@Article{info:doi/10.2196/46116, author="Zhang, Yingzi and Flannery, Marie and Zhang, Zhihong and Underhill-Blazey, Meghan and Bobry, Melanie and Leblanc, Natalie and Rodriguez, Darcey and Zhang, Chen", title="Digital Health Psychosocial Intervention in Adult Patients With Cancer and Their Families: Systematic Review and Meta-Analysis", journal="JMIR Cancer", year="2024", month="Feb", day="5", volume="10", pages="e46116", keywords="cancer", keywords="anxiety", keywords="decision-making", keywords="depression", keywords="digital health", keywords="distress", keywords="family", keywords="mental health", keywords="mortality", keywords="psychosocial intervention", keywords="quality of life", abstract="Background: Patients with cancer and their families often experience significant distress and deterioration in their quality of life. Psychosocial interventions were used to address patients' and families' psychosocial needs. Digital technology is increasingly being used to deliver psychosocial interventions to patients with cancer and their families. Objective: A systematic review and meta-analysis were conducted to review the characteristics and effectiveness of digital health interventions on psychosocial outcomes in adult patients with cancer and their family members. Methods: Databases (PubMed, Cochrane Library, Web of Science, Embase, CINAHL, PsycINFO, ProQuest Dissertations and Theses Global, and ClinicalTrials.gov) were searched for randomized controlled trials (RCTs) or quasi-experimental studies that tested the effects of a digital intervention on psychosocial outcomes. The Joanna Briggs Institute's critical appraisal checklists for RCTs and quasi-experimental studies were used to assess quality. Standardized mean differences (ie, Hedges g) were calculated to compare intervention effectiveness. Subgroup analysis was planned to examine the effect of delivery mode, duration of the intervention, type of control, and dosage on outcomes using a random-effects modeling approach. Results: A total of 65 studies involving 10,361 patients (mean 159, SD 166; range 9-803 patients per study) and 1045 caregivers or partners (mean 16, SD 54; range 9-244 caregivers or partners per study) were included in the systematic review. Of these, 32 studies were included in a meta-analysis of the effects of digital health interventions on quality of life, anxiety, depression, distress, and self-efficacy. Overall, the RCT studies' general quality was mixed (applicable scores: mean 0.61, SD 0.12; range 0.38-0.91). Quasi-experimental studies were generally of moderate to high quality (applicable scores: mean 0.75, SD 0.08; range 0.63-0.89). Psychoeducation and cognitive-behavioral strategies were commonly used. More than half (n=38, 59\%) did not identify a conceptual or theoretical framework. Most interventions were delivered through the internet (n=40, 62\%). The median number of intervention sessions was 6 (range 1-56). The frequency of the intervention was highly variable, with self-paced (n=26, 40\%) being the most common. The median duration was 8 weeks. The meta-analysis results showed that digital psychosocial interventions were effective in improving patients' quality of life with a small effect size (Hedges g=0.05, 95\% CI --0.01 to 0.10; I2=42.7\%; P=.01). The interventions effectively reduced anxiety and depression symptoms in patients, as shown by moderate effect sizes on Hospital Anxiety and Depression Scale total scores (Hedges g=--0.72, 95\% CI --1.89 to 0.46; I2=97.6\%; P<.001). Conclusions: This study demonstrated the effectiveness of digital health interventions on quality of life, anxiety, and depression in patients. Future research with a clear description of the methodology to enhance the ability to perform meta-analysis is needed. Moreover, this study provides preliminary evidence to support the integration of existing digital health psychosocial interventions in clinical practice. Trial Registration: PROSPERO CRD42020189698; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=189698 ", doi="10.2196/46116", url="https://cancer.jmir.org/2024/1/e46116", url="http://www.ncbi.nlm.nih.gov/pubmed/38315546" } @Article{info:doi/10.2196/52322, author="Zeinali, Nahid and Youn, Nayung and Albashayreh, Alaa and Fan, Weiguo and Gilbertson White, St{\'e}phanie", title="Machine Learning Approaches to Predict Symptoms in People With Cancer: Systematic Review", journal="JMIR Cancer", year="2024", month="Mar", day="19", volume="10", pages="e52322", keywords="machine learning", keywords="ML", keywords="deep learning", keywords="DL", keywords="cancer symptoms", keywords="prediction model", abstract="Background: People with cancer frequently experience severe and distressing symptoms associated with cancer and its treatments. Predicting symptoms in patients with cancer continues to be a significant challenge for both clinicians and researchers. The rapid evolution of machine learning (ML) highlights the need for a current systematic review to improve cancer symptom prediction. Objective: This systematic review aims to synthesize the literature that has used ML algorithms to predict the development of cancer symptoms and to identify the predictors of these symptoms. This is essential for integrating new developments and identifying gaps in existing literature. Methods: We conducted this systematic review in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist. We conducted a systematic search of CINAHL, Embase, and PubMed for English records published from 1984 to August 11, 2023, using the following search terms: cancer, neoplasm, specific symptoms, neural networks, machine learning, specific algorithm names, and deep learning. All records that met the eligibility criteria were individually reviewed by 2 coauthors, and key findings were extracted and synthesized. We focused on studies using ML algorithms to predict cancer symptoms, excluding nonhuman research, technical reports, reviews, book chapters, conference proceedings, and inaccessible full texts. Results: A total of 42 studies were included, the majority of which were published after 2017. Most studies were conducted in North America (18/42, 43\%) and Asia (16/42, 38\%). The sample sizes in most studies (27/42, 64\%) typically ranged from 100 to 1000 participants. The most prevalent category of algorithms was supervised ML, accounting for 39 (93\%) of the 42 studies. Each of the methods---deep learning, ensemble classifiers, and unsupervised ML---constituted 3 (3\%) of the 42 studies. The ML algorithms with the best performance were logistic regression (9/42, 17\%), random forest (7/42, 13\%), artificial neural networks (5/42, 9\%), and decision trees (5/42, 9\%). The most commonly included primary cancer sites were the head and neck (9/42, 22\%) and breast (8/42, 19\%), with 17 (41\%) of the 42 studies not specifying the site. The most frequently studied symptoms were xerostomia (9/42, 14\%), depression (8/42, 13\%), pain (8/42, 13\%), and fatigue (6/42, 10\%). The significant predictors were age, gender, treatment type, treatment number, cancer site, cancer stage, chemotherapy, radiotherapy, chronic diseases, comorbidities, physical factors, and psychological factors. Conclusions: This review outlines the algorithms used for predicting symptoms in individuals with cancer. Given the diversity of symptoms people with cancer experience, analytic approaches that can handle complex and nonlinear relationships are critical. This knowledge can pave the way for crafting algorithms tailored to a specific symptom. In addition, to improve prediction precision, future research should compare cutting-edge ML strategies such as deep learning and ensemble methods with traditional statistical models. ", doi="10.2196/52322", url="https://cancer.jmir.org/2024/1/e52322", url="http://www.ncbi.nlm.nih.gov/pubmed/38502171" } @Article{info:doi/10.2196/56969, author="Goncalves Leite Rocco, Patricia and Reategui-Rivera, Mahony C. and Finkelstein, Joseph", title="Telemedicine Applications for Cancer Rehabilitation: Scoping Review", journal="JMIR Cancer", year="2024", month="Aug", day="21", volume="10", pages="e56969", keywords="telerehabilitation", keywords="telemedicine", keywords="rehabilitation", keywords="cancer", keywords="exercise", keywords="physical therapy", keywords="telehealth", keywords="remote care", keywords="digital medicine", keywords="oncology", keywords="oncologist", keywords="metastases", keywords="exercising", keywords="scoping review", keywords="scoping reviews", keywords="PubMed", abstract="Background: Cancer is a significant public health issue worldwide. Treatments such as surgery, chemotherapy, and radiation therapy often cause psychological and physiological side effects, affecting patients' ability to function and their quality of life (QoL). Physical activity is crucial to cancer rehabilitation, improving physical function and QoL and reducing cancer-related fatigue. However, many patients face barriers to accessing cancer rehabilitation due to socioeconomic factors, transportation issues, and time constraints. Telerehabilitation can potentially overcome these barriers by delivering rehabilitation remotely. Objective: The aim of the study is to identify how telemedicine is used for the rehabilitation of patients with cancer. Methods: This scoping review followed recognized frameworks. We conducted an electronic literature search on PubMed for studies published between January 2015 and May 2023. Inclusion criteria were studies reporting physical therapy telerehabilitation interventions for patients with cancer, including randomized and nonrandomized controlled trials, feasibility studies, and usability studies. In total, 21 studies met the criteria and were included in the final review. Results: Our search yielded 37 papers, with 21 included in the final review. Randomized controlled trials comprised 47\% (n=10) of the studies, with feasibility studies at 33\% (n=7) and usability studies at 19\% (n=4). Sample sizes were typically 50 or fewer participants in 57\% (n=12) of the reports. Participants were generally aged 65 years or younger (n=17, 81\%), with a balanced gender distribution. Organ-specific cancers were the focus of 66\% (n=14) of the papers, while 28\% (n=6) included patients who were in the posttreatment period. Web-based systems were the most used technology (n=13, 61\%), followed by phone call or SMS text messaging--based systems (n=9, 42\%) and mobile apps (n=5, 23\%). Exercise programs were mainly home based (n=19, 90\%) and included aerobic (n=19, 90\%), resistance (n=13, 61\%), and flexibility training (n=7, 33\%). Outcomes included improvements in functional capacity, cognitive functioning, and QoL (n=10, 47\%); reductions in pain and hospital length of stay; and enhancements in fatigue, physical and emotional well-being, and anxiety. Positive effects on feasibility (n=3, 14\%), acceptability (n=8, 38\%), and cost-effectiveness (n=2, 9\%) were also noted. Functional outcomes were frequently assessed (n=19, 71\%) with tools like the 6-minute walk test and grip strength tests. Conclusions: Telerehabilitation for patients with cancer is beneficial and feasible, with diverse approaches in study design, technologies, exercises, and outcomes. Future research should focus on developing standardized methodologies, incorporating objective measures, and exploring emerging technologies like virtual reality, wearable or noncontact sensors, and artificial intelligence to optimize telerehabilitation interventions. Addressing these areas can enhance clinical practice and improve outcomes for remote rehabilitation with patients. ", doi="10.2196/56969", url="https://cancer.jmir.org/2024/1/e56969", url="http://www.ncbi.nlm.nih.gov/pubmed/39079103" } @Article{info:doi/10.2196/53956, author="Abraham, Olufunmilola and Agoke, Adeola and Sanuth, Kazeem and Fapohunda, Abimbola and Ogunsanya, Motolani and Piper, Megan and Trentham-Dietz, Amy", title="Need for Culturally Competent and Responsive Cancer Education for African Immigrant Families and Youth Living in the United States", journal="JMIR Cancer", year="2024", month="Mar", day="6", volume="10", pages="e53956", keywords="African immigrant", keywords="youth", keywords="adolescent", keywords="adolescents", keywords="teen", keywords="teens", keywords="teenager", keywords="teenagers", keywords="cancer awareness", keywords="health disparities", keywords="culturally competent education", keywords="African", keywords="Black", keywords="immigrant", keywords="cultural", keywords="culturally", keywords="cancer", keywords="oncology", keywords="patient education", keywords="awareness", keywords="prevention", keywords="disparity", keywords="disparities", doi="10.2196/53956", url="https://cancer.jmir.org/2024/1/e53956", url="http://www.ncbi.nlm.nih.gov/pubmed/38447129" } @Article{info:doi/10.2196/56168, author="Abraham, Olufunmilola and McCarthy, J. Tyler", title="An Introduction to the OutSMART Cancer Serious Game: Current and Future Directions", journal="JMIR Cancer", year="2024", month="May", day="29", volume="10", pages="e56168", keywords="serious game", keywords="cancer", keywords="health education", keywords="adolescents", keywords="health behavior", keywords="United States", keywords="young people", keywords="adolescent", keywords="teenager", keywords="teenagers", keywords="cancer prevention", keywords="education", keywords="cancer risk", keywords="tool", keywords="OutSMART Cancer", keywords="innovative", keywords="game development", keywords="cancer awareness", keywords="prevention", keywords="wellness", doi="10.2196/56168", url="https://cancer.jmir.org/2024/1/e56168", url="http://www.ncbi.nlm.nih.gov/pubmed/38809587" } @Article{info:doi/10.2196/52985, author="Baum, Eleonore and Thiel, Christian and Kobleder, Andrea and Bernhardsgr{\"u}tter, Daniela and Engst, Ramona and Maurer, Carola and Koller, Antje", title="Using a Mobile Messenger Service as a Digital Diary to Capture Patients' Experiences Along Their Interorganizational Treatment Path in Gynecologic Oncology: Lessons Learned", journal="JMIR Cancer", year="2024", month="Jul", day="29", volume="10", pages="e52985", keywords="mobile apps", keywords="computer security", keywords="confidentiality", keywords="data collection", keywords="oncology", keywords="breast neoplasms", keywords="mobile phone", doi="10.2196/52985", url="https://cancer.jmir.org/2024/1/e52985", url="http://www.ncbi.nlm.nih.gov/pubmed/39073852" } @Article{info:doi/10.2196/51536, author="Jones, Tamara and Edbrooke, Lara and Rawstorn, C. Jonathan and Denehy, Linda and Hayes, Sandra and Maddison, Ralph and Sverdlov, L. Aaron and Koczwara, Bogda and Kiss, Nicole and Short, E. Camille", title="Demographics and Health Characteristics Associated With the Likelihood of Participating in Digitally Delivered Exercise Rehabilitation for Improving Heart Health Among Breast Cancer Survivors: Cross-Sectional Survey Study", journal="JMIR Cancer", year="2024", month="Dec", day="16", volume="10", pages="e51536", keywords="digital health", keywords="breast cancer", keywords="exercise", keywords="rehabilitation", keywords="cardiotoxicity", keywords="demographic", keywords="cancer survivor", keywords="exercise rehabilitation", keywords="home-based program", keywords="pathologic process", keywords="radiation", keywords="physical phenomena", keywords="heart care", keywords="cardiovascular disease", keywords="diagnosis", keywords="cross-sectional study", keywords="chronic disease", keywords="statistics", abstract="Background: Strong evidence supports the benefits of exercise following both cardiovascular disease and cancer diagnoses. However, less than one-third of Australians who are referred to exercise rehabilitation complete a program following a cardiac diagnosis. Technological advances make it increasingly possible to embed real-time supervision, tailored exercise prescription, behavior change, and social support into home-based programs. Objective: This study aimed to explore demographic and health characteristics associated with the likelihood of breast cancer survivors uptaking a digitally delivered cardiac exercise rehabilitation program and to determine whether this differed according to intervention timing (ie, offered generally, before, during, or after treatment). Secondary aims were to explore the knowledge of cardiac-related treatment side-effects, exercise behavior, additional intervention interests (eg, diet, fatigue management), and service fee capabilities. Methods: This cross-sectional study involved a convenience sample of breast cancer survivors recruited via social media. A self-reported questionnaire was used to collect outcomes of interests, including the likelihood of uptaking a digitally delivered cardiac exercise rehabilitation program, and demographic and health characteristics. Descriptive statistics were used to summarize sample characteristics and outcomes. Ordered logistic regression models were used to examine associations between demographic and health characteristics and likelihood of intervention uptake generally, before, during, and after treatment, with odds ratios (ORs) <0.67 or >1.5 defined as clinically meaningful and statistical significance a priori set at P?.05. Results: A high proportion (194/208, 93\%) of the sample (mean age 57, SD 11 years; median BMI=26, IQR 23?31 kg/m2) met recommended physical activity levels at the time of the survey. Living in an outer regional area (compared with living in a major city) was associated with higher odds of uptake in each model (OR 3.86?8.57, 95\% CI 1.04-68.47; P=.01?.04). Receiving more cardiotoxic treatments was also associated with higher odds of general uptake (OR 1.42, 95\% CI 1.02-1.96; P=.04). There was some evidence that a higher BMI, more comorbid conditions, and lower education (compared with university education) were associated with lower odds of intervention uptake, but findings differed according to intervention timing. Respondents identified the need for better education about the cardiotoxic effects of breast cancer treatment, and the desire for multifaceted rehabilitation interventions that are free or low cost (median Aus \$10, IQR 10-15 per session; Aus \$1=US \$0.69 at time of study). Conclusions: These findings can be used to better inform future research and the development of intervention techniques that are critical to improving the delivery of a digital service model that is effective, equitable, and accessible, specifically, by enhancing digital inclusion, addressing general exercise barriers experienced by chronic disease populations, incorporating multidisciplinary care, and developing affordable delivery models. ", doi="10.2196/51536", url="https://cancer.jmir.org/2024/1/e51536" } @Article{info:doi/10.2196/47359, author="Shinn, H. Eileen and Garden, S. Adam and Peterson, K. Susan and Leupi, J. Dylan and Chen, Minxing and Blau, Rachel and Becerra, Laura and Rafeedi, Tarek and Ramirez, Julian and Rodriquez, Daniel and VanFossen, Finley and Zehner, Sydney and Mercier, P. Patrick and Wang, Joseph and Hutcheson, Kate and Hanna, Ehab and Lipomi, J. Darren", title="Iterative Patient Testing of a Stimuli-Responsive Swallowing Activity Sensor to Promote Extended User Engagement During the First Year After Radiation: Multiphase Remote and In-Person Observational Cohort Study", journal="JMIR Cancer", year="2024", month="Feb", day="28", volume="10", pages="e47359", keywords="user-centered design", keywords="patients with head and neck cancer", keywords="dysphagia throat sensor", abstract="Background: Frequent sensor-assisted monitoring of changes in swallowing function may help improve detection of radiation-associated dysphagia before it becomes permanent. While our group has prototyped an epidermal strain/surface electromyography sensor that can detect minute changes in swallowing muscle movement, it is unknown whether patients with head and neck cancer would be willing to wear such a device at home after radiation for several months. Objective: We iteratively assessed patients' design preferences and perceived barriers to long-term use of the prototype sensor. Methods: In study 1 (questionnaire only), survivors of pharyngeal cancer who were 3-5 years post treatment and part of a larger prospective study were asked their design preferences for a hypothetical throat sensor and rated their willingness to use the sensor at home during the first year after radiation. In studies 2 and 3 (iterative user testing), patients with and survivors of head and neck cancer attending visits at MD Anderson's Head and Neck Cancer Center were recruited for two rounds of on-throat testing with prototype sensors while completing a series of swallowing tasks. Afterward, participants were asked about their willingness to use the sensor during the first year post radiation. In study 2, patients also rated the sensor's ease of use and comfort, whereas in study 3, preferences were elicited regarding haptic feedback. Results: The majority of respondents in study 1 (116/138, 84\%) were willing to wear the sensor 9 months after radiation, and participant willingness rates were similar in studies 2 (10/14, 71.4\%) and 3 (12/14, 85.7\%). The most prevalent reasons for participants' unwillingness to wear the sensor were 9 months being excessive, unwanted increase in responsibility, and feeling self-conscious. Across all three studies, the sensor's ability to detect developing dysphagia increased willingness the most compared to its appearance and ability to increase adherence to preventive speech pathology exercises. Direct haptic signaling was also rated highly, especially to indicate correct sensor placement and swallowing exercise performance. Conclusions: Patients and survivors were receptive to the idea of wearing a personalized risk sensor for an extended period during the first year after radiation, although this may have been limited to well-educated non-Hispanic participants. A significant minority of patients expressed concern with various aspects of the sensor's burden and its appearance. Trial Registration: ClinicalTrials.gov NCT03010150; https://clinicaltrials.gov/study/NCT03010150 ", doi="10.2196/47359", url="https://cancer.jmir.org/2024/1/e47359", url="http://www.ncbi.nlm.nih.gov/pubmed/38416544" } @Article{info:doi/10.2196/46979, author="Dang, Ha Thu and Wickramasinghe, Nilmini and Forkan, Mohammad Abdur Rahim and Jayaraman, Prakash Prem and Burbury, Kate and O'Callaghan, Clare and Whitechurch, Ashley and Schofield, Penelope", title="Co-Design, Development, and Evaluation of a Mobile Solution to Improve Medication Adherence in Cancer: Design Science Research Approach", journal="JMIR Cancer", year="2024", month="Apr", day="3", volume="10", pages="e46979", keywords="cancer", keywords="behavioral science", keywords="design science research", keywords="digital", keywords="medication adherence", keywords="mobile solution", keywords="Safety and Adherence to Medication and Self-Care Advice in Oncology", keywords="SAMSON", keywords="mobile phone", abstract="Background: Medication nonadherence negatively impacts the health outcomes of people with cancer as well as health care costs. Digital technologies present opportunities to address this health issue. However, there is limited evidence on how to develop digital interventions that meet the needs of people with cancer, are perceived as useful, and are potentially effective in improving medication adherence. Objective: The objective of this study was to co-design, develop, and preliminarily evaluate an innovative mobile health solution called Safety and Adherence to Medication and Self-Care Advice in Oncology (SAMSON) to improve medication adherence among people with cancer. Methods: Using the 4 cycles and 6 processes of design science research methodology, we co-designed and developed a medication adherence solution for people with cancer. First, we conducted a literature review on medication adherence in cancer and a systematic review of current interventions to address this issue. Behavioral science research was used to conceptualize the design features of SAMSON. Second, we conducted 2 design phases: prototype design and final feature design. Last, we conducted a mixed methods study on patients with hematological cancer over 6 weeks to evaluate the mobile solution. Results: The developed mobile solution, consisting of a mobile app, a web portal, and a cloud-based database, includes 5 modules: medication reminder and acknowledgment, symptom assessment and management, reinforcement, patient profile, and reporting. The quantitative study (n=30) showed that SAMSON was easy to use (21/27, 78\%). The app was engaging (18/27, 67\%), informative, increased user interactions, and well organized (19/27, 70\%). Most of the participants (21/27, 78\%) commented that SAMSON's activities could help to improve their adherence to cancer treatments, and more than half of them (17/27, 63\%) would recommend the app to their peers. The qualitative study (n=25) revealed that SAMSON was perceived as helpful in terms of reminding, supporting, and informing patients. Possible barriers to using SAMSON include the app glitches and users' technical inexperience. Further needs to refine the solution were also identified. Technical improvements and design enhancements will be incorporated into the subsequent iteration. Conclusions: This study demonstrates the successful application of behavioral science research and design science research methodology to design and develop a mobile solution for patients with cancer to be more adherent. The study also highlights the importance of applying rigorous methodologies in developing effective and patient-centered digital intervention solutions. ", doi="10.2196/46979", url="https://cancer.jmir.org/2024/1/e46979", url="http://www.ncbi.nlm.nih.gov/pubmed/38569178" } @Article{info:doi/10.2196/45331, author="Zheng, Di and Shang, Yanhong and Ni, Jian and Peng, Ling and Tan, Xiaoming and Dai, Zhaoxia and Zhao, Yizhuo and Gu, Aiqin and Wang, Jiying and Song, Yanyan and Li, Xiaofeng and Zhang, Junping and Heng, Wei and Zhang, Cuiying and Liu, Chunling and Li, Hui and Du, Yingying and Xu, Jianfang and Wu, Dan and Cai, Xuwei and Meng, Rui and Dong, Xiaorong and Ruan, Yaoping and Jiang, Liyan", title="Telehealth With Comprehensive Live-Fed Real-World Data as a Patient Care Platform for Lung Cancer: Implementation and Evaluation Study", journal="JMIR Cancer", year="2024", month="Jun", day="5", volume="10", pages="e45331", keywords="telehealth", keywords="real-world data", keywords="patient engagement", keywords="lung carcinoma", keywords="patient-reported outcomes", abstract="Background: Telehealth has emerged as a popular channel for providing outpatient services in many countries. However, the majority of telehealth systems focus on operational functions and offer only a sectional patient journey at most. Experiences with incorporating longitudinal real-world medical record data into telehealth are valuable but have not been widely shared. The feasibility and usability of such a telehealth platform, with comprehensive, real-world data via a live feed, for cancer patient care are yet to be studied. Objective: The primary purpose of this study is to understand the feasibility and usability of cancer patient care using a telehealth platform with longitudinal, real-world data via a live feed as a supplement to hospital electronic medical record systems specifically from physician's perspective. Methods: A telehealth platform was constructed and launched for both physicians and patients. Real-world data were collected and curated using a comprehensive data model. Physician activities on the platform were recorded as system logs and analyzed. In February 2023, a survey was conducted among the platform's registered physicians to assess the specific areas of patient care and to quantify their before and after experiences, including the number of patients managed, time spent, dropout rate, visit rate, and follow-up data. Descriptive and inferential statistical analyses were performed on the data sets. Results: Over a period of 15 months, 16,035 unique users (13,888 patients, 1539 friends and family members, and 174 physician groups with 608 individuals) registered on the platform. More than 382,000 messages including text, reminders, and pictures were generated by physicians when communicating with patients. The survey was completed by 78 group leaders (45\% of the 174 physician groups). Of the participants, 84\% (65.6/78; SD 8.7) reported a positive experience, with efficient communication, remote supervision, quicker response to questions, adverse event prevention, more complete follow-up data, patient risk reduction, cross-organization collaboration, and a reduction in in-person visits. The majority of the participants (59/78, 76\% to 76/78, 97.4\%) estimated improvements in time spent, number of patients managed, the drop-off rate, and access to medical history, with the average ranging from 57\% to 105\%. When compared with prior platforms, responses from physicians indicated better experiences in terms of time spent, the drop-off rate, and medical history, while the number of patients managed did not significantly change. Conclusions: This study suggests that a telehealth platform, equipped with comprehensive, real-world data via a live feed, is feasible and effective for cancer patient care. It enhances inpatient management by improving time efficiencies, reducing drop-off rates, and providing easy access to medical history. Moreover, it fosters a positive experience in physician-patient interactions. ", doi="10.2196/45331", url="https://cancer.jmir.org/2024/1/e45331", url="http://www.ncbi.nlm.nih.gov/pubmed/38838304" } @Article{info:doi/10.2196/51072, author="Yeung, Y. Nelson C. and Lau, Y. Stephanie T. and Mak, S. Winnie W. and Cheng, Cecilia and Chan, Y. Emily Y. and Siu, M. Judy Y. and Cheung, Y. Polly S.", title="Applying the Unified Theory of Acceptance and Use of Technology to Identify Factors Associated With Intention to Use Teledelivered Supportive Care Among Recently Diagnosed Breast Cancer Survivors During COVID-19 in Hong Kong: Cross-Sectional Survey", journal="JMIR Cancer", year="2024", month="Jun", day="27", volume="10", pages="e51072", keywords="telehealth", keywords="tele-delivered supportive cancer care", keywords="breast cancer", keywords="COVID-19", keywords="technology acceptance", keywords="UTAUT", abstract="Background: Many supportive cancer care (SCC) services were teledelivered during COVID-19, but what facilitates patients' intentions to use teledelivered SCC is unknown. Objective: The study aimed to use the unified theory of acceptance and use of technology to investigate the factors associated with the intentions of breast cancer survivors (BCS) in Hong Kong to use various types of teledelivered SCC (including psychosocial care, medical consultation, complementary care, peer support groups). Favorable telehealth-related perceptions (higher performance expectancy, lower effort expectancy, more facilitating conditions, positive social influences), less technological anxiety, and greater fear of COVID-19 were hypothesized to be associated with higher intentions to use teledelivered SCC. Moreover, the associations between telehealth-related perceptions and intentions to use teledelivered SCC were hypothesized to be moderated by education level, such that associations between telehealth-related perceptions and intentions to use teledelivered SCC would be stronger among those with a higher education level. Methods: A sample of 209 (209/287, 72.8\% completion rate) women diagnosed with breast cancer since the start of the COVID-19 outbreak in Hong Kong (ie, January 2020) were recruited from the Hong Kong Breast Cancer Registry to complete a cross-sectional survey between June 2022 and December 2022. Participants' intentions to use various types of teledelivered SCC (dependent variables), telehealth-related perceptions (independent variables), and sociodemographic variables (eg, education, as a moderator variable) were measured using self-reported, validated measures. Results: Hierarchical regression analysis results showed that greater confidence using telehealth, performance expectancy (believing telehealth helps with daily tasks), social influence (important others encouraging telehealth use), and facilitating conditions (having resources for telehealth use) were associated with higher intentions to use teledelivered SCC (range: $\beta$=0.16, P=.03 to $\beta$=0.34, P<.001). Moreover, 2-way interactions emerged between education level and 2 of the telehealth perception variables. Education level moderated the associations between (1) performance expectancy and intention to use teledelivered complementary care ($\beta$=0.34, P=.04) and (2) facilitating conditions and intention to use teledelivered peer support groups ($\beta$=0.36, P=.03). The positive associations between those telehealth perceptions and intentions were only significant among those with a higher education level. Conclusions: The findings of this study implied that enhancing BCS' skills at using telehealth, BCS' and their important others' perceived benefits of telehealth, and providing assistance for telehealth use could increase BCS' intentions to use teledelivered SCC. For intentions to use specific types of SCC, addressing relevant factors (performance expectancy, facilitating conditions) might be particularly beneficial for those with a higher education level. ", doi="10.2196/51072", url="https://cancer.jmir.org/2024/1/e51072" } @Article{info:doi/10.2196/49703, author="Baik, H. Sharon and Clark, Karen and Sanchez, Marisol and Loscalzo, Matthew and Celis, Ashley and Razavi, Marianne and Yang, Dershung and Dale, William and Haas, Niina", title="Usability and Preliminary Efficacy of an Adaptive Supportive Care System for Patients With Cancer: Pilot Randomized Controlled Trial", journal="JMIR Cancer", year="2024", month="Jul", day="10", volume="10", pages="e49703", keywords="cancer", keywords="distress screening", keywords="eHealth", keywords="supportive care", keywords="mobile phone", abstract="Background: Using an iterative user-centered design process, our team developed a patient-centered adaptive supportive care system, PatientCareAnywhere, that provides comprehensive biopsychosocial screening and supportive cancer care to patients across the continuum of care adaptively. The overarching goal of PatientCareAnywhere is to improve health-related quality of life (HRQOL) and self-efficacy of patients with cancer by empowering them with self-management skills and bringing cancer care support directly to them at home. Such support is adaptive to the patient's needs and health status and coordinated across multiple sources in the forms of referrals, education, engagement of community resources, and secure social communication. Objective: This study aims to assess the usability of the new web-based PatientCareAnywhere system and examine the preliminary efficacy of PatientCareAnywhere to improve patient-reported outcomes compared with usual care. Methods: For phase 1, usability testing participants included patients with cancer (n=4) and caregivers (n=7) who evaluated the software prototype and provided qualitative (eg, interviews) and quantitative (eg, System Usability Scale) feedback. For phase 2, participants in the 3-month pilot randomized controlled trial were randomized to receive the PatientCareAnywhere intervention (n=36) or usual care control condition (n=36). HRQOL and cancer-relevant self-efficacy were assessed at baseline (preintervention assessment) and 12 weeks from baseline (postintervention assessment); mean differences between pre- and postintervention scores were compared between the 2 groups. Results: Participants were highly satisfied with the prototype and reported above-average acceptable usability, with a mean System Usability Scale score of 84.09 (SD 10.02). Qualitative data supported the overall usability and perceived usefulness of the intervention, with a few design features (eg, ``help request'' function) added based on participant feedback. With regard to the randomized controlled trial, patients in the intervention group reported significant improvements in HRQOL from pre- to postintervention scores (mean difference 6.08, SD 15.26) compared with the control group (mean difference ?2.95, SD 10.63; P=.01). In contrast, there was no significant between-group difference in self-efficacy (P=.09). Conclusions: Overall, PatientCareAnywhere represents a user-friendly, functional, and acceptable supportive care intervention with preliminary efficacy to improve HRQOL among patients diagnosed with cancer. Future studies are needed to further establish the efficacy of PatientCareAnywhere as well as explore strategies to enhance user engagement and investigate the optimal intensity, frequency, and use of the intervention to improve patient outcomes. Trial Registration: ClinicalTrials.gov NCT02408406; https://clinicaltrials.gov/study/NCT02408406 ", doi="10.2196/49703", url="https://cancer.jmir.org/2024/1/e49703" } @Article{info:doi/10.2196/43070, author="Leung, W. Yvonne and Wouterloot, Elise and Adikari, Achini and Hong, Jinny and Asokan, Veenaajaa and Duan, Lauren and Lam, Claire and Kim, Carlina and Chan, P. Kai and De Silva, Daswin and Trachtenberg, Lianne and Rennie, Heather and Wong, Jiahui and Esplen, Jane Mary", title="Artificial Intelligence--Based Co-Facilitator (AICF) for Detecting and Monitoring Group Cohesion Outcomes in Web-Based Cancer Support Groups: Single-Arm Trial Study", journal="JMIR Cancer", year="2024", month="Jul", day="22", volume="10", pages="e43070", keywords="group cohesion", keywords="LIWC", keywords="online support group", keywords="natural language processing", keywords="NLP", keywords="emotion analysis", keywords="machine learning", keywords="sentiment analysis", keywords="emotion detection", keywords="integrating human knowledge", keywords="emotion lining", keywords="cancer", keywords="oncology", keywords="support group", keywords="artificial intelligence", keywords="AI", keywords="therapy", keywords="online therapist", keywords="emotion", keywords="affect", keywords="speech tagging", keywords="speech tag", keywords="topic modeling", keywords="named entity recognition", keywords="spoken language processing", keywords="focus group", keywords="corpus", keywords="language", keywords="linguistic", abstract="Background: Commonly offered as supportive care, therapist-led online support groups (OSGs) are a cost-effective way to provide support to individuals affected by cancer. One important indicator of a successful OSG session is group cohesion; however, monitoring group cohesion can be challenging due to the lack of nonverbal cues and in-person interactions in text-based OSGs. The Artificial Intelligence--based Co-Facilitator (AICF) was designed to contextually identify therapeutic outcomes from conversations and produce real-time analytics. Objective: The aim of this study was to develop a method to train and evaluate AICF's capacity to monitor group cohesion. Methods: AICF used a text classification approach to extract the mentions of group cohesion within conversations. A sample of data was annotated by human scorers, which was used as the training data to build the classification model. The annotations were further supported by finding contextually similar group cohesion expressions using word embedding models as well. AICF performance was also compared against the natural language processing software Linguistic Inquiry Word Count (LIWC). Results: AICF was trained on 80,000 messages obtained from Cancer Chat Canada. We tested AICF on 34,048 messages. Human experts scored 6797 (20\%) of the messages to evaluate the ability of AICF to classify group cohesion. Results showed that machine learning algorithms combined with human input could detect group cohesion, a clinically meaningful indicator of effective OSGs. After retraining with human input, AICF reached an F1-score of 0.82. AICF performed slightly better at identifying group cohesion compared to LIWC. Conclusions: AICF has the potential to assist therapists by detecting discord in the group amenable to real-time intervention. Overall, AICF presents a unique opportunity to strengthen patient-centered care in web-based settings by attending to individual needs. International Registered Report Identifier (IRRID): RR2-10.2196/21453 ", doi="10.2196/43070", url="https://cancer.jmir.org/2024/1/e43070", url="http://www.ncbi.nlm.nih.gov/pubmed/39037754" } @Article{info:doi/10.2196/51061, author="Jin, William and Montoya, Christopher and Rich, James Benjamin and Taswell, Seldon Crystal and Noy, Miguel and Kwon, Deukwoo and Spieler, Benjamin and Mahal, Brandon and Abramowitz, Matthew and Yechieli, Raphael and Pollack, Alan and Dal Pra, Alan", title="A Smart Water Bottle and Companion App (HidrateSpark 3) to Improve Bladder-Filling Compliance in Patients With Prostate Cancer Receiving Radiotherapy: Nonrandomized Trial of Feasibility and Acceptability", journal="JMIR Cancer", year="2024", month="Sep", day="10", volume="10", pages="e51061", keywords="digital therapeutics", keywords="behavioral intervention", keywords="digital health", keywords="prostate cancer", keywords="radiation", keywords="smart water bottle", keywords="companion app", keywords="oncology", keywords="prostate", keywords="privacy", keywords="radiation therapy", keywords="bladder", keywords="compliance", keywords="smartphone-based behavioral intervention", keywords="mobile phone", abstract="Background: Patients with prostate cancer undergoing radiation therapy (RT) need comfortably full bladders to reduce toxicities during treatment. Poor compliance is common with standard of care written or verbal instructions, leading to wasted patient value (PV) and clinic resources via poor throughput efficiency (TE). Objective: Herein, we assessed the feasibility and acceptability of a smartphone-based behavioral intervention (SBI) to improve bladder-filling compliance and methods for quantifying PV and TE. Methods: In total, 36 patients with prostate cancer were enrolled in a single-institution, closed-access, nonrandomized feasibility trial. The SBI consists of a fully automated smart water bottle and smartphone app. Both pieces alert the patient to empty his bladder and drink a personalized volume goal, based on simulation bladder volume, 1.25 hours before his scheduled RT. Patients were trained to adjust their volume goal and notification times to achieve comfortably full bladders. The primary end point was met if qualitative (QLC) and quantitative compliance (QNC) were >80\%. For QLC, patients were asked if they prepared their bladders before daily RT. QNC was met if bladder volumes on daily cone-beam tomography were >75\% of the simulation's volume. The Service User Technology Acceptability Questionnaire (SUTAQ) was given in person pre- and post-SBI. Additional acceptability and engagement end points were met if >3 out of 5 across 4 domains on the SUTAQ and >80\% (15/18) of patients used the device >50\% of the time, respectively. Finally, the impact of SBI on PV and TE was measured by time spent in a clinic and on the linear accelerator (linac), respectively, and contrasted with matched controls. Results: QLC was 100\% in 375 out of 398 (94.2\%) total treatments, while QNC was 88.9\% in 341 out of 398 (85.7\%) total treatments. Of a total score of 5, patients scored 4.33 on privacy concerns, 4 on belief in benefits, 4.56 on satisfaction, and 4.24 on usability via SUTAQ. Further, 83\% (15/18) of patients used the SBI on >50\% of treatments. Patients in the intervention arm spent less time in a clinic (53.24, SEM 1.71 minutes) compared to the control (75.01, SEM 2.26 minutes) group (P<.001). Similarly, the intervention arm spent less time on the linac (10.67, SEM 0.40 minutes) compared to the control (14.19, SEM 0.32 minutes) group (P<.001). Conclusions: This digital intervention trial showed high rates of bladder-filling compliance and engagement. High patient value and TE were feasibly quantified by shortened clinic times and linac usage, respectively. Future studies are needed to evaluate clinical outcomes, patient experience, and cost-benefit. Trial Registration: ClinicalTrials.gov NCT04946214; https://www.clinicaltrials.gov/study/NCT04946214 ", doi="10.2196/51061", url="https://cancer.jmir.org/2024/1/e51061" } @Article{info:doi/10.2196/57510, author="Geeraerts, Joran and Pivodic, Lara and Rosquin, Lise and Naert, Eline and Crombez, Geert and De Ridder, Mark and Van den Block, Lieve", title="Uncovering the Daily Experiences of People Living With Advanced Cancer Using an Experience Sampling Method Questionnaire: Development, Content Validation, and Optimization Study", journal="JMIR Cancer", year="2024", month="Nov", day="5", volume="10", pages="e57510", keywords="cancer", keywords="quality of life", keywords="ecological momentary assessment", keywords="experience sampling method", keywords="telemedicine", keywords="mHealth", keywords="eHealth", keywords="patient outcome assessment", keywords="validated instruments", abstract="Background: The experience sampling method (ESM), a self-report method that typically uses multiple assessments per day, can provide detailed knowledge of the daily experiences of people with cancer, potentially informing oncological care. The use of the ESM among people with advanced cancer is limited, and no validated ESM questionnaires have been developed specifically for oncology. Objective: This study aims to develop, content validate, and optimize the digital Experience Sampling Method for People Living With Advanced Cancer (ESM-AC) questionnaire, covering multidimensional domains and contextual factors. Methods: A 3-round mixed methods study was designed in accordance with the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) and the European Organization for Research and Treatment of Cancer guidelines. The study included semistructured interviews with 43 people with stage IV breast cancer or stage III to IV lung cancer and 8 health care professionals. Round 1 assessed the appropriateness, relative importance, relevance, and comprehensiveness of an initial set of ESM items that were developed based on the existing questionnaires. Round 2 tested the comprehensibility of ESM items. Round 3 tested the usability of the digital ESM-AC questionnaire using the m-Path app. Analyses included descriptive statistics and qualitative content analysis. Results: Following the first round, we developed an initial core set of 68 items (to be used with all patients) and a supplementary set (optional; patients select items), both covering physical, psychological, social, spiritual-existential, and global well-being domains and concurrent contexts in which experiences occur. We categorized items to be assessed multiple times per day as momentary items (eg, ``At this moment, I feel tired''), once a day in the morning as morning items (eg, ``Last night, I slept well''), or once a day in the evening as evening items (eg, ``Today, I felt hopeful''). We used participants' evaluations to optimize the questionnaire items, the digital app, and its onboarding manual. This resulted in the ESM-AC questionnaire, which comprised a digital core questionnaire containing 31 momentary items, 2 morning items, and 7 evening items and a supplementary set containing 39 items. Participants largely rated the digital questionnaire as ``easy to use,'' with an average score of 4.5 (SD 0.5) on a scale from 1 (``completely disagree'') to 5 (``completely agree''). Conclusions: We developed the ESM-AC questionnaire, a content-validated digital questionnaire for people with advanced breast or lung cancer. It showed good usability when administered on smartphone devices. Future research should evaluate the potential of this ESM tool to uncover daily experiences of people with advanced breast or lung cancer, explore its clinical utility, and extend its validation to other populations with advanced diseases. ", doi="10.2196/57510", url="https://cancer.jmir.org/2024/1/e57510" } @Article{info:doi/10.2196/48170, author="Lally, Phillippa and May, N. Christine and Mitchell, Siobhan E. and McCallum, Meaghan and Michaelides, Andreas and Fisher, Abigail", title="Prototype of an App Designed to Support Self-Management for Health Behaviors and Weight in Women Living With Breast Cancer: Qualitative User Experience Study", journal="JMIR Cancer", year="2024", month="Dec", day="20", volume="10", pages="e48170", keywords="breast cancer", keywords="self-management", keywords="app", keywords="health behaviors", keywords="weight", keywords="prototype", keywords="user experience", keywords="development", keywords="application", keywords="coaching", keywords="peer support", keywords="oncology", abstract="Background: Accessible self-management interventions are required to support people living with breast cancer. Objective: This was an industry-academic partnership study that aimed to collect qualitative user experience data of a prototype app with built-in peer and coach support designed to support the management of health behaviors and weight in women living with breast cancer. Methods: Participants were aged ?18 years, were diagnosed with breast cancer of any stage within the last 5 years, had completed active treatment, and were prescribed oral hormone therapy. Participants completed demographic surveys and were asked to use the app for 4 weeks. Following this, they took part in in-depth qualitative interviews about their experiences. These were analyzed using thematic analysis. Results: Eight participants (mean age, 45 years; mean time since diagnosis, 32 months) were included. Of the 8 participants, 7 (88\%) were white, 6 (75\%) had a graduate degree or above, and 6 (75\%) had stage I-III breast cancer. Four overarching themes were identified: (1) Support for providing an app earlier in the care pathway; (2) Desire for more weight-focused content tailored to the breast cancer experience; (3) Tracking of health behaviors that are generally popular; and (4) High value of in-app social support. Conclusions: This early user experience work showed that women with breast cancer found an app with integrated social and psychological support appealing to receive support for behavior change and weight management or self-management. However, many features were recommended for further development. This work is the first step in an academic-industry collaboration that would ultimately aim to develop and empirically test a supportive app that could be integrated into the cancer care pathway. ", doi="10.2196/48170", url="https://cancer.jmir.org/2024/1/e48170" } @Article{info:doi/10.2196/57347, author="McClaine, Sean and Fedor, Jennifer and Bartel, Christianna and Chen, Leeann and Durica, C. Krina and Low, A. Carissa", title="Engagement With Daily Symptom Reporting, Passive Smartphone Sensing, and Wearable Device Data Collection During Chemotherapy: Longitudinal Observational Study", journal="JMIR Cancer", year="2024", month="Dec", day="10", volume="10", pages="e57347", keywords="cancer", keywords="chemotherapy", keywords="remote monitoring", keywords="mobile health", keywords="wearable device", keywords="mobile phone", keywords="oncology", keywords="metastases", keywords="chemo", keywords="mHealth", keywords="mobile application", keywords="digital health", keywords="digital intervention", abstract="Background: Chemotherapy can cause symptoms that impair quality of life and functioning. Remote monitoring of daily symptoms and activity during outpatient treatment may enable earlier detection and management of emerging toxicities but requires patients, including older and acutely ill patients, to engage with technology to report symptoms through smartphones and to charge and wear mobile devices. Objective: This study aimed to identify factors associated with participant engagement with collecting 3 data streams (ie, daily patient-reported symptom surveys, passive smartphone sensing, and a wearable Fitbit device [Google]) during chemotherapy. Methods: We enrolled 162 patients receiving outpatient chemotherapy into a 90-day prospective study. Patients were asked to install apps on their smartphones to rate daily symptoms and to collect passive sensor data and to wear a Fitbit device for the duration of the study. Participants completed baseline demographic and quality of life questionnaires, and clinical information was extracted from the electronic medical record. We fit a series of logistic generalized estimating equations to evaluate the association between demographic and clinical factors and daily engagement with each data stream. Results: Participants completed daily surveys on 61\% (SD 27\%) of days and collected sufficient smartphone data and wearable sensor data on 73\% (SD 35\%) and 70\% (SD 33\%) of enrolled days, respectively, on average. Relative to White participants, non-White patients demonstrated lower odds of engagement with both symptom surveys (odds ratio [OR] 0.49, 95\% CI 0.29-0.81; P=.006) and wearable data collection (OR 0.35, 95\% CI 0.17-0.73; P=.005). Patients with stage 4 cancer also exhibited lower odds of engagement with symptom reporting than those with earlier stage disease (OR 0.69, 95\% CI 0.48-1.00; P=.048), and patients were less likely to complete symptom ratings on the weekend (OR 0.90, 95\% CI 0.83-0.97; P=.008). Older patients (OR 1.03, 95\% CI 1.01-1.06; P=.01) and those who reported better cognitive functioning at study entry (OR 1.18, 95\% CI 1.03-1.34; P=.02) were more likely to engage with Fitbit data collection, and patients who reported higher levels of depressive symptoms were less likely to engage with smartphone data collection (OR 1.18, 95\% CI 1.03-1.36; P=.02). Conclusions: Remote patient monitoring during chemotherapy has the potential to improve clinical management, but only if patients engage with these systems. Our results suggest significant associations between demographic and clinical factors and long-term engagement with smartphone and wearable device assessments during chemotherapy. Non-White participants, those with metastatic cancer, or those with existing cognitive impairment may benefit from additional resources to optimize engagement. Contrary to hypotheses, older adults were more likely than younger adults to engage consistently with wearable device assessments. ", doi="10.2196/57347", url="https://cancer.jmir.org/2024/1/e57347", url="http://www.ncbi.nlm.nih.gov/pubmed/39656513" } @Article{info:doi/10.2196/52639, author="Hesso, Iman and Zacharias, Lithin and Kayyali, Reem and Charalambous, Andreas and Lavdaniti, Maria and Stalika, Evangelia and Ajami, Tarek and Acampa, Wanda and Boban, Jasmina and Nabhani-Gebara, Shereen", title="Artificial Intelligence for Optimizing Cancer Imaging: User Experience Study", journal="JMIR Cancer", year="2024", month="Oct", day="10", volume="10", pages="e52639", keywords="artificial intelligence", keywords="cancer", keywords="cancer imaging", keywords="UX design workshops", keywords="Delphi method", keywords="INCISIVE AI toolbox", keywords="user experience", abstract="Background: The need for increased clinical efficacy and efficiency has been the main force in developing artificial intelligence (AI) tools in medical imaging. The INCISIVE project is a European Union--funded initiative aiming to revolutionize cancer imaging methods using AI technology. It seeks to address limitations in imaging techniques by developing an AI-based toolbox that improves accuracy, specificity, sensitivity, interpretability, and cost-effectiveness. Objective: To ensure the successful implementation of the INCISIVE AI service, a study was conducted to understand the needs, challenges, and expectations of health care professionals (HCPs) regarding the proposed toolbox and any potential implementation barriers. Methods: A mixed methods study consisting of 2 phases was conducted. Phase 1 involved user experience (UX) design workshops with users of the INCISIVE AI toolbox. Phase 2 involved a Delphi study conducted through a series of sequential questionnaires. To recruit, a purposive sampling strategy based on the project's consortium network was used. In total, 16 HCPs from Serbia, Italy, Greece, Cyprus, Spain, and the United Kingdom participated in the UX design workshops and 12 completed the Delphi study. Descriptive statistics were performed using SPSS (IBM Corp), enabling the calculation of mean rank scores of the Delphi study's lists. The qualitative data collected via the UX design workshops was analyzed using NVivo (version 12; Lumivero) software. Results: The workshops facilitated brainstorming and identification of the INCISIVE AI toolbox's desired features and implementation barriers. Subsequently, the Delphi study was instrumental in ranking these features, showing a strong consensus among HCPs (W=0.741, P<.001). Additionally, this study also identified implementation barriers, revealing a strong consensus among HCPs (W=0.705, P<.001). Key findings indicated that the INCISIVE AI toolbox could assist in areas such as misdiagnosis, overdiagnosis, delays in diagnosis, detection of minor lesions, decision-making in disagreement, treatment allocation, disease prognosis, prediction, treatment response prediction, and care integration throughout the patient journey. Limited resources, lack of organizational and managerial support, and data entry variability were some of the identified barriers. HCPs also had an explicit interest in AI explainability, desiring feature relevance explanations or a combination of feature relevance and visual explanations within the toolbox. Conclusions: The results provide a thorough examination of the INCISIVE AI toolbox's design elements as required by the end users and potential barriers to its implementation, thus guiding the design and implementation of the INCISIVE technology. The outcome offers information about the degree of AI explainability required of the INCISIVE AI toolbox across the three services: (1) initial diagnosis; (2) disease staging, differentiation, and characterization; and (3) treatment and follow-up indicated for the toolbox. By considering the perspective of end users, INCISIVE aims to develop a solution that effectively meets their needs and drives adoption. ", doi="10.2196/52639", url="https://cancer.jmir.org/2024/1/e52639" } @Article{info:doi/10.2196/48860, author="Davidson, Anne Cara and Booth, Richard and Jackson, Teresa Kimberley and Mantler, Tara", title="Toxic Relationships Described by People With Breast Cancer on Reddit: Topic Modeling Study", journal="JMIR Cancer", year="2024", month="Feb", day="23", volume="10", pages="e48860", keywords="breast cancer", keywords="intimate partner violence", keywords="meaning extraction method", keywords="Reddit", keywords="sentiment analysis", keywords="social media", keywords="social support", keywords="toxic relationships", keywords="topic modelling", abstract="Background: Social support is essential to promoting optimal health outcomes for women with breast cancer. However, an estimated 12\% of women with breast cancer simultaneously experience intimate partner violence (IPV; physical, psychological, or sexual abuse by an intimate partner). Women who experience IPV during breast cancer may lack traditional social support, and thus seek out alternative sources of support. Online community forums, such as Reddit, can provide accessible social connections within breast cancer--specific communities. However, it is largely unknown how women with breast cancer use Reddit to describe and seek support for experiences of IPV. Objective: This study aims to explore how patients with breast cancer describe toxic relationships with their partners and immediate family members on Reddit. Methods: This exploratory, cross-sectional, topic-modeling study analyzed textual data from 96 users in the r/breastcancer subreddit in February 2023. The meaning extraction method, inclusive of principal component analysis, was used to identify underlying components. Components were subjected to sentiment analysis and summative content analysis with emergent categorical development to articulate themes. Results: Seven themes emerged related to toxic relationships: (1) contextualizing storytelling with lymph nodes, (2) toxic behavior and venting emotions, (3) abandonment and abuse following diagnosis, (4) toxic relationships and social-related fears, (5) inner strength and navigating breast cancer over time, (6) assessing social relationships and interactions, and (7) community advice and support. Toxic relationships were commonly characterized by isolation, abandonment, and emotional abuse, which had profound emotional consequences for patients. Reddit facilitated anonymous venting about toxic relationships that helped patients cope with intense feelings and stress. Exchanging advice and support about navigating toxic relationships during breast cancer were core functions of the r/breastcancer community. Conclusions: Findings emphasized the value of Reddit as a source of social support for patients with breast cancer experiencing toxic relationships. Clinicians who understand that many patients with breast cancer experience toxic relationships and considerable psychological sequelae are better prepared to support their patients' holistic well-being. Further investigation of Reddit as a possible resource for advice, information, and support has the potential to help inform clinical practice and subsequently, patient health outcomes. ", doi="10.2196/48860", url="https://cancer.jmir.org/2024/1/e48860", url="http://www.ncbi.nlm.nih.gov/pubmed/38393769" } @Article{info:doi/10.2196/53440, author="Blank, Ann Carol and Biedka, Sarah and Montalmant, Abigail and Saft, Katelyn and Lape, Miranda and Mao, Kate and Bradt, Joke and Liou, T. Kevin", title="Scope, Findability, and Quality of Information About Music-Based Interventions in Oncology: Quantitative Content Analysis of Public-Facing Websites at National Cancer Institute--Designated Cancer Centers", journal="JMIR Cancer", year="2024", month="Nov", day="22", volume="10", pages="e53440", keywords="music-based interventions", keywords="cancer", keywords="oncology", keywords="symptom management", keywords="music therapy", keywords="music services", keywords="National Cancer Institute", abstract="Background: Music-based interventions (MBIs) are evidence-based, nonpharmacological treatments that include music therapy (MT) delivered by board-certified music therapists, as well as music services (MS) delivered by other health professionals and volunteers. Despite MBI's growing evidence base in cancer symptom management, it remains unclear how MBI-related information is presented to the public. Over 80\% of people with cancer use the internet to find health-related information. In the United States, the National Cancer Institute (NCI) identifies certain Cancer Centers (CCs) as NCI-designated CCs or Comprehensive Cancer Centers (CCCs) based on their excellence in research. As NCI-designated CCs and CCCs are considered the gold standard in cancer care, their websites are viewed by the public as important sources of information. Objective: We aimed to determine scope, findability, and quality of MBI-related information on public-facing websites of NCI-designated CCs/CCCs. Methods: We reviewed 64 NCI-designated CC/CCC websites (excluding basic laboratories) between November 2022 and January 2023. We extracted data on the scope of information: (1) type of MBI offered (MT or MS), (2) format (individual, group), (3) method of delivery (in person or remotely delivered), (4) setting (inpatient or outpatient), (5) target population (pediatric or adult), (6) MBI practitioner qualifications, (7) clinical indications or benefits, (8) presence of testimonials, (9) cost, and (10) scheduling or referral information. We also extracted data on findability (ie, presence of direct link or drop-down menu and the number of clicks to locate MBI-related information). Based on the scope and findability data, we rated the information quality as high, moderate, or low using an adapted scale informed by prior research. Results: Thirty-one (48\%) of the 64 CC/CCCs described MBIs on their websites. Of these, 6 (19\%) mentioned both MT and MS, 16 (52\%) mentioned MT only, and 9 (29\%) mentioned MS only. The most common format was hybrid, involving individuals and groups (n=20, 65\%). The most common delivery method was in person (n=16, 52\%). The most common target population was adults (n=12, 39\%). The most common MBI practitioners were board-certified music therapists (n=21, 68\%). The most described indications or benefits were psychological. Twenty-eight (90\%) websites lacked testimonials, and 26 (84\%) lacked cost information. Twenty-six (84\%) websites provided scheduling or referral information. MBI-related information was found with an average of 4 (SD 1) clicks. Nine (29\%) websites were of high quality, 18 (58\%) were moderate, and 4 (13\%) were low. Conclusions: Based on public websites, MBIs were most commonly delivered in person by board-certified music therapists to outpatient and inpatient adults, using individual and group formats to provide psychological benefits. The findability and quality of this information should be improved to promote the dissemination of MBIs for cancer symptom management. ", doi="10.2196/53440", url="https://cancer.jmir.org/2024/1/e53440" } @Article{info:doi/10.2196/56048, author="Hoadley, Ariel and Fleisher, Linda and Kenny, Cassidy and Kelly, JA Patrick and Ma, Xinrui and Wu, Jingwei and Guerra, Carmen and Leader, E. Amy and Alhajji, Mohammed and D'Avanzo, Paul and Landau, Zoe and Bass, Bauerle Sarah", title="Exploring Racial Disparities in Awareness and Perceptions of Oncology Clinical Trials: Cross-Sectional Analysis of Baseline Data From the mychoice Study", journal="JMIR Cancer", year="2024", month="Sep", day="30", volume="10", pages="e56048", keywords="oncology clinical trial", keywords="cancer", keywords="decision-making", keywords="racial disparity", keywords="medical mistrust", abstract="Background: Black/African American adults are underrepresented in oncology clinical trials in the United States, despite efforts at narrowing this disparity. Objective: This study aims to explore differences in how Black/African American oncology patients perceive clinical trials to improve support for the clinical trial participation decision-making process. Methods: As part of a larger randomized controlled trial, a total of 244 adult oncology patients receiving active treatment or follow-up care completed a cross-sectional baseline survey on sociodemographic characteristics, clinical trial knowledge, health literacy, perceptions of cancer clinical trials, patient activation, patient advocacy, health care self-efficacy, decisional conflict, and clinical trial intentions. Self-reported race was dichotomized into Black/African American and non--Black/African American. As appropriate, 2-tailed t tests and chi-square tests of independence were used to examine differences between groups. Results: Black/African American participants had lower clinical trial knowledge (P=.006), lower health literacy (P<.001), and more medical mistrust (all P values <.05) than non--Black/African American participants. While intentions to participate in a clinical trial, if offered, did not vary between Black/African American and non--Black/African American participants, Black/African American participants indicated lower awareness of clinical trials, fewer benefits of clinical trials, and more uncertainty around clinical trial decision-making (all P values <.05). There were no differences for other variables. Conclusions: Despite no significant differences in intent to participate in a clinical trial if offered and high overall trust in individual health care providers among both groups, beliefs persist about barriers to and benefits of clinical trial participation among Black/African American patients. Findings highlight specific ways that education and resources about clinical trials could be tailored to better suit the informational and decision-making needs and preferences of Black/African American oncology patients. ", doi="10.2196/56048", url="https://cancer.jmir.org/2024/1/e56048" } @Article{info:doi/10.2196/53443, author="Lopez-Olivo, A. Maria and Suarez-Almazor, E. Maria and Duhon, F. Gabrielle and Cherry, McKenna and Lu, Huifang and Calabrese, Cassandra and Altan, Mehmet and Tawbi, Hussain and Meara, Alexa and Bingham, O. Clifton and Diab, Adi and Leal, B. Viola and Volk, J. Robert", title="Development of an Educational Website for Patients With Cancer and Preexisting Autoimmune Diseases Considering Immune Checkpoint Blockers: Usability and Acceptability Study", journal="JMIR Cancer", year="2024", month="Oct", day="25", volume="10", pages="e53443", keywords="immune checkpoint inhibitors", keywords="patient education", keywords="usability testing", keywords="cancer", keywords="autoimmune diseases", keywords="mobile phones", keywords="user testing", keywords="usability", keywords="user experience", keywords="immunotherapy", keywords="websites", keywords="development", keywords="acceptability", keywords="autoimmune", keywords="immunology", keywords="oncology", keywords="architecture", keywords="iterative", keywords="vasculitis", keywords="Crohn disease", keywords="Sjogren syndrome", keywords="educational", keywords="web-based resource", keywords="health information", keywords="rheumatology", keywords="arthritis", keywords="web design", keywords="eHealth", keywords="adverse events", keywords="patient care", keywords="treatment", abstract="Background: Patients with cancer and an underlying autoimmune disease who are considering immune checkpoint blockers (ICBs) need to know about the benefits and risks of severe immune-related adverse events and flares of the autoimmune condition. Objective: This study aims to develop and alpha test an educational website for patients with cancer. Methods: Learning topics, images, and website architecture (including flow and requirements) were developed and iteratively reviewed by members of a community scientist program, a patient advisory group, and content experts. Alpha testing was performed, measuring the site's usability using the Suitability Assessment of Materials and its acceptability using the Ottawa Acceptability Measure. Results: The website included a home page; general information about ICBs; comprehensive modules on the benefits and risks of ICBs for patients with cancer and preexisting autoimmune diseases; general wellness information; and features such as a quiz, additional resources, and a glossary. For the alpha testing, 9 users assessed the newly developed website. Patient reviewers (n=5) had rheumatoid arthritis, Crohn disease, Sjogren syndrome, or vasculitis. Health care provider reviewers (n=4) were medical oncologists or rheumatologists. The median Suitability Assessment of Materials rating was 75 (IQR 70-79; range 0-100) for patients versus 66 (IQR 57-72; range 0-100) for providers (scores ?70 indicate no substantial changes needed). Recommendations for improvement, mostly involving navigation and accessibility, were addressed. All participants expressed that the website was acceptable and balanced in terms of discussion of benefits and harms. Because half (2/4, 50\%) of the providers suggested we increase the amount of information, we extended the content on the impact of having an autoimmune disease when considering ICB treatment, the probability of flares, and the management of flares in this context. Conclusions: The feedback led to minor revisions to enhance readability, navigation, and accessibility, ensuring the website's suitability as a decision-making aid. The newly developed website could become a supporting tool to facilitate patient-physician discussion regarding ICBs. ", doi="10.2196/53443", url="https://cancer.jmir.org/2024/1/e53443" } @Article{info:doi/10.2196/48627, author="Lazard, J. Allison and Vereen, N. Rhyan and Zhou, Jieni and Nichols, B. Hazel and Pulido, Marlyn and Swift, Catherine and Dasgupta, Nabarun and Fredrickson, L. Barbara", title="Designing Positive Psychology Interventions for Social Media: Cross-Sectional Web-Based Experiment With Young Adults With Cancer", journal="JMIR Cancer", year="2024", month="Dec", day="20", volume="10", pages="e48627", keywords="young adult", keywords="cancer survivors", keywords="social media", keywords="positive psychology", keywords="acceptability", keywords="feasibility", keywords="youth", keywords="cancer", keywords="psychosocial", keywords="self-efficacy", keywords="social connection", keywords="positive emotion", keywords="emotion", keywords="social engagement", abstract="Background: Young adults (ages 18?39 years) with cancer face unique risks for negative psychosocial outcomes. These risks could be lessened with positive psychology interventions adapted for social media if intervention messages encourage intentions to do the activities and positive message reactions and if young adults with cancer perceive few downsides. Objective: This study aimed to assess whether social media messages from evidence-based positive psychology interventions encouraged intentions to do the intervention activities and intended positive message reactions, overall and among sociodemographic or cancer characteristic subgroups. We also aimed to identify perceived downsides of the activity that would negatively impact the interventions' feasibility. Methods: Young adults (ages 18?39 years, cancer diagnosis ages 15?39 years) were randomized to a between-persons web-based experiment. Participants viewed a social media message with social context cues (vs not) for 1 of 2 types of intervention (acts of kindness vs social connectedness). Participants reported intentions to do the activity, along with their perceived social presence in the message (how much they felt the sense of others) and forecasted positivity resonance (whether they would experience socially connected positive emotions when doing the activity), with 5-point items. Participants also reported their self-efficacy (how certain they can do the intervention activity) with a 0?100 item and potential downsides of the activity categorically. Results: More than 4 out of 5 young adults with cancer (N=396) reported they ``somewhat'' (coded as 3) to ``extremely'' (5) intended to do the intervention activity (336/396, 84.8\%; mean ranged from 3.4?3.6, SD 0.9-1.0), perceived social presence in the messages (350/396, 88.4\%; mean 3.8, SD 0.7), and forecasted positivity resonance (349/396, 88.1\%; mean 3.8?3.9, SD 0.8). Participants reported having self-efficacy to complete the activity (mean 70.7\% of possible 100\%, SD 15.4\%?17.2\%). Most (320/396, 80.8\%) did not think of the downsides of the interventions. Messages with social context cues (vs not) and both intervention types were rated similarly (all P>.05). Black young adults reported lower intentions, perceived social presence, and forecasted positivity resonance than White young adults (all P<.001). Participants in active treatment (vs completed) reported greater intentions to do the activities (P<.001). Conclusions: Positive psychology intervention messages adapted for social media were perceived as acceptable and feasible among young adults with cancer. The social media--based messages encouraged increasing one's social connectedness and performing acts of kindness. Young adults with cancer also predicted they would have feelings of positive social engagement (positivity resonance) when doing the interventions---the key ingredient for experiencing the health benefits of these activities. This study provides promising evidence for the development of age-appropriate, highly scalable interventions to improve psychosocial health among young adults with cancer. ", doi="10.2196/48627", url="https://cancer.jmir.org/2024/1/e48627" } @Article{info:doi/10.2196/47944, author="Schilstra, E. Clarissa and Ellis, J. Sarah and Cohen, Jennifer and Gall, Alana and Diaz, Abbey and Clarke, Kristina and Dumlao, Gadiel and Chard, Jennifer and Cumming, M. Therese and Davis, Esther and Dhillon, Haryana and Burns, Anne Mary and Docking, Kimberley and Koh, Eng-Siew and O'Reilly, Josephine and Sansom-Daly, M. Ursula and Shaw, Joanne and Speers, Nicole and Taylor, Natalie and Warne, Anthea and Fardell, E. Joanna", title="Exploring Web-Based Information and Resources That Support Adolescents and Young Adults With Cancer to Resume Study and Work: Environmental Scan Study", journal="JMIR Cancer", year="2024", month="Mar", day="25", volume="10", pages="e47944", keywords="adolescent", keywords="cancer", keywords="education", keywords="employment", keywords="information needs", keywords="oncology", keywords="online information", keywords="quality of life", keywords="resource", keywords="return to work", keywords="school", keywords="study", keywords="supportive resources", keywords="treatment", keywords="young adult", abstract="Background: Adolescents and young adults (AYAs) diagnosed with cancer experience physical, cognitive, and psychosocial effects from cancer treatment that can negatively affect their ability to remain engaged in education or work through cancer treatment and in the long term. Disengagement from education or work can have lasting implications for AYAs' financial independence, psychosocial well-being, and quality of life. Australian AYAs with cancer lack access to adequate specialist support for their education and work needs and report a preference for web-based support that they can access from anywhere, in their own time. However, it remains unclear what web-based resources exist that are tailored to support AYAs with cancer in reaching their educational or work goals. Objective: This study aimed to determine what web-based resources exist for Australian AYAs with cancer to (1) support return to education or work and (2) identify the degree to which existing resources are age-specific, cancer-specific, culturally inclusive, and evidence-based; are co-designed with AYAs; use age-appropriate language; and are easy to find. Methods: We conducted an environmental scan by searching Google with English search terms in August 2022 to identify information resources about employment and education for AYAs ever diagnosed with cancer. Data extraction was conducted in Microsoft Excel, and the following were assessed: understandability and actionability (using the Patient Education and Materials Tool), readability (using the Sydney Health Literacy Laboratory Health Literacy Editor), and whether the resource was easy to locate, evidence-based, co-designed with AYAs, and culturally inclusive of Aboriginal and Torres Strait Islander peoples. The latter was assessed using 7 criteria previously developed by members of the research team. Results: We identified 24 web-based resources, comprising 22 written text resources and 12 video resources. Most resources (21/24, 88\%) were published by nongovernmental organizations in Australia, Canada, the United States, and the United Kingdom. A total of 7 resources focused on education, 8 focused on work, and 9 focused on both education and work. The evaluation of resources demonstrated poor understandability and actionability. Resources were rarely evidence-based or co-designed by AYAs, difficult to locate on the internet, and largely not inclusive of Aboriginal and Torres Strait Islander populations. Conclusions: Although web-based resources for AYAs with cancer are often available through the websites of hospitals or nongovernmental organizations, this environmental scan suggests they would benefit from more evidence-based and actionable resources that are available in multiple formats (eg, text and audio-visual) and tailored to be age-appropriate and culturally inclusive. ", doi="10.2196/47944", url="https://cancer.jmir.org/2024/1/e47944", url="http://www.ncbi.nlm.nih.gov/pubmed/38526527" } @Article{info:doi/10.2196/53117, author="Krakowczyk, Barbara Julia and Truijens, Femke and Teufel, Martin and Lalgi, Tania and Heinen, Jana and Schug, Caterina and Erim, Yesim and Pantf{\"o}rder, Michael and Graf, Johanna and B{\"a}uerle, Alexander", title="Evaluation of the e--Mental Health Intervention Make It Training From Patients' Perspectives: Qualitative Analysis Within the Reduct Trial", journal="JMIR Cancer", year="2024", month="Apr", day="9", volume="10", pages="e53117", keywords="psycho-oncology", keywords="eHealth", keywords="digital health", keywords="cancer", keywords="Reduct trial", keywords="oncology", abstract="Background: Make It Training is an e--mental health intervention designed for individuals with cancer that aims to reduce psychological distress and improve disease-related coping and quality of life. Objective: This study evaluated the experienced usefulness and usability of the web-based Make It Training intervention using a qualitative approach. Methods: In this study, semistructured interviews were conducted with participants at different cancer stages and with different cancer entities. All participants had previously taken part in the Reduct trial, a randomized controlled trial that assessed the efficacy of the Make It Training intervention. The data were coded deductively by 2 independent researchers and analyzed iteratively using thematic codebook analysis. Results: Analysis of experienced usefulness resulted in 4 themes (developing coping strategies to reduce psychological distress, improvement in quality of life, Make It Training vs traditional psychotherapy, and integration into daily life) with 11 subthemes. Analysis of experienced usability resulted in 3 themes (efficiency and accessibility, user-friendliness, and recommendations to design the Make It Training intervention to be more appealing) with 6 subthemes. Make It Training was evaluated as a user-friendly intervention helpful for developing functional coping strategies to reduce psychological distress and improve quality of life. The consensus regarding Make It Training was that it was described as a daily companion that integrates well into daily life and that it has the potential to be routinely implemented within oncological health care either as a stand-alone intervention or in addition to psychotherapy. Conclusions: e--Mental health interventions such as Make It Training can target both the prevention of mental health issues and health promotion. Moreover, they offer a cost-efficient and low-threshold option to receive psycho-oncological support. ", doi="10.2196/53117", url="https://cancer.jmir.org/2024/1/e53117", url="http://www.ncbi.nlm.nih.gov/pubmed/38592764" } @Article{info:doi/10.2196/51332, author="Zhang, Zhouqing and Liew, Kongmeng and Kuijer, Roeline and She, Jou Wan and Yada, Shuntaro and Wakamiya, Shoko and Aramaki, Eiji", title="Differing Content and Language Based on Poster-Patient Relationships on the Chinese Social Media Platform Weibo: Text Classification, Sentiment Analysis, and Topic Modeling of Posts on Breast Cancer", journal="JMIR Cancer", year="2024", month="May", day="9", volume="10", pages="e51332", keywords="cancer", keywords="social media", keywords="text classification", keywords="topic modeling", keywords="sentiment analysis", keywords="Weibo", abstract="Background: Breast cancer affects the lives of not only those diagnosed but also the people around them. Many of those affected share their experiences on social media. However, these narratives may differ according to who the poster is and what their relationship with the patient is; a patient posting about their experiences may post different content from someone whose friends or family has breast cancer. Weibo is 1 of the most popular social media platforms in China, and breast cancer--related posts are frequently found there. Objective: With the goal of understanding the different experiences of those affected by breast cancer in China, we aimed to explore how content and language used in relevant posts differ according to who the poster is and what their relationship with the patient is and whether there are differences in emotional expression and topic content if the patient is the poster themselves or a friend, family member, relative, or acquaintance. Methods: We used Weibo as a resource to examine how posts differ according to the different poster-patient relationships. We collected a total of 10,322 relevant Weibo posts. Using a 2-step analysis method, we fine-tuned 2 Chinese Robustly Optimized Bidirectional Encoder Representations from Transformers (BERT) Pretraining Approach models on this data set with annotated poster-patient relationships. These models were lined in sequence, first a binary classifier (no\_patient or patient) and then a multiclass classifier (post\_user, family\_members, friends\_relatives, acquaintances, heard\_relation), to classify poster-patient relationships. Next, we used the Linguistic Inquiry and Word Count lexicon to conduct sentiment analysis from 5 emotion categories (positive and negative emotions, anger, sadness, and anxiety), followed by topic modeling (BERTopic). Results: Our binary model (F1-score=0.92) and multiclass model (F1-score=0.83) were largely able to classify poster-patient relationships accurately. Subsequent sentiment analysis showed significant differences in emotion categories across all poster-patient relationships. Notably, negative emotions and anger were higher for the ``no\_patient'' class, but sadness and anxiety were higher for the ``family\_members'' class. Focusing on the top 30 topics, we also noted that topics on fears and anger toward cancer were higher in the ``no\_patient'' class, but topics on cancer treatment were higher in the ``family\_members'' class. Conclusions: Chinese users post different types of content, depending on the poster- poster-patient relationships. If the patient is family, posts are sadder and more anxious but also contain more content on treatments. However, if no patient is detected, posts show higher levels of anger. We think that these may stem from rants from posters, which may help with emotion regulation and gathering social support. ", doi="10.2196/51332", url="https://cancer.jmir.org/2024/1/e51332", url="http://www.ncbi.nlm.nih.gov/pubmed/38723250" } @Article{info:doi/10.2196/52156, author="Pan, Peng and Yu, Changhua and Li, Tao and Dai, Tingting and Tian, Hanhan and Xiong, Yaozu and Lv, Jie and Hu, Xiaochu and Ma, Weidong and Yin, Wenda", title="Evaluating the Quality of Cancer-Related WeChat Public Accounts: Cross-Sectional Study", journal="JMIR Cancer", year="2024", month="May", day="30", volume="10", pages="e52156", keywords="cancer", keywords="big data", keywords="social media", keywords="health literacy", keywords="WeChat", keywords="China", keywords="public health", abstract="Background: WeChat (Tencent) is one of the most important information sources for Chinese people. Relevantly, various health-related data are constantly transmitted among WeChat users. WeChat public accounts (WPAs) for health are rapidly emerging. Health-related WeChat public accounts have a significant impact on public health. Because of the rise in web-based health-seeking behavior, the general public has grown accustomed to obtaining cancer information from WPAs. Although WPAs make it easy for people to obtain health information, the quality of the information is questionable. Objective: This study aims to assess the quality and suitability of cancer-related WeChat public accounts (CWPAs). Methods: The survey was conducted from February 1 to 28, 2023. Based on the WPA monthly list provided by Qingbo Big Data, 28 CWPAs in the WeChat communication index were selected as the survey sample. Quality assessment of the included CWPAs was performed using the HONcode instrument. Furthermore, suitability was measured by using the Suitability Assessment of Materials. A total of 2 researchers conducted the evaluations independently. Results: Of the 28 CWPAs, 12 (43\%) were academic and 16 (57\%) were commercial. No statistical difference was found regarding the HONcode scores between the 2 groups (P=.96). The quality of the academic and commercial CWPAs evaluated using the HONcode instrument demonstrated mean scores of 5.58 (SD 2.02) and 5.63 (SD 2.16), respectively, corresponding to a moderate class. All CWPAs' compliance with the HONcode principles was unsatisfactory. A statistically significant difference between the 2 groups was observed in the Suitability Assessment of Materials scores (P=.04). The commercial WPAs reached an overall 55.1\% (SD 5.5\%) score versus the 50.2\% (SD 6.4\%) score reached by academic WPAs. The suitability of academic and commercial CWPAs was considered adequate. Conclusions: This study revealed that CWPAs are not sufficiently credible. WPA owners must endeavor to create reliable health websites using approved tools such as the HONcode criteria. However, it is necessary to educate the public about the evaluation tools of health websites to assess their credibility before using the provided content. In addition, improving readability will allow the public to read and understand the content. ", doi="10.2196/52156", url="https://cancer.jmir.org/2024/1/e52156", url="http://www.ncbi.nlm.nih.gov/pubmed/38814688" } @Article{info:doi/10.2196/52386, author="Schl{\"a}pfer, Sonja and Schneider, Fabian and Santhanam, Prabhakaran and Eicher, Manuela and Kowatsch, Tobias and Witt, M. Claudia and Barth, J{\"u}rgen", title="Engagement With a Relaxation and Mindfulness Mobile App Among People With Cancer: Exploratory Analysis of Use Data and Self-Reports From a Randomized Controlled Trial", journal="JMIR Cancer", year="2024", month="May", day="31", volume="10", pages="e52386", keywords="mobile health", keywords="mHealth", keywords="digital health", keywords="eHealth", keywords="smartphone", keywords="mobile phone", keywords="implementation", keywords="adherence", keywords="self-guided", keywords="unguided", keywords="fully automated", keywords="conversational agent", keywords="chatbot", keywords="behavior change", keywords="tailoring", keywords="self-care", keywords="cancer", keywords="app development", abstract="Background: Mobile health (mHealth) apps offer unique opportunities to support self-care and behavior change, but poor user engagement limits their effectiveness. This is particularly true for fully automated mHealth apps without any human support. Human support in mHealth apps is associated with better engagement but at the cost of reduced scalability. Objective: This work aimed to (1) describe the theory-informed development of a fully automated relaxation and mindfulness app to reduce distress in people with cancer (CanRelax app 2.0), (2) describe engagement with the app on multiple levels within a fully automated randomized controlled trial over 10 weeks, and (3) examine whether engagement was related to user characteristics. Methods: The CanRelax app 2.0 was developed in iterative processes involving input from people with cancer and relevant experts. The app includes evidence-based relaxation exercises, personalized weekly coaching sessions with a rule-based conversational agent, 39 self-enactable behavior change techniques, a self-monitoring dashboard with gamification elements, highly tailored reminder notifications, an educational video clip, and personalized in-app letters. For the larger study, German-speaking adults diagnosed with cancer within the last 5 years were recruited via the web in Switzerland, Austria, and Germany. Engagement was analyzed in a sample of 100 study participants with multiple measures on a micro level (completed coaching sessions, relaxation exercises practiced with the app, and feedback on the app) and a macro level (relaxation exercises practiced without the app and self-efficacy toward self-set weekly relaxation goals). Results: In week 10, a total of 62\% (62/100) of the participants were actively using the CanRelax app 2.0. No associations were identified between engagement and level of distress at baseline, sex assigned at birth, educational attainment, or age. At the micro level, 71.88\% (3520/4897) of all relaxation exercises and 714 coaching sessions were completed in the app, and all participants who provided feedback (52/100, 52\%) expressed positive app experiences. At the macro level, 28.12\% (1377/4897) of relaxation exercises were completed without the app, and participants' self-efficacy remained stable at a high level. At the same time, participants raised their weekly relaxation goals, which indicates a potential relative increase in self-efficacy. Conclusions: The CanRelax app 2.0 achieved promising engagement even though it provided no human support. Fully automated social components might have compensated for the lack of human involvement and should be investigated further. More than one-quarter (1377/4897, 28.12\%) of all relaxation exercises were practiced without the app, highlighting the importance of assessing engagement on multiple levels. ", doi="10.2196/52386", url="https://cancer.jmir.org/2024/1/e52386", url="http://www.ncbi.nlm.nih.gov/pubmed/38819907" } @Article{info:doi/10.2196/54715, author="Deribe, Leul and Girma, Eshetu and Lindstr{\"o}m, Nataliya and Gidey, Abdulkadir and Teferra, Solomon and Addissie, Adamu", title="Association of Family-Centered Care With Psychological Distress Among Caregivers of Children With Cancer at a Tertiary-Level Hospital in Ethiopia: Cross-Sectional Study", journal="JMIR Cancer", year="2024", month="Oct", day="10", volume="10", pages="e54715", keywords="child cancer", keywords="psychological distress", keywords="Ethiopia", keywords="parent", keywords="caregivers", keywords="family", abstract="Background: Psychological distress (PD) is a common mental health problem faced by caregivers of children with cancer. The involvement of families in childcare was found to be associated with lower levels of distress. Objective: The study aims to determine the associations between family-centered care (FCC) and PD among caregivers of children with cancer receiving treatment at Tikur Anbessa Specialized Hospital (TASH), Ethiopia. Methods: An institution-based, cross-sectional study was conducted from June to December 2022. Caregivers of children with cancer aged 0-14 years receiving cancer treatment at the pediatric oncology unit completed a face-to-face, interviewer-administered, structured questionnaire during a routine inpatient or outpatient visit. The questionnaire included questions on the characteristics of the child and caregiver, PD (measured by the Kessler Psychological Distress Scale [K10]), FCC (measured by the Measure of Processes of Care [MPOC-20]), and social support (measured by the Oslo-3 Social Support Scale [OSS-3]). Data were collected using the Kobo toolbox and exported to SPSS (version 26; IBM Corp) for cleaning and analysis. A multivariable logistic regression model was used. An odds ratio with a 95\% CI was calculated, and a P value less than .05 was considered statistically significant. Results: A total of 384 caregivers of children with cancer participated in the study. The total PD score ranged from 10 to 50, with a mean score of 17.30 (SD 8.96; 95\% CI 16.84-18.60). The proportion of caregivers found to have mild, moderate, and severe levels of PD was 43 (11.2\%), 35 (9.1\%), and 51 (13.3\%), respectively. The overall prevalence of mild to severe PD symptoms was 33.6\% (95\% CI 28.9\%-38.3\%). A statistically significant negative association was found between FCC and PD (adjusted odds ratio [AOR] 0.68, 95\% CI 0.53-0.86). In addition, having no formal education (AOR 2.87, 95\% CI 1.28-6.45), having a history of relapse (AOR 3.24, 95\% CI 1.17-9.02), beginning cancer treatment at TASH (AOR 2.82, 95\% CI 1.4-4.85), beginning treatment within the last 3 months (AOR 3.99, 95\% CI 1.73-9.23), and beginning treatment within the last 4 to 18 months (AOR 2.68, 95\% CI 1.25-5.76) were significantly associated with higher level of PD. Conclusions: A total of 1 in 3 caregivers have reported PD. FCC was found to be protective of PD. The finding of this study suggests the need for FCC intervention to improve the mental health condition of caregivers. In addition, the intervention needs to consider the educational status of the caregivers, the time since the cancer diagnosis, and the history of relapse. ", doi="10.2196/54715", url="https://cancer.jmir.org/2024/1/e54715" } @Article{info:doi/10.2196/58014, author="Fox, S. Rina and Torres, K. Tara and Badger, A. Terry and Katsanis, Emmanuel and Yang, DerShung and Sanford, D. Stacy and Victorson, E. David and Yanez, Betina and Penedo, J. Frank and Antoni, H. Michael and Oswald, B. Laura", title="Delivering a Group-Based Quality of Life Intervention to Young Adult Cancer Survivors via a Web Platform: Feasibility Trial", journal="JMIR Cancer", year="2024", month="Dec", day="4", volume="10", pages="e58014", keywords="cancer survivors", keywords="survivorship", keywords="clinical trials", keywords="psychosocial intervention", keywords="usability testing", keywords="digital therapeutics", keywords="young adults", keywords="nonrandomized", abstract="Background: Young adult (YA) cancer survivors frequently report unmet health information and peer support needs, as well as poor health-related quality of life (HRQOL). YAs also have expressed a desire that behavioral interventions be convenient. In response to this, our team has developed a 10-week, group-based, supportive care intervention titled TOGETHER to improve YA cancer survivors' HRQOL. TOGETHER is delivered via videoconference and has shown initial feasibility, acceptability, and promise for improving HRQOL among YA survivors. Objective: In an effort to increase convenience, the goal of this 2-part study was to design and test a website to host the TOGETHER intervention for YA cancer survivors aged 18?39 years at the time of participation and aged 15?39 years at the time of initial cancer diagnosis. Methods: In part 1, we leveraged an existing web-based platform and adapted it to meet the needs of TOGETHER. We conducted 3 iterative waves of usability testing with 3 YAs per wave to refine the website. In part 2, we conducted a single-group feasibility trial of TOGETHER using the website. Primary outcomes were feasibility (ie, recruitment, retention, and attendance) and acceptability (ie, satisfaction). Results: Usability testing participants (n=9) indicated that the TOGETHER website was easy to use (mean 5.9, SD 1.3) and easy to learn (mean 6.5, SD 0.9; possible ranges 1?7). Qualitative feedback identified needed revisions to the aesthetics (eg, images), content (eg, session titles), function (eg, clarity of functionality), and structure (eg, expandable sections), which were implemented. In the feasibility trial, participants (n=7) were an average of 25 (SD 4.7) years old and mostly non-Hispanic White (n=4, 57\%). Recruitment (58\%) and retention (71\%) rates and average session attendance (mean 7.1 , SD 4.2) supported feasibility. Participant agreement with positive statements about TOGETHER and average satisfaction ratings (mean 5.06, SD 1.64; possible range: 1?7) demonstrated acceptability. Conclusions: Results supported the usability, feasibility, and acceptability of the TOGETHER program and website. By providing the content digitally, the program effectively addresses YAs' expressed preference for convenience. Future studies are needed to increase TOGETHER's efficiency and explore its efficacy for improving targeted outcomes. Trial Registration: NCT05597228, October 24, 2022; https://clinicaltrials.gov/study/NCT05597228 ", doi="10.2196/58014", url="https://cancer.jmir.org/2024/1/e58014" } @Article{info:doi/10.2196/59614, author="Richter, Franziska and Kronziel, Louisa Lea and K{\"o}nig, Inke and Langer, Thorsten and Gebauer, Judith", title="Implementation of Regular Lifestyle Counseling During Long-Term Follow-Up Care of Childhood Cancer Survivors: Monocentric Prospective Study", journal="JMIR Cancer", year="2024", month="Dec", day="26", volume="10", pages="e59614", keywords="lifestyle counseling", keywords="long-term follow-up", keywords="childhood cancer survivors", keywords="physical activity", keywords="metabolic disorders", keywords="cancer survivor", keywords="treatment-related", keywords="risk of obesity", keywords="metabolic syndrome", keywords="healthy lifestyle", keywords="morbidity", keywords="patient", keywords="hypercholesterolemia", keywords="diabetes mellitus", keywords="health care professionals", abstract="Background: Many childhood cancer survivors (CCS) develop treatment-related late effects, including an increased risk of obesity and metabolic syndrome. A healthy lifestyle can reduce the risk of associated comorbidities. Therefore, at-risk CCS could benefit from lifestyle counseling during regular long-term follow-up (LTFU). Objective: We implemented a new form of care to decrease the long-term morbidity among CCS and to gain new insights into the lifestyle of those patients. Methods: Over a 1-year study period, lifestyle counseling was integrated into LTFU care. Metabolic disorders, including hypercholesterolemia, diabetes mellitus, overweight or underweight, and low activity levels, were assessed as screening parameters for various risk groups. The perspectives of CCS, physicians, and sports scientists were compared to identify those with the highest needs. Each lifestyle counseling included general recommendations for physical activity, as well as an assessment of individual preferences for and barriers to the implementation of a healthy lifestyle. A follow-up appointment after 1 month was performed. Results: Of the 155 CCS aged 18 to 63 years (n=100, 65\% female and n=55, 35\% male), 112 (72\%) had an indication for lifestyle counseling, identified by physicians, sports scientists, or the CCS themselves. Metabolic disorders affected 45\% (n=70) of these CCS, and 46\% (n=72) did not meet recommended activity levels. A total of 120 (77\%) CCS received lifestyle counseling, including 8 initially uninterested individuals who became open to recommendations. Those with intensive cancer treatment history showed the greatest need. A total of 65 (54\%) CCS were advised to change their lifestyle in both areas (diet and exercise) while 51 (43\%) CCS received recommendations for only exercise (n=43 CCS, 36\%) or diet (n=8 CCS, 7\%). A total of 4 (3\%) CCS, although interested in counseling, received no advice, as they already met the recommendations. Follow-up revealed high adherence to recommendations and successful integration into daily lives. In total, 97\% (n=150) of survivors indicated that the provision of lifestyle counseling during LTFU would be generally beneficial. Conclusions: Incorporating specialized health care professionals such as sports scientists into survivorship care enhances the multidisciplinary approach of LTFU care. Promoting a healthy lifestyle by offering guideline-based lifestyle counseling is broadly accepted among CCS and may reduce long-term morbidity. ", doi="10.2196/59614", url="https://cancer.jmir.org/2024/1/e59614" } @Article{info:doi/10.2196/51210, author="Page, L. Lindsey and Fanning, Jason and Phipps, Connor and Berger, Ann and Reed, Elizabeth and Ehlers, Diane", title="Heart Rate Monitoring Among Breast Cancer Survivors: Quantitative Study of Device Agreement in a Community-Based Exercise Program", journal="JMIR Cancer", year="2024", month="Jun", day="20", volume="10", pages="e51210", keywords="wearable devices", keywords="exercise prescription", keywords="validity", keywords="photoplethysmography", keywords="monitoring", keywords="wearables", keywords="devices", keywords="exercise", keywords="heart rate", keywords="breast cancer", keywords="cancer", keywords="cancer survivor", keywords="community", keywords="chest monitor", keywords="Fitbit", keywords="recovery", keywords="safety", abstract="Background: Exercise intensity (eg, target heart rate [HR]) is a fundamental component of exercise prescription to elicit health benefits in cancer survivors. Despite the validity of chest-worn monitors, their feasibility in community and unsupervised exercise settings may be challenging. As wearable technology continues to improve, consumer-based wearable sensors may represent an accessible alternative to traditional monitoring, offering additional advantages. Objective: The purpose of this study was to examine the agreement between the Polar H10 chest monitor and Fitbit Inspire HR for HR measurement in breast cancer survivors enrolled in the intervention arm of a randomized, pilot exercise trial. Methods: Participants included breast cancer survivors (N=14; aged 38-72 years) randomized to a 12-week aerobic exercise program. This program consisted of three 60-minute, moderate-intensity walking sessions per week, either in small groups or one-on-one, facilitated by a certified exercise physiologist and held at local community fitness centers. As originally designed, the exercise prescription included 36 supervised sessions at a fitness center. However, due to the COVID-19 pandemic, the number of supervised sessions varied depending on whether participants enrolled before or after March 2020. During each exercise session, HR (in beats per minute) was concurrently measured via a Polar H10 chest monitor and a wrist-worn Fitbit Inspire HR at 5 stages: pre-exercise rest; midpoint of warm-up; midpoint of exercise session; midpoint of cool-down; and postexercise recovery. The exercise physiologist recorded the participant's HR from each device at the midpoint of each stage. HR agreement between the Polar H10 and Fitbit Inspire HR was assessed using Lin concordance correlation coefficient (rc) with a 95\% CI. Lin rc ranges from 0 to 1.00, with 0 indicating no concordance and 1.00 indicating perfect concordance. Relative error rates were calculated to examine differences across exercise session stages. Results: Data were available for 200 supervised sessions across the sample (session per participant: mean 13.33, SD 13.7). By exercise session stage, agreement between the Polar H10 monitor and the Fitbit was highest during pre-exercise seated rest (rc=0.76, 95\% CI 0.70-0.81) and postexercise seated recovery (rc=0.89, 95\% CI 0.86-0.92), followed by the midpoint of exercise (rc=0.63, 95\% CI 0.55-0.70) and cool-down (rc=0.68, 95\% CI 0.60-0.74). The agreement was lowest during warm-up (rc=0.39, 95\% CI 0.27-0.49). Relative error rates ranged from --3.91\% to 3.09\% and were greatest during warm-up (relative error rate: mean --3.91, SD 11.92\%). Conclusions: The Fitbit overestimated HR during peak exercise intensity, posing risks for overexercising, which may not be safe for breast cancer survivors' fitness levels. While the Fitbit Inspire HR may be used to estimate exercise HR, precautions are needed when considering participant safety and data interpretation. Trial Registration: Clinicaltrials.gov NCT03980626; https://clinicaltrials.gov/study/NCT03980626?term=NCT03980626\&rank=1 ", doi="10.2196/51210", url="https://cancer.jmir.org/2024/1/e51210", url="http://www.ncbi.nlm.nih.gov/pubmed/38900505" } @Article{info:doi/10.2196/53180, author="Bachman, L. Shelby and Gomes, Emma and Aryal, Suvekshya and Cella, David and Clay, Ieuan and Lyden, Kate and Leach, J. Heather", title="Do Measures of Real-World Physical Behavior Provide Insights Into the Well-Being and Physical Function of Cancer Survivors? Cross-Sectional Analysis", journal="JMIR Cancer", year="2024", month="Jul", day="15", volume="10", pages="e53180", keywords="accelerometer", keywords="cancer survivorship", keywords="cancer survivors", keywords="digital health technology", keywords="health-related quality of life", keywords="physical behavior", keywords="physical function", abstract="Background: As the number of cancer survivors increases, maintaining health-related quality of life in cancer survivorship is a priority. This necessitates accurate and reliable methods to assess how cancer survivors are feeling and functioning. Real-world digital measures derived from wearable sensors offer potential for monitoring well-being and physical function in cancer survivorship, but questions surrounding the clinical utility of these measures remain to be answered. Objective: In this secondary analysis, we used 2 existing data sets to examine how measures of real-world physical behavior, captured with a wearable accelerometer, were related to aerobic fitness and self-reported well-being and physical function in a sample of individuals who had completed cancer treatment. Methods: Overall, 86 disease-free cancer survivors aged 21-85 years completed self-report assessments of well-being and physical function, as well as a submaximal exercise test that was used to estimate their aerobic fitness, quantified as predicted submaximal oxygen uptake (VO2). A thigh-worn accelerometer was used to monitor participants' real-world physical behavior for 7 days. Accelerometry data were used to calculate average values of the following measures of physical behavior: sedentary time, step counts, time in light and moderate to vigorous physical activity, time and weighted median cadence in stepping bouts over 1 minute, and peak 30-second cadence. Results: Spearman correlation analyses indicated that 6 (86\%) of the 7 accelerometry-derived measures of real-world physical behavior were not significantly correlated with Functional Assessment of Cancer Therapy-General total well-being or linked Patient-Reported Outcomes Measurement Information System-Physical Function scores (Ps?.08). In contrast, all but one of the physical behavior measures were significantly correlated with submaximal VO2 (Ps?.03). Comparing these associations using likelihood ratio tests, we found that step counts, time in stepping bouts over 1 minute, and time in moderate to vigorous activity were more strongly associated with submaximal VO2 than with self-reported well-being or physical function (Ps?.03). In contrast, cadence in stepping bouts over 1 minute and peak 30-second cadence were not more associated with submaximal VO2 than with the self-reported measures (Ps?.08). Conclusions: In a sample of disease-free cancer survivors, we found that several measures of real-world physical behavior were more associated with aerobic fitness than with self-reported well-being and physical function. These results highlight the possibility that in individuals who have completed cancer treatment, measures of real-world physical behavior may provide additional information compared with self-reported and performance measures. To advance the appropriate use of digital measures in oncology clinical research, further research evaluating the clinical utility of real-world physical behavior over time in large, representative samples of cancer survivors is warranted. Trial Registration: ClinicalTrials.gov NCT03781154; https://clinicaltrials.gov/ct2/show/NCT03781154 ", doi="10.2196/53180", url="https://cancer.jmir.org/2024/1/e53180", url="http://www.ncbi.nlm.nih.gov/pubmed/39008350" } @Article{info:doi/10.2196/46625, author="Ow, Tsai-Wing and Sukocheva, Olga and Bampton, Peter and Iyngkaran, Guruparan and Rayner, K. Christopher and Tse, Edmund", title="Improving Concordance Between Clinicians With Australian Guidelines for Bowel Cancer Prevention Using a Digital Application: Randomized Controlled Crossover Study", journal="JMIR Cancer", year="2024", month="Feb", day="22", volume="10", pages="e46625", keywords="colorectal cancer", keywords="guidelines", keywords="colorectal cancer screening", keywords="digital application", keywords="questionnaire", keywords="application", keywords="cancer prevention", keywords="prevention", keywords="cancer", keywords="bowel cancer", keywords="surveillance", keywords="clinical vignette quiz", keywords="usability", keywords="Australia", abstract="Background: Australia's bowel cancer prevention guidelines, following a recent revision, are among the most complex in the world. Detailed decision tables outline screening or surveillance recommendations for 230 case scenarios alongside cessation recommendations for older patients. While these guidelines can help better allocate limited colonoscopy resources, their increasing complexity may limit their adoption and potential benefits. Therefore, tools to support clinicians in navigating these guidelines could be essential for national bowel cancer prevention efforts. Digital applications (DAs) represent a potentially inexpensive and scalable solution but are yet to be tested for this purpose. Objective: This study aims to assess whether a DA could increase clinician adherence to Australia's new colorectal cancer screening and surveillance guidelines and determine whether improved usability correlates with greater conformance to guidelines. Methods: As part of a randomized controlled crossover study, we created a clinical vignette quiz to evaluate the efficacy of a DA in comparison with the standard resource (SR) for making screening and surveillance decisions. Briefings were provided to study participants, which were tailored to their level of familiarity with the guidelines. We measured the adherence of clinicians according to their number of guideline-concordant responses to the scenarios in the quiz using either the DA or the SR. The maximum score was 18, with higher scores indicating improved adherence. We also tested the DA's usability using the System Usability Scale. Results: Of 117 participants, 80 were included in the final analysis. Using the SR, the adherence of participants was rated a median (IQR) score of 10 (7.75-13) out of 18. The participants' adherence improved by 40\% (relative risk 1.4, P<.001) when using the DA, reaching a median (IQR) score of 14 (12-17) out of 18. The DA was rated highly for usability with a median (IQR) score of 90 (72.5-95) and ranked in the 96th percentile of systems. There was a moderate correlation between the usability of the DA and better adherence (rs=0.4; P<.001). No differences between the adherence of specialists and nonspecialists were found, either with the SR (10 vs 9; P=.47) or with the DA (13 vs 15; P=.24). There was no significant association between participants who were less adherent with the DA (n=17) and their age (P=.06), experience with decision support tools (P=.51), or academic involvement with a university (P=.39). Conclusions: DAs can significantly improve the adoption of complex Australian bowel cancer prevention guidelines. As screening and surveillance guidelines become increasingly complex and personalized, these tools will be crucial to help clinicians accurately determine the most appropriate recommendations for their patients. Additional research to understand why some practitioners perform worse with DAs is required. Further improvements in application usability may optimize guideline concordance further. ", doi="10.2196/46625", url="https://cancer.jmir.org/2024/1/e46625", url="http://www.ncbi.nlm.nih.gov/pubmed/38238256" } @Article{info:doi/10.2196/49002, author="Owens-Jasey, Constance and Chen, Jinying and Xu, Ran and Angier, Heather and Huebschmann, G. Amy and Ito Fukunaga, Mayuko and Chaiyachati, H. Krisda and Rendle, A. Katharine and Robien, Kim and DiMartino, Lisa and Amante, J. Daniel and Faro, M. Jamie and Kepper, M. Maura and Ramsey, T. Alex and Bressman, Eric and Gold, Rachel", title="Implementation of Health IT for Cancer Screening in US Primary Care: Scoping Review", journal="JMIR Cancer", year="2024", month="Apr", day="30", volume="10", pages="e49002", keywords="cancer prevention", keywords="health information technology", keywords="implementation", keywords="implementation strategies", keywords="scoping review", abstract="Background: A substantial percentage of the US population is not up to date on guideline-recommended cancer screenings. Identifying interventions that effectively improve screening rates would enhance the delivery of such screening. Interventions involving health IT (HIT) show promise, but much remains unknown about how HIT is optimized to support cancer screening in primary care. Objective: This scoping review aims to identify (1) HIT-based interventions that effectively support guideline concordance in breast, cervical, and colorectal cancer screening provision and follow-up in the primary care setting and (2) barriers or facilitators to the implementation of effective HIT in this setting. Methods: Following scoping review guidelines, we searched MEDLINE, CINAHL Plus, Web of Science, and IEEE Xplore databases for US-based studies from 2015 to 2021 that featured HIT targeting breast, colorectal, and cervical cancer screening in primary care. Studies were dual screened using a review criteria checklist. Data extraction was guided by the following implementation science frameworks: the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework; the Expert Recommendations for Implementing Change taxonomy; and implementation strategy reporting domains. It was also guided by the Integrated Technology Implementation Model that incorporates theories of both implementation science and technology adoption. Reporting was guided by PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Results: A total of 101 studies met the inclusion criteria. Most studies (85/101, 84.2\%) involved electronic health record--based HIT interventions. The most common HIT function was clinical decision support, primarily used for panel management or at the point of care. Most studies related to HIT targeting colorectal cancer screening (83/101, 82.2\%), followed by studies related to breast cancer screening (28/101, 27.7\%), and cervical cancer screening (19/101, 18.8\%). Improvements in cancer screening were associated with HIT-based interventions in most studies (36/54, 67\% of colorectal cancer--relevant studies; 9/14, 64\% of breast cancer--relevant studies; and 7/10, 70\% of cervical cancer--relevant studies). Most studies (79/101, 78.2\%) reported on the reach of certain interventions, while 17.8\% (18/101) of the included studies reported on the adoption or maintenance. Reported barriers and facilitators to HIT adoption primarily related to inner context factors of primary care settings (eg, staffing and organizational policies that support or hinder HIT adoption). Implementation strategies for HIT adoption were reported in 23.8\% (24/101) of the included studies. Conclusions: There are substantial evidence gaps regarding the effectiveness of HIT-based interventions, especially those targeting guideline-concordant breast and colorectal cancer screening in primary care. Even less is known about how to enhance the adoption of technologies that have been proven effective in supporting breast, colorectal, or cervical cancer screening. Research is needed to ensure that the potential benefits of effective HIT-based interventions equitably reach diverse primary care populations. ", doi="10.2196/49002", url="https://cancer.jmir.org/2024/1/e49002", url="http://www.ncbi.nlm.nih.gov/pubmed/38687595" } @Article{info:doi/10.2196/52061, author="Lau, Nancy and Zhao, Xin and O'Daffer, Alison and Weissman, Hannah and Barton, Krysta", title="Pediatric Cancer Communication on Twitter: Natural Language Processing and Qualitative Content Analysis", journal="JMIR Cancer", year="2024", month="May", day="7", volume="10", pages="e52061", keywords="cancer", keywords="COVID-19", keywords="Twitter", keywords="communication", keywords="child health", keywords="caregivers", keywords="social media", keywords="tweet", keywords="tweets", keywords="sentiment", keywords="oncology", keywords="cancers", keywords="pediatric", keywords="pediatrics", keywords="child", keywords="children' youth", keywords="experience", keywords="experiences", keywords="attitude", keywords="attitudes", keywords="opinion", keywords="opinions", keywords="perception", keywords="perceptions", keywords="perspective", keywords="perspectives", abstract="Background: During the COVID-19 pandemic, Twitter (recently rebranded as ``X'') was the most widely used social media platform with over 2 million cancer-related tweets. The increasing use of social media among patients and family members, providers, and organizations has allowed for novel methods of studying cancer communication. Objective: This study aimed to examine pediatric cancer--related tweets to capture the experiences of patients and survivors of cancer, their caregivers, medical providers, and other stakeholders. We assessed the public sentiment and content of tweets related to pediatric cancer over a time period representative of the COVID-19 pandemic. Methods: All English-language tweets related to pediatric cancer posted from December 11, 2019, to May 7, 2022, globally, were obtained using the Twitter application programming interface. Sentiment analyses were computed based on Bing, AFINN, and NRC lexicons. We conducted a supplemental nonlexicon-based sentiment analysis with ChatGPT (version 3.0) to validate our findings with a random subset of 150 tweets. We conducted a qualitative content analysis to manually code the content of a random subset of 800 tweets. Results: A total of 161,135 unique tweets related to pediatric cancer were identified. Sentiment analyses showed that there were more positive words than negative words. Via the Bing lexicon, the most common positive words were support, love, amazing, heaven, and happy, and the most common negative words were grief, risk, hard, abuse, and miss. Via the NRC lexicon, most tweets were categorized under sentiment types of positive, trust, and joy. Overall positive sentiment was consistent across lexicons and confirmed with supplemental ChatGPT (version 3.0) analysis. Percent agreement between raters for qualitative coding was 91\%, and the top 10 codes were awareness, personal experiences, research, caregiver experiences, patient experiences, policy and the law, treatment, end of life, pharmaceuticals and drugs, and survivorship. Qualitative content analysis showed that Twitter users commonly used the social media platform to promote public awareness of pediatric cancer and to share personal experiences with pediatric cancer from the perspective of patients or survivors and their caregivers. Twitter was frequently used for health knowledge dissemination of research findings and federal policies that support treatment and affordable medical care. Conclusions: Twitter may serve as an effective means for researchers to examine pediatric cancer communication and public sentiment around the globe. Despite the public mental health crisis during the COVID-19 pandemic, overall sentiments of pediatric cancer--related tweets were positive. Content of pediatric cancer tweets focused on health and treatment information, social support, and raising awareness of pediatric cancer. ", doi="10.2196/52061", url="https://cancer.jmir.org/2024/1/e52061", url="http://www.ncbi.nlm.nih.gov/pubmed/38713506" } @Article{info:doi/10.2196/49197, author="Ramadan, Majed and Aboalola, Doaa and Aouabdi, Sihem and Alghamdi, Tariq and Alsolami, Mona and Samkari, Alaa and Alsiary, Rawiah", title="Influence of Breast Cancer Awareness Month on Public Interest of Breast Cancer in High-Income Countries Between 2012 and 2022: Google Trends Analysis", journal="JMIR Cancer", year="2024", month="Aug", day="12", volume="10", pages="e49197", keywords="Google Trends", keywords="breast cancer", keywords="pandemic", keywords="awareness", keywords="public interest", keywords="cancer", keywords="cancer awareness", keywords="women", keywords="mortality rate", keywords="detection", keywords="treatment", keywords="social media", keywords="tool", keywords="education", keywords="support", keywords="internet users", abstract="Background: Breast cancer is the most common cancer among women worldwide. High-income countries have a greater incidence and mortality rate of breast cancer than low-income countries. As a result, raising awareness about breast cancer is crucial in increasing the chances of early detection and treatment. Social media has evolved into an essential tool for Breast Cancer Awareness Month campaigns, allowing people to share their breast cancer stories and experiences while also providing a venue for education and support. Objective: The aim of this study was to assess the level of public interest in searches linked to breast cancer among a sample of high-income nations with a sizable internet user base from 2012 to 2022. We also sought to compare the proportional search volume for breast cancer during Breast Cancer Awareness Month with that during other months of the year. Methods: Google Trends was used to retrieve data on internet user search behaviors in the context of breast cancer from 2012 to 2022. Seven countries were evaluated in this study: Australia, Canada, Ireland, New Zealand, the United Kingdom, Saudi Arabia, and the United States, in addition to global data. Breast cancer relative search volume trends were analyzed annually, monthly, and weekly from 2012 to 2022. The annual percent change (APC) was calculated for each country and worldwide. Monthly and weekly data were used to identify potential trends. Results: A fluctuating pattern in APC rates was observed, with a notable increase in 2018 and a significant decrease in 2020, particularly in Saudi Arabia. Monthly analysis revealed a consistent peak in search volume during October (Breast Cancer Awareness Month) each year. Weekly trends over a 20-year period indicated significant decreases in Australia, Canada, New Zealand, and the United States, while increases were noted in Ireland. Heatmap analysis further highlighted a consistent elevation in median search volume during October across all countries. Conclusions: These findings underscore the impact of Breast Cancer Awareness Month and suggest potential influences of governmental COVID-19 pandemic control measures in 2020 on internet search behavior. ", doi="10.2196/49197", url="https://cancer.jmir.org/2024/1/e49197" } @Article{info:doi/10.2196/49897, author="Kaneda, Yudai and Ozaki, Akihiko and Murakami, Michio and Sawano, Toyoaki and Nomura, Shuhei and Bhandari, Divya and Saito, Hiroaki and Tsubokura, Masaharu and Yamaoka, Kazue and Nakata, Yoshinori and Tsukada, Manabu and Ohira, Hiromichi", title="Health Information Seeking on the Internet Among Patients With and Without Cancer in a Region Affected by the 2011 Fukushima Triple Disaster: Cross-Sectional Study", journal="JMIR Cancer", year="2024", month="Aug", day="21", volume="10", pages="e49897", keywords="health information", keywords="patients with cancer", keywords="disaster", keywords="Japan", keywords="internet", keywords="patient with cancer", keywords="cancer", keywords="internet health", keywords="mobile phone", abstract="Background: Health information seeking via the internet among patients with cancer in disaster-affected areas is underresearched. Objective: This study aims not only to assess the extent and means of web-based health information seeking among patients with cancer living in the disaster-affected area of the 2011 Fukushima triple disaster but also to compare these patterns with those without cancer, identifying distinct and shared factors influencing their web-based health information behaviors. Methods: We surveyed 404 patients (263 with and 141 without cancer) from the surgery department outpatient office at Minamisoma Municipal General Hospital, from October 2016 to January 2017. The survey included self-administered questions on internet and digital device use. Descriptive analyses were performed to examine the use patterns of digital devices and the internet and their impact on health information seeking across different age groups of patients with and without cancer. Multivariable logistic regression was used to examine factors associated with web-based health information seeking, stratifying by cancer diagnosis. Results: The proportion of participants who sought health information on the internet was comparable between patients with cancer and patients without cancer (19\% vs 17.4\%; P=.71). Digital device use varied significantly with age, with peak smartphone use occurring among the youngest cohorts for both groups. Multivariable logistic regression revealed that patients with cancer using smartphones or tablets daily were significantly more likely to gather web-based health information (odds ratio [OR] for smartphones 3.73, 95\% CI 1.58-8.80; OR for tablets 5.08, 95\% CI 1.27-20.35). Trust in institutional websites also significantly influenced web-based health information gathering among patients with cancer (OR 2.87, 95\% CI 1.13-7.25). Conversely, among patients without cancer, unemployment was associated with a lower likelihood of seeking web-based health information (OR 0.26, 95\% CI 0.08-0.85), whereas trust in both institutional and personal websites significantly increased this likelihood (OR for institutional websites 6.76, 95\% CI 2.19-20.88; OR for personal websites 6.97, 95\% CI 1.49-32.58). Conclusions: This study reveals that a small proportion of both patients with cancer and patients without cancer engage in health information seeking via the internet, influenced by age, digital device use, and trust in institutional websites. Given the growing prevalence of digital literacy, strategies to enhance accessible and reliable web-based health information should be developed, particularly for patients with cancer in postdisaster settings. Future efforts should focus on tailored health communication strategies that address the unique needs of these populations. ", doi="10.2196/49897", url="https://cancer.jmir.org/2024/1/e49897" } @Article{info:doi/10.2196/46303, author="Andree, Rosa and Mujcic, Ajla and den Hollander, Wouter and van Laar, Margriet and Boon, Brigitte and Engels, Rutger and Blankers, Matthijs", title="Digital Smoking Cessation Intervention for Cancer Survivors: Analysis of Predictors and Moderators of Engagement and Outcome Alongside a Randomized Controlled Trial", journal="JMIR Cancer", year="2024", month="Jun", day="20", volume="10", pages="e46303", keywords="smoking cessation", keywords="cancer survivors", keywords="engagement", keywords="digital intervention", keywords="eHealth", keywords="smoking", keywords="intervention", keywords="randomized controlled trial", keywords="predictor", keywords="RCT", keywords="smoker", keywords="addict", keywords="cessation", keywords="quit", keywords="cancer", keywords="oncology", abstract="Background: Recent studies have shown positive, though small, clinical effects of digital smoking cessation (SC) interventions for cancer survivors. However, research on associations among participant characteristics, intervention engagement, and outcomes is limited. Objective: This study aimed to explore the predictors and moderators of engagement and outcome of MyCourse-Quit Smoking (in Dutch: ``MijnKoers-Stoppen met Roken''), a digital minimally guided intervention for cancer survivors. Methods: A secondary analysis of data from the randomized controlled trial was performed. The number of cigarettes smoked in the past 7 days at 6-month follow-up was the primary outcome measure. We analyzed interactions among participant characteristics (11 variables), intervention engagement (3 variables), and outcome using robust linear (mixed) modeling. Results: In total, 165 participants were included in this study. Female participants accessed the intervention less often than male participants (B=--11.12; P=.004). A higher Alcohol Use Disorders Identification Test score at baseline was associated with a significantly higher number of logins (B=1.10; P<.001) and diary registrations (B=1.29; P<.001). A higher Fagerstr{\"o}m Test for Nicotine Dependence score at baseline in the intervention group was associated with a significantly larger reduction in tobacco use after 6 months (B=--9.86; P=.002). No other associations and no moderating effects were found. Conclusions: Overall, a limited number of associations was found between participant characteristics, engagement, and outcome, except for gender, problematic alcohol use, and nicotine dependence. Future studies are needed to shed light on how this knowledge can be used to improve the effects of digital SC programs for cancer survivors. Trial Registration: Netherlands Trial register NTR6011/NL5434; https://onderzoekmetmensen.nl/nl/trial/22832 ", doi="10.2196/46303", url="https://cancer.jmir.org/2024/1/e46303" } @Article{info:doi/10.2196/54785, author="Bourne, E. Jessica and Kelly, Paul and Armstrong, G. Miranda E.", title="A Theory and Evidence-Informed e-Cycling Intervention for Individuals Diagnosed With Cancer: Development Study", journal="JMIR Cancer", year="2024", month="Aug", day="16", volume="10", pages="e54785", keywords="prostate cancer", keywords="breast cancer", keywords="electrically assisted cycling", keywords="physical activity promotion", keywords="behavior change techniques", keywords="BCTs", keywords="Behaviour Change Wheel", keywords="Medical Research Council", keywords="Theoretical Domains Framework", keywords="TDF", keywords="physical activity", keywords="e-cycling intervention", keywords="e-cycling", keywords="cancer", keywords="risk of disease", keywords="all-cause mortality", keywords="behavioral health", keywords="instructor", keywords="instructors", keywords="cancer survivor", keywords="patient with cancer", keywords="healthy lifestyle", keywords="intervention", keywords="physical fitness", keywords="exercise", abstract="Background: Physical activity engagement following a cancer diagnosis is positively associated with survival, reduced risk of disease recurrence, and reduced cancer-specific and all-cause mortality. However, rates of physical activity engagement are low among individuals diagnosed with and being treated for breast cancer or prostate cancer. Objective: The purpose of this study was to describe the systematic process of developing an e-cycling intervention aimed at increasing physical activity among individuals living with prostate cancer or breast cancer and outline the key components to be implemented. Methods: The Medical Research Council guidance for developing complex interventions and the Behaviour Change Wheel were used to guide intervention development. Information was gathered from the literature and through discussions with end users to understand factors influencing e-cycling. These factors were mapped onto the Theoretical Domains Framework to identify potential mechanisms of action. Behavior change techniques were selected from theory and evidence to develop intervention content. Interested parties, including cycling instructors, end users, and behavior change experts, reviewed and refined the intervention. Results: Anticipated barriers and facilitators to e-cycling engagement were mapped onto 11 of the 14 domains of the Theoretical Domains Framework. A total of 23 behavior change techniques were selected to target these domains over 4 one-to-one e-cycling sessions delivered by trained cycling instructors in the community. Cycling instructors were provided a 3-hour classroom training session on delivering the intervention and a 3-hour practical session with feedback. The outcome of this work is a theory and evidence-informed intervention aimed at promoting e-cycling behavior among individuals being treated for breast cancer or prostate cancer, which is currently being implemented and evaluated. Conclusions: Transparent intervention development and reporting of content is important for comprehensively examining intervention implementation. The implementation of this intervention package is currently being evaluated in a pilot randomized controlled trial. If the intervention is found to be effective and the content and delivery are acceptable, this intervention will form a basis for the development of e-cycling interventions in other survivors of cancer. Trial Registration: ISRCTN Registry ISRCTN39112034 https://www.isrctn.com/ISRCTN39112034; and IRSCTN Registry ISRCTN42852156;https://www.isrctn.com/ISRCTN42852156 ", doi="10.2196/54785", url="https://cancer.jmir.org/2024/1/e54785" } @Article{info:doi/10.2196/48428, author="Alhuwail, Dari and Alhouti, Aisha and Alsarhan, Latifah", title="Assessing the Quality, Privacy, and Security of Breast Cancer Apps for Arabic Speakers: Systematic Search and Review of Smartphone Apps", journal="JMIR Cancer", year="2024", month="Jan", day="16", volume="10", pages="e48428", keywords="apps", keywords="Arabic", keywords="awareness", keywords="breast cancer", keywords="consumer health informatics", keywords="education", keywords="mHealth", keywords="mobile health", keywords="privacy", keywords="quality", keywords="security", keywords="smartphone", keywords="women", abstract="Background: Breast cancer is a widespread disease, and its incidence is rapidly increasing in the Middle East and North Africa region. With the increasing availability of smartphone apps for various health purposes, breast cancer apps have emerged as tools for raising awareness, providing support, and empowering women affected by this disease. These apps offer many features, including information on breast cancer risk factors, self-examination guides, appointment reminders, and community support groups or hotlines. Using apps raises the risk of privacy and security issues, and we hope that examining these features of the apps will contribute to the understanding of how technology can be used to improve these apps and provide insights for future development and improvement of breast cancer apps. Objective: This study aims to critically review the quality, privacy, and security of breast cancer apps available to Arabic speakers. Methods: Similar to several recent studies, we used a systematic search for apps available in Google Play and Apple App stores using both the web interface and the built-in native stores installed on smartphones. The search was conducted in mid-December 2022 in Arabic using the following keywords: ????? ????? -- ??? ????? ????? -- ???? ????? ????? -- ??? ????? ????? -- ????? ????? ????? -- ??? ????? (breast cancer, breast cancer treatment, breast cancer disease, breast cancer symptoms, breast cancer screening, and breast test). These preidentified search terms are based on earlier work concerning the top searched breast cancer topics by Arabic speakers through Google's search engine. We excluded apps that did not have an Arabic interface, were developed for non-Arabic speakers, were paid, needed a subscription, or were directed toward health care workers. The Mobile App Rating Scale was used to evaluate the quality of the apps concerning their engagement, functionality, aesthetics, and information. A risk score was calculated for the apps to determine their security risk factors. Results: Only 9 apps were included, with most (6/9, 67\%) being supported by advertisements and categorized as informational. Overall, the apps had low numbers of downloads (>10 to >1000). The majority of the included apps (8/9, 89\%) requested dangerous access permissions, including access to storage, media files, and the camera. The average security score of the included apps was 3.22, while only 2 apps provided information about data security and privacy. The included apps achieved an overall average quality score of 3.27, with individual dimension scores of 4.75 for functionality, 3.04 for information, 3.00 for aesthetics, and 2.32 for engagement. Conclusions: The limited availability of breast cancer apps available to Arabic speakers should be a call to action and prompt health care organizations and developers to join forces and collaboratively develop information-rich, usable, functional, engaging, and secure apps. ", doi="10.2196/48428", url="https://cancer.jmir.org/2024/1/e48428", url="http://www.ncbi.nlm.nih.gov/pubmed/38227353" } @Article{info:doi/10.2196/52128, author="Mueller, L. Emily and Cochrane, R. Anneli and Campbell, E. Madison and Nikkhah, Sarah and Holden, J. Richard and Miller, D. Andrew", title="An mHealth App to Support Caregivers in the Medical Management of Their Child With Cancer: Beta Stage Usability Study", journal="JMIR Cancer", year="2024", month="Oct", day="17", volume="10", pages="e52128", keywords="oncology", keywords="supportive care", keywords="mHealth", keywords="children", keywords="caregivers", keywords="mobile phones", abstract="Background: Previous research demonstrated that caregivers of children with cancer desired a mobile health (mHealth) tool to aid them in the medical management of their child. Prototyping and alpha testing of the Cope 360 app (Commissioning Agents, Inc) resulted in improvements in the ability to track symptoms, manage medications, and prepare for urgent medical needs. Objective: This study aims to engage caregivers of children with cancer in beta testing of a smartphone app for the medical management of children with cancer, assess acceptance, identify caregivers' perceptions and areas for improvement, and validate the app's design concepts and use cases. Methods: In this pilot, study caregivers of children with cancer used the Cope 360 mHealth app for 1 week, with the goal of daily logging. Demographics and a technology acceptance survey were obtained from each participant. Recorded semistructured interviews were transcribed and analyzed iteratively using NVivo (version 12, QSR International) and analyzed for information on usage, perceptions, and suggestions for improvement. Results: A total of 10 caregivers participated in beta testing, primarily women (n=8, 80\%), married, with some college education, and non-Hispanic White (n=10, 100\%). The majority of participants (n=7, 70\%) had children with acute lymphocytic leukemia who were being treated with chemotherapy only (n=8, 80\%). Overall, participants had a favorable opinion of Cope 360. Almost all participants (n=9, 90\%) believed that using the app would improve their ability to manage their child's medical needs at home. All participants reported that Cope 360 was easy to use, and most would use the app if given the opportunity (n=8, 80\%). These values indicate that the app had a high perceived ease of use with well-perceived usefulness and behavioral intention to use. Key topics for improvement were identified including items that were within the scope of change and others that were added to a future wish list. Changes that were made based on caregiver feedback included tracking or editing all oral and subcutaneous medications and the ability to change the time of a symptom tracked or medication administered if unable to do so immediately. Wish list items included adding a notes section, monitoring skin changes, weight and nutrition tracking, and mental health tracking. Conclusions: The Cope 360 app was well received by caregivers of children with cancer. Our validation testing suggests that the Cope 360 app is ready for testing in a randomized controlled trial to assess outcome improvements. ", doi="10.2196/52128", url="https://cancer.jmir.org/2024/1/e52128" } @Article{info:doi/10.2196/48465, author="Campbell, B. Grace and Kim, Hansol and Klinedinst, C. Tara and Klinger, Julie and Lee, Ji Young and Donovan, S. Heidi", title="Needs of Patients With Gynecologic Cancer and Their Caregivers for Obtaining mHealth-Supported Self-Management: Focus Group Study", journal="JMIR Cancer", year="2024", month="Oct", day="3", volume="10", pages="e48465", keywords="gynecologic oncology", keywords="gynecologic cancer", keywords="self-management support", keywords="user-centered design", keywords="cancer distress", keywords="self-management", keywords="caregiver support", keywords="cancer information", keywords="women's health", keywords="family support", keywords="informal caregivers", keywords="informal care", keywords="mhealth", abstract="Background: Family caregivers of individuals with gynecologic cancer experience high levels of distress. Web-based caregiver support interventions have demonstrated efficacy in improving caregiver outcomes. However, the lack of portability could be a limitation. Mobile health (mHealth) apps could fill this gap and facilitate communication between patient-caregiver dyads. Objective: We sought to obtain information on desired usage and features to be used to design an mHealth self-management support app targeting both patients with gynecologic cancer and their caregivers. Methods: We conducted Zoom focus groups with women who had been treated for gynecologic cancers (ovarian, fallopian, primary peritoneal, uterine, endometrial, cervical, and vulvar); patients were also asked to invite a self-identified ``closest support person'' (caregiver). A semistructured focus group guide was used to elicit information on patients' and caregivers' perceived gaps in information and support, desired features of an mHealth app, and interest in and preferences for app usage. After transcription, rapid qualitative analysis using a thematic matrix was used to identify common themes across groups. Results: A total of 8 groups were held. The final sample included 41 individuals with gynecologic cancer and 22 support persons or caregivers (total n=63). Patients were aged between 32 and 84 years, and most (38/41, 93\%) were White and married. For caregivers (n=22), 15 (68\%) identified as male and 7 (32\%) as female, with ages ranging between 19 and 81 years. Overall, 59\% (n=13) of caregivers were spouses. Questions geared at eliciting 3 a priori topics yielded the following themes: topic 1---gaps in information and support: finding relevant information is time-consuming; patients and caregivers lack confidence in deciding the urgency of problems that arise and from whom to seek information and guidance; topic 2---desired features of the mHealth app: patients and caregivers desire centralized, curated, trustworthy information; they desire timely recommendations tailored to specific personal and cancer-related needs; they desire opportunities to interact with clinical and peer experts through the app; and topic 3---interest and preferences for app usage: need for private space in the app for patients and caregivers to get information and support without the others' knowledge; patients and caregivers desire having control over sharing of information with other family members. Conclusions: Designing a single mHealth app to be used by patients and caregivers presents unique challenges for intervention designers and app developers. Implications of the study suggest that app developers need to prioritize flexibility in app functionality and provide individuals the ability to control information sharing between patients and caregivers. ", doi="10.2196/48465", url="https://cancer.jmir.org/2024/1/e48465", url="http://www.ncbi.nlm.nih.gov/pubmed/39361371" } @Article{info:doi/10.2196/55300, author="Peerawong, Thanarpan and Phenwan, Tharin and Makita, Meiko and Supanichwatana, Sojirat and Puttarak, Panupong and Siammai, Naowanit and Sunthorn, Prakaidao", title="Evaluating Online Cannabis Health Information for Thai Breast Cancer Survivors Using the Quality Evaluation Scoring Tool (QUEST): Mixed Method Study", journal="JMIR Cancer", year="2024", month="Dec", day="24", volume="10", pages="e55300", keywords="cannabis", keywords="medical cannabis", keywords="Thailand", keywords="critical discourse analysis", keywords="mixed method study", keywords="breast cancer", keywords="digital literacy", keywords="legislation", keywords="health literacy", abstract="Background: Following medical cannabis legalization in Thailand in 2019, more people are seeking medical cannabis--related information, including women living with breast cancer. The extent to which they access cannabis-related information from internet sources and social media platforms and the quality of such content are relatively unknown and need further evaluation. Objective: This study aims to analyze the factors determining cannabis-related content quality for breast cancer care from internet sources and on social media platforms and examine the characteristics of such content accessed and consumed by Thai breast cancer survivors. Methods: A mixed methods study was conducted between January 2021 and May 2022, involving a breast cancer survivor support group. The group identified medical cannabis--related content from frequently accessed internet sources and social media platforms. The contents were categorized based on content creators, platforms, content category, and upload dates. Four researchers used the Quality Evaluation Scoring Tool (QUEST) to assess content quality, with scores ranging from 0 to 28. Contents were expert-rated as either high or poor. The QUEST interobserver reliability was analyzed. Receiver-operating characteristic curve analysis with the Youden index was used to determine the QUEST score cut-off point. Statistical significance was set at P<.05. Fairclough Critical Discourse Analysis was undertaken to examine the underlying discourses around poor-quality content. Results: Sixty-two Thai-language cannabis-related items were evaluated. The content sources were categorized as follows: news channels (21/62, 34\%), government sources (16/62, 26\%), health care providers (12/62, 19\%), and alternative medicine providers (12/62, 19\%). Most of the contents (30/62, 48\%) were uploaded to YouTube, whereas 31\% (19/62) appeared on websites and Facebook. Forty of 62 content items (64\%) were news-related and generic cannabis advertisements while 8 of 62 (13\%) content items had no identifiable date. The interobserver QUEST score correlation was 0.86 (P<.001). The mean QUEST score was 12.1 (SD 7.6). Contents were considered ``high'' when the expert rating was >3. With a QUEST score of 15 as the threshold, the sensitivity and specificity for differentiating between high and poor content quality were 81\% and 98\%, respectively. Content creation was the only significant factor between high- and poor-quality content. Poor-quality contents were primarily created by alternative medicine providers and news channels. Two discourses were identified: advocacy for cannabis use normalization and cannabis romanticization as a panacea. These discourses overly normalize and romanticize the use of cannabis, focusing on indications and instructions for cannabis use, and medical cannabis promotion, while neglecting discussions on cannabis contraindications and potential side effects. Conclusions: The varying quality of medical cannabis--related information on internet sources and social media platforms accessed and shared by Thai breast cancer survivors is an issue of concern. Given that content creators are the sole predictive factors of high content quality, future studies should examine a wider range of cannabis-related sources accessible to both the public and patients to gain a more comprehensive understanding of the issue. ", doi="10.2196/55300", url="https://cancer.jmir.org/2024/1/e55300" } @Article{info:doi/10.2196/54178, author="Trojan, Andreas and Roth, Sven and Atassi, Ziad and Kiessling, Michael and Zenhaeusern, Reinhard and Kadvany, Yannick and Schumacher, Johannes and Kullak-Ublick, A. Gerd and Aapro, Matti and Eniu, Alexandru", title="Comparison of the Real-World Reporting of Symptoms and Well-Being for the HER2-Directed Trastuzumab Biosimilar Ogivri With Registry Data for Herceptin in the Treatment of Breast Cancer: Prospective Observational Study (OGIPRO) of Electronic Patient-Reported Outcomes", journal="JMIR Cancer", year="2024", month="Apr", day="4", volume="10", pages="e54178", keywords="breast cancer", keywords="biosimilar", keywords="trastuzumab", keywords="electronic patient-reported outcome", keywords="ePRO", keywords="medidux", keywords="app", abstract="Background: Trastuzumab has had a major impact on the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC). Anti-HER2 biosimilars such as Ogivri have demonstrated safety and clinical equivalence to trastuzumab (using Herceptin as the reference product) in clinical trials. To our knowledge, there has been no real-world report of the side effects and quality of life (QoL) in patients treated with biosimilars using electronic patient-reported outcomes (ePROs). Objective: The primary objective of this prospective observational study (OGIPRO study) was to compare the ePRO data related to treatment side effects collected with the medidux app in patients with HER2-positive BC treated with the trastuzumab biosimilar Ogivri (prospective cohort) to those obtained from historical cohorts treated with Herceptin alone or combined with pertuzumab and/or chemotherapy (ClinicalTrials.gov NCT02004496 and NCT03578731). Methods: Patients were treated with Ogivri alone or combined with pertuzumab and/or chemotherapy and hormone therapy in (neo)adjuvant and palliative settings. Patients used the medidux app to dynamically record symptoms (according to the Common Terminology Criteria for Adverse Events [CTCAE]), well-being (according to the Eastern Cooperative Oncology Group Performance Status scale), QoL (using the EQ-5D-5L questionnaire), cognitive capabilities, and vital parameters over 6 weeks. The primary endpoint was the mean CTCAE score. Key secondary endpoints included the mean well-being score. Data of this prospective cohort were compared with those of the historical cohorts (n=38 patients; median age 51, range 31-78 years). Results: Overall, 53 female patients with a median age of 54 years (range 31-87 years) were enrolled in the OGIPRO study. The mean CTCAE score was analyzed in 50 patients with available data on symptoms, while the mean well-being score was evaluated in 52 patients with available data. The most common symptoms reported in both cohorts included fatigue, taste disorder, nausea, diarrhea, dry mucosa, joint discomfort, tingling, sleep disorder, headache, and appetite loss. Most patients experienced minimal (grade 0) or mild (grade 1) toxicities in both cohorts. The mean CTCAE score was comparable between the prospective and historical cohorts (29.0 and 30.3, respectively; mean difference --1.27, 95\% CI --7.24 to 4.70; P=.68). Similarly, no significant difference was found for the mean well-being score between the groups treated with the trastuzumab biosimilar Ogivri and Herceptin (74.3 and 69.8, respectively; mean difference 4.45, 95\% CI --3.53 to 12.44; P=.28). Conclusions: Treatment of patients with HER2-positive BC with the trastuzumab biosimilar Ogivri resulted in equivalent symptoms, adverse events, and well-being as found for patients treated with Herceptin as determined by ePRO data. Hence, integration of an ePRO system into research and clinical practice can provide reliable information when investigating the real-world tolerability and outcomes of similar therapeutic compounds. Trial Registration: ClinicalTrials.gov NCT05234021; https://clinicaltrials.gov/study/NCT05234021 ", doi="10.2196/54178", url="https://cancer.jmir.org/2024/1/e54178", url="http://www.ncbi.nlm.nih.gov/pubmed/38573759" } @Article{info:doi/10.2196/55438, author="Freeman, Q. Jincong and Zhao, Fangyuan and Howard, M. Frederick and Nanda, Rita and Olopade, I. Olufunmilayo and Huo, Dezheng", title="Assessing the Relationship Between Neighborhood Socioeconomic Disadvantage and Telemedicine Use Among Patients With Breast Cancer and Examining Differential Provisions of Oncology Services Between Telehealth and In-Person Visits: Quantitative Study", journal="JMIR Cancer", year="2024", month="Jul", day="18", volume="10", pages="e55438", keywords="telemedicine", keywords="telehealth equity", keywords="Area Deprivation Index", keywords="neighborhood socioeconomic disadvantage", keywords="disparities", keywords="oncology services", keywords="treatment consultation", keywords="genetic counseling", keywords="in-person visits", keywords="breast cancer", keywords="mobile phone", abstract="Background: Since the COVID-19 pandemic began, we have seen rapid growth in telemedicine use. However, telehealth care and services are not equally distributed, and not all patients with breast cancer have equal access across US regions. There are notable gaps in existing literature regarding the influence of neighborhood-level socioeconomic status on telemedicine use in patients with breast cancer and oncology services offered through telehealth versus in-person visits. Objective: We assessed the relationship between neighborhood socioeconomic disadvantage and telemedicine use among patients with breast cancer and examined differential provisions of oncology services between telehealth and in-person visits. Methods: Neighborhood socioeconomic disadvantage was measured using the Area Deprivation Index (ADI), with higher scores indicating greater disadvantages. Telemedicine and in-person visits were defined as having had a telehealth and in-person visit with a provider, respectively, in the past 12 months. Multivariable logistic regression was performed to examine the association between ADI and telemedicine use. The McNemar test was used to assess match-paired data on types of oncology services comparing telehealth and in-person visits. Results: The mean age of the patients with breast cancer (n=1163) was 61.8 (SD 12.0) years; 4.58\% (52/1161) identified as Asian, 19.72\% (229/1161) as Black, 3.01\% (35/1161) as Hispanic, and 72.78\% (845/1161) as White. Overall, 35.96\% (416/1157) had a telemedicine visit in the past 12 months. Of these patients, 65\% (266/409) had a videoconference visit only, 22.7\% (93/409) had a telephone visit only, and 12.2\% (50/409) had visits by both videoconference and telephone. Higher ADI scores were associated with a lower likelihood of telemedicine use (adjusted odds ratio [AOR] 0.89, 95\% CI 0.82-0.97). Black (AOR 2.38, 95\% CI 1.41-4.00) and Hispanic (AOR 2.65, 95\% CI 1.07-6.58) patients had greater odds of telemedicine use than White patients. Compared to patients with high school or less education, those with an associate's degree (AOR 2.67, 95\% CI 1.33-5.35), a bachelor's degree (AOR 2.75, 95\% CI 1.38-5.48), or a graduate or professional degree (AOR 2.57, 95\% CI 1.31-5.04) had higher odds of telemedicine use in the past 12 months. There were no significant differences in providing treatment consultation (45/405, 11.1\% vs 55/405, 13.6\%; P=.32) or cancer genetic counseling (11/405, 2.7\% vs 19/405, 4.7\%; P=.14) between telehealth and in-person visits. Of the telemedicine users, 95.8\% (390/407) reported being somewhat to extremely satisfied, and 61.8\% (254/411) were likely or very likely to continue using telemedicine. Conclusions: In this study of a multiethnic cohort of patients with breast cancer, our findings suggest that neighborhood-level socioeconomic disparities exist in telemedicine use and that telehealth visits could be used to provide treatment consultation and cancer genetic counseling. Oncology programs should address these disparities and needs to improve care delivery and achieve telehealth equity for their patient populations. ", doi="10.2196/55438", url="https://cancer.jmir.org/2024/1/e55438" } @Article{info:doi/10.2196/57964, author="Hawkes, E. Rhiannon and Pegington, Mary and Davies, Alan and Mueller, Julia and Howell, Anthony and Evans, Gareth D. and Howell, J. Sacha and French, P. David and Harvie, Michelle", title="Experiences of a Digital Behavior Change Intervention to Prevent Weight Gain and Promote Risk-Reducing Health Behaviors for Women Aged 18 to 35 Years at Increased Risk of Breast Cancer: Qualitative Interview Study", journal="JMIR Cancer", year="2024", month="Nov", day="25", volume="10", pages="e57964", keywords="breast cancer", keywords="health behavior", keywords="weight gain", keywords="weight control", keywords="BMI", keywords="app", keywords="acceptability", keywords="feasibility", abstract="Background: Breast cancer is the most common form of cancer in women. Adult weight gain and modifiable health behaviors, including smoking, alcohol intake, and lack of physical activity, are well-known risk factors. Most weight gain in women occurs between the ages of 18 and 35 years. Digital interventions have the potential to address logistical challenges that arise in reaching women in this age range. We designed a digital intervention targeting weight gain prevention and other modifiable health behaviors for young women at increased risk of breast cancer. Women aged 18 to 35 years were recruited to this single-arm intervention study over 2 months to test the acceptability and usability of the intervention, which comprised a group welcome event held via videoconferencing, app, and private Facebook group. Objective: This nested qualitative substudy explored women's views and experiences of being part of the digital health intervention to inform future intervention development for a feasibility study. Methods: A total of 20 women aged 23 to 35 years who were at increased risk of breast cancer were interviewed via telephone within 1 month after completing the intervention, between February 2023 and March 2023. The women were asked about their experiences of the digital intervention and the extent to which it may have influenced their health behaviors. Data were analyzed thematically and organized using the framework approach. Results: The interviews lasted for a median of 37 (IQR 30-46) minutes. Overall, the women perceived the digital health intervention comprising education, tracking, and support to be acceptable for weight gain prevention. In total, 4 themes were generated. A ``missed opportunity'' in breast cancer prevention services encompasses the lack of services that currently exist for young women at increased risk of breast cancer. The pros and cons of being part of a community encompasses the divergent views that the women had regarding engaging with other women at increased risk. The importance of an interactive app focuses on features that the women would want from the app to promote engagement with the intervention. The different wants and needs of different age groups highlights that an intervention such as this one would need to be customizable to suit the needs of women at different life stages. Conclusions: There is an unmet need in prevention services for young women aged 18 to 35 years at increased risk of breast cancer. The women perceived the app to be an acceptable intervention for weight gain prevention but emphasized that the intervention would need to be customizable to meet the needs of different age groups within the group of women aged 18 to 35 years. The digital intervention could be a scalable behavior change strategy for UK family history clinics. ", doi="10.2196/57964", url="https://cancer.jmir.org/2024/1/e57964" } @Article{info:doi/10.2196/47856, author="Baxter-King, Ryan and Naeim, Arash and Huang, Q. Tina and Sepucha, Karen and Stanton, Annette and Rudkin, Aaron and Ryu, Rita and Sabacan, Leah and Vavreck, Lynn and Esserman, Laura and Stover Fiscalini, Allison and Wenger, S. Neil", title="Relationship Between Perceived COVID-19 Risk and Change in Perceived Breast Cancer Risk: Prospective Observational Study", journal="JMIR Cancer", year="2024", month="Dec", day="2", volume="10", pages="e47856", keywords="breast cancer", keywords="COVID-19 risk perception", keywords="cancer screening", keywords="anxiety", keywords="cancer", keywords="COVID-19", keywords="prevention", keywords="medical care", keywords="screening", keywords="survey", abstract="Background: Whether COVID-19 is associated with a change in risk perception about other health conditions is unknown. Because COVID-19 occurred during a breast cancer study, we evaluated the effect of COVID-19 risk perception on women's breast cancer risk perception. Objective: This study aims to evaluate the relationship between perceived risk of COVID-19 and change in perceived breast cancer risk. We hypothesized that women who perceived greater COVID-19 risk would evidence increased perceived breast cancer risk and this risk would relate to increased anxiety and missed cancer screening. Methods: Women aged 40-74 years with no breast cancer history were enrolled in a US breast cancer prevention trial in outpatient settings. They had provided breast cancer risk perception and general anxiety before COVID-19. We performed a prospective observational study of the relationship between the perceived risk of COVID-19 and the change in perceived breast cancer risk compared to before the pandemic. Each woman was surveyed up to 4 times about COVID-19 and breast cancer risk perception, general anxiety, and missed medical care early in COVID-19 (May to December 2020). Results: Among 13,002 women who completed a survey, compared to before COVID-19, anxiety was higher during COVID-19 (mean T score 53.5 vs 49.7 before COVID-19; difference 3.8, 95\% CI 3.6-4.0; P<.001) and directly related to perceived COVID-19 risk. In survey wave 1, anxiety increased by 2.3 T score points for women with very low perceived COVID-19 risk and 5.2 points for those with moderately or very high perceived COVID-19 risk. Despite no overall difference in breast cancer risk perception (mean 32.5\% vs 32.5\% before COVID-19; difference 0.24, 95\% CI --0.47 to 0.52; P=.93), there was a direct relationship between change in perceived breast cancer risk with COVID-19 risk perception, ranging in survey wave 4 from a 2.4\% decrease in breast cancer risk perception for those with very low COVID-19 risk perception to a 3.4\% increase for women with moderately to very high COVID-19 risk perception. This was not explained by the change in anxiety or missed cancer screening. After adjustment for age, race, education, and survey wave, compared to women with very low perceived COVID-19 risk, perceived breast cancer risk increased by 1.54\% (95\% CI 0.75\%-2.33\%; P<.001), 4.28\% (95\% CI 3.30\%-5.25\%; P<.001), and 3.67\% (95\% CI 1.94\%-5.40\%; P<.001) for women with moderately low, neither high nor low, and moderately or very high perceived COVID-19 risk, respectively. Conclusions: Low perceived COVID-19 risk was associated with reduced perceived breast cancer risk, and higher levels of perceived COVID-19 risk were associated with increased perceived breast cancer risk. This natural experiment suggests that a threat such as COVID-19 may have implications beyond the pandemic. Preventive health behaviors related to perceived risk may need attention as COVID-19 becomes endemic. ", doi="10.2196/47856", url="https://cancer.jmir.org/2024/1/e47856" } @Article{info:doi/10.2196/52551, author="Pierce, Joni and Conway, Mike and Grace, Kathryn and Mikal, Jude", title="Identifying Factors Associated With Heightened Anxiety During Breast Cancer Diagnosis Through the Analysis of Social Media Data on Reddit: Mixed Methods Study", journal="JMIR Cancer", year="2024", month="Dec", day="5", volume="10", pages="e52551", keywords="breast cancer", keywords="anxiety", keywords="NLP", keywords="natural language processing", keywords="mixed methods study", keywords="cancer diagnosis", keywords="social media apps", keywords="descriptive analysis", keywords="diagnostic progression", keywords="patient-centered care", abstract="Background: More than 85\% of patients report heightened levels of anxiety following breast cancer diagnosis. Anxiety may become amplified during the early stages of breast cancer diagnosis when ambiguity is high. High levels of anxiety can negatively impact patients by reducing their ability to function physically, make decisions, and adhere to treatment plans, with all these elements combined serving to diminish the quality of life. Objective: This study aimed to use individual social media posts about breast cancer experiences from Reddit (r/breastcancer) to understand the factors associated with breast cancer--related anxiety as individuals move from suspecting to confirming cancer diagnosis. Methods: We used a mixed method approach by combining natural language processing--based computational methods with descriptive analysis. Our team coded the entire corpus of 2170 unique posts from the r/breastcancer subreddit with respect to key variables, including whether the post was related to prediagnosis, diagnosis, or postdiagnosis concerns. We then used Linguistic Inquiry and Word Count (LIWC) to rank-order the codified posts as low, neutral, or high anxiety. High-anxiety posts were then retained for deep descriptive analysis to identify key themes relative to diagnostic progression. Results: After several iterations of data analysis and classification through both descriptive and computational methods, we identified a total of 448 high-anxiety posts across the 3 diagnostic categories. Our analyses revealed that individuals experience higher anxiety before a confirmed cancer diagnosis. Analysis of the high-anxiety posts revealed that the factors associated with anxiety differed depending on an individual's stage in the diagnostic process. Prediagnosis anxiety was associated with physical symptoms, cancer-related risk factors, communication, and interpreting medical information. During the diagnosis period, high anxiety was associated with physical symptoms, cancer-related risk factors, communication, and difficulty navigating the health care system. Following diagnosis, high-anxiety posts generally discussed topics related to treatment options, physical symptoms, emotional distress, family, and financial issues. Conclusions: This study has practical, theoretical, and methodological implications for cancer research. Content analysis reveals several possible drivers of anxiety at each stage (prediagnosis, during diagnosis, and postdiagnosis) and provides key insights into how clinicians can help to alleviate anxiety at all stages of diagnosis. Findings provide insights into cancer-related anxiety as a process beginning before engagement with the health care system: when an individual first notices possible cancer symptoms. Uncertainty around physical symptoms and risk factors suggests the need for increased education and improved access to trained medical staff who can assist patients with questions and concerns during the diagnostic process. Assistance in understanding technical reports, scheduling, and patient-centric clinician behavior may pinpoint opportunities for improved communication between patients and providers. ", doi="10.2196/52551", url="https://cancer.jmir.org/2024/1/e52551" } @Article{info:doi/10.2196/48225, author="Helissey, Carole and Cavallero, Sophie and Guitard, Nathalie and Thery, H{\'e}l{\`e}ne and Parnot, Charles and Schernberg, Antoine and Aissa, Imen and Raffin, Florent and Le Coz, Christine and Mondot, Stanislas and Christopoulos, Christos and Malek, Karim and Malaurie, Emmanuelle and Blanchard, Pierre and Chargari, Cyrus and Francois, Sabine", title="Correlation Between Electronic Patient-Reported Outcomes and Biological Markers of Key Parameters in Acute Radiation Cystitis Among Patients With Prostate Cancer (RABBIO): Prospective Observational Study", journal="JMIR Cancer", year="2024", month="Dec", day="12", volume="10", pages="e48225", keywords="prostate cancer", keywords="acute radiation cystitis", keywords="e-PRO", keywords="quality of life", keywords="biomarkers", keywords="electronic patient-reported outcome", abstract="Background: Despite advances in radiation techniques, radiation cystitis (RC) remains a significant cause of morbidity from pelvic radiotherapy, which may affect patients' quality of life (QoL). The pathophysiology of RC is not well understood, which limits the development of effective treatments. Objective: The Radiotoxicity Bladder Biomarkers study aims to investigate the correlation between blood and urinary biomarkers and the intensity of acute RC symptoms and QoL in patients undergoing localized prostate cancer radiotherapy. Methods: This study included patients with low- or intermediate-risk localized prostate cancer who were eligible for localized radiotherapy. Blood and urinary biomarkers were analyzed before radiotherapy was initiated and at weeks 4 and 12 of radiation therapy. Patients completed questionnaires related to RC symptoms and QoL (International Prostate Symptom Score and Functional Assessment of Cancer Therapy-Prostate [FACT-P]) using a digital remote monitoring platform. The information was processed by means of an algorithm, which classified patients according to the severity of symptoms and adverse events reported. Levels of blood and urinary biomarkers were tested with the severity of acute RC symptoms and patient-reported QoL. Results: A total of 401 adverse events questionnaires were collected over the duration of this study from 20 patients. The most frequently reported adverse events at week 4 were pollakiuria, constipation, and diarrhea. In comparison with baseline, the mean FACT-P score decreased at week 4. A significant increase in the proportion of M2 phenotype cells (CD206+, CD163+, CD204+) at W12 compared to W0 was observed. An increase in serum and urine levels of macrophage colony-stimulating factor (M-CSF), hepatocyte growth factor, and macrophagic inflammatory protein was observed at week 12 compared to baseline levels. Baseline serum and urine M-CSF concentrations showed a significant negative correlation with FACT-P scores at weeks 4 and 12 (r=?0.65, P=.04, and r=?0.76, P=.02, respectively). Conclusions: The Radiotoxicity Bladder Biomarkers study is the first to explore the overexpression of inflammatory proteins in blood and urine of patients with symptoms of acute RC. These preliminary findings suggest that serum and urine levels of hepatocyte growth factor, M-CSF, and macrophagic inflammatory protein, as well as macrophage polarization, are mobilized after prostate radiotherapy. The elevated M-CSF levels in serum and urine at baseline were associated with the deterioration of QoL during radiotherapy. The results of this study may help to develop mitigation strategies to limit radiation damage to the bladder. Trial Registration: ClinicalTrials.gov NCT05246774; https://clinicaltrials.gov/study/NCT05246774 ", doi="10.2196/48225", url="https://cancer.jmir.org/2024/1/e48225" } @Article{info:doi/10.2196/51936, author="Noggle, Brendan and Cheng, Hui and Sarkar, Mohamadi", title="Oral Cancer Incidence Among Adult Males With Current or Former Use of Cigarettes or Smokeless Tobacco: Population-Based Study", journal="JMIR Cancer", year="2024", month="Nov", day="6", volume="10", pages="e51936", keywords="tobacco harm reduction", keywords="oral cancer", keywords="smokeless tobacco", keywords="smoking", keywords="cancer epidemiology", keywords="cancer registry", keywords="population-based study", keywords="oral cancer incidence", keywords="cancer cases", abstract="Background: Tobacco use has been identified as a risk factor for oral cancer worldwide. However, relative oral cancer incidence among adults who smoke cigarettes, use smokeless tobacco products (ST), have transitioned from cigarettes to ST, quit cigarettes and/or ST (``quitters''), or never used tobacco has not been well studied. Objective: We aim to present population-based oral cancer incidence rates for adults who smoke cigarettes, use ST, are former smokers who now use ST, or quit. Methods: We estimated cross-sectional incidence rates and incidence rate ratios (IRRs) using data from statewide cancer registries (Colorado, Florida, North Carolina, and Texas) and population counts derived from national surveys using combined data from 2014?2017. A random-effect meta-analysis approach was used to summarize estimates among these groups, based on multiple imputation-based IRR estimates by state and age group while considering potential heterogeneity. Results: A total of 19,536 oral cancer cases were identified among adult males 35 years and older in the study geographies and period. The oral cancer incidence rate among adults who smoke was significantly higher than the ST group (2.6 times higher, 95\% CI 2.0?3.3, P<.001), 3.6 (95\% CI 3.2?4.1, P<.001) times higher than the never users, and 2.4 (95\% CI 1.8?3.1, P<.001) times higher compared to former smokers who now use ST. The IRR among the ST group relative to never users was 1.4 (95\% CI 1.1?1.9, P=.02). The IRR between former smokers who now use ST and those who quit was 1.4 (95\% CI 1.0?2.1, P=.08). Conclusions: Findings from this population-based study with a large number of oral cancer cases support significantly high oral cancer incidence among adults who smoke and a lower risk of oral cancer incidence among never users, quitters, users of ST, and former smokers who now use ST compared to cigarettes. Future studies with detailed control of tobacco history and other relevant confounders are needed to confirm these findings. ", doi="10.2196/51936", url="https://cancer.jmir.org/2024/1/e51936" } @Article{info:doi/10.2196/54162, author="Stimpson, P. Jim and Park, Sungchul and Pruitt, L. Sandi and Ortega, N. Alexander", title="Variation in Trust in Cancer Information Sources by Perceptions of Social Media Health Mis- and Disinformation and by Race and Ethnicity Among Adults in the United States: Cross-Sectional Study", journal="JMIR Cancer", year="2024", month="May", day="8", volume="10", pages="e54162", keywords="cancer", keywords="United States", keywords="cross-sectional study", keywords="trust", keywords="consumer health information", keywords="misinformation", keywords="disinformation", keywords="race", keywords="ethnicity", keywords="cancer information", keywords="source", keywords="sources", keywords="perception", keywords="perceptions", keywords="social media", keywords="health information", keywords="cross-sectional data", keywords="misleading", abstract="Background: Mis- and disinformation on social media have become widespread, which can lead to a lack of trust in health information sources and, in turn, lead to negative health outcomes. Moreover, the effect of mis- and disinformation on trust in information sources may vary by racial and ethnic minoritized populations. Objective: We evaluated how trust in multiple sources of cancer information varied by perceptions of health mis- and disinformation on social media and by race and ethnicity. Methods: Cross-sectional, nationally representative survey data from noninstitutionalized adults in the United States from the 2022 Health Information National Trends Survey 6 (HINTS 6) were analyzed (N=4137). The dependent variable measured the level of trust in cancer information sources. The independent variables were perceptions about health mis- and disinformation on social media and race and ethnicity. Multivariable logistic regression models were adjusted for survey weight and design, age, birth gender, race and ethnicity, marital status, urban/rural designation, education, employment status, feelings about household income, frequency of social media visits, and personal and family history of cancer. We also tested the interaction effect between perceptions of social media health mis- and disinformation and participants' self-reported race and ethnicity. Results: Perception of ``a lot of'' health mis- and disinformation on social media, relative to perception of ``less than a lot,'' was associated with a lower likelihood of high levels of trusting cancer information from government health agencies (odds ratio [OR] 0.60, 95\% CI 0.47-0.77), family or friends (OR 0.56, 95\% CI 0.44-0.71), charitable organizations (OR 0.78, 95\% CI 0.63-0.96), and religious organizations and leaders (OR 0.64, 95\% CI 0.52-0.79). Among White participants, those who perceived a lot of health mis- and disinformation on social media were less likely to have high trust in cancer information from government health agencies (margin=61\%, 95\% CI 57\%-66\%) and family or friends (margin=49\%, 95\% CI 43\%-55\%) compared to those who perceived less than a lot of health mis- and disinformation on social media. Among Black participants, those who perceived a lot of health mis- and disinformation on social media were less likely to have high trust in cancer information from religious organizations and leaders (margin=20\%, 95\% CI 10\%-30\%) compared to participants who perceived no or a little health mis- and disinformation on social media. Conclusions: Certain sources of cancer information may need enhanced support against the threat of mis- and disinformation, such as government health agencies, charitable organizations, religious organizations and leaders, and family or friends. Moreover, interventions should partner with racial and ethnically minoritized populations that are more likely to have low trust in certain cancer information sources associated with mis- and disinformation on social media. ", doi="10.2196/54162", url="https://cancer.jmir.org/2024/1/e54162", url="http://www.ncbi.nlm.nih.gov/pubmed/38717800" } @Article{info:doi/10.2196/53354, author="Zheng, Yue and Zhao, Ailin and Yang, Yuqi and Wang, Laduona and Hu, Yifei and Luo, Ren and Wu, Yijun", title="Real-World Survival Comparisons Between Radiotherapy and Surgery for Metachronous Second Primary Lung Cancer and Predictions of Lung Cancer--Specific Outcomes Using Machine Learning: Population-Based Study", journal="JMIR Cancer", year="2024", month="Jun", day="12", volume="10", pages="e53354", keywords="metachronous second primary lung cancer", keywords="radiotherapy", keywords="surgical resection", keywords="propensity score matching analysis", keywords="machine learning", abstract="Background: Metachronous second primary lung cancer (MSPLC) is not that rare but is seldom studied. Objective: We aim to compare real-world survival outcomes between different surgery strategies and radiotherapy for MSPLC. Methods: This retrospective study analyzed data collected from patients with MSPLC between 1988 and 2012 in the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) analyses and machine learning were performed to compare variables between patients with MSPLC. Survival curves were plotted using the Kaplan-Meier method and were compared using log-rank tests. Results: A total of 2451 MSPLC patients were categorized into the following treatment groups: 864 (35.3\%) received radiotherapy, 759 (31\%) underwent surgery, 89 (3.6\%) had surgery plus radiotherapy, and 739 (30.2\%) had neither treatment. After PSM, 470 pairs each for radiotherapy and surgery were generated. The surgery group had significantly better survival than the radiotherapy group (P<.001) and the untreated group (563 pairs; P<.001). Further analysis revealed that both wedge resection (85 pairs; P=.004) and lobectomy (71 pairs; P=.002) outperformed radiotherapy in overall survival for MSPLC patients. Machine learning models (extreme gradient boosting, random forest classifier, adaptive boosting) demonstrated high predictive performance based on area under the curve (AUC) values. Least absolute shrinkage and selection operator (LASSO) regression analysis identified 9 significant variables impacting cancer-specific survival, emphasizing surgery's consistent influence across 1 year to 10 years. These variables encompassed age at diagnosis, sex, year of diagnosis, radiotherapy of initial primary lung cancer (IPLC), primary site, histology, surgery, chemotherapy, and radiotherapy of MPSLC. Competing risk analysis highlighted lower mortality for female MPSLC patients (hazard ratio [HR]=0.79, 95\% CI 0.71-0.87) and recent IPLC diagnoses (HR=0.79, 95\% CI 0.73-0.85), while radiotherapy for IPLC increased mortality (HR=1.31, 95\% CI 1.16-1.50). Surgery alone had the lowest cancer-specific mortality (HR=0.83, 95\% CI 0.81-0.85), with sublevel resection having the lowest mortality rate among the surgical approaches (HR=0.26, 95\% CI 0.21-0.31). The findings provide valuable insights into the factors that influence cumulative cancer-specific mortality. Conclusions: Surgical resections such as wedge resection and lobectomy confer better survival than radiation therapy for MSPLC, but radiation can be a valid alternative for the treatment of MSPLC. ", doi="10.2196/53354", url="https://cancer.jmir.org/2024/1/e53354", url="http://www.ncbi.nlm.nih.gov/pubmed/38865182" } @Article{info:doi/10.2196/52018, author="Snyder, Jeremy and Zenone, Marco and Grewal, Ashmita and Caulfield, Timothy", title="Crowdfunding for Complementary and Alternative Cancer Treatments in Tijuana, Mexico: Content Analysis", journal="JMIR Cancer", year="2024", month="Aug", day="14", volume="10", pages="e52018", keywords="cancer", keywords="crowdfunding", keywords="Tijuana", keywords="CAM", keywords="patient", keywords="patients", keywords="insurance", keywords="crowdfunding platforms", keywords="GoFundMe", keywords="GiveSendGo", keywords="cancer clinic", keywords="Mexico", keywords="campaigns", keywords="cancer treatment", keywords="medical intervention", keywords="CAM cancer treatments", keywords="misinformation", keywords="alternate care", keywords="women's health", keywords="internet research", keywords="international medical tourism", keywords="alternative cancer therapy", keywords="financial toxicity", abstract="Background: Complementary and alternative (CAM) cancer treatment is often expensive and not covered by insurance. As a result, many people turn to crowdfunding to access this treatment. Objective: The aim of this study is to identify the rationales of patients with cancer seeking CAM treatment abroad by looking specifically at crowdfunding campaigns to support CAM cancer treatment in Tijuana, Mexico. Methods: We scraped the GoFundMe.com and GiveSendGo.com crowdfunding platforms for campaigns referencing CAM cancer clinics in Tijuana, initiated between January 1, 2022, and February 28, 2023. The authors created a coding framework to identify rationales for seeking CAM treatment in Tijuana. To supplement campaign metadata, we coded the beneficiary's cancer stage, type, age, specific treatment sought, whether the beneficiary died, gender, and race. Results: Patients sought CAM cancer treatment in Tijuana because the (1) treatment offers the greatest efficacy (29.9\%); (2) treatment offered domestically was not curative (23.2\%); (3) the clinic treats the whole person, and addresses the spiritual dimension of the person (20.1\%); (4) treatments are nontoxic, natural, or less invasive (18.2\%); and (5) clinic offers the newest technology (8.5\%). Campaigns raised US \$5,275,268.37 and most campaign beneficiaries were women (69.7\%) or White individuals (71.1\%). Conclusions: These campaigns spread problematic misinformation about the likely efficacy of CAM treatments, funnel money and endorsements to CAM clinics in Tijuana, and leave many campaigners short of the money needed to pay for CAM treatments while costing beneficiaries and their loved one's time, privacy, and dignity. This study affirms that Tijuana, Mexico, is a very popular destination for CAM cancer treatment. ", doi="10.2196/52018", url="https://cancer.jmir.org/2024/1/e52018" } @Article{info:doi/10.2196/54740, author="Islam, Nazmul and Reuben, S. Jamie and Dale, Justin and Coates, W. James and Sapiah, Karan and Markson, R. Frank and Jordan, T. Craig and Smith, Clay", title="Predictive Models for Long Term Survival of AML Patients Treated with Venetoclax and Azacitidine or 7+3 Based on Post Treatment Events and Responses: Retrospective Cohort Study", journal="JMIR Cancer", year="2024", month="Aug", day="21", volume="10", pages="e54740", keywords="Leukemia, Myeloid, Acute", keywords="Venetoclax", keywords="Azacitidine", keywords="Anthracycline", keywords="Arabinoside, Cytosine", keywords="Clinical Decision Support", keywords="Clinical Informatics", keywords="Machine Learning", keywords="Predictive Model", keywords="Overall Survival", abstract="Background: The treatment of acute myeloid leukemia (AML) in older or unfit patients typically involves a regimen of venetoclax plus azacitidine (ven/aza). Toxicity and treatment responses are highly variable following treatment initiation and clinical decision-making continually evolves in response to these as treatment progresses. To improve clinical decision support (CDS) following treatment initiation, predictive models based on evolving and dynamic toxicities, disease responses, and other features should be developed. Objective: This study aims to generate machine learning (ML)--based predictive models that incorporate individual predictors of overall survival (OS) for patients with AML, based on clinical events occurring after the initiation of ven/aza or 7+3 regimen. Methods: Data from 221 patients with AML, who received either the ven/aza (n=101 patients) or 7+3 regimen (n=120 patients) as their initial induction therapy, were retrospectively analyzed. We performed stratified univariate and multivariate analyses to quantify the association between toxicities, hospital events, and short-term disease responses and OS for the 7+3 and ven/aza subgroups separately. We compared the estimates of confounders to assess potential effect modifications by treatment. 17 ML-based predictive models were developed. The optimal predictive models were selected based on their predictability and discriminability using cross-validation. Uncertainty in the estimation was assessed through bootstrapping. Results: The cumulative incidence of posttreatment toxicities varies between the ven/aza and 7+3 regimen. A variety of laboratory features and clinical events during the first 30 days were differentially associated with OS for the two treatments. An initial transfer to intensive care unit (ICU) worsened OS for 7+3 patients (aHR 1.18, 95\% CI 1.10-1.28), while ICU readmission adversely affected OS for those on ven/aza (aHR 1.24, 95\% CI 1.12-1.37). At the initial follow-up, achieving a morphologic leukemia free state (MLFS) did not affect OS for ven/aza (aHR 0.99, 95\% CI 0.94-1.05), but worsened OS following 7+3 (aHR 1.16, 95\% CI 1.01-1.31) compared to that of complete remission (CR). Having blasts over 5\% at the initial follow-up negatively impacted OS for both 7+3 (P<.001) and ven/aza (P<.001) treated patients. A best response of CR and CR with incomplete recovery (CRi) was superior to MLFS and refractory disease after ven/aza (P<.001), whereas for 7+3, CR was superior to CRi, MLFS, and refractory disease (P<.001), indicating unequal outcomes. Treatment-specific predictive models, trained on 120 7+3 and 101 ven/aza patients using over 114 features, achieved survival AUCs over 0.70. Conclusions: Our findings indicate that toxicities, clinical events, and responses evolve differently in patients receiving ven/aza compared with that of 7+3 regimen. ML-based predictive models were shown to be a feasible strategy for CDS in both forms of AML treatment. If validated with larger and more diverse data sets, these findings could offer valuable insights for developing AML-CDS tools that leverage posttreatment clinical data. ", doi="10.2196/54740", url="https://cancer.jmir.org/2024/1/e54740" } @Article{info:doi/10.2196/60323, author="Janbain, Ali and Farolfi, Andrea and Guenegou-Arnoux, Armelle and Romengas, Louis and Scharl, Sophia and Fanti, Stefano and Serani, Francesca and Peeken, C. Jan and Katsahian, Sandrine and Strouthos, Iosif and Ferentinos, Konstantinos and Koerber, A. Stefan and Vogel, E. Marco and Combs, E. Stephanie and Vrachimis, Alexis and Morganti, Giuseppe Alessio and Spohn, KB Simon and Grosu, Anca-Ligia and Ceci, Francesco and Henkenberens, Christoph and Kroeze, GC Stephanie and Guckenberger, Matthias and Belka, Claus and Bartenstein, Peter and Hruby, George and Emmett, Louise and Omerieh, Afshar Ali and Schmidt-Hegemann, Nina-Sophie and Mose, Lucas and Aebersold, M. Daniel and Zamboglou, Constantinos and Wiegel, Thomas and Shelan, Mohamed", title="A Machine Learning Approach for Predicting Biochemical Outcome After PSMA-PET--Guided Salvage Radiotherapy in Recurrent Prostate Cancer After Radical Prostatectomy: Retrospective Study", journal="JMIR Cancer", year="2024", month="Sep", day="20", volume="10", pages="e60323", keywords="cancer", keywords="oncologist", keywords="metastases", keywords="prostate", keywords="prostate cancer", keywords="prostatectomy", keywords="salvage radiotherapy", keywords="PSMA-PET", keywords="prostate-specific membrane antigen--positron emission tomography", keywords="prostate-specific membrane antigen", keywords="PET", keywords="positron emission tomography", keywords="radiotherapy", keywords="radiology", keywords="radiography", keywords="machine learning", keywords="ML", keywords="artificial intelligence", keywords="AI", keywords="algorithm", keywords="algorithms", keywords="predictive model", keywords="predictive models", keywords="predictive analytics", keywords="predictive system", keywords="practical model", keywords="practical models", keywords="deep learning", abstract="Background: Salvage radiation therapy (sRT) is often the sole curative option in patients with biochemical recurrence after radical prostatectomy. After sRT, we developed and validated a nomogram to predict freedom from biochemical failure. Objective: This study aims to evaluate prostate-specific membrane antigen--positron emission tomography (PSMA-PET)--based sRT efficacy for postprostatectomy prostate-specific antigen (PSA) persistence or recurrence. Objectives include developing a random survival forest (RSF) model for predicting biochemical failure, comparing it with a Cox model, and assessing predictive accuracy over time. Multinational cohort data will validate the model's performance, aiming to improve clinical management of recurrent prostate cancer. Methods: This multicenter retrospective study collected data from 13 medical facilities across 5 countries: Germany, Cyprus, Australia, Italy, and Switzerland. A total of 1029 patients who underwent sRT following PSMA-PET--based assessment for PSA persistence or recurrence were included. Patients were treated between July 2013 and June 2020, with clinical decisions guided by PSMA-PET results and contemporary standards. The primary end point was freedom from biochemical failure, defined as 2 consecutive PSA rises >0.2 ng/mL after treatment. Data were divided into training (708 patients), testing (271 patients), and external validation (50 patients) sets for machine learning algorithm development and validation. RSF models were used, with 1000 trees per model, optimizing predictive performance using the Harrell concordance index and Brier score. Statistical analysis used R Statistical Software (R Foundation for Statistical Computing), and ethical approval was obtained from participating institutions. Results: Baseline characteristics of 1029 patients undergoing sRT PSMA-PET--based assessment were analyzed. The median age at sRT was 70 (IQR 64-74) years. PSMA-PET scans revealed local recurrences in 43.9\% (430/979) and nodal recurrences in 27.2\% (266/979) of patients. Treatment included dose-escalated sRT to pelvic lymphatics in 35.6\% (349/979) of cases. The external outlier validation set showed distinct features, including higher rates of positive lymph nodes (47/50, 94\% vs 266/979, 27.2\% in the learning cohort) and lower delivered sRT doses (<66 Gy in 57/979, 5.8\% vs 46/50, 92\% of patients; P<.001). The RSF model, validated internally and externally, demonstrated robust predictive performance (Harrell C-index range: 0.54-0.91) across training and validation datasets, outperforming a previously published nomogram. Conclusions: The developed RSF model demonstrates enhanced predictive accuracy, potentially improving patient outcomes and assisting clinicians in making treatment decisions. ", doi="10.2196/60323", url="https://cancer.jmir.org/2024/1/e60323" } @Article{info:doi/10.2196/53229, author="Ewing, P. Aldenise and Tounkara, Fode and Marshall, Daniel and Henry, V. Abhishek and Abdel-Rasoul, Mahmoud and McElwain, Skylar and Clark, Justice and Hefner, L. Jennifer and Zaire, J. Portia and Nolan, S. Timiya and Tarver, L. Willi and Doubeni, A. Chyke", title="Examining Racial Disparities in Colorectal Cancer Screening and the Role of Online Medical Record Use: Findings From a Cross-Sectional Study of a National Survey", journal="JMIR Cancer", year="2024", month="Dec", day="4", volume="10", pages="e53229", keywords="colorectal cancer", keywords="cancer screening", keywords="early detection", keywords="Health Information National Trends Survey", keywords="cancer disparities", keywords="online medical records", keywords="secondary data analysis", abstract="Background: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States. Early detection via routine CRC screening can significantly lower risks for CRC-specific morbidity and mortality. Public health initiatives between 2000 and 2015 nearly doubled CRC screening rates for some US adults. However, screening rates remain lowest for adults aged 45?49 years (20\%), patients of safety net health care facilities (42\%), adults without insurance (44\%), and other subgroups compared with national averages (72\%). Given the evolving landscape of digital health care and trends in web-based health information--seeking behaviors, leveraging online medical record (OMR) systems may be an underutilized resource to promote CRC screening utilization. Recognizing trends in OMR usage and patient demographics may enhance digital inclusion---a key social determinant of health---and support equitable web-based interventions aimed at boosting CRC screening across diverse populations. Objective: This study examined the association of accessing an OMR with CRC screening utilization and corresponding sociodemographic characteristics of US adults. Methods: In 2023, we conducted a secondary data analysis using a pooled, weighted sample from Health Information National Trends Survey (HINTS) 5 cycles, 2, 3, and 4 (2018?2020), a nationally representative survey assessing how US adults access and use health-related information. We analyzed the association between sociodemographic characteristics, medical conditions, OMR access, and CRC screening behaviors via logistic regression. Results: The sample included adults aged 45?75 years (N=5143). The mean age was 59 (SD 8) years for those who reported CRC screening and 52 (SD 6) years for those never screened. Nearly 70\% (4029/5143) of participants reported CRC screening and 52\% (2707/5143) reported OMR access in the past year. Adjusted odds of CRC screening were higher among non-Hispanic African American or Black adults than among non-Hispanic White adults (odds ratio [OR] 1.76, 95\% CI 1.22?2.53), adults who accessed an OMR (OR 1.89, 95\% CI 1.45?2.46), older individuals (OR 1.18, 95\% CI 1.16?1.21), the insured (OR 3.69, 95\% CI 2.34?5.82), and those with a professional or graduate degree versus those with a high school diploma or less (OR 2.65, 95\% CI 1.28?5.47). Individuals aged 65?75 years were significantly more likely (P<.001) to be screened (1687/1831, 91\%) than those aged 45?49 years (190/610, 29\%). Conclusions: Promoting OMR access, especially among the most disadvantaged Americans, may assist in reaching national screening goals. Emphasis should be placed on the mutability of OMR use compared with most other statistically significant associations with CRC screening behaviors. OMR access provides an intervenable means of promoting CRC education and screening, especially among those facing structural barriers to cancer diagnoses and care. Future research should focus on tailored and accessible interventions that expand OMR access, particularly for younger populations. ", doi="10.2196/53229", url="https://cancer.jmir.org/2024/1/e53229" } @Article{info:doi/10.2196/50402, author="Cheng, Vienna and Sayre, C. Eric and Cheng, Vicki and Garg, Ria and Gill, Sharlene and Farooq, Ameer and De Vera, A. Mary", title="Patterns of Prescription Medication Use Before Diagnosis of Early Age-Onset Colorectal Cancer: Population-Based Descriptive Study", journal="JMIR Cancer", year="2024", month="Jul", day="12", volume="10", pages="e50402", keywords="colorectal cancer", keywords="medications", keywords="medication patterns", keywords="cancer diagnosis", keywords="prediagnosis", keywords="prescriptions", keywords="patterns", keywords="early-onset", keywords="population-based", keywords="incidence", keywords="male individuals", keywords="female individuals", keywords="health databases", keywords="pharmacology", keywords="diagnostic", keywords="descriptive study", keywords="gastroenterology", keywords="cancers", abstract="Background: Colorectal cancer (CRC) is estimated to be the fourth most common cancer diagnosis in Canada (except for nonmelanoma skin cancers) and the second and third leading cause of cancer-related death in male and female individuals, respectively. Objective: The rising incidence of early age-onset colorectal cancer (EAO-CRC; diagnosis at less than 50 years) calls for a better understanding of patients' pathway to diagnosis. Therefore, we evaluated patterns of prescription medication use before EAO-CRC diagnosis. Methods: We used linked administrative health databases in British Columbia (BC), Canada, to identify individuals diagnosed with EAO-CRC between January 1, 2010, and December 31, 2016 (hereinafter referred to as ``cases''), along with cancer-free controls (1:10), matched by age and sex. We identified all prescriptions dispensed from community pharmacies during the year prior to diagnosis and used the Anatomical Therapeutic Chemical Classification system Level 3 to group prescriptions according to the drug class. A parallel assessment was conducted for individuals diagnosed with average age-onset CRC (diagnosis at age 50 years and older). Results: We included 1001 EAO-CRC cases (n=450, 45\% female participants; mean 41.0, SD 6.1 years), and 12,989 prescriptions were filled in the year before diagnosis by 797 (79.7\%) individuals. Top-filled drugs were antidepressants (first; n=1698, 13.1\%). Drugs for peptic ulcer disease and gastroesophageal reflux disease (third; n=795, 6.1\%) were more likely filled by EAO-CRC cases than controls (odds ratio [OR] 1.4, 95\% CI 1.2-1.7) and with more frequent fills (OR 1.8, 95\% CI 1.7-1.9). We noted similar patterns for topical agents for hemorrhoids and anal fissures, which were more likely filled by EAO-CRC cases than controls (OR 7.4, 95\% CI 5.8-9.4) and with more frequent fills (OR 15.6, 95\% CI 13.1-18.6). Conclusions: We observed frequent prescription medication use in the year before diagnosis of EAO-CRC, including for drugs to treat commonly reported symptoms of EAO-CRC. ", doi="10.2196/50402", url="https://cancer.jmir.org/2024/1/e50402" } @Article{info:doi/10.2196/52577, author="Scott, E. Suzanne and Thompson, J. Matthew", title="``Notification! You May Have Cancer.'' Could Smartphones and Wearables Help Detect Cancer Early?", journal="JMIR Cancer", year="2024", month="May", day="20", volume="10", pages="e52577", keywords="wearables", keywords="early diagnosis", keywords="cancer", keywords="challenges", keywords="diagnosis", keywords="wearable", keywords="detect", keywords="detection", keywords="smartphone", keywords="cancer diagnosis", keywords="symptoms", keywords="monitoring", keywords="monitor", keywords="implementation", keywords="anxiety", keywords="health care service", keywords="mobile phone", doi="10.2196/52577", url="https://cancer.jmir.org/2024/1/e52577", url="http://www.ncbi.nlm.nih.gov/pubmed/38767941" } @Article{info:doi/10.2196/57276, author="Garcia-Saiso, Sebastian and Marti, Myrna and Pesce, Karina and Luciani, Silvana and Mujica, Oscar and Hennis, Anselm and D'Agostino, Marcelo", title="Artificial Intelligence as a Potential Catalyst to a More Equitable Cancer Care", journal="JMIR Cancer", year="2024", month="Aug", day="12", volume="10", pages="e57276", keywords="digital health", keywords="public health", keywords="cancer", keywords="artificial intelligence", keywords="AI", keywords="catalyst", keywords="cancer care", keywords="cost", keywords="costs", keywords="demographic", keywords="epidemiological", keywords="change", keywords="changes", keywords="healthcare", keywords="equality", keywords="health system", keywords="mHealth", keywords="mobile health", doi="10.2196/57276", url="https://cancer.jmir.org/2024/1/e57276", url="http://www.ncbi.nlm.nih.gov/pubmed/39133537" } @Article{info:doi/10.2196/56935, author="McLoughlin, E. Daniel and Moreno Echevarria, M. Fabiola and Badawy, M. Sherif", title="Lessons Learned From Shared Decision-Making With Oral Anticoagulants: Viewpoint on Suggestions for the Development of Oral Chemotherapy Decision Aids", journal="JMIR Cancer", year="2024", month="Sep", day="11", volume="10", pages="e56935", keywords="shared decision-making", keywords="SDM", keywords="decision aids", keywords="decision aids design", keywords="oral chemotherapy", keywords="oral anticoagulants", keywords="drug delivery", keywords="chemotherapy", keywords="chemo", keywords="anticoagulants", keywords="drug deliveries", keywords="cancer", keywords="oncology", keywords="oncologist", keywords="metastases", keywords="literature review", keywords="literature reviews", doi="10.2196/56935", url="https://cancer.jmir.org/2024/1/e56935", url="http://www.ncbi.nlm.nih.gov/pubmed/39187430" } @Article{info:doi/10.2196/57199, author="Jafari, Mahtab and Shahverdian, Alex and Sadigh, Gelareh and Van Etten, A. Richard", title="Impact of Patient Personality on Adherence to Oral Anticancer Medications: An Opportunity?", journal="JMIR Cancer", year="2024", month="Oct", day="30", volume="10", pages="e57199", keywords="cancer", keywords="medication adherence", keywords="medication persistence", keywords="Five-Factor Model", keywords="Type D personality", keywords="oncology", keywords="cancer medications", keywords="oral anticancer therapy", keywords="chemotherapy", doi="10.2196/57199", url="https://cancer.jmir.org/2024/1/e57199" } @Article{info:doi/10.2196/52501, author="Brondfield, Sam and Schwede, Matthew and Johnson, P. Tyler and Arora, Shagun", title="Web-Based Scaffolds: The Feasibility of a Constructivist Approach to Oncology Fellow Learning", journal="JMIR Cancer", year="2024", month="Feb", day="23", volume="10", pages="e52501", keywords="constructivist learning", keywords="scaffolded learning", keywords="graduate medical education", keywords="fellowship training", keywords="oncology", keywords="feasibility", keywords="medical education", keywords="pilot study", keywords="study", keywords="online learning", keywords="online tool", keywords="online tools", keywords="remote learning", keywords="e-learning", keywords="training", keywords="cancer", doi="10.2196/52501", url="https://cancer.jmir.org/2024/1/e52501", url="http://www.ncbi.nlm.nih.gov/pubmed/38393780" }