@Article{info:doi/10.2196/65975, author="Jayeoba, Monisola and Scherr, L. Courtney and Carroll, J. Allison and Daly, Elyse and Kerstiens, Savanna and Phillips, M. Siobhan and Hitsman, Brian and Garcia, F. Sofia and Spring, Bonnie and Jacobs, Maia", title="Low-Burden Electronic Health Record Strategies for Engaging Oncologists in Digital Health Behavior Change Interventions: Qualitative Interview Study", journal="J Med Internet Res", year="2025", month="May", day="30", volume="27", pages="e65975", keywords="digital health behavior change", keywords="electronic health record", keywords="risk behavior", keywords="human-centered design", keywords="cancer survivorship", keywords="clinician-patient communication", abstract="Background: Digital health behavior change interventions play an important role in helping cancer survivors improve their quality of life and reduce the risk of cancer recurrence. Clinician-patient communication is central to promoting the uptake of and adherence to digital health behavior change interventions. However, oncologists face significant barriers, including time constraints, knowledge gaps, and conversational uneasiness that limit risk behavior and health behavior change conversations. Objective: This qualitative study aims to explore oncologists' preferences for discussing and monitoring risk behaviors with cancer survivors, with a specific focus on conversations about digital health behavior change interventions. This study also aims to explore oncologists' informational and technological support requirements to facilitate these conversations. Methods: We conducted semistructured interviews with 18 oncologists who provide cancer care in a large National Cancer Institute--designated comprehensive cancer center. The transcripts and interview notes were analyzed through an iterative thematic analysis to generate relevant themes and categories. Results: We identified 2 major themes with 7 subthemes. The first theme focused on oncologists' desired roles in promoting health behavior change, while the second theme addressed the support needs to facilitate conversations about risk and health promotion. Oncologists expressed a desire for 2 action-oriented communication mechanisms for promoting digital health behavior change with their patients: referring patients to interventions and reinforcing intervention goals longitudinally. To facilitate risk behavior and health behavior change conversations, their support needs included a preference for low-burden, electronic health record--integrated tools providing timely updates on patient enrollment and progress. The participating oncologists requested a tailored conversation aid for patient communication and parallel systems combining electronic health record messaging with print materials. They also emphasized the need for automated recommender systems to identify and refer eligible patients and reminder systems to prompt timely discussions with patients. Conclusions: Oncologists are motivated and well-positioned to support patients' health behavior change but have unmet informational and technological requirements. On the basis of oncologists' perspectives, our findings provide actionable, user-centered, low-burden strategies for facilitating oncologist-patient conversations about digital health behavior change interventions. We make recommendations for integrating these strategies directly into the electronic medical record system, with the goal of amplifying oncologists' influential roles in motivating health behavior change among survivors. These scalable strategies may be applicable beyond oncology to clinical contexts where greater promotion of patients' health behavior change is desired. ", doi="10.2196/65975", url="https://www.jmir.org/2025/1/e65975" } @Article{info:doi/10.2196/64697, author="Varma, Gowtham and Yenukoti, Kumar Rohit and Kumar M, Praveen and Ashrit, Sai Bandlamudi and Purushotham, K. and Subash, C. and Ravi, Kumar Sunil and Kurien, Verghese and Aman, Avinash and Manoharan, Mithun and Jaiswal, Shashank and Anand, Akash and Barve, Rakesh and Thiagarajan, Viswanathan and Lenehan, Patrick and Soefje, A. Scott and Soundararajan, Venky", title="A Deep Learning--Enabled Workflow to Estimate Real-World Progression-Free Survival in Patients With Metastatic Breast Cancer: Study Using Deidentified Electronic Health Records", journal="JMIR Cancer", year="2025", month="May", day="15", volume="11", pages="e64697", keywords="real-world evidence", keywords="data-driven oncology", keywords="real-world progression-free survival", keywords="metastatic breast cancer", keywords="natural language processing", keywords="NLP", keywords="survival", keywords="cancer", keywords="oncology", keywords="breast", keywords="metastatic", keywords="deep learning", keywords="machine learning", keywords="ML", keywords="workflow", keywords="report", keywords="notes", keywords="electronic health record", keywords="EHR", keywords="documentation", abstract="Background: Progression-free survival (PFS) is a crucial endpoint in cancer drug research. Clinician-confirmed cancer progression, namely real-world PFS (rwPFS) in unstructured text (ie, clinical notes), serves as a reasonable surrogate for real-world indicators in ascertaining progression endpoints. Response evaluation criteria in solid tumors (RECIST) is traditionally used in clinical trials using serial imaging evaluations but is impractical when working with real-world data. Manual abstraction of clinical progression from unstructured notes remains the gold standard. However, this process is a resource-intensive, time-consuming process. Natural language processing (NLP), a subdomain of machine learning, has shown promise in accelerating the extraction of tumor progression from real-world data in recent years. Objectives: We aim to configure a pretrained, general-purpose health care NLP framework to transform free-text clinical notes and radiology reports into structured progression events for studying rwPFS on metastatic breast cancer (mBC) cohorts. Methods: This study developed and validated a novel semiautomated workflow to estimate rwPFS in patients with mBC using deidentified electronic health record data from the Nference nSights platform. The developed workflow was validated in a cohort of 316 patients with hormone receptor--positive, human epidermal growth factor receptor-2 (HER-2) 2-negative mBC, who were started on palbociclib and letrozole combination therapy between January 2015 and December 2021. Ground-truth datasets were curated to evaluate the workflow's performance at both the sentence and patient levels. NLP-captured progression or a change in therapy line were considered outcome events, while death, loss to follow-up, and end of the study period were considered censoring events for rwPFS computation. Peak reduction and cumulative decline in Patient Health Questionnaire-8 (PHQ-8) scores were analyzed in the progressed and nonprogressed patient subgroups. Results: The configured clinical NLP engine achieved a sentence-level progression capture accuracy of 98.2\%. At the patient level, initial progression was captured within {\textpm}30 days with 88\% accuracy. The median rwPFS for the study cohort (N=316) was 20 (95\% CI 18-25) months. In a validation subset (n=100), rwPFS determined by manual curation was 25 (95\% CI 15-35) months, closely aligning with the computational workflow's 22 (95\% CI 15-35) months. A subanalysis revealed rwPFS estimates of 30 (95\% CI 24-39) months from radiology reports and 23 (95\% CI 19-28) months from clinical notes, highlighting the importance of integrating multiple note sources. External validation also demonstrated high accuracy (92.5\% sentence level; 90.2\% patient level). Sensitivity analysis revealed stable rwPFS estimates across varying levels of missing source data and event definitions. Peak reduction in PHQ-8 scores during the study period highlighted significant associations between patient-reported outcomes and disease progression. Conclusions: This workflow enables rapid and reliable determination of rwPFS in patients with mBC receiving combination therapy. Further validation across more diverse external datasets and other cancer types is needed to ensure broader applicability and generalizability. ", doi="10.2196/64697", url="https://cancer.jmir.org/2025/1/e64697" } @Article{info:doi/10.2196/65960, author="Le D{\^u}, Katell and Chauchet, Adrien and Sadot-Lebouvier, Sophie and Fitoussi, Olivier and Fontanet, Bijou and Saint-Lezer, Arnaud and Maloisel, Fr{\'e}d{\'e}ric and Rossi, C{\'e}dric and Carras, Sylvain and Parcelier, Anne and Balavoine, Magali and Septans, Anne-Lise", title="Comparison of Electronic Surveillance With Routine Monitoring for Patients With Lymphoma at High Risk of Relapse: Prospective Randomized Controlled Phase 3 Trial (Sentinel Lymphoma)", journal="JMIR Cancer", year="2025", month="May", day="6", volume="11", pages="e65960", keywords="patient-reported outcome measures", keywords="lymphoma", keywords="risk of relapse", keywords="relapse", keywords="randomized trial", keywords="web-based", keywords="quality of life", keywords="survival", keywords="detection", keywords="progression", keywords="T-cell lymphoma", keywords="Hodgkin lymphoma", abstract="Background: Relapse is a major event in patients with lymphoma. Therefore, early detection may have an impact on quality of life and overall survival. Patient-reported outcome measures have demonstrated clinical benefits for patients with lung cancer; however, evidence is lacking in patients with lymphoma. We evaluated the effect of a web-mediated follow-up application for patients with lymphoma at high risk of relapse. Objective: This study aims to demonstrate that monitoring patients via a web application enables the detection of at least 30\% more significant events occurring between 2 systematic follow-up consultations with the specialist using an electronic questionnaire. Methods: We conducted a prospective, randomized phase 3 trial comparing the impact of web-based follow-up (experimental arm) with a standard follow-up (control arm). The trial was based on a 2-step triangular test and was designed to have a power of 90\% to detect a 30\% improvement in the detection of significant events. A significant event was defined as a relapse, progression, or a serious adverse event. The study covered the follow-up period after completion of first-line treatment or relapse (24 months). Eligible patients were aged 18 years and older and had lymphoma at a high risk of relapse. In the experimental arm, patients received a 16-symptom questionnaire by email every 2 weeks. An email alert was sent to the medical team based on a predefined algorithm. The primary objective was assessed after the inclusion of the 40th patient. The study was continued for the duration of the analysis. Results: A total of 52 patients were included between July 12, 2017, and April 7, 2020, at 11 centers in France, with 27 in the experimental arm and 25 in the control arm. The median follow-up was 21.3 (range 1.3?25.6) months, and 121 events were reported during the study period. Most events occurred in the experimental arm (83/119, 69.7\%) compared with 30.2\% (36/119) in the control arm. A median number of 3.5 (range 1-8) events per patient occurred in the experimental arm, and 1.8 (range 1-6) occurred in the control arm (P=.01). Progression and infection were the most frequently reported events. Further, 19 patients relapsed during follow-up: 6 in the experimental arm and 13 in the control arm (P<.001), with a median follow-up of 7.7 (range 2.8?20.6) months and 6.7 (range 1.9?16.4) months (P=.94), respectively. Statistical analysis was conducted after including the 40th patient, which showed no superiority of the experimental arm over the control arm. The study was therefore stopped after the 52nd patient was enrolled. Conclusions: The primary objective was not reached; however, patient-reported outcome measures remain essential for detecting adverse events in patients with cancer, and the electronic monitoring method needs to demonstrate its effectiveness and comply with international safety guidelines. Trial Registration: ClinicalTrials.gov NCT03154710; https://clinicaltrials.gov/ct2/show/NCT03154710 ", doi="10.2196/65960", url="https://cancer.jmir.org/2025/1/e65960" } @Article{info:doi/10.2196/57834, author="Hou, J. Sharon H. and Henry, Brianna and Drummond, Rachelle and Forbes, Caitlin and Mendon{\c{c}}a, Kyle and Wright, Holly and Rahamatullah, Iqra and Tutelman, R. Perri and Zwicker, Hailey and Stokoe, Mehak and Duong, Jenny and Drake, K. Emily and Erker, Craig and Taccone, S. Michael and Sutherland, Liam and Nathan, Paul and Spavor, Maria and Goddard, Karen and Reynolds, Kathleen and Schulte, M. Fiona S.", title="Co-Designing Priority Components of an mHealth Intervention to Enhance Follow-Up Care in Young Adult Survivors of Childhood Cancer and Health Care Providers: Qualitative Descriptive Study", journal="JMIR Cancer", year="2025", month="Apr", day="25", volume="11", pages="e57834", keywords="mobile health", keywords="mHealth", keywords="pediatric oncology", keywords="cancer survivorship", keywords="qualitative research", keywords="patient-oriented research", keywords="co-design", keywords="intervention development", abstract="Background: Survivors of childhood cancer are at risk of medical, psychological, and social late effects. To screen for their risks, receipt of consistent, cancer-specific follow-up care is crucial. However, <50\% of survivors attend their aftercare, and only 35\% of them recognize that they could have a serious health problem. The use of mobile health (mHealth) is a promising form of intervention to educate, connect, and empower survivors of childhood cancer on the importance of follow-up care. Objective: This study aimed to use co-design to identify the priority components to include in an mHealth intervention with young adult (aged between 18 and 39 years) survivors of childhood cancer and health care providers. Methods: This study was conducted between January and November 2022 in Canada and used patient-oriented research methods. Participants were recruited through local or provincial long-term follow-up clinics, using convenience sampling from patient partners who assisted in recruiting survivors across geographical areas in western, central, and eastern Canada, and social media outreach (X, formally known as Twitter; Facebook; and Instagram). Qualitative descriptive data (focus group interviews) from survivors of childhood cancer and health care providers (individual interviews) were gathered. We analyzed the collected data using reflexive thematic analysis and verified it through member checking techniques through an online community engagement event. Results: We conducted with patient partners 5 online (Zoom) focus groups with 22 survivors of childhood cancer (mean age 29.19, SD 4.78 y). We conducted individual telephone interviews with 7 health care providers. Participants identified five priority areas to be included in an mHealth intervention: (1) connections, (2) education and information, (3) engagement, (4) personalization, and (5) resources. Results were shared with and validated by survivors of childhood cancer, their families, health care providers, and academic researchers as part of a community engagement event. Small and large group discussions were facilitated to allow participants to review and discuss the accuracy of the themes derived regarding the core components to be included in mHealth. A graphic recording artist visually captured key ideas from the event. A subset of the participants also completed a web-based satisfaction survey, and responses indicated that the community engagement event was generally well received. Conclusions: Results from this study have provided the necessary foundation to progress in intervention development. The next step of this multiphased project is to build an innovative and accessible mHealth intervention prototype that is based on the identified core components and is grounded in an established conceptual framework for co-design of mHealth. ", doi="10.2196/57834", url="https://cancer.jmir.org/2025/1/e57834" } @Article{info:doi/10.2196/67914, author="Liu, Darren and Hu, Xiao and Xiao, Canhua and Bai, Jinbing and Barandouzi, A. Zahra and Lee, Stephanie and Webster, Caitlin and Brock, La-Urshalar and Lee, Lindsay and Bold, Delgersuren and Lin, Yufen", title="Evaluation of Large Language Models in Tailoring Educational Content for Cancer Survivors and Their Caregivers: Quality Analysis", journal="JMIR Cancer", year="2025", month="Apr", day="7", volume="11", pages="e67914", keywords="large language models", keywords="GPT-4", keywords="cancer survivors", keywords="caregivers", keywords="education", keywords="health equity", abstract="Background: Cancer survivors and their caregivers, particularly those from disadvantaged backgrounds with limited health literacy or racial and ethnic minorities facing language barriers, are at a disproportionately higher risk of experiencing symptom burdens from cancer and its treatments. Large language models (LLMs) offer a promising avenue for generating concise, linguistically appropriate, and accessible educational materials tailored to these populations. However, there is limited research evaluating how effectively LLMs perform in creating targeted content for individuals with diverse literacy and language needs. Objective: This study aimed to evaluate the overall performance of LLMs in generating tailored educational content for cancer survivors and their caregivers with limited health literacy or language barriers, compare the performances of 3 Generative Pretrained Transformer (GPT) models (ie, GPT-3.5 Turbo, GPT-4, and GPT-4 Turbo; OpenAI), and examine how different prompting approaches influence the quality of the generated content. Methods: We selected 30 topics from national guidelines on cancer care and education. GPT-3.5 Turbo, GPT-4, and GPT-4 Turbo were used to generate tailored content of up to 250 words at a 6th-grade reading level, with translations into Spanish and Chinese for each topic. Two distinct prompting approaches (textual and bulleted) were applied and evaluated. Nine oncology experts evaluated 360 generated responses based on predetermined criteria: word limit, reading level, and quality assessment (ie, clarity, accuracy, relevance, completeness, and comprehensibility). ANOVA (analysis of variance) or chi-square analyses were used to compare differences among the various GPT models and prompts. Results: Overall, LLMs showed excellent performance in tailoring educational content, with 74.2\% (267/360) adhering to the specified word limit and achieving an average quality assessment score of 8.933 out of 10. However, LLMs showed moderate performance in reading level, with 41.1\% (148/360) of content failing to meet the sixth-grade reading level. LLMs demonstrated strong translation capabilities, achieving an accuracy of 96.7\% (87/90) for Spanish and 81.1\% (73/90) for Chinese translations. Common errors included imprecise scopes, inaccuracies in definitions, and content that lacked actionable recommendations. The more advanced GPT-4 family models showed better overall performance compared to GPT-3.5 Turbo. Prompting GPTs to produce bulleted-format content was likely to result in better educational content compared with textual-format content. Conclusions: All 3 LLMs demonstrated high potential for delivering multilingual, concise, and low health literacy educational content for cancer survivors and caregivers who face limited literacy or language barriers. GPT-4 family models were notably more robust. While further refinement is required to ensure simpler reading levels and fully comprehensive information, these findings highlight LLMs as an emerging tool for bridging gaps in cancer education and advancing health equity. Future research should integrate expert feedback, additional prompt engineering strategies, and specialized training data to optimize content accuracy and accessibility. International Registered Report Identifier (IRRID): RR2-10.2196/48499 ", doi="10.2196/67914", url="https://cancer.jmir.org/2025/1/e67914" } @Article{info:doi/10.2196/65001, author="Huang, Tracy and Ngan, Chun-Kit and Cheung, Ting Yin and Marcotte, Madelyn and Cabrera, Benjamin", title="A Hybrid Deep Learning--Based Feature Selection Approach for Supporting Early Detection of Long-Term Behavioral Outcomes in Survivors of Cancer: Cross-Sectional Study", journal="JMIR Bioinform Biotech", year="2025", month="Mar", day="13", volume="6", pages="e65001", keywords="machine learning", keywords="data driven", keywords="clinical domain--guided framework", keywords="survivors of cancer", keywords="cancer", keywords="oncology", keywords="behavioral outcome predictions", keywords="behavioral study", keywords="behavioral outcomes", keywords="feature selection", keywords="deep learning", keywords="neural network", keywords="hybrid", keywords="prediction", keywords="predictive modeling", keywords="patients with cancer", keywords="deep learning models", keywords="leukemia", keywords="computational study", keywords="computational biology", abstract="Background: The number of survivors of cancer is growing, and they often experience negative long-term behavioral outcomes due to cancer treatments. There is a need for better computational methods to handle and predict these outcomes so that physicians and health care providers can implement preventive treatments. Objective: This study aimed to create a new feature selection algorithm to improve the performance of machine learning classifiers to predict negative long-term behavioral outcomes in survivors of cancer. Methods: We devised a hybrid deep learning--based feature selection approach to support early detection of negative long-term behavioral outcomes in survivors of cancer. Within a data-driven, clinical domain--guided framework to select the best set of features among cancer treatments, chronic health conditions, and socioenvironmental factors, we developed a 2-stage feature selection algorithm, that is, a multimetric, majority-voting filter and a deep dropout neural network, to dynamically and automatically select the best set of features for each behavioral outcome. We also conducted an experimental case study on existing study data with 102 survivors of acute lymphoblastic leukemia (aged 15-39 years at evaluation and >5 years postcancer diagnosis) who were treated in a public hospital in Hong Kong. Finally, we designed and implemented radial charts to illustrate the significance of the selected features on each behavioral outcome to support clinical professionals' future treatment and diagnoses. Results: In this pilot study, we demonstrated that our approach outperforms the traditional statistical and computation methods, including linear and nonlinear feature selectors, for the addressed top-priority behavioral outcomes. Our approach holistically has higher F1, precision, and recall scores compared to existing feature selection methods. The models in this study select several significant clinical and socioenvironmental variables as risk factors associated with the development of behavioral problems in young survivors of acute lymphoblastic leukemia. Conclusions: Our novel feature selection algorithm has the potential to improve machine learning classifiers' capability to predict adverse long-term behavioral outcomes in survivors of cancer. ", doi="10.2196/65001", url="https://bioinform.jmir.org/2025/1/e65001", url="http://www.ncbi.nlm.nih.gov/pubmed/40080820" } @Article{info:doi/10.2196/64869, author="Groninger, Hunter and Arem, Hannah and Ayangma, Lylian and Gong, Lisa and Zhou, Eric and Greenberg, Daniel", title="Development of a Voice-Activated Virtual Assistant to Improve Insomnia Among Young Adult Cancer Survivors: Mixed Methods Feasibility and Acceptability Study", journal="JMIR Form Res", year="2025", month="Mar", day="10", volume="9", pages="e64869", keywords="cancer", keywords="survivor", keywords="insomnia", keywords="cognitive behavioral therapy", keywords="technology", keywords="app", keywords="oncology", keywords="mobile health", keywords="artificial intelligence", keywords="young adults", keywords="sleep", keywords="mHealth", keywords="CBT", keywords="voice-activated virtual assistant", keywords="virtual assistants", keywords="focus group", keywords="qualitative research", abstract="Background: Up to 75\% of young adult cancer survivors (YACS) experience chronic insomnia, negatively affecting physical and emotional health and overall quality of life. Cognitive behavioral therapy for insomnia (CBT-I) is a gold-standard intervention to address insomnia. To improve CBT-I access and treatment adherence, screen-based digital CBT-I platforms have been developed. However, even with these digital products, widespread uptake of CBT-I remains limited, and new strategies for CBT-I delivery are warranted. Objective: The objective of this study is to understand how YACS experience insomnia and how they might incorporate technology-delivered CBT-I into a daily routine and test the feasibility and acceptability of a novel screen-free voice-activated virtual assistant--delivered CBT-I prototype. Methods: Eligible participants---ages 18-39, living with a history of cancer (any type, any stage), self-reporting on average less sleep than National Sleep Foundation recommendations, and English-speaking---were recruited from a major urban cancer center, 2 regional oncology clinics, and 2 cancer survivorship support groups. We conducted 4 focus groups to understand the YACS experience of insomnia, their routine use of technology at home, particularly voice-activated virtual assistants such as Amazon Alexa, and input on how CBT-I might be delivered at home through a smart speaker system. We developed a prototype device to deliver key elements of CBT-I at home along with circadian lighting and monitoring of post-bedtime device use, collected YACS user perspectives on this prototype, and then conducted a single-arm feasibility and acceptability study. Results: In total, 26 YACS (6-7 participants per group) experiencing insomnia participated in focus groups to share experiences of insomnia during cancer survivorship and to provide input regarding a CBT-I prototype. Common triggers of insomnia included worry about disease management and progression, disease-related pain and other symptoms, choices regarding personal device use, and worry about the impact of poor sleep on daily functioning. In total, 12 participants completed device prototype testing, engaging with the prototype 94\% of the assigned times (twice daily for 14 days; meeting predetermined feasibility cutoff of engagement ?70\% of assigned times) and rating the prototype with an overall mean score of 5.43 on the Satisfaction subscale of the Usability, Satisfaction, and Ease of Use scale (range 4.42-7; exceeding the predetermined cutoff score for acceptability of 5.0). All participants completing the study reported they would be interested in using the prototype again and would recommend it to someone else with insomnia. Conclusions: YACS were highly engaged with our voice-activated virtual assistant--delivered CBT-I prototype and found it acceptable to use. Following final device development, future studies should evaluate the efficacy of this intervention among YACS. Trial Registration: ClinicalTrials.gov NCT05875129; https://clinicaltrials.gov/study/NCT05875129 ", doi="10.2196/64869", url="https://formative.jmir.org/2025/1/e64869" } @Article{info:doi/10.2196/65152, author="Nightingale, L. Chandylen and Dressler, V. Emily and Kepper, Maura and Klepin, D. Heidi and Lee, Craddock Simon and Smith, Sydney and Aguilar, Aylin and Wiseman, D. Kimberly and Sohl, J. Stephanie and Wells, J. Brian and DeMari, A. Joseph and Throckmorton, Alyssa and Kulbacki, W. Lindsey and Hanna, Jenny and Foraker, E. Randi and Weaver, E. Kathryn", title="Oncology Provider and Patient Perspectives on a Cardiovascular Health Assessment Tool Used During Posttreatment Survivorship Care in Community Oncology (Results from WF-1804CD): Mixed Methods Observational Study", journal="J Med Internet Res", year="2025", month="Mar", day="6", volume="27", pages="e65152", keywords="cancer", keywords="cardiovascular health", keywords="cancer survivors", keywords="community oncology", keywords="electronic health record integration", keywords="provider acceptability", keywords="patient-provider", keywords="assessment tool", keywords="electronic health records", keywords="clinical decision support", keywords="surveys", keywords="interviews", keywords="survivors", keywords="Automated Heart-Health Assessment", abstract="Background: Most survivors of cancer have multiple cardiovascular risk factors, increasing their risk of poor cardiovascular and cancer outcomes. The Automated Heart-Health Assessment (AH-HA) tool is a novel electronic health record clinical decision support tool based on the American Heart Association's Life's Simple 7 cardiovascular health metrics to promote cardiovascular health assessment and discussion in outpatient oncology. Before proceeding to future implementation trials, it is critical to establish the acceptability of the tool among providers and survivors. Objective: This study aims to assess provider and survivor acceptability of the AH-HA tool and provider training at practices randomized to the AH-HA tool arm within WF-1804CD. Methods: Providers (physicians, nurse practitioners, and physician assistants) completed a survey to assess the acceptability of the AH-HA training, immediately following training. Providers also completed surveys to assess AH-HA tool acceptability and potential sustainability. Tool acceptability was assessed after 30 patients were enrolled at the practice with both a survey developed for the study as well as with domains from the Unified Theory of Acceptance and Use of Technology survey (performance expectancy, effort expectancy, attitude toward using technology, and facilitating conditions). Semistructured interviews at the end of the study captured additional provider perceptions of the AH-HA tool. Posttreatment survivors (breast, prostate, colorectal, endometrial, and lymphomas) completed a survey to assess the acceptability of the AH-HA tool immediately after the designated study appointment. Results: Providers (n=15) reported high overall acceptability of the AH-HA training (mean 5.8, SD 1.0) and tool (mean 5.5, SD 1.4); provider acceptability was also supported by the Unified Theory of Acceptance and Use of Technology scores (eg, effort expectancy: mean 5.6, SD 1.5). Qualitative data also supported provider acceptability of different aspects of the AH-HA tool (eg, ``It helps focus the conversation and give the patient a visual of continuum of progress''). Providers were more favorable about using the AH-HA tool for posttreatment survivorship care. Enrolled survivors (n=245) were an average of 4.4 (SD 3.7) years posttreatment. Most survivors reported that they strongly agreed or agreed that they liked the AH-HA tool (n=231, 94.3\%). A larger proportion of survivors with high health literacy strongly agreed or agreed that it was helpful to see their heart health score (n=161, 98.2\%) compared to survivors with lower health literacy scores (n=68, 89.5\%; P=.005). Conclusions: Quantitative surveys and qualitative interview data both demonstrate high acceptability of the AH-HA tool among both providers and survivors. Although most survivors found it helpful to see their heart health score, there may be room for improving communication with survivors who have lower health literacy. Trial Registration: ClinicalTrials.gov NCT03935282; http://clinicaltrials.gov/ct2/show/NCT03935282 International Registered Report Identifier (IRRID): RR2-https://doi-org.wake.idm.oclc.org/10.1016/j.conctc.2021.100808 ", doi="10.2196/65152", url="https://www.jmir.org/2025/1/e65152", url="http://www.ncbi.nlm.nih.gov/pubmed/39854647" } @Article{info:doi/10.2196/63486, author="Lyhne, Dam Johanne and Smith, `Ben' Allan and Carstensen, Wisbech Tina Birgitte and Beatty, Lisa and Bamgboje-Ayodele, Adeola and Klein, Britt and Jensen, Henrik Lars and Frostholm, Lisbeth", title="Adapting a Self-Guided eHealth Intervention Into a Tailored Therapist-Guided eHealth Intervention for Survivors of Colorectal Cancer", journal="JMIR Cancer", year="2025", month="Mar", day="5", volume="11", pages="e63486", keywords="fear of cancer recurrence", keywords="therapist-guided", keywords="self-guided", keywords="online intervention", keywords="colorectal cancer", keywords="digital health", keywords="psychosocial intervention", keywords="survivorship", keywords="eHealth", keywords="adaptation", keywords="survivors", keywords="oncologists", keywords="therapists", keywords="acceptability", keywords="mobile phone", abstract="Trial Registration: ClinicalTrials.gov NCT04287218; https://clinicaltrials.gov/study/NCT04287218 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-020-06731-6 ", doi="10.2196/63486", url="https://cancer.jmir.org/2025/1/e63486" } @Article{info:doi/10.2196/66636, author="Werts-Pelter, J. Samantha and Chen, Zhao and Bea, W. Jennifer and Sokan, E. Amanda and Thomson, A. Cynthia", title="Analysis of the Relationship Between Rural-Urban Status and Use of Digital Health Technology Among Older Cancer Survivors Based on the Health Information National Trends Survey: Cross-Sectional Analysis", journal="JMIR Cancer", year="2025", month="Mar", day="4", volume="11", pages="e66636", keywords="cancer", keywords="non-metropolitan", keywords="disparities", keywords="digital divide", keywords="health research", keywords="aging", keywords="rural-urban", keywords="digital health technology", keywords="cross-sectional", keywords="health behaviors", keywords="mobile phone", abstract="Background: Though telehealth has been a promising avenue for engaging cancer survivors with health care and lifestyle programming, older and rural-dwelling cancer survivors may have additional challenges in accessing digital devices and tools that have not yet been described. This study aimed to use a robust, nationally representative sample collected in 2022 to provide an updated view of digital technology use and the use of technology for health in this population. Objective: This study aimed to examine the prevalence of digital technology use for health-related activities among older cancer survivors in both rural and urban settings. The primary outcomes of interest included (1) internet access and use for health-related activities, (2) digital device ownership and use as a tool for health behaviors, (3) use of social media for health, and (4) use of telehealth. Methods: A cross-sectional analysis of the National Cancer Institute's Health Information National Trends Survey Cycle 6 (HINTS 6) was completed to examine the prevalence of digital technology use among older cancer survivors. For analysis, the sample was restricted to cancer survivors over the age of 60 years (n=710). Unadjusted and adjusted logistic regression models were used to test the association between rurality and digital health tool use. Results: Overall, 17\% (125/710) of the sample lived in a rural area of the United States and the mean sample age was 73 (SD 8.2) years. Older cancer survivors, regardless of rural-urban status, reported a high prevalence of internet usage (n=553, 79.9\%), digital device ownership (n=676, 94.9\%), and social media use (n=448, 66.6\%). In unadjusted models, rural survivors were less likely than urban survivors to report that they had used a health or wellness application in the previous year (odds ratio [OR] 0.56, 95\% CI 0.32-0.97; P=.04). In adjusted models, rural survivors were more likely to report that they had shared personal health information on social media (OR 2.64, 95\% CI 1.13-6.19; P=.03). There were no differences in the proportion of rural and urban respondents who reported receiving health services through telehealth in the previous year. Conclusions: Regardless of the residential status, older cancer survivors report high internet and technology use for health-related activities. These results show promise for the feasibility of using digital technologies to implement supportive care and wellness programming with older cancer survivors. ", doi="10.2196/66636", url="https://cancer.jmir.org/2025/1/e66636" } @Article{info:doi/10.2196/67794, author="Wellman, L. Mariah and Owens, M. Camilla and Holton, E. Avery and Kaphingst, A. Kimberly", title="Examining BRCA Previvors' Social Media Content Creation as a Form of Self and Community Care: Qualitative Interview Study", journal="J Med Internet Res", year="2025", month="Mar", day="3", volume="27", pages="e67794", keywords="BRCA", keywords="breast cancer", keywords="genetic testing", keywords="social media", keywords="breast cancer gene", keywords="content creation", keywords="self care", keywords="community care", keywords="qualitative interview", keywords="qualitative", keywords="interview", keywords="previvors", keywords="cancer previvors", keywords="genetic mutations", keywords="online", keywords="content", keywords="interviews", keywords="thematic analysis", abstract="Background: Genetic testing has become a common way of identifying a woman's risk of developing hereditary breast and ovarian cancer; however, not all medical providers have the necessary information to support patients interested in genetic testing, nor do they always have the proper information for patients once they have been diagnosed. Therefore, many ``previvors''---the name given to those who have tested positive for the BRCA genetic mutation---have taken to social media to inform others about the importance of genetic testing and explain to them how to understand their test results. Historically, those desiring to speak about their medical issues online have sought out structured support groups or chat rooms; however, many previvors today are instead posting on their own personal social media accounts and creating more niche communities. Objective: This study aimed to examine why BRCA previvors are sharing content on their personal social media accounts and how posting online in this way serves a purpose for their larger community. Methods: A total of 16 semistructured interviews were conducted with individuals who posted about their experience being diagnosed with the BRCA genetic mutation and their subsequent treatment on their personal social media accounts, specifically for followers interested in their medical journey. The interviews were recorded, transcribed, and coded by an experienced qualitative researcher and a graduate student using inductive techniques, and a reflexive thematic analysis was applied to the transcripts. Results: The results suggest BRCA previvors want to control the narrative around their personalized medical experiences rather than participating in existing groups or chat rooms. Controlling their own story, rather than adding to existing narratives, gives previvors a sense of control. It also allows them to set boundaries around the types of experiences they have online when sharing their medical journey. Finally, previvors said they feel they are serving the larger BRCA community by each sharing their individual journeys, to hopefully avoid stereotyping and homogenizing the experience of patients with BRCA genetic mutations. Conclusions: Research with the objective of understanding the experiences of BRCA previvors should include exploring how and why they talk about their journeys, especially due to the lack of knowledge BRCA previvors say many of their medical providers have. We suggest further research should examine how other patients with the BRCA genetic mutation, especially racial and ethnic minority patients, are navigating their own content creation, especially considering content moderation policies that social media platforms are continuing to implement that directly impact users' ability to share about their medical experiences. ", doi="10.2196/67794", url="https://www.jmir.org/2025/1/e67794", url="http://www.ncbi.nlm.nih.gov/pubmed/40053732" } @Article{info:doi/10.2196/65118, author="Aye, Sin Phyu and Barnes, Joanne and Laking, George and Cameron, Laird and Anderson, Malcolm and Luey, Brendan and Delany, Stephen and Harris, Dean and McLaren, Blair and Brenman, Elliott and Wong, Jayden and Lawrenson, Ross and Arendse, Michael and Tin Tin, Sandar and Elwood, Mark and Hope, Philip and McKeage, James Mark", title="Treatment Outcomes From Erlotinib and Gefitinib in Advanced Epidermal Growth Factor Receptor--Mutated Nonsquamous Non--Small Cell Lung Cancer in Aotearoa New Zealand From 2010 to 2020: Nationwide Whole-of-Patient-Population Retrospective Cohort Study", journal="JMIR Cancer", year="2025", month="Mar", day="3", volume="11", pages="e65118", keywords="non--small cell lung cancer", keywords="mutations", keywords="epidemiology", keywords="target therapy", keywords="retrospective cohort study", abstract="Background: Health care system--wide outcomes from routine treatment with erlotinib and gefitinib are incompletely understood. Objective: The aim of the study is to describe the effectiveness of erlotinib and gefitinib during the first decade of their routine use for treating advanced epidermal growth factor receptor (EGFR) mutation-positive nonsquamous non--small cell lung cancer in the entire cohort of patients treated in Aotearoa New Zealand. Methods: Patients were identified, and data collated from national pharmaceutical dispensing, cancer registration, and mortality registration electronic databases by deterministic data linkage using National Health Index numbers. Time-to-treatment discontinuation and overall survival were measured from the date of first dispensing of erlotinib or gefitinib and analyzed by Kaplan-Meier curves. Associations of treatment outcomes with baseline factors were evaluated using univariable and multivariable Cox regressions. Results: Overall, 752 patients were included who started treatment with erlotinib (n=418) or gefitinib (n=334) before October 2020. Median time-to-treatment discontinuation was 11.6 (95\% CI 10.8?12.4) months, and median overall survival was 20.1 (95\% CI 18.1?21.6) months. Shorter time-to-treatment discontinuation was independently associated with high socioeconomic deprivation (hazard ratio [HR] 1.3, 95\% CI 1.1?1.5 compared to the New Zealand Index of Deprivation 1?4 group), EGFR L858R mutations (HR 1.3, 95\% CI 1.1?1.6 compared to exon 19 deletion), and distant disease at cancer diagnosis (HR 1.4, 95\% CI 1.2?1.7 compared to localized or regional disease). The same factors were independently associated with shorter overall survival. Outcome estimates and predictors remained unchanged in sensitivity analyses. Conclusions: Outcomes from routine treatment with erlotinib and gefitinib in New Zealand patients with advanced EGFR-mutant nonsquamous non--small cell lung cancer are comparable with those reported in randomized trials and other health care system--wide retrospective cohort studies. Socioeconomic status, EGFR mutation subtype, and disease extent at cancer diagnosis were independent predictors of treatment outcomes in that setting. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12615000998549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368928\&isReview=true International Registered Report Identifier (IRRID): RR2-10.2196/51381 ", doi="10.2196/65118", url="https://cancer.jmir.org/2025/1/e65118" } @Article{info:doi/10.2196/59391, author="Newton, Lorelei and Monkman, Helen and Fullerton, Claire", title="Exploring Older Adult Cancer Survivors' Digital Information Needs: Qualitative Pilot Study", journal="JMIR Cancer", year="2025", month="Feb", day="27", volume="11", pages="e59391", keywords="older adults", keywords="cancer survivors", keywords="digital health literacy", keywords="digital health technologies", keywords="aging", keywords="qualitative", keywords="pilot study", keywords="semistructured interview", abstract="Background: Older adults (aged >65 years) are disproportionately affected by cancer at a time when Canadians are surviving cancer in an unprecedented fashion. Contrary to persistent ageist assumptions, not only do the majority of older adult cancer survivors use digital health technologies (DHTs) regularly, such technologies also serve as important sources of their health information. Although older adults' transition to cancer survivorship is connected to the availability and provision of relevant and reliable information, little evidence exists as to how they use DHTs to supplement their understanding of their unique situation to manage, and make decisions about, their ongoing cancer-related concerns. Objective: This pilot study, which examined older adult cancer survivors' use of DHTs, was conducted to support a larger study designed to explore how digital health literacy dimensions might affect the management of cancer survivorship sequelae. Understanding DHT use is also an important consideration for digital health literacy. Thus, we sought to investigate older adult cancer survivors' perceptions of DHTs in the context of accessing information about their health, health care systems, and health care providers. Methods: A qualitative pilot study, which involved semistructured interviews with older adult cancer survivors (N=5), was conducted to explore how participants interacted with, accessed, and searched for information, as well as how DHT use related to their cancer survivorship. Institutional ethics approval (\#21?0421) was obtained. Interpretive description inquiry---a practice-based approach suitable for generating applied knowledge---supported exploration of the research question. Thematic analysis was used to examine the transcripts for patterns of meaning (themes). Results: Assessing the credibility of digital information remains challenging for older adult cancer survivors. Identified benefits of DHTs included improved access to meet health information needs, older adult cancer survivors feeling empowered to make informed decisions regarding their health trajectory, and the ability to connect with interdisciplinary teams for care continuity. Additionally, participants described feeling disconnected when DHTs seemed to be used as substitutes for human interaction. The results of this pilot study were used to create 12 additional questions to supplement a digital health literacy survey, through which we will seek a more fulsome account of the relationship between digital health literacy and DHTs for older adult cancer survivors. Conclusions: Overall, this pilot study confirmed the utility of DHTs in enhancing the connection of older adult cancer survivors to their health care needs. Importantly, this connection exists on a continuum, and providing greater access to technologies, in combination with human support, leads to feelings of empowerment. DHTs are an important aspect of contemporary health care; yet, these technologies must be seen as complementary and not as replacements for human interaction. Otherwise, we risk dehumanizing patients and disconnecting them from the care that they need and deserve. ", doi="10.2196/59391", url="https://cancer.jmir.org/2025/1/e59391" } @Article{info:doi/10.2196/60034, author="Dabbagh, Zakery and Najjar, Reem and Kamberi, Ariana and Gerber, S. Ben and Singh, Aditi and Soni, Apurv and Cutrona, L. Sarah and McManus, D. David and Faro, M. Jamie", title="Usability and Implementation Considerations of Fitbit and App Intervention for Diverse Cancer Survivors: Mixed Methods Study", journal="JMIR Cancer", year="2025", month="Feb", day="24", volume="11", pages="e60034", keywords="physical activity", keywords="cancer survivor", keywords="wearable device", keywords="smartphone app", keywords="diverse", keywords="Fitbit", keywords="wearable", keywords="feasibility", keywords="usability", keywords="digital health", keywords="digital health method", keywords="breast cancer", keywords="Hispanic", keywords="women", keywords="mobile health", keywords="activity tracker", keywords="mHealth", abstract="Background: Despite the known benefits of physical activity, cancer survivors remain insufficiently active. Prior trials have adopted digital health methods, although several have been pedometer-based and enrolled mainly female, non-Hispanic White, and more highly educated survivors of breast cancer. Objective: The objective of this study was to test a previously developed mobile health system consisting of a Fitbit activity tracker and the MyDataHelps smartphone app for feasibility in a diverse group of cancer survivors, with the goal of refining the program and setting the stage for a larger future trial. Methods: Participants were identified from one academic medical center's electronic health records, referred by a clinician, or self-referred to participate in the study. Participants were screened for eligibility, enrolled, provided a Fitbit activity tracker, and instructed to download the Fitbit: Health \& Wellness and MyDataHelps apps. They completed usability surveys at 1 and 3 months. Interviews were conducted at the end of the 3-month intervention with participants and cancer care clinicians to assess the acceptability of the intervention and the implementation of the intervention into clinical practice, respectively. Descriptive statistics were calculated for demographics, usability surveys, and Fitbit adherence and step counts. Rapid qualitative analysis was used to identify key findings from interview transcriptions. Results: Of the 100 patients screened for eligibility, 31 were enrolled in the trial (mean age 64.8, SD 11.1 years; female patients=17/31, 55\%; Hispanic or Latino=7/31, 23\%; non-White=11/31, 35\%; less than a bachelor's degree=14/31, 45\%; and household income