10.2196/28524 ",
doi="10.2196/28524",
url="https://www.researchprotocols.org/2021/9/e28524",
url="http://www.ncbi.nlm.nih.gov/pubmed/34550079"
}


@Article{info:doi/10.2196/27576,
author="Yu, Jing
and Wu, Jiayi
and Huang, Ou
and Chen, Xiaosong
and Shen, Kunwei",
title="A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="16",
volume="23",
number="9",
pages="e27576",
keywords="breast cancer",
keywords="adherence",
keywords="multidisciplinary treatment",
keywords="adjuvant treatment",
keywords="smartphone-based app",
keywords="mobile phone",
abstract="Background: Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery. Objective: This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs. Methods: Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated. Results: A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28\%), 861 (19.24\%), and 648 (14.48\%) patients, respectively. Overall, 15.53\% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4\% (75/273) in 2013 to 8.8\% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95\% CI 0.43-0.87; P=.007); no significant difference was found in the App nonused cohort (P=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95\% CI 0.27-0.65; P<.001) and radiotherapy (OR 0.49, 95\% CI 0.25-0.96; P=.04), but not for anti-HER2 therapy (P=.76) or endocrine therapy (P=.39). Conclusions: This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy. ",
doi="10.2196/27576",
url="https://www.jmir.org/2021/9/e27576",
url="http://www.ncbi.nlm.nih.gov/pubmed/34528890"
}


@Article{info:doi/10.2196/26574,
author="Veldhuijzen, Evalien
and Walraven, Iris
and Belderbos, Jos{\'e}",
title="Selecting a Subset Based on the Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events for Patient-Reported Symptom Monitoring in Lung Cancer Treatment: Mixed Methods Study",
journal="JMIR Cancer",
year="2021",
month="Sep",
day="14",
volume="7",
number="3",
pages="e26574",
keywords="PRO-CTCAE",
keywords="lung cancer",
keywords="side effects",
keywords="patient-reported outcomes",
keywords="PROM",
keywords="symptomatic adverse events",
abstract="Background: The Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) item library covers a wide range of symptoms relevant to oncology care. There is a need to select a subset of items relevant to specific patient populations to enable the implementation of PRO-CTCAE--based symptom monitoring in clinical practice. Objective: The aim of this study is to develop a PRO-CTCAE--based subset relevant to patients with lung cancer that can be used for monitoring during multidisciplinary clinical practice. Methods: The PRO-CTCAE--based subset for patients with lung cancer was generated using a mixed methods approach based on the European Organization for Research and Treatment of Cancer guidelines for developing questionnaires, comprising a literature review and semistructured interviews with both patients with lung cancer and health care practitioners (HCPs). Both patients and HCPs were queried on the relevance and impact of all PRO-CTCAE items. The results were summarized, and after a final round of expert review, a selection of clinically relevant items for patients with lung cancer was made. Results: A heterogeneous group of patients with lung cancer (n=25) from different treatment modalities and HCPs (n=22) participated in the study. A final list of eight relevant PRO-CTCAE items was created: decreased appetite, cough, shortness of breath, fatigue, constipation, nausea, sadness, and pain (general). Conclusions: On the basis of the literature and both professional and patient input, a subset of PRO-CTCAE items has been identified for use in patients with lung cancer in clinical practice. Future work is needed to confirm the validity and effectiveness of this PRO-CTCAE--based lung cancer subset internationally and in real-world clinical practice settings. ",
doi="10.2196/26574",
url="https://cancer.jmir.org/2021/3/e26574",
url="http://www.ncbi.nlm.nih.gov/pubmed/34519658"
}


@Article{info:doi/10.2196/24515,
author="Wartenberg, Lisa
and Raber, Margaret
and Chandra, Joya",
title="Unique Features of a Web-Based Nutrition Website for Childhood Cancer Populations: Descriptive Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="13",
volume="23",
number="9",
pages="e24515",
keywords="pediatric oncology",
keywords="web-based resources",
keywords="oncology nutrition",
keywords="culinary education",
keywords="oncology",
keywords="children",
keywords="pediatric",
keywords="nutrition",
keywords="culinary",
keywords="education",
abstract="Background: Children with cancer experience a myriad of nutritional challenges that impact their nutrition status during treatment and into survivorship. Growing evidence suggests that weight at diagnosis impacts cancer outcomes, but provider guidance on nutrition and diet during treatment varies. Nutrition literacy and culinary resources may help mitigate some common nutritional problems; however, many patients may face barriers to accessing in-person classes. Along with dietitian-led clinical interventions, web-based resources such as the newly updated electronic cookbook (e-cookbook) created by The University of Texas MD Anderson Cancer Center, @TheTable, may facilitate access to nutrition and culinary education during treatment and into survivorship. Objective: We sought to define and describe the features and content of the @TheTable e-cookbook and compare it with analogous resources for a lay audience of patients with childhood cancer and childhood cancer survivors as well as their families. Methods: We evaluated freely available web-based resources via a popular online search engine (ie, Google). These searches yielded three web-based resources analogous to @TheTable: the American Institute for Cancer Research's Healthy Recipes, The Children's Hospital of San Antonio's Culinary Health Education for Families Recipe for Life, and Ann Ogden Gaffney and Fred Hutchinson Cancer Research Center's Cook for Your Life. These sites were analyzed for the following: number of recipes, search functionality, child or family focus, cancer focus, specific dietary guidance, videos or other media, and miscellaneous unique features. Results: Cook for Your Life and Culinary Health Education for Families Recipe for Life were the most comparable to @TheTable with respect to cancer focus and family focus, respectively. Healthy Recipes is the least user-friendly, with few search options and no didactic videos. Conclusions: The @TheTable e-cookbook is unique in its offering of child- and family-focused content centered on the cancer and survivorship experience. ",
doi="10.2196/24515",
url="https://www.jmir.org/2021/9/e24515",
url="http://www.ncbi.nlm.nih.gov/pubmed/34515643"
}


@Article{info:doi/10.2196/26220,
author="Blasi, Livio
and Bordonaro, Roberto
and Serretta, Vincenzo
and Piazza, Dario
and Firenze, Alberto
and Gebbia, Vittorio",
title="Virtual Clinical and Precision Medicine Tumor Boards---Cloud-Based Platform--Mediated Implementation of Multidisciplinary Reviews Among Oncology Centers in the COVID-19 Era: Protocol for an Observational Study",
journal="JMIR Res Protoc",
year="2021",
month="Sep",
day="10",
volume="10",
number="9",
pages="e26220",
keywords="virtual tumor board",
keywords="multidisciplinary collaboration",
keywords="oncology",
keywords="multidisciplinary communication",
keywords="health services",
keywords="multidisciplinary oncology consultations",
keywords="virtual health",
keywords="digital health",
keywords="precision medicine",
keywords="tumor",
keywords="cancer",
keywords="cloud-based",
keywords="platform",
keywords="implementation",
keywords="COVID-19",
abstract="Background: Multidisciplinary tumor boards play a pivotal role in the patient-centered clinical management and in the decision-making process to provide best evidence-based, diagnostic, and therapeutic care to patients with cancer. Among the barriers to achieve an efficient multidisciplinary tumor board, lack of time and geographical distance play a major role. Therefore, the elaboration of an efficient virtual multidisciplinary tumor board (VMTB) is a key point to successfully obtain an oncology team and implement a network among health professionals and institutions. This need is stronger than ever during the COVID-19 pandemic. Objective: This paper presents a research protocol for an observational study focused on exploring the structuring process and the implementation of a multi-institutional VMTB in Sicily, Italy. Other endpoints include analysis of cooperation between participants, adherence to guidelines, patients' outcomes, and patient satisfaction. Methods: This protocol encompasses a pragmatic, observational, multicenter, noninterventional, prospective trial. The study's programmed duration is 5 years, with a half-yearly analysis of the primary and secondary objectives' measurements. Oncology care health professionals from various oncology subspecialties at oncology departments in multiple hospitals (academic and general hospitals as well as tertiary centers and community hospitals) are involved in a nonhierarchic manner. VMTB employs an innovative, virtual, cloud-based platform to share anonymized medical data that are discussed via a videoconferencing system both satisfying security criteria and compliance with the Health Insurance Portability and Accountability Act. Results: The protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology units and departments spread in the Sicily region. The results of this study will particularly focus on the organization of VMTBs, involving oncology units present in different hospitals spread in the area, and creating a network to allow best patient care pathways and a hub-and-spoke relationship. The present results will also include data concerning organization skills and pitfalls, barriers, efficiency, number, and types with respect to clinical cases and customer satisfaction. Conclusions: VMTB represents a unique opportunity to optimize patient management through a patient-centered approach. An efficient virtualization and data-banking system is potentially time-saving, a source for outcome data, and a detector of possible holes in the hull of clinical pathways. The observations and results from this VMTB study may hopefully be useful to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology. International Registered Report Identifier (IRRID): DERR1-10.2196/26220 ",
doi="10.2196/26220",
url="https://www.researchprotocols.org/2021/9/e26220",
url="http://www.ncbi.nlm.nih.gov/pubmed/34387553"
}


@Article{info:doi/10.2196/30549,
author="Denis, Fabrice
and Krakowski, Ivan",
title="How Should Oncologists Choose an Electronic Patient-Reported Outcome System for Remote Monitoring of Patients With Cancer?",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="9",
volume="23",
number="9",
pages="e30549",
keywords="ePRO",
keywords="cancer",
keywords="remote monitoring",
keywords="quality",
keywords="effectiveness",
keywords="security",
keywords="digital monitoring",
keywords="digital health",
keywords="cancer patients",
keywords="patients with cancer",
keywords="oncology",
doi="10.2196/30549",
url="https://www.jmir.org/2021/9/e30549",
url="http://www.ncbi.nlm.nih.gov/pubmed/34499046"
}


@Article{info:doi/10.2196/28279,
author="Huseb{\o}, Lunde Anne Marie",
title="Stakeholders' Perspectives on eHealth Support in Colorectal Cancer Survivorship: Qualitative Interview Study",
journal="JMIR Cancer",
year="2021",
month="Sep",
day="7",
volume="7",
number="3",
pages="e28279",
keywords="cancer patients",
keywords="carers",
keywords="colorectal cancer",
keywords="digital competence",
keywords="eHealth",
keywords="health care professionals",
keywords="follow-up service",
keywords="web-based information seeking, self-management support",
keywords="treatment burden",
keywords="mobile phone",
abstract="Background: eHealth interventions may represent the way forward in following up patients with colorectal cancer (CRC) after hospital discharge to support them in coping with the illness, strengthen their self-management, and increase their quality of life. By involving end users of eHealth in cocreation processes when designing eHealth solutions, an acceptable and relevant product can be secured. Stakeholders' perspectives could aid in closing the gap between research-developed products and the implementation of eHealth services in real-life scenarios. Objective: This study aims to explore the views of patients with CRC, their informal caregivers, and health care professionals (HCPs) on information technology and the design of eHealth support in CRC care. Methods: A qualitative, explorative design was used to conduct 31 semistructured individual interviews with 41\% (13/31) patients with CRC, 29\% (9/31) informal caregivers, and 29\% (9/31) HCPs recruited from the gastrosurgical ward of a university hospital in southwestern Norway. A semistructured interview guide was used for data collection, and the data were analyzed by systematic text condensation. Results: Participants described the diverse experiences of patients with CRC seeking web-based information. Age and digital competence were highlighted as influencers of the use of information technology. Patients rarely received advice from HCPs about relevant and secure websites containing information on CRC diagnosis and treatment. Features of desired eHealth interventions in following up patients with CRC were patient education, health monitoring, and communication with HCPs. Conclusions: Several elements affect the activities of patients with CRC seeking health information. Age, inexperience with computer technology, and lack of access to web-based health information may reduce the ability of patients with CRC to engage in decision-making processes regarding illness and treatment. An eHealth service for patients with CRC should comprise features for information, education, and support for self-management and should aim to be individually adapted to the patient's age and digital competence. Involving end users of eHealth services is necessary to ensure high-quality tailored services that are perceived as user friendly and relevant to the end users. ",
doi="10.2196/28279",
url="https://cancer.jmir.org/2021/3/e28279",
url="http://www.ncbi.nlm.nih.gov/pubmed/34491210"
}


@Article{info:doi/10.2196/30430,
author="Bandala-Jacques, Antonio
and Castellanos Esquivel, Daniel Kevin
and P{\'e}rez-Hurtado, Fernanda
and Hern{\'a}ndez-Silva, Cristobal
and Reynoso-Nover{\'o}n, Nancy",
title="Prostate Cancer Risk Calculators for Healthy Populations: Systematic Review",
journal="JMIR Cancer",
year="2021",
month="Sep",
day="3",
volume="7",
number="3",
pages="e30430",
keywords="prostate cancer",
keywords="risk calculator",
keywords="risk reduction",
abstract="Background: Screening for prostate cancer has long been a debated, complex topic. The use of risk calculators for prostate cancer is recommended for determining patients' individual risk of cancer and the subsequent need for a prostate biopsy. These tools could lead to better discrimination of patients in need of invasive diagnostic procedures and optimized allocation of health care resources Objective: The goal of the research was to systematically review available literature on the performance of current prostate cancer risk calculators in healthy populations by comparing the relative impact of individual items on different cohorts and on the models' overall performance. Methods: We performed a systematic review of available prostate cancer risk calculators targeted at healthy populations. We included studies published from January 2000 to March 2021 in English, Spanish, French, Portuguese, or German. Two reviewers independently decided for or against inclusion based on abstracts. A third reviewer intervened in case of disagreements. From the selected titles, we extracted information regarding the purpose of the manuscript, analyzed calculators, population for which it was calibrated, included risk factors, and the model's overall accuracy. Results: We included a total of 18 calculators from 53 different manuscripts. The most commonly analyzed ones were the Prostate Cancer Prevention Trial (PCPT) and European Randomized Study on Prostate Cancer (ERSPC) risk calculators developed from North American and European cohorts, respectively. Both calculators provided high diagnostic ability of aggressive prostate cancer (AUC as high as 0.798 for PCPT and 0.91 for ERSPC). We found 9 calculators developed from scratch for specific populations that reached a diagnostic ability as high as 0.938. The most commonly included risk factors in the calculators were age, prostate specific antigen levels, and digital rectal examination findings. Additional calculators included race and detailed personal and family history. Conclusions: Both the PCPR and ERSPC risk calculators have been successfully adapted for cohorts other than the ones they were originally created for with no loss of diagnostic ability. Furthermore, designing calculators from scratch considering each population's sociocultural differences has resulted in risk tools that can be well adapted to be valid in more patients. The best risk calculator for prostate cancer will be that which has been calibrated for its intended population and can be easily reproduced and implemented. Trial Registration: PROSPERO CRD42021242110; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=242110 ",
doi="10.2196/30430",
url="https://cancer.jmir.org/2021/3/e30430",
url="http://www.ncbi.nlm.nih.gov/pubmed/34477564"
}


@Article{info:doi/10.2196/28234,
author="Lazard, J. Allison
and Collins, Reffner Meredith K.
and Hedrick, Ashley
and Varma, Tushar
and Love, Brad
and Valle, G. Carmina
and Brooks, Erik
and Benedict, Catherine",
title="Using Social Media for Peer-to-Peer Cancer Support: Interviews With Young Adults With Cancer",
journal="JMIR Cancer",
year="2021",
month="Sep",
day="2",
volume="7",
number="3",
pages="e28234",
keywords="cancer survivors",
keywords="social support",
keywords="peer groups",
keywords="social media",
keywords="young adults",
keywords="pyscho-oncology",
keywords="mobile phone",
abstract="Background: Web-based social support can address social isolation and unmet support needs among young adults with cancer (aged 18-39 years). Given that 94\% of young adults own and use smartphones, social media can offer personalized, accessible social support among peers with cancer. Objective: This study aims to examine the specific benefits, downsides, and topics of social support via social media among young adults with cancer. Methods: We conducted semistructured interviews with young adults with cancer, aged between 18 and 39 years, who were receiving treatment or had completed treatment for cancer. Results: Most participants (N=45) used general audience platforms (eg, Facebook groups), and some cancer-specific social media (eg, Caring Bridge), to discuss relevant lived experiences for medical information (managing side effects and treatment uncertainty) and navigating life with cancer (parenting and financial issues). Participants valued socializing with other young adults with cancer, making connections outside their personal networks, and being able to validate their emotional and mental health experiences without time and physical constraints. However, using social media for peer support can be an emotional burden, especially when others post disheartening or harassing content, and can heighten privacy concerns, especially when navigating cancer-related stigma. Conclusions: Social media allows young adults to connect with peers to share and feel validated about their treatment and life concerns. However, barriers exist for receiving support from social media; these could be reduced through content moderation and developing more customizable, potentially cancer-specific social media apps and platforms to enhance one's ability to find peers and manage groups. ",
doi="10.2196/28234",
url="https://cancer.jmir.org/2021/3/e28234",
url="http://www.ncbi.nlm.nih.gov/pubmed/34473063"
}


@Article{info:doi/10.2196/21088,
author="Keum, Jiyoung
and Chung, Jae Moon
and Kim, Youngin
and Ko, Hyunyoung
and Sung, Je Min
and Jo, Hyun Jung
and Park, Youp Jeong
and Bang, Seungmin
and Park, Woo Seung
and Song, Young Si
and Lee, Seung Hee",
title="Usefulness of Smartphone Apps for Improving Nutritional Status of Pancreatic Cancer Patients: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Aug",
day="31",
volume="9",
number="8",
pages="e21088",
keywords="pancreatic ductal adenocarcinoma",
keywords="mobile app",
keywords="nutritional support",
keywords="quality of life",
keywords="chemotherapy",
abstract="Background: Approximately 80\% of pancreatic ductal adenocarcinoma (PDAC) patients suffer from anorexia, weight loss, and asthenia. Most PDAC patients receive chemotherapy, which often worsens their nutritional status owing to the adverse effects of chemotherapy. Malnutrition of PDAC patients is known to be associated with poor prognosis; therefore, nutritional management during chemotherapy is a key factor influencing the outcome of the treatment. Mobile apps have the potential to provide readily accessible nutritional support for patients with PDAC. Objective: We aimed to evaluate the efficacy of a mobile app--based program, Noom, in patients receiving chemotherapy for PDAC. Methods: We prospectively enrolled 40 patients who were newly diagnosed with unresectable PDAC from a single university-affiliated hospital in South Korea, and randomly assigned them into a Noom user group (n=20) and a non-Noom user group (n=20). The 12-week in-app interventions included meal and physical activity logging as well as nutritional education feedback from dietitians. The non-Noom user group did not receive any nutrition intervention. The primary outcomes were the changes in the nutritional status and quality of life (QoL) from the baseline to 12 weeks. The secondary outcomes included the changes in the skeletal muscle index (SMI) from the baseline to 12 weeks. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and the Patient-Generated Subjective Global Assessment (PG-SGA) were used as paper questionnaires to assess the QoL and nutritional status of the patients. Intention-to-treat and per-protocol analyses were conducted. Regarding the study data collection time points, we assessed the nutritional status and QoL at the baseline (T0), and at 4 (T1), 8 (T2), and 12 (T3) weeks. Abdominal computed tomography (CT) imaging was conducted at the baseline and after 8 weeks for tumor response and SMI evaluation. The skeletal muscle area (cm2) was calculated using routine CT images. The cross-sectional areas (cm2) of the L3 skeletal muscles were analyzed. Results: Between February 2017 and January 2018, 48 patients were assessed for eligibility. Totally 40 patients with pancreatic cancer were included by random allocation. Only 17 participants in the Noom user group and 16 in the non-Noom user group completed all follow-ups. All the study participants showed a significant improvement in the nutritional status according to the PG-SGA score regardless of Noom app usage. Noom users showed statistically significant improvements on the global health status (GHS) and QoL scales compared to non-Noom users, based on the EORTC QLQ (P=.004). The SMI decreased in both groups during chemotherapy (Noom users, 49.08{\textpm}12.27 cm2/m2 to 46.08{\textpm}10.55 cm2/m2; non-Noom users, 50.60{\textpm}9.05 cm2/m2 to 42.97{\textpm}8.12 cm2/m2). The decrement was higher in the non-Noom user group than in the Noom user group, but it was not statistically significant (-13.96\% vs. -3.27\%; P=.11). Conclusions: This pilot study demonstrates that a mobile app--based approach is beneficial for nutritional and psychological support for PDAC patients receiving chemotherapy. Trial Registration: ClinicalTrials.gov NCT04109495; https://clinicaltrials.gov/ct2/show/NCT04109495. ",
doi="10.2196/21088",
url="https://mhealth.jmir.org/2021/8/e21088",
url="http://www.ncbi.nlm.nih.gov/pubmed/34463630"
}


@Article{info:doi/10.2196/29807,
author="Lee, Eunsaem
and Jung, Young Se
and Hwang, Ju Hyung
and Jung, Jaewoo",
title="Patient-Level Cancer Prediction Models From a Nationwide Patient Cohort: Model Development and Validation",
journal="JMIR Med Inform",
year="2021",
month="Aug",
day="30",
volume="9",
number="8",
pages="e29807",
keywords="prediction",
keywords="model",
keywords="claim data",
keywords="cancer",
keywords="machine learning",
keywords="development",
keywords="cohort",
keywords="validation",
keywords="database",
keywords="algorithm",
abstract="Background: Nationwide population-based cohorts provide a new opportunity to build automated risk prediction models at the patient level, and claim data are one of the more useful resources to this end. To avoid unnecessary diagnostic intervention after cancer screening tests, patient-level prediction models should be developed. Objective: We aimed to develop cancer prediction models using nationwide claim databases with machine learning algorithms, which are explainable and easily applicable in real-world environments. Methods: As source data, we used the Korean National Insurance System Database. Every Korean in ?40 years old undergoes a national health checkup every 2 years. We gathered all variables from the database including demographic information, basic laboratory values, anthropometric values, and previous medical history. We applied conventional logistic regression methods, light gradient boosting methods, neural networks, survival analysis, and one-class embedding classifier methods to effectively analyze high dimension data based on deep learning--based anomaly detection. Performance was measured with area under the curve and area under precision recall curve. We validated our models externally with a health checkup database from a tertiary hospital. Results: The one-class embedding classifier model received the highest area under the curve scores with values of 0.868, 0.849, 0.798, 0.746, 0.800, 0.749, and 0.790 for liver, lung, colorectal, pancreatic, gastric, breast, and cervical cancers, respectively. For area under precision recall curve, the light gradient boosting models had the highest score with values of 0.383, 0.401, 0.387, 0.300, 0.385, 0.357, and 0.296 for liver, lung, colorectal, pancreatic, gastric, breast, and cervical cancers, respectively. Conclusions: Our results show that it is possible to easily develop applicable cancer prediction models with nationwide claim data using machine learning. The 7 models showed acceptable performances and explainability, and thus can be distributed easily in real-world environments. ",
doi="10.2196/29807",
url="https://medinform.jmir.org/2021/8/e29807",
url="http://www.ncbi.nlm.nih.gov/pubmed/34459743"
}


@Article{info:doi/10.2196/27824,
author="van de Water, F. Lo{\"i}s
and van den Boorn, G. H{\'e}ctor
and Hoxha, Florian
and Henselmans, Inge
and Calff, M. Mart
and Sprangers, G. Mirjam A.
and Abu-Hanna, Ameen
and Smets, A. Ellen M.
and van Laarhoven, M. Hanneke W.",
title="Informing Patients With Esophagogastric Cancer About Treatment Outcomes by Using a Web-Based Tool and Training: Development and Evaluation Study",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="27",
volume="23",
number="8",
pages="e27824",
keywords="prediction tool",
keywords="communication skills training",
keywords="shared decision-making",
keywords="risk communication",
keywords="treatment outcomes",
keywords="esophageal cancer",
keywords="gastric cancer",
keywords="patient-physician communication",
abstract="Background: Due to the increasing use of shared decision-making, patients with esophagogastric cancer play an increasingly important role in the decision-making process. To be able to make well-informed decisions, patients need to be adequately informed about treatment options and their outcomes, namely survival, side effects or complications, and health-related quality of life. Web-based tools and training programs can aid physicians in this complex task. However, to date, none of these instruments are available for use in informing patients with esophagogastric cancer about treatment outcomes. Objective: This study aims to develop and evaluate the feasibility of using a web-based prediction tool and supporting communication skills training to improve how physicians inform patients with esophagogastric cancer about treatment outcomes. By improving the provision of treatment outcome information, we aim to stimulate the use of information that is evidence-based, precise, and personalized to patient and tumor characteristics and is communicated in a way that is tailored to individual information needs. Methods: We designed a web-based, physician-assisted prediction tool---Source---to be used during consultations by using an iterative, user-centered approach. The accompanying communication skills training was developed based on specific learning objectives, literature, and expert opinions. The Source tool was tested in several rounds---a face-to-face focus group with 6 patients and survivors, semistructured interviews with 5 patients, think-aloud sessions with 3 medical oncologists, and interviews with 6 field experts. In a final pilot study, the Source tool and training were tested as a combined intervention by 5 medical oncology fellows and 3 esophagogastric outpatients. Results: The Source tool contains personalized prediction models and data from meta-analyses regarding survival, treatment side effects and complications, and health-related quality of life. The treatment outcomes were visualized in a patient-friendly manner by using pictographs and bar and line graphs. The communication skills training consisted of blended learning for clinicians comprising e-learning and 2 face-to-face sessions. Adjustments to improve both training and the Source tool were made according to feedback from all testing rounds. Conclusions: The Source tool and training could play an important role in informing patients with esophagogastric cancer about treatment outcomes in an evidence-based, precise, personalized, and tailored manner. The preliminary evaluation results are promising and provide valuable input for the further development and testing of both elements. However, the remaining uncertainty about treatment outcomes in patients and established habits in doctors, in addition to the varying trust in the prediction models, might influence the effectiveness of the tool and training in daily practice. We are currently conducting a multicenter clinical trial to investigate the impact that the combined tool and training have on the provision of information in the context of treatment decision-making. ",
doi="10.2196/27824",
url="https://www.jmir.org/2021/8/e27824",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448703"
}


@Article{info:doi/10.2196/27235,
author="Chang, Panchun
and Dang, Jun
and Dai, Jianrong
and Sun, Wenzheng",
title="Real-Time Respiratory Tumor Motion Prediction Based on a Temporal Convolutional Neural Network: Prediction Model Development Study",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="27",
volume="23",
number="8",
pages="e27235",
keywords="radiation therapy",
keywords="temporal convolutional neural network",
keywords="respiratory signal prediction",
keywords="neural network",
keywords="deep learning model",
keywords="dynamic tracking",
abstract="Background: The dynamic tracking of tumors with radiation beams in radiation therapy requires the prediction of real-time target locations prior to beam delivery, as treatment involving radiation beams and gating tracking results in time latency. Objective: In this study, a deep learning model that was based on a temporal convolutional neural network was developed to predict internal target locations by using multiple external markers. Methods: Respiratory signals from 69 treatment fractions of 21 patients with cancer who were treated with the CyberKnife Synchrony device (Accuray Incorporated) were used to train and test the model. The reported model's performance was evaluated by comparing the model to a long short-term memory model in terms of the root mean square errors (RMSEs) of real and predicted respiratory signals. The effect of the number of external markers was also investigated. Results: The average RMSEs of predicted (ahead time=400 ms) respiratory motion in the superior-inferior, anterior-posterior, and left-right directions and in 3D space were 0.49 mm, 0.28 mm, 0.25 mm, and 0.67 mm, respectively. Conclusions: The experiment results demonstrated that the temporal convolutional neural network--based respiratory prediction model could predict respiratory signals with submillimeter accuracy. ",
doi="10.2196/27235",
url="https://www.jmir.org/2021/8/e27235",
url="http://www.ncbi.nlm.nih.gov/pubmed/34236336"
}


@Article{info:doi/10.2196/22909,
author="Haggenm{\"u}ller, Sarah
and Krieghoff-Henning, Eva
and Jutzi, Tanja
and Trapp, Nicole
and Kiehl, Lennard
and Utikal, Sven Jochen
and Fabian, Sascha
and Brinker, Josef Titus",
title="Digital Natives' Preferences on Mobile Artificial Intelligence Apps for Skin Cancer Diagnostics: Survey Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Aug",
day="27",
volume="9",
number="8",
pages="e22909",
keywords="artificial intelligence",
keywords="skin cancer",
keywords="skin cancer screening",
keywords="diagnostics",
keywords="digital natives",
keywords="acceptance",
keywords="concerns",
keywords="preferences",
keywords="online survey",
abstract="Background: Artificial intelligence (AI) has shown potential to improve diagnostics of various diseases, especially for early detection of skin cancer. Studies have yet to investigate the clear application of AI technology in clinical practice or determine the added value for younger user groups. Translation of AI-based diagnostic tools can only be successful if they are accepted by potential users. Young adults as digital natives may offer the greatest potential for successful implementation of AI into clinical practice, while at the same time, representing the future generation of skin cancer screening participants. Objective: We conducted an anonymous online survey to examine how and to what extent individuals are willing to accept AI-based mobile apps for skin cancer diagnostics. We evaluated preferences and relative influences of concerns, with a focus on younger age groups. Methods: We recruited participants below 35 years of age using three social media channels---Facebook, LinkedIn, and Xing. Descriptive analysis and statistical tests were performed to evaluate participants' attitudes toward mobile apps for skin examination. We integrated an adaptive choice-based conjoint to assess participants' preferences. We evaluated potential concerns using maximum difference scaling. Results: We included 728 participants in the analysis. The majority of participants (66.5\%, 484/728; 95\% CI 0.631-0.699) expressed a positive attitude toward the use of AI-based apps. In particular, participants residing in big cities or small towns (P=.02) and individuals that were familiar with the use of health or fitness apps (P=.02) were significantly more open to mobile diagnostic systems. Hierarchical Bayes estimation of the preferences of participants with a positive attitude (n=484) revealed that the use of mobile apps as an assistance system was preferred. Participants ruled out app versions with an accuracy of ?65\%, apps using data storage without encryption, and systems that did not provide background information about the decision-making process. However, participants did not mind their data being used anonymously for research purposes, nor did they object to the inclusion of clinical patient information in the decision-making process. Maximum difference scaling analysis for the negative-minded participant group (n=244) showed that data security, insufficient trust in the app, and lack of personal interaction represented the dominant concerns with respect to app use. Conclusions: The majority of potential future users below 35 years of age were ready to accept AI-based diagnostic solutions for early detection of skin cancer. However, for translation into clinical practice, the participants' demands for increased transparency and explainability of AI-based tools seem to be critical. Altogether, digital natives between 18 and 24 years and between 25 and 34 years of age expressed similar preferences and concerns when compared both to each other and to results obtained by previous studies that included other age groups. ",
doi="10.2196/22909",
url="https://mhealth.jmir.org/2021/8/e22909",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448722"
}


@Article{info:doi/10.2196/29682,
author="Bang, Seok Chang
and Lee, Jun Jae
and Baik, Ho Gwang",
title="Computer-Aided Diagnosis of Diminutive Colorectal Polyps in Endoscopic Images: Systematic Review and Meta-analysis of Diagnostic Test Accuracy",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="25",
volume="23",
number="8",
pages="e29682",
keywords="artificial intelligence",
keywords="deep learning",
keywords="polyps",
keywords="colon",
keywords="colonoscopy",
keywords="diminutive",
abstract="Background: Most colorectal polyps are diminutive and benign, especially those in the rectosigmoid colon, and the resection of these polyps is not cost-effective. Advancements in image-enhanced endoscopy have improved the optical prediction of colorectal polyp histology. However, subjective interpretability and inter- and intraobserver variability prohibits widespread implementation. The number of studies on computer-aided diagnosis (CAD) is increasing; however, their small sample sizes limit statistical significance. Objective: This review aims to evaluate the diagnostic test accuracy of CAD models in predicting the histology of diminutive colorectal polyps by using endoscopic images. Methods: Core databases were searched for studies that were based on endoscopic imaging, used CAD models for the histologic diagnosis of diminutive colorectal polyps, and presented data on diagnostic performance. A systematic review and diagnostic test accuracy meta-analysis were performed. Results: Overall, 13 studies were included. The pooled area under the curve, sensitivity, specificity, and diagnostic odds ratio of CAD models for the diagnosis of diminutive colorectal polyps (adenomatous or neoplastic vs nonadenomatous or nonneoplastic) were 0.96 (95\% CI 0.93-0.97), 0.93 (95\% CI 0.91-0.95), 0.87 (95\% CI 0.76-0.93), and 87 (95\% CI 38-201), respectively. The meta-regression analysis showed no heterogeneity, and no publication bias was detected. Subgroup analyses showed robust results. The negative predictive value of CAD models for the diagnosis of adenomatous polyps in the rectosigmoid colon was 0.96 (95\% CI 0.95-0.97), and this value exceeded the threshold of the diagnosis and leave strategy. Conclusions: CAD models show potential for the optical histological diagnosis of diminutive colorectal polyps via the use of endoscopic images. Trial Registration: PROSPERO CRD42021232189; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=232189 ",
doi="10.2196/29682",
url="https://www.jmir.org/2021/8/e29682",
url="http://www.ncbi.nlm.nih.gov/pubmed/34432643"
}


@Article{info:doi/10.2196/23367,
author="Lange-Drenth, Lukas
and Schulz, Holger
and Endsin, Gero
and Bleich, Christiane",
title="Patients With Cancer Searching for Cancer- or Health-Specific Web-Based Information: Performance Test Analysis",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="16",
volume="23",
number="8",
pages="e23367",
keywords="telemedicine",
keywords="eHealth",
keywords="eHealth literacy",
keywords="digital literacy",
keywords="internet",
keywords="web-based",
keywords="health information",
keywords="health education",
keywords="cancer",
keywords="mobile phone",
abstract="Background: Searching the internet for cancer-related information helps patients with cancer satisfy their unmet information needs and empowers them to play a more active role in the management of their disease. However, to benefit from the search, patients need a sufficient level of skill to search, select, appraise, and apply web-based health information. Objective: We aim to study the operational, navigational, information, and evaluation skills and problems of patients with cancer performing cancer-related search tasks using the internet. Methods: A total of 21 patients with cancer were recruited during their stay at the rehabilitation clinic for oncological rehabilitation. Participants performed eight cancer-related search tasks using the internet. The participants were asked to think aloud while performing the tasks, and the screen activities were recorded. The types and frequencies of performance problems were identified and coded into categories following an inductive coding process. In addition, the performance and strategic characteristics of task execution were summarized descriptively. Results: All participants experienced problems or difficulties in executing the tasks, and a substantial percentage of tasks (57/142, 40.1\%) could not be completed successfully. The participants' performance problems were coded into four categories, namely operating the computer and web browser, navigating and orientating, using search strategies, and evaluating the relevance and reliability of web-based information. The most frequent problems occurred in the third and fourth categories. A total of 90\% (19/21) of participants used nontask-related search terms or nonspecific search terms. A total of 95\% (20/21) of participants did not control for the source or topicality of the information found. In addition, none of the participants verified the information on 1 website with that on another website for each task. Conclusions: A substantial group of patients with cancer did not have the necessary skills to benefit from cancer-related internet searches. Future interventions are needed to support patients in the development of sufficient internet-searching skills, focusing particularly on information and evaluation skills. ",
doi="10.2196/23367",
url="https://www.jmir.org/2021/8/e23367",
url="http://www.ncbi.nlm.nih.gov/pubmed/34398801"
}


@Article{info:doi/10.2196/22608,
author="Oakley-Girvan, Ingrid
and Davis, Watkins Sharon
and Kurian, Allison
and Rosas, G. Lisa
and Daniels, Jena
and Palesh, Gronskaya Oxana
and Mesia, J. Rachel
and Kamal, H. Arif
and Longmire, Michelle
and Divi, Vasu",
title="Development of a Mobile Health App (TOGETHERCare) to Reduce Cancer Care Partner Burden: Product Design Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="13",
volume="5",
number="8",
pages="e22608",
keywords="cancer",
keywords="oncology",
keywords="mHealth",
keywords="caregiver",
keywords="cancer survivor",
keywords="mobile app",
keywords="smartphone",
keywords="feasibility",
keywords="caregiver burden",
keywords="symptom reporting",
abstract="Background: Approximately 6.1 million adults in the United States serve as care partners for cancer survivors. Studies have demonstrated that engaging cancer survivors and their care partners through technology-enabled structured symptom collection has several benefits. Given the high utilization of mobile technologies, even among underserved populations and in low resource areas, mobile apps may provide a meaningful access point for all stakeholders for symptom management. Objective: We aimed to develop a mobile app incorporating user preferences to enable cancer survivors' care partners to monitor the survivors' health and to provide care partner resources. Methods: An iterative information gathering process was conducted that included (1) discussions with 138 stakeholders to identify challenges and gaps in survivor home care; (2) semistructured interviews with clinicians (n=3), cancer survivors (n=3), and care partners (n=3) to identify specific needs; and (3) a 28-day feasibility field test with seven care partners. Results: Health professionals noted the importance of identifying early symptoms of adverse events. Survivors requested modules on medication, diet, self-care, reminders, and a version in Spanish. Care partners preferred to focus primarily on the patient's health and not their own. The app was developed incorporating quality-of-life surveys and symptom reporting, as well as resources on home survivor care. Early user testing demonstrated ease of use and app feasibility. Conclusions: TOGETHERCare, a novel mobile app, was developed with user input to track the care partner's health and report on survivor symptoms during home care. The following two clinical benefits emerged: (1) reduced anxiety among care partners who use the app and (2) the potential for identifying survivor symptoms noted by the care partner, which might prevent adverse events. Trial Registration: ClinicalTrials.gov NCT04018677; https://clinicaltrials.gov/ct2/show/NCT04018677 ",
doi="10.2196/22608",
url="https://formative.jmir.org/2021/8/e22608",
url="http://www.ncbi.nlm.nih.gov/pubmed/34398787"
}


@Article{info:doi/10.2196/18502,
author="Sivanandan, Ananth Mayuran
and Sharma, Catherine
and Bullard, Pippa
and Christian, Judith",
title="Digital Patient-Reported Outcome Measures for Monitoring of Patients on Cancer Treatment: Cross-sectional Questionnaire Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="13",
volume="5",
number="8",
pages="e18502",
keywords="patient-reported outcome measures",
keywords="patient-reported outcomes",
keywords="remote monitoring",
keywords="toxicity",
keywords="outpatients",
keywords="digital technology",
keywords="digital health",
keywords="mobile health",
keywords="oncology",
keywords="chemotherapy",
keywords="immunotherapy",
keywords="radiotherapy",
abstract="Background: Oncology has been facing increasing outpatient activity associated with higher cancer incidence, better survival rates, and more treatment options. Innovative technological solutions could help deal with this increasing demand. Using digital patient-reported outcome measures (PROMs) to identify patients who need a face-to-face (FTF) appointment is a potential approach. Objective: This study aims to assess the feasibility of digital PROM questionnaires to enable remote symptom monitoring for patients undergoing cancer treatment and their ability to highlight the requirement for an FTF appointment. Methods: This study was performed at a tertiary oncology center between December 2018 and February 2019. The Common Terminology Criteria for Adverse Events were adapted into patient-friendly language to form the basis of treatment-specific digital questionnaires covering specific cancer drugs and radiotherapy treatments. These treatment-specific digital PROM questionnaires were scored by both patients and their clinicians during FTF appointments. Patients and clinicians did not see each other's scored PROMs. Agreement between patients and clinicians was assessed using descriptive statistics. Patient and staff feedback was also obtained. Results: In total, 90 patients participated in the study across 10 different treatment pathways. By comparing paired patient and clinician responses, the sensitivity of the patient-completed questionnaires in correctly highlighting the need for FTF review was 94\% (44/47), and all patients with severe or grade 3+ symptoms were identified (6/6, 100\%). Patient-completed PROMs appropriately revealed that 29\% (26/90) of the participating patients did not need FTF review based on their symptoms alone. Certain oncological treatment pathways, such as immunotherapy, were found to have a larger proportion of patients with minimal symptoms than others, such as conventional chemotherapy. Patient and staff feedback showed high approval of digital PROMs and their potential for use in remote monitoring. Conclusions: Digital PROM questionnaires can feasibly highlight the need for FTF review in oncology clinics for treatment. Their use with specific treatments could safely reduce the requirement for FTF care, and future work should evaluate their application in the remote monitoring of patients. ",
doi="10.2196/18502",
url="https://formative.jmir.org/2021/8/e18502",
url="http://www.ncbi.nlm.nih.gov/pubmed/34398785"
}


@Article{info:doi/10.2196/25789,
author="Wang, Quan
and Yang, Ke-Lu
and Zhang, Zhen
and Wang, Zhu
and Li, Chen
and Li, Lun
and Tian, Jin-Hui
and Ye, Ying-Jiang
and Wang, Shan
and Jiang, Ke-Wei",
title="Characterization of Global Research Trends and Prospects on Single-Cell Sequencing Technology: Bibliometric Analysis",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="10",
volume="23",
number="8",
pages="e25789",
keywords="single-cell sequencing",
keywords="bibliometric analysis",
keywords="cancer",
keywords="cancer genomics",
keywords="bioinformatics",
keywords="cancer subtyping",
keywords="tumor dissociation",
keywords="tumor microenvironment",
keywords="precision medicine",
keywords="immunology",
keywords="development trends",
keywords="hotspots",
keywords="research topics",
keywords="Web of Science",
keywords="CiteSpace",
keywords="VOSviewer",
keywords="network",
abstract="Background: As single-cell sequencing technology has been gradually introduced, it is essential to characterize global collaboration networks and map development trends over the past 20 years. Objective: The aim of this paper was to illustrate collaboration in the field of single-cell sequencing methods and explore key topics and future directions. Methods: Bibliometric analyses were conducted with CiteSpace and VOSviewer software on publications prior to November 2019 from the Web of Science Core Collection about single-cell sequencing methods. Results: Ultimately, we identified 2489 records, which were published in 495 journals by 14,202 authors from 1970 institutes in 61 countries. There was a noticeable increase in publications in 2014. The United States and high-income countries in Europe contributed to most of the records included. Harvard University, Stanford University, Karolinska Institutes, Peking University, and the University of Washington were the biggest nodes in every cluster of the collaboration network, and SA Teichmann, JC Marioni, A Regev, and FC Tang were the top-producing authors. Keywords co-occurrence analysis suggested applications in immunology as a developing research trend. Conclusions: We concluded that the global collaboration network was unformed and that high-income countries contributed more to the rapidly growth of publications of single-cell sequencing technology. Furthermore, the application in immunology might be the next research hotspot and developmental direction. ",
doi="10.2196/25789",
url="https://www.jmir.org/2021/8/e25789",
url="http://www.ncbi.nlm.nih.gov/pubmed/34014832"
}


@Article{info:doi/10.2196/29271,
author="Trojan, Andreas
and Leuthold, Nicolas
and Thomssen, Christoph
and Rody, Achim
and Winder, Thomas
and Jakob, Andreas
and Egger, Claudine
and Held, Ulrike
and Jackisch, Christian",
title="The Effect of Collaborative Reviews of Electronic Patient-Reported Outcomes on the Congruence of Patient- and Clinician-Reported Toxicity in Cancer Patients Receiving Systemic Therapy: Prospective, Multicenter, Observational Clinical Trial",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="5",
volume="23",
number="8",
pages="e29271",
keywords="cancer",
keywords="consilium",
keywords="app",
keywords="eHealth",
keywords="ePRO",
keywords="CTCAE",
keywords="congruency",
keywords="patient-reported",
keywords="symptoms",
abstract="Background: Electronic patient-reported outcomes (ePRO) are a relatively novel form of data and have the potential to improve clinical practice for cancer patients. In this prospective, multicenter, observational clinical trial, efforts were made to demonstrate the reliability of patient-reported symptoms. Objective: The primary objective of this study was to assess the level of agreement $\kappa$ between symptom ratings by physicians and patients via a shared review process in order to determine the future reliability and utility of self-reported electronic symptom monitoring. Methods: Patients receiving systemic therapy in a (neo-)adjuvant or noncurative intention setting captured ePRO for 52 symptoms over an observational period of 90 days. At 3-week intervals, randomly selected symptoms were reviewed between the patient and physician for congruency on severity of the grading of adverse events according to the Common Terminology Criteria of Adverse Events (CTCAE). The patient-physician agreement for the symptom review was assessed via Cohen kappa ($\kappa$), through which the interrater reliability was calculated. Chi-square tests were used to determine whether the patient-reported outcome was different among symptoms, types of cancer, demographics, and physicians' experience. Results: Among the 181 patients (158 women and 23 men; median age 54.4 years), there was a fair scoring agreement ($\kappa$=0.24; 95\% CI 0.16-0.33) for symptoms that were entered 2 to 4 weeks before the intended review (first rating) and a moderate agreement ($\kappa$=0.41; 95\% CI 0.34-0.48) for symptoms that were entered within 1 week of the intended review (second rating). However, the level of agreement increased from moderate (first rating, $\kappa$=0.43) to substantial (second rating, $\kappa$=0.68) for common symptoms of pain, fever, diarrhea, obstipation, nausea, vomiting, and stomatitis. Similar congruency levels of ratings were found for the most frequently entered symptoms (first rating: $\kappa$=0.42; second rating: $\kappa$=0.65). The symptom with the lowest agreement was hair loss ($\kappa$=--0.05). With regard to the latency of symptom entry into the review, hardly any difference was demonstrated between symptoms that were entered from days 1 to 3 and from days 4 to 7 before the intended review ($\kappa$=0.40 vs $\kappa$=0.39, respectively). In contrast, for symptoms that were entered 15 to 21 days before the intended review, no congruency was demonstrated ($\kappa$=--0.15). Congruency levels seemed to be unrelated to the type of cancer, demographics, and physicians' review experience. Conclusions: The shared monitoring and review of symptoms between patients and clinicians has the potential to improve the understanding of patient self-reporting. Our data indicate that the integration of ePRO into oncological clinical research and continuous clinical practice provides reliable information for self-empowerment and the timely intervention of symptoms. Trial Registration: ClinicalTrials.gov NCT03578731; https://clinicaltrials.gov/ct2/show/NCT03578731 ",
doi="10.2196/29271",
url="https://www.jmir.org/2021/8/e29271",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383675"
}


@Article{info:doi/10.2196/23790,
author="Kindratt, B. Tiffany
and Allicock, Marlyn
and Atem, Folefac
and Dallo, J. Florence
and Balasubramanian, A. Bijal",
title="Email Patient-Provider Communication and Cancer Screenings Among US Adults: Cross-sectional Study",
journal="JMIR Cancer",
year="2021",
month="Jul",
day="30",
volume="7",
number="3",
pages="e23790",
keywords="email",
keywords="patient-provider communication",
keywords="online, patient portals",
keywords="mammogram",
keywords="Pap test",
keywords="colon cancer screening",
keywords="cancer screenings",
keywords="National Health Interview Survey",
abstract="Background: The growth of electronic medical records and use of patient portals have allowed for patients and health care providers to communicate via email and direct messaging between health care visits. Email patient-provider communication (PPC) may enhance traditional face-to-face PPC by allowing patients to ask questions, receive clear explanations, engage in shared decision-making, and confirm their understanding between in-person visits. Despite increasing trends in the use of email PPC since the early 2000s, few studies have evaluated associations between email PPC and the uptake of preventive services. Objective: The objective of this study was to determine associations between the use of email PPC and the likelihood of undergoing breast, cervical, and colon cancer screenings among adults who have received health care in the past 12 months. Methods: Secondary, cross-sectional data from the 2011-2015 National Health Interview Survey were combined and analyzed. For each cancer screening, inclusion criteria were based on the age of screening recommendations and prior history of cancer diagnosis (n=35,912 for breast, n=48,512 for cervical, and n=45,884 for colon). The independent variable was whether adults used email PPC in the past 12 months (yes or no). The dependent variables were whether (1) women (aged ?40 years) received a mammogram in the past 12 months; (2) women (aged 21-65 years) received a Pap test in the past 12 months; and (3) individuals (aged ?50 years) received a colon cancer screening in the past 12 months. Bivariate and multivariable logistic regression analyses were conducted. Results: Adults who reported receiving all three cancer screenings in the past 12 months were more likely to be non-Hispanic White; be married or living with a partner; have a bachelor's degree or higher education level; have health insurance coverage; and perceive their health as excellent, very good, or good (all P<.001). Men were more likely to receive colon cancer screenings than women (P<.001). Multivariable logistic regression models showed women who used email to communicate with their health care providers had greater odds of receiving breast (odds ratio [OR] 1.32, 95\% CI 1.20-1.44) and cervical (OR 1.11, 95\% CI 1.02-1.20) cancer screenings than women who did not use email PPC. Adults who used email to communicate with their health care providers had 1.55 times greater odds (95\% CI 1.42-1.69) of receiving a colon cancer screening than those who did not use email PPC. Conclusions: Our results demonstrate that email PPC is a marker of increased likelihood of adults completing age-appropriate cancer screenings, particularly breast, cervical, and colon cancer screenings. More research is needed to examine other factors related to the reasons for and quality of email PPC between patients and health care providers and determine avenues for health education and intervention to further explore this association. ",
doi="10.2196/23790",
url="https://cancer.jmir.org/2021/3/e23790",
url="http://www.ncbi.nlm.nih.gov/pubmed/34328421"
}


@Article{info:doi/10.2196/24651,
author="Yoo, Junsang
and Kim, Si-Ho
and Hur, Sujeong
and Ha, Juhyung
and Huh, Kyungmin
and Cha, Chul Won",
title="Candidemia Risk Prediction (CanDETEC) Model for Patients With Malignancy: Model Development and Validation in a Single-Center Retrospective Study",
journal="JMIR Med Inform",
year="2021",
month="Jul",
day="26",
volume="9",
number="7",
pages="e24651",
keywords="candidemia",
keywords="precision medicine",
keywords="supervised machine learning",
keywords="decision support systems, clinical",
keywords="infection control",
keywords="decision support",
keywords="machine learning",
keywords="development",
keywords="validation",
keywords="prediction",
keywords="risk",
keywords="model",
abstract="Background: Appropriate empirical treatment for candidemia is associated with reduced mortality; however, the timely diagnosis of candidemia in patients with sepsis remains poor. Objective: We aimed to use machine learning algorithms to develop and validate a candidemia prediction model for patients with cancer. Methods: We conducted a single-center retrospective study using the cancer registry of a tertiary academic hospital. Adult patients diagnosed with malignancies between January 2010 and December 2018 were included. Our study outcome was the prediction of candidemia events. A stratified undersampling method was used to extract control data for algorithm learning. Multiple models were developed---a combination of 4 variable groups and 5 algorithms (auto-machine learning, deep neural network, gradient boosting, logistic regression, and random forest). The model with the largest area under the receiver operating characteristic curve (AUROC) was selected as the Candida detection (CanDETEC) model after comparing its performance indexes with those of the Candida Score Model. Results: From a total of 273,380 blood cultures from 186,404 registered patients with cancer, we extracted 501 records of candidemia events and 2000 records as control data. Performance among the different models varied (AUROC 0.771- 0.889), with all models demonstrating superior performance to that of the Candida Score (AUROC 0.677). The random forest model performed the best (AUROC 0.889, 95\% CI 0.888-0.889); therefore, it was selected as the CanDETEC model. Conclusions: The CanDETEC model predicted candidemia in patients with cancer with high discriminative power. This algorithm could be used for the timely diagnosis and appropriate empirical treatment of candidemia. ",
doi="10.2196/24651",
url="https://medinform.jmir.org/2021/7/e24651",
url="http://www.ncbi.nlm.nih.gov/pubmed/34309570"
}


@Article{info:doi/10.2196/28664,
author="Fonseka, N. Lakshan
and Woo, KP Benjamin",
title="Consumer Wearables and the Integration of New Objective Measures in Oncology: Patient and Provider Perspectives",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="15",
volume="9",
number="7",
pages="e28664",
keywords="consumer",
keywords="wearables",
keywords="smartwatch",
keywords="cancer",
keywords="oncology",
keywords="chemotherapy",
keywords="apps",
doi="10.2196/28664",
url="https://mhealth.jmir.org/2021/7/e28664",
url="http://www.ncbi.nlm.nih.gov/pubmed/34264191"
}


@Article{info:doi/10.2196/26151,
author="Nikolov, Stanislav
and Blackwell, Sam
and Zverovitch, Alexei
and Mendes, Ruheena
and Livne, Michelle
and De Fauw, Jeffrey
and Patel, Yojan
and Meyer, Clemens
and Askham, Harry
and Romera-Paredes, Bernadino
and Kelly, Christopher
and Karthikesalingam, Alan
and Chu, Carlton
and Carnell, Dawn
and Boon, Cheng
and D'Souza, Derek
and Moinuddin, Ali Syed
and Garie, Bethany
and McQuinlan, Yasmin
and Ireland, Sarah
and Hampton, Kiarna
and Fuller, Krystle
and Montgomery, Hugh
and Rees, Geraint
and Suleyman, Mustafa
and Back, Trevor
and Hughes, Owen C{\'i}an
and Ledsam, R. Joseph
and Ronneberger, Olaf",
title="Clinically Applicable Segmentation of Head and Neck Anatomy for Radiotherapy: Deep Learning Algorithm Development and Validation Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="12",
volume="23",
number="7",
pages="e26151",
keywords="radiotherapy",
keywords="segmentation",
keywords="contouring",
keywords="machine learning",
keywords="artificial intelligence",
keywords="UNet",
keywords="convolutional neural networks",
keywords="surface DSC",
abstract="Background: Over half a million individuals are diagnosed with head and neck cancer each year globally. Radiotherapy is an important curative treatment for this disease, but it requires manual time to delineate radiosensitive organs at risk. This planning process can delay treatment while also introducing interoperator variability, resulting in downstream radiation dose differences. Although auto-segmentation algorithms offer a potentially time-saving solution, the challenges in defining, quantifying, and achieving expert performance remain. Objective: Adopting a deep learning approach, we aim to demonstrate a 3D U-Net architecture that achieves expert-level performance in delineating 21 distinct head and neck organs at risk commonly segmented in clinical practice. Methods: The model was trained on a data set of 663 deidentified computed tomography scans acquired in routine clinical practice and with both segmentations taken from clinical practice and segmentations created by experienced radiographers as part of this research, all in accordance with consensus organ at risk definitions. Results: We demonstrated the model's clinical applicability by assessing its performance on a test set of 21 computed tomography scans from clinical practice, each with 21 organs at risk segmented by 2 independent experts. We also introduced surface Dice similarity coefficient, a new metric for the comparison of organ delineation, to quantify the deviation between organ at risk surface contours rather than volumes, better reflecting the clinical task of correcting errors in automated organ segmentations. The model's generalizability was then demonstrated on 2 distinct open-source data sets, reflecting different centers and countries to model training. Conclusions: Deep learning is an effective and clinically applicable technique for the segmentation of the head and neck anatomy for radiotherapy. With appropriate validation studies and regulatory approvals, this system could improve the efficiency, consistency, and safety of radiotherapy pathways. ",
doi="10.2196/26151",
url="https://www.jmir.org/2021/7/e26151",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255661"
}


@Article{info:doi/10.2196/27502,
author="Chen, Ciao-Sin
and Kim, Judith
and Garg, Noemi
and Guntupalli, Harsha
and Jagsi, Reshma
and Griggs, J. Jennifer
and Sabel, Michael
and Dorsch, P. Michael
and Callaghan, C. Brian
and Hertz, L. Daniel",
title="Chemotherapy-Induced Peripheral Neuropathy Detection via a Smartphone App: Cross-sectional Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="5",
volume="9",
number="7",
pages="e27502",
keywords="chemotherapy-induced peripheral neuropathy",
keywords="smartphone",
keywords="mobile health",
keywords="gait",
keywords="balance",
keywords="9-Hole Peg Test",
abstract="Background: Severe chemotherapy-induced peripheral neuropathy (CIPN) can cause long-term dysfunction of the hands and feet, interfere with activities of daily living, and diminish the quality of life. Monitoring to identify CIPN and adjust treatment before it progressing to a life-altering severity relies on patients self-reporting subjective symptoms to their clinical team. Objective assessment is not a standard component of CIPN monitoring due to the requirement for specially trained health care professionals and equipment. Smartphone apps have the potential to conveniently collect both subjective and objective CIPN data directly from patients, which could improve CIPN monitoring. Objective: The objective of this cross-sectional pilot study was to assess the feasibility of functional CIPN assessment via a smartphone app in patients with cancer that have received neurotoxic chemotherapy. Methods: A total of 26 patients who had completed neurotoxic chemotherapy were enrolled and classified as CIPN cases (n=17) or controls (n=9) based on self-report symptoms. All participants completed CIPN assessments within the NeuroDetect app a single time, including patient-reported surveys (CIPN20 [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Chemotherapy-induced Peripheral Neuropathy 20-item scale] and PRO-CTCAE [Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events]) and functional assessments (Gait and Balance and 9-Hole Peg Test). Functional assessment data were decomposed into features. The primary analysis was done to identify features indicative of the difference between CIPN cases and controls using partial least squares analyses. Exploratory analyses were performed to test if any features were associated with specific symptom subtypes or patient-reported survey scores. Patient interviews were also conducted to understand the challenges they experienced with the app. Results: Comparisons between CIPN cases and controls indicate that CIPN cases had shorter step length (P=.007), unique swaying acceleration patterns during a walking task, and shorter hand moving distance in the dominant hands during a manual dexterity task (variable importance in projection scores ?2). Exploratory analyses showed similar signatures associated with symptoms subtypes, CIPN20, and PRO-CTCAE. The interview results showed that some patients had difficulties due to technical issues, which indicated a need for additional training or oversight during the initial app download. Conclusions: Our results supported the feasibility of remote CIPN assessment via a smartphone app and suggested that functional assessments may indicate CIPN manifestations in the hands and feet. Additional work is needed to determine which functional assessments are most indicative of CIPN and could be used for CIPN monitoring within clinical care. ",
doi="10.2196/27502",
url="https://mhealth.jmir.org/2021/7/e27502",
url="http://www.ncbi.nlm.nih.gov/pubmed/36260403"
}


@Article{info:doi/10.2196/25791,
author="Shih, Chi-Huang
and Chou, Pai-Chien
and Chou, Ting-Ling
and Huang, Tsai-Wei",
title="Measurement of Cancer-Related Fatigue Based on Heart Rate Variability: Observational Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="5",
volume="23",
number="7",
pages="e25791",
keywords="cancer-related fatigue",
keywords="heart rate variability",
keywords="LF-HF ratio",
keywords="photoplethysmography",
keywords="wearables",
keywords="chemotherapy",
abstract="Background: Cancer-related fatigue is a serious side effect of cancer, and its treatment can disrupt the quality of life of patients. Clinically, the standard method for assessing cancer-related fatigue relies on subjective experience retrieved from patient self-reports, such as the Brief Fatigue Inventory (BFI). However, most patients do not self-report their fatigue levels. Objective: In this study, we aim to develop an objective cancer-related fatigue assessment method to track and monitor fatigue in patients with cancer. Methods: In total, 12 patients with lung cancer who were undergoing chemotherapy or targeted therapy were enrolled. We developed frequency-domain parameters of heart rate variability (HRV) and BFI based on a wearable-based HRV measurement system. All patients completed the BFI-Taiwan version questionnaire and wore the device for 7 consecutive days to record HRV parameters such as low frequency (LF), high frequency (HF), and LF-HF ratio (LF-HF). Statistical analysis was used to map the correlation between subjective fatigue and objective data. Results: A moderate positive correlation was observed between the average LF-HF ratio and BFI in the sleep phase ($\rho$=0.86). The mapped BFI score derived by the BFI mapping method could approximate the BFI from the patient self-report. The mean absolute error rate between the subjective and objective BFI scores was 3\%. Conclusions: LF-HF is highly correlated with the cancer-related fatigue experienced by patients with lung cancer undergoing chemotherapy or targeted therapy. Beyond revealing fatigue levels objectively, continuous HRV recordings through the photoplethysmography watch device and the defined parameters (LF-HF) can define the active phase and sleep phase in patients with lung cancer who undergo chemotherapy or targeted chemotherapy, allowing a deduction of their sleep patterns. ",
doi="10.2196/25791",
url="https://www.jmir.org/2021/7/e25791",
url="http://www.ncbi.nlm.nih.gov/pubmed/36260384"
}


@Article{info:doi/10.2196/23670,
author="de Looper, Melanie
and van Weert, M. Julia C.
and Schouten, C. Barbara
and Bolle, Sifra
and Belgers, J. Eric H.
and Eddes, H. Eric
and Smets, A. Ellen M.",
title="The Influence of Online Health Information Seeking Before a Consultation on Anxiety, Satisfaction, and Information Recall, Mediated by Patient Participation: Field Study",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="5",
volume="23",
number="7",
pages="e23670",
keywords="online health seeking",
keywords="patients",
keywords="aging",
keywords="patient participation",
keywords="memory",
keywords="anxiety",
keywords="patient reported outcomes",
keywords="consultation",
keywords="health communication",
keywords="cancer",
abstract="Background: Today, many cancer patients engage in online health information seeking (OHIS). However, little is known about how patients differ in their OHIS levels. In addition, OHIS might influence patient participation during a consultation with a physician, which might mediate the effects on patient outcomes. Objective: The aim of this study is twofold: first, to provide insight into which personal characteristics and psychosocial factors affect patients' OHIS levels and, second, to test the hypothesis that the effects of OHIS on patient outcomes are mediated by patient participation during the consultation. Methods: Patient participation was operationalized in terms of patients' absolute word count; the relative contribution of the patient, compared with the health care provider; and the number of questions and assertions expressed during the consultation. The patient outcomes measured were anxiety after the consultation, satisfaction with the consultation, and information recall. Participants in this study were patients recently diagnosed with colorectal cancer recruited from 6 hospitals in the Netherlands (n=90). Data were collected using questionnaires and audio-recorded consultations of patients with health care providers before their surgery. Results: The results showed that younger patients, higher educated patients, patients with a monitoring coping style, and patients who experienced more cancer-related stress engaged more in OHIS. In turn, OHIS was related to patient participation in terms of the patient's absolute word count but not to the relative contribution to the consultation or expressing questions and assertions. We did not find a relation between OHIS and anxiety and OHIS and recall mediated by patient participation. However, we found that patients' absolute word count significantly mediated the positive association between OHIS and patients' satisfaction with the consultation. Conclusions: Results indicate positive implications of OHIS for patients' care experience and, therefore, the importance of helping patients engage in OHIS. However, the results also suggest that OHIS is only successful in increasing a single aspect of patient participation, which might explain the absence of relations with anxiety and recall. The results suggest that more beneficial effects on patient outcomes may be achieved when health care providers support patients in OHIS. ",
doi="10.2196/23670",
url="https://www.jmir.org/2021/7/e23670",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255657"
}


@Article{info:doi/10.2196/20708,
author="H{\"o}hn, Julia
and Hekler, Achim
and Krieghoff-Henning, Eva
and Kather, Nikolas Jakob
and Utikal, Sven Jochen
and Meier, Friedegund
and Gellrich, Friedrich Frank
and Hauschild, Axel
and French, Lars
and Schlager, Gabriel Justin
and Ghoreschi, Kamran
and Wilhelm, Tabea
and Kutzner, Heinz
and Heppt, Markus
and Haferkamp, Sebastian
and Sondermann, Wiebke
and Schadendorf, Dirk
and Schilling, Bastian
and Maron, C. Roman
and Schmitt, Max
and Jutzi, Tanja
and Fr{\"o}hling, Stefan
and Lipka, B. Daniel
and Brinker, Josef Titus",
title="Integrating Patient Data Into Skin Cancer Classification Using Convolutional Neural Networks: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Jul",
day="2",
volume="23",
number="7",
pages="e20708",
keywords="skin cancer classification",
keywords="convolutional neural networks",
keywords="patient data",
abstract="Background: Recent years have been witnessing a substantial improvement in the accuracy of skin cancer classification using convolutional neural networks (CNNs). CNNs perform on par with or better than dermatologists with respect to the classification tasks of single images. However, in clinical practice, dermatologists also use other patient data beyond the visual aspects present in a digitized image, further increasing their diagnostic accuracy. Several pilot studies have recently investigated the effects of integrating different subtypes of patient data into CNN-based skin cancer classifiers. Objective: This systematic review focuses on the current research investigating the impact of merging information from image features and patient data on the performance of CNN-based skin cancer image classification. This study aims to explore the potential in this field of research by evaluating the types of patient data used, the ways in which the nonimage data are encoded and merged with the image features, and the impact of the integration on the classifier performance. Methods: Google Scholar, PubMed, MEDLINE, and ScienceDirect were screened for peer-reviewed studies published in English that dealt with the integration of patient data within a CNN-based skin cancer classification. The search terms skin cancer classification, convolutional neural network(s), deep learning, lesions, melanoma, metadata, clinical information, and patient data were combined. Results: A total of 11 publications fulfilled the inclusion criteria. All of them reported an overall improvement in different skin lesion classification tasks with patient data integration. The most commonly used patient data were age, sex, and lesion location. The patient data were mostly one-hot encoded. There were differences in the complexity that the encoded patient data were processed with regarding deep learning methods before and after fusing them with the image features for a combined classifier. Conclusions: This study indicates the potential benefits of integrating patient data into CNN-based diagnostic algorithms. However, how exactly the individual patient data enhance classification performance, especially in the case of multiclass classification problems, is still unclear. Moreover, a substantial fraction of patient data used by dermatologists remains to be analyzed in the context of CNN-based skin cancer classification. Further exploratory analyses in this promising field may optimize patient data integration into CNN-based skin cancer diagnostics for patients' benefits. ",
doi="10.2196/20708",
url="https://www.jmir.org/2021/7/e20708",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255646"
}


@Article{info:doi/10.2196/26332,
author="Fu, Henry
and Garrett, Bernie
and Tao, Gordon
and Cordingley, Elliott
and Ofoghi, Zahra
and Taverner, Tarnia
and Sun, Crystal
and Cheung, Teresa",
title="Virtual Reality--Guided Meditation for Chronic Pain in Patients With Cancer: Exploratory Analysis of Electroencephalograph Activity",
journal="JMIR Biomed Eng",
year="2021",
month="Jun",
day="24",
volume="6",
number="2",
pages="e26332",
keywords="virtual reality",
keywords="guided meditation",
keywords="neurophysiology",
keywords="electroencephalograph",
keywords="EEG",
abstract="Background: Mindfulness-based stress reduction has demonstrated some efficacy for chronic pain management. More recently, virtual reality (VR)--guided meditation has been used to assist mindfulness-based stress reduction. Although studies have also found electroencephalograph (EEG) changes in the brain during mindfulness meditation practices, such changes have not been demonstrated during VR-guided meditation. Objective: This exploratory study is designed to explore the potential for recording and analyzing EEG during VR experiences in terms of the power of EEG waveforms, topographic mapping, and coherence. We examine how these measures changed during a VR-guided meditation experience in participants with cancer-related chronic pain. Methods: A total of 10 adult patients with chronic cancer pain underwent a VR-guided meditation experience while EEG signals were recorded during the session using a BioSemi ActiveTwo system (64 channels, standard 10-20 configuration). The EEG recording session consisted of an 8-minute resting condition (pre), a 30-minute sequence of 3 VR-guided meditation conditions (med), and a final rest condition (post). Power spectral density (PSD) was compared between each condition using a cluster-based permutation test and across conditions using multivariate analysis of variance. A topographic analysis, including coherence exploration, was performed. In addition, an exploratory repeated measures correlation was used to examine possible associations between pain scores and EEG signal power. Results: The predominant pattern was for increased $\beta$ and $\gamma$ bandwidth power in the meditation condition (P<.025), compared with both the baseline and postexperience conditions. Increased power in the $\delta$ bandwidth was evident, although not statistically significant. The pre versus post comparison also showed changes in the $\theta$ and $\alpha$ bands (P=.02) located around the frontal, central, and parietal cortices. Across conditions, multivariate analysis of variance tests identified 4 clusters with significant (P<.05) PSD differences in the $\delta$, $\theta$, $\beta$, and $\gamma$ bands located around the frontal, central, and parietal cortices. Topographically, 5 peak channels were identified: AF7, FP2, FC1, CP5, and P5, and verified the changes in power in the different brain regions. Coherence changes were observed primarily between the frontal, parietal, and occipital regions in the $\theta$, $\alpha$, and $\gamma$ bands (P<.0025). No significant associations were observed between pain scores and EEG PSD. Conclusions: This study demonstrates the feasibility of EEG recording in exploring neurophysiological changes in brain activity during VR-guided meditation and its effect on pain reduction. These findings suggest that distinct altered neurophysiological brain signals are detectable during VR-guided meditation. However, these changes were not necessarily associated with pain. These exploratory findings may guide further studies to investigate the highlighted regions and EEG bands with respect to VR-guided meditation. Trial Registration: ClinicalTrials.gov NCT00102401; http://clinicaltrials.gov/ct2/show/NCT00102401 ",
doi="10.2196/26332",
url="https://biomedeng.jmir.org/2021/2/e26332/"
}


@Article{info:doi/10.2196/25800,
author="Plasek, Joseph
and Weissert, John
and Downs, Tracy
and Richards, Kyle
and Ravvaz, Kourosh",
title="Clinicopathological Criteria Predictive of Recurrence Following Bacillus Calmette-Gu{\'e}rin Therapy Initiation in Non--Muscle-Invasive Bladder Cancer: Retrospective Cohort Study",
journal="JMIR Cancer",
year="2021",
month="Jun",
day="22",
volume="7",
number="2",
pages="e25800",
keywords="urinary bladder neoplasms",
keywords="risk factor",
keywords="bacillus Calmette-Gu{\'e}rin",
keywords="recurrence",
abstract="Background: Bacillus Calmette-Gu{\'e}rin (BCG) is currently the most clinically effective intravesical treatment for non--muscle-invasive bladder cancer (NMIBC), particularly for patients with high-risk NMIBC such as those with carcinoma in situ. BCG treatments could be optimized to improve patient safety and conserve supply by predicting BCG efficacy based on tumor characteristics or clinicopathological criteria. Objective: The aim of this study is to assess the ability of specific clinicopathological criteria to predict tumor recurrence in patients with NMIBC who received BCG therapy along various treatment timelines. Methods: A total of 1331 patients (stage Ta, T1, or carcinoma in situ) who underwent transurethral resection of a bladder tumor between 2006 and 2017 were included. Univariate analysis, including laboratory tests (eg, complete blood panels, creatinine levels, and hemoglobin A1c levels) within 180 days of BCG therapy initiation, medications, and clinical and demographic variables to assess their ability to predict NMIBC recurrence, was completed. This was followed by multivariate regression that included the elements of the Club Urol{\'o}gico Espa{\~n}ol de Tratamiento Oncol{\'o}gico (CUETO) scoring model and variables that were significant predictors of recurrence in univariate analysis. Results: BCG was administered to 183 patients classified as intermediate or high risk, and 76 (41.5\%) experienced disease recurrence. An abnormal neutrophil-to-lymphocyte ratio measured within 180 days of induction BCG therapy was a significant predictor (P=.047) of future cancer recurrence and was a stronger predictor than the CUETO score or the individual variables included in the CUETO scoring model through multivariate analysis. Conclusions: An abnormal neutrophil-to-lymphocyte ratio within 180 days of BCG therapy initiation is predictive of recurrence and could be suggestive of additional or alternative interventions. ",
doi="10.2196/25800",
url="https://cancer.jmir.org/2021/2/e25800",
url="http://www.ncbi.nlm.nih.gov/pubmed/34156341"
}


@Article{info:doi/10.2196/27940,
author="Koppel, D. Paula
and De Gagne, C. Jennie",
title="Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Protocol for a Qualitative Study",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="14",
volume="10",
number="6",
pages="e27940",
keywords="nursing",
keywords="oncology ambulatory care",
keywords="provider-patient relationship",
keywords="rapport",
keywords="telehealth",
keywords="videoconferencing visits",
abstract="Background: Telehealth videoconferencing has largely been embraced by health care providers and patients during the COVID-19 pandemic; however, little is known about specific techniques for building rapport and provider-patient relationships in this care environment. Although research suggests that videoconferencing is feasible and can be effective for some types of care, concerns about the impact of technology on provider-patient relationships exist across health disciplines. Suggestions for adapting some in-person rapport techniques, such as the use of small talk, eye contact, and body language to facilitate trust, personal connection, and communication during videoconferencing encounters, have been discussed in the popular press and clinical commentaries. Notably, evidence regarding the effects of these strategies on rapport and clinical care outcomes is lacking. Understanding how to establish rapport in videoconferencing visits is especially important in oncology nursing, where rapport with patients enables nurses to become a source of emotional support, helping patients adapt and navigate the cancer journey. Objective: This study aims to investigate the nature of nurse-patient rapport in ambulatory cancer care videoconferencing visits. The objectives include exploring how patients with cancer and nurses describe experiences of rapport and strategies for cultivating rapport in videoconferencing visits and similarities and differences identified by patients with cancer and nurses between experiences of rapport in videoconferencing and in-person visits. Methods: Semistructured narrative interviews of patients with cancer and nurses will be conducted to understand the experience of rapport building in videoconferencing visits. Nurses and patients will be interviewed separately to facilitate an understanding of the perspectives of both types of participants. Interviews will be conducted on a secure videoconferencing platform. This qualitative descriptive study will describe participant experiences in a manner that, although not without interpretation, is as close to the data as possible. The research team will meet regularly to discuss, define, and document codes, categories, and themes, and the team will maintain a detailed audit trail of analytical decisions. In addition, member checking will enhance the rigor of the study. Nurse and patient interviews will be analyzed separately using identical procedures and may be explored side by side in the final analysis to provide a comparative analysis. Data management and analysis will be performed using NVivo 12. Results: Data collection will begin during summer 2021, with results from the data analysis anticipated by winter 2021. A research team trained in qualitative methodology will use conventional content analysis to analyze the data using first- and second-level codes derived directly from the transcribed text data. Conclusions: This study aims to determine what behaviors, communication techniques, and relational practices need to be adapted in videoconferencing telehealth visits, setting the foundation for future development of interventions and evidence-based practice guidelines for relationship building during videoconferencing telehealth visits. International Registered Report Identifier (IRRID): PRR1-10.2196/27940 ",
doi="10.2196/27940",
url="https://www.researchprotocols.org/2021/6/e27940",
url="http://www.ncbi.nlm.nih.gov/pubmed/34125073"
}


@Article{info:doi/10.2196/27384,
author="Emard, Nicholas
and Lynch, A. Kathleen
and Liou, T. Kevin
and Atkinson, Thomas
and Green, K. Angela
and Daly, Bobby
and Trevino, Kelly
and Mao, J. Jun",
title="Virtual Mind-Body Programming for Patients With Cancer During the COVID-19 Pandemic: Qualitative Study",
journal="JMIR Cancer",
year="2021",
month="Jun",
day="8",
volume="7",
number="2",
pages="e27384",
keywords="cancer",
keywords="fitness",
keywords="meditation",
keywords="stress",
keywords="COVID-19",
keywords="qualitative",
keywords="coping",
keywords="wellbeing",
keywords="psychosocial",
keywords="virtual health",
abstract="Background: Patients with cancer are particularly vulnerable to stress and anxiety during the COVID-19 pandemic. Social distancing is critical for patients with cancer; however, it can also reduce their access to psychosocial coping resources. Objective: The aim of this study was to explore patient experiences to generate a model of how virtual mind-body programs can support the psychosocial well-being of patients with cancer. Methods: We conducted a qualitative study among patients (aged ?18 years) who participated in a virtual mind-body program offered by a National Cancer Institute--designated Comprehensive Cancer Center during the COVID-19 pandemic. The program consisted of mind-body group therapy sessions of fitness, yoga, tai chi, dance therapy, music therapy, and meditation. Live integrative medicine clinicians held each session via Zoom videoconferencing for 30-45 minutes. In semistructured phone interviews (n=30), patients were asked about their overall impressions and perceptions of the benefits of the sessions, including impacts on stress and anxiety. Interviews were analyzed using grounded theory. Results: Among the 30 participants (average age 64.5 years, SD 9.36, range 40-80, 29 female), three major themes were identified relating to experiences in the virtual mind-body program: (1) the sessions helped the patients maintain structured routines and motivated them to adhere to healthy behaviors; (2) the sessions enhanced coping with COVID-19-related-stressors, allowing patients to ``refocus'' and ``re-energize''; and (3) the sessions allowed patients to connect, fostering social relationships during a time of isolation. These themes informed the constructs of a novel behavioral-psychological-social coping model for patients with cancer. Conclusions: Virtual mind-body programming supported patients with cancer during the COVID-19 pandemic through a behavioral-psychological-social coping model by enhancing psychological coping for external stressors, supporting adherence to motivation and health behaviors, and increasing social connection and camaraderie. These programs have potential to address the behavioral, psychological, and social challenges faced by patients with cancer during and beyond the COVID-19 pandemic. The constructs of the conceptual model proposed in this study can inform future interventions to support isolated patients with cancer. Further clinical trials are needed to confirm the specific benefits of virtual mind-body programming for the psychosocial well-being and healthy behaviors of patients with cancer. ",
doi="10.2196/27384",
url="https://cancer.jmir.org/2021/2/e27384",
url="http://www.ncbi.nlm.nih.gov/pubmed/33882018"
}


@Article{info:doi/10.2196/23350,
author="Rossman, H. Andrea
and Reid, W. Hadley
and Pieters, M. Michelle
and Mizelle, Cecelia
and von Isenburg, Megan
and Ramanujam, Nimmi
and Huchko, J. Megan
and Vasudevan, Lavanya",
title="Digital Health Strategies for Cervical Cancer Control in Low- and Middle-Income Countries: Systematic Review of Current Implementations and Gaps in Research",
journal="J Med Internet Res",
year="2021",
month="May",
day="27",
volume="23",
number="5",
pages="e23350",
keywords="cervical cancer",
keywords="digital health",
keywords="mobile phones",
keywords="low- and middle-income countries",
keywords="colposcopy",
keywords="uterine cervical neoplasms",
keywords="telemedicine or mobile apps",
keywords="cell phones",
keywords="developing countries",
abstract="Background: Nearly 90\% of deaths due to cervical cancer occur in low- and middle-income countries (LMICs). In recent years, many digital health strategies have been implemented in LMICs to ameliorate patient-, provider-, and health system--level challenges in cervical cancer control. However, there are limited efforts to systematically review the effectiveness and current landscape of digital health strategies for cervical cancer control in LMICs. Objective: We aim to conduct a systematic review of digital health strategies for cervical cancer control in LMICs to assess their effectiveness, describe the range of strategies used, and summarize challenges in their implementation. Methods: A systematic search was conducted to identify publications describing digital health strategies for cervical cancer control in LMICs from 5 academic databases and Google Scholar. The review excluded digital strategies associated with improving vaccination coverage against human papillomavirus. Titles and abstracts were screened, and full texts were reviewed for eligibility. A structured data extraction template was used to summarize the information from the included studies. The risk of bias and data reporting guidelines for mobile health were assessed for each study. A meta-analysis of effectiveness was planned along with a narrative review of digital health strategies, implementation challenges, and opportunities for future research. Results: In the 27 included studies, interventions for cervical cancer control focused on secondary prevention (ie, screening and treatment of precancerous lesions) and digital health strategies to facilitate patient education, digital cervicography, health worker training, and data quality. Most of the included studies were conducted in sub-Saharan Africa, with fewer studies in other LMIC settings in Asia or South America. A low risk of bias was found in 2 studies, and a moderate risk of bias was found in 4 studies, while the remaining 21 studies had a high risk of bias. A meta-analysis of effectiveness was not conducted because of insufficient studies with robust study designs and matched outcomes or interventions. Conclusions: Current evidence on the effectiveness of digital health strategies for cervical cancer control is limited and, in most cases, is associated with a high risk of bias. Further studies are recommended to expand the investigation of digital health strategies for cervical cancer using robust study designs, explore other LMIC settings with a high burden of cervical cancer (eg, South America), and test a greater diversity of digital strategies. ",
doi="10.2196/23350",
url="https://www.jmir.org/2021/5/e23350",
url="http://www.ncbi.nlm.nih.gov/pubmed/34042592"
}


@Article{info:doi/10.2196/23586,
author="Zong, Nansu
and Ngo, Victoria
and Stone, J. Daniel
and Wen, Andrew
and Zhao, Yiqing
and Yu, Yue
and Liu, Sijia
and Huang, Ming
and Wang, Chen
and Jiang, Guoqian",
title="Leveraging Genetic Reports and Electronic Health Records for the Prediction of Primary Cancers: Algorithm Development and Validation Study",
journal="JMIR Med Inform",
year="2021",
month="May",
day="25",
volume="9",
number="5",
pages="e23586",
keywords="genetic reports",
keywords="electronic health records",
keywords="predicting primary cancers",
keywords="Fast Healthcare Interoperability Resources",
keywords="FHIR",
keywords="Resource Description Framework",
keywords="RDF",
abstract="Background: Precision oncology has the potential to leverage clinical and genomic data in advancing disease prevention, diagnosis, and treatment. A key research area focuses on the early detection of primary cancers and potential prediction of cancers of unknown primary in order to facilitate optimal treatment decisions. Objective: This study presents a methodology to harmonize phenotypic and genetic data features to classify primary cancer types and predict cancers of unknown primaries. Methods: We extracted genetic data elements from oncology genetic reports of 1011 patients with cancer and their corresponding phenotypical data from Mayo Clinic's electronic health records. We modeled both genetic and electronic health record data with HL7 Fast Healthcare Interoperability Resources. The semantic web Resource Description Framework was employed to generate the network-based data representation (ie, patient-phenotypic-genetic network). Based on the Resource Description Framework data graph, Node2vec graph-embedding algorithm was applied to generate features. Multiple machine learning and deep learning backbone models were compared for cancer prediction performance. Results: With 6 machine learning tasks designed in the experiment, we demonstrated the proposed method achieved favorable results in classifying primary cancer types (area under the receiver operating characteristic curve [AUROC] 96.56\% for all 9 cancer predictions on average based on the cross-validation) and predicting unknown primaries (AUROC 80.77\% for all 8 cancer predictions on average for real-patient validation). To demonstrate the interpretability, 17 phenotypic and genetic features that contributed the most to the prediction of each cancer were identified and validated based on a literature review. Conclusions: Accurate prediction of cancer types can be achieved with existing electronic health record data with satisfactory precision. The integration of genetic reports improves prediction, illustrating the translational values of incorporating genetic tests early at the diagnosis stage for patients with cancer. ",
doi="10.2196/23586",
url="https://medinform.jmir.org/2021/5/e23586",
url="http://www.ncbi.nlm.nih.gov/pubmed/34032581"
}


@Article{info:doi/10.2196/26096,
author="Holl{\"a}nder-Mieritz, Cecilie
and Vogelius, R. Ivan
and Kristensen, A. Claus
and Green, Allan
and Rindum, L. Judith
and Pappot, Helle",
title="Using Biometric Sensor Data to Monitor Cancer Patients During Radiotherapy: Protocol for the OncoWatch Feasibility Study",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="13",
volume="10",
number="5",
pages="e26096",
keywords="biometric sensor technology",
keywords="cancer",
keywords="head and neck cancer",
keywords="home monitoring",
keywords="patient-generated health data",
keywords="radiotherapy",
keywords="sensor",
keywords="smartwatch",
abstract="Background: Patients with head and neck cancer (HNC) experience severe side effects during radiotherapy (RT). Ongoing technological advances in wearable biometric sensors allow for the collection of objective data (eg, physical activity and heart rate), which might, in the future, help detect and counter side effects before they become severe. A smartwatch such as the Apple Watch allows for objective data monitoring outside the hospital with minimal effort from the patient. To determine whether such tools can be implemented in the oncological setting, feasibility studies are needed. Objective: This protocol describes the design of the OncoWatch 1.0 feasibility study that assesses the adherence of patients with HNC to an Apple Watch during RT. Methods: A prospective, single-cohort trial will be conducted at the Department of Oncology, Rigshospitalet (Copenhagen, Denmark). Patients aged ?18 years intended for primary or postoperative curatively intended RT for HNC will be recruited. Consenting patients will be asked to wear an Apple Watch on the wrist during and until 2 weeks after RT. The study will include 10 patients. Data on adherence, data acquisition, and biometric data will be collected. Demographic data, objective toxicity scores, and hospitalizations will be documented. Results: The primary outcome is to determine if it is feasible for the patients to wear a smartwatch continuously (minimum 12 hours/day) during RT. Furthermore, we will explore how the heart rate and physical activity change over the treatment course. Conclusions: The study will assess the feasibility of using the Apple Watch for home monitoring of patients with HNC. Our findings may provide novel insights into the patient's activity levels and variations in heart rate during the treatment course. The knowledge obtained from this study will be essential for further investigating how biometric data can be used as part of symptom monitoring for patients with HNC. Trial Registration: ClinicalTrials.gov NCT04613232; https://clinicaltrials.gov/ct2/show/NCT04613232 International Registered Report Identifier (IRRID): PRR1-10.2196/26096 ",
doi="10.2196/26096",
url="https://www.researchprotocols.org/2021/5/e26096",
url="http://www.ncbi.nlm.nih.gov/pubmed/33983123"
}


@Article{info:doi/10.2196/22296,
author="Chandra, Alvin
and Philips, T. Steven
and Pandey, Ambarish
and Basit, Mujeeb
and Kannan, Vaishnavi
and Sara, J. Evan
and Das, R. Sandeep
and Lee, C. Simon J.
and Haley, Barbara
and Willett, L. DuWayne
and Zaha, G. Vlad",
title="Electronic Health Records--Based Cardio-Oncology Registry for Care Gap Identification and Pragmatic Research: Procedure and Observational Study",
journal="JMIR Cardio",
year="2021",
month="May",
day="12",
volume="5",
number="1",
pages="e22296",
keywords="electronic health records",
keywords="cardio-oncology",
keywords="patient registry",
keywords="heart failure",
keywords="screening",
abstract="Background: Professional society guidelines are emerging for cardiovascular care in cancer patients. However, it is not yet clear how effectively the cancer survivor population is screened and treated for cardiomyopathy in contemporary clinical practice. As electronic health records (EHRs) are now widely used in clinical practice, we tested the hypothesis that an EHR-based cardio-oncology registry can address these questions. Objective: The aim of this study was to develop an EHR-based pragmatic cardio-oncology registry and, as proof of principle, to investigate care gaps in the cardiovascular care of cancer patients. Methods: We generated a programmatically deidentified, real-time EHR-based cardio-oncology registry from all patients in our institutional Cancer Population Registry (N=8275, 2011-2017). We investigated: (1) left ventricular ejection fraction (LVEF) assessment before and after treatment with potentially cardiotoxic agents; and (2) guideline-directed medical therapy (GDMT) for left ventricular dysfunction (LVD), defined as LVEF<50\%, and symptomatic heart failure with reduced LVEF (HFrEF), defined as LVEF<50\% and Problem List documentation of systolic congestive heart failure or dilated cardiomyopathy. Results: Rapid development of an EHR-based cardio-oncology registry was feasible. Identification of tests and outcomes was similar using the EHR-based cardio-oncology registry and manual chart abstraction (100\% sensitivity and 83\% specificity for LVD). LVEF was documented prior to initiation of cancer therapy in 19.8\% of patients. Prevalence of postchemotherapy LVD and HFrEF was relatively low (9.4\% and 2.5\%, respectively). Among patients with postchemotherapy LVD or HFrEF, those referred to cardiology had a significantly higher prescription rate of a GDMT. Conclusions: EHR data can efficiently populate a real-time, pragmatic cardio-oncology registry as a byproduct of clinical care for health care delivery investigations. ",
doi="10.2196/22296",
url="https://cardio.jmir.org/2021/1/e22296",
url="http://www.ncbi.nlm.nih.gov/pubmed/33797396"
}


@Article{info:doi/10.2196/28668,
author="Petrocchi, Serena
and Filipponi, Chiara
and Montagna, Giacomo
and Bonollo, Marta
and Pagani, Olivia
and Meani, Francesco",
title="A Breast Cancer Smartphone App to Navigate the Breast Cancer Journey: Mixed Methods Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="10",
volume="5",
number="5",
pages="e28668",
keywords="breast cancer",
keywords="decision-making process",
keywords="breast cancer patient",
keywords="smartphone app",
keywords="empowerment",
keywords="breast cancer journey",
keywords="mobile app",
abstract="Background: Several mobile apps have been designed for patients with a diagnosis of cancer. Unfortunately, despite the promising potential and impressive spread, their effectiveness often remains unclear. Most mobile apps are developed without any medical professional involvement and quality evidence-based assessment. Furthermore, they are often implemented in clinical care before any research is performed to confirm usability, appreciation, and clinical benefits for patients. Objective: We aimed to develop a new smartphone app (Centro di Senologia della Svizzera Italiana [CSSI]) specifically designed by breast care specialists and patients together to help breast cancer patients better understand and organize their journey through the diagnosis and treatment of cancer. We describe the development of the app and present assessments to evaluate its feasibility, usefulness, and capability to improve patient empowerment. Methods: A mixed method study with brief longitudinal quantitative data collection and subsequent qualitative semistructured interviews was designed. Twenty breast cancer patients participated in the study (mean age 51 years, SD 10 years). The usability of the app, the user experience, and empowerment were measured after 1 month. The semistructured interviews measured the utility of the app and the necessary improvements. Results: The app received good responses from the patients in terms of positive perception of the purpose of the app (7/20, 35\%), organizing the cure path and being aware of the steps in cancer management (5/20, 25\%), facilitating doctor-patient communication (4/20, 20\%), and having detailed information about the resources offered by the hospital (2/20, 10\%). Correlation and regression analyses showed that user experience increased the level of empowerment of patients (B=0.31, 95\% CI 0.22-0.69; P=.009). The interviews suggested the need to constantly keep the app updated and to synchronize it with the hospital's electronic agenda, and carefully selecting the best time to offer the tool to final users was considered crucial. Conclusions: Despite the very small number of participants in this study, the findings demonstrate the potential of the app and support a fully powered trial to evaluate the empowering effect of the mobile health app. More data will be gathered with an improved version of the app in the second phase involving a larger study sample. ",
doi="10.2196/28668",
url="https://formative.jmir.org/2021/5/e28668",
url="http://www.ncbi.nlm.nih.gov/pubmed/33970120"
}


@Article{info:doi/10.2196/16156,
author="Peltola, Kristiina Maria
and Poikonen-Saksela, Paula
and Mattson, Johanna
and Parkkari, Timo",
title="A Novel Digital Patient-Reported Outcome Platform (Noona) for Clinical Use in Patients With Cancer: Pilot Study Assessing Suitability",
journal="JMIR Form Res",
year="2021",
month="May",
day="6",
volume="5",
number="5",
pages="e16156",
keywords="electronic patient-reported outcome",
keywords="adverse events",
keywords="patients with cancer",
abstract="Background: As the incidence of cancer is on the rise, there is a need to develop modern communication tools between patients and the medical personnel. Electronic patient-reported outcome (ePRO) measures increase the safety of cancer treatments and may have an impact on treatment outcome as well. ePRO may also provide a cost-efficient way to organize follow-up for patients with cancer. Noona is an internet-based system for patients to self-report symptoms and adverse events of cancer treatments from home via a computer or a smart device (eg, smartphone, tablet). Objective: In this pilot study, we assessed the suitability of a novel ePRO application (Noona) for patients with cancer, nurses, and doctors at the Helsinki University Hospital, Finland. Methods: The study included 44 patients with cancer (different solid tumor types) and 17 health care professionals (nurses or medical doctors). Patients were either operated or received systemic treatment or radiotherapy. Patients reported their symptoms to the medical staff via Noona. In addition, patients and clinicians answered a questionnaire, based on which Noona's suitability for clinical use was evaluated in terms of usability (ease of use, operability, and learnability), reliability (subjective opinion of the participant), and incidence of harmful events reported by the participants. Results: A total of 41/44 (93\%) patients and 15/17 (88\%) professionals reported that the program was easy or quite easy to use; 38/44 (86\%) patients and 11/17 (65\%) professionals found Noona reliable, and 38/44 (86\%) patients and 10/17 (59\%) professionals would recommend Noona to other patients or their colleagues. No harmful incidences caused by the use of Noona were reported by the patients; however, 1 harmful incidence was reported by one of the professionals. Conclusions: The majority of the participants felt that Noona appeared reliable and it was easy to use. Noona seems to be a useful tool for monitoring patient's symptoms during cancer therapy. Future studies will determine the impact of this ePRO platform in routine clinical practice. ",
doi="10.2196/16156",
url="https://formative.jmir.org/2021/5/e16156",
url="http://www.ncbi.nlm.nih.gov/pubmed/33955841"
}


@Article{info:doi/10.2196/27975,
author="Low, A. Carissa
and Li, Meng
and Vega, Julio
and Durica, C. Krina
and Ferreira, Denzil
and Tam, Vernissia
and Hogg, Melissa
and Zeh III, Herbert
and Doryab, Afsaneh
and Dey, K. Anind",
title="Digital Biomarkers of Symptom Burden Self-Reported by Perioperative Patients Undergoing Pancreatic Surgery: Prospective Longitudinal Study",
journal="JMIR Cancer",
year="2021",
month="Apr",
day="27",
volume="7",
number="2",
pages="e27975",
keywords="mobile sensing",
keywords="symptom",
keywords="cancer",
keywords="surgery",
keywords="wearable device",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Cancer treatments can cause a variety of symptoms that impair quality of life and functioning but are frequently missed by clinicians. Smartphone and wearable sensors may capture behavioral and physiological changes indicative of symptom burden, enabling passive and remote real-time monitoring of fluctuating symptoms Objective: The aim of this study was to examine whether smartphone and Fitbit data could be used to estimate daily symptom burden before and after pancreatic surgery. Methods: A total of 44 patients scheduled for pancreatic surgery participated in this prospective longitudinal study and provided sufficient sensor and self-reported symptom data for analyses. Participants collected smartphone sensor and Fitbit data and completed daily symptom ratings starting at least two weeks before surgery, throughout their inpatient recovery, and for up to 60 days after postoperative discharge. Day-level behavioral features reflecting mobility and activity patterns, sleep, screen time, heart rate, and communication were extracted from raw smartphone and Fitbit data and used to classify the next day as high or low symptom burden, adjusted for each individual's typical level of reported symptoms. In addition to the overall symptom burden, we examined pain, fatigue, and diarrhea specifically. Results: Models using light gradient boosting machine (LightGBM) were able to correctly predict whether the next day would be a high symptom day with 73.5\% accuracy, surpassing baseline models. The most important sensor features for discriminating high symptom days were related to physical activity bouts, sleep, heart rate, and location. LightGBM models predicting next-day diarrhea (79.0\% accuracy), fatigue (75.8\% accuracy), and pain (79.6\% accuracy) performed similarly. Conclusions: Results suggest that digital biomarkers may be useful in predicting patient-reported symptom burden before and after cancer surgery. Although model performance in this small sample may not be adequate for clinical implementation, findings support the feasibility of collecting mobile sensor data from older patients who are acutely ill as well as the potential clinical value of mobile sensing for passive monitoring of patients with cancer and suggest that data from devices that many patients already own and use may be useful in detecting worsening perioperative symptoms and triggering just-in-time symptom management interventions. ",
doi="10.2196/27975",
url="https://cancer.jmir.org/2021/2/e27975",
url="http://www.ncbi.nlm.nih.gov/pubmed/33904822"
}


@Article{info:doi/10.2196/24254,
author="Phillips, Siobhan
and Solk, Payton
and Welch, Whitney
and Auster-Gussman, Lisa
and Lu, Marilyn
and Cullather, Erin
and Torre, Emily
and Whitaker, Madelyn
and Izenman, Emily
and La, Jennifer
and Lee, Jungwha
and Spring, Bonnie
and Gradishar, William",
title="A Technology-Based Physical Activity Intervention for Patients With Metastatic Breast Cancer (Fit2ThriveMB): Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Apr",
day="23",
volume="10",
number="4",
pages="e24254",
keywords="physical activity",
keywords="metastatic breast cancer",
keywords="technology",
keywords="randomized controlled trial",
keywords="mobile phone",
abstract="Background: Increased incidence and life expectancy have resulted in a growing population of patients with metastatic breast cancer, and these patients experience high rates of morbidity and premature mortality. Increased physical activity (PA) is consistently associated with improved health and disease outcomes among early-stage survivors. However, there is a paucity of research on PA in patients with metastatic breast cancer, and existing PA interventions have exhibited low feasibility because of their focus on intense PA and/or requirement of on-site visits. Mobile health (mHealth)--based PA interventions may be particularly useful for patients with metastatic breast cancer because they allow for remote monitoring, which facilitates individual tailoring of PA recommendations to patients' abilities and may minimize participant burden. However, no studies have examined mHealth PA interventions in patients with metastatic breast cancer. Objective: We aim to address these critical research gaps by testing a highly tailored technology-based intervention to promote PA of any intensity (ie, light, moderate, or vigorous) by increasing daily steps in patients with metastatic breast cancer. The primary aim of this study is to test the feasibility and acceptability of the Fit2ThriveMB intervention. We will also examine outcome patterns suggesting the efficacy of Fit2ThriveMB on symptom burden, quality of life, and functional performance. Methods: The Fit2ThriveMB trial is a two-arm pilot randomized controlled trial that will compare the effects of a smartphone-delivered, home-based PA intervention and an attention-control education condition on PA and quality of life in low-active female patients with metastatic breast cancer. A subsample (n=25) will also complete functional performance measures. This innovative trial will recruit 50 participants who will be randomized into the study's intervention or control arm. The intervention will last 12 weeks. The Fit2ThriveMB intervention consists of a Fitbit, coaching calls, and the Fit2ThriveMB smartphone app that provides self-monitoring, a tailored goal-setting tool, real-time tailored feedback, app notifications, and a group message board. Assessments will occur at baseline and post intervention. Results: The Fit2ThriveMB study is ongoing. Data collection ended in February 2021. Conclusions: Data from this study will provide the preliminary effect sizes needed to assemble an intervention that is to be evaluated in a fully powered trial. In addition, these data will provide essential evidence to support the feasibility and acceptability of using a technology-based PA promotion intervention, a scalable strategy that could be easily integrated into care, among patients with metastatic breast cancer. Trial Registration: ClinicalTrials.gov NCT04129346; https://clinicaltrials.gov/ct2/show/NCT04129346 International Registered Report Identifier (IRRID): DERR1-10.2196/24254 ",
doi="10.2196/24254",
url="https://www.researchprotocols.org/2021/4/e24254",
url="http://www.ncbi.nlm.nih.gov/pubmed/33890857"
}


@Article{info:doi/10.2196/25053,
author="Bang, Seok Chang
and Ahn, Yong Ji
and Kim, Jie-Hyun
and Kim, Young-Il
and Choi, Ju Il
and Shin, Geon Woon",
title="Establishing Machine Learning Models to Predict Curative Resection in Early Gastric Cancer with Undifferentiated Histology: Development and Usability Study",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="15",
volume="23",
number="4",
pages="e25053",
keywords="early gastric cancer",
keywords="artificial intelligence",
keywords="machine learning",
keywords="endoscopic submucosal dissection",
keywords="undifferentiated",
keywords="gastric cancer",
keywords="endoscopy",
keywords="dissection",
abstract="Background: Undifferentiated type of early gastric cancer (U-EGC) is included among the expanded indications of endoscopic submucosal dissection (ESD); however, the rate of curative resection remains unsatisfactory. Endoscopists predict the probability of curative resection by considering the size and shape of the lesion and whether ulcers are present or not. The location of the lesion, indicating the likely technical difficulty, is also considered. Objective: The aim of this study was to establish machine learning (ML) models to better predict the possibility of curative resection in U-EGC prior to ESD. Methods: A nationwide cohort of 2703 U-EGCs treated by ESD or surgery were adopted for the training and internal validation cohorts. Separately, an independent data set of the Korean ESD registry (n=275) and an Asan medical center data set (n=127) treated by ESD were chosen for external validation. Eighteen ML classifiers were selected to establish prediction models of curative resection with the following variables: age; sex; location, size, and shape of the lesion; and whether ulcers were present or not. Results: Among the 18 models, the extreme gradient boosting classifier showed the best performance (internal validation accuracy 93.4\%, 95\% CI 90.4\%-96.4\%; precision 92.6\%, 95\% CI 89.5\%-95.7\%; recall 99.0\%, 95\% CI 97.8\%-99.9\%; and F1 score 95.7\%, 95\% CI 93.3\%-98.1\%). Attempts at external validation showed substantial accuracy (first external validation 81.5\%, 95\% CI 76.9\%-86.1\% and second external validation 89.8\%, 95\% CI 84.5\%-95.1\%). Lesion size was the most important feature in each explainable artificial intelligence analysis. Conclusions: We established an ML model capable of accurately predicting the curative resection of U-EGC before ESD by considering the morphological and ecological characteristics of the lesions. ",
doi="10.2196/25053",
url="https://www.jmir.org/2021/4/e25053",
url="http://www.ncbi.nlm.nih.gov/pubmed/33856358"
}


@Article{info:doi/10.2196/25167,
author="Bang, Seok Chang
and Lim, Hyun
and Jeong, Min Hae
and Hwang, Hyeon Sung",
title="Use of Endoscopic Images in the Prediction of Submucosal Invasion of Gastric Neoplasms: Automated Deep Learning Model Development and Usability Study",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="15",
volume="23",
number="4",
pages="e25167",
keywords="convolutional neural network",
keywords="deep learning",
keywords="automated deep learning",
keywords="endoscopy",
keywords="gastric neoplasms",
keywords="neural network",
keywords="deep learning model",
keywords="artificial intelligence",
abstract="Background: In a previous study, we examined the use of deep learning models to classify the invasion depth (mucosa-confined versus submucosa-invaded) of gastric neoplasms using endoscopic images. The external test accuracy reached 77.3\%. However, model establishment is labor intense, requiring high performance. Automated deep learning (AutoDL) models, which enable fast searching of optimal neural architectures and hyperparameters without complex coding, have been developed. Objective: The objective of this study was to establish AutoDL models to classify the invasion depth of gastric neoplasms. Additionally, endoscopist--artificial intelligence interactions were explored. Methods: The same 2899 endoscopic images that were employed to establish the previous model were used. A prospective multicenter validation using 206 and 1597 novel images was conducted. The primary outcome was external test accuracy. Neuro-T, Create ML Image Classifier, and AutoML Vision were used in establishing the models. Three doctors with different levels of endoscopy expertise were asked to classify the invasion depth of gastric neoplasms for each image without AutoDL support, with faulty AutoDL support, and with best performance AutoDL support in sequence. Results: The Neuro-T--based model reached 89.3\% (95\% CI 85.1\%-93.5\%) external test accuracy. For the model establishment time, Create ML Image Classifier showed the fastest time of 13 minutes while reaching 82.0\% (95\% CI 76.8\%-87.2\%) external test accuracy. While the expert endoscopist's decisions were not influenced by AutoDL, the faulty AutoDL misled the endoscopy trainee and the general physician. However, this was corrected by the support of the best performance AutoDL model. The trainee gained the most benefit from the AutoDL support. Conclusions: AutoDL is deemed useful for the on-site establishment of customized deep learning models. An inexperienced endoscopist with at least a certain level of expertise can benefit from AutoDL support. ",
doi="10.2196/25167",
url="https://www.jmir.org/2021/4/e25167",
url="http://www.ncbi.nlm.nih.gov/pubmed/33856356"
}


@Article{info:doi/10.2196/23304,
author="Lim, Young Ji
and Kim, Kwang Jong
and Kim, Yoon
and Ahn, So-Yeon
and Yu, Jonghan
and Hwang, Hye Ji",
title="A Modular Mobile Health App for Personalized Rehabilitation Throughout the Breast Cancer Care Continuum: Development Study",
journal="JMIR Form Res",
year="2021",
month="Apr",
day="13",
volume="5",
number="4",
pages="e23304",
keywords="breast cancer",
keywords="mobile health",
keywords="rehabilitation",
keywords="cancer continuum",
abstract="Background: Although many mobile health (mHealth) apps have evolved as support tools for self-management of breast cancer, limited studies have developed a comprehensive app and described the algorithms for personalized rehabilitation throughout the breast cancer care continuum. Objective: This study aimed to develop a comprehensive mobile app and to describe an algorithm that adjusts personalized content to facilitate self-management throughout the breast cancer care continuum. Methods: The development process of the modular mHealth app included the following 4 steps: (1) organizing expert teams, (2) defining evidence-based fundamental content and modules, (3) classifying user information for algorithms to personalize the content, and (4) creating the app platform and connectivity to digital health care devices. Results: We developed a modular mHealth app service, which took 18 months, including a review of related literature and guidelines and the development of the app and connectivity to digital health care devices. A total of 11 functionalities were defined in the app with weekly analysis. The user information classification was formulated for personalized rehabilitation according to 5 key criteria: general user information, breast operation type, lymph node surgery type, chemotherapy and hormonal therapy use, and change in treatment after surgery. The main modules for personalized content included a self-monitoring screen, personalized health information, personalized exercise, and diet management. Conclusions: The strength of this study was the development of a comprehensive mHealth app and algorithms to adjust content based on user medical information for personalized rehabilitation during the breast cancer care continuum. ",
doi="10.2196/23304",
url="https://formative.jmir.org/2021/4/e23304",
url="http://www.ncbi.nlm.nih.gov/pubmed/33847589"
}


@Article{info:doi/10.2196/26010,
author="Porter, J. Kathleen
and Moon, E. Katherine
and LeBaron, T. Virginia
and Zoellner, M. Jamie",
title="A Novel Behavioral Intervention for Rural Appalachian Cancer Survivors (weSurvive): Participatory Development and Proof-of-Concept Testing",
journal="JMIR Cancer",
year="2021",
month="Apr",
day="12",
volume="7",
number="2",
pages="e26010",
keywords="cancer survivors",
keywords="quality of life",
keywords="behavior change",
keywords="rural",
keywords="feasibility",
keywords="Appalachia",
abstract="Background: Addressing the modifiable health behaviors of cancer survivors is important in rural communities that are disproportionately impacted by cancer (eg, those in Central Appalachia). However, such efforts are limited, and existing interventions may not meet the needs of rural communities. Objective: This study describes the development and proof-of-concept testing of weSurvive, a behavioral intervention for rural Appalachian cancer survivors. Methods: The Obesity-Related Behavioral Intervention Trials (ORBIT) model, a systematic model for designing behavioral interventions, informed the study design. An advisory team (n=10) of community stakeholders and researchers engaged in a participatory process to identify desirable features for interventions targeting rural cancer survivors. The resulting multimodal, 13-week weSurvive intervention was delivered to 12 participants across the two cohorts. Intervention components included in-person group classes and group and individualized telehealth calls. Indicators reflecting five feasibility domains (acceptability, demand, practicality, implementation, and limited efficacy) were measured using concurrent mixed methods. Pre-post changes and effect sizes were assessed for limited efficacy data. Descriptive statistics and content analysis were used to summarize data for other domains. Results: Participants reported high program satisfaction (acceptability). Indicators of demand included enrollment of cancer survivors with various cancer types and attrition (1/12, 8\%), recruitment (12/41, 30\%), and attendance (median 62\%) rates. Dietary (7/12, 59\%) and physical activity (PA; 10/12, 83\%) behaviors were the most frequently chosen behavioral targets. However, the findings indicate that participants did not fully engage in action planning activities, including setting specific goals. Implementation indicators showed 100\% researcher fidelity to delivery and retention protocols, whereas practicality indicators highlighted participation barriers. Pre-post changes in limited efficacy outcomes regarding cancer-specific beliefs and knowledge and behavior-specific self-efficacy, intentions, and behaviors were in desired directions and demonstrated small and moderate effect sizes. Regarding dietary and PA behaviors, effect sizes for fruit and vegetable intake, snacks, dietary fat, and minutes of moderate-to-vigorous activity were small (Cohen d=0.00 to 0.32), whereas the effect sizes for change in PA were small to medium (Cohen d=0.22 to 0.45). Conclusions: weSurvive has the potential to be a feasible intervention for rural Appalachian cancer survivors. It will be refined and further tested based on the study findings, which also provide recommendations for other behavioral interventions targeting rural cancer survivors. Recommendations included adding additional recruitment and engagement strategies to increase demand and practicality as well as increasing accountability and motivation for participant involvement in self-monitoring activities through the use of technology (eg, text messaging). Furthermore, this study highlights the importance of using a systematic model (eg, the ORBIT framework) and small-scale proof-of-concept studies when adapting or developing behavioral interventions, as doing so identifies the intervention's potential for feasibility and areas that need improvement before time- and resource-intensive efficacy trials. This could support a more efficient translation into practice. ",
doi="10.2196/26010",
url="https://cancer.jmir.org/2021/2/e26010",
url="http://www.ncbi.nlm.nih.gov/pubmed/33843597"
}


@Article{info:doi/10.2196/25035,
author="Jeon, Hokyun
and You, Chan Seng
and Kang, Yun Seok
and Seo, In Seung
and Warner, L. Jeremy
and Belenkaya, Rimma
and Park, Woong Rae",
title="Characterizing the Anticancer Treatment Trajectory and Pattern in Patients Receiving Chemotherapy for Cancer Using Harmonized Observational Databases: Retrospective Study",
journal="JMIR Med Inform",
year="2021",
month="Apr",
day="6",
volume="9",
number="4",
pages="e25035",
keywords="antineoplastic combined chemotherapy protocols",
keywords="electronic health record",
keywords="cancer",
keywords="pattern",
keywords="chemotherapy",
keywords="database",
keywords="retrospective",
keywords="algorithm",
keywords="scalability",
keywords="interoperability",
abstract="Background: Accurate and rapid clinical decisions based on real-world evidence are essential for patients with cancer. However, the complexity of chemotherapy regimens for cancer impedes retrospective research that uses observational health databases. Objective: The aim of this study is to compare the anticancer treatment trajectories and patterns of clinical events according to regimen type using the chemotherapy episodes determined by an algorithm. Methods: We developed an algorithm to extract the regimen-level abstracted chemotherapy episodes from medication records in a conventional Observational Medical Outcomes Partnership (OMOP) common data model (CDM) database. The algorithm was validated on the Ajou University School Of Medicine (AUSOM) database by manual review of clinical notes. Using the algorithm, we extracted episodes of chemotherapy from patients in the EHR database and the claims database. We also developed an application software for visualizing the chemotherapy treatment patterns based on the treatment episodes in the OMOP-CDM database. Using this software, we generated the trends in the types of regimen used in the institutions, the patterns of the iterative chemotherapy use, and the trajectories of cancer treatment in two EHR-based OMOP-CDM databases. As a pilot study, the time of onset of chemotherapy-induced neutropenia according to regimen was measured using the AUSOM database. The anticancer treatment trajectories for patients with COVID-19 were also visualized based on the nationwide claims database. Results: We generated 178,360 treatment episodes for patients with colorectal, breast, and lung cancer for 85 different regimens. The algorithm precisely identified the type of chemotherapy regimen in 400 patients (average positive predictive value >98\%). The trends in the use of routine clinical chemotherapy regimens from 2008-2018 were identified for 8236 patients. For a total of 12 regimens (those administered to the largest proportion of patients), the number of repeated treatments was concordant with the protocols for standard chemotherapy regimens for certain cases. In addition, the anticancer treatment trajectories for 8315 patients were shown, including 62 patients with COVID-19. A comparative analysis of neutropenia showed that its onset in colorectal cancer regimens tended to cluster between days 9-15, whereas it tended to cluster between days 2-8 for certain regimens for breast cancer or lung cancer. Conclusions: We propose a method for generating chemotherapy episodes for introduction into the oncology extension module of the OMOP-CDM databases. These proof-of-concept studies demonstrated the usability, scalability, and interoperability of the proposed framework through a distributed research network. ",
doi="10.2196/25035",
url="https://medinform.jmir.org/2021/4/e25035",
url="http://www.ncbi.nlm.nih.gov/pubmed/33720842"
}


@Article{info:doi/10.2196/22394,
author="Castaldo, Rossana
and Cavaliere, Carlo
and Soricelli, Andrea
and Salvatore, Marco
and Pecchia, Leandro
and Franzese, Monica",
title="Radiomic and Genomic Machine Learning Method Performance for Prostate Cancer Diagnosis: Systematic Literature Review",
journal="J Med Internet Res",
year="2021",
month="Apr",
day="1",
volume="23",
number="4",
pages="e22394",
keywords="prostate cancer",
keywords="machine learning",
keywords="systematic review",
keywords="meta-analysis",
keywords="diagnosis",
keywords="imaging",
keywords="radiomics",
keywords="genomics",
keywords="clinical",
keywords="biomarkers",
abstract="Background: Machine learning algorithms have been drawing attention at the joining of pathology and radiology in prostate cancer research. However, due to their algorithmic learning complexity and the variability of their architecture, there is an ongoing need to analyze their performance. Objective: This study assesses the source of heterogeneity and the performance of machine learning applied to radiomic, genomic, and clinical biomarkers for the diagnosis of prostate cancer. One research focus of this study was on clearly identifying problems and issues related to the implementation of machine learning in clinical studies. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol, 816 titles were identified from the PubMed, Scopus, and OvidSP databases. Studies that used machine learning to detect prostate cancer and provided performance measures were included in our analysis. The quality of the eligible studies was assessed using the QUADAS-2 (quality assessment of diagnostic accuracy studies--version 2) tool. The hierarchical multivariate model was applied to the pooled data in a meta-analysis. To investigate the heterogeneity among studies, I2 statistics were performed along with visual evaluation of coupled forest plots. Due to the internal heterogeneity among machine learning algorithms, subgroup analysis was carried out to investigate the diagnostic capability of machine learning systems in clinical practice. Results: In the final analysis, 37 studies were included, of which 29 entered the meta-analysis pooling. The analysis of machine learning methods to detect prostate cancer reveals the limited usage of the methods and the lack of standards that hinder the implementation of machine learning in clinical applications. Conclusions: The performance of machine learning for diagnosis of prostate cancer was considered satisfactory for several studies investigating the multiparametric magnetic resonance imaging and urine biomarkers; however, given the limitations indicated in our study, further studies are warranted to extend the potential use of machine learning to clinical settings. Recommendations on the use of machine learning techniques were also provided to help researchers to design robust studies to facilitate evidence generation from the use of radiomic and genomic biomarkers. ",
doi="10.2196/22394",
url="https://www.jmir.org/2021/4/e22394",
url="http://www.ncbi.nlm.nih.gov/pubmed/33792552"
}


@Article{info:doi/10.2196/24062,
author="Morse, S. Robert
and Lambden, Kaley
and Quinn, Erin
and Ngoma, Twalib
and Mushi, Beatrice
and Ho, Xian Yun
and Ngoma, Mamsau
and Mahuna, Habiba
and Sagan, B. Sarah
and Mmari, Joshua
and Miesfeldt, Susan",
title="A Mobile App to Improve Symptom Control and Information Exchange Among Specialists and Local Health Workers Treating Tanzanian Cancer Patients: Human-Centered Design Approach",
journal="JMIR Cancer",
year="2021",
month="Mar",
day="23",
volume="7",
number="1",
pages="e24062",
keywords="mobile health",
keywords="mHealth",
keywords="user-centered design",
keywords="palliative care",
keywords="pain",
keywords="cancer",
keywords="sub-Saharan Africa",
keywords="mobile phone",
abstract="Background: Improving access to end-of-life symptom control interventions among cancer patients is a public health priority in Tanzania, and innovative community-based solutions are needed. Mobile health technology holds promise; however, existing resources are limited, and outpatient access to palliative care specialists is poor. A mobile platform that extends palliative care specialist access via shared care with community-based local health workers (LHWs) and provides remote support for pain and other symptom management can address this care gap. Objective: The aim of this study is to design and develop mobile-Palliative Care Link (mPCL), a web and mobile app to support outpatient symptom assessment and care coordination and control, with a focus on pain. Methods: A human-centered iterative design framework was used to develop the mPCL prototype for use by Tanzanian palliative care specialists (physicians and nurses trained in palliative care), poor-prognosis cancer patients and their lay caregivers (patients and caregivers), and LHWs. Central to mPCL is the validated African Palliative Care Outcome Scale (POS), which was adapted for automated, twice-weekly collection of quality of life--focused patient and caregiver responses and timely review, reaction, and tracking by specialists and LHWs. Prototype usability testing sessions were conducted in person with 21 key informants representing target end users. Sessions consisted of direct observations and qualitative and quantitative feedback on app ease of use and recommendations for improvement. Results were applied to optimize the prototype for subsequent real-world testing. Early pilot testing was conducted by deploying the app among 10 patients and caregivers, randomized to mPCL use versus phone-contact POS collection, and then gathering specialist and study team feedback to further optimize the prototype for a broader randomized field study to examine the app's effectiveness in symptom control among cancer patients. Results: mPCL functionalities include the ability to create and update a synoptic clinical record, regular real-time symptom assessment, patient or caregiver and care team communication and care coordination, symptom-focused educational resources, and ready access to emergency phone contact with a care team member. Results from the usability and pilot testing demonstrated that all users were able to successfully navigate the app, and feedback suggests that mPCL has clinical utility. User-informed recommendations included further improvement in app navigation, simplification of patient and caregiver components and language, and delineation of user roles. Conclusions: We designed, built, and tested a usable, functional mobile app prototype that supports outpatient palliative care for Tanzanian patients with cancer. mPCL is expressly designed to facilitate coordinated care via customized interfaces supporting core users---patients or caregivers, LHWs, and members of the palliative care team---and their respective roles. Future work is needed to demonstrate the effectiveness and sustainability of mPCL to remotely support the symptom control needs of Tanzanian cancer patients, particularly in harder-to-reach areas. ",
doi="10.2196/24062",
url="https://cancer.jmir.org/2021/1/e24062",
url="http://www.ncbi.nlm.nih.gov/pubmed/33755022"
}


@Article{info:doi/10.2196/22647,
author="Liu, Fan
and Guo, Peng
and Su, Xiangqian
and Cui, Ming
and Jiang, Jianlong
and Wang, Suo
and Yu, Zhouman
and Zhou, Runhe
and Ye, Yingjiang",
title="A Novel Remote Follow-Up Tool Based on an Instant Messaging/Social Media App for the Management of Patients With Low Anterior Resection Syndrome: Pilot Prospective Self-Control Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Mar",
day="19",
volume="9",
number="3",
pages="e22647",
keywords="instant messaging social media",
keywords="rectal cancer",
keywords="low anterior resection syndrome",
keywords="follow-up",
keywords="telephone interview",
abstract="Background: Low anterior resection syndrome (LARS) is a common functional disorder that develops after patients with rectal cancer undergo anal preservation surgery. Common approaches to assess the symptoms of patients with LARS are often complex and time-consuming. Instant messaging/social media has great application potential in LARS follow-up, but has been underdeveloped. Objective: The aim of this study was to compare data between a novel instant messaging/social media follow-up system and a telephone interview in patients with LARS and to analyze the consistency of the instant messaging/social media platform. Methods: Patients with R0 resectable rectal cancer who accepted several defecation function visits via the instant messaging/social media platform and agreed to a telephone interview after the operation using the same questionnaire including subjective questions and LARS scores were included. Differences between the 2 methods were analyzed in pairs and the diagnostic consistency of instant messaging/social media was calculated based on telephone interview results. Results: In total, 21 questionnaires from 15 patients were included. The positive rates of defecation dissatisfaction, life restriction, and medication use were 10/21 (48\%), 11/21 (52\%), and 8/21 (38\%) for telephone interview and 10/21 (48\%), 13/21 (62\%), and 5/21 (24\%) for instant messaging/social media, respectively. No statistically significant difference was observed between instant messaging/social media and telephone interview in terms of total LARS score (mean 22.4 [SD 11.9] vs mean 24.7 [SD 10.7], P<.21) and LARS categories (Z=--0.264, P=.79); however, instant messaging/social media showed a more negative tendency. The kappa values of 3 subjective questions were 0.618, 0.430, and 0.674, respectively. The total LARS scores were consistent between both groups (Pearson coefficient 0.760, P<.001; category correlation coefficient 0.570, P=.005). Patients with major LARS had highly consistent results, with sensitivity, specificity, kappa value, and P value of 77.8\%, 91.7\%, 0.704, and .001, respectively. Conclusions: Instant messaging/social media can be a major LARS screening method. However, further research on information accuracy and user acceptance is needed before implementing a mature system. Trial Registration: ClinicalTrials.gov NCT03009747; https://clinicaltrials.gov/ct2/show/NCT03009747 ",
doi="10.2196/22647",
url="https://mhealth.jmir.org/2021/3/e22647",
url="http://www.ncbi.nlm.nih.gov/pubmed/33739295"
}


@Article{info:doi/10.2196/23595,
author="Cos, Heidy
and Li, Dingwen
and Williams, Gregory
and Chininis, Jeffrey
and Dai, Ruixuan
and Zhang, Jingwen
and Srivastava, Rohit
and Raper, Lacey
and Sanford, Dominic
and Hawkins, William
and Lu, Chenyang
and Hammill, W. Chet",
title="Predicting Outcomes in Patients Undergoing Pancreatectomy Using Wearable Technology and Machine Learning: Prospective Cohort Study",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="18",
volume="23",
number="3",
pages="e23595",
keywords="pancreatectomy",
keywords="pancreatic cancer",
keywords="telemonitoring",
keywords="remote monitoring",
keywords="machine learning",
keywords="wearable technology",
keywords="activity",
abstract="Background: Pancreatic cancer is the third leading cause of cancer-related deaths, and although pancreatectomy is currently the only curative treatment, it is associated with significant morbidity. Objective: The objective of this study was to evaluate the utility of wearable telemonitoring technologies to predict treatment outcomes using patient activity metrics and machine learning. Methods: In this prospective, single-center, single-cohort study, patients scheduled for pancreatectomy were provided with a wearable telemonitoring device to be worn prior to surgery. Patient clinical data were collected and all patients were evaluated using the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator (ACS-NSQIP SRC). Machine learning models were developed to predict whether patients would have a textbook outcome and compared with the ACS-NSQIP SRC using area under the receiver operating characteristic (AUROC) curves. Results: Between February 2019 and February 2020, 48 patients completed the study. Patient activity metrics were collected over an average of 27.8 days before surgery. Patients took an average of 4162.1 (SD 4052.6) steps per day and had an average heart rate of 75.6 (SD 14.8) beats per minute. Twenty-eight (58\%) patients had a textbook outcome after pancreatectomy. The group of 20 (42\%) patients who did not have a textbook outcome included 14 patients with severe complications and 11 patients requiring readmission. The ACS-NSQIP SRC had an AUROC curve of 0.6333 to predict failure to achieve a textbook outcome, while our model combining patient clinical characteristics and patient activity data achieved the highest performance with an AUROC curve of 0.7875. Conclusions: Machine learning models outperformed ACS-NSQIP SRC estimates in predicting textbook outcomes after pancreatectomy. The highest performance was observed when machine learning models incorporated patient clinical characteristics and activity metrics. ",
doi="10.2196/23595",
url="https://www.jmir.org/2021/3/e23595",
url="http://www.ncbi.nlm.nih.gov/pubmed/33734096"
}


@Article{info:doi/10.2196/24638,
author="Cho, Youmin
and Zhang, Huiting
and Harris, Ruth Marcelline
and Gong, Yang
and Smith, Lavoie Ellen
and Jiang, Yun",
title="Acceptance and Use of Home-Based Electronic Symptom Self-Reporting Systems in Patients With Cancer: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="12",
volume="23",
number="3",
pages="e24638",
keywords="symptom",
keywords="self report",
keywords="telemedicine",
keywords="technology",
keywords="internet",
keywords="mobile phone",
keywords="patient preference",
keywords="cancer",
keywords="patient-reported outcomes",
abstract="Background: Electronic symptom self-reporting systems (e-SRS) have been shown to improve symptoms and survival in patients with cancer. However, patient engagement in using e-SRS for voluntary symptom self-reporting is less optimal. Multiple factors can potentially affect patients' acceptance and engagement in using home-based e-SRS. However, such factors have not been fully explored in cancer populations. Objective: The aim of this study is to understand the acceptance and use of home-based e-SRS by patients with cancer and identify associated facilitators and barriers. Methods: PubMed, CINAHL, Scopus, and PsycINFO (January 2010 to March 2020) were searched using a combination of Medical Subject Headings (MeSH) terms and keywords such as symptom self-reporting, electronic/technology, cancer, and their synonyms. Included studies focused on the use of home-based e-SRS by patients with cancer and their families. Studies on patients' use of e-SRS in clinical settings only were excluded. Of the 3740 papers retrieved, 33 were included in the final review. Factors associated with patient acceptance and use of e-SRS were extracted and synthesized. Results: Most e-SRS were web based (22/33, 66\%) or mobile app based (9/33, 27\%). The e-SRS initial acceptance, represented by patient enrollment rates, ranged from 40\% (22/55) to 100\% (100/100). High e-SRS acceptance was rated by 69\% (59/85) to 77.6\% (337/434) of the patients after they used the system. The e-SRS use, measured by patients' response rates to questionnaires (ranging from 1596/3521, 45.33\% to 92\%) or system log-on rates (ranging from 4/12, 33\% to 99/100, 99\%), declined over time in general patterns. Few studies (n=7) reported e-SRS use beyond 6 months, with the response rates ranging from 62\% (40/64) to 85.1\% (541/636) and the log-on rates ranging from 63.6\% (103/162) to 77\% (49/64). The availability of compatible devices and technical support, interactive system features, information accessibility, privacy, questionnaire quality, patient physical/psychosocial status, and age were associated with patient acceptance and use of home-based e-SRS. Conclusions: Acceptance and use of home-based e-SRS by patients with cancer varied significantly across studies, as assessed by a variety of approaches. The lack of access to technology has remained a barrier to e-SRS adoption. Interactive system features and personalized questionnaires may increase patient engagement. More studies are needed to further understand patients' long-term use of home-based e-SRS behavior patterns to develop personalized interventions to support symptom self-management and self-reporting of patients with cancer for optimal health outcomes. ",
doi="10.2196/24638",
url="https://www.jmir.org/2021/3/e24638",
url="http://www.ncbi.nlm.nih.gov/pubmed/33709929"
}


@Article{info:doi/10.2196/26911,
author="Kataoka, Yuki
and Takemura, Tomoyasu
and Sasajima, Munehiko
and Katoh, Naoki",
title="Development and Early Feasibility of Chatbots for Educating Patients With Lung Cancer and Their Caregivers in Japan: Mixed Methods Study",
journal="JMIR Cancer",
year="2021",
month="Mar",
day="10",
volume="7",
number="1",
pages="e26911",
keywords="cancer",
keywords="caregivers",
keywords="chatbot",
keywords="lung cancer",
keywords="mixed methods approach",
keywords="online health",
keywords="patients",
keywords="symptom management education",
keywords="web-based platform",
abstract="Background: Chatbots are artificial intelligence--driven programs that interact with people. The applications of this technology include the collection and delivery of information, generation of and responding to inquiries, collection of end user feedback, and the delivery of personalized health and medical information to patients through cellphone- and web-based platforms. However, no chatbots have been developed for patients with lung cancer and their caregivers. Objective: This study aimed to develop and evaluate the early feasibility of a chatbot designed to improve the knowledge of symptom management among patients with lung cancer in Japan and their caregivers. Methods: We conducted a sequential mixed methods study that included a web-based anonymized questionnaire survey administered to physicians and paramedics from June to July 2019 (phase 1). Two physicians conducted a content analysis of the questionnaire to curate frequently asked questions (FAQs; phase 2). Based on these FAQs, we developed and integrated a chatbot into a social network service (phase 3). The physicians and paramedics involved in phase I then tested this chatbot ($\alpha$ test; phase 4). Thereafter, patients with lung cancer and their caregivers tested this chatbot ($\beta$ test; phase 5). Results: We obtained 246 questions from 15 health care providers in phase 1. We curated 91 FAQs and their corresponding responses in phase 2. In total, 11 patients and 1 caregiver participated in the $\beta$ test in phase 5. The participants were asked 60 questions, 8 (13\%) of which did not match the appropriate categories. After the $\beta$ test, 7 (64\%) participants responded to the postexperimental questionnaire. The mean satisfaction score was 2.7 (SD 0.5) points out of 5. Conclusions: Medical staff providing care to patients with lung cancer can use the categories specified in this chatbot to educate patients on how they can manage their symptoms. Further studies are required to improve chatbots in terms of interaction with patients. ",
doi="10.2196/26911",
url="https://cancer.jmir.org/2021/1/e26911",
url="http://www.ncbi.nlm.nih.gov/pubmed/33688839"
}


@Article{info:doi/10.2196/18325,
author="Wolbers, Roos
and Bode, Christina
and Siemerink, Ester
and Siesling, Sabine
and Pieterse, Marcel",
title="Cognitive Bias Modification Training to Improve Implicit Vitality in Patients With Breast Cancer: App Design Using a Cocreation Approach",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="10",
volume="5",
number="3",
pages="e18325",
keywords="breast cancer",
keywords="cognitive bias modification",
keywords="eHealth",
keywords="fatigue",
keywords="oncology",
keywords="psychology",
keywords="vitality",
abstract="Background: More than 50\% of all patients with breast cancer experience fatigue symptoms during and after their treatment course. Recent evidence has shown that fatigue is partly driven by cognitive biases such as the self-as-fatigued identity bias, which may be corrected with computer-based cognitive bias modification (CBM) techniques. Objective: The aim of this study was to design a CBM-training app by adopting a cocreation approach. Methods: Semistructured interviews were conducted with 7 health care professionals, 3 patients with breast cancer, and 2 patient advocates. The aim of the interviews was to collect input for the design of the CBM training, taking the values and preferences of the stakeholders into account, and to determine the timing and implementation of the training in the treatment course. Results: Overall, the interviews showed that the concept of CBM was accepted among all stakeholders. Important requirements were revealed such as the training needs to be simple and undemanding, yet engaging and persuasive. Based on the results, an eHealth app IVY (Implicit VitalitY) was created. The findings from the interviews suggested that IVY should be offered early in the breast cancer treatment course and should be carefully aligned with clinical treatment. Conclusions: The findings of this study show that using CBM as a preventive approach to target cancer-related fatigue is an innovative technique, and this approach was embraced by breast cancer stakeholders. Our study suggests that CBM training has several benefits such as being easy to use and potentially increasing perceived self-control in patients. ",
doi="10.2196/18325",
url="https://formative.jmir.org/2021/3/e18325",
url="http://www.ncbi.nlm.nih.gov/pubmed/33688833"
}


@Article{info:doi/10.2196/23483,
author="Jones, T. Owain
and Calanzani, Natalia
and Saji, Smiji
and Duffy, W. Stephen
and Emery, Jon
and Hamilton, Willie
and Singh, Hardeep
and de Wit, J. Niek
and Walter, M. Fiona",
title="Artificial Intelligence Techniques That May Be Applied to Primary Care Data to Facilitate Earlier Diagnosis of Cancer: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="3",
volume="23",
number="3",
pages="e23483",
keywords="artificial intelligence",
keywords="machine learning",
keywords="electronic health records",
keywords="primary health care",
keywords="early detection of cancer",
abstract="Background: More than 17 million people worldwide, including 360,000 people in the United Kingdom, were diagnosed with cancer in 2018. Cancer prognosis and disease burden are highly dependent on the disease stage at diagnosis. Most people diagnosed with cancer first present in primary care settings, where improved assessment of the (often vague) presenting symptoms of cancer could lead to earlier detection and improved outcomes for patients. There is accumulating evidence that artificial intelligence (AI) can assist clinicians in making better clinical decisions in some areas of health care. Objective: This study aimed to systematically review AI techniques that may facilitate earlier diagnosis of cancer and could be applied to primary care electronic health record (EHR) data. The quality of the evidence, the phase of development the AI techniques have reached, the gaps that exist in the evidence, and the potential for use in primary care were evaluated. Methods: We searched MEDLINE, Embase, SCOPUS, and Web of Science databases from January 01, 2000, to June 11, 2019, and included all studies providing evidence for the accuracy or effectiveness of applying AI techniques for the early detection of cancer, which may be applicable to primary care EHRs. We included all study designs in all settings and languages. These searches were extended through a scoping review of AI-based commercial technologies. The main outcomes assessed were measures of diagnostic accuracy for cancer. Results: We identified 10,456 studies; 16 studies met the inclusion criteria, representing the data of 3,862,910 patients. A total of 13 studies described the initial development and testing of AI algorithms, and 3 studies described the validation of an AI algorithm in independent data sets. One study was based on prospectively collected data; only 3 studies were based on primary care data. We found no data on implementation barriers or cost-effectiveness. Risk of bias assessment highlighted a wide range of study quality. The additional scoping review of commercial AI technologies identified 21 technologies, only 1 meeting our inclusion criteria. Meta-analysis was not undertaken because of the heterogeneity of AI modalities, data set characteristics, and outcome measures. Conclusions: AI techniques have been applied to EHR-type data to facilitate early diagnosis of cancer, but their use in primary care settings is still at an early stage of maturity. Further evidence is needed on their performance using primary care data, implementation barriers, and cost-effectiveness before widespread adoption into routine primary care clinical practice can be recommended. ",
doi="10.2196/23483",
url="https://www.jmir.org/2021/3/e23483",
url="http://www.ncbi.nlm.nih.gov/pubmed/33656443"
}


@Article{info:doi/10.2196/26799,
author="Fu, Zhiying
and Jiang, Min
and Wang, Kun
and Li, Jian",
title="Minimizing the Impact of the COVID-19 Epidemic on Oncology Clinical Trials: Retrospective Study of Beijing Cancer Hospital",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="2",
volume="23",
number="3",
pages="e26799",
keywords="COVID-19",
keywords="clinical trials",
keywords="management strategy",
keywords="information technology",
abstract="Background: In view of repeated COVID-19 outbreaks in most countries, clinical trials will continue to be conducted under outbreak prevention and control measures for the next few years. It is very significant to explore an optimal clinical trial management model during the outbreak period to provide reference and insight for other clinical trial centers worldwide. Objective: The aim of this study was to explore the management strategies used to minimize the impact of the COVID-19 epidemic on oncology clinical trials. Methods: We implemented a remote management model to maintain clinical trials conducted at Beijing Cancer Hospital, which realized remote project approval, remote initiation, remote visits, remote administration and remote monitoring to get through two COVID-19 outbreaks in the capital city from February to April and June to July 2020. The effectiveness of measures was evaluated as differences in rates of protocol compliance, participants lost to follow-up, participant withdrawal, disease progression, participant mortality, and detection of monitoring problems. Results: During the late of the first outbreak, modifications were made in trial processing, participant management and quality control, which allowed the hospital to ensure the smooth conduct of 572 trials, with a protocol compliance rate of 85.24\% for 3718 participants across both outbreaks. No COVID-19 infections were recorded among participants or trial staff, and no major procedural errors occurred between February and July 2020. These measures led to significantly higher rates of protocol compliance and significantly lower rates of loss to follow-up or withdrawal after the second outbreak than after the first, without affecting rates of disease progression or mortality. The hospital provided trial sponsors with a remote monitoring system in a timely manner, and 3820 trial issues were identified. Conclusions: When public health emergencies occur, an optimal clinical trial model combining on-site and remote management could guarantee the health care and treatment needs of clinical trial participants, in which remote management plays a key role. ",
doi="10.2196/26799",
url="https://www.jmir.org/2021/3/e26799",
url="http://www.ncbi.nlm.nih.gov/pubmed/33591924"
}


@Article{info:doi/10.2196/18269,
author="Ma, Jinfei
and Zou, Zihao
and Pazo, Eric Emmanuel
and Moutari, Salissou
and Liu, Ye
and Jin, Feng",
title="Comparative Analysis of Paper-Based and Web-Based Versions of the National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy-Breast Cancer Symptom Index (NFBSI-16) Questionnaire in Breast Cancer Patients: Randomized Crossover Study",
journal="JMIR Med Inform",
year="2021",
month="Mar",
day="2",
volume="9",
number="3",
pages="e18269",
keywords="breast cancer",
keywords="NFBSI-16",
keywords="patient-reported outcome",
keywords="reproducibility",
keywords="test-retest reliability",
keywords="web-based questionnaire",
abstract="Background: Breast cancer remains the most common neoplasm diagnosed among women in China and globally. Health-related questionnaire assessments in research and clinical oncology settings have gained prominence. The National Comprehensive Cancer Network--Functional Assessment of Cancer Therapy--Breast Cancer Symptom Index (NFBSI-16) is a rapid and powerful tool to help evaluate disease- or treatment-related symptoms, both physical and emotional, in patients with breast cancer for clinical and research purposes. Prevalence of individual smartphones provides a potential web-based approach to administrating the questionnaire; however, the reliability of the NFBSI-16 in electronic format has not been assessed. Objective: This study aimed to assess the reliability of a web-based NFBSI-16 questionnaire in breast cancer patients undergoing systematic treatment with a prospective open-label randomized crossover study design. Methods: We recruited random patients with breast cancer under systematic treatment from the central hospital registry to complete both paper- and web-based versions of the questionnaires. Both versions of the questionnaires were self-assessed. Patients were randomly assigned to group A (paper-based first and web-based second) or group B (web-based first and paper-based second). A total of 354 patients were included in the analysis (group A: n=177, group B: n=177). Descriptive sociodemographic characteristics, reliability and agreement rates for single items, subscales, and total score were analyzed using the Wilcoxon test. The Lin concordance correlation coefficient (CCC) and Spearman and Kendall $\tau$ rank correlations were used to assess test-retest reliability. Results: Test-retest reliability measured with CCCs was 0.94 for the total NFBSI-16 score. Significant correlations (Spearman $\rho$) were documented for all 4 subscales---Disease-Related Symptoms Subscale--Physical ($\rho$=0.93), Disease-Related Symptoms Subscale--Emotional ($\rho$=0.85), Treatment Side Effects Subscale ($\rho$=0.95), and Function and Well-Being Subscale ($\rho$=0.91)---and total NFBSI-16 score ($\rho$=0.94). Mean differences of the test and retest were all close to zero (?0.06). The parallel test-retest reliability of subscales with the Wilcoxon test comparing individual items found GP3 (item 5) to be significantly different (P=.02). A majority of the participants in this study (255/354, 72.0\%) preferred the web-based over the paper-based version. Conclusions: The web-based version of the NFBSI-16 questionnaire is an excellent tool for monitoring individual breast cancer patients under treatment, with the majority of participants preferring it over the paper-based version. ",
doi="10.2196/18269",
url="https://medinform.jmir.org/2021/3/e18269",
url="http://www.ncbi.nlm.nih.gov/pubmed/33650978"
}


@Article{info:doi/10.2196/25635,
author="Kim, HyungMin
and Lee, Jung Sun
and Park, Jin So
and Choi, Young In
and Hong, Sung-Hoo",
title="Machine Learning Approach to Predict the Probability of Recurrence of Renal Cell Carcinoma After Surgery: Prediction Model Development Study",
journal="JMIR Med Inform",
year="2021",
month="Mar",
day="1",
volume="9",
number="3",
pages="e25635",
keywords="renal cell carcinoma",
keywords="recurrence",
keywords="machine learning",
keywords="na{\"i}ve Bayes",
keywords="algorithm",
keywords="cancer",
keywords="surgery",
keywords="web-based",
keywords="database",
keywords="prediction",
keywords="probability",
keywords="carcinoma",
keywords="kidney",
keywords="model",
keywords="development",
abstract="Background: Renal cell carcinoma (RCC) has a high recurrence rate of 20\% to 30\% after nephrectomy for clinically localized disease, and more than 40\% of patients eventually die of the disease, making regular monitoring and constant management of utmost importance. Objective: The objective of this study was to develop an algorithm that predicts the probability of recurrence of RCC within 5 and 10 years of surgery. Methods: Data from 6849 Korean patients with RCC were collected from eight tertiary care hospitals listed in the KOrean Renal Cell Carcinoma (KORCC) web-based database. To predict RCC recurrence, analytical data from 2814 patients were extracted from the database. Eight machine learning algorithms were used to predict the probability of RCC recurrence, and the results were compared. Results: Within 5 years of surgery, the highest area under the receiver operating characteristic curve (AUROC) was obtained from the na{\"i}ve Bayes (NB) model, with a value of 0.836. Within 10 years of surgery, the highest AUROC was obtained from the NB model, with a value of 0.784. Conclusions: An algorithm was developed that predicts the probability of RCC recurrence within 5 and 10 years using the KORCC database, a large-scale RCC cohort in Korea. It is expected that the developed algorithm will help clinicians manage prognosis and establish customized treatment strategies for patients with RCC after surgery. ",
doi="10.2196/25635",
url="https://medinform.jmir.org/2021/3/e25635",
url="http://www.ncbi.nlm.nih.gov/pubmed/33646127"
}


@Article{info:doi/10.2196/23147,
author="Jo, Yong-Yeon
and Han, JaiHong
and Park, Woo Hyun
and Jung, Hyojung
and Lee, Dong Jae
and Jung, Jipmin
and Cha, Soung Hyo
and Sohn, Kyung Dae
and Hwangbo, Yul",
title="Prediction of Prolonged Length of Hospital Stay After Cancer Surgery Using Machine Learning on Electronic Health Records: Retrospective Cross-sectional Study",
journal="JMIR Med Inform",
year="2021",
month="Feb",
day="22",
volume="9",
number="2",
pages="e23147",
keywords="postoperative length of stay",
keywords="cancer surgery",
keywords="machine learning",
keywords="electronic health records",
abstract="Background: Postoperative length of stay is a key indicator in the management of medical resources and an indirect predictor of the incidence of surgical complications and the degree of recovery of the patient after cancer surgery. Recently, machine learning has been used to predict complex medical outcomes, such as prolonged length of hospital stay, using extensive medical information. Objective: The objective of this study was to develop a prediction model for prolonged length of stay after cancer surgery using a machine learning approach. Methods: In our retrospective study, electronic health records (EHRs) from 42,751 patients who underwent primary surgery for 17 types of cancer between January 1, 2000, and December 31, 2017, were sourced from a single cancer center. The EHRs included numerous variables such as surgical factors, cancer factors, underlying diseases, functional laboratory assessments, general assessments, medications, and social factors. To predict prolonged length of stay after cancer surgery, we employed extreme gradient boosting classifier, multilayer perceptron, and logistic regression models. Prolonged postoperative length of stay for cancer was defined as bed-days of the group of patients who accounted for the top 50\% of the distribution of bed-days by cancer type. Results: In the prediction of prolonged length of stay after cancer surgery, extreme gradient boosting classifier models demonstrated excellent performance for kidney and bladder cancer surgeries (area under the receiver operating characteristic curve [AUC] >0.85). A moderate performance (AUC 0.70-0.85) was observed for stomach, breast, colon, thyroid, prostate, cervix uteri, corpus uteri, and oral cancers. For stomach, breast, colon, thyroid, and lung cancers, with more than 4000 cases each, the extreme gradient boosting classifier model showed slightly better performance than the logistic regression model, although the logistic regression model also performed adequately. We identified risk variables for the prediction of prolonged postoperative length of stay for each type of cancer, and the importance of the variables differed depending on the cancer type. After we added operative time to the models trained on preoperative factors, the models generally outperformed the corresponding models using only preoperative variables. Conclusions: A machine learning approach using EHRs may improve the prediction of prolonged length of hospital stay after primary cancer surgery. This algorithm may help to provide a more effective allocation of medical resources in cancer surgery. ",
doi="10.2196/23147",
url="https://medinform.jmir.org/2021/2/e23147",
url="http://www.ncbi.nlm.nih.gov/pubmed/33616544"
}


@Article{info:doi/10.2196/21401,
author="Yang, Hsuan-Chia
and Islam, Mohaimenul Md
and Nguyen, Alex Phung Anh
and Wang, Ching-Huan
and Poly, Nasrin Tahmina
and Huang, Chih-Wei
and Li, Jack Yu-Chuan",
title="Development of a Web-Based System for Exploring Cancer Risk With Long-term Use of Drugs: Logistic Regression Approach",
journal="JMIR Public Health Surveill",
year="2021",
month="Feb",
day="15",
volume="7",
number="2",
pages="e21401",
keywords="cancer",
keywords="risk",
keywords="prevention",
keywords="chemoprevention",
keywords="long-term--use drugs",
keywords="drug",
keywords="epidemiology",
keywords="temporal model",
keywords="modeling",
keywords="web-based system",
abstract="Background: Existing epidemiological evidence regarding the association between the long-term use of drugs and cancer risk remains controversial. Objective: We aimed to have a comprehensive view of the cancer risk of the long-term use of drugs. Methods: A nationwide population-based, nested, case-control study was conducted within the National Health Insurance Research Database sample cohort of 1999 to 2013 in Taiwan. We identified cases in adults aged 20 years and older who were receiving treatment for at least two months before the index date. We randomly selected control patients from the patients without a cancer diagnosis during the 15 years (1999-2013) of the study period. Case and control patients were matched 1:4 based on age, sex, and visit date. Conditional logistic regression was used to estimate the association between drug exposure and cancer risk by adjusting potential confounders such as drugs and comorbidities. Results: There were 79,245 cancer cases and 316,980 matched controls included in this study. Of the 45,368 associations, there were 2419, 1302, 662, and 366 associations found statistically significant at a level of P<.05, P<.01, P<.001, and P<.0001, respectively. Benzodiazepine derivatives were associated with an increased risk of brain cancer (adjusted odds ratio [AOR] 1.379, 95\% CI 1.138-1.670; P=.001). Statins were associated with a reduced risk of liver cancer (AOR 0.470, 95\% CI 0.426-0.517; P<.0001) and gastric cancer (AOR 0.781, 95\% CI 0.678-0.900; P<.001). Our web-based system, which collected comprehensive data of associations, contained 2 domains: (1) the drug and cancer association page and (2) the overview page. Conclusions: Our web-based system provides an overview of comprehensive quantified data of drug-cancer associations. With all the quantified data visualized, the system is expected to facilitate further research on cancer risk and prevention, potentially serving as a stepping-stone to consulting and exploring associations between the long-term use of drugs and cancer risk. ",
doi="10.2196/21401",
url="http://publichealth.jmir.org/2021/2/e21401/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33587043"
}


@Article{info:doi/10.2196/15598,
author="O'Cathail, Micheal
and Aznar-Garcia, Luis
and Sivanandan, Ananth
and Diver, Claire
and Patel, Poulam
and Tang, Pui-Shan
and Christian, Judith",
title="Use of Teleconsultations in a Regional Stereotactic Radiosurgery Service: Pilot Study",
journal="JMIR Form Res",
year="2021",
month="Feb",
day="5",
volume="5",
number="2",
pages="e15598",
keywords="telemedicine",
keywords="teleconsultations",
keywords="brain metastases",
keywords="stereotactic radiosurgery",
keywords="mobile phone",
abstract="Background: The National Health Service Long Term Plan details plans to make digital interactions available to all patients in 5 years. Teleconsultations can improve access to specialist services; however, there is a lack of evidence for the use of teleconsultations in an oncology setting in the United Kingdom. Objective: We aim to describe a service evaluation of teleconsultations for patients attending a regional brain metastases clinic. These patients have unique travel restrictions that prevent them from driving. Methods: From April to October 2018, all patients attending the brain metastases clinic were offered the choice of teleconsultation in place of a face-to-face appointment. Feedback was assessed using a satisfaction questionnaire, and data of all clinic attendances were collected. Results: A total of 69 individual patients had 119 appointments over the duration of the pilot, of which 36 (30.2\%) were new patient appointments and 73 (61.3\%) were follow-ups. Of the 69 patients, 24 (35\%) took part in teleconsultations (41/119, 34.5\%). User satisfaction was high, and no patients who took part in a teleconsultation reverted to face-to-face appointments. These patients avoided 2521 miles (61.6 miles per appointment) of hospital-associated travel and travel costs of {\textsterling}441.48 (US \$599.83) to {\textsterling}10.78 (US \$14.65) per appointment. Conclusions: Teleconsultations appear to be acceptable in this cohort of patients with brain metastases attending a regional stereotactic radiosurgery service with the potential for significant savings in travel and expenses. ",
doi="10.2196/15598",
url="http://formative.jmir.org/2021/2/e15598/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33544082"
}


@Article{info:doi/10.2196/24619,
author="Chen, Zhuo-Jia
and Liang, Wei-Ting
and Liu, Qing
and He, Rong
and Chen, Qian-Chao
and Li, Qiu-Feng
and Zhang, Yao
and Du, Xiao-Dong
and Pan, Ying
and Liu, Shu
and Li, Xiao-Yan
and Wei, Xue
and Huang, He
and Huang, Hong-Bing
and Liu, Tao",
title="Use of a Remote Oncology Pharmacy Service Platform for Patients With Cancer During the COVID-19 Pandemic: Implementation and User Acceptance Evaluation",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="21",
volume="23",
number="1",
pages="e24619",
keywords="COVID-19",
keywords="cancer patients",
keywords="remote pharmacy",
keywords="service platform",
keywords="implementation",
keywords="oncology",
keywords="pharmacy",
keywords="online platform",
keywords="cancer",
keywords="health management",
keywords="app",
keywords="online hospital",
keywords="acceptance",
keywords="impact",
abstract="Background: The COVID-19 outbreak has increased challenges associated with health management, especially cancer management. In an effort to provide continuous pharmaceutical care to cancer patients, Sun Yat-sen University Cancer Center (SYSUCC) implemented a remote pharmacy service platform based on its already existing web-based hospital app known as Cloud SYSUCC. Objective: The aim of this study was to investigate the characteristics, acceptance, and initial impact of the Cloud SYSUCC app during a COVID-19 outbreak in a tertiary cancer hospital in China. Methods: The total number of online prescriptions and detailed information on the service were obtained during the first 6 months after the remote service platform was successfully set up. The patients' gender, age, residence, primary diagnosis, drug classification, weekly number of prescriptions, and prescribed drugs were analyzed. In addition, a follow-up telephonic survey was conducted to evaluate patients' satisfaction in using the remote prescription service. Results: A total of 1718 prescriptions, including 2022 drugs for 1212 patients, were delivered to 24 provinces and municipalities directly under the Central Government of China between February 12, 2020, and August 11, 2020. The majority of patients were female (841/1212, 69.39\%), and 90.18\% (1093/1212) of them were aged 31-70 years old. The top 3 primary diagnoses for which remote medical prescriptions were made included breast cancer (599/1212, 49.42\%), liver cancer (249/1212, 20.54\%), and thyroid cancer (125/1212, 10.31\%). Of the 1718 prescriptions delivered, 1435 (83.5\%) were sent to Guangdong Province and 283 (16.5\%) were sent to other provinces in China. Of the 2022 drugs delivered, 1012 (50.05\%) were hormonal drugs. The general trend in the use of the remote prescription service declined since the 10th week. A follow-up telephonic survey found that 88\% (88/100) of the patients were very satisfied, and 12\% (12/100) of the patients were somewhat satisfied with the remote pharmacy service platform. Conclusions: The remote pharmacy platform Cloud SYSUCC is efficient and convenient for providing continuous pharmaceutical care to patients with cancer during the COVID-19 crisis. The widespread use of this platform can help to reduce person-to-person transmission as well as infection risk for these patients. Further efforts are needed to improve the quality and acceptance of the Cloud SYSUCC platform, as well as to regulate and standardize the management of this novel service. ",
doi="10.2196/24619",
url="http://www.jmir.org/2021/1/e24619/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33395398"
}


@Article{info:doi/10.2196/21752,
author="Sandell, Tiffany
and Sch{\"u}tze, Heike
and Miller, Andrew",
title="A Shared Cancer Follow-Up Model of Care Between General Practitioners and Radiation Oncologists for Patients With Breast, Prostate, and Colorectal Cancer: Protocol for a Mixed Methods Implementation Study",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="19",
volume="10",
number="1",
pages="e21752",
keywords="radiation oncology",
keywords="general practice",
keywords="health technology",
keywords="communication",
keywords="cancer",
keywords="shared care",
keywords="follow-up",
abstract="Background: The rising incidence of cancer and increasing numbers of cancer survivors have resulted in the need to find alternative models of care for cancer follow-up care. The acceptability for follow-up care in general practice is growing, and acceptance increases with shared-care models where oncologists continue to oversee the care. However, a major barrier to this model is the effective exchange of information in real time between oncologists and general practitioners. Improved communication technology plays an important role in the acceptability and feasibility of shared cancer follow-up care. Objective: The aim of this study is to evaluate the feasibility and acceptability of a shared cancer follow-up model of care between patients, general practitioners and radiation oncologists. Methods: This is a mixed methods, multisite implementation study exploring shared follow-up care for breast, colorectal, and prostate cancer patients treated with curative radiotherapy in New South Wales, Australia. This study uses web-based technology to support general practitioners in performing some aspects of routine radiotherapy follow-up care, while being overseen by a radiation oncologist in real time. The study has two phases: Phase 1 is designed to establish the level of agreement between general practitioners and radiation oncologists and Phase 2 is designed to implement shared follow-up care into practice and to evaluate this implementation. Results: Recruitment of radiation oncologists, patients, and general practitioners commenced in December 2020 and will continue until February 2021. Data collection will occur during 2021, and data will be ready for analysis by the end of 2021. Conclusions: Few studies have investigated the role of health technologies in supporting communication deficiencies for shared cancer follow-up care. The implementation and evaluation of models of care need to be conducted using a person-centered approach that is responsive to patients' preferences and needs. Should the findings of the study be acceptable and feasible to radiation oncologists, general practitioners, and patients, it can be quickly implemented and expanded to other tumor groups or to medical oncology and hematology. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001083987; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380057 International Registered Report Identifier (IRRID): PRR1-10.2196/21752 ",
doi="10.2196/21752",
url="http://www.researchprotocols.org/2021/1/e21752/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33464209"
}


@Article{info:doi/10.2196/19689,
author="Liu, Honglei
and Zhang, Zhiqiang
and Xu, Yan
and Wang, Ni
and Huang, Yanqun
and Yang, Zhenghan
and Jiang, Rui
and Chen, Hui",
title="Use of BERT (Bidirectional Encoder Representations from Transformers)-Based Deep Learning Method for Extracting Evidences in Chinese Radiology Reports: Development of a Computer-Aided Liver Cancer Diagnosis Framework",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="12",
volume="23",
number="1",
pages="e19689",
keywords="BiLSTM-CRF",
keywords="natural language processing",
keywords="radiology reports",
keywords="information extraction",
keywords="computer-aided diagnosis",
keywords="BERT",
abstract="Background: Liver cancer is a substantial disease burden in China. As one of the primary diagnostic tools for detecting liver cancer, dynamic contrast-enhanced computed tomography provides detailed evidences for diagnosis that are recorded in free-text radiology reports. Objective: The aim of our study was to apply a deep learning model and rule-based natural language processing (NLP) method to identify evidences for liver cancer diagnosis automatically. Methods: We proposed a pretrained, fine-tuned BERT (Bidirectional Encoder Representations from Transformers)-based BiLSTM-CRF (Bidirectional Long Short-Term Memory-Conditional Random Field) model to recognize the phrases of APHE (hyperintense enhancement in the arterial phase) and PDPH (hypointense in the portal and delayed phases). To identify more essential diagnostic evidences, we used the traditional rule-based NLP methods for the extraction of radiological features. APHE, PDPH, and other extracted radiological features were used to design a computer-aided liver cancer diagnosis framework by random forest. Results: The BERT-BiLSTM-CRF predicted the phrases of APHE and PDPH with an F1 score of 98.40\% and 90.67\%, respectively. The prediction model using combined features had a higher performance (F1 score, 88.55\%) than those using APHE and PDPH (84.88\%) or other extracted radiological features (83.52\%). APHE and PDPH were the top 2 essential features for liver cancer diagnosis. Conclusions: This work was a comprehensive NLP study, wherein we identified evidences for the diagnosis of liver cancer from Chinese radiology reports, considering both clinical knowledge and radiology findings. The BERT-based deep learning method for the extraction of diagnostic evidence achieved state-of-the-art performance. The high performance proves the feasibility of the BERT-BiLSTM-CRF model in information extraction from Chinese radiology reports. The findings of our study suggest that the deep learning--based method for automatically identifying evidences for diagnosis can be extended to other types of Chinese clinical texts. ",
doi="10.2196/19689",
url="http://www.jmir.org/2021/1/e19689/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33433395"
}


@Article{info:doi/10.2196/24733,
author="Zhang, Di
and Hu, Hongchao
and Shi, Zhen
and Li, Biao",
title="Perceived Needs Versus Predisposing/Enabling Characteristics in Relation to Internet Cancer Information Seeking Among the US and Chinese Public: Comparative Survey Research",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="11",
volume="23",
number="1",
pages="e24733",
keywords="HINTS",
keywords="health information seeking behavior (HISB)",
keywords="China",
keywords="United States",
keywords="comparative research",
keywords="cultural sensitivity",
abstract="Background: Since the rise of the internet, online health information seeking has become a worldwide phenomenon. However, health and health communication are inherently culture bound. A data-driven cross-country comparison enables us to better understand how cultural factors moderate the association between individual-level determinants and online health information seeking. Objective: The objective of the study was to examine similarities and differences in determinants of internet cancer information seeking between the US and Chinese general public (excluding cancer patients and survivors) under the framework of a behavioral model of health services use. Methods: This study used Health Information National Trends Survey (HINTS) 2017 (US data) and HINTS-China 2017 data to answer the research question. It focused on people with no cancer history and with internet access. For the HINTS 2017, the sample size was 2153; for the HINTS-China 2017, the sample size was 2358. To compare China and the United States, the researchers selected the same set of study variables for each dataset. Under the framework of the behavioral model of health services use, these predictors were predisposing factors, enabling factors, and need factors. Results: In terms of the predisposing factors, a higher age, college degree or above, being currently unemployed, and having a family history of cancer were associated with internet cancer information seeking for the Chinese respondents; none of these factors were related to information seeking for the US respondents, although a lower age was associated with information seeking. Regarding the enabling conditions, lower trust in family members and friends as reliable information sources was the only factor associated with information seeking for the Chinese respondents, while no enabling factor was related to information seeking for the US respondents. Regarding the need factors, perceived health status was not related to information seeking for the Chinese respondents, while perception of poorer health condition was related to information seeking for the US respondents. Higher cancer fear was related to information seeking for both groups, but the magnitude of association was smaller for the Chinese respondents than for the US respondents. Conclusions: Overall, under the framework of the behavioral model of health services use, the results based on multivariate logistic regression reveal clear patterns of cross-country/cultural differences in the factors associated with internet cancer information seeking behaviors: predisposing characteristics and enabling conditions are more important in China, while perceived needs are more significant in the US. Such differences might reflect possible US-China differences in job environment (eg, job pressure) and culture (individualism vs collectivism and family structure). ",
doi="10.2196/24733",
url="http://www.jmir.org/2021/1/e24733/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33427668"
}


@Article{info:doi/10.2196/18655,
author="Schmalz, Oliver
and Jacob, Christine
and Ammann, Johannes
and Liss, Blasius
and Iivanainen, Sanna
and Kammermann, Manuel
and Koivunen, Jussi
and Klein, Alexander
and Popescu, Andrei Razvan",
title="Digital Monitoring and Management of Patients With Advanced or Metastatic Non-Small Cell Lung Cancer Treated With Cancer Immunotherapy and Its Impact on Quality of Clinical Care: Interview and Survey Study Among Health Care Professionals and Patients",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="21",
volume="22",
number="12",
pages="e18655",
keywords="advanced or metastatic non-small cell lung cancer",
keywords="cancer immunotherapy",
keywords="digital patient monitoring",
keywords="drug- and indication-specific cancer immunotherapy module",
keywords="eHealth",
keywords="mHealth",
keywords="quality of patient care",
keywords="patient-reported outcomes",
keywords="real-time symptom reporting",
keywords="user experience",
abstract="Background: Cancer immunotherapy (CIT), as a monotherapy or in combination with chemotherapy, has been shown to extend overall survival in patients with locally advanced or metastatic non-small cell lung cancer (NSCLC). However, patients experience treatment-related symptoms that they are required to recall between hospital visits. Digital patient monitoring and management (DPMM) tools may improve clinical practice by allowing real-time symptom reporting. Objective: This proof-of-concept pilot study assessed patient and health care professional (HCP) adoption of our DPMM tool, which was designed specifically for patients with advanced or metastatic NSCLC treated with CIT, and the tool's impact on clinical care. Methods: Four advisory boards were assembled in order to co-develop a drug- and indication-specific CIT (CIT+) module, based on a generic CIT DPMM tool from Kaiku Health, Helsinki, Finland. A total of 45 patients treated with second-line single-agent CIT (ie, atezolizumab or otherwise) for advanced or metastatic NSCLC, as well as HCPs, whose exact number was decided by the clinics, were recruited from 10 clinics in Germany, Finland, and Switzerland between February and May 2019. All clinics were provided with the Kaiku Health generic CIT DPMM tool, including our CIT+ module. Data on user experience, overall satisfaction, and impact of the tool on clinical practice were collected using anonymized surveys---answers ranged from 1 (low agreement) to 5 (high agreement)---and HCP interviews; surveys and interviews consisted of closed-ended Likert scales and open-ended questions, respectively. The first survey was conducted after 2 months of DPMM use, and a second survey and HCP interviews were conducted at study end (ie, after ?3 months of DPMM use); only a subgroup of HCPs from each clinic responded to the surveys and interviews. Survey data were analyzed quantitatively; interviews were recorded, transcribed verbatim, and translated into English, where applicable, for coding and qualitative thematic analysis. Results: Among interim survey respondents (N=51: 13 [25\%] nurses, 11 [22\%] physicians, and 27 [53\%] patients), mean rankings of the tool's seven usability attributes ranged from 3.2 to 4.4 (nurses), 3.7 to 4.5 (physicians), and 3.7 to 4.2 (patients). At the end-of-study survey (N=48: 19 [40\%] nurses, 8 [17\%] physicians, and 21 [44\%] patients), most respondents agreed that the tool facilitated more efficient and focused discussions between patients and HCPs (nurses and patients: mean rating 4.2, SD 0.8; physicians: mean rating 4.4, SD 0.8) and allowed HCPs to tailor discussions with patients (mean rating 4.35, SD 0.65). The standalone tool was well integrated into HCP daily clinical workflow (mean rating 3.80, SD 0.75), enabled workflow optimization between physicians and nurses (mean rating 3.75, SD 0.80), and saved time by decreasing phone consultations (mean rating 3.75, SD 1.00) and patient visits (mean rating 3.45, SD 1.20). Workload was the most common challenge of tool use among respondents (12/19, 63\%). Conclusions: Our results demonstrate high user satisfaction and acceptance of DPMM tools by HCPs and patients, and highlight the improvements to clinical care in patients with advanced or metastatic NSCLC treated with CIT monotherapy. However, further integration of the tool into the clinical information technology data flow is required. Future studies or registries using our DPMM tool may provide insights into significant effects on patient quality of life or health-economic benefits. ",
doi="10.2196/18655",
url="http://www.jmir.org/2020/12/e18655/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33346738"
}


@Article{info:doi/10.2196/25501,
author="Thiessen, Maclean
and Soriano, Michelle Andrea
and Loewen, John Hal
and Decker, Margaret Kathleen",
title="Impact of Telemedicine Use by Oncology Physicians on the Patient and Informal Caregiver Experience of Receiving Care: Protocol for a Scoping Review in the Context of COVID-19",
journal="JMIR Res Protoc",
year="2020",
month="Dec",
day="15",
volume="9",
number="12",
pages="e25501",
keywords="cancer",
keywords="experience",
keywords="information needs",
keywords="telemedicine",
keywords="telehealth",
keywords="COVID-19",
keywords="patient satisfaction",
abstract="Background: During the COVID-19 pandemic, the use of telemedicine by oncology physicians in Manitoba, Canada, has increased to limit the risk of exposure to the virus for both patients and health care providers. It is not clear how telemedicine impacts the information needs of patients or the experience of receiving cancer care. Objective: The objective of this study is to describe how the use of telemedicine impacts the information needs and experience of patients with cancer and their informal caregivers (ie, family and friends) and identify directions for future research. Methods: This review will include all studies addressing telemedicine in the cancer context including those using quantitative, qualitative, and mixed methods approaches. This scoping review will be conducted using the methodology described by the Joanna Briggs Institute. In collaboration with a librarian scientist specializing in health sciences, a comprehensive search will be undertaken to identify and retrieve relevant reports published in English from 1990 to the present. Databases searched will include MEDLINE, CINAHL, EMBASE, Scopus, Cochrane Library, and PsycINFO. Data will be extracted by two independent reviewers, synthesized, and reported in a summary table and in a narrative format describing what has been reported regarding the impact of telemedicine by physicians in oncology on the experience of patients and their informal caregivers and their receipt of information. Results: The results from this scoping review are expected to be available by late spring 2021. Conclusions: The results from this scoping review will be useful for informing practice as well as directing future research, both in the context of COVID-19 and beyond. International Registered Report Identifier (IRRID): PRR1-10.2196/25501 ",
doi="10.2196/25501",
url="http://www.researchprotocols.org/2020/12/e25501/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33290243"
}


@Article{info:doi/10.2196/22034,
author="Kondylakis, Haridimos
and Axenie, Cristian
and (Kiran) Bastola, Dhundy
and Katehakis, G. Dimitrios
and Kouroubali, Angelina
and Kurz, Daria
and Larburu, Nekane
and Mac{\'i}a, Iv{\'a}n
and Maguire, Roma
and Maramis, Christos
and Marias, Kostas
and Morrow, Philip
and Muro, Naiara
and N{\'u}{\~n}ez-Benjumea, Jos{\'e} Francisco
and Rampun, Andrik
and Rivera-Romero, Octavio
and Scotney, Bryan
and Signorelli, Gabriel
and Wang, Hui
and Tsiknakis, Manolis
and Zwiggelaar, Reyer",
title="Status and Recommendations of Technological and Data-Driven Innovations in Cancer Care: Focus Group Study",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="15",
volume="22",
number="12",
pages="e22034",
keywords="neoplasms",
keywords="inventions",
keywords="data-driven science",
abstract="Background: The status of the data-driven management of cancer care as well as the challenges, opportunities, and recommendations aimed at accelerating the rate of progress in this field are topics of great interest. Two international workshops, one conducted in June 2019 in Cordoba, Spain, and one in October 2019 in Athens, Greece, were organized by four Horizon 2020 (H2020) European Union (EU)--funded projects: BOUNCE, CATCH ITN, DESIREE, and MyPal. The issues covered included patient engagement, knowledge and data-driven decision support systems, patient journey, rehabilitation, personalized diagnosis, trust, assessment of guidelines, and interoperability of information and communication technology (ICT) platforms. A series of recommendations was provided as the complex landscape of data-driven technical innovation in cancer care was portrayed. Objective: This study aims to provide information on the current state of the art of technology and data-driven innovations for the management of cancer care through the work of four EU H2020--funded projects. Methods: Two international workshops on ICT in the management of cancer care were held, and several topics were identified through discussion among the participants. A focus group was formulated after the second workshop, in which the status of technological and data-driven cancer management as well as the challenges, opportunities, and recommendations in this area were collected and analyzed. Results: Technical and data-driven innovations provide promising tools for the management of cancer care. However, several challenges must be successfully addressed, such as patient engagement, interoperability of ICT-based systems, knowledge management, and trust. This paper analyzes these challenges, which can be opportunities for further research and practical implementation and can provide practical recommendations for future work. Conclusions: Technology and data-driven innovations are becoming an integral part of cancer care management. In this process, specific challenges need to be addressed, such as increasing trust and engaging the whole stakeholder ecosystem, to fully benefit from these innovations. ",
doi="10.2196/22034",
url="https://www.jmir.org/2020/12/e22034",
url="http://www.ncbi.nlm.nih.gov/pubmed/33320099"
}


@Article{info:doi/10.2196/17485,
author="Verot, Elise
and Bouleftour, Wafa
and Macron, Corinne
and Rivoirard, Romain
and Chauvin, Franck",
title="Effect of PARACT (PARAmedical Interventions on Patient ACTivation) on the Cancer Care Pathway: Protocol for Implementation of the Patient Activation Measure-13 Item (PAM-13) Version",
journal="JMIR Res Protoc",
year="2020",
month="Dec",
day="8",
volume="9",
number="12",
pages="e17485",
keywords="oncology",
keywords="nursing",
keywords="implementation science",
keywords="PAM-13",
keywords="patient activation",
keywords="REALM-R",
keywords="health literacy",
keywords="mixed method",
abstract="Background: The increase in the number of cancer cases and the evolution of cancer care management have become a significant problem for the French health care system, thereby making patient empowerment as a long sought-after goal in chronic pathologies. The implementation of an activation measure via the Patient Activation Measure-13 item (PAM-13) in the course of cancer care can potentially highlight the patient's needs, with nursing care adapting accordingly. Objective: The objectives of this PARACT (PARAmedical Interventions on Patient ACTivation) multicentric study were as follows: (1) evaluate the implementation of PAM-13 in oncology nursing practices in 5 comprehensive cancer centers, (2) identify the obstacles and facilitators to the implementation of PAM-13, and (3) produce recommendations for the dissemination of such interventions in other comprehensive cancer centers. Methods: This study will follow the ``Reach, Effectiveness, Adoption, Implementation, and Maintenance'' framework and will consist of 3 stages. First, a robust preimplementation analysis will be conducted using the Theoretical Domains Framework (TDF) linked to the ``Capability, Opportunity, Motivation, and Behavior'' model to identify the obstacles and facilitators to implementing new nursing practices in each context. Then, using the Behavior Change Wheel, we will personalize a strategy for implementing the PAM-13, depending on the specificities of each context, to encourage acceptability by the nursing staff involved in the project. This analysis will be performed via a qualitative study through semistructured interviews. Second, the patient will be included in the study for 12 months, during which the patient care pathway will be studied, particularly to collect all relevant contacts of oncology nurses and other health professionals involved in the pathway. The axes of nursing care will also be collected. The primary goal is to implement PAM-13. Secondary factors to be measured are the patient's anxiety level, quality of life, and health literacy level. The oncology nurses will be responsible for completing the questionnaires when the patient is at the hospital for his/her intravenous chemotherapy/immunotherapy treatment. The questionnaires will be completed thrice in a year: (1) at the time of the patient's enrollment, (2) at 6 months, and (3) at 12 months. Third, a postimplementation analysis will be performed through semistructured interviews using the TDF to investigate the implementation problems at each site. Results: This study was supported by a grant from the French Ministry of Health (PHRIP PARACT 2016-0405) and the Lucien Neuwirth Institute of Cancerology of Saint-Etienne, France. Data collection for this study is ongoing. Conclusions: This study would improve the implemented targeted nursing interventions in cancer centers so that a patient is offered a personalized cancer care pathway. Furthermore, measuring the level of activation and the implementation of measures intended to increase such activation could constitute a significant advantage in reducing social health inequalities. Trial Registration: ClinicalTrials.gov NCT03240341; https://clinicaltrials.gov/ct2/show/NCT03240341 International Registered Report Identifier (IRRID): DERR1-10.2196/17485 ",
doi="10.2196/17485",
url="https://www.researchprotocols.org/2020/12/e17485",
url="http://www.ncbi.nlm.nih.gov/pubmed/33289495"
}


@Article{info:doi/10.2196/20137,
author="McCaughan, Eil{\'i}s
and Flannagan, Carrie
and Parahoo, Kader
and Connaghan, John
and Maguire, Roma
and Steele, Mary
and Thompson, Samantha
and Jain, Suneil
and Kirby, Michael
and Brady, Nuala
and O'Connor, R. Se{\'a}n",
title="The Tablet-Based, Engagement, Assessment, Support, and Sign-Posting (EASSi) Tool for Facilitating and Structuring Sexual Well-Being Conversations in Routine Prostate Cancer Care: Mixed-Methods Study",
journal="JMIR Cancer",
year="2020",
month="Dec",
day="4",
volume="6",
number="2",
pages="e20137",
keywords="prostate cancer",
keywords="sexual well-being",
keywords="quality of life",
keywords="communication",
abstract="Background: Long-term side-effects associated with different prostate cancer treatment approaches are common. Sexual challenges are the most frequently occurring issues and can result in increased psychological morbidity. It is recognized that barriers to communication can make initiating discussions around sexual concerns in routine practice difficult. Health care professionals need to routinely initiate conversations, effectively engage with patients, and assess needs in order to provide essential support. One proposed method that could support health care professionals to do this involves the use of prompts or structured frameworks to guide conversations. Objective: This study aimed to assess feasibility, acceptability, and satisfaction with the tablet-based Engagement, Assessment, Support, and Sign-posting (EASSi) tool designed to facilitate and structure sexual well-being discussions in routine prostate cancer care. Methods: Health care professionals (n=8) used the EASSi tool during 89 posttreatment appointments. Quantitative data were recorded based on program usage and surveys completed by health care professionals and patients. Qualitative data exploring perceptions on use of the tool were gathered using semistructured interviews with all health care professionals (n=8) and a sample of patients (n=10). Results: Surveys were completed by health care professionals immediately following each appointment (n=89, 100\%). Postal surveys were returned by 59 patients (66\%). Health care professionals and patients reported that the tool helped facilitate discussions (81/89, 91\% and 50/59, 85\%, respectively) and that information provided was relevant (82/89, 92\% and 50/59, 85\%, respectively). The mean conversation duration was 6.01 minutes (SD 2.91). Qualitative synthesis identified the tool's ability to initiate and structure discussions, improve the ``depth'' of conversations, and normalize sexual concerns. Conclusions: The EASSi tool was appropriate and acceptable for use in practice and provided a flexible approach to facilitate routine brief conversations and deliver essential sexual well-being support. Further work will be conducted to evaluate the effectiveness of using the tablet-based tool in prostate cancer care settings. ",
doi="10.2196/20137",
url="http://cancer.jmir.org/2020/2/e20137/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33275109"
}


@Article{info:doi/10.2196/24222,
author="Levine, Hannun Oren
and McGillion, Michael
and Levine, Mark",
title="Virtual Cancer Care During the COVID-19 Pandemic and Beyond: A Call for Evaluation",
journal="JMIR Cancer",
year="2020",
month="Nov",
day="24",
volume="6",
number="2",
pages="e24222",
keywords="care",
keywords="patient-physician relationship",
keywords="patient-centered care",
keywords="oncology care delivery",
keywords="virtual visits",
keywords="telehealth",
keywords="virtual care",
keywords="cancer",
keywords="oncology",
keywords="evaluation",
keywords="COVID-19",
doi="10.2196/24222",
url="http://cancer.jmir.org/2020/2/e24222/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33180741"
}


@Article{info:doi/10.2196/20288,
author="Grewal, Singh Udhayvir
and Terauchi, Stephanie
and Beg, Shaalan Muhammad",
title="Telehealth and Palliative Care for Patients With Cancer: Implications of the COVID-19 Pandemic",
journal="JMIR Cancer",
year="2020",
month="Nov",
day="24",
volume="6",
number="2",
pages="e20288",
keywords="COVID-19",
keywords="telehealth",
keywords="palliative care",
keywords="telepalliative care",
keywords="patients with cancer",
keywords="telemedicine",
doi="10.2196/20288",
url="http://cancer.jmir.org/2020/2/e20288/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33049695"
}


@Article{info:doi/10.2196/18982,
author="Biran, Noa
and Anthony Kouyat{\'e}, Robin
and Yucel, Emre
and McGovern, E. Gillian
and Schoenthaler, M. Antoinette
and Durling, G. Olivia
and Unawane, Rashmi
and Schutt, Andrew
and Panjabi, Sumeet",
title="Adaptation and Evaluation of a Symptom-Monitoring Digital Health Intervention for Patients With Relapsed and Refractory Multiple Myeloma: Pilot Mixed-Methods Implementation Study",
journal="JMIR Form Res",
year="2020",
month="Nov",
day="17",
volume="4",
number="11",
pages="e18982",
keywords="mHealth",
keywords="digital health",
keywords="electronic patient-reported outcome",
keywords="ePRO",
keywords="patient-reported outcome",
keywords="PRO",
keywords="mobile",
keywords="app",
keywords="implementation science",
keywords="multiple myeloma",
keywords="relapsed refractory multiple myeloma",
abstract="Background: Relapsed and refractory multiple myeloma (RRMM) is a bone marrow cancer that requires systemic treatment, which often results in severe symptom burden. Recent studies have found that electronic patient-reported outcome (ePRO) interventions implemented in the clinic setting have had positive outcomes for other oncology populations. Evidence of the efficacy of a similar approach is lacking for patients with RRMM. Objective: Recent recommendations for digital health interventions call for the publication of descriptions of iterative development processes in order to improve reproducibility and comparability. This study is an implementation pilot aiming to evaluate the acceptability and appropriateness of an ePRO intervention for patients with RRMM and to explore its impact on clinic workflow. Methods: A total of 11 patients with RRMM were recruited from the John Theurer Cancer Center in Hackensack, New Jersey. Patients used a mobile app to report on 17 symptoms at 4 sessions, each a week apart. Patients could also report symptoms ad hoc. When reports met predefined thresholds, the clinic was alerted and patients received automated guidance. Study end points were assessed using qualitative and quantitative methods. Results: A total of 9 patients (mean age 69.7 years) completed the study. Overall, 83\% (30/36) of weekly sessions were completed. Patients found the frequency and time required to complete reporting acceptable. All patients agreed that the app was easy to use and understand. Providers felt the alerts they received required refinement. Patients and providers agreed it would be beneficial for patients to report for longer than 4 weeks. Patients felt that the training they received was adequate but contained too much information for a single session. All patients found the symptoms tracked to be appropriate; providers suggested shortening the list. All patients understood how to use the app for weekly reporting but had confusion about using it ad hoc. Providers felt the ad hoc feature could be removed. Neither patients nor providers viewed the in-app data reports but agreed on their potential value. Patients reported benefitting from symptom reporting through increased awareness of their symptoms. Clinic staff reported that app alerts were too numerous and redundant. They had difficulty responding to alerts within their existing workflow, partially because the data were not integrated into the electronic medical record system. Conclusions: Overall, the intervention was found to be acceptable and appropriate for patients with RRMM. Points of friction integrating the intervention into the clinic workflow were identified. Clinic staff provided recommendations for addressing these issues. Once such modifications are implemented, ePRO data from patients with RRMM could be used to inform and improve clinical research and care. This study underlines the importance of an iterative approach to implementation that includes all stakeholders in order to ensure successful adoption. ",
doi="10.2196/18982",
url="http://formative.jmir.org/2020/11/e18982/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33200997"
}


@Article{info:doi/10.2196/20709,
author="Matis, Juraj
and Svetlak, Miroslav
and Slezackova, Alena
and Svoboda, Marek
and {\vS}umec, Rastislav",
title="Mindfulness-Based Programs for Patients With Cancer via eHealth and Mobile Health: Systematic Review and Synthesis of Quantitative Research",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="16",
volume="22",
number="11",
pages="e20709",
keywords="eHealth",
keywords="mHealth",
keywords="mindfulness",
keywords="cancer",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: eHealth mindfulness-based programs (eMBPs) are on the rise in complex oncology and palliative care. However, we are still at the beginning of answering the questions of how effective eMBPs are and for whom, and what kinds of delivery modes are the most efficient. Objective: This systematic review aims to examine the feasibility and efficacy of eMBPs in improving the mental health and well-being of patients with cancer, to describe intervention characteristics and delivery modes of these programs, and to summarize the results of the included studies in terms of moderators, mediators, and predictors of efficacy, adherence, and attrition. Methods: In total, 4 databases (PubMed, PsycINFO, Scopus, and Web of Knowledge) were searched using relevant search terms (eg, mindfulness, program, eHealth, neoplasm) and their variations. No restrictions were imposed on language or publication type. The results of the efficacy of eMBPs were synthesized through the summarizing effect estimates method. Results:                     A total of 29 published papers describing 24 original studies were included in this review. In general, the results indicate that eMBPs have the potential to reduce the levels of stress, anxiety, depression, fatigue, sleep problems, and pain, and improve the levels of mindfulness, posttraumatic growth, and some parameters of general health. The largest median of Cohen d effect sizes were observed in reducing anxiety and depression (within-subject: median ?0.38, IQR ?0.62 to ?0.27; between-group:median ?0.42, IQR ?0.58 to ?0.22) and facilitating posttraumatic growth (within-subject: median 0.42, IQR 0.35 to 0.48;between-group: median 0.32, IQR 0.22 to 0.39). The efficacy of eMBP may be comparable with that of parallel, face-to-faceMBPs in some cases. All studies that evaluated the feasibility of eMBPs reported that they are feasible for patients with cancer.Potential moderators, mediators, and predictors of the efficacy, attrition, and adherence of eMBPs are discussed.           Conclusions: Although the effects of the reviewed studies were highly heterogeneous, the review provides evidence that eMBPs are an appropriate way for mindfulness practice to be delivered to patients with cancer. Thus far, existing eMBPs have mostly attempted to convert proven face-to-face mindfulness programs to the eHealth mode. They have not yet fully exploited the potential of eHealth technology. ",
doi="10.2196/20709",
url="http://www.jmir.org/2020/11/e20709/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33196452"
}


@Article{info:doi/10.2196/19180,
author="Maguire, Roma
and Connaghan, John
and Arber, Anne
and Klepacz, Naomi
and Blyth, G. Kevin
and McPhelim, John
and Murray, Paul
and Rupani, Hitasha
and Chauhan, Anoop
and Williams, Peter
and McNaughton, Laura
and Woods, Kirstie
and Moylan, Anne",
title="Advanced Symptom Management System for Patients with Malignant Pleural Mesothelioma (ASyMSmeso): Mixed Methods Study",
journal="J Med Internet Res",
year="2020",
month="Nov",
day="12",
volume="22",
number="11",
pages="e19180",
keywords="malignant pleural mesothelioma",
keywords="patient reported outcome measures",
keywords="cancer",
keywords="mobile health",
keywords="telemedicine, symptom monitoring",
abstract="Background: Patients with malignant pleural mesothelioma (MPM) have a life-limiting illness and short prognosis and experience many debilitating symptoms from early in the illness. Innovations such as remote symptom monitoring are needed to enable patients to maintain wellbeing and manage symptoms in a proactive and timely manner. The Advanced Symptom Management System (ASyMS) has been successfully used to monitor symptoms associated with cancer. Objective: This study aimed to determine the feasibility and acceptability of using an ASyMS adapted for use by patients with MPM, called ASyMSmeso, enabling the remote monitoring of symptoms using a smartphone. Methods: This was a convergent mixed methods study using patient-reported outcome measures (PROMs) at key time points over a period of 2-3 months with 18 patients. The Sheffield Profile for Assessment and Referral for Care (SPARC), Technology Acceptance Model (TAM) measure for eHealth, and Lung Cancer Symptom Scale-Mesothelioma (LCSS-Meso) were the PROMs used in the study. Patients were also asked to complete a daily symptom questionnaire on a smartphone throughout the study. At the end of the study, semistructured interviews with 11 health professionals, 8 patients, and 3 carers were conducted to collect their experience with using ASyMSmeso. Results: Eighteen patients with MPM agreed to participate in the study (33.3\% response rate). The completion rates of study PROMs were high (97.2\%-100\%), and completion rates of the daily symptom questionnaire were also high, at 88.5\%. There were no significant changes in quality of life, as measured by LCSS-Meso. There were statistically significant improvements in the SPARC psychological need domain (P=.049) and in the ``Usefulness'' domain of the TAM (P=.022). End-of-study interviews identified that both patients and clinicians found the system quick and easy to use. For patients, in particular, the system provided reassurance about symptom experience and the feeling of being listened to. The clinicians largely viewed the system as feasible and acceptable, and areas that were mentioned included the early management of symptoms and connectivity between patients and clinicians, leading to enhanced communication. Conclusions: This study demonstrates that remote monitoring and management of symptoms of people with MPM using a mobile phone are feasible and acceptable. The evidence supports future trials using remote symptom monitoring to support patients with MPM at home. ",
doi="10.2196/19180",
url="https://www.jmir.org/2020/11/e19180",
url="http://www.ncbi.nlm.nih.gov/pubmed/33180025"
}


@Article{info:doi/10.2196/20224,
author="Nabi, Junaid
and Cone, B. Eugene
and Vasavada, Anjali
and Sun, Maxine
and Kilbridge, L. Kerry
and Kibel, S. Adam
and Berry, L. Donna
and Trinh, Quoc-Dien",
title="Mobile Health App for Prostate Cancer Patients on Androgen Deprivation Therapy: Qualitative Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="3",
volume="8",
number="11",
pages="e20224",
keywords="mobile health application",
keywords="prostate cancer",
keywords="androgen deprivation therapy",
keywords="thematic analysis",
keywords="qualitative methods",
abstract="Background: Androgen deprivation therapy (ADT) increases the risk of metabolic adverse effects among patients with prostate cancer. The transformative impact of mobile health (mHealth) apps may benefit men managing activity and nutrition at home. Objective: This study aimed to evaluate the usability and patient experience of a newly developed mHealth app among prostate cancer patients on ADT and physicians' beliefs about the potential benefits of using this app. Methods: This study took place over 2 months, beginning in March 2019. A sample of 5 patients (age 45-75 years) initiating ADT participated in a semistructured focus group discussion with a facilitator. The study participants also included 5 specialist physicians who provided in-depth interviews. An institutional review board--approved script was used to guide both the focus group and physician interviews. Usability was tested through specific scenarios presented to the patients, including downloading the mHealth app, entering information on physical activity and meals, and navigating the app. The focus group and interviews were audio recorded and transcribed. Content analysis was used to analyze the transcripts iteratively and exhaustively. Thematic discrepancies between reviewers were resolved through consensus. Results: The mean age of the patients was 62 years. This group included 4 White and 1 Latin American patients. The physician specialists included 2 urologists, 2 medical oncologists, and 1 radiation oncologist. Analyses revealed that the patients appreciated the holistic care enabled by the app. Difficulties were observed with registration of the app among 60\% (3/5) of the patients; however, all the patients were able to input information about their physical activity and navigate the options within the app. Most patients (4/5, 80\%) were able to input data on their recent meal. Among the health care physicians, the dominant themes reflected in the interviews included undermining of patients ability to use technology, patients' fear of technology, and concern for the ability of older patients to access technology. Conclusions: The patients reported an overall positive experience of using an mHealth app to record and track diet and exercise. Usability was observed to be an important factor for adoption and was determined by ease of registration and use, intuitive appearance of the app, and focus on holistic cancer care. The physicians believed that the app was easy to use but raised concerns about usability among older men who may not typically use smartphone apps. ",
doi="10.2196/20224",
url="https://mhealth.jmir.org/2020/11/e20224",
url="http://www.ncbi.nlm.nih.gov/pubmed/33141104"
}


@Article{info:doi/10.2196/20510,
author="Thiessen, Maclean
and Sinclair, Shane
and Tang, A. Patricia
and Raffin Bouchal, Shelley",
title="Information Access and Use by Patients With Cancer and Their Friends and Family: Development of a Grounded Theory",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="29",
volume="22",
number="10",
pages="e20510",
keywords="persons",
keywords="personal autonomy",
keywords="patient-centered care",
keywords="health education",
keywords="health information--seeking behavior",
keywords="grounded theory",
keywords="empowerment",
keywords="cancer",
keywords="qualitative research",
keywords="adaptation, psychological",
keywords="mobile phone",
abstract="Background: Information has been identified as a commonly unmet supportive care need for those living with cancer (ie, patients and their friends and family). The information needed to help individuals plan their lives around the consequences of cancer, such as the receipt of health care, is an example of an important informational need. A suitable theory to guide the development of interventions designed to meet this informational need has not been identified by the authors. Objective: The aim of this study is to generate a grounded theory capable of guiding the development of interventions designed to assist those living with cancer in meeting their informational needs. Methods: Classic grounded theory was used to analyze data collected through digitally recorded one-on-one audio interviews with 31 patients with cancer and 29 friends and family members. These interviews focused on how the participants had accessed and used information to plan their lives and what barriers they faced in obtaining and using this information. Results: The theory that emerged consisted of 4 variables: personal projects, cancer as a source of disruption to personal projects, information as the process of accessing and interpreting cancer-related data (CRD) to inform action, and CRD quality as defined by accessibility, credibility, applicability, and framing. CRD quality as a moderator of personal project disruption by cancer is the core concept of this theory. Conclusions: Informational resources providing accessible, credible, applicable, and positively framed CRD are likely key to meeting the information needs of those affected by cancer. Web-based informational resources delivering high-quality CRD focused on assisting individuals living with cancer in maintaining and planning their personal projects are predicted to improve quality of life. Research is needed to develop and integrate resources informed by this theoretical framework into clinical practice. ",
doi="10.2196/20510",
url="http://www.jmir.org/2020/10/e20510/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33118940"
}


@Article{info:doi/10.2196/19685,
author="Girgis, Afaf
and Durcinoska, Ivana
and Arnold, Anthony
and Descallar, Joseph
and Kaadan, Nasreen
and Koh, Eng-Siew
and Miller, Andrew
and Ng, Weng
and Carolan, Martin
and Della-Fiorentina, A. Stephen
and Avery, Sandra
and Delaney, P. Geoff",
title="Web-Based Patient-Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care): Multicenter Pragmatic Nonrandomized Trial",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="29",
volume="22",
number="10",
pages="e19685",
keywords="patient-reported outcomes (PROs)",
keywords="eHealth",
keywords="patient-centered care",
keywords="electronic health record",
keywords="nonrandomized controlled trial",
keywords="emergency department presentations",
keywords="pragmatic trial",
keywords="symptom screening",
abstract="Background: Despite the acceptability and efficacy of e--patient-reported outcome (ePRO) systems, implementation in routine clinical care remains challenging. Objective: This pragmatic trial implemented the PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care) web-based system into existing clinical workflows and evaluated its effectiveness among a diverse population of patients with cancer. Methods: Adult patients with solid tumors receiving active treatment or follow-up care in four cancer centers were enrolled. The PROMPT-Care intervention supported patient management through (1) monthly off-site electronic PRO physical symptom and psychosocial well-being assessments, (2) automated electronic clinical alerts notifying the care team of unresolved clinical issues following two consecutive assessments, and (3) tailored online patient self-management resources. Propensity score matching was used to match controls with intervention patients in a 4:1 ratio for patient age, sex, and treatment status. The primary outcome was a reduction in emergency department presentations. Secondary outcomes were time spent on chemotherapy and the number of allied health service referrals. Results: From April 2016 to October 2018, 328 patients from four public hospitals received the intervention. Matched controls (n=1312) comprised the general population of patients with cancer, seen at the participating hospitals during the study period. Emergency department visits were significantly reduced by 33\% (P=.02) among patients receiving the intervention compared with patients in the matched controls. No significant associations were found in allied health referrals or time to end of chemotherapy. At baseline, the most common patient reported outcomes (above-threshold) were fatigue (39\%), tiredness (38.4\%), worry (32.9\%), general wellbeing (32.9\%), and sleep (24.1\%), aligning with the most frequently accessed self-management domain pages of physical well-being (36\%) and emotional well-being (23\%). The majority of clinical feedback reports were reviewed by nursing staff (729/893, 82\%), largely in response to the automated clinical alerts (n=877). Conclusions: Algorithm-supported web-based systems utilizing patient reported outcomes in clinical practice reduced emergency department presentations among a diverse population of patients with cancer. This study also highlighted the importance of (1) automated triggers for reviewing above-threshold results in patient reports, rather than passive manual review of patient records; (2) the instrumental role nurses play in managing alerts; and (3) providing patients with resources to support guided self-management, where appropriate. Together, these factors will inform the integration of web-based PRO systems into future models of routine cancer care. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000615482; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370633 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-018-4729-3 ",
doi="10.2196/19685",
url="http://www.jmir.org/2020/10/e19685/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33118954"
}


@Article{info:doi/10.2196/21238,
author="Sungur, Hande
and Y?lmaz, Gizem Nida
and Chan, Chu Brittany Ming
and van den Muijsenbergh, C. Maria E. T.
and van Weert, M. Julia C.
and Schouten, C. Barbara",
title="Development and Evaluation of a Digital Intervention for Fulfilling the Needs of Older Migrant Patients With Cancer: User-Centered Design Approach",
journal="J Med Internet Res",
year="2020",
month="Oct",
day="26",
volume="22",
number="10",
pages="e21238",
keywords="cancer",
keywords="patient participation",
keywords="health services needs and demand",
keywords="eHealth",
keywords="migrants",
keywords="physician-patient relations",
keywords="culture",
keywords="mobile phone",
abstract="Background: Older migrant patients with cancer face many language- and culture-related barriers to patient participation during medical consultations. To bridge these barriers, an eHealth tool called Health Communicator was developed in the Netherlands. Essentially used as a digital translator that can collect medical history information from patients, the Health Communicator did not include an oncological module so far, despite the fact that the prevalence of Dutch migrant patients with cancer is rising. Objective: This study aims to systematically develop, implement, and conduct a pilot evaluation of an oncological module that can be integrated into the Health Communicator to stimulate patient participation among older Turkish-Dutch and Moroccan-Dutch patients with cancer. Methods: The Spiral Technology Action Research model, which incorporates 5 cycles that engage key stakeholders in intervention development, was used as a framework. The listen phase consisted of a needs assessment. The plan phase consisted of developing the content of the oncological module, namely the question prompt lists (QPLs) and scripts for patient education videos. On the basis of pretests in the do phase, 6 audiovisual QPLs on patient rights, treatment, psychosocial support, lifestyle and access to health care services, patient preferences, and clinical trials were created. Additionally, 5 patient education videos were created about patient rights, psychosocial support, clinical trials, and patient-professional communication. In the study phase, the oncological module was pilot-tested among 27 older Turkish-Dutch and Moroccan-Dutch patients with cancer during their consultations. In the act phase, the oncological model was disseminated to practice. Results: The patient rights QPL was chosen most often during the pilot testing in the study phase. Patients and health care professionals perceived the QPLs as easy to understand and useful. There was a negative correlation between the tool's ease of use and patient age. Patients reported that using the module impacted the consultations positively and thought they were more active compared with previous consultations. Health care professionals also found patients to be more active than usual. Health care professionals asked significantly more questions than patients during consultations. Patients requested to see the patients' rights video most often. Patients rated the videos as easy to understand, useful, and informative. Most of the patients wanted to use the tool in the future. Conclusions: Older migrant patients with cancer, survivors, and health care professionals found the oncological module to be a useful tool and have shown intentions to incorporate it into future consultation sessions. Both QPLs and videos were evaluated positively, the latter indicating that the use of narratives to inform older, low-literate migrant patients with cancer about health-related topics in their mother tongue is a viable approach to increase the effectiveness of health care communication with this target group. ",
doi="10.2196/21238",
url="http://www.jmir.org/2020/10/e21238/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33104008"
}


@Article{info:doi/10.2196/20480,
author="Collado-Borrell, Roberto
and Escudero-Vilaplana, Vicente
and Ribed, Almudena
and Gonzalez-Anleo, Cristina
and Martin-Conde, Maite
and Romero-Jimenez, Rosa
and Iglesias-Peinado, Irene
and Herranz-Alonso, Ana
and Sanjurjo-Saez, Maria",
title="Effect of a Mobile App for the Pharmacotherapeutic Follow-Up of Patients With Cancer on Their Health Outcomes: Quasi-Experimental Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Oct",
day="16",
volume="8",
number="10",
pages="e20480",
keywords="e-OncoSalud",
keywords="app",
keywords="smartphone",
keywords="oral antineoplastic agent",
keywords="oncology",
abstract="Background: Oral antineoplastic agents (OAAs) have revolutionized cancer management. However, they have been reported with adverse side effects and drug-drug interactions. Moreover, patient adherence to OAA treatment is critical. Mobile apps can enable remote and real-time pharmacotherapeutic monitoring of patients, while also promoting patient autonomy in their health care. Objective: The primary objective was to analyze the effect of using a mobile app for the follow-up of patients with oncohematological malignancies undergoing treatment with OAAs on their health outcomes. The secondary objectives were to analyze the role of the app in communication with health care professionals and patient satisfaction with the app. Methods: We performed a comparative, quasi-experimental study based on a prepost intervention with 101 patients (control group, n=51, traditional pharmacotherapeutic follow-up vs intervention group, n=50, follow-up through e-OncoSalud, a custom-designed app that promotes follow-up at home and the safety of patients receiving OAAs). The effect of this app on drug safety, adherence to treatment, and quality of life was evaluated. Results: With regard to drug safety, 73\% (37/51) of the patients in the control group and 70\% (35/50) of the patients in the intervention group (P=.01) presented with drug-related problems. The probability of detecting an insufficiently treated health problem in the intervention group was significantly higher than that in the control group (P=.04). The proportion of patients who presented with side effects in the intervention group was significantly lower than that in the control group (P>.99). In the control group, 49\% (25/51) of the patients consumed some health resources during the first 6 months of treatment compared with 36\% (18/50) of the patients in the intervention group (P=.76). Adherence to treatment was 97.6\% (SD 7.9) in the intervention group, which was significantly higher than that in the control group (92.9\% [SD 10.0]; P=.02). The EuroQol-5D in the intervention group yielded a mean (SD) index of 0.875 (0.156), which was significantly higher than that in the control group (0.741 [0.177]; P<.001). Approximately 60\% (29/50) of the patients used the messaging module to communicate with pharmacists. The most frequent types of messages were acknowledgments (77/283, 27.2\%), doubts about contraindications and interactions with OAAs (70/283, 24.7\%), and consultations for adverse reactions to treatment (39/283, 13.8\%). The satisfaction with the app survey conducted in the intervention group yielded an overall mean (SD) score of 9.1 (0.4) out of 10. Conclusions: Use of e-OncoSalud for the real-time follow-up of patients receiving OAAs facilitated the optimization of some health outcomes. The intervention group had significantly higher health-related quality of life and adherence to treatment than the control group. Further, the probability of the intervention group presenting with side effects was significantly lower than that of the control group. ",
doi="10.2196/20480",
url="http://mhealth.jmir.org/2020/10/e20480/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33064100"
}


@Article{info:doi/10.2196/19694,
author="Cott{\'e}, Fran{\c{c}}ois-Emery
and Voillot, Pam{\'e}la
and Bennett, Bryan
and Falissard, Bruno
and Tzourio, Christophe
and Foulqui{\'e}, Pierre
and Gaudin, Anne-Fran{\c{c}}oise
and Lemasson, Herv{\'e}
and Grumberg, Valentine
and McDonald, Laura
and Faviez, Carole
and Sch{\"u}ck, St{\'e}phane",
title="Exploring the Health-Related Quality of Life of Patients Treated With Immune Checkpoint Inhibitors: Social Media Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="11",
volume="22",
number="9",
pages="e19694",
keywords="health-related quality of life",
keywords="immunotherapy",
keywords="patients with cancer",
keywords="social media use",
keywords="measures",
keywords="real world",
abstract="Background: Immune checkpoint inhibitors (ICIs) are increasingly used to treat several types of tumors. Impact of this emerging therapy on patients' health-related quality of life (HRQoL) is usually collected in clinical trials through standard questionnaires. However, this might not fully reflect HRQoL of patients under real-world conditions. In parallel, users' narratives from social media represent a potential new source of research concerning HRQoL. Objective: The aim of this study is to assess and compare coverage of ICI-treated patients' HRQoL domains and subdomains in standard questionnaires from clinical trials and in real-world setting from social media posts. Methods: A retrospective study was carried out by collecting social media posts in French language written by internet users mentioning their experiences with ICIs between January 2011 and August 2018. Automatic and manual extractions were implemented to create a corpus where domains and subdomains of HRQoL were classified. These annotations were compared with domains covered by 2 standard HRQoL questionnaires, the EORTC QLQ-C30 and the FACT-G. Results: We identified 150 users who described their own experience with ICI (89/150, 59.3\%) or that of their relative (61/150, 40.7\%), with 137 users (91.3\%) reporting at least one HRQoL domain in their social media posts. A total of 8 domains and 42 subdomains of HRQoL were identified: Global health (1 subdomain; 115 patients), Symptoms (13; 76), Emotional state (10; 49), Role (7; 22), Physical activity (4; 13), Professional situation (3; 9), Cognitive state (2; 2), and Social state (2; 2). The QLQ-C30 showed a wider global coverage of social media HRQoL subdomains than the FACT-G, 45\% (19/42) and 29\% (12/42), respectively. For both QLQ-C30 and FACT-G questionnaires, coverage rates were particularly suboptimal for Symptoms (68/123, 55.3\% and 72/123, 58.5\%, respectively), Emotional state (7/49, 14\% and 24/49, 49\%, respectively), and Role (17/22, 77\% and 15/22, 68\%, respectively). Conclusions: Many patients with cancer are using social media to share their experiences with immunotherapy. Collecting and analyzing their spontaneous narratives are helpful to capture and understand their HRQoL in real-world setting. New measures of HRQoL are needed to provide more in-depth evaluation of Symptoms, Emotional state, and Role among patients with cancer treated with immunotherapy. ",
doi="10.2196/19694",
url="http://www.jmir.org/2020/9/e19694/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32915159"
}


@Article{info:doi/10.2196/18228,
author="Guo, Yuqi
and Hao, Zhichao
and Zhao, Shichong
and Gong, Jiaqi
and Yang, Fan",
title="Artificial Intelligence in Health Care: Bibliometric Analysis",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="29",
volume="22",
number="7",
pages="e18228",
keywords="health care",
keywords="artificial intelligence",
keywords="bibliometric analysis",
keywords="telehealth",
keywords="neural networks",
keywords="machine learning",
abstract="Background: As a critical driving power to promote health care, the health care--related artificial intelligence (AI) literature is growing rapidly. Objective: The purpose of this analysis is to provide a dynamic and longitudinal bibliometric analysis of health care--related AI publications. Methods: The Web of Science (Clarivate PLC) was searched to retrieve all existing and highly cited AI-related health care research papers published in English up to December 2019. Based on bibliometric indicators, a search strategy was developed to screen the title for eligibility, using the abstract and full text where needed. The growth rate of publications, characteristics of research activities, publication patterns, and research hotspot tendencies were computed using the HistCite software. Results: The search identified 5235 hits, of which 1473 publications were included in the analyses. Publication output increased an average of 17.02\% per year since 1995, but the growth rate of research papers significantly increased to 45.15\% from 2014 to 2019. The major health problems studied in AI research are cancer, depression, Alzheimer disease, heart failure, and diabetes. Artificial neural networks, support vector machines, and convolutional neural networks have the highest impact on health care. Nucleosides, convolutional neural networks, and tumor markers have remained research hotspots through 2019. Conclusions: This analysis provides a comprehensive overview of the AI-related research conducted in the field of health care, which helps researchers, policy makers, and practitioners better understand the development of health care--related AI research and possible practice implications. Future AI research should be dedicated to filling in the gaps between AI health care research and clinical applications. ",
doi="10.2196/18228",
url="http://www.jmir.org/2020/7/e18228/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32723713"
}


@Article{info:doi/10.2196/15911,
author="Abdulaal, Ahmed
and Arhi, Chanpreet
and Ziprin, Paul",
title="Effect of Health Care Provider Delays on Short-Term Outcomes in Patients With Colorectal Cancer: Multicenter Population-Based Observational Study",
journal="Interact J Med Res",
year="2020",
month="Jul",
day="17",
volume="9",
number="3",
pages="e15911",
keywords="surgery",
keywords="cancer",
keywords="colorectal",
keywords="delay",
abstract="Background: The United Kingdom has lower survival figures for all types of cancers compared to many European countries despite similar national expenditures on health. This discrepancy may be linked to long diagnostic and treatment delays. Objective: The aim of this study was to determine whether delays experienced by patients with colorectal cancer (CRC) affect their survival. Methods: This observational study utilized the Somerset Cancer Register to identify patients with CRC who were diagnosed on the basis of positive histology findings. The effects of diagnostic and treatment delays and their subdivisions on outcomes were investigated using Cox proportional hazards regression. Kaplan-Meier plots were used to illustrate group differences. Results: A total of 648 patients (375 males, 57.9\% males) were included in this study. We found that neither diagnostic delay nor treatment delay had an effect on the overall survival in patients with CRC ($\chi$23=1.5, P=.68; $\chi$23=0.6, P=.90, respectively). Similarly, treatment delays did not affect the outcomes in patients with CRC ($\chi$23=5.5, P=.14). The initial Cox regression analysis showed that patients with CRC who had short diagnostic delays were less likely to die than those experiencing long delays (hazard ratio 0.165, 95\% CI 0.044-0.616; P=.007). However, this result was nonsignificant following sensitivity analysis. Conclusions: Diagnostic and treatment delays had no effect on the survival of this cohort of patients with CRC. The utility of the 2-week wait referral system is therefore questioned. Timely screening with subsequent early referral and access to diagnostics may have a more beneficial effect. ",
doi="10.2196/15911",
url="https://www.i-jmr.org/2020/3/e15911",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706666"
}


@Article{info:doi/10.2196/19322,
author="Lonergan, E. Peter
and Washington III, L. Samuel
and Branagan, Linda
and Gleason, Nathaniel
and Pruthi, S. Raj
and Carroll, R. Peter
and Odisho, Y. Anobel",
title="Rapid Utilization of Telehealth in a Comprehensive Cancer Center as a Response to COVID-19: Cross-Sectional Analysis",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="6",
volume="22",
number="7",
pages="e19322",
keywords="health informatics",
keywords="telehealth",
keywords="video visits",
keywords="COVID-19",
keywords="video consultation",
keywords="pandemic",
keywords="electronic health record",
keywords="EHR",
abstract="Background: The emergence of the coronavirus disease (COVID-19) pandemic in March 2020 created unprecedented challenges in the provision of scheduled ambulatory cancer care. As a result, there has been a renewed focus on video-based telehealth consultations as a means to continue ambulatory care. Objective: The aim of this study is to analyze the change in video visit volume at the University of California, San Francisco (UCSF) Comprehensive Cancer Center in response to COVID-19 and compare patient demographics and appointment data from January 1, 2020, and in the 11 weeks after the transition to video visits. Methods: Patient demographics and appointment data (dates, visit types, and departments) were extracted from the electronic health record reporting database. Video visits were performed using a HIPAA (Health Insurance Portability and Accountability Act)-compliant video conferencing platform with a pre-existing workflow. Results: In 17 departments and divisions at the UCSF Cancer Center, 2284 video visits were performed in the 11 weeks before COVID-19 changes were implemented (mean 208, SD 75 per week) and 12,946 video visits were performed in the 11-week post--COVID-19 period (mean 1177, SD 120 per week). The proportion of video visits increased from 7\%-18\% to 54\%-72\%, between the pre-- and post--COVID-19 periods without any disparity based on race/ethnicity, primary language, or payor. Conclusions: In a remarkably brief period of time, we rapidly scaled the utilization of telehealth in response to COVID-19 and maintained access to complex oncologic care at a time of social distancing. ",
doi="10.2196/19322",
url="https://www.jmir.org/2020/7/e19322",
url="http://www.ncbi.nlm.nih.gov/pubmed/32568721"
}


@Article{info:doi/10.2196/19691,
author="Tashkandi, Emad
and Zeeneldin, Ahmed
and AlAbdulwahab, Amal
and Elemam, Omima
and Elsamany, Shereef
and Jastaniah, Wasil
and Abdullah, Shaker
and Alfayez, Mohammad
and Jazieh, Rahman Abdul
and Al-Shamsi, O. Humaid",
title="Virtual Management of Patients With Cancer During the COVID-19 Pandemic: Web-Based Questionnaire Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="24",
volume="22",
number="6",
pages="e19691",
keywords="teleoncology",
keywords="telemedicine",
keywords="eHealth",
keywords="cancer",
keywords="COVID-19",
keywords="public health",
abstract="Background: During the coronavirus disease (COVID-19) pandemic, patients with cancer in rural settings and distant geographical areas will be affected the most by curfews. Virtual management (telemedicine) has been shown to reduce health costs and improve access to care. Objective: The aim of this survey is to understand oncologists' awareness of and views on virtual management, challenges, and preferences, as well as their priorities regarding the prescribing of anticancer treatments during the COVID-19 pandemic. Methods: We created a self-administrated electronic survey about the virtual management of patients with cancer during the COVID-19 pandemic. We evaluated its clinical sensibility and pilot tested the instrument. We surveyed practicing oncologists in Gulf and Arab countries using snowball sampling via emails and social media networks. Reminders were sent 1 and 2 weeks later using SurveyMonkey. Results: We received 222 responses from validated oncologists from April 2-22, 2020. An awareness of virtual clinics, virtual multidisciplinary teams, and virtual prescriptions was reported by 182 (82\%), 175 (79\%), and 166 (75\%) respondents, respectively. Reported challenges associated with virtual management were the lack of physical exam (n=134, 60\%), patients' awareness and access (n=131, 59\%), the lack of physical attendance of patients (n=93, 42\%), information technology (IT) support (n=82, 37\%), and the safety of virtual management (n=78, 35\%). Overall, 111 (50\%) and 107 (48\%) oncologists did not prefer the virtual prescription of chemotherapy and novel immunotherapy, respectively. However, 188 (85\%), 165 (74\%), and 127 (57\%) oncologists preferred the virtual prescription of hormonal therapy, bone modifying agents, and targeted therapy, respectively. In total, 184 (83\%), 183 (83\%), and 176 (80\%) oncologists preferred to continue neoadjuvant, adjuvant, and perioperative treatments, respectively. Overall, 118 (53\%) respondents preferred to continue first-line palliative treatment, in contrast to 68 (30\%) and 47 (21\%) respondents indicating a preference to interrupt second- and third-line palliative treatment, respectively. For administration of virtual prescriptions, all respondents preferred the oral route and 118 (53\%) preferred the subcutaneous route. In contrast, 193 (87\%) did not prefer the intravenous route for virtual prescriptions. Overall, 102 (46\%) oncologists responded that they would ``definitely'' prefer to manage patients with cancer virtually. Conclusions: Oncologists have a high level of awareness of virtual management. Although their survey responses indicated that second- and third-line palliative treatments should be interrupted, they stated that neoadjuvant, adjuvant, perioperative, and first-line palliative treatments should continue. Our results confirm that oncologists' views on the priority of anticancer treatments are consistent with the evolving literature during the COVID-19 pandemic. Challenges to virtual management should be addressed to improve the care of patients with cancer. ",
doi="10.2196/19691",
url="http://www.jmir.org/2020/6/e19691/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32501807"
}


@Article{info:doi/10.2196/17821,
author="Liu, Ziqing
and He, Haiyang
and Yan, Shixing
and Wang, Yong
and Yang, Tao
and Li, Guo-Zheng",
title="End-to-End Models to Imitate Traditional Chinese Medicine Syndrome Differentiation in Lung Cancer Diagnosis: Model Development and Validation",
journal="JMIR Med Inform",
year="2020",
month="Jun",
day="16",
volume="8",
number="6",
pages="e17821",
keywords="traditional Chinese medicine",
keywords="syndrome differentiation",
keywords="lung cancer",
keywords="medical record",
keywords="deep learning",
keywords="model fusion",
abstract="Background: Traditional Chinese medicine (TCM) has been shown to be an efficient mode to manage advanced lung cancer, and accurate syndrome differentiation is crucial to treatment. Documented evidence of TCM treatment cases and the progress of artificial intelligence technology are enabling the development of intelligent TCM syndrome differentiation models. This is expected to expand the benefits of TCM to lung cancer patients. Objective: The objective of this work was to establish end-to-end TCM diagnostic models to imitate lung cancer syndrome differentiation. The proposed models used unstructured medical records as inputs to capitalize on data collected for practical TCM treatment cases by lung cancer experts. The resulting models were expected to be more efficient than approaches that leverage structured TCM datasets. Methods: We approached lung cancer TCM syndrome differentiation as a multilabel text classification problem. First, entity representation was conducted with Bidirectional Encoder Representations from Transformers and conditional random fields models. Then, five deep learning--based text classification models were applied to the construction of a medical record multilabel classifier, during which two data augmentation strategies were adopted to address overfitting issues. Finally, a fusion model approach was used to elevate the performance of the models. Results: The F1 score of the recurrent convolutional neural network (RCNN) model with augmentation was 0.8650, a 2.41\% improvement over the unaugmented model. The Hamming loss for RCNN with augmentation was 0.0987, which is 1.8\% lower than that of the same model without augmentation. Among the models, the text-hierarchical attention network (Text-HAN) model achieved the highest F1 scores of 0.8676 and 0.8751. The mean average precision for the word encoding--based RCNN was 10\% higher than that of the character encoding--based representation. A fusion model of the text-convolutional neural network, text-recurrent neural network, and Text-HAN models achieved an F1 score of 0.8884, which showed the best performance among the models. Conclusions: Medical records could be used more productively by constructing end-to-end models to facilitate TCM diagnosis. With the aid of entity-level representation, data augmentation, and model fusion, deep learning--based multilabel classification approaches can better imitate TCM syndrome differentiation in complex cases such as advanced lung cancer. ",
doi="10.2196/17821",
url="https://medinform.jmir.org/2020/6/e17821",
url="http://www.ncbi.nlm.nih.gov/pubmed/32543445"
}


@Article{info:doi/10.2196/16527,
author="Ngo, Victoria
and Matsumoto, G. Cynthia
and Joseph, G. Jill
and Bell, F. Janice
and Bold, J. Richard
and Davis, Andra
and Reed, C. Sarah
and Kim, K. Katherine",
title="The Personal Health Network Mobile App for Chemotherapy Care Coordination: Qualitative Evaluation of a Randomized Clinical Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="26",
volume="8",
number="5",
pages="e16527",
keywords="care coordination, continuity of patient care",
keywords="oncology",
keywords="chemotherapy",
keywords="patient-centered care",
keywords="mobile health",
keywords="technology adoption",
abstract="Background: Cancer care coordination addresses the fragmented and inefficient care of individuals with complex care needs. The complexity of care coordination can be aided by innovative technology. Few examples of information technology-enabled care coordination exist beyond the conventional telephone follow-up. For this study, we implemented a custom-designed app, the Personal Health Network (PHN)---a Health Insurance Portability and Accountability Act-compliant social network built around a patient to enable patient-centered health and health care activities in collaboration with clinicians, care team members, caregivers, and others designated by the patient. The app facilitates a care coordination intervention for patients undergoing chemotherapy. Objective: This study aimed to understand patient experiences with PHN technology and assess their perspectives on the usability and usefulness of PHNs with care coordination during chemotherapy. Methods: A two-arm randomized clinical trial was conducted to compare the PHN and care coordination with care coordination alone over a 6-month period beginning with the initiation of chemotherapy. A semistructured interview guide was constructed based on a theoretical framework of technology acceptance addressing usefulness, usability, and the context of use of the technology within the participant's life and health care setting. All participants in the intervention arm were interviewed on completion of the study. Interviews were recorded and transcribed verbatim. A summative thematic analysis was completed for the transcribed interviews. Features of the app were also evaluated. Results: A total of 27 interviews were completed. The resulting themes included the care coordinator as a partner in care, learning while sick, comparison of other technology to make sense of the PHN, communication, learning, usability, and usefulness. Users expressed that the nurse care coordinators were beneficial to them because they helped them stay connected to the care team and answered their questions. They shared that the mobile app gave them access to the health information they were seeking. Users expressed that the mobile app would be more useful if it was fully integrated with the electronic health record. Conclusions: The findings highlight the value of care coordination from the perspectives of cancer patients undergoing chemotherapy and the important role of technology, such as the PHN, in enhancing this process by facilitating better communication and access to information regarding their illness. ",
doi="10.2196/16527",
url="http://mhealth.jmir.org/2020/5/e16527/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32452814"
}


@Article{info:doi/10.2196/16604,
author="Igelstr{\"o}m, Helena
and Hauffman, Anna
and Alfonsson, Sven
and Sj{\"o}str{\"o}m, Jonas
and Cajander, {\AA}sa
and Johansson, Birgitta",
title="User Experiences of an Internet-Based Stepped-Care Intervention for Individuals With Cancer and Concurrent Symptoms of Anxiety or Depression (the U-CARE AdultCan Trial): Qualitative Study",
journal="J Med Internet Res",
year="2020",
month="May",
day="19",
volume="22",
number="5",
pages="e16604",
keywords="interactive web portal",
keywords="stepped care",
keywords="user experience",
keywords="cancer",
keywords="interviews",
abstract="Background: The internet-based stepped-care intervention iCAN-DO, used in the multicenter randomized controlled trial AdultCan, was developed for adult patients undergoing treatment for cancer and concurrently experiencing anxiety or depressive symptoms. iCAN-DO aimed to decrease symptoms of anxiety or depression. Step 1 comprises access to a library with psychoeducational material and a peer-support section, as well as the possibility to pose questions to a nurse. Step 2 of the intervention offers treatment consisting of internet-based cognitive behavioral therapy (iCBT) to participants still experiencing anxiety or depression at 1, 4, or 7 months after inclusion. Objective: The study aimed to explore user experiences of delivery, design, and structure of iCAN-DO from the perspective of people with cancer. Methods: We studied user experiences by interviewing 15 informants individually: 10 women with breast cancer (67\%), 4 men with prostate cancer (27\%), and 1 man with colorectal cancer (7\%) with a mean age 58.9 years (SD 8.9). The interviews focused on informants' perceptions of ease of use and of system design and structure. Informants had been included in iCAN-DO for at least 7 months. They were purposefully selected based on activity in Step 1, participation in iCBT (ie, Step 2), gender, and diagnosis. Results: Of the 15 informants, 6 had been offered iCBT (40\%). All informants used the internet on a daily basis, but 2 (13\%) described themselves as very inexperienced computer users. The analysis revealed three subthemes, concerning how user experiences were affected by disease-specific factors and side effects (User experience in the context of cancer), technical problems (Technical struggles require patience and troubleshooting), and the structure and design of iCAN-DO (Appealing and usable, but rather simple). Conclusions: The results indicate that user experiences were affected by informants' life situations, the technical aspects and the design of iCAN-DO, and informants' preferences. The results have generated some developments feasible to launch during the ongoing study, but if iCAN-DO is to be used beyond research interest, a greater level of tailoring of information, features, and design may be needed to improve user experiences. The use of recurrent questionnaires during the treatment period may highlight an individual's health, but also function as a motivator showing improvements over time. ",
doi="10.2196/16604",
url="http://www.jmir.org/2020/5/e16604/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32427108"
}


@Article{info:doi/10.2196/16493,
author="Berbyuk Lindstr{\"o}m, Nataliya
and Woldemariam, Abraha Aynalem
and Bekele, Abebe
and Munthe, Christian
and Andersson, Rune
and Girma Kebede, Bethlehem
and Linderholm, Barbro
and Tigeneh, Wondemagegnhu",
title="Person and Family Centeredness in Ethiopian Cancer Care: Proposal for a Project for Improving Communication, Ethics, Decision Making, and Health",
journal="JMIR Res Protoc",
year="2020",
month="May",
day="19",
volume="9",
number="5",
pages="e16493",
keywords="communication",
keywords="culture",
keywords="cancer",
keywords="ethics",
keywords="person-centered care",
keywords="Ethiopia",
abstract="Background: Cancer is a major burden in Ethiopia. The Oncology Department of Tikur Anbessa (Black Lion) Specialized Hospital in Addis Ababa is the sole specialist unit for cancer care in the country. With only a handful of oncologists, a lack of resources, and a huge patient load, the work is challenging, especially in terms of achieving effective and ethical patient consultations. Patients, usually accompanied by family members, often wait for a long time to receive medical attention and frequently depart without treatment. Handling consultations effectively is essential to help patients as much as possible within such limitations. Objective: The project has the following three main aims: (1) to enhance and expand the understanding of communicative and associated ethical challenges in Ethiopian cancer care; (2) to enhance and expand the understanding of the implications and use of person- and family-centered solutions to address such communicative challenges in practice; and (3) to plan and evaluate interventions in this area. Methods: This project develops and consolidates a research collaboration to better understand and mitigate the communicative challenges in Ethiopian cancer care, with a focus on the handling and sharing of decision making and ethical tension among patients, staff, and family. Using theoretical models from linguistics, health communication, and health care ethics, multiple sources of data will be analyzed. Data sources currently include semistructured interviews with Ethiopian staff (n= 16), patients (n= 54), and family caregivers (n= 22); survey data on cancer awareness (n=150) and attitudes toward breaking bad news (n=450); and video recordings of medical consultations (n=45). In addition, we will develop clinical and methodological solutions to formulate educational interventions. Results: The project was awarded funding by the Swedish Research Council in December 2017 for the period 2018 to 2021. The research ethics boards in Sweden and Ethiopia approved the project in May 2018. The results of the studies will be published in 2020 and 2021. Conclusions: The project is the first step toward providing unique and seminal knowledge for the specific context of Ethiopia in the areas of physician-patient communication research and ethics. It contributes to the understanding of the complexity of the role of family and ethical challenges in relation to patient involvement and decision making in Ethiopia. Improved knowledge in this area can provide a fundamental model for ways to improve cancer care in many other low-resource settings in Africa and the Middle East, which share central cultural prerequisites, such as a strong patriarchal family structure, along with strong and devout religiosity. The project will also serve to develop greater understanding about the current challenges in Western health systems associated with greater family and patient participation in decision making. In addition, the project will contribute to improving the education of Ethiopian health professionals working in cancer care by developing a training program to help them better understand and respond to identified challenges associated with communication. International Registered Report Identifier (IRRID): DERR1-10.2196/16493 ",
doi="10.2196/16493",
url="https://www.researchprotocols.org/2020/5/e16493",
url="http://www.ncbi.nlm.nih.gov/pubmed/32427112"
}


@Article{info:doi/10.2196/15895,
author="Ector, ICG Genevi{\`e}ve
and Westerweel, E. Peter
and Hermens, PMG Rosella
and Braspenning, AE Karin
and Heeren, CM Barend
and Vinck, MF Oscar
and de Jong, JM Jan
and Janssen, JWM Jeroen
and Blijlevens, MA Nicole",
title="The Development of a Web-Based, Patient-Centered Intervention for Patients With Chronic Myeloid Leukemia (CMyLife): Design Thinking Development Approach",
journal="J Med Internet Res",
year="2020",
month="May",
day="15",
volume="22",
number="5",
pages="e15895",
keywords="eHealth",
keywords="chronic myeloid leukemia",
keywords="patient participation",
keywords="mobile apps",
abstract="Background: With the global rise in chronic health conditions, health care is transforming, and patient empowerment is being emphasized to improve treatment outcomes and reduce health care costs. Patient-centered innovations are needed. We focused on patients with chronic myeloid leukemia (CML), a chronic disease with a generally good long-term prognosis because of the advent of tyrosine kinase inhibitors. However, both medication adherence by patients and guideline adherence by physicians are suboptimal, unnecessarily jeopardizing treatment outcomes. Objective: The aim of this study was to develop a patient-centered innovation for patients with CML using a design thinking methodology. Methods: The 5 phases of design thinking (ie, empathize, define, ideate, prototype, and test) were completed, and each phase started with the patient. Stakeholders and end users were identified and interviewed, and observations in the care system were made. Using tools in human-centered design, problems were defined and various prototypes of solutions were generated. These were evaluated by patients and stakeholders and then further refined. Results: The patients desired (1) insights into their own disease; (2) insights into the symptoms experienced, both in terms of knowledge and comprehension; and (3) improvements in the organization of care delivery. A web-based platform, CMyLife, was developed and pilot-tested. It has multiple features, all targeting parts of the bigger solution, including a website with reliable information and a forum, a guideline app, personal medical records with logs of symptoms and laboratory results (including a molecular marker and linked to the guideline app), tailored feedback based on the patients' symptoms and/or results, screen-to-screen consulting, delivery of medication, and the collection of blood samples at home. Conclusions: The multifeatured innovation, CMyLife, was developed in a multidisciplinary way and with active patient participation. The aim of developing CMyLife was to give patients the tools to monitor their results, interpret these results, and act on them. With this tool, they are provided with the know-how to consider their results in relation to their personal care process. Whether CMyLife achieves its goal and the evaluation of the added value will be the focus of future studies. CML could become the first malignancy for which patients are able to monitor and manage their disease by themselves. ",
doi="10.2196/15895",
url="https://www.jmir.org/2020/5/e15895",
url="http://www.ncbi.nlm.nih.gov/pubmed/32412424"
}


@Article{info:doi/10.2196/18378,
author="Shaw, E. Sara
and Seuren, Martinus Lucas
and Wherton, Joseph
and Cameron, Deborah
and A'Court, Christine
and Vijayaraghavan, Shanti
and Morris, Joanne
and Bhattacharya, Satyajit
and Greenhalgh, Trisha",
title="Video Consultations Between Patients and Clinicians in Diabetes, Cancer, and Heart Failure Services: Linguistic Ethnographic Study of Video-Mediated Interaction",
journal="J Med Internet Res",
year="2020",
month="May",
day="11",
volume="22",
number="5",
pages="e18378",
keywords="delivery of health care",
keywords="physical examination",
keywords="remote consultation",
keywords="telemedicine",
keywords="health communication",
keywords="language",
keywords="nonverbal communication",
keywords="mobile phone",
abstract="Background: Video-mediated clinical consultations offer potential benefits over conventional face-to-face in terms of access, convenience, and sometimes cost. The improved technical quality and dependability of video-mediated consultations has opened up the possibility for more widespread use. However, questions remain regarding clinical quality and safety. Video-mediated consultations are sometimes criticized for being not as good as face-to-face, but there has been little previous in-depth research on their interactional dynamics, and no agreement on what a good video consultation looks like. Objective: Using conversation analysis, this study aimed to identify and analyze the communication strategies through which video-mediated consultations are accomplished and to produce recommendations for patients and clinicians to improve the communicative quality of such consultations. Methods: We conducted an in-depth analysis of the clinician-patient interaction in a sample of video-mediated consultations and a comparison sample of face-to-face consultations drawn from 4 clinical settings across 2 trusts (1 community and 1 acute care) in the UK National Health Service. The video dataset consisted of 37 recordings of video-mediated consultations (with diabetes, antenatal diabetes, cancer, and heart failure patients), 28 matched audio recordings of face-to-face consultations, and fieldnotes from before and after each consultation. We also conducted 37 interviews with staff and 26 interviews with patients. Using linguistic ethnography (combining analysis of communication with an appreciation of the context in which it takes place), we examined in detail how video interaction was mediated by 2 software platforms (Skype and FaceTime). Results: Patients had been selected by their clinician as appropriate for video-mediated consultation. Most consultations in our sample were technically and clinically unproblematic. However, we identified 3 interactional challenges: (1) opening the video consultation, (2) dealing with disruption to conversational flow (eg, technical issues with audio and/or video), and (3) conducting an examination. Operational and technological issues were the exception rather than the norm. In all but 1 case, both clinicians and patients (deliberately or intuitively) used established communication strategies to successfully negotiate these challenges. Remote physical examinations required the patient (and, in some cases, a relative) to simultaneously follow instructions and manipulate technology (eg, camera) to make it possible for the clinician to see and hear adequately. Conclusions: A remote video link alters how patients and clinicians interact and may adversely affect the flow of conversation. However, our data suggest that when such problems occur, clinicians and patients can work collaboratively to find ways to overcome them. There is potential for a limited physical examination to be undertaken remotely with some patients and in some conditions, but this appears to need complex interactional work by the patient and/or their relatives. We offer preliminary guidance for patients and clinicians on what is and is not feasible when consulting via a video link. International Registered Report Identifier (IRRID): RR2-10.2196/10913 ",
doi="10.2196/18378",
url="http://www.jmir.org/2020/5/e18378/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32391799"
}


@Article{info:doi/10.2196/16084,
author="Pak, Kyoungjune
and Oh, Sae-Ock
and Goh, Sik Tae
and Heo, Jin Hye
and Han, Myoung-Eun
and Jeong, Cheon Dae
and Lee, Chi-Seung
and Sun, Hokeun
and Kang, Junho
and Choi, Suji
and Lee, Soohwan
and Kwon, Jung Eun
and Kang, Wan Ji
and Kim, Hak Yun",
title="A User-Friendly, Web-Based Integrative Tool (ESurv) for Survival Analysis: Development and Validation Study",
journal="J Med Internet Res",
year="2020",
month="May",
day="5",
volume="22",
number="5",
pages="e16084",
keywords="survival analysis",
keywords="grouped variable selection",
keywords="The Cancer Genome Atlas",
keywords="web-based tool",
keywords="user service",
abstract="Background: Prognostic genes or gene signatures have been widely used to predict patient survival and aid in making decisions pertaining to therapeutic actions. Although some web-based survival analysis tools have been developed, they have several limitations. Objective: Taking these limitations into account, we developed ESurv (Easy, Effective, and Excellent Survival analysis tool), a web-based tool that can perform advanced survival analyses using user-derived data or data from The Cancer Genome Atlas (TCGA). Users can conduct univariate analyses and grouped variable selections using multiomics data from TCGA. Methods: We used R to code survival analyses based on multiomics data from TCGA. To perform these analyses, we excluded patients and genes that had insufficient information. Clinical variables were classified as 0 and 1 when there were two categories (for example, chemotherapy: no or yes), and dummy variables were used where features had 3 or more outcomes (for example, with respect to laterality: right, left, or bilateral). Results: Through univariate analyses, ESurv can identify the prognostic significance for single genes using the survival curve (median or optimal cutoff), area under the curve (AUC) with C statistics, and receiver operating characteristics (ROC). Users can obtain prognostic variable signatures based on multiomics data from clinical variables or grouped variable selections (lasso, elastic net regularization, and network-regularized high-dimensional Cox-regression) and select the same outputs as above. In addition, users can create custom gene signatures for specific cancers using various genes of interest. One of the most important functions of ESurv is that users can perform all survival analyses using their own data. Conclusions: Using advanced statistical techniques suitable for high-dimensional data, including genetic data, and integrated survival analysis, ESurv overcomes the limitations of previous web-based tools and will help biomedical researchers easily perform complex survival analyses. ",
doi="10.2196/16084",
url="https://www.jmir.org/2020/5/e16084",
url="http://www.ncbi.nlm.nih.gov/pubmed/32369034"
}


@Article{info:doi/10.2196/14710,
author="Park, Phillip
and Shin, Soo-Yong
and Park, Yun Seog
and Yun, Jeonghee
and Shin, Chulmin
and Jung, Jipmin
and Choi, Son Kui
and Cha, Soung Hyo",
title="Next-Generation Sequencing--Based Cancer Panel Data Conversion Using International Standards to Implement a Clinical Next-Generation Sequencing Research System: Single-Institution Study",
journal="JMIR Med Inform",
year="2020",
month="Apr",
day="24",
volume="8",
number="4",
pages="e14710",
keywords="data standardization",
keywords="clinical sequencing data",
keywords="next-generation sequencing",
keywords="translational research information system",
abstract="Background: The analytical capacity and speed of next-generation sequencing (NGS) technology have been improved. Many genetic variants associated with various diseases have been discovered using NGS. Therefore, applying NGS to clinical practice results in precision or personalized medicine. However, as clinical sequencing reports in electronic health records (EHRs) are not structured according to recommended standards, clinical decision support systems have not been fully utilized. In addition, integrating genomic data with clinical data for translational research remains a great challenge. Objective: To apply international standards to clinical sequencing reports and to develop a clinical research information system to integrate standardized genomic data with clinical data. Methods: We applied the recently published ISO/TS 20428 standard to 367 clinical sequencing reports generated by panel (91 genes) sequencing in EHRs and implemented a clinical NGS research system by extending the clinical data warehouse to integrate the necessary clinical data for each patient. We also developed a user interface with a clinical research portal and an NGS result viewer. Results: A single clinical sequencing report with 28 items was restructured into four database tables and 49 entities. As a result, 367 patients' clinical sequencing data were connected with clinical data in EHRs, such as diagnosis, surgery, and death information. This system can support the development of cohort or case-control datasets as well. Conclusions: The standardized clinical sequencing data are not only for clinical practice and could be further applied to translational research. ",
doi="10.2196/14710",
url="http://medinform.jmir.org/2020/4/e14710/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32329738"
}


@Article{info:doi/10.2196/13188,
author="Janssen, Anna
and Donnelly, Candice
and Kay, Judy
and Thiem, Peter
and Saavedra, Aldo
and Pathmanathan, Nirmala
and Elder, Elisabeth
and Dinh, Phuong
and Kabir, Masrura
and Jackson, Kirsten
and Harnett, Paul
and Shaw, Tim",
title="Developing an Intranet-Based Lymphedema Dashboard for Breast Cancer Multidisciplinary Teams: Design Research Study",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="21",
volume="22",
number="4",
pages="e13188",
keywords="eHealth",
keywords="clinical informatics",
keywords="human-centered design",
keywords="data visualization",
abstract="Background: A large quantity of data is collected during the delivery of cancer care. However, once collected, these data are difficult for health professionals to access to support clinical decision making and performance review. There is a need for innovative tools that make clinical data more accessible to support health professionals in these activities. One approach for providing health professionals with access to clinical data is to create the infrastructure and interface for a clinical dashboard to make data accessible in a timely and relevant manner. Objective: This study aimed to develop and evaluate 2 prototype dashboards for displaying data on the identification and management of lymphedema. Methods: The study used a co-design framework to develop 2 prototype dashboards for use by health professionals delivering breast cancer care. The key feature of these dashboards was an approach for visualizing lymphedema patient cohort and individual patient data. This project began with 2 focus group sessions conducted with members of a breast cancer multidisciplinary team (n=33) and a breast cancer consumer (n=1) to establish clinically relevant and appropriate data for presentation and the visualization requirements for a dashboard. A series of fortnightly meetings over 6 months with an Advisory Committee (n=10) occurred to inform and refine the development of a static mock-up dashboard. This mock-up was then presented to representatives of the multidisciplinary team (n=3) to get preliminary feedback about the design and use of such dashboards. Feedback from these presentations was reviewed and used to inform the development of the interactive prototypes. A structured evaluation was conducted on the prototypes, using Think Aloud Protocol and semistructured interviews with representatives of the multidisciplinary team (n=5). Results: Lymphedema was selected as a clinically relevant area for the prototype dashboards. A qualitative evaluation is reported for 5 health professionals. These participants were selected from 3 specialties: surgery (n=1), radiation oncology (n=2), and occupational therapy (n=2). Participants were able to complete the majority of tasks on the dashboard. Semistructured interview themes were categorized into engagement or enthusiasm for the dashboard, user experience, and data quality and completeness. Conclusions: Findings from this study constitute the first report of a co-design process for creating a lymphedema dashboard for breast cancer health professionals. Health professionals are interested in the use of data visualization tools to make routinely collected clinical data more accessible. To be used effectively, dashboards need to be reliable and sourced from accurate and comprehensive data sets. While the co-design process used to develop the visualization tool proved effective for designing an individual patient dashboard, the complexity and accessibility of the data required for a cohort dashboard remained a challenge. ",
doi="10.2196/13188",
url="https://www.jmir.org/2020/4/e13188",
url="http://www.ncbi.nlm.nih.gov/pubmed/32314968"
}


@Article{info:doi/10.2196/16533,
author="Nasseh, Daniel
and Schneiderbauer, Sophie
and Lange, Michael
and Schweizer, Diana
and Heinemann, Volker
and Belka, Claus
and Cadenovic, Ranko
and Buysse, Laurence
and Erickson, Nicole
and Mueller, Michael
and Kortuem, Karsten
and Niyazi, Maximilian
and Marschner, Sebastian
and Fey, Theres",
title="Optimizing the Analytical Value of Oncology-Related Data Based on an In-Memory Analysis Layer: Development and Assessment of the Munich Online Comprehensive Cancer Analysis Platform",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="17",
volume="22",
number="4",
pages="e16533",
keywords="oncology",
keywords="database management systems",
keywords="data visualization",
keywords="usability",
abstract="Background: Many comprehensive cancer centers incorporate tumor documentation software supplying structured information from the associated centers' oncology patients for internal and external audit purposes.  However, much of the documentation data included in these systems often remain unused and unknown by most of the clinicians at the sites. Objective: To improve access to such data for analytical purposes, a prerollout of an analysis layer based on the business intelligence software QlikView was implemented. This software allows for the real-time analysis and inspection of oncology-related data. The system is meant to increase access to the data while simultaneously providing tools for user-friendly real-time analytics. Methods: The system combines in-memory capabilities (based on QlikView software) with innovative techniques that compress the complexity of the data, consequently improving its readability as well as its accessibility for designated end users. Aside from the technical and conceptual components, the software's implementation necessitated a complex system of permission and governance. Results: A continuously running system including daily updates with a user-friendly Web interface and real-time usage was established. This paper introduces its main components and major design ideas.  A commented video summarizing and presenting the work can be found within the Multimedia Appendix. Conclusions: The system has been well-received by a focus group of physicians within an initial prerollout. Aside from improving data transparency, the system's main benefits are its quality and process control capabilities, knowledge discovery, and hypothesis generation. Limitations such as run time, governance, or misinterpretation of data are considered. ",
doi="10.2196/16533",
url="https://www.jmir.org/2020/4/e16533",
url="http://www.ncbi.nlm.nih.gov/pubmed/32077858"
}


@Article{info:doi/10.2196/16680,
author="Alcaraz, I. Kassandra
and Vereen, N. Rhyan
and Burnham, Donna",
title="Use of Telephone and Digital Channels to Engage Socioeconomically Disadvantaged Adults in Health Disparities Research Within a Social Service Setting: Cross-Sectional Study",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="1",
volume="22",
number="4",
pages="e16680",
keywords="cross-sectional studies",
keywords="electronic mail",
keywords="health status disparities",
keywords="health care disparities",
keywords="internet",
keywords="mobile phone",
keywords="telephone",
keywords="text messaging",
keywords="social services",
abstract="Background: Engaging socioeconomically disadvantaged populations in health research is vital to understanding and, ultimately, eliminating health-related disparities. Digital communication channels are increasingly used to recruit study participants, and recent trends indicate a growing need to partner with the social service sector to improve population health. However, few studies have recruited participants from social service settings using multiple digital channels. Objective: This study aimed to recruit and survey 3791 adult clients of a social service organization via telephone and digital channels. This paper aimed to describe recruitment outcomes across five channels and compare participant characteristics by recruitment channel type. Methods: The Cancer Communication Channels in Context Study recruited and surveyed adult clients of 2-1-1, a social service--focused information and referral system, using five channels: telephone, website, text message, web-based live chat, and email. Participants completed surveys administered either by phone (if recruited by phone) or on the web (if recruited from digital channels, ie, website, text message, Web-based live chat, or email). Measures for the current analysis included demographic and health characteristics. Results: A total of 3293 participants were recruited, with 1907 recruited by phone and 1386 recruited from digital channels. Those recruited by phone had a moderate study eligibility rate (42.23\%) and the highest survey completion rate (91.24\%) of all channels. Individuals recruited by text message had a high study eligibility rate (94.14\%) yet the lowest survey completion rate (74.0\%) of all channels. Sample accrual goals were achieved for phone, text message, and website recruitment. Multivariable analyses found differences in participant characteristics by recruitment channel type. Compared with participants recruited by phone, those recruited from digital channels were younger (adjusted odds ratio [aOR] 0.96, 95\% CI 0.96-0.97) and more likely to be female (aOR 1.52, 95\% CI 1.23-1.88), married (aOR 1.52, 95\% CI 1.22-1.89), and other than non-Hispanic black (aOR 1.48, 95\% CI 1.22-1.79). Those recruited via phone also were more likely to have more than a high school education (aOR 2.17, 95\% CI 1.67-2.82), have a household income ?US \$25,000 a year (aOR 2.02, 95\% CI 1.56-2.61), and have children living in the home (aOR 1.26, 95\% CI 1.06-1.51). Additionally, participants recruited from digital channels were less likely than those recruited by phone to have public health insurance (aOR 0.75, 95\% CI 0.62-0.90) and more likely to report better overall health (aOR 1.52, 95\% CI 1.27-1.83 for good-to-excellent health). Conclusions: Findings indicate the feasibility and utility of recruiting socioeconomically disadvantaged adults from the social service sector using multiple communication channels, including digital channels. As social service--based health research evolves, strategic recruitment using a combination of traditional and digital channels may be warranted to avoid underrepresentation of highly medically vulnerable individuals, which could exacerbate disparities in health. ",
doi="10.2196/16680",
url="https://www.jmir.org/2020/4/e16680",
url="http://www.ncbi.nlm.nih.gov/pubmed/32234699"
}


@Article{info:doi/10.2196/16547,
author="Hauffman, Anna
and Alfonsson, Sven
and Igelstr{\"o}m, Helena
and Johansson, Birgitta",
title="Experiences of Internet-Based Stepped Care in Individuals With Cancer and Concurrent Symptoms of Anxiety and Depression: Qualitative Exploration Conducted Alongside the U-CARE AdultCan Randomized Controlled Trial",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="30",
volume="22",
number="3",
pages="e16547",
keywords="internet-based stepped care",
keywords="internet-based interactive health communication application",
keywords="internet-based intervention",
keywords="telemedicine",
keywords="patient portals",
keywords="oncology nursing",
keywords="self care",
keywords="psychoeducation",
abstract="Background: Individuals with newly diagnosed cancer may experience impaired health in several aspects and often have a large need for information and support. About 30\% will experience symptoms of anxiety and depression, with varying needs of knowledge and support. Despite this, many of these patients lack appropriate support. Internet-based support programs may offer a supplement to standard care services, but must be carefully explored from a user perspective. Objective: The purpose of this study was to explore the participants' perceptions of the relevance and benefits of an internet-based stepped care program (iCAN-DO) targeting individuals with cancer and concurrent symptoms of anxiety and depression. Methods: We performed a qualitative study with an inductive approach, in which we used semistructured questions to interview 15 individuals using iCAN-DO. We analyzed the interviews using content analysis. Results: The analysis found 17 subcategories regarding the stepped care intervention, resulting in 4 categories. Participants described the need for information as large and looked upon finding information almost as a survival strategy when receiving the cancer diagnosis. iCAN-DO was seen as a useful, reliable source of information and support. It was used as a complement to standard care and as a means to inform next of kin. Increased knowledge was a foundation for continued processing of participants' own feelings. The optimal time to gain access to iCAN-DO would have been when being informed of the diagnosis. The most common denominator was feeling acknowledged and supported, but with a desire for further adaptation of the system to each individual's own situation and needs. Conclusions: Users saw the internet-based stepped care program as safe and reliable and used it as a complement to standard care. Similar interventions may gain from more personalized contents, being integrated into standard care, or using symptom tracking to adjust the contents. Offering this type of program close to diagnosis may provide benefits to users. Trial Registration: ClincalTrials.gov NCT-01630681; https://clinicaltrials.gov/ct2/show/NCT01630681 ",
doi="10.2196/16547",
url="http://www.jmir.org/2020/3/e16547/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32224483"
}


@Article{info:doi/10.2196/16013,
author="Alonso Puig, Mario
and Alonso-Prieto, Mercedes
and Mir{\'o}, Jordi
and Torres-Luna, Raquel
and Plaza L{\'o}pez de Sabando, Diego
and Reinoso-Barbero, Francisco",
title="The Association Between Pain Relief Using Video Games and an Increase in Vagal Tone in Children With Cancer: Analytic Observational Study With a Quasi-Experimental Pre/Posttest Methodology",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="30",
volume="22",
number="3",
pages="e16013",
keywords="hematology oncology",
keywords="pediatric patient",
keywords="acute pain",
keywords="patient-controlled analgesia",
keywords="video pupilometer",
keywords="analgesia nociception index",
abstract="Background: Patients with secondary pain due to mucositis after chemotherapy require treatment with morphine. Use of electronic video games (EVGs) has been shown to be an effective method of analgesia in other clinical settings. Objective: The main objective of this study was to assess the association between the use of EVGs and the intensity of pain caused by chemotherapy-induced mucositis in pediatric patients with cancer. The secondary objective was to assess the association between changes in pain intensity and sympathetic-parasympathetic balance in this sample of pediatric patients. Methods: Clinical records were compared between the day prior to the use of EVGs and the day after the use of EVGs. The variables were variations in pupil size measured using the AlgiScan video pupilometer (IDMed, Marseille, France), heart rate variability measured using the Analgesia Nociception Index (ANI) monitor (Mdoloris Medical Systems, Loos, France), intensity of pain measured using the Numerical Rating Scale (score 0-10), and self-administered morphine pump parameters. Results: Twenty patients (11 girls and nine boys; mean age 11.5 years, SD 4.5 years; mean weight 41.5 kg, SD 20.7 kg) who met all the inclusion criteria were recruited. EVGs were played for a mean of 2.3 (SD 1.3) hours per day, resulting in statistically significant changes. After playing EVGs, there was significantly lower daily morphine use (before vs after playing EVGs: 35.9 vs 28.6 {\textmu}g/kg/day, P=.003), lower demand for additional pain relief medication (17 vs 9.6 boluses in 24 hours, P=.001), lower scores of incidental pain intensity (7.7 vs 5.4, P=.001), lower scores of resting pain (4.8 vs 3.2, P=.01), and higher basal parasympathetic tone as measured using the ANI monitor (61.8 vs 71.9, P=.009). No variation in pupil size was observed with the use of EVGs. Conclusions: The use of EVGs in pediatric patients with chemotherapy-induced mucositis has a considerable analgesic effect, which is associated physiologically with an increase in parasympathetic vagal tone despite lower consumption of morphine. ",
doi="10.2196/16013",
url="http://www.jmir.org/2020/3/e16013/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32224482"
}


@Article{info:doi/10.2196/16810,
author="Glicksberg, Scott Benjamin
and Burns, Shohei
and Currie, Rob
and Griffin, Ann
and Wang, Jane Zhen
and Haussler, David
and Goldstein, Theodore
and Collisson, Eric",
title="Blockchain-Authenticated Sharing of Genomic and Clinical Outcomes Data of Patients With Cancer: A Prospective Cohort Study",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="20",
volume="22",
number="3",
pages="e16810",
keywords="data sharing",
keywords="electronic health records",
keywords="genomics",
keywords="medicine",
keywords="blockchain",
keywords="neoplasms",
abstract="Background: Efficiently sharing health data produced during standard care could dramatically accelerate progress in cancer treatments, but various barriers make this difficult. Not sharing these data to ensure patient privacy is at the cost of little to no learning from real-world data produced during cancer care. Furthermore, recent research has demonstrated a willingness of patients with cancer to share their treatment experiences to fuel research, despite potential risks to privacy. Objective: The objective of this study was to design, pilot, and release a decentralized, scalable, efficient, economical, and secure strategy for the dissemination of deidentified clinical and genomic data with a focus on late-stage cancer. Methods: We created and piloted a blockchain-authenticated system to enable secure sharing of deidentified patient data derived from standard of care imaging, genomic testing, and electronic health records (EHRs), called the Cancer Gene Trust (CGT). We prospectively consented and collected data for a pilot cohort (N=18), which we uploaded to the CGT. EHR data were extracted from both a hospital cancer registry and a common data model (CDM) format to identify optimal data extraction and dissemination practices. Specifically, we scored and compared the level of completeness between two EHR data extraction formats against the gold standard source documentation for patients with available data (n=17). Results: Although the total completeness scores were greater for the registry reports than those for the CDM, this difference was not statistically significant. We did find that some specific data fields, such as histology site, were better captured using the registry reports, which can be used to improve the continually adapting CDM. In terms of the overall pilot study, we found that CGT enables rapid integration of real-world data of patients with cancer in a more clinically useful time frame. We also developed an open-source Web application to allow users to seamlessly search, browse, explore, and download CGT data. Conclusions: Our pilot demonstrates the willingness of patients with cancer to participate in data sharing and how blockchain-enabled structures can maintain relationships between individual data elements while preserving patient privacy, empowering findings by third-party researchers and clinicians. We demonstrate the feasibility of CGT as a framework to share health data trapped in silos to further cancer research. Further studies to optimize data representation, stream, and integrity are required. ",
doi="10.2196/16810",
url="http://www.jmir.org/2020/3/e16810/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32196460"
}


@Article{info:doi/10.2196/15002,
author="Fern{\'a}ndez-M{\'e}ndez, Roc{\'i}o
and Wong, Yin Mei
and Rastall, J. Rebecca
and Rebollo-D{\'i}az, Samuel
and Oberg, Ingela
and Price, J. Stephen
and Joannides, J. Alexis",
title="Improvement of the Efficiency and Completeness of Neuro-Oncology Patient Referrals to a Tertiary Center Through the Implementation of an Electronic Referral System: Retrospective Cohort Study",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="5",
volume="22",
number="3",
pages="e15002",
keywords="quality improvement",
keywords="electronic health records",
keywords="hospital referral",
keywords="hospital oncology services",
abstract="Background: Quality referrals to specialist care are key for prompt, optimal decisions about the management of patients with brain tumors. Objective: This study aimed to determine the impact of introducing a Web-based, electronic referral (eReferral) system to a specialized neuro-oncology center, using a service-developed proforma, in terms of waiting times and information completeness. Methods: We carried out a retrospective cohort study based on the review of medical records of referred adult patients, excluding follow-ups. Primary outcome measures were durations of three key phases within the referral pathway and completion rates of six referral fields. Results: A total of 248 patients were referred to the specialist center during the study period. Median (IQR) diagnostic imaging to referral intervals were 3 (1-5) days with eReferrals, and 9 (4-19), 19 (14-49), and 8 (4-23) days with paper proforma, paper letter, and internal referrals, respectively (P<.001). Median (IQR) referral to multidisciplinary team decision intervals were 3 (2-7), 2 (1-3), 8 (2-24), and 3 (2-6) days respectively (P=.01). For patients having surgery, median (IQR) diagnostic imaging to surgery intervals were 28 (21-41), 34 (27-51), 104 (69-143), and 32 (15-89) days, respectively (P<.001). Proportions of complete fields differed significantly by referral type in all study fields (all with Ps <.001) except for details of presentation, which were present in all referrals. All study fields were always present in eReferrals, as these are compulsory for referral submission. Depending on the data field, level of completeness in the remaining referral types ranged within 69\% (65/94) to 87\% (82/94), 15\% (3/20) to 65\% (13/20), and 22\% (8/41) to 63\% (26/41) in paper proforma, paper letter, and internal referrals, respectively. Conclusions: An electronic, Web-based, service-developed specific proforma for neuro-oncology referrals performs significantly better, with shorter waiting times and greater completeness of information than other referral types. A wider application of eReferrals is an important first step to streamlining specialist care pathways and providing excellent care. International Registered Report Identifier (IRRID): RR2-10.2196/10.2196/15002 ",
doi="10.2196/15002",
url="https://www.jmir.org/2020/3/e15002",
url="http://www.ncbi.nlm.nih.gov/pubmed/32134389"
}


@Article{info:doi/10.2196/16334,
author="Yongping, Liang
and Zhou, Ping
and Juan, Zhang
and Yongfeng, Zhao
and Liu, Wengang
and Shi, Yifan",
title="Performance of Computer-Aided Diagnosis in Ultrasonography for Detection of Breast Lesions Less and More Than 2 cm: Prospective Comparative Study",
journal="JMIR Med Inform",
year="2020",
month="Mar",
day="2",
volume="8",
number="3",
pages="e16334",
keywords="ultrasonography",
keywords="breast neoplasm",
keywords="breast imaging reporting and data system (BI-RADS)",
keywords="breast neoplasms diagnosis",
keywords="cancer screening",
keywords="computer diagnostic aid",
abstract="Background: Computer-aided diagnosis (CAD) is used as an aid tool by radiologists on breast lesion diagnosis in ultrasonography. Previous studies demonstrated that CAD can improve the diagnosis performance of radiologists. However, the optimal use of CAD on breast lesions according to size (below or above 2 cm) has not been assessed. Objective: The aim of this study was to compare the performance of different radiologists using CAD to detect breast tumors less and more than 2 cm in size. Methods: We prospectively enrolled 261 consecutive patients (mean age 43 years; age range 17-70 years), including 398 lesions (148 lesions>2 cm, 79 malignant and 69 benign; 250 lesions?2 cm, 71 malignant and 179 benign) with breast mass as the prominent symptom. One novice radiologist with 1 year of ultrasonography experience and one experienced radiologist with 5 years of ultrasonography experience were each assigned to read the ultrasonography images without CAD, and then again at a second reading while applying the CAD S-Detect. We then compared the diagnostic performance of the readers in the two readings (without and combined with CAD) with breast imaging. The McNemar test for paired data was used for statistical analysis. Results: For the novice reader, the area under the receiver operating characteristic curve (AUC) improved from 0.74 (95\% CI 0.67-0.82) from the without-CAD mode to 0.88 (95\% CI 0.83-0.93; P<.001) at the combined-CAD mode in lesions?2 cm. For the experienced reader, the AUC improved from 0.84 (95\% CI 0.77-0.90) to 0.90 (95\% CI 0.86-0.94; P=.002). In lesions>2 cm, the AUC moderately decreased from 0.81 to 0.80 (novice reader) and from 0.90 to 0.82 (experienced reader). The sensitivity of the novice and experienced reader in lesions?2 cm improved from 61.97\% and 73.23\% at the without-CAD mode to 90.14\% and 97.18\% (both P<.001) at the combined-CAD mode, respectively. Conclusions: S-Detect is a feasible diagnostic tool that can improve the sensitivity for both novice and experienced readers, while also improving the negative predictive value and AUC for lesions?2 cm, demonstrating important application value in the clinical diagnosis of breast cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800019649; http://www.chictr.org.cn/showprojen.aspx?proj=33094 ",
doi="10.2196/16334",
url="https://medinform.jmir.org/2020/3/e16334",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130149"
}


@Article{info:doi/10.2196/14122,
author="Tian, Yulong
and Liu, Xiaodong
and Wang, Zixuan
and Cao, Shougen
and Liu, Zimin
and Ji, Qinglian
and Li, Zequn
and Sun, Yuqi
and Zhou, Xin
and Wang, Daosheng
and Zhou, Yanbing",
title="Concordance Between Watson for Oncology and a Multidisciplinary Clinical Decision-Making Team for Gastric Cancer and the Prognostic Implications: Retrospective Study",
journal="J Med Internet Res",
year="2020",
month="Feb",
day="20",
volume="22",
number="2",
pages="e14122",
keywords="Watson for Oncology",
keywords="artificial intelligence",
keywords="gastric cancer",
keywords="concordance",
keywords="multidisciplinary team",
abstract="Background: With the increasing number of cancer treatments, the emergence of multidisciplinary teams (MDTs) provides patients with personalized treatment options. In recent years, artificial intelligence (AI) has developed rapidly in the medical field. There has been a gradual tendency to replace traditional diagnosis and treatment with AI. IBM Watson for Oncology (WFO) has been proven to be useful for decision-making in breast cancer and lung cancer, but to date, research on gastric cancer is limited. Objective: This study compared the concordance of WFO with MDT and investigated the impact on patient prognosis. Methods: This study retrospectively analyzed eligible patients (N=235) with gastric cancer who were evaluated by an MDT, received corresponding recommended treatment, and underwent follow-up. Thereafter, physicians inputted the information of all patients into WFO manually, and the results were compared with the treatment programs recommended by the MDT. If the MDT treatment program was classified as ``recommended'' or ``considered'' by WFO, we considered the results concordant. All patients were divided into a concordant group and a nonconcordant group according to whether the WFO and MDT treatment programs were concordant. The prognoses of the two groups were analyzed. Results: The overall concordance of WFO and the MDT was 54.5\% (128/235) in this study. The subgroup analysis found that concordance was less likely in patients with human epidermal growth factor receptor 2 (HER2)-positive tumors than in patients with HER2-negative tumors (P=.02). Age, Eastern Cooperative Oncology Group performance status, differentiation type, and clinical stage were not found to affect concordance. Among all patients, the survival time was significantly better in concordant patients than in nonconcordant patients (P<.001). Multivariate analysis revealed that concordance was an independent prognostic factor of overall survival in patients with gastric cancer (hazard ratio 0.312 [95\% CI 0.187-0.521]). Conclusions: The treatment recommendations made by WFO and the MDT were mostly concordant in gastric cancer patients. If the WFO options are updated to include local treatment programs, the concordance will greatly improve. The HER2 status of patients with gastric cancer had a strong effect on the likelihood of concordance. Generally, survival was better in concordant patients than in nonconcordant patients. ",
doi="10.2196/14122",
url="http://www.jmir.org/2020/2/e14122/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130123"
}


@Article{info:doi/10.2196/15969,
author="Spahrk{\"a}s, S. Simon
and Looijmans, Anne
and Sanderman, Robbert
and Hagedoorn, Mari{\"e}t",
title="Beating Cancer-Related Fatigue With the Untire Mobile App: Protocol for a Waiting List Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2020",
month="Feb",
day="14",
volume="9",
number="2",
pages="e15969",
keywords="RCT",
keywords="mHealth",
keywords="app",
keywords="intervention",
keywords="fatigue",
keywords="quality of life",
keywords="cancer patients",
keywords="cancer survivors",
keywords="psycho-oncology",
abstract="Background: Many cancer patients and survivors worldwide experience disabling fatigue as the main side effect of their illness and the treatments involved. Face-to-face therapy is effective in treating cancer-related fatigue (CRF), but it is also resource-intensive. Offering a self-management program via a mobile phone app (ie, the Untire app), based on elements of effective face-to-face treatments, might increase the number of patients receiving adequate support for fatigue and decrease care costs. Objective: The aim of this protocol is to describe a randomized controlled trial (RCT) to assess the effectiveness of the Untire app in reducing fatigue in cancer patients and survivors after 12 weeks of app use as compared with a waiting list control group. Substudies nested within this trial include questions concerning the reach and costs of online recruitment and uptake and usage of the Untire app. Methods: The Untire app study is a waiting list RCT targeting cancer patients and survivors who experience moderate to severe fatigue via social media (Facebook and Instagram) across 4 English-speaking countries (Australia, Canada, the United Kingdom, and the United States). The Untire app includes psychoeducation and exercises concerning energy conservation, activity management, optimizing restful sleep, mindfulness-based stress reduction, psychosocial support, cognitive behavioral therapy, and physical activity. After randomization, participants in the intervention group could access the Untire app immediately, whereas control participants had no access to the Untire app until the primary follow-up assessment at 12 weeks. Participants completed questionnaires at baseline before randomization and after 4, 8, 12, and 24 weeks. The study outcomes are fatigue (primary) and quality of life (QoL; secondary). Potential moderators and mediators of the hypothesized treatment effect on levels of fatigue and QoL were also assessed. Link clicks and app activation are used to assess reach and uptake, respectively. Log data are used to explore the characteristics of app use. Sample size calculations for the primary outcome showed that we needed to include 164 participants with complete 12-week measures both in the intervention and the control groups. The intention-to-treat approach is used in the primary analyses, which refers to analyzing all participants regardless of their app use. Results: Participants were recruited from March to October 2018. The last participant completed the 24-week assessment in March 2019. Conclusions: This mobile health (mHealth) RCT recruited participants online in multiple countries to examine the uptake and effectiveness of the Untire self-management app to reduce CRF. Many advantages of mHealth apps are assumed, such as the immediate access to the app, the low thresholds to seek support, and the absence of contact with care professionals that will reduce costs. If found effective, this app can easily be offered worldwide to patients experiencing CRF. Trial Registration: Netherlands Trial Register NL6642; https://www.trialregister.nl/trial/6642. International Registered Report Identifier (IRRID): DERR1-10.2196/15969 ",
doi="10.2196/15969",
url="http://www.researchprotocols.org/2020/2/e15969/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130185"
}


@Article{info:doi/10.2196/15535,
author="Pooni, Amandeep
and Schmocker, Selina
and Brown, Carl
and MacLean, Anthony
and Williams, Lara
and Baxter, N. Nancy
and Simunovic, Marko
and Liberman, Sender Alexander
and Drolet, Sebastien
and Neumann, Katerina
and Jhaveri, Kartik
and Kirsch, Richard
and Kennedy, Diane Erin",
title="The Canadian Partnership Against Cancer Rectal Cancer Project: Protocol for a Pan-Canadian, Multidisciplinary Quality Improvement Initiative to Optimize the Quality of Rectal Cancer Care",
journal="JMIR Res Protoc",
year="2020",
month="Jan",
day="29",
volume="9",
number="1",
pages="e15535",
keywords="rectal cancer",
keywords="quality improvement",
keywords="knowledge translation",
abstract="Background: Over the last 2 decades, the use of multimodal strategies, including total mesorectal excision (TME) surgery, preoperative chemotherapy, multidisciplinary case conference, pelvic magnetic resonance imaging, and pathologic assessment using Quirke method, has led to significant improvements in oncologic outcomes for patients with rectal cancer. Although the literature supports claims on the effectiveness of these multimodal strategies, the uptake of these multimodal strategies varies considerably among centers, suggesting that the best evidence is not always implemented into clinical practice. Objective: This study aims to perform a quality improvement initiative to (1) identify existing gaps in care for these multimodal strategies and (2) implement knowledge translation (KT) interventions to close these gaps to optimize quality of care for patients with rectal cancer across high-volume centers in Canada. Methods: Process indicators for the selected multimodal strategies to optimize rectal cancer care will be selected and prospectively collected for all patients with stages 1 to 3 rectal cancer undergoing TME surgery. KT interventions, including audit and feedback, opinion leaders, and community of practice, will be implemented to increase the uptake of these clinical strategies. Results: The uptake of the process indicators over time and the effect of the uptake of the process indicators on short- and long-term oncologic outcomes will be evaluated for each multimodal strategy. Conclusions: This quality improvement initiative will identify existing gaps in care for the selected multimodal strategies and implement KT interventions to close these gaps. The results of this study will inform further efforts to optimize rectal cancer care. International Registered Report Identifier (IRRID): DERR1-10.2196/15535 ",
doi="10.2196/15535",
url="https://www.researchprotocols.org/2020/1/e15535",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012108"
}


@Article{info:doi/10.2196/17055,
author="Zheng, Caiyun
and Chen, Xu
and Weng, Lizhu
and Guo, Ling
and Xu, Haiting
and Lin, Meimei
and Xue, Yan
and Lin, Xiuqin
and Yang, Aiqin
and Yu, Lili
and Xue, Zenggui
and Yang, Jing",
title="Benefits of Mobile Apps for Cancer Pain Management: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jan",
day="23",
volume="8",
number="1",
pages="e17055",
keywords="mobile apps",
keywords="cancer pain",
keywords="meta-analysis",
keywords="instant messaging",
abstract="Background: Pain ratings reported by patients with cancer continue to increase, and numerous computer and phone apps for managing cancer-related pain have been developed recently; however, whether these apps effectively alleviate patients' pain remains unknown. Objective: This study aimed to comprehensively evaluate the role of mobile apps in the management of cancer pain. Methods: Literature on the use of apps for cancer pain management and interventions, published before August 2019, was retrieved from the following databases: MEDLINE, Embase, Cochrane, CINAHL, Scopus, and PsycINFO. The effects of apps on cancer pain were evaluated using RevMan5.3 software, and the rates of adverse drug reactions were analyzed using the R Statistical Software Package 3.5.3. Results: A total of 13 studies were selected for the analysis: 5 randomized controlled trials (RCTs), 4 before-after studies, 2 single-arm trials, 1 prospective cohort study, and 1 prospective descriptive study. The 5 RCTs reported data for 487 patients (240 patients in the intervention group and 247 patients in the control group), and the remaining studies reported data for 428 patients. We conducted a meta-analysis of the RCTs. According to the meta-analysis, apps can significantly reduce pain scores (mean difference [MD]=--0.50, 95\% CI --0.94 to --0.07, I2=62\%, P=.02). We then used apps that have an instant messaging module for subgroup analysis; these apps significantly reduced patients' pain scores (MD=--0.67, 95\% CI --1.06 to --0.28, I2=57\%, P<.01). Patients using apps without an instant messaging module did not see a reduction in the pain score (MD=0.30, 95\% CI --1.31 to 1.92, I2=70\%, P=.71). Overall, patients were highly satisfied with using apps. Other outcomes, such as pain catastrophizing or quality of life, demonstrated greater improvement in patients using apps with instant messaging modules compared with patients not using an app. Conclusions: The use of apps with instant messaging modules is associated with reduced pain scores in patients with cancer-related pain, and patient acceptance of these apps is high. Apps without instant messaging modules are associated with relatively higher pain scores. The presence of an instant messaging module may be a key factor affecting the effect of an app on cancer pain. ",
doi="10.2196/17055",
url="http://mhealth.jmir.org/2020/1/e17055/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012088"
}


@Article{info:doi/10.2196/16652,
author="Bricker, B. Jonathan
and Watson, L. Noreen
and Heffner, L. Jaimee
and Sullivan, Brianna
and Mull, Kristin
and Kwon, Diana
and Westmaas, Lee Johann
and Ostroff, Jamie",
title="A Smartphone App Designed to Help Cancer Patients Stop Smoking: Results From a Pilot Randomized Trial on Feasibility, Acceptability, and Effectiveness",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="17",
volume="4",
number="1",
pages="e16652",
keywords="smartphone app",
keywords="mHealth",
keywords="tobacco",
keywords="smoking",
keywords="cancer patient",
abstract="Background: Persistent smoking after a cancer diagnosis predicts worse treatment outcomes and mortality, but access to effective smoking cessation interventions is limited. Smartphone apps can address this problem by providing a highly accessible, low-cost smoking cessation intervention designed for patients with a recent cancer diagnosis. Objective: This study aimed to summarize our development process and report the trial design, feasibility, participant acceptability, preliminary effectiveness, and impact on processes of change (eg, cancer stigma) of the first-known smoking cessation smartphone app targeted for cancer patients. Methods: We used an agile, user-centered design framework to develop a fully automated smartphone app called Quit2Heal that provided skills training and stories from cancer survivors focusing on coping with internalized shame, cancer stigma, depression, and anxiety as core triggers of smoking. Quit2Heal was compared with the National Cancer Institute's QuitGuide, a widely used stop smoking app for the general population, in a pilot double-blinded randomized trial with a 2-month follow-up period. Participants were 59 adult smokers diagnosed with cancer within the past 12 months and recruited through 2 cancer center care networks and social media over a 12-month period. The most common types of cancer diagnosed were lung (21/59, 36\%) and breast (10/59, 17\%) cancers. The 2-month follow-up survey retention rate was 92\% (54/59) and did not differ by study arm (P=.15). Results: Compared with QuitGuide participants, Quit2Heal participants were more satisfied with their assigned app (90\% [19/21] for Quit2Heal vs 65\% [17/26] for QuitGuide; P=.047) and were more likely to report that the app assigned to them was made for someone like them (86\% [18/21] for Quit2Heal vs 62\% [16/26] for QuitGuide; P=.04). Quit2Heal participants opened their app a greater number of times during the 2-month trial period, although this difference was not statistically significant (mean 10.0, SD 14.40 for Quit2Heal vs mean 6.1, SD 5.3 for QuitGuide; P=.33). Self-reported 30-day point prevalence quit rates at the 2-month follow-up were 20\% (5/25) for Quit2Heal versus 7\% (2/29) for QuitGuide (odds ratio 5.16, 95\% CI 0.71-37.29; P=.10). Quit2Heal participants also showed greater improvement in internalized shame, cancer stigma, depression, and anxiety, although these were not statistically significant (all P>.05). Conclusions: In a pilot randomized trial with a high short-term retention rate, Quit2Heal showed promising acceptability and effectiveness for helping cancer patients stop smoking. Testing in a full-scale randomized controlled trial with a longer follow-up period and a larger sample size is required to test the effectiveness, mediators, and moderators of this promising digital cessation intervention. Trial Registration: ClinicalTrials.gov NCT03600038; https://clinicaltrials.gov/ct2/show/NCT03600038 ",
doi="10.2196/16652",
url="http://formative.jmir.org/2020/1/e16652/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31951215"
}


@Article{info:doi/10.2196/14985,
author="de Wit, Matthijs
and Kleijnen, Mirella
and Lissenberg-Witte, Birgit
and van Uden-Kraan, Cornelia
and Millet, Kobe
and Frambach, Ruud
and Verdonck-de Leeuw, Irma",
title="Understanding Drivers of Resistance Toward Implementation of Web-Based Self-Management Tools in Routine Cancer Care Among Oncology Nurses: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2019",
month="Dec",
day="17",
volume="21",
number="12",
pages="e14985",
keywords="psycho-oncology",
keywords="health-related quality of life",
keywords="self-management",
keywords="eHealth",
keywords="implementation science",
keywords="resistance to innovations",
abstract="Background: Supporting patients to engage in (Web-based) self-management tools is increasingly gaining importance, but the engagement of health care professionals is lagging behind. This can partly be explained by resistance among health care professionals. Objective: The aim of this study was to investigate drivers of resistance among oncology nurses toward Web-based self-management tools in cancer care. Methods: Drawing from previous research, combining clinical and marketing perspectives, and several variables and instruments, we developed the Resistance to Innovation model (RTI-model). The RTI-model distinguishes between passive and active resistance, which can be enhanced or reduced by functional drivers (incompatibility, complexity, lack of value, and risk) and psychological drivers (role ambiguity, social pressure from the institute, peers, and patients). Both types of drivers can be moderated by staff-, organization-, patient-, and environment-related factors. We executed a survey covering all components of the RTI-model on a cross-sectional sample of nurses working in oncology in the Netherlands. Structural equation modeling was used to test the full model, using a hierarchical approach. In total, 2500 nurses were approached, out of which 285 (11.40\%) nurses responded. Results: The goodness of fit statistic of the uncorrected base model of the RTI-model (n=239) was acceptable ($\chi$21=9.2; Comparative Fit Index=0.95; Tucker Lewis index=0.21; Root Mean Square Error of Approximation=0.19; Standardized Root Mean Square=0.016). In line with the RTI-model, we found that both passive and active resistance among oncology nurses toward (Web-based) self-management tools were driven by both functional and psychological drivers. Passive resistance toward Web-based self-management tools was enhanced by complexity, lack of value, and role ambiguity, and it was reduced by institutional social pressure. Active resistance was enhanced by complexity, lack of value, and social pressure from peers, and it was reduced by social pressure from the institute and patients. In contrast to what we expected, incompatibility with current routines was not a significant driver of either passive or active resistance. This study further showed that these drivers of resistance were moderated by expertise (P=.03), managerial support (P=.004), and influence from external stakeholders (government; P=.04). Conclusions: Both passive and active resistance in oncology nurses toward Web-based self-management tools for patients with cancer are driven by functional and psychological drivers, which may be more or less strong, depending on expertise, managerial support, and governmental influence. ",
doi="10.2196/14985",
url="http://www.jmir.org/2019/12/e14985/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31845900"
}


@Article{info:doi/10.2196/14361,
author="Guccione, Lisa
and Gough, Karla
and Drosdowsky, Allison
and Fisher, Krista
and Price, Timothy
and Pavlakis, Nick
and Khasraw, Mustafa
and Wyld, David
and Ransom, David
and Kong, Grace
and Rogers, Megan
and Leyden, Simone
and Leyden, John
and Michael, Michael
and Schofield, Penelope",
title="Defining the Supportive Care Needs and Psychological Morbidity of Patients With Functioning Versus Nonfunctioning Neuroendocrine Tumors: Protocol for a Phase 1 Trial of a Nurse-Led Online and Phone-Based Intervention",
journal="JMIR Res Protoc",
year="2019",
month="Dec",
day="3",
volume="8",
number="12",
pages="e14361",
keywords="cancer",
keywords="neuroendocrine tumors",
keywords="NETs",
keywords="supportive care interventions",
keywords="telehealth",
keywords="eHealth",
abstract="Background: Online information resources and support have been demonstrated to positively influence the well-being of people diagnosed with cancer. This has been explored in past literature for more common cancers; however, for rare cancers, such as neuroendocrine tumors (NETs), there are little to no support or resources available. Despite relatively good prognoses, the quality of life (QoL) of patients with NETs is significantly lower compared with samples of mixed cancer patients and the general population. Patients with NETs also typically report unclear and difficult pathways of disease management and treatment, given the heterogeneity of the diagnosis. There is a vital need to improve the availability of disease-specific information for this patient group and provide supportive care that is tailored to the unique needs of the NET patient population. Objective: This study described the protocol of a study aimed to better understand the outcomes and experiences of patients diagnosed with NETs and to develop and pilot test a nurse-led online and phone-based intervention that will provide tailored supportive care targeted to NET subgroups (functioning vs nonfunctioning). Methods: This is a multisite cohort with 3 phases, incorporating both quantitative and qualitative data collection. Phase 1 is a mixed methods prospective cohort study of NET patients identifying differences in patient experiences and priority of needs between NET subgroups. Phase 2 utilizes results from phase 1 to develop an online and nurse-led phone-based intervention. Phase 3 is to pilot test and evaluate the intervention's acceptability, appropriateness, and feasibility. Results: Currently, the project is progressing through phase 1 and has completed recruitment. A total of 138 participants have been recruited to the study. To date, patient-reported outcome data from 123 participants at baseline and 87 participants at 6-month follow-up have been collected. Of these, qualitative data from semistructured interviews from 35 participants have also been obtained. Phase 2 and phase 3 of the project are yet to be completed. Conclusions: Limited research for patients with NETs suggests that QoL and patient experiences are significantly impaired compared with the general population. Furthermore, past research has failed to delineate how the clinical variability between those with functioning and nonfunctioning NETs impacts patient supportive care needs. This study will improve on the availability of disease-specific information as well as informing the design of a nurse-led online and phone-based supportive care intervention tailored for the unique needs of the NET patient population. International Registered Report Identifier (IRRID): DERR1-10.2196/14361 ",
doi="10.2196/14361",
url="https://www.researchprotocols.org/2019/12/e14361",
url="http://www.ncbi.nlm.nih.gov/pubmed/31793892"
}


@Article{info:doi/10.2196/14360,
author="Signorelli, Ruiz Gabriel
and Lehocki, Fedor
and Mora Fern{\'a}ndez, Matilde
and O'Neill, Gillian
and O'Connor, Dominic
and Brennan, Louise
and Monteiro-Guerra, Francisco
and Rivero-Rodriguez, Alejandro
and Hors-Fraile, Santiago
and Munoz-Penas, Juan
and Bonjorn Dalmau, Merc{\`e}
and Mota, Jorge
and Oliveira, B. Ricardo
and Mrinakova, Bela
and Putekova, Silvia
and Muro, Naiara
and Zambrana, Francisco
and Garcia-Gomez, M. Juan",
title="A Research Roadmap: Connected Health as an Enabler of Cancer Patient Support",
journal="J Med Internet Res",
year="2019",
month="Oct",
day="29",
volume="21",
number="10",
pages="e14360",
keywords="cancer",
keywords="Connected Health",
keywords="mHealth",
keywords="eHealth",
keywords="mental health",
keywords="physical activity",
keywords="rehabilitation",
keywords="wearable",
keywords="Internet of Things",
keywords="quality of life",
doi="10.2196/14360",
url="http://www.jmir.org/2019/10/e14360/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31663861"
}


@Article{info:doi/10.2196/12163,
author="Sena, Ribeiro Gabrielle
and Lima, Ferreira Tiago Pessoa
and Mello, Gon{\c{c}}alves Maria Julia
and Thuler, Santos Luiz Claudio
and Lima, Oliveira Jurema Telles",
title="Developing Machine Learning Algorithms for the Prediction of Early Death in Elderly Cancer Patients: Usability Study",
journal="JMIR Cancer",
year="2019",
month="Sep",
day="26",
volume="5",
number="2",
pages="e12163",
keywords="geriatric assessment",
keywords="aged",
keywords="machine learning",
keywords="medical oncology",
keywords="death",
abstract="Background: The importance of classifying cancer patients into high- or low-risk groups has led many research teams, from the biomedical and bioinformatics fields, to study the application of machine learning (ML) algorithms. The International Society of Geriatric Oncology recommends the use of the comprehensive geriatric assessment (CGA), a multidisciplinary tool to evaluate health domains, for the follow-up of elderly cancer patients. However, no applications of ML have been proposed using CGA to classify elderly cancer patients. Objective: The aim of this study was to propose and develop predictive models, using ML and CGA, to estimate the risk of early death in elderly cancer patients. Methods: The ability of ML algorithms to predict early mortality in a cohort involving 608 elderly cancer patients was evaluated. The CGA was conducted during admission by a multidisciplinary team and included the following questionnaires: mini-mental state examination (MMSE), geriatric depression scale-short form, international physical activity questionnaire-short form, timed up and go, Katz index of independence in activities of daily living, Charlson comorbidity index, Karnofsky performance scale (KPS), polypharmacy, and mini nutritional assessment-short form (MNA-SF). The 10-fold cross-validation algorithm was used to evaluate all possible combinations of these questionnaires to estimate the risk of early death, considered when occurring within 6 months of diagnosis, in a variety of ML classifiers, including Naive Bayes (NB), decision tree algorithm J48 (J48), and multilayer perceptron (MLP). On each fold of evaluation, tiebreaking is handled by choosing the smallest set of questionnaires. Results: It was possible to select CGA questionnaire subsets with high predictive capacity for early death, which were either statistically similar (NB) or higher (J48 and MLP) when compared with the use of all questionnaires investigated. These results show that CGA questionnaire selection can improve accuracy rates and decrease the time spent to evaluate elderly cancer patients. Conclusions: A simplified predictive model aiming to estimate the risk of early death in elderly cancer patients is proposed herein, minimally composed by the MNA-SF and KPS. We strongly recommend that these questionnaires be incorporated into regular geriatric assessment of older patients with cancer. ",
doi="10.2196/12163",
url="https://cancer.jmir.org/2019/2/e12163",
url="http://www.ncbi.nlm.nih.gov/pubmed/31573896"
}


@Article{info:doi/10.2196/12071,
author="McCann, Lisa
and McMillan, Anne Kathryn
and Pugh, Gemma",
title="Digital Interventions to Support Adolescents and Young Adults With Cancer: Systematic Review",
journal="JMIR Cancer",
year="2019",
month="Jul",
day="31",
volume="5",
number="2",
pages="e12071",
keywords="adolescent",
keywords="neoplasms",
keywords="telemedicine",
keywords="systematic review",
keywords="eHealth",
abstract="Background: The last decade has seen an increase in the number of digital health interventions designed to support adolescents and young adults (AYAs) with cancer. Objective: The objective of this review was to identify, characterize, and fully assess the quality, feasibility, and efficacy of existing digital health interventions developed specifically for AYAs, aged between 13 and 39 years, living with or beyond a cancer diagnosis. Methods: Searches were performed in PubMed, EMBASE, and Web of Science to identify digital health interventions designed specifically for AYA living with or beyond a cancer diagnosis. Data on the characteristics and outcomes of each intervention were synthesized. Results: A total of 4731 intervention studies were identified through the searches; 38 interventions (43 research papers) met the inclusion criteria. Most (20/38, 53\%) were website-based interventions. Most studies focused on symptom management and medication adherence (15, 39\%), behavior change (15, 39\%), self-care (8, 21\%), and emotional health (7, 18\%). Most digital health interventions included multiple automated and communicative functions such as enriched information environments, automated follow-up messages, and access to peer support. Where reported (20, 53\% of studies), AYAs' subjective experience of using the digital platform was typically positive. The overall quality of the studies was found to be good (mean Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields scores >68\%). Some studies reported feasibility outcomes (uptake, acceptability, and attrition) but were not sufficiently powered to comment on intervention effects. Conclusions: Numerous digital interventions have been developed and designed to support young people living with and beyond a diagnosis of cancer. However, many of these interventions have yet to be deployed, implemented, and evaluated at scale. ",
doi="10.2196/12071",
url="http://cancer.jmir.org/2019/2/e12071/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31368438"
}


@Article{info:doi/10.2196/14292,
author="Huberty, Jennifer
and Eckert, Ryan
and Larkey, Linda
and Joeman, Lynda
and Mesa, Ruben",
title="Experiences of Using a Consumer-Based Mobile Meditation App to Improve Fatigue in Myeloproliferative Patients: Qualitative Study",
journal="JMIR Cancer",
year="2019",
month="Jul",
day="22",
volume="5",
number="2",
pages="e14292",
keywords="mindfulness",
keywords="meditation",
keywords="mobile phone",
keywords="mHealth",
keywords="digital health",
keywords="cancer",
abstract="Background: Myeloproliferative neoplasm (MPN) patients suffer from long-term symptoms and reduced quality of life. Mindfulness meditation is a complementary therapy shown to be beneficial for alleviating a range of cancer-related symptoms; however, in-person meditation interventions are difficult for cancer patients to attend. Meditation via a mobile phone app represents a novel approach in MPN patients for delivering meditation. Objective: The study aimed to report MPN patients' (ie, na{\"i}ve or nearly na{\"i}ve meditators) perceptions of meditation and explore their experiences in the context of using a mobile phone for meditation after participation in an 8-week consumer-based meditation app feasibility study. Methods: MPN patients (n=128) were recruited nationally through organizational partners and social media. Eligible and consented patients were enrolled into 1 of 4 groups, 2 that received varying orders of 2 consumer-based apps (10\% Happier and Calm) and 2 that received one of the apps alone for the second 4 weeks of the 8-week intervention after an educational control condition. Participants were asked to perform 10 min per day of mobile phone-based meditation, irrespective of the app and order in which they received the apps. At the conclusion of the study, participants were asked whether they would like to participate in a 20-min phone interview comprising 9 to 10 questions to discuss their perceptions and experiences while using the mobile phone meditation apps. The interviews were transcribed verbatim and imported into NVivo 12 (QSR International) for coding and analysis, using a combination of deductive and inductive methods to organize the data, generate categories, and develop themes and subthemes. Results: A total of 48 MPN patients completed postintervention interviews, of which 29\% (14/48) of the patients only used the 10\% Happier app, 21\% (10/48) of the patients only used the Calm app, and 46\% (22/48) of the patients used both apps during the 8-week intervention. Themes identified in the analysis of interview data related to (1) perceptions of meditation before, during, and after the study, (2) perceptions of the Calm app, (3) perceptions of the 10\% Happier app, (4) perceived impacts of using the meditation apps, (5) overall experiences of participating in the study, (6) recommendations surrounding meditation for other MPN patients, and (7) plans to continue meditation. Conclusions: The qualitative findings of this study suggest that MPN patients who are na{\"i}ve or nearly na{\"i}ve meditators perceived mobile phone meditation as enjoyable, preferred the Calm app over the 10\% Happier app, perceived the Calm app as more appealing (eg, narrator's voice and different meditations or background sounds offered), and perceived beneficial effects of meditation on mental health, sleep, fatigue, and pain. Future research is needed to better understand the efficacy of mobile phone meditation on MPN patient outcomes and meditation app design features that enhance uptake among its users. ",
doi="10.2196/14292",
url="http://cancer.jmir.org/2019/2/e14292/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31333197"
}


@Article{info:doi/10.2196/12542,
author="Yang, Jing
and Weng, Lizhu
and Chen, Zhikui
and Cai, Hongfu
and Lin, Xiaoyan
and Hu, Zhijian
and Li, Na
and Lin, Bijuan
and Zheng, Bin
and Zhuang, Qian
and Du, Bin
and Zheng, Zhiyuan
and Liu, Maobai",
title="Development and Testing of a Mobile App for Pain Management Among  Cancer Patients Discharged From Hospital Treatment: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="May",
day="29",
volume="7",
number="5",
pages="e12542",
keywords="cancer",
keywords="pain management",
keywords="quality of life",
keywords="adherence",
abstract="Background: The incidence of cancer pain increases in discharged patients because of discontinued standard treatments and reductions in medication adherence. Motivated by the need for better pain management in discharged patients, we developed a mobile phone app (Pain Guard) to provide continuous treatment information and feedback to discharged cancer patients suffering from pain. Objective: The aim was to design, construct, and test the Pain Guard app in patients managing cancer pain, evaluate the total remission rate of pain and the improvement in quality of life (QoL) to improve pain management for cancer pain patients, and assess patient acceptance of the app. Methods: This randomized controlled double-arm study involved 58 patients with cancer pain symptoms. Participants were randomly assigned to a group receiving care through the Pain Guard app (n=31) or to a control group (n=27) who received only traditional pharmaceutical care. In a pretest, participants were rated using a baseline cancer pain assessment and QoL evaluation. During treatment, the consumption levels of analgesic drugs were recorded every week. After a 4-week study period, another round of cancer pain assessment and QoL evaluation was conducted. The system's usability, feasibility, app compliance, and satisfaction were also assessed. Our primary outcome was remission rate of pain, and secondary outcomes were medication adherence, improvements in QoL, frequency of breakthrough cancer pain (BTcP), incidence of adverse reactions, and satisfaction of patients. Results: All participants (N=58) successfully completed the study. There were no significant differences in baseline pain scores or baseline QoL scores between groups. At the end of the study, the rate of pain remission in the trial group was significantly higher than that in the control group (P<.001). The frequency of BTcP in the app group was considerably lower than that in the control group (P<.001). The rate of medication adherence in the trial group was considerably higher than that in the control group (P<.001). Improvements in global QoL scores in the trial group were also significantly higher than those in the control group (P<.001). The incidence of adverse reactions in the trial group (7/31) was lower than that in the control group (12/27), especially constipation, with significant differences (P=.01). The 31 participants in the trial group completed a satisfaction survey regarding Pain Guard: 23 (74\%) indicated that they were satisfied with receiving pharmaceutical care by Pain Guard, 5 (16\%) indicated that they were somewhat satisfied, 2 (6\%) indicated neutral feelings, and 1 (3\%) indicated that they were somewhat dissatisfied; no participants indicated that they were very dissatisfied. Conclusions: Pain Guard was effective for the management of pain in discharged patients with cancer pain, and its operability was effective and easily accepted by patients. Trial Registration: Chinese Clinical Trials Registry ChiCTR1800016066; http://www.chictr.org.cn/showproj.aspx?proj=27153 ",
doi="10.2196/12542",
url="http://mhealth.jmir.org/2019/5/e12542/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31144672"
}


@Article{info:doi/10.2196/10256,
author="Tarver, L. Will
and Haggstrom, A. David",
title="The Use of Cancer-Specific Patient-Centered Technologies Among Underserved Populations in the United States: Systematic Review",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="23",
volume="21",
number="4",
pages="e10256",
keywords="underserved populations",
keywords="medical informatics",
keywords="cancer",
abstract="Background: In the United States, more than 1.6 million new cases of cancer are estimated to be diagnosed each year. However, the burden of cancer among the US population is not shared equally, with racial and ethnic minorities and lower-income populations having a higher cancer burden compared with their counterparts. For example, African Americans have the highest mortality rates and shortest survival rates for most cancers compared with other racial or ethnic groups in the United States. A wide range of technologies (eg, internet-based [electronic health, eHealth] technologies, mobile [mobile health, mHealth] apps, and telemedicine) available to patients are designed to improve their access to care and empower them to participate actively in their care, providing a means to reduce health care disparities; however, little is known of their use among underserved populations. Objective: The aim of this study was to systematically review the current evidence on the use of cancer-specific patient-centered technologies among various underserved populations. Methods: Computer-based search was conducted in the following academic databases: (1) PubMed (cancer subset), (2) MEDLINE, (3) PsycINFO, and (4) CINAHL. We included studies that were peer-reviewed, published in the English language, and conducted in the United States. Each study was individually assessed for relevance, with any disagreements being reconciled by consensus. We used a 3-step inclusion process in which we examined study titles, abstracts, and full-text papers for assessment of inclusion criteria. We systematically extracted information from each paper meeting our inclusion criteria. Results: This review includes 71 papers that use patient-centered technologies that primarily targeted African Americans (n=31), rural populations (n=14), and Hispanics (n=12). A majority of studies used eHealth technologies (n=41) finding them to be leading sources of cancer-related health information and significantly improving outcomes such as screening among nonadherent individuals and increasing knowledge about cancer and cancer screening. Studies on mHealth found that participants reported overall favorable responses to receiving health information via short message service (SMS) text message; however, challenges were experienced with respect to lack of knowledge of how to text among some participants. More complex mobile technologies (eg, a tablet-based risk assessment tool) were also found favorable to use and acceptable among underserved populations; however, they also resulted in more significant barriers, for example, participants expressed concerns regarding security and unfamiliarity with the technology and preferred further instruction and assistance in its use. Conclusions: There is a growing body of literature exploring patient-centered technology and its influence on care of underserved populations. In this review, we find that these technologies seem to be effective, especially when tailored, in improving patient and care-related outcomes. Despite the potential of patient-centered technologies and the receptivity of underserved populations, challenges still exist with respect to their effective use and usability. ",
doi="10.2196/10256",
url="http://www.jmir.org/2019/4/e10256/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31012855"
}


@Article{info:doi/10.2196/11387,
author="Mattsson, Susanne
and Olsson, Gustaf Erik Martin
and Carlsson, Maria
and Johansson, Kristina Birgitta Beda",
title="Identification of Anxiety and Depression Symptoms in Patients With Cancer: Comparison Between Short and Long Web-Based Questionnaires",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="05",
volume="21",
number="4",
pages="e11387",
keywords="screening",
keywords="cancer",
keywords="depression",
keywords="anxiety",
keywords="internet",
keywords="eHealth",
abstract="Background: Physicians and nurses in cancer care easily fail to detect symptoms of psychological distress because of barriers such as lack of time, training on screening methods, and knowledge about how to diagnose anxiety and depression. National guidelines in several countries recommend routine screening for emotional distress in patients with cancer, but in many clinics, this is not implemented. By inventing screening methods that are time-efficient, such as digitalized and automatized screenings with short instruments, we can alleviate the burden on patients and staff. Objective: The aim of this study was to compare Web-based versions of the ultrashort electronic Visual Analogue Scale (eVAS) anxiety and eVAS depression and the short Hospital Anxiety and Depression Scale (HADS) with Web-based versions of the longer Montgomery {\AA}sberg Depression Rating Scale-Self-report (MADRS-S) and the State Trait Anxiety Inventory- State (STAI-S) with regard to their ability to identify symptoms of anxiety and depression in patients with cancer. Methods: Data were obtained from a consecutive sample of patients with newly diagnosed (<6 months) breast, prostate, or colorectal cancer or with recurrence of colorectal cancer (N=558). The patients were recruited at 4 hospitals in Sweden between April 2013 and September 2015, as part of an intervention study administered via the internet. All questionnaires were completed on the Web at the baseline assessment in the intervention study. Results: The ultrashort and short Web-based-delivered eVAS anxiety, eVAS depression and HADS were found to have an excellent ability to discriminate between persons with and without clinical levels of symptoms of anxiety and depression compared with recommended cutoffs of the longer instruments MADRS-S and STAI-S (area under the curve: 0.88-0.94). Cutoffs of >6 on HADS anxiety and >7 hundredths (hs) on eVAS anxiety identified patients with anxiety symptoms with high accuracy. For HADS depression, at a cutoff of >5 and eVAS depression at a cutoff of >7 hs, the accuracy was very high likewise. Conclusions: The use of the short and ultrashort tools, eVAS and HADS, may be a suitable initial method of Web-based screening in busy clinical settings. However, there are still a proportion of patients who lack access to the internet or the ability to use it. There is a need to find solutions for this group to find all the patients with psychological distress. ",
doi="10.2196/11387",
url="https://www.jmir.org/2019/4/e11387/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30950804"
}


@Article{info:doi/10.2196/10530,
author="Waxer, Fredric Jonathan
and Srivastav, Sudesh
and DiBiase, Steven Christian
and DiBiase, Joseph Steven",
title="Investigation of Radiation Oncologists' Awareness of Online Reputation Management",
journal="JMIR Cancer",
year="2019",
month="Apr",
day="01",
volume="5",
number="1",
pages="e10530",
keywords="reputation",
keywords="management",
keywords="internet",
keywords="patient satisfaction",
keywords="surveys and questionnaires",
keywords="radiation oncology",
abstract="Background: Online reputation management (ORM) is an emerging practice strategy that emphasizes the systematic and proactive monitoring of online reviews relating to one's professional reputation. Objective: We developed this survey project to assess whether radiation oncologists are aware of ORM and how it is utilized in their practices. We hypothesized that ORM is largely unknown by most practicing radiation oncologists and that little time is spent actively managing their reputations. Methods: An online survey was submitted to 1222 radiation oncologists using the Qualtrics research platform. Physician emails were gathered from the American Society for Radiation Oncology member directory. A total of 85 physicians initiated the survey, whereas 76 physicians completed more than or equal to 94\% (15/16) of the survey questions and were subsequently used in our analyses. The survey consisted of 15 questions querying practice demographics, patient satisfaction determination, ORM understanding, and activities to address ORM and 1 question for physicians to opt-in to a US \$50 Amazon gift card raffle. The survey data were summarized using a frequency table, and data were analyzed using the Chi-square test, Fisher exact test, and Spearman correlation coefficients. Results: We calculated a 7\% (85/1222) response rate for our survey, with a completion rate of 89\% (76/85). A majority of respondents (97\%, 74/76) endorsed being somewhat or strongly concerned about patient satisfaction (P<.001). However, 58\% (44/76) of respondents reported spending 0 hours per week reviewing or managing their online reputation and 39\% (30/76) reported spending less than 1 hour per week (P<.001). A majority of physicians (58\%, 44/76) endorsed no familiarity with ORM (P<.001) and 70\% (53/76) did not actively manage their online reputation (P<.001). Although 83\% (63/76) of respondents strongly or somewhat believed that patients read online reviews (P<.001), 57\% (43/76) of respondents did not check their online reviews (P=.25) and 80\% (61/76) endorsed never responding to online reviews (P<.001). Moreover, 58\% (44/76) of the respondents strongly or somewhat supported the idea of managing their online reputation going forward (P=.001). In addition, 11 out of the 28 pairs of questions asked in our correlation studies reached statistical significance. Degree of concern for patient satisfaction and the notion of managing one's ORM going forward were the 2 most frequently correlated topics of statistical significance in our analyses. Conclusions: ORM is presently under-recognized in radiation oncology. Although most practitioners are concerned about patient satisfaction, little effort is directed toward the internet on this matter. ORM offers an area of practice improvement for many practicing radiation oncologists. ",
doi="10.2196/10530",
url="https://cancer.jmir.org/2019/1/e10530/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30932863"
}


@Article{info:doi/10.2196/jmir.9958,
author="Prince, M. Rebecca
and Soung Yee, Anthony
and Parente, Laura
and Enright, A. Katherine
and Grunfeld, Eva
and Powis, Melanie
and Husain, Amna
and Gandhi, Sonal
and Krzyzanowska, K. Monika",
title="User-Centered Design of a Web-Based Tool to Support Management of Chemotherapy-Related Toxicities in Cancer Patients",
journal="J Med Internet Res",
year="2019",
month="Mar",
day="28",
volume="21",
number="3",
pages="e9958",
keywords="prototype",
keywords="Web-based tool",
keywords="toxicity management",
keywords="chemotherapy",
keywords="self-management",
abstract="Background: Cancer patients receiving chemotherapy have high symptom needs that can negatively impact quality of life and result in high rates of unplanned acute care visits. Remote monitoring tools may improve symptom management in this patient population. Objective: This study aimed to design a prototype tool to facilitate remote management of chemotherapy-related toxicities. Methods: User needs were assessed using a participatory, user-centered design methodology that included field observation, interviews, and focus groups, and then analyzed using affinity diagramming. Participants included oncology patients, caregivers, and health care providers (HCPs) including medical oncologists, oncology nurses, primary care physicians, and pharmacists in Ontario, Canada. Overarching themes informed development of a Web-based prototype, which was further refined over 2 rounds of usability testing with end users. Results: Overarching themes were derived from needs assessments, which included 14 patients, 1 caregiver, and 12 HCPs. Themes common to both patients and HCPs included gaps and barriers in current systems, need for decision aids, improved communication and options in care delivery, secure access to credible and timely information, and integration into existing systems. In addition, patients identified missed opportunities, care not meeting their needs, feeling overwhelmed and anxious, and wanting to be more empowered. HCPs identified accountability for patient management as an issue. These themes informed development of a Web-based prototype (bridges), which included toxicity tracking, self-management advice, and HCP communication functionalities. Usability testing with 11 patients and 11 HCPs was generally positive; however, identified challenges included tool integration into existing workflows, need for standardized toxicity self-management advice, issues of privacy and consent, and patient-tailored information. Conclusions: Web-based tools integrating just-in-time self-management advice and HCP support into routine care may address gaps in systems for managing chemotherapy-related toxicities. Attention to the integration of new electronic tools into self-care by patients and practice was a strong theme for both patients and HCP participants and is a key issue that needs to be addressed for wide-scale adoption. ",
doi="10.2196/jmir.9958",
url="http://www.jmir.org/2019/3/e9958/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30920373"
}


@Article{info:doi/10.2196/10813,
author="Furlong, Eileen
and Darley, Andrew
and Fox, Patricia
and Buick, Alison
and Kotronoulas, Grigorios
and Miller, Morven
and Flowerday, Adrian
and Miaskowski, Christine
and Patiraki, Elisabeth
and Katsaragakis, Stylianos
and Ream, Emma
and Armes, Jo
and Gaiger, Alexander
and Berg, Geir
and McCrone, Paul
and Donnan, Peter
and McCann, Lisa
and Maguire, Roma",
title="Adaptation and Implementation of a Mobile Phone--Based Remote Symptom Monitoring System for People With Cancer in Europe",
journal="JMIR Cancer",
year="2019",
month="Mar",
day="14",
volume="5",
number="1",
pages="e10813",
keywords="telemedicine",
keywords="methods",
keywords="patient care",
keywords="cancer",
keywords="symptom management",
abstract="Background: There has been an international shift in health care, which has seen an increasing focus and development of technological and personalized at-home interventions that aim to improve health outcomes and patient-clinician communication. However, there is a notable lack of empirical evidence describing the preparatory steps of adapting and implementing technology of this kind across multiple countries and clinical settings. Objective: This study aimed to describe the steps undertaken in the preparation of a multinational, multicenter randomized controlled trial (RCT) to test a mobile phone--based remote symptom monitoring system, that is, Advanced Symptom Management System (ASyMS), designed to enhance management of chemotherapy toxicities among people with cancer receiving adjuvant chemotherapy versus standard cancer center care. Methods: There were 13 cancer centers across 5 European countries (Austria, Greece, Ireland, Norway, and the United Kingdom). Multiple steps were undertaken, including a scoping review of empirical literature and clinical guidelines, translation and linguistic validation of study materials, development of standardized international care procedures, and the integration and evaluation of the technology within each cancer center. Results: The ASyMS was successfully implemented and deployed in clinical practices across 5 European countries. The rigorous and simultaneous steps undertaken by the research team highlighted the strengths of the system in clinical practice, as well as the clinical and technical changes required to meet the diverse needs of its intended users within each country, before the commencement of the RCT. Conclusions: Adapting and implementing this multinational, multicenter system required close attention to diverse considerations and unique challenges primarily related to communication and clinical and technical issues. Success was dependent on collaborative and transparent communication among academics, the technology industry, translation partners, patients, and clinicians as well as a simultaneous and rigorous methodological approach within the 5 relevant countries. ",
doi="10.2196/10813",
url="http://cancer.jmir.org/2019/1/e10813/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30869641"
}


@Article{info:doi/10.2196/11111,
author="Lipson-Smith, Ruby
and White, Fiona
and White, Alan
and Serong, Lesley
and Cooper, Guy
and Price-Bell, Georgia
and Hyatt, Amelia",
title="Co-Design of a Consultation Audio-Recording Mobile App for People With Cancer: The SecondEars App",
journal="JMIR Form Res",
year="2019",
month="Mar",
day="12",
volume="3",
number="1",
pages="e11111",
keywords="referral and consultation",
keywords="adult",
keywords="humans",
keywords="cancer",
keywords="audiovisual aids",
keywords="mobile apps",
keywords="community-based participatory research",
keywords="health behavior",
keywords="psychological theory",
abstract="Background: Many patients choose to audio-record their medical consultations so that they can relisten to them at home and share them with family. Consultation audio-recordings can improve patients' recall and understanding of medical information and increase their involvement in decision making. A hospital-endorsed consultation audio-recording mobile app would provide patients with the permission and means to audio-record their consultations. The Theory of Planned Behavior provides a framework for understanding how patients can be encouraged to appropriately audio-record consultations. Objective: The aim of this study was to use a co-design process to develop a consultation audio-recording mobile app called SecondEars. Methods: App development began with stakeholder engagement, followed by a series of 6 co-design workshops and then user acceptance testing. Stakeholder engagement included advice from legal, information technology (IT), clinical and allied health leads; digital strategy; and medical records. he co-design workshops were attended by: patient consumers, members of the research team, IT staff, the app designers, clinicians, and staff from medical records. During workshops 1 to 4, the purpose and scope of the app were refined, possible pitfalls were addressed, and design features were discussed. The app designers then incorporated the results from these workshops to produce a wireframe mock-up of the proposed SecondEars app, which was presented for feedback at workshops 5 and 6. Results: The stakeholders identified 6 requirements for the app, including that it be patient driven, secure, clear in terms of legal responsibilities, linked to the patient's medical record, and that it should require minimal upfront and ongoing resources. These requirements informed the scope of the co-design workshops. The workshops were attended by between 4 and 13 people. The workshop attendees developed a list of required features and suggestions for user interface design. The app developers used these requirements and recommendations to develop a prototype of the SecondEars app in iOS, which was then refined through user acceptance testing. Conclusions: The SecondEars app allows patients to have control and autonomy over audio-recording and sharing their consultations while maintaining privacy and safety for medical information and legal protection for clinicians. The app has been designed to have low upkeep and minimal impact on clinical processes. The SecondEars prototype is currently being tested with patients in a clinical setting. ",
doi="10.2196/11111",
url="http://formative.jmir.org/2019/1/e11111/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30860487"
}


@Article{info:doi/10.2196/11094,
author="Park, Sojung
and Kim, Youn Ji
and Lee, Cheol Jae
and Kim, Ryul Hyeong
and Song, Seungjae
and Kwon, Hee
and Ji, Wonjun
and Choi, Min Chang",
title="Mobile Phone App--Based Pulmonary Rehabilitation for Chemotherapy-Treated Patients With Advanced Lung Cancer: Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Feb",
day="04",
volume="7",
number="2",
pages="e11094",
keywords="chemotherapy",
keywords="physical fitness",
keywords="lung cancer",
keywords="rehabilitation",
keywords="quality of life",
abstract="Background: Advanced lung cancer patients often have chronic lung disease with reduced exercise capacities and various symptoms leading to altered quality of life (QoL). No studies have assessed pulmonary rehabilitation (PR) employing a mobile app and an Internet of Things device in advanced lung cancer patients undergoing chemotherapy. Objective: This study aimed to determine the feasibility and efficacy of smartphone app--based PR on exercise capacity, symptom management, and QoL in patients with advanced lung cancer undergoing chemotherapy. Methods: A total of 100 patients were recruited in a prospective, single-arm intervention study using a smartphone app--based PR program for 12 weeks. Exercise capacity (6-min walking distance, 6MWD), QoL, symptom scale scores, and distress indexes were investigated. Results: A total of 90 patients completed the PR program. The most common cause of drop out was hospitalization because of cancer progression. After PR, there was significant improvement in the 6MWD; 380.1 m (SD 74.1) at baseline, 429.1 m (SD 58.6) at 6 weeks (P<.001), and 448.1 m (SD 50.0) at 12 weeks (P<.001). However, the dyspnea scale score showed no significant improvement in the patients overall, but there was a trend for improvement in those with a stable tumor response (P=.07). Role (P=.02), emotional (P<.001), and social functioning (P=.002) scale scores showed significant improvement after PR. Symptom scale scores for fatigue (P<.001), anorexia (P=.047), and diarrhea (P=.01) also showed significant improvement. There was significant improvement in depression (P=.048) and anxiety (P=.01), whereas there was no significant change in QoL (P=.06) and severity of pain (P=.24). Conclusions: Smartphone app--based PR represents an effective and feasible program to improve exercise capacity and to manage symptoms and distress in patients with advanced lung cancer who are undergoing chemotherapy. ",
doi="10.2196/11094",
url="http://mhealth.jmir.org/2019/2/e11094/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30714943"
}


@Article{info:doi/10.2196/10875,
author="Warrington, Lorraine
and Absolom, Kate
and Conner, Mark
and Kellar, Ian
and Clayton, Beverly
and Ayres, Michael
and Velikova, Galina",
title="Electronic Systems for Patients to Report and Manage Side Effects of Cancer Treatment: Systematic Review",
journal="J Med Internet Res",
year="2019",
month="Jan",
day="24",
volume="21",
number="1",
pages="e10875",
keywords="oncology",
keywords="chemotherapy",
keywords="patient reported outcomes",
keywords="patient centered",
keywords="medical informatics",
abstract="Background: There has been a dramatic increase in the development of electronic systems to support cancer patients to report and manage side effects of treatment from home. Systems vary in the features they offer to patients, which may affect how patients engage with them and how they improve patient-centered outcomes. Objective: This review aimed to (1) describe the features and functions of existing electronic symptom reporting systems (eg, symptom monitoring, tailored self-management advice), and (2) explore which features may be associated with patient engagement and patient-centered outcomes. Methods: The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and followed guidelines from the Centre for Reviews and Dissemination (University of York, United Kingdom). Primary searches were undertaken of MEDLINE, Embase, PsycInfo, Web of Science, Cochrane Central Register of Controlled Trials, and the Health Technology Assessment databases. Secondary searches were undertaken by screening reference lists and citations. Two researchers applied broad inclusion criteria to identify and select relevant records. Data were extracted and summarized using Microsoft Excel. In order to meet the aims, the study selection, data extraction, and data synthesis comprised two stages: (1) identifying and characterizing available systems and (2) summarizing data on patient engagement and patient-centered outcomes. Results: We identified 77 publications relating to 41 distinct systems. In Stage 1, all publications were included (N=77). The features identified that supported clinicians and care were facility for health professionals to remotely access and monitor patient-reported data (24/41, 58\%) and function to send alerts to health professionals for severe symptoms (17/41, 41\%). Features that supported patients were facility for patients to monitor/review their symptom reports over time (eg, graphs) (19/41, 46\%), general patient information about cancer treatment and side effects (17/41, 41\%), tailored automated patient advice on symptom management (12/41, 29\%), feature for patients to communicate with the health care team (6/41, 15\%), and a forum for patients to communicate with one another (4/41, 10\%). In Stage 2, only publications that included some data on patient engagement or patient-centered outcomes were included (N=29). A lack of consistency between studies in how engagement was defined, measured, or reported, and a wide range of methods chosen to evaluate systems meant that it was not possible to compare across studies or make conclusions on relationships with system features. Conclusions: Electronic systems have the potential to help patients manage side effects of cancer treatment, with some evidence to suggest a positive effect on patient-centered outcomes. However, comparison across studies is difficult due to the wide range of assessment tools used. There is a need to develop guidelines for assessing and reporting engagement with systems, and a set of core outcomes for evaluation. We hope that this review will contribute to the field by introducing a taxonomy for characterizing system features. Trial Registration: PROSPERO CRD42016035915; www.crd.york.ac.uk/PROSPERO/display\_record.asp?ID=CRD42016035915 ",
doi="10.2196/10875",
url="http://www.jmir.org/2019/1/e10875/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30679145"
}


@Article{info:doi/10.2196/11373,
author="Karsten, M. Maria
and Speiser, Dorothee
and Hartmann, Claudia
and Zeuschner, Nele
and Lippold, Kai
and Kiver, Verena
and Gocke, Peter
and Kirchberger, Valerie
and Blohmer, Jens-Uwe",
title="Web-Based Patient-Reported Outcomes Using the International Consortium for Health Outcome Measurement Dataset in a Major German University Hospital: Observational Study",
journal="JMIR Cancer",
year="2018",
month="Dec",
day="20",
volume="4",
number="2",
pages="e11373",
keywords="breast cancer",
keywords="International Council Health Outcome Measurement",
keywords="mobile phone",
keywords="patient-reported outcomes",
abstract="Background: Collecting patient-reported outcome (PRO) data systematically enables objective evaluation of treatment and its related outcomes. Using disease-specific questionnaires developed by the International Consortium for Health Outcome Measurement (ICHOM) allows for comparison between physicians, hospitals, and even different countries. Objective: This pilot project aimed to establish a digital system to measure PROs for new patients with breast cancer who attended the Charit{\'e} Breast Center This approach should serve as a blueprint to further expand the PRO measurement to other disease entities and departments. Methods: In November 2016, we implemented a Web-based system to collect PRO data at Charit{\'e} Breast Center using the ICHOM dataset. All new patients at the Breast Center were enrolled and answered a predefined set of questions using a tablet computer. Once they started their treatment at Charit{\'e}, automated emails were sent to the patients at predefined treatment points. Those emails contained a Web-based link through which they could access and answer questionnaires. Results: By now, 541 patients have been enrolled and 2470 questionnaires initiated. Overall, 9.4\% (51/541) of the patients were under the age of 40 years, 49.7\% (269/541) between 40 and 60 years, 39.6\% (214/541) between 60 and 80 years, and 1.3\% (7/541) over the age of 80 years. The average return rate of questionnaires was 67.0\%. When asked about the preference regarding paper versus Web-based questionnaires, 6.0\% (8/134) of the patients between 50 and 60 years, 6.0\% (9/150) between 60 and 70 years, and 12.7\% (9/71) over the age of 70 years preferred paper versions. Conclusions: Measuring PRO in patients with breast cancer in an automated electronic version is possible across all age ranges while simultaneously achieving a high return rate. ",
doi="10.2196/11373",
url="http://cancer.jmir.org/2018/2/e11373/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30573450"
}


@Article{info:doi/10.2196/cancer.9918,
author="Asfaw, Ayele Alemseged
and Yan, H. Connie
and Sweiss, Karen
and Wirth, Scott
and Ramirez, H. Victor
and Patel, R. Pritesh
and Sharp, K. Lisa",
title="Barriers and Facilitators of Using Sensored Medication Adherence Devices in a Diverse Sample of Patients With Multiple Myeloma: Qualitative Study",
journal="JMIR Cancer",
year="2018",
month="Nov",
day="12",
volume="4",
number="2",
pages="e12",
keywords="antineoplastic therapy",
keywords="challenges",
keywords="race/ethnicity",
keywords="medication adherence",
keywords="multiple myeloma",
abstract="Background: Many recently approved medications to manage multiple myeloma (MM) are oral, require supportive medications to prevent adverse effects, and are taken under complex schedules. Medication adherence is a concern; however, little attention has been directed toward understanding adherence in MM or associated barriers and facilitators. Advanced sensored medication devices (SMDs) offer opportunities to intervene; however, acceptability among patients with MM, particularly African American patients, is untested. Objective: This study aimed to explore patients' (1) perceptions of their health before MM including experiences with chronic medications, (2) perceptions of adherence barriers and facilitators, and (3) attitudes toward using SMDs. Methods: An in-person, semistructured, qualitative interview was conducted with a convenience sample of patients being treated for MM. Patients were recruited from within an urban, minority-serving, academic medical center that had an established cancer center. A standardized interview guide included questions targeting medication use, attitudes, adherence, barriers, and facilitators. Demographics included the use of cell phone technology. Patients were shown 2 different pill bottles with sensor technology---Medication Event Monitoring System and the SMRxT bottle. After receiving information on the transmission ability of the bottles, patients were asked to discuss their reactions and concerns with the idea of using such a device. Medical records were reviewed to capture information on medication and diagnoses. The interviews were audio-recorded and transcribed. Interviews were independently coded by 2 members of the team with a third member providing guidance. Results: A total of 20 patients with a mean age of 56 years (median=59 years; range=29-71 years) participated in this study and 80\% (16/20) were African American. In addition, 18 (90\%, 18/20) owned a smartphone and 85\% (17/20) were comfortable using the internet, text messaging, and cell phone apps. The average number of medications reported per patient was 13 medications (median=10; range=3-24). Moreover, 14 (70\%, 14/20) patients reported missed doses for a range of reasons such as fatigue, feeling ill, a busy schedule, forgetting, or side effects. Interest in using an SMD ranged from great interest to complete lack of interest. Examples of concerns related to the SMDs included privacy issues, potential added cost, and the size of the bottle (ie, too large). Despite the concerns, 60\% (12/20) of the patients expressed interest in trying a bottle in the future. Conclusions: Results identified numerous patient-reported barriers and facilitators to missed doses of oral anticancer therapy. Many appear to be potentially mutable if uncovered and addressed. SMDs may allow for capture of these data. Although patients expressed concerns with SMDs, most remained willing to use one. A feasibility trial with SMDs is planned. ",
doi="10.2196/cancer.9918",
url="http://cancer.jmir.org/2018/2/e12/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30425032"
}


@Article{info:doi/10.2196/medinform.9525,
author="Lucas, R. Alexander
and Bass, B. Michael
and Rothrock, E. Nan
and O'Connor, L. Mary
and Sorkin, R. Mia
and Nawyn, Jason
and Albinali, Fahd
and Wagner, I. Lynne",
title="Development of an eHealth System to Capture and Analyze Patient Sensor and Self-Report Data: Mixed-Methods Assessment of Potential Applications to Improve Cancer Care Delivery",
journal="JMIR Med Inform",
year="2018",
month="Oct",
day="22",
volume="6",
number="4",
pages="e46",
keywords="cancer",
keywords="care delivery",
keywords="decision support",
keywords="eHealth",
keywords="mobile phone",
keywords="survivorship",
keywords="symptom monitoring",
abstract="Background: Capturing and Analyzing Sensor and Self-Report Data for Clinicians and Researchers (COMPASS) is an electronic health (eHealth) platform designed to improve cancer care delivery through passive monitoring of patients' health status and delivering customizable reports to clinicians. Based on data from sensors and context-driven administration of patient-reported outcome (PRO) measures, key indices of patients' functional status can be collected between regular clinic visits, supporting clinicians in the delivery of patient care. Objective: The first phase of this project aimed to systematically collect input from oncology providers and patients on potential clinical applications for COMPASS to refine the system. Methods: Ten clinicians representing various oncology specialties and disciplines completed semi-structured interviews designed to solicit clinician input on how COMPASS can best support clinical care delivery. Three cancer patients tested a prototype of COMPASS for 7 days and provided feedback. Interview data were tabulated using thematic content analysis to identify the most clinically relevant objective and PRO domains. Results: Thematic content analysis revealed that clinicians were most interested in monitoring vital statistics, symptoms, and functional status, including the physical activity level (n=9), weight (n=5), fatigue (n=9), sleep quality (n=8), and anxiety (n=7). Patients (2 in active treatment and 1 in remission) reported that they would use such a device, were enthusiastic about their clinicians monitoring their health status, especially the tracking of symptoms, and felt knowing their clinicians were monitoring and reviewing their health status provided valuable reassurance. Patients would, however, like to provide some context to their data. Conclusions: Clinicians and patients both articulated potential benefits of the COMPASS system in improving cancer care. From a clinician standpoint, data need to be easily interpretable and actionable. The fact that patients and clinicians both see potential value in eHealth systems suggests wider adoption and utilization could prove to be a useful tool for improving care delivery. ",
doi="10.2196/medinform.9525",
url="http://medinform.jmir.org/2018/4/e46/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30348634"
}


@Article{info:doi/10.2196/11826,
author="Backonja, Uba
and Haynes, C. Sarah
and Kim, K. Katherine",
title="Data Visualizations to Support Health Practitioners' Provision of Personalized Care for Patients With Cancer and Multiple Chronic Conditions: User-Centered Design Study",
journal="JMIR Hum Factors",
year="2018",
month="Oct",
day="16",
volume="5",
number="4",
pages="e11826",
keywords="cancer care facilities",
keywords="informatics",
keywords="patient-centered care",
keywords="patient-generated health data",
keywords="precision medicine",
keywords="visualization",
abstract="Background: There exists a challenge of understanding and integrating various types of data collected to support the health of individuals with multiple chronic conditions engaging in cancer care. Data visualization has the potential to address this challenge and support personalized cancer care. Objective: The aim of the study was to assess the health care practitioners' perceptions of and feedback regarding visualizations developed to support the care of individuals with multiple chronic conditions engaging in cancer care. Methods: Medical doctors (n=4) and registered nurses (n=4) providing cancer care at an academic medical center in the western United States provided feedback on visualization mock-ups. Mock-up designs were guided by current health informatics and visualization literature and the Munzner Nested Model for Visualization Design. User-centered design methods, a mock patient persona, and a scenario were used to elicit insights from participants. Directed content analysis was used to identify themes from session transcripts. Means and SDs were calculated for health care practitioners' rankings of overview visualizations. Results: Themes identified were data elements, supportive elements, confusing elements, interpretation, and use of visualization. Overall, participants found the visualizations useful and with the potential to provide personalized care. Use of color, reference lines, and familiar visual presentations (calendars, line graphs) were noted as helpful in interpreting data. Conclusions: Visualizations guided by a framework and literature can support health care practitioners' understanding of data for individuals with multiple chronic conditions engaged in cancer care. This understanding has the potential to support the provision of personalized care. ",
doi="10.2196/11826",
url="http://humanfactors.jmir.org/2018/4/e11826/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30327290"
}


@Article{info:doi/10.2196/11087,
author="Liu, Chaoyuan
and Liu, Xianling
and Wu, Fang
and Xie, Mingxuan
and Feng, Yeqian
and Hu, Chunhong",
title="Using Artificial Intelligence (Watson for Oncology) for Treatment Recommendations Amongst Chinese Patients with Lung Cancer: Feasibility Study",
journal="J Med Internet Res",
year="2018",
month="Sep",
day="25",
volume="20",
number="9",
pages="e11087",
keywords="Watson for Oncology",
keywords="artificial intelligence",
keywords="lung neoplasms",
keywords="comparative study",
keywords="interdisciplinary communication",
abstract="Background: Artificial intelligence (AI) is developing quickly in the medical field and can benefit both medical staff and patients. The clinical decision support system Watson for Oncology (WFO) is an outstanding representative AI in the medical field, and it can provide to cancer patients prompt treatment recommendations comparable with ones made by expert oncologists. WFO is increasingly being used in China, but limited reports on whether WFO is suitable for Chinese patients, especially patients with lung cancer, exist. Here, we report a retrospective study based on the consistency between the lung cancer treatment recommendations made for the same patient by WFO and by the multidisciplinary team at our center. Objective: The aim of this study was to explore the feasibility of using WFO for lung cancer cases in China and to ascertain ways to make WFO more suitable for Chinese patients with lung cancer. Methods: We selected all lung cancer patients who were hospitalized and received antitumor treatment for the first time at the Second Xiangya Hospital Cancer Center from September to December 2017 (N=182). WFO made treatment recommendations for all supported cases (n=149). If the actual therapeutic regimen (administered by our multidisciplinary team) was recommended or for consideration according to WFO, we defined the recommendations as consistent; if the actual therapeutic regimen was not recommended by WFO or if WFO did not provide the same treatment option, we defined the recommendations as inconsistent. Blinded second round reviews were performed by our multidisciplinary team to reassess the incongruent cases. Results: WFO did not support 18.1\% (33/182) of recommendations among all cases. Of the 149 supported cases, 65.8\% (98/149) received recommendations that were consistent with the recommendations of our team. Logistic regression analysis showed that pathological type and staging had significant effects on consistency (P=.004, odds ratio [OR] 0.09, 95\% CI 0.02-0.45 and P<.001, OR 9.5, 95\% CI 3.4-26.1, respectively). Age, gender, and presence of epidermal growth factor receptor gene mutations had no effect on consistency. In 82\% (42/51) of the inconsistent cases, our team administered two China-specific treatments, which were different from the recommendations made by WFO but led to excellent outcomes. Conclusions: In China, most of the treatment recommendations of WFO are consistent with the recommendations of the expert group, although a relatively high proportion of cases are still not supported by WFO. Therefore, WFO cannot currently replace oncologists. WFO can improve the efficiency of clinical work by providing assistance to doctors, but it needs to learn the regional characteristics of patients to improve its assistive ability. ",
doi="10.2196/11087",
url="http://www.jmir.org/2018/9/e11087/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30257820"
}


@Article{info:doi/10.2196/11547,
author="Rollin, Audrey
and Ridout, Brad
and Campbell, Andrew",
title="Digital Health in Melanoma Posttreatment Care in Rural and Remote Australia: Systematic Review",
journal="J Med Internet Res",
year="2018",
month="Sep",
day="24",
volume="20",
number="9",
pages="e11547",
keywords="digital health",
keywords="eHealth",
keywords="technology",
keywords="melanoma",
keywords="posttreatment care",
keywords="support care services",
keywords="rural areas",
keywords="remote communities",
keywords="patient-centric",
keywords="oncology",
abstract="Background: The melanoma incidence and mortality rates in rural and remote communities are exponentially higher than in urban areas. Digital health could be used to close the urban/rural gap for melanoma and improve access to posttreatment and support care services. Objective: The aim of this review was to understand how digital health is currently used for melanoma posttreatment care and determine the benefits for Australian rural and remote areas. Methods: A systematic search of PubMed, Medline, PsycINFO, and Scopus was conducted in March 2018. Findings were clustered per type of intervention and related direct outcomes. Results: Five studies met the inclusion criteria, but none investigated the benefits of digital health for melanoma posttreatment care in rural and remote areas of Australia. Some empirical studies demonstrated consumers' acceptance of digital intervention for posttreatment care. The findings did not take into consideration individual, psychological, and socioeconomic factors, even though studies show their significant impacts on melanoma quality of aftercare. Conclusions: Digital interventions may be used as an adjunct service by clinicians during melanoma posttreatment care, especially in regions that are less-resourced by practitioners and health infrastructure, such as rural and remote Australia. Technology could be used to reduce the disparity in melanoma incidence, mortality rates, and accessibility to posttreatment care management between urban and rural/remote populations. ",
doi="10.2196/11547",
url="http://www.jmir.org/2018/9/e11547/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30249578"
}


@Article{info:doi/10.2196/10287,
author="McCann, Lisa
and McMillan, A. Kathryn
and Hewitt, Christopher",
title="An e-Prehabilitation System of Care for Teenagers and Young Adults Diagnosed With Cancer: Protocol for a Qualitative Co-Design Study",
journal="JMIR Res Protoc",
year="2018",
month="Sep",
day="12",
volume="7",
number="9",
pages="e10287",
keywords="digital health",
keywords="human factors",
keywords="co-design",
keywords="prehabilitation",
keywords="teenagers and young adults",
keywords="cancer",
keywords="mobile phone",
abstract="Background: A diagnosis of cancer in young adulthood can pose many different and unique challenges for individuals. The provision of adequate and appropriate information as well as care and support for teenagers and young adults at the time of diagnosis is central to their health care experience going forward. Moreover, appropriate and accessible information provision is critical to ensure that young individuals with cancer feel equipped and empowered to make decisions about, and be involved in, their treatment and recovery throughout their experience; this is a concept known as prehabilitation. As digital interventions and resources that support teenagers and young adults with cancer are an increasingly desirable part of health care provision, this study will focus on the development of an age- and population-appropriate electronic prehabilitation (e-Prehabilitation) system of care. Objective: We will conduct an exploratory, co-design research project that will inform the development of an e-Prehabilitation system of care to support teenagers and young adults diagnosed with cancer. A collaborative approach to data collection and prototype design will ensure that a patient-centered approach is embedded throughout. Methods: A qualitative, co-design study utilizing surveys, interviews, and focus group discussions is being conducted with teenagers and young adults, health care professionals, and technologists. Results: This research study is in progress; recruitment and data collection activities have commenced and findings are expected in early 2019. Conclusions: The findings of this study will have important implications for informing the future development and evaluation of an e-Prehabilitation system of care to support teenagers and young adults diagnosed with cancer. Registered Report Identifier: RR1-10.2196/10287 ",
doi="10.2196/10287",
url="http://www.researchprotocols.org/2018/9/e10287/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30209030"
}


@Article{info:doi/10.2196/jmir.9812,
author="Marzorati, Chiara
and Renzi, Chiara
and Russell-Edu, William Samuel
and Pravettoni, Gabriella",
title="Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="18",
volume="20",
number="6",
pages="e223",
keywords="telemedicine",
keywords="family",
keywords="caregivers",
keywords="neoplasms",
keywords="systematic review",
abstract="Background: The number of published studies and systematic reviews examining different telehealth interventions targeting patients and their effects on patients' well-being and quality of life have grown in recent decades. However, the use of telemedicine tools aimed at the family members and caregivers of adult cancer patients is less defined. Objective: We aimed to conduct a systematic review to provide a more complete picture regarding telemedicine tools for informal caregivers (usually family members or close friends) implemented in all phases of cancer care. More specifically, the review aimed to better describe the study samples' characteristics, to analyze measured outcomes and the specific questionnaires used to assess them, and to describe in depth the implemented interventions and their formats. Finally, we examined the role of telehealth, and usability and feasibility trends in supporting patients' caregivers. Methods: We systematically searched the literature in the following databases: Web of Science, Cochrane Library, PubMed, Scopus, CINAHL, MEDLINE, EMBASE, Google Scholar, and PsycINFO. Inclusion criteria were being written in English, published in peer-reviewed journals, describing a telehealth-implemented intervention, and focusing on caregivers of adult cancer patients at any stage of the disease. We selected studies published up to November 2017. We critically appraised included articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and graded the quality of evidence by outcome using the Centre for Evidence-Based Medicine framework. Results: We included 24 studies in the final selection. In 21 of the 24 studies, the patient-caregiver dyad was analyzed, and the study population dealt with different types of cancer at different stages. Included studies considered the caregiver's condition from both an individual and a relational point of view. Along with psychosocial variables, some studies monitored engagement and user satisfaction regarding Web-based platforms or telehealth interventions. All studies reported significant improvements in some of the investigated areas, but they often showed small effect sizes. Two types of telehealth intervention formats were used: Web-based platforms and telephone calls. Some of the included studies referred to the same project, but on study samples with different cancer diagnoses or with new versions of previously developed interventions. Conclusions: Reported outcomes seem to suggest that we are in an exploratory phase. More detailed and targeted research hypotheses are still needed. Clarifying caregivers' needs related to telehealth tools and better defining outcome measures may yield more significant results. ",
doi="10.2196/jmir.9812",
url="http://www.jmir.org/2018/6/e223/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29914858"
}


@Article{info:doi/10.2196/10160,
author="Brinker, Josef Titus
and Rudolph, Stefanie
and Richter, Daniela
and von Kalle, Christof",
title="Patient-Centered Mobile Health Data Management Solution for the German Health Care System (The DataBox Project)",
journal="JMIR Cancer",
year="2018",
month="May",
day="11",
volume="4",
number="1",
pages="e10160",
keywords="medical informatics",
keywords="health data management",
doi="10.2196/10160",
url="http://cancer.jmir.org/2018/1/e10160/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29752255"
}


@Article{info:doi/10.2196/jmir.9897,
author="Greenhalgh, Trisha
and Shaw, Sara
and Wherton, Joseph
and Vijayaraghavan, Shanti
and Morris, Joanne
and Bhattacharya, Satya
and Hanson, Philippa
and Campbell-Richards, Desir{\'e}e
and Ramoutar, Seendy
and Collard, Anna
and Hodkinson, Isabel",
title="Real-World Implementation of Video Outpatient Consultations at Macro, Meso, and Micro Levels: Mixed-Method Study",
journal="J Med Internet Res",
year="2018",
month="Apr",
day="17",
volume="20",
number="4",
pages="e150",
keywords="remote consultations",
keywords="diabetes mellitus",
keywords="ethnography",
keywords="interviews",
keywords="organizational case studies",
keywords="health systems",
abstract="Background: There is much interest in virtual consultations using video technology. Randomized controlled trials have shown video consultations to be acceptable, safe, and effective in selected conditions and circumstances. However, this model has rarely been mainstreamed and sustained in real-world settings. Objective: The study sought to (1) define good practice and inform implementation of video outpatient consultations and (2) generate transferable knowledge about challenges to scaling up and routinizing this service model. Methods: A multilevel, mixed-method study of Skype video consultations (micro level) was embedded in an organizational case study (meso level), taking account of national context and wider influences (macro level). The study followed the introduction of video outpatient consultations in three clinical services (diabetes, diabetes antenatal, and cancer surgery) in a National Health Service trust (covering three hospitals) in London, United Kingdom. Data sources included 36 national-level stakeholders (exploratory and semistructured interviews), longitudinal organizational ethnography (300 hours of observations; 24 staff interviews), 30 videotaped remote consultations, 17 audiotaped face-to-face consultations, and national and local documents. Qualitative data, analyzed using sociotechnical change theories, addressed staff and patient experience and organizational and system drivers. Quantitative data, analyzed via descriptive statistics, included uptake of video consultations by staff and patients and microcategorization of different kinds of talk (using the Roter interaction analysis system). Results: When clinical, technical, and practical preconditions were met, video consultations appeared safe and were popular with some patients and staff. Compared with face-to-face consultations for similar conditions, video consultations were very slightly shorter, patients did slightly more talking, and both parties sometimes needed to make explicit things that typically remained implicit in a traditional encounter. Video consultations appeared to work better when the clinician and patient already knew and trusted each other. Some clinicians used Skype adaptively to respond to patient requests for ad hoc encounters in a way that appeared to strengthen supported self-management. The reality of establishing video outpatient services in a busy and financially stretched acute hospital setting proved more complex and time-consuming than originally anticipated. By the end of this study, between 2\% and 22\% of consultations were being undertaken remotely by participating clinicians. In the remainder, clinicians chose not to participate, or video consultations were considered impractical, technically unachievable, or clinically inadvisable. Technical challenges were typically minor but potentially prohibitive. Conclusions: Video outpatient consultations appear safe, effective, and convenient for patients in situations where participating clinicians judge them clinically appropriate, but such situations are a fraction of the overall clinic workload. As with other technological innovations, some clinicians will adopt readily, whereas others will need incentives and support. There are complex challenges to embedding video consultation services within routine practice in organizations that are hesitant to change, especially in times of austerity. ",
doi="10.2196/jmir.9897",
url="http://www.jmir.org/2018/4/e150/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29625956"
}


@Article{info:doi/10.2196/resprot.9239,
author="Horlait, Melissa
and Van Belle, Simon
and Leys, Mark",
title="Input of Psychosocial Information During Multidisciplinary Team Meetings at Medical Oncology Departments: Protocol for an Observational Study",
journal="JMIR Res Protoc",
year="2018",
month="Feb",
day="26",
volume="7",
number="2",
pages="e64",
keywords="multidisciplinary collaboration",
keywords="oncology",
keywords="multidisciplinary communication",
keywords="health services",
keywords="qualitative research",
keywords="multidisciplinary oncology consultations",
abstract="Background: Multidisciplinary team meetings (MDTMs) have become standard practice in oncology and gained the status of the key decision-making forum for cancer patient management. The current literature provides evidence that MDTMs are achieving their intended objectives but there are also indications to question the positive impact of MDTMs in oncology settings. For cancer management to be patient-centered, it is crucial that medical information as well as psychosocial aspects---such as the patients' living situation, possible family problems, patients' mental state, and patients' perceptions and values or preferences towards treatment or care---are considered and discussed during MDTMs. Previous studies demonstrate that failure to account for patients' psychosocial information has a negative impact on the implementation of the treatment recommendations formulated during MDTMs. Few empirical studies have demonstrated the predominant role of physicians during MDTMs, leading to the phenomenon that medical information is shared almost exclusively at the expense of psychosocial information. However, more in-depth insight on the underlying reasons why MDTMs fail to take into account psychosocial information of cancer patients is needed. Objective: This paper presents a research protocol for a cross-sectional observational study that will focus on exploring the barriers to considering psychosocial information during MDTMs at medical oncology departments. Methods: This protocol encompasses a cross-sectional comparative case study of MDTMs at medical oncology departments in Flanders, Belgium. MDTMs from various oncology subspecialties at inpatient medical oncology departments in multiple hospitals (academic as well as general hospitals) are compared. The observations focus on the ``multidisciplinary oncology consultation'' (MOC), a formally regulated and financed type of MDTM in Belgian oncology since 2003. Data are collected through nonparticipant observations of MOC--meetings. Observational data are supplemented with semi-structured individual interviews with members of the MOC--meetings. Results: The protocol is part of a larger research project on communication and multidisciplinary collaboration in oncology departments. Results of this study will particularly focus on the input of psychosocial information during MDTMs. Conclusions: The concept of an MDTM should not merely be a group of care professionals who mostly work independently and occasionally liaise with one another. Interventions aiming to enhance the input of psychosocial information are crucial to ensure that MDTMs can benefit from their diverse membership to achieve their full potential. The findings from this study can be used to design nonclinical and organizational interventions that enhance multidisciplinary decision-making in oncology. ",
doi="10.2196/resprot.9239",
url="http://www.researchprotocols.org/2018/2/e64/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29483068"
}


@Article{info:doi/10.2196/jmir.8485,
author="Cherrez Ojeda, Ivan
and Vanegas, Emanuel
and Torres, Michell
and Calder{\'o}n, Carlos Juan
and Calero, Erick
and Cherrez, Annia
and Felix, Miguel
and Mata, Valeria
and Cherrez, Sofia
and Simancas, Daniel",
title="Ecuadorian Cancer Patients' Preference for Information and Communication Technologies: Cross-Sectional Study",
journal="J Med Internet Res",
year="2018",
month="Feb",
day="20",
volume="20",
number="2",
pages="e50",
keywords="social media",
keywords="telemedicine",
keywords="cancer",
keywords="Web 2.0",
keywords="mHealth",
abstract="Background: The instantaneous spread of information, low costs, and broad availability of information and communication technologies (ICTs) make them an attractive platform for managing care, patient communication, and medical interventions in cancer treatment. There is little information available in Latin America about the level of usage of ICTs for and by cancer patients. Our study attempts to fill this gap. Objective: The aim of this study was to assess the level of ICT use and patterns of preferences among cancer patients. Methods: We conducted an anonymous cross-sectional survey study in 500 Ecuadorian cancer patients. This questionnaire consisted of 22 items about demographic and clinical data, together with the preferences of people who use ICTs. Chi-square, crude, and adjusted logistic regressions were performed. Results: Of the total, 43.2\% (216/500) of participants reported that they had access to the Internet, and 25.4\% (127/500) reported that they neither owned a cell phone nor did they have access to the Internet. The Internet constituted the highest usage rate as a source of information about malignant diseases (74.3\%, 162/218) regardless of age (P<.001). With regard to the preferences on how patients would like to use ICTs to receive information about diseases, WhatsApp (66.5\%, 145/218) and short message service (SMS) text messaging (61.0\%, 133/218) were widely reported as interesting communication channels. Similarly, WhatsApp (72.0\%, 157/218) followed by SMS (63.8\%, 139/218) were reported as the preferred ICTs through which patients would like to ask physicians about diseases. Adjusted regression analysis showed that patients aged between 40 and 64 years were more likely to be interested in receiving information through SMS (odds ratio, OR 5.09, 95\% CI 1.92-13.32), as well as for asking questions to physicians through this same media (OR 9.78, CI 3.45-27.67) than the oldest group. Conclusions: WhatsApp, SMS, and email are effective and widely used ICTs that can promote communication between cancer patients and physicians. According to age range, new ICTs such as Facebook are still emerging. Future studies should investigate how to develop and promote ICT-based resources more effectively to engage the outcomes of cancer patients. The widespread use of ICTs narrows the gap between cancer patients with restricted socioeconomic conditions and those with wealth and easily available technological means, thereby opening up new possibilities in low-income countries. ",
doi="10.2196/jmir.8485",
url="http://www.jmir.org/2018/2/e50/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29463492"
}


@Article{info:doi/10.2196/humanfactors.7882,
author="Kurahashi, M. Allison
and Stinson, N. Jennifer
and van Wyk, Margaret
and Luca, Stephanie
and Jamieson, Trevor
and Weinstein, Peter
and Cafazzo, A. Joseph
and Lokuge, Bhadra
and Cohen, Eyal
and Rapoport, Adam
and Husain, Amna",
title="The Perceived Ease of Use and Usefulness of Loop: Evaluation and Content Analysis of a Web-Based Clinical Collaboration System",
journal="JMIR Hum Factors",
year="2018",
month="Jan",
day="09",
volume="5",
number="1",
pages="e2",
keywords="patient-centered care",
keywords="patient participation",
keywords="chronic disease",
keywords="communication",
keywords="internet communication tools",
keywords="usability testing",
keywords="interdisciplinary communication",
keywords="health communication",
keywords="continuity of patient care",
keywords="patient care team",
keywords="inventions",
abstract="Background: Patients with complex health care needs require the expertise of many health care providers. Communication, collaboration, and patient-centered care positively impact care quality and patient outcomes. Few technologies exist that facilitate collaboration between providers across settings of care and also engage the patient. We developed a Web-based clinical collaboration system, Loop, to address this gap. The likelihood of a technological system's uptake is associated with its perceived ease of use and perceived usefulness. We engaged stakeholders in the conceptualization and development of Loop in an effort to maximize its intuitiveness and utility. Objective: This study aimed to report end users' perceptions about the ease of use and usefulness of Loop captured during usability tests of Loop. Methods: Participants represented three user types (patients, caregivers, and health care providers) recruited from three populations (adults with cancer, adolescents and young adults with cancer, and children with medical complexity). We conducted usability testing over three iterative cycles of testing and development in both laboratory-based and off-site environments. We performed a content analysis of usability testing transcripts to summarize and describe participant perceptions about the ease of use and usefulness of Loop. Results: Participants enjoyed testing Loop and were able to use the core functions---composing, posting, and reading messages---with little difficulty. They had difficulty interpreting certain visual cues and design elements or the purpose of some features. This difficulty negatively impacted perceived ease of use but was primarily limited to auxiliary features. Participants predicted that Loop could improve the efficiency and effectiveness of communication between care team members; however, this perceived usefulness could be compromised by disruptions to personal workflow such as additional time or task requirements. Conclusions: Loop was perceived to have value as a collaboration system; however, usability testing findings indicate that some design and functional elements need to be addressed to improve ease of use. Additionally, participant concerns highlight the need to consider how a system can be implemented so as to minimize impact on workflow and optimize usefulness. ",
doi="10.2196/humanfactors.7882",
url="http://humanfactors.jmir.org/2018/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29317386"
}


@Article{info:doi/10.2196/jmir.7783,
author="Compen, R. F{\'e}lix
and Bisseling, M. Else
and Schellekens, PJ Melanie
and Jansen, TM Ellen
and van der Lee, L. Marije
and Speckens, EM Anne",
title="Mindfulness-Based Cognitive Therapy for Cancer Patients Delivered via Internet: Qualitative Study of Patient and Therapist Barriers and Facilitators",
journal="J Med Internet Res",
year="2017",
month="Dec",
day="18",
volume="19",
number="12",
pages="e407",
keywords="mindfulness",
keywords="psycho-oncology",
keywords="cancer survivors",
keywords="telemedicine",
keywords="qualitative research",
abstract="Background: The number of patients living with cancer is growing, and a substantial number of patients suffer from psychological distress. Mindfulness-based interventions (MBIs) seem effective in alleviating psychological distress. Unfortunately, several cancer patients find it difficult, if not impossible, to attend a group-based course. Internet-based MBIs (eMBIs) such as Internet-based mindfulness-based cognitive therapy (eMBCT) may offer solutions. However, it is yet to be studied what facilitators and barriers cancer patients experience during eMBCT. Objective: This study aimed to explore facilitators and barriers of individual asynchronous therapist-assisted eMBCT as experienced by both patients and therapists. Methods: Patients with heterogeneous cancer diagnoses suffering from psychological distress were offered eMBCT. This 9-week intervention mirrored the group-based MBCT protocol and included weekly asynchronous written therapist feedback. Patients were granted access to a website that contained the eMBCT protocol and a secured inbox, and they were asked to practice and fill out diaries on which the therapist provided feedback. In total, 31 patients participated in an individual posttreatment interview on experienced facilitators and barriers during eMBCT. Moreover, eight therapists were interviewed. The data were analyzed with qualitative content analysis to identify barriers and facilitators in eMBCT. Results: Both patients and therapists mentioned four overarching themes as facilitators and barriers: treatment setting (the individual and Internet-based nature of the treatment), treatment format (how the treatment and its guidance were organized and delivered), role of the therapist, and individual patient characteristics. Conclusions: The eMBCT provided flexibility in when, where, and how patients and therapists engage in MBCT. Future studies should assess how different eMBCT designs could further improve barriers that were found. ",
doi="10.2196/jmir.7783",
url="http://www.jmir.org/2017/12/e407/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29254912"
}


@Article{info:doi/10.2196/jmir.7466,
author="Gustafson, H. David
and DuBenske, L. Lori
and Atwood, K. Amy
and Chih, Ming-Yuan
and Johnson, A. Roberta
and McTavish, Fiona
and Quanbeck, Andrew
and Brown, L. Roger
and Cleary, F. James
and Shah, Dhavan",
title="Reducing Symptom Distress in Patients With Advanced Cancer Using an e-Alert System for Caregivers: Pooled Analysis of Two Randomized Clinical Trials",
journal="J Med Internet Res",
year="2017",
month="Nov",
day="14",
volume="19",
number="11",
pages="e354",
keywords="Internet",
keywords="health communication",
keywords="palliative care",
keywords="communication barriers",
keywords="signs and symptoms",
keywords="eHealth",
abstract="Background: Symptom distress in patients toward the end of life can change rapidly. Family caregivers have the potential to help patients manage those symptoms, as well as their own stress, if they are equipped with the proper resources. Electronic health (eHealth) systems may be able to provide those resources. Very sick patients may not be able to use such systems themselves to report their symptoms but family caregivers could. Objective: The aim of this paper was to assess the effects on cancer patient symptom distress of an eHealth system that alerts clinicians to significant changes in the patient's symptoms, as reported by a family caregiver. Methods: A pooled analysis from two randomized clinical trials (NCT00214162 and NCT00365963) compared outcomes at 12 months for two unblinded groups: a control group (Comprehensive Health Enhancement Support System [CHESS]-Only) that gave caregivers access to CHESS, an online support system, and an experimental group (CHESS+CR [Clinician Report]), which also had CHESS but with a CR that automatically alerted clinicians if symptoms exceeded a predetermined threshold of severity. Participants were dyads (n=235) of patients with advanced lung, breast, or prostate cancer and their respective family caregivers from 5 oncology clinics in the United States of America. The proportion of improved patient threshold symptoms was compared between groups using area-under-the-curve analysis and binomial proportion tests. The proportion of threshold symptoms out of all reported symptoms was also examined. Results: When severe caregiver-reported symptoms were shared with clinicians, the symptoms were more likely to be subsequently reported as improved than when the symptoms were not shared with clinicians (P<.001). Fewer symptom reports were completed in the group of caregivers whose reports went to clinicians than in the CHESS-Only group (P<.001), perhaps because caregivers, knowing their reports might be sent to a doctor, feared they might be bothering the clinician. Conclusions: This study suggests that an eHealth system designed for caregivers that alerts clinicians to worrisome changes in patient health status may lead to reduced patient distress. Trial Registration: Clinicaltrials.gov NCT00214162; https://clinicaltrials.gov/ct2/show/NCT00214162 (Archived by WebCite at http://www.webcitation.org/6nmgdGfuD) and Clinicaltrials.gov NCT00365963; https://clinicaltrials.gov/ct2/show/NCT00365963 (Archived by WebCite at http://www.webcitation.org/6nmh0U8VP) ",
doi="10.2196/jmir.7466",
url="http://www.jmir.org/2017/11/e354/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29138131"
}


@Article{info:doi/10.2196/cancer.7599,
author="Langius-Ekl{\"o}f, Ann
and Christiansen, Mats
and Lindstr{\"o}m, Veronica
and Blomberg, Karin
and H{\"a}lleberg Nyman, Maria
and Wengstr{\"o}m, Yvonne
and Sundberg, Kay",
title="Adherence to Report and Patient Perception of an Interactive App for Managing Symptoms During Radiotherapy for Prostate Cancer: Descriptive Study of Logged and Interview Data",
journal="JMIR Cancer",
year="2017",
month="Oct",
day="31",
volume="3",
number="2",
pages="e18",
keywords="mobile apps",
keywords="mHealth",
keywords="prostate cancer",
keywords="symptom assessment",
abstract="Background: Patients undergoing radiotherapy for prostate cancer experience symptoms related to both the cancer itself and its treatment, and it is evident that patients with prostate cancer have unmet supportive care needs related to their disease. Over the past decade, there has been an increase in the amount of research within the field of mobile health and the use of apps as tools for managing illness. The main challenge is to develop a mobile technology to its full potential of being interactive in real time. The interactive app Interaktor, which aims to identify and manage symptoms in real time includes (1) a function for patients' assessment of the occurrence, frequency, and distress of symptoms; (2) a connection to a monitoring Web interface; (3) a risk assessment model that sends alerts via text message to health care providers; (4) continuous access to evidence-based self-care advice and links to relevant websites for more information; and (5) graphs for the patients and health care providers to view the history of symptom reporting. Objective: The aim of the study was to investigate user behavior, adherence to reporting, and the patients' experiences of using Interaktor during radiotherapy for localized advanced prostate cancer. Methods: The patients were instructed to report daily during the time of treatment and then for an additional 3 weeks. Logged data from patients' use of the app were analyzed with descriptive statistics. Interview data about experiences of using the app were analyzed with content analysis. Results: A total of 66 patients participated in the study. Logged data showed that adherence to daily reporting of symptoms was high (87\%). The patients used all the symptoms included in the app. Of the reports, 15.6\% generated alerts to the health care providers. Overall, the patients found that it was easy and not particularly time-consuming to send a daily report, and many described it as becoming a routine. Reporting symptoms facilitated reflection on their symptoms and gave them a sense of security. Few technological problems were reported. Conclusions: The use of Interaktor increased patients' sense of security and their reflections on their own well-being and thereby served as a supportive tool for the self-management of symptoms during treatment of prostate cancer. Some further development of the app's content might be beneficial for future use. ",
doi="10.2196/cancer.7599",
url="http://cancer.jmir.org/2017/2/e18/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29089290"
}


@Article{info:doi/10.2196/jmir.7180,
author="Bruggeman-Everts, Z. Fieke
and Wolvers, J. Marije D.
and van de Schoot, Rens
and Vollenbroek-Hutten, R. Miriam M.
and Van der Lee, L. Marije",
title="Effectiveness of Two Web-Based Interventions for Chronic Cancer-Related Fatigue Compared to an Active Control Condition: Results of the ``Fitter na kanker'' Randomized Controlled Trial",
journal="J Med Internet Res",
year="2017",
month="Oct",
day="19",
volume="19",
number="10",
pages="e336",
keywords="fatigue",
keywords="cancer survivors",
keywords="Internet interventions",
keywords="mindfulness-based cognitive therapy",
keywords="physiotherapy",
keywords="accelerometry",
keywords="latent growth analysis",
keywords="implementation",
keywords="RCT",
abstract="Background: Approximately one third of all patients who have been successfully treated for cancer suffer from chronic cancer-related fatigue (CCRF). Effective and easily accessible interventions are needed for these patients. Objective: The current paper reports on the results of a 3-armed randomized controlled trial investigating the clinical effectiveness of two different guided Web-based interventions for reducing CCRF compared to an active control condition. Methods: Severely fatigued cancer survivors were recruited via online and offline channels, and self-registered on an open-access website. After eligibility checks, 167 participants were randomized via an embedded automated randomization function into: (1) physiotherapist-guided Ambulant Activity Feedback (AAF) therapy encompassing the use of an accelerometer (n=62); (2) psychologist-guided Web-based mindfulness-based cognitive therapy (eMBCT; n=55); or (3) an unguided active control condition receiving psycho-educational emails (n=50). All interventions lasted nine weeks. Fatigue severity was self-assessed using the Checklist Individual Strength - Fatigue Severity subscale (primary outcome) six times from baseline (T0b) to six months (T2). Mental health was self-assessed three times using the Hospital Anxiety and Depression Scale and Positive and Negative Affect Schedule (secondary outcome). Treatment dropout was investigated. Results: Multiple group latent growth curve analysis, corrected for individual time between assessments, showed that fatigue severity decreased significantly more in the AAF and eMBCT groups compared to the psycho-educational group. The analyses were checked by a researcher who was blind to allocation. Clinically relevant changes in fatigue severity were observed in 66\% (41/62) of patients in AAF, 49\% (27/55) of patients in eMBCT, and 12\% (6/50) of patients in psycho-education. Dropout was 18\% (11/62) in AAF, mainly due to technical problems and poor usability of the accelerometer, and 38\% (21/55) in eMBCT, mainly due to the perceived high intensity of the program. Conclusions: Both the AAF and eMBCT interventions are effective for managing fatigue severity compared to receiving psycho-educational emails. Trial Registration: Trialregister.nl NTR3483; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3483 (Archived by WebCite at http://www.webcitation.org/6NWZqon3o)  ",
doi="10.2196/jmir.7180",
url="http://www.jmir.org/2017/10/e336/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29051138"
}


@Article{info:doi/10.2196/jmir.7639,
author="Giesler, M. J{\"u}rgen
and Keller, Bettina
and Repke, Tim
and Leonhart, Rainer
and Weis, Joachim
and Muckelbauer, Rebecca
and Rieckmann, Nina
and M{\"u}ller-Nordhorn, Jacqueline
and Lucius-Hoene, Gabriele
and Holmberg, Christine",
title="Effect of a Website That Presents Patients' Experiences on Self-Efficacy and Patient Competence of Colorectal Cancer Patients: Web-Based Randomized Controlled Trial",
journal="J Med Internet Res",
year="2017",
month="Oct",
day="13",
volume="19",
number="10",
pages="e334",
keywords="self-efficacy",
keywords="colorectal cancer",
keywords="patient competence",
keywords="narrative information",
keywords="Web-based experiential information",
abstract="Background: Patients often seek other patients' experiences with the disease. The Internet provides a wide range of opportunities to share and learn about other people's health and illness experiences via blogs or patient-initiated online discussion groups. There also exists a range of medical information devices that include experiential patient information. However, there are serious concerns about the use of such experiential information because narratives of others may be powerful and pervasive tools that may hinder informed decision making. The international research network DIPEx (Database of Individual Patients' Experiences) aims to provide scientifically based online information on people's experiences with health and illness to fulfill patients' needs for experiential information, while ensuring that the presented information includes a wide variety of possible experiences. Objective: The aim is to evaluate the colorectal cancer module of the German DIPEx website krankheitserfahrungen.de with regard to self-efficacy for coping with cancer and patient competence. Methods: In 2015, a Web-based randomized controlled trial was conducted using a two-group between-subjects design and repeated measures. The study sample consisted of individuals who had been diagnosed with colorectal cancer within the past 3 years or who had metastasis or recurrent disease. Outcome measures included self-efficacy for coping with cancer and patient competence. Participants were randomly assigned to either an intervention group that had immediate access to the colorectal cancer module for 2 weeks or to a waiting list control group. Outcome criteria were measured at baseline before randomization and at 2 weeks and 6 weeks Results: The study randomized 212 persons. On average, participants were 54 (SD 11.1) years old, 58.8\% (124/211) were female, and 73.6\% (156/212) had read or heard stories of other patients online before entering the study, thus excluding any influence of the colorectal cancer module on krankheitserfahrungen.de. No intervention effects were found at 2 and 6 weeks after baseline. Conclusions: The results of this study do not support the hypothesis that the website studied may increase self-efficacy for coping with cancer or patient competencies such as self-regulation or managing emotional distress. Possible explanations may involve characteristics of the website itself, its use by participants, or methodological reasons. Future studies aimed at evaluating potential effects of websites providing patient experiences on the basis of methodological principles such as those of DIPEx might profit from extending the range of outcome measures, from including additional measures of website usage behavior and users' motivation, and from expanding concepts, such as patient competency to include items that more directly reflect patients' perceived effects of using such a website. Trial Registration: Clinicaltrials.gov NCT02157454; https://clinicaltrials.gov/ct2/show/NCT02157454 (Archived by WebCite at http://www.webcitation.org/6syrvwXxi) ",
doi="10.2196/jmir.7639",
url="http://www.jmir.org/2017/10/e334/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29030329"
}


@Article{info:doi/10.2196/jmir.8360,
author="Girgis, Afaf
and Durcinoska, Ivana
and Levesque, V. Janelle
and Gerges, Martha
and Sandell, Tiffany
and Arnold, Anthony
and Delaney, P. Geoff
and ",
title="eHealth System for Collecting and Utilizing Patient Reported Outcome Measures for Personalized Treatment and Care (PROMPT-Care) Among Cancer Patients: Mixed Methods Approach to Evaluate Feasibility and Acceptability",
journal="J Med Internet Res",
year="2017",
month="Oct",
day="02",
volume="19",
number="10",
pages="e330",
keywords="patient reported outcome measures",
keywords="eHealth",
keywords="self-management",
keywords="medical oncology",
keywords="patient-centered care",
keywords="electronic health records",
abstract="Background: Despite accumulating evidence indicating that collecting patient-reported outcomes (PROs) and transferring results to the treating health professional in real time has the potential to improve patient well-being and cancer outcomes, this practice is not widespread. Objective: The aim of this study was to test the feasibility and acceptability of PROMPT-Care (Patient Reported Outcome Measures for Personalized Treatment and Care), a newly developed electronic health (eHealth) system that facilitates PRO data capture from cancer patients, data linkage and retrieval to support clinical decisions and patient self-management, and data retrieval to support ongoing evaluation and innovative research. Methods: We developed an eHealth system in consultation with content-specific expert advisory groups and tested it with patients receiving treatment or follow-up care in two hospitals in New South Wales, Australia, over a 3-month period. Participants were recruited in clinic and completed self-report Web-based assessments either just before their upcoming clinical consultation or every 4 weeks if in follow-up care. A mixed methods approach was used to evaluate feasibility and acceptability of PROMPT-Care; data collected throughout the study informed the accuracy and completeness of data transfer procedures, and extent of missing data was determined from participants' assessments. Patients participated in cognitive interviews while completing their first assessment and completed evaluation surveys and interviews at study-end to assess system acceptability and usefulness of patient self-management resources, and oncology staff were interviewed at study-end to determine the acceptability and perceived usefulness of real-time PRO reporting. Results: A total of 42 patients consented to the study; 7 patients were withdrawn before starting the intervention primarily because of changes in eligibility. Overall, 35 patients (13 on treatment and 22 in follow-up) completed 67 assessments during the study period. Mean completeness of patient-reported data was 93\%, with 100\% accuracy of data transfer. Ten patients completed cognitive interviews, 28 completed evaluation surveys, and 14 completed evaluation interviews at study-end. PROMPT-Care patient acceptability was high---100\% (28/28) reported the time to complete the Web-based assessments (average 15 min) as about right, most willing to answer more questions (79\%, 22/28 yes), 96\% (27/28) found the Web-based assessment easier or same as completing a paper copy, and they valued the self-management resources . Oncology staff (n=5) also reported high acceptability and potential feasibility of the system. Conclusions: Patients and oncology staff found the PROMPT-Care system to be highly acceptable, and the results suggest that it would be feasible to implement it into an oncology setting. Suggested modifications to the patient assessment survey, clinician access to the reports, and system requirements will be made as part of the next stage of large-scale testing and future implementation of the system as part of routine care. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN1261500135294; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369299\&isReview=true (Archived by WebCite at http://www.webcitation.org/6lzylG5A0). ",
doi="10.2196/jmir.8360",
url="https://www.jmir.org/2017/10/e330/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28970188"
}


@Article{info:doi/10.2196/humanfactors.7845,
author="Reblin, Maija
and Wu, P. Yelena
and Pok, Justin
and Kane, Lauren
and Colman, Howard
and Cohen, L. Adam
and Mendivil, Eduardo
and Warner, L. Echo
and Meyer, Miriah
and Agutter, James",
title="Development of the Electronic Social Network Assessment Program Using the Center for eHealth and Wellbeing Research Roadmap",
journal="JMIR Hum Factors",
year="2017",
month="Aug",
day="30",
volume="4",
number="3",
pages="e23",
keywords="intervention development",
keywords="user-centered design",
keywords="oncology",
keywords="caregiver",
abstract="Background: The number of Web-based psychological and behavioral interventions is growing. Beyond their theoretical underpinnings, a key factor to the success of these interventions is how they are designed and developed to ensure usability over a new method of delivery. Our team has adapted ecomapping, a tool for visualizing family caregiver social network resources, for the Web. Here, we describe how we designed and developed the electronic Social Network Assessment Program (eSNAP) Web-based tool using a framework of the Center for eHealth and Wellbeing Research (CeHRes) Roadmap for Web-based intervention development. The CeHRes Roadmap is still new in terms of tool development and we showcase an example of its application. Objective: The aim of our study was to provide an example of the application of the Web-based intervention development process using the CeHRes Roadmap for other research teams to follow. In doing so, we are also sharing our pilot work to enhance eSNAP's acceptance and usability for users and the feasibility of its implementation. Methods: We describe the development of the eSNAP app to support family caregivers of neuro-oncology patients. This development is based on the 5 iterative stages of the CeHRes Roadmap: contextual inquiry, value specification, design, operationalization, and summative evaluation. Research activities to support eSNAP development prior to implementation included literature review, focus groups, and iterative rounds of interviews. Results: Key lessons learned in developing the eSNAP app broadly fell under a theme of translating theoretical needs and ideas to the real world. This included how to prioritize needs to be addressed at one time, how the modality of delivery may change design requirements, and how to develop a tool to fit within the context it will be used. Conclusions: Using the CeHRes Roadmap to develop Web-based interventions such as eSNAP helps to address potential issues by outlining important intervention development milestones. In addition, by encouraging inclusion of users and other stakeholders in the process, Web-based intervention developers using the Roadmap can identify what will work in the real world and increase feasibility and effectiveness. ",
doi="10.2196/humanfactors.7845",
url="http://humanfactors.jmir.org/2017/3/e23/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28855149"
}


@Article{info:doi/10.2196/jopm.8949,
author="Belkora, K. Jeffrey
and Naguit, Marijoyce
and Stupar, Lauren
and Wiley, James
and Volz, Shelley
and O'Donnell, Sara",
title="The Effects of Coaching Patients to List Questions Before Visiting Cancer Specialists: Retrospective Evaluation of Visit Preparation in a Rural, Underserved Setting",
journal="J Participat Med",
year="2017",
month="Aug",
day="22",
volume="9",
number="1",
pages="e15",
keywords="Visit preparation",
keywords="self-efficacy",
keywords="anxiety",
keywords="question list",
keywords="patient support",
keywords="community-based participatory research",
keywords="psycho-oncology.",
abstract="Background: A community-based organization implemented an evidence-based intervention to help rural cancer patients list questions before oncology visits. Objective: Was the question-listing intervention effective in reducing anxiety and increasing decision self-efficacy? Methods: The organization surveyed patients on decision self-efficacy (273 respondents, 99\% response rate) and anxiety (190, 68\%) before and after question-listing interventions delivered from 2006 -- 2011. We analyzed responses using two-sided paired t-tests at 5\% significance and conducted linear regression to identify significant predictors of change. We examined predictors related to the patient (location, demographics, disease status and baseline decision self-efficacy and anxiety); the intervention (including interventionist case volume); and the visit (including type of doctor seen). Results: Question-listing was associated with higher mean decision self-efficacy (2.70/3.43 pre/post, 1-4 min-max, P<.001) and lower mean anxiety (7.26/5.87, 1-10 min-max, P<.001). Significant predictors of change in decision self-efficacy included: patient location; interventionist case volume; baseline decision self-efficacy and anxiety. Higher baseline anxiety was also associated with reductions in anxiety. Conclusions: In a sustained community-based implementation, the intervention helped patients prepare for oncology visits. Patients reported higher self-efficacy and lower anxiety. ",
doi="10.2196/jopm.8949",
url="http://jopm.jmir.org/2017/1/e15/",
url="http://www.ncbi.nlm.nih.gov/pubmed/36262006"
}


@Article{info:doi/10.2196/jmir.7079,
author="Oerlemans, Simone
and Arts, P. Lindy
and Horevoorts, J. Nicole
and van de Poll-Franse, V. Lonneke",
title="``Am I normal?'' The Wishes of Patients With Lymphoma to Compare Their Patient-Reported Outcomes With Those of Their Peers",
journal="J Med Internet Res",
year="2017",
month="Aug",
day="15",
volume="19",
number="8",
pages="e288",
keywords="lymphoma",
keywords="health-related quality of life",
keywords="personalized feedback",
keywords="self-care",
keywords="access to information",
keywords="population-based research",
abstract="Background: Providing feedback to patients on their patient-reported outcomes (PROs) can help patients in monitoring their functioning and symptoms and may help empower them. Objective: The objective of this study was to investigate whether patients with lymphoma wished to receive PRO feedback, including the option to compare their scores with those of their peers, and how this feedback was evaluated. Methods: We invited 64 patients participating in a lymphoma cohort who were eligible for a follow-up questionnaire and gave them the option to receive PRO feedback. Patients completed questions about health-related quality of life (HRQoL) and symptoms. PRO feedback was provided via bar charts. Results: Of the 64 invited patients, 45 participated (response rate 70\%) and 36 of those (80\%) wished to receive PRO feedback. The vast majority (34/36, 94\%) compared their scores with those of a lymphoma reference cohort, and 64\% (23/36) compared their score with those of a normative population without cancer. All patients wished to receive feedback on their HRQoL, and 29 (81\%) to 33 (92\%) wanted feedback on their functioning, fatigue, neuropathy, anxiety, and depressive symptoms. Of the 36 participants wishing to receive PRO feedback, 35 (97\%) viewed it as being useful, with reassurance and knowledge about their own functioning in relation to what is ``normal'' being the most frequently mentioned reasons. Conclusions: A high number of patients with lymphoma wished to receive PRO feedback. Patients reported the comparison of their scores versus a lymphoma reference cohort as most valuable. Further research should investigate whether PRO feedback could increase empowerment and possibly improve HRQoL. ",
doi="10.2196/jmir.7079",
url="http://www.jmir.org/2017/8/e288/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28811271"
}


@Article{info:doi/10.2196/cancer.7443,
author="Groen, G. Wim
and Kuijpers, Wilma
and Oldenburg, SA Hester
and Wouters, WJM Michel
and Aaronson, K. Neil
and van Harten, H. Wim",
title="Supporting Lung Cancer Patients With an Interactive Patient Portal: Feasibility Study",
journal="JMIR Cancer",
year="2017",
month="Aug",
day="08",
volume="3",
number="2",
pages="e10",
keywords="non-small cell lung cancer",
keywords="patient empowerment",
keywords="patient portal",
keywords="supportive care",
keywords="eHealth",
keywords="feasibility",
abstract="Background: MyAVL is an interactive portal for cancer patients that aims to support lung cancer patients. Objective: We aimed to evaluate the feasibility and usability of the patient portal and generate preliminary evidence on its impact. Methods: Lung cancer patients currently or recently treated with curative intent could use MyAVL noncommittally for 4 months. Feasibility, usability, and preliminary impact (ie, patient activation, quality of life, and physical activity) were studied by means of questionnaires, a focus group, and analysis of user log data. Results: We included 37 of 123 eligible patients (mean age 59.6 years). The majority of responses (82\%) were positive about using MyAVL, 69\% saw it as a valuable addition to care, and 56\% perceived increased control over their health. No positive effects could be substantiated on the impact measures. Conclusions: MyAVL appears to be a feasible and user-friendly, multifunctional eHealth program for a selected group of lung cancer patients. However, it needs further improvements to positively impact patient outcomes. ",
doi="10.2196/cancer.7443",
url="http://cancer.jmir.org/2017/2/e10/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28790025"
}


@Article{info:doi/10.2196/cancer.6996,
author="Hartkopf, D. Andreas
and Graf, Joachim
and Simoes, Elisabeth
and Keilmann, Lucia
and Sickenberger, Nina
and Gass, Paul
and Wallwiener, Diethelm
and Matthies, Lina
and Taran, Florin-Andrei
and Lux, P. Michael
and Wallwiener, Stephanie
and Belleville, Eric
and Sohn, Christof
and Fasching, A. Peter
and Schneeweiss, Andreas
and Brucker, Y. Sara
and Wallwiener, Markus",
title="Electronic-Based Patient-Reported Outcomes: Willingness, Needs, and Barriers in Adjuvant and Metastatic Breast Cancer Patients",
journal="JMIR Cancer",
year="2017",
month="Aug",
day="07",
volume="3",
number="2",
pages="e11",
keywords="breast cancer",
keywords="patient-reported outcome measures",
keywords="electronic patient- reported outcome",
keywords="technical skills",
keywords="willingness to use",
keywords="needs and barriers",
abstract="Background: Patient-reported outcomes (PROs) play an increasingly important role as an adjunct to clinical outcome parameters in measuring health-related quality of life (HRQoL). In fact, PROs are already the accepted gold standard for collecting data about patients' subjective perception of their own state of health. Currently, paper-based surveys of PRO still predominate; however, knowledge regarding the feasibility of and barriers to electronic-based PRO (ePRO) acceptance remains limited. Objective: The objective of this trial was to analyze the willingness, specific needs, and barriers of adjuvant breast cancer (aBC) and metastatic breast cancer (mBC) patients in nonexposed (no exposure to electronic assessment) and exposed (after exposure to electronic assessment decision, whether a tablet-based questionnaire is favored) settings before implementing digital ePRO assessment in relation to health status. We also investigated whether providing support can increase the patients' willingness to participate in such programs. Methods: The nonexposed patients only answered a paper-based questionnaire, whereas the exposed patients filled out both paper- and tablet-based questionnaires. The assessment comprised socioeconomic variables, HRQoL, preexisting technical skills, general attitude toward electronic-based surveys, and potential barriers in relation to health status. Furthermore, nonexposed patients were asked about the existing need for technological support structures. In the course of data evaluation, we performed a frequency analysis as well as chi-square tests and Wilcoxon signed-rank tests. Subsequently, relative risks analysis, univariate categorical regression (CATREG), and mediation analyses (Hayes' bias-corrected bootstrap) were performed. Results: A total of 202 female breast cancer patients completed the PRO assessment (nonexposed group: n=96 patients; exposed group: n=106 patients). Self-reported technical skills were higher in exposed patients (2.79 vs 2.33, P ?.001). Significant differences were found in relation to willingness to use ePRO (92.3\% in the exposed group vs 59\% in the nonexposed group; P=.001). Multiple barriers were identified, and most of them showed statistically significant differences in favor of the exposed patients (ie, data security [13\% in the exposed patients vs 30\% in the nonexposed patients; P=.003] and no prior technology usage [5\% in the exposed group vs 15\% in the nonexposed group; P=.02]), whereas the differences in disease burden (somatic dimension: 4\% in the exposed group vs 9\% in the nonexposed group; P=.13) showed no significance. In nonexposed patients, requests for support services were identified, which could increase their ePRO willingness. Conclusions: Significant barriers in relation to HRQoL, cancer-related restrictions, and especially the setting of the survey were identified in this trial. Thus, it is necessary to address and eliminate these barriers to ensure data accuracy and reliability for future ePRO assessments. Exposure seems to be a potential option to increase willingness to use ePRO and to reduce barriers. ",
doi="10.2196/cancer.6996",
url="http://cancer.jmir.org/2017/2/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28784595"
}


@Article{info:doi/10.2196/mhealth.7178,
author="Sun, Yunheng
and Jiang, Feng
and Gu, J. Juan
and Wang, Ken Y.
and Hua, Hongwei
and Li, Jing
and Cheng, Zhijun
and Liao, Zhijun
and Huang, Qian
and Hu, Weiwei
and Ding, Gang",
title="Development and Testing of an Intelligent Pain Management System (IPMS) on Mobile Phones Through a Randomized Trial Among Chinese Cancer Patients: A New Approach in Cancer Pain Management",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jul",
day="25",
volume="5",
number="7",
pages="e108",
keywords="cancer pain",
keywords="intelligent pain management system",
keywords="smart phone",
keywords="intervention",
abstract="Background: Cancer has become increasingly prevalent in China over the past few decades. Among the factors that determine the quality of life of cancer patients, pain has commonly been recognized as a most critical one; it could also lead to the ineffective treatment of the cancer. Driven by the need for better pain management for cancer patients, our research team developed a mobile-based Intelligent Pain Management System (IPMS). Objective: Our objective was to design, develop, and test the IPMS to facilitate real-time pain recording and timely intervention among cancer patients with pain. The system's usability, feasibility, compliance, and satisfaction were also assessed. Methods: A sample of 46 patients with cancer pain symptoms were recruited at the Oncology Center of Xinhua Hospital affiliated to Shanghai Jiao Tong University School of Medicine, Chongming Branch (hereinafter referred to as ``the Oncology Center''). In a pretest, participants completed a pain management knowledge questionnaire and were evaluated using the baseline cancer pain assessment and Karnofsky Performance Status (KPS) evaluation. The participants were then randomly assigned into two groups (the trial group and the control group). After a 14-day trial period, another round of cancer pain assessment, KPS evaluation and pain management knowledge assessment were repeated. In the trial group, the data were fully automatically collected by the IPMS. In the control group, the data were collected using conventional methods, such as phone interviews or door-to-door visits by physicians. The participants were also asked to complete a satisfaction questionnaire on the use of the IPMS. Results: All participants successfully completed the trial. First, the feasibility of IPMS by observing the number of daily pain assessments recorded among patients was assessed. Second, the users' satisfaction, effectiveness of pain management, and changes in the quality of their lives were evaluated. All the participants gave high satisfaction score after they used IMPS. Both groups reported similar pain scores and KPS scores at the baseline. At the end of the trial, the mean pain score of the trial group was significantly lower than of the control group (P<.001). The ending KPS score of the trial group was significantly higher than of the control group (P<.001). The improvement of pain management knowledge score in the trial group was more pronounced than that in the control group (P<.001). Conclusions: This study provided preliminary data to support the potentials of using IPMS in cancer pain communication between patients and doctors and to provide real-time supportive intervention on a convenient basis at a low cost. Overall, the IPMS can serve as a reliable and effective approach to control cancer pain and improve quality of life for patients with cancer pain. Trial Registration: Clinicaltrials.gov NCT02765269; http://clinicaltrials.gov/ct2/show/NCT02765269 (Archived by WebCite at?http://www.webcitation.org/6rnwsgDgv) ",
doi="10.2196/mhealth.7178",
url="http://mhealth.jmir.org/2017/7/e108/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28743681"
}


@Article{info:doi/10.2196/cancer.7120,
author="Henton, Michelle
and Gaglio, Bridget
and Cynkin, Laurie
and Feuer, J. Eric
and Rabin, A. Borsika",
title="Development, Feasibility, and Small-Scale Implementation of a Web-Based Prognostic Tool---Surveillance, Epidemiology, and End Results Cancer Survival Calculator",
journal="JMIR Cancer",
year="2017",
month="Jul",
day="20",
volume="3",
number="2",
pages="e9",
keywords="clinical decision-making",
keywords="communication",
keywords="neoplasms",
keywords="patient care team",
keywords="Internet",
abstract="Background: Population datasets and the Internet are playing an ever-growing role in the way cancer information is made available to providers, patients, and their caregivers. The Surveillance, Epidemiology, and End Results Cancer Survival Calculator (SEER*CSC) is a Web-based cancer prognostic tool that uses SEER data, a large population dataset, to provide physicians with highly valid, evidence-based prognostic estimates for increasing shared decision-making and improving patient-provider communication of complex health information. Objective: The aim of this study was to develop, test, and implement SEER*CSC. Methods: An iterative approach was used to develop the SEER*CSC. Based on input from cancer patient advocacy groups and physicians, an initial version of the tool was developed. Next, providers from 4 health care delivery systems were recruited to do formal usability testing of SEER*CSC. A revised version of SEER*CSC was then implemented in two health care delivery sites using a real-world clinical implementation approach, and usage data were collected. Post-implementation follow-up interviews were conducted with site champions. Finally, patients from two cancer advocacy groups participated in usability testing. Results: Overall feedback of SEER*CSC from both providers and patients was positive, with providers noting that the tool was professional and reliable, and patients finding it to be informational and helpful to use when discussing their diagnosis with their provider. However, use during the small-scale implementation was low. Reasons for low usage included time to enter data, not having treatment options in the tool, and the tool not being incorporated into the electronic health record (EHR). Patients found the language in its current version to be too complex. Conclusions: The implementation and usability results showed that participants were enthusiastic about the use and features of SEER*CSC, but sustained implementation in a real-world clinical setting faced significant challenges. As a result of these findings, SEER*CSC is being redesigned with more accessible language for a public facing release. Meta-tools, which put different tools in context of each other, are needed to assist in understanding the strengths and limitations of various tools and their place in the clinical decision-making pathway. The continued development and eventual release of prognostic tools should include feedback from multidisciplinary health care teams, various stakeholder groups, patients, and caregivers. ",
doi="10.2196/cancer.7120",
url="http://cancer.jmir.org/2017/2/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28729232"
}


@Article{info:doi/10.2196/jmir.7421,
author="Voruganti, Teja
and Grunfeld, Eva
and Jamieson, Trevor
and Kurahashi, M. Allison
and Lokuge, Bhadra
and Krzyzanowska, K. Monika
and Mamdani, Muhammad
and Moineddin, Rahim
and Husain, Amna",
title="My Team of Care Study: A Pilot Randomized Controlled Trial of a Web-Based Communication Tool for Collaborative Care in Patients With Advanced Cancer",
journal="J Med Internet Res",
year="2017",
month="Jul",
day="18",
volume="19",
number="7",
pages="e219",
keywords="MeSH: Internet",
keywords="professional-patient relations",
keywords="interdisciplinary communication",
keywords="neoplasms",
keywords="adult",
keywords="chronic disease",
keywords="continuity of patient care",
keywords="patient care team",
keywords="communication",
keywords="outcome assessment (health care)",
abstract="Background: The management of patients with complex care needs requires the expertise of health care providers from multiple settings and specialties. As such, there is a need for cross-setting, cross-disciplinary solutions that address deficits in communication and continuity of care. We have developed a Web-based tool for clinical collaboration, called Loop, which assembles the patient and care team in a virtual space for the purpose of facilitating communication around care management. Objective: The objectives of this pilot study were to evaluate the feasibility of integrating a tool like Loop into current care practices and to capture preliminary measures of the effect of Loop on continuity of care, quality of care, symptom distress, and health care utilization. Methods: We conducted an open-label pilot cluster randomized controlled trial allocating patients with advanced cancer (defined as stage III or IV disease) with ?3 months prognosis, their participating health care team and caregivers to receive either the Loop intervention or usual care. Outcome data were collected from patients on a monthly basis for 3 months. Trial feasibility was measured with rate of uptake, as well as recruitment and system usage. The Picker Continuity of Care subscale, Palliative care Outcomes Scale, Edmonton Symptom Assessment Scale, and Ambulatory and Home Care Record were patient self-reported measures of continuity of care, quality of care, symptom distress, and health services utilization, respectively. We conducted a content analysis of messages posted on Loop to understand how the system was used. Results: Nineteen physicians (oncologists or palliative care physicians) were randomized to the intervention or control arms. One hundred twenty-seven of their patients with advanced cancer were approached and 48 patients enrolled. Of 24 patients in the intervention arm, 20 (83.3\%) registered onto Loop. In the intervention and control arms, 12 and 11 patients completed three months of follow-up, respectively. A mean of 1.2 (range: 0 to 4) additional healthcare providers with an average total of 3 healthcare providers participated per team. An unadjusted between-arm increase of +11.4 was observed on the Picker scale in favor of the intervention arm. Other measures showed negligible changes. Loop was primarily used for medical care management, symptom reporting, and appointment coordination. Conclusions: The results of this study show that implementation of Loop was feasible. It provides useful information for planning future studies further examining effectiveness and team collaboration. Numerically higher scores were observed for the Loop arm relative to the control arm with respect to continuity of care. Future work is required to understand the incentives and barriers to participation so that the implementation of tools like Loop can be optimized. Trial Registration: ClinicalTrials.gov NCT02372994; https://clinicaltrials.gov/ct2/show/NCT02372994 (Archived by WebCite at http://www.webcitation.org/6r00L4Skb). ",
doi="10.2196/jmir.7421",
url="http://www.jmir.org/2017/7/e219/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28720558"
}


@Article{info:doi/10.2196/resprot.7523,
author="Marsolo, Keith
and Shuman, William
and Nix, Jeremy
and Morrison, F. Caroline
and Mullins, L. Larry
and Pai, LH Ahna",
title="Reducing Parental Uncertainty Around Childhood Cancer: Implementation Decisions and Design Trade-Offs in Developing an Electronic Health Record-Linked Mobile App",
journal="JMIR Res Protoc",
year="2017",
month="Jun",
day="26",
volume="6",
number="6",
pages="e122",
keywords="electronic health records",
keywords="mobile apps",
keywords="uncertainty",
keywords="ethnographic design",
abstract="Background: Parents of children newly diagnosed with cancer are confronted with multiple stressors that place them at risk for significant psychological distress. One strategy that has been shown to help reduce uncertainty is the provision of basic information; however, families of newly diagnosed cancer patients are often bombarded with educational material. Technology has the potential to help families manage their informational needs and move towards normalization. Objective: The aim of this study was to create a mobile app that pulls together data from both the electronic health record (EHR) and vetted external information resources to provide tailored information to parents of newly diagnosed children as one method to reduce the uncertainty around their child's illness. This app was developed to be used by families in a National Institutes of Health (NIH)-funded randomized controlled trial (RCT) aimed at decreasing uncertainty and the subsequent psychological distress. Methods: A 2-phase qualitative study was conducted to elicit the features and content of the mobile app based on the needs and experience of parents of children newly diagnosed with cancer and their providers. Example functions include the ability to view laboratory results, look up appointments, and to access educational material. Educational material was obtained from databases maintained by the National Cancer Institute (NCI) as well as from groups like the Children's Oncology Group (COG) and care teams within Cincinnati Children's Hospital Medical Center (CCHMC). The use of EHR-based Web services was explored to allow data like laboratory results to be retrieved in real-time. Results: The ethnographic design process resulted in a framework that divided the content of the mobile app into the following 4 sections: (1) information about the patient's current treatment and other data from the EHR; (2) educational background material; (3) a calendar to view upcoming appointments at their medical center; and (4) a section where participants in the RCT document the study data. Integration with the NCI databases was straightforward; however, accessing the EHR Web services posed a challenge, though the roadblocks were not technical in nature. The lack of a formal, end-to-end institutional process for requesting Web service access and a mechanism to shepherd the request through all stages of implementation proved to be the biggest barrier. Conclusions: We successfully deployed a mobile app with a custom user interface that can integrate with the EHR to retrieve laboratory results and appointment information using vendor-provided Web services. Developers should expect to face hurdles when integrating with the EHR, but many of them can be addressed with frequent communication and thorough documentation. Executive sponsorship is also a key factor for success. Trial Registration: ClinicalTrials.gov NCT02505165; https://clinicaltrials.gov/ct2/show/NCT02505165 (Archived by WebCite at http://www.Webcitation.org/6r9ZSUgoT) ",
doi="10.2196/resprot.7523",
url="http://www.researchprotocols.org/2017/6/e122/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28652227"
}


@Article{info:doi/10.2196/jmir.6688,
author="Hanlon, Peter
and Daines, Luke
and Campbell, Christine
and McKinstry, Brian
and Weller, David
and Pinnock, Hilary",
title="Telehealth Interventions to Support Self-Management of Long-Term Conditions: A Systematic Metareview of Diabetes, Heart Failure, Asthma, Chronic Obstructive Pulmonary Disease, and Cancer",
journal="J Med Internet Res",
year="2017",
month="May",
day="17",
volume="19",
number="5",
pages="e172",
keywords="telehealth",
keywords="telemonitoring",
keywords="self-management",
keywords="chronic disease",
keywords="diabetes",
keywords="heart failure",
keywords="asthma",
keywords="COPD",
keywords="pulmonary disease, chronic obstructive",
keywords="cancer",
abstract="Background: Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. Objective: The objectives of this metareview were to (1) assess the impact of telehealth interventions to support self-management on disease control and health care utilization, and (2) identify components of telehealth support and their impact on disease control and the process of self-management. Our goal was to synthesise evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. Methods: We performed a metareview (a systematic review of systematic reviews) of randomized controlled trials (RCTs) of telehealth interventions to support self-management in 6 exemplar long-term conditions. We searched 7 databases for reviews published from January 2000 to May 2016 and screened identified studies against eligibility criteria. We weighted reviews by quality (revised A Measurement Tool to Assess Systematic Reviews), size, and relevance. We then combined our results in a narrative synthesis and using harvest plots. Results: We included 53 systematic reviews, comprising 232 unique RCTs. Reviews concerned diabetes (type 1: n=6; type 2, n=11; mixed, n=19), heart failure (n=9), asthma (n=8), COPD (n=8), and cancer (n=3). Findings varied between and within disease areas. The highest-weighted reviews showed that blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycemic control in type 2, but not type 1, diabetes, and that telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure, but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multifaceted interventions were associated with greater improvements in diabetes, heart failure, and asthma. Conclusions: While telehealth-mediated self-management was not consistently superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth is a safe option for delivery of self-management support, particularly in conditions such as heart failure and type 2 diabetes, where the evidence base is more developed. Larger-scale trials of telehealth-supported self-management, based on explicit self-management theory, are needed before the extent to which telehealth technologies may be harnessed to support self-management can be established. ",
doi="10.2196/jmir.6688",
url="http://www.jmir.org/2017/5/e172/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28526671"
}


@Article{info:doi/10.2196/jmir.6830,
author="Mattsson, Susanne
and Olsson, Gustaf Erik Martin
and Johansson, Birgitta
and Carlsson, Maria",
title="Health-Related Internet Use in People With Cancer: Results From a Cross-Sectional Study in Two Outpatient Clinics in Sweden",
journal="J Med Internet Res",
year="2017",
month="May",
day="15",
volume="19",
number="5",
pages="e163",
keywords="Oncology",
keywords="eHealth",
keywords="support",
abstract="Background: The access to various forms of support during the disease trajectory is crucial for people with cancer. The provision and use of Internet health services is increasing, and it is important to further investigate the preferences and demographical characteristics of its users. Investigating the uptake and perceived value of Internet health services is a prerequisite to be able to meet the needs in the targeted group. Objective: The objective of this study was to investigate health-related Internet use among people with cancer. Methods: The health online support questionnaire (HOSQ), examining the incentives for health-related Internet support use, was administered in two Swedish outpatient hospital clinics. Of the 350 copies of the questionnaire handed out, 285 (81.4\%) were returned, answered by persons with cancer who had completed treatment or were under active surveillance or another medical treatment. Results: A total of 215 (76.2\%, 215/282) participants reported Internet use since being diagnosed with cancer. Internet-users were younger (P<.001), more likely to have a partner (P=.03), and had a higher level of education than nonusers (P<.001). The most common health-related activity on the Internet was searching for information (77.2\%, 166/215), and users searched significantly more immediately after diagnosis compared with later on (P<.001). Use of My Healthcare Contacts was considered the most valuable Internet activity. Having a university degree (P ?.001) and being younger in age (P=.01) were associated with a significantly higher frequency of health- related Internet use. Conclusions: People with cancer turn to the Internet for informational support that enables them to influence their care and to stay in touch with friends and relatives. Demographical differences regarding the uptake of Web-based support remains. This indicates a need for research on how to bridge this digital gap. By learning more about the use of health-related support on the Web among people with cancer, adequate support can be offered and potential strain reduced. ",
doi="10.2196/jmir.6830",
url="http://www.jmir.org/2017/5/e163/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28506959"
}


@Article{info:doi/10.2196/resprot.6979,
author="van Dulmen, Sandra
and Driesenaar, A. Jeanine
and van Weert, CM Julia
and van Osch, Mara
and Noordman, Janneke",
title="PatientVOICE: Development of a Preparatory, Pre-Chemotherapy Online Communication Tool for Older Patients With Cancer",
journal="JMIR Res Protoc",
year="2017",
month="May",
day="10",
volume="6",
number="5",
pages="e85",
keywords="intervention mapping",
keywords="chemotherapy",
keywords="online intervention",
keywords="communication",
keywords="patient participation",
keywords="question prompt sheet",
keywords="elderly",
abstract="Background: Good communication around cancer treatment is essential in helping patients cope with their disease and related care, especially when this information is tailored to one's needs. Despite its importance, communication is often complex, in particular in older patients (aged 65 years or older). In addition to the age-related deterioration in information and memory processing older patients experience, communication is also complicated by their required yet often unmet role of being an active, participatory patient. Older patients rarely express their informational needs and their contributions to consultations are often limited. Therefore, older patients with cancer need to be prepared to participate more actively in their care and treatment. Objective: The objective of this paper was to report the development of PatientVOICE, an online, preparatory tool with audio facility aimed to enhance the participation of older patients during educational nursing encounters preceding chemotherapy and to improve their information recall. Methods: PatientVOICE was developed by applying the following 6 steps of the intervention mapping framework that involved both patients and nurses: (1) needs assessment, (2) specifying determinants and change objectives, (3) reviewing and selecting theoretical methods and practical strategies, (4) developing intervention components, (5) designing adoption and implementation, and (6) making an evaluation plan. Results: A careful execution of these consecutive steps resulted in the ready-to-use preparatory website. PatientVOICE provides pre-visit information about chemotherapy (ie, medical information, side effects, and recommendations of dealing with side effects), information about the educational nursing visit preceding chemotherapy (ie, aim, structure, and recommendations for preparation), techniques to improve patients' communication skills using a question prompt sheet (QPS) and video-modeling examples showing ``best practices'', and the opportunity to upload and listen back to an audio recording of a patient's own nursing visit. Conclusions: The development process resulted in PatientVOICE, a multi-component online intervention targeted to older patients with cancer. PatientVOICE contains information about the treatment as well as information about the role of the patient during treatment. Using different methods (QPS and audio facility), we hope to support these patients during their treatment. In the future, the utility and usability of this complex intervention will be evaluated in a group of older patients who receive or have received chemotherapy. ",
doi="10.2196/resprot.6979",
url="http://www.researchprotocols.org/2017/5/e85/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28490421"
}


@Article{info:doi/10.2196/resprot.6597,
author="Pugh, Gemma
and McCann, Lisa",
title="Assessing the Quality, Feasibility, and Efficacy of Electronic Patient Platforms Designed to Support Adolescents and Young Adults With Cancer: A Systematic Review Protocol",
journal="JMIR Res Protoc",
year="2017",
month="Jan",
day="17",
volume="6",
number="1",
pages="e4",
keywords="adolescent",
keywords="neoplasms",
keywords="telemedicine",
keywords="review",
abstract="Background: A range of innovative websites, mobile technologies, eHealth and mHealth platforms have emerged to support adolescents and young adults (AYAs) with cancer. Previous reviews have identified these various applications and solutions, but no review has summarized the quality, feasibility, and efficacy of existing patient platforms (inclusive of websites, mobile technologies, mHealth and eHealth platforms) developed specifically for young people with cancer. Objective: This paper describes the design of a protocol to conduct a review of published studies or reports which describe or report on an existing platform designed specifically for AYAs who have had a cancer diagnosis. Methods: A search string was developed using a variety of key words and Medical Subject Heading and applied to bibliographic databases. General data (sample characteristics, patient platform development, design and, if applicable, pilot testing outcomes) will be extracted from reports and studies. Drawing on a previously developed coding schematic, the identified patient platforms will be coded for mode of delivery into (1) automated functions, (2) communicative functions, and (3) use of supplementary modes. An adapted version of the Mobile App Rating Scale (MARS) will be used to assess the of quality of each identified patient platform. The methodological quality of included studies will be assessed using the Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields (QualSyst). Both authors will independently screen eligible studies for final inclusion and will both be responsible for data extraction and appraisal. Data will be synthesized narratively to provide an overview of identified patient platforms. Results: The review began in October 2016 and is currently in progress. The review paper will be submitted for peer-review and publication in the summer of 2017. Conclusions: This review will be unique in its focus on assessing, where possible, the quality and efficacy of patient platforms for adolescents and young adults diagnosed with cancer. Results generated from this review will provide an invaluable insight into the utility of modern technology in supporting young people with cancer. ",
doi="10.2196/resprot.6597",
url="http://www.researchprotocols.org/2017/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28096067"
}


@Article{info:doi/10.2196/jmir.6575,
author="Cox, Anna
and Lucas, Grace
and Marcu, Afrodita
and Piano, Marianne
and Grosvenor, Wendy
and Mold, Freda
and Maguire, Roma
and Ream, Emma",
title="Cancer Survivors' Experience With Telehealth: A Systematic Review and Thematic Synthesis",
journal="J Med Internet Res",
year="2017",
month="Jan",
day="09",
volume="19",
number="1",
pages="e11",
keywords="neoplasms",
keywords="telemedicine",
keywords="systematic review",
keywords="survival",
keywords="patient satisfaction",
keywords="patient preference",
abstract="Background: Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors---individuals living with and beyond cancer---to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are ``complex,'' and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized. Objective: To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group. Methods: Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes. Analytical themes were developed through an iterative process of reflection on, and interpretation of, the descriptive themes within and across studies. Results: Across the 22 included papers, 3 analytical themes emerged, each with 3 descriptive subthemes: (1) influence of telehealth on the disrupted lives of cancer survivors (convenience, independence, and burden); (2) personalized care across physical distance (time, space, and the human factor); and (3) remote reassurance---a safety net of health care professional connection (active connection, passive connection, and slipping through the net). Telehealth interventions represent a convenient approach, which can potentially minimize treatment burden and disruption to cancer survivors' lives. Telehealth interventions can facilitate an experience of personalized care and reassurance for those living with and beyond cancer; however, it is important to consider individual factors when tailoring interventions to ensure engagement promotes benefit rather than burden. Conclusions: Telehealth interventions can provide cancer survivors with independence and reassurance. Future telehealth interventions need to be developed iteratively in collaboration with a broad range of cancer survivors to maximize engagement and benefit. ",
doi="10.2196/jmir.6575",
url="http://www.jmir.org/2017/1/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28069561"
}


@Article{info:doi/10.2196/jmir.6303,
author="Innominato, F. Pasquale
and Komarzynski, Sandra
and Mohammad-Djafari, Ali
and Arbaud, Alexandre
and Ulusakarya, Ayhan
and Bouchahda, Mohamed
and Haydar, Mazen
and Bossevot-Desmaris, Rachel
and Plessis, Virginie
and Mocquery, Magali
and Bouchoucha, Davina
and Afshar, Mehran
and Beau, Jacques
and Karabou{\'e}, Abdoulaye
and Mor{\`e}re, Jean-Fran{\c{c}}ois
and Fursse, Joanna
and Rovira Simon, Jordi
and Levi, Francis",
title="Clinical Relevance of the First Domomedicine Platform Securing Multidrug Chronotherapy Delivery in Metastatic Cancer Patients at Home: The inCASA European Project",
journal="J Med Internet Res",
year="2016",
month="Nov",
day="25",
volume="18",
number="11",
pages="e305",
keywords="domomedicine",
keywords="chronotherapy",
keywords="actigraphy",
keywords="MDASI",
keywords="telemonitoring",
abstract="Background: Telehealth solutions can improve the safety of ambulatory chemotherapy, contributing to the maintenance of patients at their home, hence improving their well-being, all the while reducing health care costs. There is, however, need for a practicable multilevel monitoring solution, encompassing relevant outputs involved in the pathophysiology of chemotherapy-induced toxicity. Domomedicine embraces the delivery of complex care and medical procedures at the patient's home based on modern technologies, and thus it offers an integrated approach for increasing the safety of cancer patients on chemotherapy. Objective: The objective was to evaluate patient compliance and clinical relevance of a novel integrated multiparametric telemonitoring domomedicine platform in cancer patients receiving multidrug chemotherapy at home. Methods: Self-measured body weight, self-rated symptoms using the 19-item MD Anderson Symptom Inventory (MDASI), and circadian rest-activity rhythm recording with a wrist accelerometer (actigraph) were transmitted daily by patients to a server via the Internet, using a dedicated platform installed at home. Daily body weight changes, individual MDASI scores, and relative percentage of activity in-bed versus out-of-bed (I<O) were computed. Chemotherapy was administered according to the patient medical condition. Compliance was evaluated according to the proportions of (1) patient-days with all data available (full) and (2) patient-days with at least one parameter available (minimal). Acceptability was assessed using the Whole Systems Demonstrator Service User Technology Acceptability Questionnaire. Linear discriminant analysis was used to identify the combination of parameters associated with subsequent unplanned hospitalization. Results: A total of 31 patients (males: 55\% [17/31]; World Health Organization Performance Status=0: 29\% (9/31); age range: 35-91 years) participated for a median of 58 days (38-313). They received a total of 102 chemotherapy courses (64.7\% as outpatients). Overall full compliance was 59.7\% (522/874), with at least one data available for 830/874 patient-days (95.0\%), during the 30-day per-protocol span. Missing data rates were similar for each parameter. Patients were altogether satisfied with the use of the platform. Ten toxicity-related hospitalizations occurred in 6 patients. The combination of weighted circadian function (actigraphy parameter I<O), body weight change, and MDASI scores predicted for ensuing emergency hospitalization within 3 days, with an accuracy of 94\%. Conclusions: Multidimensional daily telemonitoring of body weight, circadian rest-activity rhythm, and patient-reported symptoms was feasible, satisfactory, and clinically relevant in patients on chemotherapy. This domomedicine platform constitutes a unique tool for the further development of safe home-based chemotherapy administration. ",
doi="10.2196/jmir.6303",
url="http://www.jmir.org/2016/11/e305/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27888171"
}


@Article{info:doi/10.2196/medinform.5728,
author="Lobach, F. David
and Johns, B. Ellis
and Halpenny, Barbara
and Saunders, Toni-Ann
and Brzozowski, Jane
and Del Fiol, Guilherme
and Berry, L. Donna
and Braun, M. Ilana
and Finn, Kathleen
and Wolfe, Joanne
and Abrahm, L. Janet
and Cooley, E. Mary",
title="Increasing Complexity in Rule-Based Clinical Decision Support: The Symptom Assessment and Management Intervention",
journal="JMIR Med Inform",
year="2016",
month="Nov",
day="08",
volume="4",
number="4",
pages="e36",
keywords="rule-based clinical decision support",
keywords="clinical algorithms",
keywords="Web services",
keywords="software as a service",
keywords="symptom management",
keywords="patient-reported outcomes",
keywords="lung cancer",
abstract="Background: Management of uncontrolled symptoms is an important component of quality cancer care. Clinical guidelines are available for optimal symptom management, but are not often integrated into the front lines of care. The use of clinical decision support (CDS) at the point-of-care is an innovative way to incorporate guideline-based symptom management into routine cancer care. Objective: The objective of this study was to develop and evaluate a rule-based CDS system to enable management of multiple symptoms in lung cancer patients at the point-of-care. Methods: This study was conducted in three phases involving a formative evaluation, a system evaluation, and a contextual evaluation of clinical use. In Phase 1, we conducted iterative usability testing of user interface prototypes with patients and health care providers (HCPs) in two thoracic oncology clinics. In Phase 2, we programmed complex algorithms derived from clinical practice guidelines into a rules engine that used Web services to communicate with the end-user application. Unit testing of algorithms was conducted using a stack-traversal tree-spanning methodology to identify all possible permutations of pathways through each algorithm, to validate accuracy. In Phase 3, we evaluated clinical use of the system among patients and HCPs in the two clinics via observations, structured interviews, and questionnaires. Results: In Phase 1, 13 patients and 5 HCPs engaged in two rounds of formative testing, and suggested improvements leading to revisions until overall usability scores met a priori benchmarks. In Phase 2, symptom management algorithms contained between 29 and 1425 decision nodes, resulting in 19 to 3194 unique pathways per algorithm. Unit testing required 240 person-hours, and integration testing required 40 person-hours. In Phase 3, both patients and HCPs found the system usable and acceptable, and offered suggestions for improvements. Conclusions: A rule-based CDS system for complex symptom management was systematically developed and tested. The complexity of the algorithms required extensive development and innovative testing. The Web service-based approach allowed remote access to CDS knowledge, and could enable scaling and sharing of this knowledge to accelerate availability, and reduce duplication of effort. Patients and HCPs found the system to be usable and useful. ",
doi="10.2196/medinform.5728",
url="http://medinform.jmir.org/2016/4/e36/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27826132"
}


@Article{info:doi/10.2196/cancer.5132,
author="Kirkovits, Thomas
and Schinkoethe, Timo
and Drewes, Caroline
and Gehring, Caroline
and Bauerfeind, Ingo
and Harbeck, Nadia
and Wuerstlein, Rachel",
title="eHealth in Modern Patient-Caregiver Communication: High Rate of Acceptance Among Physicians for Additional Support of Breast Cancer Patients During Long-Term Therapy",
journal="JMIR Cancer",
year="2016",
month="Sep",
day="19",
volume="2",
number="2",
pages="e14",
keywords="eHealth",
keywords="mobile health",
keywords="telemedicine",
keywords="physicians",
keywords="acceptance",
keywords="breast cancer",
keywords="patient compliance",
keywords="patient adherence",
abstract="Background: Lack of adherence and compliance with drug regimens among breast cancer patients represent substantial problems in oral therapies, leading to significant impacts on mortality. Where other systems have failed, electronic health (eHealth) could be a possible solution to improve medication intake, along with the doctor-patient relationship. Initial results from studies concerning new interventions for therapy support are promising, but reports suggest that general acceptance of new treatment support tools is needed among patients and physicians alike. Objective: The aim of this study was to investigate the actual use of the Internet and other modern media among physicians involved in breast cancer treatment. Methods: Using a standardized questionnaire, actual utilization of new media among physicians was analyzed. Internet-related behaviors in private, as well as in business life, were investigated. Attention was focused on physicians' opinions regarding modern eHealth tools and how patients could be best supported to enhance adherence. Results: A total of 120 physicians, all participating in breast cancer care, completed the questionnaire (median age 41 years). Almost all participants (99.2\%, 119/120) used the Internet for general purposes and 98.3\% (118/120) used it for medical issues as well. Virtually all medical professionals (99.2\%, 119/120) reported that they owned a computer, while more recently invented technologies such as tablets and smartphones were owned by 31.9\% (38/119) and 73.1\% (87/119), respectively. The Internet was favored by 66.4\% (79/119) of the physicians in our survey as a source for patient support; 71.2\% (84/118) would also favor modern media for side effect registration. Based on our analysis, the most frequent Internet-utilizing physicians were characterized by age <60, worked in a hospital, and were employed as a junior physician. Conclusions: This study demonstrated a high usage of Internet-related technologies among physicians, indicating that the use of eHealth for advanced and individualized support in breast cancer care is a promising addition to treatment management. Such technologies have the potential to enhance adherence and compliance in therapy among cancer patients. ",
doi="10.2196/cancer.5132",
url="http://cancer.jmir.org/2016/2/e14/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410173"
}


@Article{info:doi/10.2196/jmir.6414,
author="Egbring, Marco
and Far, Elmira
and Roos, Malgorzata
and Dietrich, Michael
and Brauchbar, Mathis
and Kullak-Ublick, A. Gerd
and Trojan, Andreas",
title="A Mobile App to Stabilize Daily Functional Activity of Breast Cancer Patients in Collaboration With the Physician: A Randomized Controlled Clinical Trial",
journal="J Med Internet Res",
year="2016",
month="Sep",
day="06",
volume="18",
number="9",
pages="e238",
keywords="collaboration",
keywords="breast cancer",
keywords="mobile app",
keywords="daily functional activity",
keywords="breast neoplasms",
abstract="Background: The well-being of breast cancer patients and reporting of adverse events require close monitoring. Mobile apps allow continuous recording of disease- and medication-related symptoms in patients undergoing chemotherapy. Objective: The aim of the study was to evaluate the effects of a mobile app on patient-reported daily functional activity in a supervised and unsupervised setting. Methods: We conducted a randomized controlled study of 139 breast cancer patients undergoing chemotherapy. Patient status was self-measured using Eastern Cooperative Oncology Group scoring and Common Terminology Criteria for Adverse Events. Participants were randomly assigned to a control group, an unsupervised group that used a mobile app to record data, or a supervised group that used the app and reviewed data with a physician. Primary outcome variables were change in daily functional activity and symptoms over three outpatient visits. Results: Functional activity scores declined in all groups from the first to second visit. However, from the second to third visit, only the supervised group improved, whereas the others continued to decline. Overall, the supervised group showed no significant difference from the first (median 90.85, IQR 30.67) to third visit (median 84.76, IQR 18.29, P=.72). Both app-using groups reported more distinct adverse events in the app than in the questionnaire (supervised: n=1033 vs n=656; unsupervised: n=852 vs n=823), although the unsupervised group reported more symptoms overall (n=4808) in the app than the supervised group (n=4463). Conclusions: The mobile app was associated with stabilized daily functional activity when used under collaborative review. App-using participants could more frequently report adverse events, and those under supervision made fewer and more precise entries than unsupervised participants. Our findings suggest that patient well-being and awareness of chemotherapy adverse effects can be improved by using a mobile app in collaboration with the treating physician. ClinicalTrial: ClinicalTrials.gov NCT02004496; https://clinicaltrials.gov/ct2/show/NCT02004496 (Archived by WebCite at http://www.webcitation.org/6k68FZHo2) ",
doi="10.2196/jmir.6414",
url="http://www.jmir.org/2016/9/e238/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27601354"
}


@Article{info:doi/10.2196/jmir.5975,
author="Kanera, Maria Iris
and Willems, A. Roy
and Bolman, W. Catherine A.
and Mesters, Ilse
and Zambon, Victor
and Gijsen, CM Brigitte
and Lechner, Lilian",
title="Use and Appreciation of a Tailored Self-Management eHealth Intervention for Early Cancer Survivors: Process Evaluation of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2016",
month="Aug",
day="23",
volume="18",
number="8",
pages="e229",
keywords="eHealth",
keywords="web-based intervention",
keywords="computer tailoring",
keywords="cancer survivorship",
keywords="intervention usage",
keywords="appreciation",
keywords="multiple behavior intervention",
keywords="process evaluation",
keywords="self-management",
abstract="Background: A fully automated computer-tailored Web-based self-management intervention, Kanker Nazorg Wijzer (KNW [Cancer Aftercare Guide]), was developed to support early cancer survivors to adequately cope with psychosocial complaints and to promote a healthy lifestyle. The KNW self-management training modules target the following topics: return to work, fatigue, anxiety and depression, relationships, physical activity, diet, and smoking cessation. Participants were guided to relevant modules by personalized module referral advice that was based on participants' current complaints and identified needs. Objective: The aim of this study was to evaluate the adherence to the module referral advice, examine the KNW module use and its predictors, and describe the appreciation of the KNW and its predictors. Additionally, we explored predictors of personal relevance. Methods: This process evaluation was conducted as part of a randomized controlled trial. Early cancer survivors with various types of cancer were recruited from 21 Dutch hospitals. Data from online self-report questionnaires and logging data were analyzed from participants allocated to the intervention condition. Chi-square tests were applied to assess the adherence to the module referral advice, negative binominal regression analysis was used to identify predictors of module use, multiple linear regression analysis was applied to identify predictors of the appreciation, and ordered logistic regression analysis was conducted to explore possible predictors of perceived personal relevance. Results: From the respondents (N=231; mean age 55.6, SD 11.5; 79.2\% female [183/231]), 98.3\% (227/231) were referred to one or more KNW modules (mean 2.9, SD 1.5), and 85.7\% (198/231) of participants visited at least one module (mean 2.1, SD 1.6). Significant positive associations were found between the referral to specific modules (range 1-7) and the use of corresponding modules. The likelihoods of visiting modules were higher when respondents were referred to those modules by the module referral advice. Predictors of visiting a higher number of modules were a higher number of referrals by the module referral advice ($\beta$=.136, P=.009), and having a partner was significantly related with a lower number of modules used ($\beta$=-.256, P=.044). Overall appreciation was high (mean 7.5, SD 1.2; scale 1-10) and was significantly predicted by a higher perceived personal relevance ($\beta$=.623, P=.000). None of the demographic and cancer-related characteristics significantly predicted the perceived personal relevance. Conclusions: The KNW in general and more specifically the KNW modules were well used and highly appreciated by early cancer survivors. Indications were found that the module referral advice might be a meaningful intervention component to guide the users in following a preferred selection of modules. These results indicate that the fully automated Web-based KNW provides personal relevant and valuable information and support for early cancer survivors. Therefore, this intervention can complement usual cancer aftercare and may serve as a first step in a stepped-care approach. Trial Registration: Nederlands Trial Register: NTR3375; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3375 (Archived by WebCite at http://www.webcitation.org/6jo4jO7kb) ",
doi="10.2196/jmir.5975",
url="http://www.jmir.org/2016/8/e229/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27554525"
}


@Article{info:doi/10.2196/jmir.5598,
author="Kim, Junetae
and Lim, Sanghee
and Min, Ha Yul
and Shin, Yong-Wook
and Lee, Byungtae
and Sohn, Guiyun
and Jung, Hae Kyung
and Lee, Jae-Ho
and Son, Ho Byung
and Ahn, Hyun Sei
and Shin, Soo-Yong
and Lee, Won Jong",
title="Depression Screening Using Daily Mental-Health Ratings from a Smartphone Application for Breast Cancer Patients",
journal="J Med Internet Res",
year="2016",
month="Aug",
day="04",
volume="18",
number="8",
pages="e216",
keywords="depression",
keywords="smartphone applications",
keywords="mental health",
keywords="breast cancer (neoplasms)",
abstract="Background: Mobile mental-health trackers are mobile phone apps that gather self-reported mental-health ratings from users. They have received great attention from clinicians as tools to screen for depression in individual patients. While several apps that ask simple questions using face emoticons have been developed, there has been no study examining the validity of their screening performance. Objective: In this study, we (1) evaluate the potential of a mobile mental-health tracker that uses three daily mental-health ratings (sleep satisfaction, mood, and anxiety) as indicators for depression, (2) discuss three approaches to data processing (ratio, average, and frequency) for generating indicator variables, and (3) examine the impact of adherence on reporting using a mobile mental-health tracker and accuracy in depression screening. Methods: We analyzed 5792 sets of daily mental-health ratings collected from 78 breast cancer patients over a 48-week period. Using the Patient Health Questionnaire-9 (PHQ-9) as the measure of true depression status, we conducted a random-effect logistic panel regression and receiver operating characteristic (ROC) analysis to evaluate the screening performance of the mobile mental-health tracker. In addition, we classified patients into two subgroups based on their adherence level (higher adherence and lower adherence) using a k-means clustering algorithm and compared the screening accuracy between the two groups. Results: With the ratio approach, the area under the ROC curve (AUC) is 0.8012, indicating that the performance of depression screening using daily mental-health ratings gathered via mobile mental-health trackers is comparable to the results of PHQ-9 tests. Also, the AUC is significantly higher (P=.002) for the higher adherence group (AUC=0.8524) than for the lower adherence group (AUC=0.7234). This result shows that adherence to self-reporting is associated with a higher accuracy of depression screening. Conclusions: Our results support the potential of a mobile mental-health tracker as a tool for screening for depression in practice. Also, this study provides clinicians with a guideline for generating indicator variables from daily mental-health ratings. Furthermore, our results provide empirical evidence for the critical role of adherence to self-reporting, which represents crucial information for both doctors and patients. ",
doi="10.2196/jmir.5598",
url="http://www.jmir.org/2016/8/e216/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27492880"
}


@Article{info:doi/10.2196/mhealth.5426,
author="Drott, Jenny
and Vilhelmsson, Maria
and Kjellgren, Karin
and Berter{\"o}, Carina",
title="Experiences With a Self-Reported Mobile Phone-Based System Among Patients With Colorectal Cancer: A Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jun",
day="09",
volume="4",
number="2",
pages="e66",
keywords="cancer",
keywords="conventional content analysis",
keywords="informatics technology systems",
keywords="mHealth",
keywords="self-reported mobile phone-based system",
keywords="symptom monitoring",
abstract="Background: In cancer care, mobile phone-based systems are becoming more widely used in the assessment, monitoring, and management of side effects. Objective: To explore the experiences of patients with colorectal cancer on using a mobile phone-based system for reporting neurotoxic side effects. Methods: Eleven patients were interviewed (ages 44-68 years). A semistructured interview guide was used to perform telephone interviews. The interviews were transcribed verbatim and analyzed with qualitative content analysis. Results: The patients' experiences of using a mobile phone-based system were identified and constructed as: ``being involved,'' ``pacing oneself,'' and ``managing the questions.'' ``Being involved'' refers to their individual feelings. Patients were participating in their own care by being observant of the side effects they were experiencing. They were aware that the answers they gave were monitored in real time and taken into account by health care professionals when planning further treatment. ``Pacing oneself'' describes how the patients can have an impact on the time and place they choose to answer the questions. Answering the questionnaire was easy, and despite the substantial number of questions, it was quickly completed. ``Managing the questions'' pointed out that the patients needed to be observant because of the construction of the questions. They could not routinely answer all the questions. Patients understood that side effects can vary during the cycles of treatment and need to be assessed repeatedly during treatment. Conclusions: This mobile phone-based system reinforced the patients' feeling of involvement in their own care. The patients were comfortable with the technology and appreciated that the system was not time consuming. ",
doi="10.2196/mhealth.5426",
url="http://mhealth.jmir.org/2016/2/e66/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27282257"
}


@Article{info:doi/10.2196/cancer.5334,
author="Young-Afat, A. Danny
and van Gils, H. Carla
and Bruinvels, J. David
and van der Pol, C. Carmen
and Witkamp, J. Arjen
and Sijtsema, Sieta
and Jonasse, Yvette
and Bijlsma, M. Rhod{\'e}
and Ausems, G. Margreet
and Bos, M. Annelies
and van den Bongard, H. Desir{\'e}e
and Verkooijen, M. Helena",
title="Patients' and Health Care Providers' Opinions on a Supportive Health App During Breast Cancer Treatment: A Qualitative Evaluation",
journal="JMIR Cancer",
year="2016",
month="Jun",
day="07",
volume="2",
number="1",
pages="e8",
keywords="breast cancer",
keywords="health apps",
keywords="quality of life",
keywords="patient-reported outcomes",
keywords="PROs",
abstract="Background: Health apps are increasingly being used in clinical care and may hold significant theoretical potential. However, they are often implemented in clinical care before any research has been done to confirm actual benefits for patients, physicians, and researchers. Objective: This study aimed to explore experiences of patients and health care providers with the use of a supportive breast cancer app during the first 6 months following diagnosis, in terms of benefits for clinical practice and research purposes. Methods: Between June 2013 and April 2014, breast cancer patients of all ages were invited shortly after diagnosis to use a supportive breast cancer app, and were followed for 6 months. Patients were asked to use the app at their own convenience. In-depth interviews were conducted regularly with patients and their medical team (ie, physicians and nurses) to evaluate their experiences. Results: A total of 15 patients aged 30-63 years participated. The medical team consisted of 7 physicians and 3 specialized breast cancer nurses. Out of the 15 patients, 12 (80\%) used the app to obtain information on breast cancer and treatment. A total of 11 out of 12 patients (92\%) evaluated this information as useful. All 15 patients used the app to record consultations with practitioners, and 14 (93\%) found this useful. Symptom registration was used by 8 out of 15 patients (53\%), and was found useful by 4 out of these 8 patients (50\%). Overall, 14 out of 15 patients (93\%) would recommend the app to other patients. The app, in particular the recording function, was rated as useful by 9 out of 10 medical professionals (90\%), and they reported that it did not increase consultation time. These 9 professionals would recommend the app to their patients. Conclusions: This evaluation of a supportive health app shows positive experiences among patients and their medical teams. Based on experiences in this study, patients may need to be actively encouraged to regularly register symptoms within health apps to generate sufficient patient-reported app data for use in clinical practice and scientific research. ",
doi="10.2196/cancer.5334",
url="http://cancer.jmir.org/2016/1/e8/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410170"
}


@Article{info:doi/10.2196/resprot.4805,
author="Lucchiari, Claudio
and Masiero, Marianna
and Veronesi, Giulia
and Maisonneuve, Patrick
and Spina, Stefania
and Jemos, Costantino
and Omodeo Sal{\`e}, Emanuela
and Pravettoni, Gabriella",
title="Benefits of E-Cigarettes Among Heavy Smokers Undergoing a Lung Cancer Screening Program: Randomized Controlled Trial Protocol",
journal="JMIR Res Protoc",
year="2016",
month="Feb",
day="03",
volume="5",
number="1",
pages="e21",
keywords="tobacco cessation",
keywords="electronic cigarettes",
keywords="lung cancer screening",
keywords="smoking related diseases.",
abstract="Background: Smoking is a global public health problem. For this reason, experts have called smoking dependence a global epidemic. Over the past 5 years, sales of electronic cigarettes, or e-cigarettes, have been growing strongly in many countries. Yet there is only partial evidence that e-cigarettes are beneficial for smoking cessation. In particular, although it has been proven that nicotine replacement devices may help individuals stop smoking and tolerate withdrawal symptoms, e-cigarettes' power to increase the quitting success rate is still limited, ranging from 5\% to 20\% dependent on smokers' baseline conditions as shown by a recent Cochrane review. Consequently, it is urgent to know if e-cigarettes may have a higher success rate than other nicotine replacement methods and under what conditions. Furthermore, the effects of the therapeutic setting and the relationship between individual characteristics and the success rate have not been tested. This protocol is particularly innovative, because it aims to test the effectiveness of electronic devices in a screening program (the COSMOS II lung cancer prevention program at the European Institute of Oncology), where tobacco reduction is needed to lower individuals' lung cancer risks. Objective: This protocol was designed with the primary aim of investigating the role of tobacco-free cigarettes in helping smokers improve lung health and either quit smoking or reduce their tobacco consumption. In particular, we aim to investigate the impact of a 3-month e-cigarettes program to reduce smoking-related respiratory symptoms (eg, dry cough, shortness of breath, mouth irritation, and phlegm) through reduced consumption of tobacco cigarettes. Furthermore, we evaluate the behavioral and psychological (eg, well-being, mood, and quality of life) effects of the treatment. Methods: This is a prospective, randomized, placebo-controlled, double-blind, three-parallel group study. The study is organized as a nested randomized controlled study with 3 branches: a nicotine e-cigarettes group, a nicotine-free e-cigarettes group, and a control group. The study is nested in a screening program for early lung cancer detection in heavy smokers. Results: The study is open and is still recruiting. Conclusions: Stopping or reducing tobacco consumption should be a main goal of any health organization. However, traditional antismoking programs are expensive and not always effective. Therefore, favoring a partial or complete shift to e-cigarettes in heavy smokers (eg, persons at high risk for a number of diseases) could be considered a moral imperative. However, before following this path, sound and reliable data on large samples and in a variety of contexts are required. Trial Registration: Clinicaltrials.gov NCT02422914; https://clinicaltrials.gov/ct2/show/NCT02422914 (Archived by WebCite at http://www.webcitation.org/6etwz1bPL) ",
doi="10.2196/resprot.4805",
url="http://www.researchprotocols.org/2016/1/e21/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26842790"
}


@Article{info:doi/10.2196/resprot.4363,
author="Wolvers, DJ Marije
and Bruggeman-Everts, Z. Fieke
and Van der Lee, L. Marije
and Van de Schoot, Rens
and Vollenbroek-Hutten, MR Miriam",
title="Effectiveness, Mediators, and Effect Predictors of Internet Interventions for Chronic Cancer-Related Fatigue: The Design and an Analysis Plan of a 3-Armed Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2015",
month="Jun",
day="23",
volume="4",
number="2",
pages="e77",
keywords="fatigue",
keywords="cancer survivors",
keywords="chronic disease",
keywords="Internet interventions",
keywords="mindfulness-based cognitive therapy",
keywords="motor activity",
keywords="behavior therapy",
keywords="accelerometry",
keywords="effect predictors",
keywords="mediation",
keywords="Bayesian statistics",
keywords="latent growth analysis",
abstract="Background: Internet interventions offer advantages that especially cancer survivors who suffer from fatigue could benefit from. Given the growing number of such patients, Internet interventions could supplement and strengthen currently available health care. Objective: This paper describes the design and analysis plan that will be used to study 2 Internet interventions aimed at reducing severe fatigue in cancer survivors: a mobile ambulant activity feedback therapy supported through a weekly email by a physiotherapist and a weekly Web- and mindfulness-based cognitive therapy supported online by a psychologist. The data resulting from this trial will be used to (1) investigate the effectiveness, (2) investigate potential mediators of these interventions, and (3) explore participant characteristics that can predict the effect of these interventions. Methods: A 3-armed randomized controlled trial is proposed that compares both Internet interventions with an active control condition that solely consists of receiving psycho-educational emails. The intervention period is 9 weeks for all 3 conditions. Six months after baseline, participants in the control condition can choose to follow 1 of the 2 experimental Internet interventions. Outcomes are measured in terms of fatigue severity, mental health, and self-perceived work ability. All are Web-assessed at baseline, 2 weeks after the intervention period, and at 6 and 12 months after baseline. Fatigue severity, mindfulness, physical activity, expectations and credibility of the intervention, therapeutic working alliance, sleep quality, and sense of control over fatigue are assessed 3 times during the intervention period for identifying mediators of the interventions. Recruitment is performed nationally throughout the Netherlands through patient organizations and their websites, newspapers, and by informing various types of health professionals. All participants register at an open-access website. We aim at including 330 cancer survivors who have finished curative-intent cancer treatment at least 3 months previously, and have been suffering from severe fatigue ever since. All cancer types are included. A detailed analysis plan is described to address the research questions, which allows for individual variation, and fully exploits the longitudinal design. Results: Recruitment started in April 2013 and will proceed until April 2015. Conclusions: This paper describes a systematic trial design for studying 2 different interventions for chronic cancer-related fatigue in order to gain insight into the effectiveness and mediators of the interventions. This design will also be used to identify predictors for the interventions' effect on fatigue. By publishing our hypotheses and analysis plan before completion of data collection, this paper is a first step in reporting on this trial comprehensively. Trial Registration: The Netherlands National Trial Register (NTR3483). (Archived by WebCite at http://www.webcitation.org/6NWZqon3o). ",
doi="10.2196/resprot.4363",
url="http://www.researchprotocols.org/2015/2/e77/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26104114"
}


@Article{info:doi/10.2196/jmir.4190,
author="Berry, L. Donna
and Blonquist, M. Traci
and Patel, A. Rupa
and Halpenny, Barbara
and McReynolds, Justin",
title="Exposure to a Patient-Centered, Web-Based Intervention for Managing Cancer Symptom and Quality of Life Issues: Impact on Symptom Distress",
journal="J Med Internet Res",
year="2015",
month="Jun",
day="03",
volume="17",
number="6",
pages="e136",
keywords="patient-centered technology",
keywords="cancer",
keywords="symptoms",
keywords="quality of life",
keywords="eHealth",
keywords="Internet",
abstract="Background: Effective eHealth interventions can benefit a large number of patients with content intended to support self-care and management of both chronic and acute conditions. Even though usage statistics are easily logged in most eHealth interventions, usage or exposure has rarely been reported in trials, let alone studied in relationship to effectiveness. Objective: The intent of the study was to evaluate use of a fully automated, Web-based program, the Electronic Self Report Assessment-Cancer (ESRA-C), and how delivery and total use of the intervention may have affected cancer symptom distress. Methods: Patients at two cancer centers used ESRA-C to self-report symptom and quality of life (SxQOL) issues during therapy. Participants were randomized to ESRA-C assessment only (control) or the ESRA-C intervention delivered via the Internet to patients' homes or to a tablet at the clinic. The intervention enabled participants to self-monitor SxQOL and receive self-care education and customized coaching on how to report concerns to clinicians. Overall and voluntary intervention use were defined as having ?2 exposures, and one non-prompted exposure to the intervention, respectively. Factors associated with intervention use were explored with Fisher's exact test. Propensity score matching was used to select a sample of control participants similar to intervention participants who used the intervention. Analysis of covariance (ANCOVA) was used to compare change in Symptom Distress Scale (SDS-15) scores from pre-treatment to end-of-study by groups in the matched sample. Results: Radiation oncology participants used the intervention, overall and voluntarily, more than medical oncology and transplant participants. Participants who were working and had more than a high school education voluntarily used the intervention more. The SDS-15 score was reduced by an estimated 1.53 points (P=.01) in the intervention group users compared to the matched control group. Conclusions: The intended effects of a Web-based, patient-centered intervention on cancer symptom distress were modified by intervention use frequency. Clinical and personal demographics influenced voluntary use. Trial Registration: Clinicaltrials.gov NCT00852852; http://clinicaltrials.gov/ct2/show/NCT00852852 (Archived by WebCite at http://www.webcitation.org/6YwAfwWl7). ",
doi="10.2196/jmir.4190",
url="http://www.jmir.org/2015/6/e136/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26041682"
}


@Article{info:doi/10.2196/jmir.3884,
author="Baudendistel, Ines
and Winkler, Eva
and Kamradt, Martina
and L{\"a}ngst, Gerda
and Eckrich, Felicitas
and Heinze, Oliver
and Bergh, Bjoern
and Szecsenyi, Joachim
and Ose, Dominik",
title="Personal Electronic Health Records: Understanding User Requirements and Needs in Chronic Cancer Care",
journal="J Med Internet Res",
year="2015",
month="May",
day="21",
volume="17",
number="5",
pages="e121",
keywords="personal electronic health record",
keywords="user requirements",
keywords="functions",
keywords="colorectal cancer",
keywords="chronic care",
abstract="Background: The integration of new information and communication technologies (ICTs) is becoming increasingly important in reorganizing health care. Adapting ICTs as supportive tools to users' needs and daily practices is vital for adoption and use. Objective: In order to develop a Web-based personal electronic health record (PEPA), we explored user requirements and needs with regard to desired information and functions. Methods: A qualitative study across health care sectors and health professions was conducted in a regional health care setting in Germany. Overall, 10 semistructured focus groups were performed, collecting views of 3 prospective user groups: patients with colorectal cancer (n=12) and representatives from patient support groups (n=2), physicians (n=17), and non-medical HCPs (n=16). Data were audio- and videotaped, transcribed verbatim, and thematically analyzed using qualitative content analysis. Results: For both patients and HCPs, it was central to have a tool representing the chronology of illness and its care processes, for example, patients wanted to track their long-term laboratory findings (eg, tumor markers). Designing health information in a patient accessible way was highlighted as important. Users wanted to have general and tumor-specific health information available in a PEPA. Functions such as filtering information and adding information by patients (eg, on their well-being or electronic communication with HCPs via email) were discussed. Conclusions: In order to develop a patient/user centered tool that is tailored to user needs, it is essential to address their perspectives. A challenge for implementation will be how to design PEPA's health data in a patient accessible way. Adequate patient support and technical advice for users have to be addressed. ",
doi="10.2196/jmir.3884",
url="http://www.jmir.org/2015/5/e121/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25998006"
}


@Article{info:doi/10.2196/jmir.3743,
author="Galligioni, Enzo
and Piras, Maria Enrico
and Galvagni, Michele
and Eccher, Claudio
and Caramatti, Silvia
and Zanolli, Daniela
and Santi, Jonni
and Berloffa, Flavio
and Dianti, Marco
and Maines, Francesca
and Sannicol{\`o}, Mirella
and Sandri, Marco
and Bragantini, Lara
and Ferro, Antonella
and Forti, Stefano",
title="Integrating mHealth in Oncology: Experience in the Province of Trento",
journal="J Med Internet Res",
year="2015",
month="May",
day="13",
volume="17",
number="5",
pages="e114",
keywords="health informatics",
keywords="mobile health",
keywords="home monitoring",
keywords="supportive care",
keywords="patient safety",
keywords="safe chemotherapy",
abstract="Background: The potential benefits of the introduction of electronic and mobile health (mHealth) information technologies, to support the safe delivery of intravenous chemotherapy or oral anticancer therapies, could be exponential in the context of a highly integrated computerized system. Objective: Here we describe a safe therapy mobile (STM) system for the safe delivery of intravenous chemotherapy, and a home monitoring system for monitoring and managing toxicity and improving adherence in patients receiving oral anticancer therapies at home. Methods: The STM system is fully integrated with the electronic oncological patient record. After the prescription of chemotherapy, specific barcodes are automatically associated with the patient and each drug, and a bedside barcode reader checks the patient, nurse, infusion bag, and drug sequence in order to trace the entire administration process, which is then entered in the patient's record. The usability and acceptability of the system was investigated by means of a modified questionnaire administered to nurses. The home monitoring system consists of a mobile phone or tablet diary app, which allows patients to record their state of health, the medications taken, their side effects, and a Web dashboard that allows health professionals to check the patient data and monitor toxicity and treatment adherence. A built-in rule-based alarm module notifies health care professionals of critical conditions. Initially developed for chronic patients, the system has been subsequently customized in order to monitor home treatments with capecitabine or sunitinib in cancer patients (Onco-TreC). Results: The STM system never failed to match the patient/nurse/drug sequence association correctly, and proved to be accurate and reliable in tracing and recording the entire administration process. The questionnaires revealed that the users were generally satisfied and had a positive perception of the system's usefulness and ease of use, and the quality of their working lives. The pilot studies with the home monitoring system with 43 chronic patients have shown that the approach is reliable and useful for clinicians and patients, but it is also necessary to pay attention to the expectations that mHealth solutions may raise in users. The Onco-TreC version has been successfully laboratory tested, and is now ready for validation. Conclusions: The STM and Onco-TreC systems are fully integrated with our complex and composite information system, which guarantees privacy, security, interoperability, and real-time communications between patients and health professionals. They need to be validated in order to confirm their positive contribution to the safer administration of anticancer drugs. ",
doi="10.2196/jmir.3743",
url="http://www.jmir.org/2015/5/e114/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25972226"
}


@Article{info:doi/10.2196/resprot.4251,
author="Gorini, Alessandra
and Marzorati, Chiara
and Casiraghi, Monica
and Spaggiari, Lorenzo
and Pravettoni, Gabriella",
title="A Neurofeedback-Based Intervention to Reduce Post-Operative Pain in Lung Cancer Patients: Study Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2015",
month="May",
day="04",
volume="4",
number="2",
pages="e52",
keywords="acute post-surgical pain",
keywords="lung cancer",
keywords="neurofeedback",
keywords="relaxation",
keywords="video games",
keywords="virtual environments",
abstract="Background: Thoracic surgery appears to be the treatment of choice for many lung cancers. Nevertheless, depending on the type of surgery, the chest area may be painful for several weeks to months after surgery. This painful state has multiple physical and psychological implications, including respiratory failure, inability to clear secretions by coughing, and even anxiety and depression that have negative effects on recovery. Objective: The aim of this study is to evaluate the effect of a neurofeedback-based intervention on controlling acute post-surgery pain and improving long-term recovery in patients who undergo thoracotomy for lung resection for non-small cell lung cancer (NSCLC) at an academic oncologic hospital. Methods: This study will be based on a 2-parallel group randomized controlled trial design, intervention versus usual care, with multiple in-hospital assessments and 2 clinical, radiological, and quality of life follow-ups. Participants will be randomized to either the intervention group receiving a neurofeedback-based relaxation training and usual care, or to a control group receiving only usual care. Pain intensity is the primary outcome and will be assessed using the Numeric Pain Rating Scale (NRS) in the days following the operation. Secondary outcomes will include the effect of the intervention on hospital utilization for pain crisis, daily opioid consumption, anxiety, patient engagement, blood test and chest x-ray results, and long-term clinical, radiological, and quality of life evaluations. Outcome measures will be repeatedly taken during hospitalization, while follow-up assessments will coincide with the follow-up visits. Pain intensity will be assessed by mixed model repeated analysis. Effect sizes will be calculated as mean group differences with standard deviations. Results: We expect to have results for this study before the end of 2016. Conclusions: The proposed innovative, neurofeedback- and relaxation-based approach to support post-surgery pain management could lead to significant improvements in patient short and long-term outcomes. ",
doi="10.2196/resprot.4251",
url="http://www.researchprotocols.org/2015/2/e52/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25940965"
}


@Article{info:doi/10.2196/cancer.3887,
author="Carter, Wendy
and Fergus, Karen
and Ahmad, Saunia
and McLeod, Deborah
and Stephen, Joanne",
title="Defining the Role of the Online Therapeutic Facilitator: Principles and Guidelines Developed for Couplelinks, an Online Support Program for Couples Affected by Breast Cancer",
journal="JMIR Cancer",
year="2015",
month="Apr",
day="14",
volume="1",
number="1",
pages="e4",
keywords="couples",
keywords="cancer",
keywords="Internet",
keywords="online therapist",
keywords="psychosocial support",
keywords="therapeutic alliance",
doi="10.2196/cancer.3887",
url="http://cancer.jmir.org/2015/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410159"
}


@Article{info:doi/10.2196/cancer.4019,
author="Kim, Matthew",
title="Evaluation of a Web-Based App Demonstrating an Exclusionary Algorithmic Approach to TNM Cancer Staging",
journal="JMIR Cancer",
year="2015",
month="Apr",
day="02",
volume="1",
number="1",
pages="e3",
keywords="TNM staging",
keywords="neoplasms",
keywords="medical oncology",
keywords="instructional technology",
abstract="Background: TNM staging plays a critical role in the evaluation and management of a range of different types of cancers. The conventional combinatorial approach to the determination of an anatomic stage relies on the identification of distinct tumor (T), node (N), and metastasis (M) classifications to generate a TNM grouping. This process is inherently inefficient due to the need for scrupulous review of the criteria specified for each classification to ensure accurate assignment. An exclusionary approach to TNM staging based on sequential constraint of options may serve to minimize the number of classifications that need to be reviewed to accurately determine an anatomic stage. Objective: Our aim was to evaluate the usability and utility of a Web-based app configured to demonstrate an exclusionary approach to TNM staging. Methods: Internal medicine residents, surgery residents, and oncology fellows engaged in clinical training were asked to evaluate a Web-based app developed as an instructional aid incorporating (1) an exclusionary algorithm that polls tabulated classifications and sorts them into ranked order based on frequency counts, (2) reconfiguration of classification criteria to generate disambiguated yes/no questions that function as selection and exclusion prompts, and (3) a selectable grid of TNM groupings that provides dynamic graphic demonstration of the effects of sequentially selecting or excluding specific classifications. Subjects were asked to evaluate the performance of this app after completing exercises simulating the staging of different types of cancers encountered during training. Results: Survey responses indicated high levels of agreement with statements supporting the usability and utility of this app. Subjects reported that its user interface provided a clear display with intuitive controls and that the exclusionary approach to TNM staging it demonstrated represented an efficient process of assignment that helped to clarify distinctions between tumor, node, and metastasis classifications. High overall usefulness ratings were bolstered by supplementary comments suggesting that this app might be readily adopted for use in clinical practice. Conclusions: A Web-based app that utilizes an exclusionary algorithm to prompt the assignment of tumor, node, and metastasis classifications may serve as an effective instructional aid demonstrating an efficient and informative approach to TNM staging. ",
doi="10.2196/cancer.4019",
url="http://cancer.jmir.org/2015/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410163"
}


@Article{info:doi/10.2196/jmir.4009,
author="Agboola, O. Stephen
and Ju, Woong
and Elfiky, Aymen
and Kvedar, C. Joseph
and Jethwani, Kamal",
title="The Effect of Technology-Based Interventions on Pain, Depression, and Quality of Life in Patients With Cancer: A Systematic Review of Randomized Controlled Trials",
journal="J Med Internet Res",
year="2015",
month="Mar",
day="13",
volume="17",
number="3",
pages="e65",
keywords="telehealth",
keywords="connected health",
keywords="cancer",
keywords="telephone",
keywords="pain",
keywords="depression",
keywords="quality of life",
keywords="systematic review",
keywords="randomized controlled trials",
abstract="Background: The burden of cancer is increasing; projections over the next 2 decades suggest that the annual cases of cancer will rise from 14 million in 2012 to 22 million. However, cancer patients in the 21st century are living longer due to the availability of novel therapeutic regimens, which has prompted a growing focus on maintaining patients' health-related quality of life. Telehealth is increasingly being used to connect with patients outside of traditional clinical settings, and early work has shown its importance in improving quality of life and other clinical outcomes in cancer care. Objective: The aim of this study was to systematically assess the literature for the effect of supportive telehealth interventions on pain, depression, and quality of life in cancer patients via a systematic review of clinical trials. Methods: We searched PubMed, EMBASE, Google Scholar, CINAHL, and PsycINFO in July 2013 and updated the literature search again in January 2015 for prospective randomized trials evaluating the effect of telehealth interventions in cancer care with pain, depression, and quality of life as main outcomes. Two of the authors independently reviewed and extracted data from eligible randomized controlled trials, based on pre-determined selection criteria. Methodological quality of studies was assessed by the Cochrane Collaboration risk of bias tool. Results: Of the 4929 articles retrieved from databases and relevant bibliographies, a total of 20 RCTs were included in the final review. The studies were largely heterogeneous in the type and duration of the intervention as well as in outcome assessments. A majority of the studies were telephone-based interventions that remotely connected patients with their health care provider or health coach. The intervention times ranged from 1 week to 12 months. In general, most of the studies had low risk of bias across the domains of the Cochrane Collaboration risk of bias tool, but most of the studies had insufficient information about the allocation concealment domain. Two of the three studies focused on pain control reported significant effects of the intervention; four of the nine studies focus on depression reported significant effects, while only the studies that were focused on quality of life reported significant effects. Conclusions: This systematic review demonstrates the potential of telehealth interventions in improving outcomes in cancer care. However, more high-quality large-sized trials are needed to demonstrate cogent evidence of its effectiveness. ",
doi="10.2196/jmir.4009",
url="http://www.jmir.org/2015/3/e65/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25793945"
}


@Article{info:doi/10.2196/resprot.3407,
author="Stienen, JC Jozette
and Ottevanger, B. Petronella
and Wennekes, Lianne
and Dekker, M. Helena
and van der Maazen, WM Richard
and Mandigers, MPW Caroline
and van Krieken, HJM Johan
and Blijlevens, MA Nicole
and Hermens, PMG Rosella",
title="Development and Evaluation of an Educational E-Tool to Help Patients With Non-Hodgkin's Lymphoma Manage Their Personal Care Pathway",
journal="JMIR Res Protoc",
year="2015",
month="Jan",
day="09",
volume="4",
number="1",
pages="e6",
keywords="eHealth",
keywords="personalized care",
keywords="non-Hodgkin's lymphoma",
keywords="patient education",
keywords="care pathway",
keywords="consumer health information",
keywords="empowerment",
keywords="personal care management",
abstract="Background: An overload of health-related information is available for patients on numerous websites, guidelines, and information leaflets. However, the increasing need for personalized health-related information is currently unmet. Objective: This study evaluates an educational e-tool for patients with non-Hodgkin's lymphoma (NHL) designed to meet patient needs with respect to personalized and complete health-related information provision. The e-tool aims to help NHL patients manage and understand their personal care pathway, by providing them with insight into their own care pathway, the possibility to keep a diary, and structured health-related information. Methods: Together with a multidisciplinary NHL expert panel, we developed an e-tool consisting of two sections: (1) a personal section for patients' own care pathway and their experiences, and (2) an informative section including information on NHL. We developed an ideal NHL care pathway based on the available (inter)national guidelines. The ideal care pathway, including date of first consultation, diagnosis, and therapy start, was used to set up the personal care pathway. The informative section was developed in collaboration with the patient association, Hematon. Regarding participants, 14 patients and 6 laymen were asked to evaluate the e-tool. The 24-item questionnaire used discussed issues concerning layout (6 questions), user convenience (3 questions), menu clarity (3 questions), information clarity (5 questions), and general impression (7 questions). In addition, the panel members were asked to give their feedback by email. Results: A comprehensive overview of diagnostics, treatments, and aftercare can be established by patients completing the questions from the personal section. The informative section consisted of NHL information regarding NHL in general, diagnostics, therapy, aftercare, and waiting times. Regarding participants, 6 patients and 6 laymen completed the questionnaire. Overall, the feedback was positive, with at least 75\% satisfaction on each feedback item. Important strengths mentioned were the use of a low health-literacy level, the opportunity to document the personal care pathway and experiences, and the clear overview of the information provided. The added value of the e-tool in general was pointed out as very useful for preparing the consultation with one's doctor and for providing all information on one website, including the opportunity for a personalized care pathway and diary. The majority of the revisions concerned wording and clarity. In addition, more explicit information on immunotherapy, experimental therapy, and psychosocial support was added. Conclusions: We have developed a personal care management e-tool for NHL patients. This tool contains a unique way to help patients manage their personal care pathway and give them insight into their NHL by providing health-related information and a personal diary. This evaluation showed that our e-tool meets patients' needs concerning personalized health-related information, which might serve as a good example for other oncologic diseases. Future research should focus on the possible impact of the e-tool on doctor-patient communication during consultations. ",
doi="10.2196/resprot.3407",
url="http://www.researchprotocols.org/2015/1/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25575019"
}