@Article{info:doi/10.2196/71062, author="Marrison, Tucker Sarah and Shungu, Nicholas and Diaz, Vanessa", title="Perception and Counseling for Cardiac Health in Breast Cancer Survivors Using the Health Belief Model: Qualitative Analysis", journal="JMIR Cancer", year="2025", month="Jul", day="3", volume="11", pages="e71062", keywords="cardiovascular health", keywords="cancer survivorship", keywords="lifestyle counseling", keywords="breast cancer", keywords="cancer survivors", abstract="Background: Breast cancer survivors have increased cardiovascular risk compared to those without cancer history. Cardiovascular disease is the most common cause of death in breast cancer survivors. Cardiovascular risk in breast cancer survivors is impacted by both cancer treatment--associated effects and in risk factors for breast cancer and cardiovascular disease overlap. Strategies to improve screening for and management of cardiovascular disease in breast cancer survivors are needed to improve the delivery of survivorship care. Objective: This study aims to assess current cardiovascular risk counseling practices and perceived cardiovascular risk in breast cancer survivors. Methods: Semistructured interviews were conducted from May to December 2021 with breast cancer survivors identified as having a primary care clinician within an academic family medicine center in Charleston, South Carolina. The interview guide and content were developed using the Health Belief Model with a focus on cardiovascular risk behaviors, risk perception, and barriers to risk reduction. Analysis of categorical data was conducted by frequency and quantitative variables by mean and SD. Template analysis was performed for qualitative analysis. Outcome measures included self-reported history of cardiovascular disease, risk perception, and risk behaviors. Results: The average age of participants (n=19) was 54 (SD 7) years; 68\% (13/19) were White and 32\% (6/19) were Black or African American. Of the interviewed women, 90\% (17/19) reported a personal history and 90\% (17/19) reported a family history of cardiovascular disease. Only 53\% (10/19) had previously reported receipt of cardiovascular counseling. Primary care most commonly provided counseling, followed by oncology. Among breast cancer survivors, 32\% (6/19) reported being at increased cardiovascular risk, and 47\% (9/19) were unsure of their relative cardiovascular risk. Factors affecting perceived cardiovascular risk included family history, cancer treatments, cardiovascular diagnoses, and lifestyle factors. Video (15/19, 79\%) and SMS text messaging (13/19, 68\%) were the most highly reported mechanisms through which breast cancer survivors requested to receive additional information and counseling on cardiovascular risk and risk reduction. Commonly reported barriers to risk reduction such as physical activity included time for meal planning and exercise, resources to support dietary and exercise changes, physical limitations, and competing responsibilities. Barriers specific to survivorship status included concerns for immune status during the COVID-19 pandemic, physical limitations associated with cancer treatment, and psychosocial aspects of cancer survivorship. Conclusions: Breast cancer survivors identified that factors associated with their cancer diagnosis and treatment both impacted their cardiovascular risk and introduced additional barriers to risk reduction. Potential strategies to improve counseling and awareness around cardiovascular risk include video and messaging platforms. Further risk reduction strategies should consider the unique challenges of cancer survivorship in delivery and implementation. ", doi="10.2196/71062", url="https://cancer.jmir.org/2025/1/e71062" } @Article{info:doi/10.2196/66471, author="Sterba, Katherine and Graboyes, Evan and Burris, Jessica and Scallion, Megan and Kinder, Hannah and Olsen, Jama and Toll, Benjamin and Armeson, Kent and Day, Terry and Chera, Bhishamjit and Ruggiero, Kenneth", title="Development of a Mobile App to Support Head and Neck Cancer Caregiving: Mixed Methods Study", journal="JMIR Cancer", year="2025", month="Jun", day="10", volume="11", pages="e66471", keywords="head and neck cancer", keywords="cancer survivorship", keywords="caregiving", keywords="nutrition", keywords="mobile health", keywords="app development", keywords="mixed methods", abstract="Background: Survivors with head and neck cancer (HNC) face challenging treatment consequences that can lead to severe disruptions in swallowing and result in weight loss, malnutrition, and feeding tube dependence. Caregivers (family or friends who provide support), therefore, often encounter distressing nutritional caregiving burdens and feel unprepared to provide adequate support at home. Objective: The purpose of this mixed methods study was to develop a mobile support app to support HNC caregiving with an emphasis on nutritional support following treatment. Methods: We assessed perspectives on nutritional recovery challenges and mobile support app preferences in (1) a national panel of oncology dietitians using a web-based cross-sectional survey and (2) survivors with HNC completing treatment within the past 24 months and their nominated caregivers using dyadic semistructured interviews. Descriptive statistics for survey data were synthesized with thematic analysis of interview data to characterize nutrition-related perceptions and intervention preferences; results were integrated, and themes were translated to high-priority main menu domains and subdomains for a mobile app for caregivers. Results: Surveys were completed by dietitians (n=116, 100\%; female n=87, 50\%, with >10 years practice experience). Interviews included survivors with HNC (n=15; 12/15, 80\% male, and 6/15, 40\% with oropharynx cancer) and their caregivers (n=13; 11/13, 85\% female, and 10/13, 77\% spouses). Dietitians, survivors, and caregivers perceived that the majority of nutritional concerns assessed (eg, swallowing, feeding tube management, weight maintenance, and caregiver distress about nutrition) were very or extremely important to caregiving in the 6 months following treatment conclusion. The caregiving tasks rated highest in importance by dietitians included tracking nutritional concerns (n=113, 97\%), working together as a team on nutritional concerns (n=104, 90\%), and making care decisions (n=102, 88\%). Five themes emerged from dyadic interviews, including types of nutritional challenges faced, that competing symptoms were difficult to separate from nutritional challenges, the emotional challenges related to nutrition and recovery, the diverse set of medical and support tasks taken on by caregivers, and information and resource needs in caregivers. Qualitative interview and survey themes guided the content of the Healthy Eating and Recovery Together (HEART) app with an intake tracker and sections for nutrition recovery support, other competing caregiving tips, peer support, and caregiver self-care. Conclusions: Results pinpointed optimal content for a mobile app for caregivers of individuals with HNC and support the acceptability of implementing the HEART app following HNC treatment. ", doi="10.2196/66471", url="https://cancer.jmir.org/2025/1/e66471" } @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/10.2196/59228, author="Yu, Kaitao and Yin, Baobing and Zhu, Ying and Meng, Hongdao and Zhu, Wenwei and Lu, Lu and Wang, Junqiao and Chen, Shugeng and Ni, Jun and Lin, Yifang and Jia, Jie", title="Efficacy of a Digital Postoperative Rehabilitation Intervention in Patients With Primary Liver Cancer: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2025", month="Apr", day="7", volume="13", pages="e59228", keywords="digital health", keywords="surgery", keywords="exercise rehabilitation", keywords="randomized controlled trial", keywords="primary liver cancer", abstract="Background: Rehabilitation is considered a fundamental component of cancer treatment, especially for patients undergoing cancer surgery. In contrast to conventional rehabilitation education, digital rehabilitation has the potential to improve patients' access to postoperative rehabilitation programs. While digital health has rapidly emerged to aid patients with various diseases, their clinical efficacy in the recovery of patients with primary liver cancer (PLC) undergoing hepatectomy remains inadequately investigated. Objective: This study aims to evaluate whether a digital postoperative rehabilitation intervention is efficient in improving physical fitness, enhancing exercise adherence, and alleviating fatigue among patients with PLC after hepatectomy. Methods: A randomized controlled trial was undertaken across 2 university-affiliated hospitals in Eastern China. A total of 100 participants were enrolled in this study and were allocated randomly to either the digital health (intervention group, n=50) or the rehabilitation manual-based group (control group, n=50) at a 1:1 ratio. Patients were unblinded and prospectively followed for the intervention of 3 weeks. Outcome measures included physical fitness, exercise adherence, and status of fatigue. Results: Overall, 91 out of 100 patients completed the research and were evaluated after 3 weeks of intervention. The digital health group showed better cardiopulmonary endurance than the control group. The mean difference in the change of 6-minute walk test distance from baseline between the groups was 70.21 (95\% CI 0.730-82.869) m (P=.05). No statistically significant effects were found for grip strength, 5-repetition-sit-to-stand test time, and fatigue. The exercise adherence in the digital health group was higher than that in the control group ($\chi$22=15.871, P<.001). Conclusions: The findings suggested that the implementation of digital health had a positive impact on recovery in exercise capacity after hepatectomy. In addition, rehabilitation exercise mode based on digital health has the potential to improve the exercise adherence of patients with PLC compared to conventional manual-based rehabilitation guidance. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100052911; https://www.chictr.org.cn/showproj.html?proj=135351 ", doi="10.2196/59228", url="https://mhealth.jmir.org/2025/1/e59228" } @Article{info:doi/10.2196/67108, author="Lin, Chen Yu and Hagen, Ryan and Powers, D. Benjamin and Dineen, P. Sean and Milano, Jeanine and Hume, Emma and Sprow, Olivia and Diaz-Carraway, Sophia and Permuth, B. Jennifer and Deneve, Jeremiah and Alishahi Tabriz, Amir and Turner, Kea", title="Digital Health Intervention to Reduce Malnutrition Among Individuals With Gastrointestinal Cancer Receiving Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Chemotherapy: Feasibility, Acceptability, and Usability Trial", journal="JMIR Cancer", year="2025", month="Apr", day="7", volume="11", pages="e67108", keywords="gastrointestinal cancer", keywords="peritoneal disease", keywords="cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy", keywords="digital health intervention", keywords="nutrition", keywords="feasibility", abstract="Background: Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can improve survival outcomes for individuals with gastrointestinal (GI) cancer and peritoneal disease (PD). Individuals with GI cancer and PD receiving CRS-HIPEC are at increased risk for malnutrition. Despite the increased risk for malnutrition, there has been limited study of nutritional interventions for individuals receiving CRS-HIPEC. Objective: We aimed to test the feasibility, acceptability, and usability of Support Through Remote Observation and Nutrition Guidance (STRONG), a multilevel digital health intervention to improve nutritional management among individuals with GI cancer and PD receiving CRS-HIPEC. We also assessed patient-reported outcomes, including malnutrition risk, health-related quality of life, and weight-related measures. Methods: STRONG is a 12-week digital intervention in which participants received biweekly nutritional counseling with a dietitian, logged food intake using a Fitbit tracker, and reported nutrition-related outcomes. Dietitians received access to a web-based dashboard and remotely monitored patients' reported food intake and nutrition-impact symptoms. Implementation outcomes were assessed against prespecified benchmarks consistent with benchmarks used in prior studies. Changes in patient-reported outcomes at baseline and follow-up were assessed using linear and ordered logistic regressions. Results: Participants (N=10) had a median age of 57.5 (IQR 54-69) years. Feasibility benchmarks were achieved for recruitment (10/17, 59\% vs benchmark: 50\%), study assessment completion (9/10, 90\% vs benchmark: 60\%), dietitian appointment attendance (7/10, 70\% vs benchmark: 60\%), daily food intake logging adherence (6/10, 60\% vs benchmark: 60\%), and participant retention (10/10, 100\% vs benchmark: 60\%). Most participants rated the intervention as acceptable (8/10, 80\% vs benchmark: 70\%) and reported a high level of usability for dietitian services (10/10, 100\%). The benchmark usability for the Fitbit tracker to log food intake was not met. Compared to baseline, participants saw on average a 6.0 point reduction in malnutrition risk score (P=.01), a 20.5 point improvement in general health-related quality of life score (P=.002), and a 5.6 percentage point increase in 1-month weight change (P=.04) at the end of the study. Conclusions: The STRONG intervention demonstrated to be feasible, acceptable, and usable among individuals with GI cancer and PD receiving CRS-HIPEC. A fully powered randomized controlled trial is needed to test the effectiveness of STRONG for reducing malnutrition and improving patient outcomes. Trial Registration: ClinicalTrials.gov NCT05649969; https://clinicaltrials.gov/study/NCT05649969 ", doi="10.2196/67108", url="https://cancer.jmir.org/2025/1/e67108" } @Article{info:doi/10.2196/52694, author="Tak, Won Yae and Kim, Junetae and Chung, Haekwon and Lee, Byul Sae and Park, Ja In and Lee, Won Sei and Jo, Min-Woo and Lee, Won Jong and Baek, Seunghee and Lee, Yura", title="Analysis of Metabolic and Quality-of-Life Factors in Patients With Cancer for a New Approach to Classifying Walking Habits: Secondary Analysis of a Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Apr", day="1", volume="27", pages="e52694", keywords="telemedicine", keywords="mobile phone", keywords="physical activity", keywords="mobile apps", keywords="mobile health intervention", keywords="cancer", keywords="step count", abstract="Background: As the number of people diagnosed with cancer continues to increase, self-management has become crucial for patients recovering from cancer surgery or undergoing chemotherapy. Technology has emerged as a key tool in supporting self-management, particularly through interventions that promote physical activity, which is important for improving health outcomes and quality of life for patients with cancer. Despite the growing availability of digital tools that facilitate physical activity tracking, high-level evidence of their long-term effectiveness remains limited. Objective: This study aimed to investigate the effect of long-term physical activity on patients with cancer by categorizing them into active and inactive groups based on step count time-series data using the mobile health intervention, the Walkon app (Swallaby Co, Ltd.). Methods: Patients with cancer who had previously used the Walkon app in a previous randomized controlled trial were chosen for this study. Walking step count data were acquired from the app users. Biometric measurements, including BMI, waist circumference, blood sugar levels, and body composition, along with quality of life (QOL) questionnaire responses (European Quality of Life 5 Dimensions 5 Level version and Health-related Quality of Life Instrument with 8 Items), were collected during both the baseline and 6-month follow-up at an outpatient clinic. To analyze step count patterns over time, the concept of sample entropy was used for patient clustering, distinguishing between the active walking group (AWG) and the inactive walking group (IWG). Statistical analysis was performed using the Shapiro-Wilk test for normality, with paired t tests for parametric data, Wilcoxon signed-rank tests for nonparametric data, and chi-square tests for categorical variables. Results: The proposed method effectively categorized the AWG (n=137) and IWG (n=75) based on step count trends, revealing significant differences in daily (4223 vs 5355), weekly (13,887 vs 40,247), and monthly (60,178 vs 174,405) step counts. Higher physical activity levels were observed in patients with breast cancer and younger individuals. In terms of biometric measurements, only waist circumference (P=.01) and visceral fat (P=.002) demonstrated a significant improvement exclusively within the AWG. Regarding QOL measurements, aspects such as energy (P=.01), work (P<.003), depression (P=.02), memory (P=.01), and happiness (P=.05) displayed significant improvements solely in the AWG. Conclusions: This study introduces a novel methodology for categorizing patients with cancer based on physical activity using step count data. Although significant improvements were noted in the AWG, particularly in QOL and specific physical metrics, differences in 6-month change between the AWG and IWG were statistically insignificant. These findings highlight the potential of digital interventions in improving outcomes for patients with cancer, contributing valuable insights into cancer care and self-management. Trial Registration: Clinical Research Information Service by Korea Centers for Diseases Control and Prevention, Republic of Korea KCT0005447; https://tinyurl.com/3zc7zvzz ", doi="10.2196/52694", url="https://www.jmir.org/2025/1/e52694" } @Article{info:doi/10.2196/57537, author="Tandon, Puneeta and Ismond, P. Kathleen and Purdy, Graeme and Cruz, Christofer and Etruw, Evelyn and Suderman, Kirsten and Hyde, Ashley and Stickland, Michael and Spence, C. John and Lien, C. Dale and Bhanji, Rahima and Prado, M. Carla and Miguel-Cruz, Antonio and Joy, A. Anil and Yaskina, Maryna and McNeely, L. Margaret", title="Acceptability and Effectiveness of a Fully Web-Based Nutrition and Exercise Program for Individuals With Chronic Disease During COVID-19: Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Mar", day="24", volume="27", pages="e57537", keywords="eHealth", keywords="patient-centered care", keywords="adults", keywords="geriatrics", keywords="self-management", keywords="web-based", keywords="nutrition", keywords="exercise rehabilitation", keywords="wearable", keywords="activity tracker", keywords="quality of life", keywords="physical health", keywords="2-minute step test", keywords="patients with cancer", keywords="chronic diseases", keywords="COVID-19", keywords="randomized controlled trial", keywords="acceptability", keywords="effectiveness", keywords="intervention", abstract="Background: In-person nutrition and exercise interventions improve physical function in chronic diseases, yet the acceptability and effectiveness of web-based delivery, especially with different levels of personnel support, require further investigation. Objective: This study aims to evaluate a web-based nutrition and exercise intervention delivered entirely digitally from recruitment to trial completion. Methods: A randomized controlled trial was conducted using the Heal-Me version 1 platform across 2 levels of personnel support (Light and Intensive). Eligible adults with a history of cancer, chronic lung disease, or liver or lung transplant; internet access; and prior participation in a rehabilitation program were enrolled in a fully web-based program to minimize barriers to exercise participation. Participants were randomly assigned (1:1:1) to 1 of 3 study groups. The control group received a detailed, self-directed digital nutrition and exercise guide. The Heal-Me Light group received the web-based intervention alongside dietitian and exercise specialist--led group classes. The Heal-Me Intensive group received web-based intervention, group classes, and one-to-one sessions with the dietitians and exercise specialists. All participants received a wearable activity tracker. The primary acceptability outcome was adherence to the intervention based on a priori targets. The primary effectiveness outcome was the change in Lower Extremity Functional Scale (LEFS) score. Secondary outcomes included physical function tests, which were performed and measured by videoconference. Questionnaires were used to assess well-being, quality of life, and food intake. Analyses adhered to the intention-to-treat principle. Results: Of 216 participants, 202 (93.5\%) completed the intervention (mean 61, SD 11 years; female: 130/202, 64.4\%; cancer: 126/202, 62.4\%). Adherence exceeded a priori targets, with 82\% (105/128) attending >75\% of the program elements including postintervention tests. Participants rated the program as ``quite a bit'' or ``very'' useful, with similar ratings between Heal-Me Light (56/64, 88\%) and Heal-Me Intensive (51/58, 88\%) groups (P=.69). No significant differences were found for changes in LEFS scores (control: mean 0.8, SD 7.7; Heal-Me: mean 0.3, SD 6.6; P=.53). Significant benefits were found in favor of the combined Heal-Me intervention groups versus controls for change in the 2-minute step test, World Health Organization-5 Well-Being Index, Short-Form-36 general, physical health role, energy or fatigue scales, and protein intake. While the change in physical function was similar between the 2 intervention arms, the more intensive one-to-one interaction (Heal-Me Intensive) led to greater improvements in perceived nutrition self-management. No serious adverse events occurred. Conclusions: The demonstrated satisfaction, adherence, and effectiveness highlight the high acceptability of a web-based, semisupervised nutrition and exercise intervention delivered entirely digitally in individuals with chronic disease. Future studies may benefit from having a baseline physical function inclusion threshold, the use of a more sensitive primary physical function measure, and a higher intensity digital exercise intervention in exercise-experienced participants. Trial Registration: Clinicaltrials.gov NCT04666558; https://clinicaltrials.gov/study/NCT04666558 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2022.106791 ", doi="10.2196/57537", url="https://www.jmir.org/2025/1/e57537", url="http://www.ncbi.nlm.nih.gov/pubmed/40126542" } @Article{info:doi/10.2196/63891, author="Garc{\'i}a-Molina, Jennifer and Saiz-V{\'a}zquez, Olalla and Santamar{\'i}a-V{\'a}zquez, Montserrat and Ortiz-Huerta, Hilario Juan", title="Efficacy of a Supervised Exercise Program on Pain, Physical Function, and Quality of Life in Patients With Breast Cancer: Protocol for a Randomized Clinical Trial", journal="JMIR Res Protoc", year="2025", month="Mar", day="12", volume="14", pages="e63891", keywords="breast cancer", keywords="exercise", keywords="quality of life", keywords="muscle strength", keywords="pain", keywords="efficacy", keywords="protocol", keywords="physical exercise", keywords="fatigue", keywords="loss of muscle", keywords="physical function", keywords="randomized clinical trial", keywords="patients with cancer", abstract="Background: Breast cancer is the second most common cancer in women worldwide. Treatments for this disease often result in side effects such as pain, fatigue, loss of muscle mass, and reduced quality of life. Physical exercise has been shown to effectively mitigate these side effects and improve the quality of life in patients with breast cancer. Objective: This randomized clinical trial aims to evaluate the efficacy of a 12-week supervised exercise program on pain, physical function, and quality of life in female patients with cancer. Methods: This randomized, double-blind clinical trial will recruit 325 participants, divided into an intervention group receiving the exercise program and a control group receiving standard care recommendations. Outcome measures, including pain (assessed via the Brief Pain Inventory), physical function (Disability of the Arm, Shoulder, and Hand Questionnaire), and quality of life (European Organization for Research and Treatment of Cancer QLQ-C30 and European Organization for Research and Treatment of Cancer QLQ-BR23), will be evaluated at baseline, immediately post intervention, and 12 weeks post intervention. Statistical analysis will involve repeated measures of ANOVA and MANOVA to determine the significance of the intervention's effects across time points. Results: Recruitment and data collection will commence in February of 2025, and data analysis is scheduled for completion at the end of 2025. No results are currently available Conclusions: Physical exercise is anticipated to play a significant role in alleviating pain, enhancing physical function, and improving the quality of life in female patients with cancer. This study will provide robust evidence to support the integration of supervised exercise into standard care protocols for this population. Trial Registration: ClinicalTrials.gov NCT06618690; https://clinicaltrials.gov/ct2/show/NCT06618690 International Registered Report Identifier (IRRID): PRR1-10.2196/63891 ", doi="10.2196/63891", url="https://www.researchprotocols.org/2025/1/e63891" } @Article{info:doi/10.2196/60791, author="Langley, E. Jodi and Sibley, Daniel and Chiekwe, Joy and Keats, R. Melanie and Snow, Stephanie and Purcell, Judith and Sollows, Stephen and Hill, Leslie and Watton, David and Gaudry, E. Abbigael and Hashish, Ibrahim and Wallace, Alison", title="Prehabilitation Program for Lung and Esophageal Cancers (Boosting Recovery and Activity Through Early Wellness): Protocol for a Nonrandomized Trial", journal="JMIR Res Protoc", year="2025", month="Mar", day="10", volume="14", pages="e60791", keywords="cancer", keywords="prehabilitation", keywords="physical activity", keywords="lung", keywords="esophageal", keywords="wellness", keywords="surgical", keywords="candidacy", keywords="feasibility", keywords="implementation", keywords="community-based", keywords="coaching program", keywords="Canada", keywords="lung cancer", keywords="esophageal cancer", keywords="surgery", keywords="nonrandomized trial", keywords="mixed method", abstract="Background: Cancer is the leading cause of death in Canada, responsible for 28.2\% of all deaths. Based on surgical candidacy and disease status, both lung and esophageal cancer are treated through surgical resection by a thoracic surgeon. Although surgery contributes to improved outcomes, the 30-day postoperative mortality risks are as high as 10\% and 2.8\%, respectively. Evidence has shown that prehabilitation is a way in which patients can have improved postoperative outcomes. Prehabilitation is multimodal, often including some form of movement, nutrition, stress management, and smoking cessation. Given the complexity of the health care system, pragmatic trials are important methodological tools to assess internal validity and improve current practice under real-world conditions. Concurrently, using community resources is imperative to keep people active in their community and create sustainable programming. Objective: The Boosting Recovery and Activity Through Early Wellness (BREATHE WELL) study aims to explore the feasibility, implementation, and preliminary effectiveness of a clinically integrated, community-based, prehabilitation health coaching program. This includes nutrition, smoking cessation, sleep hygiene, and movement for individuals scheduled to undergo surgery for lung or esophageal cancer. Methods: This is a pilot, nonrandomized, pragmatic, repeated measures, mixed methods trial. We will recruit 32 participants diagnosed with lung or esophageal cancer and are scheduled to undergo surgical resection into the prehabilitation program, with 32 additional participants who decline participation to act as a control group. Participants who agree will then go through an 8-week tailored prehabilitation program (in person or virtual), covering movement, nutrition, stress management, nutrition, goal setting, and smoking cessation. They will complete 6 sessions prior to surgery and then have 4 sessions, 1{\texttimes}/week following surgery. Following the completion of the program, they will have 3 booster sessions via phone or Zoom (Zoom Video Communications). The primary outcome is feasibility: (1) recruitment feasibility---recruitment rate (the number of participants referred per month), enrollment rate (the number of enrolled participants divided by the number of referred participants), reasons for declining, and prehabilitation window (time between consent and surgery); and (2) intervention feasibility---adherence to the movement intervention, attrition, safety, study completion rate, and adverse events. Secondary outcomes include measures of preliminary effectiveness including patient-reported outcomes, such as well-being, fatigue, and functional measures. All measures will be assessed before, during, and after the prehabilitation program. Results: Enrollment has begun in January 2025, with 2 participants enrolled in the health coaching program. The full study is expected to be completed in approximately 3 years and be published in winter 2027. Conclusions: This study will inform the feasibility, implementation, and preliminary effectiveness of a clinically integrated, community-based, prehabilitation program in Nova Scotia, Canada, for people scheduled to undergo curative intent surgery for lung and esophageal cancer. Trial Registration: ClinicalTrials.gov NCT06354959; https://clinicaltrials.gov/study/NCT06354959 International Registered Report Identifier (IRRID): PRR1-10.2196/60791 ", doi="10.2196/60791", url="https://www.researchprotocols.org/2025/1/e60791" } @Article{info:doi/10.2196/72477, author="Lee, Yura and Park, Ye-Eun", title="Authors' Reply: Advancing Digital Health Integration in Oncology", journal="J Med Internet Res", year="2025", month="Mar", day="7", volume="27", pages="e72477", keywords="mHealth", keywords="user experience", keywords="cancer", keywords="technology acceptance model", keywords="structural equation modeling", keywords="health care app", keywords="mixed-method study", keywords="medical care", keywords="digital health care", keywords="cancer survivors", keywords="disparities", keywords="health status", keywords="behavioral intervention", keywords="clinician", doi="10.2196/72477", url="https://www.jmir.org/2025/1/e72477", url="http://www.ncbi.nlm.nih.gov/pubmed/40053760" } @Article{info:doi/10.2196/70316, author="Khan, Umar Rai Muhammad and Tariq, Hassan", title="Advancing Digital Health Integration in Oncology", journal="J Med Internet Res", year="2025", month="Mar", day="7", volume="27", pages="e70316", keywords="mHealth", keywords="user experience", keywords="cancer", keywords="technology acceptance model", keywords="structural equation modeling", keywords="health care app", keywords="mixed-method study", keywords="medical care", keywords="digital health care", keywords="cancer survivors", keywords="disparities", keywords="health status", keywords="behavioral intervention", keywords="clinician", doi="10.2196/70316", url="https://www.jmir.org/2025/1/e70316", url="http://www.ncbi.nlm.nih.gov/pubmed/40053796" } @Article{info:doi/10.2196/60115, author="Li, Guangqi and Zhou, Xueyan and Deng, Junyue and Wang, Jiao and Ai, Ping and Zeng, Jingyuan and Ma, Xuelei and Liao, Hu", title="Digital Therapeutics--Based Cardio-Oncology Rehabilitation for Lung Cancer Survivors: Randomized Controlled Trial", journal="JMIR Mhealth Uhealth", year="2025", month="Feb", day="25", volume="13", pages="e60115", keywords="cardio-oncology rehabilitation", keywords="digital therapeutics", keywords="telerehabilitation", keywords="non-small cell lung cancer", keywords="exercise prescription", keywords="cardiology", keywords="oncology", keywords="rehabilitation", keywords="cardiorespiratory fitness", keywords="cardiopulmonary", keywords="cancer", keywords="physical activity", keywords="digital health", keywords="digital technology", keywords="randomized controlled trial", keywords="wearable", keywords="app", keywords="quality of life", keywords="survivor", abstract="Background: Lung cancer ranks as the leading cause of cancer-related deaths. For lung cancer survivors, cardiopulmonary fitness is a strong independent predictor of survival, while surgical interventions impact both cardiovascular and pulmonary function. Home-based cardiac telerehabilitation through wearable devices and mobile apps is a substitution for traditional, center-based rehabilitation with equal efficacy and a higher completion rate. However, it has not been widely used in clinical practice. Objective: The objective of this study was to broaden the use of digital health care in the cardiopulmonary rehabilitation of lung cancer survivors and to assess its impact on cardiopulmonary fitness and quality of life (QOL). Methods: Early-stage nonsmall cell lung cancer survivors aged 18-70 years were included. All the participants received surgery 1-2 months before enrollment and did not require further antitumor therapy. Participants were randomly assigned to receive cardiac telerehabilitation or usual care for 5 months. Artificial intelligence--driven exercise prescription with a video guide and real-time heart rate (HR) monitoring was generated based on cardiopulmonary exercise testing. Aerobic exercise combining elastic band--based resistance exercises were recommended with a frequency of 3-5 d/wk and a duration of 90-150 min/wk. The effective exercise duration was recorded when patients' HR reached the target zone (HRresting + [HRmax -- HRresting] {\texttimes} [?40\%-60\%]), representing the duration under the target intensity. The prescription used a gradual progression in duration and action intensity based on the exercise data and feedback. Outcome measurements included cardiopulmonary fitness; lung function; cardiac function; tumor marker; safety; compliance; and scales assessing symptoms, psychology, sleep, fatigue, and QOL. Results: A total of 40 (85\%) out of 47 patients finished the trial. The average prescription compliance rate of patients in the telerehabilitation group reached 101.2\%, with an average exercise duration of 151.4 min/wk and an average effective exercise duration of 92.3 min/wk. The cardiac telerehabilitation was associated with higher improvement of maximal oxygen uptake peak (3.66, SD 3.23 mL/Kg/min vs 1.09, SD 3.23 mL/Kg/min; P=.02) and global health status or QOL (16.25, SD 23.02 vs 1.04, SD 13.90; P=.03) compared with usual care. Better alleviation of affective interference (--0.88, SD 1.50 vs 0.21, SD 1.22; P=.048), fatigue (--8.89, SD 15.96 vs 1.39, SD 12.09; P=.02), anxiety (--0.31, SD 0.44 vs --0.05, SD 0.29; P=.048), and daytime dysfunction (--0.55, SD 0.69 vs 0.00, SD 0.52; P=.02) was also observed in the telerehabilitation group. No exercise-related adverse events were identified during the intervention period. Conclusions: The 5-month, digital therapeutics--based telerehabilitation improved cardiorespiratory fitness in lung cancer survivors with good compliance and safety. Patients receiving telerehabilitation also reported improved QOL with reduced levels of fatigue, anxiety, and daytime dysfunction. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200064000; https://www.chictr.org.cn/showproj.html?proj=180594 ", doi="10.2196/60115", url="https://mhealth.jmir.org/2025/1/e60115" } @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