@Article{info:doi/10.2196/12547, author="Psihogios, M. Alexandra and Li, Yimei and Butler, Eliana and Hamilton, Jessica and Daniel, C. Lauren and Barakat, P. Lamia and Bonafide, P. Christopher and Schwartz, A. Lisa", title="Text Message Responsivity in a 2-Way Short Message Service Pilot Intervention With Adolescent and Young Adult Survivors of Cancer", journal="JMIR Mhealth Uhealth", year="2019", month="Apr", day="18", volume="7", number="4", pages="e12547", keywords="mHealth", keywords="adolescents", keywords="young adults", keywords="cancer", keywords="chronic illness", keywords="self-management", abstract="Objective: Within a 2-way text messaging study in AYAs who recently completed treatment for cancer, we sought to evaluate text message responsivity across different types of text messages. Methods: AYAs who recently completed treatment for cancer (n=26; mean age=16 years; 62\% female, 16/26 participants) received 2-way text messages about survivorship health topics over a 16-week period. Using participants' text message log data, we coded responsivity to text messages and evaluated trends in responsivity to unprompted text messages and prompted text messages of varying content (eg, medication reminders, appointment reminders, and texts about personal experiences as a cancer survivor). Results: Across prompted and unprompted text messages, responsivity rapidly decreased (P ?.001 and =.01, respectively) and plateaued by the third week of the intervention. However, participants were more responsive to prompted text messages (mean responsivity=46\% by week 16) than unprompted messages (mean responsivity=10\% by week 16). They also demonstrated stable responsivity to certain prompted content: medication reminders, appointment reminders, goal motivation, goal progress, and patient experience texts. Conclusions: Our methodology of evaluating text message responsivity revealed important patterns of engagement in a 2-way text message intervention for AYA cancer survivors. ", doi="10.2196/12547", url="http://mhealth.jmir.org/2019/4/e12547/", url="http://www.ncbi.nlm.nih.gov/pubmed/30998225" } @Article{info:doi/10.2196/10918, author="Roberts, L. Anna and Potts, WW Henry and Koutoukidis, A. Dimitrios and Smith, Lee and Fisher, Abigail", title="Breast, Prostate, and Colorectal Cancer Survivors' Experiences of Using Publicly Available Physical Activity Mobile Apps: Qualitative Study", journal="JMIR Mhealth Uhealth", year="2019", month="Jan", day="04", volume="7", number="1", pages="e10918", keywords="physical activity", keywords="health behavior", keywords="cancer survivors", keywords="mobile apps", keywords="mHealth", keywords="digital health", abstract="Background: Physical activity (PA) can improve a range of outcomes following a cancer diagnosis. These include an improvement in experience of side effects of treatment (eg, fatigue) and management of comorbid conditions. PA might also increase survival and reduce recurrence. Digital interventions have shown potential for PA promotion among cancer survivors, but most in a previous review were Web-based, and few studies used mobile apps. There are many PA apps available for general public use, but it is unclear whether these are suitable as a PA intervention after a cancer diagnosis. Objective: This study sought posttreatment nonmetastatic breast, prostate, and colorectal cancer survivors' opinions of using smartphone apps to promote PA and gathered their views on existing publicly available PA apps to inform a future intervention. Methods: Each participant was randomly assigned to download 2 of 4 apps (Human, The Walk, The Johnson \& Johnson Official 7 Minute Workout, and Gorilla Workout). Participants used each app for 1 week consecutively. In-depth semistructured telephone interviews were then conducted to understand participants' experiences of using the apps and how app-based PA interventions could be developed for cancer survivors. The interviews were analyzed using thematic analysis. Results: Thirty-two participants took part: 50\% (16/32) had prostate cancer, 25\% (8/32) had breast cancer, and 25\% (8/32) had colorectal cancer. Three core themes were identified. The first theme was that multiple factors affect engagement with PA apps and this is highly personalized. Factors affecting engagement included participants' perceptions of (1) the advantages and disadvantages of using apps to support PA, (2) the relevance of the app to the user (eg, in terms of cancer-related factors, their PA goals, the difficulty level of the app, the way in which they interact with their mobile phone, and the extent to which the app fits with their self-identity), (3) the quality of the app (eg, usability, accuracy, quality of production, and scientific evidence-base), and (4) the behavior change techniques used to promote PA. In the second theme, participants recommended that apps that promote walking are most appealing, as walking removes many barriers to PA. Finally, the participants suggested that PA apps should be integrated into cancer care, as they valued guidance and recommendations from health care professionals. Conclusions: This sample of breast, prostate, and colorectal cancer survivors was receptive to the use of apps to promote PA. Although no publicly available PA app was deemed wholly suitable, many suggestions for adaptation and intervention development were provided. The results can inform the development of an app-based PA intervention for cancer survivors. They also highlight the wide-ranging and dynamic influences on engagement with digital interventions, which can be applied to other evaluations of mobile health products in other health conditions and other health behaviors. ", doi="10.2196/10918", url="http://mhealth.jmir.org/2019/1/e10918/", url="http://www.ncbi.nlm.nih.gov/pubmed/30609982" } @Article{info:doi/10.2196/formative.9954, author="B{\o}r{\o}sund, Elin and Mirkovic, Jelena and Clark, M. Matthew and Ehlers, L. Shawna and Andrykowski, A. Michael and Bergland, Anne and Westeng, Marianne and Solberg Nes, Lise", title="A Stress Management App Intervention for Cancer Survivors: Design, Development, and Usability Testing", journal="JMIR Formativ Res", year="2018", month="Sep", day="06", volume="2", number="2", pages="e19", keywords="stress management", keywords="mindfulness", keywords="cancer", keywords="eHealth", keywords="mHealth", keywords="mobile apps", keywords="development", keywords="usability", keywords="user-centered design", keywords="mobile phones", abstract="Background: Distress is prevalent in cancer survivors. Stress management interventions can reduce distress and improve quality of life for cancer patients, but many people with cancer are unfortunately not offered or able to attend such in-person stress management interventions. Objective: The objective of this study was to develop an evidence-based stress management intervention for patients living with cancer that can be delivered electronically with wide reach and dissemination. This paper describes the design and development process of a technology-based stress management intervention for cancer survivors, including the exploration phase, intervention content development, iterative software development (including design, development, and formative evaluation of low- and high-level prototypes), and security and privacy considerations. Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=48). In the exploration phase, identifying needs and requirements for the intervention, 28 participants gave input, including male and female cancer survivors (n=11) representing a wide age range (31-81 years) and cancer diagnoses, healthcare providers (n=8) including psychosocial oncology experts, and eHealth experts (n=9) including information technology design and developers. To ensure user involvement in each phase various user-centered design and service design methods were included, such as interviews, usability testing, and think aloud processes. Overall, participants were involved usability testing in the software development and formative evaluation phase, including cancer survivors (n=6), healthy volunteers (n=7), health care providers (n=2), and eHealth experts (n=5). Intervention content was developed by stress management experts based on well-known cognitive behavioral stress management strategies and adjusted to electronic format through multiple iterations with stakeholders. Privacy and security issues were considered throughout. Results: The design and development process identified a variety of stakeholder requirements. Cancer survivors preferred stress management through a mobile app rather than through a personal computer (PC) and identified usefulness, easy access, user friendliness, use of easily understandable language, and many brief sections rather than longer ones as important components of the intervention. These requirements were also supported by recommendations from health care providers and eHealth experts. The final intervention was named StressProffen and the hospital Privacy and Security Protection Committee was part of the final intervention approval to also ensure anchoring in the hospital organization. Conclusions: Interventions, even evidence-based, have little impact if not actively used. This study illustrates how user-centered design and service design can be applied to identify and incorporate essential stakeholder aspects in the entire design and development process. In combination with evidence-based concepts, this process facilitated development of a stress management intervention truly designed for the end users, in this case, cancer survivors. Trial Registration: ClinicalTrials.gov NCT02939612; https://clinicaltrials.gov/ct2/show/NCT02939612 (Archived at WebCite at http://www.webcitation.org/71l9HcfcB) ", doi="10.2196/formative.9954", url="http://formative.jmir.org/2018/2/e19/", url="http://www.ncbi.nlm.nih.gov/pubmed/30684438" } @Article{info:doi/10.2196/cancer.9050, author="McRoy, Susan and Rastegar-Mojarad, Majid and Wang, Yanshan and Ruddy, J. Kathryn and Haddad, C. Tufia and Liu, Hongfang", title="Assessing Unmet Information Needs of Breast Cancer Survivors: Exploratory Study of Online Health Forums Using Text Classification and Retrieval", journal="JMIR Cancer", year="2018", month="May", day="15", volume="4", number="1", pages="e10", keywords="online health forum", keywords="automated content analysis", keywords="text retrieval", keywords="text classification", abstract="Background: Patient education materials given to breast cancer survivors may not be a good fit for their information needs. Needs may change over time, be forgotten, or be misreported, for a variety of reasons. An automated content analysis of survivors' postings to online health forums can identify expressed information needs over a span of time and be repeated regularly at low cost. Identifying these unmet needs can guide improvements to existing education materials and the creation of new resources. Objective: The primary goals of this project are to assess the unmet information needs of breast cancer survivors from their own perspectives and to identify gaps between information needs and current education materials. Methods: This approach employs computational methods for content modeling and supervised text classification to data from online health forums to identify explicit and implicit requests for health-related information. Potential gaps between needs and education materials are identified using techniques from information retrieval. Results: We provide a new taxonomy for the classification of sentences in online health forum data. 260 postings from two online health forums were selected, yielding 4179 sentences for coding. After annotation of data and training alternative one-versus-others classifiers, a random forest-based approach achieved F1 scores from 66\% (Other, dataset2) to 90\% (Medical, dataset1) on the primary information types. 136 expressions of need were used to generate queries to indexed education materials. Upon examination of the best two pages retrieved for each query, 12\% (17/136) of queries were found to have relevant content by all coders, and 33\% (45/136) were judged to have relevant content by at least one. Conclusions: Text from online health forums can be analyzed effectively using automated methods. Our analysis confirms that breast cancer survivors have many information needs that are not covered by the written documents they typically receive, as our results suggest that at most a third of breast cancer survivors' questions would be addressed by the materials currently provided to them. ", doi="10.2196/cancer.9050", url="http://cancer.jmir.org/2018/1/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/29764801" } @Article{info:doi/10.2196/mhealth.9669, author="Lozano-Lozano, Mario and Galiano-Castillo, Noelia and Mart{\'i}n-Mart{\'i}n, Lydia and Pace-Bedetti, Nicol{\'a}s and Fern{\'a}ndez-Lao, Carolina and Arroyo-Morales, Manuel and Cantarero-Villanueva, Irene", title="Monitoring Energy Balance in Breast Cancer Survivors Using a Mobile App: Reliability Study", journal="JMIR Mhealth Uhealth", year="2018", month="Mar", day="27", volume="6", number="3", pages="e67", keywords="telemedicine", keywords="breast neoplasms", keywords="survivors", keywords="life style", keywords="exercise", keywords="diet", keywords="mhealth", abstract="Background: The majority of breast cancer survivors do not meet recommendations in terms of diet and physical activity. To address this problem, we developed a mobile health (mHealth) app for assessing and monitoring healthy lifestyles in breast cancer survivors, called the Energy Balance on Cancer (BENECA) mHealth system. The BENECA mHealth system is a novel and interactive mHealth app, which allows breast cancer survivors to engage themselves in their energy balance monitoring. BENECA was designed to facilitate adherence to healthy lifestyles in an easy and intuitive way. Objective: The objective of the study was to assess the concurrent validity and test-retest reliability between the BENECA mHealth system and the gold standard assessment methods for diet and physical activity. Methods: A reliability study was conducted with 20 breast cancer survivors. In the study, tri-axial accelerometers (ActiGraphGT3X+) were used as gold standard for 8 consecutive days, in addition to 2, 24-hour dietary recalls, 4 dietary records, and sociodemographic questionnaires. Two-way random effect intraclass correlation coefficients, a linear regression-analysis, and a Passing-Bablok regression were calculated. Results: The reliability estimates were very high for all variables (alpha?.90). The lowest reliability was found in fruit and vegetable intakes (alpha=.94). The reliability between the accelerometer and the dietary assessment instruments against the BENECA system was very high (intraclass correlation coefficient=.90). We found a mean match rate of 93.51\% between instruments and a mean phantom rate of 3.35\%. The Passing-Bablok regression analysis did not show considerable bias in fat percentage, portions of fruits and vegetables, or minutes of moderate to vigorous physical activity. Conclusions: The BENECA mHealth app could be a new tool to measure energy balance in breast cancer survivors in a reliable and simple way. Our results support the use of this technology to not only to encourage changes in breast cancer survivors' lifestyles, but also to remotely monitor energy balance. Trial Registration: ClinicalTrials.gov NCT02817724; https://clinicaltrials.gov/ct2/show/NCT02817724 (Archived by WebCite at http://www.webcitation.org/6xVY1buCc) ", doi="10.2196/mhealth.9669", url="http://mhealth.jmir.org/2018/3/e67/", url="http://www.ncbi.nlm.nih.gov/pubmed/29588273" } @Article{info:doi/10.2196/resprot.9118, author="Song, Lixin and Dunlap, L. Kaitlyn and Tan, Xianming and Chen, C. Ronald and Nielsen, E. Matthew and Rabenberg, L. Rebecca and Asafu-Adjei, K. Josephine and Koontz, F. Bridget and Birken, A. Sarah and Northouse, L. Laurel and Mayer, K. Deborah", title="Enhancing Survivorship Care Planning for Patients With Localized Prostate Cancer Using a Couple-Focused mHealth Symptom Self-Management Program: Protocol for a Feasibility Study", journal="JMIR Res Protoc", year="2018", month="Feb", day="26", volume="7", number="2", pages="e51", keywords="survivorship", keywords="prostate cancer", keywords="symptom, randomized trial", keywords="mHealth", keywords="caregiver", keywords="Patient Reported Outcome Measures", abstract="Background: This project explores a new model of care that enhances survivorship care planning and promotes health for men with localized prostate cancer transitioning to posttreatment self-management. Survivorship care planning is important for patients with prostate cancer because of its high incidence rate in the United States, the frequent occurrence of treatment-related side effects, and reduced quality of life (QOL) for both men and their partners. A key component of comprehensive survivorship care planning is survivorship care plans (SCPs), documents that summarize cancer diagnosis, treatment, and plans for follow-up care. However, research concerning the effectiveness of SCPs on patient outcomes or health service use has thus far been inconclusive. SCPs that are tailored to individual patients' needs for information and care may improve effectiveness. Objective: This study aims to examine the feasibility of an enhanced survivorship care plan (ESCP) that integrates a symptom self-management mHealth program called Prostate Cancer Education and Resources for Couples (PERC) into the existing standardized SCP. The specific aims are to (1) examine the feasibility of delivering ESCPs and (2) to estimate the magnitude of benefit of ESCPs. Methods: We will use a two-group randomized controlled pretest-posttest design and collect data at baseline (T1) and 4 months later (T2) among 50 patients completing initial treatment for localized prostate cancer and their partners. First, we will assess the feasibility of ESCP by recruitment, enrollment, and retention rates; program satisfaction with the ESCP; and perceived ease of use of the ESCP. To achieve the secondary aim, we will compare the ESCP users with the standardized SCP users and assess their primary outcomes of QOL (overall, physical, emotional, and social QOL); secondary outcomes (reduction in negative appraisals and improvement in self-efficacy, social support, and health behaviors to manage symptoms); and number of visits to posttreatment care services between T1 and T2. We will assess the primary and secondary outcomes using measurements with sound psychometrical properties. We will use a qualitative and quantitative mixed methods approach to achieve the research aims. Results: This project is ongoing and will be completed by the end of 2018. Conclusions: The results from this study will help design a definitive randomized trial to test the efficacy of the ESCPs, a potentially scalable program, to enhance supportive care for prostate cancer patients and their families. ", doi="10.2196/resprot.9118", url="http://www.researchprotocols.org/2018/2/e51/", url="http://www.ncbi.nlm.nih.gov/pubmed/29483070" } @Article{info:doi/10.2196/resprot.9096, author="Hassoon, Ahmed and Schrack, Jennifer and Naiman, Daniel and Lansey, Dina and Baig, Yasmin and Stearns, Vered and Celentano, David and Martin, Seth and Appel, Lawrence", title="Increasing Physical Activity Amongst Overweight and Obese Cancer Survivors Using an Alexa-Based Intelligent Agent for Patient Coaching: Protocol for the Physical Activity by Technology Help (PATH) Trial", journal="JMIR Res Protoc", year="2018", month="Feb", day="12", volume="7", number="2", pages="e27", abstract="Background: Physical activity has established health benefits, but motivation and adherence remain challenging. Objective: We designed and launched a three-arm randomized trial to test artificial intelligence technology solutions to increase daily physical activity in cancer survivors. Methods: A single-center, three-arm randomized clinical trial with an allocation ration of 1:1:1: (A) control, in which participants are provided written materials about the benefits of physical activity; (B) text intervention, where participants receive daily motivation from a fully automated, data-driven algorithmic text message via mobile phone (Coachtext); and (C) Voice Assist intervention, where participants are provided with an in-home on demand autonomous Intelligent Agent using data driven Interactive Digital Voice Assist on the Amazon Alexa/Echo (MyCoach). Results: The study runs for 5 weeks: a one-week run-in to establish baseline, followed by 4 weeks of intervention. Data for study outcomes is collected automatically through a wearable sensor, and data are transferred in real-time to the study server. The recruitment goal is 42 participants, 14 in each arm. Electronic health records are used to prescreen candidates, with 39 participants recruited to date. Discussion: This study aims to investigate the effects of different types of intelligent technology solutions on promoting physical activity in cancer survivors. This innovative approach can easily be expanded and customized to other interventions. Early lessons from our initial participants are helping us develop additional advanced solutions to improve health outcomes. Trial Registration: Retrospectively registered on July 10, 2017 at ClinicalTrials.gov: NCT03212079; https://clinicaltrials.gov/ct2/show/NCT03212079 (Archived by WebCite at http://www.webcitation.org/6wgvqjTji) ", doi="10.2196/resprot.9096", url="https://www.researchprotocols.org/2018/2/e27/", url="http://www.ncbi.nlm.nih.gov/pubmed/29434016" } @Article{info:doi/10.2196/resprot.8900, author="Mountford, Nicola and Dorronzoro Zubiete, Enrique and Kessie, Threase and Garcia-Zapirain, Begonya and Nu{\~{n}}o-Solin{\'i}s, Roberto and Coyle, David and Munksgaard, B. Kristin and Fernandez-Luque, Luis and Rivera Romero, Octavio and Mora Fernandez, Matilde and Valero Jimenez, Pedro and Daly, Ailish and Whelan, Ruth and Caulfield, Brian", title="Activating Technology for Connected Health in Cancer: Protocol for a Research and Training Program", journal="JMIR Res Protoc", year="2018", month="Jan", day="24", volume="7", number="1", pages="e14", keywords="eHealth", keywords="mHealth", keywords="consumer health informatics", keywords="cancer", keywords="cancer rehabilitation", abstract="Background: As cancer survival rates increase, the challenge of ensuring that cancer survivors reclaim their quality of life (QoL) becomes more important. This paper outlines the research element of a research and training program that is designed to do just that. Objective: Bridging sectors, disciplines, and geographies, it brings together eight PhD projects and students from across Europe to identify the underlying barriers, test different technology-enabled rehabilitative approaches, propose a model to optimize the patient pathways, and examine the business models that might underpin a sustainable approach to cancer survivor reintegration using technology. Methods: The program, funded under the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No 722012, includes deep disciplinary PhD projects, intersectoral and international secondments, interdisciplinary plenary training schools, and virtual subject-specific education modules. Results: The 8 students have now been recruited and are at the early stages of their projects. Conclusions: CATCH will provide a comprehensive training and research program by embracing all key elements---technical, social, and economic sciences---required to produce researchers and project outcomes that are capable of meeting existing and future needs in cancer rehabilitation. ", doi="10.2196/resprot.8900", url="http://www.researchprotocols.org/2018/1/e14/", url="http://www.ncbi.nlm.nih.gov/pubmed/29367184" } @Article{info:doi/10.2196/cancer.8430, author="Kinner, M. Ellen and Armer, S. Jessica and McGregor, A. Bonnie and Duffecy, Jennifer and Leighton, Susan and Corden, E. Marya and Gauthier Mullady, Janine and Penedo, J. Frank and Lutgendorf, K. Susan", title="Internet-Based Group Intervention for Ovarian Cancer Survivors: Feasibility and Preliminary Results", journal="JMIR Cancer", year="2018", month="Jan", day="15", volume="4", number="1", pages="e1", keywords="ovarian cancer", keywords="quality of life", keywords="feasibility studies", keywords="eHealth", keywords="psychological stress", abstract="Background: Development of psychosocial group interventions for ovarian cancer survivors has been limited. Drawing from elements of cognitive-behavioral stress management (CBSM), mindfulness-based stress reduction (MBSR), and acceptance and commitment therapy (ACT), we developed and conducted preliminary testing of an Internet-based group intervention tailored specifically to meet the needs of ovarian cancer survivors. The Internet-based platform facilitated home delivery of the psychosocial intervention to a group of cancer survivors for whom attending face-to-face programs could be difficult given their physical limitations and the small number of ovarian cancer survivors at any one treatment site. Objective: The aim of this study was to develop, optimize, and assess the usability, acceptability, feasibility, and preliminary intended effects of an Internet-based group stress management intervention for ovarian cancer survivors delivered via a tablet or laptop. Methods: In total, 9 ovarian cancer survivors provided feedback during usability testing. Subsequently, 19 survivors participated in 5 waves of field testing of the 10-week group intervention led by 2 psychologists. The group met weekly for 2 hours via an Internet-based videoconference platform. Structured interviews and weekly evaluations were used to elicit feedback on the website and intervention content. Before and after the intervention, measures of mood, quality of life (QOL), perceived stress, sleep, and social support were administered. Paired t tests were used to examine changes in psychosocial measures over time. Results: Usability results indicated that participants (n=9) performed basic tablet functions quickly with no errors and performed website functions easily with a low frequency of errors. In the field trial (n=19), across 5 groups, the 10-week intervention was well attended. Perceived stress (P=.03) and ovarian cancer-specific QOL (P=.01) both improved significantly during the course of the intervention. Trends toward decreased distress (P=.18) and greater physical (P=.05) and functional well-being (P=.06) were also observed. Qualitative interviews revealed that the most common obstacles participants experienced were technical issues and the time commitment for practicing the techniques taught in the program. Participants reported that the intervention helped them to overcome a sense of isolation and that they appreciated the ability to participate at home. Conclusions: An Internet-based group intervention tailored specifically for ovarian cancer survivors is highly usable and acceptable with moderate levels of feasibility. Preliminary psychosocial outcomes indicate decreases in perceived stress and improvements in ovarian cancer-specific QOL following the intervention. A randomized clinical trial is needed to demonstrate the efficacy of this promising intervention for ovarian cancer survivors. ", doi="10.2196/cancer.8430", url="http://cancer.jmir.org/2018/1/e1/", url="http://www.ncbi.nlm.nih.gov/pubmed/29335233" } @Article{info:doi/10.2196/resprot.8302, author="Chaput, Cynthia and Beaulieu-Gagnon, Sabrina and B{\'e}langer, V{\'e}ronique and Drouin, Simon and Bertout, Laurence and Lafrance, Lucie and Olivier, Cinthia and Robitaille, Marthe and Laverdi{\`e}re, Caroline and Sinnett, Daniel and Marquis, Marie and Marcil, Val{\'e}rie", title="Research- and Practice-Based Nutrition Education and Cooking Workshops in Pediatric Oncology: Protocol for Implementation and Development of Curriculum", journal="JMIR Res Protoc", year="2018", month="Jan", day="09", volume="7", number="1", pages="e2", keywords="child", keywords="diet", keywords="education", keywords="neoplasms", keywords="hospitals", keywords="methods", abstract="Background: Progresses in childhood cancer treatment, diagnosis, and management have resulted in childhood cancer survival rates of over 80\%. However, this therapeutic success comes with a heavy price: two-thirds of childhood cancer survivors will be affected by further complications, including cardiovascular and metabolic diseases. Adequate nutrition during cancer treatment is essential to ensure the child's optimal development, improve tolerance to treatments, and can contribute to lower the risk of developing cardiometabolic diseases. Side effects of cancer treatments can negatively impact children's nutritional intake and eating behaviors. Involving the families of childhood cancer patients in educational workshops could be a promising avenue to promote healthy eating during and after cancer treatment. Objective: The objectives of this study were to develop, validate, and implement a family-based nutrition education and cooking workshop curriculum in a pediatric oncology setting that addresses the nutritional issues encountered during treatments while promoting the adoption of healthy eating habits for the prevention of long-term cardiometabolic effects. Methods: The workshops were developed and validated following an 8-step iterative process, including a review of the literature and consultations with a steering committee. An evaluation tool was also developed. A nonrandomized study protocol was elaborated to implement the workshops and measure their impact. The themes of the 6 research- and practice-based lessons are as follows: meal fortification during cancer treatment, changes in taste during cancer therapy and their impact on children, adapting diet to eating-related side effects of treatments, nutritional support during cancer treatment, Mediterranean diet and health, and planning quick and economic meals. The validation process included consultations with the institution's clinical nutrition professionals. Self-administered post questionnaires were developed according to the content of each workshop to measure short-term outcomes, namely, participants' perception of knowledge acquisition, behavioral intention, and satisfaction. Medium-term outcomes that will be evaluated are participants' anthropometric profile, quality of the diet, and circulating biomarkers of metabolic health. Results: The project was funded in 2016 and enrollment will be completed in 2021. Data analysis is currently under way and the first results are expected to be submitted for publication in 2019. Conclusions: This research- and practice-based nutrition education and cooking demonstration curriculum could be a valuable complement to a multidisciplinary lifestyle intervention for the prevention of long-term cardiometabolic complications in childhood cancer. ", doi="10.2196/resprot.8302", url="http://www.researchprotocols.org/2018/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/29317383" } @Article{info:doi/10.2196/resprot.5428, author="Li, In-Fun and Hsiung, Yvonne", title="Exploring Advance Care Planning in Taiwanese Indigenous Cancer Survivors: Proposal for a Pilot Case-Control Study", journal="JMIR Res Protoc", year="2017", month="Dec", day="21", volume="6", number="12", pages="e238", keywords="Taiwanese indigenous peoples", keywords="advance care planning", keywords="cancer survivors", abstract="Background: Research on Taiwanese indigenous cancer survivors' end-of-life (EOL) planning is still in its infancy, despite recent government and societal efforts to promote quality EOL care. Previous national studies in Taiwan have characterized indigenous peoples as a socioeconomically disadvantaged minority group. Compared with their mainstream cohorts, these remote residents are vulnerable to multiple social welfare problems, receiving and accessing little in the way of health care in rural mountain areas. Although advance care planning (ACP) has been shown to help patients achieve better quality of dying, very little is known about indigenous intentions for such interventions. Relevant studies are scarce in Taiwan, and programs for cancer survivors have been based almost entirely on nonindigenous populations. Since there has been no research on Taiwanese indigenous people's aims for ACP, there is a need to understand the impact of survivorship on ACP readiness among those who are currently living with, through, and beyond cancer. Objective: We aim to identify differences in ACP intent and readiness among indigenous peoples with and without cancer diagnoses. We will identify the impact of factors such as tribal cultural beliefs and quality of life along with cancer exposure on the outcome of ACP readiness differences. In particular, we will examine the effects of ACP knowledge from previous ACP participation, EOL care experiences, and personal registry status of Do-Not-Resuscitate (DNR) in the national database. A secondary objective is to describe indigenous people's intent to participate in public education related to EOL planning. Methods: A descriptive case-control study (N=200) is proposed where controls are matched to cases' attributes of age, gender, and cancer diagnosis. This matching analysis allows assessment of cancer as an exposure while taking into account age and gender as confounding variables. We are currently in the process of training personnel and extracting clinical and administrative information from the health care system of collaborating facilities. This carefully designed study provides a unique opportunity because for the first time in Taiwan, cancer survivorship and ACP readiness for EOL planning will be examined among difficult-to-reach indigenous peoples. Results: We plan to complete this study in approximately 3 years. Conclusions: In this study, we expect to survey palliative care usage in the remote indigenous group, understand factors that influence ACP readiness, and later foster culturally appropriate ACP public participation and policies in order to facilitate collaboration between cancer health care providers in various Taiwanese subcultures. ", doi="10.2196/resprot.5428", url="http://www.researchprotocols.org/2017/12/e238/", url="http://www.ncbi.nlm.nih.gov/pubmed/29269340" } @Article{info:doi/10.2196/resprot.8051, author="Pham, Quynh and Cafazzo, A. Joseph and Feifer, Andrew", title="Adoption, Acceptability, and Effectiveness of a Mobile Health App for Personalized Prostate Cancer Survivorship Care: Protocol for a Realist Case Study of the Ned App", journal="JMIR Res Protoc", year="2017", month="Oct", day="12", volume="6", number="10", pages="e197", keywords="prostate-specific antigen", keywords="prostate cancer survivorship", keywords="prostate cancer", keywords="patient-centered care", keywords="mobile health", keywords="mHealth", keywords="telemedicine", keywords="mobile health app", keywords="realist evaluation", keywords="case study", abstract="Background: By 2030, prostate cancer will be the most commonly diagnosed cancer in North America. To mitigate this impending challenge, comprehensive support mechanisms for disease- and treatment-specific changes in health and well-being must be proactively designed and thoughtfully implemented for streamlined survivorship care. mHealth apps have been lauded as a promising complement to current outpatient treatment and monitoring strategies, but have not yet been widely used to support prostate cancer survivorship needs. A realist evaluation is needed to examine the impact of such apps on the prostate cancer survivorship experience. Objective: We seek to gain an understanding of how an mHealth app for prostate cancer survivorship care called Ned (No Evident Disease) is adopted and accepted by patients, caregivers, and clinicians. We also aim to determine the effect of Ned on health-related quality of life, satisfaction with cancer care, unmet needs, self-efficacy, and prostate cancer-related levels of anxiety. Methods: The Ned case study is a 12-month mixed-methods embedded single-case study with a nested within-group pre-post comparison of health outcomes. We will give 400 patients, 200 caregivers, and 10 clinicians access to Ned. Participants will be asked to complete study assessments at baseline, 2 months, 6 months, and 12 months. We will conduct 30 semistructured qualitative interviews with patients (n=20) and their caregivers (n=10) poststudy to gain insight into their experience with the app. Results: We recruited our first survivor in October 2017 and anticipate completing this study by May 2019. Conclusions: This will, to our knowledge, be the first realist case study to evaluate an app for prostate cancer survivorship care. Prostate cancer survivors are set to increase in number and longevity, heightening the need for integrated survivorship solutions to provide them with optimal and durable outcomes. The knowledge gained from this study will comprehensively inform how and why Ned works, for whom, and in what circumstances. Understanding the impact of digital health interventions such as Ned on how survivors care for themselves is critical to realizing patient-centered care. ", doi="10.2196/resprot.8051", url="http://www.researchprotocols.org/2017/10/e197/", url="http://www.ncbi.nlm.nih.gov/pubmed/29025699" } @Article{info:doi/10.2196/cancer.8192, author="Baseman, Janet and Revere, Debra and Baldwin, Laura-Mae", title="A Mobile Breast Cancer Survivorship Care App: Pilot Study", journal="JMIR Cancer", year="2017", month="Sep", day="26", volume="3", number="2", pages="e14", keywords="breast neoplasms", keywords="data collection", keywords="feasibility studies", keywords="mobile apps", keywords="survivors", keywords="telemedicine", abstract="Background: Cancer survivors living in rural areas experience unique challenges due to additional burdens, such as travel and limited access to specialists. Rural survivors of breast cancer have reported poorer outcomes, poorer mental health and physical functioning, and lower-than-average quality of life compared to urban survivors. Objective: To explore the feasibility and acceptability of developing a mobile health survivorship care app to facilitate care coordination; support medical, psychosocial, and practical needs; and improve survivors' long-term health outcomes. Methods: An interactive prototype app, SmartSurvivor, was developed that included recommended survivorship care plan components. The prototype's feasibility and acceptability were tested by a sample of breast cancer survivors (n=6), primary care providers (n=4), and an oncologist (n=1). Results: Overall, both survivors and providers felt that SmartSurvivor was a potentially valuable tool to support long-term survivorship care plan objectives. Portability, accessibility, and having one place for all contact, treatment, symptom tracking, and medication summaries was highly valued. Conclusions: Our pilot study indicates that SmartSurvivor is a feasible and acceptable approach to meeting survivorship care objectives and the needs of both breast cancer survivors and their health care providers. Exploration of mobile health options for supporting survivorship care plan needs is a promising area of research. ", doi="10.2196/cancer.8192", url="http://cancer.jmir.org/2017/2/e14/", url="http://www.ncbi.nlm.nih.gov/pubmed/28951383" } @Article{info:doi/10.2196/cancer.7495, author="Paxton, J. Raheem and Hajek, Richard and Newcomb, Patricia and Dobhal, Megha and Borra, Sujana and Taylor, C. Wendell and Parra-Medina, Deborah and Chang, Shine and Courneya, S. Kerry and Block, Gladys and Block, Torin and Jones, A. Lovell", title="A Lifestyle Intervention via Email in Minority Breast Cancer Survivors: Randomized Parallel-Group Feasibility Study", journal="JMIR Cancer", year="2017", month="Sep", day="21", volume="3", number="2", pages="e13", keywords="breast neoplasm", keywords="African Americans", keywords="diet", keywords="feasibility study", keywords="physical activity", keywords="posture", keywords="program evaluation", keywords="Internet", keywords="computer tailoring", keywords="email", abstract="Background: Our data have indicated that minority breast cancer survivors are receptive to participating in lifestyle interventions delivered via email or the Web, yet few Web-based studies exist in this population. Objective: The aim of this study was to examine the feasibility and preliminary results of an email-delivered diet and activity intervention program, ``A Lifestyle Intervention Via Email (ALIVE),'' delivered to a sample of racial and ethnic minority breast cancer survivors. Methods: Survivors (mean age: 52 years, 83\% [59/71] African American) were recruited and randomized to receive either the ALIVE program's 3-month physical activity track or its 3-month dietary track. The fully automated system provided tools for self-monitoring and goal setting, tailored content, and automated phone calls. Descriptive statistics and mixed-effects models were computed to examine the outcomes of the study. Results: Upon completion, 44 of 71 survivors completed the study. Our ``intention-to-treat'' analysis revealed that participants in the physical activity track made greater improvements in moderate to vigorous activity than those in the dietary track (+97 vs. +49 min/week, P<.001). Similarly, reductions in total sedentary time among those in the physical activity track (?304 vs. ?59 min/week, P<.001) was nearly 5 times greater than that for participants in the dietary track. Our completers case analysis indicated that participants in the dietary track made improvements in the intake of fiber (+4.4 g/day), fruits and vegetables (+1.0 cup equivalents/day), and reductions in saturated fat (?2.3 g/day) and trans fat (?0.3 g/day) (all P<.05). However, these improvements in dietary intake were not significantly different from the changes observed by participants in the physical activity track (all P>.05). Process evaluation data indicated that most survivors would recommend ALIVE to other cancer survivors (97\%), were satisfied with ALIVE (82\%), and felt that ALIVE was effective (73\%). However, survivors expressed concerns about the functionality of the interactive emails. Conclusions: ALIVE appears to be feasible for racial and ethnic minority cancer survivors and showed promising results for larger implementation. Although survivors favored the educational content, a mobile phone app and interactive emails that work on multiple email domains may help to boost adherence rates and to improve satisfaction with the Web-based platform. Trial Registration: ClinicalTrials.gov NCT02722850; https://clinicaltrials.gov/ct2/show/NCT02722850 (Archived by WebCite at http://www.webcitation.org/6tHN9VsPh) ", doi="10.2196/cancer.7495", url="http://cancer.jmir.org/2017/2/e13/", url="http://www.ncbi.nlm.nih.gov/pubmed/28935620" } @Article{info:doi/10.2196/resprot.6615, author="Ritvo, Paul and Obadia, Maya and Santa Mina, Daniel and Alibhai, Shabbir and Sabiston, Catherine and Oh, Paul and Campbell, Kristin and McCready, David and Auger, Leslie and Jones, Michelle Jennifer", title="Smartphone-Enabled Health Coaching Intervention (iMOVE) to Promote Long-Term Maintenance of Physical Activity in Breast Cancer Survivors: Protocol for a Feasibility Pilot Randomized Controlled Trial", journal="JMIR Res Protoc", year="2017", month="Aug", day="24", volume="6", number="8", pages="e165", keywords="breast neoplasm", keywords="exercise", keywords="health coaching", keywords="RCT", keywords="telehealth", abstract="Background: Although physical activity has been shown to contribute to long-term disease control and health in breast cancer survivors, a majority of breast cancer survivors do not meet physical activity guidelines. Past research has focused on promoting physical activity components for short-term breast cancer survivor benefits, but insufficient attention has been devoted to long-term outcomes and sustained exercise adherence. We are assessing a health coach intervention (iMOVE) that uses mobile technology to increase and sustain physical activity maintenance in initially inactive breast cancer survivors. Objective: This pilot randomized controlled trial (RCT) is an initial step in evaluating the iMOVE intervention and will inform development of a full-scale pragmatic RCT. Methods: We will enroll 107 physically inactive breast cancer survivors and randomly assign them to intervention or control groups at the University Health Network, a tertiary cancer care center in Toronto, Canada. Participants will be women (age 18 to 74 years) stratified by age (55 years and older/younger than 55 years) and adjuvant hormone therapy (AHT) exposure (AHT vs no AHT) following breast cancer treatment with no metastases or recurrence who report less than 60 minutes of preplanned physical activity per week. Both intervention and control groups receive the 12-week physical activity program with weekly group sessions and an individualized, progressive, home-based exercise program. The intervention group will additionally receive (1) 10 telephone-based health coaching sessions, (2) smartphone with data plan, if needed, (3) supportive health tracking software (Connected Wellness, NexJ Health Inc), and (4) a wearable step-counting device linked to a smartphone program. Results: We will be assessing recruitment rates; acceptability reflected in selective, semistructured interviews; and enrollment, retention, and adherence quantitative intervention markers as pilot outcome measures. The primary clinical outcome will be directly measured peak oxygen consumption. Secondary clinical outcomes include health-related quality of life and anthropometric measures. All outcome measures are administered at baseline, after exercise program (month 3), and 6 months after program (month 9). Conclusions: This pilot RCT will inform full-scale RCT planning. We will assess pilot procedures and interventions and collect preliminary effect estimates. Trial Registration: ClinicalTrials.gov NCT02620735; https://clinicaltrials.gov/ct2/show/NCT02620735 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02620735) ", doi="10.2196/resprot.6615", url="http://www.researchprotocols.org/2017/8/e165/", url="http://www.ncbi.nlm.nih.gov/pubmed/28838886" } @Article{info:doi/10.2196/jmir.7838, author="Golsteijn, Johanna Rianne Henrica and Bolman, Catherine and Peels, Astrid Denise and Volders, Esmee and de Vries, Hein and Lechner, Lilian", title="A Web-Based and Print-Based Computer-Tailored Physical Activity Intervention for Prostate and Colorectal Cancer Survivors: A Comparison of User Characteristics and Intervention Use", journal="J Med Internet Res", year="2017", month="Aug", day="23", volume="19", number="8", pages="e298", keywords="eHealth", keywords="web-based intervention", keywords="print-delivered intervention", keywords="computer tailoring", keywords="intervention usage", keywords="physical activity", keywords="prostate cancer", keywords="colorectal cancer", keywords="cancer survivorship", abstract="Background: Physical activity (PA) is beneficial in improving negative physical and psychological effects of cancer. The rapidly increasing number of cancer survivors, resulting from aging and improved cancer care, emphasizes the importance to develop and provide low cost, easy accessible PA programs. Such programs could be provided through the Internet, but that could result in the exclusion of cancer survivors not familiar with the Internet. Therefore, we developed a computer-tailored PA intervention for prostate and colorectal cancer survivors in which both Web-based and print materials are provided, and participants can choose their own preferred delivery mode. Objective: The aim of this study was to assess participants' characteristics related to delivery mode and use of intervention materials. Methods: We studied characteristics of participants using Web-based and printed intervention materials in a randomized controlled trial (RCT). Prostate and colorectal cancer survivors recruited from hospitals were randomized to OncoActive (computer-tailored PA intervention) or a usual-care control group. OncoActive participants received both Web-based and printed materials. Participants were classified into initial print- or Web-based participants based on their preferred mode of completion of the first questionnaire, which was needed for the computer-tailored PA advice. Intervention material use during the remainder of the intervention was compared for initial print- or Web-based participants. Additionally, participants were classified into those using only print materials and those using Web-based materials. Differences in participant characteristics and intervention material use were studied through analysis of variance (ANOVAs), chi-square tests, and logistic regressions. Results: The majority of the participants in the intervention group were classified as initial Web-based participants (170/249, 68.3\%), and 84.9\% (191/249) used Web-based intervention materials. Dropout was low (15/249, 6.0\%) and differed between initial Web-based (4/170, 2.4\%) and print-based (11/79, 14\%) participants. Participants were less likely to start Web-based with higher age (odds ratio [OR]=0.93), longer time since last treatment (OR=0.87), and higher fatigue (OR=0.96), and more likely with higher education (OR=4.08) and having completed treatments (OR=5.58). Those who were older (OR=0.93) and post treatment for a longer time (OR=0.86) were less likely to use Web-based intervention materials. Initial print-based participants predominantly used print-based materials, whereas initial Web-based participants used both print- and Web-based materials. Conclusions: To our knowledge, this is one of the first studies that assessed participant characteristics related to delivery mode in an intervention in which participants had a free choice of delivery modes. Use of print-based materials among the initial Web-based participants was substantial, indicating the importance of print-based materials. According to our findings, it may be important to offer Web- and print-based materials alongside each other. Providing Web-based materials only may exclude older, less educated, more fatigued, or currently treated participants; these groups are especially more vulnerable and could benefit most from PA interventions. ", doi="10.2196/jmir.7838", url="http://www.jmir.org/2017/8/e298/", url="http://www.ncbi.nlm.nih.gov/pubmed/28835353" } @Article{info:doi/10.2196/cancer.6987, author="Corbett, Teresa and Walsh, C. Jane and Groarke, AnnMarie and Moss-Morris, Rona and Morrissey, Eimear and McGuire, E. Brian", title="Cancer-Related Fatigue in Post-Treatment Cancer Survivors: Theory-Based Development of a Web-Based Intervention", journal="JMIR Cancer", year="2017", month="Jul", day="04", volume="3", number="2", pages="e8", keywords="cancer", keywords="survivor", keywords="design", keywords="person-based approach", keywords="theory", abstract="Background: Cancer-related fatigue (CrF) is the most common and disruptive symptom experienced by cancer survivors. We aimed to develop a theory-based, interactive Web-based intervention designed to facilitate self-management and enhance coping with CrF following cancer treatment. Objective: The aim of our study was to outline the rationale, decision-making processes, methods, and findings which led to the development of a Web-based intervention to be tested in a feasibility trial. This paper outlines the process and method of development of the intervention. Methods: An extensive review of the literature and qualitative research was conducted to establish a therapeutic approach for this intervention, based on theory. The psychological principles used in the development process are outlined, and we also clarify hypothesized causal mechanisms. We describe decision-making processes involved in the development of the content of the intervention, input from the target patient group and stakeholders, the design of the website features, and the initial user testing of the website. Results: The cocreation of the intervention with the experts and service users allowed the design team to ensure that an acceptable intervention was developed. This evidence-based Web-based program is the ?rst intervention of its kind based on self-regulation model theory, with the primary aim of targeting the representations of fatigue and enhancing self-management of CrF, speci?cally. Conclusions: This research sought to integrate psychological theory, existing evidence of effective interventions, empirically derived principles of Web design, and the views of potential users into the systematic planning and design of the intervention of an easy-to-use website for cancer survivors. ", doi="10.2196/cancer.6987", url="http://cancer.jmir.org/2017/2/e8/", url="http://www.ncbi.nlm.nih.gov/pubmed/28676465" } @Article{info:doi/10.2196/jmir.7175, author="W{\"a}rnest{\aa}l, Pontus and Svedberg, Petra and Lindberg, Susanne and Nygren, M. Jens", title="Effects of Using Child Personas in the Development of a Digital Peer Support Service for Childhood Cancer Survivors", journal="J Med Internet Res", year="2017", month="May", day="18", volume="19", number="5", pages="e161", keywords="peer", keywords="childhood", keywords="cancer", keywords="survivor", keywords="participation", keywords="user experience", keywords="service design", abstract="Background: Peer support services have the potential to support children who survive cancer by handling the physical, mental, and social challenges associated with survival and return to everyday life. Involving the children themselves in the design process allows for adapting services to authentic user behaviors and goals. As there are several challenges that put critical requirements on a user-centered design process, we developed a design method based on personas adapted to the particular needs of children that promotes health and handles a sensitive design context. Objective: The purpose of this study was to evaluate the effects of using child personas in the development of a digital peer support service for childhood cancer survivors. Methods: The user group's needs and behaviors were characterized based on cohort data and literature, focus group interviews with childhood cancer survivors (n=15, 8-12 years), stakeholder interviews with health care professionals and parents (n=13), user interviews, and observations. Data were interpreted and explained together with childhood cancer survivors (n=5) in three explorative design workshops and a validation workshop with children (n=7). Results: We present findings and insights on how to codesign child personas in the context of developing digital peer support services with childhood cancer survivors. The work resulted in three primary personas that model the behaviors, attitudes, and goals of three user archetypes tailored for developing health-promoting services in this particular use context. Additionally, we also report on the effects of using these personas in the design of a digital peer support service called Give Me a Break. Conclusions: By applying our progressive steps of data collection and analysis, we arrive at authentic child-personas that were successfully used to design and develop health-promoting services for children in vulnerable life stages. The child-personas serve as effective collaboration and communication aids for both internal and external purposes. ", doi="10.2196/jmir.7175", url="http://www.jmir.org/2017/5/e161/", url="http://www.ncbi.nlm.nih.gov/pubmed/28526663" } @Article{info:doi/10.2196/jmir.6834, author="Wang, Xi and Zhao, Kang and Street, Nick", title="Analyzing and Predicting User Participations in Online Health Communities: A Social Support Perspective", journal="J Med Internet Res", year="2017", month="Apr", day="24", volume="19", number="4", pages="e130", keywords="social support", keywords="machine learning", keywords="community networks", keywords="patient engagement", keywords="prediction", abstract="Background: Online health communities (OHCs) have become a major source of social support for people with health problems. Members of OHCs interact online with similar peers to seek, receive, and provide different types of social support, such as informational support, emotional support, and companionship. As active participations in an OHC are beneficial to both the OHC and its users, it is important to understand factors related to users' participations and predict user churn for user retention efforts. Objective: This study aimed to analyze OHC users' Web-based interactions, reveal which types of social support activities are related to users' participation, and predict whether and when a user will churn from the OHC. Methods: We collected a large-scale dataset from a popular OHC for cancer survivors. We used text mining techniques to decide what kinds of social support each post contained. We illustrated how we built text classifiers for 5 different social support categories: seeking informational support (SIS), providing informational support (PIS), seeking emotional support (SES), providing emotional support (PES), and companionship (COM). We conducted survival analysis to identify types of social support related to users' continued participation. Using supervised machine learning methods, we developed a predictive model for user churn. Results: Users' behaviors to PIS, SES, and COM had hazard ratios significantly lower than 1 (0.948, 0.972, and 0.919, respectively) and were indicative of continued participations in the OHC. The churn prediction model based on social support activities offers accurate predictions on whether and when a user will leave the OHC. Conclusions: Detecting different types of social support activities via text mining contributes to better understanding and prediction of users' participations in an OHC. The outcome of this study can help the management and design of a sustainable OHC via more proactive and effective user retention strategies. ", doi="10.2196/jmir.6834", url="http://www.jmir.org/2017/4/e130/", url="http://www.ncbi.nlm.nih.gov/pubmed/28438725" } @Article{info:doi/10.2196/cancer.6435, author="Krebs, Paul and Shtaynberger, Jonathan and McCabe, Mary and Iocolano, Michelle and Williams, Katie and Shuk, Elyse and Ostroff, S. Jamie", title="An eHealth Intervention to Increase Physical Activity and Healthy Eating in Older Adult Cancer Survivors: Summative Evaluation Results", journal="JMIR Cancer", year="2017", month="Mar", day="01", volume="3", number="1", pages="e4", keywords="survivors", keywords="diet", keywords="food and nutrition", keywords="breast neoplasms", keywords="prostatic neoplasms", keywords="eHealth", abstract="Background: A healthy lifestyle is associated with improved quality of life among cancer survivors, yet adherence to health behavior recommendations is low. Objective: This pilot trial developed and tested the feasibility of a tailored eHealth program to increase fruit and vegetable consumption and physical activity among older, long-term cancer survivors. Methods: American Cancer Society (ACS) guidelines for cancer survivors were translated into an interactive, tailored health behavior program on the basis of Social Cognitive Theory. Patients (N=86) with a history of breast (n=83) or prostate cancer (n=3) and less than 5 years from active treatment were randomized 1:1 to receive either provider advice, brief counseling, and the eHealth program (intervention) or advice and counseling alone (control). Primary outcomes were self-reported fruit and vegetable intake and physical activity. Results: About half (52.7\%, 86/163) of the eligible patients consented to participate. The most common refusal reasons were lack of perceived time for the study (32/163) and lack of interest in changing health behaviors (29/163). Furthermore, 72\% (23/32) of the intervention group reported using the program and most would recommend it to others (56\%, 14/25). Qualitative results indicated that the intervention was highly acceptable for survivors. For behavioral outcomes, the intervention group reported increased fruit and vegetable consumption. Self-reported physical activity declined in both groups. Conclusions: The brief intervention showed promising results for increasing fruit and vegetable intake. Results and participant feedback suggest that providing the intervention in a mobile format with greater frequency of contact and more indepth information would strengthen treatment effects. ", doi="10.2196/cancer.6435", url="http://cancer.jmir.org/2017/1/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410171" } @Article{info:doi/10.2196/cancer.5821, author="Vollmer Dahlke, Deborah and Fair, Kayla and Hong, Alicia Yan and Kellstedt, Debra and Ory, G. Marcia", title="Adolescent and Young Adult Cancer Survivorship Educational Programming: A Qualitative Evaluation", journal="JMIR Cancer", year="2017", month="Feb", day="10", volume="3", number="1", pages="e3", keywords="cancer survivorship", keywords="adolescent and young adult", keywords="qualitative", keywords="mixed methods", keywords="evaluation", abstract="Background: This program evaluation considers the need for increased professional and patient education for adolescent and young adult (AYA) cancer survivorship. Due to the high incidence of late effects of cancer treatment among AYA cancer survivors, knowledge sharing and communications are needed throughout the transition from cancer care into community care. AYA survivors are likely to need developmentally appropriate psychosocial care as well as extensive follow-on surveillance by physicians who are educated and aware of the likely chronic conditions and late effects that may occur in these patients. Objective: The objective of this study was to evaluate the outcomes of the After Cancer Care Ends, Survivorship Starts for Adolescent and Young Adults (ACCESS AYA) programming. The intent of the ACCESS AYA program was to build health literacy around AYA survivorship issues and to stimulate improved communications between survivors and health care providers. This paper addresses the central research question of ``How did the ACCESS AYA program increase health literacy, communications, and understanding among AYA survivors and providers?'' Methods: The primarily qualitative evaluation included a brief introductory survey of participant awareness and effectiveness of the ACCESS AYA project serving as a recruitment tool. Survey respondents were invited to participate in in-depth interviews based on interview guides tailored to the different stakeholder groups. The evaluation used the Atlas Ti qualitative database and software for coding and key word analyses. Interrater reliability analyses were assessed using Cohen kappa analysis with Stata 12.1 (StataCorp LLC) software. Results: The key themes, which included survivor wellbeing, health care professional education, cancer advocates role and education, hospital and community-based resources, and the role of societal support, are presented in a concept map. The interrater reliability scores (ranging from 1 to minus 1) were .893 for first cycle coding and .784 for the second cycle. In the brief quantitative survey based on a scale of 1 to 5 with 5 as high, the 22 respondents rated their level of awareness of the project with a mean 3.2 (CI 3.02-3.45) and project effectiveness with a mean of 4 (CI 3.72-4.27). Conclusions: This study contributes to understanding of the ACCESS AYA survivor community in central Texas and the health care professionals and advocates who aid them in their efforts to a new normal life and wellbeing in their survivorship. The results of the evaluation highlight the need to continue to build both survivor and professional resources to address the unique impact of cancer on AYA cancer survivors. ", doi="10.2196/cancer.5821", url="http://cancer.jmir.org/2017/1/e3/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410172" } @Article{info:doi/10.2196/cancer.6680, author="Folta, Sara and Chang, Winnie and Hill, Rachel and Kelly, Michael and Meagher, Susan and Bowman, Paul W. and Zhang, Fang Fang", title="Parent and Health Care Provider Perceptions for Development of a Web-Based Weight Management Program for Survivors of Pediatric Acute Lymphoblastic Leukemia: A Mixed Methods Study", journal="JMIR Cancer", year="2017", month="Feb", day="09", volume="3", number="1", pages="e2", keywords="weight management", keywords="childhood cancer survivors", keywords="mixed methods", abstract="Background: Survivors of pediatric acute lymphoblastic leukemia (ALL) may experience unhealthy weight gain during treatment, which has been associated with higher risk for chronic health issues. Objective: The purpose of this study was to obtain feedback on weight management in pediatric ALL survivors and on the content and implementation of a Web-based weight management program. Methods: Study participants included 54 parent survey respondents and 19 pediatric oncology professionals in 4 focus groups. Survey questions included report of child weight status and interest in participating in weight management programming at various time points. Pediatric oncology professionals were asked about the preferred topics and timing, as well as their role. Focus group data were analyzed by a multidisciplinary research team for common themes. Results: The mean age of survivors was 6.5 years. By parent report, 19\% of children were overweight and 25\% were obese. Preferred timing for weight management program participation was within 3 months of starting maintenance chemotherapy (23/53, 43\%) or within 12 months after completion of all cancer treatments (18/53, 34\%). Pediatric oncology professionals likewise considered the maintenance phase appropriate. They considered parenting to be an important topic to include and indicated that their most appropriate roles would be promotion and support. Conclusions: Parents and pediatric oncology professionals are interested in and supportive of early weight management in pediatric ALL survivors. Future research needs to identify strategies to integrate this into pediatric cancer care and to evaluate the feasibility and efficacy of these strategies. ", doi="10.2196/cancer.6680", url="http://cancer.jmir.org/2017/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410182" } @Article{info:doi/10.2196/resprot.7094, author="Nygren, M. Jens and Lindberg, Susanne and W{\"a}rnest{\aa}l, Pontus and Svedberg, Petra", title="Involving Children With Cancer in Health Promotive Research: A Case Study Describing Why, What, and How", journal="JMIR Res Protoc", year="2017", month="Feb", day="07", volume="6", number="2", pages="e19", keywords="children", keywords="participation", keywords="involvement", keywords="research", abstract="Background: Participatory research approaches have been introduced to meet end-users' needs in the development of health promotion interventions among children. However, whereas children are increasingly involved as passive informants in particular parts of research, they are rarely involved as partners, equal to adult researchers, throughout the research process. This is especially prominent in the context of child health where the child is commonly considered to be vulnerable or when the research concerns sensitive situations. In these cases, researchers and gatekeepers to children's involvement base their resistance to active involvement of children on potential adverse effects on the accuracy or quality of the research or on ethical or moral principles that participation might harm the child. Thus most research aimed at developing health promotion interventions for children in health care is primarily based on the involvement of parents, caregivers, and other stakeholders. Objective: The objective of this paper is to discuss reasons for involving children in health promotive research and to explore models for children's participation in research as a basis for describing how researchers can use design methodology and participatory approaches to support the participation and contribution of children in a vulnerable context. Methods: We developed and applied a model for children's participation in research to the development of a digital peer support service for children cancer survivors. This guided the selection of appropriate research and design methodologies (such as interviews, focus groups, design sessions, and usability evaluation) for involving the children cancer survivors (8-12 years) in the design of a digital peer support service. Results: We present a model for what children's participation in research means and describe how we practically implemented this model in a research project on children with cancer. This paper can inform researchers in their planning of strategies for children's participation and ensure future development of health promotion interventions for children is based on their perspectives. Conclusions: Challenges in reaching a suitable degree of participation during a research project involve both creating opportunities for children to have genuine influence on the research process and organizing this involvement so that they feel they understand what they are involved in and why. To achieve this, it is essential to enable children to be involved in research over time to gain confidence in the researchers and to develop children's abilities to make decisions throughout the research processes. ", doi="10.2196/resprot.7094", url="http://www.researchprotocols.org/2017/2/e19/", url="http://www.ncbi.nlm.nih.gov/pubmed/28174150" } @Article{info:doi/10.2196/mhealth.6970, author="Robertson, C. Michael and Tsai, Edward and Lyons, J. Elizabeth and Srinivasan, Sanjana and Swartz, C. Maria and Baum, L. Miranda and Basen-Engquist, M. Karen", title="Mobile Health Physical Activity Intervention Preferences in Cancer Survivors: A Qualitative Study", journal="JMIR Mhealth Uhealth", year="2017", month="Jan", day="24", volume="5", number="1", pages="e3", keywords="mHealth", keywords="physical activity", keywords="survivors", keywords="technology", keywords="focus groups", keywords="smartphone", abstract="Background: Cancer survivors are at an elevated risk for several negative health outcomes, but physical activity (PA) can decrease those risks. Unfortunately, adherence to PA recommendations among survivors is low. Fitness mobile apps have been shown to facilitate the adoption of PA in the general population, but there are limited apps specifically designed for cancer survivors. This population has unique needs and barriers to PA, and most existing PA apps do not address these issues. Moreover, incorporating user preferences has been identified as an important priority for technology-based PA interventions, but at present there is limited literature that serves to establish these preferences in cancer survivors. This is especially problematic given the high cost of app development and because the majority of downloaded apps fail to engage users over the long term. Objective: The aim of this study was to take a qualitative approach to provide practical insight regarding this population's preferences for the features and messages of an app to increase PA. Methods: A total of 35 cancer survivors each attended 2 focus groups; a moderator presented slide shows on potential app features and messages and asked open-ended questions to elicit participant preferences. All sessions were audio recorded and transcribed verbatim. Three reviewers independently conducted thematic content analysis on all transcripts, then organized and consolidated findings to identify salient themes. Results: Participants (mean age 63.7, SD 10.8, years) were mostly female (24/35, 69\%) and mostly white (25/35, 71\%). Participants generally had access to technology and were receptive to engaging with an app to increase PA. Themes identified included preferences for (1) a casual, concise, and positive tone, (2) tools for personal goal attainment, (3) a prescription for PA, and (4) an experience that is tailored to the user. Participants reported wanting extensive background data collection with low data entry burden and to have a trustworthy source translate their personal data into individualized PA recommendations. They expressed a desire for app functions that could facilitate goal achievement and articulated a preference for a more private social experience. Finally, results indicated that PA goals might be best established in the context of personally held priorities and values. Conclusions: Many of the desired features identified are compatible with both empirically supported methods of behavior change and the relative strengths of an app as a delivery vehicle for behavioral intervention. Participating cancer survivors' preferences contrasted with many current standard practices for mobile app development, including value-based rather than numeric goals, private socialization in small groups rather than sharing with broader social networks, and interpretation of PA data rather than merely providing numerical data. Taken together, these insights may help increase the acceptability of theory-based mHealth PA interventions in cancer survivors. ", doi="10.2196/mhealth.6970", url="http://mhealth.jmir.org/2017/1/e3/", url="http://www.ncbi.nlm.nih.gov/pubmed/28119278" } @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/resprot.6381, author="Zhang, Fang Fang and Meagher, Susan and Scheurer, Michael and Folta, Sara and Finnan, Emily and Criss, Kerry and Economos, Christina and Dreyer, ZoAnn and Kelly, Michael", title="Developing a Web-Based Weight Management Program for Childhood Cancer Survivors: Rationale and Methods", journal="JMIR Res Protoc", year="2016", month="Nov", day="18", volume="5", number="4", pages="e214", keywords="weight management", keywords="childhood cancer survivors", keywords="obesity", keywords="Web-based", keywords="development", keywords="nutrition", keywords="physical activity", abstract="Background: Due to advances in the field of oncology, survival rates for children with cancer have improved significantly. However, these childhood cancer survivors are at a higher risk for obesity and cardiovascular diseases and for developing these conditions at an earlier age. Objective: In this paper, we describe the rationale, conceptual framework, development process, novel components, and delivery plan of a behavioral intervention program for preventing unhealthy weight gain in survivors of childhood acute lymphoblastic leukemia (ALL). Methods: A Web-based program, the Healthy Eating and Active Living (HEAL) program, was designed by a multidisciplinary team of researchers who first identified behaviors that are appropriate targets for weight management in childhood ALL survivors and subsequently developed the intervention components, following core behavioral change strategies grounded in social cognitive and self-determination theories. Results: The Web-based HEAL curriculum has 12 weekly self-guided sessions to increase parents' awareness of the potential impact of cancer treatment on weight and lifestyle habits and the importance of weight management in survivors' long-term health. It empowers parents with knowledge and skills on parenting, nutrition, and physical activity to help them facilitate healthy eating and active living soon after the child completes intensive cancer treatment. Based on social cognitive theory, the program is designed to increase behavioral skills (goal-setting, self-monitoring, and problem-solving) and self-efficacy and to provide positive reinforcement to sustain behavioral change. Conclusions: Lifestyle interventions are a priority for preventing the early onset of obesity and cardiovascular risk factors in childhood cancer survivors. Intervention programs need to meet survivors' targeted behavioral needs, address specific barriers, and capture a sensitive window for behavioral change. In addition, they should be convenient, cost-effective and scalable. Future studies are needed to evaluate the feasibility of introducing weight management early in cancer care and the efficacy of early weight management on survivors' health outcomes. ", doi="10.2196/resprot.6381", url="http://www.researchprotocols.org/2016/4/e214/", url="http://www.ncbi.nlm.nih.gov/pubmed/27864163" } @Article{info:doi/10.2196/cancer.6295, author="Fazzino, L. Tera and Fleming, Kimberly and Befort, Christie", title="Alcohol Intake Among Breast Cancer Survivors: Change in Alcohol Use During a Weight Management Intervention", journal="JMIR Cancer", year="2016", month="Nov", day="09", volume="2", number="2", pages="e15", keywords="alcohol drinking", keywords="breast cancer", keywords="weight loss", keywords="weight reduction programs", keywords="obesity", abstract="Background: Daily alcohol intake in quantities as small as half a drink/day significantly increases the risk of breast cancer recurrence for postmenopausal survivors. Interventions designed to modify alcohol use among survivors have not been studied; however, lifestyle interventions that target change in dietary intake may affect alcohol intake. Objective: To evaluate change in alcohol use during a weight loss intervention for obese, rural-dwelling breast cancer survivors. Methods: Data were derived from an 18-month trial that included a 6-month weight loss intervention delivered via group conference calls, followed by a 12-month randomized weight loss maintenance phase in which participants received continued group calls or mailed newsletters. Participants who reported regular alcohol use at baseline (N=37) were included in this study. Results: Mean daily alcohol intake significantly decreased from baseline to 6 months during the weight loss intervention (19.6-2.3 g; P=.001). Mean alcohol intake did not significantly increase (b=0.99, P=.12) during the weight loss maintenance phase (months 6-18) and did not depend on randomization group (b=0.32, P=.799). Conclusions: Findings provide preliminary evidence that a weight loss intervention may address obesity and alcohol use risk factors for cancer recurrence. Minimal mail-based contact post weight loss can maintain alcohol use reductions through 18 months, suggesting durability in these effects. These results highlight a possibility that lifestyle interventions for survivors may modify health behaviors that are not the main foci of an intervention but that coincide with intervention goals. Trial Registration: Clinicaltrials.gov NCT01441011; https://clinicaltrials.gov/ct2/show/NCT01441011 (Archived by WebCite at http://www.webcitation.org/6lsJ9dMa9) ", doi="10.2196/cancer.6295", url="http://cancer.jmir.org/2016/2/e15/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410181" } @Article{info:doi/10.2196/cancer.5947, author="Smith, Clegg Katherine and Tolbert, Elliott and Hannum, M. Susan and Radhakrishnan, Archana and Zorn, Kelsey and Blackford, Amanda and Greco, Stephen and Smith, Karen and Snyder, F. Claire", title="Comparing Web-Based Provider-Initiated and Patient-Initiated Survivorship Care Planning for Cancer Patients: A Randomized Controlled Trial", journal="JMIR Cancer", year="2016", month="Aug", day="30", volume="2", number="2", pages="e12", keywords="survivorship care plan", keywords="mixed methods study", keywords="randomized controlled trial", abstract="Background: Survivorship care plans (SCPs) are intended to facilitate communication and coordination between patients, oncologists, and primary care providers. Most SCP initiatives have focused on oncology providers initiating the SCP process, but time and resource barriers have limited uptake. Objective: This trial compares the feasibility and value of 2 Web-based SCP tools: provider-initiated versus patient-initiated. Methods: This mixed-methods study recruited clinicians from 2 academically-affiliated community oncology practices. Eligible patients were treated by a participating oncologist, had nonmetastatic cancer, completed acute treatment ? 2 months before enrollment, and had no evidence of disease. Patients were randomized 1:1 to either provider-initiated or patient-initiated SCPs---both are Web-based tools. We conducted qualitative interviews with providers at baseline and follow-up and with patients 2 months after enrollment. In addition, patients were administered the Preparing for Life as a (New) Survivor (PLANS) and Cancer Survivors' Unmet Needs (CaSUN) surveys at baseline and 2 months. Results: A total of 40 providers were approached for the study, of whom 13 (33\%) enrolled. Providers or clinic staff required researcher assistance to identify eligible patients; 41 patients were randomized, of whom 25 completed follow-up (61\%; 13 provider-initiated, 12 patient-initiated). Of the 25, 11 (44\%) had initiated the SCP; 5 (20\%) provided the SCP to their primary care provider. On the Preparing for Life as a (New) Survivor and Cancer Survivors' Unmet Needs, patients in both arms tended to report high knowledge and confidence and few unmet needs. In qualitative interviews, providers and patients discussed SCPs' value. Conclusions: Regardless of patient- versus provider-initiated templates and the Web-based design of these tools, barriers to survivorship care planning persist. Further efforts should emphasize workflow functions for identifying and completing SCPs---regardless of the SCP form used. Trial Registration: ClinicalTrials.gov NCT02405819; https://clinicaltrials.gov/ct2/show/NCT02405819 (Archived by WebCite at http://www.webcitation.org/6jWqcWOvK) ", doi="10.2196/cancer.5947", url="http://cancer.jmir.org/2016/2/e12/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410187" } @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.4914, author="Nicolaije, AH Kim and Ezendam, PM Nicole and Pijnenborg, MA Johanna and Boll, Dorry and Vos, Caroline Maria and Kruitwagen, FPM Roy and van de Poll-Franse, V. Lonneke", title="Paper-Based Survivorship Care Plans May be Less Helpful for Cancer Patients Who Search for Disease-Related Information on the Internet: Results of the Registrationsystem Oncological Gynecology (ROGY) Care Randomized Trial", journal="J Med Internet Res", year="2016", month="Jul", day="08", volume="18", number="7", pages="e162", keywords="Survivorship Care Plan", keywords="Internet use", keywords="pragmatic cluster randomized trial", keywords="endometrial neoplasms", keywords="patient-reported outcomes", keywords="information provision", abstract="Background: The Institute of Medicine recommends Survivorship Care Plans (SCPs) for all cancer survivors. However, it is unclear whether certain patient groups may or may not benefit from SCPs. Objective: The aim was to assess whether the effects of an automatically generated paper SCP on patients' satisfaction with information provision and care, illness perceptions, and health care utilization were moderated by disease-related Internet use. Methods: Twelve hospitals were randomized to either SCP care or usual care in the pragmatic cluster randomized Registrationsystem Oncological GYnecology (ROGY) Care trial. Newly diagnosed endometrial cancer patients completed questionnaires after diagnosis (N=221; response: 74.7\%, 221/296), 6 months (n=158), and 12 months (n=147), including patients' satisfaction with information provision and care, illness perceptions, health care utilization (how many times patients visited a medical specialist or primary care physician about their cancer in the past 6 months), and disease-related Internet use (whether patients used the Internet to look for information about cancer). Results: In total, 80 of 221 (36.2\%) patients used the Internet to obtain disease-related information. Disease-related Internet use moderated the SCP care effect on the amount of information received about the disease (P=.03) and medical tests (P=.01), helpfulness of the information (P=.01), and how well patients understood their illness (P=.04). All stratified analyses were not statistically significant. However, it appeared that patients who did not seek disease-related information on the Internet in the SCP care arm reported receiving more information about their disease (mean 63.9, SD 20.1 vs mean 58.3, SD 23.7) and medical tests (mean 70.6, SD 23.5 vs mean 64.7, SD 24.9), finding the information more helpful (76.7, SD 22.9 vs mean 67.8, SD 27.2; scale 0-100), and understanding their illness better (mean 6.6, SD 3.0 vs mean 6.1, SD 3.2; scale 1-10) than patients in the usual care arm did. In addition, although all stratified analyses were not significant, patients who did seek disease-related information on the Internet in the SCP care arm appeared to receive less information about their disease (mean 65.7, SD 23.4 vs mean 67.1, SD 20.7) and medical tests (mean 72.4, SD 23.5 vs mean 75.3, SD 21.6), did not find the information more helpful (mean 78.6, SD 21.2 vs mean 76.0, SD 22.0), and reported less understanding of their illness (mean 6.3, SD 2.8 vs mean 7.1, SD 2.7) than patients in the usual care arm did. Conclusions: Paper SCPs appear to improve the amount of information received about the disease and medical tests, the helpfulness of the information, and understanding of the illness for patients who do not search for disease-related information on the Internet. In contrast, paper SCPs do not seem beneficial for patients who do seek disease-related information on the Internet. Trial Registration: ClinicalTrials.gov NCT01185626; https://clinicaltrials.gov/ct2/show/NCT01185626 (Archived by WebCite at http://www.webcitation.org/6fpaMXsDn) ", doi="10.2196/jmir.4914", url="http://www.jmir.org/2016/7/e162/", url="http://www.ncbi.nlm.nih.gov/pubmed/27392550" } @Article{info:doi/10.2196/resprot.5565, author="Tamminga, J. Sietske and van Hezel, Sanne and de Boer, GEM Angela and Frings-Dresen, HW Monique", title="Enhancing the Return to Work of Cancer Survivors: Development and Feasibility of the Nurse-Led eHealth Intervention Cancer@Work", journal="JMIR Res Protoc", year="2016", month="Jun", day="10", volume="5", number="2", pages="e118", keywords="cancer", keywords="return to work", keywords="eHealth", keywords="survivorship", keywords="feasibility studies", keywords="self-management", abstract="Background: It is important to enhance the return to work of cancer survivors with an appropriate intervention, as cancer survivors experience problems upon their return to work but consider it an essential part of their recovery. Objective: The objective of our study was to develop an eHealth intervention to enhance the return to work of cancer survivors and to test the feasibility of the eHealth intervention with end users. Methods: To develop the intervention we 1) searched the literature, 2) interviewed 7 eHealth experts, 3) interviewed 7 cancer survivors, 2 employers, and 7 occupational physicians, and 4) consulted experts. To test feasibility, we enrolled 39 cancer survivors, 9 supervisors, 7 occupational physicians, 9 general physicians and 2 social workers and gave them access to the eHealth intervention. We also interviewed participants, asked them to fill in a questionnaire, or both, to test which functionalities of the eHealth intervention were appropriate and which aspects needed improvement. Results: Cancer survivors particularly want information and support regarding the possibility of returning to work, and on financial and legal aspects of their situation. Furthermore, the use of blended care and the personalization of the eHealth intervention were preferred features for increasing compliance. The first version of the eHealth intervention consisted of access to a personal and secure website containing various functionalities for cancer survivors blended with support from their specialized nurse, and a public website for employers, occupational physicians, and general physicians. The eHealth intervention appeared feasible. We adapted it slightly by adding more information on different cancer types and their possible effects on return to work. Conclusions: A multistakeholder and mixed-method design appeared useful in the development of the eHealth intervention. It was challenging to meet all end user requirements due to legal and privacy constraints. The eHealth intervention appeared feasible, although implementation in daily practice needs to be subject of further research. ClinicalTrial: Dutch Trial Register number (NTR): 5190; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5190 (Archived by WebCite at http://www.webcitation.org/6hm4WQJqC) ", doi="10.2196/resprot.5565", url="http://www.researchprotocols.org/2016/2/e118/", url="http://www.ncbi.nlm.nih.gov/pubmed/27286819" } @Article{info:doi/10.2196/cancer.5380, author="Puszkiewicz, Patrycja and Roberts, L. Anna and Smith, Lee and Wardle, Jane and Fisher, Abigail", title="Assessment of Cancer Survivors' Experiences of Using a Publicly Available Physical Activity Mobile Application", journal="JMIR Cancer", year="2016", month="May", day="31", volume="2", number="1", pages="e7", keywords="cancer survivors", keywords="mobile applications", keywords="mHealth", keywords="physical activity", keywords="sleep", abstract="Background: Regular participation in physical activity (PA) is associated with improved physical and psychosocial outcomes in cancer survivors. However, PA levels are low during and after cancer treatment. Interventions to promote PA in this population are needed. PA mobile apps are popular and have potential to increase PA participation, but little is known about how appropriate or relevant they are for cancer survivors. Objective: This study aims to (1) assess recruitment, study uptake, and engagement for a publicly available PA mobile app (GAINFitness) intervention in cancer survivors; (2) assess cancer survivors' attitudes towards the app; (3) understand how the app could be adapted to better meet the needs of cancer survivors; and (4) to determine the potential for change in PA participation and psychosocial outcomes over a 6-week period of using the app. Methods: The present study was a one-arm, pre-post design. Cancer survivors (N=11) aged 33 to 62 years with a mean (SD) age of 45 (9.4), and 82\% (9/11) female, were recruited (via community/online convenience sampling to use the app for 6 weeks). Engagement with the app was measured using self-reported frequency and duration of usage. Qualitative semi-structured telephone interviews were conducted after the 6-week study period and were analyzed using thematic analysis. PA, well-being, fatigue, quality of life (QOL), sleep quality, and anxiety and depression were self-reported at baseline and at a 6-week follow-up using the Godin Leisure Time Exercise Questionnaire (GLTEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale Questionnaire, the Health and Quality of Life Outcomes (EQ5D) Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS), respectively. Results: Of the people who responded to the study advertisement, 73\% (16/22) agreed to participate and 100\% (11/11) of the participants who started the study completed all baseline and follow-up outcome measures and the telephone interview. On average, participants used the app twice a week for 25 minutes per session. Four themes were identified from the qualitative interviews surrounding the suitability of the app for cancer survivors and how it could be adapted: (1) barriers to PA, (2) receiving advice about PA from reliable sources, (3) tailoring the application to one's lifestyle, and (4) receiving social support from others. Pre-post comparison showed significant increases in strenuous PA, improvements in sleep quality, and reductions in mild PA. There were no significant changes in moderate PA or other psychosocial outcomes. Conclusions: All participants engaged with the app and qualitative interviews highlighted that the app was well-received. A generic PA mobile app could bring about positive improvements in PA participation and psychosocial outcomes among cancer survivors. However, a targeted PA app aimed specifically towards cancer survivors may increase the relevance and suitability of the app for this population. ", doi="10.2196/cancer.5380", url="http://cancer.jmir.org/2016/1/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410168" } @Article{info:doi/10.2196/cancer.5431, author="Wurz, Amanda and Brunet, Jennifer", title="The Effects of Physical Activity on Health and Quality of Life in Adolescent Cancer Survivors: A Systematic Review", journal="JMIR Cancer", year="2016", month="May", day="24", volume="2", number="1", pages="e6", keywords="exercise", keywords="controlled clinical trial", keywords="randomized controlled trial", keywords="review", keywords="treatment effectiveness", abstract="Background: There are numerous published controlled trials assessing the safety and the benefits of physical activity (PA) for child and adult cancer survivors. However, trials exclusively comprised of adolescent cancer survivors aged 13-19 years, who may experience different health and quality of life (QOL) effects as a function of their developmental status, are lacking. Rather, some trials have included both adolescent and child cancer survivors together. Objective: The aim of this systematic review was to synthesize the findings from randomized controlled trails (RCTs) and controlled clinical trials (CCTs) investigating the effects of PA on health and QOL outcomes in samples comprised of >50\% adolescent cancer survivors to summarize the current state of evidence, identify knowledge gaps, and highlight areas in need of additional research within this population. Methods: Using a search strategy developed for this review, 10 electronic databases were searched for RCTs and CCTs that reported on the effects of PA on at least 1 health and/or QOL outcome in samples comprised of >50\% adolescent cancer survivors. Results: From the 2249 articles identified, 2 CCTs met the predetermined eligibility criteria and were included in this review. Combined, 28 adolescents (of 41 participants) who were receiving active treatment participated in the 2 studies reviewed. A total of 4 health and QOL outcomes (ie, bone mass, fatigue, grip strength, QOL) were assessed pre- and post-PA intervention. Conclusions: On the basis of the 2 studies reviewed, PA appears to be safe and feasible. PA also shows promise to mitigate reductions in bone mass and might be a viable strategy to improve fatigue, grip strength, and QOL. High-quality controlled trials with larger samples exclusively comprised of adolescent cancer survivors that assess a wide range of outcomes are needed to determine the effects of PA on health and QOL outcomes in this population. ", doi="10.2196/cancer.5431", url="http://cancer.jmir.org/2016/1/e6/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410184" } @Article{info:doi/10.2196/cancer.5305, author="M Quintiliani, Lisa and Mann, M. Devin and Puputti, Marissa and Quinn, Emily and Bowen, J. Deborah", title="Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors", journal="JMIR Cancer", year="2016", month="May", day="09", volume="2", number="1", pages="e4", keywords="telemedicine", keywords="survivors", keywords="breast neoplasms", keywords="health behavior", keywords="body weight", abstract="Background: Health behavior and weight management interventions for cancer survivors have the potential to prevent future cancer recurrence and improve long-term health; however, their translation can be limited if the intervention is complex and involves high participant burden. Mobile health (mHealth) offers a delivery modality to integrate interventions into daily life routines. Objective: The objective of this study was to evaluate the effects of a one-group trial with a pre-post evaluation design on engagement (use and acceptability), physiological (weight), behavioral (diet and physical activity), and other secondary outcomes. Methods: The 10-week intervention consisted of mHealth components (self-monitoring of selected diet behaviors via daily text messages, wireless devices to automatically track weight and steps) and 4 motivational interviewing--based technology-assisted phone sessions with a nonprofessionally trained counselor. Participants were overweight breast cancer survivors who had completed treatment and owned a smartphone. Weight was measured objectively; diet and physical activity were measured with brief self-reported questionnaires. Results: Ten women participated; they had a mean age of 59 years (SD 6), 50\% belonged to a racial or ethnic minority group, 50\% had some college or less, and 40\% reported using Medicaid health insurance. Engagement was high: out of 70 days in total, the mean number of days recording steps via the wristband pedometer was 64 (SD 7), recording a weight via the scale was 45 (SD 24), and responding to text messages was 60 (SD 13); 100\% of participants completed all 4 calls with the counselor. Most (90\%) were very likely to participate again and recommend the program to others. Mean weight in pounds decreased (182.5 to 179.1, mean change ?3.38 [SD 7.67]), fruit and vegetable daily servings increased (2.89 to 4.42, mean change 1.53 [SD 2.82]), and self-reported moderate physical activity increased in metabolic equivalent of task (MET) minutes per week (2791 to 3336, mean change 545 [SD 1694]). Conclusions: Findings support the conduct of a fully powered trial to evaluate the efficacy of mHealth as a feasible intervention modality for breast cancer survivors. Future research should employ accelerometer-based physical activity assessment and consider development of an all-in-one app to integrate devices, messaging, and educational content and other mHealth approaches to support behavioral counselors conducting weight management interventions. Trial Registration: ClinicalTrials.gov NCT02387671; https://clinicaltrials.gov/ct2/show/NCT02387671 (Archived by WebCite at http://www.webcitation.org/6hGEuttbZ). ", doi="10.2196/cancer.5305", url="http://cancer.jmir.org/2016/1/e4/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410174" } @Article{info:doi/10.2196/resprot.5300, author="Woods, Luxh{\o}j Pernille and Schumacher, Lauren and Sadhra, S. Steven and Sutton, J. Andrew and Zarkar, Anjali and Rolf, Pauline and Grunfeld, A. Elizabeth", title="A Guided Workbook Intervention (WorkPlan) to Support Work-Related Goals Among Cancer Survivors: Protocol of a Feasibility Randomized Controlled Trial", journal="JMIR Res Protoc", year="2016", month="May", day="03", volume="5", number="2", pages="e75", keywords="oncology", keywords="cancer", keywords="return to work", keywords="intervention", keywords="protocol", keywords="RCT", abstract="Background: Returning to and staying at work following illness is associated with better physical and psychological functioning. Not working has been shown to be associated with reduced self-esteem, lowered self-efficacy, and decreased belief in one's ability to return to the workplace. Although there is a growing body of research looking at what predicts return to work following cancer treatment, there are fewer studies examining interventions targeting return to work. Objective: The primary objective is to assess the feasibility and acceptability of a theoretically led workbook intervention designed to support cancer patients in returning to work to inform a fully powered randomized controlled trial (RCT). Methods: This is a multicenter feasibility RCT where the main analysis uses a qualitative approach. Sixty participants (aged 18-65 years) who have received a diagnosis of cancer and who intend to return to work will be randomized to either the WorkPlan intervention group or a usual care group (ratio 1:1). Participants in the intervention group will receive a guided workbook intervention (which contains activities aimed at eliciting thoughts and beliefs, identifying targets and actions, and concrete steps to achieve goals) and will receive telephone support over a 4-week period. The primary outcome measure is time taken to return to work (in days), and secondary outcome measures include mood, quality of life, illness perceptions, and job satisfaction. Data will be collected through postal questionnaires administered immediately postintervention and at 6- and 12-month follow-ups. In addition, interviews will be undertaken immediately postintervention (to explore acceptability of the intervention and materials) and at 12-month follow-up (to explore perceptions of participation in the trial and experiences of returning to work). Results: Enrollment for the study will be completed in May 2016. Data analysis will commence in April 2017, and the first results are expected to be submitted for publication in late 2017. Conclusions: Currently no standardized return-to-work intervention based on targeting cancer patient beliefs is in existence. If the intervention is shown to be feasible and acceptable, the results of this study will inform a future full RCT with the potential to provide a valuable and cost-efficient tool in supporting cancer survivors in the return-to-work process. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN56342476; http://www.isrctn.com/ISRCTN56342476 (Archived by WebCite at http://www.webcitation.org/6gblhEPXd). ", doi="10.2196/resprot.5300", url="http://www.researchprotocols.org/2016/2/e75/", url="http://www.ncbi.nlm.nih.gov/pubmed/27143229" } @Article{info:doi/10.2196/resprot.5383, author="Wurz, Amanda and Brunet, Jennifer", title="A Systematic Review Protocol to Assess the Effects of Physical Activity on Health and Quality of Life Outcomes in Adolescent Cancer Survivors", journal="JMIR Res Protoc", year="2016", month="Mar", day="30", volume="5", number="1", pages="e54", keywords="controlled clinical trial", keywords="randomized controlled trial", keywords="adolescent", keywords="oncology", keywords="neoplasm", keywords="exercise", keywords="quality of life.", abstract="Background: The benefits of physical activity for child and adult cancer survivors have been summarized in previous systematic reviews. However, no review has summarized the evidence for adolescent cancer survivors. Objective: This paper describes the design of a protocol to conduct a systematic review of published studies examining the effects of physical activity on health and quality of life outcomes for adolescent cancer survivors. Methods: Several guidelines informed the development of this protocol. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines provided the structure by which to conduct and report the protocol; though some adaptations were made with regards to search terms, data synthesis, and evaluating the risk of bias. The Cochrane Handbook for Systematic Reviews of Interventions was used to guide research question development, search term selection, and the data extraction form. The Consolidated Standards of Reporting Trials guidelines helped inform the data extraction form. Lastly, the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews informed the data synthesis. Ten electronic databases were identified and a search strategy was developed using a combination of Medical Subject Headings terms and keywords that were developed by the authors and peer reviewed by a university librarian. Both authors independently screened eligible studies for final inclusion, and data were abstracted using a form developed by the research team. A decision was made to synthesize all data narratively. Results: The review has now been completed, peer-reviewed, and accepted for publication in a forthcoming issue of JMIR Cancer. Conclusions: As this will be the first systematic review on this topic, outlining the protocol ensures transparency for the completed review. Further, this protocol illustrates how elements from several guidelines were incorporated to answer the research question (ie, what is the effect of physical activity on health and quality of life outcomes in adolescent cancer survivors). This flexible approach was necessary as a function of the paucity of available research on this topic. ", doi="10.2196/resprot.5383", url="http://www.researchprotocols.org/2016/1/e54/", url="http://www.ncbi.nlm.nih.gov/pubmed/27030210" } @Article{info:doi/10.2196/resprot.5290, author="Smith, Ann Selina and Whitehead, Smith Mary and Sheats, Joyce and Mastromonico, Jeff and Yoo, Wonsuk and Coughlin, Scott Steven", title="A Community-Engaged Approach to Developing a Mobile Cancer Prevention App: The mCPA Study Protocol", journal="JMIR Res Protoc", year="2016", month="Mar", day="02", volume="5", number="1", pages="e34", keywords="smartphone applications", keywords="African Americans", keywords="breast cancer survivors", keywords="cancer prevention guidelines", keywords="dietary intake", keywords="physical activity", abstract="Background: Rapid growth of mobile technologies has resulted in a proliferation of lifestyle-oriented mobile phone apps. However, most do not have a theoretical framework and few have been developed using a community-based participatory research approach. A community academic team will develop a theory-based, culturally tailored, mobile-enabled, Web-based app---the Mobile Cancer Prevention App (mCPA)---to promote adherence to dietary and physical activity guidelines. Objective: The aim of this study is to develop mCPA content with input from breast cancer survivors. Methods: Members of SISTAAH (Survivors Involving Supporters to Take Action in Advancing Health) Talk (N=12), treated for Stages I-IIIc breast cancer for less than 1 year, 75 years of age or younger, and English-speaking and writing, will be recruited to participate in the study. To develop the app content, breast cancer survivors will engage with researchers in videotaped and audiotaped sessions, including (1) didactic instructions with goals for, benefits of, and strategies to enhance dietary intake and physical activity, (2) guided discussions for setting individualized goals, monitoring progress, and providing or receiving feedback, (3) experiential nutrition education through cooking demonstrations, and (4) interactive physical activity focused on walking, yoga, and strength training. Qualitative (focus group discussions and key informant interviews) and quantitative (sensory evaluation) methods will be used to evaluate the participatory process and outcomes. Results: Investigators and participants anticipate development of an acceptable (frequency and duration of usage) feasible (structure, ease of use, features), and accessible mobile app available for intervention testing in early 2017. Conclusions: Depending on the availability of research funding, mCPA testing, which will be initiated in Miami, will be extended to Chicago, Houston, Philadelphia, and Los Angeles. ", doi="10.2196/resprot.5290", url="http://www.researchprotocols.org/2016/1/e34/", url="http://www.ncbi.nlm.nih.gov/pubmed/26935995" } @Article{info:doi/10.2196/cancer.5247, author="Martin, C. Emily and Basen-Engquist, Karen and Cox, G. Matthew and Lyons, J. Elizabeth and Carmack, L. Cindy and Blalock, A. Janice and Demark-Wahnefried, Wendy", title="Interest in Health Behavior Intervention Delivery Modalities Among Cancer Survivors: A Cross-Sectional Study", journal="JMIR Cancer", year="2016", month="Feb", day="11", volume="2", number="1", pages="e1", keywords="cancer survivor", keywords="technology", keywords="smartphone", keywords="behavioral intervention", keywords="physical activity", keywords="diet", abstract="Background: Effective, broad-reaching channels are important for the delivery of health behavior interventions in order to meet the needs of the growing population of cancer survivors in the United States. New technology presents opportunities to increase the reach of health behavior change interventions and therefore their overall impact. However, evidence suggests that older adults may be slower in their adoption of these technologies than the general population. Survivors' interest for more traditional channels of delivery (eg, clinic) versus new technology-based channels (eg, smartphones) may depend on a variety of factors, including demographics, current health status, and the behavior requiring intervention. Objective: The aim of this study was to determine the factors that predict cancer survivors' interest in new technology-based health behavior intervention modalities versus traditional modalities. Methods: Surveys were mailed to 1871 survivors of breast, prostate, and colorectal cancer. Participants' demographics, diet and physical activity behaviors, interest in health behavior interventions, and interest in intervention delivery modalities were collected. Using path analysis, we explored the relationship between four intervention modality variables (ie, clinic, telephone, computer, and smartphone) and potential predictors of modality interest. Results: In total, 1053 respondents to the survey (56.3\% response rate); 847 provided complete data for this analysis. Delivery channel interest was highest for computer-based interventions (236/847, 27.9\% very/extremely interested) and lowest for smartphone--based interventions (73/847, 8.6\%), with interest in clinic-based (147/847, 17.3\%) and telephone-delivered (143/847, 16.9\%) falling in between. Use of other technology platforms, such as Web cameras and social networking sites, was positively predictive of interest in technology-based delivery channels. Older survivors were less likely to report interest in smartphone--based diet interventions. Physical activity, fruit and vegetable consumption, weight status, and age moderated relationships between interest in targeted intervention behavior and modality. Conclusions: This study identified several predictors of survivor interest in various health behavior intervention delivery modalities. Overall, computer-based interventions were found to be most acceptable, while smartphones were the least. Factors related to survivors' current technology use and health status play a role in their interest for technology-based intervention versus more traditional delivery channels. Future health behavior change research in this population should consider participants' demographic, clinical, and lifestyle characteristics when selecting a delivery channel. Furthermore, current health behavior interventions for older cancer survivors may be best delivered over the Internet. Smartphone interventions may be feasible in the future following further adoption and familiarization by this particular population. ", doi="10.2196/cancer.5247", url="http://cancer.jmir.org/2016/1/e1/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410164" } @Article{info:doi/10.2196/jmir.4818, 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="Empowerment of Cancer Survivors Through Information Technology: An Integrative Review", journal="J Med Internet Res", year="2015", month="Nov", day="27", volume="17", number="11", pages="e270", keywords="review", keywords="neoplasms", keywords="Internet", keywords="technology", keywords="health education", keywords="chronic disease", keywords="power (psychology)", abstract="Background: Patient empowerment may be an effective approach to strengthen the role of cancer survivors and to reduce the burden on health care. However, it is not well conceptualized, notably in oncology. Furthermore, it is unclear to what extent information technology (IT) services can contribute to empowerment of cancer survivors. Objective: We aim to define the conceptual components of patient empowerment of chronic disease patients, especially cancer survivors, and to explore the contribution of existing and new IT services to promote empowerment. Methods: Electronic databases were searched to identify theoretical and empirical articles regarding empowerment. We extracted and synthesized conceptual components of patient empowerment (ie, attributes, antecedents, and consequences) according to the integrated review methodology. We identified recent IT services for cancer survivors by examining systematic reviews and a proposed inventory of new services, and we related their features and effects to the identified components of empowerment. Results: Based on 26 articles, we identified five main attributes of patient empowerment: (1) being autonomous and respected, (2) having knowledge, (3) having psychosocial and behavioral skills, (4) perceiving support from community, family, and friends, and (5) perceiving oneself to be useful. The latter two were specific for the cancer setting. Systematic reviews of IT services and our additional inventory helped us identify five main categories: (1) educational services, including electronic survivorship care plan services, (2) patient-to-patient services, (3) electronic patient-reported outcome (ePRO) services, (4) multicomponent services, and (5) portal services. Potential impact on empowerment included knowledge enhancement and, to a lesser extent, enhancing autonomy and skills. Newly developed services offer promising and exciting opportunities to empower cancer survivors, for instance, by providing tailored advice for supportive or follow-up care based on patients' input. Conclusions: We identified five main components of empowerment and showed that IT services may especially contribute to empowerment by providing knowledge. The components of empowerment could be used to develop IT services for cancer survivors. It is important to take into account patients' needs, follow up on these needs, and create a service that is attractive and easy to use. ", doi="10.2196/jmir.4818", url="http://www.jmir.org/2015/11/e270/", url="http://www.ncbi.nlm.nih.gov/pubmed/26614438" } @Article{info:doi/10.2196/cancer.4586, author="Forbes, C. Cynthia and Blanchard, M. Chris and Mummery, Kerry W. and Courneya, S. Kerry", title="Feasibility and Preliminary Efficacy of an Online Intervention to Increase Physical Activity in Nova Scotian Cancer Survivors: A Randomized Controlled Trial", journal="JMIR Cancer", year="2015", month="Nov", day="23", volume="1", number="2", pages="e12", keywords="Web-based", keywords="survivorship", keywords="home-based", keywords="exercise", keywords="efficacy", keywords="feasibility", abstract="Background: Physical activity (PA) behavior change interventions among cancer survivors have used face-to-face, telephone, email, and print-based methods. However, computer-tailored, Internet-delivered programs may be a more viable option to achieve PA behavior change. Objective: The objective of this study is to test the feasibility and preliminary efficacy of a Web-based PA behavior change program among cancer survivors. Methods: Nova Scotian cancer survivors (N=415) who previously expressed interest in a research study were approached. Interested participants were asked to complete an online assessment of PA and quality of life (QOL) before being randomized to either a theory-based PA behavior change program using the PA tracking website UWALK (UCAN; n=48) or usual care (UC; n=47). After the intervention (9 weeks), participants completed another online assessment of PA and QOL as well as measures to evaluate the program and website. Descriptive analyses from surveys and Web analytic software were used to assess feasibility and mean change scores were used to test efficacy. Results: Of all contacted survivors, 95 (22.3\%, 95/415) completed baseline measures and were randomized with 84 (88\%, 84/95) completing the 9-week assessment. The behavior change program and website were rated highly on the satisfaction items. Average logins were 10.3 (1.1 per week) and 26.0\% (111/432) of the weekly modules were completed. Most participants (71\%, 29/41) indicated they were more aware of their daily PA levels and 68\% (28/41) found the site easily navigable. Adjusted group differences in total exercise minutes favored the UCAN group by an increase of 42 minutes (95\% CI -65 to 150; P=.44, d=0.17). Results were more pronounced, though still nonsignificant, among those not meeting guidelines at baseline where UCAN increased PA by 52 minutes compared to a decrease of 15 minutes in UC (adjusted between group difference=75, 95\% CI -95 to 244; P=.38, d=0.27). Conclusions: We found that Internet-delivery may be a feasible alternative to more costly methods to promote PA among Nova Scotian cancer survivors. Moreover, there was a trend toward increased PA among those in the UCAN group, especially among those who were not meeting PA guidelines at baseline. Future research should focus on recruiting inactive cancer survivors and engaging them in the website to determine the optimal potential of Web-based interventions for promoting PA in cancer survivors. ", doi="10.2196/cancer.4586", url="http://cancer.jmir.org/2015/2/e12/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410166" } @Article{info:doi/10.2196/jmir.4870, author="Duman-Lubberding, Sanne and van Uden-Kraan, F. Cornelia and Peek, Niels and Cuijpers, Pim and Leemans, Ren{\'e} C. and Verdonck-de Leeuw, M. Irma", title="An eHealth Application in Head and Neck Cancer Survivorship Care: Health Care Professionals' Perspectives", journal="J Med Internet Res", year="2015", month="Oct", day="21", volume="17", number="10", pages="e235", keywords="cancer", keywords="tertiary prevention", keywords="participatory design approach", keywords="follow-up care", keywords="supportive care", abstract="Background: Although many cancer survivors could benefit from supportive care, they often do not utilize such services. Previous studies have shown that patient-reported outcomes (PROs) could be a solution to meet cancer survivors' needs, for example through an eHealth application that monitors quality of life and provides personalized advice and supportive care options. In order to develop an effective application that can successfully be implemented in current health care, it is important to include health care professionals in the development process. Objective: The aim of this study was to investigate health care professionals' perspectives toward follow-up care and an eHealth application, OncoKompas, in follow-up cancer care that monitors quality of life via PROs, followed by automatically generated tailored feedback and personalized advice on supportive care. Methods: Health care professionals involved in head and neck cancer care (N=11) were interviewed on current follow-up care and the anticipated value of the proposed eHealth application (Step 1). A prototype of the eHealth application, OncoKompas, was developed (Step 2). Cognitive walkthroughs were conducted among health care professionals (N=21) to investigate perceived usability (Step 3). Interviews were recorded, transcribed verbatim, and analyzed by 2 coders. Results: Health care professionals indicated several barriers in current follow-up care including difficulties in detecting symptoms, patients' perceived need for supportive care, and a lack of time to encourage survivors to obtain supportive care. Health care professionals expected the eHealth application to be of added value. The cognitive walkthroughs demonstrated that health care professionals emphasized the importance of tailoring care. They considered the navigation structure of OncoKompas to be complex. Health care professionals differed in their opinion toward the best strategy to implement the application in clinical practice but indicated that it should be incorporated in the HNC cancer care pathway to ensure all survivors would benefit. Conclusions: Health care professionals experienced several barriers in directing patients to supportive care. They were positive toward the development and implementation of an eHealth application and expected it could support survivors in obtaining supportive care tailored to their needs. The cognitive walkthroughs revealed several points for optimizing the application prototype and developing an efficient implementation strategy. Including health care professionals in an early phase of a participatory design approach is valuable in developing an eHealth application and an implementation strategy meeting stakeholders' needs. ", doi="10.2196/jmir.4870", url="http://www.jmir.org/2015/10/e235/", url="http://www.ncbi.nlm.nih.gov/pubmed/26489918" } @Article{info:doi/10.2196/resprot.3974, author="Parker, Brent and Rajapakshe, Rasika and Moldovan, Andrew and Araujo, Cynthia and Crook, Juanita", title="An Internet-Based Means of Monitoring Quality of Life in Post-Prostate Radiation Treatment: A Prospective Cohort Study", journal="JMIR Res Protoc", year="2015", month="Sep", day="28", volume="4", number="3", pages="e115", keywords="prostate cancer", keywords="radiation oncology", keywords="quality of life", keywords="patient-reported outcomes", keywords="Internet survey", keywords="prospective study", abstract="Background: Widespread integration of the Internet has resulted in an increase in the feasibility of using Web-based technologies as a means of communicating with patients. It may be possible to develop secure and standardized systems that facilitate Internet-based patient-reported outcomes which could be used to improve patient care. Objective: This study investigates patient interest in participating in an online post-treatment disease outcomes and quality of life monitoring program developed specifically for patients who have received radiation treatment for prostate cancer at a regional oncology center. Methods: Patients treated for prostate cancer between 2007 and 2011 (N=1113) at the British Columbia Cancer Agency, Centre for the Southern Interior were invited by mail to participate in a standardized questionnaire related to their post-treatment health. Overall participation rates were calculated. In addition, demographics, access to broadband Internet services, and treatment modalities were compared between participants and nonparticipants. Results: Of the 1030 eligible invitees, 358 (358/1030, 34.7\%) completed the online questionnaire. Participation rates were higher in individuals younger than age 60 when compared to those age 60 or older (42\% vs 31\%) and also for those living in urban areas compared with rural (37\% vs 29\%) and in those who received brachytherapy versus external beam radiotherapy (EBRT) (41\% vs 31\%). Better participation rates were seen in individuals who had access to Internet connectivity based on the different types of broadband services (DSL 35\% for those with DSL connectivity vs 29\% for those without DSL connectivity; cable 35\% vs 32\%; wireless 38\% vs 26\%). After adjusting for age, the model indicates that lack of access to wireless broadband connectivity, living in a rural area, and receiving EBRT were significant predictors of lower participation. Conclusions: This study demonstrates that participation rates vary in patient populations within the interior region of British Columbia, especially with older patients, those in rural areas, and those with limited access to quality Internet services. ", doi="10.2196/resprot.3974", url="http://www.researchprotocols.org/2015/3/e115/", url="http://www.ncbi.nlm.nih.gov/pubmed/26416584" } @Article{info:doi/10.2196/cancer.4892, author="Smith, A. Selina and Claridy, D. Mechelle and Smith Whitehead, Mary and Sheats, Q. Joyce and Yoo, Wonsuk and Alema-Mensah, A. Ernest and Ansa, E-O Benjamin and Coughlin, S. Steven", title="Lifestyle Modification Experiences of African American Breast Cancer Survivors: A Needs Assessment", journal="JMIR Cancer", year="2015", month="Aug", day="17", volume="1", number="2", pages="e9", keywords="African Americans", keywords="breast cancer", keywords="cancer survivors", keywords="nutrition", keywords="physical activity", abstract="Background: Little is known about the rates of obesity among African American (AA) breast cancer survivors (BCSs), the availability and use of lifestyle modification methods suitable for this population, and the impact of changes in dietary intake and physical activity on health-related quality of life (HR-QoL). Objective: The objectives of the study were to describe obesity rates, dietary intake, and physical activity as lifestyle modification strategies; examine predictors of engagement in these strategies post diagnosis; and learn more about salient features of lifestyle interventions from AA BCSs participating in a breast cancer support group. Methods: The needs assessment included four components: (1) a literature review to determine existing lifestyle modification strategies of AA BCSs; (2) secondary data analysis of the 2010 National Health Interview Survey, Cancer Control Supplement to examine HR-QoL; (3) administration, to 200 AA BCSs, of an assessment tool relating to weight and breast cancer history, dietary intake, and physical activity through a variety of approaches (eg, Internet, mail, in-person, and telephone); and (4) focus group discussions to frame lifestyle interventions. Results: Preliminary findings indicate that AA BCSs are underrepresented in lifestyle intervention research, have disparities in HR-QoL outcomes, do not meet current cancer prevention guidelines, and have recommendations for effective strategies for lifestyle modification. Conclusions: As analyses of the needs assessment are completed, the research team is partnering with community coalitions and breast cancer support groups in Miami, Chicago, Houston, Los Angeles, and Philadelphia to develop community-engaged intervention approaches for promoting adherence to cancer prevention guidelines. ", doi="10.2196/cancer.4892", url="http://cancer.jmir.org/2015/2/e9/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410162" } @Article{info:doi/10.2196/cancer.4389, author="Hong, Alicia Yan and Goldberg, Daniel and Ory, G. Marcia and Towne Jr, D. Samuel and Forjuoh, N. Samuel and Kellstedt, Debra and Wang, Suojin", title="Efficacy of a Mobile-Enabled Web App (iCanFit) in Promoting Physical Activity Among Older Cancer Survivors: A Pilot Study", journal="JMIR Cancer", year="2015", month="Jun", day="26", volume="1", number="1", pages="e7", keywords="physical activity", keywords="mobile health", keywords="older adults", keywords="cancer survivors", keywords="iCanFit", keywords="pilot", abstract="Background: The benefits of physical activity for cancer survivors are well documented. However, few older cancer survivors are engaged in regular physical activity. Mobile technologies may be an effective method to deliver physical activity promotion programs for older cancer survivors. iCanFit, a mobile-enabled Web-based app, was developed based on formative research and usability testing. This app includes interactive features of physical activity, goal setting and tracking, and receiving personalized visual feedback. Objective: The aim of this study is to pilot test the initial efficacy of iCanFit. Methods: Older cancer survivors (N=30) were recruited online through our collaborative partnership with a cancer survivor's organization. After the participants completed an online baseline survey, they were asked to use the iCanFit website. Instructional videos on how to use the web app were available on the website. Participants were asked to complete a follow-up survey 2-3 months later. Participants' physical activity, quality of life, and their experience with iCanFit were measured. Results: A total of 30 participants completed the baseline survey, and 26 of them (87\%, 26/30) also completed a follow-up survey 2-3 months later. The median age of participants was 69 years (range 60-78). Participants' quality of life and engagement in regular physical activity improved significantly after the use of iCanFit. Participants indicated a general affinity towards the key function ``Goals'' in iCanFit, which motivated continued activity. They also provided suggestions to further improve the app (eg, adding a reminder functionality, easier or alternative ways of entering activities). Conclusion: The interactive Web-based app iCanFit has demonstrated initial efficacy. Even though our study was limited by a small sample size, convenience sampling, and a short follow-up period, results suggest that using mobile tools to promote physical activity and healthy living among older cancer survivors holds promise. Next steps include refining iCanFit based on users' feedback and developing versatile functionality to allow easier physical activity goal setting and tracking. We also call for more studies on developing and evaluating mobile and web apps for older cancer survivors. ", doi="10.2196/cancer.4389", url="http://cancer.jmir.org/2015/1/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410158" } @Article{info:doi/10.2196/resprot.3777, author="Li, Rhea and Raber, Margaret and Chandra, Joya", title="Developing a Healthy Web-Based Cookbook for Pediatric Cancer Patients and Survivors: Rationale and Methods", journal="JMIR Res Protoc", year="2015", month="Mar", day="31", volume="4", number="1", pages="e37", keywords="obesity", keywords="pediatric cancer", keywords="survivorship", keywords="nutrition", keywords="cooking", abstract="Background: Obesity has been a growing problem among children and adolescents in the United States for a number of decades. Childhood cancer survivors (CCS) are more susceptible to the downstream health consequences of obesity such as cardiovascular disease, endocrine issues, and risk of cancer recurrence due to late effects of treatment and suboptimal dietary and physical activity habits. Objective: The objective of this study was to document the development of a Web-based cookbook of healthy recipes and nutrition resources to help enable pediatric cancer patients and survivors to lead healthier lifestyles. Methods: The Web-based cookbook, named ``@TheTable'', was created by a committee of researchers, a registered dietitian, patients and family members, a hospital chef, and community advisors and donors. Recipes were collected from several sources including recipe contests and social media. We incorporated advice from current patients, parents, and CCS. Results: Over 400 recipes, searchable by several categories and with accompanying nutritional information, are currently available on the website. In addition to healthy recipes, social media functionality and cooking videos are integrated into the website. The website also features nutrition information resources including nutrition and cooking tip sheets available on several subjects. Conclusions: The ``@TheTable'' website is a unique resource for promoting healthy lifestyles spanning pediatric oncology prevention, treatment, and survivorship. Through evaluations of the website's current and future use, as well as incorporation into interventions designed to promote energy balance, we will continue to adapt and build this unique resource to serve cancer patients, survivors, and the general public. ", doi="10.2196/resprot.3777", url="http://www.jmir.org/2015/1/e37/", url="http://www.ncbi.nlm.nih.gov/pubmed/25840596" } @Article{info:doi/10.2196/mhealth.3861, author="Vollmer Dahlke, Deborah and Fair, Kayla and Hong, Alicia Y. and Beaudoin, E. Christopher and Pulczinski, Jairus and Ory, G. Marcia", title="Apps Seeking Theories: Results of a Study on the Use of Health Behavior Change Theories in Cancer Survivorship Mobile Apps", journal="JMIR mHealth uHealth", year="2015", month="Mar", day="27", volume="3", number="1", pages="e31", keywords="mobile apps", keywords="health behavior", keywords="survivorship", keywords="health promotion", keywords="eHealth", keywords="mobile health", abstract="Background: Thousands of mobile health apps are now available for use on mobile phones for a variety of uses and conditions, including cancer survivorship. Many of these apps appear to deliver health behavior interventions but may fail to consider design considerations based in human computer interface and health behavior change theories. Objective: This study is designed to assess the presence of and manner in which health behavior change and health communication theories are applied in mobile phone cancer survivorship apps. Methods: The research team selected a set of criteria-based health apps for mobile phones and assessed each app using qualitative coding methods to assess the application of health behavior change and communication theories. Each app was assessed using a coding derived from the taxonomy of 26 health behavior change techniques by Abraham and Michie with a few important changes based on the characteristics of mHealth apps that are specific to information processing and human computer interaction such as control theory and feedback systems. Results: A total of 68 mobile phone apps and games built on the iOS and Android platforms were coded, with 65 being unique. Using a Cohen's kappa analysis statistic, the inter-rater reliability for the iOS apps was 86.1 (P<.001) and for the Android apps, 77.4 (P<.001). For the most part, the scores for inclusion of theory-based health behavior change characteristics in the iOS platform cancer survivorship apps were consistently higher than those of the Android platform apps. For personalization and tailoring, 67\% of the iOS apps (24/36) had these elements as compared to 38\% of the Android apps (12/32). In the area of prompting for intention formation, 67\% of the iOS apps (34/36) indicated these elements as compared to 16\% (5/32) of the Android apps. Conclusions: Mobile apps are rapidly emerging as a way to deliver health behavior change interventions that can be tailored or personalized for individuals. As these apps and games continue to evolve and include interactive and adaptive sensors and other forms of dynamic feedback, their content and interventional elements need to be grounded in human computer interface design and health behavior and communication theory and practice. ", doi="10.2196/mhealth.3861", url="http://mhealth.jmir.org/2015/1/e31/", url="http://www.ncbi.nlm.nih.gov/pubmed/25830810" } @Article{info:doi/10.2196/cancer.3521, author="Williams, Kate and Fisher, Abigail and Beeken, J. Rebecca and Wardle, Jane", title="Availability of Information About Lifestyle for Cancer Survivors in England: A Review of Statutory and Charitable Sector Organizations and Cancer Centers", journal="JMIR Cancer", year="2015", month="Mar", day="09", volume="1", number="1", pages="e2", keywords="cancer", keywords="survivorship", keywords="guideline", keywords="health behavior", keywords="lifestyle", keywords="diet", keywords="physical activity", keywords="body weight", keywords="smoking", keywords="alcohol drinking", abstract="Background: Health behavior change following a cancer diagnosis has the potential to improve long-term outcomes. However, many patients do not receive professional advice about lifestyle and are therefore increasingly using the Internet to seek further information. The statutory and charitable sectors and cancer centers all play an important role in the provision of information and have been found to be favored by cancer survivors searching for information. However, to date there has been no systematic evaluation of the lifestyle information available online for cancer survivors. Objective: The purpose of this review was to identify the lifestyle information provided for cancer survivors by statutory and charitable sector organizations and cancer centers in the United Kingdom. We aimed to identify information on tobacco, physical activity, diet, weight, and alcohol designed for people who have been diagnosed with breast, prostate, or colorectal cancer. Methods: The National Health Service (NHS) website was the focus of the search for information provided by the statutory sector. Cancer centers were identified from the Organization of European Cancer Institutes and an Internet search, and charitable sector organizations were identified by searching the Charity Commission database. The three largest generic, breast, prostate, and colorectal cancer charitable organizations were included. A systematic search of the organizations was conducted to identify lifestyle information for cancer survivors. Results: Ten organizations had some lifestyle information for cancer survivors on their websites. The Christie NHS Foundation Trust, Macmillan Cancer Support, and Prostate Cancer UK had the most comprehensive guides, covering physical activity, diet, weight management, smoking, and alcohol. The NHS website did not provide any information but had a link to Cancer Research UK's information about diet. Eight organizations suggested talking to a health professional before making any changes. Conclusions: The majority of organizations included in this review would benefit from updating their websites to include adequate information and advice about lifestyle for cancer survivors, or they risk cancer survivors turning to less reliable sources of information. Health professionals should be appropriately trained to deal with questions about lifestyle and to advise cancer survivors about lifestyle changes following their diagnosis. ", doi="10.2196/cancer.3521", url="http://cancer.jmir.org/2015/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/28410175" }