@Article{info:doi/10.2196/71196, author="Tian, Lv and Wen, Yixuan and Li, Jingmiao and Guan, Jiexin and Li, Tao and Fan, Jun", title="Effects of Remote Web-Based Interventions on the Physiological and Psychological States of Patients With Cancer: Systematic Review With Meta-Analysis", journal="JMIR Mhealth Uhealth", year="2025", month="Jun", day="12", volume="13", pages="e71196", keywords="meta-analysis", keywords="cancer patients", keywords="pain", keywords="depression", keywords="anxiety", keywords="quality of life", keywords="remote web-based intervention", keywords="PRISMA", abstract="Background: Patients with cancer may experience physiological and psychological adverse reactions, such as fatigue, pain, anxiety, and depression, which seriously affect their quality of life. Research has shown that remote interventions based on apps or miniprograms may help improve the physiological and mental health of patients with cancer. However, due to the limited number of relevant studies, the impact of web-based interventions in cancer management remains unclear. Objective: We aimed to determine the efficacy of interventions based on apps, miniprograms, or other web-based tools on the physiological (body pain and fatigue) and psychological (anxiety and depression) states and the quality of life of patients with cancer. Methods: We conducted electronic literature searches in PubMed, Scopus, Web of Science, the Cochrane Library, CINAHL, and EMBASE databases. The search period spanned from the inception of each database to October 15, 2024. Two researchers independently conducted literature retrieval and data extraction. The risk of bias was assessed with the Cochrane risk-of-bias tool, and the quality of evidence was assessed according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). All statistical analyses were performed using Review Manager version 5.4. Results: A total of 36 randomized controlled trials were included. The remote web-based interventions significantly improved the pain intensity (n=14, 39\% studies; standardized mean difference [SMD] --0.39, 95\% CI --0.64 to --0.14; I2=82\%; GRADE rating=low) and fatigue status (n=11, 31\% studies; SMD --0.52, 95\% CI --0.95 to --0.09; I2=95\%; GRADE rating=low) in patients with cancer. Regarding psychology, the results indicated that the remote web-based interventions significantly improved the anxiety (n=14, 39\% studies; SMD --0.60, 95\% CI --0.90 to --0.30; I2=91\%; GRADE rating=low) and depressive state (n=10, 28\% studies; SMD --0.36, 95\% CI --0.58 to --0.14; I2=81\%; GRADE rating=low) of patients with cancer. For quality of life, the results showed that the remote web-based interventions had a significant positive impact on the quality of life of patients with cancer (n=26, 72\% studies; SMD 0.63, 95\% CI 0.39-0.87; I2=92\%; GRADE rating=low). Conclusions: The remote web-based interventions were effective in reducing the intensity of physiological pain, relieving fatigue, improving depression and anxiety, and improving the quality of life of patients with cancer. However, due to the low certainty of evidence, more rigorous randomized controlled trials are needed to validate these findings further. Trial Registration: PROSPERO CRD42024611768; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024611768 ", doi="10.2196/71196", url="https://mhealth.jmir.org/2025/1/e71196" } @Article{info:doi/10.2196/66471, author="Sterba, Katherine and Graboyes, Evan and Burris, Jessica and Scallion, Megan and Kinder, Hannah and Olsen, Jama and Toll, Benjamin and Armeson, Kent and Day, Terry and Chera, Bhishamjit and Ruggiero, Kenneth", title="Development of a Mobile App to Support Head and Neck Cancer Caregiving: Mixed Methods Study", journal="JMIR Cancer", year="2025", month="Jun", day="10", volume="11", pages="e66471", keywords="head and neck cancer", keywords="cancer survivorship", keywords="caregiving", keywords="nutrition", keywords="mobile health", keywords="app development", keywords="mixed methods", abstract="Background: Survivors with head and neck cancer (HNC) face challenging treatment consequences that can lead to severe disruptions in swallowing and result in weight loss, malnutrition, and feeding tube dependence. Caregivers (family or friends who provide support), therefore, often encounter distressing nutritional caregiving burdens and feel unprepared to provide adequate support at home. Objective: The purpose of this mixed methods study was to develop a mobile support app to support HNC caregiving with an emphasis on nutritional support following treatment. Methods: We assessed perspectives on nutritional recovery challenges and mobile support app preferences in (1) a national panel of oncology dietitians using a web-based cross-sectional survey and (2) survivors with HNC completing treatment within the past 24 months and their nominated caregivers using dyadic semistructured interviews. Descriptive statistics for survey data were synthesized with thematic analysis of interview data to characterize nutrition-related perceptions and intervention preferences; results were integrated, and themes were translated to high-priority main menu domains and subdomains for a mobile app for caregivers. Results: Surveys were completed by dietitians (n=116, 100\%; female n=87, 50\%, with >10 years practice experience). Interviews included survivors with HNC (n=15; 12/15, 80\% male, and 6/15, 40\% with oropharynx cancer) and their caregivers (n=13; 11/13, 85\% female, and 10/13, 77\% spouses). Dietitians, survivors, and caregivers perceived that the majority of nutritional concerns assessed (eg, swallowing, feeding tube management, weight maintenance, and caregiver distress about nutrition) were very or extremely important to caregiving in the 6 months following treatment conclusion. The caregiving tasks rated highest in importance by dietitians included tracking nutritional concerns (n=113, 97\%), working together as a team on nutritional concerns (n=104, 90\%), and making care decisions (n=102, 88\%). Five themes emerged from dyadic interviews, including types of nutritional challenges faced, that competing symptoms were difficult to separate from nutritional challenges, the emotional challenges related to nutrition and recovery, the diverse set of medical and support tasks taken on by caregivers, and information and resource needs in caregivers. Qualitative interview and survey themes guided the content of the Healthy Eating and Recovery Together (HEART) app with an intake tracker and sections for nutrition recovery support, other competing caregiving tips, peer support, and caregiver self-care. Conclusions: Results pinpointed optimal content for a mobile app for caregivers of individuals with HNC and support the acceptability of implementing the HEART app following HNC treatment. ", doi="10.2196/66471", url="https://cancer.jmir.org/2025/1/e66471" } @Article{info:doi/10.2196/69115, author="Wolff, Dominik and Kupka, Thomas and Reichert, Chiara and Ammon, Nils and Oeltze-Jafra, Steffen and Vajen, Beate", title="Personalized Support in Hereditary Breast and Ovarian Cancer After Genetic Counseling by the Chatbot-Based GENIE Mobile App: Proof-of-Concept Wizard of Oz Study", journal="JMIR Form Res", year="2025", month="Jun", day="5", volume="9", pages="e69115", keywords="HBOC", keywords="hereditary breast and ovarian cancer", keywords="Wizard of Oz study", keywords="mobile health", keywords="evaluation", keywords="hereditary diseases", abstract="Background: The primary aim of genetic counseling at a human genetics center is to empower individuals at risk for hereditary diseases to make informed decisions regarding their health. In Germany, genetic counseling sessions typically last approximately 1 hour and provide highly personalized information by a specialist in human genetics. Despite this, many counselees report a need for additional support following the counseling session. Objective: This study introduces GENIE, a chatbot-based mobile app designed to assist individuals in the postcounseling phase, with a focus on hereditary breast and ovarian cancer. GENIE delivers expert-curated, personalized information tailored to the user's health and family circumstances. The content is presented through predefined dialogs between the user and the mobile assistant, aiming to extend the benefits of genetic counseling beyond the initial session. Methods: A Wizard of Oz study was conducted to evaluate a functional prototype of GENIE. A total of 6 patients with breast cancer, at least 2 years postdiagnosis, participated in the study. Participants were given access to the app for a minimum of 1 week. The evaluation was based on their interaction with GENIE, which was personalized using the details of a fictitious patient. Data collection included semistructured interviews and a 45-item questionnaire to assess usability and content quality. Results: The analysis of the interview and questionnaire data indicated high usability for GENIE, with a mean System Usability Score of 75.33 (SD 4.13). In total, 5 of the 6 participants used the app daily; 3 participants were willing to pay between US \$5 and US \$45 as a single purchase, while the other 3 participants agreed that the app should be free for the user and the costs should be directly covered by health insurance. Still, opinions on the app's appeal were divided. The layout was seen as moderately professional, a bit crowded, and slightly uninspiring. Nevertheless, participants highlighted the credibility and relevance of the content, noting its alignment with the fictitious patient's scenario. However, areas for improvement were identified, particularly concerning the app's design. All participants would recommend the app to other affected persons. Conclusions: The findings suggest that a mobile app like GENIE can provide valuable support to individuals in the postcounseling phase of genetic services. GENIE offers distinct advantages over large language models, as the information it provides is carefully curated by human experts, minimizing the risk of inaccuracies or hallucinations and significantly enhancing the system's credibility. This study highlights the need to involve the user group as early as possible in the development of a digital health app. Future work will focus on the implementation of a comprehensive personalization engine, redesign of the user interface, and the execution of a large-scale, 2-arm randomized intervention study to validate GENIE's effectiveness. ", doi="10.2196/69115", url="https://formative.jmir.org/2025/1/e69115" } @Article{info:doi/10.2196/66847, author="Kochashvili, Mariam and Guttoo, Parishma and Sezgin, Emre and Pai, Ahna and Bajwa, Rajinder and Landier, Wendy and Gerhardt, Cynthia and Skeens, Micah", title="Supporting Medication Adherence in Pediatric Patients Undergoing Hematopoietic Stem Cell Transplant Using the BMT4me mHealth App: Mixed Methods Usability Study", journal="JMIR Cancer", year="2025", month="May", day="29", volume="11", pages="e66847", keywords="mHealth", keywords="pediatric transplant", keywords="digital health", keywords="medication adherence", keywords="usability", keywords="hematopoietic stem cell transplant", keywords="bone marrow transplant", keywords="pediatric", keywords="children", keywords="hematopoietic stem cell", keywords="HSC", keywords="smartphone", keywords="mobile health", keywords="BMT4me", keywords="digital health intervention", keywords="descriptive statistics", keywords="thematic analysis", keywords="usability study", keywords="mixed method", keywords="social support", keywords="health outcomes", keywords="medication management", keywords="symptom tracking", keywords="electronic medical records", keywords="user-friendly", abstract="Background: Due to multifaceted outpatient regimens, children receiving hematopoietic stem cell transplants (HCTs) are at high risk of medication nonadherence, leading to life-threatening complications. Mobile health (mHealth) interventions have proven effective in improving adherence in various pediatric conditions; however, adherence intervention literature on HCT is limited. Objective: This study aimed to assess the usability of a mHealth intervention (BMT4me) designed to serve as a real-time, personalized tool for medication management or adherence, symptom tracking, and journal keeping. Methods: Following a mixed methods approach, 14 caregivers (n=11, 79\% female; n=10, 71\% White) of children aged 2?18 (mean age 8.51, SD 5.18) years in the acute phase (first 100 d) post-HCT were recruited. Caregivers were asked to use the BMT4me app for 100 days or until weaning of the immunosuppressant medications to measure usability. The System Usability Scale (assessing functionality and acceptability), reaction cards (assessing desirability), caregiver satisfaction (assessing satisfaction) with the app, and semistructured interviews (assessing participant experience using the app and feedback regarding features) were conducted at two time points, at enrollment and study completion. Results: The mean System Usability Scale score was 86.15 (SD 12.81) at enrollment and 73.13 (SD 16.13) at study completion, with most participants reporting the app easy to use and accepable during both time points. At enrollment, 80\% (n=12) of caregivers reported that the app was effective in motivating them to stay on schedule, and 87\% (n=13) indicated they would recommend it to others. At study completion, 75\% (n=6) of caregivers found the app helpful for tracking their child's medication schedule, and 64\% (n=5) would recommend it to others. Caregivers described the app as ``accessible,'' ``useful,'' and ``valuable.'' Qualitative interviews during both time points revealed caregivers' positive reactions to the app, particularly regarding medication reminders, tracking symptoms, and notes features, while also providing suggestions for improvements, such as integrating the BMT4me app with electronic medical records, incorporating educational content, adding fields for recording vital signs, and important phone numbers. Conclusions: The BMT4me app demonstrated promising usability as a mHealth intervention among pediatric patients undergoing HCT. Caregivers considered the app user-friendly and valuable, with positive feedback on its features, such as medication reminders and symptom tracking. Despite minor reported issues with app functionality, the overall acceptance of the app suggests its potential to support families in managing complex treatment. The findings from this study will inform the feasibility of testing in larger randomized controlled trials. Trial Registration: ClinicalTrials.gov NCT04976933; https://clinicaltrials.gov/ct2/show/NCT04976933 International Registered Report Identifier (IRRID): RR2-10.2196/39098 ", doi="10.2196/66847", url="https://cancer.jmir.org/2025/1/e66847" } @Article{info:doi/10.2196/69855, author="Deutsch, M. Thomas and Volmer, L. L{\'e}a and Feisst, Manuel and Bodenbeck, Laura and Hassdenteufel, Kathrin and Tretschock, Lara and Breit, Christiane and Stefanovic, Stefan and Bauer, Armin and Anders, Carolin and Weinert, Lina and Engler, Tobias and Hartkopf, D. Andreas and Pfeifer, Nico and Escher, Pascal and Mausch, Marc and Heinze, Oliver and Suetterlin, Marc and Brucker, Y. Sara and Schneeweiss, Andreas and Wallwiener, Markus", title="ENABLE---App-Based Digital Capture and Intervention of Patient-Reported Quality of Life, Adverse Events, and Treatment Satisfaction in Breast Cancer: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="May", day="26", volume="14", pages="e69855", keywords="breast cancer", keywords="electronic patient-reported outcomes", keywords="ePRO", keywords="health-related quality of life", keywords="HRQoL", keywords="eHealth apps", abstract="Background: In recent years, breast cancer treatment has taken the path toward personalized medicine. Based on individual tumor biology, therapy tailored to the particular subtype of cancer is increasingly being used. The aim here is to find the most suitable therapy for the disease. However, the success of therapy depends to a large extent on the patient's adherence to treatment. This, in turn, depends on how the therapy is tolerated and how the treatment team cares for the patient. Patient-centered care seeks to identify and address the individual needs of each patient and to find the best form of care for that person. Objective: In order to improve comprehensive oncological care of patients with breast cancer, the ENABLE trial digitally recorded the health-related quality of life (HRQoL), adverse events (AEs), and patient satisfaction using a mobile smartphone app. The trial provided individualized responses to reported AEs and offered assistance. Additionally, it assessed the impact of a patient-reported outcome--based intervention across various therapy settings. Methods: Patients with breast cancer were eligible to participate in the study before neoadjuvant, adjuvant, postneoadjuvant, or palliative systemic therapy against breast cancer was initiated at the Heidelberg, Mannheim, and Tuebingen, Germany, university hospitals. After 1:1 randomization into an intervention and a control group, HRQoL assessments were performed at six fixed time points during the therapy using validated questionnaires. In the intervention group, HRQoL was also assessed briefly every week using a visual analog scale (EQ-VAS). In cases of significant deterioration, therapy-associated side effects were assessed in a graduated manner, recommendations were sent to the patient, and the treatment team was informed. Additionally, the app served as an ``eHealth companion'' for education, training, and organizational support during therapy. Results: Recruitment started in March 2021; follow-up was completed in February 2024. In total, 606 patients were enrolled, and 592 patients participated in the study. Enrollment was completed in September 2023, and the last visit was in February 2024. The first results are expected to be published in Q2 2025. Conclusions: Participation in the intervention group is expected to improve treatment satisfaction, adherence, detection, and timely treatment of critical AEs. The close-meshed, weekly, brief HRQoL assessment will also be tested as a screening tool to detect relevant side effects during therapy. The study offers a more objective HRQoL assessment across treatment strategies. Trial Registration: Deutsches Register Klinischer Studien DRKS00025611; https://drks.de/search/en/trial/DRKS00025611 International Registered Report Identifier (IRRID): DERR1-10.2196/69855 ", doi="10.2196/69855", url="https://www.researchprotocols.org/2025/1/e69855" } @Article{info:doi/10.2196/56282, author="Trieu, Phillip and Fetzer, Dominique and McLeod, Briana and Schweickert, Kathryn and Gutstein, Lauren and Egleston, Brian and Domchek, Susan and Fleisher, Linda and Wagner, Lynne and Wen, Kuang-Yi and Cacioppo, Cara and Ebrahimzadeh, E. Jessica and Falcone, Dana and Langer, Claire and Wood, Elisabeth and Karpink, Kelsey and Posen, Shelby and Selmani, Enida and Bradbury, R. Angela", title="Developing the MyCancerGene Digital Health Portal to Improve Patients' Understanding of Germline Cancer Genetic Test Results: Development, User, and Usability Testing Study", journal="JMIR Form Res", year="2025", month="May", day="14", volume="9", pages="e56282", keywords="genetic health portal", keywords="digital intervention development", keywords="health portal", keywords="usability", keywords="digital health", keywords="germline cancer", keywords="multigene panels", keywords="clinical practice", keywords="likelihood", keywords="effectiveness", keywords="medical history", keywords="genetic medicine", keywords="risk information", keywords="digital tool", keywords="intervention", keywords="longitudinal care", keywords="patient-centered content", keywords="electronic information", abstract="Background: The use of multigene panels has significantly increased the likelihood that genetic testing will leave patients with uncertainties regarding test interpretation, implications, and recommendations, which will change over time. Effective longitudinal care models are needed to provide patients with updated information and to obtain patient and family history updates. Objective: To bridge this gap, we aimed to develop a patient- and genetic provider--informed digital genetic health portal (GHP), MyCancerGene, to improve longitudinal patient understanding of and responses to genetic testing. Methods: We used a 5-step process to develop MyCancerGene. To better understand their interest in and willingness to use a digital GHP, we surveyed 307 patients who completed genetic testing (step 1). We completed qualitative interviews with 10 patients and a focus group with 17 genetic providers to inform the content and function of MyCancerGene (step 2). Next, we developed initial intervention content (step 3) and completed user testing of intervention content with 25 providers and 28 patients (step 4). After developing the prototype intervention, we completed usability testing with 8 patients for their feedback on the final content, functions, and ease of use (step 5). Results: In surveys conducted in step 1, 90\% of patients with positive results reported interest in a digital GHP, and over 75\% of participants with variants of uncertain significance or uninformative negative results reported similar interest. The most frequently reported advantages among patients were increasing accessibility, convenience, and efficiency (103/224, 46\%); keeping genetic information organized (54/224, 24.1\%); and increasing or maintaining patient understanding of the information (38/224, 17\%). In qualitative interviews (step 2), both patients and genetic providers endorsed the benefit of the tool for updating personal and family history and for providers to share new risk information, test interpretation, or other medical changes. Patient and provider input informed eight key components of the tool: (1) Landing Page, (2) Summary of Care page, (3) My Genetic Test Results page, (4) My Family History page, (5) Provide an Update page, (6) Review an Update page, (7) Resources page, and (8) the Screenings Tracker. They also recommended key functions, including the ability to download and print materials and the inclusion of reminders and engagement functions. Potential challenges identified by patients included privacy and security concerns (67/206, 32.5\%) and the potential for electronic information to generate distress (20/206, 9.7\%). While patients were comfortable with updates (ie, even variant reclassification upgrades or clinically significant results), 44\% (11/25) of genetic providers were uncomfortable sharing variant reclassification upgrades through MyCancerGene. Conclusions: MyCancerGene, a patient-centered digital GHP, was developed with extensive patient and genetic provider feedback and designed to enhance longitudinal patient understanding of and affective and behavioral responses to genetic testing, particularly in the era of evolving evidence and risk information. ", doi="10.2196/56282", url="https://formative.jmir.org/2025/1/e56282" } @Article{info:doi/10.2196/65960, author="Le D{\^u}, Katell and Chauchet, Adrien and Sadot-Lebouvier, Sophie and Fitoussi, Olivier and Fontanet, Bijou and Saint-Lezer, Arnaud and Maloisel, Fr{\'e}d{\'e}ric and Rossi, C{\'e}dric and Carras, Sylvain and Parcelier, Anne and Balavoine, Magali and Septans, Anne-Lise", title="Comparison of Electronic Surveillance With Routine Monitoring for Patients With Lymphoma at High Risk of Relapse: Prospective Randomized Controlled Phase 3 Trial (Sentinel Lymphoma)", journal="JMIR Cancer", year="2025", month="May", day="6", volume="11", pages="e65960", keywords="patient-reported outcome measures", keywords="lymphoma", keywords="risk of relapse", keywords="relapse", keywords="randomized trial", keywords="web-based", keywords="quality of life", keywords="survival", keywords="detection", keywords="progression", keywords="T-cell lymphoma", keywords="Hodgkin lymphoma", abstract="Background: Relapse is a major event in patients with lymphoma. Therefore, early detection may have an impact on quality of life and overall survival. Patient-reported outcome measures have demonstrated clinical benefits for patients with lung cancer; however, evidence is lacking in patients with lymphoma. We evaluated the effect of a web-mediated follow-up application for patients with lymphoma at high risk of relapse. Objective: This study aims to demonstrate that monitoring patients via a web application enables the detection of at least 30\% more significant events occurring between 2 systematic follow-up consultations with the specialist using an electronic questionnaire. Methods: We conducted a prospective, randomized phase 3 trial comparing the impact of web-based follow-up (experimental arm) with a standard follow-up (control arm). The trial was based on a 2-step triangular test and was designed to have a power of 90\% to detect a 30\% improvement in the detection of significant events. A significant event was defined as a relapse, progression, or a serious adverse event. The study covered the follow-up period after completion of first-line treatment or relapse (24 months). Eligible patients were aged 18 years and older and had lymphoma at a high risk of relapse. In the experimental arm, patients received a 16-symptom questionnaire by email every 2 weeks. An email alert was sent to the medical team based on a predefined algorithm. The primary objective was assessed after the inclusion of the 40th patient. The study was continued for the duration of the analysis. Results: A total of 52 patients were included between July 12, 2017, and April 7, 2020, at 11 centers in France, with 27 in the experimental arm and 25 in the control arm. The median follow-up was 21.3 (range 1.3?25.6) months, and 121 events were reported during the study period. Most events occurred in the experimental arm (83/119, 69.7\%) compared with 30.2\% (36/119) in the control arm. A median number of 3.5 (range 1-8) events per patient occurred in the experimental arm, and 1.8 (range 1-6) occurred in the control arm (P=.01). Progression and infection were the most frequently reported events. Further, 19 patients relapsed during follow-up: 6 in the experimental arm and 13 in the control arm (P<.001), with a median follow-up of 7.7 (range 2.8?20.6) months and 6.7 (range 1.9?16.4) months (P=.94), respectively. Statistical analysis was conducted after including the 40th patient, which showed no superiority of the experimental arm over the control arm. The study was therefore stopped after the 52nd patient was enrolled. Conclusions: The primary objective was not reached; however, patient-reported outcome measures remain essential for detecting adverse events in patients with cancer, and the electronic monitoring method needs to demonstrate its effectiveness and comply with international safety guidelines. Trial Registration: ClinicalTrials.gov NCT03154710; https://clinicaltrials.gov/ct2/show/NCT03154710 ", doi="10.2196/65960", url="https://cancer.jmir.org/2025/1/e65960" } @Article{info:doi/10.2196/60849, author="Wienands, Linda and Valenta, Sabine and Leppla, Lynn and De Geest, Sabina and Kov{\'a}cs, L{\'a}szl{\'o} and Teynor, Alexandra and Krumme, Julia", title="Examining Practices Related to Ethical Aspects in eHealth Evaluation Research: Protocol for a Scoping Review", journal="JMIR Res Protoc", year="2025", month="May", day="5", volume="14", pages="e60849", keywords="cancer", keywords="cardiovascular", keywords="eHealth", keywords="remote patient monitoring", keywords="ethics", keywords="ethical aspects", keywords="applied ethics", keywords="evaluation designs", keywords="evaluation research", keywords="scoping review", keywords="protocol", abstract="Background: eHealth technologies, including remote patient monitoring (RPM) applications, have the potential to improve care for diseases such as cancer and cardiovascular conditions. However, they also raise ethical aspects that are often inadequately addressed in eHealth evaluation research. This is problematic, as evaluations guide decision-making at multiple levels. To improve evaluation practices, it is essential to understand how ethical aspects are addressed in terms of both content and methodology, enabling the development of tailored recommendations for enhancement. Objective: This scoping review systematically examines how ethical aspects are addressed in eHealth research, focusing on original studies evaluating RPM applications for cancer and cardiovascular diseases. Methods: Using Joanna Briggs Institute (JBI) methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, this review implemented a comprehensive search strategy with the terms ``cancer or cardiovascular diseases,'' ``eHealth or telemonitoring,'' and ``evaluation designs.'' Searches included MEDLINE, Embase, CINAHL, SocINDEX, Philosopher's Index, PsycINFO, and Google Scholar. Data extraction will emphasize ethical aspects and methodological approaches to consider them. The analysis will apply inductive-deductive qualitative content analysis. Results: Initial searches identified 3321 articles published between 2014 and August 2024. Screening and analysis will be completed in the first quarter of 2025, with results anticipated by summer 2025. Conclusions: Overlooking ethical aspects in evaluation studies can significantly impact eHealth practices. This scoping review will map ethical considerations in original evaluation research, identifying opportunities for more holistic integration of ethics and informing future practical guidance. Trial Registration: OSF Registries OSF.IO/7XAFV; https://osf.io/7xafv/ International Registered Report Identifier (IRRID): DERR1-10.2196/60849 ", doi="10.2196/60849", url="https://www.researchprotocols.org/2025/1/e60849" } @Article{info:doi/10.2196/64083, author="Huebner, Hanna and Wurmthaler, A. Lena and Goossens, Chlo{\"e} and Ernst, Mathias and Mocker, Alexander and Kr{\"u}ckel, Annika and Kallert, Maximilian and Geck, J{\"u}rgen and Limpert, Milena and Seitz, Katharina and Ruebner, Matthias and Kreis, Philipp and Heindl, Felix and H{\"o}rner, Manuel and Volz, Bernhard and Roth, Eduard and Hack, C. Carolin and Beckmann, W. Matthias and Uhrig, Sabrina and Fasching, A. Peter", title="A Digital Home-Based Health Care Center for Remote Monitoring of Side Effects During Breast Cancer Therapy: Prospective, Single-Arm, Monocentric Feasibility Study", journal="JMIR Cancer", year="2025", month="May", day="2", volume="11", pages="e64083", keywords="breast cancer", keywords="digital medicine", keywords="telehealth", keywords="remote monitoring", keywords="cyclin-dependent kinase 4/6 inhibitor", keywords="CDK4/6 inhibitor", keywords="mobile phone", abstract="Background: The introduction of oral anticancer therapies has, at least partially, shifted treatment from clinician-supervised hospital care to patient-managed home regimens. However, patients with breast cancer receiving oral cyclin-dependent kinase 4/6 inhibitor therapy still require regular hospital visits to monitor side effects. Telemonitoring has the potential to reduce hospital visits while maintaining quality care. Objective: This study aims to develop a digital home-based health care center (DHHC) for acquiring electrocardiograms (ECGs), white blood cell (WBC) counts, side effect photo documentation, and patient-reported quality of life (QoL) data. Methods: The DHHC was set up using an Apple Watch Series 6 (ECG measurements), a HemoCue WBC DIFF Analyzer (WBC counts), an iPhone SE (QoL assessments and photo documentation), a TP-Link M7350-4G Wi-Fi router, and a Raspberry Pi 4 Model B. A custom-built app stored and synchronized remotely collected data with the clinic. The feasibility and acceptance of the DHHC among patients with breast cancer undergoing cyclin-dependent kinase 4/6 inhibitor therapy were evaluated in a prospective, single-arm, monocentric study. Patients (n=76) monitored side effects---ECGs, WBC counts, photo documentation, and QoL---at 3 predefined time points: study inclusion (on-site), day 14 (remote), and day 28 (remote). After the study completion, patients completed a comprehensive questionnaire on user perception and feasibility. Adherence to scheduled visits, the success rate of the data transfer, user perception and feasibility, and the clinical relevance of remote measurements were evaluated. Results: Mean adherence to the planned remote visits was 63\% on day 14 and 37\% on day 28. ECG measurements were performed most frequently (day 14: 57/76, 75\%; day 28: 31/76, 41\%). The primary patient-reported reason for nonadherence was device malfunction. The expected versus the received data transfer per patient was as follows: ECGs: 3 versus 3.04 (SD 1.9); WBC counts: 3 versus 2.14 (SD 1.14); QoL questionnaires: 3 versus 2.5 (SD 1.14); and photo documentation: 6 versus 4.4 (SD 3.36). Among patients, 81\% (55/68) found ECG measurements easy, 82\% (55/67) found photo documentation easy, and 48\% (33/69) found WBC measurements easy. Additionally, 61\% (40/66) of patients felt comfortable with self-monitoring and 79\% (54/68) were willing to integrate remote monitoring into their future cancer care. Therapy-induced decreased neutrophil count was successfully detected (P<.001; mean baseline: 4.3, SD 2.2, {\texttimes}109/L; on-treatment: 1.8, SD 0.8, {\texttimes}109/L). All-grade neutropenia and corrected QT interval prolongations were detected in 80\% (55/68) and 2\% (1/42) of patients, respectively. Conclusions: Adherence to scheduled remote visits was moderate, with nonadherence primarily attributed to device-related complications, which may have also affected the success rate of data transfer. Overall, patients considered remote monitoring useful and feasible. The prevalence of reported adverse events was comparable to existing literature, suggesting clinical potential. This initial feasibility study highlights the potential of the DHHC. ", doi="10.2196/64083", url="https://cancer.jmir.org/2025/1/e64083" } @Article{info:doi/10.2196/60169, author="Mu{\~n}oz Olivar, Carolina and Pineiro, Miguel and G{\'o}mez Quintero, Sebasti{\'a}n Juan and Avenda{\~n}o-V{\'a}squez, Javier Carlos and Orme{\~n}o-Arriagada, Pablo and Palma Rivadeneira, Silvia and Taramasco Toro, Carla", title="Education and Symptom Reporting in an mHealth App for Patients With Cancer: Mixed Methods Development and Validation Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="28", volume="12", pages="e60169", keywords="cancer", keywords="patient-reported outcome measures", keywords="software design", keywords="unpleasant symptom", keywords="toxicity", keywords="mHealth", keywords="mobile health", keywords="surveys and questionnaires", keywords="application", keywords="design", keywords="evaluation", keywords="chemotherapy", keywords="health care communication", keywords="mixed methods", keywords="validation", keywords="efficiency", keywords="security", abstract="Background: The widespread prevalence of cancer across the globe demands cutting-edge solutions for its treatment. Current cancer therapies, notably chemotherapy, pose challenges due to their side effects. The early detection and management of the side effects are vital but complex. This study introduces a mobile health app designed to bridge the communication gaps between patients with cancer and health care providers. Hence, it allows patients to report symptoms immediately and also enables proactive symptom management by health care providers. Objective: This study has 2 objectives: first, to design a cancer-focused mobile health app that integrates educational content and real-time symptom reporting for chemotherapy patients. Second, to validate and evaluate the app quality using the Mobile App Rating Scale (MARS). The app seeks to foster health care communication, reduce hospital readmissions, and optimize symptom management, contributing to a more impactful patient experience. Methods: This mixed-methods study details the development and validation of mobile health applications. The app was designed by a multidisciplinary team, including nurses, medical professionals, pharmaceutical chemists, computer engineers, and software developers, using agile methodologies. For validation, the app was assessed by 13 evaluators, including clinical professionals (nurses and physicians) and engineers. The evaluation included technical performance analysis using Google tools and quality assessment using the MARS, which measures engagement, functionality, aesthetics, and information quality. Results: Performance metrics highlighted areas for improvement, with loading times showing delays in displaying content. Meanwhile, the response time of the app was moderate, and visual stability remained excellent. The app achieved an overall MARS score of 3.75 (SD 0.42), indicating consistent quality, with functionality scoring the highest (4.35; SD 0.52) and engagement the lowest (3.31; SD 0.61). The reliability of the MARS was confirmed (interclass correlation coefficient: 0.84; 95\% CI: 0.72?0.92). Evaluators unanimously praised the app's potential benefits for patients and clinical professionals while identifying areas for improvement such as customization, onboarding guidance, and navigation. Conclusions: The CONTIGO app showed strengths in functionality, usability, and information quality, supported by robust security measures. However, areas such as user interactivity and engagement require improvement. Future refinements will integrate insights from patients with cancer to address user-specific needs and enhance the oncology care experience. ", doi="10.2196/60169", url="https://humanfactors.jmir.org/2025/1/e60169" } @Article{info:doi/10.2196/69398, author="Hubel, J. Niclas and Vorbach, M. Samuel and de Ligt, M. Kelly and Rathgeber, S. Ines and Beyer, Katharina and Wintner, M. Lisa and Faller, Barbara and Nemec, Jasmin and Holzner, Bernhard and Sztankay, Monika and Lehmann, Jens", title="Sustainability and Time Trends in Electronic Patient-Reported Outcome Assessment in Routine Cancer Care: Systematic Scoping Review and Follow-Up Survey", journal="J Med Internet Res", year="2025", month="Apr", day="25", volume="27", pages="e69398", keywords="patient-reported outcome measures", keywords="cancer, clinical routine", keywords="health-related quality of life", keywords="quality of care", keywords="mobile applications", keywords="digital technology", abstract="Background: Routine electronic assessment of patient-reported outcomes (ePROs) can improve cancer care; yet, its implementation in routine practice and long-term sustainability remain unclear. Understanding these aspects is critical to advancing the field. Objective: To review and describe the past and current status, time trends, and long-term sustainability of clinical ePRO applications in routine oncology care. Methods: We conducted a systematic review of publications on ePRO use in oncology care up to December 31, 2023, searching PubMed and Web of Science and extracting data on clinical ePRO applications. We included peer-reviewed studies including patients with cancer using ePRO assessments in clinical practice, excluding research letters and conference abstracts. Data from the review were analyzed using descriptive statistics and univariate regression models to evaluate time trends, with year of publication as the predictor. A follow-up survey was sent to authors of published ePRO applications to assess their current use of the application or reasons for discontinuation. Responses from the follow-up survey were analyzed descriptively. Results: For the review, we screened 2933 references, and 303 met inclusion criteria. Results showed that Europe was the most common region (n=141, 46.5\%), and study populations consisted mostly of adult patients (n=276, 91.1\%) under chemotherapy treatment (n=124, 40.9\%) assessed in an outpatient setting (n=261, 86.1\%). The EORTC (European Organisation for Research and Treatment of Cancer; n=77, 25.4\%) and PRO-CTCAE (Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events) questionnaires (n=65, 21.5\%) were most frequently integrated into ePRO applications. In the univariate analysis, we found that publications increased significantly over time (2003-2023, P<.001). Trends showed a rise in mobile app use (odds ratio [OR] 1.211, P<.001), remote assessments (OR 1.094, P=.002), and feedback provided to patients (OR 1.060, P=.04). Of the 303 studies, 221 unique clinical ePRO applications were identified, merging publications at the application level. The follow-up survey had a 35.3\% response rate (78/221), with 61.1\% of ePRO applications still in use, lasting a median of 5 years. The most common reason for discontinuation was a lack of funding and resources (42.9\%, 12/28). Conclusions: The field of ePRO assessment in oncology is rapidly evolving, with a shift toward remote, app-based tools and a growing emphasis on providing feedback to patients. We present, for the first time, data on the sustainability of ePRO use in routine care. While our findings offer valuable insights, they should be interpreted in light of potential response bias in the follow-up survey. Several ePRO applications remain in active use, highlighting potential for long-term integration into clinical practice. However, financial constraints, limited reimbursement models, and challenges with workflow integration continue to hinder broader and more sustainable adoption. Addressing these barriers will be essential to support the continued use of ePROs in clinical care. ", doi="10.2196/69398", url="https://www.jmir.org/2025/1/e69398" } @Article{info:doi/10.2196/57342, author="Bonotis, Panos and Angelidis, Pantelis and Natsiavas, Pantelis", title="Usability and User Experience Testing of a Co-Designed Electronic Patient-Reported Outcomes App (``MyPal for Adults'') for Palliative Cancer Care: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="24", volume="12", pages="e57342", keywords="mHealth", keywords="app", keywords="digital intervention", keywords="think-aloud test", keywords="palliative care", keywords="cancer care", keywords="patient-reported outcomes", keywords="usability evaluation", keywords="mobile health", keywords="mobile phone", abstract="Background: Mobile health technologies have the potential to enhance the management, communication, and overall quality of life of patients with cancer. The MyPal project, using a participatory design approach, aims to provide palliative care support for patients with cancer through an electronic patient-reported outcomes eHealth platform. Objective: This study aims to evaluate the usability and user experience of ``MyPal for adults,'' a co-designed palliative care mobile app designed to support adults with cancer. Methods: Representative users participated in a 4-step usability study using a ``think-aloud'' protocol, complemented with feature satisfaction, difficulty perceived, and design impression surveys along with a short, structured interview. Participants were also asked to provide quantitative feedback via the postuse System Usability Scale, User Experience Questionnaire, and Post-Study System Usability Questionnaire. The data were analyzed along the lines of the International Organization for Standardization (ISO) 9241?210 framework. Results: All participants found the intervention content useful, and they reported satisfactory usability, with a mean Post-Study System Usability Questionnaire score of 2.458 (SD 1.08) and a System Usability Scale score of 68.9. All aspects of the User Experience Questionnaire (attractiveness, perspicuity, efficiency, dependability, stimulation, and novelty) surpassed usability quality benchmarks. The qualitative analysis identified 43 usability issues, primarily related to effectiveness and efficiency as defined in ISO 9241?210. Conclusions: In this study, we conducted a usability evaluation of the ``MyPal for adults'' app, a digital tool designed to enhance the palliative care experience. This approach identifies real-world usability issues, enabling iterative improvements in the eHealth platform's design. Our findings reveal a user-friendly interface and positive patient experiences. This study emphasizes the need to enhance mobile health platform usability, offering insights to improve digital palliative care. Trial Registration: ClinicalTrials.gov NCT04370457; https://www.clinicaltrials.gov/study/NCT04370457 ", doi="10.2196/57342", url="https://humanfactors.jmir.org/2025/1/e57342" } @Article{info:doi/10.2196/71684, author="Pang, Yan and He, Honggu and Ng, Ruey-Pyng and Lee, Luan Nicole Kim and Htein, Win Me Me and Zhao, Xiao-Xin and Li, Ying-Hong and Chan, Jiahui Elizabeth and Zhu, Lixia and Liu, Yu Guang and Pikkarainen, Minna and Lim, Swee-Ho", title="Effectiveness of an Innovative Mobile-Based Perioperative Care Program for Women Undergoing Breast Cancer Surgery (iCareBreast): Randomized Controlled Trial", journal="J Med Internet Res", year="2025", month="Apr", day="21", volume="27", pages="e71684", keywords="breast cancer", keywords="digital health", keywords="mHealth", keywords="mobile health", keywords="psychosocial", keywords="randomized controlled trial", keywords="self-efficacy", keywords="mobile phone", abstract="Background: Breast cancer is one of the most prevalent cancers among women and significantly impacts psychological well-being and health-related quality of life (HR-QoL) during the perioperative period. Mobile health interventions offer a promising approach to providing education and psychosocial support, yet their effectiveness in this context remains underexplored. Objective: This study aimed to develop and evaluate the effectiveness of an innovative, mobile-based, perioperative care program for women undergoing breast cancer surgery (iCareBreast). The assessment focused on perioperative self-efficacy, anxiety, depression, fatigue, HR-QoL, and perioperative care satisfaction. Methods: A two-group randomized control trial was conducted at a tertiary hospital in Singapore. The intervention group used the iCareBreast app, offering four main resources: perioperative care guidance, breast cancer and surgery education, psychological support, and social support. The control group received standard hospital care. Participants in the intervention group engaged with the fully automated app daily for 29 days (two weeks before surgery, on the day of surgery, and two weeks after surgery). Data were collected face-to-face or on the web at three time points: baseline, immediately after the intervention (T1; two weeks after surgery), and at a 2.5-month follow-up (T2; three months after surgery). The primary outcome was perioperative care self-efficacy, while secondary outcomes included anxiety, depression, fatigue, HR-QoL, and perioperative care satisfaction. Results: A total of 123 patients with early-stage breast cancer scheduled for breast surgery were enrolled in the study, with 62 patients assigned to the iCareBreast group and 61 patients to the control group. The results showed no significant differences between the groups in the primary outcome---perioperative self-efficacy---at any time point. Baseline scores were similar (P=.80), and while the iCareBreast group showed slightly lower scores at T1 (mean difference [MD] --1.63, 95\% CI --3.43 to 0.18; P=.08) and T2 (MD --1.90, 95\% CI --4.06 to 0.26; P=.09), the differences were not statistically significant. Similarly, secondary outcomes, including anxiety, depression, fatigue, HR-QoL, and perioperative care satisfaction, showed no significant changes between groups (all P>.05). However, the iCareBreast group reported higher perioperative care satisfaction during the postintervention assessment. Satisfaction scores were comparable at T1 (P=.68), while at T2, the iCareBreast group showed a slight increase compared to the control group (MD 0.35, 95\% CI 0.04-0.73; P=.08), though the difference was not statistically significant. Conclusions: The mobile-based psychosocial intervention, although satisfied by users, did not demonstrate significant benefits compared to standard care. This highlights the need to refine the iCareBreast app in future iterations to enhance its effectiveness in addressing the targeted health outcomes. Future mobile health research should prioritize optimizing user engagement strategies and incorporating personalized approaches to better address the perioperative care needs of patients with breast cancer. Trial Registration: ClinicalTrials.gov NCT04172350; https://clinicaltrials.gov/study/NCT04172350 ", doi="10.2196/71684", url="https://www.jmir.org/2025/1/e71684" } @Article{info:doi/10.2196/65188, author="Fleszar-Pavlovic, E. Sara and Noriega Esquives, Blanca and Lovan, Padideh and Brito, E. Arianna and Sia, Marie Ann and Kauffman, Adelyn Mary and Lopes, Maria and Moreno, I. Patricia and Koru-Sengul, Tulay and Gong, Rui and Wang, Trent and Wieder, D. Eric and Rueda-Lara, Maria and Antoni, Michael and Komanduri, Krishna and Lesiuk, Teresa and Penedo, J. Frank", title="Development of an eHealth Mindfulness-Based Music Therapy Intervention for Adults Undergoing Allogeneic Hematopoietic Stem Cell Transplantation: Qualitative Study", journal="JMIR Form Res", year="2025", month="Apr", day="11", volume="9", pages="e65188", keywords="allogeneic stem cell transplantation", keywords="hematologic malignancy", keywords="bone marrow transplant", keywords="mindfulness-based music therapy", keywords="mindfulness", keywords="music therapy", keywords="eHealth", keywords="music therapy intervention", keywords="adult", keywords="adolescence", keywords="allogeneic", keywords="stem cell transplantation", keywords="stem cell", keywords="transplantation", keywords="qualitative study", keywords="treatment", keywords="hematologic cancers", keywords="psychological distress", keywords="side effects", keywords="mindfulness-based stress reduction", keywords="stress reduction", keywords="anxiety", keywords="depression", keywords="diagnosis", keywords="blood sample collection", keywords="eHealth tool", keywords="quality of life", keywords="cancer survivors", abstract="Background: Allogeneic hematopoietic stem cell transplantation (allo-SCT) is an effective treatment for various hematologic cancers, though it often results in severe side effects and psychological distress, which can negatively impact health outcomes. Integrative therapies like mindfulness-based stress reduction (MBSR), mindfulness meditation (MM), and music therapy (MT) yield promising results in enhancing both psychosocial outcomes (eg, reducing anxiety and depression) and physiological adaptation (eg, decreasing inflammation) in cancer patients. Objective: We developed and refined, using focus groups and environmental and field testing, an eHealth-delivered mindfulness-based music therapy (eMBMT) intervention aimed at improving health-related quality of life, symptom burden (ie, pain, fatigue, and sleep), disease activity (ie, chronic graft-versus-host disease, cytomegalovirus activation, and infections) and psychosocial (ie, depression, anxiety, and cancer-specific distress) and physiological adaptation (ie, inflammation and immune reconstitution) tailored to adults receiving allo-SCT. Methods: eMBMT intervention content is grounded in MT, MM, and MBSR, developed by a multidisciplinary team, and adapted for adults undergoing allo-SCT. eMBMT content was refined through focus groups and usability and field testing. Focus groups used a semistructured interview guide, while field testing used the ``think aloud'' method. Usability was evaluated using the 30-item Usefulness, Satisfaction, and Ease of Use (USE) questionnaire. Descriptive statistics analyzed the USE questionnaire and participant characteristics, while rapid qualitative analysis was applied to focus groups and field-testing sessions. Survivors eligible to participate in the focus groups and usability and field testing were adults (>18 years old) who received an allo-SCT (<36 months) for myelodysplastic syndrome, acute myeloid leukemia, or chronic myeloid leukemia, and were in remission for greater than 3 months. Results: During the focus groups, participants (n=11; mean age 43.6, SD 17.8 years) provided qualitative feedback highlighting the shock of diagnosis, challenges during hospitalization, and coping strategies posttreatment. The eMBMT platform received positive evaluations for usefulness (mean 6.47, SD 0.29), ease of use (mean 6.92, SD 0.60), and satisfaction (mean 6.16, SD 0.82). Key themes from field testing highlighted the significance of social support, hope, and maintaining an active lifestyle. Suggestions for improvement included incorporating more representative content, reducing text, enhancing guidance, offering diverse music options, and streamlining blood sample collection. Conclusions: The eMBMT intervention is a comprehensive, user-friendly eHealth tool tailored to the unique needs of allo-SCT patients. The positive feedback and identified areas for improvement underscore its potential to enhance well-being, symptom management, and overall quality of life for cancer survivors. A future pilot randomized controlled trial will further evaluate the feasibility, acceptability, and preliminary efficacy of the eMBMT intervention in improving health-related quality of life, symptom burden, disease activity, and psychosocial and physiological adaptation. Trial Registration: ClinicalTrials.gov NCT05968963; https://clinicaltrials.gov/study/NCT05968963 ", doi="10.2196/65188", url="https://formative.jmir.org/2025/1/e65188" } @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/10.2196/71865, author="Kim, Minjin and Kim, Ellie and Lee, Hyeongsuk and Piao, Meihua and Rosen, Brittany and Allison, J. Jeroan and Zai, H. Adrian and Nguyen, L. Hoa and Shin, Dong-Soo and Kahn, A. Jessica", title="A Culturally Tailored Artificial Intelligence Chatbot (K-Bot) to Promote Human Papillomavirus Vaccination Among Korean Americans: Development and Usability Study", journal="Asian Pac Isl Nurs J", year="2025", month="Apr", day="7", volume="9", pages="e71865", keywords="human papillomavirus", keywords="HPV vaccination", keywords="artificial intelligence", keywords="AI", keywords="chatbot intervention", keywords="Korean Americans", keywords="usability testing", keywords="culturally tailored intervention", abstract="Background: Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) worldwide and is associated with various cancers, including cervical and oropharyngeal cancers. Despite the availability of effective vaccines, significant disparities in HPV vaccination rates persist, particularly among racial and ethnic minorities, such as Korean Americans. Cultural stigma, language barriers, and limited access to tailored health information contribute to these disparities. Objective: This study aimed to develop and evaluate the usability of K-Bot, an artificial intelligence (AI)--powered, culturally tailored, bilingual (Korean and English) chatbot designed to provide culturally sensitive health information about HPV vaccination to Korean immigrants and Korean Americans. Methods: K-Bot was developed using CloudTuring and Google Dialogflow. Its dialogues were created using Centers for Disease Control and Prevention (CDC) evidence-based HPV information and tailored to the Korean American population based on findings from previous studies. The evaluation and refinement process for K-Bot was organized into 3 phases: (1) expert evaluation by a multidisciplinary panel, (2) usability testing, and (3) iterative refinement based on feedback. An online survey collected demographics, HPV awareness, and vaccination status before 6 focus groups (N=21) sessions using semistructured questions guided by Peter Morville's usability framework. Quantitative data were analyzed descriptively, and thematic analysis assessed usability, cultural relevance, and content clarity across 6 dimensions: desirability, accessibility, findability, credibility, usability, and usefulness. Results: Participants had a mean age of 23.7 (SD 4.7) years, with most being female (n=12, 57.1\%), second-generation individuals (n=13, 61.9\%), and single (n=20, 95.2\%). HPV awareness was high (n=19, 90.5\%), vaccine knowledge was also high (n=18, 81.8\%), but only 11 (52.4\%) participants were vaccinated. Feedback-driven refinements addressed usability challenges, including simplifying navigation and adding visual elements. Participants described K-Bot as a promising tool for promoting HPV vaccination among Korean and Korean American users, citing its bilingual functionality and culturally tailored content as key strengths. Evidence-based information was valued, but participants recommended visuals to improve engagement and reduce cognitive load. Accessibility concerns included broken links, and participants proposed enhancements, such as animations, demographic-specific resources, and interactive features, to improve usability and engagement further. Conclusions: Usability testing of K-Bot revealed its potential as a culturally tailored, bilingual tool for promoting HPV vaccination among Korean immigrants and Korean Americans. Participants valued its evidence-based information, cultural relevance, and bilingual functionality but recommended improvements, such as enhanced navigation, visual elements, and interactive features, to boost engagement and usability. These findings support the potential of AI-driven tools to improve health care access by addressing key barriers to care. Further research is needed to evaluate their broader impact and optimize their design and implementation for individuals with diverse health care needs. ", doi="10.2196/71865", url="https://apinj.jmir.org/2025/1/e71865" } @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/10.2196/65542, author="Nasrudin, Nurfarhana and Sazlina, Shariff-Ghazali and Cheong, Theng Ai and Lee, Yein Ping and Teo, Soo-Hwang and Aneesa, Rashid Abdul and Teo, Hai Chin and Rokhani, Zaman Fakhrul and Haron, Azam Nuzul and Harrun, Harzana Noor and Ho, Kiau Bee and Mohamed Isa, Salbiah", title="Increasing the Uptake of Breast and Cervical Cancer Screening Via the MAwar Application: Stakeholder-Driven Web Application Development Study", journal="JMIR Form Res", year="2025", month="Mar", day="28", volume="9", pages="e65542", keywords="cancer screening", keywords="stakeholder engagement", keywords="Quality Function Deployment", keywords="web health app", abstract="Background: Digital health interventions such as web health applications significantly enhance screening accessibility and uptake, particularly for individuals with low literacy and income levels. By involving stakeholders---including health care professionals, patients, and technical experts---an intervention can be tailored to effectively meet the users' needs, ensuring contextual relevance for better acceptance and impact. Objective: The aim of this study is to prioritize the content and user interface appropriate for developing a web health application, known as the MAwar app, to promote breast and cervical cancer screening. Methods: A cross-sectional study for stakeholder engagement was conducted to develop a web-based application known as the MAwar app as part of a larger study entitled ``The Effectiveness of an Interactive Web Application to Motivate and Raise Awareness on Early Detection of Breast and Cervical Cancers (The MAwar study)''. The stakeholder engagement process was conducted in a public health district that oversees 12 public primary care clinics with existing cervical and breast cancer screening programs. We purposively selected the stakeholders for their relevant roles in breast and cervical cancer screening (health care staff, patients, and public representatives), as well as expertise in software and user interface design (technology experts). The Quality Function Deployment method was used to reflect the priorities of diverse stakeholders (health care, technology experts, patients, and public representatives) in its design. The Quality Function Deployment method facilitated the translation of stakeholder perspectives into app features. Stakeholders rated features on a scale from 1 (least important) to 5 (most important), ensuring the app's design resonated with user needs. The correlations between the ``WHATs'' (user requirements) and the ``HOWs'' (technical requirements) were scored using a 3-point ordinal scale, with 1 indicating weak correlation, 5 indicating medium correlation, and 9 indicating the strongest correlation. Results: A total of 13 stakeholders participated in the study, including women who had either underwent or never had health screening, a health administrator, a primary care physician, medical officers, nurses, and software designers. Stakeholder evaluations highlighted cost-free access (mean 4.64, SD 0.81), comprehensive cancer information (mean 4.55, SD 0.69), detailed screening benefits (mean 4.45, SD 0.68), detailed screening facilities (mean 4.45, SD 0.68) and personalized risk calculator for breast and cervical cancers (mean 4.45, SD 0.68) as essential priorities of the app. The highest-ranked features include detailed information on screening procedures (weighted score [WS]=367.84), information on treatment options (WS=345.80), benefits of screening (WS=333.75), information about breast and cervical cancers (WS=332.15), and frequently asked questions about the concerns around screening (WS=312.00). Conclusions: The MAwar app, conceived through a collaborative, stakeholder-driven process, represents a significant step in leveraging digital health solutions to tackle cancer screening disparities. By prioritizing accessibility, information quality, and clarity on benefits, the app promises to encourage early cancer detection and management for targeted communities. Trial Registration: ISRCTN Registry ISRCTN10403163; https://www.isrctn.com/ISRCTN10403163 ", doi="10.2196/65542", url="https://formative.jmir.org/2025/1/e65542" } @Article{info:doi/10.2196/63989, author="Kim, Mi Sun and Kim, Seul Da and Jang, Yoonsung and Kim, Kyoon Min and Yu, Eun-Seung and Han, Hyun Doug and Kim, Jun Hee", title="Evaluating the Effectiveness of a Mobile App for Breast Cancer Self-Management on Self-Efficacy: Nonrandomized Intervention Trial", journal="JMIR Mhealth Uhealth", year="2025", month="Mar", day="26", volume="13", pages="e63989", keywords="breast cancer", keywords="mobile health", keywords="mHealth", keywords="health education", keywords="self-efficacy", keywords="psychological adjustments", keywords="mobile phone", abstract="Background: Numerous mobile apps have been developed for patients with cancer. However, there is still no comprehensive app for patients with breast cancer that integrates evidence-based medical information, psychological support, and schedule management through a multidisciplinary medical approach. Objective: We aimed to investigate whether a mobile app designed to assist in the self-management of patients with breast cancer is feasible and positively affects their self-efficacy and other psychological aspects. Methods: The Cancer Manager (CAMA) app was developed to assist in the self-management of patients with breast cancer and survivors of cancer according to cancer trajectory. Its functionalities include providing evidence-based digitalized information created by experts, managing patients' medication and medical appointment schedules, and providing a delayed question and answer system for patients to query health care professionals. In this nonrandomized intervention trial, we analyzed data from 66 patients with breast cancer, divided into experimental (CAMA: n=34, 52\%) and control (treatment as usual: n=32, 48\%) groups. Group allocation was determined based on the patient's willingness to use the app and access to compatible smartphones. Outcome measures included the Korean version of the Cancer Survivor Self-Efficacy Scale, the Korean version of the Mini-Mental Adjustment to Cancer (K-Mini-MAC) Scale, the World Health Organization Quality of Life Brief Version, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Menopause Emotional Symptoms Questionnaire (MESQ). A user satisfaction survey was also conducted. Results: Throughout the intervention period, the CAMA group (vs treatment as usual group) demonstrated significant improvements in the seeking help and support subscale of the Korean version of the Cancer Survivor Self-Efficacy Scale (F1,64=5.09; P=.03), the psychological well-being subscale of the World Health Organization Quality of Life Brief Version (F1,64=5.48; P=.02), the anxious preoccupation subscale (F1,64=5.49; P=.02) and positive attitude subscale (F1,64=5.44; P=.02) of the K-Mini-MAC Scale, PHQ-9 (F1,64=4.83; P=.03), GAD-7 (F1,64=5.48; P=.02), and MESQ (F1,64=4.30; P=.04). Changes in the anxious preoccupation subscale of the K-Mini-MAC Scale scores were positively correlated with changes in the PHQ-9 (r=0.46; P=.007) and GAD-7 (r=0.41; P=.02) scores and negatively correlated with changes in the positive attitude subscale of the K-Mini-MAC Scale scores (r=--0.36; P=.04). Changes in the PHQ-9 scores were positively correlated with changes in the GAD-7 (r=0.66; P<.001) and MESQ (r=0.35; P=.04) scores. The user satisfaction survey offered insights into the CAMA app's positive impact; trust-building outcomes; and opportunities for enhancement, such as the inclusion of communication tools and continued content enrichment. Conclusions: The mobile app for breast cancer self-management, CAMA, was deemed feasible and showed promise in improving the patients' self-efficacy regarding seeking help and support, positive attitude toward cancer, and psychological well-being. In addition, its use might help reduce anxious preoccupation with cancer, depressive mood, anxiety, and menopausal emotional symptoms. Trial Registration: Clinical Research Information Service KCT0007917; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=23348 ", doi="10.2196/63989", url="https://mhealth.jmir.org/2025/1/e63989" } @Article{info:doi/10.2196/53539, author="Crafoord, Marie-Ther{\'e}se and Ekstrand, Joakim and Sundberg, Kay and Nilsson, I. Marie and Fjell, Maria and Langius-Ekl{\"o}f, Ann", title="Mobile Electronic Patient-Reported Outcomes and Interactive Support During Breast and Prostate Cancer Treatment: Health Economic Evaluation From Two Randomized Controlled Trials", journal="JMIR Cancer", year="2025", month="Mar", day="11", volume="11", pages="e53539", keywords="cost-effectiveness", keywords="ePRO", keywords="mHealth", keywords="disease monitoring", keywords="cancer", keywords="RCT", keywords="randomized controlled trial", keywords="controlled trials", keywords="digital intervention", keywords="patient-reported outcomes", keywords="management", keywords="payers' perspective", keywords="health care costs", keywords="apps", keywords="prostate cancer", keywords="breast cancer", abstract="Background: Digital interventions for supportive care during cancer treatment incorporating electronic patient-reported outcomes (ePROs) can enhance early detection of symptoms and facilitate timely symptom management. However, economic evaluations are needed. Objective: This study aims to conduct a cost-utility analysis of an app for ePRO and interactive support from the perspective of the payer (Region Stockholm Health Care Organization) and to explore its impact on patient health care utilization and costs. Methods: Two open-label randomized controlled trials (RCTs) were conducted, including patients undergoing neoadjuvant chemotherapy for breast cancer (B-RCT; N=149) and radiotherapy for prostate cancer (P-RCT; N=150), recruited from oncology clinics at 2 university hospitals in Stockholm, Sweden. EORTC QLQ-C30 scores were mapped to EQ-5D-3L to calculate quality-adjusted life years (QALYs). Intervention and implementation costs and health care costs, obtained from an administrative database, were used to calculate incremental cost-effectiveness ratios (ICERs) in 3 ways: including all health care costs (ICERa), excluding nonacute health care costs (ICERb), and excluding health care costs altogether (ICERc). Nonparametric bootstrapping was used to explore ICER uncertainty. Health care costs were analyzed by classifying them as disease-related or acute. Results: In both RCT intervention groups, fewer QALYs were lost compared with the control group (P<.001). In the B-RCT, the mean intervention cost was {\texteuro}92 (SD {\texteuro}2; {\texteuro}1=US \$1.03). The mean cost for the intervention and all health care was {\texteuro}36,882 (SD {\texteuro}1032) in the intervention group and {\texteuro}35,427 (SD {\texteuro}959) in the control group (P<.001), with an ICERa of {\texteuro}202,368 (95\% CI {\texteuro}152,008-{\texteuro}252,728). The mean cost for the intervention and acute health care was {\texteuro}3585 (SD {\texteuro}480) in the intervention group and {\texteuro}3235 (SD {\texteuro}494) in the control group (P<.001). ICERb was {\texteuro}49,903 (95\% CI {\texteuro}37,049-{\texteuro}62,758) and ICERc was {\texteuro}13,213 (95\% CI {\texteuro}11,145-{\texteuro}15,281); 22 out of 74 (30\%) intervention group patients and 24 out of 75 (32\%) of the control group patients required acute inpatient care for fever. In the P-RCT, the mean intervention cost was {\texteuro}43 (SD {\texteuro}0.2). The mean cost for the intervention and all health care was {\texteuro}3419 (SD {\texteuro}739) in the intervention group and {\texteuro}3537 (SD {\texteuro}689) in the control group (P<.001), with an ICERa of --{\texteuro}1,092,136 (95\% CI --{\texteuro}3,274,774 to {\texteuro}1,090,502). The mean cost for the intervention and acute health care was {\texteuro}1219 (SD {\texteuro}593) in the intervention group and {\texteuro}802 (SD {\texteuro}281) in the control group (P<.001). ICERb was {\texteuro}745,987 (95\% CI --{\texteuro}247,317 to {\texteuro}1,739,292) and ICERc was {\texteuro}13,118 (95\% CI --68,468 to {\texteuro}94,704). As many as 10 out of the 75 (13\%) intervention group patients had acute inpatient care, with the most common symptom being dyspnea, while 9 out of the 75 (12\%) control group patients had acute inpatient care, with the most common symptom being urinary tract infection. Conclusions: ePRO and interactive support via an app generated a small improvement in QALYs at a low intervention cost and may be cost-effective, depending on the costs considered. Considerable variability in patient health care costs introduced uncertainty around the estimates, preventing a robust determination of cost-effectiveness. Larger studies examining cost-effectiveness from a societal perspective are needed. The study provides valuable insights into acute health care utilization during cancer treatment. Trial Registration: ClinicalTrials.gov NCT02479607; https://clinicaltrials.gov/ct2/show/NCT02479607, ClinicalTrials.gov NCT02477137; https://clinicaltrials.gov/ct2/show/NCT02477137 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-017-3450-y ", doi="10.2196/53539", url="https://cancer.jmir.org/2025/1/e53539" } @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/10.2196/64145, author="Bargas-Ochoa, Miguel and Zulbaran-Rojas, Alejandro and Finco, G. M. and Costales, B. Anthony and Flores-Camargo, Areli and Bara, O. Rasha and Pacheco, Manuel and Phan, Tina and Khichi, Aleena and Najafi, Bijan", title="Development and Implementation of a Personal Virtual Assistant for Patient Engagement and Communication in Postsurgical Cancer Care: Feasibility Cohort Study", journal="JMIR Cancer", year="2025", month="Feb", day="18", volume="11", pages="e64145", keywords="digital health", keywords="personal virtual assistant", keywords="remote patient monitoring", keywords="surgical oncology", keywords="posthospital discharge", keywords="postoperative support", keywords="medication adherence postsurgery", keywords="patient engagement", keywords="mHealth", keywords="mobile health", abstract="Background: Cancer-care complexity heightens communication challenges between health care providers and patients, impacting their treatment adherence. This is especially evident upon hospital discharge in patients undergoing surgical procedures. Digital health tools offer potential solutions to address communication challenges seen in current discharge protocols. We aim to explore the usability and acceptability of an interactive health platform among discharged patients who underwent oncology-related procedures. Methods: A 4-week exploratory cohort study was conducted. Following hospital discharge, a tablet equipped with an integrated Personal Virtual Assistant (PVA) system was provided to patients who underwent oncology-related procedures. The PVA encompasses automated features that provide personalized care plans, developed through collaboration among clinicians, researchers, and engineers from various disciplines. These plans include guidance on daily specific assignments that were divided into 4 categories: medication intake, exercise, symptom surveys, and postprocedural specific tasks. The aim was to explore the acceptability of the PVA by quantification of dropout rate and assessing adherence to each care plan category throughout the study duration. The secondary aim assessed acceptability of the PVA through a technology acceptance model (TAM) questionnaire that examined ease of use, usefulness, attitude toward use, and privacy concerns. Results: In total, 17 patients were enrolled. However, 1 (5.8\%) patient dropped out from the study after 3 days due to health deterioration, leaving 16/17 (94.2\%) completing the study (mean age 54.5, SD 12.7, years; n=9, 52\% Caucasian; n=14, 82\% with a gynecological disease; n=3, 18\% with a hepatobiliary disease). At the study end point, adherence to care plan categories were 78\% (SD 25\%) for medications, 81\% (SD 24\%) for exercises, 61\% (SD 30\%) for surveys, and 58\% (SD 44\%) for specific tasks such as following step-by step wound care instructions, managing drains, administering injectable medications independently, and performing pelvic baths as instructed. There was an 80\% patient endorsement (strongly agree or agree) across all TAM categories. Conclusion: This study suggests the potential acceptability of the PVA among patients discharged after oncology-related procedures, with a dropout rate of less than 6\% and fair-to-good adherence to tasks such as medication intake and exercise. However, these findings are preliminary due to the small sample size and highlight the need for further research with larger cohorts to validate and refine the system. ", doi="10.2196/64145", url="https://cancer.jmir.org/2025/1/e64145" } @Article{info:doi/10.2196/67043, author="Jacob, Christine and M{\"u}ller, Roman and Sch{\"u}ler, Sonja and Rey, Alix and Rey, Guillaume and Armenian, Berj and Vonlaufen, Alain and Drepper, Michael and Zimmerli, Marius", title="Think-Aloud Testing of a Companion App for Colonoscopy Examinations: Usability Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="12", volume="12", pages="e67043", keywords="eHealth", keywords="mobile health", keywords="mHealth", keywords="digital health", keywords="technology assessment", keywords="technology adoption", keywords="technology implementation", keywords="usability study", keywords="colonoscopy", keywords="app", keywords="application", keywords="examinations", keywords="smartphone", keywords="usability", abstract="Background: Colonoscopies are vital for initial screening, follow-ups, surveillance of neoplasia, and assessing symptoms such as rectal bleeding. Successful colonoscopies require thorough colon preparation, but up to 25\% fail due to poor preparation. This can lead to longer procedures, repeat colonoscopies, inconvenience, poorer health outcomes, and higher costs. eHealth tools can enhance bowel preparation and potentially reduce the need for repeat procedures. Objective: This usability study aimed to identify strengths and weaknesses in a prototype companion app for colonoscopy examinations. The objective was to obtain in-depth insights into the app's usability, ease of use, and content comprehension, with the aim of refining the tool to effectively fulfill its intended purpose, guided by feedback from potential users. Methods: From February to August 2024, we conducted a qualitative study using the think-aloud procedure. Each session involved 6 tasks and a semistructured interview to delve deeper into participants' task experiences. All think-aloud sessions and interviews were recorded. Quantitative usability questions were analyzed using Microsoft Excel, while qualitative data underwent coding and analysis based on thematic analysis principles. Results: In total, 17 individuals, all smartphone users, participated in this study. Participants were recruited from 1 hospital, 1 private clinic, and 1 patient organization in Switzerland. The study found that participants rated the app's usability metrics positively, with an overall mean rating of ease of use at 4.29 (SD 0.59), usefulness at 4.53 (SD 0.72), and comprehensibility at 4.29 (SD 0.92). For the individual features, the mean ratings for ease of use were between 4 and 4.65, usefulness ranged from 4.35 to 4.82, and comprehensibility received ratings between 4.29 and 4.53, all measured on a 5-point scale, where 1 represented low agreement and 5 indicated high agreement. Additionally, 100\% of participants indicated they will or may use the app if they require a colonoscopy examination. Participants highlighted the need for reminders and alerts in the week leading up to the colonoscopy, along with tailored content, simplified language, and visual aids. Conclusions: The app prototype demonstrated favorable results with the majority of participants, and the testing process enabled the prompt identification and resolution of usability issues. The next phase will prioritize and assess potential improvements based on urgency and feasibility to guide a focused development plan. Usability testing highlighted features such as push notifications and personalized content as top priorities for participants, making them key areas for immediate attention. Moving forward, the app has the potential to function effectively as a companion app for colonoscopy examinations. To achieve this, further studies with a larger sample in real-world settings will be crucial. ", doi="10.2196/67043", url="https://humanfactors.jmir.org/2025/1/e67043" } @Article{info:doi/10.2196/59161, author="Lee, Kyungmi and Azuero, Andres and Engler, Sally and Kumar, Sidharth and Puga, Frank and Wright, A. Alexi and Kamal, Arif and Ritchie, S. Christine and Demiris, George and Bakitas, A. Marie and Odom, Nicholas J.", title="Exploring the Relationship Between Smartphone GPS Patterns and Quality of Life in Patients With Advanced Cancer and Their Family Caregivers: Longitudinal Study", journal="JMIR Form Res", year="2025", month="Feb", day="7", volume="9", pages="e59161", keywords="cancer", keywords="digital phenotyping", keywords="global positioning system", keywords="quality of life", keywords="smartphone", keywords="mobile phone", keywords="family caregiver", abstract="Background: Patients with advanced cancer and their family caregivers often experience poor quality of life (QOL). Self-report measures are commonly used to quantify QOL of family caregivers but may have limitations such as recall bias and social desirability bias. Variables derived from passively obtained smartphone GPS data are a novel approach to measuring QOL that may overcome these limitations and enable detection of early signs of mental and physical health (PH) deterioration. Objective: This study explored the feasibility of a digital phenotyping approach by assessing participant adherence and examining correlations between smartphone GPS data and QOL levels among family caregivers and patients with advanced cancer. Methods: This was a secondary analysis involving 7 family caregivers and 4 patients with advanced cancer that assessed correlations between GPS sensor data captured by a personally owned smartphone and QOL self-report measures over 12 weeks through linear correlation coefficients. QOL as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health 10 was collected at baseline, 6, and 12 weeks. Using a Beiwe smartphone app, GPS data were collected and processed into variables including total distance, time spent at home, transition time, and number of significant locations. Results: The study identified relevant temporal correlations between QOL and smartphone GPS data across specific time periods. For instance, in terms of PH, associations were observed with the total distance traveled (12 and 13 wk, with r ranging 0.37 to 0.38), time spent at home (?4 to ?2 wk, with r ranging from ?0.41 to ?0.49), and transition time (?4 to ?2 wk, with r ranging ?0.38 to ?0.47). Conclusions: This research offers insights into using passively obtained smartphone GPS data as a novel approach for assessing and monitoring QOL among family caregivers and patients with advanced cancer, presenting potential advantages over traditional self-report measures. The observed correlations underscore the potential of this method to detect early signs of deteriorating mental health and PH, providing opportunities for timely intervention and support. ", doi="10.2196/59161", url="https://formative.jmir.org/2025/1/e59161" } @Article{info:doi/10.2196/63403, author="Ezeigwe, Juliet Ogochukwu and Nwosu, Samuel Kenechukwu Obumneme and Afolayan, Kunle Oladipo and Ojaruega, Amanda Akpevwe and Echere, Jovita and Desai, Manali and Onigbogi, Olajumoke Modupe and Oladoyin, Ope Olajumoke and Okoye, Chioma Nnenna and Fwelo, Pierre", title="Technological-Based Interventions in Cancer and Factors Associated With the Use of Mobile Digital Wellness and Health Apps Among Cancer Information Seekers: Cross-Sectional Study", journal="J Med Internet Res", year="2025", month="Feb", day="5", volume="27", pages="e63403", keywords="cancer intervention", keywords="digital health and wellness apps", keywords="cancer management", keywords="telehealth", keywords="mobile health", keywords="mhealth", keywords="decision-making", keywords="United States", keywords="cross-sectional study", keywords="adult", keywords="logistic regression", keywords="regression analysis", keywords="digital health", keywords="young adult", keywords="cancer screening", keywords="knowledge seeking", keywords="barrier", keywords="utilization", keywords="engagement", keywords="digital health engagement", keywords="diversity", keywords="cancer information", keywords="health seeking behavior", keywords="mobile phone", abstract="Background: Mobile digital wellness and health apps play a significant role in optimizing health and aiding in cancer management and decision-making. Objective: This study aims to identify the factors influencing the use of mobile health and wellness apps among cancer information seekers in the United States. Methods: We conducted a cross-sectional study using data from the Health Information National Trends Survey. Our analysis focused on 4770 participants who sought cancer information. We performed weighted univariate and multivariable logistic regression to determine the association between the use of health and wellness apps and socioeconomic factors, medical history and conditions, and lifestyle and behavioral factors. Results: A total of 4770 participants who sought cancer information were included in the final analysis. Of these, 80.9\% (n=2705) were health and wellness app users, while 19.1\% (n=793) were nonusers. In the final adjusted model, participants with household incomes ?US \$50,000 had 49\% higher adjusted odds of using these apps than those with incomes