@Article{info:doi/10.2196/59228,
author="Yu, Kaitao
and Yin, Baobing
and Zhu, Ying
and Meng, Hongdao
and Zhu, Wenwei
and Lu, Lu
and Wang, Junqiao
and Chen, Shugeng
and Ni, Jun
and Lin, Yifang
and Jia, Jie",
title="Efficacy of a Digital Postoperative Rehabilitation Intervention in Patients With Primary Liver Cancer: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Apr",
day="7",
volume="13",
pages="e59228",
keywords="digital health",
keywords="surgery",
keywords="exercise rehabilitation",
keywords="randomized controlled trial",
keywords="primary liver cancer",
abstract="Background: Rehabilitation is considered a fundamental component of cancer treatment, especially for patients undergoing cancer surgery. In contrast to conventional rehabilitation education, digital rehabilitation has the potential to improve patients' access to postoperative rehabilitation programs. While digital health has rapidly emerged to aid patients with various diseases, their clinical efficacy in the recovery of patients with primary liver cancer (PLC) undergoing hepatectomy remains inadequately investigated. Objective: This study aims to evaluate whether a digital postoperative rehabilitation intervention is efficient in improving physical fitness, enhancing exercise adherence, and alleviating fatigue among patients with PLC after hepatectomy. Methods: A randomized controlled trial was undertaken across 2 university-affiliated hospitals in Eastern China. A total of 100 participants were enrolled in this study and were allocated randomly to either the digital health (intervention group, n=50) or the rehabilitation manual-based group (control group, n=50) at a 1:1 ratio. Patients were unblinded and prospectively followed for the intervention of 3 weeks. Outcome measures included physical fitness, exercise adherence, and status of fatigue. Results: Overall, 91 out of 100 patients completed the research and were evaluated after 3 weeks of intervention. The digital health group showed better cardiopulmonary endurance than the control group. The mean difference in the change of 6-minute walk test distance from baseline between the groups was 70.21 (95\% CI 0.730-82.869) m (P=.05). No statistically significant effects were found for grip strength, 5-repetition-sit-to-stand test time, and fatigue. The exercise adherence in the digital health group was higher than that in the control group ($\chi$22=15.871, P<.001). Conclusions: The findings suggested that the implementation of digital health had a positive impact on recovery in exercise capacity after hepatectomy. In addition, rehabilitation exercise mode based on digital health has the potential to improve the exercise adherence of patients with PLC compared to conventional manual-based rehabilitation guidance. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100052911; https://www.chictr.org.cn/showproj.html?proj=135351 ",
doi="10.2196/59228",
url="https://mhealth.jmir.org/2025/1/e59228"
}


@Article{info:doi/10.2196/67108,
author="Lin, Chen Yu
and Hagen, Ryan
and Powers, D. Benjamin
and Dineen, P. Sean
and Milano, Jeanine
and Hume, Emma
and Sprow, Olivia
and Diaz-Carraway, Sophia
and Permuth, B. Jennifer
and Deneve, Jeremiah
and Alishahi Tabriz, Amir
and Turner, Kea",
title="Digital Health Intervention to Reduce Malnutrition Among Individuals With Gastrointestinal Cancer Receiving Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Chemotherapy: Feasibility, Acceptability, and Usability Trial",
journal="JMIR Cancer",
year="2025",
month="Apr",
day="7",
volume="11",
pages="e67108",
keywords="gastrointestinal cancer",
keywords="peritoneal disease",
keywords="cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy",
keywords="digital health intervention",
keywords="nutrition",
keywords="feasibility",
abstract="Background: Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can improve survival outcomes for individuals with gastrointestinal (GI) cancer and peritoneal disease (PD). Individuals with GI cancer and PD receiving CRS-HIPEC are at increased risk for malnutrition. Despite the increased risk for malnutrition, there has been limited study of nutritional interventions for individuals receiving CRS-HIPEC. Objective: We aimed to test the feasibility, acceptability, and usability of Support Through Remote Observation and Nutrition Guidance (STRONG), a multilevel digital health intervention to improve nutritional management among individuals with GI cancer and PD receiving CRS-HIPEC. We also assessed patient-reported outcomes, including malnutrition risk, health-related quality of life, and weight-related measures. Methods: STRONG is a 12-week digital intervention in which participants received biweekly nutritional counseling with a dietitian, logged food intake using a Fitbit tracker, and reported nutrition-related outcomes. Dietitians received access to a web-based dashboard and remotely monitored patients' reported food intake and nutrition-impact symptoms. Implementation outcomes were assessed against prespecified benchmarks consistent with benchmarks used in prior studies. Changes in patient-reported outcomes at baseline and follow-up were assessed using linear and ordered logistic regressions. Results: Participants (N=10) had a median age of 57.5 (IQR 54-69) years. Feasibility benchmarks were achieved for recruitment (10/17, 59\% vs benchmark: 50\%), study assessment completion (9/10, 90\% vs benchmark: 60\%), dietitian appointment attendance (7/10, 70\% vs benchmark: 60\%), daily food intake logging adherence (6/10, 60\% vs benchmark: 60\%), and participant retention (10/10, 100\% vs benchmark: 60\%). Most participants rated the intervention as acceptable (8/10, 80\% vs benchmark: 70\%) and reported a high level of usability for dietitian services (10/10, 100\%). The benchmark usability for the Fitbit tracker to log food intake was not met. Compared to baseline, participants saw on average a 6.0 point reduction in malnutrition risk score (P=.01), a 20.5 point improvement in general health-related quality of life score (P=.002), and a 5.6 percentage point increase in 1-month weight change (P=.04) at the end of the study. Conclusions: The STRONG intervention demonstrated to be feasible, acceptable, and usable among individuals with GI cancer and PD receiving CRS-HIPEC. A fully powered randomized controlled trial is needed to test the effectiveness of STRONG for reducing malnutrition and improving patient outcomes. Trial Registration: ClinicalTrials.gov NCT05649969; https://clinicaltrials.gov/study/NCT05649969 ",
doi="10.2196/67108",
url="https://cancer.jmir.org/2025/1/e67108"
}


@Article{info:doi/10.2196/52694,
author="Tak, Won Yae
and Kim, Junetae
and Chung, Haekwon
and Lee, Byul Sae
and Park, Ja In
and Lee, Won Sei
and Jo, Min-Woo
and Lee, Won Jong
and Baek, Seunghee
and Lee, Yura",
title="Analysis of Metabolic and Quality-of-Life Factors in Patients With Cancer for a New Approach to Classifying Walking Habits: Secondary Analysis of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="1",
volume="27",
pages="e52694",
keywords="telemedicine",
keywords="mobile phone",
keywords="physical activity",
keywords="mobile apps",
keywords="mobile health intervention",
keywords="cancer",
keywords="step count",
abstract="Background: As the number of people diagnosed with cancer continues to increase, self-management has become crucial for patients recovering from cancer surgery or undergoing chemotherapy. Technology has emerged as a key tool in supporting self-management, particularly through interventions that promote physical activity, which is important for improving health outcomes and quality of life for patients with cancer. Despite the growing availability of digital tools that facilitate physical activity tracking, high-level evidence of their long-term effectiveness remains limited. Objective: This study aimed to investigate the effect of long-term physical activity on patients with cancer by categorizing them into active and inactive groups based on step count time-series data using the mobile health intervention, the Walkon app (Swallaby Co, Ltd.). Methods: Patients with cancer who had previously used the Walkon app in a previous randomized controlled trial were chosen for this study. Walking step count data were acquired from the app users. Biometric measurements, including BMI, waist circumference, blood sugar levels, and body composition, along with quality of life (QOL) questionnaire responses (European Quality of Life 5 Dimensions 5 Level version and Health-related Quality of Life Instrument with 8 Items), were collected during both the baseline and 6-month follow-up at an outpatient clinic. To analyze step count patterns over time, the concept of sample entropy was used for patient clustering, distinguishing between the active walking group (AWG) and the inactive walking group (IWG). Statistical analysis was performed using the Shapiro-Wilk test for normality, with paired t tests for parametric data, Wilcoxon signed-rank tests for nonparametric data, and chi-square tests for categorical variables. Results: The proposed method effectively categorized the AWG (n=137) and IWG (n=75) based on step count trends, revealing significant differences in daily (4223 vs 5355), weekly (13,887 vs 40,247), and monthly (60,178 vs 174,405) step counts. Higher physical activity levels were observed in patients with breast cancer and younger individuals. In terms of biometric measurements, only waist circumference (P=.01) and visceral fat (P=.002) demonstrated a significant improvement exclusively within the AWG. Regarding QOL measurements, aspects such as energy (P=.01), work (P<.003), depression (P=.02), memory (P=.01), and happiness (P=.05) displayed significant improvements solely in the AWG. Conclusions: This study introduces a novel methodology for categorizing patients with cancer based on physical activity using step count data. Although significant improvements were noted in the AWG, particularly in QOL and specific physical metrics, differences in 6-month change between the AWG and IWG were statistically insignificant. These findings highlight the potential of digital interventions in improving outcomes for patients with cancer, contributing valuable insights into cancer care and self-management. Trial Registration: Clinical Research Information Service by Korea Centers for Diseases Control and Prevention, Republic of Korea KCT0005447; https://tinyurl.com/3zc7zvzz ",
doi="10.2196/52694",
url="https://www.jmir.org/2025/1/e52694"
}


@Article{info:doi/10.2196/57537,
author="Tandon, Puneeta
and Ismond, P. Kathleen
and Purdy, Graeme
and Cruz, Christofer
and Etruw, Evelyn
and Suderman, Kirsten
and Hyde, Ashley
and Stickland, Michael
and Spence, C. John
and Lien, C. Dale
and Bhanji, Rahima
and Prado, M. Carla
and Miguel-Cruz, Antonio
and Joy, A. Anil
and Yaskina, Maryna
and McNeely, L. Margaret",
title="Acceptability and Effectiveness of a Fully Web-Based Nutrition and Exercise Program for Individuals With Chronic Disease During COVID-19: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="24",
volume="27",
pages="e57537",
keywords="eHealth",
keywords="patient-centered care",
keywords="adults",
keywords="geriatrics",
keywords="self-management",
keywords="web-based",
keywords="nutrition",
keywords="exercise rehabilitation",
keywords="wearable",
keywords="activity tracker",
keywords="quality of life",
keywords="physical health",
keywords="2-minute step test",
keywords="patients with cancer",
keywords="chronic diseases",
keywords="COVID-19",
keywords="randomized controlled trial",
keywords="acceptability",
keywords="effectiveness",
keywords="intervention",
abstract="Background: In-person nutrition and exercise interventions improve physical function in chronic diseases, yet the acceptability and effectiveness of web-based delivery, especially with different levels of personnel support, require further investigation. Objective: This study aims to evaluate a web-based nutrition and exercise intervention delivered entirely digitally from recruitment to trial completion. Methods: A randomized controlled trial was conducted using the Heal-Me version 1 platform across 2 levels of personnel support (Light and Intensive). Eligible adults with a history of cancer, chronic lung disease, or liver or lung transplant; internet access; and prior participation in a rehabilitation program were enrolled in a fully web-based program to minimize barriers to exercise participation. Participants were randomly assigned (1:1:1) to 1 of 3 study groups. The control group received a detailed, self-directed digital nutrition and exercise guide. The Heal-Me Light group received the web-based intervention alongside dietitian and exercise specialist--led group classes. The Heal-Me Intensive group received web-based intervention, group classes, and one-to-one sessions with the dietitians and exercise specialists. All participants received a wearable activity tracker. The primary acceptability outcome was adherence to the intervention based on a priori targets. The primary effectiveness outcome was the change in Lower Extremity Functional Scale (LEFS) score. Secondary outcomes included physical function tests, which were performed and measured by videoconference. Questionnaires were used to assess well-being, quality of life, and food intake. Analyses adhered to the intention-to-treat principle. Results: Of 216 participants, 202 (93.5\%) completed the intervention (mean 61, SD 11 years; female: 130/202, 64.4\%; cancer: 126/202, 62.4\%). Adherence exceeded a priori targets, with 82\% (105/128) attending >75\% of the program elements including postintervention tests. Participants rated the program as ``quite a bit'' or ``very'' useful, with similar ratings between Heal-Me Light (56/64, 88\%) and Heal-Me Intensive (51/58, 88\%) groups (P=.69). No significant differences were found for changes in LEFS scores (control: mean 0.8, SD 7.7; Heal-Me: mean 0.3, SD 6.6; P=.53). Significant benefits were found in favor of the combined Heal-Me intervention groups versus controls for change in the 2-minute step test, World Health Organization-5 Well-Being Index, Short-Form-36 general, physical health role, energy or fatigue scales, and protein intake. While the change in physical function was similar between the 2 intervention arms, the more intensive one-to-one interaction (Heal-Me Intensive) led to greater improvements in perceived nutrition self-management. No serious adverse events occurred. Conclusions: The demonstrated satisfaction, adherence, and effectiveness highlight the high acceptability of a web-based, semisupervised nutrition and exercise intervention delivered entirely digitally in individuals with chronic disease. Future studies may benefit from having a baseline physical function inclusion threshold, the use of a more sensitive primary physical function measure, and a higher intensity digital exercise intervention in exercise-experienced participants. Trial Registration: Clinicaltrials.gov NCT04666558; https://clinicaltrials.gov/study/NCT04666558 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2022.106791 ",
doi="10.2196/57537",
url="https://www.jmir.org/2025/1/e57537",
url="http://www.ncbi.nlm.nih.gov/pubmed/40126542"
}


@Article{info:doi/10.2196/63891,
author="Garc{\'i}a-Molina, Jennifer
and Saiz-V{\'a}zquez, Olalla
and Santamar{\'i}a-V{\'a}zquez, Montserrat
and Ortiz-Huerta, Hilario Juan",
title="Efficacy of a Supervised Exercise Program on Pain, Physical Function, and Quality of Life in Patients With Breast Cancer: Protocol for a Randomized Clinical Trial",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="12",
volume="14",
pages="e63891",
keywords="breast cancer",
keywords="exercise",
keywords="quality of life",
keywords="muscle strength",
keywords="pain",
keywords="efficacy",
keywords="protocol",
keywords="physical exercise",
keywords="fatigue",
keywords="loss of muscle",
keywords="physical function",
keywords="randomized clinical trial",
keywords="patients with cancer",
abstract="Background: Breast cancer is the second most common cancer in women worldwide. Treatments for this disease often result in side effects such as pain, fatigue, loss of muscle mass, and reduced quality of life. Physical exercise has been shown to effectively mitigate these side effects and improve the quality of life in patients with breast cancer. Objective: This randomized clinical trial aims to evaluate the efficacy of a 12-week supervised exercise program on pain, physical function, and quality of life in female patients with cancer. Methods: This randomized, double-blind clinical trial will recruit 325 participants, divided into an intervention group receiving the exercise program and a control group receiving standard care recommendations. Outcome measures, including pain (assessed via the Brief Pain Inventory), physical function (Disability of the Arm, Shoulder, and Hand Questionnaire), and quality of life (European Organization for Research and Treatment of Cancer QLQ-C30 and European Organization for Research and Treatment of Cancer QLQ-BR23), will be evaluated at baseline, immediately post intervention, and 12 weeks post intervention. Statistical analysis will involve repeated measures of ANOVA and MANOVA to determine the significance of the intervention's effects across time points. Results: Recruitment and data collection will commence in February of 2025, and data analysis is scheduled for completion at the end of 2025. No results are currently available Conclusions: Physical exercise is anticipated to play a significant role in alleviating pain, enhancing physical function, and improving the quality of life in female patients with cancer. This study will provide robust evidence to support the integration of supervised exercise into standard care protocols for this population. Trial Registration: ClinicalTrials.gov NCT06618690; https://clinicaltrials.gov/ct2/show/NCT06618690 International Registered Report Identifier (IRRID): PRR1-10.2196/63891 ",
doi="10.2196/63891",
url="https://www.researchprotocols.org/2025/1/e63891"
}


@Article{info:doi/10.2196/60791,
author="Langley, E. Jodi
and Sibley, Daniel
and Chiekwe, Joy
and Keats, R. Melanie
and Snow, Stephanie
and Purcell, Judith
and Sollows, Stephen
and Hill, Leslie
and Watton, David
and Gaudry, E. Abbigael
and Hashish, Ibrahim
and Wallace, Alison",
title="Prehabilitation Program for Lung and Esophageal Cancers (Boosting Recovery and Activity Through Early Wellness): Protocol for a Nonrandomized Trial",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="10",
volume="14",
pages="e60791",
keywords="cancer",
keywords="prehabilitation",
keywords="physical activity",
keywords="lung",
keywords="esophageal",
keywords="wellness",
keywords="surgical",
keywords="candidacy",
keywords="feasibility",
keywords="implementation",
keywords="community-based",
keywords="coaching program",
keywords="Canada",
keywords="lung cancer",
keywords="esophageal cancer",
keywords="surgery",
keywords="nonrandomized trial",
keywords="mixed method",
abstract="Background: Cancer is the leading cause of death in Canada, responsible for 28.2\% of all deaths. Based on surgical candidacy and disease status, both lung and esophageal cancer are treated through surgical resection by a thoracic surgeon. Although surgery contributes to improved outcomes, the 30-day postoperative mortality risks are as high as 10\% and 2.8\%, respectively. Evidence has shown that prehabilitation is a way in which patients can have improved postoperative outcomes. Prehabilitation is multimodal, often including some form of movement, nutrition, stress management, and smoking cessation. Given the complexity of the health care system, pragmatic trials are important methodological tools to assess internal validity and improve current practice under real-world conditions. Concurrently, using community resources is imperative to keep people active in their community and create sustainable programming. Objective: The Boosting Recovery and Activity Through Early Wellness (BREATHE WELL) study aims to explore the feasibility, implementation, and preliminary effectiveness of a clinically integrated, community-based, prehabilitation health coaching program. This includes nutrition, smoking cessation, sleep hygiene, and movement for individuals scheduled to undergo surgery for lung or esophageal cancer. Methods: This is a pilot, nonrandomized, pragmatic, repeated measures, mixed methods trial. We will recruit 32 participants diagnosed with lung or esophageal cancer and are scheduled to undergo surgical resection into the prehabilitation program, with 32 additional participants who decline participation to act as a control group. Participants who agree will then go through an 8-week tailored prehabilitation program (in person or virtual), covering movement, nutrition, stress management, nutrition, goal setting, and smoking cessation. They will complete 6 sessions prior to surgery and then have 4 sessions, 1{\texttimes}/week following surgery. Following the completion of the program, they will have 3 booster sessions via phone or Zoom (Zoom Video Communications). The primary outcome is feasibility: (1) recruitment feasibility---recruitment rate (the number of participants referred per month), enrollment rate (the number of enrolled participants divided by the number of referred participants), reasons for declining, and prehabilitation window (time between consent and surgery); and (2) intervention feasibility---adherence to the movement intervention, attrition, safety, study completion rate, and adverse events. Secondary outcomes include measures of preliminary effectiveness including patient-reported outcomes, such as well-being, fatigue, and functional measures. All measures will be assessed before, during, and after the prehabilitation program. Results: Enrollment has begun in January 2025, with 2 participants enrolled in the health coaching program. The full study is expected to be completed in approximately 3 years and be published in winter 2027. Conclusions: This study will inform the feasibility, implementation, and preliminary effectiveness of a clinically integrated, community-based, prehabilitation program in Nova Scotia, Canada, for people scheduled to undergo curative intent surgery for lung and esophageal cancer. Trial Registration: ClinicalTrials.gov NCT06354959; https://clinicaltrials.gov/study/NCT06354959 International Registered Report Identifier (IRRID): PRR1-10.2196/60791 ",
doi="10.2196/60791",
url="https://www.researchprotocols.org/2025/1/e60791"
}


@Article{info:doi/10.2196/72477,
author="Lee, Yura
and Park, Ye-Eun",
title="Authors' Reply: Advancing Digital Health Integration in Oncology",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="7",
volume="27",
pages="e72477",
keywords="mHealth",
keywords="user experience",
keywords="cancer",
keywords="technology acceptance model",
keywords="structural equation modeling",
keywords="health care app",
keywords="mixed-method study",
keywords="medical care",
keywords="digital health care",
keywords="cancer survivors",
keywords="disparities",
keywords="health status",
keywords="behavioral intervention",
keywords="clinician",
doi="10.2196/72477",
url="https://www.jmir.org/2025/1/e72477",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053760"
}


@Article{info:doi/10.2196/70316,
author="Khan, Umar Rai Muhammad
and Tariq, Hassan",
title="Advancing Digital Health Integration in Oncology",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="7",
volume="27",
pages="e70316",
keywords="mHealth",
keywords="user experience",
keywords="cancer",
keywords="technology acceptance model",
keywords="structural equation modeling",
keywords="health care app",
keywords="mixed-method study",
keywords="medical care",
keywords="digital health care",
keywords="cancer survivors",
keywords="disparities",
keywords="health status",
keywords="behavioral intervention",
keywords="clinician",
doi="10.2196/70316",
url="https://www.jmir.org/2025/1/e70316",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053796"
}


@Article{info:doi/10.2196/60115,
author="Li, Guangqi
and Zhou, Xueyan
and Deng, Junyue
and Wang, Jiao
and Ai, Ping
and Zeng, Jingyuan
and Ma, Xuelei
and Liao, Hu",
title="Digital Therapeutics--Based Cardio-Oncology Rehabilitation for Lung Cancer Survivors: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Feb",
day="25",
volume="13",
pages="e60115",
keywords="cardio-oncology rehabilitation",
keywords="digital therapeutics",
keywords="telerehabilitation",
keywords="non-small cell lung cancer",
keywords="exercise prescription",
keywords="cardiology",
keywords="oncology",
keywords="rehabilitation",
keywords="cardiorespiratory fitness",
keywords="cardiopulmonary",
keywords="cancer",
keywords="physical activity",
keywords="digital health",
keywords="digital technology",
keywords="randomized controlled trial",
keywords="wearable",
keywords="app",
keywords="quality of life",
keywords="survivor",
abstract="Background: Lung cancer ranks as the leading cause of cancer-related deaths. For lung cancer survivors, cardiopulmonary fitness is a strong independent predictor of survival, while surgical interventions impact both cardiovascular and pulmonary function. Home-based cardiac telerehabilitation through wearable devices and mobile apps is a substitution for traditional, center-based rehabilitation with equal efficacy and a higher completion rate. However, it has not been widely used in clinical practice. Objective: The objective of this study was to broaden the use of digital health care in the cardiopulmonary rehabilitation of lung cancer survivors and to assess its impact on cardiopulmonary fitness and quality of life (QOL). Methods: Early-stage nonsmall cell lung cancer survivors aged 18-70 years were included. All the participants received surgery 1-2 months before enrollment and did not require further antitumor therapy. Participants were randomly assigned to receive cardiac telerehabilitation or usual care for 5 months. Artificial intelligence--driven exercise prescription with a video guide and real-time heart rate (HR) monitoring was generated based on cardiopulmonary exercise testing. Aerobic exercise combining elastic band--based resistance exercises were recommended with a frequency of 3-5 d/wk and a duration of 90-150 min/wk. The effective exercise duration was recorded when patients' HR reached the target zone (HRresting + [HRmax -- HRresting] {\texttimes} [?40\%-60\%]), representing the duration under the target intensity. The prescription used a gradual progression in duration and action intensity based on the exercise data and feedback. Outcome measurements included cardiopulmonary fitness; lung function; cardiac function; tumor marker; safety; compliance; and scales assessing symptoms, psychology, sleep, fatigue, and QOL. Results: A total of 40 (85\%) out of 47 patients finished the trial. The average prescription compliance rate of patients in the telerehabilitation group reached 101.2\%, with an average exercise duration of 151.4 min/wk and an average effective exercise duration of 92.3 min/wk. The cardiac telerehabilitation was associated with higher improvement of maximal oxygen uptake peak (3.66, SD 3.23 mL/Kg/min vs 1.09, SD 3.23 mL/Kg/min; P=.02) and global health status or QOL (16.25, SD 23.02 vs 1.04, SD 13.90; P=.03) compared with usual care. Better alleviation of affective interference (--0.88, SD 1.50 vs 0.21, SD 1.22; P=.048), fatigue (--8.89, SD 15.96 vs 1.39, SD 12.09; P=.02), anxiety (--0.31, SD 0.44 vs --0.05, SD 0.29; P=.048), and daytime dysfunction (--0.55, SD 0.69 vs 0.00, SD 0.52; P=.02) was also observed in the telerehabilitation group. No exercise-related adverse events were identified during the intervention period. Conclusions: The 5-month, digital therapeutics--based telerehabilitation improved cardiorespiratory fitness in lung cancer survivors with good compliance and safety. Patients receiving telerehabilitation also reported improved QOL with reduced levels of fatigue, anxiety, and daytime dysfunction. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200064000; https://www.chictr.org.cn/showproj.html?proj=180594 ",
doi="10.2196/60115",
url="https://mhealth.jmir.org/2025/1/e60115"
}


@Article{info:doi/10.2196/60034,
author="Dabbagh, Zakery
and Najjar, Reem
and Kamberi, Ariana
and Gerber, S. Ben
and Singh, Aditi
and Soni, Apurv
and Cutrona, L. Sarah
and McManus, D. David
and Faro, M. Jamie",
title="Usability and Implementation Considerations of Fitbit and App Intervention for Diverse Cancer Survivors: Mixed Methods Study",
journal="JMIR Cancer",
year="2025",
month="Feb",
day="24",
volume="11",
pages="e60034",
keywords="physical activity",
keywords="cancer survivor",
keywords="wearable device",
keywords="smartphone app",
keywords="diverse",
keywords="Fitbit",
keywords="wearable",
keywords="feasibility",
keywords="usability",
keywords="digital health",
keywords="digital health method",
keywords="breast cancer",
keywords="Hispanic",
keywords="women",
keywords="mobile health",
keywords="activity tracker",
keywords="mHealth",
abstract="Background: Despite the known benefits of physical activity, cancer survivors remain insufficiently active. Prior trials have adopted digital health methods, although several have been pedometer-based and enrolled mainly female, non-Hispanic White, and more highly educated survivors of breast cancer. Objective: The objective of this study was to test a previously developed mobile health system consisting of a Fitbit activity tracker and the MyDataHelps smartphone app for feasibility in a diverse group of cancer survivors, with the goal of refining the program and setting the stage for a larger future trial. Methods: Participants were identified from one academic medical center's electronic health records, referred by a clinician, or self-referred to participate in the study. Participants were screened for eligibility, enrolled, provided a Fitbit activity tracker, and instructed to download the Fitbit: Health \& Wellness and MyDataHelps apps. They completed usability surveys at 1 and 3 months. Interviews were conducted at the end of the 3-month intervention with participants and cancer care clinicians to assess the acceptability of the intervention and the implementation of the intervention into clinical practice, respectively. Descriptive statistics were calculated for demographics, usability surveys, and Fitbit adherence and step counts. Rapid qualitative analysis was used to identify key findings from interview transcriptions. Results: Of the 100 patients screened for eligibility, 31 were enrolled in the trial (mean age 64.8, SD 11.1 years; female patients=17/31, 55\%; Hispanic or Latino=7/31, 23\%; non-White=11/31, 35\%; less than a bachelor's degree=14/31, 45\%; and household income <US \$75,000=11/31, 35\%). The mean (SD) years since diagnosis was 7.1 (8.2), and the two most frequent cancer diagnoses were prostate (9/31, 29\%) and breast (4/31, 13\%) cancer. Participants provided positive feedback on the MyDataHelps app usability; the overall app quality received a mean score of 3.79 (SD 0.82) on a 5-point Likert scale (1=worst, 5=best). Interviews with 10 patients yielded four themes: (1) Fitbit and app setup was easy but the research team provided assistance, when needed, which was helpful, (2) motivational messages within the app were not memorable, (3) step counts and Fitbit notifications were motivating, and (4) medical professionals viewing their data were acceptable. Interviews with 5 cancer care clinicians yielded four themes: (1) some patients used wearables but rarely discussed data with clinicians; (2) activity trackers can be helpful to motivate patients and keep them accountable; (3) objective activity measures---similar to BMI, weight, and blood pressure--- that they can track over time and refer to afterward were preferred; and (4) training and systematic processes to view these data as part of active workflow were desired. Conclusions: Implementing a remotely delivered, light-intensity physical activity program was feasible and acceptable in a sample of diverse cancer survivors. Future studies should consider registry-based methods and work with clinicians to engage hard-to-reach survivor populations who have low physical activity levels and disproportionately high adverse health outcomes. Trial Registration: ClinicalTrials.gov NCT05417438; https://clinicaltrials.gov/study/NCT05417438 ",
doi="10.2196/60034",
url="https://cancer.jmir.org/2025/1/e60034"
}


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


@Article{info:doi/10.2196/60559,
author="Soleymani, Dagmar
and Pougheon-Bertrand, Dominique
and Gagnayre, R{\'e}mi",
title="A Digital Behavior Change Intervention for Health Promotion for Adults in Midlife: Protocol for a Multidimensional Assessment Study",
journal="JMIR Res Protoc",
year="2025",
month="Feb",
day="7",
volume="14",
pages="e60559",
keywords="digital behavior change intervention",
keywords="assessment protocol",
keywords="middle-aged adults",
keywords="health promotion",
keywords="user account",
keywords="mixed assessments",
keywords="health information technologies",
abstract="Background: To support lifelong health promotion and disease prevention, Sant{\'e} publique France studied the methodology for building a social marketing scheme with a digital intervention targeting middle-aged adults, specifically socioeconomically disadvantaged groups. The digital intervention aims to encourage people aged 40-55 years to look after their health in the short and medium terms by adopting small actions relating to 8 health determinants: nutrition, physical activity, smoking, alcohol, stress, cognitive health, sleep, and environmental health. In the long term, the intervention intends to prevent frailty and reduce the burden of multimorbidities in older age, particularly for lower socioeconomic groups. Objective: This study aims to measure behavior changes among registered users of the future website. The protocol assesses the impact of the website based on users' implementation of small actions relating to the 8 health determinants. Specifically, it intends to evaluate the website's performance in terms of engaging a specific population, triggering behavior change, raising awareness about a multifactorial approach to health, and encouraging user interaction with the website's resources. Methods: The methodology is based on clinical assessments developed alongside the website according to the functionalities offered to registered users in their personalized space. The assessment tool design draws on logic models for digital interventions, and their consistency for digital applications is verified. The target audience is clearly defined from the outset. The protocol sets out a 3-step assessment: upon registration, after 3 weeks of use, and after 10 weeks of use (end of assessment). Users are divided into 2 groups (socioeconomically disadvantaged users and others) to characterize differences and make corrections. The protocol uses a mixed assessment approach based on website traffic and user login data. Specific and identifiable behavior changes are documented by monitoring the same individuals from T0 to T2, using verbatim comments to classify them into profiles and conducting semistructured individual interviews with a sample of users. Results: The protocol creates a multidimensional assessment of digital intervention, showing that during a given timeline, interactions with users can reveal their capabilities, opportunities, and motivations to adopt healthy lifestyles. The protocol's principles were integrated into the development of a personal account to assess users' behavior changes. Given the delayed launch of the website, no recruitment or effects analysis of the protocol took place. Conclusions: As no multidimensional assessment protocol is currently available for digital behavior change interventions, our methods reveal that the different framework stages can strengthen the effect measurement, consolidate the choice of assumptions used within the logic model and steer the digital intervention toward action while reducing the burden of information. The suitability of the assessment protocol remains to be evaluated given the delayed launch of the website. International Registered Report Identifier (IRRID): PRR1-10.2196/60559 ",
doi="10.2196/60559",
url="https://www.researchprotocols.org/2025/1/e60559"
}


@Article{info:doi/10.2196/50662,
author="Ng, Shin Krystal Lu
and Munisamy, Murallitharan
and Lim, Yin Joanne Bee
and Alshagga, Mustafa",
title="The Effect of Nutritional Mobile Apps on Populations With Cancer: Systematic Review",
journal="JMIR Cancer",
year="2025",
month="Feb",
day="5",
volume="11",
pages="e50662",
keywords="cancer",
keywords="mobile app",
keywords="nutrition",
keywords="body composition",
keywords="quality of life",
keywords="mobile health",
keywords="mHealth",
keywords="diet",
keywords="intervention",
keywords="mobile phone",
keywords="PRISMA",
abstract="Background: Limited access to nutrition support among populations with cancer is a major barrier to sustainable and quality cancer care. Increasing use of mobile health in health care has raised concerns about its validity and health impacts. Objective: This systematic review aimed to determine the effectiveness of commercial or cancer-specific nutritional mobile apps among people living with cancer. Methods: A systematic search of the CENTRAL, Embase, PubMed (MEDLINE), and Scopus databases was carried out in May 2024. All types of intervention studies were included, except observational studies, gray literature, and reference lists of key systematic reviews. Studies were eligible for inclusion if they involved (1) patients with or survivors of cancer and (2) nutrition-related mobile apps. Studies were excluded if the nutrition intervention was not delivered via mobile app or the app intervention was accompanied by dietary counseling. The review process was conducted based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Risk of Bias 2 and Risk of Bias in Nonrandomized Studies tools were used to assess the study quality. The Cochrane Review Manager (version 5.4) software was used to synthesize the results of the bias assessment. Results: A total of 13 interventions were included, comprising 783 adults or teenagers with cancer. Most studies focused on breast cancer (6/13, 46\%), overweight (6/13, 46\%), and survivors (9/13, 69\%). Data on anthropometry and body composition (7/13, 54\%; 387 participants), nutritional status (3/13, 23\%; 249 participants), dietary intake (7/13, 54\%; 352 participants), and quality of life (6/13, 46\%; 384 participants) were gathered. Experimental groups were more likely to report significant improvements in body weight or composition, dietary compliance, nutritional status, and quality of life than control groups. Conclusions: Although mobile app platforms are used to deliver nutrition interventions, the evidence for long-term efficacy, particularly in populations with cancer, remains elusive. More robust randomized controlled trials with larger sample sizes, as well as more homogeneous population characteristics and outcome measures, are warranted. Trial Registration: PROSPERO CRD42023330575; https://tinyurl.com/55v56yaj ",
doi="10.2196/50662",
url="https://cancer.jmir.org/2025/1/e50662"
}


@Article{info:doi/10.2196/58093,
author="Inayama, Yoshihide
and Yamaguchi, Ken
and Mizuno, Kayoko
and Tanaka-Mizuno, Sachiko
and Koike, Ayami
and Higashiyama, Nozomi
and Taki, Mana
and Yamanoi, Koji
and Murakami, Ryusuke
and Hamanishi, Junzo
and Yoshida, Satomi
and Mandai, Masaki
and Kawakami, Koji",
title="Changes in Physical Activity Across Cancer Diagnosis and Treatment Based on Smartphone Step Count Data Linked to a Japanese Claims Database: Retrospective Cohort Study",
journal="JMIR Cancer",
year="2025",
month="Jan",
day="20",
volume="11",
pages="e58093",
keywords="cancer",
keywords="lifelog data",
keywords="physical activity",
keywords="quality of life",
keywords="step count",
keywords="Japanese",
keywords="database",
keywords="smartphone",
keywords="mobile app",
keywords="exercise",
keywords="mobile phone",
abstract="Background: Although physical activity (PA) is recommended for patients with cancer, changes in PA across cancer diagnosis and treatment have not been objectively evaluated. Objective: This study aimed to assess the impact of cancer diagnosis and treatment on PA levels. Methods: This was a retrospective cohort study using a Japanese claims database provided by DeSC Healthcare Inc, in which daily step count data, derived from smartphone pedometers, are linked to the claims data. In this study, we included patients newly diagnosed with cancer, along with those newly diagnosed with diabetes mellitus for reference. We collected data between April 2014 and September 2021 and analyzed them. The observation period spanned from 6 months before diagnosis to 12 months after diagnosis. We applied a generalized additive mixed model with a cubic spline to describe changes in step counts before and after diagnosis. Results: We analyzed the step count data of 326 patients with malignant solid tumors and 1388 patients with diabetes. Patients with cancer exhibited a 9.6\% (95\% CI 7.1\%-12.1\%; P<.001) reduction in step counts from baseline at the start of the diagnosis month, which further deepened to 12.4\% (95\% CI 9.5\%-15.2\%; P<.001) at 3 months and persisted at 7.1\% (95\% CI 4.2\%-10.0\%; P<.001) at 12 months, all relative to baseline. Conversely, in patients with diabetes, step counts remained relatively stable after diagnosis, with a slight upward trend, resulting in a change of +0.6\% (95\% CI --0.6\% to 1.9\%; P=.31) from baseline at 3 months after diagnosis. At 12 months after diagnosis, step counts remained decreased in the nonendoscopic subdiaphragmatic surgery group, with an 18.0\% (95\% CI 9.1\%-26.2\%; P<.001) reduction, whereas step counts returned to baseline in the laparoscopic surgery group (+0.3\%, 95\% CI --6.3\% to 7.5\%; P=.93). Conclusions: The analysis of objective pre- and postdiagnostic step count data provided fundamental information crucial for understanding changes in PA among patients with cancer. While cancer diagnosis and treatment reduced PA, the decline may have already started before diagnosis. The study findings may help tailor exercise recommendations based on lifelog data for patients with cancer in the future. ",
doi="10.2196/58093",
url="https://cancer.jmir.org/2025/1/e58093",
url="http://www.ncbi.nlm.nih.gov/pubmed/39726139"
}


@Article{info:doi/10.2196/64427,
author="Zhang, Fuquan
and Bang, Deepali
and Visperas, Alejandro Christine
and Tun, Hnin Mon
and Tay, San San",
title="Feasibility, User Acceptance, and Outcomes of Using a Cancer Prehabilitation App for Exercise: Pilot Cohort Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="20",
volume="9",
pages="e64427",
keywords="cancer prehabilitation",
keywords="mobile app",
keywords="technology",
keywords="feasibility",
keywords="acceptance",
keywords="cancer",
keywords="prehabilitation",
keywords="mHealth",
keywords="exercise",
keywords="application",
keywords="app",
keywords="mobile application",
keywords="reliability",
keywords="smartphone app",
keywords="sustainability",
keywords="effectiveness",
keywords="older patients",
keywords="older adults",
keywords="elderly",
abstract="Background: The efficacy of cancer prehabilitation programs is supported by international reviews and meta-analyses. Technology has been deployed in cancer prehabilitation to address challenges such as access or limited resources. This study evaluated the feasibility, user acceptance, safety, and program outcomes of a newly developed mobile app for cancer prehabilitation. The app integrates with Singapore's existing health care mobile app, Health Buddy, and provides instructional videos for prescribed exercises. Objective: The objectives of this study were to investigate the feasibility, user experience, safety, and outcomes of a mobile app for cancer prehabilitation within a hospital-associated, home-based, multimodal cancer prehabilitation program. Methods: This retrospective study analyzed the records of patients enrolled in the cancer prehabilitation program from September 1, 2022, to March 30, 2023. Patients who participated in the prehabilitation program (n=63) were categorized into 2 groups: those prescribed the app (n=41) and those who were not (n=22). There was further subgroup analysis of those who were prescribed: app users (n=25) versus those who were non-app users (n=16). Demographics, Fried Frailty Phenotype, prehabilitation duration, app use, and functional outcome measures (6-minute walk test [6MWT], 30-second sit-to-stand test [STS], timed up and go test [TUG], and Hospital Anxiety and Depression Scale [HADS]) were collected. Compliance was determined by the completion of prescribed exercises and the accuracy of executing these exercises, with a high compliance rate considered to be at 80\% or more. Baseline characteristics and preoperative outcomes were compared between the groups. User satisfaction was assessed through surveys among app users (n=25). Results: Among 63 patients, 41 (65.1\%) patients were prescribed the app, of which 22 (34.9\%) patients were users. No significant differences in preoperative functional improvements were observed between app users and nonusers (6MWT: P=.60; STS: P=.81; TUG: P=.53; HADS: P=.36), or between those prescribed and not prescribed the app (6MWT: P=.94; STS: P=.26; TUG: P=.39; HADS: P=.62). However, high compliance rates (80\%) were observed among app users. Patient satisfaction with the app was high (>90\%), with positive feedback on ease of use and technical reliability. Baseline measures revealed significantly lower functional scores and higher mean frailty scores in the nonprescribed group. Conclusions: This preliminary study demonstrates the acceptability, feasibility, and safety of Singapore's first smartphone app for exercise prescription in cancer prehabilitation. Lower baseline functional outcome measures and a higher mean frailty score in the unprescribed group have implications for the selection process and patient participation. Further studies should include strategies to enhance patients' readiness for technology, sustainability, and effectiveness in older patients. ",
doi="10.2196/64427",
url="https://formative.jmir.org/2025/1/e64427"
}


@Article{info:doi/10.2196/56718,
author="Dunston, R. Emily
and Oza, Sonal
and Bai, Yang
and Newton, Maria
and Podlog, Leslie
and Larson, Kish
and Walker, Darren
and Zingg, W. Rebecca
and Hansen, A. Pamela
and Coletta, M. Adriana",
title="Preliminary Effectiveness of a Telehealth-Delivered Exercise Program in Older Adults Living With and Beyond Cancer: Retrospective Study",
journal="JMIR Cancer",
year="2025",
month="Jan",
day="13",
volume="11",
pages="e56718",
keywords="physical activity",
keywords="physical function",
keywords="telerehabilitation",
keywords="remote exercise",
keywords="digital health",
keywords="cancer survivors",
keywords="older adults",
keywords="smartphone",
abstract="Background: Exercise can attenuate the deleterious combined effects of cancer treatment and aging among older adults with cancer, yet exercise participation is low. Telehealth exercise may improve exercise engagement by decreasing time and transportation barriers; however, the utility of telehealth exercise among older adults with cancer is not well established. Objective: We aimed to evaluate the preliminary effectiveness of a one-on-one, supervised telehealth exercise program on physical function, muscular endurance, balance, and flexibility among older adults with cancer. Methods: In this retrospective study, we analyzed electronic health record data collected from the Personal Optimism With Exercise Recovery clinical exercise program delivered via telehealth among older adults with cancer (?65 y) who completed a virtual initial program telehealth assessment between March 2020 and December 2021. The virtual initial assessment included the following measures: 30-second chair stand test, 30-second maximum push-up test, 2-minute standing march, single leg stance, plank, chair sit and reach, shoulder range of motion, and the clock test. All baseline measures were repeated after 12-weeks of telehealth exercise. Change scores were calculated for all assessments and compared to minimal clinically important difference (MCID) values for assessments with published MCIDs. Paired samples t tests (2-tailed) were conducted to determine change in assessment outcomes. Results: Older adults with cancer who chose to participate in the telehealth exercise program (N=68) were 71.8 (SD 5.3) years of age on average (range 65?92 y). The 3 most common cancer types in this sample were breast (n=13), prostate (n=13), and multiple myeloma (n=8). All cancer stages were represented in this sample with stage II (n=16, 23.5\%) and III (n=18, 26.5\%) being the most common. A follow-up telehealth assessment was completed by 29.4\% (n=20) of older adults with cancer. Among those who completed a follow-up telehealth assessment, there were significant increases in the 30-second chair stand (n=19; mean change +2.00 repetitions, 95\% CI 0.12 to 3.88) and 30-second maximum push-up scores (n=20; mean change +2.85 repetitions, 95\% CI 1.60 to 4.11). There were no significant differences for the 2-minute standing march, plank, single leg stance, sit and reach, shoulder mobility, or clock test (P>.05). Nine (47.3\%) older adults with cancer had a change in 30-second chair stand scores greater than the MCID of 2 repetitions. Conclusions: Our findings suggest a one-on-one, supervised telehealth exercise program may positively influence measures of physical function, muscular endurance, balance, and flexibility among older adults with cancer, but more adequately powered trials are needed to confirm these findings. ",
doi="10.2196/56718",
url="https://cancer.jmir.org/2025/1/e56718"
}


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


@Article{info:doi/10.2196/59614,
author="Richter, Franziska
and Kronziel, Louisa Lea
and K{\"o}nig, Inke
and Langer, Thorsten
and Gebauer, Judith",
title="Implementation of Regular Lifestyle Counseling During Long-Term Follow-Up Care of Childhood Cancer Survivors: Monocentric Prospective Study",
journal="JMIR Cancer",
year="2024",
month="Dec",
day="26",
volume="10",
pages="e59614",
keywords="lifestyle counseling",
keywords="long-term follow-up",
keywords="childhood cancer survivors",
keywords="physical activity",
keywords="metabolic disorders",
keywords="cancer survivor",
keywords="treatment-related",
keywords="risk of obesity",
keywords="metabolic syndrome",
keywords="healthy lifestyle",
keywords="morbidity",
keywords="patient",
keywords="hypercholesterolemia",
keywords="diabetes mellitus",
keywords="health care professionals",
abstract="Background: Many childhood cancer survivors (CCS) develop treatment-related late effects, including an increased risk of obesity and metabolic syndrome. A healthy lifestyle can reduce the risk of associated comorbidities. Therefore, at-risk CCS could benefit from lifestyle counseling during regular long-term follow-up (LTFU). Objective: We implemented a new form of care to decrease the long-term morbidity among CCS and to gain new insights into the lifestyle of those patients. Methods: Over a 1-year study period, lifestyle counseling was integrated into LTFU care. Metabolic disorders, including hypercholesterolemia, diabetes mellitus, overweight or underweight, and low activity levels, were assessed as screening parameters for various risk groups. The perspectives of CCS, physicians, and sports scientists were compared to identify those with the highest needs. Each lifestyle counseling included general recommendations for physical activity, as well as an assessment of individual preferences for and barriers to the implementation of a healthy lifestyle. A follow-up appointment after 1 month was performed. Results: Of the 155 CCS aged 18 to 63 years (n=100, 65\% female and n=55, 35\% male), 112 (72\%) had an indication for lifestyle counseling, identified by physicians, sports scientists, or the CCS themselves. Metabolic disorders affected 45\% (n=70) of these CCS, and 46\% (n=72) did not meet recommended activity levels. A total of 120 (77\%) CCS received lifestyle counseling, including 8 initially uninterested individuals who became open to recommendations. Those with intensive cancer treatment history showed the greatest need. A total of 65 (54\%) CCS were advised to change their lifestyle in both areas (diet and exercise) while 51 (43\%) CCS received recommendations for only exercise (n=43 CCS, 36\%) or diet (n=8 CCS, 7\%). A total of 4 (3\%) CCS, although interested in counseling, received no advice, as they already met the recommendations. Follow-up revealed high adherence to recommendations and successful integration into daily lives. In total, 97\% (n=150) of survivors indicated that the provision of lifestyle counseling during LTFU would be generally beneficial. Conclusions: Incorporating specialized health care professionals such as sports scientists into survivorship care enhances the multidisciplinary approach of LTFU care. Promoting a healthy lifestyle by offering guideline-based lifestyle counseling is broadly accepted among CCS and may reduce long-term morbidity. ",
doi="10.2196/59614",
url="https://cancer.jmir.org/2024/1/e59614"
}


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


@Article{info:doi/10.2196/55176,
author="Park, Ye-Eun
and Tak, Won Yae
and Kim, Inhye
and Lee, Jeong Hui
and Lee, Bok Jung
and Lee, Won Jong
and Lee, Yura",
title="User Experience and Extended Technology Acceptance Model in Commercial Health Care App Usage Among Patients With Cancer: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="18",
volume="26",
pages="e55176",
keywords="mHealth",
keywords="user experience",
keywords="cancer",
keywords="technology acceptance model",
keywords="structural equation modeling",
keywords="health care app",
keywords="mixed-method study",
keywords="medical care",
keywords="digital health care",
keywords="cancer survivors",
keywords="disparities",
keywords="health status",
keywords="behavioral intervention",
keywords="clinician",
abstract="Background: The shift in medical care toward prediction and prevention has led to the emergence of digital health care as a valuable tool for managing health issues. Aiding long-term follow-up care for cancer survivors and contributing to improved survival rates. However, potential barriers to mobile health usage, including age-related disparities and challenges in user retention for commercial health apps, highlight the need to assess the impact of patients' abilities and health status on the adoption of these interventions. Objective: This study aims to investigate the app adherence and user experience of commercial health care apps among cancer survivors using an extended technology acceptance model (TAM). Methods: The study enrolled 264 cancer survivors. We collected survey results from May to August 2022 and app usage records from the app companies. The survey questions were created based on the TAM. Results: We categorized 264 participants into 3 clusters based on their app usage behavior: short use (n=77), medium use (n=101), and long use (n=86). The mean usage days were 9 (SD 11) days, 58 (SD 20) days, and 84 (SD 176) days, respectively. Analysis revealed significant differences in perceived usefulness (P=.01), interface satisfaction (P<.01), equity (P<.01), and utility (P=.01) among the clusters. Structural equation modeling indicated that perceived ease-of-use significantly influenced perceived usefulness ($\beta$=0.387, P<.01), and both perceived usefulness and attitude significantly affected behavioral intention and actual usage. Conclusions: This study showed the importance of positive user experience and clinician recommendations in facilitating the effective usage of digital health care tools among cancer survivors and contributing to the evolving landscape of medical care. ",
doi="10.2196/55176",
url="https://www.jmir.org/2024/1/e55176"
}


@Article{info:doi/10.2196/59504,
author="Blair, K. Cindy
and Brown-Glaberman, Ursa
and Walters, T. Scott
and Pestak, Claire
and Boyce, Tawny
and Barriga, Laura
and Burgess, Ellen
and Tawfik, Bernard
and Killough, Cynthia
and Kinney, Y. Anita
and Demark-Wahnefried, Wendy
and Meisner, L. Angela
and Wiggins, L. Charles
and Pankratz, Shane V.
and Davis, Sally",
title="A Remotely Delivered Light-Intensity Physical Activity Intervention for Older Cancer Survivors: Protocol for a Feasibility Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Dec",
day="13",
volume="13",
pages="e59504",
keywords="cancer survivor",
keywords="physical performance",
keywords="physical activity",
keywords="physical function",
keywords="older adults",
keywords="activity tracker",
keywords="mobile phone",
abstract="Background: Older cancer survivors face age- and treatment-related comorbidities, including physical functional impairment, which are exacerbated by physical inactivity and sedentary behavior. Regular physical activity can reduce this risk, yet less than 30\% of older cancer survivors meet the recommended guidelines for physical activity. Objective: This study aims to describe the design, methods, and rationale for a remotely delivered intervention that uses a whole-of-day approach to physical activity in older cancer survivors. This approach focuses on the accumulation of intermittent bouts of light-intensity activity throughout the entire day by disrupting and reducing sedentary activity. The intervention was guided by social cognitive and self-determination theories and incorporated motivational interviewing. Methods: The 12-week Move for Your Health trial randomly assigned 64 older cancer survivors to a theory-based physical activity intervention or a waitlist control. A Fitbit (Google) activity tracker and smartphone app were used to promote awareness of activity levels and enable self-monitoring of both activity and inactivity in tandem with health coaching phone calls. Motivational interviewing was used to engage participants and tailor strategies to achieve goals during the 12-week intervention. Data were collected at baseline, immediately after the intervention, and at longer-term follow-up (3 months thereafter). Feasibility outcomes included recruitment, retention, adherence, adverse events, and acceptability. Other outcomes included obtaining the parameter estimates for changes in physical function, physical performance, physical activity, sedentary behavior, and quality of life. Results: Recruitment for the Move for Your Health randomized controlled trial was completed in June 2023. Data collection was completed in March 2024. Data analyses are ongoing. Conclusions: The results of this trial will provide information on the feasibility of implementing this intervention in the target patient population, as well as data that will provide information about the potential impact of the intervention on the outcomes. Both of these outcomes will inform the design of a larger randomized controlled trial to more fully test a physical activity intervention in an older cancer survivor population. Trial Registration: ClinicalTrials.gov NCT05582889; https://clinicaltrials.gov/study/NCT05582889 International Registered Report Identifier (IRRID): DERR1-10.2196/59504 ",
doi="10.2196/59504",
url="https://www.researchprotocols.org/2024/1/e59504"
}


@Article{info:doi/10.2196/56475,
author="Tian, Xiaojuan
and Liu, Yan
and Zhang, Jiahua
and Yang, Lixiao
and Feng, Linyao
and Qi, Aidong
and Liu, Hanjiazi
and Liu, Pengju
and Li, Ying",
title="Efficacy of a WeChat-Based, Multidisciplinary, Full-Course Nutritional Management Program on the Nutritional Status of Patients With Ovarian Cancer Undergoing Chemotherapy: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Nov",
day="4",
volume="12",
pages="e56475",
keywords="WeChat",
keywords="nutrition management",
keywords="ovarian cancer",
keywords="chemotherapy",
keywords="mobile health",
abstract="Background: As the most malignant type of cancer in the female reproductive system, ovarian cancer (OC) has become the second leading cause of death among Chinese women. Chemotherapy is the main treatment for patients with OC, and its numerous adverse effects can easily lead to malnutrition. It is difficult to centrally manage patients with OC in the intervals between chemotherapy. The use of WeChat, an effective mobile tool, in chronic disease management has been highlighted. Objective: This study aimed to implement a continuous follow-up strategy and health monitoring based on the WeChat platform for patients with OC undergoing chemotherapy to ensure that each phase of chemotherapy was delivered on schedule and to improve the survival rate of patients with OC. Methods: Participants were recruited and randomly assigned to either the WeChat-based nutrition intervention group or the usual care group. A self-administered general information questionnaire was used at enrollment to obtain basic information about the patients. The Patient-Generated Subjective Global Assessment (PG-SGA) Scale was used to investigate the nutritional status of the patients at 3 time points (T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). The blood indices of patients were investigated through the inhospital health care system at 3 times?T0=before the first admission to the hospital for chemotherapy, T1=2 weeks after the first chemotherapy, and T6=2 weeks after the sixth chemotherapy). Patients in the intervention group were introduced to the nutrition applet, invited to join the nutrition management group chat, and allowed to consult on nutritional issues in private chats with nutrition management team members. Linear mixed models were used to analyze changes in each nutritional indicator in the 2 groups, with their baseline measurements as covariates; with group, time, and group-time interactions considered as fixed effects; and with patients considered as random effects. Results: A total of 96 patients with OC undergoing chemotherapy were recruited into the study. Distribution was based on a 1:1 ratio, with 48 patients each in the nutrition intervention group and the usual care group. The attrition rate after the first chemotherapy session was 18.75\%. The mixed linear model revealed that the group-based effect and the group-time interaction effect on PG-SGA scores were significant (F38,38=4.763, P=.03; F37,37=6.368, P=.01), whereas the time-based effect on PG-SGA scores was not (F38,38=0.377; P=.54). The findings indicated that the group-based effect, the time-based effect, and the group-time interaction effect on nutrition-inflammation composite indices were significant (F38,38=7.653, P=.006; F38,38=13.309, P<.001; F37,37=92.304, P<.001; F37,38=110.675, P<.001; F38,38=10.379, P=.002; and F37,37=5.289, P=.02). Conclusions: This study provided evidence that a WeChat-based, multidisciplinary, full-course nutritional management program can significantly improve the nutritional status of patients with OC during chemotherapy. Trial Registration: ClinicalTrials.gov NCT06379191; https://clinicaltrials.gov/study/NCT06379191 ",
doi="10.2196/56475",
url="https://mhealth.jmir.org/2024/1/e56475"
}


@Article{info:doi/10.2196/51291,
author="Zhou, Weijiao
and Shang, Shaomei
and Cho, Youmin",
title="Associations of Wearable Activity Tracker Use With Physical Activity and Health Outcomes in Patients With Cancer: Findings from a Population-Based Survey Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="22",
volume="26",
pages="e51291",
keywords="physical activity",
keywords="exercise",
keywords="wearable tracker",
keywords="wearable device",
keywords="cancer",
keywords="oncology",
keywords="cancer survivorship",
keywords="wearable",
keywords="wearables",
keywords="tracker",
keywords="trackers",
keywords="health outcome",
keywords="health outcomes",
keywords="HINTS",
keywords="survey",
keywords="surveys",
keywords="national",
keywords="bivariate",
keywords="epidemiology",
keywords="epidemiological",
keywords="association",
keywords="associations",
abstract="Background: Physical inactivity is a global issue for cancer survivors. Wearable activity trackers are promising to address physical inactivity by providing real-time feedback on physical activity and offering opportunities for self-monitoring and goal setting. Meta-analysis has reported the effects of interventions that incorporate wearable activity trackers on improved physical inactivity and related health outcomes (eg, BMI, anxiety and depression, and self-rated health status). However, wearable activity trackers were often used as an adjunct to physical activity interventions, and the effectiveness of wearable activity trackers alone is unknown. Objective: This study aims to determine the association of wearable activity trackers with physical activity and health outcomes in patients with cancer. Methods: Data from 957 cancer survivors from the Health Information National Trends Survey--Surveillance, Epidemiology, and End Results (HINTS-SEER) were analyzed. The outcome variables examined were time spent in moderate to vigorous physical activity, weekly frequency of strength training, BMI, anxiety and depression levels, and self-assessed health status. The primary independent variable was whether cancer survivors had used wearable activity trackers within the past 12 months. Design-based linear regression for continuous outcome variables and ordinal logistic regression for ordinal outcome variables were conducted to determine the associations after controlling for sociodemographic, cancer-related, and health-related factors. All data analyses accounted for the complex survey design and sample weights. Results: Only 29\% of cancer survivors reported wearable activity tracker use. Bivariate analyses showed that younger age (P<.001), higher education (P=.04), higher income (P<.001), and an employed status (P<.001) were significantly associated with wearable activity tracker use. Wearable activity tracker use was significantly associated with higher time spent in moderate to vigorous physical activity (adjusted =37.94, 95\% CI 8.38-67.5; P=.01), more frequent strength training per week (adjusted odds ratio [OR] 1.50, 95\% CI 1.09-2.06; P=.01), and better self-rated health status (adjusted OR 1.58, 95\% CI 1.09-2.29; P=.01), but not with BMI or anxiety and depression. Conclusions: This study suggests that the uptake of wearable activity trackers is low and highlights the digital divide among patients with cancer. This study has confirmed the associations of wearable activity tracker use with physical activity and self-rated health, supporting using wearable activity trackers as a promising tool to facilitate physical activity promotion. ",
doi="10.2196/51291",
url="https://www.jmir.org/2024/1/e51291",
url="http://www.ncbi.nlm.nih.gov/pubmed/39436693"
}


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


@Article{info:doi/10.2196/60828,
author="Selles, Lima William de
and Miyamoto, Cristiane Gisela
and Santos, Concei{\c{c}}{\~a}o Elinaldo da
and Carmo, Lima Cibelle Regina
and Moura, Marini Giovanni
and Santos, Frascoli Giovanna Marques
and Lopes, Santos Giovanna dos
and Silva, Wisnieski Diego
and Pereira, Ferreira Leticia Jeremias
and Lunardi, Claudia Adriana",
title="Effectiveness of Aerobic Training for Adverse Symptoms Related to Chemotherapy During Treatment: Protocol for a Randomized Controlled Trial With Cost-Effectiveness Assessment",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="20",
volume="13",
pages="e60828",
keywords="cancer",
keywords="exercise",
keywords="chemotherapy",
keywords="physical therapy",
keywords="cost benefit analyses",
keywords="economic evaluation",
abstract="Background: One strategy to prevent adverse effects resulting from chemotherapy treatment is to perform physical exercises during treatment. However, there is still no consensus on the best type and intensity of exercise, nor when it should be started. Most studies have been carried out in patients with breast cancer, usually a few weeks after starting chemotherapy, on an outpatient basis 2 to 3 times a week. The main differences in our study are that we carried out physical training in hospitalized patients undergoing a cycle of chemotherapy for cancer treatment and that this training was carried out 5 times a week and was not restricted to a specific type of cancer. Objective: We aimed to evaluate the effects of aerobic training on symptoms related to chemotherapy (nausea, vomiting, asthenia, and sensation of weakness), fatigue, mobility, clinical complications, and length of hospital stay of patients during the drug treatment cycle. We also evaluated patient satisfaction with the proposed intervention, the adverse effects of aerobics training, and the cost-effectiveness of this intervention. Methods: This is a controlled and randomized trial with blinded evaluation that will include 94 hospitalized patients with cancer for 1 or more cycles of chemotherapy. The intervention group will perform aerobic training during a cycle of chemotherapy. The control group will receive a booklet with guidelines for staying active during the hospitalization period. The groups will be compared using a linear mixed model for fatigue, mobility, and chemotherapy-related symptoms before and after the intervention. The length of hospital stay will also be compared between groups using Kaplan-Meier survival analysis. The incidence of complications will be compared using the $\chi$2 test. Cost-effectiveness and cost-utility analyses will be performed for the impact of exercise and quality-adjusted life years with the EQ-5D-3L-21 quality of life trials. The implementation variables (acceptability, suitability, and feasibility) will be evaluated by frequencies. Results: The clinical trial registration was approved in March 2023. Recruitment and data collection for the trial are ongoing, and the results of this study are likely to be published in late 2025. Conclusions: Chemotherapy has side effects that negatively impact the quality of life of patients with cancer. Aerobic exercise can reduce these side effects in a simple and inexpensive way. The field of work of physical therapists could be expanded to oncology if the intervention works. Trial Registration: Registro Brasileiro de Ensaios Cl{\'i}nicos RBR-6b4zwx3; https://tinyurl.com/39c4c7wz International Registered Report Identifier (IRRID): DERR1-10.2196/60828 ",
doi="10.2196/60828",
url="https://www.researchprotocols.org/2024/1/e60828",
url="http://www.ncbi.nlm.nih.gov/pubmed/39163116"
}


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


@Article{info:doi/10.2196/54819,
author="Nygren, M. Jens
and Aili, Katarina
and Arvidsson, Susann
and Olsson, Maria
and Jarfelt, Marianne",
title="Charting Health Challenges for Digital Preventive Interventions Among Adult Survivors of Childhood Acute Lymphoblastic Leukemia: National Long-Term Follow-Up Survey of Self-Rated Health Outcomes",
journal="JMIR Form Res",
year="2024",
month="Aug",
day="12",
volume="8",
pages="e54819",
keywords="digital preventive interventions",
keywords="long-term follow-up",
keywords="self-rated health outcomes",
keywords="adult survivors",
keywords="childhood acute lymphoblastic leukemia",
abstract="Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood, but the prognosis has remarkably improved over the last 50 years in high-income countries, and thus, there is a focus on long-term health outcomes following survival and how to best provide health care support to adult long-term survivors of childhood ALL to prevent and handle potential health problems. Digital health interventions are promising to deliver feasible health promotion and prevention programs. This is particularly relevant for ensuring long-term follow-up in cases where continuous contact with oncology care may be disrupted. Moreover, these interventions are beneficial in reaching geographically dispersed target groups and overcoming the time constraints of everyday life that often hinder participation in such programs. Objective: This study aimed to fill the gaps in existing research on adult long-term survivors of childhood ALL and provide formative data that can inform the development of formalized follow-up services designed to meet the needs of these survivors in ways that align with their preferences for digital health interventions. Methods: In this cross-sectional national study, adult survivors (aged ?18 years) of childhood ALL for over 10 years after diagnosis were compared to their siblings in terms of mental and physical health-related factors, including sleep, stress, anxiety, and depression (Depression Anxiety and Stress Scale 21 [DASS-21]); several dimensions of fatigue (Multidimensional Fatigue Inventory 20 [MFI-20]); work ability (Work Ability Index); chronic pain; and prevalences of diabetes, cardiovascular disease, headache or migraine, and rheumatic disease. Results: Overall, 426 of 855 eligible ALL survivors responded (mean age 30.9, SD 7.7 years), and they participated at an average of 24 (SD 6.9) years after ALL diagnosis. Siblings (n=135; mean age 31.5, SD 7.7 years) acted as controls. Sleep quality, sleep quantity, and mean work ability scores were significantly lower, and physical fatigue, reduced motivation, and reduced activity scores were higher in ALL survivors than in siblings. There were no significant differences between the groups in terms of BMI and prevalence of chronic pain, depression, anxiety, or stress. Physical and psychological complications were more frequent among adult ALL survivors who had received hematopoietic stem cell transplantation (HSCT) than among those who had not received HSCT. Conclusions: Our nationwide cross-sectional study addressed the scarcity of knowledge regarding the self-reported health outcomes of adult long-term survivors of childhood ALL. We highlighted significant disparities within this population and emphasized the potential of comprehensive digital interventions that target vitality, sleep quality, fatigue, and psychosocial well-being to enhance well-being and bolster the capacity for managing chronic health conditions in this target group. Such an intervention would align with the needs of this target group, which is a prerequisite for successfully incorporating technology into the daily lives of survivors of childhood ALL. ",
doi="10.2196/54819",
url="https://formative.jmir.org/2024/1/e54819"
}


@Article{info:doi/10.2196/53180,
author="Bachman, L. Shelby
and Gomes, Emma
and Aryal, Suvekshya
and Cella, David
and Clay, Ieuan
and Lyden, Kate
and Leach, J. Heather",
title="Do Measures of Real-World Physical Behavior Provide Insights Into the Well-Being and Physical Function of Cancer Survivors? Cross-Sectional Analysis",
journal="JMIR Cancer",
year="2024",
month="Jul",
day="15",
volume="10",
pages="e53180",
keywords="accelerometer",
keywords="cancer survivorship",
keywords="cancer survivors",
keywords="digital health technology",
keywords="health-related quality of life",
keywords="physical behavior",
keywords="physical function",
abstract="Background: As the number of cancer survivors increases, maintaining health-related quality of life in cancer survivorship is a priority. This necessitates accurate and reliable methods to assess how cancer survivors are feeling and functioning. Real-world digital measures derived from wearable sensors offer potential for monitoring well-being and physical function in cancer survivorship, but questions surrounding the clinical utility of these measures remain to be answered. Objective: In this secondary analysis, we used 2 existing data sets to examine how measures of real-world physical behavior, captured with a wearable accelerometer, were related to aerobic fitness and self-reported well-being and physical function in a sample of individuals who had completed cancer treatment. Methods: Overall, 86 disease-free cancer survivors aged 21-85 years completed self-report assessments of well-being and physical function, as well as a submaximal exercise test that was used to estimate their aerobic fitness, quantified as predicted submaximal oxygen uptake (VO2). A thigh-worn accelerometer was used to monitor participants' real-world physical behavior for 7 days. Accelerometry data were used to calculate average values of the following measures of physical behavior: sedentary time, step counts, time in light and moderate to vigorous physical activity, time and weighted median cadence in stepping bouts over 1 minute, and peak 30-second cadence. Results: Spearman correlation analyses indicated that 6 (86\%) of the 7 accelerometry-derived measures of real-world physical behavior were not significantly correlated with Functional Assessment of Cancer Therapy-General total well-being or linked Patient-Reported Outcomes Measurement Information System-Physical Function scores (Ps?.08). In contrast, all but one of the physical behavior measures were significantly correlated with submaximal VO2 (Ps?.03). Comparing these associations using likelihood ratio tests, we found that step counts, time in stepping bouts over 1 minute, and time in moderate to vigorous activity were more strongly associated with submaximal VO2 than with self-reported well-being or physical function (Ps?.03). In contrast, cadence in stepping bouts over 1 minute and peak 30-second cadence were not more associated with submaximal VO2 than with the self-reported measures (Ps?.08). Conclusions: In a sample of disease-free cancer survivors, we found that several measures of real-world physical behavior were more associated with aerobic fitness than with self-reported well-being and physical function. These results highlight the possibility that in individuals who have completed cancer treatment, measures of real-world physical behavior may provide additional information compared with self-reported and performance measures. To advance the appropriate use of digital measures in oncology clinical research, further research evaluating the clinical utility of real-world physical behavior over time in large, representative samples of cancer survivors is warranted. Trial Registration: ClinicalTrials.gov NCT03781154; https://clinicaltrials.gov/ct2/show/NCT03781154 ",
doi="10.2196/53180",
url="https://cancer.jmir.org/2024/1/e53180",
url="http://www.ncbi.nlm.nih.gov/pubmed/39008350"
}


@Article{info:doi/10.2196/46303,
author="Andree, Rosa
and Mujcic, Ajla
and den Hollander, Wouter
and van Laar, Margriet
and Boon, Brigitte
and Engels, Rutger
and Blankers, Matthijs",
title="Digital Smoking Cessation Intervention for Cancer Survivors: Analysis of Predictors and Moderators of Engagement and Outcome Alongside a Randomized Controlled Trial",
journal="JMIR Cancer",
year="2024",
month="Jun",
day="20",
volume="10",
pages="e46303",
keywords="smoking cessation",
keywords="cancer survivors",
keywords="engagement",
keywords="digital intervention",
keywords="eHealth",
keywords="smoking",
keywords="intervention",
keywords="randomized controlled trial",
keywords="predictor",
keywords="RCT",
keywords="smoker",
keywords="addict",
keywords="cessation",
keywords="quit",
keywords="cancer",
keywords="oncology",
abstract="Background: Recent studies have shown positive, though small, clinical effects of digital smoking cessation (SC) interventions for cancer survivors. However, research on associations among participant characteristics, intervention engagement, and outcomes is limited. Objective: This study aimed to explore the predictors and moderators of engagement and outcome of MyCourse-Quit Smoking (in Dutch: ``MijnKoers-Stoppen met Roken''), a digital minimally guided intervention for cancer survivors. Methods: A secondary analysis of data from the randomized controlled trial was performed. The number of cigarettes smoked in the past 7 days at 6-month follow-up was the primary outcome measure. We analyzed interactions among participant characteristics (11 variables), intervention engagement (3 variables), and outcome using robust linear (mixed) modeling. Results: In total, 165 participants were included in this study. Female participants accessed the intervention less often than male participants (B=--11.12; P=.004). A higher Alcohol Use Disorders Identification Test score at baseline was associated with a significantly higher number of logins (B=1.10; P<.001) and diary registrations (B=1.29; P<.001). A higher Fagerstr{\"o}m Test for Nicotine Dependence score at baseline in the intervention group was associated with a significantly larger reduction in tobacco use after 6 months (B=--9.86; P=.002). No other associations and no moderating effects were found. Conclusions: Overall, a limited number of associations was found between participant characteristics, engagement, and outcome, except for gender, problematic alcohol use, and nicotine dependence. Future studies are needed to shed light on how this knowledge can be used to improve the effects of digital SC programs for cancer survivors. Trial Registration: Netherlands Trial register NTR6011/NL5434; https://onderzoekmetmensen.nl/nl/trial/22832 ",
doi="10.2196/46303",
url="https://cancer.jmir.org/2024/1/e46303"
}


@Article{info:doi/10.2196/51210,
author="Page, L. Lindsey
and Fanning, Jason
and Phipps, Connor
and Berger, Ann
and Reed, Elizabeth
and Ehlers, Diane",
title="Heart Rate Monitoring Among Breast Cancer Survivors: Quantitative Study of Device Agreement in a Community-Based Exercise Program",
journal="JMIR Cancer",
year="2024",
month="Jun",
day="20",
volume="10",
pages="e51210",
keywords="wearable devices",
keywords="exercise prescription",
keywords="validity",
keywords="photoplethysmography",
keywords="monitoring",
keywords="wearables",
keywords="devices",
keywords="exercise",
keywords="heart rate",
keywords="breast cancer",
keywords="cancer",
keywords="cancer survivor",
keywords="community",
keywords="chest monitor",
keywords="Fitbit",
keywords="recovery",
keywords="safety",
abstract="Background: Exercise intensity (eg, target heart rate [HR]) is a fundamental component of exercise prescription to elicit health benefits in cancer survivors. Despite the validity of chest-worn monitors, their feasibility in community and unsupervised exercise settings may be challenging. As wearable technology continues to improve, consumer-based wearable sensors may represent an accessible alternative to traditional monitoring, offering additional advantages. Objective: The purpose of this study was to examine the agreement between the Polar H10 chest monitor and Fitbit Inspire HR for HR measurement in breast cancer survivors enrolled in the intervention arm of a randomized, pilot exercise trial. Methods: Participants included breast cancer survivors (N=14; aged 38-72 years) randomized to a 12-week aerobic exercise program. This program consisted of three 60-minute, moderate-intensity walking sessions per week, either in small groups or one-on-one, facilitated by a certified exercise physiologist and held at local community fitness centers. As originally designed, the exercise prescription included 36 supervised sessions at a fitness center. However, due to the COVID-19 pandemic, the number of supervised sessions varied depending on whether participants enrolled before or after March 2020. During each exercise session, HR (in beats per minute) was concurrently measured via a Polar H10 chest monitor and a wrist-worn Fitbit Inspire HR at 5 stages: pre-exercise rest; midpoint of warm-up; midpoint of exercise session; midpoint of cool-down; and postexercise recovery. The exercise physiologist recorded the participant's HR from each device at the midpoint of each stage. HR agreement between the Polar H10 and Fitbit Inspire HR was assessed using Lin concordance correlation coefficient (rc) with a 95\% CI. Lin rc ranges from 0 to 1.00, with 0 indicating no concordance and 1.00 indicating perfect concordance. Relative error rates were calculated to examine differences across exercise session stages. Results: Data were available for 200 supervised sessions across the sample (session per participant: mean 13.33, SD 13.7). By exercise session stage, agreement between the Polar H10 monitor and the Fitbit was highest during pre-exercise seated rest (rc=0.76, 95\% CI 0.70-0.81) and postexercise seated recovery (rc=0.89, 95\% CI 0.86-0.92), followed by the midpoint of exercise (rc=0.63, 95\% CI 0.55-0.70) and cool-down (rc=0.68, 95\% CI 0.60-0.74). The agreement was lowest during warm-up (rc=0.39, 95\% CI 0.27-0.49). Relative error rates ranged from --3.91\% to 3.09\% and were greatest during warm-up (relative error rate: mean --3.91, SD 11.92\%). Conclusions: The Fitbit overestimated HR during peak exercise intensity, posing risks for overexercising, which may not be safe for breast cancer survivors' fitness levels. While the Fitbit Inspire HR may be used to estimate exercise HR, precautions are needed when considering participant safety and data interpretation. Trial Registration: Clinicaltrials.gov NCT03980626; https://clinicaltrials.gov/study/NCT03980626?term=NCT03980626\&rank=1 ",
doi="10.2196/51210",
url="https://cancer.jmir.org/2024/1/e51210",
url="http://www.ncbi.nlm.nih.gov/pubmed/38900505"
}


@Article{info:doi/10.2196/52494,
author="Pinto, M. Bernardine
and Patel, Ashwin
and Ostendorf, M. Danielle
and Huebschmann, G. Amy
and Dunsiger, I. Shira
and Kindred, M. Madison",
title="Adapting an Efficacious Peer-Delivered Physical Activity Program for Survivors of Breast Cancer for Web Platform Delivery: Protocol for a 2-Phase Study",
journal="JMIR Res Protoc",
year="2024",
month="Jun",
day="19",
volume="13",
pages="e52494",
keywords="physical activity adoption",
keywords="web platform",
keywords="breast cancer survivors",
keywords="design",
keywords="implementation",
keywords="cost-effectiveness",
keywords="mobile phone",
abstract="Background: Interventions promoting physical activity (PA) among survivors of cancer improve their functioning, reduce fatigue, and offer other benefits in cancer recovery and risk reduction for future cancer. There is a need for interventions that can be implemented on a wider scale than that is possible in research settings. We have previously demonstrated that a 3-month peer-delivered PA program (Moving Forward Together [MFT]) significantly increased the moderate to vigorous PA (MVPA) of survivors of breast cancer. Objective: Our goal is to scale up the MFT program by adapting an existing peer mentoring web platform, Mentor1to1. InquistHealth's web platform (Mentor1to1) has demonstrated efficacy in peer mentoring for chronic disease management. We will partner with InquisitHealth to adapt their web platform for MFT. The adaptation will allow for automating key resource-intensive components such as matching survivors with a coach via the web-based peer mentoring platform and collecting key indexes to prepare for large-scale implementation. The aim is to streamline intervention delivery, assure fidelity, and improve survivor outcomes. Methods: In phase 1 of this 2-phase study, we will interview 4 peer mentors or coaches with experience in delivering MFT and use their feedback to create Mentor1to1 web platform adapted for MFT (webMFT). Next, another 4 coaches will participate in rapid, iterative user-centered testing of webMFT. In phase 2, we will conduct a randomized controlled trial by recruiting and training 10 to 12 coaches from cancer organizations to deliver webMFT to 56 survivors of breast cancer, who will be assigned to receive either webMFT or MVPA tracking (control) for 3 months. We will assess effectiveness with survivors' accelerometer-measured MVPA and self-reported psychosocial well-being at baseline and 3 months. We will assess implementation outcomes, including acceptability, feasibility, and program costs from the perspective of survivors, coaches, and collaborating organizations, as guided by the expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Results: As of September 2023, phase 1 of the study was completed, and 61 survivors were enrolled in phase 2. Using newer technologies for enhanced intervention delivery, program management, and automated data collection has the exciting promise of facilitating effective implementation by organizations with limited resources. Adapting evidence-based MFT to a customized web platform and collecting data at multiple levels (coaches, survivors, and organizations) along with costs will provide a strong foundation for a robust multisite implementation trial to increase MVPA and its benefits among many more survivors of breast cancer. Conclusions: The quantitative and qualitative data collected from survivors of cancer, coaches, and organizations will be analyzed to inform a future larger-scale trial of peer mentoring for PA delivered by cancer care organizations to survivors. Trial Registration: ClinicalTrials.gov NCT05409664; https://clinicaltrials.gov/study/NCT05409664 International Registered Report Identifier (IRRID): DERR1-10.2196/52494 ",
doi="10.2196/52494",
url="https://www.researchprotocols.org/2024/1/e52494",
url="http://www.ncbi.nlm.nih.gov/pubmed/38896452"
}


@Article{info:doi/10.2196/54126,
author="Jerome, J. Gerald
and Appel, J. Lawrence
and Bunyard, Linda
and Dalcin, T. Arlene
and Durkin, Nowella
and Charleston, B. Jeanne
and Kanarek, F. Norma
and Carducci, A. Michael
and Wang, Nae-Yuh
and Yeh, Hsin-Chieh",
title="Behavioral Weight Loss Programs for Cancer Survivors Throughout Maryland: Protocol for a Pragmatic Trial and Participant Characteristics",
journal="JMIR Res Protoc",
year="2024",
month="Jun",
day="12",
volume="13",
pages="e54126",
keywords="cancer",
keywords="obesity",
keywords="weight loss",
keywords="pragmatic trial",
keywords="oncology",
keywords="weight",
keywords="overweight",
keywords="obese",
keywords="USA",
keywords="United States",
keywords="survivor",
keywords="survivors",
keywords="remote",
keywords="self-directed",
keywords="self-guided",
keywords="coach",
keywords="coaching",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="apps",
keywords="application",
keywords="applications",
keywords="EHR",
keywords="health record",
keywords="health records",
keywords="mobile phone",
abstract="Background: Clinical trials examining lifestyle interventions for weight loss in cancer survivors have been demonstrated to be safe, feasible, and effective. However, scalable weight loss programs are needed to support their widespread implementation. The ASPIRE trial was designed to evaluate real-world, lifestyle-based, weight loss programs for cancer survivors throughout Maryland. Objective: The objectives of this protocol paper are to describe the design of a nonrandomized pragmatic trial, study recruitment, and baseline characteristics of participants. Methods: Participants were aged ?18 years, residing in Maryland, with a BMI ?25 kg/m2, who reported a diagnosis of a malignant solid tumor, completed curative treatment, and had no ongoing or planned cancer treatment. Enrollment criteria were minimized to increase generalizability. The primary recruitment source was the Johns Hopkins Health System electronic health records (EHRs). Participants selected 1 of 3 remotely delivered weight loss programs: self-directed, app-supported, or coach-supported program. Results: Participants were recruited across all 5 geographic regions of Maryland. Targeted invitations using EHRs accounted for 287 (84.4\%) of the 340 participants enrolled. Of the 5644 patients invited through EHR, 5.1\% (287/5644) enrolled. Participants had a mean age of 60.7 (SD 10.8) years, 74.7\% (254/340) were female, 55.9\% (190/340) identified as non-Hispanic Black, 58.5\% (199/340) had a bachelor's degree, and the average BMI was 34.1 kg/m2 (SD 5.9 kg/m2). The most common types of cancers were breast (168/340, 49.4\%), prostate (72/340, 21.2\%), and thyroid (39/340, 8.5\%). The self-directed weight loss program (n=91) included 25 participants who agreed to provide weights through a study scale; the app-supported program (n=142) included 108 individuals who agreed to provide their weight measurements; and the coach-supported weight loss program included 107 participants. We anticipate final analysis will take place in the fall of 2024. Conclusions: Using EHR-based recruitment efforts, this study took a pragmatic approach to reach and enroll cancer survivors into remotely delivered weight loss programs. Trial Registration: ClinicalTrials.gov NCT04534309; https://clinicaltrials.gov/study/NCT04534309 International Registered Report Identifier (IRRID): DERR1-10.2196/54126 ",
doi="10.2196/54126",
url="https://www.researchprotocols.org/2024/1/e54126",
url="http://www.ncbi.nlm.nih.gov/pubmed/38865181"
}


@Article{info:doi/10.2196/50783,
author="Jiang, Lulu
and Xu, Jiehui
and Wu, Yanwei
and Liu, Yanyan
and Wang, Xiyi
and Hu, Yun",
title="Effects of the ``AI-TA'' Mobile App With Intelligent Design on Psychological and Related Symptoms of Young Survivors of Breast Cancer: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jun",
day="4",
volume="12",
pages="e50783",
keywords="mobile app",
keywords="artificial intelligence",
keywords="interactivity",
keywords="breast cancer",
keywords="psychological symptoms",
keywords="self-efficacy",
keywords="social support",
keywords="quality of life",
abstract="Background: Young women often face substantial psychological challenges in the initial years following cancer diagnosis, leading to a comparatively lower quality of life than older survivors. While mobile apps have emerged as potential interventions, their effectiveness remains inconclusive due to the diversity in intervention types and variation in follow-up periods. Furthermore, there is a particular dearth of evidence regarding the efficacy of these apps' intelligent features in addressing psychological distress with these apps. Objective: This study aims to evaluate the effectiveness of a mobile app with intelligent design called ``AI-TA'' on cancer-related psychological health and ongoing symptoms with a randomized controlled design. Methods: Women aged 18 to 45 years diagnosed with breast cancer were randomly assigned to the intervention or control group. The intervention was AI-TA, which included 2-way web-based follow-up every 2 weeks. Both intention-to-treat (ITT) and per-protocol (PP) analyses employed repeated measurement analysis of variance. The participants' background features, primary outcomes (psychological distress and frequency, self-efficacy, and social support), and secondary outcomes (quality of life) were measured using multiple instruments at 3 time points (baseline, 1-month intervention, and 3-month intervention). Results: A total of 124 participants were randomly allocated to the control group (n=62, 50\%) or intervention group (n=62, 50\%). In total, 92.7\% (115/124) of the participants completed the intervention. Significant improvements in psychological symptoms (Memorial Symptom Assessment Scale-Short Form) were observed in the ITT group from baseline to 1-month intervention relative to the control group (ITT vs control: 1.17 vs 1.23; P<.001), which persisted at 3-month follow-up (ITT vs control: 0.68 vs 0.91; P<.001). Both the ITT and PP groups exhibited greater improvements in self-efficacy (Cancer Behavior Inventory-Brief Version) than the control group at 1-month (ITT vs PP vs control: 82.83 vs 77.12 vs 65.35; P<.001) and 3-month intervention (ITT vs PP vs control: 92.83 vs 89.30 vs 85.65; P<.001). However, the change in social support (Social Support Rating Scale) did not increase significantly until 3-month intervention (ITT vs control: 50.09 vs 45.10; P=.002) (PP vs control: 49.78 vs 45.10; P<.001). All groups also experienced beneficial effects on quality of life (Functional Assessment of Cancer Therapy-Breast), which persisted at 3-month follow-up (P<.001). Conclusions: The intelligent mobile app AI-TA incorporating intelligent design shows promise for reducing psychological and cancer-related symptoms among young survivors of breast cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200058823; https://www.chictr.org.cn/showproj.html?proj=151195 ",
doi="10.2196/50783",
url="https://mhealth.jmir.org/2024/1/e50783",
url="http://www.ncbi.nlm.nih.gov/pubmed/38833298"
}


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


@Article{info:doi/10.2196/48380,
author="Choi, Young Yoon
and Lee, Myeongjee
and Kim, Hwa Eun
and Lee, Eun Jae
and Jung, Inkyung
and Cheong, Jae-Ho",
title="Risk of Subsequent Primary Cancers Among Adult-Onset 5-Year Cancer Survivors in South Korea: Retrospective Cohort Study",
journal="JMIR Public Health Surveill",
year="2024",
month="May",
day="8",
volume="10",
pages="e48380",
keywords="cancer",
keywords="survivors",
keywords="subsequent primary cancer",
keywords="adult",
keywords="onset",
keywords="primary cancer",
keywords="risk",
keywords="general population",
keywords="screening",
keywords="genetic testing",
keywords="retrospective",
keywords="cohort study",
keywords="health Insurance",
keywords="survivability",
keywords="hereditary",
keywords="FPC",
keywords="SPC",
keywords="subsequent cancer",
abstract="Background: The number of cancer survivors who develop subsequent primary cancers (SPCs) is expected to increase. Objective: We evaluated the overall and cancer type--specific risks of SPCs among adult-onset cancer survivors by first primary cancer (FPC) types considering sex and age. Methods: We conducted a retrospective cohort study using the Health Insurance Review and Assessment database of South Korea including 5-year cancer survivors diagnosed with an FPC in 2009 to 2010 and followed them until December 31, 2019. We measured the SPC incidence per 10,000 person-years and the standardized incidence ratio (SIR) compared with the incidence expected in the general population. Results: Among 266,241 survivors (mean age at FPC: 55.7 years; 149,352/266,241, 56.1\% women), 7348 SPCs occurred during 1,003,008 person-years of follow-up (median 4.3 years), representing a 26\% lower risk of developing SPCs (SIR 0.74, 95\% CI 0.72-0.76). Overall, men with 14 of the 20 FPC types had a significantly lower risk of developing any SPCs; women with 7 of the 21 FPC types had a significantly lower risk of developing any SPCs. The risk of developing any SPC type differed by age; the risk was 28\% higher in young (<40 years) cancer survivors (SIR 1.28, 95\% CI 1.16-1.42; incidence: 30 per 10,000 person-years) and 27\% lower in middle-aged and older (?40 years) cancer survivors (SIR 0.73, 95\% CI 0.71-0.74; incidence: 80 per 10,000 person-years) compared with the age-corresponding general population. The most common types of FPCs were mainly observed as SPCs in cancer survivors, with lung (21.6\%) and prostate (15.2\%) cancers in men and breast (18.9\%) and lung (12.2\%) cancers in women. The risks of brain cancer in colorectal cancer survivors, lung cancer in laryngeal cancer survivors, and both kidney cancer and leukemia in thyroid cancer survivors were significantly higher for both sexes. Other high-risk SPCs varied by FPC type and sex. Strong positive associations among smoking-related cancers, such as laryngeal, head and neck, lung, and esophageal cancers, were observed. Substantial variation existed in the associations between specific types of FPC and specific types of SPC risk, which may be linked to hereditary cancer syndrome: for women, the risks of ovarian cancer for breast cancer survivors and uterus cancers for colorectal cancer survivors, and for men, the risk of pancreas cancer for kidney cancer survivors. Conclusions: The varying risk for SPCs by age, sex, and FPC types in cancer survivors implies the necessity for tailored prevention and screening programs targeting cancer survivors. Lifestyle modifications, such as smoking cessation, are essential to reduce the risk of SPCs in cancer survivors. In addition, genetic testing, along with proactive cancer screening and prevention strategies, should be implemented for young cancer survivors because of their elevated risk of developing SPCs. ",
doi="10.2196/48380",
url="https://publichealth.jmir.org/2024/1/e48380",
url="http://www.ncbi.nlm.nih.gov/pubmed/38717807"
}


@Article{info:doi/10.2196/52957,
author="Innominato, F. Pasquale
and Macdonald, H. Jamie
and Saxton, Wendy
and Longshaw, Laura
and Granger, Rachel
and Naja, Iman
and Allocca, Carlo
and Edwards, Ruth
and Rasheed, Solah
and Folkvord, Frans
and de Batlle, Jordi
and Ail, Rohit
and Motta, Enrico
and Bale, Catherine
and Fuller, Claire
and Mullard, P. Anna
and Subbe, P. Christian
and Griffiths, Dawn
and Wreglesworth, I. Nicholas
and Pecchia, Leandro
and Fico, Giuseppe
and Antonini, Alessio",
title="Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="30",
volume="13",
pages="e52957",
keywords="cancer",
keywords="survivorship",
keywords="artificial intelligence",
keywords="remote monitoring",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
keywords="circadian",
keywords="actigraphy",
keywords="mobile phone",
abstract="Background: Healthy lifestyle interventions have a positive impact on multiple disease trajectories, including cancer-related outcomes. Specifically, appropriate habitual physical activity, adequate sleep, and a regular wholesome diet are of paramount importance for the wellness and supportive care of survivors of cancer. Mobile health (mHealth) apps have the potential to support novel tailored lifestyle interventions. Objective: This observational pilot study aims to assess the feasibility of mHealth multidimensional longitudinal monitoring in survivors of cancer. The primary objective is to test the compliance (user engagement) with the monitoring solution. Secondary objectives include recording clinically relevant subjective and objective measures collected through the digital solution. Methods: This is a monocentric pilot study taking place in Bangor, Wales, United Kingdom. We plan to enroll up to 100 adult survivors of cancer not receiving toxic anticancer treatment, who will provide self-reported behavioral data recorded via a dedicated app and validated questionnaires and objective data automatically collected by a paired smartwatch over 16 weeks. The participants will continue with their normal routine surveillance care for their cancer. The primary end point is feasibility (eg, mHealth monitoring acceptability). Composite secondary end points include clinically relevant patient-reported outcome measures (eg, the Edmonton Symptom Assessment System score) and objective physiological measures (eg, step counts). This trial received a favorable ethical review in May 2023 (Integrated Research Application System 301068). Results: This study is part of an array of pilots within a European Union funded project, entitled ``GATEKEEPER,'' conducted at different sites across Europe and covering various chronic diseases. Study accrual is anticipated to commence in January 2024 and continue until June 2024. It is hypothesized that mHealth monitoring will be feasible in survivors of cancer; specifically, at least 50\% (50/100) of the participants will engage with the app at least once a week in 8 of the 16 study weeks. Conclusions: In a population with potentially complex clinical needs, this pilot study will test the feasibility of multidimensional remote monitoring of patient-reported outcomes and physiological parameters. Satisfactory compliance with the use of the app and smartwatch, whether confirmed or infirmed through this study, will be propaedeutic to the development of innovative mHealth interventions in survivors of cancer. International Registered Report Identifier (IRRID): PRR1-10.2196/52957 ",
doi="10.2196/52957",
url="https://www.researchprotocols.org/2024/1/e52957",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687985"
}


@Article{info:doi/10.2196/53442,
author="Henriksen, Berg Hege
and Knudsen, Dines Markus
and Hjart{\aa}ker, Anette
and Blomhoff, Rune
and Carlsen, Hauger Monica",
title="Digital Food Frequency Questionnaire Assessing Adherence to the Norwegian Food--Based Dietary Guidelines and Other National Lifestyle Recommendations: Instrument Validation Study",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="30",
volume="26",
pages="e53442",
keywords="digital food frequency questionnaire",
keywords="lifestyle assessment tool",
keywords="relative validity",
keywords="physical activity",
keywords="Norwegian food--based dietary guidelines",
keywords="Norway",
keywords="Norwegian",
keywords="food",
keywords="foods",
keywords="diet",
keywords="dietary",
keywords="lifestyle",
keywords="assessment",
keywords="digital questionnaire",
keywords="investigation",
keywords="food intake",
keywords="dietary intake",
keywords="dietary intakes",
keywords="observation",
keywords="monitoring",
keywords="youths",
keywords="adolescent",
keywords="adolescents",
keywords="teen",
keywords="teens",
keywords="teenager",
keywords="teenagers",
keywords="cross-sectional study",
abstract="Background: Valid assessment tools are needed when investigating adherence to national dietary and lifestyle guidelines. Objective: The relative validity of the new digital food frequency questionnaire, the DIGIKOST-FFQ, against 7-day weighed food records and activity sensors was investigated. Methods: In total, 77 participants were included in the validation study and completed the DIGIKOST-FFQ and the weighed food record, and of these, 56 (73\%) also used the activity sensors. The DIGIKOST-FFQ estimates the intake of foods according to the Norwegian food--based dietary guidelines (FBDGs) in addition to lifestyle factors. Results: At the group level, the DIGIKOST-FFQ showed good validity in estimating intakes according to the Norwegian FBDG. The median differences were small and well below portion sizes for all foods except ``water'' (median difference 230 g/day). The DIGIKOST-FFQ was able to rank individual intakes for all foods (r=0.2-0.7). However, ranking estimates of vegetable intakes should be interpreted with caution. Between 69\% and 88\% of the participants were classified into the same or adjacent quartile for foods and between 71\% and 82\% for different activity intensities. The Bland-Altman plots showed acceptable agreements between DIGIKOST-FFQ and the reference methods. The absolute amount of time in ``moderate to vigorous intensity'' was underestimated with the DIGIKOST-FFQ. However, estimated time in ``moderate to vigorous intensity,'' ``vigorous intensity,'' and ``sedentary time'' showed acceptable correlations and good agreement between the methods. The DIGIKOST-FFQ was able to identify adherence to the Norwegian FBDG and physical activity recommendations. Conclusions: The DIGIKOST-FFQ gave valid estimates of dietary intakes and was able to identify individuals with different degrees of adherence to the Norwegian FBDG and physical activity recommendations. Moderate physical activity was underreported, water was overreported, and vegetables showed poor correlation, which are important to consider when interpreting the data. Good agreement was observed between the methods in estimating dietary intakes and time in ``moderate to vigorous physical activity,'' ``sedentary time,'' and ``sleep.'' ",
doi="10.2196/53442",
url="https://www.jmir.org/2024/1/e53442",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687986"
}


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


@Article{info:doi/10.2196/51669,
author="Erdrich, Jennifer
and Cordova-Marks, M. Felina
and Carson, O. William
and Bea, W. Jennifer
and Montfort, R. William
and Thomson, A. Cynthia",
title="Health Behavior Change Intervention Preferences Expressed by American Indian Cancer Survivors From a Southwest Tribal Community: Semistructured Interview Study",
journal="JMIR Form Res",
year="2024",
month="Mar",
day="27",
volume="8",
pages="e51669",
keywords="Native American cancer disparities",
keywords="diet",
keywords="physical activity",
keywords="prehabilitation",
keywords="native",
keywords="exercise",
keywords="fitness",
keywords="interviews",
keywords="thematic analysis",
keywords="lifestyle",
keywords="Apache",
abstract="Background: While many factors, including social determinants of health, affect cancer mortality, one modifiable risk factor that may contribute to cancer disparities is obesity. The prevalence of obesity in the American Indian/Alaska Native population is 48.1\% per the Centers for Disease Control and Prevention. The overall cancer mortality for the American Indian/Alaska Native population is 18\% higher than the White population as reported by the American Cancer Society. Interventions tailored to American Indian/Alaska Native communities that promote healthy lifestyle behaviors after cancer diagnosis and prior to cancer surgery (prehab) might improve cancer outcomes for this population. Objective: The aim of the study is to characterize the lifestyle behaviors of San Carlos Apache cancer survivors and identify preferences for the adaption of a prehab intervention. Methods: Semistructured interviews and validated questionnaires were completed with San Carlos Apache cancer survivors (N=4), exploring their viewpoints on healthy lifestyle and cancer risk and preferences for program development. A thematic content analysis was conducted. Results: Participants had an average BMI of 31 kg/m2 and walked 53 minutes daily. The majority of participants reported a high willingness to change eating habits (n=3, 75\%). All 4 reported willingness to participate in a diet and exercise program. Important themes and subthemes were identified: (1) cancer is perceived as a serious health condition in the community (N=4, 100\%); (2) environmental exposures are perceived as cancer-causing threats (n=3, 75\%); (3) healthy diet, exercise, and avoiding harmful substances are perceived as mitigating cancer risk (n=3, 75\%); (4) barriers to healthy habits include distance to affordable groceries (n=3, 75\%) and lack of transportation (n=2, 50\%); (5) there is high interest in a prehab program geared toward patients with cancer (N=4, 100\%); and (6) standard monitoring practiced in published prehab programs showed early acceptability with participants (N=4, 100\%). Conclusions: Collaboration with tribal partners provided important insight that can help inform the adaptation of a culturally appropriate prehab program for San Carlos Apache patients diagnosed with cancer. ",
doi="10.2196/51669",
url="https://formative.jmir.org/2024/1/e51669",
url="http://www.ncbi.nlm.nih.gov/pubmed/38536214"
}


@Article{info:doi/10.2196/51057,
author="Robertson, C. Michael
and Cox-Martin, Emily
and Basen-Engquist, Karen
and Lyons, J. Elizabeth",
title="Reflective Engagement With a Digital Physical Activity Intervention Among People Living With and Beyond Breast Cancer: Mixed Methods Study",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Feb",
day="9",
volume="12",
pages="e51057",
keywords="survivors of cancer",
keywords="exercise",
keywords="acceptance and commitment therapy",
keywords="fatigue",
keywords="mindfulness",
keywords="motivation",
keywords="behavioral sciences",
abstract="Background: People living with and beyond breast cancer can face internal barriers to physical activity (eg, fatigue and pain). Digital interventions that promote psychological acceptance and motivation may help this population navigate these barriers. The degree to which individuals (1) adhere to intervention protocols and (2) reflect on and internalize intervention content may predict intervention efficacy. Objective: The objective of this study was to characterize the nature of reflective processes brought about by an 8-week acceptance- and mindfulness-based physical activity intervention for insufficiently active survivors of breast cancer (n=75). Furthermore, we explored the potential utility of a metric of reflective processes for predicting study outcomes. Methods: Of the intervention's 8 weekly modules, 7 (88\%) included an item that asked participants to reflect on what they found to be most useful. Two coders conducted directed content analysis on participants' written responses. They assessed each comment's depth of reflection using an existing framework (ranging from 0 to 4, with 0=simple description and 4=fundamental change with consideration of social and ethical issues). The coders identified themes within the various levels of reflection. We fit multiple linear regression models to evaluate whether participants' (1) intervention adherence (ie, number of modules completed) and (2) the mean level of the depth of reflection predicted study outcomes. Results: Participants were aged on average 57.2 (SD 11.2) years, mostly non-Hispanic White (58/75, 77\%), and mostly overweight or obese (54/75, 72\%). Of the 407 responses to the item prompting personal reflection, 70 (17.2\%) were rated as reflection level 0 (ie, description), 247 (60.7\%) were level 1 (ie, reflective description), 74 (18.2\%) were level 2 (ie, dialogic reflection), 14 (3.4\%) were level 3 (ie, transformative reflection), and 2 (0.5\%) were level 4 (ie, critical reflection). Lower levels of reflection were characterized by the acquisition of knowledge or expressing intentions. Higher levels were characterized by personal insight, commentary on behavior change processes, and a change of perspective. Intervention adherence was associated with increases in self-reported weekly bouts of muscle-strengthening exercise (B=0.26, SE 0.12, 95\% CI 0.02-0.50) and decreases in sleep disturbance (B=?1.04, SE 0.50, 95\% CI ?0.06 to ?2.02). The mean level of reflection was associated with increases in psychological acceptance (B=3.42, SE 1.70, 95\% CI 0.09-6.75) and motivation for physical activity (ie, integrated regulation: B=0.55, SE 0.25, 95\% CI 0.06-1.04). Conclusions: We identified a useful method for understanding the reflective processes that can occur during digital behavior change interventions serving people living with and beyond breast cancer. Intervention adherence and the depth of reflection each predicted changes in study outcomes. Deeper reflection on intervention content was associated with beneficial changes in the determinants of sustained behavior change. More research is needed to investigate the relations among digital behavior change intervention use, psychological processes, and intervention efficacy. ",
doi="10.2196/51057",
url="https://mhealth.jmir.org/2024/1/e51057",
url="http://www.ncbi.nlm.nih.gov/pubmed/38335025"
}


@Article{info:doi/10.2196/49934,
author="Tam, M. Rowena
and Zablocki, W. Rong
and Liu, Chenyu
and Narayan, K. Hari
and Natarajan, Loki
and LaCroix, Z. Andrea
and Dillon, Lindsay
and Sakoulas, Eleanna
and Hartman, J. Sheri",
title="Feasibility of a Health Coach Intervention to Reduce Sitting Time and Improve Physical Functioning Among Breast Cancer Survivors: Pilot Intervention Study",
journal="JMIR Cancer",
year="2023",
month="Dec",
day="19",
volume="9",
pages="e49934",
keywords="physical function",
keywords="sedentary behavior",
keywords="quality of life",
keywords="activPAL",
keywords="health coaching",
keywords="cancer survivors",
keywords="physical functions",
keywords="breast cancer",
keywords="survivors",
keywords="sitting time",
keywords="physical activity",
keywords="walking",
keywords="exercise",
keywords="fatigue",
keywords="sitting",
abstract="Background: Sedentary behavior among breast cancer survivors is associated with increased risk of poor physical function and worse quality of life. While moderate to vigorous physical activity can improve outcomes for cancer survivors, many are unable to engage in that intensity of physical activity. Decreasing sitting time may be a more feasible behavioral target to potentially mitigate the impact of cancer and its treatments. Objective: The purpose of this study was to investigate the feasibility and preliminary impact of an intervention to reduce sitting time on changes to physical function and quality of life in breast cancer survivors, from baseline to a 3-month follow-up. Methods: Female breast cancer survivors with self-reported difficulties with physical function received one-on-one, in-person personalized health coaching sessions aimed at reducing sitting time. At baseline and follow-up, participants wore the activPAL (thigh-worn accelerometer; PAL Technologies) for 3 months and completed physical function tests (4-Meter Walk Test, Timed Up and Go, and 30-Second Chair Stand) and Patient-Reported Outcomes Measurement Information System (PROMIS) self-reported outcomes. Changes in physical function and sedentary behavior outcomes were assessed by linear mixed models. Results: On average, participants (n=20) were aged 64.5 (SD 9.4) years; had a BMI of 30.4 (SD 4.5) kg/m2; and identified as Black or African American (n=3, 15\%), Hispanic or Latina (n=4, 20\%), and non-Hispanic White (n=14, 55\%). Average time since diagnosis was 5.8 (SD 2.2) years with participants receiving chemotherapy (n=8, 40\%), radiotherapy (n=18, 90\%), or endocrine therapy (n=17, 85\%). The intervention led to significant reductions in sitting time: activPAL average daily sitting time decreased from 645.7 (SD 72.4) to 532.7 (SD 142.1; $\beta$=--112.9; P=.001) minutes and average daily long sitting bouts (bout length ?20 min) decreased from 468.3 (SD 94.9) to 366.9 (SD 150.4; $\beta$=--101.4; P=.002) minutes. All physical function tests had significant improvements: on average, 4-Meter Walk Test performance decreased from 4.23 (SD 0.95) to 3.61 (SD 2.53; $\beta$=--.63; P=.002) seconds, Timed Up and Go performance decreased from 10.30 (SD 3.32) to 8.84 (SD 1.58; $\beta$=--1.46; P=.003) seconds, and 30-Second Chair Stand performance increased from 9.75 (SD 2.81) to 13.20 completions (SD 2.53; $\beta$=3.45; P<.001). PROMIS self-reported physical function score improved from 44.59 (SD 4.40) to 47.12 (SD 5.68; $\beta$=2.53; P=.05) and average fatigue decreased from 52.51 (SD 10.38) to 47.73 (SD 8.43; $\beta$=--4.78; P=.02). Conclusions: This 3-month pilot study suggests that decreasing time spent sitting may be helpful for breast cancer survivors experiencing difficulties with physical function and fatigue. Reducing sitting time is a novel and potentially more feasible approach to improving health and quality of life in cancer survivors. ",
doi="10.2196/49934",
url="https://cancer.jmir.org/2023/1/e49934",
url="http://www.ncbi.nlm.nih.gov/pubmed/38113082"
}


@Article{info:doi/10.2196/53602,
author="Edbrooke, Lara
and Jones, L. Tamara",
title="Behavior Change Techniques for the Maintenance of Physical Activity in Cancer",
journal="JMIR Cancer",
year="2023",
month="Nov",
day="28",
volume="9",
pages="e53602",
keywords="cancer",
keywords="physical activity",
keywords="behavior change",
doi="10.2196/53602",
url="https://cancer.jmir.org/2023/1/e53602",
url="http://www.ncbi.nlm.nih.gov/pubmed/38015601"
}


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


@Article{info:doi/10.2196/46051,
author="Li, Peng
and Jing, Jing
and Liu, Wenjun
and Wang, Jizhao
and Qi, Xin
and Zhang, Guangjian",
title="Spatiotemporal Patterns of Esophageal Cancer Burden Attributable to Behavioral, Metabolic, and Dietary Risk Factors From 1990 to 2019: Longitudinal Observational Study",
journal="JMIR Public Health Surveill",
year="2023",
month="Oct",
day="6",
volume="9",
pages="e46051",
keywords="esophageal cancer",
keywords="age-standardized mortality rate",
keywords="disability-adjusted life years",
keywords="attributable risk",
keywords="average annual percentage change",
abstract="Background: Esophageal cancer (EC) is the sixth leading cause of cancer-related burden with distinct regional variations globally. Although the burden of EC has decreased, the specific reasons for this decline are still unclear. Objective: This study aims to uncover the spatiotemporal patterns of EC risk--attributable burden in 204 countries and territories from 1990 to 2019 so that prevention and control strategies of EC can be prioritized worldwide. Methods: We extracted EC risk--attributable deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMRs), and age-standardized DALY rates (ASDRs) from the global burden of disease (GBD) study from 1990 to 2019, in terms of behavioral, metabolic, and dietary factors by age, sex, and geographical location. Average annual percentage change (AAPC) was used to assess the long-term trends in the ASMRs and ASDRs of EC due to specific risk factors. Results: Between 1990 and 2019, the greatest decrease in EC burden was attributed to low intake of fruits and vegetables. An AAPC of --2.96 (95\% CI --3.28 to --2.63) and --3.12 (95\% CI --3.44 to --2.79) in ASMR and ASDR was attributable to a low-fruit diet, while an AAPC of --3.60 (95\% CI --3.84 to --3.36) and --3.64 (95\% CI --3.92 to --3.35) in ASMR and ASDR was attributed to a low-vegetable diet. However, the trends in ASMRs and ASDRs due to high BMI showed significant increases with an AAPC of 0.52 (95\% CI 0.29-0.75) in ASMR and 0.42 (95\% CI 0.18-0.66) in ASDR from 1990 to 2019 compared to significant decreases in other attributable risks with AAPC<0 (P<.05). East Asia had the largest decrease in EC burden due to low-vegetable diets, with an AAPC of --11.00 (95\% CI --11.32 to --10.67) in ASMR and --11.81 (95\% CI --12.21 to --11.41) in ASDR, followed by Central Asia, whereas Western Sub-Saharan Africa had the largest increase in ASMR and ASDR due to high BMI, with an AAPC of 3.28 (95\% CI 3.14-3.42) and 3.09 (95\% CI 2.96-3.22), respectively. China had the highest EC burden attributed to smoking, alcohol use, high BMI, and low-fruit diets. Between 1990 and 2019, there was a significant decrease in EC burden attributable to smoking, alcohol use, chewing tobacco, low-fruit diets, and low-vegetable diets in most countries, wherein a significant increase in the EC burden was due to high BMI. Conclusions: Our study shows that smoking and alcohol consumption are still the leading risk factors of EC burden and that EC burden attributable to low intake of fruits and vegetables has shown the largest decline recently. The risks of ASMRs and ASDRs of EC showed distinct spatiotemporal patterns, and future studies should focus on the upward trend in the EC burden attributed to high BMI. ",
doi="10.2196/46051",
url="https://publichealth.jmir.org/2023/1/e46051",
url="http://www.ncbi.nlm.nih.gov/pubmed/37801354"
}


@Article{info:doi/10.2196/48719,
author="B{\o}r{\o}sund, Elin
and Meland, Anders
and Eriksen, R. Hege
and Rygg, M. Christine
and Ursin, Giske
and Solberg Nes, Lise",
title="Digital Cognitive Behavioral- and Mindfulness-Based Stress-Management Interventions for Survivors of Breast Cancer: Development Study",
journal="JMIR Form Res",
year="2023",
month="Sep",
day="19",
volume="7",
pages="e48719",
keywords="cancer",
keywords="stress management",
keywords="mindfulness",
keywords="cognitive behavioral therapy",
keywords="digital",
keywords="eHealth",
keywords="mHealth",
keywords="app",
keywords="user-driven development",
keywords="usability",
abstract="Background: Psychosocial stress-management interventions can reduce stress and distress and improve the quality of life for survivors of cancer. As these in-person interventions are not always offered or accessible, evidence-informed digital stress-management interventions may have the potential to improve outreach of psychosocial support for survivors of cancer. Few such digital interventions exist so far, few if any have been developed specifically for survivors of breast cancer, and few if any have attempted to explore more than 1 distinct type of intervention framework. Objective: This study aimed to develop 2 digital psychosocial stress-management interventions for survivors of breast cancer; 1 cognitive behavioral therapy-based intervention (CBI), and 1 mindfulness-based intervention (MBI). Methods: The development of the CBI and MBI interventions originated from the existing StressProffen program, a digital stress-management intervention program for survivors of cancer, based on a primarily cognitive behavioral therapeutic concept. Development processes entailed a multidisciplinary design approach and were iteratively conducted in close collaboration between key stakeholders, including experts within psychosocial oncology, cancer epidemiology, stress-management, and eHealth as well as survivors of breast cancer and health care providers. Core psychosocial oncology stress-management and cancer epidemiology experts first conducted a series of workshops to identify cognitive behavioral and mindfulness specific StressProffen content, overlapping psychoeducational content, and areas where development and incorporation of new material were needed. Following the program content adaptation and development phase, phases related to user testing of new content and technical, privacy, security, and ethical aspects and adjustments ensued. Intervention content for the distinct CBI and MBI interventions was refined in iterative user-centered design processes and adjusted to electronic format through stakeholder-centered iterations. Results: For the CBI version, the mindfulness-based content of the original StressProffen was removed, and for the MBI version, cognitive behavioral content was removed. Varying degrees of new content were created for both versions, using a similar layout as for the original StressProffen program. New content and new exercises in particular were tested by survivors of breast cancer and a project-related editorial team, resulting in subsequent user centered adjustments, including ensuring auditory versions and adequate explanations before less intuitive sections. Other improvements included implementing a standard closing sentence to round off every exercise, and allowing participants to choose the length of some of the mindfulness exercises. A legal disclaimer and a description of data collection, user rights and study contact information were included to meet ethical, privacy, and security requirements. Conclusions: This study shows how theory specific (ie, CBI and MBI) digital stress-management interventions for survivors of breast cancer can be developed through extensive collaborations between key stakeholders, including scientists, health care providers, and survivors of breast cancer. Offering a variety of evidence-informed stress-management approaches may potentially increase interest for outreach and impact of psychosocial interventions for survivors of cancer. International Registered Report Identifier (IRRID): RR2-10.2196/47195 ",
doi="10.2196/48719",
url="https://formative.jmir.org/2023/1/e48719",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725424"
}


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


@Article{info:doi/10.2196/47473,
author="Mitchell, Siobhan Ellen
and Fabry, Alexander
and Ho, Suh Annabell
and May, N. Christine
and Baldwin, Matthew
and Blanco, Paige
and Smith, Kyle
and Michaelides, Andreas
and Shokoohi, Mostafa
and West, Michael
and Gotera, Kim
and El Massad, Omnya
and Zhou, Anna",
title="The Impact of a Digital Weight Loss Intervention on Health Care Resource Utilization and Costs Compared Between Users and Nonusers With Overweight and Obesity: Retrospective Analysis Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Aug",
day="24",
volume="11",
pages="e47473",
keywords="mobile health",
keywords="mHealth",
keywords="obesity",
keywords="overweight",
keywords="Noom Weight",
keywords="digital weight loss intervention",
keywords="health care resource utilization",
keywords="costs",
keywords="electronic health record",
keywords="EHR",
keywords="insurance claims",
keywords="inverse probability of treatment weighting",
keywords="IPTW",
keywords="mobile phone",
abstract="Background: The Noom Weight program is a smartphone-based weight management program that uses cognitive behavioral therapy techniques to motivate users to achieve weight loss through a comprehensive lifestyle intervention. Objective: This retrospective database analysis aimed to evaluate the impact of Noom Weight use on health care resource utilization (HRU) and health care costs among individuals with overweight and obesity. Methods: Electronic health record data, insurance claims data, and Noom Weight program data were used to conduct the analysis. The study included 43,047 Noom Weight users and 14,555 non--Noom Weight users aged between 18 and 80 years with a BMI of ?25 kg/m{\texttwosuperior} and residing in the United States. The index date was defined as the first day of a 3-month treatment window during which Noom Weight was used at least once per week on average. Inverse probability treatment weighting was used to balance sociodemographic covariates between the 2 cohorts. HRU and costs for inpatient visits, outpatient visits, telehealth visits, surgeries, and prescriptions were analyzed. Results: Within 12 months after the index date, Noom Weight users had less inpatient costs (mean difference [MD] ?US \$20.10, 95\% CI ?US \$30.08 to ?US \$10.12), less outpatient costs (MD ?US \$124.33, 95\% CI ?US \$159.76 to ?US \$88.89), less overall prescription costs (MD ?US \$313.82, 95\% CI ?US \$565.42 to ?US \$62.21), and less overall health care costs (MD ?US \$450.39, 95\% CI ?US \$706.28 to ?US \$194.50) per user than non--Noom Weight users. In terms of HRU, Noom Weight users had fewer inpatient visits (MD ?0.03, 95\% CI ?0.04 to ?0.03), fewer outpatient visits (MD ?0.78, 95\% CI ?0.93 to ?0.62), fewer surgeries (MD ?0.01, 95\% CI ?0.01 to 0.00), and fewer prescriptions (MD ?1.39, 95\% CI ?1.76 to ?1.03) per user than non--Noom Weight users. Among a subset of individuals with 24-month follow-up data, Noom Weight users incurred lower overall prescription costs (MD ?US \$1139.52, 95\% CI ?US \$1972.21 to ?US \$306.83) and lower overall health care costs (MD ?US \$1219.06, 95\% CI ?US \$2061.56 to ?US \$376.55) per user than non--Noom Weight users. The key differences were associated with reduced prescription use. Conclusions: Noom Weight use is associated with lower HRU and costs than non--Noom Weight use, with potential cost savings of up to US \$1219.06 per user at 24 months after the index date. These findings suggest that Noom Weight could be a cost-effective weight management program for individuals with overweight and obesity. This study provides valuable evidence for health care providers and payers in evaluating the potential benefits of digital weight loss interventions such as Noom Weight. ",
doi="10.2196/47473",
url="https://mhealth.jmir.org/2023/1/e47473",
url="http://www.ncbi.nlm.nih.gov/pubmed/37616049"
}


@Article{info:doi/10.2196/47158,
author="Jung, Miyeon
and Lee, Byul Sae
and Lee, Won Jong
and Park, Rang Yu
and Chung, Haekwon
and Min, Ha Yul
and Park, Jin Hye
and Lee, Minsun
and Chung, Seockhoon
and Son, Ho Byung
and Ahn, Sei-Hyun
and Chung, Yong Il",
title="The Impact of a Mobile Support Group on Distress and Physical Activity in Breast Cancer Survivors: Randomized, Parallel-Group, Open-Label, Controlled Trial",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="7",
volume="25",
pages="e47158",
keywords="breast neoplasms",
keywords="mental distress",
keywords="mobile apps",
keywords="mobile health intervention",
keywords="mobile phone",
keywords="physical activity",
keywords="randomized controlled trial",
keywords="RCT",
keywords="support group",
keywords="survivorship",
keywords="telemedicine",
abstract="Background: While mobile health apps have demonstrated their potential in revolutionizing health behavior changes, the impact of a mobile community built on these apps on the level of physical activity and mental well-being in cancer survivors remains unexplored. Objective: In this randomized controlled trial, we examine the effects of participation in a mobile health community specifically designed for breast cancer survivors on their physical activity levels and mental distress. Methods: We performed a single-center, randomized, parallel-group, open-label, controlled trial. This trial enrolled women between 20 and 60 years of age with stage 0 to III breast cancer, an Eastern Cooperative Oncology Group performance status of 0, and the capability of using their own smartphone apps. From January 7, 2019, to April 17, 2020, a total of 2,616 patients were consecutively screened for eligibility after breast cancer surgery. Overall, 202 patients were enrolled in this trial, and 186 patients were randomly assigned (1:1) to either the intervention group (engagement in a mobile peer support community using an app for tracking steps; n=93) or the control group (using the app for step tracking only; n=93) with a block size of 10 without stratification. The mobile app provides a visual interface of daily step counts, while the community function also provides rankings among its members and regular notifications encouraging physical activity. The primary end point was the rate of moderate to severe distress for the 24-week study period, measured through an app-based survey using the Distress Thermometer. The secondary end point was the total weekly steps during the 24-week period. Results: After excluding dropouts, 85 patients in the intervention group and 90 patients in the control group were included in the analysis. Multivariate analyses showed that patients in the intervention group had a significantly lower degree of moderate to severe distress (B=--0.558; odds ratio 0.572; P<.001) and a higher number of total weekly step counts (B=0.125; rate ratio 1.132; P<.001) during the 24-week period. Conclusions: Engagement in a mobile app--based patient community was effective in reducing mental distress and increasing physical activity in breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT03783481; https://classic.clinicaltrials.gov/ct2/show/NCT03783481 ",
doi="10.2196/47158",
url="https://www.jmir.org/2023/1/e47158",
url="http://www.ncbi.nlm.nih.gov/pubmed/37549004"
}


@Article{info:doi/10.2196/45432,
author="Wang, Y. Elizabeth
and Borno, T. Hala
and Washington III, L. Samuel
and Friedlander, Terence
and Zhang, Sylvia
and Trejo, Evelin
and Van Blarigan, L. Erin
and Chan, M. June
and Shariff-Marco, Salma
and Beatty, L. Alexis
and Kenfield, A. Stacey",
title="Engaging Men of Diverse Racial and Ethnic Groups With Advanced Prostate Cancer in the Design of an mHealth Diet and Exercise Intervention: Focus Group Study",
journal="JMIR Cancer",
year="2023",
month="Jun",
day="1",
volume="9",
pages="e45432",
keywords="cancer survivorship",
keywords="digital health",
keywords="technology-based intervention",
keywords="modifiable behaviors",
keywords="metastatic",
keywords="androgen deprivation therapy",
keywords="race and ethnicity",
keywords="social determinants of health",
keywords="mobile phone",
abstract="Background: Healthy diet and exercise can improve quality of life and prognosis among men with prostate cancer. Understanding the perceived barriers to lifestyle change and patient preferences in a diverse cohort of men with prostate cancer is necessary to inform mobile health (mHealth) lifestyle interventions and increase health equity. Objective: We conducted a multisite study to understand the preferences, attitudes, and health behaviors related to diet and lifestyle in this patient population. This report focuses on the qualitative findings from 4 web-based focus groups comprising a racially and ethnically diverse group of patients with advanced prostate cancer who are on androgen deprivation therapy. Methods: We used grounded theory analyses including open, axial, and selective coding to generate codes. Qualitative data were analyzed as a whole rather than by focus group to optimize data saturation and the transferability of results. We present codes and themes that emerged for lifestyle intervention design and provide recommendations and considerations for future mHealth intervention studies. Results: Overall, 14 men participated in 4 racially and ethnically concordant focus groups (African American or Black: 3/14, 21\%; Asian American: 3/14, 21\%; Hispanic or Latino: 3/14, 21\%; and White: 5/14, 36\%). Analyses converged on 7 interwoven categories: context (home environment, access, competing priorities, and lifestyle programs), motivation (accountability, discordance, feeling supported, fear, and temptation), preparedness (health literacy, technological literacy, technological preferences, trust, readiness to change, identity, adaptability, and clinical characteristics), data-driven design (education, psychosocial factors, and quality of life), program mechanics (communication, materials, customization, and being holistic), habits (eg, dietary habits), and intervention impressions. These results suggest actionable pathways to increase program intuitiveness. Recommendations for future mHealth intervention design and implementation include but are not limited to assessment at the individual, household, and neighborhood levels to support a tailored intervention; prioritization of information to disseminate based on individuals' major concerns and the delivery of information based on health and technological literacy and communication preferences; prescribing a personalized intervention based on individuals' baseline responses, home and neighborhood environment, and support network; and incorporating strategies to foster engagement (eg, responsive and relevant feedback systems) to aid participant decision-making and behavior change. Conclusions: Assessing a patient's social context, motivation, and preparedness is necessary when tailoring a program to each patient's needs in all racial and ethnic groups. Addressing the patients' contexts and motivation and preparedness related to diet and exercise including the household, access (to food and exercise), competing priorities, health and technological literacy, readiness to change, and clinical characteristics will help to customize the intervention to the participant. These data support a tailored approach leveraging the identified components and their interrelationships to ensure that mHealth lifestyle interventions will engage and be effective in racially and ethnically diverse patients with cancer. Trial Registration: ClinicalTrials.gov NCT05324098; https://clinicaltrials.gov/ct2/show/NCT05324098 ",
doi="10.2196/45432",
url="https://cancer.jmir.org/2023/1/e45432",
url="http://www.ncbi.nlm.nih.gov/pubmed/37261885"
}


@Article{info:doi/10.2196/45244,
author="Nilsen, Skogstad Tormod
and S{\ae}ter, Mali
and Sarvari, Imre Sebastian
and Reinertsen, Valborg Kristin
and Johansen, Hassing Sara
and Edvardsen, Rustad Elisabeth
and Hall{\'e}n, Jostein
and Edvardsen, Elisabeth
and Grydeland, May
and Kiserud, Essholt Cecilie
and Lie, Cathrine Hanne
and Solberg, Andr{\'e} Paul
and Wisl{\o}ff, Torbj{\o}rn
and Sharples, Philip Adam
and Raastad, Truls
and Haugaa, Hermann Kristina
and Thorsen, Lene",
title="Effects of Aerobic Exercise on Cardiorespiratory Fitness, Cardiovascular Risk Factors, and Patient-Reported Outcomes in Long-Term Breast Cancer Survivors: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="15",
volume="12",
pages="e45244",
keywords="breast cancer",
keywords="cardiooncology",
keywords="cardiorespiratory fitness",
keywords="exercise medicine",
abstract="Background: Anthracycline-based chemotherapy has been mainstay of adjuvant breast cancer therapy for decades. Although effective, anthracyclines place long-term breast cancer survivors at risk of late effects, such as reduced cardiorespiratory fitness and increased risk of cardiovascular disease. Previous research has shown beneficial effects of exercise training on cardiorespiratory fitness, but the effects of exercise on limiting factors for cardiorespiratory fitness, cardiovascular risk factors, and patient-reported outcomes in long-term survivors are less clear. Whether previous exposure to breast cancer therapy modulates the effects of exercise is also unknown. Objective: The primary aim of the CAUSE (Cardiovascular Survivors Exercise) trial is to examine the effect of aerobic exercise on cardiorespiratory fitness in anthracycline-treated long-term breast cancer survivors. Secondary aims are to examine effects of exercise training on limiting factors for cardiorespiratory fitness, cardiovascular risk factors, and patient-reported outcomes, and to compare baseline values and effects of exercise training between similar-aged women with and those without prior breast cancer. A third aim is to examine the 24-month postintervention effects of aerobic exercise on primary and secondary outcomes. Methods: The CAUSE trial is a 2-armed randomized controlled trial, where 140 long-term breast cancer survivors, 8-12 years post diagnosis, are assigned to a 5-month nonlinear aerobic exercise program with 3 weekly sessions or to standard care. Seventy similar-aged women with no history of cancer will undergo the same exercise program. Cardiorespiratory fitness measured as peak oxygen consumption (VO2peak), limiting factors for VO2peak (eg, cardiac function, pulmonary function, hemoglobin mass, blood volume, and skeletal muscle characteristics), cardiovascular risk factors (eg, hypertension, diabetes, dyslipidemia, obesity, physical activity level, and smoking status), and patient-reported outcomes (eg, body image, fatigue, mental health, and health-related quality of life) will be assessed at baseline, post intervention, and 24 months post intervention. Results: A total of 209 patients were included from October 2020 to August 2022, and postintervention assessments were completed in January 2023. The 24-month follow-up will be completed in February 2025. Conclusions: The findings from the CAUSE trial will provide novel scientific understanding of the potential benefits of exercise training in long-term breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT04307407; https://clinicaltrials.gov/ct2/show/NCT04307407 International Registered Report Identifier (IRRID): DERR1-10.2196/45244 ",
doi="10.2196/45244",
url="https://www.researchprotocols.org/2023/1/e45244",
url="http://www.ncbi.nlm.nih.gov/pubmed/36920460"
}


@Article{info:doi/10.2196/39640,
author="Manne, Sharon
and Pagoto, Sherry
and Peterson, Susan
and Heckman, Carolyn
and Kashy, Deborah
and Berger, Adam
and Studts, Christina
and Negr{\'o}n, Rosalyn
and Buller, David
and Paddock, Lisa
and Gallo, Joseph
and Kulik, Alexandria
and Frederick, Sara
and Pesanelli, Morgan
and Domider, Mara
and Grosso, Marissa",
title="Facebook Intervention for Young-Onset Melanoma Survivors and Families: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Jan",
day="24",
volume="12",
pages="e39640",
keywords="cancer survivors",
keywords="melanoma survivors",
keywords="skin self-examination",
keywords="clinical skin examination",
keywords="sun protection",
keywords="behavioral intervention",
keywords="social media",
abstract="Background: Individuals diagnosed with melanoma before the age of 40 years (young-onset melanoma survivors) and their first-degree relatives (FDRs) are a growing population at risk for developing recurrent melanoma or new melanomas. Regular surveillance using clinical skin examination (CSE) and skin self-examination (SSE) and engagement in preventive behaviors including sun protection are recommended. Given the growing population of survivors and their families who are at increased risk, it is surprising that no behavioral interventions have been developed and evaluated to improve risk-reduction behaviors. Objective: We describe the rationale and methodology for a randomized controlled trial evaluating the efficacy of a Facebook intervention providing information, goal setting, and peer support to increase CSE, SSE, and sun protection for young-onset melanoma survivors and their FDRs. Methods: Overall, 577 survivors and 577 FDRs will be randomly assigned to either the Young Melanoma Family Facebook Group or the Melanoma Family Healthy Lifestyle Facebook Group condition. Participants will complete measures of CSE, SSE, and sun protection, and mediator measures of attitudes and beliefs before and after the intervention. The primary aim is to evaluate the impact of the Young Melanoma Family Facebook intervention versus the Melanoma Family Healthy Lifestyle Facebook intervention on CSE, SSE frequency and comprehensiveness, and sun protection among FDRs. The secondary aims examine the efficacy of the Young Melanoma Family Facebook intervention on survivors' SSE frequency and comprehensiveness and sun protection behaviors and mechanisms of intervention efficacy for intervention impact on FDR and survivor outcomes. The exploratory aim is to evaluate the efficacy of the 2 interventions on perceived stress, physical activity, and healthy eating. Results: This project was funded by the National Institutes of Health (R01CA221854). The project began in May 2018, and recruitment started in January 2019. We anticipate completing enrollment by November 2023. Power calculations recommended a sample size of 577 survivors and 577 FDRs. Multilevel modeling treating family as the upper-level sampling unit and individual as the lower-level sampling unit will be the primary data analytic approach. Fixed effect predictors in these models will include condition, role, sex, all 2- and 3-way interactions, and covariates. Conclusions: The Young Melanoma Family Facebook intervention aims to improve primary and secondary skin cancer prevention for young-onset melanoma survivors and their family members. The intervention's delivery via a popular, freely available social media platform increases its impact because of the potential for dissemination in many contexts. If efficacious, this program could be disseminated by dermatologist practices, public health or nonprofit organizations focused on melanoma, and existing melanoma and skin cancer Facebook groups, thereby expanding its reach. This project will produce a content library of posts and a moderation guide for others. Trial Registration: ClinicalTrials.gov NCT03677739; https://clinicaltrials.gov/ct2/show/NCT03677739 International Registered Report Identifier (IRRID): DERR1-10.2196/39640 ",
doi="10.2196/39640",
url="https://www.researchprotocols.org/2023/1/e39640",
url="http://www.ncbi.nlm.nih.gov/pubmed/36692933"
}


@Article{info:doi/10.2196/40352,
author="van der Linden, W. Manouk J.
and Nahar van Venrooij, W. Lenny M.
and Verdaasdonk, G. Emiel G.",
title="Personal Devices to Monitor Physical Activity and Nutritional Intake After Colorectal Cancer Surgery: Feasibility Study",
journal="JMIR Perioper Med",
year="2022",
month="Dec",
day="13",
volume="5",
number="1",
pages="e40352",
keywords="eHealth",
keywords="fitness trackers",
keywords="diet records",
keywords="colorectal neoplasm",
keywords="colorectal cancer",
keywords="surgery",
keywords="self management",
keywords="patient care",
keywords="physical activity",
keywords="tracking",
keywords="activity tracking",
keywords="self-monitoring",
keywords="feasibility",
keywords="usability",
abstract="Background: The use of self-monitoring devices is promising for improving perioperative physical activity and nutritional intake. Objective: This study aimed to assess the feasibility, usability, and acceptability of a physical activity tracker and digital food record in persons scheduled for colorectal cancer (CRC) surgery. Methods: This observational cohort study was conducted at a large training hospital between November 2019 and November 2020. The study population consisted of persons with CRC between 18- and 75 years of age who were able to use a smartphone or tablet and scheduled for elective surgery with curative intent. Excluded were persons not proficient in Dutch or following a protein-restricted diet. Participants used an activity tracker (Fitbit Charge 3) from 4 weeks before until 6 weeks after surgery. In the week before surgery (preoperative) and the fifth week after surgery (postoperative), participants also used a food record for 1 week. They shared their experience regarding usability (system usability scale, range 0-100) and acceptability (net promoter score, range --100 to +100). Results: In total, 28 persons were included (n=16, 57\% male, mean age 61, SD 8 years), and 27 shared their experiences. Scores regarding the activity tracker were as follows: preoperative median system usability score, 85 (IQR 73-90); net promoter score, +65; postoperative median system usability score, 78 (IQR 68-85); net promotor score, +67. The net promoter scores regarding the food record were +37 (preoperative) and--7 (postoperative). Conclusions: The perioperative use of a physical activity tracker is considered feasible, usable, and acceptable by persons with CRC in this study. Preoperatively, the use of a digital food record was acceptable, and postoperatively, the acceptability decreased. ",
doi="10.2196/40352",
url="https://periop.jmir.org/2022/1/e40352",
url="http://www.ncbi.nlm.nih.gov/pubmed/36512385"
}


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


@Article{info:doi/10.2196/39228,
author="Huberty, Jennifer
and Bhuiyan, Nishat
and Puzia, Megan
and Joeman, Lynda
and Larkey, Linda
and Mesa, Ruben",
title="Meditation Mobile App Developed for Patients With and Survivors of Cancer: Feasibility Randomized Controlled Trial",
journal="JMIR Cancer",
year="2022",
month="Nov",
day="23",
volume="8",
number="4",
pages="e39228",
keywords="cancer",
keywords="mobile health",
keywords="mHealth",
keywords="meditation",
keywords="feasibility",
keywords="mobile phone",
abstract="Background: To address the unmet need for a commercial cancer-specific meditation app, we leveraged a long-standing partnership with a consumer-based app (ie, Calm) to develop the first commercial meditation app prototype adapted specifically for the needs of patients with cancer. Input was obtained at both the individual user and clinic levels (ie, patients with and survivors of cancer and health care providers). Objective: This study aimed to determine the feasibility of a cancer-specific meditation app prototype. Methods: Patients with and survivors of cancer who were recruited and enrolled in the feasibility randomized controlled trial were asked to use the prototype app daily (?70 minutes per week) for 4 weeks. Participants completed web-based weekly questionnaires and a final poststudy questionnaire and were asked to participate in an optional web-based poststudy interview. The questionnaires and interviews covered the following feasibility categories: acceptability, demand, practicality, and adaptation. Results: A total of 36 patients with and survivors of cancer completed the baseline questionnaire, 18 completed the final questionnaire, and 6 completed the optional interviews. Weekly and poststudy questionnaires indicated high overall enjoyment, ease of use, and satisfaction with the app content, aesthetics, and graphics. The objective use data indicated that the average total app use rate was 73.39 (SD 7.12) minutes per week. Interviews (N=6) revealed positive and mixed responses to the app prototype and informative differences related to preferences for narrators, emotional content, and meditation teaching but an overall appreciation for the variety of options. Conclusions: The most likely candidates for moving from cancer-specific meditation apps to dissemination are through partnering with the industry, in which name recognition and market distribution are already established (even showing a base of users from the targeted population with cancer). This study established the feasibility of a cancer-specific mobile meditation app prototype for patients with and survivors of cancer, using a commercially available app. The quantitative and qualitative data demonstrated the acceptability, demand, practicality, and adaptation of the prototype. Improvements suggested by the participants will be considered in the final app design before testing the efficacy of the app in a future study. Trial Registration: Clinicaltrials.gov NCT05459168; https://clinicaltrials.gov/ct2/show/record/NCT05459168 ",
doi="10.2196/39228",
url="https://cancer.jmir.org/2022/4/e39228",
url="http://www.ncbi.nlm.nih.gov/pubmed/36416880"
}


@Article{info:doi/10.2196/40811,
author="Vikmoen, Olav
and Wiestad, Helge Tor
and Thormodsen, Inger
and Nordin, Karin
and Berntsen, Sveinung
and Demmelmaier, Ingrid
and Strandberg, Emelie
and Raastad, Truls",
title="Effects of High and Low-To-Moderate Intensity Exercise During (Neo-) Adjuvant Chemotherapy on Muscle Cells, Cardiorespiratory Fitness, and Muscle Function in Women With Breast Cancer: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Nov",
day="11",
volume="11",
number="11",
pages="e40811",
keywords="resistance training",
keywords="endurance training",
keywords="muscle strength",
keywords="muscle endurance",
keywords="anthracyclines",
keywords="taxanes",
abstract="Background: (Neo-)adjuvant chemotherapy for breast cancer is effective but has deleterious side effects on muscle tissue, resulting in reduced skeletal muscle mass, muscle function, and cardiorespiratory fitness. Various exercise regimens during cancer treatment have been shown to counteract some of these side effects. However, no study has compared the effect of high-intensity training versus low-to-moderate intensity training on muscle tissue cellular outcomes and physical function in patients with breast cancer during chemotherapy. Objective: The aim of this substudy within the Physical Training in Cancer (Phys-Can) consortium is to evaluate and compare the effects of high and low-to-moderate intensity exercise on muscle cellular outcomes, muscle function, and cardiorespiratory fitness in women with breast cancer undergoing (neo-)adjuvant chemotherapy. We further aim to investigate if the effects of chemotherapy including taxanes on muscles will be different from those of taxane-free chemotherapy. Methods: Eighty women recently diagnosed with breast cancer scheduled to start (neo-)adjuvant chemotherapy will be randomized to a combination of strength and endurance training, either at high intensity or at low-to-moderate intensity. Testing of muscle function and cardiorespiratory fitness and collection of muscle biopsies from the vastus lateralis muscle will be performed before the first cycle of chemotherapy (or after 1 week, when not possible) (T0), halfway through chemotherapy (T1), and after completion of chemotherapy (T2). It is estimated that approximately 50\% of the participants will be willing to undergo muscle biopsies. To separate the effect of the treatment itself, a usual care group with no supervised training will also be included, and in this group, testing and collection of muscle biopsies will be performed at T0 and T2 only. Results: This study is funded by Active Against Cancer (Aktiv mot kreft) (May 2013) and the Norwegian Cancer Society (December 2018). Inclusion started in December 2016 and the last participant is expected to be recruited in December 2022. As of June 2022, we enrolled 38 (19 with biopsies) participants to the high-intensity training group, 36 (19 with biopsies) participants to the low-to-moderate intensity training group, and 17 (16 with biopsies) participants to the usual care group. Data analyses will start in fall 2022. The first results are expected to be published in spring 2024. Conclusions: This study will generate new knowledge about the effects of different training intensities for women with breast cancer during chemotherapy treatment. It will give further insight into how chemotherapy affects the muscle tissue and how physical training at different intensities may counteract the treatment side effects in muscles. The results of this study will inform the development and refinement of exercise programs that are effective and compatible with the multidisciplinary management of breast cancer. Trial Registration: ClinicalTrials.gov NCT05218876; https://tinyurl.com/ysaj9dhm International Registered Report Identifier (IRRID): DERR1-10.2196/40811 ",
doi="10.2196/40811",
url="https://www.researchprotocols.org/2022/11/e40811",
url="http://www.ncbi.nlm.nih.gov/pubmed/36367769"
}


@Article{info:doi/10.2196/35933,
author="Henriksen, Berg Hege
and Knudsen, Dines Markus
and Carlsen, Hauger Monica
and Hjart{\aa}ker, Anette
and Blomhoff, Rune",
title="A Short Digital Food Frequency Questionnaire (DIGIKOST-FFQ) Assessing Dietary Intake and Other Lifestyle Factors Among Norwegians: Qualitative Evaluation With Focus Group Interviews and Usability Testing",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="8",
volume="6",
number="11",
pages="e35933",
keywords="digital assessment tool",
keywords="assessment tool",
keywords="food frequency questionnaire",
keywords="food",
keywords="diet",
keywords="nutrition",
keywords="questionnaire",
keywords="focus group",
keywords="interview",
keywords="usability",
keywords="physical activity",
keywords="lifestyle factor",
keywords="dietary intake",
keywords="digital health",
keywords="chronic disease",
keywords="chronic condition",
keywords="health promotion",
keywords="cancer",
keywords="survivor",
keywords="thematic analysis",
keywords="research tool",
keywords="measurement tool",
abstract="Background: In-person dietary counseling and interventions have shown promising results in changing habits toward healthier lifestyles, but they are costly to implement in large populations. Developing digital tools to assess individual dietary intake and lifestyle with integrated personalized feedback systems may help overcome this challenge. We developed a short digital food frequency questionnaire, known as the DIGIKOST-FFQ, to assess diet and other lifestyle factors based on the Norwegian Food-Based Dietary Guidelines. The DIGIKOST-FFQ includes a personalized feedback system, the DIGIKOST report, that benchmarks diet and lifestyle habits. We used qualitative focus group interviews and usability tests to test the feasibility and usability of the DIGIKOST application. Objective: We aimed to explore attitudes, perceptions, and challenges in completing the DIGIKOST-FFQ. We also investigated perceptions and understanding of the personalized feedback in the DIGIKOST report and the technical flow and usability of the DIGIKOST-FFQ and the DIGIKOST report. Methods: Healthy individuals and cancer survivors were invited to participate in the focus group interviews. The transcripts were analyzed using thematic analysis. Another group of healthy individuals completed the usability testing, which was administered individually by a moderator and 2 observers. The results were analyzed based on predefined assignments and discussion with the participants about the interpretation of the DIGIKOST report and technical flow of the DIGIKOST-FFQ. Results: A total of 20 individuals participated in the focus group interviews, divided into 3 groups of healthy individuals and 3 groups of cancer survivors. Each group consisted of 3 to 4 individuals. Five main themes were investigated: (1) completion time (on average 19.1, SD 8.3, minutes, an acceptable duration), (2) layout (participants reported the DIGIKOST-FFQ was easy to navigate and had clear questions but presented challenges in reporting dietary intake, sedentary time, and physical activity in the last year), (3) questions (the introductory questions on habitual intake worked well), (4) pictures (the pictures were very helpful, but some portion sizes were difficult to differentiate and adding weight in grams would have been helpful), and (5) motivation (users were motivated to obtain personalized feedback). Four individuals participated in the usability testing. The results showed that the users could seamlessly log in, give consent, fill in the DIGIKOST-FFQ, and receive, print, and read the DIGIKOST report. However, parts of the report were perceived as difficult to interpret. Conclusions: The DIGIKOST-FFQ was overall well received by participants, who found it feasible to use; however, some adjustments with regard to reporting dietary intake and lifestyle habits were suggested. The DIGIKOST report with personalized feedback was the main motivation to complete the questionnaire. The results from the usability testing revealed a need for adjustments and updates to make the report easier to read. ",
doi="10.2196/35933",
url="https://formative.jmir.org/2022/11/e35933",
url="http://www.ncbi.nlm.nih.gov/pubmed/36346647"
}


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


@Article{info:doi/10.2196/36889,
author="Swartz, C. Maria
and Lewis, H. Zakkoyya
and Deer, R. Rachel
and Stahl, L. Anna
and Swartz, D. Michael
and Christopherson, Ursela
and Basen-Engquist, Karen
and Wells, J. Stephanie
and Silva, Colleen H.
and Lyons, J. Elizabeth",
title="Feasibility and Acceptability of an Active Video Game--Based Physical Activity Support Group (Pink Warrior) for Survivors of Breast Cancer: Randomized Controlled Pilot Trial",
journal="JMIR Cancer",
year="2022",
month="Aug",
day="22",
volume="8",
number="3",
pages="e36889",
keywords="physical activity",
keywords="survivors of cancer",
keywords="pilot study",
keywords="breast cancer",
keywords="video games",
keywords="group intervention",
keywords="physical function",
keywords="motivation",
keywords="mobile phone",
abstract="Background: Survivors of breast cancer with functional limitations have a 40\% higher mortality rate than those without. Despite the known benefits of physical activity (PA), <40\% of survivors of breast cancer meet the recommendations for PA. The combination of active video games (AVGs) and group-based PA counseling may hold potential for motivating PA adoption and improving physical function. However, this method has not been widely studied in survivors of breast cancer. Objective: We aimed to determine the feasibility and acceptability of a group AVG-based multicomponent PA intervention and estimate its effect size and variability on PA and physical function in female survivors of breast cancer in a clinic setting. Methods: Female survivors of breast cancer (N=60) were recruited through the clinic and randomly assigned to the intervention group (12 weekly sessions) or the control group (existing support group). The intervention group received game-based pedometers and participated in weekly group AVG sessions, PA behavioral coaching, and survivorship navigation discussions. A participant manual with weekly reflection worksheets was provided to reinforce the coaching lessons and promote self-led PA. The control group received conventional pedometers and participated in an existing breast cancer support group. Feasibility was assessed by enrollment rate (?50\%), retention rate (?80\%), group attendance rate (75\% attending ?9 sessions [intervention group]), and the number of technological issues and adverse events. Acceptability was measured by participants' attitudes (from strongly disagree=1 to strongly agree=5) toward the use of AVGs and the overall program. The outcomes included PA (accelerometers) and physical function (Short Physical Performance Battery and gait speed). Analysis of covariance was used to determine differences in PA and physical function between the groups. The Cohen d and its 95\% CI determined the effect size and variability, respectively. All the analyses followed the intention-to-treat principle. Results: Participants were an average of 57.4 (SD 10.5) years old, 70\% (42/60) White, and 58\% (35/60) off treatment. The enrollment rate was 55.9\% (66/118). Despite substantial long-term hurricane-related disruptions, we achieved an 80\% (48/60) retention. The intervention group's attendance rate was 78\% (14/18), whereas the control group's attendance rate was 53\% (9/17). Of the 26 game-based pedometers, 3 (12\%) were damaged or lost. No study-related adverse events occurred. Acceptability items were highly rated. Steps ($\beta$=1621.64; P=.01; d=0.72), Short Physical Performance Battery ($\beta$=.47; P=.01; d=0.25), and gait speed ($\beta$=.12; P=.004; d=0.48) had a significant intervention effect. Conclusions: The intervention was feasible and acceptable in this population despite the occurrence of a natural disaster. Pilot results indicate that group AVG sessions, PA coaching, and survivorship navigation produced moderate effects on PA and physical functioning. AVGs with PA counseling can potentially be used in existing breast cancer support groups to encourage PA and improve physical function. Trial Registration: ClinicalTrials.gov NCT02750241; https://clinicaltrials.gov/ct2/show/NCT02750241 ",
doi="10.2196/36889",
url="https://cancer.jmir.org/2022/3/e36889",
url="http://www.ncbi.nlm.nih.gov/pubmed/35994321"
}


@Article{info:doi/10.2196/38367,
author="Ha, Lauren
and Wakefield, E. Claire
and Mizrahi, David
and Diaz, Claudio
and Cohn, J. Richard
and Signorelli, Christina
and Yacef, Kalina
and Simar, David",
title="A Digital Educational Intervention With Wearable Activity Trackers to Support Health Behaviors Among Childhood Cancer Survivors: Pilot Feasibility and Acceptability Study",
journal="JMIR Cancer",
year="2022",
month="Aug",
day="17",
volume="8",
number="3",
pages="e38367",
keywords="childhood cancer",
keywords="survivorship",
keywords="physical activity",
keywords="exercise",
keywords="activity tracker",
keywords="eHealth",
keywords="education",
keywords="behavior change",
abstract="Background: Childhood cancer survivors are at increased risk of cardiometabolic complications that are exacerbated by poor health behaviors. Critically, many survivors do not meet physical activity guidelines. Objective: The primary aim was to evaluate the feasibility and acceptability of iBounce, a digital health intervention for educating and engaging survivors in physical activity. Our secondary aims were to assess the change in survivors' physical activity levels and behaviors, aerobic fitness, and health-related quality of life (HRQoL) after participating in the iBounce program. Methods: We recruited survivors aged 8 to 13 years who were ?12 months post cancer treatment completion. The app-based program involved 10 educational modules, goal setting, and home-based physical activities monitored using an activity tracker. We assessed objective physical activity levels and behaviors using cluster analysis, aerobic fitness, and HRQoL at baseline and after the intervention (week 12). Parents were trained to reassess aerobic fitness at home at follow-up (week 24). Results: In total, 30 participants opted in, of whom 27 (90\%) completed baseline assessments, and 23 (77\%) commenced iBounce. Our opt-in rate was 59\% (30/51), and most (19/23, 83\%) of the survivors completed the intervention. More than half (13/23, 57\%) of the survivors completed all 10 modules (median 10, IQR 4-10). We achieved a high retention rate (19/27, 70\%) and activity tracker compliance (15/19, 79\%), and there were no intervention-related adverse events. Survivors reported high satisfaction with iBounce (median enjoyment score 75\%; ease-of-use score 86\%), but lower satisfaction with the activity tracker (median enjoyment score 60\%). Parents reported the program activities to be acceptable (median score 70\%), and their overall satisfaction was 60\%, potentially because of technological difficulties that resulted in the program becoming disjointed. We did not observe any significant changes in physical activity levels or HRQoL at week 12. Our subgroup analysis for changes in physical activity behaviors in participants (n=11) revealed five cluster groups: most active, active, moderately active, occasionally active, and least active. Of these 11 survivors, 3 (27\%) moved to a more active cluster group, highlighting their engagement in more frequent and sustained bouts of moderate-to-vigorous physical activity; 6 (56\%) stayed in the same cluster; and 2 (18\%) moved to a less active cluster. The survivors' mean aerobic fitness percentiles increased after completing iBounce (change +17, 95\% CI 1.7-32.1; P=.03) but not at follow-up (P=.39). Conclusions: We demonstrated iBounce to be feasible for delivery and acceptable among survivors, despite some technical difficulties. The distance-delivered format provides an opportunity to engage survivors in physical activity at home and may address barriers to care, particularly for regional or remote families. We will use these pilot findings to evaluate an updated version of iBounce. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000259842; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=ACTRN12621000259842 ",
doi="10.2196/38367",
url="https://cancer.jmir.org/2022/3/e38367",
url="http://www.ncbi.nlm.nih.gov/pubmed/35976683"
}


@Article{info:doi/10.2196/36658,
author="Smith, S. Isabelle
and Wallace, Rebecca
and Wellecke, Cornelia
and Bind, Marie-Ab{\`e}le
and Weihs, L. Karen
and Bei, Bei
and Wiley, F. Joshua",
title="Assessing an Internet-Delivered, Emotion-Focused Intervention Compared With a Healthy Lifestyle Active Control Intervention in Improving Mental Health in Cancer Survivors: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Jul",
day="27",
volume="11",
number="7",
pages="e36658",
keywords="cancer survivor",
keywords="depressive symptoms",
keywords="anxiety symptoms",
keywords="emotion regulation",
keywords="Unified Protocol",
keywords="transdiagnostic",
keywords="internet-delivered intervention",
keywords="quality of life",
keywords="eHealth",
keywords="randomized controlled trial",
keywords="psycho-oncology",
keywords="mobile phone",
abstract="Background: Cancer survivors are vulnerable to experiencing symptoms of anxiety and depression and may benefit from accessible interventions focused on improving emotion regulation. CanCope Mind (CM) was developed as an internet-delivered intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to improve emotion regulation and support the mental health of cancer survivors. Objective: This protocol aims to provide an outline of the CanCope Study, a trial comparing the efficacy of a Unified Protocol--adapted internet-delivered intervention (CM) designed for cancer survivors compared with an active control condition---an internet-delivered healthy lifestyle intervention, CanCope Lifestyle (CL). The primary aim is to assess and compare the efficacy of both interventions in improving emotion regulation, anxiety and depressive symptoms, and quality of life. The secondary aims involve assessing the mechanisms of the CM intervention. Methods: This trial is a 2-arm randomized controlled trial that allocates cancer survivors to either CM or CL. Both interventions comprise 4 web-based modules and are expected to take participants at least 8 weeks to complete. Participants' mental and physical health will be assessed via self-reported surveys at baseline (T0), between each module (T1, T2, and T3), immediately after the intervention (T4), and at 3-month follow-up (T5). The study aims to recruit 110 participants who have completed T4. Results: The CanCope study began recruitment in September 2020. A total of 224 participants have been randomized to the CM (n=110, 49.1\%) and CL (n=114, 50.9\%) groups. Conclusions: This is one of the first trials to develop and investigate the efficacy of a web-based intervention for cancer survivors that specifically targets emotion regulation. Trial Registration: Australian Clinical Trials ACTRN12620000943943; https://tinyurl.com/b3z9cjsp International Registered Report Identifier (IRRID): DERR1-10.2196/36658 ",
doi="10.2196/36658",
url="https://www.researchprotocols.org/2022/7/e36658",
url="http://www.ncbi.nlm.nih.gov/pubmed/35896021"
}


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


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


@Article{info:doi/10.2196/32354,
author="Signorelli, Ruiz Gabriel
and Monteiro-Guerra, Francisco
and Rivera-Romero, Octavio
and N{\'u}{\~n}ez-Benjumea, J. Francisco
and Fern{\'a}ndez-Luque, Luis",
title="Breast Cancer Physical Activity Mobile Intervention: Early Findings From a User Experience and Acceptability Mixed Methods Study",
journal="JMIR Form Res",
year="2022",
month="Jun",
day="22",
volume="6",
number="6",
pages="e32354",
keywords="breast cancer",
keywords="BC",
keywords="mobile app",
keywords="physical activity",
keywords="mHealth",
keywords="acceptability",
keywords="user experience",
keywords="mobile phone",
abstract="Background: Physical activity (PA) is the most well-established lifestyle factor associated with breast cancer (BC) survival. Even women with advanced BC may benefit from moderate PA. However, most BC symptoms and treatment side effects are barriers to PA. Mobile health coaching systems can implement functionalities and features based on behavioral change theories to promote healthier behaviors. However, to increase its acceptability among women with BC, it is essential that these digital persuasive systems are designed considering their contextual characteristics, needs, and preferences. Objective: This study aimed to examine the potential acceptability and feasibility of a mobile-based intervention to promote PA in patients with BC; assess usability and other aspects of the user experience; and identify key considerations and aspects for future improvements, which may help increase and sustain acceptability and engagement. Methods: A mixed methods case series evaluation of usability and acceptability was conducted in this study. The study comprised 3 sessions: initial, home, and final sessions. Two standardized scales were used: the Satisfaction with Life Scale and the International Physical Activity Questionnaire--Short Form. Participants were asked to use the app at home for approximately 2 weeks. App use and PA data were collected from the app and stored on a secure server during this period. In the final session, the participants filled in 2 app evaluation scales and took part in a short individual interview. They also completed the System Usability Scale and the user version of the Mobile App Rating Scale. Participants were provided with a waist pocket, wired in-ear headphones, and a smartphone. They also received printed instructions. A content analysis of the qualitative data collected in the interviews was conducted iteratively, ensuring that no critical information was overlooked. Results: The International Physical Activity Questionnaire--Short Form found that all participants (n=4) were moderately active; however, half of them did not reach the recommended levels in the guidelines. System Usability Scale scores were all >70 out of 100 (72.5, 77.5, 95, and 80), whereas the overall user version of the Mobile App Rating Scale scores were 4, 4.3, 4.4, and 3.6 out of 5. The app was perceived to be nice, user-friendly, straightforward, and easy to understand. Recognition of achievements, the possibility of checking activity history, and the rescheduling option were positively highlighted. Technical difficulties with system data collection, particularly with the miscount of steps, could make users feel frustrated. The participants suggested improvements and indicated that the app has the potential to work well for survivors of BC. Conclusions: Early results presented in this study point to the potential of this tool concept to provide a friendly and satisfying coaching experience to users, which may help improve PA adherence in survivors of BC. ",
doi="10.2196/32354",
url="https://formative.jmir.org/2022/6/e32354",
url="http://www.ncbi.nlm.nih.gov/pubmed/35731554"
}


@Article{info:doi/10.2196/31815,
author="Robertson, C. Michael
and Cox-Martin, Emily
and Shegog, Ross
and Markham, M. Christine
and Fujimoto, Kayo
and Durand, P. Casey
and Brewster, Abenaa
and Lyons, J. Elizabeth
and Liao, Yue
and Flores, A. Sara
and Basen-Engquist, M. Karen",
title="The Acceptability of an Electronically Delivered Acceptance- and Mindfulness-Based Physical Activity Intervention for Survivors of Breast Cancer: One-Group Pretest-Posttest Design",
journal="JMIR Cancer",
year="2022",
month="Apr",
day="29",
volume="8",
number="2",
pages="e31815",
keywords="cancer survivors",
keywords="exercise",
keywords="mindfulness",
keywords="Acceptance and Commitment Therapy",
keywords="behavioral sciences",
abstract="Background: Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of the internal barriers associated with physical activity. Objective: The primary aim of this study was to investigate the acceptability of an electronically delivered physical activity intervention for survivors of breast cancer, centered on ACT processes. Methods: This study used a 1-group pretest-posttest design. We recruited 80 insufficiently active female survivors of breast cancer using a web-based recruitment strategy. The 8-week intervention consisted of weekly modules that featured didactic lessons and experiential exercises targeting key ACT processes in the context of physical activity promotion (namely, values, committed action, acceptance, defusion, and contacting the present moment). We determined intervention acceptability according to study retention (?70\%), adherence rates (?75\% of the participants completing ?50\% of the modules), and posttest survey scores reflecting the perceived ease of use, perceived usefulness, and interest and enjoyment of the intervention (?5 on a 7-point Likert-type scale). We also evaluated changes in self-reported aerobic and muscle strengthening--physical activity, physical activity acceptance, physical activity regulation, and health-related outcomes. Results: The retention rate (61/80, 76\%), adherence rate (60/80, 75\%), average perceived ease of use (6.17, SD 1.17), perceived usefulness (5.59, SD 1.40), and interest and enjoyment scores (5.43, SD 1.40) met the acceptability criteria. Participants increased their self-reported aerobic physical activity (Cohen d=1.04), muscle strengthening--physical activity (Cohen d=1.02), physical activity acceptance (cognitive acceptance: Cohen d=0.35; behavioral commitment: Cohen d=0.51), physical activity regulation (identified regulation: Cohen d=0.37; integrated regulation: Cohen d=0.66), increased their ability to participate in social roles and activities (Cohen d=0.18), and reported less fatigue (Cohen d=0.33) and sleep disturbance (Cohen d=0.53). Conclusions: Electronically delivered acceptance- and mindfulness-based interventions may be useful for promoting physical activity in survivors of breast cancer. Further research is needed to refine these approaches and evaluate their effectiveness. ",
doi="10.2196/31815",
url="https://cancer.jmir.org/2022/2/e31815",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486425"
}


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


@Article{info:doi/10.2196/26827,
author="Patel, I. Darpan
and Gonzalez, Angela
and Moon, Crisann
and Serra, Monica
and Bridges, Blake Preston
and Hughes, Daniel
and Clarke, Geoffrey
and Kilpela, Lisa
and Jiwani, Rozmin
and Musi, Nicolas",
title="Exercise and Creatine Supplementation to Augment the Adaptation of Exercise Training Among Breast Cancer Survivors Completing Chemotherapy: Protocol for an Open-label Randomized Controlled Trial (the THRIVE Study)",
journal="JMIR Res Protoc",
year="2022",
month="Apr",
day="1",
volume="11",
number="4",
pages="e26827",
keywords="rehabilitation",
keywords="supplements",
keywords="resistant exercise",
keywords="oncology",
keywords="quality of life",
keywords="doxorubicin",
abstract="Background: In breast cancer survivors, chemotherapy-induced muscle loss has been shown to be attenuated with structured resistance exercise. Creatine supplementation can increase bioenergetics in skeletal muscle, which helps to improve overall strength and endurance and reduce muscular fatigue. Therefore, we hypothesize that adding creatinine supplementation to exercise training will accelerate improvements in strength, endurance, and bioenergetics in breast cancer survivors. Objective: The primary objective is to determine the effects of combining creatine supplementation with exercise on modulating strength and physical function in breast cancer survivors by comparing these effects to those of exercise alone. The secondary objectives are to determine if creatine supplementation and exercise can increase the intramuscular storage of creatine and improve body composition by comparing this intervention to exercise alone. Methods: We aim to test our hypothesis by conducting an open-label randomized controlled trial of 30 breast cancer survivors who have completed chemotherapy within 6 months of enrollment. Eligible participants will be equally randomized (1:1) to either a creatine and exercise group or an exercise-only group for this 12-week intervention. Individuals who are randomized to receive creatine will be initially dosed at 20 g per day for 7 days to boost the availability of creatine systemically. Thereafter, the dose will be reduced to 5 g per day for maintenance throughout the duration of the 12-week protocol. All participants will engage in 3 center-based exercise sessions, which will involve completing 3 sets of 8 to 12 repetitions on chest press, leg press, seated row, shoulder press, leg extension, and leg curl machines. The primary outcomes will include changes in strength, body composition, and physical function in breast cancer survivors. The secondary outcomes will be intramuscular concentrations of creatine and adenosine triphosphate in the vastus lateralis, midthigh cross-sectional area, and quality of life. Results: As of October 2021, a total of 9 patients have been enrolled into the study. No unexpected adverse events have been reported. Conclusions: Creatine is being studied as a potential agent for improving strength, endurance, and bioenergetics in breast cancer survivors following chemotherapy. The findings from our trial may have future implications for supporting breast cancer survivors in reversing the muscle loss experienced during chemotherapy and improving their physical function and quality of life. Trial Registration: ClinicalTrials.gov NCT04207359; https://clinicaltrials.gov/ct2/show/NCT04207359 International Registered Report Identifier (IRRID): PRR1-10.2196/26827 ",
doi="10.2196/26827",
url="https://www.researchprotocols.org/2022/4/e26827",
url="http://www.ncbi.nlm.nih.gov/pubmed/35363152"
}


@Article{info:doi/10.2196/35838,
author="Lie, C. Hanne
and Anderssen, Sigmund
and Rueegg, Silvia Corina
and Raastad, Truls
and Grydeland, May
and Thorsen, Lene
and Stensrud, Trine
and Edvardsen, Elisabeth
and Larsen, Hamilton Marie
and Torsvik, Kristin Ingrid
and Bovim, Peder Lars
and G{\"o}tte, Miriam
and L{\"a}hteenm{\"a}ki, Maria P{\"a}ivi
and Kriemler, Susi
and Larsen, B{\ae}kgaard Hanne
and Fridh, Kaj Martin
and {\O}rstavik, Kristin
and Brun, Henrik
and Matthews, Iren
and Hornset, Else
and Ruud, Ellen",
title="The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) Study: Protocol for an International Mixed Methods Study",
journal="JMIR Res Protoc",
year="2022",
month="Mar",
day="8",
volume="11",
number="3",
pages="e35838",
keywords="childhood cancer survivor",
keywords="physical activity",
keywords="physical fitness",
keywords="barriers",
keywords="intervention",
keywords="quality of life",
keywords="fatigue",
abstract="Background: Survivors of childhood cancer represent a growing population with a long life expectancy but high risks of treatment-induced morbidity and premature mortality. Regular physical activity (PA) may improve their long-term health; however, high-quality empirical knowledge is sparse. Objective: The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) study comprises 4 work packages (WPs) aiming for the objective determination of PA and self-reported health behavior, fatigue, and quality of life (WP 1); physical fitness determination (WP 2); the evaluation of barriers to and facilitators of PA (WP 1 and 3); and the feasibility testing of an intervention to increase PA and physical fitness (WP 4). Methods: The PACCS study will use a mixed methods design, combining patient-reported outcome measures and objective clinical and physiological assessments with qualitative data gathering methods. A total of 500 survivors of childhood cancer aged 9 to 18 years with ?1 year after treatment completion will be recruited in follow-up care clinics in Norway, Denmark, Finland, Germany, and Switzerland. All participants will participate in WP 1, of which approximately 150, 40, and 30 will be recruited to WP 2, WP3, and WP 4, respectively. The reference material for WP 1 is available from existing studies, whereas WP 2 will recruit healthy controls. PA levels will be measured using ActiGraph accelerometers and self-reports. Validated questionnaires will be used to assess health behaviors, fatigue, and quality of life. Physical fitness will be measured by a cardiopulmonary exercise test, isometric muscle strength tests, and muscle power and endurance tests. Limiting factors will be identified via neurological, pulmonary, and cardiac evaluations and the assessment of body composition and muscle size. Semistructured, qualitative interviews, analyzed using systematic text condensation, will identify the perceived barriers to and facilitators of PA for survivors of childhood cancer. In WP 4, we will evaluate the feasibility of a 6-month personalized PA intervention with the involvement of local structures. Results: Ethical approvals have been secured at all participating sites (Norwegian Regional Committee for Medical Research Ethics [2016/953 and 2018/739]; the Oslo University Hospital Data Protection Officer; equivalent institutions in Finland, Denmark [file H-19032270], Germany, and Switzerland [Ethics Committee of Northwestern and Central Switzerland, project ID: 2019-00410]). Data collection for WP 1 to 3 is complete. This will be completed by July 2022 for WP 4. Several publications are already in preparation, and 2 have been published. Conclusions: The PACCS study will generate high-quality knowledge that will contribute to the development of an evidence-based PA intervention for young survivors of childhood cancer to improve their long-term care and health. We will identify physiological, psychological, and social barriers to PA that can be targeted in interventions with immediate benefits for young survivors of childhood cancer in need of rehabilitation. International Registered Report Identifier (IRRID): DERR1-10.2196/35838 ",
doi="10.2196/35838",
url="https://www.researchprotocols.org/2022/3/e35838",
url="http://www.ncbi.nlm.nih.gov/pubmed/35258456"
}


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


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


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


@Article{info:doi/10.2196/27349,
author="Passardi, Alessandro
and Foca, Flavia
and Caffo, Orazio
and Tondini, Alberto Carlo
and Zambelli, Alberto
and Vespignani, Roberto
and Bartolini, Giulia
and Sullo, Giulio Francesco
and Andreis, Daniele
and Dianti, Marco
and Eccher, Claudio
and Piras, Maria Enrico
and Forti, Stefano",
title="A Remote Monitoring System to Optimize the Home Management of Oral Anticancer Therapies (ONCO-TreC): Prospective Training--Validation Trial",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="26",
volume="24",
number="1",
pages="e27349",
keywords="adherence",
keywords="oral anticancer drug",
keywords="mHealth",
keywords="ONCO-TreC",
keywords="electronic diary",
abstract="Background: A platform designed to support the home management of oral anticancer treatments and provide a secure web-based patient--health care professional communication modality, ONCO-TreC, was tested in 3 cancer centers in Italy. Objective: The overall aims of the trial are to customize the platform; assess the system's ability to facilitate the shared management of oral anticancer therapies by patients and health professionals; and evaluate system usability and acceptability by patients, caregivers, and health care professionals. Methods: Patients aged ?18 years who were candidates for oral anticancer treatment as monotherapy with an Eastern Cooperative Oncology Group performance status score of 0 to 1 and a sufficient level of familiarity with mobile devices were eligible. ONCO-TreC consisted of a mobile app for patients and a web-based dashboard for health care professionals. Adherence to treatment (pill count) and toxicities reported by patients through the app were compared with those reported by physicians in medical records. Usability and acceptability were evaluated using questionnaires. Results: A total of 40 patients were enrolled, 38 (95\%) of whom were evaluable for adherence to treatment. The ability of the system to measure adherence to treatment was high, with a concordance of 97.3\% (95\% CI 86.1\%-99.9\%) between the investigator and system pill count. Only 60\% (3/5) of grade 3, 54\% (13/24) of grade 2, and 19\% (7/36) of grade 1 adverse events reported by physicians in the case report forms were also reported in the app directly by patients. In total, 94\% (33/35) of patients had ?1 app launch each week, and the median number of daily accesses per patient was 2. Approximately 71\% (27/38) and 68\% (26/38) of patients used the app for messages and vital sign entering, respectively, at least once during the study period. Conclusions: ONCO-TreC is an important tool for measuring and monitoring adherence to oral anticancer drugs. System usability and acceptability were very high, whereas its reliability in registering toxicity could be improved. Trial Registration: ClinicalTrials.gov NCT02921724; https://www.clinicaltrials.gov/ct2/show/NCT02921724 ",
doi="10.2196/27349",
url="https://www.jmir.org/2022/1/e27349",
url="http://www.ncbi.nlm.nih.gov/pubmed/35080505"
}


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


@Article{info:doi/10.2196/29494,
author="Thirumalai, Mohanraj
and Brown, Nashira
and Niranjan, Soumya
and Townsend, Sh'Nese
and Powell, Anne Mary
and Neal, Whitney
and Schleicher, Erica
and Raparla, Venkatadri
and Oster, Robert
and Demark-Wahnefried, Wendy
and Pekmezi, Dori",
title="An Interactive Voice Response System to Increase Physical Activity and Prevent Cancer in the Rural Alabama Black Belt: Design and Usability Study",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="4",
volume="9",
number="1",
pages="e29494",
keywords="interactive voice response systems",
keywords="usability",
keywords="exercise",
keywords="physical activity",
keywords="rural health",
keywords="telehealth",
abstract="Background: Increased physical activity (PA) levels are associated with reduced risk and improved survival for several cancers; however, most Americans engage in less than the recommended levels of PA. Using interactive voice response (IVR) systems to provide personalized health education and counseling may represent a high-reach, low-cost strategy for addressing physical inactivity and cancer disparities in disproportionately burdened rural regions. However, there has been a paucity of research conducted in this area to date. Objective: The aim of this study is to design, develop, and test the usability of an IVR system aimed at increasing PA levels in the rural Alabama Black Belt. Methods: A pilot version of the IVR system was used to assess initial feasibility and acceptability. Detailed exit interviews were conducted to elicit participant feedback, which helped inform the development of a substantially upgraded in-house IVR system. This refined IVR system was then subjected to a sequential explanatory mixed methods evaluation. Participating rural county coordinators and research staff (N=10) tested the usability of the IVR system features for 2 weeks and then completed the System Usability Scale and qualitative semistructured interviews. Results: The study sample comprised mostly African American people, women, rural county coordinators, and research staff (N=10). Participants rated the IVR system with a mean score of 81 (SD 5) on the System Usability Scale, implying excellent usability. In total, 5 overarching themes emerged from the qualitative interviews: likes or dislikes of the intervention, barriers to or facilitators of PA, technical difficulties, quality of calls, and suggestions for intervention improvement. Message framing on step feedback, call completion incentives, and incremental goal-setting challenges were areas identified for improvement. The positive areas highlighted in the interviews included the personalized call schedules, flexibility to call in or receive a call, ability to make up for missed calls, narration, and PA tips. Conclusions: The usability testing and feedback received from the rural county coordinators and research staff helped inform a final round of refinement to the IVR system before use in a large randomized controlled trial. This study stresses the importance of usability testing of all digital health interventions and the benefits it can offer to the intervention. ",
doi="10.2196/29494",
url="https://humanfactors.jmir.org/2022/1/e29494",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982714"
}


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


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


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


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


@Article{info:doi/10.2196/26226,
author="Ivankova, V. Nataliya
and Rogers, Q. Laura
and Herbey, I. Ivan
and Martin, Y. Michelle
and Pisu, Maria
and Pekmezi, Dorothy
and Thompson, Lieu
and Schoenberger-Godwin, M. Yu-Mei
and Oster, A. Robert
and Fontaine, Kevin
and Anderson, L. Jami
and Kenzik, Kelly
and Farrell, David
and Demark-Wahnefried, Wendy",
title="Features That Middle-aged and Older Cancer Survivors Want in Web-Based Healthy Lifestyle Interventions: Qualitative Descriptive Study",
journal="JMIR Cancer",
year="2021",
month="Oct",
day="6",
volume="7",
number="4",
pages="e26226",
keywords="cancer survivors",
keywords="diet",
keywords="physical activity",
keywords="lifestyle",
keywords="internet",
keywords="interventions",
keywords="qualitative",
keywords="eHealth",
keywords="mobile phone",
abstract="Background: With the increasing number of older cancer survivors, it is imperative to optimize the reach of interventions that promote healthy lifestyles. Web-based delivery holds promise for increasing the reach of such interventions with the rapid increase in internet use among older adults. However, few studies have explored the views of middle-aged and older cancer survivors on this approach and potential variations in these views by gender or rural and urban residence. Objective: The aim of this study was to explore the views of middle-aged and older cancer survivors regarding the features of web-based healthy lifestyle programs to inform the development of a web-based diet and exercise intervention. Methods: Using a qualitative descriptive approach, we conducted 10 focus groups with 57 cancer survivors recruited from hospital cancer registries in 1 southeastern US state. Data were analyzed using inductive thematic and content analyses with NVivo (version 12.5, QSR International). Results: A total of 29 male and 28 female urban and rural dwelling Black and White survivors, with a mean age of 65 (SD 8.27) years, shared their views about a web-based healthy lifestyle program for cancer survivors. Five themes emerged related to program content, design, delivery, participation, technology training, and receiving feedback. Cancer survivors felt that web-based healthy lifestyle programs for cancer survivors must deliver credible, high-quality, and individually tailored information, as recommended by health care professionals or content experts. Urban survivors were more concerned about information reliability, whereas women were more likely to trust physicians' recommendations. Male and rural survivors wanted information to be tailored to the cancer type and age group. Privacy, usability, interaction frequency, and session length were important factors for engaging cancer survivors with a web-based program. Female and rural participants liked the interactive nature and visual appeal of the e-learning sessions. Learning from experts, an attractive design, flexible schedule, and opportunity to interact with other cancer survivors in Facebook closed groups emerged as factors promoting program participation. Low computer literacy, lack of experience with web program features, and concerns about Facebook group privacy were important concerns influencing cancer survivors' potential participation. Participants noted the importance of technology training, preferring individualized help to standardized computer classes. More rural cancer survivors acknowledged the need to learn how to use computers. The receipt of regular feedback about progress was noted as encouragement toward goal achievement, whereas women were particularly interested in receiving immediate feedback to stay motivated. Conclusions: Important considerations for designing web-based healthy lifestyle interventions for middle-aged and older cancer survivors include program quality, participants' privacy, ease of use, attractive design, and the prominent role of health care providers and content experts. Cancer survivors' preferences based on gender and residence should be considered to promote program participation. ",
doi="10.2196/26226",
url="https://cancer.jmir.org/2021/4/e26226",
url="http://www.ncbi.nlm.nih.gov/pubmed/34612832"
}


@Article{info:doi/10.2196/25464,
author="vd Wiel, J. Hester
and Stuiver, M. Martijn
and May, M. Anne
and van Grinsven, Susan
and Benink, A. Marlou F.
and Aaronson, K. Neil
and Oldenburg, A. Hester S.
and van der Poel, G. Henk
and van Harten, H. Wim
and Groen, G. Wim",
title="Characteristics of Participants and Nonparticipants in a Blended Internet-Based Physical Activity Trial for Breast and Prostate Cancer Survivors: Cross-sectional Study",
journal="JMIR Cancer",
year="2021",
month="Oct",
day="5",
volume="7",
number="4",
pages="e25464",
keywords="internet-based intervention",
keywords="physical activity",
keywords="nonparticipants",
keywords="breast cancer survivors",
keywords="prostate cancer survivors",
keywords="RCT",
abstract="Background: As the number of cancer survivors is increasing, it is important to be able to offer exercise and physical activity (PA)--promoting interventions that are both effective and reasonably accessible. Internet-based interventions are typically less expensive and more accessible alternatives to on-site supervised interventions. Currently, little is known about the characteristics of nonparticipants in PA promotion trials in the cancer survivorship setting, both in general and specifically in trials using internet-supported interventions. Objective: This study aims to gain insight into the characteristics associated with nonparticipation in a blended internet-based supported intervention trial to promote PA. Methods: Breast and prostate cancer survivors, 3-36 months after primary curative treatment, were invited to participate in the PABLO trial; this trial compared an internet-based intervention to enhance PA levels, with or without additional support from a physical therapist, to usual care. Participants and nonparticipants were asked to complete a comprehensive questionnaire assessing sociodemographics, fatigue, and health-related quality of life. Baseline data for participants and nonparticipants were compared using the independent Student t test and chi-square test. Results: The inclusion rate in the trial was 11.03\% (137/1242). Of the nonparticipants, 13.95\% (154/1104) completed the questionnaire. Participants were more highly educated (P=.04), had a paid job less often (P=.03), and were on sick leave more often (P=.03). They reported less PA per week, both moderate (P=.03) and vigorous (P<.01), before diagnosis and during leisure time (P<.01, effect size [ES]=0.44). They reported a significantly lower stage of change (P?.01), lower self-efficacy (P<.01, ES=0.61), perceived barriers to PA (P<.01, ES=0.54), and more general fatigue (P<.01, ES=0.60). Participants reported lower health-related quality of life for most domains (ES ranging from 0.34 for mental health to 0.48 for social functioning). No significant differences were found for other sociodemographics, mood state, or attitudes toward or perceived social support for PA. Conclusions: The participants who self-selected for trial participation reported lower PA levels before diagnosis and a stronger need for support compared with nonparticipants. The trial thus included those patients who might benefit the most from internet-based supportive PA interventions. Trial Registration: Netherlands trial register NTR6911; https://www.trialregister.nl/trial/6733 ",
doi="10.2196/25464",
url="https://cancer.jmir.org/2021/4/e25464",
url="http://www.ncbi.nlm.nih.gov/pubmed/34609311"
}


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


@Article{info:doi/10.2196/28852,
author="Ester, Manuel
and Eisele, Maximilian
and Wurz, Amanda
and McDonough, H. Meghan
and McNeely, Margaret
and Culos-Reed, Nicole S.",
title="Current Evidence and Directions for Future Research in eHealth Physical Activity Interventions for Adults Affected by Cancer: Systematic Review",
journal="JMIR Cancer",
year="2021",
month="Sep",
day="20",
volume="7",
number="3",
pages="e28852",
keywords="eHealth",
keywords="electronic health",
keywords="mHealth",
keywords="cancer",
keywords="oncology",
keywords="physical activity",
keywords="exercise",
keywords="systematic review",
keywords="mobile phone",
abstract="Background: Physical activity (PA) interventions can increase PA and improve well-being among adults affected by cancer; however, most adults do not meet cancer-specific PA recommendations. Lack of time, facility access, and travel distances are barriers to participation in PA interventions. eHealth technologies may address some of these barriers, serving as a viable way to promote PA behavior change in this population. However, no review from July 2018 has synthesized available evidence across eHealth and cancer types or examined the use of behavioral theory and behavior change techniques (BCTs), leaving important gaps in knowledge. Objective: This review aims to provide a comprehensive, updated overview of evidence on eHealth PA interventions for adults with cancer by describing the current state of the literature, exploring associations between intervention characteristics and effectiveness, and identifying future research needs. Methods: MEDLINE, Embase, CINAHL, SportDiscus, Scopus, and CENTRAL were searched for eHealth PA interventions for adults affected by cancer. Study selection and data extraction were performed in duplicate, with consultation from the senior author (NCR). BCT coding, risk of bias, and completeness of reporting were performed using standardized tools. Results were summarized via narrative synthesis and harvest plots. Weight analyses were conducted to explore the associations between intervention characteristics and effectiveness. Results: A total of 71 articles (67 studies) involving 6655 participants (mean age 56.7 years, SD 8.2) were included. Nearly 50\% (32/67) of the articles were published after July 2018. Significant postintervention PA increases were noted in 52\% (35/67) of the studies, and PA maintenance was noted in 41\% (5/12) of the studies that included a follow-up. Study duration, primary objectives, and eHealth modality (eg, websites, activity trackers, and SMS text messaging) varied widely. Social cognitive theory (23/67, 34\%) was the most used theory. The mean number of BCTs used across the studies was 13.5 (SD 5.5), with self-monitoring, credible sources, and goal setting being used in >90\% of studies. Weight analyses showed the greatest associations between increased PA levels and PA as a primary outcome (0.621), interventions using websites (0.656) or mobile apps (0.563), interventions integrating multiple behavioral theories (0.750), and interventions using BCTs of problem solving (0.657) and action planning (0.645). All studies had concerns with high risk of bias, mostly because of the risk of confounding, measurement bias, and incomplete reporting. Conclusions: A range of eHealth PA interventions may increase PA levels among adults affected by cancer, and specific components (eg, websites, use of theory, and action planning) may be linked to greater effectiveness. However, more work is needed to ascertain and optimize effectiveness, measure long-term effects, and address concerns with bias and incomplete reporting. This evidence is required to support arguments for integrating eHealth within PA promotion in oncology. ",
doi="10.2196/28852",
url="https://cancer.jmir.org/2021/3/e28852",
url="http://www.ncbi.nlm.nih.gov/pubmed/34542415"
}


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


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


@Article{info:doi/10.2196/28695,
author="Yang, Kyungmi
and Oh, Dongryul
and Noh, Myoung Jae
and Yoon, Gyul Han
and Sun, Jong-Mu
and Kim, Kwan Hong
and Zo, Ill Jae
and Shim, Mog Young
and Ko, Hyunyoung
and Lee, Jungeun
and Kim, Youngin",
title="Feasibility of an Interactive Health Coaching Mobile App to Prevent Malnutrition and Muscle Loss in Esophageal Cancer Patients Receiving Neoadjuvant Concurrent Chemoradiotherapy: Prospective Pilot Study",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="27",
volume="23",
number="8",
pages="e28695",
keywords="esophageal cancer",
keywords="malnutrition",
keywords="muscle loss",
keywords="sarcopenia",
keywords="mobile app",
keywords="mHealth",
abstract="Background: Excessive muscle loss is an important prognostic factor in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT), as reported in our previous research. Objective: In this pilot study, we prospectively tested the feasibility of a health coaching mobile app for preventing malnutrition and muscle loss in this patient population. Methods: Between July 2019 and May 2020, we enrolled 38 male patients with esophageal cancer scheduled for NACRT. For 8 weeks from the start of radiotherapy (RT), the patients used Noom, a health coaching mobile app that interactively provided online advice about food intake, exercise, and weight changes. The skeletal muscle index (SMI) measured based on computed tomography and nutrition-related laboratory markers were assessed before and after RT. We evaluated the changes in the SMI, nutrition, and inflammatory factors between the patient group that used the mobile app (mHealth group) and our previous study cohort (usual care group). Additionally, we analyzed the factors associated with walk steps recorded in the app. Results: Two patients dropped out of the study (no app usage; treatment changed to a definitive aim). The use (or activation) of the app was noted in approximately 70\% (25/36) of the patients until the end of the trial. Compared to the 1:2 matched usual care group by propensity scores balanced with their age, primary tumor location, tumor stage, pre-RT BMI, and pre-RT SMI level, 30 operable patients showed less aggravation of the prognostic nutritional index (PNI) (--6.7 vs --9.8; P=.04). However, there was no significant difference in the SMI change or the number of patients with excessive muscle loss (?SMI/50 days >10\%). In patients with excessive muscle loss, the walk steps significantly decreased in the last 4 weeks compared to those in the first 4 weeks. Age affected the absolute number of walk steps (P=.01), whereas pre-RT sarcopenia was related to the recovery of the reduced walk steps (P=.03). Conclusions: For esophageal cancer patients receiving NACRT, a health care mobile app helped nutritional self-care with less decrease in the PNI, although it did not prevent excessive muscle loss. An individualized care model with proper exercise as well as nutritional support may be required to reduce muscle loss and malnutrition. ",
doi="10.2196/28695",
url="https://www.jmir.org/2021/8/e28695",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448714"
}


@Article{info:doi/10.2196/16846,
author="Humphry, Angharad Nia
and Wilson, Thomas
and Cox, Christian Michael
and Carter, Ben
and Arkesteijn, Marco
and Reeves, Laura Nicola
and Brakenridge, Scott
and McCarthy, Kathryn
and Bunni, John
and Draper, John
and Hewitt, Jonathan",
title="Association of Postoperative Clinical Outcomes With Sarcopenia, Frailty, and Nutritional Status in Older Patients With Colorectal Cancer: Protocol for a Prospective Cohort Study",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="17",
volume="10",
number="8",
pages="e16846",
keywords="sarcopenia",
keywords="frailty",
keywords="nutritional status",
keywords="urine metabolomics",
keywords="surgery",
keywords="geriatric medicine",
abstract="Background: Older patients account for a significant proportion of patients undergoing colorectal cancer surgery and are vulnerable to a number of preoperative risk factors that are not often present in younger patients. Further, three preoperative risk factors that are more prevalent in older adults include frailty, sarcopenia, and malnutrition. Although each of these has been studied in isolation, there is little information on the interplay between them in older surgical patients. A particular area of increasing interest is the use of urine metabolomics for the objective evaluation of dietary profiles and malnutrition. Objective: Herein, we describe the design, cohort, and standard operating procedures of a planned prospective study of older surgical patients undergoing colorectal cancer resection across multiple institutions in the United Kingdom. The objectives are to determine the association between clinical outcomes and frailty, nutritional status, and sarcopenia. Methods: The procedures will include serial frailty evaluations (Clinical Frailty Scale and Groningen Frailty Indicator), functional assessments (hand grip strength and 4-meter walk test), muscle mass evaluations via computerized tomography morphometric analysis, and the evaluation of nutritional status via the analysis of urinary dietary biomarkers. The primary feasibility outcome is the estimation of the incidence rate of postoperative complications, and the primary clinical outcome is the association between the presence of postoperative complications and frailty, sarcopenia, and nutritional status. The secondary outcome measures are the length of hospital stay, 30-day hospital readmission rate, and mortality rate at days 30 and 90. Results: Our study was approved by the National Health Service Research Ethics Committee (reference number: 19/WA/0190) via the Integrated Research Application System (project ID: 231694) prior to subject recruitment. Cardiff University is acting as the study sponsor. Our study is financially supported through an external, peer-reviewed grant from the British Geriatrics Society and internal funding resources from Cardiff University. The results will be disseminated through peer-review publications, social media, and conference proceedings. Conclusions: As frailty, sarcopenia, and malnutrition are all areas of common derangement in the older surgical population, prospectively studying these risk factors in concert will allow for the analysis of their interplay as well as the development of predictive models for those at risk of commonly tracked surgical complications and outcomes. International Registered Report Identifier (IRRID): PRR1-10.2196/16846 ",
doi="10.2196/16846",
url="https://www.researchprotocols.org/2021/8/e16846",
url="http://www.ncbi.nlm.nih.gov/pubmed/34402798"
}


@Article{info:doi/10.2196/24835,
author="Arietaleanizbeaskoa, Soledad Maria
and Gil Rey, Erreka
and Mendizabal Gallastegui, Nere
and Garc{\'i}a-{\'A}lvarez, Arturo
and De La Fuente, Ibon
and Dom{\'i}nguez-Martinez, Silvia
and Pablo, Susana
and Coca, Aitor
and Guti{\'e}rrez Santamar{\'i}a, Borja
and Grandes, Gonzalo",
title="Implementing Exercise in Standard Cancer Care (Bizi Orain Hybrid Exercise Program): Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Aug",
day="9",
volume="10",
number="8",
pages="e24835",
keywords="patients with cancer",
keywords="physical activity",
keywords="primary care",
keywords="behavioral change",
keywords="randomized controlled trial",
keywords="overall survival",
abstract="Background: Despite the established benefits of regular exercise for patients with cancer to counteract the deleterious effects of the disease itself and treatment-related adverse effects, most of them do not engage in sufficient levels of physical activity and there is a paucity of data on the integration of efficacious exercise programs that are accessible and generalizable to a large proportion of patients with cancer into routine cancer care. Objective: We intend to examine the effects attributable to the implementation of a community-based exercise program on cardiorespiratory functional capacity and quality of life for patients with cancer. Methods: This will be a hybrid study. In the first experimental phase, patients diagnosed with any type of cancer will be randomized into two parallel groups. One group immediately performs Bizi Orain, a 3-month supervised exercise program (3 times a week), in addition to behavioral counseling in a primary health care setting; the other is a reference group that starts the exercise program 3 months later (delayed treatment). In the second observational phase, the entire cohort of participants will be followed-up for 5 years. Any person diagnosed with cancer in the previous 2 years is eligible for the program. The program evaluation involves the uptake, safety, adherence, and effectiveness assessed after completion of the program and with follow-ups at 3, 6, 12, 24, 36, 48, and 60 months. The primary outcomes of the experimental study, to be compared between groups, are improved physical function and quality of life, whereas overall survival is the main objective of the prospective study. To analyze the association between changes in physical activity levels and overall survival, longitudinal mixed-effects models will be used for repeated follow-up measures. Results: A total of 265 patients have been enrolled into the study since January 2019, with 42 patients from the hematology service and 223 from the oncology service. Conclusions: Bizi Orain is the first population-based exercise program in Spain that will offer more insight into the implementation of feasible, generalizable, and sustainable supportive care services involving structured exercise to extend survival of patients with cancer, improve their physical function and quality of life, and reverse the adverse effects of their disease and related treatments, thereby reducing the clinical burden. Trial Registration: ClinicalTrials.gov NCT03819595; http://clinicaltrials.gov/ct2/show/NCT03819595 International Registered Report Identifier (IRRID): DERR1-10.2196/24835 ",
doi="10.2196/24835",
url="https://www.researchprotocols.org/2021/8/e24835",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383676"
}


@Article{info:doi/10.2196/28370,
author="Evans, EL Holly
and Forbes, C. Cynthia
and Galv{\~a}o, A. Daniel
and Vandelanotte, Corneel
and Newton, U. Robert
and Wittert, Gary
and Chambers, Suzanne
and Vincent, D. Andrew
and Kichenadasse, Ganessan
and Girard, Danielle
and Brook, Nicholas
and Short, E. Camille",
title="Usability, Acceptability, and Safety Analysis of a Computer-Tailored Web-Based Exercise Intervention (ExerciseGuide) for Individuals With Metastatic Prostate Cancer: Multi-Methods Laboratory-Based Study",
journal="JMIR Cancer",
year="2021",
month="Jul",
day="28",
volume="7",
number="3",
pages="e28370",
keywords="exercise",
keywords="metastatic prostate cancer",
keywords="behavioral change",
keywords="eHealth",
keywords="computer-tailoring",
keywords="usability",
keywords="acceptability",
abstract="Background: Digital health interventions such as tailored websites are emerging as valuable tools to provide individualized exercise and behavioral change information for individuals diagnosed with cancer. Objective: The aim of this study is to investigate and iteratively refine the acceptability and usability of a web-based exercise intervention (ExerciseGuide) for men with metastatic prostate cancer and determine how well individuals can replicate the video-based exercise prescription. Methods: A laboratory-based multi-methods design was used, incorporating questionnaires, think-aloud tests, interviews, and movement screening among 11 men aged 63 to 82 years with metastatic prostate cancer. Overall, 9 participants were undergoing androgen deprivation therapy, and 2 were completing chemotherapy. Data were collected in two waves, with changes made for quality improvement after participant 5. Results: The intervention's usability score was deemed moderate overall but improved after modifications (from 60, SD 2.9 to 69.6, SD 2.2 out of 100). Overall, the participants found the intervention acceptable, with scores improving from wave 1 (24.2, SD 1.1 out of 30) to wave 2 (26.3, SD 2.1 out of 30). The personalized multimodal exercise prescription and computer-tailored education were seen as valuable. After wave 1, website navigation videos were added, medical terminology was simplified, and a telehealth component was included after expert real-time telehealth support was requested. Wave 2 changes included the added variety for aerobic exercise modes, reduced computer-tailoring question loads, and improved consistency of style and grammar. Finally, the participants could replicate the resistance exercise videos to a satisfactory level as judged by the movement screen; however, additional technique cueing within the videos is recommended to address safety concerns. Conclusions: The acceptability and usability of ExerciseGuide were deemed satisfactory. Various problems were identified and resolved. Notably, the participants requested the inclusion of personalized expert support through telehealth. The resistance training algorithms were shown to provide appropriate content safely, and the users could replicate the exercise technique unaided to a satisfactory level. This study has optimized the ExerciseGuide intervention for further investigation in this population. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618001978257; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001978257 ",
doi="10.2196/28370",
url="https://cancer.jmir.org/2021/3/e28370",
url="http://www.ncbi.nlm.nih.gov/pubmed/34318759"
}


@Article{info:doi/10.2196/24915,
author="Walsh, C. Jane
and Richmond, Janice
and Mc Sharry, Jenny
and Groarke, AnnMarie
and Glynn, Liam
and Kelly, Grace Mary
and Harney, Owen
and Groarke, M. Jenny",
title="Examining the Impact of an mHealth Behavior Change Intervention With a Brief In-Person Component for Cancer Survivors With Overweight or Obesity: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Jul",
day="5",
volume="9",
number="7",
pages="e24915",
keywords="cancer survivors",
keywords="overweight",
keywords="obesity",
keywords="health behavior",
keywords="goals",
keywords="accelerometry",
keywords="text messaging",
keywords="technology",
keywords="Ireland",
keywords="self-management",
keywords="mobile phone",
abstract="Background: Cancer survivorship in Ireland is increasing in both frequency and longevity. However, a significant proportion of cancer survivors do not reach the recommended physical activity levels and have overweight. This has implications for both physical and psychological health, including an increased risk of subsequent and secondary cancers. Mobile health (mHealth) interventions demonstrate potential for positive health behavior change, but there is little evidence for the efficacy of mobile technology in improving health outcomes in cancer survivors with overweight or obesity. Objective: This study aims to investigate whether a personalized mHealth behavior change intervention improves physical and psychological health outcomes in cancer survivors with overweight or obesity. Methods: A sample of 123 cancer survivors (BMI?25 kg/m2) was randomly assigned to the standard care control (n=61) or intervention (n=62) condition. Group allocation was unblinded. The intervention group attended a 4-hour tailored lifestyle education and information session with physiotherapists, a dietician, and a clinical psychologist to support self-management of health behavior. Over the following 12 weeks, participants engaged in personalized goal setting to incrementally increase physical activity (with feedback and review of goals through SMS text messaging contact with the research team). Direct measures of physical activity were collected using a Fitbit accelerometer. Data on anthropometric, functional exercise capacity, dietary behavior, and psychological measures were collected at face-to-face assessments in a single hospital site at baseline (T0), 12 weeks (T1; intervention end), and 24 weeks (T2; follow-up). Results: The rate of attrition was 21\% (13/61) for the control condition and 14\% (9/62) for the intervention condition. Using intent-to-treat analysis, significant reductions in BMI (F2,242=4.149; P=.02; $\eta$p2=0.033) and waist circumference (F2,242=3.342; P=.04; $\eta$p2=0.027) were observed in the intervention group. Over the 24-week study, BMI was reduced by 0.52 in the intervention condition, relative to a nonsignificant reduction of 0.11 in the control arm. Waist circumference was reduced by 3.02 cm in the intervention condition relative to 1.82 cm in the control condition. Physical activity level was significantly higher in the intervention group on 8 of the 12 weeks of the intervention phase and on 5 of the 12 weeks of the follow-up period, accounting for up to 2500 additional steps per day (mean 2032, SD 270). Conclusions: The results demonstrate that for cancer survivors with a BMI?25 kg/m2, lifestyle education and personalized goal setting using mobile technology can yield significant changes in clinically relevant health indicators. Further research is needed to elucidate the mechanisms of behavior change and explore the capacity for mHealth interventions to improve broader health and well-being outcomes in the growing population of cancer survivors. Trial Registration: ISRCTN Registry ISRCTN18676721; https://www.isrctn.com/ISRCTN18676721 International Registered Report Identifier (IRRID): RR2-10.2196/13214 ",
doi="10.2196/24915",
url="https://mhealth.jmir.org/2021/7/e24915",
url="http://www.ncbi.nlm.nih.gov/pubmed/36260394"
}


@Article{info:doi/10.2196/25569,
author="Lambert, Genevieve
and Alos, Nathalie
and Bernier, Pascal
and Laverdi{\`e}re, Caroline
and Kairy, Dahlia
and Drummond, Kenneth
and Dahan-Oliel, No{\'e}mi
and Lemay, Martin
and Veilleux, Louis-Nicolas",
title="Home-Based Telehealth Exercise Intervention in Early-On Survivors of Childhood Acute Lymphoblastic Leukemia: Feasibility Study",
journal="JMIR Cancer",
year="2021",
month="Jun",
day="16",
volume="7",
number="2",
pages="e25569",
keywords="exercise therapy",
keywords="rehabilitation",
keywords="acute lymphoblastic leukemia",
keywords="intervention study",
keywords="telehealth",
keywords="mobile phone",
abstract="Background: Acute lymphoblastic leukemia is the most common type of pediatric cancer. Acute lymphoblastic leukemia causes an altered bone mineral homeostasis state, which can contribute to osteopenia, and bone fractures, most commonly vertebral fractures. With the increasing number of childhood cancer survivors, late adverse effects such as musculoskeletal comorbidities are often reported and are further influenced by inactive lifestyle habits. Physical activity has been shown to increase the mechanical workload of the bone, mitigating bone impairment in other cancer-specific populations. Objective: This interventional pilot study aims to investigate the use of telehealth to deliver a home-based exercise intervention for early-on survivors of bone marrow--related hematological malignancies and to assess its impact on survivors' musculoskeletal and functional health. Methods: We aimed to recruit a group of 12 early-on survivors of acute lymphoblastic leukemia, within 6 months to 5 years of treatment, to participate in and complete the proposed telehealth intervention with a parent. The 16-week intervention included 40 potential home-based physical activity interventions supervised by a kinesiologist through a telehealth internet platform, with monthly progression. Patients were recruited to the cohort if they were able to participate in the intervention during the first month (minimum 12 weeks of intervention). Evaluation before and after the intervention protocol highlighted differences in functional capacities and musculoskeletal health of patients using mechanography, peripheral quantitative computed tomography, 6-minute walk test, and grip force test. Results: The recruitment rate for the intervention was low (12/57, 21\% of contacted patients). Of 12 patients, 3 were excluded (1=relapse, 1=failure to meet technical requirements, and 1=abandoned). The 9 patients who completed the intervention (6 girls; mean age 10.93, SD 2.83 years; mean BMI 21.58, SD 6.55 kg/m2; mean time since treatment completion 36.67, SD 16.37 months) had a mean adherence of 89\% and a completion rate of 75\%. In addition, these patients showed functional improvements in lower limb muscle force and power as well as in the 6-minute walk test distance. Participants also showed improved bone health after the intervention on the following parameters: bone mineral content, stress-strain index, total and cortical cross-sectional area at the 14\% site (P=.03, P=.01, P=.01, and P=.001, respectively) and 38\% site of the tibia (P=.003, P=.04, P=.001, and P=.003, respectively). Conclusions: High adherence and participation rates suggest that telehealth is a feasible method to deliver exercise interventions to young early-on survivors of acute lymphoblastic leukemia. The proposed intervention seems promising in providing benefits to patients' functional performance and bone health, but a large-scale study is needed to confirm this assumption. ",
doi="10.2196/25569",
url="https://cancer.jmir.org/2021/2/e25569",
url="http://www.ncbi.nlm.nih.gov/pubmed/34132645"
}


@Article{info:doi/10.2196/27076,
author="Singleton, Anna
and Raeside, Rebecca
and Partridge, R. Stephanie
and Hayes, Molly
and Maka, Katherine
and Hyun, K. Karice
and Thiagalingam, Aravinda
and Chow, K. Clara
and Sherman, A. Kerry
and Elder, Elisabeth
and Redfern, Julie",
title="Co-designing a Lifestyle-Focused Text Message Intervention for Women After Breast Cancer Treatment: Mixed Methods Study",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="14",
volume="23",
number="6",
pages="e27076",
keywords="breast neoplasms",
keywords="cancer survivors",
keywords="text messaging",
keywords="telemedicine",
keywords="mobile health",
keywords="co-design",
abstract="Background: Breast cancer is the most common cancer among women globally. Recovery from breast cancer treatment can be mentally and physically challenging. SMS text message programs offer a novel way to provide health information and support, but few programs are co-designed with consumer representatives. Objective: This study aims to report the procedures and outcomes of a co-design process of a lifestyle-focused SMS text message program to support women's mental and physical health after breast cancer treatment. Methods: We followed an iterative mixed methods two-step process: (1) co-design workshop with consumers and health professionals and researchers to draft text messages and (2) evaluation of message content, which was scored (5-point Likert scale; 1=strongly disagree to 5=strongly agree) for ease of understanding, usefulness, and appropriateness, and readability (Flesch-Kincaid score). Additional free-text responses and semistructured interviews were coded into themes. Messages were edited or deleted based on the evaluations, with consumers' evaluations prioritized. Results: In step 1, co-designed text messages (N=189) were semipersonalized, and the main content themes were (1) physical activity and healthy eating, (2) medications and side effects, (3) mental health, and (4) general breast cancer information. In step 2, consumers (n=14) and health professionals and researchers (n=14) provided 870 reviews of 189 messages and found that most messages were easy to understand (799/870, 91.8\%), useful (746/870, 85.7\%), and appropriate (732/870, 84.1\%). However, consumers rated 50 messages differently from health professionals and researchers. On the basis of evaluations, 37.6\% (71/189) of messages were deleted, 36.5\% (69/189) were edited, and 12 new messages related to fatigue, self-care, and cognition were created. The final 130 text messages had a mean 7.12 (SD 2.8) Flesch-Kincaid grade level and 68.9 (SD 15.5) ease-of-reading score, which represents standard reading ease. Conclusions: Co-designing and evaluating a bank of evidence-based mental and physical health-themed text messages with breast cancer survivors, health professionals, and researchers was feasible and resulted in a bank of 130 text messages evaluated highly by participants. Some consumer evaluations differed from health professionals and researchers, supporting the importance of co-design. ",
doi="10.2196/27076",
url="https://www.jmir.org/2021/6/e27076",
url="http://www.ncbi.nlm.nih.gov/pubmed/34125072"
}


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


@Article{info:doi/10.2196/22670,
author="Drijver, Josephine A.
and Reijneveld, C. Jaap
and Wesselman, P. Linda M.
and Klein, Martin",
title="A Web-Based Lifestyle Intervention Aimed at Improving Cognition in Patients With Cancer Returning to Work in an Outpatient Setting: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Apr",
day="26",
volume="10",
number="4",
pages="e22670",
keywords="cancer",
keywords="cognitive functioning",
keywords="lifestyle",
keywords="web-based intervention",
keywords="RCT",
keywords="cancer-related cognitive impairment",
abstract="Background: A high percentage of patients with cancer experience cognitive impairment after cancer treatment, resulting in a decreased health-related quality of life and difficulty returning to work. Consequently, there is a need for effective treatment options to improve cognitive functioning in these patients. In a healthy aging population, multidomain web-based lifestyle interventions have been found to be effective in preventing cognitive decline and improving cognitive functioning. Objective: This study aims to investigate the feasibility and effectiveness of the web-based lifestyle intervention Mijn Fitte Brein (My Fit Brain [MFB]) on cognitive functioning in patients with cancer returning to work. Methods: The study consists of a feasibility study (N=10), followed by a randomized controlled trial (RCT; N=220). Patients will be recruited by their occupational physicians after their return to work following cancer treatment. Mijn Fitte Brein is organized into 4-week cycles in which patients set a lifestyle goal using the Goal Attainment Scale, receive weekly tips and support, and finally evaluate whether they succeeded in achieving this goal. Lifestyle goals are based on 6 domains: physical exercise, diet, sleep, stress, alcohol use, and smoking. In the feasibility study, data on user experience (structured interview) and usability, assessed with the Post-Study System Usability Scale, will be collected and used to optimize Mijn Fitte Brein. In the RCT, patients will be randomized 1:1 between an intervention group and a control group. Patients will be assessed at baseline, 3 months, and 6 months. The primary outcome measure is subjective cognitive functioning, assessed with the Functional Assessment of Cancer Therapy--Cognitive Function (FACT-Cog). Secondary outcome measures are lifestyle, objective cognitive functioning, and work and psychosocial factors. Results: Recruitment for the feasibility study has started in February 2020. As of July 2020, however, no patients have been enrolled (due to COVID-19 restrictions). The findings of the feasibility study will be used to optimize the Mijn Fitte Brein intervention. Enrollment for the RCT will continue when possible. The feasibility study will take 6 months (including making adjustments to the intervention), and the RCT will take 2 years. The final results are expected in 2024. The results of the feasibility study and the RCT will be published in peer-reviewed journals. Conclusions: This is the first time the feasibility and efficacy of a multidomain web-based lifestyle intervention will be studied in patients with cancer. If Mijn Fitte Brein is found to be effective in decreasing cognitive complaints in these patients returning to work, it will be a promising treatment option because of being both affordable and accessible. Trial Registration: Netherlands Trial Register NL8407; https://www.trialregister.nl/trial/8407 International Registered Report Identifier (IRRID): DERR1-10.2196/22670 ",
doi="10.2196/22670",
url="https://www.researchprotocols.org/2021/4/e22670",
url="http://www.ncbi.nlm.nih.gov/pubmed/33900201"
}


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


@Article{info:doi/10.2196/18819,
author="Blair, K. Cindy
and Harding, Elizabeth
and Wiggins, Charles
and Kang, Huining
and Schwartz, Matthew
and Tarnower, Amy
and Du, Ruofei
and Kinney, Y. Anita",
title="A Home-Based Mobile Health Intervention to Replace Sedentary Time With Light Physical Activity in Older Cancer Survivors: Randomized Controlled Pilot Trial",
journal="JMIR Cancer",
year="2021",
month="Apr",
day="13",
volume="7",
number="2",
pages="e18819",
keywords="light-intensity physical activity",
keywords="physical activity",
keywords="sedentary behavior",
keywords="mobile health",
keywords="cancer survivors",
keywords="consumer wearable",
keywords="activity monitor",
keywords="mobile phone",
abstract="Background: Older cancer survivors are at risk of the development or worsening of both age- and treatment-related morbidity. Sedentary behavior increases the risk of or exacerbates these chronic conditions. Light-intensity physical activity (LPA) is more common in older adults and is associated with better health and well-being. Thus, replacing sedentary time with LPA may provide a more successful strategy to reduce sedentary time and increase physical activity. Objective: This study primarily aims to evaluate the feasibility, acceptability, and preliminary efficacy of a home-based mobile health (mHealth) intervention to interrupt and replace sedentary time with LPA (standing and stepping). The secondary objective of this study is to examine changes in objective measures of physical activity, physical performance, and self-reported quality of life. Methods: Overall, 54 cancer survivors (aged 60-84 years) were randomized in a 1:1:1 allocation to the tech support intervention group, tech support plus health coaching intervention group, or waitlist control group. Intervention participants received a Jawbone UP2 activity monitor for use with their smartphone app for 13 weeks. Tech support and health coaching were provided via 5 telephone calls during the 13-week intervention. Sedentary behavior and physical activity were objectively measured using an activPAL monitor for 7 days before and after the intervention. Results: Participants included survivors of breast cancer (21/54, 39\%), prostate cancer (16/54, 30\%), and a variety of other cancer types; a mean of 4.4 years (SD 1.6) had passed since their cancer diagnosis. Participants, on average, were 70 years old (SD 4.8), 55\% (30/54) female, 24\% (13/54) Hispanic, and 81\% (44/54) overweight or obese. Malfunction of the Jawbone trackers occurred in one-third of the intervention group, resulting in enrollment stopping at 54 rather than the initial goal of 60 participants. Despite these technical issues, the retention in the intervention was high (47/54, 87\%). Adherence was high for wearing the tracker (29/29, 100\%) and checking the app daily (28/29, 96\%) but low for specific aspects related to the sedentary features of the tracker and app (21\%-25\%). The acceptability of the intervention was moderately high (81\%). There were no significant between-group differences in total sedentary time, number of breaks, or number of prolonged sedentary bouts. There were no significant between-group differences in physical activity. The only significant within-group change occurred within the health coaching group, which increased by 1675 daily steps (95\% CI 444-2906; P=.009). This increase was caused by moderate-intensity stepping rather than light-intensity stepping (+15.2 minutes per day; 95\% CI 4.1-26.2; P=.008). Conclusions: A home-based mHealth program to disrupt and replace sedentary time with stepping was feasible among and acceptable to older cancer survivors. Future studies are needed to evaluate the optimal approach for replacing sedentary behavior with standing and/or physical activity in this population. Trial Registration: ClinicalTrials.gov NCT03632694; https://clinicaltrials.gov/ct2/show/NCT03632694 ",
doi="10.2196/18819",
url="https://cancer.jmir.org/2021/2/e18819",
url="http://www.ncbi.nlm.nih.gov/pubmed/33847588"
}


@Article{info:doi/10.2196/20461,
author="Cerbas, Shannon
and Kelemen, Arpad
and Liang, Yulan
and Sik-Lanyi, Cecilia
and Van de Castle, Barbara",
title="A Physical Activity Mobile Game for Hematopoietic Stem Cell Transplant Patients: App Design, Development, and Evaluation",
journal="JMIRx Med",
year="2021",
month="Apr",
day="13",
volume="2",
number="2",
pages="e20461",
keywords="cancer",
keywords="mobile app",
keywords="gamification",
keywords="bone marrow transplant",
keywords="alpha testing",
keywords="physical activity",
abstract="Background: Physical activity mobile apps may encourage patients with cancer to increase exercise uptake, consequently decreasing cancer-related fatigue. While many fitness apps are currently available for download, most are not suitable for patients with cancer due to the unique barriers these patients face, such as fatigue, pain, and nausea. Objective: The aim of this study is to design, develop, and perform alpha testing of a physical activity mobile health game for hematopoietic stem cell transplant (HSCT) patients. The ultimate future goal of this project is to motivate HSCT patients to increase physical activity and provide them with a safe and fun way to exercise. Methods: A mobile health game called Walking Warrior was designed as a puzzle game where tiles are moved and matched. Walking Warrior interfaces with an open-source step counter and communicates with a central online MySQL database to record game play and walking performance. The game came to fruition after following an iterative process model with several prototypes. Game developers and bone marrow transplant nurses were recruited to perform an expert usability evaluation of the Walking Warrior prototype by completing a heuristic questionnaire and providing qualitative suggestions for improvement. Experts also made qualitative recommendations for improvements on speed, movement of tiles, appearance, and accuracy of the step counter. We recruited 5 additional usability evaluators who searched for and compared 4 open-source step counter programs, then qualitatively compared them for accuracy, robustness, cheat proofing, ease of use, and battery drain issues. Patient recruitment is planned at a later stage in this project. This paper only describes software design, development, and evaluation, rather than behavioral evaluation (ie, impact on physical activity), which is the long-term goal of this project. Results: Internal consistency and the instrument's reliability evaluation results from 1 clinical expert and 4 technical experts were deemed excellent (Cronbach $\alpha$=.933). A hierarchical cluster analysis of the questionnaire item responses for similarity/dissimilarity among the experts indicated that the two expert groups were not clustered into two separate groups in the dendrogram. This indicates that the item responses were not affected by profession. Factor analyses indicate that responses from the 40-item questionnaire were classified into five primary factors. The associated descriptive statistics for each of these categories were as follows (on a scale of 1 to 5): clarity and ease (median 4; mean 3.7, SD 0.45), appropriateness (median 4; mean 3.7, SD 0.49), game quality (median 3.5; mean 3.3, SD 0.42), motivation to walk (median 3; mean 3.1, SD 0.58), and mental effort (median 3.5; mean 3.1, SD 1.27). Conclusions: The evaluation from experts and clinicians provided qualitative information to further improve game design and development. Findings from the expert usability evaluation suggest the game's assets of clarity, ease of use, appropriateness, quality, motivation to walk, and mental effort were all favorable. This mobile game could ultimately help patients increase physical activity as an aid to recovery. ",
doi="10.2196/20461",
url="https://xmed.jmir.org/2021/2/e20461",
url="http://www.ncbi.nlm.nih.gov/pubmed/37725560"
}


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


@Article{info:doi/10.2196/24828,
author="De La Torre, Steven
and Spruijt-Metz, Donna
and Farias, J. Albert",
title="Associations Among Wearable Activity Tracker Use, Exercise Motivation, and Physical Activity in a Cohort of Cancer Survivors: Secondary Data Analysis of the Health Information National Trends Survey",
journal="JMIR Cancer",
year="2021",
month="Apr",
day="12",
volume="7",
number="2",
pages="e24828",
keywords="mHealth",
keywords="mobile health",
keywords="cancer survivors",
keywords="exercise",
keywords="physical activity",
keywords="motivation",
keywords="wearable electronic devices",
keywords="fitness trackers",
abstract="Background: Cancer survivors who meet physical activity (PA) recommendations (?150 minutes of moderate-to-vigorous physical activity [MVPA] per week) experience better health outcomes. With the growing availability of wearable activity trackers (WATs), it may be easier to track PA. However, it is unknown what motivates survivors to use these devices. Objective: The aim of this study is to investigate the associations among motivations for exercise, previous WAT use for tracking a health goal or activity, and meeting the recommended amount of PA among a cohort of cancer survivors. Methods: Data on WAT users who reported having a previous cancer diagnosis were analyzed from the National Cancer Institute's Health Information National Trends Survey 5 Cycle 3. All survivors with complete information on demographics, exercise motivations (internal guilt, external pressure, physical appearance, and exercise enjoyment), previous WAT use (yes or no), and minutes of MVPA per week (N=608) were included. Multivariate logistic regression models were used to test these associations. A separate cluster analysis was conducted to identify the profiles of exercise motivation that were associated with reporting WAT use. Results: The mean age of the cohort was 66.9 years (SD 12.1). The majority were non-Hispanic White (473/608, 78.8\%) and female (322/608, 54.9\%), and skin cancer was the most commonly reported diagnosed cancer (154/608, 27.8\%). Survivors who reported using WATs to track a health goal or activity were 1.6 times more likely to meet MVPA recommendations than those who did not use WATs (odds ratio [OR] 1.65, 95\% CI 1.03-2.65; P=.04). When exercise motivations were assessed independently, survivors who reported not feeling any internal guilt as an exercise motivation were 73\% less likely to report having used a WAT than those who felt any internal guilt (OR 0.27, 95\% CI 0.14-0.54; P<.001). A total of 3 distinct motivational profiles emerged from the cluster analysis. WAT users had an increased probability of membership in profile 3, which was characterized as being strongly motivated to exercise by internal guilt, physical appearance, and exercise enjoyment (OR 4.5, 95\% CI 2.1-9.7; P<.001). Conclusions: Among this cohort, survivors who reported using WATs to track a health goal or activity were significantly more likely to report meeting PA recommendations. Survivors who reported feeling internal guilt as an exercise motivation were significantly more likely to report using WATs to track a health goal or activity. When examining clusters of motivation, survivors who reported previous WAT use were more likely to report being motivated to exercise by a mix of intrinsic and extrinsic motivations, including internal guilt, exercise enjoyment, and physical appearance. Given the health benefits of PA for cancer survivors, technology-focused interventions that use WATs and target exercise motivation may aid in cancer survivors meeting the level of recommended PA. ",
doi="10.2196/24828",
url="https://cancer.jmir.org/2021/2/e24828",
url="http://www.ncbi.nlm.nih.gov/pubmed/33843595"
}


@Article{info:doi/10.2196/23927,
author="Martin, Elise
and Di Meglio, Antonio
and Charles, Cecile
and Ferreira, Arlindo
and Gbenou, Arnauld
and Blond, Marine
and Fagnou, Benoit
and Arvis, Johanna
and Pistilli, Barbara
and Saghatchian, Mahasti
and Vaz Luis, Ines",
title="Use of mHealth to Increase Physical Activity Among Breast Cancer Survivors With Fatigue: Qualitative Exploration",
journal="JMIR Cancer",
year="2021",
month="Mar",
day="22",
volume="7",
number="1",
pages="e23927",
keywords="mHealth",
keywords="physical activity",
keywords="breast cancer",
keywords="cancer-related fatigue",
keywords="qualitative study",
keywords="survivorship",
abstract="Background: Physical activity has shown beneficial effects in the treatment of breast cancer fatigue; nevertheless, a significant portion of patients remain insufficiently physically active after breast cancer. Currently most patients have a smartphone, and therefore mobile health (mHealth) holds the promise of promoting health behavior uptake for many of them. Objective: In this study, we explored representations, levers, and barriers to physical activity and mHealth interventions among inactive breast cancer patients with fatigue. Methods: This was an exploratory, qualitative study including breast cancer patients from a French cancer center. A total of 4 focus groups were conducted with 9 patients; 2 independent groups of patients (groups A and B) were interviewed at 2 consecutive times (sessions 1 to 4), before and after their participation in a 2-week mHealth group experience consisting of (1) a competitive virtual exercise group activity (a fictitious world tour), (2) participation in a daily chat network, and (3) access to physical activity information and world tour classification feedback. We used a thematic content analysis. Results: Several physical activity levers emerged including (1) physical factors such as perception of physical benefit and previous practice, (2) psychological factors such as motivation increased by provider recommendations, (3) social factors such as group practice, and (4) organizational factors including preplanning physical activity sessions. The main barriers to physical activity identified included late effects of cancer treatment, lack of motivation, and lack of time. The lack of familiarity with connected devices was perceived as the main barrier to the use of mHealth as a means to promote physical activity. The tested mHealth group challenge was associated with several positive representations including well-being and good habit promotion and being a motivational catalyzer. Following feedback, modifications were implemented into the mHealth challenge. Conclusions: mHealth-based, easily accessed group challenges were perceived as levers for the practice of physical activity in this population. mHealth-based group challenges should be explored as options to promote physical activity in a population with fatigue after breast cancer. ",
doi="10.2196/23927",
url="https://cancer.jmir.org/2021/1/e23927",
url="http://www.ncbi.nlm.nih.gov/pubmed/33749606"
}


@Article{info:doi/10.2196/23979,
author="Furness, Kate
and Huggins, Elizabeth Catherine
and Truby, Helen
and Croagh, Daniel
and Haines, Peter Terry",
title="Attitudes of Australian Patients Undergoing Treatment for Upper Gastrointestinal Cancers to Different Models of Nutrition Care Delivery: Qualitative Investigation",
journal="JMIR Form Res",
year="2021",
month="Mar",
day="12",
volume="5",
number="3",
pages="e23979",
keywords="qualitative",
keywords="upper gastrointestinal",
keywords="cancer",
keywords="nutrition",
keywords="mobile phone",
abstract="Background: Adults diagnosed with cancers of the stomach, esophagus, and pancreas are at high risk of malnutrition. In many hospital-based health care settings, there is a lack of systems in place to provide the early and intensive nutritional support that is required by these high-risk cancer patients. Our research team conducted a 3-arm parallel randomized controlled trial to test the provision of an early and intensive nutrition intervention to patients with upper gastrointestinal cancers using a synchronous telephone-based delivery approach versus an asynchronous mobile app--based approach delivered using an iPad compared with a control group to address this issue. Objective: This study aims to explore the overall acceptability of an early and intensive eHealth nutrition intervention delivered either via a synchronous telephone-based approach or an asynchronous mobile app--based approach. Methods: Patients who were newly diagnosed with upper gastrointestinal cancer and who consented to participate in a nutrition intervention were recruited. In-depth, semistructured qualitative interviews were conducted by telephone and transcribed verbatim. Data were analyzed using deductive thematic analysis using the Theoretical Framework of Acceptability in NVivo Pro 12 Plus. Results: A total of 20 participants were interviewed, 10 from each intervention group (synchronous or asynchronous delivery). Four major themes emerged from the qualitative synthesis: participants' self-efficacy, low levels of burden, and intervention comprehension were required for intervention effectiveness and positive affect; participants sought a sense of support and security through relationship building and rapport with their dietitian; knowledge acquisition and learning-enabled empowerment through self-management; and convenience, flexibility, and bridging the gap to hard-to-reach individuals. Conclusions: Features of eHealth models of nutrition care delivered via telephone and mobile app can be acceptable to those undergoing treatment for upper gastrointestinal cancer. Convenience, knowledge acquisition, improved self-management, and support were key benefits for the participants. Future interventions should focus on home-based interventions delivered with simple, easy-to-use technology. Providing participants with a choice of intervention delivery mode (synchronous or asynchronous) and allowing them to make individual choices that align to their individual values and capabilities may support improved outcomes. Trial Registration: Australian and New Zealand Clinical Trial Registry (ACTRN) 12617000152325; https://tinyurl.com/p3kxd37b. ",
doi="10.2196/23979",
url="https://formative.jmir.org/2021/3/e23979",
url="http://www.ncbi.nlm.nih.gov/pubmed/33709939"
}


@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"
}