@Article{info:doi/10.2196/18288,
author="Groarke, M. Jenny
and Richmond, Janice
and Mc Sharry, Jenny
and Groarke, AnnMarie
and Harney, M. Owen
and Kelly, Grace Mary
and Walsh, C. Jane",
title="Acceptability of a Mobile Health Behavior Change Intervention for Cancer Survivors With Obesity or Overweight: Nested Mixed Methods Study Within a Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Feb",
day="16",
volume="9",
number="2",
pages="e18288",
keywords="mHealth",
keywords="self-management",
keywords="text messaging",
keywords="activity tracker",
keywords="exercise",
keywords="diet",
keywords="overweight",
keywords="obesity",
keywords="cancer survivors",
keywords="qualitative research",
keywords="mobile phone",
abstract="Background: A significant proportion of cancer survivors have overweight or obesity. Although this has negative implications for health, weight management is not a standard component of oncology aftercare. Mobile health (mHealth) technology, in combination with behavior change techniques (BCTs), has the potential to support positive lifestyle changes. Few studies have been carried out with cancer survivors; therefore, the acceptability of these tools and techniques requires further investigation. Objective: The aim of this study is to examine the acceptability of a behavior change intervention using mHealth for cancer survivors with a BMI of 25 or more and to gather constructive feedback from participants. Methods: The intervention consisted of educational sessions and an 8-week physical activity goal setting intervention delivered using mobile technology (ie, Fitbit activity monitor plus SMS contact). In the context of a two-arm randomized controlled trial, semistructured interviews were conducted to assess the retrospective acceptability of the intervention from the perspective of the recipients. The theoretical framework for the acceptability of health care interventions was used to inform a topic guide. The interviews were transcribed and analyzed using thematic analysis. A quantitative survey was also conducted to determine the acceptability of the intervention. A total of 13 participants were interviewed, and 36 participants completed the quantitative survey. Results: The results strongly support the acceptability of the intervention. The majority of the survey respondents held a positive attitude toward the intervention (35/36, 97\%). In qualitative reports, many of the intervention components were enjoyed and the mHealth components (ie, Fitbit and goal setting through text message contact) were rated especially positively. Responses were mixed as to whether the burden of participating in the intervention was high (6/36, 17\%) or low (5/36, 14\%). Participants perceived the intervention as having high efficacy in improving health and well-being (34/36, 94\%). Most respondents said that they understood how the intervention works (35/36, 97\%), and qualitative data show that participants' understanding of the aim of the intervention was broader than weight management and focused more on moving on psychologically from cancer. Conclusions: On the basis of the coherence of responses with theorized aspects of intervention acceptability, we are confident that this intervention using mHealth and BCTs is acceptable to cancer survivors with obesity or overweight. Participants made several recommendations concerning the additional provision of social support. Future studies are needed to assess the feasibility of delivery in clinical practice and the acceptability of the intervention to those delivering the intervention. International Registered Report Identifier (IRRID): RR2-10.2196/13214 ",
doi="10.2196/18288",
url="http://mhealth.jmir.org/2021/2/e18288/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33591290"
}


@Article{info:doi/10.2196/25317,
author="Faro, M. Jamie
and Mattocks, M. Kristin
and Nagawa, S. Catherine
and Lemon, C. Stephenie
and Wang, Bo
and Cutrona, L. Sarah
and Sadasivam, S. Rajani",
title="Physical Activity, Mental Health, and Technology Preferences to Support Cancer Survivors During the COVID-19 Pandemic: Cross-sectional Study",
journal="JMIR Cancer",
year="2021",
month="Feb",
day="3",
volume="7",
number="1",
pages="e25317",
keywords="cancer",
keywords="COVID-19",
keywords="digital",
keywords="physical activity",
keywords="support",
keywords="technology",
abstract="Background: COVID-19 has had significant health-related and behavioral impacts worldwide. Cancer survivors (hereafter referred to as ``survivors'') are particularly prone to behavioral changes and are encouraged to be more vigilant and observe stricter social distancing measures. Objective: We explored (1) changes in physical activity and sedentary behaviors since the onset of COVID-19, along with changes in mental health status, and (2) alternative strategies to support survivors' physical activity and social health during and after COVID-19, along with the role of digital health in such strategies. Methods: A questionnaire was distributed among survivors participating (currently or previously) in the community-based physical activity program LIVESTRONG at the Young Men's Christian Association (YMCA), from 3 sites outside an urban area in Massachusetts. Questions addressed pre--COVID-19 vs current changes in physical activity and sedentary behavior. Anxiety and depression were assessed using the 2-item Generalized Anxiety Disorder scale (GAD-2) and 2-item Patient Health Questionnaire (PHQ-2), and scores ?3 indicated a clinical diagnosis of anxiety or depression, respectively. Digital health preferences were assessed through closed-ended questions. Open-ended responses addressing other preferences for physical activity programs and social support were analyzed, coded, and categorized into themes. Results: Among 61 participants (mean age 62 [SD 10.4] years; females: 51/61 [83.6\%]), 67.2\% (n=41) reported decreased physical activity and 67.2\% (n=41) reported prolonged sitting times since the onset of COVID-19. Further, 24.6\% (n=15) and 26.2\% (n=16) met the GAD-2 and PHQ-2 criteria for clinical anxiety and depression, respectively. All participants owned a cellphone; 90\% (n=54) owned a smartphone. Preferences for physical activity programs (n=28) included three themes: (1) use of digital or remote platforms (Zoom, other online platforms, and video platforms), (2) specific activities and locations (eg, outdoor activities, walking, gardening, biking, and physical activities at the YMCA and at senior centers), and (3) importance of social support regardless of activity type (eg, time spent with family, friends, peers, or coaches). The survey revealed a mean score of 71.8 (SD 21.4; scale 0-100) for the importance of social support during physical activity programs. Social support preferences (n=15) revealed three themes: (1) support through remote platforms (eg, texting, Zoom, phone calls, emails, and Facebook), (2) tangible in-person support (YMCA and senior centers), and (3) social support with no specific platform (eg, small gatherings and family or friend visits). Conclusions: Physical activity and mental health are critical factors for the quality of life of survivors, and interventions tailored to their activity preferences are necessary. Digital or remote physical activity programs with added social support may help address the ongoing needs of survivors during and after the pandemic. ",
doi="10.2196/25317",
url="http://cancer.jmir.org/2021/1/e25317/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33471776"
}


@Article{info:doi/10.2196/21256,
author="Pluimakers, Vincent
and Fiocco, Marta
and van Atteveld, Jenneke
and Hobbelink, Monique
and Bresters, Dorine
and Van Dulmen-den Broeder, Eline
and Van der Heiden-van der Loo, Margriet
and Janssens, O. Geert
and Kremer, Leontien
and Loonen, Jacqueline
and Louwerens, Marloes
and Van der Pal, Helena
and Ronckers, C{\'e}cile
and Van Santen, Hanneke
and Versluys, Birgitta
and De Vries, Andrica
and Van den Heuvel-Eibrink, Marry
and Neggers, Sebastian",
title="Metabolic Syndrome Parameters, Determinants, and Biomarkers in Adult Survivors of Childhood Cancer: Protocol for the Dutch Childhood Cancer Survivor Study on Metabolic Syndrome (Dutch LATER METS)",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="27",
volume="10",
number="1",
pages="e21256",
keywords="metabolic syndrome",
keywords="childhood cancer survivor",
keywords="Dutch Childhood Cancer Survivor Study",
keywords="methodology",
keywords="Dutch LATER METS",
abstract="Background: Potential late effects of treatment for childhood cancer include adiposity, insulin resistance, dyslipidemia, and hypertension. These risk factors cluster together as metabolic syndrome and increase the risk for development of diabetes mellitus and cardio- and cerebrovascular disease. Knowledge on risk factors, timely diagnosis, and preventive strategies is of importance to prevent cardio- and cerebrovascular complications and improve quality of life. Currently, no national cohort studies on the prevalence and determinants of metabolic syndrome in childhood cancer survivors, including biomarkers and genetic predisposition, are available. Objective: The objectives of the Dutch LATER METS study are to assess 1) the prevalence and risk factors of metabolic syndrome and its separate components, and 2) the potential diagnostic and predictive value of additional biomarkers for surveillance of metabolic syndrome in the national cohort of adult long-term survivors of childhood cancer. Methods: This is a cross-sectional study based on recruitment of all survivors treated in the Netherlands between 1963 and 2002. Metabolic syndrome will be classified according to the definitions of the third Adult Treatment Panel Report of the National Cholesterol Education Program as well as the Joint Interim Statement and compared to reference data. Dual-energy x-ray absorptiometry scans were performed to assess body composition in more detail. The effect of patient characteristics, previous treatment, and genetic variation on the risk of metabolic syndrome will be assessed. The diagnostic and predictive value of novel biomarkers will be tested. Results: Patient accrual started in 2016 and lasted until April 2020. A total of 2380 survivors from 7 pediatric oncology hospitals have participated. From July 2020, biomarker testing, single nucleotide polymorphism analysis, and data analysis will be performed. Conclusions: The Dutch LATER METS study will provide knowledge on clinical and genetic determinants of metabolic syndrome and the diagnostic value of biomarkers in childhood cancer survivors. The results of this study will be used to optimize surveillance guidelines for metabolic syndrome in survivors based on enhanced risk stratification and screening strategies. This will improve diagnosis of metabolic syndrome and prevent complications. International Registered Report Identifier (IRRID): DERR1-10.2196/21256 ",
doi="10.2196/21256",
url="https://www.researchprotocols.org/2021/1/e21256",
url="http://www.ncbi.nlm.nih.gov/pubmed/32750002"
}


@Article{info:doi/10.2196/18396,
author="Weaver, E. Kathryn
and Klepin, D. Heidi
and Wells, J. Brian
and Dressler, V. Emily
and Winkfield, M. Karen
and Lamar, S. Zanetta
and Avery, P. Tiffany
and Pajewski, M. Nicholas
and Hundley, Gregory W.
and Johnson, Aimee
and Davidson, C. Eleanor
and Lopetegui, Marcelo
and Foraker, E. Randi",
title="Cardiovascular Assessment Tool for Breast Cancer Survivors and Oncology Providers: Usability Study",
journal="JMIR Cancer",
year="2021",
month="Jan",
day="21",
volume="7",
number="1",
pages="e18396",
keywords="electronic health records",
keywords="clinical decision support",
keywords="usability testing",
keywords="cardiovascular diseases",
keywords="cancer survivors",
keywords="breast cancer",
abstract="Background: Cardiovascular health is of increasing concern to breast cancer survivors and their health care providers, as many survivors are more likely to die from cardiovascular disease than cancer. Implementing clinical decision support tools to address cardiovascular risk factor awareness in the oncology setting may enhance survivors' attainment or maintenance of cardiovascular health. Objective: We sought to evaluate survivors' awareness of cardiovascular risk factors and examine the usability of a novel electronic health record enabled cardiovascular health tool from the perspective of both breast cancer survivors and oncology providers. Methods: Breast cancer survivors (n=49) recruited from a survivorship clinic interacted with the cardiovascular health tool and completed pre and posttool assessments about cardiovascular health knowledge and perceptions of the tool. Oncologists, physician assistants, and nurse practitioners (n=20) who provide care to survivors also viewed the cardiovascular health tool and completed assessments of perceived usability and acceptability. Results: Enrolled breast cancer survivors (84\% White race, 4\% Hispanic ethnicity) had been diagnosed 10.8 years ago (SD 6.0) with American Joint Committee on Cancer stage 0, I, or II (45/49, 92\%). Prior to viewing the tool, 65\% of survivors (32/49) reported not knowing their level for one or more cardiovascular health factors (range 0-4). On average, only 45\% (range 0\%-86\%) of survivors' known cardiovascular health factors were at an ideal level. More than 50\% of survivors had ideal smoking status (45/48, 94\%) or blood glucose level (29/45, 64\%); meanwhile, less than 50\% had ideal blood pressure (12/49, 24\%), body mass index (12/49, 24\%), cholesterol level (17/35, 49\%), diet (7/49, 14\%), and physical activity (10/49. 20\%). More than 90\% of survivors thought the tool was easy to understand (46/47, 98\%), improved their understanding (43/47, 91\%), and was helpful (45/47, 96\%); overall, 94\% (44/47 survivors) liked the tool. A majority of survivors (44/47, 94\%) thought oncologists should discuss cardiovascular health during survivorship care. Most (12/20, 60\%) oncology providers (female: 12/20, 60\%; physicians: 14/20, 70\%) had been practicing for more than 5 years. Most providers agreed the tool provided useful information (18/20, 90\%), would help their effectiveness (18/20, 90\%), was easy to use (20/20, 100\%), and presented information in a useful format (19/20, 95\%); and 85\% of providers (17/20) reported they would use the tool most or all of the time when providing survivorship care. Conclusions: These usability data demonstrate acceptability of a cardiovascular health clinical decision support tool in oncology practices. Oncology providers and breast cancer survivors would likely value the integration of such apps in survivorship care. By increasing awareness and communication regarding cardiovascular health, electronic health record--enabled tools may improve survivorship care delivery for breast cancer and ultimately patient outcomes. ",
doi="10.2196/18396",
url="http://cancer.jmir.org/2021/1/e18396/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33475511"
}


@Article{info:doi/10.2196/19238,
author="Chan, M. June
and Van Blarigan, L. Erin
and Langlais, S. Crystal
and Zhao, Shoujun
and Ramsdill, W. Justin
and Daniel, Kimi
and Macaire, Greta
and Wang, Elizabeth
and Paich, Kellie
and Kessler, R. Elizabeth
and Beer, M. Tomasz
and Lyons, S. Karen
and Broering, M. Jeanette
and Carroll, R. Peter
and Kenfield, A. Stacey
and Winters-Stone, M. Kerri",
title="Feasibility and Acceptability of a Remotely Delivered, Web-Based Behavioral Intervention for Men With Prostate Cancer: Four-Arm Randomized Controlled Pilot Trial",
journal="J Med Internet Res",
year="2020",
month="Dec",
day="31",
volume="22",
number="12",
pages="e19238",
keywords="diet",
keywords="physical activity",
keywords="exercise",
keywords="lifestyle",
keywords="cancer",
keywords="survivorship",
keywords="text messages",
keywords="internet",
abstract="Background: Diet and exercise may be associated with quality of life and survival in men with prostate cancer. Objective: This study aimed to determine the feasibility and acceptability of a remotely delivered web-based behavioral intervention among men with prostate cancer. Methods: We conducted a multi-site 4-arm pilot randomized controlled trial of a 3-month intervention (TrueNTH Community of Wellness). Eligibility included self-reported prostate cancer diagnosis, having a personal device that connected to the internet, age ?18 years, and ability to read English and receive text messages and emails. Men receiving chemotherapy or radiation, or those who reported contraindications to exercise, could participate with physician clearance. Participants were randomized (1:1:1:1) to additive intervention levels: website; website and personalized diet and exercise prescription; website, personalized prescription, Fitbit, and text messages; and website, personalized prescription, Fitbit, text messages, and 2 30-minute phone calls---one with an exercise trainer and one with a registered dietician. Primary outcomes were feasibility (accrual and attrition) and acceptability (survey data and website use). We described self-reported diet and exercise behavior at the time of enrollment, 3 months, and 6 months as secondary outcomes. Results: In total, 202 men consented and were randomized between August 2017 and September 2018 (level 1: 49, level 2: 51, level 3: 50, level 4: 52). A total of 160 men completed the onboarding process and were exposed to their randomly assigned intervention (38, 38, 42, and 42 in levels 1, 2, 3, and 4, respectively). The follow-up rate was 82.7\% (167/202) at 3 months and 77.2\% (156/202) at 6 months. Participants had a median age of 70 years and were primarily White and college educated. Website visit frequency over the 3-month intervention period increased across levels (median: 2, 9, 11, and 16 visits for levels 1, 2, 3, and 4, respectively). Most were satisfied or very satisfied with the intervention (20/39, 51\%; 27/42, 64\%; 23/44, 52\%; and 27/42, 64\% for levels 1, 2, 3, and 4, respectively). The percentage of men who reported being very satisfied was highest among level 4 participants (10/42, 24\% vs 4/39, 10\%; 5/42, 12\%; and 5/44, 11\% for levels 1, 2, and 3, respectively). Dissatisfaction was highest in level 1 (5/39, 13\% vs 1/42, 2\%; 3/44, 7\%; and 2/42, 5\% for levels 2, 3, and 4, respectively). We observed small improvements in diet and physical activity at 3 months among men in level 4 versus those in level 1. Conclusions: A web-based, remotely delivered, tailored behavioral intervention for men with prostate cancer is feasible. Future studies are warranted to increase the effect of the intervention on patient behavior while maintaining sustainability and scalability as well as to design and implement interventions for more diverse populations. Trial Registration: ClinicalTrials.gov NCT03406013; http://clinicaltrials.gov/ct2/show/NCT03406013 ",
doi="10.2196/19238",
url="http://www.jmir.org/2020/12/e19238/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33382378"
}


@Article{info:doi/10.2196/17538,
author="Baik, H. Sharon
and Oswald, B. Laura
and Buscemi, Joanna
and Buitrago, Diana
and Iacobelli, Francisco
and Perez-Tamayo, Alejandra
and Guitelman, Judith
and Penedo, J. Frank
and Yanez, Betina",
title="Patterns of Use of Smartphone-Based Interventions Among Latina Breast Cancer Survivors: Secondary Analysis of a Pilot Randomized Controlled Trial",
journal="JMIR Cancer",
year="2020",
month="Dec",
day="8",
volume="6",
number="2",
pages="e17538",
keywords="breast cancer",
keywords="cancer survivorship",
keywords="Hispanics/Latinas",
keywords="eHealth",
keywords="psychosocial intervention",
keywords="mobile phone",
abstract="Background: Latina breast cancer survivors experience poorer health-related quality of life (HRQoL), greater symptom burden, and more psychosocial needs compared to non-Latina breast cancer survivors. eHealth platforms such as smartphone apps are increasingly being used to deliver psychosocial interventions to cancer survivors. However, few psychosocial eHealth interventions have been developed specifically for Latina breast cancer survivors. Further, little is known about how Latinas, in general, engage with eHealth interventions and whether specific participant characteristics are associated with app use in this population. We evaluated the use of 2 culturally informed, evidence-based smartphone apps for Latina breast cancer survivors---one that was designed to improve HRQoL and reduce symptom burden (My Guide) and the other to promote healthy lifestyle behaviors (My Health). Objective: The objectives of our study were to explore the patterns of use of the My Guide intervention app and My Health attention-control app among Latina breast cancer survivors. Methods: Eighty Latina breast cancer survivors were randomized to use the My Guide or My Health app for 6 weeks. Assessments were collected at baseline (T1), immediately after the 6-week intervention (T2), and 2 weeks after T2 (T3). Specific study outcomes included subdomains of HRQoL, symptom burden, cancer-specific distress, cancer-relevant self-efficacy, and breast cancer knowledge. Results: On average, participants used their assigned app for more than 1 hour per week. Sociodemographic or psychological characteristics were not significantly associated with app use, except for employment status in the My Health group. Content related to common physical and emotional symptoms of breast cancer survivors as well as recommendations for nutrition and physical activity were most frequently accessed by My Guide and My Health participants, respectively. Lastly, clinically meaningful improvements were demonstrated in breast cancer well-being among low app users (ie, <60 minutes of use/week) of My Guide and social well-being among high app users (ie, ?60 minutes of use/week) of My Health. Conclusions: The favorable rates of participant use across both apps suggest that Latina breast cancer survivors are interested in the content delivered across both My Guide and My Health. Furthermore, since sociodemographic variables, excluding employment status, and baseline HRQoL (psychological variable) were not related to app use, My Guide and My Health may be accessible to diverse Latina breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT03645005; https://clinicaltrials.gov/ct2/show/NCT03645005 ",
doi="10.2196/17538",
url="http://cancer.jmir.org/2020/2/e17538/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33289669"
}


@Article{info:doi/10.2196/24137,
author="Lin, Wen Annie
and Baik, H. Sharon
and Aaby, David
and Tello, Leslie
and Linville, Twila
and Alshurafa, Nabil
and Spring, Bonnie",
title="eHealth Practices in Cancer Survivors With BMI in Overweight or Obese Categories: Latent Class Analysis Study",
journal="JMIR Cancer",
year="2020",
month="Dec",
day="3",
volume="6",
number="2",
pages="e24137",
keywords="eHealth",
keywords="patient communication",
keywords="cancer survivorship",
keywords="obesity",
keywords="behavior",
abstract="Background: eHealth technologies have been found to facilitate health-promoting practices among cancer survivors with BMI in overweight or obese categories; however, little is known about their engagement with eHealth to promote weight management and facilitate patient-clinician communication. Objective: The objective of this study was to determine whether eHealth use was associated with sociodemographic characteristics, as well as medical history and experiences (ie, patient-related factors) among cancer survivors with BMI in overweight or obese categories. Methods: Data were analyzed from a nationally representative cross-sectional survey (National Cancer Institute's Health Information National Trends Survey). Latent class analysis was used to derive distinct classes among cancer survivors based on sociodemographic characteristics, medical attributes, and medical experiences. Logistic regression was used to examine whether class membership was associated with different eHealth practices. Results: Three distinct classes of cancer survivors with BMI in overweight or obese categories emerged: younger with no comorbidities, younger with comorbidities, and older with comorbidities. Compared to the other classes, the younger with comorbidities class had the highest probability of identifying as female (73\%) and Hispanic (46\%) and feeling that clinicians did not address their concerns (75\%). The older with comorbidities class was 6.5 times more likely than the younger with comorbidities class to share eHealth data with a clinician (odds ratio [OR] 6.53, 95\% CI 1.08-39.43). In contrast, the younger with no comorbidities class had a higher likelihood of using a computer to look for health information (OR 1.93, 95\% CI 1.10-3.38), using an electronic device to track progress toward a health-related goal (OR 2.02, 95\% CI 1.08-3.79), and using the internet to watch health-related YouTube videos (OR 2.70, 95\% CI 1.52-4.81) than the older with comorbidities class. Conclusions: Class membership was associated with different patterns of eHealth engagement, indicating the importance of tailored digital strategies for delivering effective care. Future eHealth weight loss interventions should investigate strategies to engage younger cancer survivors with comorbidities and address racial and ethnic disparities in eHealth use. ",
doi="10.2196/24137",
url="http://cancer.jmir.org/2020/2/e24137/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33156810"
}


@Article{info:doi/10.2196/18364,
author="Robertson, C. Michael
and Lyons, J. Elizabeth
and Liao, Yue
and Baum, L. Miranda
and Basen-Engquist, M. Karen",
title="Gamified Text Messaging Contingent on Device-Measured Steps: Randomized Feasibility Study of a Physical Activity Intervention for Cancer Survivors",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Nov",
day="24",
volume="8",
number="11",
pages="e18364",
keywords="cancer survivors",
keywords="physical activity",
keywords="motivation",
keywords="self-control",
keywords="mobile health",
keywords="mobile phone",
keywords="technology",
abstract="Background: Physical activity can confer diverse benefits on cancer survivors. Unfortunately, many cancer survivors are not sufficiently active. The efficacy of physical activity interventions for this population may be increased by grounding them in Self-Determination Theory (SDT). Combining game design elements with wearable technologies may be a useful and scalable approach to targeting SDT constructs to promote cancer survivors' physical activity. Objective: The primary aim of this study is to evaluate the feasibility and acceptability of Steps2Health, a physical activity intervention for cancer survivors. It also aims to investigate the effects of the intervention on motivation, physical activity, and step count. Methods: We randomized 78 insufficiently active cancer survivors to an experimental or comparison group. All participants received a physical activity tracker. The experimental group participants also received a set sequence of multimedia messaging service messages that were triggered in real time by meeting predetermined cumulative step count totals. Messages presented information about a virtual journey and included photographs and vivid descriptions of locations to increase autonomous motivation. Additional messages targeted perceptions of relatedness (eg, role modeling) and competence (eg, facilitating mastery experiences). We administered pre- and postintervention surveys and conducted 15 individual interviews to evaluate the intervention. We performed directed content analysis of qualitative data and conducted mixed effects linear modeling to investigate participants' changes in motivation, self-reported physical activity, and device-measured step counts. Results: There was minimal loss to follow-up (3/78, 4\%), the device wear rate was high (2548/3044, 83.71\% of days), and technical problems with messaging based on real-time step counts were limited. Our qualitative data analysis revealed 3 overarching themes: accessibility, autonomous motivation, and relatedness. Participants successfully navigated the technological aspects and game design elements of the intervention. Participants found messages targeting autonomous motivation and competence or self-efficacy to be enjoyable and compelling, but one feasibility criterion for participant engagement (response rate to text messages) was not met. Messages targeting relatedness were less highly rated than the messages targeting autonomous motivation and competence or self-efficacy. During the intervention, both groups increased their motivation for physical activity (B=0.16; 95\% CI 0.01 to 0.30; P=.04; d=0.49), and assignment to the experimental group was associated with increased self-reported leisure activity score (B=10.78; 95\% CI 3.54 to 18.02; P=.005; d=0.64). The experimental group had greater increases in daily step counts over time (B=322.08; 95\% CI 54.01 to 590.15; P=.02; d=0.28). Conclusions: This study supports the feasibility of using real-time game design elements to target SDT constructs and increase cancer survivors' physical activity. Overall, our findings support the acceptability of the Steps2Health intervention, but fostering active participant engagement and targeting relatedness may present additional challenges. Steps2Health may help cancer survivors increase their physical activity levels. ",
doi="10.2196/18364",
url="https://mhealth.jmir.org/2020/11/e18364",
url="http://www.ncbi.nlm.nih.gov/pubmed/33231551"
}


@Article{info:doi/10.2196/19362,
author="Wang, Y. Elizabeth
and Graff, E. Rebecca
and Chan, M. June
and Langlais, S. Crystal
and Broering, M. Jeanette
and Ramsdill, W. Justin
and Kessler, R. Elizabeth
and Winters-Stone, M. Kerri
and Van Blarigan, L. Erin
and Kenfield, A. Stacey",
title="Web-Based Lifestyle Interventions for Prostate Cancer Survivors: Qualitative Study",
journal="JMIR Cancer",
year="2020",
month="Nov",
day="10",
volume="6",
number="2",
pages="e19362",
keywords="cancer survivorship",
keywords="digital health",
keywords="technology-based intervention",
keywords="internet-based intervention",
keywords="usability",
abstract="Background: Exercise and a healthy diet can improve the quality of life and prognosis of prostate cancer survivors, but there have been limited studies on the feasibility of web-based lifestyle interventions in this population. Objective: This study aims to develop a data-driven grounded theory of web-based engagement by prostate cancer survivors based on their experience in the Community of Wellness, a 12-week randomized clinical trial designed to support healthy diet and exercise habits. Methods: TrueNTH's Community of Wellness was a four-arm pilot study of men with prostate cancer (N=202) who received progressive levels of behavioral support (level 1: website; level 2: website with individualized diet and exercise recommendations; level 3: website with individualized diet and exercise recommendations, Fitbit, and text messages; and level 4: website with individualized diet and exercise recommendations, Fitbit and text messages, and separate phone calls with an exercise trainer and a registered dietitian). The primary aim of the study is to determine the feasibility and estimate the effects on behaviors (results reported in a separate paper). Following the 12-week intervention, we invited participants to participate in 4 focus groups, one for each intervention level. In this report, we used grounded theory analyses including open, axial, and selective coding to generate codes and themes from the focus group transcripts. Categories were refined across levels using embodied categorization and constant comparative methods. Results: In total, 20 men with prostate cancer participated in the focus groups: 5, 4, 5, and 6 men in levels 1, 2, 3, and 4, respectively. Participants converged on 5 common factors influencing engagement with the intervention: environment (home environment, competing priorities, and other lifestyle programs), motivation (accountability and discordance experienced within the health care system), preparedness (technology literacy, health literacy, trust, and readiness to change), program design (communication, materials, and customization), and program support (education, ally, and community). Each of these factors influenced the survivors' long-term impressions and habits. We proposed a grounded theory associating these constructs to describe the components contributing to the intuitiveness of a web-based lifestyle intervention. Conclusions: These analyses suggest that web-based lifestyle interventions are more intuitive when we optimize participants' technology and health literacy; tailor interface design, content, and feedback; and leverage key motivators (ie, health care providers, family members, web-based coach) and environmental factors (ie, familiarity with other lifestyle programs). Together, these grounded theory--based efforts may improve engagement with web-based interventions designed to support prostate cancer survivorship. ",
doi="10.2196/19362",
url="http://cancer.jmir.org/2020/2/e19362/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33170126"
}


@Article{info:doi/10.2196/18491,
author="Crane, E. Tracy
and Skiba, B. Meghan
and Miller, Austin
and Garcia, O. David
and Thomson, A. Cynthia",
title="Development and Evaluation of an Accelerometer-Based Protocol for Measuring Physical Activity Levels in Cancer Survivors: Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="24",
volume="8",
number="9",
pages="e18491",
keywords="wearable electronic devices",
keywords="physical activity",
keywords="cancer survivors",
keywords="activity trackers",
keywords="mobile phone",
abstract="Background: The collection of self-reported physical activity using validated questionnaires has known bias and measurement error. Objective: Accelerometry, an objective measure of daily activity, increases the rigor and accuracy of physical activity measurements. Here, we describe the methodology and related protocols for accelerometry data collection and quality assurance using the Actigraph GT9X accelerometer data collection in a convenience sample of ovarian cancer survivors enrolled in GOG/NRG 0225, a 24-month randomized controlled trial of diet and physical activity intervention versus attention control. Methods: From July 2015 to December 2019, accelerometers were mailed on 1337 separate occasions to 580 study participants to wear at 4 time points (baseline, 6, 12, and 24 months) for 7 consecutive days. Study staff contacted participants via telephone to confirm their availability to wear the accelerometers and reviewed instructions and procedures regarding the return of the accelerometers and assisted with any technology concerns. Results: We evaluated factors associated with wear compliance, including activity tracking, use of a mobile app, and demographic characteristics with chi-square tests and logistic regression. Compliant data, defined as ?4 consecutive days with ?10 hours daily wear time, exceeded 90\% at all study time points. Activity tracking, but no other characteristics, was significantly associated with compliant data at all time points (P<.001). This implementation of data collection through accelerometry provided highly compliant and usable activity data in women who recently completed treatment for ovarian cancer. Conclusions: The high compliance and data quality associated with this protocol suggest that it could be disseminated to support researchers who seek to collect robust objective activity data in cancer survivors residing in a wide geographic area. ",
doi="10.2196/18491",
url="http://mhealth.jmir.org/2020/9/e18491/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32969828"
}


@Article{info:doi/10.2196/18867,
author="Monteiro-Guerra, Francisco
and Signorelli, Ruiz Gabriel
and Rivera-Romero, Octavio
and Dorronzoro-Zubiete, Enrique
and Caulfield, Brian",
title="Breast Cancer Survivors' Perspectives on Motivational and Personalization Strategies in Mobile App--Based Physical Activity Coaching Interventions: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Sep",
day="21",
volume="8",
number="9",
pages="e18867",
keywords="mHealth",
keywords="mobile app",
keywords="mobile phone",
keywords="coaching",
keywords="physical activity",
keywords="breast cancer",
abstract="Background: Despite growing evidence supporting the vital benefits of physical activity (PA) for breast cancer survivors, the majority do not meet the recommended levels of activity. Mobile app--based PA coaching interventions might be a feasible strategy to facilitate adherence of breast cancer survivors to the PA guidelines. To engage these individuals, PA apps need to be specifically designed based on their needs and preferences and to provide targeted support and motivation. However, more information is needed to understand how these technologies can provide individual and relevant experiences that have the ability to increase PA adherence and retain the individual's interest in the long term. Objective: The aim of this study is to explore insights from breast cancer survivors on motivational and personalization strategies to be used in PA coaching apps and interventions. Methods: A qualitative study was conducted, using individual semistructured interviews, with 14 breast cancer survivors. The moderator asked open-ended questions and made use of a slideshow presentation to elicit the participants' perspectives on potential mobile app--based intervention features. Transcribed interviews were evaluated by 3 reviewers using thematic content analysis. Results: Participants (mean age 53.3, SD 8.7 years) were White women. In total, 57\% (8/14) of the participants did not adhere to the PA guidelines. In general, participants had access to and were interested in using technology. The identified themes included (1) barriers to PA, (2) psychological mediators of PA motivation, (3) needs and suggestions for reinforcing motivation support, (4) personalization aspects of the PA coaching experience, and (5) technology trustworthiness. Motivational determinants included perceived control, confidence and perceived growth, and connectedness. Participants were interested in having a straightforward app for monitoring and goal setting, which would include a prescribed activity program and schedule, and positive communication. Opinions varied in terms of social and game-like system possibilities. In addition, they expressed a desire for a highly personalized coaching experience based on as much information collected from them as possible (eg, disease stage, physical limitations, preferences) to provide individualized progress information, dynamic adjustment of the training plan, and context-aware activity suggestions (eg, based on weather and location). Participants also wanted the app to be validated or backed by professionals and were willing to share their data in exchange for a more personalized experience. Conclusions: This work suggests the need to develop simple, guiding, encouraging, trustworthy, and personalized PA coaching apps. The findings are in line with behavioral and personalization theories and methods that can be used to inform intervention design decisions. This paper opens new possibilities for the design of personalized and motivating PA coaching app experiences for breast cancer survivors, which might ultimately facilitate the sustained adherence of these individuals to the recommended levels of activity. ",
doi="10.2196/18867",
url="https://mhealth.jmir.org/2020/9/e18867",
url="http://www.ncbi.nlm.nih.gov/pubmed/32955446"
}


@Article{info:doi/10.2196/20834,
author="Blair, K. Cindy
and Harding, Elizabeth
and Herman, Carla
and Boyce, Tawny
and Demark-Wahnefried, Wendy
and Davis, Sally
and Kinney, Y. Anita
and Pankratz, S. Vernon",
title="Remote Assessment of Functional Mobility and Strength in Older Cancer Survivors: Protocol for a Validity and Reliability Study",
journal="JMIR Res Protoc",
year="2020",
month="Sep",
day="1",
volume="9",
number="9",
pages="e20834",
keywords="physical function",
keywords="physical performance",
keywords="older adults",
keywords="remote assessment",
keywords="videoconferencing",
keywords="cancer survivors",
keywords="cancer",
keywords="elderly",
keywords="physical activity",
keywords="telehealth",
abstract="Background: Older cancer survivors, faced with both age- and treatment-related morbidity, are at increased and premature risk for physical function limitations. Physical performance is an important predictor of disability, quality of life, and premature mortality, and thus is considered an important target of interventions designed to prevent, delay, or attenuate the physical functional decline. Currently, low-cost, valid, and reliable methods to remotely assess physical performance tests that are self-administered by older adults in the home-setting do not exist, thus limiting the reach, scalability, and dissemination of interventions. Objective: This paper will describe the rationale and design for a study to evaluate the accuracy, reliability, safety, and acceptability of videoconferencing and self-administered tests of functional mobility and strength by older cancer survivors in their own homes. Methods: To enable remote assessment, participants receive a toolkit and instructions for setting up their test course and communicating with the investigator. Two standard gerontologic performance tests are being evaluated: the Timed Up and Go test and the 30-second chair stand test. Phase 1 of the study evaluates proof-of-concept that older cancer survivors (age ?60 years) can follow the testing protocol and use a tablet PC to communicate with the study investigator. Phase 2 evaluates the criterion validity of videoconference compared to direct observation of the two physical performance tests. Phase 3 evaluates reliability by enrolling 5-10 participants who agree to repeat the remote assessment (without direct observation). Phase 4 enrolls 5-10 new study participants to complete the remote assessment test protocol. Feedback from participants in each phase is used to refine the test protocol and instructions. Results: Enrollment began in December 2019. Ten participants completed the Phase 1 proof-of-concept. The study was paused in mid-March 2020 due to the COVID-19 pandemic. The study is expected to be completed by the end of 2020. Conclusions: This validity and reliability study will provide important information on the acceptability and safety of using videoconferencing to remotely assess two tests of functional mobility and strength, self-administered by older adults in their homes. Videoconferencing has the potential to expand the reach, scalability, and dissemination of interventions to older cancer survivors, and potentially other older adults, especially in rural areas. Trial Registration: ClinicalTrials.gov NCT04339959; https://clinicaltrials.gov/ct2/show/NCT04339959 International Registered Report Identifier (IRRID): DERR1-10.2196/20834 ",
doi="10.2196/20834",
url="https://www.researchprotocols.org/2020/9/e20834",
url="http://www.ncbi.nlm.nih.gov/pubmed/32769075"
}


@Article{info:doi/10.2196/15335,
author="Rossen, Sine
and Kayser, Lars
and Vibe-Petersen, Jette
and Christensen, Frank Jesper
and Ried-Larsen, Mathias",
title="Cancer Survivors' Receptiveness to Digital Technology--Supported Physical Rehabilitation and the Implications for Design: Qualitative Study",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="5",
volume="22",
number="8",
pages="e15335",
keywords="cancer",
keywords="rehabilitation",
keywords="physical activity",
keywords="digital technology",
abstract="Background: Physical activity is associated with a positive prognosis in cancer survivors and may decrease the risk of adverse effects of treatment. Accordingly, physical activity programs are recommended as a part of cancer rehabilitation services. Digital technology may support cancer survivors in increasing their level of physical activity and increase the reach or efficiency of cancer rehabilitation services, yet it also comes with a range of challenges. Objective: The aim of this qualitative study was to explore cancer survivors' receptiveness to using digital technology as a mode of support to increase their physical activity in a municipality-based cancer rehabilitation setting. Methods: Semistructured interviews were conducted with 11 cancer survivors (3 males, 8 females, age range 32-82 years) who were referred for cancer rehabilitation and had participated in a questionnaire survey using the Readiness and Enablement Index for Health Technology (READHY) questionnaire. Data analysis was based on the content analysis method. Results: Two themes were identified as important for the interviewees' receptiveness to using digital technology services in connection with their physical activity during rehabilitation: their attitude toward physical activity and their attitude toward digital technology--assisted physical activity. Our results indicated that it is important to address the cancer survivors' motivation for using technology for physical activity and their individual preferences in terms of the following: (1) incidental or structured (eg, cardiovascular and strength exercises or disease-specific rehabilitative exercises) physical activity; (2) social or individual context; and (3) instruction (know-how) or information (know-why). Conclusions: The identified preferences provide new insight that complements the cancer survivors' readiness level and can likely help designers, service providers, and caregivers provide solutions that increase patient receptiveness toward technology-assisted physical activity. Combining digital technology informed by cancer survivors' needs, preferences, and readiness with the capacity building of the workforce can aid in tailoring digital solutions to suit not only individuals who are receptive to using such technologies but also those reluctant to do so. ",
doi="10.2196/15335",
url="https://www.jmir.org/2020/8/e15335",
url="http://www.ncbi.nlm.nih.gov/pubmed/32755892"
}


@Article{info:doi/10.2196/18420,
author="Weiner, S. Lauren
and Nagel, Stori
and Su, Irene H.
and Hurst, Samantha
and Hartman, J. Sheri",
title="A Remotely Delivered, Peer-Led Physical Activity Intervention for Younger Breast Cancer Survivors (Pink Body Spirit): Protocol for a Feasibility Study and Mixed Methods Process Evaluation",
journal="JMIR Res Protoc",
year="2020",
month="Jul",
day="8",
volume="9",
number="7",
pages="e18420",
keywords="physical activity",
keywords="cancer survivors",
keywords="peer mentors",
keywords="quality of life",
keywords="pilot study",
keywords="breast cancer",
keywords="fitness trackers",
keywords="mobile phone",
abstract="Background: Younger breast cancer survivors consistently report a greater impact of their cancer experience on quality of life compared with older survivors, including higher rates of body image disturbances, sexual dysfunction, and fatigue. One potential strategy to improve quality of life is through physical activity, but this has been understudied in younger breast cancer survivors, who often decrease their activity during and after cancer treatment. Objective: The aim of this study is to explore the feasibility and acceptability of a technology-based, remotely delivered, peer-led physical activity intervention for younger breast cancer survivors. We will also assess the preliminary impact of the intervention on changes in physical activity and multiple aspects of quality of life. Methods: This study is a community-academic partnership between University of California, San Diego and Haus of Volta, a nonprofit organization that promotes positive self-image in younger breast cancer survivors. This ongoing pilot study aims to recruit 30 younger breast cancer survivors across the United States (<55 years old, >6 months post primary cancer treatment, self-report <60 min of moderate-to-vigorous-intensity physical activity [MVPA]) into a 3-month peer-delivered, fully remote exercise program. Participants will complete 6 biweekly video chat sessions with a trained peer mentor, a fellow younger breast cancer survivor. Participants will receive a Fitbit Charge 3; weekly feedback on Fitbit data from their peer mentor; and access to a private, in-app Fitbit Community to provide and receive support from other participants and all peer mentors. At baseline, 3 months, and 6 months, participants will complete quality of life questionnaires, and MVPA will be measured using the ActiGraph accelerometer. Feasibility and acceptability will be explored through a mixed methods approach (ie, quantitative questionnaires and qualitative interviews). Intervention delivery and adaptations by peer mentors will be tracked through peer mentor self-evaluations and reflections, review of video-recorded mentoring sessions, and monthly templated reflections by the research team. Results: Recruitment began in September 2019. As of February 2020, the physical activity intervention is ongoing. Final measures are expected to occur in summer 2020. Conclusions: This study explores the potential for physical activity to improve sexual function, body image, and fatigue, key quality of life issues in younger breast cancer survivors. Using peer mentors extends our reach into the young survivor community. The detailed process evaluation of intervention delivery and adaptations by mentors could inform a future hybrid-effectiveness implementation trial. Finally, remote delivery with commercially available technology could promote broader dissemination. Trial Registration: ClinicalTrials.gov NCT04064892; https://clinicaltrials.gov/ct2/show/NCT04064892 International Registered Report Identifier (IRRID): DERR1-10.2196/18420 ",
doi="10.2196/18420",
url="https://www.researchprotocols.org/2020/7/e18420",
url="http://www.ncbi.nlm.nih.gov/pubmed/32673270"
}


@Article{info:doi/10.2196/16112,
author="Furness, Kate
and Sarkies, N. Mitchell
and Huggins, E. Catherine
and Croagh, Daniel
and Haines, P. Terry",
title="Impact of the Method of Delivering Electronic Health Behavior Change Interventions in Survivors of Cancer on Engagement, Health Behaviors, and Health Outcomes: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="23",
volume="22",
number="6",
pages="e16112",
keywords="eHealth",
keywords="mHealth",
keywords="behavior",
keywords="neoplasm",
keywords="mobile phones",
abstract="Background: Increased accessibility to the internet and mobile devices has seen a rapid expansion in electronic health (eHealth) behavior change interventions delivered to patients with cancer and survivors using synchronous, asynchronous, and combined delivery methods. Characterizing effective delivery methods of eHealth interventions is required to enable improved design and implementation of evidence-based health behavior change interventions. Objective: This study aims to systematically review the literature and synthesize evidence on the success of eHealth behavior change interventions in patients with cancer and survivors delivered by synchronous, asynchronous, or combined methods compared with a control group. Engagement with the intervention, behavior change, and health outcomes, including quality of life, fatigue, depression, and anxiety, were examined. Methods: A search of Scopus, Ovid MEDLINE, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature Plus, PsycINFO, Cochrane CENTRAL, and PubMed was conducted for studies published between March 2007 and March 2019. We looked for randomized controlled trials (RCTs) examining interventions delivered to adult cancer survivors via eHealth methods with a measure of health behavior change. Random-effects meta-analysis was performed to examine whether the method of eHealth delivery impacted the level of engagement, behavior change, and health outcomes. Results: A total of 24 RCTs were included predominantly examining dietary and physical activity behavior change interventions. There were 11 studies that used a synchronous approach and 11 studies that used an asynchronous approach, whereas 2 studies used a combined delivery method. Use of eHealth interventions improved exercise behavior (standardized mean difference [SMD] 0.34, 95\% CI 0.21-0.48), diet behavior (SMD 0.44, 95\% CI 0.18-0.70), fatigue (SMD 0.21, 95\% CI ?0.08 to 0.50; SMD change 0.22, 95\% CI 0.09-0.35), anxiety (SMD 1.21, 95\% CI: 0.36-2.07; SMD change 0.15, 95\% CI ?0.09 to 0.40), depression (SMD 0.15, 95\% CI 0.00-0.30), and quality of life (SMD 0.12, 95\% CI ?0.10 to 0.34; SMD change 0.14, 95\% CI 0.04-0.24). The mode of delivery did not influence the amount of dietary and physical activity behavior change observed. Conclusions: Physical activity and dietary behavior change eHealth interventions delivered to patients with cancer or survivors have a small to moderate impact on behavior change and a small to very small benefit to quality of life, fatigue, depression, and anxiety. There is insufficient evidence to determine whether asynchronous or synchronous delivery modes yield superior results. Three-arm RCTs comparing delivery modes with a control with robust engagement reporting are required to determine the most successful delivery method for promoting behavior change and ultimately favorable health outcomes. ",
doi="10.2196/16112",
url="http://www.jmir.org/2020/6/e16112/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32574147"
}


@Article{info:doi/10.2196/16059,
author="Power, M. Julianne
and Tate, F. Deborah
and Valle, G. Carmina",
title="Experiences of African American Breast Cancer Survivors Using Digital Scales and Activity Trackers in a Weight Gain Prevention Intervention: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jun",
day="8",
volume="8",
number="6",
pages="e16059",
keywords="African American",
keywords="cancer survivors",
keywords="digital tools",
keywords="weight gain prevention",
keywords="qualitative",
abstract="Background: The use of digital tools to promote daily self-weighing and daily activity tracking may be a promising strategy for weight control among African American breast cancer survivors (AABCS). There have been no studies exploring the acceptability and feasibility of using digital tools for weight control or qualitative studies characterizing perceptions of daily self-weighing and daily activity tracking among AABCS. Objective: This study aimed to explore the subjective experiences of daily self-weighing and daily activity tracking using digital tools, including wireless scales and activity trackers, in a sample of AABCS participating in two technology-based weight gain prevention interventions over 6 months. Methods: Semistructured interviews (N=21) were conducted in person or over the phone, were audio recorded, and then transcribed verbatim. Each transcript was read to identify key themes and develop a codebook. Each transcript was coded using Atlas.ti software, and code outputs were used to identify overarching themes and patterns in the data. Results: On average, participants were 52.6 (SD 8.3) years of age, with obesity at baseline (BMI 33.1 kg/m2, SD 5.9), and weighed on 123.4 (SD 48.0) days out of the 168 days (73.5\%) in the study period. Women tended to attribute their weight gain to cancer treatment and framed program benefits in terms of improved quality of life and perceptions of prolonging their survival following treatment. Using the smart scale for daily self-weighing was viewed as the tool by which participants could control their weight and improve their health and well-being posttreatment. The activity tracker increased awareness of physical activity and motivated participants to be more active. Conclusions: Participants reported positive experiences and benefits from daily self-weighing and daily activity tracking. Findings suggest that daily self-weighing and daily activity tracking using digital tools are well-received, acceptable, and feasible intervention strategies for AABCS in the context of posttreatment weight management. ",
doi="10.2196/16059",
url="https://mhealth.jmir.org/2020/6/e16059",
url="http://www.ncbi.nlm.nih.gov/pubmed/32510461"
}


@Article{info:doi/10.2196/17320,
author="Jung, Miyeon
and Lee, SaeByul
and Kim, Jisun
and Kim, HeeJeong
and Ko, BeomSeok
and Son, Ho Byung
and Ahn, Sei-Hyun
and Park, Rang Yu
and Cho, Daegon
and Chung, Haekwon
and Park, Jin Hye
and Lee, Minsun
and Lee, Won Jong
and Chung, Seockhoon
and Chung, Yong Il",
title="A Mobile Technology for Collecting Patient-Reported Physical Activity and Distress Outcomes: Cross-Sectional Cohort Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="4",
volume="8",
number="5",
pages="e17320",
keywords="telemedicine",
keywords="breast neoplasms",
keywords="mobile apps",
keywords="quality of life",
keywords="validation",
keywords="patient-reported outcome measures (PROMs)",
keywords="questionnaire",
abstract="Background: Electronic patient-reported outcome (PROs) provides a fast and reliable assessment of a patient's health-related quality of life. Nevertheless, using PRO in the traditional paper format is not practical for clinical practice due to the limitations associated with data analysis and management. A questionnaire app was developed to address the need for a practical way to group and use distress and physical activity assessment tools. Objective: The purpose of this study was to assess the level of agreement between electronic (mobile) and paper-and-pencil questionnaire responses. Methods: We validated the app version of the distress thermometer (DT), International Physical Activity Questionnaire (IPAQ), and Patient Health Questionnaire--9 (PHQ-9). A total of 102 participants answered the paper and app versions of the DT and IPAQ, and 96 people completed the PHQ-9. The study outcomes were the correlation of the data between the paper-and-pencil and app versions. Results: A total of 106 consecutive breast cancer patients were enrolled and analyzed for validation of paper and electronic (app) versions. The Spearman correlation values of paper and app surveys for patients who responded to the DT questionnaire within 7 days, within 3 days, and on the same day were .415 (P<.001), .437 (P<.001), and .603 (P<.001), respectively. Similarly, the paper and app survey correlation values of the IPAQ total physical activity metabolic equivalent of task (MET; Q2-6) were .291 (P=.003), .324 (P=.005), and .427 (P=.01), respectively. The correlation of the sum of the Patient Health Questionnaire--9 (Q1-9) according to the time interval between the paper-based questionnaire and the app-based questionnaire was .469 for 14 days (P<.001), .574 for 7 days (P<.001), .593 for 3 days (P<.001), and .512 for the same day (P=.03). These were all statistically significant. Similarly, the correlation of the PHQ (Q10) value according to the time interval between the paper-based questionnaire and the app-based questionnaire was .283 for 14 days (P=.005), .409 for 7 days (P=.001), .415 for 3 days (P=.009), and .736 for the same day (P=.001). These were all statistically significant. In the overall trend, the shorter the interval between the paper-and-pencil questionnaire and the app-based questionnaire, the higher the correlation value. Conclusions: The app version of the distress and physical activity questionnaires has shown validity and a high level of association with the paper-based DT, IPAQ (Q2-6), and PHQ-9. The app-based questionnaires were not inferior to their respective paper versions and confirm the feasibility for their use in clinical practice. The high correlation between paper and mobile app data allows the use of new mobile apps to benefit the overall health care system. Trial Registration: ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966 ",
doi="10.2196/17320",
url="https://mhealth.jmir.org/2020/5/e17320",
url="http://www.ncbi.nlm.nih.gov/pubmed/32364508"
}


@Article{info:doi/10.2196/15780,
author="Hou, I-Ching
and Lan, Min-Fang
and Shen, Shan-Hsiang
and Tsai, Yu Pei
and Chang, Jen King
and Tai, Hao-Chih
and Tsai, Ay-Jen
and Chang, Polun
and Wang, Tze-Fang
and Sheu, Shuh-Jen
and Dykes, C. Patricia",
title="The Development of a Mobile Health App for Breast Cancer Self-Management Support in Taiwan: Design Thinking Approach",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="30",
volume="8",
number="4",
pages="e15780",
keywords="breast cancer",
keywords="mobile health application",
keywords="self-management",
keywords="design thinking",
abstract="Background: Evidence has shown that breast cancer self-management support from mobile health (mHealth) apps can improve the quality of life of survivors. Although many breast cancer self-management support apps exist, few papers have documented the procedure for the development of a user-friendly app from the patient's perspective. Objective: This study aimed to investigate the information needs of Taiwanese women with breast cancer to inform the development of a self-management support mHealth app. Methods: A 5-step design thinking approach, comprising empathy, define, ideate, prototype, and test steps, was used in the focus groups and individual interviews conducted to collect information on the requirements and expectations of Taiwanese women with breast cancer with respect to the app. A thematic analysis was used to identify information needs. Results: A total of 8 major themes including treatment, physical activity, diet, emotional support, health records, social resources, experience sharing, and expert consultation were identified. Minor themes included the desire to use the app under professional supervision and a trustworthy app manager to ensure the credibility of information. Conclusions: The strengths of the design thinking approach were user-centered design and cultural sensitivity. The results retrieved from each step contributed to the development of the app and reduction of the gap between end users and developers. An mHealth app that addresses these 8 main themes can facilitate disease self-management for Taiwanese women with breast cancer. ",
doi="10.2196/15780",
url="http://mhealth.jmir.org/2020/4/e15780/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32352390"
}


@Article{info:doi/10.2196/16469,
author="Haberlin, Ciaran
and O' Donnell, M. Dearbhaile
and Moran, Jonathan
and Broderick, Julie",
title="Perceptions of eHealth-Enabled Physical Activity Interventions Among Cancer Survivors: Mixed Methods Study",
journal="JMIR Cancer",
year="2020",
month="Apr",
day="28",
volume="6",
number="1",
pages="e16469",
keywords="cancer",
keywords="eHealth",
keywords="exercise",
keywords="focus group",
keywords="physical activity",
keywords="qualitative",
keywords="mobile phone",
abstract="Background: Achieving adequate levels of physical activity (PA) is especially important for cancer survivors to mitigate the side effects of cancer and its treatment as well as for other health benefits. Electronic health (eHealth)-based PA interventions may offer feasible alternatives to traditionally delivered programs and optimize physical recovery after a cancer diagnosis, but perspectives of cancer survivors on this new delivery medium have not been extensively explored. Objective: The overall aim was to explore participants' perspectives of eHealth-enabled PA interventions to inform the design of a future intervention among cancer survivors. Methods: The study took place in a designated cancer center in Dublin, Ireland. A preceding questionnaire-based study was conducted primarily to establish interest in participating in subsequent eHealth-based studies. A follow-on focus group study was conducted to explore the concept of eHealth-based PA interventions for cancer survivors. The data were analyzed using thematic analysis. Results: The questionnaire-based study (N=102) indicated that participants had a high level of interest in participating in follow-on eHealth-based studies. The focus group study (n=23) indicated that, despite some trepidation, overall positivity was expressed by participants toward the concept of eHealth-based PA interventions. Four themes were generated: (1) Health impact, including PA as a barrier and as a motivating factor, (2) Education needs, which emphasized the need for integrated information about PA and to increase technical literacy, (3) Goal setting, which should be integrated within the technical specification as a motivating factor, and (4) Support needs, as well as the importance of personalized human interaction, in tandem with technology. Conclusions: Qualitative research at the pretrial phase adds value to the design of a complex intervention and is especially useful in an area such as eHealth. The findings highlighted an interest in participating in eHealth-focused research as well as barriers, training needs, and key design features that can be applied to optimize the design of future eHealth-based PA interventions in cancer. ",
doi="10.2196/16469",
url="http://cancer.jmir.org/2020/1/e16469/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32343259"
}


@Article{info:doi/10.2196/17292,
author="Low, A. Carissa
and Danko, Michaela
and Durica, C. Krina
and Kunta, Reddy Abhineeth
and Mulukutla, Raghu
and Ren, Yiyi
and Bartlett, L. David
and Bovbjerg, H. Dana
and Dey, K. Anind
and Jakicic, M. John",
title="A Real-Time Mobile Intervention to Reduce Sedentary Behavior Before and After Cancer Surgery: Usability and Feasibility Study",
journal="JMIR Perioper Med",
year="2020",
month="Mar",
day="23",
volume="3",
number="1",
pages="e17292",
keywords="sedentary behavior",
keywords="mobile health",
keywords="smartphone",
keywords="mobile phone",
keywords="wearable device",
keywords="surgical oncology",
keywords="physical activity",
abstract="Background: Sedentary behavior (SB) is common after cancer surgery and may negatively affect recovery and quality of life, but postoperative symptoms such as pain can be a significant barrier to patients achieving recommended physical activity levels. We conducted a single-arm pilot trial evaluating the usability and acceptability of a real-time mobile intervention that detects prolonged SB in the perioperative period and delivers prompts to walk that are tailored to daily self-reported symptom burden. Objective: The aim of this study is to develop and test a mobile technology-supported intervention to reduce SB before and after cancer surgery, and to evaluate the usability and feasibility of the intervention. Methods: A total of 15 patients scheduled for abdominal cancer surgery consented to the study, which involved using a Fitbit smartwatch with a companion smartphone app across the perioperative period (from a minimum of 2 weeks before surgery to 30 days postdischarge). Participants received prompts to walk after any SB that exceeded a prespecified threshold, which varied from day to day based on patient-reported symptom severity. Participants also completed weekly semistructured interviews to collect information on usability, acceptability, and experience using the app and smartphone; in addition, smartwatch logs were examined to assess participant study compliance. Results: Of eligible patients approached, 79\% (15/19) agreed to participate. Attrition was low (1/15, 7\%) and due to poor health and prolonged hospitalization. Participants rated (0-100) the smartphone and smartwatch apps as very easy (mean 92.3 and 93.2, respectively) and pleasant to use (mean 93.0 and 93.2, respectively). Overall satisfaction with the whole system was 89.9, and the mean System Usability Scale score was 83.8 out of 100. Overall compliance with symptom reporting was 51\% (469/927 days), decreasing significantly from before surgery (264/364, 73\%) to inpatient recovery (32/143, 22\%) and postdischarge (173/420, 41\%). Overall Fitbit compliance was 70\% (653/927 days) but also declined from before surgery (330/364, 91\%) to inpatient (51/143, 36\%) and postdischarge (272/420, 65\%). Conclusions: Perioperative patients with cancer were willing to use a smartwatch- and smartphone-based real-time intervention to reduce SB, and they rated the apps as very easy and pleasant to use. Compliance with the intervention declined significantly after surgery. The effects of the intervention on postoperative activity patterns, recovery, and quality of life will be evaluated in an ongoing randomized trial. ",
doi="10.2196/17292",
url="http://periop.jmir.org/2020/1/e17292/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33393915"
}


@Article{info:doi/10.2196/14435,
author="Kim, Yoon
and Seo, Jinserk
and An, So-Yeon
and Sinn, Hyun Dong
and Hwang, Hye Ji",
title="Efficacy and Safety of an mHealth App and Wearable Device in Physical Performance for Patients With Hepatocellular Carcinoma: Development and Usability Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="11",
volume="8",
number="3",
pages="e14435",
keywords="mHealth",
keywords="hepatocellular carcinoma",
keywords="rehabilitation",
keywords="exercise",
keywords="physical fitness",
keywords="physical activity",
abstract="Background: Exercise is predicted to have a positive effect among hepatocellular carcinoma (HCC) patients. However, these patients are hesitant to start and build up an exercise program for one major reason: the vague fear of developing hepatic decompensation, a potentially fatal condition that can lead to death. Integrating mobile health (mHealth) with individualized exercise programs could be a possible option for promoting physical capacity among HCC patients. Objective: The aim of this study was to evaluate the efficacy and safety of rehabilitation exercises, which have been individually prescribed via an mHealth app, on physical fitness, body composition, biochemical profile, and quality of life among HCC patients. Methods: A total of 37 HCC patients were enrolled in a 12-week course with an mHealth app program targeted to HCC patients. The wearable wristband device Neofit (Partron Co) was provided to participants, and recorded daily physical data, such as the number of steps, calorie expenditure, exercise time, and heart rate. Each participant was given an individualized rehabilitation exercise program that was prescribed and adjusted at the 6-week midintervention period based on the assessment results. At baseline, 6-week, and 12-week sessions, participants' physical fitness levels (ie, 6-minute walk test, grip strength test, and 30-second chair stand test) were measured. Physical activity levels, as measured by the International Physical Activity Questionnaire-Short Form (IPAQ-SF); body composition (ie, body mass index, body fat percentage, and muscle mass); biochemical profiles; and quality of life, as measured by the  European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30, were assessed at baseline and at the end point. At the 6-week midpoint, exercise intensity was individually adjusted. Results: Of the 37 patients, 31 (84\%) completed the 12-week intervention. Grip strength improved significantly after 12 weeks of the intervention. The 30-second chair stand test and the 6-minute walk test showed significant improvement from 0 to 6 weeks, from 0 to 12 weeks, and from 6 to 12 weeks. Muscle mass and the IPAQ-SF score increased significantly after 12 weeks of the intervention without biochemical deterioration. Conclusions: Following 12 weeks of mHealth care, including an individually prescribed rehabilitation exercise program, we saw significant improvements in physical fitness, body composition, and physical activity without any complication or biochemical deterioration among compensated HCC patients who had completed therapy. ",
doi="10.2196/14435",
url="http://mhealth.jmir.org/2020/3/e14435/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32159517"
}


@Article{info:doi/10.2196/15750,
author="Chow, I. Philip
and Drago, Fabrizio
and Kennedy, M. Erin
and Cohn, F. Wendy",
title="A Novel Mobile Phone App Intervention With Phone Coaching to Reduce Symptoms of Depression in Survivors of Women's Cancer: Pre-Post Pilot Study",
journal="JMIR Cancer",
year="2020",
month="Feb",
day="6",
volume="6",
number="1",
pages="e15750",
keywords="mobile apps",
keywords="mental health",
keywords="mHealth",
keywords="women",
keywords="cancer survivors",
abstract="Background: Psychological distress is a major issue among survivors of women's cancer who face numerous barriers to accessing in-person mental health treatments. Mobile phone app--based interventions are scalable and have the potential to increase access to mental health care among survivors of women's cancer worldwide. Objective: This study aimed to evaluate the acceptability and preliminary efficacy of a novel app-based intervention with phone coaching in a sample of survivors of women's cancer. Methods: In a single-group, pre-post, 6-week pilot study in the United States, 28 survivors of women's cancer used iCanThrive, a novel app intervention that teaches skills for coping with stress and enhancing well-being, with added phone coaching. The primary outcome was self-reported symptoms of depression (Center for Epidemiologic Studies Depression Scale). Emotional self-efficacy and sleep disruption were also assessed at baseline, 6-week postintervention, and 4 weeks after the intervention period. Feedback obtained at the end of the study focused on user experience of the intervention. Results: There were significant decreases in symptoms of depression and sleep disruption from baseline to postintervention. Sleep disruption remained significantly lower at 4-week postintervention compared with baseline. The iCanThrive app was launched a median of 20.5 times over the intervention period. The median length of use was 2.1 min. Of the individuals who initiated the intervention, 87\% (20/23) completed the 6-week intervention. Conclusions: This pilot study provides support for the acceptability and preliminary efficacy of the iCanThrive intervention. Future work should validate the intervention in a larger randomized controlled study. It is important to develop scalable interventions that meet the psychosocial needs of different cancer populations. The modular structure of the iCanThrive app and phone coaching could impact a large population of survivors of women's cancer. ",
doi="10.2196/15750",
url="http://cancer.jmir.org/2020/1/e15750/"
}


@Article{info:doi/10.2196/12306,
author="Delrieu, Lidia
and Pialoux, Vincent
and P{\'e}rol, Olivia
and Morelle, Magali
and Martin, Agn{\`e}s
and Friedenreich, Christine
and Febvey-Combes, Olivia
and P{\'e}rol, David
and Belladame, Elodie
and Cl{\'e}men{\c{c}}on, Michel
and Roitmann, Eva
and Dufresne, Armelle
and Bachelot, Thomas
and Heudel, Etienne Pierre
and Touillaud, Marina
and Tr{\'e}dan, Olivier
and Fervers, B{\'e}atrice",
title="Feasibility and Health Benefits of an Individualized Physical Activity Intervention in Women With Metastatic Breast Cancer: Intervention Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Jan",
day="28",
volume="8",
number="1",
pages="e12306",
keywords="metastatic breast cancer",
keywords="physical activity",
keywords="activity trackers",
keywords="feasibility",
keywords="tumor progression",
abstract="Background: There is limited knowledge regarding the potential benefits of physical activity in patients with metastatic breast cancer. Objective: The Advanced stage Breast cancer and Lifestyle Exercise (ABLE) Trial aimed to assess the feasibility of a physical activity intervention in women with metastatic breast cancer and to explore the effects of physical activity on functional, psychological, and clinical parameters. Methods: The ABLE Trial was a single-arm, 6-month intervention study with a home-based, unsupervised, and personalized walking program using an activity tracker. At baseline and 6 months, we assessed anthropometrics, functional fitness, physical activity level, sedentary behavior, quality of life, fatigue, and tumor progression. Paired proportions were compared using the McNemar test and changes of parameters during the intervention were analyzed using the Wilcoxon signed-rank test, the Mann-Whitney test, and Spearman rank correlations. Results: Overall, 49 participants (mean age 55 years; recruitment rate 94\%) were enrolled and 96\% adhered to the exercise prescription (attrition rate 2\%). Statistically significant improvements in the 6-minute walking distance test (+7\%, P<.001) and isometric quadriceps strength (+22\%, P<.001), as well as decreases in body mass index (-2.5\%, P=.03) and hip circumference (-4.0\%, P<.001) were observed at 6 months. Quality of life remained stable and a nonstatistically significant decrease (-16\%, P=.07) in fatigue was observed. Conclusions: The high recruitment and adherence rates suggest the willingness of patients with metastatic breast cancer to participate in a physical activity program. The beneficial outcomes regarding physical fitness and anthropometry of this unsupervised physical activity program may encourage these patients to maintain a physically active lifestyle. Future randomized controlled trials with larger sample sizes are warranted. Trial Registration: ClinicalTrials.gov NCT03148886; https://clinicaltrials.gov/ct2/show/NCT03148886 ",
doi="10.2196/12306",
url="https://mhealth.jmir.org/2020/1/e12306",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012082"
}


@Article{info:doi/10.2196/13929,
author="Olsen, Alicia
and Keogh, Justin
and Sargeant, Sally",
title="Investigating How Bowel Cancer Survivors Discuss Exercise and Physical Activity Within Web-Based Discussion Forums: Qualitative Analysis",
journal="J Med Internet Res",
year="2019",
month="Dec",
day="16",
volume="21",
number="12",
pages="e13929",
keywords="exercise",
keywords="physical activity",
keywords="cancer",
keywords="qualitative research",
keywords="patient portals",
keywords="internet",
abstract="Background: Online cancer support group discussions enable patients to share their illness experience with others. The sharing of technical and emotional support information and the ability to ask for advice are some of the primary discussions shared online. People with bowel cancer can also use these forums to support each other by sharing information based on personal experiences. This type of support provides newly diagnosed patients with advice about several topics, including exercise from those who have been there. Information gathered from online discussion boards may complement the advice received by health professionals. Objective: This study aimed to explore the nature of information related to exercise and physical activity exchanged online for cancer survivors. Methods: A public open access bowel cancer discussion board was searched for threads containing information related to physical activity or exercise. Keywords such as exercise, physical activity, moving, walking, lifting, weights training, and resistance were used to search for threads (online conversations) related to exercise or physical activity. Only threads initiated by bowel cancer patients or survivors were included. From more than 6000 posts, the inclusion criteria yielded 75 threads for analysis. Inductive thematic analysis was conducted across all included threads. Results: Analysis yielded 3 main themes: level of exercise competence, beneficial dimensions of exercise, and faith in the knowledge. Level of exercise competence illustrated the varying definitions of exercise that members of the forum discussed in the forum. Beneficial dimensions of exercise revealed that forum members shared both the spiritual benefits associated with exercise as well as the physical benefits or goodness that they feel exercise or physical activity provides them. Faith in the knowledge of exercise demonstrated that forum members were aware of the general benefits of exercise but felt disappointed that it did not keep the cancer at bay. However, members also had faith that exercise would keep them healthy after diagnosis and treatment. Conclusions: The analysis revealed that people with bowel cancer discuss exercise and physical activity online and that they view exercise as having a mostly positive influence on their cancer journey. However, personal definitions of exercise became a source of conflict within the group. People with bowel cancer seeking information about exercise may benefit from participating in online support groups as it appears that there are many similar others willing to share their personal experiences with exercise. In addition, health care professionals responsible for caring for people with bowel cancer may use these findings to discuss exercise with their patients while being mindful of how they may view exercise. ",
doi="10.2196/13929",
url="https://www.jmir.org/2019/12/e13929",
url="http://www.ncbi.nlm.nih.gov/pubmed/31841117"
}


@Article{info:doi/10.2196/15539,
author="Marthick, Michael
and Janssen, Anna
and Cheema, S. Birinder
and Alison, Jennifer
and Shaw, Tim
and Dhillon, Haryana",
title="Feasibility of an Interactive Patient Portal for Monitoring Physical Activity, Remote Symptom Reporting, and Patient Education in Oncology: Qualitative Study",
journal="JMIR Cancer",
year="2019",
month="Nov",
day="28",
volume="5",
number="2",
pages="e15539",
keywords="physical activity",
keywords="patient Web portals",
keywords="neoplasms",
abstract="Background: Digital health interventions, such as the use of patient portals, have been shown to offer benefits to a range of patients including those with a diagnosis of cancer. Objective: This study aimed to explore the participant experience and perception of using an interactive Web-based portal for monitoring physical activity, remote symptom reporting, and delivering educational components. Methods: Participants who were currently under treatment or had recently completed intensive treatment for cancer were recruited to three cohorts and invited to join a Web-based portal to enhance their physical activity. Cohort 1 received Web portal access and an activity monitor; cohort 2 had additional summative messaging; and cohort 3 had additional personalized health coaching messaging. Following the 10-week intervention, participants were invited to participate in a semistructured interview. Interview recordings were transcribed and evaluated using qualitative thematic analysis. Results: A total of 17 semistructured interviews were carried out. Participants indicated that using the Web portal was feasible. Personalized messaging improved participant perceptions of the value of the intervention. There was a contrast between cohorts and levels of engagement with increasing health professional contact leading to an increase in engagement. Educational material needs to be tailored to the participants' cancer treatment status, health literacy, and background. Conclusions: Participants reported an overall positive experience using the Web portal and that personalized messaging positively impacted on their health behaviors. Future studies should focus more on design of interventions, ensuring appropriate tailoring of information and personalization of behavioral support messaging. International Registered Report Identifier (IRRID): RR2-10.2196/9586 ",
doi="10.2196/15539",
url="http://cancer.jmir.org/2019/2/e15539/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31778123"
}


@Article{info:doi/10.2196/14427,
author="Belle, Naomi Fabi{\"e}n
and Beck Popovic, Maja
and Ansari, Marc
and Otth, Maria
and Kuehni, Elisabeth Claudia
and Bochud, Murielle",
title="Nutritional Assessment of Childhood Cancer Survivors (the Swiss Childhood Cancer Survivor Study-Nutrition): Protocol for a Multicenter Observational Study",
journal="JMIR Res Protoc",
year="2019",
month="Nov",
day="18",
volume="8",
number="11",
pages="e14427",
keywords="child",
keywords="cancer survivors",
keywords="urine specimen collection",
keywords="diet surveys",
keywords="food frequency questionnaire",
keywords="Swiss Childhood Cancer Registry",
keywords="Switzerland",
abstract="Background: Childhood cancer survivors are at high risk of developing adverse late health effects. Poor nutritional intake may contribute to this risk, but information about dietary intake is limited. Objective: This study will assess childhood cancer survivors' dietary intake and compare two dietary assessment tools: a self-reported food frequency questionnaire, and dietary measurements from urine spot samples. Methods: In a substudy of the Swiss Childhood Cancer Survivor Study (SCCSS), SCCSS-Nutrition, we assessed childhood cancer survivors' dietary intake via a validated food frequency questionnaire. We sent a urine spot collection kit to a subset of 212 childhood cancer survivors from the French-speaking region of Switzerland to analyze urinary sodium, potassium, urea, urate, creatinine, and phosphate content. We will compare the food frequency questionnaire results with the urine spot analyses to quantify childhood cancer survivors' intake of various nutrients. We collected data between March 2016 and March 2018. Results: We contacted 1599 childhood cancer survivors, of whom 919 (57.47\%) returned a food frequency questionnaire. We excluded 11 childhood cancer survivors who were pregnant or were breastfeeding, 35 with missing dietary data, and 71 who had unreliable food frequency questionnaire data, resulting in 802 childhood cancer survivors available for food frequency questionnaire analyses. To a subset of 212 childhood cancer survivors in French-speaking Switzerland we sent a urine spot collection kit, and 111 (52.4\%) returned a urine sample. We expect to have the results from analyses of these samples in mid-2019. Conclusions: The SCCSS-Nutrition study has collected in-depth dietary data that will allow us to assess dietary intake and quality and compare two dietary assessment tools. This study will contribute to the knowledge of nutrition among childhood cancer survivors and is a step toward surveillance guidelines and targeted nutritional recommendations for childhood cancer survivors in Switzerland. Trial Registration: ClinicalTrials.gov NCT03297034; https://clinicaltrials.gov/ct2/show/NCT03297034 International Registered Report Identifier (IRRID): DERR1-10.2196/14427 ",
doi="10.2196/14427",
url="http://www.researchprotocols.org/2019/11/e14427/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31738177"
}


@Article{info:doi/10.2196/13150,
author="Hartman, J. Sheri
and Weiner, S. Lauren
and Nelson, H. Sandahl
and Natarajan, Loki
and Patterson, E. Ruth
and Palmer, W. Barton
and Parker, A. Barbara
and Sears, D. Dorothy",
title="Mediators of a Physical Activity Intervention on Cognition in Breast Cancer Survivors: Evidence From a Randomized Controlled Trial",
journal="JMIR Cancer",
year="2019",
month="Oct",
day="11",
volume="5",
number="2",
pages="e13150",
keywords="cognitive function",
keywords="exercise",
keywords="anxiety",
keywords="neoplasms",
abstract="Background: Emerging research suggests that increasing physical activity can help improve cognition among breast cancer survivors. However, little is known about the mechanism through which physical activity impacts cancer survivors' cognition. Objective: The objective of this secondary analysis examined physical and psychological function potentially linking physical activity with changes in cognition among breast cancer survivors in a randomized controlled trial where the exercise arm had greater improvements in cognition than the control arm. Methods: A total of 87 sedentary breast cancer survivors were randomized to a 12-week physical activity intervention (n=43) or control condition (n=44). Objectively measured processing speed (National Institutes of Health Toolbox Oral Symbol Digit), self-reported cognition (patient-reported outcomes measurement information system [PROMIS] cognitive abilities), PROMIS measures of physical and psychological function (depression, anxiety, fatigue, and physical functioning), and plasma biomarkers (brain-derived neurotrophic factor, homeostatic model assessment 2 of insulin resistance, and C-reactive protein [CRP]) were collected at baseline and 12 weeks. Linear mixed-effects models tested intervention effects on changes in physical and psychological function variables and biomarkers. Bootstrapping was used to assess mediation. Exploratory analyses examined self-reported cognitive abilities and processing speed as mediators of the intervention effect on physical functioning. Results: Participants in the exercise arm had significantly greater improvements in physical functioning (beta=1.23; 95\% CI 2.42 to 0.03; P=.049) and reductions in anxiety (beta=?1.50; 95\% CI ?0.07 to ?2.94; P=.04) than those in the control arm. Anxiety significantly mediated the intervention effect on cognitive abilities (bootstrap 95\% CI ?1.96 to ?0.06), whereas physical functioning did not (bootstrap 95\% CI ?1.12 to 0.10). Neither anxiety (bootstrap 95\% CI ?1.18 to 0.74) nor physical functioning (bootstrap 95\% CI ?2.34 to 0.15) mediated the intervention effect on processing speed. Of the biomarkers, only CRP had greater changes in the exercise arm than the control arm (beta=.253; 95\% CI ?0.04 to 0.57; P=.09), but CRP was not associated with cognition; therefore, none of the biomarker measures mediated the intervention effect on cognition. Neither cognitive abilities (bootstrap 95\% CI ?0.06 to 0.68) nor processing speed (bootstrap 95\% CI ?0.15 to 0.63) mediated the intervention effect on physical function. Conclusions: Physical activity interventions may improve self-reported cognition by decreasing anxiety. If supported by larger studies, reducing anxiety may be an important target for improving self-reported cognition among cancer survivors. Trial Registration: ClinicalTrials.gov NCT02332876; https://clinicaltrials.gov/ct2/show/NCT02332876 ",
doi="10.2196/13150",
url="https://cancer.jmir.org/2019/2/e13150",
url="http://www.ncbi.nlm.nih.gov/pubmed/31605514"
}


@Article{info:doi/10.2196/13463,
author="Chung, Yong Il
and Jung, Miyeon
and Lee, Byul Sae
and Lee, Won Jong
and Park, Rang Yu
and Cho, Daegon
and Chung, Haekwon
and Youn, Soyoung
and Min, Ha Yul
and Park, Jin Hye
and Lee, Minsun
and Chung, Seockhoon
and Son, Ho Byung
and Ahn, Sei-Hyun",
title="An Assessment of Physical Activity Data Collected via a Smartphone App and a Smart Band in Breast Cancer Survivors: Observational Study",
journal="J Med Internet Res",
year="2019",
month="Sep",
day="06",
volume="21",
number="9",
pages="e13463",
keywords="telemedicine",
keywords="breast neoplasms",
keywords="mobile apps",
keywords="quality of life",
keywords="stress, psychological",
keywords="patient compliance",
keywords="smartphone",
keywords="mobile phone",
keywords="wearable electronic devices",
keywords="survivorship",
abstract="Background: Although distress screening is crucial for cancer survivors, it is not easy for clinicians to recognize distress. Physical activity (PA) data collected by mobile devices such as smart bands and smartphone apps have the potential to be used to screen distress in breast cancer survivors. Objective: The aim of this study was to assess data collection rates of smartphone apps and smart bands in terms of PA data, investigate the correlation between PA data from mobile devices and distress-related questionnaires from smartphone apps, and demonstrate factors associated with data collection with smart bands and smartphone apps in breast cancer survivors. Methods: In this prospective observational study, patients who underwent surgery for breast cancer at Asan Medical Center, Seoul, Republic of Korea, between June 2017 and March 2018 were enrolled and asked to use both a smartphone app and smart band for 6 months. The overall compliance rates of the daily PA data collection via the smartphone walking apps and wearable smart bands were analyzed in a within-subject manner. The longitudinal daily collection rates were calculated to examine the dropout pattern. We also performed multivariate linear regression analysis to examine factors associated with compliance with daily collection. Finally, we tested the correlation between the count of daily average steps and distress level using Pearson correlation analysis. Results: A total of 160 female patients who underwent breast cancer surgeries were enrolled. The overall compliance rates for using a smartphone app and smart bands were 88.0\% (24,224/27,513) and 52.5\% (14,431/27,513), respectively. The longitudinal compliance rate for smartphone apps was 77.8\% at day 180, while the longitudinal compliance rate for smart bands rapidly decreased over time, reaching 17.5\% at day 180. Subjects who were young, with other comorbidities, or receiving antihormonal therapy or targeted therapy showed significantly higher compliance rates to the smartphone app. However, no factor was associated with the compliance rate to the smart band. In terms of the correlation between the count of daily steps and distress level, step counts collected via smart band showed a significant correlation with distress level. Conclusions: Smartphone apps or smart bands are feasible tools to collect data on the physical activity of breast cancer survivors. PA data from mobile devices are correlated with participants' distress data, which suggests the potential role of mobile devices in the management of distress in breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966 ",
doi="10.2196/13463",
url="https://www.jmir.org/2019/9/e13463",
url="http://www.ncbi.nlm.nih.gov/pubmed/31493319"
}


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


@Article{info:doi/10.2196/13543,
author="N{\'a}poles, Mar{\'i}a Anna
and Santoyo-Olsson, Jasmine
and Chac{\'o}n, Liliana
and Stewart, L. Anita
and Dixit, Niharika
and Ortiz, Carmen",
title="Feasibility of a Mobile Phone App and Telephone Coaching Survivorship Care Planning Program Among Spanish-Speaking Breast Cancer Survivors",
journal="JMIR Cancer",
year="2019",
month="Jul",
day="09",
volume="5",
number="2",
pages="e13543",
keywords="Hispanic Americans",
keywords="cancer survivors",
keywords="mobile apps",
keywords="feasibility studies",
abstract="Background: Spanish-speaking Latina breast cancer survivors experience disparities in knowledge of breast cancer survivorship care, psychosocial health, lifestyle risk factors, and symptoms compared with their white counterparts. Survivorship care planning programs (SCPPs) could help these women receive optimal follow-up care and manage their condition. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a culturally and linguistically suitable SCPP called the Nuevo Amanecer (New Dawn) Survivorship Care Planning Program for Spanish-speaking breast cancer patients in public hospital settings, approaching the end of active treatment. Methods: The 2-month intervention was delivered via a written bilingual survivorship care plan and booklet, Spanish-language mobile phone app with integrated activity tracker, and telephone coaching. This single-arm feasibility study used mixed methods to evaluate the intervention. Acceptability and feasibility were examined via tracking of implementation processes, debriefing interviews, and postintervention satisfaction surveys. Preliminary efficacy was assessed via baseline and 2-month interviews using structured surveys and pre- and postintervention average daily steps count based on activity tracker data. Primary outcomes were self-reported fatigue, health distress, knowledge of cancer survivorship care, and self-efficacy for managing cancer follow-up health care and self-care. Secondary outcomes were emotional well-being, depressive and somatic symptoms, and average daily steps. Results: All women (n=23) were foreign-born with limited English proficiency; 13 (57\%) had an elementary school education or less, 16 (70\%) were of Mexican origin, and all had public health insurance. Coaching calls lasted on average 15 min each (SD 3.4). A total of 19 of 23 participants (83\%) completed all 5 coaching calls. The majority (n=17; 81\%) rated the overall quality of the app as ``very good'' or ``excellent'' (all rated it as at least ``good''). Women checked their daily steps graph on the app between 4.2 to 5.9 times per week. Compared with baseline, postintervention fatigue (B=--.26; P=.02; Cohen d=0.4) and health distress levels (B=--.36; P=.01; Cohen d=0.3) were significantly lower and knowledge of recommended follow-up care and resources (B=.41; P=.03; Cohen d=0.5) and emotional well-being improved significantly (B=1.42; P=.02; Cohen d=0.3); self-efficacy for managing cancer follow-up care did not change. Average daily steps increased significantly from 6157 to 7469 (B=1311.8; P=.02; Cohen d=0.5). Conclusions: We found preliminary evidence of program feasibility, acceptability, and efficacy, with significant 2-month improvements in fatigue, health distress, and emotional well-being and increased knowledge of recommended follow-up care and average daily steps. Tailored mobile phone and health coaching SCPPs could help to ensure equitable access to these services and improve symptoms and physical activity levels among Spanish-speaking Latina breast cancer survivors. ",
doi="10.2196/13543",
url="http://cancer.jmir.org/2019/2/e13543/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31290395"
}


@Article{info:doi/10.2196/14136,
author="Lozano-Lozano, Mario
and Cantarero-Villanueva, Irene
and Martin-Martin, Lydia
and Galiano-Castillo, Noelia
and Sanchez, Maria-Jos{\'e}
and Fern{\'a}ndez-Lao, Carolina
and Postigo-Martin, Paula
and Arroyo-Morales, Manuel",
title="A Mobile System to Improve Quality of Life Via Energy Balance in Breast Cancer Survivors (BENECA mHealth): Prospective Test-Retest Quasiexperimental Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jun",
day="25",
volume="7",
number="6",
pages="e14136",
keywords="mHealth",
keywords="energy balance",
keywords="monitoring",
keywords="breast cancer",
keywords="survivors",
keywords="quality of life",
abstract="Background: Energy balance is defined as the difference between energy expenditure and energy intake. The current state of knowledge supports the need to better integrate mechanistic approaches through effective studies of energy balance in the cancer population because of an observed significant lack of adherence to healthy lifestyle recommendations. To stimulate changes in breast cancer survivors' lifestyles based on energy balance, our group developed the BENECA (Energy Balance on Cancer) mHealth app. BENECA has been previously validated as a reliable energy balance monitoring system. Objective: Based on our previous results, the goal of this study was to investigate the feasibility of BENECA mHealth in an ecological clinical setting with breast cancer survivors, by studying (1) its feasibility and (2) pretest-posttest differences with regard to breast cancer survivor lifestyles, quality of life (QoL), and physical activity (PA) motivation. Methods: Eighty breast cancer survivors diagnosed with stage I to IIIA and with a body mass index over 25 kg/m2 were enrolled in this prospective test-retest quasi-experimental study. Patients used BENECA mHealth for 8 weeks and were assessed at baseline and the postintervention period. Feasibility main outcomes included percentage of adoption, usage, and attrition; user app quality perception measured with the Mobile App Rating Scale (MARS); satisfaction with the Net Promoter Score (NPS); and barriers and facilitators of its use. Clinical main outcomes included measuring QoL with the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORT QLQ-C30), PA assessment with accelerometry, PA motivation measure with a Spanish self-efficacy scale for physical activity (EAF), and body composition with dual-energy x-ray absorptiometry. Statistical tests (using paired-sample t tests) and Kaplan-Meier survival curves were analyzed. Results: BENECA was considered feasible by the breast cancer survivors in terms of use (76\%, 58/76), adoption (69\%, 80/116), and satisfaction (positive NPS). The app quality score did not make it one of the best-rated apps (mean 3.71, SD 0.47 points out of 5). BENECA mHealth improved the QoL of participants (global health mean difference [MD] 12.83, 95\% CI 8.95-16.71, P<.001), and EAF score (global MD 36.99, 95\% CI 25.52-48.46, P<.001), daily moderate-to-vigorous PA (MD 7.38, 95\% CI 0.39-14.37, P=.04), and reduced body weight (MD ?1.42, 95\% CI ?1.97 to ?0.87, P<.001). Conclusions: BENECA mHealth can be considered feasible in a real clinical context to promote behavioral changes in the lifestyles of breast cancer survivors, but it needs to be enhanced to improve user satisfaction with use and functionality. This study highlights the importance of the use of mobile apps based on energy balance and how the QoL of breast cancer survivors can be improved via monitoring. ",
doi="10.2196/14136",
url="http://mhealth.jmir.org/2019/6/e14136/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31237570"
}


@Article{info:doi/10.2196/cancer.7850,
author="Keaver, Laura
and McGough, Aisling
and Du, Mengxi
and Chang, Winnie
and Chomitz, Virginia
and Allen, D. Jennifer
and Attai, J. Deanna
and Gualtieri, Lisa
and Zhang, Fang Fang",
title="Potential of Using Twitter to Recruit Cancer Survivors and Their Willingness to Participate in Nutrition Research and Web-Based Interventions: A Cross-Sectional Study",
journal="JMIR Cancer",
year="2019",
month="May",
day="28",
volume="5",
number="1",
pages="e7850",
keywords="social media",
keywords="nutrition survey",
keywords="cancer survivors",
abstract="Background: Social media is rapidly changing how cancer survivors search for and share health information and can potentially serve as a cost-effective channel to reach cancer survivors and invite them to participate in nutrition intervention programs. Objective: This study aimed to assess the feasibility of using Twitter to recruit cancer survivors for a web-based survey and assess their willingness to complete web-based nutrition surveys, donate biospecimens, and to be contacted about web-based nutrition programs. Methods: We contacted 301 Twitter accounts of cancer organizations, advocates, and survivors to request assistance promoting a web-based survey among cancer survivors. The survey asked respondents whether they would be willing to complete web-based nutrition or lifestyle surveys, donate biospecimens, and be contacted about web-based nutrition programs. Survey promotion rate was assessed by the percentage of Twitter accounts that tweeted the survey link at least once. Survey response was assessed by the number of survey respondents who answered at least 85\% (26/30). We compared the characteristics of cancer survivors who responded to this survey with those who participated in the National Health and Nutrition Examination Survey (NHANES) 1999-2010 and evaluated factors associated with willingness to complete web-based surveys, donate biospecimens, and be contacted to participate in web-based nutrition programs among those who responded to the social media survey. Results: Over 10 weeks, 113 Twitter account owners and 165 of their followers promoted the survey, and 444 cancer survivors provided complete responses. Two-thirds of respondents indicated that they would be willing to complete web-based nutrition or lifestyle surveys (297/444, 67.0\%) and to be contacted to participate in web-based nutrition interventions (294/444, 66.2\%). The percentage of respondents willing to donate biospecimens were 59.3\% (263/444) for oral swab, 52.1\% (231/444) for urine sample, 37.9\% (168/444) for blood sample, and 35.6\% (158/444) for stool sample. Compared with a nationally representative sample of 1550 cancer survivors in NHANES, those who responded to the social media survey were younger (53.1 years vs 60.8 years; P<.001), more likely to be female (93.9\% [417/444] vs 58.7\% [909/1550]; P<.001), non-Hispanic whites (85.4\% [379/444] vs 64.0\% [992/1550]; P<.001), to have completed college or graduate school (30.1 [133/444] vs 19.9\% [308/444]; P<.001), and to be within 5 years of their initial diagnosis (55.2\% [244/444] vs 34.1\% [528/1550]; P<.001). Survivors younger than 45 years, female, and non-Hispanic whites were more willing to complete web-based nutrition surveys than older (65+ years), male, and racial or ethnic minority survivors. Non-Hispanic whites and breast cancer survivors were more willing to donate biospecimens than those with other race, ethnicity or cancer types. Conclusions: Twitter could be a feasible approach to recruit cancer survivors into nutrition research and web-based interventions with potentially high yields. Specific efforts are needed to recruit survivors who are older, male, racial and ethnic minorities, and from socioeconomically disadvantaged groups when Twitter is used as a recruitment method. ",
doi="10.2196/cancer.7850",
url="http://cancer.jmir.org/2019/1/e7850/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31140436"
}


@Article{info:doi/10.2196/12662,
author="Huberty, Jennifer
and Eckert, Ryan
and Larkey, Linda
and Kurka, Jonathan
and Rodr{\'i}guez De Jes{\'u}s, A. Sue
and Yoo, Wonsuk
and Mesa, Ruben",
title="Smartphone-Based Meditation for Myeloproliferative Neoplasm Patients: Feasibility Study to Inform Future Trials",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="29",
volume="3",
number="2",
pages="e12662",
keywords="mindfulness",
keywords="meditation",
keywords="smartphone",
keywords="mHealth",
keywords="cancer",
keywords="quality of life",
abstract="Background: Myeloproliferative neoplasm (MPN) patients often report high symptom burden that persists despite the best available pharmacologic therapy. Meditation has gained popularity in recent decades as a way to manage cancer patient symptoms. Objective: The aim of this study was to examine the feasibility of 2 different consumer-based meditation smartphone apps in MPN patients and to examine the limited efficacy of smartphone-based meditation on symptoms compared with an educational control group. Methods: Patients (n=128) were recruited nationally through organizational partners and social media. Eligible and consented patients were enrolled into 1 of 4 groups, 2 of which received varying orders of 2 consumer-based apps (10\% Happier and Calm) and 2 that received one of the apps alone for the second 4 weeks of the 8-week intervention after an educational control condition. Participants were asked to perform 10 min of meditation per day irrespective of the app and the order in which they received the apps. Feasibility outcomes were measured at weeks 5 and 9 with a Web-based survey. Feasibility outcomes were acceptability, demand, and limited efficacy for depression, anxiety, pain intensity, sleep disturbance, sexual function, quality of life, global health, and total symptom burden. Results: A total of 128 patients were enrolled across all 4 groups, with 73.4\% (94/128) patients completing the intervention. Of the participants who completed the 10\% Happier app, 61\% (46/76) enjoyed it, 66\% (50/76) were satisfied with the content, and 77\% (59/76) would recommend to others. Of those who completed the Calm app, 83\% (56/68) enjoyed it, 84\% (57/68) were satisfied with the content, and 97\% (66/68) would recommend to others. Of those who completed the educational control, 91\% (56/61) read it, 87\% (53/61) enjoyed it, and 71\% (43/61) learned something. Participants who completed the 10\% Happier app averaged 31 (SD 33) min/week; patients completing the Calm app averaged 71 (SD 74) min/week. 10\% Happier app participants saw small effects on anxiety (P<.001 d=?0.43), depression (P=.02; d=?0.38), sleep disturbance (P=.01; d=?0.40), total symptom burden (P=.13; d=?0.27), and fatigue (P=.06; d=?0.30), and moderate effects on physical health (P<.001; d=0.52). Calm app participants saw small effects on anxiety (P=.29; d=?0.22), depression (P=.09; d=?0.29), sleep disturbance (P=.002; d=?0.47), physical health (P=.005; d=0.44), total symptom burden (P=.13; d=?0.27), and fatigue (P=.13; d=?0.27). Educational control participants (n=61) did not have effects on any patient-reported outcome except for a moderate effect on physical health (P<.001; d=0.77). Conclusions: Delivering meditation via the Calm app is feasible and scored higher in terms of feasibility when compared with the 10\% Happier app. The Calm app will be used to implement a randomized controlled trial, testing the effects of meditation on symptom burden in MPNs. Trial Registration: ClinicalTrials.gov NCT03726944; https://clinicaltrials.gov/ct2/show/NCT03726944 (Archived by WebCite at http://www.webcitation.org/77MVdFJwM) ",
doi="10.2196/12662",
url="http://formative.jmir.org/2019/2/e12662/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31033443"
}


@Article{info:doi/10.2196/11989,
author="Wu, Jin-Ming
and Ho, Te-Wei
and Chang, Yao-Ting
and Hsu, ChungChieh
and Tsai, Jui Chia
and Lai, Feipei
and Lin, Ming-Tsan",
title="Wearable-Based Mobile Health App in Gastric Cancer Patients for Postoperative Physical Activity Monitoring: Focus Group Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="23",
volume="7",
number="4",
pages="e11989",
keywords="telemedicine",
keywords="exercise",
keywords="perioperative care",
keywords="gastrectomy",
keywords="stomach neoplasms",
abstract="Background: Surgical cancer patients often have deteriorated physical activity (PA), which in turn, contributes to poor outcomes and early recurrence of cancer. Mobile health (mHealth) platforms are progressively used for monitoring clinical conditions in medical subjects. Despite prevalent enthusiasm for the use of mHealth, limited studies have applied these platforms to surgical patients who are in much need of care because of acutely significant loss of physical function during the postoperative period. Objective: The aim of our study was to determine the feasibility and clinical value of using 1 wearable device connected with the mHealth platform to record PA among patients with gastric cancer (GC) who had undergone gastrectomy. Methods: We enrolled surgical GC patients during their inpatient stay and trained them to use the app and wearable device, enabling them to automatically monitor their walking steps. The patients continued to transmit data until postoperative day 28. The primary aim of this study was to validate the feasibility of this system, which was defined as the proportion of participants using each element of the system (wearing the device and uploading step counts) for at least 70\% of the 28-day study. ``Definitely feasible,'' ``possibly feasible,'' and ``not feasible'' were defined as ?70\%, 50\%-69\%, and <50\% of participants meeting the criteria, respectively. Moreover, the secondary aim was to evaluate the clinical value of measuring walking steps by examining whether they were associated with early discharge (length of hospital stay <9 days). Results: We enrolled 43 GC inpatients for the analysis. The weekly submission rate at the first, second, third, and fourth week was 100\%, 93\%, 91\%, and 86\%, respectively. The overall daily submission rate was 95.5\% (1150 days, with 43 subjects submitting data for 28 days). These data showed that this system met the definition of ``definitely feasible.'' Of the 54 missed transmission days, 6 occurred in week 2, 12 occurred in week 3, and 36 occurred in week 4. The primary reason for not sending data was that patients or caregivers forgot to charge the wearable devices (>90\%). Furthermore, we used a multivariable-adjusted model to predict early discharge, which demonstrated that every 1000-step increment of walking on postoperative day 5 was associated with early discharge (odds ratio 2.72, 95\% CI 1.17-6.32; P=.02). Conclusions: Incorporating the use of mobile phone apps with wearable devices to record PA in patients of postoperative GC was feasible in patients undergoing gastrectomy in this study. With the support of the mHealth platform, this app offers seamless tracing of patients' recovery with a little extra burden and turns subjective PA into an objective, measurable parameter. ",
doi="10.2196/11989",
url="http://mhealth.jmir.org/2019/4/e11989/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31012858"
}


@Article{info:doi/10.2196/11735,
author="Giuliani, Elana Meredith
and Liu, Geoffrey
and Xu, Wei
and Dirlea, Mihaela
and Selby, Peter
and Papadakos, Janet
and Abdelmutti, Nazek
and Yang, Dongyang
and Eng, Lawson
and Goldstein, Paul David
and Jones, Michelle Jennifer",
title="Implementation of a Novel Electronic Patient-Directed Smoking Cessation Platform for Cancer Patients: Interrupted Time Series Analysis",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="09",
volume="21",
number="4",
pages="e11735",
keywords="neoplasms",
keywords="smoking cessation",
keywords="implementation science",
keywords="quality improvement",
abstract="Background: Continued smoking in cancer patients undergoing treatment results in significantly higher rates of treatment toxicities and persistent effects, increased risk of recurrence and second malignancy, and increased all-cause mortality. Despite this, routine tobacco use screening and the provision of smoking cessation treatment has yet to be implemented widely in the cancer setting. Objective: The objective of this study was to implement and evaluate the adoption and impact of an innovative Smoking Cessation e-referral System (CEASE) to promote referrals to smoking cessation programs in cancer patients. Methods: A patient-directed electronic smoking cessation platform (CEASE) was developed to promote smoking screening and referral and implemented at 1 of Canada's largest cancer centers. The implementation and evaluation were guided by the Ottawa Model of Research Use. An interrupted time series design was used to examine the impact of CEASE on screening rates, referrals offered, and referrals accepted compared with a previous paper-based screening program. A subsample of smokers or recent quitters was also assessed and compared pre- and postimplementation to examine the effect of CEASE on subsequent contact with smoking cessation programs and quit attempts. Results: A total of 17,842 new patients attended clinics over the 20-month study period. The CEASE platform was successfully implemented across all disease sites. Screening rates increased from 44.28\% (2366/5343) using the paper-based approach to 65.72\% (3538/5383) using CEASE (P<.01), and referrals offered to smokers who indicated interest in quitting increased from 18.6\% (58/311) to 98.8\% (421/426; P<.01). Accepted referrals decreased from 41\% (24/58) to 20.4\% (86/421), though the overall proportion of referrals generated from total current/recent tobacco users willing to quit increased from 5.8\% (24/414) to 20.2\% (86/426) due to the increase in referrals offered. At 1-month postscreening, there was no significant difference in the proportion that was currently using tobacco and had not changed use in the past 4 weeks (pre: 28.9\% [24/83] and post: 28.8\% [83/288]). However, contact with the referral program increased from 0\% to 78\% in the postCEASE cohort (P<.001). Conclusions: CEASE is an innovative tool to improve smoking screening and can be implemented in both a time- and cost-effective manner which promotes sustainability. CEASE was successfully implemented across all clinics and resulted in improvements in overall screening and referral rates and engagement with referral services. ",
doi="10.2196/11735",
url="https://www.jmir.org/2019/4/e11735/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30964445"
}


@Article{info:doi/10.2196/10820,
author="Wu, San Hoi
and Gal, Roxanne
and van Sleeuwen, C. Niek
and Brombacher, C. Aarnout
and IJsselsteijn, A. Wijnand
and May, M. Anne
and Monninkhof, M. Evelyn",
title="Breast Cancer Survivors' Experiences With an Activity Tracker Integrated Into a Supervised Exercise Program: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Feb",
day="21",
volume="7",
number="2",
pages="e10820",
keywords="breast cancer",
keywords="activity trackers",
keywords="physical activity",
keywords="sedentary behavior",
keywords="qualitative research",
abstract="Background: There is growing evidence that physical activity is related to a better prognosis after a breast cancer diagnosis, whereas sedentary behavior is associated with worse outcomes. It is therefore important to stimulate physical activity and reduce sedentary time among patients with breast cancer. Activity trackers offer a new opportunity for interventions directed at stimulating physical activity behavior change. Objective: This study aimed to explore the experience of patients with breast cancer who used an activity tracker in addition to a supervised exercise intervention in the randomized UMBRELLA Fit trial. Methods: A total of 10 patients with breast cancer who completed cancer treatment participated in semistructured in-depth interviews about their experience with and suggestions for improvements for the Jawbone UP2 activity tracker. Results: The activity tracker motivated women to be physically active and created more awareness of their (sedentary) lifestyles. The women indicated that the automatically generated advice (received via the Jawbone UP app) lacked individualization and was not applicable to their personal situations (ie, having been treated for cancer). Furthermore, women felt that the daily step goal was one-dimensional, and they preferred to incorporate other physical activity goals. The activity tracker's inability to measure strength exercises was a noted shortcoming. Finally, women valued personal feedback about the activity tracker from the physiotherapist. Conclusions: Wearing an activity tracker raised lifestyle awareness in patients with breast cancer. The women also reported additional needs not addressed by the system. Potential improvements include a more realistic total daily physical activity representation, personalized advice, and personalized goals. ",
doi="10.2196/10820",
url="https://mhealth.jmir.org/2019/2/e10820/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30789349"
}


@Article{info:doi/10.2196/12281,
author="Kiss, Nicole
and Baguley, James Brenton
and Ball, Kylie
and Daly, M. Robin
and Fraser, F. Steve
and Granger, L. Catherine
and Ugalde, Anna",
title="Technology-Supported Self-Guided Nutrition and Physical Activity Interventions for Adults With Cancer: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Feb",
day="12",
volume="7",
number="2",
pages="e12281",
keywords="cancer",
keywords="diet",
keywords="exercise",
keywords="nutrition",
keywords="physical activity",
keywords="self-guided interventions",
keywords="technology",
abstract="Background: Nutrition and physical activity interventions are important components of cancer care. With an increasing demand for services, there is a need to consider flexible, easily accessible, and tailored models of care while maintaining optimal outcomes. Objective: This systematic review describes and appraises the efficacy of technology-supported self-guided nutrition and physical activity interventions for people with cancer. Methods: A systematic search of multiple databases from 1973 to July 2018 was conducted for randomized and nonrandomized trials investigating technology-supported self-guided nutrition and physical activity interventions. Risk of bias was assessed using the Cochrane Risk of Bias tool. Outcomes included behavioural, health-related, clinical, health service, or financial measures. Results: Sixteen randomized controlled trials representing 2684 participants were included. Most studies were web-based interventions (n=9) and had a 12-week follow-up duration (n=8). Seven studies assessed dietary behaviour, of which two reported a significant benefit on diet quality or fruit and vegetable intake. Fifteen studies measured physical activity behaviour, of which eight studies reported a significant improvement in muscle strength and moderate-to-vigorous physical activity. Four of the nine studies assessing the health-related quality of life (HRQoL) reported a significant improvement in global HRQoL or a domain subscale. A significant improvement in fatigue was found in four of six studies. Interpretation of findings was influenced by inadequate reporting of intervention description and compliance. Conclusions: This review identified short-term benefits of technology-supported self-guided interventions on the physical activity level and fatigue and some benefit on dietary behaviour and HRQoL in people with cancer. However, current literature demonstrates a lack of evidence for long-term benefit. Trial Registration: PROSPERO CRD42017080346; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=80346 ",
doi="10.2196/12281",
url="http://mhealth.jmir.org/2019/2/e12281/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30747720"
}


@Article{info:doi/10.2196/10071,
author="Krebs, Paul
and Burkhalter, Jack
and Fiske, Jeffrey
and Snow, Herbert
and Schofield, Elizabeth
and Iocolano, Michelle
and Borderud, Sarah
and Ostroff, S. Jamie",
title="The QuitIT Coping Skills Game for Promoting Tobacco Cessation Among Smokers Diagnosed With Cancer: Pilot Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="10",
volume="7",
number="1",
pages="e10071",
keywords="tobacco",
keywords="cancer",
keywords="mHealth",
keywords="app",
keywords="mobile phone",
abstract="Background: Although smoking cessation apps have become popular, few have been tested in randomized clinical trials or undergone formative evaluation with target users. Objective: We developed a cessation app targeting tobacco-dependent cancer patients. Game design and behavioral rehearsal principles were incorporated to help smokers identify, model, and practice coping strategies to avoid relapse to smoking. In this randomized pilot trial, we examined feasibility (recruitment and retention rates), acceptability (patient satisfaction), quitting self-confidence, and other cessation-related indices to guide the development of a larger trial. Methods: We randomized 42 English-speaking cancer patients scheduled for surgical treatment to either the Standard Care (SC; telecounseling and cessation pharmacotherapies) or the experimental QuitIT study arm (SC and QuitIT game). Gameplay parameters were captured in-game; satisfaction with the game was assessed at 1-month follow-up. We report study screening, exclusion, and refusal reasons; compare refusal and attrition by key demographic and clinical variables; and report tobacco-related outcomes. Results: Follow-up data were collected from 65\% (13/20) patients in the QuitIT and 61\% (11/18) in SC arms. Study enrollees were 71\% (27/38) females, 92\% (35/38) white people, and 95\% (36/38) non-Hispanic people. Most had either lung (12/38, 32\%) or gastrointestinal (9/38, 24\%) cancer. Those dropping out were less likely than completers to have used a tablet (P<.01) and have played the game at all (P=.02) and more likely to be older (P=.05). Of 20 patients in the QuitIT arm, 40\% (8/20) played the game (system data). There were no differences between those who played and did not play by demographic, clinical, technology use, and tobacco-related variables. Users completed an average of 2.5 (SD 4.0) episodes out of 10. A nonsignificant trend was found for increased confidence to quit in the QuitIT arm (d=0.25, 95\% CI ?0.56 to 1.06), and more participants were abstinent in the QuitIT group than in the SC arm (4/13, 30\%, vs 2/11, 18\%). Satisfaction with gameplay was largely positive, with most respondents enjoying use, relating to the characters, and endorsing that gameplay helped them cope with actual smoking urges. Conclusions: Recruitment and retention difficulties suggest that the perihospitalization period may be a less than ideal time for delivering a smoking cessation app intervention. Framing of the app as a ``game'' may have decreased receptivity as participants may have been preoccupied with hospitalization demands and illness concerns. Less tablet experience and older age were associated with participant dropout. Although satisfaction with the gameplay was high, 60\% (12/20) of QuitIT participants did not play the game. Paying more attention to patient engagement, changing the intervention delivery period, providing additional reward and support for use, and improving cessation app training may bolster feasibility for a larger trial. Trial Registration: ClinicalTrials.gov NCT01915836; https://clinicaltrials.gov/ct2/show/NCT01915836 (Archived by WebCite at http://www.webcitation.org/73vGsjG0Y) ",
doi="10.2196/10071",
url="http://mhealth.jmir.org/2019/1/e10071/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30632971"
}


@Article{info:doi/10.2196/10918,
author="Roberts, L. Anna
and Potts, WW Henry
and Koutoukidis, A. Dimitrios
and Smith, Lee
and Fisher, Abigail",
title="Breast, Prostate, and Colorectal Cancer Survivors' Experiences of Using Publicly Available Physical Activity Mobile Apps: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jan",
day="04",
volume="7",
number="1",
pages="e10918",
keywords="physical activity",
keywords="health behavior",
keywords="cancer survivors",
keywords="mobile apps",
keywords="mHealth",
keywords="digital health",
abstract="Background: Physical activity (PA) can improve a range of outcomes following a cancer diagnosis. These include an improvement in experience of side effects of treatment (eg, fatigue) and management of comorbid conditions. PA might also increase survival and reduce recurrence. Digital interventions have shown potential for PA promotion among cancer survivors, but most in a previous review were Web-based, and few studies used mobile apps. There are many PA apps available for general public use, but it is unclear whether these are suitable as a PA intervention after a cancer diagnosis. Objective: This study sought posttreatment nonmetastatic breast, prostate, and colorectal cancer survivors' opinions of using smartphone apps to promote PA and gathered their views on existing publicly available PA apps to inform a future intervention. Methods: Each participant was randomly assigned to download 2 of 4 apps (Human, The Walk, The Johnson \& Johnson Official 7 Minute Workout, and Gorilla Workout). Participants used each app for 1 week consecutively. In-depth semistructured telephone interviews were then conducted to understand participants' experiences of using the apps and how app-based PA interventions could be developed for cancer survivors. The interviews were analyzed using thematic analysis. Results: Thirty-two participants took part: 50\% (16/32) had prostate cancer, 25\% (8/32) had breast cancer, and 25\% (8/32) had colorectal cancer. Three core themes were identified. The first theme was that multiple factors affect engagement with PA apps and this is highly personalized. Factors affecting engagement included participants' perceptions of (1) the advantages and disadvantages of using apps to support PA, (2) the relevance of the app to the user (eg, in terms of cancer-related factors, their PA goals, the difficulty level of the app, the way in which they interact with their mobile phone, and the extent to which the app fits with their self-identity), (3) the quality of the app (eg, usability, accuracy, quality of production, and scientific evidence-base), and (4) the behavior change techniques used to promote PA. In the second theme, participants recommended that apps that promote walking are most appealing, as walking removes many barriers to PA. Finally, the participants suggested that PA apps should be integrated into cancer care, as they valued guidance and recommendations from health care professionals. Conclusions: This sample of breast, prostate, and colorectal cancer survivors was receptive to the use of apps to promote PA. Although no publicly available PA app was deemed wholly suitable, many suggestions for adaptation and intervention development were provided. The results can inform the development of an app-based PA intervention for cancer survivors. They also highlight the wide-ranging and dynamic influences on engagement with digital interventions, which can be applied to other evaluations of mobile health products in other health conditions and other health behaviors. ",
doi="10.2196/10918",
url="http://mhealth.jmir.org/2019/1/e10918/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30609982"
}


@Article{info:doi/10.2196/11978,
author="Marthick, Michael
and Dhillon, M. Haryana
and Alison, A. Jennifer
and Cheema, S. Bobby
and Shaw, Tim",
title="An Interactive Web Portal for Tracking Oncology Patient Physical Activity and Symptoms: Prospective Cohort Study",
journal="JMIR Cancer",
year="2018",
month="Dec",
day="21",
volume="4",
number="2",
pages="e11978",
keywords="physical activity",
keywords="fitness trackers",
keywords="eHealth",
keywords="neoplasms",
abstract="Background: Physical activity levels typically decline during cancer treatment and often do not return to prediagnosis or minimum recommended levels. Interventions to promote physical activity are needed. Support through the use of digital health tools may be helpful in this situation. Objective: The goal of the research was to evaluate the feasibility, usability, and acceptability of an interactive Web portal developed to support patients with cancer to increase daily physical activity levels. Methods: A Web portal for supportive cancer care which was developed to act as a patient-clinician information and coaching tool focused on integrating wearable device data and remote symptom reporting. Patients currently receiving or who had completed intensive anticancer therapy were recruited to 3 cohorts. All cohorts were given access to the Web portal and an activity monitor over a 10-week period. Cohort 2 received additional summative messaging, and cohort 3 received personalized coaching messaging. Qualitative semistructured interviews were completed following the intervention. The primary outcome was feasibility of the use of the portal assessed as both the number of log-ins to the portal to record symptoms and the completion of post-program questionnaires. Results: Of the 49 people were recruited, 40 completed the intervention. Engagement increased with more health professional contact and was highest in cohort 3. The intervention was found to be acceptable by participants. Conclusions: The portal was feasible for use by people with a history of cancer. Further research is needed to determine optimal coaching methods. ",
doi="10.2196/11978",
url="http://cancer.jmir.org/2018/2/e11978/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30578217"
}


@Article{info:doi/10.2196/10487,
author="Delrieu, Lidia
and P{\'e}rol, Olivia
and Fervers, B{\'e}atrice
and Friedenreich, Christine
and Vallance, Jeff
and Febvey-Combes, Olivia
and P{\'e}rol, David
and Canada, Brice
and Roitmann, Eva
and Dufresne, Armelle
and Bachelot, Thomas
and Heudel, Pierre-Etienne
and Tr{\'e}dan, Olivier
and Touillaud, Marina
and Pialoux, Vincent",
title="A Personalized Physical Activity Program With Activity Trackers and a Mobile Phone App for Patients With Metastatic Breast Cancer: Protocol for a Single-Arm Feasibility Trial",
journal="JMIR Res Protoc",
year="2018",
month="Aug",
day="30",
volume="7",
number="8",
pages="e10487",
keywords="metastatic breast cancer",
keywords="physical activity",
keywords="oxidative stress",
keywords="activity trackers",
keywords="feasibility",
abstract="Background: About 5\% of breast cancer cases are metastatic at diagnosis, and 20\%-30\% of localized breast cancer cases become secondarily metastatic. Patients frequently report many detrimental symptoms related to metastasis and treatments. The physical, biological, psychological, and clinical benefits of physical activity during treatment in patients with localized breast cancer have been demonstrated; however, limited literature exists regarding physical activity and physical activity behavior change in patients with metastatic breast cancer. Objective: The primary objective of this study is to assess the feasibility of a 6-month physical activity intervention with activity trackers in patients with metastatic breast cancer (the Advanced stage Breast cancer and Lifestyle Exercise, ABLE Trial). Secondary objectives are to examine the effects of physical activity on physical, psychological, anthropometrics, clinical, and biological parameters. Methods: We plan to conduct a single-center, single-arm trial with 60 patients who are newly diagnosed with metastatic breast cancer. Patients will receive an unsupervised and personalized 6-month physical activity program that includes an activity tracker Nokia Go and is based on the physical activity recommendation. Patients will be encouraged to accumulate at least 150 minutes per week of moderate-to-vigorous intensity physical activity. Baseline and 6-month assessments will include anthropometric measures, functional tests (eg, 6-minute walk test and upper and lower limb strength), blood draws, patient-reported surveys (eg, quality of life and fatigue), and clinical markers of tumor progression (eg, Response Evaluation Criteria In Solid Tumors criteria). Results: Data collection occurred between October 2016 and January 2018, and the results are expected in August 2018. Conclusions: The ABLE Trial will be the first study to assess the feasibility and effectiveness of an unsupervised and personalized physical activity intervention performed under real-life conditions with activity trackers in patients with metastatic breast cancer. Trial Registration: ClinicalTrials.gov NCT03148886; https://clinicaltrials.gov/ct2/show/NCT03148886 (Accessed by WebCite at http://www.webcitation.org/71yabi0la) Registered Report Identifier: RR1-10.2196/10487 ",
doi="10.2196/10487",
url="http://www.researchprotocols.org/2018/8/e10487/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30166274"
}


@Article{info:doi/10.2196/resprot.8607,
author="Pfirrmann, Daniel
and Haller, Nils
and Huber, Yvonne
and Jung, Patrick
and Lieb, Klaus
and Gockel, Ines
and Poplawska, Krystyna
and Schattenberg, Markus J{\"o}rn
and Simon, Perikles",
title="Applicability of a Web-Based, Individualized Exercise Intervention in Patients With Liver Disease, Cystic Fibrosis, Esophageal Cancer, and Psychiatric Disorders: Process Evaluation of 4 Ongoing Clinical Trials",
journal="JMIR Res Protoc",
year="2018",
month="May",
day="22",
volume="7",
number="5",
pages="e106",
keywords="esophageal cancer",
keywords="cystic fibrosis",
keywords="depression",
keywords="nonalcoholic fatty liver disease",
keywords="exercise",
keywords="eHealth",
abstract="Background: In the primary and secondary prevention of civilization diseases, regular physical activity is recommended in international guidelines to improve disease-related symptoms, delay the progression of the disease, or to enhance postoperative outcomes. In the preoperative context, there has been a paradigm shift in favor of using preconditioning concepts before surgery. Web-based interventions seem an innovative and effective tool for delivering general information, individualized exercise recommendations, and peer support. Objective: Our first objective was to assess feasibility of our Web-based interventional concept and analyze similarities and differences in a sustained exercise implementation in different diseases. The second objective was to investigate the overall participants' satisfaction with our Web-based concept. Methods: A total of 4 clinical trials are still being carried out, including patients with esophageal carcinoma scheduled for oncologic esophagectomy (internet-based perioperative exercise program, iPEP, study), nonalcoholic fatty liver disease (hepatic inflammation and physical performance in patients with nonalcoholic steatohepatitis, HELP, study), depression (exercise for depression, EXDEP, study), and cystic fibrosis (cystic fibrosis online mentoring for microbiome, exercise, and diet, COMMED, study). During the intervention period, the study population had access to the website with disease-specific content and a disease-specific discussion forum. All participants received weekly, individual tailored exercise recommendations from the sports therapist. The main outcome was the using behavior, which was obtained by investigating the log-in rate and duration. Results: A total of 20 participants (5 from each trial) were analyzed. During the intervention period, a regular contact and a consequent implementation of exercise prescription were easily achieved in all substudies. Across the 4 substudies, there was a significant decrease in log-in rates (P<.001) and log-in durations (P<.001) over time. A detailed view of the different studies shows a significant decrease in log-in rates and log-in durations in the HELP study (P=.004; P=.002) and iPEP study (P=.02; P=.001), whereas the EXDEP study (P=.58; P=.38) and COMMED study (P=.87; P=.56) showed no significant change over the 8-week intervention period. There was no significant change in physical activity within all studies (P=.31). Only in the HELP study, the physical activity level increased steadily over the period analyzed (P=.045). Overall, 17 participants (85\%, 17/20) felt secure and were not scared of injury, with no major differences in the subtrials. Conclusions: The universal use of the Web-based intervention appears to be applicable across the heterogonous collectives of our study patients with regard to age and disease. Although the development of physical activity shows only moderate improvements, flexible communication and tailored support could be easily integrated into patients' daily routine. Trial Registration: iPEP study: ClinicalTrials.gov NCT02478996; https://clinicaltrials.gov/ct2/show/NCT02478996 (Archived by WebCite at http://www.webcitation.org/6zL1UmHaW); HELP study: ClinicalTrials.gov NCT02526732; http://www.webcitation.org/6zJjX7d6K (Archived by WebCite at http://www.webcitation.org/6Nch4ldcL); EXDEP study: ClinicalTrials.gov NCT02874833; https://clinicaltrials.gov/ct2/show/NCT02874833 (Archived by WebCite at http://www.webcitation.org/6zJjj7FuA) ",
doi="10.2196/resprot.8607",
url="http://www.researchprotocols.org/2018/5/e106/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29789277"
}


@Article{info:doi/10.2196/resprot.9252,
author="Touyz, Lauren
and Cohen, Jennifer
and Wakefield, Claire
and Grech, Allison
and Garnett, Sarah
and Gohil, Paayal
and Cohn, Richard",
title="Design and Rationale for a Parent-Led Intervention to Increase Fruit and Vegetable Intake in Young Childhood Cancer Survivors (Reboot): Protocol for a Pilot Study",
journal="JMIR Res Protoc",
year="2018",
month="May",
day="16",
volume="7",
number="5",
pages="e129",
keywords="childhood cancer survivor",
keywords="child, diet",
keywords="feeding patterns",
keywords="fruit",
keywords="vegetables",
abstract="Background: Poor dietary habits are common among childhood cancer survivors, despite increasing their risk of cardio metabolic complications after cancer treatment. Here, we describe the design and rationale for a pilot telephone-based, parent-led intervention aimed at increasing fruit and vegetable intake in young cancer survivors (Reboot). Objective: This pilot study aims to assess the feasibility and acceptability of delivering evidence-based telephone support to parents of childhood cancer survivors. A secondary aim includes assessing the effect of Reboot on improving childhood cancer survivors' dietary quality by increasing child fruit and vegetable intake and variety and its contribution to overall nutrient intake. Methods: We aim to recruit parents of 15 young cancer survivors aged 2 to 12 years who have completed cancer treatment less than five years ago. The intervention comprises of 4 weekly 45-minute telephone sessions led by a health professional and one booster session 6 weeks later. Sessions address the effects of cancer treatment on children's diets, recommended fruit and vegetable intake for children, and evidence-based strategies to promote the consumption of fruit and vegetables as well as to manage fussy eating. Results: Reboot is based on an existing, evidence-based parent nutrition intervention and modified for childhood cancer survivors following extensive collaboration with experts in the field. Primary outcomes of feasibility and acceptability will be measured by the number of participants who complete all five sessions, average session length (minutes), length between sessions (days) and parent Likert ratings of the usefulness and impact of the intervention collected after the booster session. Of the 15 participants we aim to recruit, 3 have completed the intervention, 1 declined to participate, 11 are actively completing the intervention and 2 participants are providing written consent. The remaining 3 participants will be recruited via telephone follow-up calls. The intervention is due to be completed by July 2018. Conclusions: Reboot aims to support healthy dietary behaviors in childhood cancer survivors who are at increased risk of developing serious cardiometabolic complications after their cancer treatment. Results will inform the development and implementation of future evidence-based dietary interventions delivered to childhood cancer survivors, particularly those living in rural and remote areas. Registered Report Identifier: RR1-10.2196/9252 ",
doi="10.2196/resprot.9252",
url="http://www.researchprotocols.org/2018/5/e129/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29769170"
}


@Article{info:doi/10.2196/mhealth.9363,
author="Soh, Yeong Ji
and Cha, Chul Won
and Chang, Kyung Dong
and Hwang, Hye Ji
and Kim, Kihyung
and Rha, Miyong
and Kwon, Hee",
title="Development and Validation of a Multidisciplinary Mobile Care System for Patients With Advanced Gastrointestinal Cancer: Interventional Observation Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="May",
day="07",
volume="6",
number="5",
pages="e115",
keywords="mobile health",
keywords="health apps",
keywords="mobile phone",
keywords="mobile care system",
abstract="Background: Mobile health apps have emerged as supportive tools in the management of advanced cancers. However, only a few apps have self-monitoring features, and they are not standardized and validated. Objective: This study aimed to develop and validate a multidisciplinary mobile care system with self-monitoring features that can be useful for patients with advanced gastrointestinal cancer. Methods: The development of the multidisciplinary mobile health management system was divided into 3 steps. First, the service scope was set up, and the measurement tools were standardized. Second, the service flow of the mobile care system was organized. Third, the mobile app (Life Manager) was developed. The app was developed to achieve 3 major clinical goals: support for quality of life, nutrition, and rehabilitation. Three main functional themes were developed to achieve clinical goals: a to-do list, health education, and in-app chat. Thirteen clinically oriented measures were included: the modified Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events questionnaire, Scored Patient-Generated Subjective Global Assessment (PG-SGA), distress, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, International Physical Activity Questionnaire--Short Form, Low anterior resection syndrome score, satisfaction rate, etc. To validate the system, a prospective observational study was conducted. Patients with gastric cancer or colon cancer undergoing chemotherapy were recruited. We followed the subjects for 12 weeks, and selected clinical measures were taken online and offline. Results: After the development process, a multidisciplinary app, the Life Manager, was launched. For evaluation, 203 patients were recruited for the study, of whom 101 (49.8\%) had gastric cancer, and 102 (50.2\%) were receiving palliative care. Most patients were in their fifties (35.5\%), and 128 (63.1\%) were male. Overall, 176 subjects (86.7\%) completed the study. Among subjects who dropped out, the most common reason was the change of patient's clinical condition (51.9\%). During the study period, subjects received multiple health education sessions. For the gastric cancer group, the ``general gastric cancer education'' was most frequently viewed (322 times), and for the colon cancer group, the ``warming-up exercise'' was most viewed (340 times). Of 13 measurements taken from subjects, 9 were taken offline (response rate: 52.0\% to 90.1\%), and 3 were taken online (response rate: 17.6\% to 57.4\%). The overall satisfaction rate among subjects was favorable and ranged from 3.93 (SD 0.88) to 4.01 (SD 0.87) on the 5-point Likert scale. Conclusions: A multidisciplinary mobile care system for patients with advanced gastrointestinal cancer was developed with clinically oriented measures. A prospective study was performed for its evaluation, which showed favorable satisfaction. ",
doi="10.2196/mhealth.9363",
url="http://mhealth.jmir.org/2018/5/e115/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29735478"
}


@Article{info:doi/10.2196/mhealth.9669,
author="Lozano-Lozano, Mario
and Galiano-Castillo, Noelia
and Mart{\'i}n-Mart{\'i}n, Lydia
and Pace-Bedetti, Nicol{\'a}s
and Fern{\'a}ndez-Lao, Carolina
and Arroyo-Morales, Manuel
and Cantarero-Villanueva, Irene",
title="Monitoring Energy Balance in Breast Cancer Survivors Using a Mobile App: Reliability Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Mar",
day="27",
volume="6",
number="3",
pages="e67",
keywords="telemedicine",
keywords="breast neoplasms",
keywords="survivors",
keywords="life style",
keywords="exercise",
keywords="diet",
keywords="mhealth",
abstract="Background: The majority of breast cancer survivors do not meet recommendations in terms of diet and physical activity. To address this problem, we developed a mobile health (mHealth) app for assessing and monitoring healthy lifestyles in breast cancer survivors, called the Energy Balance on Cancer (BENECA) mHealth system. The BENECA mHealth system is a novel and interactive mHealth app, which allows breast cancer survivors to engage themselves in their energy balance monitoring. BENECA was designed to facilitate adherence to healthy lifestyles in an easy and intuitive way. Objective: The objective of the study was to assess the concurrent validity and test-retest reliability between the BENECA mHealth system and the gold standard assessment methods for diet and physical activity. Methods: A reliability study was conducted with 20 breast cancer survivors. In the study, tri-axial accelerometers (ActiGraphGT3X+) were used as gold standard for 8 consecutive days, in addition to 2, 24-hour dietary recalls, 4 dietary records, and sociodemographic questionnaires. Two-way random effect intraclass correlation coefficients, a linear regression-analysis, and a Passing-Bablok regression were calculated. Results: The reliability estimates were very high for all variables (alpha?.90). The lowest reliability was found in fruit and vegetable intakes (alpha=.94). The reliability between the accelerometer and the dietary assessment instruments against the BENECA system was very high (intraclass correlation coefficient=.90). We found a mean match rate of 93.51\% between instruments and a mean phantom rate of 3.35\%. The Passing-Bablok regression analysis did not show considerable bias in fat percentage, portions of fruits and vegetables, or minutes of moderate to vigorous physical activity. Conclusions: The BENECA mHealth app could be a new tool to measure energy balance in breast cancer survivors in a reliable and simple way. Our results support the use of this technology to not only to encourage changes in breast cancer survivors' lifestyles, but also to remotely monitor energy balance. Trial Registration: ClinicalTrials.gov NCT02817724; https://clinicaltrials.gov/ct2/show/NCT02817724 (Archived by WebCite at http://www.webcitation.org/6xVY1buCc) ",
doi="10.2196/mhealth.9669",
url="http://mhealth.jmir.org/2018/3/e67/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29588273"
}


@Article{info:doi/10.2196/resprot.9096,
author="Hassoon, Ahmed
and Schrack, Jennifer
and Naiman, Daniel
and Lansey, Dina
and Baig, Yasmin
and Stearns, Vered
and Celentano, David
and Martin, Seth
and Appel, Lawrence",
title="Increasing Physical Activity Amongst Overweight and Obese Cancer Survivors Using an Alexa-Based Intelligent Agent for Patient Coaching: Protocol for the Physical Activity by Technology Help (PATH) Trial",
journal="JMIR Res Protoc",
year="2018",
month="Feb",
day="12",
volume="7",
number="2",
pages="e27",
abstract="Background: Physical activity has established health benefits, but motivation and adherence remain challenging. Objective: We designed and launched a three-arm randomized trial to test artificial intelligence technology solutions to increase daily physical activity in cancer survivors. Methods: A single-center, three-arm randomized clinical trial with an allocation ration of 1:1:1: (A) control, in which participants are provided written materials about the benefits of physical activity; (B) text intervention, where participants receive daily motivation from a fully automated, data-driven algorithmic text message via mobile phone (Coachtext); and (C) Voice Assist intervention, where participants are provided with an in-home on demand autonomous Intelligent Agent using data driven Interactive Digital Voice Assist on the Amazon Alexa/Echo (MyCoach). Results: The study runs for 5 weeks: a one-week run-in to establish baseline, followed by 4 weeks of intervention. Data for study outcomes is collected automatically through a wearable sensor, and data are transferred in real-time to the study server. The recruitment goal is 42 participants, 14 in each arm. Electronic health records are used to prescreen candidates, with 39 participants recruited to date. Discussion: This study aims to investigate the effects of different types of intelligent technology solutions on promoting physical activity in cancer survivors. This innovative approach can easily be expanded and customized to other interventions. Early lessons from our initial participants are helping us develop additional advanced solutions to improve health outcomes. Trial Registration: Retrospectively registered on July 10, 2017 at ClinicalTrials.gov: NCT03212079; https://clinicaltrials.gov/ct2/show/NCT03212079 (Archived by WebCite at http://www.webcitation.org/6wgvqjTji) ",
doi="10.2196/resprot.9096",
url="https://www.researchprotocols.org/2018/2/e27/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29434016"
}


@Article{info:doi/10.2196/resprot.8302,
author="Chaput, Cynthia
and Beaulieu-Gagnon, Sabrina
and B{\'e}langer, V{\'e}ronique
and Drouin, Simon
and Bertout, Laurence
and Lafrance, Lucie
and Olivier, Cinthia
and Robitaille, Marthe
and Laverdi{\`e}re, Caroline
and Sinnett, Daniel
and Marquis, Marie
and Marcil, Val{\'e}rie",
title="Research- and Practice-Based Nutrition Education and Cooking Workshops in Pediatric Oncology: Protocol for Implementation and Development of Curriculum",
journal="JMIR Res Protoc",
year="2018",
month="Jan",
day="09",
volume="7",
number="1",
pages="e2",
keywords="child",
keywords="diet",
keywords="education",
keywords="neoplasms",
keywords="hospitals",
keywords="methods",
abstract="Background: Progresses in childhood cancer treatment, diagnosis, and management have resulted in childhood cancer survival rates of over 80\%. However, this therapeutic success comes with a heavy price: two-thirds of childhood cancer survivors will be affected by further complications, including cardiovascular and metabolic diseases. Adequate nutrition during cancer treatment is essential to ensure the child's optimal development, improve tolerance to treatments, and can contribute to lower the risk of developing cardiometabolic diseases. Side effects of cancer treatments can negatively impact children's nutritional intake and eating behaviors. Involving the families of childhood cancer patients in educational workshops could be a promising avenue to promote healthy eating during and after cancer treatment. Objective: The objectives of this study were to develop, validate, and implement a family-based nutrition education and cooking workshop curriculum in a pediatric oncology setting that addresses the nutritional issues encountered during treatments while promoting the adoption of healthy eating habits for the prevention of long-term cardiometabolic effects. Methods: The workshops were developed and validated following an 8-step iterative process, including a review of the literature and consultations with a steering committee. An evaluation tool was also developed. A nonrandomized study protocol was elaborated to implement the workshops and measure their impact. The themes of the 6 research- and practice-based lessons are as follows: meal fortification during cancer treatment, changes in taste during cancer therapy and their impact on children, adapting diet to eating-related side effects of treatments, nutritional support during cancer treatment, Mediterranean diet and health, and planning quick and economic meals. The validation process included consultations with the institution's clinical nutrition professionals. Self-administered post questionnaires were developed according to the content of each workshop to measure short-term outcomes, namely, participants' perception of knowledge acquisition, behavioral intention, and satisfaction. Medium-term outcomes that will be evaluated are participants' anthropometric profile, quality of the diet, and circulating biomarkers of metabolic health. Results: The project was funded in 2016 and enrollment will be completed in 2021. Data analysis is currently under way and the first results are expected to be submitted for publication in 2019. Conclusions: This research- and practice-based nutrition education and cooking demonstration curriculum could be a valuable complement to a multidisciplinary lifestyle intervention for the prevention of long-term cardiometabolic complications in childhood cancer. ",
doi="10.2196/resprot.8302",
url="http://www.researchprotocols.org/2018/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29317383"
}


@Article{info:doi/10.2196/cancer.7166,
author="Cox, Matthew
and Basen-Engquist, Karen
and Carmack, L. Cindy
and Blalock, Janice
and Li, Yisheng
and Murray, James
and Pisters, Louis
and Rodriguez-Bigas, Miguel
and Song, Jaejoon
and Cox-Martin, Emily
and Demark-Wahnefried, Wendy",
title="Comparison of Internet and Telephone Interventions for Weight Loss Among Cancer Survivors: Randomized Controlled Trial and Feasibility Study",
journal="JMIR Cancer",
year="2017",
month="Sep",
day="27",
volume="3",
number="2",
pages="e16",
keywords="weight loss intervention",
keywords="cancer survivors",
keywords="Internet",
keywords="telephone",
abstract="Background: Weight loss interventions have been successfully delivered via several modalities, but recent research has focused on more disseminable and sustainable means such as telephone- or Internet-based platforms. Objective: The aim of this study was to compare an Internet-delivered weight loss intervention to a comparable telephone-delivered weight loss intervention. Methods: This randomized pilot study examined the effects of 6-month telephone- and Internet-delivered social cognitive theory--based weight loss interventions among 37 cancer survivors. Measures of body composition, physical activity, diet, and physical performance were the outcomes of interest. Results: Participants in the telephone intervention (n=13) showed greater decreases in waist circumference (--0.75 cm for telephone vs --0.09 cm for Internet, P=.03) than the Internet condition (n=24), and several other outcomes trended in the same direction. Measures of engagement (eg, number of telephone sessions completed and number of log-ins) suggest differences between groups which may account for the difference in outcomes. Conclusions: Cancer survivors in the telephone group evidenced better health outcomes than the Internet group. Group differences may be due to higher engagement in the telephone group. Incorporating a telephone-based component into existing weight loss programs for cancer survivors may help enhance the reach of the intervention while minimizing costs. More research is needed on how to combine Internet and telephone weight loss intervention components so as to maximize engagement and outcomes. Trial Registration: ClinicalTrials.gov NCT01311856; https://clinicaltrials.gov/ct2/show/NCT01311856 (Archived by WebCite at http://www.webcitation.org/6tKdklShY) ",
doi="10.2196/cancer.7166",
url="http://cancer.jmir.org/2017/2/e16/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28954716"
}


@Article{info:doi/10.2196/cancer.7495,
author="Paxton, J. Raheem
and Hajek, Richard
and Newcomb, Patricia
and Dobhal, Megha
and Borra, Sujana
and Taylor, C. Wendell
and Parra-Medina, Deborah
and Chang, Shine
and Courneya, S. Kerry
and Block, Gladys
and Block, Torin
and Jones, A. Lovell",
title="A Lifestyle Intervention via Email in Minority Breast Cancer Survivors: Randomized Parallel-Group Feasibility Study",
journal="JMIR Cancer",
year="2017",
month="Sep",
day="21",
volume="3",
number="2",
pages="e13",
keywords="breast neoplasm",
keywords="African Americans",
keywords="diet",
keywords="feasibility study",
keywords="physical activity",
keywords="posture",
keywords="program evaluation",
keywords="Internet",
keywords="computer tailoring",
keywords="email",
abstract="Background: Our data have indicated that minority breast cancer survivors are receptive to participating in lifestyle interventions delivered via email or the Web, yet few Web-based studies exist in this population. Objective: The aim of this study was to examine the feasibility and preliminary results of an email-delivered diet and activity intervention program, ``A Lifestyle Intervention Via Email (ALIVE),'' delivered to a sample of racial and ethnic minority breast cancer survivors. Methods: Survivors (mean age: 52 years, 83\% [59/71] African American) were recruited and randomized to receive either the ALIVE program's 3-month physical activity track or its 3-month dietary track. The fully automated system provided tools for self-monitoring and goal setting, tailored content, and automated phone calls. Descriptive statistics and mixed-effects models were computed to examine the outcomes of the study. Results: Upon completion, 44 of 71 survivors completed the study. Our ``intention-to-treat'' analysis revealed that participants in the physical activity track made greater improvements in moderate to vigorous activity than those in the dietary track (+97 vs. +49 min/week, P<.001). Similarly, reductions in total sedentary time among those in the physical activity track (?304 vs. ?59 min/week, P<.001) was nearly 5 times greater than that for participants in the dietary track. Our completers case analysis indicated that participants in the dietary track made improvements in the intake of fiber (+4.4 g/day), fruits and vegetables (+1.0 cup equivalents/day), and reductions in saturated fat (?2.3 g/day) and trans fat (?0.3 g/day) (all P<.05). However, these improvements in dietary intake were not significantly different from the changes observed by participants in the physical activity track (all P>.05). Process evaluation data indicated that most survivors would recommend ALIVE to other cancer survivors (97\%), were satisfied with ALIVE (82\%), and felt that ALIVE was effective (73\%). However, survivors expressed concerns about the functionality of the interactive emails. Conclusions: ALIVE appears to be feasible for racial and ethnic minority cancer survivors and showed promising results for larger implementation. Although survivors favored the educational content, a mobile phone app and interactive emails that work on multiple email domains may help to boost adherence rates and to improve satisfaction with the Web-based platform. Trial Registration: ClinicalTrials.gov NCT02722850; https://clinicaltrials.gov/ct2/show/NCT02722850 (Archived by WebCite at http://www.webcitation.org/6tHN9VsPh) ",
doi="10.2196/cancer.7495",
url="http://cancer.jmir.org/2017/2/e13/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28935620"
}


@Article{info:doi/10.2196/cancer.6935,
author="Van Blarigan, L. Erin
and Kenfield, A. Stacey
and Tantum, Lucy
and Cadmus-Bertram, A. Lisa
and Carroll, R. Peter
and Chan, M. June",
title="The Fitbit One Physical Activity Tracker in Men With Prostate Cancer: Validation Study",
journal="JMIR Cancer",
year="2017",
month="Apr",
day="18",
volume="3",
number="1",
pages="e5",
keywords="prostatic neoplasms",
keywords="exercise",
abstract="Background: Physical activity after cancer diagnosis improves quality of life and may lengthen survival. However, objective data in cancer survivors are limited and no physical activity tracker has been validated for use in this population. Objective: The aim of this study was to validate the Fitbit One's measures of physical activity over 7 days in free-living men with localized prostate cancer. Methods: We validated the Fitbit One against the gold-standard ActiGraph GT3X+ accelerometer in 22 prostate cancer survivors under free-living conditions for 7 days. We also compared these devices with the HJ-322U Tri-axis USB Omron pedometer and a physical activity diary. We used descriptive statistics (eg, mean, standard deviation, median, interquartile range) and boxplots to examine the distribution of average daily light, moderate, and vigorous physical activity and steps measured by each device and the diary. We used Pearson and Spearman rank correlation coefficients to compare measures of physical activity and steps between the devices and the diary. Results: On average, the men wore the devices for 5.8 days. The mean (SD) moderate-to-vigorous physical activity (MVPA; minutes/day) measured was 100 (48) via Fitbit, 51 (29) via ActiGraph, and 110 (78) via diary. The mean (SD) steps/day was 8724 (3535) via Fitbit, 8024 (3231) via ActiGraph, and 6399 (3476) via pedometer. Activity measures were well correlated between the Fitbit and ActiGraph: 0.85 for MPVA and 0.94 for steps (all P<.001). The Fitbit's step measurements were well correlated with the pedometer (0.67, P=.001), and the Fitbit's measure of MVPA was well correlated with self-reported activity in the diary (0.84; P<.001). Conclusions: Among prostate cancer survivors, the Fitbit One's activity and step measurements were well correlated with the ActiGraph GT3X+ and Omron pedometer. However, the Fitbit One measured two times more MVPA on average compared with the ActiGraph. ",
doi="10.2196/cancer.6935",
url="http://cancer.jmir.org/2017/1/e5/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28420602"
}


@Article{info:doi/10.2196/cancer.6435,
author="Krebs, Paul
and Shtaynberger, Jonathan
and McCabe, Mary
and Iocolano, Michelle
and Williams, Katie
and Shuk, Elyse
and Ostroff, S. Jamie",
title="An eHealth Intervention to Increase Physical Activity and Healthy Eating in Older Adult Cancer Survivors: Summative Evaluation Results",
journal="JMIR Cancer",
year="2017",
month="Mar",
day="01",
volume="3",
number="1",
pages="e4",
keywords="survivors",
keywords="diet",
keywords="food and nutrition",
keywords="breast neoplasms",
keywords="prostatic neoplasms",
keywords="eHealth",
abstract="Background: A healthy lifestyle is associated with improved quality of life among cancer survivors, yet adherence to health behavior recommendations is low. Objective: This pilot trial developed and tested the feasibility of a tailored eHealth program to increase fruit and vegetable consumption and physical activity among older, long-term cancer survivors. Methods: American Cancer Society (ACS) guidelines for cancer survivors were translated into an interactive, tailored health behavior program on the basis of Social Cognitive Theory. Patients (N=86) with a history of breast (n=83) or prostate cancer (n=3) and less than 5 years from active treatment were randomized 1:1 to receive either provider advice, brief counseling, and the eHealth program (intervention) or advice and counseling alone (control). Primary outcomes were self-reported fruit and vegetable intake and physical activity. Results: About half (52.7\%, 86/163) of the eligible patients consented to participate. The most common refusal reasons were lack of perceived time for the study (32/163) and lack of interest in changing health behaviors (29/163). Furthermore, 72\% (23/32) of the intervention group reported using the program and most would recommend it to others (56\%, 14/25). Qualitative results indicated that the intervention was highly acceptable for survivors. For behavioral outcomes, the intervention group reported increased fruit and vegetable consumption. Self-reported physical activity declined in both groups. Conclusions: The brief intervention showed promising results for increasing fruit and vegetable intake. Results and participant feedback suggest that providing the intervention in a mobile format with greater frequency of contact and more indepth information would strengthen treatment effects. ",
doi="10.2196/cancer.6435",
url="http://cancer.jmir.org/2017/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410171"
}


@Article{info:doi/10.2196/cancer.6680,
author="Folta, Sara
and Chang, Winnie
and Hill, Rachel
and Kelly, Michael
and Meagher, Susan
and Bowman, Paul W.
and Zhang, Fang Fang",
title="Parent and Health Care Provider Perceptions for Development of a Web-Based Weight Management Program for Survivors of Pediatric Acute Lymphoblastic Leukemia: A Mixed Methods Study",
journal="JMIR Cancer",
year="2017",
month="Feb",
day="09",
volume="3",
number="1",
pages="e2",
keywords="weight management",
keywords="childhood cancer survivors",
keywords="mixed methods",
abstract="Background: Survivors of pediatric acute lymphoblastic leukemia (ALL) may experience unhealthy weight gain during treatment, which has been associated with higher risk for chronic health issues. Objective: The purpose of this study was to obtain feedback on weight management in pediatric ALL survivors and on the content and implementation of a Web-based weight management program. Methods: Study participants included 54 parent survey respondents and 19 pediatric oncology professionals in 4 focus groups. Survey questions included report of child weight status and interest in participating in weight management programming at various time points. Pediatric oncology professionals were asked about the preferred topics and timing, as well as their role. Focus group data were analyzed by a multidisciplinary research team for common themes. Results: The mean age of survivors was 6.5 years. By parent report, 19\% of children were overweight and 25\% were obese. Preferred timing for weight management program participation was within 3 months of starting maintenance chemotherapy (23/53, 43\%) or within 12 months after completion of all cancer treatments (18/53, 34\%). Pediatric oncology professionals likewise considered the maintenance phase appropriate. They considered parenting to be an important topic to include and indicated that their most appropriate roles would be promotion and support. Conclusions: Parents and pediatric oncology professionals are interested in and supportive of early weight management in pediatric ALL survivors. Future research needs to identify strategies to integrate this into pediatric cancer care and to evaluate the feasibility and efficacy of these strategies. ",
doi="10.2196/cancer.6680",
url="http://cancer.jmir.org/2017/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410182"
}


@Article{info:doi/10.2196/resprot.6381,
author="Zhang, Fang Fang
and Meagher, Susan
and Scheurer, Michael
and Folta, Sara
and Finnan, Emily
and Criss, Kerry
and Economos, Christina
and Dreyer, ZoAnn
and Kelly, Michael",
title="Developing a Web-Based Weight Management Program for Childhood Cancer Survivors: Rationale and Methods",
journal="JMIR Res Protoc",
year="2016",
month="Nov",
day="18",
volume="5",
number="4",
pages="e214",
keywords="weight management",
keywords="childhood cancer survivors",
keywords="obesity",
keywords="Web-based",
keywords="development",
keywords="nutrition",
keywords="physical activity",
abstract="Background: Due to advances in the field of oncology, survival rates for children with cancer have improved significantly. However, these childhood cancer survivors are at a higher risk for obesity and cardiovascular diseases and for developing these conditions at an earlier age. Objective: In this paper, we describe the rationale, conceptual framework, development process, novel components, and delivery plan of a behavioral intervention program for preventing unhealthy weight gain in survivors of childhood acute lymphoblastic leukemia (ALL). Methods: A Web-based program, the Healthy Eating and Active Living (HEAL) program, was designed by a multidisciplinary team of researchers who first identified behaviors that are appropriate targets for weight management in childhood ALL survivors and subsequently developed the intervention components, following core behavioral change strategies grounded in social cognitive and self-determination theories. Results: The Web-based HEAL curriculum has 12 weekly self-guided sessions to increase parents' awareness of the potential impact of cancer treatment on weight and lifestyle habits and the importance of weight management in survivors' long-term health. It empowers parents with knowledge and skills on parenting, nutrition, and physical activity to help them facilitate healthy eating and active living soon after the child completes intensive cancer treatment. Based on social cognitive theory, the program is designed to increase behavioral skills (goal-setting, self-monitoring, and problem-solving) and self-efficacy and to provide positive reinforcement to sustain behavioral change. Conclusions: Lifestyle interventions are a priority for preventing the early onset of obesity and cardiovascular risk factors in childhood cancer survivors. Intervention programs need to meet survivors' targeted behavioral needs, address specific barriers, and capture a sensitive window for behavioral change. In addition, they should be convenient, cost-effective and scalable. Future studies are needed to evaluate the feasibility of introducing weight management early in cancer care and the efficacy of early weight management on survivors' health outcomes. ",
doi="10.2196/resprot.6381",
url="http://www.researchprotocols.org/2016/4/e214/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27864163"
}


@Article{info:doi/10.2196/cancer.6295,
author="Fazzino, L. Tera
and Fleming, Kimberly
and Befort, Christie",
title="Alcohol Intake Among Breast Cancer Survivors: Change in Alcohol Use During a Weight Management Intervention",
journal="JMIR Cancer",
year="2016",
month="Nov",
day="09",
volume="2",
number="2",
pages="e15",
keywords="alcohol drinking",
keywords="breast cancer",
keywords="weight loss",
keywords="weight reduction programs",
keywords="obesity",
abstract="Background: Daily alcohol intake in quantities as small as half a drink/day significantly increases the risk of breast cancer recurrence for postmenopausal survivors. Interventions designed to modify alcohol use among survivors have not been studied; however, lifestyle interventions that target change in dietary intake may affect alcohol intake. Objective: To evaluate change in alcohol use during a weight loss intervention for obese, rural-dwelling breast cancer survivors. Methods: Data were derived from an 18-month trial that included a 6-month weight loss intervention delivered via group conference calls, followed by a 12-month randomized weight loss maintenance phase in which participants received continued group calls or mailed newsletters. Participants who reported regular alcohol use at baseline (N=37) were included in this study. Results: Mean daily alcohol intake significantly decreased from baseline to 6 months during the weight loss intervention (19.6-2.3 g; P=.001). Mean alcohol intake did not significantly increase (b=0.99, P=.12) during the weight loss maintenance phase (months 6-18) and did not depend on randomization group (b=0.32, P=.799). Conclusions: Findings provide preliminary evidence that a weight loss intervention may address obesity and alcohol use risk factors for cancer recurrence. Minimal mail-based contact post weight loss can maintain alcohol use reductions through 18 months, suggesting durability in these effects. These results highlight a possibility that lifestyle interventions for survivors may modify health behaviors that are not the main foci of an intervention but that coincide with intervention goals. Trial Registration: Clinicaltrials.gov NCT01441011; https://clinicaltrials.gov/ct2/show/NCT01441011 (Archived by WebCite at http://www.webcitation.org/6lsJ9dMa9) ",
doi="10.2196/cancer.6295",
url="http://cancer.jmir.org/2016/2/e15/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410181"
}


@Article{info:doi/10.2196/cancer.5380,
author="Puszkiewicz, Patrycja
and Roberts, L. Anna
and Smith, Lee
and Wardle, Jane
and Fisher, Abigail",
title="Assessment of Cancer Survivors' Experiences of Using a Publicly Available Physical Activity Mobile Application",
journal="JMIR Cancer",
year="2016",
month="May",
day="31",
volume="2",
number="1",
pages="e7",
keywords="cancer survivors",
keywords="mobile applications",
keywords="mHealth",
keywords="physical activity",
keywords="sleep",
abstract="Background: Regular participation in physical activity (PA) is associated with improved physical and psychosocial outcomes in cancer survivors. However, PA levels are low during and after cancer treatment. Interventions to promote PA in this population are needed. PA mobile apps are popular and have potential to increase PA participation, but little is known about how appropriate or relevant they are for cancer survivors. Objective: This study aims to (1) assess recruitment, study uptake, and engagement for a publicly available PA mobile app (GAINFitness) intervention in cancer survivors; (2) assess cancer survivors' attitudes towards the app; (3) understand how the app could be adapted to better meet the needs of cancer survivors; and (4) to determine the potential for change in PA participation and psychosocial outcomes over a 6-week period of using the app. Methods: The present study was a one-arm, pre-post design. Cancer survivors (N=11) aged 33 to 62 years with a mean (SD) age of 45 (9.4), and 82\% (9/11) female, were recruited (via community/online convenience sampling to use the app for 6 weeks). Engagement with the app was measured using self-reported frequency and duration of usage. Qualitative semi-structured telephone interviews were conducted after the 6-week study period and were analyzed using thematic analysis. PA, well-being, fatigue, quality of life (QOL), sleep quality, and anxiety and depression were self-reported at baseline and at a 6-week follow-up using the Godin Leisure Time Exercise Questionnaire (GLTEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale Questionnaire, the Health and Quality of Life Outcomes (EQ5D) Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS), respectively. Results: Of the people who responded to the study advertisement, 73\% (16/22) agreed to participate and 100\% (11/11) of the participants who started the study completed all baseline and follow-up outcome measures and the telephone interview. On average, participants used the app twice a week for 25 minutes per session. Four themes were identified from the qualitative interviews surrounding the suitability of the app for cancer survivors and how it could be adapted: (1) barriers to PA, (2) receiving advice about PA from reliable sources, (3) tailoring the application to one's lifestyle, and (4) receiving social support from others. Pre-post comparison showed significant increases in strenuous PA, improvements in sleep quality, and reductions in mild PA. There were no significant changes in moderate PA or other psychosocial outcomes. Conclusions: All participants engaged with the app and qualitative interviews highlighted that the app was well-received. A generic PA mobile app could bring about positive improvements in PA participation and psychosocial outcomes among cancer survivors. However, a targeted PA app aimed specifically towards cancer survivors may increase the relevance and suitability of the app for this population. ",
doi="10.2196/cancer.5380",
url="http://cancer.jmir.org/2016/1/e7/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410168"
}


@Article{info:doi/10.2196/cancer.5431,
author="Wurz, Amanda
and Brunet, Jennifer",
title="The Effects of Physical Activity on Health and Quality of Life in Adolescent Cancer Survivors: A Systematic Review",
journal="JMIR Cancer",
year="2016",
month="May",
day="24",
volume="2",
number="1",
pages="e6",
keywords="exercise",
keywords="controlled clinical trial",
keywords="randomized controlled trial",
keywords="review",
keywords="treatment effectiveness",
abstract="Background: There are numerous published controlled trials assessing the safety and the benefits of physical activity (PA) for child and adult cancer survivors. However, trials exclusively comprised of adolescent cancer survivors aged 13-19 years, who may experience different health and quality of life (QOL) effects as a function of their developmental status, are lacking. Rather, some trials have included both adolescent and child cancer survivors together. Objective: The aim of this systematic review was to synthesize the findings from randomized controlled trails (RCTs) and controlled clinical trials (CCTs) investigating the effects of PA on health and QOL outcomes in samples comprised of >50\% adolescent cancer survivors to summarize the current state of evidence, identify knowledge gaps, and highlight areas in need of additional research within this population. Methods: Using a search strategy developed for this review, 10 electronic databases were searched for RCTs and CCTs that reported on the effects of PA on at least 1 health and/or QOL outcome in samples comprised of >50\% adolescent cancer survivors. Results: From the 2249 articles identified, 2 CCTs met the predetermined eligibility criteria and were included in this review. Combined, 28 adolescents (of 41 participants) who were receiving active treatment participated in the 2 studies reviewed. A total of 4 health and QOL outcomes (ie, bone mass, fatigue, grip strength, QOL) were assessed pre- and post-PA intervention. Conclusions: On the basis of the 2 studies reviewed, PA appears to be safe and feasible. PA also shows promise to mitigate reductions in bone mass and might be a viable strategy to improve fatigue, grip strength, and QOL. High-quality controlled trials with larger samples exclusively comprised of adolescent cancer survivors that assess a wide range of outcomes are needed to determine the effects of PA on health and QOL outcomes in this population. ",
doi="10.2196/cancer.5431",
url="http://cancer.jmir.org/2016/1/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410184"
}


@Article{info:doi/10.2196/cancer.5305,
author="M Quintiliani, Lisa
and Mann, M. Devin
and Puputti, Marissa
and Quinn, Emily
and Bowen, J. Deborah",
title="Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors",
journal="JMIR Cancer",
year="2016",
month="May",
day="09",
volume="2",
number="1",
pages="e4",
keywords="telemedicine",
keywords="survivors",
keywords="breast neoplasms",
keywords="health behavior",
keywords="body weight",
abstract="Background: Health behavior and weight management interventions for cancer survivors have the potential to prevent future cancer recurrence and improve long-term health; however, their translation can be limited if the intervention is complex and involves high participant burden. Mobile health (mHealth) offers a delivery modality to integrate interventions into daily life routines. Objective: The objective of this study was to evaluate the effects of a one-group trial with a pre-post evaluation design on engagement (use and acceptability), physiological (weight), behavioral (diet and physical activity), and other secondary outcomes. Methods: The 10-week intervention consisted of mHealth components (self-monitoring of selected diet behaviors via daily text messages, wireless devices to automatically track weight and steps) and 4 motivational interviewing--based technology-assisted phone sessions with a nonprofessionally trained counselor. Participants were overweight breast cancer survivors who had completed treatment and owned a smartphone. Weight was measured objectively; diet and physical activity were measured with brief self-reported questionnaires. Results: Ten women participated; they had a mean age of 59 years (SD 6), 50\% belonged to a racial or ethnic minority group, 50\% had some college or less, and 40\% reported using Medicaid health insurance. Engagement was high: out of 70 days in total, the mean number of days recording steps via the wristband pedometer was 64 (SD 7), recording a weight via the scale was 45 (SD 24), and responding to text messages was 60 (SD 13); 100\% of participants completed all 4 calls with the counselor. Most (90\%) were very likely to participate again and recommend the program to others. Mean weight in pounds decreased (182.5 to 179.1, mean change ?3.38 [SD 7.67]), fruit and vegetable daily servings increased (2.89 to 4.42, mean change 1.53 [SD 2.82]), and self-reported moderate physical activity increased in metabolic equivalent of task (MET) minutes per week (2791 to 3336, mean change 545 [SD 1694]). Conclusions: Findings support the conduct of a fully powered trial to evaluate the efficacy of mHealth as a feasible intervention modality for breast cancer survivors. Future research should employ accelerometer-based physical activity assessment and consider development of an all-in-one app to integrate devices, messaging, and educational content and other mHealth approaches to support behavioral counselors conducting weight management interventions. Trial Registration: ClinicalTrials.gov NCT02387671; https://clinicaltrials.gov/ct2/show/NCT02387671 (Archived by WebCite at http://www.webcitation.org/6hGEuttbZ). ",
doi="10.2196/cancer.5305",
url="http://cancer.jmir.org/2016/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410174"
}


@Article{info:doi/10.2196/resprot.5383,
author="Wurz, Amanda
and Brunet, Jennifer",
title="A Systematic Review Protocol to Assess the Effects of Physical Activity on Health and Quality of Life Outcomes in Adolescent Cancer Survivors",
journal="JMIR Res Protoc",
year="2016",
month="Mar",
day="30",
volume="5",
number="1",
pages="e54",
keywords="controlled clinical trial",
keywords="randomized controlled trial",
keywords="adolescent",
keywords="oncology",
keywords="neoplasm",
keywords="exercise",
keywords="quality of life.",
abstract="Background: The benefits of physical activity for child and adult cancer survivors have been summarized in previous systematic reviews. However, no review has summarized the evidence for adolescent cancer survivors. Objective: This paper describes the design of a protocol to conduct a systematic review of published studies examining the effects of physical activity on health and quality of life outcomes for adolescent cancer survivors. Methods: Several guidelines informed the development of this protocol. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines provided the structure by which to conduct and report the protocol; though some adaptations were made with regards to search terms, data synthesis, and evaluating the risk of bias. The Cochrane Handbook for Systematic Reviews of Interventions was used to guide research question development, search term selection, and the data extraction form. The Consolidated Standards of Reporting Trials guidelines helped inform the data extraction form. Lastly, the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews informed the data synthesis. Ten electronic databases were identified and a search strategy was developed using a combination of Medical Subject Headings terms and keywords that were developed by the authors and peer reviewed by a university librarian. Both authors independently screened eligible studies for final inclusion, and data were abstracted using a form developed by the research team. A decision was made to synthesize all data narratively. Results: The review has now been completed, peer-reviewed, and accepted for publication in a forthcoming issue of JMIR Cancer. Conclusions: As this will be the first systematic review on this topic, outlining the protocol ensures transparency for the completed review. Further, this protocol illustrates how elements from several guidelines were incorporated to answer the research question (ie, what is the effect of physical activity on health and quality of life outcomes in adolescent cancer survivors). This flexible approach was necessary as a function of the paucity of available research on this topic. ",
doi="10.2196/resprot.5383",
url="http://www.researchprotocols.org/2016/1/e54/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27030210"
}


@Article{info:doi/10.2196/cancer.5247,
author="Martin, C. Emily
and Basen-Engquist, Karen
and Cox, G. Matthew
and Lyons, J. Elizabeth
and Carmack, L. Cindy
and Blalock, A. Janice
and Demark-Wahnefried, Wendy",
title="Interest in Health Behavior Intervention Delivery Modalities Among Cancer Survivors: A Cross-Sectional Study",
journal="JMIR Cancer",
year="2016",
month="Feb",
day="11",
volume="2",
number="1",
pages="e1",
keywords="cancer survivor",
keywords="technology",
keywords="smartphone",
keywords="behavioral intervention",
keywords="physical activity",
keywords="diet",
abstract="Background: Effective, broad-reaching channels are important for the delivery of health behavior interventions in order to meet the needs of the growing population of cancer survivors in the United States. New technology presents opportunities to increase the reach of health behavior change interventions and therefore their overall impact. However, evidence suggests that older adults may be slower in their adoption of these technologies than the general population. Survivors' interest for more traditional channels of delivery (eg, clinic) versus new technology-based channels (eg, smartphones) may depend on a variety of factors, including demographics, current health status, and the behavior requiring intervention. Objective: The aim of this study was to determine the factors that predict cancer survivors' interest in new technology-based health behavior intervention modalities versus traditional modalities. Methods: Surveys were mailed to 1871 survivors of breast, prostate, and colorectal cancer. Participants' demographics, diet and physical activity behaviors, interest in health behavior interventions, and interest in intervention delivery modalities were collected. Using path analysis, we explored the relationship between four intervention modality variables (ie, clinic, telephone, computer, and smartphone) and potential predictors of modality interest. Results: In total, 1053 respondents to the survey (56.3\% response rate); 847 provided complete data for this analysis. Delivery channel interest was highest for computer-based interventions (236/847, 27.9\% very/extremely interested) and lowest for smartphone--based interventions (73/847, 8.6\%), with interest in clinic-based (147/847, 17.3\%) and telephone-delivered (143/847, 16.9\%) falling in between. Use of other technology platforms, such as Web cameras and social networking sites, was positively predictive of interest in technology-based delivery channels. Older survivors were less likely to report interest in smartphone--based diet interventions. Physical activity, fruit and vegetable consumption, weight status, and age moderated relationships between interest in targeted intervention behavior and modality. Conclusions: This study identified several predictors of survivor interest in various health behavior intervention delivery modalities. Overall, computer-based interventions were found to be most acceptable, while smartphones were the least. Factors related to survivors' current technology use and health status play a role in their interest for technology-based intervention versus more traditional delivery channels. Future health behavior change research in this population should consider participants' demographic, clinical, and lifestyle characteristics when selecting a delivery channel. Furthermore, current health behavior interventions for older cancer survivors may be best delivered over the Internet. Smartphone interventions may be feasible in the future following further adoption and familiarization by this particular population. ",
doi="10.2196/cancer.5247",
url="http://cancer.jmir.org/2016/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410164"
}


@Article{info:doi/10.2196/cancer.4586,
author="Forbes, C. Cynthia
and Blanchard, M. Chris
and Mummery, Kerry W.
and Courneya, S. Kerry",
title="Feasibility and Preliminary Efficacy of an Online Intervention to Increase Physical Activity in Nova Scotian Cancer Survivors: A Randomized Controlled Trial",
journal="JMIR Cancer",
year="2015",
month="Nov",
day="23",
volume="1",
number="2",
pages="e12",
keywords="Web-based",
keywords="survivorship",
keywords="home-based",
keywords="exercise",
keywords="efficacy",
keywords="feasibility",
abstract="Background: Physical activity (PA) behavior change interventions among cancer survivors have used face-to-face, telephone, email, and print-based methods. However, computer-tailored, Internet-delivered programs may be a more viable option to achieve PA behavior change. Objective: The objective of this study is to test the feasibility and preliminary efficacy of a Web-based PA behavior change program among cancer survivors. Methods: Nova Scotian cancer survivors (N=415) who previously expressed interest in a research study were approached. Interested participants were asked to complete an online assessment of PA and quality of life (QOL) before being randomized to either a theory-based PA behavior change program using the PA tracking website UWALK (UCAN; n=48) or usual care (UC; n=47). After the intervention (9 weeks), participants completed another online assessment of PA and QOL as well as measures to evaluate the program and website. Descriptive analyses from surveys and Web analytic software were used to assess feasibility and mean change scores were used to test efficacy. Results: Of all contacted survivors, 95 (22.3\%, 95/415) completed baseline measures and were randomized with 84 (88\%, 84/95) completing the 9-week assessment. The behavior change program and website were rated highly on the satisfaction items. Average logins were 10.3 (1.1 per week) and 26.0\% (111/432) of the weekly modules were completed. Most participants (71\%, 29/41) indicated they were more aware of their daily PA levels and 68\% (28/41) found the site easily navigable. Adjusted group differences in total exercise minutes favored the UCAN group by an increase of 42 minutes (95\% CI -65 to 150; P=.44, d=0.17). Results were more pronounced, though still nonsignificant, among those not meeting guidelines at baseline where UCAN increased PA by 52 minutes compared to a decrease of 15 minutes in UC (adjusted between group difference=75, 95\% CI -95 to 244; P=.38, d=0.27). Conclusions: We found that Internet-delivery may be a feasible alternative to more costly methods to promote PA among Nova Scotian cancer survivors. Moreover, there was a trend toward increased PA among those in the UCAN group, especially among those who were not meeting PA guidelines at baseline. Future research should focus on recruiting inactive cancer survivors and engaging them in the website to determine the optimal potential of Web-based interventions for promoting PA in cancer survivors. ",
doi="10.2196/cancer.4586",
url="http://cancer.jmir.org/2015/2/e12/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410166"
}