@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