%0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e71062 %T Perception and Counseling for Cardiac Health in Breast Cancer Survivors Using the Health Belief Model: Qualitative Analysis %A Marrison,Sarah Tucker %A Shungu,Nicholas %A Diaz,Vanessa %K cardiovascular health %K cancer survivorship %K lifestyle counseling %K breast cancer %K cancer survivors %D 2025 %7 3.7.2025 %9 %J JMIR Cancer %G English %X Background: Breast cancer survivors have increased cardiovascular risk compared to those without cancer history. Cardiovascular disease is the most common cause of death in breast cancer survivors. Cardiovascular risk in breast cancer survivors is impacted by both cancer treatment–associated effects and in risk factors for breast cancer and cardiovascular disease overlap. Strategies to improve screening for and management of cardiovascular disease in breast cancer survivors are needed to improve the delivery of survivorship care. Objective: This study aims to assess current cardiovascular risk counseling practices and perceived cardiovascular risk in breast cancer survivors. Methods: Semistructured interviews were conducted from May to December 2021 with breast cancer survivors identified as having a primary care clinician within an academic family medicine center in Charleston, South Carolina. The interview guide and content were developed using the Health Belief Model with a focus on cardiovascular risk behaviors, risk perception, and barriers to risk reduction. Analysis of categorical data was conducted by frequency and quantitative variables by mean and SD. Template analysis was performed for qualitative analysis. Outcome measures included self-reported history of cardiovascular disease, risk perception, and risk behaviors. Results: The average age of participants (n=19) was 54 (SD 7) years; 68% (13/19) were White and 32% (6/19) were Black or African American. Of the interviewed women, 90% (17/19) reported a personal history and 90% (17/19) reported a family history of cardiovascular disease. Only 53% (10/19) had previously reported receipt of cardiovascular counseling. Primary care most commonly provided counseling, followed by oncology. Among breast cancer survivors, 32% (6/19) reported being at increased cardiovascular risk, and 47% (9/19) were unsure of their relative cardiovascular risk. Factors affecting perceived cardiovascular risk included family history, cancer treatments, cardiovascular diagnoses, and lifestyle factors. Video (15/19, 79%) and SMS text messaging (13/19, 68%) were the most highly reported mechanisms through which breast cancer survivors requested to receive additional information and counseling on cardiovascular risk and risk reduction. Commonly reported barriers to risk reduction such as physical activity included time for meal planning and exercise, resources to support dietary and exercise changes, physical limitations, and competing responsibilities. Barriers specific to survivorship status included concerns for immune status during the COVID-19 pandemic, physical limitations associated with cancer treatment, and psychosocial aspects of cancer survivorship. Conclusions: Breast cancer survivors identified that factors associated with their cancer diagnosis and treatment both impacted their cardiovascular risk and introduced additional barriers to risk reduction. Potential strategies to improve counseling and awareness around cardiovascular risk include video and messaging platforms. Further risk reduction strategies should consider the unique challenges of cancer survivorship in delivery and implementation. %R 10.2196/71062 %U https://cancer.jmir.org/2025/1/e71062 %U https://doi.org/10.2196/71062 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e71596 %T Family Experiences, Needs, and Perceptions in Home-Based Hospice Care for Patients With Terminal Cancer: Meta-Synthesis and Systematic Review %A Deng,Xin Ming %A Hounsri,Kanokwan %A Lopez,Violeta %A Tam,Wilson Wai-San %K palliative %K hospice %K home care %K cancer %K meta-synthesis. %D 2025 %7 19.6.2025 %9 %J JMIR Cancer %G English %X Background: Home-based hospice care offers patients with terminal cancer the comfort of receiving care in a familiar environment while enabling family members to provide personalised support. Despite the critical role families play, the literature remains underexplored in terms of their experiences, needs, and perceptions. A robust qualitative synthesis is needed to inform improvements in palliative care services. Objective: This meta-synthesis aims to systematically review and synthesize qualitative evidence regarding the experiences, needs, and perceptions of family caregivers in home-based hospice care for patients with terminal cancer. The goal is identifying key themes that can improve caregiver support and service delivery. Methods: A systematic search was conducted across MEDLINE, Embase, Scopus, PsycINFO, CINAHL, Google Scholar, and relevant gray literature sources up to March 14, 2025. Studies were included if they focused on family caregivers’ experiences in home-based hospice care settings, excluding those that addressed only patients or health care providers. Two independent reviewers performed study selection, data extraction, and quality assessment using the Critical Appraisal Skills Programme checklist. Data were synthesized using a 3-step thematic synthesis approach, and the confidence in the findings was assessed via the GRADE-CERQual (Grading of Recommendations Assessment, Development, and Evaluation–Confidence in the Evidence from Reviews of Qualitative Research) framework. Results: Five studies published between 1989 and 2022 from diverse geographical regions (including Asia and Western settings) met the inclusion criteria. Two major themes emerged: (1) being physically and emotionally present, where caregivers expressed a strong commitment to remain with their loved ones, providing emotional support and maintaining a sense of control; and (2) sharing responsibilities, which underscored the importance of both formal support from palliative care teams and informal support from family and friends in mitigating caregiver burden. These findings directly address the study’s aims by illustrating how caregivers balance emotional commitment with the practical challenges of providing home-based care. Conclusions: Although family caregivers are dedicated to delivering high-quality, personalized care, they encounter significant emotional and logistical challenges. Variability in study settings, potential recall bias from retrospective interviews, and limited gray literature access may affect the generalizability of the findings. This meta-synthesis underscores the essential role of family involvement in home-based hospice care for patients with terminal cancer. The combined reliance on emotional commitment and shared responsibilities—with support from professional care teams—is vital for optimal care delivery. Future interventions should enhance formal and informal support systems to meet family caregivers’ diverse needs better. Trial Registration: PROSPERO CRD42023486012; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023486012 %R 10.2196/71596 %U https://cancer.jmir.org/2025/1/e71596 %U https://doi.org/10.2196/71596 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65278 %T Digital Behavior Change Interventions to Promote Physical Activity and Reduce Sedentary Behavior Among Survivors of Breast Cancer: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Zhang,Xiaoyan %A Fang,Jiaxin %A Hao,Yufang %A Yang,Dan %A Luo,Jiayin %A Li,Xin %+ Department of Nursing, Beijing Hospital, National Center of Gerontology; Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, 1 Dahua Road, Dongcheng District, Dongdan, Beijing, 100730, China, 86 13701217515, 13701217515@163.com %K breast cancer %K digital behavior change intervention %K physical activity %K sedentary behavior %K systematic review %K meta-analysis %D 2025 %7 19.6.2025 %9 Review %J J Med Internet Res %G English %X Background: Survivors of breast cancer often face challenges in maintaining physical activity (PA) and reducing sedentary behavior (SB), which are crucial for recovery and long-term health. Digital behavior change interventions (DBCIs) have emerged as promising tools to address these behavioral targets. Objective: This systematic review and meta-analysis aimed to assess the effectiveness of DBCIs in promoting PA and reducing SB among survivors of breast cancer. Methods: A comprehensive search of 10 databases—PubMed, Embase, PsycINFO, the Cochrane Library, CINAHL, Web of Science, the China National Knowledge Infrastructure database, the Wanfang database, the VIP database, and the Sedentary Behavior Research Database—was conducted to identify eligible randomized controlled trials that investigated the effectiveness of DBCIs in promoting PA and reducing SB among survivors of breast cancer. Study quality was assessed using the Cochrane Risk-of-Bias tool. Data synthesis was conducted via Review Manager. Owing to anticipated heterogeneity, a random-effects meta-analysis was used. The evidence quality was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. Results: A total of 29 randomized controlled trials involving 2229 participants met the inclusion criteria. Most DBCIs were delivered at the interpersonal level using common behavior change techniques, including social support (unspecified), instruction on how to perform the behavior, demonstration of the behavior, action planning, and problem-solving. Meta-analysis revealed that DBCIs significantly improved shoulder range of motion across all planes (flexion: standardized mean difference [SMD]=2.08, 95% CI 1.14-3.01; P<.001; extension: SMD=1.74, 95% CI 0.79-2.70; P<.001; abduction: SMD=2.32, 95% CI 1.35-3.28; P<.001; external rotation: SMD=2.29, 95% CI 0.96-3.62; P<.001; internal rotation: SMD=2.98, 95% CI 1.08-4.87; P=.002; adduction: SMD=2.09, 95% CI 1.16-3.02; P<.001), finger climbing wall height (SMD=1.65, 95% CI 1.35-1.95; P<.001), upper-extremity function (SMD=−0.96, 95% CI −1.50 to −0.42; P<.001), quality of life (SMD=1.83, 95% CI 0.44-3.22; P=.01), and reduced pain (SMD=−0.58, 95% CI −0.93 to −0.22; P=.002). However, no significant differences were found in steps (P=.69), time spent in light PA (P=.51), time spent in moderate to vigorous PA (P=.43), sedentary time (P=.18), or physical function (P=.71 or .11). Conclusions: DBCIs effectively improve upper-body mobility, function, quality of life, and pain management in survivors of breast cancer. Future research should explore multilevel DBCIs specifically designed to address whole-body PA and SB reduction, with effectiveness evaluated through methodologically rigorous, large-scale trials. Trial Registration: PROSPERO CRD42023448098; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023448098 %M 40537089 %R 10.2196/65278 %U https://www.jmir.org/2025/1/e65278 %U https://doi.org/10.2196/65278 %U http://www.ncbi.nlm.nih.gov/pubmed/40537089 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e70472 %T Comparing the Accuracy of Different Wearable Activity Monitors in Patients With Lung Cancer and Providing Initial Recommendations: Protocol for a Pilot Validation Study %A Benzo,Roberto M %A Singh,Rujul %A Presley,Carolyn J %A Tetrick,Macy K %A Chaplow,Zachary L %A Hery,Chloe M %A Yu,Jane %A Washington,Peter %A Penedo,Frank J %A Paskett,Electra D %A Lugade,Vipul %A Fortune,Emma %+ Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State Comprehensive Cancer Center, College of Medicine, The Ohio State University Wexner Medical Center, 3650 Olentangy River Rd, Suite 200, Columbus, OH, 43214, United States, 1 614) 293 3675, roberto.benzo@osumc.edu %K physical activity monitoring %K wearable devices %K validation study %K lung cancer %K consumer technology %K Fitbit %K ActiGraph %K activPAL3 micro %K cancer survivorship %K digital health %D 2025 %7 19.6.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Wearable activity monitors (WAMs) provide insights into physical activity (PA) and are widely used in behavioral interventions and cancer survivorship research. However, validation studies of wearable devices in populations with cancer are scarce, and existing studies using activity monitors in patients with cancer lack standardization. This gap is particularly significant in patients with lung cancer (LC), who often experience unique mobility challenges and gait impairments that may affect device accuracy. This study addresses this gap by validating the Fitbit Charge 6, ActiGraph LEAP, and activPAL3 micro in patients with LC in both laboratory and free-living conditions and developing a standardized framework for assessing wearable devices in populations with cancer and impaired mobility. Objective: This study aims to validate and compare the accuracy of consumer-grade (Fitbit Charge 6) and research-grade (activPAL3 micro and ActiGraph LEAP) WAMs in patients with LC under both laboratory and free-living conditions. Moreover, this protocol aims to establish standardized procedures that can be adapted for validating current and future generations of wearable devices while accounting for disease-specific factors that may impact measurement accuracy. Methods: In total, 15 adults diagnosed with LC (stages 1-4) will participate in laboratory and free-living protocols, wearing Fitbit Charge 6, activPAL3 micro, and ActiGraph LEAP devices simultaneously. The laboratory protocol will consist of a series of structured activities, including variable-time walking trials, sitting and standing tests, posture changes, and gait speed assessments. Activities will be video recorded for validation. In the free-living protocol, participants will wear the devices continuously for 7 days except during water-based activities. WAM-based outcome measures will include step count; time spent at light, moderate, and vigorous PA intensity levels; posture; and posture changes (only the activPAL3 micro measured posture). Validated survey instruments will be administered both before and after WAM data collection to control for potential confounding factors that may influence movement patterns and device accuracy. Laboratory-based validity measures will compare WAM data to video-recorded observations. Sensitivity, specificity, positive predictive value, and agreement will also be determined. Free-living agreement between devices will be assessed using Bland-Altman plots, intraclass correlation analysis, and 95% limits of agreement. Results: Data collection is ongoing, with 11 participants enrolled and 7 (64%) having completed both in-laboratory and free-living protocols. On average, enrolled participants are aged 63.0 (SD 7.8; range 50.0-73.0) years, with 8 (73%) participants being women. Participant enrollment is expected to conclude in mid-2025, and initial findings are expected to be disseminated by the end of 2025. Conclusions: This is the first study that validates WAM accuracy for populations with LC while providing comprehensive recommendations for future validation studies. This study will provide critical insights into the accuracy and reliability of WAMs for assessing PA in LC survivors, which are essential for interpreting clinical research and informing future interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/70472 %M 40536804 %R 10.2196/70472 %U https://www.researchprotocols.org/2025/1/e70472 %U https://doi.org/10.2196/70472 %U http://www.ncbi.nlm.nih.gov/pubmed/40536804 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e66471 %T Development of a Mobile App to Support Head and Neck Cancer Caregiving: Mixed Methods Study %A Sterba,Katherine %A Graboyes,Evan %A Burris,Jessica %A Scallion,Megan %A Kinder,Hannah %A Olsen,Jama %A Toll,Benjamin %A Armeson,Kent %A Day,Terry %A Chera,Bhishamjit %A Ruggiero,Kenneth %K head and neck cancer %K cancer survivorship %K caregiving %K nutrition %K mobile health %K app development %K mixed methods %D 2025 %7 10.6.2025 %9 %J JMIR Cancer %G English %X Background: Survivors with head and neck cancer (HNC) face challenging treatment consequences that can lead to severe disruptions in swallowing and result in weight loss, malnutrition, and feeding tube dependence. Caregivers (family or friends who provide support), therefore, often encounter distressing nutritional caregiving burdens and feel unprepared to provide adequate support at home. Objective: The purpose of this mixed methods study was to develop a mobile support app to support HNC caregiving with an emphasis on nutritional support following treatment. Methods: We assessed perspectives on nutritional recovery challenges and mobile support app preferences in (1) a national panel of oncology dietitians using a web-based cross-sectional survey and (2) survivors with HNC completing treatment within the past 24 months and their nominated caregivers using dyadic semistructured interviews. Descriptive statistics for survey data were synthesized with thematic analysis of interview data to characterize nutrition-related perceptions and intervention preferences; results were integrated, and themes were translated to high-priority main menu domains and subdomains for a mobile app for caregivers. Results: Surveys were completed by dietitians (n=116, 100%; female n=87, 50%, with >10 years practice experience). Interviews included survivors with HNC (n=15; 12/15, 80% male, and 6/15, 40% with oropharynx cancer) and their caregivers (n=13; 11/13, 85% female, and 10/13, 77% spouses). Dietitians, survivors, and caregivers perceived that the majority of nutritional concerns assessed (eg, swallowing, feeding tube management, weight maintenance, and caregiver distress about nutrition) were very or extremely important to caregiving in the 6 months following treatment conclusion. The caregiving tasks rated highest in importance by dietitians included tracking nutritional concerns (n=113, 97%), working together as a team on nutritional concerns (n=104, 90%), and making care decisions (n=102, 88%). Five themes emerged from dyadic interviews, including types of nutritional challenges faced, that competing symptoms were difficult to separate from nutritional challenges, the emotional challenges related to nutrition and recovery, the diverse set of medical and support tasks taken on by caregivers, and information and resource needs in caregivers. Qualitative interview and survey themes guided the content of the Healthy Eating and Recovery Together (HEART) app with an intake tracker and sections for nutrition recovery support, other competing caregiving tips, peer support, and caregiver self-care. Conclusions: Results pinpointed optimal content for a mobile app for caregivers of individuals with HNC and support the acceptability of implementing the HEART app following HNC treatment. %R 10.2196/66471 %U https://cancer.jmir.org/2025/1/e66471 %U https://doi.org/10.2196/66471 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65975 %T Low-Burden Electronic Health Record Strategies for Engaging Oncologists in Digital Health Behavior Change Interventions: Qualitative Interview Study %A Jayeoba,Monisola %A Scherr,Courtney L %A Carroll,Allison J %A Daly,Elyse %A Kerstiens,Savanna %A Phillips,Siobhan M %A Hitsman,Brian %A Garcia,Sofia F %A Spring,Bonnie %A Jacobs,Maia %+ Department of Computer Science, McCormick School of Engineering and Applied Science, Northwestern University, Mudd Building, 2233 Tech Dr, Evanston, IL, 60208, United States, 1 (847) 491 3361, maia.jacobs@northwestern.edu %K digital health behavior change %K electronic health record %K risk behavior %K human-centered design %K cancer survivorship %K clinician-patient communication %D 2025 %7 30.5.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health behavior change interventions play an important role in helping cancer survivors improve their quality of life and reduce the risk of cancer recurrence. Clinician-patient communication is central to promoting the uptake of and adherence to digital health behavior change interventions. However, oncologists face significant barriers, including time constraints, knowledge gaps, and conversational uneasiness that limit risk behavior and health behavior change conversations. Objective: This qualitative study aims to explore oncologists’ preferences for discussing and monitoring risk behaviors with cancer survivors, with a specific focus on conversations about digital health behavior change interventions. This study also aims to explore oncologists’ informational and technological support requirements to facilitate these conversations. Methods: We conducted semistructured interviews with 18 oncologists who provide cancer care in a large National Cancer Institute–designated comprehensive cancer center. The transcripts and interview notes were analyzed through an iterative thematic analysis to generate relevant themes and categories. Results: We identified 2 major themes with 7 subthemes. The first theme focused on oncologists’ desired roles in promoting health behavior change, while the second theme addressed the support needs to facilitate conversations about risk and health promotion. Oncologists expressed a desire for 2 action-oriented communication mechanisms for promoting digital health behavior change with their patients: referring patients to interventions and reinforcing intervention goals longitudinally. To facilitate risk behavior and health behavior change conversations, their support needs included a preference for low-burden, electronic health record–integrated tools providing timely updates on patient enrollment and progress. The participating oncologists requested a tailored conversation aid for patient communication and parallel systems combining electronic health record messaging with print materials. They also emphasized the need for automated recommender systems to identify and refer eligible patients and reminder systems to prompt timely discussions with patients. Conclusions: Oncologists are motivated and well-positioned to support patients’ health behavior change but have unmet informational and technological requirements. On the basis of oncologists’ perspectives, our findings provide actionable, user-centered, low-burden strategies for facilitating oncologist-patient conversations about digital health behavior change interventions. We make recommendations for integrating these strategies directly into the electronic medical record system, with the goal of amplifying oncologists’ influential roles in motivating health behavior change among survivors. These scalable strategies may be applicable beyond oncology to clinical contexts where greater promotion of patients’ health behavior change is desired. %M 40446287 %R 10.2196/65975 %U https://www.jmir.org/2025/1/e65975 %U https://doi.org/10.2196/65975 %U http://www.ncbi.nlm.nih.gov/pubmed/40446287 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e64697 %T A Deep Learning–Enabled Workflow to Estimate Real-World Progression-Free Survival in Patients With Metastatic Breast Cancer: Study Using Deidentified Electronic Health Records %A Varma,Gowtham %A Yenukoti,Rohit Kumar %A Kumar M,Praveen %A Ashrit,Bandlamudi Sai %A Purushotham,K %A Subash,C %A Ravi,Sunil Kumar %A Kurien,Verghese %A Aman,Avinash %A Manoharan,Mithun %A Jaiswal,Shashank %A Anand,Akash %A Barve,Rakesh %A Thiagarajan,Viswanathan %A Lenehan,Patrick %A Soefje,Scott A %A Soundararajan,Venky %K real-world evidence %K data-driven oncology %K real-world progression-free survival %K metastatic breast cancer %K natural language processing %K NLP %K survival %K cancer %K oncology %K breast %K metastatic %K deep learning %K machine learning %K ML %K workflow %K report %K notes %K electronic health record %K EHR %K documentation %D 2025 %7 15.5.2025 %9 %J JMIR Cancer %G English %X Background: Progression-free survival (PFS) is a crucial endpoint in cancer drug research. Clinician-confirmed cancer progression, namely real-world PFS (rwPFS) in unstructured text (ie, clinical notes), serves as a reasonable surrogate for real-world indicators in ascertaining progression endpoints. Response evaluation criteria in solid tumors (RECIST) is traditionally used in clinical trials using serial imaging evaluations but is impractical when working with real-world data. Manual abstraction of clinical progression from unstructured notes remains the gold standard. However, this process is a resource-intensive, time-consuming process. Natural language processing (NLP), a subdomain of machine learning, has shown promise in accelerating the extraction of tumor progression from real-world data in recent years. Objectives: We aim to configure a pretrained, general-purpose health care NLP framework to transform free-text clinical notes and radiology reports into structured progression events for studying rwPFS on metastatic breast cancer (mBC) cohorts. Methods: This study developed and validated a novel semiautomated workflow to estimate rwPFS in patients with mBC using deidentified electronic health record data from the Nference nSights platform. The developed workflow was validated in a cohort of 316 patients with hormone receptor–positive, human epidermal growth factor receptor-2 (HER-2) 2-negative mBC, who were started on palbociclib and letrozole combination therapy between January 2015 and December 2021. Ground-truth datasets were curated to evaluate the workflow’s performance at both the sentence and patient levels. NLP-captured progression or a change in therapy line were considered outcome events, while death, loss to follow-up, and end of the study period were considered censoring events for rwPFS computation. Peak reduction and cumulative decline in Patient Health Questionnaire-8 (PHQ-8) scores were analyzed in the progressed and nonprogressed patient subgroups. Results: The configured clinical NLP engine achieved a sentence-level progression capture accuracy of 98.2%. At the patient level, initial progression was captured within ±30 days with 88% accuracy. The median rwPFS for the study cohort (N=316) was 20 (95% CI 18-25) months. In a validation subset (n=100), rwPFS determined by manual curation was 25 (95% CI 15-35) months, closely aligning with the computational workflow’s 22 (95% CI 15-35) months. A subanalysis revealed rwPFS estimates of 30 (95% CI 24-39) months from radiology reports and 23 (95% CI 19-28) months from clinical notes, highlighting the importance of integrating multiple note sources. External validation also demonstrated high accuracy (92.5% sentence level; 90.2% patient level). Sensitivity analysis revealed stable rwPFS estimates across varying levels of missing source data and event definitions. Peak reduction in PHQ-8 scores during the study period highlighted significant associations between patient-reported outcomes and disease progression. Conclusions: This workflow enables rapid and reliable determination of rwPFS in patients with mBC receiving combination therapy. Further validation across more diverse external datasets and other cancer types is needed to ensure broader applicability and generalizability. %R 10.2196/64697 %U https://cancer.jmir.org/2025/1/e64697 %U https://doi.org/10.2196/64697 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e65960 %T Comparison of Electronic Surveillance With Routine Monitoring for Patients With Lymphoma at High Risk of Relapse: Prospective Randomized Controlled Phase 3 Trial (Sentinel Lymphoma) %A Le Dû,Katell %A Chauchet,Adrien %A Sadot-Lebouvier,Sophie %A Fitoussi,Olivier %A Fontanet,Bijou %A Saint-Lezer,Arnaud %A Maloisel,Frédéric %A Rossi,Cédric %A Carras,Sylvain %A Parcelier,Anne %A Balavoine,Magali %A Septans,Anne-Lise %K patient-reported outcome measures %K lymphoma %K risk of relapse %K relapse %K randomized trial %K web-based %K quality of life %K survival %K detection %K progression %K T-cell lymphoma %K Hodgkin lymphoma %D 2025 %7 6.5.2025 %9 %J JMIR Cancer %G English %X Background: Relapse is a major event in patients with lymphoma. Therefore, early detection may have an impact on quality of life and overall survival. Patient-reported outcome measures have demonstrated clinical benefits for patients with lung cancer; however, evidence is lacking in patients with lymphoma. We evaluated the effect of a web-mediated follow-up application for patients with lymphoma at high risk of relapse. Objective: This study aims to demonstrate that monitoring patients via a web application enables the detection of at least 30% more significant events occurring between 2 systematic follow-up consultations with the specialist using an electronic questionnaire. Methods: We conducted a prospective, randomized phase 3 trial comparing the impact of web-based follow-up (experimental arm) with a standard follow-up (control arm). The trial was based on a 2-step triangular test and was designed to have a power of 90% to detect a 30% improvement in the detection of significant events. A significant event was defined as a relapse, progression, or a serious adverse event. The study covered the follow-up period after completion of first-line treatment or relapse (24 months). Eligible patients were aged 18 years and older and had lymphoma at a high risk of relapse. In the experimental arm, patients received a 16-symptom questionnaire by email every 2 weeks. An email alert was sent to the medical team based on a predefined algorithm. The primary objective was assessed after the inclusion of the 40th patient. The study was continued for the duration of the analysis. Results: A total of 52 patients were included between July 12, 2017, and April 7, 2020, at 11 centers in France, with 27 in the experimental arm and 25 in the control arm. The median follow-up was 21.3 (range 1.3‐25.6) months, and 121 events were reported during the study period. Most events occurred in the experimental arm (83/119, 69.7%) compared with 30.2% (36/119) in the control arm. A median number of 3.5 (range 1-8) events per patient occurred in the experimental arm, and 1.8 (range 1-6) occurred in the control arm (P=.01). Progression and infection were the most frequently reported events. Further, 19 patients relapsed during follow-up: 6 in the experimental arm and 13 in the control arm (P<.001), with a median follow-up of 7.7 (range 2.8‐20.6) months and 6.7 (range 1.9‐16.4) months (P=.94), respectively. Statistical analysis was conducted after including the 40th patient, which showed no superiority of the experimental arm over the control arm. The study was therefore stopped after the 52nd patient was enrolled. Conclusions: The primary objective was not reached; however, patient-reported outcome measures remain essential for detecting adverse events in patients with cancer, and the electronic monitoring method needs to demonstrate its effectiveness and comply with international safety guidelines. Trial Registration: ClinicalTrials.gov NCT03154710; https://clinicaltrials.gov/ct2/show/NCT03154710 %R 10.2196/65960 %U https://cancer.jmir.org/2025/1/e65960 %U https://doi.org/10.2196/65960 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e57834 %T Co-Designing Priority Components of an mHealth Intervention to Enhance Follow-Up Care in Young Adult Survivors of Childhood Cancer and Health Care Providers: Qualitative Descriptive Study %A Hou,Sharon H J %A Henry,Brianna %A Drummond,Rachelle %A Forbes,Caitlin %A Mendonça,Kyle %A Wright,Holly %A Rahamatullah,Iqra %A Tutelman,Perri R %A Zwicker,Hailey %A Stokoe,Mehak %A Duong,Jenny %A Drake,Emily K %A Erker,Craig %A Taccone,Michael S %A Sutherland,Liam %A Nathan,Paul %A Spavor,Maria %A Goddard,Karen %A Reynolds,Kathleen %A Schulte,Fiona S M %+ Department of Oncology, University of Calgary, 3395 Hospital Drive N.W., Calgary, AB, T2N5G2, Canada, 1 403 698 8103, fsmschul@ucalgary.ca %K mobile health %K mHealth %K pediatric oncology %K cancer survivorship %K qualitative research %K patient-oriented research %K co-design %K intervention development %D 2025 %7 25.4.2025 %9 Original Paper %J JMIR Cancer %G English %X Background: Survivors of childhood cancer are at risk of medical, psychological, and social late effects. To screen for their risks, receipt of consistent, cancer-specific follow-up care is crucial. However, <50% of survivors attend their aftercare, and only 35% of them recognize that they could have a serious health problem. The use of mobile health (mHealth) is a promising form of intervention to educate, connect, and empower survivors of childhood cancer on the importance of follow-up care. Objective: This study aimed to use co-design to identify the priority components to include in an mHealth intervention with young adult (aged between 18 and 39 years) survivors of childhood cancer and health care providers. Methods: This study was conducted between January and November 2022 in Canada and used patient-oriented research methods. Participants were recruited through local or provincial long-term follow-up clinics, using convenience sampling from patient partners who assisted in recruiting survivors across geographical areas in western, central, and eastern Canada, and social media outreach (X, formally known as Twitter; Facebook; and Instagram). Qualitative descriptive data (focus group interviews) from survivors of childhood cancer and health care providers (individual interviews) were gathered. We analyzed the collected data using reflexive thematic analysis and verified it through member checking techniques through an online community engagement event. Results: We conducted with patient partners 5 online (Zoom) focus groups with 22 survivors of childhood cancer (mean age 29.19, SD 4.78 y). We conducted individual telephone interviews with 7 health care providers. Participants identified five priority areas to be included in an mHealth intervention: (1) connections, (2) education and information, (3) engagement, (4) personalization, and (5) resources. Results were shared with and validated by survivors of childhood cancer, their families, health care providers, and academic researchers as part of a community engagement event. Small and large group discussions were facilitated to allow participants to review and discuss the accuracy of the themes derived regarding the core components to be included in mHealth. A graphic recording artist visually captured key ideas from the event. A subset of the participants also completed a web-based satisfaction survey, and responses indicated that the community engagement event was generally well received. Conclusions: Results from this study have provided the necessary foundation to progress in intervention development. The next step of this multiphased project is to build an innovative and accessible mHealth intervention prototype that is based on the identified core components and is grounded in an established conceptual framework for co-design of mHealth. %M 40279633 %R 10.2196/57834 %U https://cancer.jmir.org/2025/1/e57834 %U https://doi.org/10.2196/57834 %U http://www.ncbi.nlm.nih.gov/pubmed/40279633 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e67914 %T Evaluation of Large Language Models in Tailoring Educational Content for Cancer Survivors and Their Caregivers: Quality Analysis %A Liu,Darren %A Hu,Xiao %A Xiao,Canhua %A Bai,Jinbing %A Barandouzi,Zahra A %A Lee,Stephanie %A Webster,Caitlin %A Brock,La-Urshalar %A Lee,Lindsay %A Bold,Delgersuren %A Lin,Yufen %K large language models %K GPT-4 %K cancer survivors %K caregivers %K education %K health equity %D 2025 %7 7.4.2025 %9 %J JMIR Cancer %G English %X Background: Cancer survivors and their caregivers, particularly those from disadvantaged backgrounds with limited health literacy or racial and ethnic minorities facing language barriers, are at a disproportionately higher risk of experiencing symptom burdens from cancer and its treatments. Large language models (LLMs) offer a promising avenue for generating concise, linguistically appropriate, and accessible educational materials tailored to these populations. However, there is limited research evaluating how effectively LLMs perform in creating targeted content for individuals with diverse literacy and language needs. Objective: This study aimed to evaluate the overall performance of LLMs in generating tailored educational content for cancer survivors and their caregivers with limited health literacy or language barriers, compare the performances of 3 Generative Pretrained Transformer (GPT) models (ie, GPT-3.5 Turbo, GPT-4, and GPT-4 Turbo; OpenAI), and examine how different prompting approaches influence the quality of the generated content. Methods: We selected 30 topics from national guidelines on cancer care and education. GPT-3.5 Turbo, GPT-4, and GPT-4 Turbo were used to generate tailored content of up to 250 words at a 6th-grade reading level, with translations into Spanish and Chinese for each topic. Two distinct prompting approaches (textual and bulleted) were applied and evaluated. Nine oncology experts evaluated 360 generated responses based on predetermined criteria: word limit, reading level, and quality assessment (ie, clarity, accuracy, relevance, completeness, and comprehensibility). ANOVA (analysis of variance) or chi-square analyses were used to compare differences among the various GPT models and prompts. Results: Overall, LLMs showed excellent performance in tailoring educational content, with 74.2% (267/360) adhering to the specified word limit and achieving an average quality assessment score of 8.933 out of 10. However, LLMs showed moderate performance in reading level, with 41.1% (148/360) of content failing to meet the sixth-grade reading level. LLMs demonstrated strong translation capabilities, achieving an accuracy of 96.7% (87/90) for Spanish and 81.1% (73/90) for Chinese translations. Common errors included imprecise scopes, inaccuracies in definitions, and content that lacked actionable recommendations. The more advanced GPT-4 family models showed better overall performance compared to GPT-3.5 Turbo. Prompting GPTs to produce bulleted-format content was likely to result in better educational content compared with textual-format content. Conclusions: All 3 LLMs demonstrated high potential for delivering multilingual, concise, and low health literacy educational content for cancer survivors and caregivers who face limited literacy or language barriers. GPT-4 family models were notably more robust. While further refinement is required to ensure simpler reading levels and fully comprehensive information, these findings highlight LLMs as an emerging tool for bridging gaps in cancer education and advancing health equity. Future research should integrate expert feedback, additional prompt engineering strategies, and specialized training data to optimize content accuracy and accessibility. International Registered Report Identifier (IRRID): RR2-10.2196/48499 %R 10.2196/67914 %U https://cancer.jmir.org/2025/1/e67914 %U https://doi.org/10.2196/67914 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 6 %N %P e65001 %T A Hybrid Deep Learning–Based Feature Selection Approach for Supporting Early Detection of Long-Term Behavioral Outcomes in Survivors of Cancer: Cross-Sectional Study %A Huang,Tracy %A Ngan,Chun-Kit %A Cheung,Yin Ting %A Marcotte,Madelyn %A Cabrera,Benjamin %+ Worcester Polytechnic Institute, 100 Institute Rd, Worcester, MA, 01609, United States, 1 (508) 831 5000, cngan@wpi.edu %K machine learning %K data driven %K clinical domain–guided framework %K survivors of cancer %K cancer %K oncology %K behavioral outcome predictions %K behavioral study %K behavioral outcomes %K feature selection %K deep learning %K neural network %K hybrid %K prediction %K predictive modeling %K patients with cancer %K deep learning models %K leukemia %K computational study %K computational biology %D 2025 %7 13.3.2025 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: The number of survivors of cancer is growing, and they often experience negative long-term behavioral outcomes due to cancer treatments. There is a need for better computational methods to handle and predict these outcomes so that physicians and health care providers can implement preventive treatments. Objective: This study aimed to create a new feature selection algorithm to improve the performance of machine learning classifiers to predict negative long-term behavioral outcomes in survivors of cancer. Methods: We devised a hybrid deep learning–based feature selection approach to support early detection of negative long-term behavioral outcomes in survivors of cancer. Within a data-driven, clinical domain–guided framework to select the best set of features among cancer treatments, chronic health conditions, and socioenvironmental factors, we developed a 2-stage feature selection algorithm, that is, a multimetric, majority-voting filter and a deep dropout neural network, to dynamically and automatically select the best set of features for each behavioral outcome. We also conducted an experimental case study on existing study data with 102 survivors of acute lymphoblastic leukemia (aged 15-39 years at evaluation and >5 years postcancer diagnosis) who were treated in a public hospital in Hong Kong. Finally, we designed and implemented radial charts to illustrate the significance of the selected features on each behavioral outcome to support clinical professionals’ future treatment and diagnoses. Results: In this pilot study, we demonstrated that our approach outperforms the traditional statistical and computation methods, including linear and nonlinear feature selectors, for the addressed top-priority behavioral outcomes. Our approach holistically has higher F1, precision, and recall scores compared to existing feature selection methods. The models in this study select several significant clinical and socioenvironmental variables as risk factors associated with the development of behavioral problems in young survivors of acute lymphoblastic leukemia. Conclusions: Our novel feature selection algorithm has the potential to improve machine learning classifiers’ capability to predict adverse long-term behavioral outcomes in survivors of cancer. %M 40080820 %R 10.2196/65001 %U https://bioinform.jmir.org/2025/1/e65001 %U https://doi.org/10.2196/65001 %U http://www.ncbi.nlm.nih.gov/pubmed/40080820 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64869 %T Development of a Voice-Activated Virtual Assistant to Improve Insomnia Among Young Adult Cancer Survivors: Mixed Methods Feasibility and Acceptability Study %A Groninger,Hunter %A Arem,Hannah %A Ayangma,Lylian %A Gong,Lisa %A Zhou,Eric %A Greenberg,Daniel %+ , MedStar Health Research Institute, c/o 110 Irving Street NW, Room 2A68, Washington, DC, 20010, United States, 1 202 877 7445, hunter.groninger@medstar.net %K cancer %K survivor %K insomnia %K cognitive behavioral therapy %K technology %K app %K oncology %K mobile health %K artificial intelligence %K young adults %K sleep %K mHealth %K mobile health %K CBT %K voice-activated virtual assistant %K virtual assistants %K focus group %K qualitative research %D 2025 %7 10.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Up to 75% of young adult cancer survivors (YACS) experience chronic insomnia, negatively affecting physical and emotional health and overall quality of life. Cognitive behavioral therapy for insomnia (CBT-I) is a gold-standard intervention to address insomnia. To improve CBT-I access and treatment adherence, screen-based digital CBT-I platforms have been developed. However, even with these digital products, widespread uptake of CBT-I remains limited, and new strategies for CBT-I delivery are warranted. Objective: The objective of this study is to understand how YACS experience insomnia and how they might incorporate technology-delivered CBT-I into a daily routine and test the feasibility and acceptability of a novel screen-free voice-activated virtual assistant–delivered CBT-I prototype. Methods: Eligible participants—ages 18-39, living with a history of cancer (any type, any stage), self-reporting on average less sleep than National Sleep Foundation recommendations, and English-speaking—were recruited from a major urban cancer center, 2 regional oncology clinics, and 2 cancer survivorship support groups. We conducted 4 focus groups to understand the YACS experience of insomnia, their routine use of technology at home, particularly voice-activated virtual assistants such as Amazon Alexa, and input on how CBT-I might be delivered at home through a smart speaker system. We developed a prototype device to deliver key elements of CBT-I at home along with circadian lighting and monitoring of post-bedtime device use, collected YACS user perspectives on this prototype, and then conducted a single-arm feasibility and acceptability study. Results: In total, 26 YACS (6-7 participants per group) experiencing insomnia participated in focus groups to share experiences of insomnia during cancer survivorship and to provide input regarding a CBT-I prototype. Common triggers of insomnia included worry about disease management and progression, disease-related pain and other symptoms, choices regarding personal device use, and worry about the impact of poor sleep on daily functioning. In total, 12 participants completed device prototype testing, engaging with the prototype 94% of the assigned times (twice daily for 14 days; meeting predetermined feasibility cutoff of engagement ≥70% of assigned times) and rating the prototype with an overall mean score of 5.43 on the Satisfaction subscale of the Usability, Satisfaction, and Ease of Use scale (range 4.42-7; exceeding the predetermined cutoff score for acceptability of 5.0). All participants completing the study reported they would be interested in using the prototype again and would recommend it to someone else with insomnia. Conclusions: YACS were highly engaged with our voice-activated virtual assistant–delivered CBT-I prototype and found it acceptable to use. Following final device development, future studies should evaluate the efficacy of this intervention among YACS. Trial Registration: ClinicalTrials.gov NCT05875129; https://clinicaltrials.gov/study/NCT05875129 %M 40063947 %R 10.2196/64869 %U https://formative.jmir.org/2025/1/e64869 %U https://doi.org/10.2196/64869 %U http://www.ncbi.nlm.nih.gov/pubmed/40063947 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65152 %T Oncology Provider and Patient Perspectives on a Cardiovascular Health Assessment Tool Used During Posttreatment Survivorship Care in Community Oncology (Results from WF-1804CD): Mixed Methods Observational Study %A Nightingale,Chandylen L %A Dressler,Emily V %A Kepper,Maura %A Klepin,Heidi D %A Lee,Simon Craddock %A Smith,Sydney %A Aguilar,Aylin %A Wiseman,Kimberly D %A Sohl,Stephanie J %A Wells,Brian J %A DeMari,Joseph A %A Throckmorton,Alyssa %A Kulbacki,Lindsey W %A Hanna,Jenny %A Foraker,Randi E %A Weaver,Kathryn E %+ Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, United States, 1 3367131432, cnightin@wakehealth.edu %K cancer %K cardiovascular health %K cancer survivors %K community oncology %K electronic health record integration %K provider acceptability %K patient-provider %K assessment tool %K electronic health records %K clinical decision support %K surveys %K interviews %K survivors %K Automated Heart-Health Assessment %D 2025 %7 6.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Most survivors of cancer have multiple cardiovascular risk factors, increasing their risk of poor cardiovascular and cancer outcomes. The Automated Heart-Health Assessment (AH-HA) tool is a novel electronic health record clinical decision support tool based on the American Heart Association’s Life’s Simple 7 cardiovascular health metrics to promote cardiovascular health assessment and discussion in outpatient oncology. Before proceeding to future implementation trials, it is critical to establish the acceptability of the tool among providers and survivors. Objective: This study aims to assess provider and survivor acceptability of the AH-HA tool and provider training at practices randomized to the AH-HA tool arm within WF-1804CD. Methods: Providers (physicians, nurse practitioners, and physician assistants) completed a survey to assess the acceptability of the AH-HA training, immediately following training. Providers also completed surveys to assess AH-HA tool acceptability and potential sustainability. Tool acceptability was assessed after 30 patients were enrolled at the practice with both a survey developed for the study as well as with domains from the Unified Theory of Acceptance and Use of Technology survey (performance expectancy, effort expectancy, attitude toward using technology, and facilitating conditions). Semistructured interviews at the end of the study captured additional provider perceptions of the AH-HA tool. Posttreatment survivors (breast, prostate, colorectal, endometrial, and lymphomas) completed a survey to assess the acceptability of the AH-HA tool immediately after the designated study appointment. Results: Providers (n=15) reported high overall acceptability of the AH-HA training (mean 5.8, SD 1.0) and tool (mean 5.5, SD 1.4); provider acceptability was also supported by the Unified Theory of Acceptance and Use of Technology scores (eg, effort expectancy: mean 5.6, SD 1.5). Qualitative data also supported provider acceptability of different aspects of the AH-HA tool (eg, “It helps focus the conversation and give the patient a visual of continuum of progress”). Providers were more favorable about using the AH-HA tool for posttreatment survivorship care. Enrolled survivors (n=245) were an average of 4.4 (SD 3.7) years posttreatment. Most survivors reported that they strongly agreed or agreed that they liked the AH-HA tool (n=231, 94.3%). A larger proportion of survivors with high health literacy strongly agreed or agreed that it was helpful to see their heart health score (n=161, 98.2%) compared to survivors with lower health literacy scores (n=68, 89.5%; P=.005). Conclusions: Quantitative surveys and qualitative interview data both demonstrate high acceptability of the AH-HA tool among both providers and survivors. Although most survivors found it helpful to see their heart health score, there may be room for improving communication with survivors who have lower health literacy. Trial Registration: ClinicalTrials.gov NCT03935282; http://clinicaltrials.gov/ct2/show/NCT03935282 International Registered Report Identifier (IRRID): RR2-https://doi-org.wake.idm.oclc.org/10.1016/j.conctc.2021.100808 %M 39854647 %R 10.2196/65152 %U https://www.jmir.org/2025/1/e65152 %U https://doi.org/10.2196/65152 %U http://www.ncbi.nlm.nih.gov/pubmed/39854647 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e63486 %T Adapting a Self-Guided eHealth Intervention Into a Tailored Therapist-Guided eHealth Intervention for Survivors of Colorectal Cancer %A Lyhne,Johanne Dam %A Smith,Allan ‘Ben’ %A Carstensen,Tina Birgitte Wisbech %A Beatty,Lisa %A Bamgboje-Ayodele,Adeola %A Klein,Britt %A Jensen,Lars Henrik %A Frostholm,Lisbeth %K fear of cancer recurrence %K therapist-guided %K self-guided %K online intervention %K colorectal cancer %K digital health %K psychosocial intervention %K survivorship %K eHealth %K adaptation %K survivors %K oncologists %K therapists %K acceptability %K mobile phone %D 2025 %7 5.3.2025 %9 %J JMIR Cancer %G English %X Therapist-guided eHealth interventions have been shown to engage users more effectively and achieve better outcomes than self-guided interventions when addressing psychological symptoms. Building on this evidence, this viewpoint aimed to describe the adaptation of iConquerFear, a self-guided eHealth intervention targeting fear of cancer recurrence, into a therapist-guided version (TG-iConquerFear) tailored specifically for survivors of colorectal cancer (CRC). The goal was to optimize patient outcomes while minimizing the need for extensive resources. The adaptation process followed the Information System research framework, which facilitated a systematic integration of knowledge and iterative testing. Drawing on insights from the original iConquerFear development, as well as feedback from end users, oncologists, and therapists, we began by identifying areas for improvement. These insights formed the foundation for the first design cycle. Initial internal testing revealed the need for several adjustments to enhance the intervention. While the core concept of iConquerFear remained unchanged, we made significant modifications to improve access by optimizing the platform for mobile devices, to support adherence by expanding the exercises, and to equip therapists with tools such as reflective questions and a monitoring control panel. External field testing with 5 survivors of CRC provided further validation. Participants reported a high level of acceptability, and their feedback guided additional minor points to consider incorporating in future versions. This study illustrates how a self-guided eHealth intervention can be successfully adapted into a therapist-guided format for fear of cancer recurrence, tailored to meet the needs of survivors of CRC. The described approach serves as a valuable framework for integrating therapist guidance into similar interventions, ensuring their relevance and effectiveness for targeted populations.Trial Registration: ClinicalTrials.gov NCT04287218; https://clinicaltrials.gov/study/NCT04287218 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-020-06731-6 %R 10.2196/63486 %U https://cancer.jmir.org/2025/1/e63486 %U https://doi.org/10.2196/63486 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e66636 %T Analysis of the Relationship Between Rural-Urban Status and Use of Digital Health Technology Among Older Cancer Survivors Based on the Health Information National Trends Survey: Cross-Sectional Analysis %A Werts-Pelter,Samantha J %A Chen,Zhao %A Bea,Jennifer W %A Sokan,Amanda E %A Thomson,Cynthia A %K cancer %K non-metropolitan %K disparities %K digital divide %K health research %K aging %K rural-urban %K digital health technology %K cross-sectional %K health behaviors %K mobile phone %D 2025 %7 4.3.2025 %9 %J JMIR Cancer %G English %X Background: Though telehealth has been a promising avenue for engaging cancer survivors with health care and lifestyle programming, older and rural-dwelling cancer survivors may have additional challenges in accessing digital devices and tools that have not yet been described. This study aimed to use a robust, nationally representative sample collected in 2022 to provide an updated view of digital technology use and the use of technology for health in this population. Objective: This study aimed to examine the prevalence of digital technology use for health-related activities among older cancer survivors in both rural and urban settings. The primary outcomes of interest included (1) internet access and use for health-related activities, (2) digital device ownership and use as a tool for health behaviors, (3) use of social media for health, and (4) use of telehealth. Methods: A cross-sectional analysis of the National Cancer Institute’s Health Information National Trends Survey Cycle 6 (HINTS 6) was completed to examine the prevalence of digital technology use among older cancer survivors. For analysis, the sample was restricted to cancer survivors over the age of 60 years (n=710). Unadjusted and adjusted logistic regression models were used to test the association between rurality and digital health tool use. Results: Overall, 17% (125/710) of the sample lived in a rural area of the United States and the mean sample age was 73 (SD 8.2) years. Older cancer survivors, regardless of rural-urban status, reported a high prevalence of internet usage (n=553, 79.9%), digital device ownership (n=676, 94.9%), and social media use (n=448, 66.6%). In unadjusted models, rural survivors were less likely than urban survivors to report that they had used a health or wellness application in the previous year (odds ratio [OR] 0.56, 95% CI 0.32-0.97; P=.04). In adjusted models, rural survivors were more likely to report that they had shared personal health information on social media (OR 2.64, 95% CI 1.13-6.19; P=.03). There were no differences in the proportion of rural and urban respondents who reported receiving health services through telehealth in the previous year. Conclusions: Regardless of the residential status, older cancer survivors report high internet and technology use for health-related activities. These results show promise for the feasibility of using digital technologies to implement supportive care and wellness programming with older cancer survivors. %R 10.2196/66636 %U https://cancer.jmir.org/2025/1/e66636 %U https://doi.org/10.2196/66636 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67794 %T Examining BRCA Previvors’ Social Media Content Creation as a Form of Self and Community Care: Qualitative Interview Study %A Wellman,Mariah L %A Owens,Camilla M %A Holton,Avery E %A Kaphingst,Kimberly A %+ Advertising & Public Relations, College of Communication Arts and Sciences, Michigan State University, 404 Wilson Road, East Lansing, 48824, United States, 1 5173553410, mwellman@msu.edu %K BRCA %K breast cancer %K genetic testing %K social media %K breast cancer gene %K content creation %K self care %K community care %K qualitative interview %K qualitative %K interview %K previvors %K cancer previvors %K genetic mutations %K online %K content %K interviews %K thematic analysis %D 2025 %7 3.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Genetic testing has become a common way of identifying a woman’s risk of developing hereditary breast and ovarian cancer; however, not all medical providers have the necessary information to support patients interested in genetic testing, nor do they always have the proper information for patients once they have been diagnosed. Therefore, many “previvors”—the name given to those who have tested positive for the BRCA genetic mutation—have taken to social media to inform others about the importance of genetic testing and explain to them how to understand their test results. Historically, those desiring to speak about their medical issues online have sought out structured support groups or chat rooms; however, many previvors today are instead posting on their own personal social media accounts and creating more niche communities. Objective: This study aimed to examine why BRCA previvors are sharing content on their personal social media accounts and how posting online in this way serves a purpose for their larger community. Methods: A total of 16 semistructured interviews were conducted with individuals who posted about their experience being diagnosed with the BRCA genetic mutation and their subsequent treatment on their personal social media accounts, specifically for followers interested in their medical journey. The interviews were recorded, transcribed, and coded by an experienced qualitative researcher and a graduate student using inductive techniques, and a reflexive thematic analysis was applied to the transcripts. Results: The results suggest BRCA previvors want to control the narrative around their personalized medical experiences rather than participating in existing groups or chat rooms. Controlling their own story, rather than adding to existing narratives, gives previvors a sense of control. It also allows them to set boundaries around the types of experiences they have online when sharing their medical journey. Finally, previvors said they feel they are serving the larger BRCA community by each sharing their individual journeys, to hopefully avoid stereotyping and homogenizing the experience of patients with BRCA genetic mutations. Conclusions: Research with the objective of understanding the experiences of BRCA previvors should include exploring how and why they talk about their journeys, especially due to the lack of knowledge BRCA previvors say many of their medical providers have. We suggest further research should examine how other patients with the BRCA genetic mutation, especially racial and ethnic minority patients, are navigating their own content creation, especially considering content moderation policies that social media platforms are continuing to implement that directly impact users’ ability to share about their medical experiences. %M 40053732 %R 10.2196/67794 %U https://www.jmir.org/2025/1/e67794 %U https://doi.org/10.2196/67794 %U http://www.ncbi.nlm.nih.gov/pubmed/40053732 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e65118 %T Treatment Outcomes From Erlotinib and Gefitinib in Advanced Epidermal Growth Factor Receptor–Mutated Nonsquamous Non–Small Cell Lung Cancer in Aotearoa New Zealand From 2010 to 2020: Nationwide Whole-of-Patient-Population Retrospective Cohort Study %A Aye,Phyu Sin %A Barnes,Joanne %A Laking,George %A Cameron,Laird %A Anderson,Malcolm %A Luey,Brendan %A Delany,Stephen %A Harris,Dean %A McLaren,Blair %A Brenman,Elliott %A Wong,Jayden %A Lawrenson,Ross %A Arendse,Michael %A Tin Tin,Sandar %A Elwood,Mark %A Hope,Philip %A McKeage,Mark James %K non–small cell lung cancer %K mutations %K epidemiology %K target therapy %K retrospective cohort study %D 2025 %7 3.3.2025 %9 %J JMIR Cancer %G English %X Background: Health care system–wide outcomes from routine treatment with erlotinib and gefitinib are incompletely understood. Objective: The aim of the study is to describe the effectiveness of erlotinib and gefitinib during the first decade of their routine use for treating advanced epidermal growth factor receptor (EGFR) mutation-positive nonsquamous non–small cell lung cancer in the entire cohort of patients treated in Aotearoa New Zealand. Methods: Patients were identified, and data collated from national pharmaceutical dispensing, cancer registration, and mortality registration electronic databases by deterministic data linkage using National Health Index numbers. Time-to-treatment discontinuation and overall survival were measured from the date of first dispensing of erlotinib or gefitinib and analyzed by Kaplan-Meier curves. Associations of treatment outcomes with baseline factors were evaluated using univariable and multivariable Cox regressions. Results: Overall, 752 patients were included who started treatment with erlotinib (n=418) or gefitinib (n=334) before October 2020. Median time-to-treatment discontinuation was 11.6 (95% CI 10.8‐12.4) months, and median overall survival was 20.1 (95% CI 18.1‐21.6) months. Shorter time-to-treatment discontinuation was independently associated with high socioeconomic deprivation (hazard ratio [HR] 1.3, 95% CI 1.1‐1.5 compared to the New Zealand Index of Deprivation 1‐4 group), EGFR L858R mutations (HR 1.3, 95% CI 1.1‐1.6 compared to exon 19 deletion), and distant disease at cancer diagnosis (HR 1.4, 95% CI 1.2‐1.7 compared to localized or regional disease). The same factors were independently associated with shorter overall survival. Outcome estimates and predictors remained unchanged in sensitivity analyses. Conclusions: Outcomes from routine treatment with erlotinib and gefitinib in New Zealand patients with advanced EGFR-mutant nonsquamous non–small cell lung cancer are comparable with those reported in randomized trials and other health care system–wide retrospective cohort studies. Socioeconomic status, EGFR mutation subtype, and disease extent at cancer diagnosis were independent predictors of treatment outcomes in that setting. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12615000998549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368928&isReview=true International Registered Report Identifier (IRRID): RR2-10.2196/51381 %R 10.2196/65118 %U https://cancer.jmir.org/2025/1/e65118 %U https://doi.org/10.2196/65118 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e59391 %T Exploring Older Adult Cancer Survivors’ Digital Information Needs: Qualitative Pilot Study %A Newton,Lorelei %A Monkman,Helen %A Fullerton,Claire %K older adults %K cancer survivors %K digital health literacy %K digital health technologies %K aging %K qualitative %K pilot study %K semistructured interview %D 2025 %7 27.2.2025 %9 %J JMIR Cancer %G English %X Background: Older adults (aged >65 years) are disproportionately affected by cancer at a time when Canadians are surviving cancer in an unprecedented fashion. Contrary to persistent ageist assumptions, not only do the majority of older adult cancer survivors use digital health technologies (DHTs) regularly, such technologies also serve as important sources of their health information. Although older adults’ transition to cancer survivorship is connected to the availability and provision of relevant and reliable information, little evidence exists as to how they use DHTs to supplement their understanding of their unique situation to manage, and make decisions about, their ongoing cancer-related concerns. Objective: This pilot study, which examined older adult cancer survivors’ use of DHTs, was conducted to support a larger study designed to explore how digital health literacy dimensions might affect the management of cancer survivorship sequelae. Understanding DHT use is also an important consideration for digital health literacy. Thus, we sought to investigate older adult cancer survivors’ perceptions of DHTs in the context of accessing information about their health, health care systems, and health care providers. Methods: A qualitative pilot study, which involved semistructured interviews with older adult cancer survivors (N=5), was conducted to explore how participants interacted with, accessed, and searched for information, as well as how DHT use related to their cancer survivorship. Institutional ethics approval (#21‐0421) was obtained. Interpretive description inquiry—a practice-based approach suitable for generating applied knowledge—supported exploration of the research question. Thematic analysis was used to examine the transcripts for patterns of meaning (themes). Results: Assessing the credibility of digital information remains challenging for older adult cancer survivors. Identified benefits of DHTs included improved access to meet health information needs, older adult cancer survivors feeling empowered to make informed decisions regarding their health trajectory, and the ability to connect with interdisciplinary teams for care continuity. Additionally, participants described feeling disconnected when DHTs seemed to be used as substitutes for human interaction. The results of this pilot study were used to create 12 additional questions to supplement a digital health literacy survey, through which we will seek a more fulsome account of the relationship between digital health literacy and DHTs for older adult cancer survivors. Conclusions: Overall, this pilot study confirmed the utility of DHTs in enhancing the connection of older adult cancer survivors to their health care needs. Importantly, this connection exists on a continuum, and providing greater access to technologies, in combination with human support, leads to feelings of empowerment. DHTs are an important aspect of contemporary health care; yet, these technologies must be seen as complementary and not as replacements for human interaction. Otherwise, we risk dehumanizing patients and disconnecting them from the care that they need and deserve. %R 10.2196/59391 %U https://cancer.jmir.org/2025/1/e59391 %U https://doi.org/10.2196/59391 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e60034 %T Usability and Implementation Considerations of Fitbit and App Intervention for Diverse Cancer Survivors: Mixed Methods Study %A Dabbagh,Zakery %A Najjar,Reem %A Kamberi,Ariana %A Gerber,Ben S %A Singh,Aditi %A Soni,Apurv %A Cutrona,Sarah L %A McManus,David D %A Faro,Jamie M %K physical activity %K cancer survivor %K wearable device %K smartphone app %K diverse %K Fitbit %K wearable %K feasibility %K usability %K digital health %K digital health method %K breast cancer %K Hispanic %K women %K mobile health %K activity tracker %K mHealth %D 2025 %7 24.2.2025 %9 %J JMIR Cancer %G English %X Background: Despite the known benefits of physical activity, cancer survivors remain insufficiently active. Prior trials have adopted digital health methods, although several have been pedometer-based and enrolled mainly female, non-Hispanic White, and more highly educated survivors of breast cancer. Objective: The objective of this study was to test a previously developed mobile health system consisting of a Fitbit activity tracker and the MyDataHelps smartphone app for feasibility in a diverse group of cancer survivors, with the goal of refining the program and setting the stage for a larger future trial. Methods: Participants were identified from one academic medical center’s electronic health records, referred by a clinician, or self-referred to participate in the study. Participants were screened for eligibility, enrolled, provided a Fitbit activity tracker, and instructed to download the Fitbit: Health & Wellness and MyDataHelps apps. They completed usability surveys at 1 and 3 months. Interviews were conducted at the end of the 3-month intervention with participants and cancer care clinicians to assess the acceptability of the intervention and the implementation of the intervention into clinical practice, respectively. Descriptive statistics were calculated for demographics, usability surveys, and Fitbit adherence and step counts. Rapid qualitative analysis was used to identify key findings from interview transcriptions. Results: Of the 100 patients screened for eligibility, 31 were enrolled in the trial (mean age 64.8, SD 11.1 years; female patients=17/31, 55%; Hispanic or Latino=7/31, 23%; non-White=11/31, 35%; less than a bachelor’s degree=14/31, 45%; and household income 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. %R 10.2196/55300 %U https://cancer.jmir.org/2024/1/e55300 %U https://doi.org/10.2196/55300 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59504 %T A Remotely Delivered Light-Intensity Physical Activity Intervention for Older Cancer Survivors: Protocol for a Feasibility Randomized Controlled Trial %A Blair,Cindy K %A Brown-Glaberman,Ursa %A Walters,Scott T %A Pestak,Claire %A Boyce,Tawny %A Barriga,Laura %A Burgess,Ellen %A Tawfik,Bernard %A Killough,Cynthia %A Kinney,Anita Y %A Demark-Wahnefried,Wendy %A Meisner,Angela L %A Wiggins,Charles L %A Pankratz,V Shane %A Davis,Sally %+ Department of Internal Medicine, University of New Mexico, 1 University of New Mexico, MSC07-4025, Albuquerque, NM, 87131, United States, 1 505 925 7907, CiBlair@salud.unm.edu %K cancer survivor %K physical performance %K physical activity %K physical function %K older adults %K activity tracker %K mobile phone %D 2024 %7 13.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older cancer survivors face age- and treatment-related comorbidities, including physical functional impairment, which are exacerbated by physical inactivity and sedentary behavior. Regular physical activity can reduce this risk, yet less than 30% of older cancer survivors meet the recommended guidelines for physical activity. Objective: This study aims to describe the design, methods, and rationale for a remotely delivered intervention that uses a whole-of-day approach to physical activity in older cancer survivors. This approach focuses on the accumulation of intermittent bouts of light-intensity activity throughout the entire day by disrupting and reducing sedentary activity. The intervention was guided by social cognitive and self-determination theories and incorporated motivational interviewing. Methods: The 12-week Move for Your Health trial randomly assigned 64 older cancer survivors to a theory-based physical activity intervention or a waitlist control. A Fitbit (Google) activity tracker and smartphone app were used to promote awareness of activity levels and enable self-monitoring of both activity and inactivity in tandem with health coaching phone calls. Motivational interviewing was used to engage participants and tailor strategies to achieve goals during the 12-week intervention. Data were collected at baseline, immediately after the intervention, and at longer-term follow-up (3 months thereafter). Feasibility outcomes included recruitment, retention, adherence, adverse events, and acceptability. Other outcomes included obtaining the parameter estimates for changes in physical function, physical performance, physical activity, sedentary behavior, and quality of life. Results: Recruitment for the Move for Your Health randomized controlled trial was completed in June 2023. Data collection was completed in March 2024. Data analyses are ongoing. Conclusions: The results of this trial will provide information on the feasibility of implementing this intervention in the target patient population, as well as data that will provide information about the potential impact of the intervention on the outcomes. Both of these outcomes will inform the design of a larger randomized controlled trial to more fully test a physical activity intervention in an older cancer survivor population. Trial Registration: ClinicalTrials.gov NCT05582889; https://clinicaltrials.gov/study/NCT05582889 International Registered Report Identifier (IRRID): DERR1-10.2196/59504 %M 39671575 %R 10.2196/59504 %U https://www.researchprotocols.org/2024/1/e59504 %U https://doi.org/10.2196/59504 %U http://www.ncbi.nlm.nih.gov/pubmed/39671575 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59426 %T Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach %A Nuseibeh,Betsey Zenk %A Johns,Shelley A %A Shih,Patrick C %A Lewis,Gregory F %A Gowan,Tayler M %A Jordan,Evan J %+ School of Public Health, Indiana University, 1025 East Seventh Street, Bloomington, IN, 47405, United States, 1 5132255577, bznuseib@iu.edu %K breast cancer survivors %K acceptance and commitment therapy %K mHealth app %K user-centered design %K depression %K anxiety %K therapy %K app %K breast cancer %K expert %K designer %K psychosocial %K need %K co-design %K MOSAIC %K mobile acceptance and commitment therapy stress intervention %K interviews %D 2024 %7 9.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer is the world’s most prevalent cancer. Although the 5-year survival rate for breast cancer in the United States is 91%, the stress and uncertainty of survivorship can often lead to symptoms of depression and anxiety. With nearly half of breast cancer survivors living with stress and symptoms of depression and anxiety, there are a significant number of unmet supportive care needs. New and potentially scalable approaches to meeting these supportive care needs are warranted. Objective: This study aimed to engage breast cancer survivors and acceptance and commitment therapy (ACT) content experts in user-centered design (UCD) to develop a mobile health app (MOSAIC [Mobile Acceptance and Commitment Therapy Stress Intervention]) using stress intervention strategies. Methods: We held 5 UCD sessions with 5 breast cancer survivors, 3 ACT content experts, 2 user experience design experts, and 1 stress expert facilitator over the course of 10 weeks. The sessions were developed to lead the 10 co-designers through the 5-step UCD process (eg, problem identification, solution generation, convergence, prototyping, and debriefing and evaluation). Following the fifth session, a prototype was generated and evaluated by the 5 breast cancer survivors and 3 ACT experts using the System Usability Scale, Acceptability E-scale, and a brief set of semistructured interview questions. Results: The 10 co-designers were present for each of the 5 co-design sessions. Co-designers identified 5 design characteristics: simple entry with use reminders (behavioral nudges), a manageable number of intervention choices, highly visual content, skill-building exercises, and social support. A total of 4 features were also identified as critical to the use of the tool: an ACT and breast cancer–specific onboarding process, clean navigation tools, clear organization of the interventions, and once-per-week behavioral nudges. These requirements created the foundation for the app prototype. The 5 breast cancer survivors and 3 ACT co-designers evaluated the app prototype for 1 week, using an Android smartphone. They rated the app as usable (mean 79.29, SD 19.83) on the System Usability Scale (a priori mean cutoff score=68) and acceptable (mean 24.28, SD 2.77) on the Acceptability E-scale (a priori mean cutoff score=24). Conclusions: Through the UCD process, we created an ACT app prototype with 5 breast cancer survivors, 3 ACT experts, and 2 UCD designers. The next step in our research is to continue the assessment and refining of the prototype with additional breast cancer survivors. Future work will pilot-test the app to examine the feasibility of a large-scale, randomized control trial. Studies will enroll increasingly diverse breast cancer survivors to broaden the generalizability of findings. %R 10.2196/59426 %U https://formative.jmir.org/2024/1/e59426 %U https://doi.org/10.2196/59426 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e58014 %T Delivering a Group-Based Quality of Life Intervention to Young Adult Cancer Survivors via a Web Platform: Feasibility Trial %A Fox,Rina S %A Torres,Tara K %A Badger,Terry A %A Katsanis,Emmanuel %A Yang,DerShung %A Sanford,Stacy D %A Victorson,David E %A Yanez,Betina %A Penedo,Frank J %A Antoni,Michael H %A Oswald,Laura B %K cancer survivors %K survivorship %K clinical trials %K psychosocial intervention %K usability testing %K digital therapeutics %K young adults %K nonrandomized %D 2024 %7 4.12.2024 %9 %J JMIR Cancer %G English %X 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 %R 10.2196/58014 %U https://cancer.jmir.org/2024/1/e58014 %U https://doi.org/10.2196/58014 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60762 %T Sleep Treatment Education Program for Cancer Survivors: Protocol for an Efficacy Trial %A Bice,Briana L %A Michaud,Alexis L %A McCormick,Katherine G %A Miklos,Eva M %A Descombes,Indiana D %A Medeiros-Nancarrow,Cheryl %A Zhou,Eric S %A Recklitis,Christopher J %+ Perini Family Survivors' Center, Dana-Farber Cancer Institute, Boston, MA, United States, 1 6175828260, christopher_recklitis@dfci.harvard.edu %K insomnia %K mood %K cancer survivors %K online interventions %K protocol %K cognitive behavioral therapy %K CBT %K cognitive behavioral therapy for insomnia %K CBTI %K digital health %K sleep disorders %K sleep treatment education program %K STEP-1 %D 2024 %7 28.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer survivors are at increased risk for chronic insomnia, even years after treatment completion. As insomnia is associated with a variety of long-term health consequences, access to insomnia treatment is critically important for the survivor population. Cognitive behavioral therapy for insomnia (CBTI) is the recommended first-line treatment for insomnia but remains largely unavailable to survivors. Treatment barriers include geographic limitations, a shortage of trained providers, and demanding treatment regimens. Designed with these limitations in mind, the Sleep Treatment Education Program (STEP-1) delivers components of CBTI in a low-intensity educational intervention delivered online. Objective: This is a phase II pilot randomized controlled trial. The primary aims are to test the efficacy of STEP-1 to improve (1) insomnia symptoms and (2) mood in cancer survivors compared to a control condition. The secondary aims will (1) explore participant factors associated with clinically significant response, (2) evaluate acceptability of the control intervention, (3) explore feasibility of delivering individualized coaching sessions for participants who do not have a significant response to STEP-1, and (4) describe participants’ satisfaction with STEP-1 and suggestions for improvement. Methods: This 2-arm randomized controlled trial enrolled 70 off-treatment cancer survivors aged 40-89 years with clinically significant insomnia. Participants are randomized to receive either the STEP-1 intervention or control condition (relaxation education); interventions are delivered in one-on-one, synchronous, virtual videoconference sessions by trained interventionists. The STEP-1 intervention presents educational information on the development of insomnia after cancer and offers suggestions for improving insomnia symptoms based on the CBTI elements of sleep hygiene, stimulus control, and cognitive restructuring. With the interventionist, participants review the suggestions and develop a personalized sleep action plan for implementation. The relaxation education session provides information on the potential benefits of relaxation and how to independently access online relaxation exercises. The Insomnia Severity Index is used to measure insomnia symptoms, and the Profile of Mood States Short Form is used to measure mood at baseline and 4 and 8 weeks after intervention. The primary end point is change in the Insomnia Severity Index score at 8 weeks, and the secondary end point is change in mood symptoms (Profile of Mood States Short Form) at 8 weeks. Results: This trial was funded in July 2022. Enrollment and data collection began in February 2023 and concluded in October 2024, with 70 participants enrolled. The analysis will begin in fall 2024, and the results are expected in winter 2025. Conclusions: Trial results will determine if STEP-1 effects go beyond those that could be attributed to placebo and other nonspecific treatment factors. Should results support the efficacy of STEP-1 to improve mood and insomnia symptoms, we anticipate developing efficacy and implementation trials of STEP-1 in larger and more diverse samples. Trial Registration: ClinicalTrials.gov NCT05519982; https://clinicaltrials.gov/study/NCT05519982 International Registered Report Identifier (IRRID): DERR1-10.2196/60762 %M 39608001 %R 10.2196/60762 %U https://www.researchprotocols.org/2024/1/e60762 %U https://doi.org/10.2196/60762 %U http://www.ncbi.nlm.nih.gov/pubmed/39608001 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51291 %T Associations of Wearable Activity Tracker Use With Physical Activity and Health Outcomes in Patients With Cancer: Findings from a Population-Based Survey Study %A Zhou,Weijiao %A Shang,Shaomei %A Cho,Youmin %+ College of Nursing, Chungnam National University, 266 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea, 82 42 580 8336, youmcho@cnu.ac.kr %K physical activity %K exercise %K wearable tracker %K wearable device %K cancer %K oncology %K cancer survivorship %K wearable %K wearables %K tracker %K trackers %K health outcome %K health outcomes %K HINTS %K survey %K surveys %K national %K bivariate %K epidemiology %K epidemiological %K association %K associations %D 2024 %7 22.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical inactivity is a global issue for cancer survivors. Wearable activity trackers are promising to address physical inactivity by providing real-time feedback on physical activity and offering opportunities for self-monitoring and goal setting. Meta-analysis has reported the effects of interventions that incorporate wearable activity trackers on improved physical inactivity and related health outcomes (eg, BMI, anxiety and depression, and self-rated health status). However, wearable activity trackers were often used as an adjunct to physical activity interventions, and the effectiveness of wearable activity trackers alone is unknown. Objective: This study aims to determine the association of wearable activity trackers with physical activity and health outcomes in patients with cancer. Methods: Data from 957 cancer survivors from the Health Information National Trends Survey–Surveillance, Epidemiology, and End Results (HINTS-SEER) were analyzed. The outcome variables examined were time spent in moderate to vigorous physical activity, weekly frequency of strength training, BMI, anxiety and depression levels, and self-assessed health status. The primary independent variable was whether cancer survivors had used wearable activity trackers within the past 12 months. Design-based linear regression for continuous outcome variables and ordinal logistic regression for ordinal outcome variables were conducted to determine the associations after controlling for sociodemographic, cancer-related, and health-related factors. All data analyses accounted for the complex survey design and sample weights. Results: Only 29% of cancer survivors reported wearable activity tracker use. Bivariate analyses showed that younger age (P<.001), higher education (P=.04), higher income (P<.001), and an employed status (P<.001) were significantly associated with wearable activity tracker use. Wearable activity tracker use was significantly associated with higher time spent in moderate to vigorous physical activity (adjusted =37.94, 95% CI 8.38-67.5; P=.01), more frequent strength training per week (adjusted odds ratio [OR] 1.50, 95% CI 1.09-2.06; P=.01), and better self-rated health status (adjusted OR 1.58, 95% CI 1.09-2.29; P=.01), but not with BMI or anxiety and depression. Conclusions: This study suggests that the uptake of wearable activity trackers is low and highlights the digital divide among patients with cancer. This study has confirmed the associations of wearable activity tracker use with physical activity and self-rated health, supporting using wearable activity trackers as a promising tool to facilitate physical activity promotion. %M 39436693 %R 10.2196/51291 %U https://www.jmir.org/2024/1/e51291 %U https://doi.org/10.2196/51291 %U http://www.ncbi.nlm.nih.gov/pubmed/39436693 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59222 %T Digitizing Survivorship Care Plans Through the POST-Treatment Health Outcomes of Cancer Survivors (POSTHOC) Mobile App: Protocol for a Phase II Randomized Controlled Trial %A Chung,Kaitlin H %A Youngblood,Shari M %A Clingan,Carin L %A Deighton,Dana C %A Jump,Virginia A %A Manuweera,Thushini %A McGeorge,Nicolette M %A Renn,Cynthia L %A Rosenblatt,Paula Y %A Winder,Aaron T %A Zhu,Shijun %A Kleckner,Ian R %A Kleckner,Amber S %+ Department of Pain and Translational Symptom Science, University of Maryland School of Nursing, 655 W. Lombard Ave., Baltimore, MD, 21201, United States, 1 410 706 5961, amber.kleckner@umaryland.edu %K mobile health %K mHealth %K symptoms %K clinical trial %K posttreatment %K oncology %K mobile phone %D 2024 %7 5.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Survivorship care plans (SCPs) are provided at the completion of cancer treatment to aid in the transition from active treatment to long-term survivorship. They describe the details of a patient’s diagnosis and treatment and offer recommendations for follow-up appointments, referrals, and healthy behaviors. The plans are currently paper-based and become outdated as soon as a patient’s health status changes. There is a need to digitize these plans to improve their accessibility, modifiability, and longevity. With current technology, SCPs can be linked to mobile devices and activity trackers so that patients can track health behaviors and compare them to their clinical goals, taking charge of their own health. Objective: A mobile app, POSTHOC (POST-Treatment Health Outcomes of Cancer Survivors), that digitizes the SCP was developed, with goals of integrating it with wearable technologies and electronic medical records. Herein, we are conducting a randomized controlled trial that evaluates the POSTHOC app versus the traditional SCP on total symptom burden in the early posttreatment period. Methods: We will recruit 54 patients who have recently completed curative therapy for cancer (any type) in person and remotely. They will be randomized 2:1, POSTHOC:usual care (unblinded). Those randomized to the POSTHOC group will receive their SCP via the app and will choose to focus on nutrition or exercise for the duration of the study based on their individual plan and personal preferences. Those randomized to the control group will get a paper-based plan. At baseline, 6 weeks, and 12 weeks, we will evaluate patient-reported outcomes, including total symptom burden (web-based questionnaire), diet (24-hour Automated Self-Administered [ASA24]), and physical activity (Fitbit Charge 6 [Google LLC]). We will also collect quantitative and qualitative feedback on the usability of the app from those in the POSTHOC arm to improve the app for future implementation studies, with a specific focus on patient-provider communication. For feasibility, we will calculate the percentage of patients who used the POSTHOC app at least 3 times per week. We will use linear mixed models to evaluate the effects of the POSTHOC app versus those of usual care on other outcomes at weeks 6 and 12. Results: This trial is open to accrual in the University of Maryland Medical System as of March 2024, and as of July 3, 2024, a total of 20 participants have consented. Conclusions: This study is among the first to digitize the SCP in a mobile app and test the effects of a mobile health–delivered behavioral health intervention on symptom burden in cancer survivors. Our results will provide evidence about the effects of health self-management on symptoms. This knowledge will be integral to larger randomized controlled studies, integration with the electronic medical record, and nationwide implementation. Trial Registration: ClinicalTrials.gov NCT05499663; https://clinicaltrials.gov/ct2/show/NCT05499663 International Registered Report Identifier (IRRID): DERR1-10.2196/59222 %M 39235855 %R 10.2196/59222 %U https://www.researchprotocols.org/2024/1/e59222 %U https://doi.org/10.2196/59222 %U http://www.ncbi.nlm.nih.gov/pubmed/39235855 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e56969 %T Telemedicine Applications for Cancer Rehabilitation: Scoping Review %A Goncalves Leite Rocco,Patricia %A Reategui-Rivera,C Mahony %A Finkelstein,Joseph %+ Department of Biomedical Informatics, School of Medicine, University of Utah, 421 Wakara Way, Suite 140, Salt Lake City, UT, 84108, United States, 1 801 581 4080, patricia.rocco@utah.edu %K telerehabilitation %K telemedicine %K rehabilitation %K cancer %K exercise %K physical therapy %K telehealth %K remote care %K digital medicine %K oncology %K oncologist %K metastases %K exercising %K scoping review %K scoping reviews %K PubMed %D 2024 %7 21.8.2024 %9 Review %J JMIR Cancer %G English %X 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. %M 39079103 %R 10.2196/56969 %U https://cancer.jmir.org/2024/1/e56969 %U https://doi.org/10.2196/56969 %U http://www.ncbi.nlm.nih.gov/pubmed/39079103 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e54740 %T 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 %A Islam,Nazmul %A Reuben,Jamie S %A Dale,Justin %A Coates,James W %A Sapiah,Karan %A Markson,Frank R %A Jordan,Craig T %A Smith,Clay %+ RefinedScience, Bioscience 1, Suite 175, 12635 E Montview Blvd, Aurora, CO, 80045, United States, 1 9196049705, nazmul.islam@refinedscience.com %K Leukemia, Myeloid, Acute %K Venetoclax %K Azacitidine %K Anthracycline %K Arabinoside, Cytosine %K Clinical Decision Support %K Clinical Informatics %K Machine Learning %K Predictive Model %K Overall Survival %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Cancer %G English %X 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. %M 39167784 %R 10.2196/54740 %U https://cancer.jmir.org/2024/1/e54740 %U https://doi.org/10.2196/54740 %U http://www.ncbi.nlm.nih.gov/pubmed/39167784 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57781 %T Factorial Trial to Optimize an Internet-Delivered Intervention for Sexual Health After Breast Cancer: Protocol for the WF-2202 Sexual Health and Intimacy Enhancement (SHINE) Trial %A Shaffer,Kelly M %A Reese,Jennifer Barsky %A Dressler,Emily V %A Glazer,Jillian V %A Cohn,Wendy %A Showalter,Shayna L %A Clayton,Anita H %A Danhauer,Suzanne C %A Loch,Michelle %A Kadi,Mai %A Smith,Caleigh %A Weaver,Kathryn E %A Lesser,Glenn J %A Ritterband,Lee M %+ University of Virginia School of Medicine, PO Box 801075, Charlottesville, VA, 22902, United States, 1 434 982 1022, kshaffer@virginia.edu %K breast neoplasms %K cancer survivorship %K clinical trial %K communication skills %K factorial trial %K internet interventions %K intimacy %K mobile phone %K multiphase optimization strategy %K sexual distress %K sexual functioning %K sexual health %D 2024 %7 19.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although most survivors of breast cancer report substantial sexual concerns following treatment, few receive support for these concerns. Delivering sexual health care to survivors of breast cancer via the internet could overcome many of the barriers to in-person treatment. Even when delivered remotely, survivor time constraints remain a leading barrier to sexual health intervention uptake. Objective: Guided by the multiphase optimization strategy methodological framework, the primary objective of this study is to identify the most efficient internet-delivered sexual health intervention package that is expected to provide survivors of breast cancer the greatest benefit with the fewest (and least-intensive) intervention components. This study aims to determine how intervention components work (mediators) and for whom they work best (moderators). Methods: Partnered, posttreatment adult female survivors of breast cancer (N=320) experiencing at least 1 bothersome sexual symptom (ie, pain with sex, vaginal dryness, low sexual desire, and difficulty with orgasm) related to their breast cancer treatment will be enrolled. Clinic-based recruitment will be conducted via the Wake Forest National Cancer Institute Community Oncology Research Program (NCORP) Research Base. Participants will be randomly assigned to 1 of 16 combinations of four intervention components with two levels each in this factorial trial: (1) psychoeducation about cancer-related sexual morbidity (receive either enhanced vs standard versions); (2) communication skills training for discussing concerns with health care providers (received vs not received); (3) communication skills training for discussing concerns with a partner (received vs not received); and (4) intimacy promotion skills training (received vs not received). Cores will be fully automated and implemented using a robust internet intervention platform with highly engaging elements such as animation, video, and automated email prompts. Survivors will complete web-based assessments at baseline (prerandomization time point) and again at 12 and 24 weeks later. The primary study aim will be achieved through a decision-making process based on systematically evaluating the main and interaction effects of components on sexual distress (Female Sexual Distress Scale–Desire, Arousal, Orgasm) and sexual functioning (Female Sexual Function Index) using a generalized linear model approach to ANOVA with effect coding. Mediation analyses will be conducted through a structural equation modeling approach, and moderation analyses will be conducted by extending the generalized linear model to include interaction effects. Results: This protocol has been reviewed and approved by the National Cancer Institute Central Institutional Review Board. Data collection is planned to begin in March 2024 and conclude in 2027. Conclusions: By identifying the combination of the fewest and least-intensive intervention components likely to provide survivors of breast cancer the greatest sexual health benefit, this study will result in the first internet intervention that is optimized for maximum impact on the undertreated, prevalent, and distressing problem of breast cancer–related sexual morbidity. Trial Registration: ClinicalTrials.gov NCT06216574; https://clinicaltrials.gov/study/NCT06216574 International Registered Report Identifier (IRRID): PRR1-10.2196/57781 %M 39159450 %R 10.2196/57781 %U https://www.researchprotocols.org/2024/1/e57781 %U https://doi.org/10.2196/57781 %U http://www.ncbi.nlm.nih.gov/pubmed/39159450 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54819 %T Charting Health Challenges for Digital Preventive Interventions Among Adult Survivors of Childhood Acute Lymphoblastic Leukemia: National Long-Term Follow-Up Survey of Self-Rated Health Outcomes %A Nygren,Jens M %A Aili,Katarina %A Arvidsson,Susann %A Olsson,Maria %A Jarfelt,Marianne %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 035167100, jens.nygren@hh.se %K digital preventive interventions %K long-term follow-up %K self-rated health outcomes %K adult survivors %K childhood acute lymphoblastic leukemia %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Acute lymphoblastic leukemia (ALL) is the most common malignancy in childhood, but the prognosis has remarkably improved over the last 50 years in high-income countries, and thus, there is a focus on long-term health outcomes following survival and how to best provide health care support to adult long-term survivors of childhood ALL to prevent and handle potential health problems. Digital health interventions are promising to deliver feasible health promotion and prevention programs. This is particularly relevant for ensuring long-term follow-up in cases where continuous contact with oncology care may be disrupted. Moreover, these interventions are beneficial in reaching geographically dispersed target groups and overcoming the time constraints of everyday life that often hinder participation in such programs. Objective: This study aimed to fill the gaps in existing research on adult long-term survivors of childhood ALL and provide formative data that can inform the development of formalized follow-up services designed to meet the needs of these survivors in ways that align with their preferences for digital health interventions. Methods: In this cross-sectional national study, adult survivors (aged ≥18 years) of childhood ALL for over 10 years after diagnosis were compared to their siblings in terms of mental and physical health-related factors, including sleep, stress, anxiety, and depression (Depression Anxiety and Stress Scale 21 [DASS-21]); several dimensions of fatigue (Multidimensional Fatigue Inventory 20 [MFI-20]); work ability (Work Ability Index); chronic pain; and prevalences of diabetes, cardiovascular disease, headache or migraine, and rheumatic disease. Results: Overall, 426 of 855 eligible ALL survivors responded (mean age 30.9, SD 7.7 years), and they participated at an average of 24 (SD 6.9) years after ALL diagnosis. Siblings (n=135; mean age 31.5, SD 7.7 years) acted as controls. Sleep quality, sleep quantity, and mean work ability scores were significantly lower, and physical fatigue, reduced motivation, and reduced activity scores were higher in ALL survivors than in siblings. There were no significant differences between the groups in terms of BMI and prevalence of chronic pain, depression, anxiety, or stress. Physical and psychological complications were more frequent among adult ALL survivors who had received hematopoietic stem cell transplantation (HSCT) than among those who had not received HSCT. Conclusions: Our nationwide cross-sectional study addressed the scarcity of knowledge regarding the self-reported health outcomes of adult long-term survivors of childhood ALL. We highlighted significant disparities within this population and emphasized the potential of comprehensive digital interventions that target vitality, sleep quality, fatigue, and psychosocial well-being to enhance well-being and bolster the capacity for managing chronic health conditions in this target group. Such an intervention would align with the needs of this target group, which is a prerequisite for successfully incorporating technology into the daily lives of survivors of childhood ALL. %M 39133918 %R 10.2196/54819 %U https://formative.jmir.org/2024/1/e54819 %U https://doi.org/10.2196/54819 %U http://www.ncbi.nlm.nih.gov/pubmed/39133918 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e55011 %T Socioeconomic Disparities in Six Common Cancer Survival Rates in South Korea: Population-Wide Retrospective Cohort Study %A Lee,JinWook %A Park,JuWon %A Kim,Nayeon %A Nari,Fatima %A Bae,Seowoo %A Lee,Hyeon Ji %A Lee,Mingyu %A Jun,Jae Kwan %A Choi,Kui Son %A Suh,Mina %K cancer survival %K income level %K socioeconomic status %K deprivation index %K inequality %K nationwide analysis %K cancer %K South Korea %K public health %D 2024 %7 22.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: In South Korea, the cancer incidence rate has increased by 56.5% from 2001 to 2021. Nevertheless, the 5-year cancer survival rate from 2017 to 2021 increased by 17.9% compared with that from 2001 to 2005. Cancer survival rates tend to decline with lower socioeconomic status, and variations exist in the survival rates among different cancer types. Analyzing socioeconomic patterns in the survival of patients with cancer can help identify high-risk groups and ensure that they benefit from interventions. Objective: The aim of this study was to analyze differences in survival rates among patients diagnosed with six types of cancer—stomach, colorectal, liver, breast, cervical, and lung cancers—based on socioeconomic status using Korean nationwide data. Methods: This study used the Korea Central Cancer Registry database linked to the National Health Information Database to follow up with patients diagnosed with cancer between 2014 and 2018 until December 31, 2021. Kaplan-Meier curves stratified by income status were generated, and log-rank tests were conducted for each cancer type to assess statistical significance. Hazard ratios with 95% CIs for any cause of overall survival were calculated using Cox proportional hazards regression models with the time since diagnosis. Results: The survival rates for the six different types of cancer were as follows: stomach cancer, 69.6% (96,404/138,462); colorectal cancer, 66.6% (83,406/125,156); liver cancer, 33.7% (23,860/70,712); lung cancer, 30.4% (33,203/109,116); breast cancer, 91.5% (90,730/99,159); and cervical cancer, 78% (12,930/16,580). When comparing the medical aid group to the highest income group, the hazard ratios were 1.72 (95% CI 1.66‐1.79) for stomach cancer, 1.60 (95% CI 1.54‐1.56) for colorectal cancer, 1.51 (95% CI 1.45‐1.56) for liver cancer, 1.56 (95% CI 1.51‐1.59) for lung cancer, 2.19 (95% CI 2.01‐2.38) for breast cancer, and 1.65 (95% CI 1.46‐1.87) for cervical cancer. A higher deprivation index and advanced diagnostic stage were associated with an increased risk of mortality. Conclusions: Socioeconomic status significantly mediates disparities in cancer survival in several cancer types. This effect is particularly pronounced in less fatal cancers such as breast cancer. Therefore, considering the type of cancer and socioeconomic factors, social and medical interventions such as early cancer detection and appropriate treatment are necessary for vulnerable populations. %R 10.2196/55011 %U https://publichealth.jmir.org/2024/1/e55011 %U https://doi.org/10.2196/55011 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57529 %T Measuring Engagement in Provider-Guided Digital Health Interventions With a Conceptual and Analytical Framework Using Nurse WRITE as an Exemplar: Exploratory Study With an Iterative Approach %A Wang,Yan %A DeVito Dabbs,Annette %A Thomas,Teresa Hagan %A Campbell,Grace %A Donovan,Heidi %+ Department of Health & Community Systems, School of Nursing, University of Pittsburgh, 3500 Victoria Street, Victoria Building, Pittsburgh, PA, 15261, United States, 1 14126261172, yaw75@pitt.edu %K engagement %K digital health intervention %K framework %K symptom management %K eHealth %K gynecological cancer %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Limited guidance exists for analyzing participant engagement in provider-guided digital health interventions (DHIs). System usage is commonly assessed, with acknowledged limitations in measuring socio-affective and cognitive aspects of engagement. Nurse WRITE, an 8-week web-based nurse-guided DHI for managing symptoms among women with recurrent ovarian cancer, offers an opportunity to develop a framework for assessing multidimensional engagement. Objective: This study aims to develop a conceptual and analytic framework to measure socio-affective, cognitive, and behavioral engagement with provider-guided DHIs. We then illustrate the framework’s ability to describe and categorize engagement using Nurse WRITE as an example. Methods: A sample of 68 participants from Nurse WRITE who posted on the message boards were included. We adapted a prior framework for conceptualizing and operationalizing engagement across 3 dimensions and finalized a set of 6 distinct measures. Using patients' posts, we created 2 socio-affective engagement measures—total count of socio-affective engagement classes (eg, sharing personal experience) and total word count—and 2 cognitive engagement measures—total count of cognitive engagement classes (eg, asking information-seeking questions) and average question completion percentage. Additionally, we devised behavioral engagement measures using website data—the total count of symptom care plans and plan reviews. k-Means clustering categorized the participants into distinct groups based on levels of engagement across 3 dimensions. Descriptive statistics and narratives were used to describe engagement in 3 dimensions. Results: On average, participants displayed socio-affective engagement 34.7 times, writing 14,851 words. They showed cognitive engagement 19.4 times, with an average of 78.3% completion of nurses' inquiries. Participants also submitted an average of 1.6 symptom care plans and 0.7 plan reviews. Participants were clustered into high (n=13), moderate (n=17), and low engagers (n=38) based on the 6 measures. High engagers wrote a median of 36,956 (IQR 26,199-46,265) words. They demonstrated socio-affective engagement approximately 81 times and cognitive engagement around 46 times, approximately 6 times that of the low engagers and twice that of the moderate engagers. High engagers had a median of 91.7% (IQR 82.2%-93.7%) completion of the nurses’ queries, whereas moderate engagers had 86.4% (IQR 80%-96.4%), and low engagers had 68.3% (IQR 60.1%-79.6%). High engagers completed a median of 3 symptom care plans and 2 reviews, while moderate engagers completed 2 plans and 1 review. Low engagers completed a median of 1 plan with no reviews. Conclusions: This study developed and reported an engagement framework to guide behavioral intervention scientists in understanding and analyzing participants’ engagement with provider-guided DHIs. Significant variations in engagement levels across 3 dimensions highlight the importance of measuring engagement with provider-guided DHIs in socio-affective, cognitive, and behavioral dimensions. Future studies should validate the framework with other DHIs, explore the influence of patient and provider factors on engagement, and investigate how engagement influences intervention efficacy. %M 39037757 %R 10.2196/57529 %U https://formative.jmir.org/2024/1/e57529 %U https://doi.org/10.2196/57529 %U http://www.ncbi.nlm.nih.gov/pubmed/39037757 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e53180 %T Do Measures of Real-World Physical Behavior Provide Insights Into the Well-Being and Physical Function of Cancer Survivors? Cross-Sectional Analysis %A Bachman,Shelby L %A Gomes,Emma %A Aryal,Suvekshya %A Cella,David %A Clay,Ieuan %A Lyden,Kate %A Leach,Heather J %+ VivoSense, Inc, 27 Dorian, Newport Coast, CA, 92657, United States, 1 8588768486, shelby.bachman@vivosense.com %K accelerometer %K cancer survivorship %K cancer survivors %K digital health technology %K health-related quality of life %K physical behavior %K physical function %D 2024 %7 15.7.2024 %9 Original Paper %J JMIR Cancer %G English %X 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 %M 39008350 %R 10.2196/53180 %U https://cancer.jmir.org/2024/1/e53180 %U https://doi.org/10.2196/53180 %U http://www.ncbi.nlm.nih.gov/pubmed/39008350 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e51072 %T 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 %A Yeung,Nelson C Y %A Lau,Stephanie T Y %A Mak,Winnie W S %A Cheng,Cecilia %A Chan,Emily Y Y %A Siu,Judy Y M %A Cheung,Polly S Y %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, Postgraduate Education Centre, Prince of Wales Hospital, Hong Kong, China (Hong Kong), 852 22528740, nelsonyeung@cuhk.edu.hk %K telehealth %K tele-delivered supportive cancer care %K breast cancer %K COVID-19 %K technology acceptance %K UTAUT %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Cancer %G English %X 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: β=0.16, P=.03 to β=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 (β=0.34, P=.04) and (2) facilitating conditions and intention to use teledelivered peer support groups (β=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. %M 38935942 %R 10.2196/51072 %U https://cancer.jmir.org/2024/1/e51072 %U https://doi.org/10.2196/51072 %U http://www.ncbi.nlm.nih.gov/pubmed/38935942 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47704 %T Effectiveness of Web-Based Mindfulness-Based Interventions for Patients With Cancer: Systematic Review and Meta-Analyses %A Wang,Ting %A Tang,Chulei %A Jiang,Xiaoman %A Guo,Yinning %A Zhu,Shuqin %A Xu,Qin %+ School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China, 86 13601587208, qinxu@njmu.edu.cn %K cancer %K mindfulness-based interventions %K mental health %K randomized controlled trial %K systematic review %K meta-analysis %K mindfulness %K web-based intervention %K oncology %K delivery mode %K efficacy %K quality of life %K program %K adherence %K mobile phone %D 2024 %7 25.6.2024 %9 Review %J J Med Internet Res %G English %X Background: Cancer has emerged as a considerable global health concern, contributing substantially to both morbidity and mortality. Recognizing the urgent need to enhance the overall well-being and quality of life (QOL) of cancer patients, a growing number of researchers have started using online mindfulness-based interventions (MBIs) in oncology. However, the effectiveness and optimal implementation methods of these interventions remain unknown. Objective: This study evaluates the effectiveness of online MBIs, encompassing both app- and website-based MBIs, for patients with cancer and provides insights into the potential implementation and sustainability of these interventions in real-world settings. Methods: Searches were conducted across 8 electronic databases, including the Cochrane Library, Web of Science, PubMed, Embase, SinoMed, CINAHL Complete, Scopus, and PsycINFO, until December 30, 2022. Randomized controlled trials involving cancer patients aged ≥18 years and using app- and website-based MBIs compared to standard care were included. Nonrandomized studies, interventions targeting health professionals or caregivers, and studies lacking sufficient data were excluded. Two independent authors screened articles, extracted data using standardized forms, and assessed the risk of bias in the studies using the Cochrane Bias Risk Assessment Tool. Meta-analyses were performed using Review Manager (version 5.4; The Cochrane Collaboration) and the meta package in R (R Foundation for Statistical Computing). Standardized mean differences (SMDs) were used to determine the effects of interventions. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was used to assess the potential implementation and sustainability of these interventions in real-world settings. Results: Among 4349 articles screened, 15 (0.34%) were included. The total population comprised 1613 participants, of which 870 (53.9%) were in the experimental conditions and 743 (46.1%) were in the control conditions. The results of the meta-analysis showed that compared with the control group, the QOL (SMD 0.37, 95% CI 0.18-0.57; P<.001), sleep (SMD −0.36, 95% CI −0.71 to −0.01; P=.04), anxiety (SMD −0.48, 95% CI −0.75 to −0.20; P<.001), depression (SMD −0.36, 95% CI −0.61 to −0.11; P=.005), distress (SMD −0.50, 95% CI −0.75 to −0.26; P<.001), and perceived stress (SMD −0.89, 95% CI −1.33 to −0.45; P=.003) of the app- and website-based MBIs group in patients with cancer was significantly alleviated after the intervention. However, no significant differences were found in the fear of cancer recurrence (SMD −0.30, 95% CI −1.04 to 0.44; P=.39) and posttraumatic growth (SMD 0.08, 95% CI −0.26 to 0.42; P=.66). Most interventions were multicomponent, website-based health self-management programs, widely used by international and multilingual patients with cancer. Conclusions: App- and website-based MBIs show promise for improving mental health and QOL outcomes in patients with cancer, and further research is needed to optimize and customize these interventions for individual physical and mental symptoms. Trial Registration: PROSPERO CRD42022382219; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=382219 %M 38917445 %R 10.2196/47704 %U https://www.jmir.org/2024/1/e47704 %U https://doi.org/10.2196/47704 %U http://www.ncbi.nlm.nih.gov/pubmed/38917445 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e51210 %T Heart Rate Monitoring Among Breast Cancer Survivors: Quantitative Study of Device Agreement in a Community-Based Exercise Program %A Page,Lindsey L %A Fanning,Jason %A Phipps,Connor %A Berger,Ann %A Reed,Elizabeth %A Ehlers,Diane %+ Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic Arizona, 200 First Street SW, Rochester, AZ, 55905, United States, 1 408 574 2739, ehlers.diane@mayo.edu %K wearable devices %K exercise prescription %K validity %K photoplethysmography %K monitoring %K wearables %K devices %K exercise %K heart rate %K breast cancer %K cancer %K cancer survivor %K community %K chest monitor %K Fitbit %K recovery %K safety %D 2024 %7 20.6.2024 %9 Original Paper %J JMIR Cancer %G English %X 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 %M 38900505 %R 10.2196/51210 %U https://cancer.jmir.org/2024/1/e51210 %U https://doi.org/10.2196/51210 %U http://www.ncbi.nlm.nih.gov/pubmed/38900505 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52494 %T Adapting an Efficacious Peer-Delivered Physical Activity Program for Survivors of Breast Cancer for Web Platform Delivery: Protocol for a 2-Phase Study %A Pinto,Bernardine M %A Patel,Ashwin %A Ostendorf,Danielle M %A Huebschmann,Amy G %A Dunsiger,Shira I %A Kindred,Madison M %+ College of Nursing, University of South Carolina, 1601 Greene Street, Rm 302B, Columbia, SC, 29208, United States, 1 8037779272, Pintob@mailbox.sc.edu %K physical activity adoption %K web platform %K breast cancer survivors %K design %K implementation %K cost-effectiveness %K mobile phone %D 2024 %7 19.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Interventions promoting physical activity (PA) among survivors of cancer improve their functioning, reduce fatigue, and offer other benefits in cancer recovery and risk reduction for future cancer. There is a need for interventions that can be implemented on a wider scale than that is possible in research settings. We have previously demonstrated that a 3-month peer-delivered PA program (Moving Forward Together [MFT]) significantly increased the moderate to vigorous PA (MVPA) of survivors of breast cancer. Objective: Our goal is to scale up the MFT program by adapting an existing peer mentoring web platform, Mentor1to1. InquistHealth’s web platform (Mentor1to1) has demonstrated efficacy in peer mentoring for chronic disease management. We will partner with InquisitHealth to adapt their web platform for MFT. The adaptation will allow for automating key resource-intensive components such as matching survivors with a coach via the web-based peer mentoring platform and collecting key indexes to prepare for large-scale implementation. The aim is to streamline intervention delivery, assure fidelity, and improve survivor outcomes. Methods: In phase 1 of this 2-phase study, we will interview 4 peer mentors or coaches with experience in delivering MFT and use their feedback to create Mentor1to1 web platform adapted for MFT (webMFT). Next, another 4 coaches will participate in rapid, iterative user-centered testing of webMFT. In phase 2, we will conduct a randomized controlled trial by recruiting and training 10 to 12 coaches from cancer organizations to deliver webMFT to 56 survivors of breast cancer, who will be assigned to receive either webMFT or MVPA tracking (control) for 3 months. We will assess effectiveness with survivors’ accelerometer-measured MVPA and self-reported psychosocial well-being at baseline and 3 months. We will assess implementation outcomes, including acceptability, feasibility, and program costs from the perspective of survivors, coaches, and collaborating organizations, as guided by the expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Results: As of September 2023, phase 1 of the study was completed, and 61 survivors were enrolled in phase 2. Using newer technologies for enhanced intervention delivery, program management, and automated data collection has the exciting promise of facilitating effective implementation by organizations with limited resources. Adapting evidence-based MFT to a customized web platform and collecting data at multiple levels (coaches, survivors, and organizations) along with costs will provide a strong foundation for a robust multisite implementation trial to increase MVPA and its benefits among many more survivors of breast cancer. Conclusions: The quantitative and qualitative data collected from survivors of cancer, coaches, and organizations will be analyzed to inform a future larger-scale trial of peer mentoring for PA delivered by cancer care organizations to survivors. Trial Registration: ClinicalTrials.gov NCT05409664; https://clinicaltrials.gov/study/NCT05409664 International Registered Report Identifier (IRRID): DERR1-10.2196/52494 %M 38896452 %R 10.2196/52494 %U https://www.researchprotocols.org/2024/1/e52494 %U https://doi.org/10.2196/52494 %U http://www.ncbi.nlm.nih.gov/pubmed/38896452 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e53354 %T 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 %A Zheng,Yue %A Zhao,Ailin %A Yang,Yuqi %A Wang,Laduona %A Hu,Yifei %A Luo,Ren %A Wu,Yijun %+ Division of Thoracic Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Guoxue Lane 37, Chengdu, 610041, China, 86 17888841669, wuyj01029@wchscu.cn %K metachronous second primary lung cancer %K radiotherapy %K surgical resection %K propensity score matching analysis %K machine learning %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Cancer %G English %X 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. %M 38865182 %R 10.2196/53354 %U https://cancer.jmir.org/2024/1/e53354 %U https://doi.org/10.2196/53354 %U http://www.ncbi.nlm.nih.gov/pubmed/38865182 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54126 %T Behavioral Weight Loss Programs for Cancer Survivors Throughout Maryland: Protocol for a Pragmatic Trial and Participant Characteristics %A Jerome,Gerald J %A Appel,Lawrence J %A Bunyard,Linda %A Dalcin,Arlene T %A Durkin,Nowella %A Charleston,Jeanne B %A Kanarek,Norma F %A Carducci,Michael A %A Wang,Nae-Yuh %A Yeh,Hsin-Chieh %+ Department of Medicine, Johns Hopkins University, 2024 East Monument Street, Baltimore, MD, 21287, United States, 1 4106144316, hyeh1@jhmi.edu %K cancer %K obesity %K weight loss %K pragmatic trial %K oncology %K weight %K overweight %K obese %K USA %K United States %K survivor %K survivors %K remote %K self-directed %K self-guided %K coach %K coaching %K mHealth %K mobile health %K app %K apps %K application %K applications %K EHR %K health record %K health records %K mobile phone %D 2024 %7 12.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Clinical trials examining lifestyle interventions for weight loss in cancer survivors have been demonstrated to be safe, feasible, and effective. However, scalable weight loss programs are needed to support their widespread implementation. The ASPIRE trial was designed to evaluate real-world, lifestyle-based, weight loss programs for cancer survivors throughout Maryland. Objective: The objectives of this protocol paper are to describe the design of a nonrandomized pragmatic trial, study recruitment, and baseline characteristics of participants. Methods: Participants were aged ≥18 years, residing in Maryland, with a BMI ≥25 kg/m2, who reported a diagnosis of a malignant solid tumor, completed curative treatment, and had no ongoing or planned cancer treatment. Enrollment criteria were minimized to increase generalizability. The primary recruitment source was the Johns Hopkins Health System electronic health records (EHRs). Participants selected 1 of 3 remotely delivered weight loss programs: self-directed, app-supported, or coach-supported program. Results: Participants were recruited across all 5 geographic regions of Maryland. Targeted invitations using EHRs accounted for 287 (84.4%) of the 340 participants enrolled. Of the 5644 patients invited through EHR, 5.1% (287/5644) enrolled. Participants had a mean age of 60.7 (SD 10.8) years, 74.7% (254/340) were female, 55.9% (190/340) identified as non-Hispanic Black, 58.5% (199/340) had a bachelor’s degree, and the average BMI was 34.1 kg/m2 (SD 5.9 kg/m2). The most common types of cancers were breast (168/340, 49.4%), prostate (72/340, 21.2%), and thyroid (39/340, 8.5%). The self-directed weight loss program (n=91) included 25 participants who agreed to provide weights through a study scale; the app-supported program (n=142) included 108 individuals who agreed to provide their weight measurements; and the coach-supported weight loss program included 107 participants. We anticipate final analysis will take place in the fall of 2024. Conclusions: Using EHR-based recruitment efforts, this study took a pragmatic approach to reach and enroll cancer survivors into remotely delivered weight loss programs. Trial Registration: ClinicalTrials.gov NCT04534309; https://clinicaltrials.gov/study/NCT04534309 International Registered Report Identifier (IRRID): DERR1-10.2196/54126 %M 38865181 %R 10.2196/54126 %U https://www.researchprotocols.org/2024/1/e54126 %U https://doi.org/10.2196/54126 %U http://www.ncbi.nlm.nih.gov/pubmed/38865181 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54089 %T Multivisceral Oncological Resections Involving the Pancreas: Protocol for a Systematic Review and Meta-Analysis %A Neuhaus,Melina %A Friedrichs,Juliane %A Grilli,Maurizio %A Ukkat,Jörg %A Klose,Johannes %A Ronellenfitsch,Ulrich %A Kleeff,Jörg %A Rebelo,Artur %+ Uniklinikum Halle, Ernst-Grube-Straße 40, Halle, 06120, Germany, 49 03455577712, artur.rebelo@uk-halle.de %K meta-analysis %K systematic review %K multivisceral resection %K pancreatic resection %K oncological resection %K surgery %K outcomes %K mortality %K morbidity %K survival %K cancer %K tumor %K pancreas %D 2024 %7 11.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: With the continuous advancement of cancer treatments, a comprehensive analysis of the impact of multivisceral oncological pancreatic resections on morbidity, mortality, and long-term survival is currently lacking. Objective: This manuscript presents the protocol for a systematic review and meta-analysis designed to summarize the existing evidence concerning the outcomes of multivisceral oncological pancreatic resections across diverse tumor entities. Methods: We will conduct a systematic search of the PubMed or MEDLINE, Embase, Cochrane Library, CINAHL, and ClinicalTrials.gov databases in strict accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The predefined outcomes encompass postoperative mortality, postoperative morbidity, overall and disease-free survival (1- to 5-year survival rates), the proportion of macroscopically complete (R0) resections (according to the Royal College of Pathologists definition), duration of hospital stay (in days), reoperation rate (%), postoperative complications (covering all complications according to the Clavien-Dindo classification), as well as pancreatic fistula, postpancreatectomy hemorrhage, and delayed gastric emptying (all according to the definitions of the International Study Group of Pancreas Surgery). Results: Systematic database searches will begin in July 2024. The completion of the meta-analysis is anticipated by December 2024. Before completion, the literature search will be checked for new publications that must be considered in the context of the work. Conclusions: The forthcoming findings will provide an up-to-date overview of the feasibility, safety, and oncological efficacy of multivisceral pancreatic resections across diverse tumor entities. This data will serve as a valuable resource for health care professionals and patients to make well-informed clinical decisions. Trial Registration: PROSPERO CRD42023437858; https://tinyurl.com/bde5xmfw International Registered Report Identifier (IRRID): PRR1-10.2196/54089 %M 38861712 %R 10.2196/54089 %U https://www.researchprotocols.org/2024/1/e54089 %U https://doi.org/10.2196/54089 %U http://www.ncbi.nlm.nih.gov/pubmed/38861712 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50783 %T Effects of the “AI-TA” Mobile App With Intelligent Design on Psychological and Related Symptoms of Young Survivors of Breast Cancer: Randomized Controlled Trial %A Jiang,Lulu %A Xu,Jiehui %A Wu,Yanwei %A Liu,Yanyan %A Wang,Xiyi %A Hu,Yun %+ School of Nursing, Shanghai Jiao Tong University, No.277 Chongqing South Roud, Huangpu District, Shanghai, 200025, China, 86 021 63546078, huyunsy@shsmu.edu.cn %K mobile app %K artificial intelligence %K interactivity %K breast cancer %K psychological symptoms %K self-efficacy %K social support %K quality of life %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young women often face substantial psychological challenges in the initial years following cancer diagnosis, leading to a comparatively lower quality of life than older survivors. While mobile apps have emerged as potential interventions, their effectiveness remains inconclusive due to the diversity in intervention types and variation in follow-up periods. Furthermore, there is a particular dearth of evidence regarding the efficacy of these apps’ intelligent features in addressing psychological distress with these apps. Objective: This study aims to evaluate the effectiveness of a mobile app with intelligent design called “AI-TA” on cancer-related psychological health and ongoing symptoms with a randomized controlled design. Methods: Women aged 18 to 45 years diagnosed with breast cancer were randomly assigned to the intervention or control group. The intervention was AI-TA, which included 2-way web-based follow-up every 2 weeks. Both intention-to-treat (ITT) and per-protocol (PP) analyses employed repeated measurement analysis of variance. The participants’ background features, primary outcomes (psychological distress and frequency, self-efficacy, and social support), and secondary outcomes (quality of life) were measured using multiple instruments at 3 time points (baseline, 1-month intervention, and 3-month intervention). Results: A total of 124 participants were randomly allocated to the control group (n=62, 50%) or intervention group (n=62, 50%). In total, 92.7% (115/124) of the participants completed the intervention. Significant improvements in psychological symptoms (Memorial Symptom Assessment Scale-Short Form) were observed in the ITT group from baseline to 1-month intervention relative to the control group (ITT vs control: 1.17 vs 1.23; P<.001), which persisted at 3-month follow-up (ITT vs control: 0.68 vs 0.91; P<.001). Both the ITT and PP groups exhibited greater improvements in self-efficacy (Cancer Behavior Inventory-Brief Version) than the control group at 1-month (ITT vs PP vs control: 82.83 vs 77.12 vs 65.35; P<.001) and 3-month intervention (ITT vs PP vs control: 92.83 vs 89.30 vs 85.65; P<.001). However, the change in social support (Social Support Rating Scale) did not increase significantly until 3-month intervention (ITT vs control: 50.09 vs 45.10; P=.002) (PP vs control: 49.78 vs 45.10; P<.001). All groups also experienced beneficial effects on quality of life (Functional Assessment of Cancer Therapy-Breast), which persisted at 3-month follow-up (P<.001). Conclusions: The intelligent mobile app AI-TA incorporating intelligent design shows promise for reducing psychological and cancer-related symptoms among young survivors of breast cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200058823; https://www.chictr.org.cn/showproj.html?proj=151195 %M 38833298 %R 10.2196/50783 %U https://mhealth.jmir.org/2024/1/e50783 %U https://doi.org/10.2196/50783 %U http://www.ncbi.nlm.nih.gov/pubmed/38833298 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56888 %T The Experience of Cancer-Related Cognitive Impairment Across Common Cancers: Protocol for a Qualitative Systematic Review %A Ibrar,Maryam %A Rai,Harleen Kaur %A Main,Ashleigh %A McCartney,Haruno %A Maguire,Roma %A Rodriguez,Mario Alfredo Parra %+ Department of Computer and Information Sciences, University of Strathclyde, Livingstone Tower, 7th Fl, 26 Richmond St, Glasgow, G1 1XH, United Kingdom, 44 7769914387, maryam.ibrar@strath.ac.uk %K cancer %K neoplasms %K cancer survivors %K cancer-related cognitive impairment %K chemotherapy-related cognitive impairment %K qualitative research %K executive function %K cognition %K cognitive impairment %K quality of life %K common cancer %K qualitative synthesis %K adult %K young adult %K functional ability %K functional outcome %K qualitative %K cognitive impairments %K cancer survivor %K survival rates %D 2024 %7 31.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer-related cognitive impairment (CRCI) is commonly experienced by patients with cancer during treatment, and 35% of patients experience cognitive impairment after treatment completion. Impairments in memory, attention, executive functioning, and information processing speed are most reported and often negatively impact daily functioning and quality of life (QoL). Despite the large scale of reports, this adverse side effect is underinvestigated across common cancer types, and there is a lack of insight into the CRCI experience. Objective: This qualitative synthesis aims to explore the evidence in relation to the experience of CRCI across common cancers. It also aims to understand the prevalence of CRCI across various cancer types, cognitive domains, and its impact on QoL and functional ability. Methods: A comprehensive search of databases, including PubMed, American Psychological Association PsycINFO, CINAHL, and Scopus, will be conducted. A total of 2 independent reviewers will screen titles and abstracts for inclusion, followed by full-text screening. A third reviewer will resolve any arising conflicts in the process of data screening and inclusion. Subsequently, data extraction and quality assessment using the Critical Appraisal Skills Programme (CASP) tool will be conducted. The results will be analyzed using thematic analysis. Results: This review is part of a PhD program funded in January 2023. The review commenced in June 2023, and data analysis is currently in progress. The qualitative synthesis will explore the experiences of CRCI across common cancers. The included studies are expected to report on numerous cancer types such as breast cancer, prostate cancer, leukemia, and lung cancer. The included study types are most likely to be interviews, focus groups, and surveys with qualitative components. Conclusions: This protocol highlights the need for a qualitative synthesis that will explore the experience of CRCI across common cancer types. It will provide valuable insight into the lived experience of CRCI and the cognitive domains that may be disproportionately affected. There is a growing demand for further management interventions and clinically tested treatments of CRCI and the qualitative exploration of patient experience is crucial for their development. This qualitative synthesis will inform future developments and will contribute to improving QoL after cancer. International Registered Report Identifier (IRRID): DERR1-10.2196/56888 %M 38820581 %R 10.2196/56888 %U https://www.researchprotocols.org/2024/1/e56888 %U https://doi.org/10.2196/56888 %U http://www.ncbi.nlm.nih.gov/pubmed/38820581 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46737 %T Predicting Lung Cancer Survival to the Future: Population-Based Cancer Survival Modeling Study %A Meng,Fan-Tsui %A Jhuang,Jing-Rong %A Peng,Yan-Teng %A Chiang,Chun-Ju %A Yang,Ya-Wen %A Huang,Chi-Yen %A Huang,Kuo-Ping %A Lee,Wen-Chung %+ Institute of Health Data Analytics and Statistics, College of Public Health, National Taiwan University, Room 536, No 17, Xuzhou Road, Taipei, 100, Taiwan, 886 233668036, wenchung@ntu.edu.tw %K lung cancer %K survival %K survivorship-period-cohort model %K prediction %K prognosis %K early diagnosis %K lung cancer screening %K survival trend %K population-based %K population health %K public health %K surveillance %K low-dose computed tomography %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Lung cancer remains the leading cause of cancer-related mortality globally, with late diagnoses often resulting in poor prognosis. In response, the Lung Ambition Alliance aims to double the 5-year survival rate by 2025. Objective: Using the Taiwan Cancer Registry, this study uses the survivorship-period-cohort model to assess the feasibility of achieving this goal by predicting future survival rates of patients with lung cancer in Taiwan. Methods: This retrospective study analyzed data from 205,104 patients with lung cancer registered between 1997 and 2018. Survival rates were calculated using the survivorship-period-cohort model, focusing on 1-year interval survival rates and extrapolating to predict 5-year outcomes for diagnoses up to 2020, as viewed from 2025. Model validation involved comparing predicted rates with actual data using symmetric mean absolute percentage error. Results: The study identified notable improvements in survival rates beginning in 2004, with the predicted 5-year survival rate for 2020 reaching 38.7%, marking a considerable increase from the most recent available data of 23.8% for patients diagnosed in 2013. Subgroup analysis revealed varied survival improvements across different demographics and histological types. Predictions based on current trends indicate that achieving the Lung Ambition Alliance’s goal could be within reach. Conclusions: The analysis demonstrates notable improvements in lung cancer survival rates in Taiwan, driven by the adoption of low-dose computed tomography screening, alongside advances in diagnostic technologies and treatment strategies. While the ambitious target set by the Lung Ambition Alliance appears achievable, ongoing advancements in medical technology and health policies will be crucial. The study underscores the potential impact of continued enhancements in lung cancer management and the importance of strategic health interventions to further improve survival outcomes. %M 38819904 %R 10.2196/46737 %U https://publichealth.jmir.org/2024/1/e46737 %U https://doi.org/10.2196/46737 %U http://www.ncbi.nlm.nih.gov/pubmed/38819904 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51695 %T How Informal Carers Support Video Consulting in Physiotherapy, Heart Failure, and Cancer: Qualitative Study Using Linguistic Ethnography %A Seuren,Lucas Martinus %A Shaw,Sara %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 1 4372607372, lucas.seuren@phc.ox.ac.uk %K delivery of health care %K remote consultation %K carer %K telemedicine %K videoconferencing %K language %K linguistics %K gestures %K physiotherapy %K heart failure %K care %K patient care %K feasibility %K safety %K communication %K mobile phone %D 2024 %7 31.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Informal carers play an important role in the everyday care of patients and the delivery of health care services. They aid patients in transportation to and from appointments, and they provide assistance during the appointments (eg, answering questions on the patient’s behalf). Video consultations are often seen as a way of providing patients with easier access to care. However, few studies have considered how this affects the role of informal carers and how they are needed to make video consultations safe and feasible. Objective: This study aims to identify how informal carers, usually friends or family who provide unpaid assistance, support patients and clinicians during video consultations. Methods: We conducted an in-depth analysis of the communication in a sample of video consultations drawn from 7 clinical settings across 4 National Health Service Trusts in the United Kingdom. The data set consisted of 52 video consultation recordings (of patients with diabetes, gestational diabetes, cancer, heart failure, orthopedic problems, long-term pain, and neuromuscular rehabilitation) and interviews with all participants involved in these consultations. Using Linguistic Ethnography, which embeds detailed analysis of verbal and nonverbal communication in the context of the interaction, we examined the interactional, technological, and clinical work carers did to facilitate video consultations and help patients and clinicians overcome challenges of the remote and video-mediated context. Results: Most patients (40/52, 77%) participated in the video consultation without support from an informal carer. Only 23% (12/52) of the consultations involved an informal carer. In addition to facilitating the clinical interaction (eg, answering questions on behalf of the patient), we identified 3 types of work that informal carers did: facilitating the use of technology; addressing problems when the patient could not hear or understand the clinician; and assisting with physical examinations, acting as the eyes, ears, and hands of the clinician. Carers often stayed in the background, monitoring the consultation to identify situations where they might be needed. In doing so, copresent carers reassured patients and helped them conduct the activities that make up a consultation. However, carers did not necessarily help patients solve all the challenges of a video consultation (eg, aiming the camera while laying hands on the patient during an examination). We compared cases where an informal carer was copresent with cases where the patient was alone, which showed that carers provided an important safety net, particularly for patients who were frail and experienced mobility difficulties. Conclusions: Informal carers play a critical role in making video consultations safe and feasible, particularly for patients with limited technological experience or complex needs. Guidance and research on video consulting need to consider the availability and work done by informal carers and how they can be supported in providing patients access to digital health care services. %M 38819900 %R 10.2196/51695 %U https://www.jmir.org/2024/1/e51695 %U https://doi.org/10.2196/51695 %U http://www.ncbi.nlm.nih.gov/pubmed/38819900 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51059 %T Association of Remote Patient-Reported Outcomes and Step Counts With Hospitalization or Death Among Patients With Advanced Cancer Undergoing Chemotherapy: Secondary Analysis of the PROStep Randomized Trial %A Manz,Christopher R %A Schriver,Emily %A Ferrell,William J %A Williamson,Joelle %A Wakim,Jonathan %A Khan,Neda %A Kopinsky,Michael %A Balachandran,Mohan %A Chen,Jinbo %A Patel,Mitesh S %A Takvorian,Samuel U %A Shulman,Lawrence N %A Bekelman,Justin E %A Barnett,Ian J %A Parikh,Ravi B %+ Division of Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Room 1102, Philadelphia, PA, 19104, United States, 1 3524224285, Ravi.Parikh@pennmedicine.upenn.edu %K wearables %K accelerometers %K patient-reported outcomes %K step counts %K oncology %K accelerometer %K patient-generated health data %K cancer %K death %K chemotherapy %K symptoms %K gastrointestinal cancer %K lung cancer %K monitoring %K symptom burden %K risk %K hospitalization %K mobile phone %D 2024 %7 17.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with advanced cancer undergoing chemotherapy experience significant symptoms and declines in functional status, which are associated with poor outcomes. Remote monitoring of patient-reported outcomes (PROs; symptoms) and step counts (functional status) may proactively identify patients at risk of hospitalization or death. Objective: The aim of this study is to evaluate the association of (1) longitudinal PROs with step counts and (2) PROs and step counts with hospitalization or death. Methods: The PROStep randomized trial enrolled 108 patients with advanced gastrointestinal or lung cancers undergoing cytotoxic chemotherapy at a large academic cancer center. Patients were randomized to weekly text-based monitoring of 8 PROs plus continuous step count monitoring via Fitbit (Google) versus usual care. This preplanned secondary analysis included 57 of 75 patients randomized to the intervention who had PRO and step count data. We analyzed the associations between PROs and mean daily step counts and the associations of PROs and step counts with the composite outcome of hospitalization or death using bootstrapped generalized linear models to account for longitudinal data. Results: Among 57 patients, the mean age was 57 (SD 10.9) years, 24 (42%) were female, 43 (75%) had advanced gastrointestinal cancer, 14 (25%) had advanced lung cancer, and 25 (44%) were hospitalized or died during follow-up. A 1-point weekly increase (on a 32-point scale) in aggregate PRO score was associated with 247 fewer mean daily steps (95% CI –277 to –213; P<.001). PROs most strongly associated with step count decline were patient-reported activity (daily step change –892), nausea score (–677), and constipation score (524). A 1-point weekly increase in aggregate PRO score was associated with 20% greater odds of hospitalization or death (adjusted odds ratio [aOR] 1.2, 95% CI 1.1-1.4; P=.01). PROs most strongly associated with hospitalization or death were pain (aOR 3.2, 95% CI 1.6-6.5; P<.001), decreased activity (aOR 3.2, 95% CI 1.4-7.1; P=.01), dyspnea (aOR 2.6, 95% CI 1.2-5.5; P=.02), and sadness (aOR 2.1, 95% CI 1.1-4.3; P=.03). A decrease in 1000 steps was associated with 16% greater odds of hospitalization or death (aOR 1.2, 95% CI 1.0-1.3; P=.03). Compared with baseline, mean daily step count decreased 7% (n=274 steps), 9% (n=351 steps), and 16% (n=667 steps) in the 3, 2, and 1 weeks before hospitalization or death, respectively. Conclusions: In this secondary analysis of a randomized trial among patients with advanced cancer, higher symptom burden and decreased step count were independently associated with and predictably worsened close to hospitalization or death. Future interventions should leverage longitudinal PRO and step count data to target interventions toward patients at risk for poor outcomes. Trial Registration: ClinicalTrials.gov NCT04616768; https://clinicaltrials.gov/study/NCT04616768 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-054675 %M 38758583 %R 10.2196/51059 %U https://www.jmir.org/2024/1/e51059 %U https://doi.org/10.2196/51059 %U http://www.ncbi.nlm.nih.gov/pubmed/38758583 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52274 %T Determinants and Factors of Physical Activity After Oncology Treatments (DEFACTO) in Metropolitan France: Protocol of a Mixed Methods Study and Intervention %A Aumaitre,Albane %A Gagnayre,Rémi %A Foucaut,Aude-Marie %+ Health Educations and Promotion Laboratory, LEPS, UR 3412, Sorbonne Paris North University, 99 Avenue Jean Baptiste Clément, Villetaneuse, 93430, France, 33 148387641, albane.aumaitre@univ-paris13.fr %K socioecological model %K mixed methods %K cancer survivorship %K physical activity %K sedentary behavior %K individualized health education program %K feasibility %D 2024 %7 16.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: While the scientific community widely recognizes the benefits of physical activity (PA) in oncology supportive care, cancer survivors who have undergone chemo- or radio-immunotherapy treatments struggle to meet PA recommendations. This underscores the importance of identifying factors influencing active lifestyle adoption and maintenance and proposing a multilevel model (micro-, meso-, and macrolevel) to better understand facilitators and barriers. Currently, no socioecological model explains an active lifestyle in the posttreatment phase of breast, colorectal, prostate, and lung cancers. Objective: The objective is to identify factors influencing an active lifestyle in cancer survivorship and assess the feasibility of an individualized program targeting an active lifestyle. The objectives will be addressed in 3 stages. Stage 1 aims to elucidate factors associated with the active lifestyle of cancer survivors. Stage 2 involves developing an explanatory model based on previously identified factors to create a tailored health education program for an active lifestyle after oncology treatments. Stage 3 aims to evaluate the feasibility and potential effects of this personalized health education program after its national implementation. Methods: First, the exploration of factors influencing PA (stage 1) will be based on a mixed methods approach, using an explanatory sequential design and multilevel analysis. The quantitative phase involves completing a questionnaire from a socioecological perspective. Subsequently, a subset of respondents will engage in semistructured interviews to aid in interpreting the quantitative results. This phase aims to construct a model of the factors influencing an active lifestyle and develop an individualized 12-week program based on our earlier findings (stage 2). In stage 3, we will implement our multicenter, multimodal program for 150 physically inactive and sedentary cancer survivors across metropolitan France. Program feasibility will be evaluated. Measured PA level by connected device and multidimensional variables such as declared PA and sedentary behaviors, PA readiness, motivation, PA preferences, PA knowledge and skills, and barriers and facilitators will be assessed before and during the program and 52 weeks afterward. Results: The institutional review board approved the mixed methods study (phase 1) in April 2020, and the intervention (phase 3) was approved in March 2022. Recruitment and data collection commenced in April 2022, with intervention implementation concluded in May 2023. Data collection and full analysis are expected to be finalized by July 2024. Conclusions: The Determinants and Factors of Physical Activity After Oncology Treatments (DEFACTO) study seeks to enhance our understanding, within our socioecological model, of factors influencing an active lifestyle among cancer survivors and to assess whether a tailored intervention based on this model can support an active lifestyle. Trial Registration: ClinicalTrials.gov NCT05354882; https://www.clinicaltrials.gov/study/NCT05354882 International Registered Report Identifier (IRRID): DERR1-10.2196/52274 %M 38753415 %R 10.2196/52274 %U https://www.researchprotocols.org/2024/1/e52274 %U https://doi.org/10.2196/52274 %U http://www.ncbi.nlm.nih.gov/pubmed/38753415 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48380 %T Risk of Subsequent Primary Cancers Among Adult-Onset 5-Year Cancer Survivors in South Korea: Retrospective Cohort Study %A Choi,Yoon Young %A Lee,Myeongjee %A Kim,Eun Hwa %A Lee,Jae Eun %A Jung,Inkyung %A Cheong,Jae-Ho %+ Department of Surgery, Yonsei University Health System, Yonsei University College of Medicine, Yonsei-ro 50, Seoul, 03722, Republic of Korea, 82 2 2228 2094, jhcheong@yuhs.ac %K cancer %K survivors %K subsequent primary cancer %K adult %K onset %K primary cancer %K risk %K general population %K screening %K genetic testing %K retrospective %K cohort study %K health Insurance %K survivability %K hereditary %K FPC %K SPC %K subsequent cancer %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The number of cancer survivors who develop subsequent primary cancers (SPCs) is expected to increase. Objective: We evaluated the overall and cancer type–specific risks of SPCs among adult-onset cancer survivors by first primary cancer (FPC) types considering sex and age. Methods: We conducted a retrospective cohort study using the Health Insurance Review and Assessment database of South Korea including 5-year cancer survivors diagnosed with an FPC in 2009 to 2010 and followed them until December 31, 2019. We measured the SPC incidence per 10,000 person-years and the standardized incidence ratio (SIR) compared with the incidence expected in the general population. Results: Among 266,241 survivors (mean age at FPC: 55.7 years; 149,352/266,241, 56.1% women), 7348 SPCs occurred during 1,003,008 person-years of follow-up (median 4.3 years), representing a 26% lower risk of developing SPCs (SIR 0.74, 95% CI 0.72-0.76). Overall, men with 14 of the 20 FPC types had a significantly lower risk of developing any SPCs; women with 7 of the 21 FPC types had a significantly lower risk of developing any SPCs. The risk of developing any SPC type differed by age; the risk was 28% higher in young (<40 years) cancer survivors (SIR 1.28, 95% CI 1.16-1.42; incidence: 30 per 10,000 person-years) and 27% lower in middle-aged and older (≥40 years) cancer survivors (SIR 0.73, 95% CI 0.71-0.74; incidence: 80 per 10,000 person-years) compared with the age-corresponding general population. The most common types of FPCs were mainly observed as SPCs in cancer survivors, with lung (21.6%) and prostate (15.2%) cancers in men and breast (18.9%) and lung (12.2%) cancers in women. The risks of brain cancer in colorectal cancer survivors, lung cancer in laryngeal cancer survivors, and both kidney cancer and leukemia in thyroid cancer survivors were significantly higher for both sexes. Other high-risk SPCs varied by FPC type and sex. Strong positive associations among smoking-related cancers, such as laryngeal, head and neck, lung, and esophageal cancers, were observed. Substantial variation existed in the associations between specific types of FPC and specific types of SPC risk, which may be linked to hereditary cancer syndrome: for women, the risks of ovarian cancer for breast cancer survivors and uterus cancers for colorectal cancer survivors, and for men, the risk of pancreas cancer for kidney cancer survivors. Conclusions: The varying risk for SPCs by age, sex, and FPC types in cancer survivors implies the necessity for tailored prevention and screening programs targeting cancer survivors. Lifestyle modifications, such as smoking cessation, are essential to reduce the risk of SPCs in cancer survivors. In addition, genetic testing, along with proactive cancer screening and prevention strategies, should be implemented for young cancer survivors because of their elevated risk of developing SPCs. %M 38717807 %R 10.2196/48380 %U https://publichealth.jmir.org/2024/1/e48380 %U https://doi.org/10.2196/48380 %U http://www.ncbi.nlm.nih.gov/pubmed/38717807 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55917 %T Impact of Electronic Patient-Reported Outcomes on Unplanned Consultations and Hospitalizations in Patients With Cancer Undergoing Systemic Therapy: Results of a Patient-Reported Outcome Study Compared With Matched Retrospective Data %A Trojan,Andreas %A Kühne,Christian %A Kiessling,Michael %A Schumacher,Johannes %A Dröse,Stefan %A Singer,Christian %A Jackisch,Christian %A Thomssen,Christoph %A Kullak-Ublick,Gerd A %+ Oncology, Breast Center Zürichsee, Seestrasse 88, Horgen, 8810, Switzerland, 41 76 34 30 200, trojan@1st.ch %K systemic cancer therapy %K electronic patient-reported outcome %K ePRO %K ePROs %K Consilium Care %K medidux %K unplanned consultation %K hospitalization %K hospitalizations %K hospitalized %K cancer %K oncology %K side effect %K side effects %K adverse %K chemotherapy %K patient reported outcome %K PRO %K PROs %K mobile health %K mHealth %K app %K apps %K application %K applications %K mobile phone %D 2024 %7 6.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The evaluation of electronic patient-reported outcomes (ePROs) is increasingly being used in clinical studies of patients with cancer and enables structured and standardized data collection in patients’ everyday lives. So far, few studies or analyses have focused on the medical benefit of ePROs for patients. Objective: The current exploratory analysis aimed to obtain an initial indication of whether the use of the Consilium Care app (recently renamed medidux; mobile Health AG) for structured and regular self-assessment of side effects by ePROs had a recognizable effect on incidences of unplanned consultations and hospitalizations of patients with cancer compared to a control group in a real-world care setting without app use. To analyze this, the incidences of unplanned consultations and hospitalizations of patients with cancer using the Consilium Care app that were recorded by the treating physicians as part of the patient reported outcome (PRO) study were compared retrospectively to corresponding data from a comparable population of patients with cancer collected at 2 Swiss oncology centers during standard-of-care treatment. Methods: Patients with cancer in the PRO study (178 included in this analysis) receiving systemic therapy in a neoadjuvant or noncurative setting performed a self-assessment of side effects via the Consilium Care app over an observational period of 90 days. In this period, unplanned (emergency) consultations and hospitalizations were documented by the participating physicians. The incidence of these events was compared with retrospective data obtained from 2 Swiss tumor centers for a matched cohort of patients with cancer. Results: Both patient groups were comparable in terms of age and gender ratio, as well as the distribution of cancer entities and Joint Committee on Cancer stages. In total, 139 patients from each group were treated with chemotherapy and 39 with other therapies. Looking at all patients, no significant difference in events per patient was found between the Consilium group and the control group (odds ratio 0.742, 90% CI 0.455-1.206). However, a multivariate regression model revealed that the interaction term between the Consilium group and the factor “chemotherapy” was significant at the 5% level (P=.048). This motivated a corresponding subgroup analysis that indicated a relevant reduction of the risk for the intervention group in the subgroup of patients who underwent chemotherapy. The corresponding odds ratio of 0.53, 90% CI 0.288-0.957 is equivalent to a halving of the risk for patients in the Consilium group and suggests a clinically relevant effect that is significant at a 2-sided 10% level (P=.08, Fisher exact test). Conclusions: A comparison of unplanned consultations and hospitalizations from the PRO study with retrospective data from a comparable cohort of patients with cancer suggests a positive effect of regular app-based ePROs for patients receiving chemotherapy. These data are to be verified in the ongoing randomized PRO2 study (registered on ClinicalTrials.gov; NCT05425550). Trial Registration: ClinicalTrials.gov NCT03578731; https://www.clinicaltrials.gov/ct2/show/NCT03578731 International Registered Report Identifier (IRRID): RR2-10.2196/29271 %M 38710048 %R 10.2196/55917 %U https://formative.jmir.org/2024/1/e55917 %U https://doi.org/10.2196/55917 %U http://www.ncbi.nlm.nih.gov/pubmed/38710048 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49910 %T IT-Related Barriers and Facilitators to the Implementation of a New European eHealth Solution, the Digital Survivorship Passport (SurPass Version 2.0): Semistructured Digital Survey %A de Beijer,Ismay A E %A van den Oever,Selina R %A Charalambous,Eliana %A Cangioli,Giorgio %A Balaguer,Julia %A Bardi,Edit %A Alfes,Marie %A Cañete Nieto,Adela %A Correcher,Marisa %A Pinto da Costa,Tiago %A Degelsegger-Márquez,Alexander %A Düster,Vanessa %A Filbert,Anna-Liesa %A Grabow,Desiree %A Gredinger,Gerald %A Gsell,Hannah %A Haupt,Riccardo %A van Helvoirt,Maria %A Ladenstein,Ruth %A Langer,Thorsten %A Laschkolnig,Anja %A Muraca,Monica %A Pluijm,Saskia M F %A Rascon,Jelena %A Schreier,Günter %A Tomášikova,Zuzana %A Trauner,Florian %A Trinkūnas,Justas %A Trunner,Kathrin %A Uyttebroeck,Anne %A Kremer,Leontien C M %A van der Pal,Helena J H %A Chronaki,Catherine %A , %+ Princess Máxima Center for Pediatric Oncology, Heidelberglaan 25, Utrecht, 3484 CS, Netherlands, 31 638960162, i.a.e.debeijer-3@prinsesmaximacentrum.nl %K pediatric oncology %K long-term follow up care %K survivorship %K cancer survivors %K Survivorship Passport %K SurPass, eHealth %K information and technology %D 2024 %7 2.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: To overcome knowledge gaps and optimize long-term follow-up (LTFU) care for childhood cancer survivors, the concept of the Survivorship Passport (SurPass) has been invented. Within the European PanCareSurPass project, the semiautomated and interoperable SurPass (version 2.0) will be optimized, implemented, and evaluated at 6 LTFU care centers representing 6 European countries and 3 distinct health system scenarios: (1) national electronic health information systems (EHISs) in Austria and Lithuania, (2) regional or local EHISs in Italy and Spain, and (3) cancer registries or hospital-based EHISs in Belgium and Germany. Objective: We aimed to identify and describe barriers and facilitators for SurPass (version 2.0) implementation concerning semiautomation of data input, interoperability, data protection, privacy, and cybersecurity. Methods: IT specialists from the 6 LTFU care centers participated in a semistructured digital survey focusing on IT-related barriers and facilitators to SurPass (version 2.0) implementation. We used the fit-viability model to assess the compatibility and feasibility of integrating SurPass into existing EHISs. Results: In total, 13/20 (65%) invited IT specialists participated. The main barriers and facilitators in all 3 health system scenarios related to semiautomated data input and interoperability included unaligned EHIS infrastructure and the use of interoperability frameworks and international coding systems. The main barriers and facilitators related to data protection or privacy and cybersecurity included pseudonymization of personal health data and data retention. According to the fit-viability model, the first health system scenario provides the best fit for SurPass implementation, followed by the second and third scenarios. Conclusions: This study provides essential insights into the information and IT-related influencing factors that need to be considered when implementing the SurPass (version 2.0) in clinical practice. We recommend the adoption of Health Level Seven Fast Healthcare Interoperability Resources and data security measures such as encryption, pseudonymization, and multifactor authentication to protect personal health data where applicable. In sum, this study offers practical insights into integrating digital health solutions into existing EHISs. %M 38696248 %R 10.2196/49910 %U https://www.jmir.org/2024/1/e49910 %U https://doi.org/10.2196/49910 %U http://www.ncbi.nlm.nih.gov/pubmed/38696248 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52957 %T Digital Remote Monitoring Using an mHealth Solution for Survivors of Cancer: Protocol for a Pilot Observational Study %A Innominato,Pasquale F %A Macdonald,Jamie H %A Saxton,Wendy %A Longshaw,Laura %A Granger,Rachel %A Naja,Iman %A Allocca,Carlo %A Edwards,Ruth %A Rasheed,Solah %A Folkvord,Frans %A de Batlle,Jordi %A Ail,Rohit %A Motta,Enrico %A Bale,Catherine %A Fuller,Claire %A Mullard,Anna P %A Subbe,Christian P %A Griffiths,Dawn %A Wreglesworth,Nicholas I %A Pecchia,Leandro %A Fico,Giuseppe %A Antonini,Alessio %+ Knowledge Media Institute, The Open University, Level 4, Room 4, Berrill Building, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 1908 654356, alessio.antonini@open.ac.uk %K cancer %K survivorship %K artificial intelligence %K remote monitoring %K mobile health %K mHealth %K digital health %K circadian %K actigraphy %K mobile phone %D 2024 %7 30.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Healthy lifestyle interventions have a positive impact on multiple disease trajectories, including cancer-related outcomes. Specifically, appropriate habitual physical activity, adequate sleep, and a regular wholesome diet are of paramount importance for the wellness and supportive care of survivors of cancer. Mobile health (mHealth) apps have the potential to support novel tailored lifestyle interventions. Objective: This observational pilot study aims to assess the feasibility of mHealth multidimensional longitudinal monitoring in survivors of cancer. The primary objective is to test the compliance (user engagement) with the monitoring solution. Secondary objectives include recording clinically relevant subjective and objective measures collected through the digital solution. Methods: This is a monocentric pilot study taking place in Bangor, Wales, United Kingdom. We plan to enroll up to 100 adult survivors of cancer not receiving toxic anticancer treatment, who will provide self-reported behavioral data recorded via a dedicated app and validated questionnaires and objective data automatically collected by a paired smartwatch over 16 weeks. The participants will continue with their normal routine surveillance care for their cancer. The primary end point is feasibility (eg, mHealth monitoring acceptability). Composite secondary end points include clinically relevant patient-reported outcome measures (eg, the Edmonton Symptom Assessment System score) and objective physiological measures (eg, step counts). This trial received a favorable ethical review in May 2023 (Integrated Research Application System 301068). Results: This study is part of an array of pilots within a European Union funded project, entitled “GATEKEEPER,” conducted at different sites across Europe and covering various chronic diseases. Study accrual is anticipated to commence in January 2024 and continue until June 2024. It is hypothesized that mHealth monitoring will be feasible in survivors of cancer; specifically, at least 50% (50/100) of the participants will engage with the app at least once a week in 8 of the 16 study weeks. Conclusions: In a population with potentially complex clinical needs, this pilot study will test the feasibility of multidimensional remote monitoring of patient-reported outcomes and physiological parameters. Satisfactory compliance with the use of the app and smartwatch, whether confirmed or infirmed through this study, will be propaedeutic to the development of innovative mHealth interventions in survivors of cancer. International Registered Report Identifier (IRRID): PRR1-10.2196/52957 %M 38687985 %R 10.2196/52957 %U https://www.researchprotocols.org/2024/1/e52957 %U https://doi.org/10.2196/52957 %U http://www.ncbi.nlm.nih.gov/pubmed/38687985 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55102 %T Marital Self-Disclosure Intervention for the Fear of Cancer Recurrence in Chinese Patients With Gastric Cancer: Protocol for a Quasiexperimental Study %A Zhao,Haiyan %A Zhou,Ye %A Che,Chong Chin %A Chong,Mei Chan %A Zheng,Yu %A Hou,Yuzhu %A Chen,Canjuan %A Zhu,Yantao %+ Chinese Nursing Journals Publishing House Co, Ltd, 28/F, Tower C, Chengming Building, Xizhimen South Street, Xicheng District, Beijing, 806054, China, 86 18801155781, yeyecrystal@126.com %K fear of cancer recurrence %K dyadic coping ability %K gastric cancer %K intervention %K nursing %K protocol %K psychological %K marital self-disclosure %D 2024 %7 29.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with gastric cancer experience different degrees of fear of cancer recurrence. The fear of cancer recurrence can cause and worsen many physical and psychological problems. We considered the “intimacy and relationship processes in couples’ psychosocial adaptation” model. Objective: The study aims to examine the effectiveness of a marital self-disclosure intervention for improving the level of fear of cancer recurrence and the dyadic coping ability among gastric cancer survivors and their spouses. Methods: This is a quasiexperimental study with a nonequivalent (pretest-posttest) control group design. The study will be conducted at 2 tertiary hospitals in Taizhou City, Jiangsu Province, China. A total of 42 patients with gastric cancer undergoing chemotherapy and their spouses will be recruited from each hospital. Participants from Jingjiang People’s Hospital will be assigned to an experimental group, while participants from Taizhou People’s Hospital will be assigned to a control group. The participants in the experimental group will be involved in 4 phases of the marital self-disclosure (different topics, face-to-face) intervention. Patients will be evaluated at baseline after a diagnosis of gastric cancer and reassessed 2 to 4 months after baseline. The primary outcome is the score of the Fear of Progression Questionnaire-Short Form (FoP-Q-SF) for patients. The secondary outcomes are the scores of the FoP-Q-SF for partners and the Dyadic Coping Inventory. Results: Research activities began in October 2022. Participant enrollment and data collection began in February 2023 and are expected to be completed in 12 months. The primary results of this study are anticipated to be announced in June 2024. Conclusions: This study aims to assess a marital self-disclosure intervention for improving the fear of cancer recurrence in Chinese patients with gastric cancer and their spouses. The study is likely to yield desirable positive outcomes as marital self-disclosure is formulated based on evidence and inputs obtained through stakeholder interviews and expert consultation. The study process will be carried out by nurses who have received psychological training, and the quality of the intervention will be strictly controlled. Trial Registration: ClinicalTrials.gov NCT05606549; https://clinicaltrials.gov/study/NCT05606549 International Registered Report Identifier (IRRID): DERR1-10.2196/55102 %M 38684089 %R 10.2196/55102 %U https://www.researchprotocols.org/2024/1/e55102 %U https://doi.org/10.2196/55102 %U http://www.ncbi.nlm.nih.gov/pubmed/38684089 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55402 %T Mi Sleep Coach Mobile App to Address Insomnia Symptoms Among Cancer Survivors: Single-Arm Feasibility Study %A Arring,Noel %A Barton,Debra L %A Lafferty,Carolyn %A Cox,Bryana %A Conroy,Deirdre A %A An,Lawrence %+ College of Nursing, University of Tennessee, 1412 Circle Drive, Room 411, Knoxville, TN, 37966, United States, 1 8659741988, narring@utk.edu %K cognitive behavioral therapy %K insomnia %K mobile health %K breast cancer %K prostate cancer %K colon cancer %K cancer survivor %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Rates of sleep disturbance among survivors of cancer are more than 3 times higher than the general population. Causes of sleep disturbance among survivors are many and multifaceted, including anxiety and fear related to cancer diagnosis and treatments. Cognitive behavioral therapy for insomnia (CBT-I) is considered a first-line treatment for insomnia; However, a lack of access to trained professionals and limited insurance coverage for CBT-I services has limited patient access to these effective treatments. Evidence supports digital delivery of CBT-I (dCBT-I), but there is only limited evidence to support its use among survivors of cancer. Broad adoption of smartphone technology provides a new channel to deliver dCBT-I, but no prior studies have evaluated mobile dCBT-I interventions for survivors. To address the need for accessible and efficacious CBT-I for survivors of cancer, the Mi Sleep Coach program was developed to adapt CBT-I for delivery to survivors of cancer as a self-directed mobile health app. Objective: This single-arm feasibility study assessed the adherence, attrition, usefulness, and satisfaction of the Mi Sleep Coach app for insomnia. Methods: A 7-week, single-arm study was conducted, enrolling adult survivors of breast, prostate, or colon cancer reporting sleep disturbances. Results: In total, 30 participants were enrolled, with 100% completing the study and providing data through week 7. Further, 9 out of 10 app features were found to be useful by 80% (n=24) to 93% (n=28) of the 30 participants. Furthermore, 27 (90%) participants were satisfied with the Mi Sleep Coach app and 28 (93%) would recommend the use of the Mi Sleep Coach app for those with insomnia. The Insomnia Severity Index showed a decrease from baseline (18.5, SD 4.6) to week 7 (10.4, SD 4.2) of 8.1 (P<.001; Cohen d=1.5). At baseline, 25 (83%) participants scored in the moderate (n=19; 15-21) or severe (n=6; 22-28) insomnia range. At week 7, a total of 4 (13%) patients scored in the moderate (n=4) or severe (n=0) range. The number of patients taking prescription sleep medications decreased from 7 (23%) at baseline to 1 (3%; P<.001) at week 7. The number of patients taking over-the-counter sleep medications decreased from 14 (47%) at baseline to 9 (30%; P=.03) at week 7. Conclusions: The Mi Sleep Coach app demonstrated high levels of program adherence and user satisfaction and had large effects on the severity of insomnia among survivors of cancer. The Mi Sleep Coach app is a promising intervention for cancer-related insomnia, and further clinical trials are warranted. If proven to significantly decrease insomnia in survivors of cancer in future randomized controlled clinical trials, this intervention would provide more survivors of cancer with easy access to evidence-based CBT-I treatment. Trial Registration: ClinicalTrials.gov NCT04827459; https://clinicaltrials.gov/study/NCT04827459 %M 38669678 %R 10.2196/55402 %U https://formative.jmir.org/2024/1/e55402 %U https://doi.org/10.2196/55402 %U http://www.ncbi.nlm.nih.gov/pubmed/38669678 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53668 %T Cancer Care Supportive Text Messaging Program (Text4Hope) for People Living With Cancer and Their Caregivers During the COVID-19 Pandemic: Longitudinal Observational Study %A Shalaby,Reham %A Vuong,Wesley %A Agyapong,Belinda %A Gusnowski,April %A Surood,Shireen %A Agyapong,Vincent %+ Department of Psychiatry, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 7802157771, vn602367@dal.ca %K Text4Hope Cancer Care %K COVID-19 %K cancer %K caregivers %K mental health %K anxiety %K depression %K cancer care %K Canada %K Canadian %K treatment %K stress %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cancer is the leading cause of death in Canada, and living with cancer generates psychological demands, including depression and anxiety among cancer survivors and caregivers. Text4Hope-Cancer Care SMS text messaging–based service was provided to people with cancer and caregivers during the COVID-19 pandemic to support their mental health. Objective: The aim of this study is to examine the clinical effectiveness of and satisfaction with Text4Hope-Cancer Care in addressing mental health conditions among people living with cancer and caregivers. Methods: The study was conducted in Alberta, Canada. People who were diagnosed or receiving cancer treatment and caregivers self-subscribed to receive 3-months daily supportive cognitive behavioral therapy–based SMS text messages and a web-based survey was sent at designated time points to collect clinical and nonclinical data. The Hospital Anxiety and Depression scale (HADS) was used to examine changes in anxiety and depression symptoms after receiving the service. Satisfaction with the service was assessed using a survey with a Likert scale. Descriptive and inferential statistics were used, and test significance was considered with P≤.05. Results: Overall, 107 individuals subscribed to the service, and 93 completed the program (completion rate 93/107, 86.9%). A significant improvement in the anxiety symptoms (HADS-Anxiety [HADS-A] subscale) was reported after 3 months of Text4Hope-Cancer Care (t11=2.62; P=.02), with medium effect size (Hedges g=0.7), but not depression symptoms (HADS-Depression [HADS-D] subscale). Subscribers expressed high satisfaction and agreed that the service has helped them to cope with mental health symptoms and improve their quality of life. Most subscribers read the SMS text messages more than once (30/30, 100%); took time to reflect or took a beneficial action after reading the messages (27/30, 90%); and highly agreed (27/30, >80%) with the value of the received supportive SMS text messages as being relevant, succinct, affirmative, and positive. All subscribers recommended SMS text messaging for stress, anxiety, and depression and for cancer care support (30/30, 100%). Conclusions: Text4Hope-Cancer Care was well-perceived and effectively addressed anxiety symptoms among people living with cancer and caregivers during the peak of the COVID-19 pandemic. This study provides evidence-based support and insight for policy and stakeholders to implement similar convenient, economic, and accessible mental health services that support vulnerable populations during crises. International Registered Report Identifier (IRRID): RR2-10.2196/20240 %M 38657234 %R 10.2196/53668 %U https://formative.jmir.org/2024/1/e53668 %U https://doi.org/10.2196/53668 %U http://www.ncbi.nlm.nih.gov/pubmed/38657234 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53307 %T Associations Between Stress, Health Behaviors, and Quality of Life in Young Couples During the Transition to Survivorship: Protocol for a Measurement Burst Study %A Cho,Dalnim %A Roth,Michael %A Peterson,Susan K %A Jennings,Kristofer %A Kim,Seokhun %A Weathers,Shiao-Pei %A Ahmed,Sairah %A Livingston,J Andrew %A Barcenas,Carlos %A You,Y Nancy %A Milbury,Kathrin %+ Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, United States, 1 713 745 8476, dcho1@mdanderson.org %K young adult survivors %K caregivers %K dyadic %K couple-based %K stress %K health behaviors %K quality of life %K transition to survivorship %K measurement-burst %D 2024 %7 23.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer is a life-threatening, stressful event, particularly for young adults due to delays and disruptions in their developmental transitions. Cancer treatment can also cause adverse long-term effects, chronic conditions, psychological issues, and decreased quality of life (QoL) among young adults. Despite numerous health benefits of health behaviors (eg, physical activity, healthy eating, no smoking, no alcohol use, and quality sleep), young adult cancer survivors report poor health behavior profiles. Determining the associations of stress (either cancer-specific or day-to-day stress), health behaviors, and QoL as young adult survivors transition to survivorship is key to understanding and enhancing these survivors’ health. It is also crucial to note that the effects of stress on health behaviors and QoL may manifest on a shorter time scale (eg, daily within-person level). Moreover, given that stress spills over into romantic relationships, it is important to identify the role of spouses or partners (hereafter partners) in these survivors’ health behaviors and QoL. Objective: This study aims to investigate associations between stress, health behaviors, and QoL at both within- and between-person levels during the transition to survivorship in young adult cancer survivors and their partners, to identify the extent to which young adult survivors’ and their partners’ stress facilitates or hinders their own and each other’s health behaviors and QoL. Methods: We aim to enroll 150 young adults (aged 25-39 years at the time of cancer diagnosis) who have recently completed cancer treatment, along with their partners. We will conduct a prospective longitudinal study using a measurement burst design. Participants (ie, survivors and their partners) will complete a daily web-based survey for 7 consecutive days (a “burst”) 9 times over 2 years, with the bursts spaced 3 months apart. Participants will self-report their stress, health behaviors, and QoL. Additionally, participants will be asked to wear an accelerometer to assess their physical activity and sleep during the burst period. Finally, dietary intake (24-hour diet recalls) will be assessed during each burst via telephone by research staff. Results: Participant enrollment began in January 2022. Recruitment and data collection are expected to conclude by December 2024 and December 2026, respectively. Conclusions: To the best of our knowledge, this will be the first study that determines the interdependence of health behaviors and QoL of young adult cancer survivors and their partners at both within- and between-person levels. This study is unique in its focus on the transition to cancer survivorship and its use of a measurement burst design. Results will guide the creation of a developmentally appropriate dyadic psychosocial or behavioral intervention that improves both young adult survivors’ and their partners’ health behaviors and QoL and potentially their physical health. International Registered Report Identifier (IRRID): DERR1-10.2196/53307 %M 38652520 %R 10.2196/53307 %U https://www.researchprotocols.org/2024/1/e53307 %U https://doi.org/10.2196/53307 %U http://www.ncbi.nlm.nih.gov/pubmed/38652520 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55601 %T Effectiveness and Cost-Effectiveness of Survivorship Care for Survivors of Hodgkin Lymphoma (INSIGHT Study): Protocol for a Multicenter Retrospective Cohort Study With a Quasi-Experimental Design %A Lammers,Eline M J %A Zijlstra,Josée M %A Retèl,Valesca P %A Aleman,Berthe M P %A van Leeuwen,Flora E %A Nijdam,Annelies %A , %+ Department of Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, 1066 CX Amsterdam, Netherlands, 31 20 5126132, a.nijdam@nki.nl %K research design %K Hodgkin lymphoma %K late effects of cancer treatment %K survivorship care %K screening %K cost-effectiveness analysis %D 2024 %7 18.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hodgkin lymphoma (HL) occurs at young ages, with the highest incidence between 20 and 40 years. While cure rates have improved to 80%-90% over the past decades, survivors of HL are at substantial risk of late treatment–related complications, such as cardiovascular diseases, breast cancer, severe infections, and hypothyroidism. To reduce morbidity and mortality from late treatment effects, the Dutch Better care after lymphoma, Evaluation of long-term Treatment Effects and screening Recommendations (BETER) consortium developed a survivorship care program for 5-year survivors of HL that includes risk-based screening for and treatment of (risk factors for) late adverse events. Even though several cancer survivorship care programs have been established worldwide, there is a lack of knowledge about their effectiveness in clinical practice. Objective: The Improving Nationwide Survivorship care Infrastructure and Guidelines after Hodgkin lymphoma Treatment (INSIGHT) study evaluates whether Dutch BETER survivorship care for survivors of HL decreases survivors’ burden of disease from late adverse events after HL treatment and associated health care costs and improves their quality of life. Methods: The INSIGHT study is a multicenter retrospective cohort study with a quasi-experimental design and prospective follow-up, embedded in the national BETER survivorship care infrastructure. The first BETER clinics started in 2013-2016 and several other centers started or will start BETER clinics in 2019-2024. This allows us to compare survivors who did and those who did not receive BETER survivorship care in the last decade. Survivors in the intervention group are matched to controls (n=450 per group) based on sex, age at diagnosis (±5 years), age in 2013 (±5 years), and treatment characteristics. The primary outcome is the burden of disease in disability-adjusted life years from cardiovascular disease, breast cancer, severe infections, and hypothyroidism. In a cost-effectiveness analysis, we will assess the cost of BETER survivorship care per averted or gained disability-adjusted life year and quality-adjusted life year. Secondary outcomes are BETER clinic attendance, adherence to screening guidelines, and knowledge and distress about late effects among survivors of HL. Study data are collected from a survivor survey, a general practitioner survey, medical records, and through linkages with national disease registries. Results: The study was funded in November 2020 and approved by the institutional review board of the Netherlands Cancer Institute in July 2021. We expect to finalize recruitment by October 2024, data collection by early 2025, and data analysis by May 2025. Conclusions: INSIGHT is the first evaluation of a comprehensive survivorship program using real-world data; it will result in new information on the (cost-)effectiveness of survivorship care in survivors of HL in clinical practice. The results of this study will be used to improve the BETER program where necessary and contribute to more effective evidence-based long-term survivorship care for lymphoma survivors. International Registered Report Identifier (IRRID): PRR1-10.2196/55601 %M 38635308 %R 10.2196/55601 %U https://www.researchprotocols.org/2024/1/e55601 %U https://doi.org/10.2196/55601 %U http://www.ncbi.nlm.nih.gov/pubmed/38635308 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49574 %T Development and Implementation of an eHealth Oncohematonootric Program: Descriptive, Observational, Prospective Cohort Pilot Study %A Sánchez-Quiñones,Beatriz %A Antón-Maldonado,Cristina %A Ibarra Vega,Nataly %A Martorell Mariné,Isabel %A Santamaria,Amparo %+ Hybrid Hematology Department, University Hospital Vinalopó, Calle Tonico Sansano Mora, 14, Alicante, Elche, 03293, Spain, 34 658981769, masantamaria@vinaloposalud.com %K Nootric app %K oncohematology patient %K physical-nutritional well-being %K multidisciplinary team %D 2024 %7 8.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In oncohematology, both the development of the disease and the side effects of antineoplastic treatment often take a toll on patients’ physical and nutritional well-being. In this era of digital transformation, we launched a pioneering project for oncohematologic patients to promote adherence to a healthy lifestyle and improve their physical and nutritional well-being. We aim to achieve this goal by involving doctors and nutritionists through the Nootric app. Objective: This study aims to assess the impact of the use of eHealth tools to facilitate nutrition and well-being in oncohematologic patients. We also aim to determine the usefulness of physical-nutritional management in improving tolerance to chemotherapy treatments within routine clinical practice. Methods: We designed a descriptive, observational, longitudinal, prospective cohort pilot study that included a total of 22 patients from March to May 2022 in the Vinalopó University Hospital. The inclusion criteria were adults over 18 years of age diagnosed with oncohematological pathology in active chemotherapy treatment. An action plan was created to generate alerts between the doctor and the nutritionist. In the beginning, the patients were trained to use the app and received education highlighting the importance of nutrition and physical exercise. Sociodemographic, clinical-biological-analytical (eg, malnutrition index), health care impact, usability, and patient adherence data were collected. Tolerance to chemotherapy treatment and its health care impact were evaluated. Results: We included 22 patients, 11 (50%) female and 11 (50%) male, ranging between 42 and 84 years of age. Among them, 13 (59%) were adherents to the program. The most frequent diseases were lymphoproliferative syndromes (13/22, 59%) and multiple myeloma (4/22, 18%). Moreover, 15 (68%) out of 22 patients received immunochemotherapy, while 7 (32%) out of 22 patients received biological treatment. No worsening of clinical-biological parameters was observed. Excluding dropouts and abandonments (n=9/22, 41%), the adherence rate was 81%, established by calculating the arithmetic mean of the adherence rates of 13 patients. No admission was observed due to gastrointestinal toxicity or discontinuation of treatment related to alterations in physical and nutritional well-being. In addition, only 5.5% of unscheduled consultations were increased due to incidents in well-being, mostly telematic (n=6/103 consultation are unscheduled). Additionally, 92% of patients reported an improvement in their nutritional habits (n=12/13), and up to 45% required adjustment of medical supportive treatment (n=5/11). There were no cases of grade 3 or greater gastrointestinal toxicity. All of this reflects improved tolerance to treatments. Patients reported a satisfaction score of 4.3 out of 5, while professionals rated their satisfaction at 4.8 out of 5. Conclusions: We demonstrated the usefulness of integrating new technologies through a multidisciplinary approach. The Nootric app facilitated collaboration among the medical team, nutritionists, and patients. It enabled us to detect health issues related to physical-nutritional well-being, anticipate major complications, and mitigate potentially avoidable risks. Consequently, there was a decrease in unscheduled visits and admissions related to this condition. %M 38588522 %R 10.2196/49574 %U https://formative.jmir.org/2024/1/e49574 %U https://doi.org/10.2196/49574 %U http://www.ncbi.nlm.nih.gov/pubmed/38588522 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53301 %T Evaluating a Remotely Delivered Cardio-Oncology Rehabilitation Intervention for Patients With Breast Cancer (REMOTE-COR-B): Protocol for a Single-Arm Feasibility Trial %A Short,Camille E %A Rawstorn,Jonathan C %A Jones,Tamara L %A Edbrooke,Lara %A Hayes,Sandra C %A Maddison,Ralph %A Nightingale,Sophie %A Ismail,Hilmy %A De Boer,Richard %A Hegi-Johnson,Fiona %A Sverdlov,Aaron L %A Bell,Robyn %A Halligan,Irene %A Denehy,Linda %+ Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Tin Alley, Melbourne, 3010, Australia, 61 0408 288 786, camille.short@unimelb.edu.au %K breast cancer survivor %K breast cancer %K cancer survivor %K cancer %K cardiac rehabilitation %K cardiac %K cardiotoxicity %K cardiovascular disease %K digital health %K efficacy %K exercise %K exercise %K feasibility %K fitness %K rehabilitation intervention %K rehabilitation %K safety %D 2024 %7 5.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Exercise rehabilitation is a promising strategy for reducing cardiovascular disease risk among patients with breast cancer. However, the evidence is primarily derived from programs based at exercise centers with in-person supervised delivery. Conversely, most patients report a preference for home-based rehabilitation. As such, there is a clear need to explore strategies that can provide real-time supervision and coaching while addressing consumer preferences. Evidence from cardiac rehabilitation has demonstrated the noninferiority of a smartphone-based telerehabilitation approach (REMOTE-CR) to improve cardiorespiratory fitness in people with cardiovascular disease compared to a center-based program. Objective: This study aims to assess the feasibility, safety, and preliminary efficacy of the REMOTE-CR program adapted for patients with breast cancer at risk of cardiotoxicity (REMOTE-COR-B). We will also assess the satisfaction and usability of REMOTE-COR-B. Methods: We will conduct a single-arm feasibility study of the REMOTE-COR-B program among patients with stage I-III breast cancer who are at risk of cardiotoxicity (taking treatment type and dose, as well as other common cardiovascular disease risk factors into account) and who are within 24 months of completing primary definitive treatment. Participants (target sample size of 40) will receive an 8-week smartphone-based telerehabilitation exercise program involving remotely delivered real-time supervision and behavior change support. The platform comprises a smartphone and wearable heart rate monitor, as well as a custom-built smartphone app and web application. Participants will be able to attend remotely monitored exercise sessions during set operating hours each week, scheduled in both the morning and evening. Adherence is the primary outcome of the trial, assessed through the number of remotely monitored exercise sessions attended compared to the trial target (ie, 3 sessions per week). Secondary outcomes include additional trial feasibility indicators (eg, recruitment and retention), safety, satisfaction, and usability, and objective and patient-reported efficacy outcomes (cardiovascular fitness, quality of life, fatigue, self-reported exercise, self-efficacy, habit strength, and motivation). Adherence, feasibility, and safety outcomes will be assessed during the intervention period; intervention satisfaction and usability will be assessed post intervention; and objective and patient-reported efficacy outcomes will be assessed at baseline, post intervention (2-month postbaseline assessment), and at follow-up (5-month postbaseline assessment). Results: Recruitment for this trial commenced in March 2023, and 7 participants had been recruited as of the submission of the manuscript. The estimated completion date for the project is October 2024, with results expected to be published in mid-2025. Conclusions: The REMOTE-COR-B intervention is a novel and promising approach to providing exercise therapy to patients with breast cancer at risk of cardiotoxicity who have unique needs and heightened safety risks. This project will provide important information on the extent to which this approach is satisfactory to patients with breast cancer, safe, and potentially effective, which is necessary before larger-scale research or clinical projects. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001557820; www.anzctr.org.au/ACTRN12621001557820.aspx International Registered Report Identifier (IRRID): DERR1-10.2196/53301 %M 38578682 %R 10.2196/53301 %U https://www.researchprotocols.org/2024/1/e53301 %U https://doi.org/10.2196/53301 %U http://www.ncbi.nlm.nih.gov/pubmed/38578682 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e46979 %T Co-Design, Development, and Evaluation of a Mobile Solution to Improve Medication Adherence in Cancer: Design Science Research Approach %A Dang,Thu Ha %A Wickramasinghe,Nilmini %A Forkan,Abdur Rahim Mohammad %A Jayaraman,Prem Prakash %A Burbury,Kate %A O’Callaghan,Clare %A Whitechurch,Ashley %A Schofield,Penelope %+ Department of Psychological Sciences, School of Health Sciences, Swinburne University of Technology, John Street, Melbourne, 3122, Australia, 61 422703347, thuhadang@swin.edu.au %K cancer %K behavioral science %K design science research %K digital %K medication adherence %K mobile solution %K Safety and Adherence to Medication and Self-Care Advice in Oncology %K SAMSON %K mobile phone %D 2024 %7 3.4.2024 %9 Original Paper %J JMIR Cancer %G English %X 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. %M 38569178 %R 10.2196/46979 %U https://cancer.jmir.org/2024/1/e46979 %U https://doi.org/10.2196/46979 %U http://www.ncbi.nlm.nih.gov/pubmed/38569178 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e51522 %T Evaluating the Usability of an mHealth App for Empowering Cancer Survivors With Disabilities: Heuristic Evaluation and Usability Testing %A Adler,Rachel F %A Baez,Kevin %A Morales,Paulina %A Sotelo,Jocelyn %A Victorson,David %A Magasi,Susan %+ School of Information Sciences, University of Illinois Urbana-Champaign, 501 E. Daniel St., Champaign, IL, 61820, United States, 1 217 244 4192, radler@illinois.edu %K mobile health %K mHealth %K apps %K usability %K cancer survivors %K accessibility %K disabilities %K cancer %K oncology %K heuristics %K empowerment %K advocacy %K mindfulness %K problem-solving %D 2024 %7 2.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: More than 18 million cancer survivors are living in the United States. The effects of cancer and its treatments can have cognitive, psychological, physical, and social consequences that many survivors find incredibly disabling. Posttreatment support is often unavailable or underused, especially for survivors living with disabilities. This leaves them to deal with new obstacles and struggles on their own, oftentimes feeling lost during this transition. Mobile health (mHealth) interventions have been shown to effectively aid cancer survivors in dealing with many of the aftereffects of cancer and its treatments; these interventions hold immense potential for survivors living with disabilities. We developed a prototype for WeCanManage, an mHealth-delivered self-management intervention to empower cancer survivors living with disabilities through problem-solving, mindfulness, and self-advocacy training. Objective: Our study conducted a heuristic evaluation of the WeCanManage high-fidelity prototype and assessed its usability among cancer survivors with known disabilities. Methods: We evaluated the prototype using Nielsen’s 10 principles of heuristic evaluation with 22 human-computer interaction university students. On the basis of the heuristic evaluation findings, we modified the prototype and conducted usability testing on 10 cancer survivors with a variety of known disabilities, examining effectiveness, efficiency, usability, and satisfaction, including a completion of the modified System Usability Scale (SUS). Results: The findings from the heuristic evaluation were mostly favorable, highlighting the need for a help guide, addressing accessibility concerns, and enhancing the navigation experience. After usability testing, the average SUS score was 81, indicating a good-excellent design. The participants in the usability testing sample expressed positive reactions toward the app’s design, educational content and videos, and the available means of connecting with others. They identified areas for improvement, such as improving accessibility, simplifying navigation within the community forums, and providing a more convenient method to access the help guide. Conclusions: Overall, usability testing showed positive results for the design of WeCanManage. The course content and features helped participants feel heard, understood, and less alone. %M 38564261 %R 10.2196/51522 %U https://humanfactors.jmir.org/2024/1/e51522 %U https://doi.org/10.2196/51522 %U http://www.ncbi.nlm.nih.gov/pubmed/38564261 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51669 %T Health Behavior Change Intervention Preferences Expressed by American Indian Cancer Survivors From a Southwest Tribal Community: Semistructured Interview Study %A Erdrich,Jennifer %A Cordova-Marks,Felina M %A Carson,William O %A Bea,Jennifer W %A Montfort,William R %A Thomson,Cynthia A %+ Department of Surgery, College of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724-5018, United States, 1 520 626 2635, jerdrich@surgery.arizona.edu %K Native American cancer disparities %K diet %K physical activity %K prehabilitation %K native %K exercise %K fitness %K interviews %K thematic analysis %K lifestyle %K Apache %D 2024 %7 27.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: While many factors, including social determinants of health, affect cancer mortality, one modifiable risk factor that may contribute to cancer disparities is obesity. The prevalence of obesity in the American Indian/Alaska Native population is 48.1% per the Centers for Disease Control and Prevention. The overall cancer mortality for the American Indian/Alaska Native population is 18% higher than the White population as reported by the American Cancer Society. Interventions tailored to American Indian/Alaska Native communities that promote healthy lifestyle behaviors after cancer diagnosis and prior to cancer surgery (prehab) might improve cancer outcomes for this population. Objective: The aim of the study is to characterize the lifestyle behaviors of San Carlos Apache cancer survivors and identify preferences for the adaption of a prehab intervention. Methods: Semistructured interviews and validated questionnaires were completed with San Carlos Apache cancer survivors (N=4), exploring their viewpoints on healthy lifestyle and cancer risk and preferences for program development. A thematic content analysis was conducted. Results: Participants had an average BMI of 31 kg/m2 and walked 53 minutes daily. The majority of participants reported a high willingness to change eating habits (n=3, 75%). All 4 reported willingness to participate in a diet and exercise program. Important themes and subthemes were identified: (1) cancer is perceived as a serious health condition in the community (N=4, 100%); (2) environmental exposures are perceived as cancer-causing threats (n=3, 75%); (3) healthy diet, exercise, and avoiding harmful substances are perceived as mitigating cancer risk (n=3, 75%); (4) barriers to healthy habits include distance to affordable groceries (n=3, 75%) and lack of transportation (n=2, 50%); (5) there is high interest in a prehab program geared toward patients with cancer (N=4, 100%); and (6) standard monitoring practiced in published prehab programs showed early acceptability with participants (N=4, 100%). Conclusions: Collaboration with tribal partners provided important insight that can help inform the adaptation of a culturally appropriate prehab program for San Carlos Apache patients diagnosed with cancer. %M 38536214 %R 10.2196/51669 %U https://formative.jmir.org/2024/1/e51669 %U https://doi.org/10.2196/51669 %U http://www.ncbi.nlm.nih.gov/pubmed/38536214 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52689 %T A Digital Intervention to Improve Skin Self-Examination Among Survivors of Melanoma: Protocol for a Type-1 Hybrid Effectiveness-Implementation Randomized Trial %A Manne,Sharon %A Heckman,Carolyn J %A Frederick,Sara %A Schaefer,Alexis A %A Studts,Christina R %A Khavjou,Olga %A Honeycutt,Amanda %A Berger,Adam %A Liu,Hao %+ Rutgers Cancer Institute of New Jersey, 195 Little Albany St,, New Brunswick, NJ, 08901, United States, 1 (732) 357 7978, mannesl@cinj.rutgers.edu %K melanoma %K cancer survivorship %K skin self-examinations %K digital interventions %D 2024 %7 12.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although melanoma survival rates have improved in recent years, survivors remain at risk of recurrence, second primary cancers, and keratinocyte carcinomas. The National Comprehensive Cancer Network recommends skin examinations by a physician every 3 to 12 months. Regular thorough skin self-examinations (SSEs) are recommended for survivors of melanoma to promote the detection of earlier-stage, thinner melanomas, which are associated with improved survival and lower treatment costs. Despite their importance, less than a quarter of survivors of melanoma engage in SSEs. Objective: Previously, our team developed and evaluated a web-based, fully automated intervention called mySmartSkin (MSS) that successfully improved SSE among survivors of melanoma. Enhancements were proposed to improve engagement with and outcomes of MSS. The purpose of this paper is to describe the rationale and methodology for a type-1 hybrid effectiveness-implementation randomized trial evaluating the enhanced MSS versus control and exploring implementation outcomes and contextual factors. Methods: This study will recruit from state cancer registries and social media 300 individuals diagnosed with cutaneous malignant melanoma between 3 months and 5 years after surgery who are currently cancer free. Participants will be randomly assigned to either enhanced MSS or a noninteractive educational web page. Surveys will be collected from both arms at baseline and at 3, 6, 12, and 18 months to assess measures of intervention engagement, barriers, self-efficacy, habit, and SSE. The primary outcome is thorough SSE. The secondary outcomes are the diagnosis of new or recurrent melanomas and sun protection practices. Results: Multilevel modeling will be used to examine whether there are significant differences in survivor outcomes between MSS and the noninteractive web page over time. Mixed methods will evaluate reach, adoption, implementation (including costs), and potential for maintenance of MSS, as well as contextual factors relevant to those outcomes and future scale-up. Conclusions: This trial has the potential to improve outcomes in survivors of melanoma. If MSS is effective, the results could guide its implementation in oncology care and nonprofit organizations focused on skin cancers. International Registered Report Identifier (IRRID): RR1-10.2196/52689 %M 38345836 %R 10.2196/52689 %U https://www.researchprotocols.org/2024/1/e52689 %U https://doi.org/10.2196/52689 %U http://www.ncbi.nlm.nih.gov/pubmed/38345836 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e48069 %T Survivorship Care for Women Living With Ovarian Cancer: Protocol for a Randomized Controlled Trial %A Kvale,Elizabeth %A Phillips,Farya %A Ghosh,Samiran %A Lea,Jayanthi %A Hoppenot,Claire %A Costales,Anthony %A Sunde,Jan %A Badr,Hoda %A Nwogu-Onyemkpa,Eberechi %A Saleem,Nimrah %A Ward,Rikki %A Balasubramanian,Bijal %+ Section of Geriatrics and Palliative Medicine, Department of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, United States, 1 713 798 2272, Elizabeth.kvale@bcm.edu %K chronic survivorship %K metastatic survivor %K metavivor %K ovarian cancer %K persons living with cancer %K quality of life %K survivor %K survivorship care %K survivorship transition %D 2024 %7 9.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Ovarian cancer ranks 12th in cancer incidence among women in the United States and 5th among causes of cancer-related death. The typical treatment of ovarian cancer focuses on disease management, with little attention given to the survivorship needs of the patient. Qualitative work alludes to a gap in survivorship care; yet, evidence is lacking to support the delivery of survivorship care for individuals living with ovarian cancer. We developed the POSTCare survivorship platform with input from survivors of ovarian cancer and care partners as a means of delivering patient-centered survivorship care. This process is framed by the chronic care model and relevant behavioral theory. Objective: The overall goal of this study is to test processes of care that support quality of life (QOL) in survivorship. The specific aims are threefold: first, to test the efficacy of the POSTCare platform in supporting QOL, reducing depressive symptom burden, and reducing recurrence worry. In our second aim, we will examine factors that mediate the effect of the intervention. Our final aim focuses on understanding aspects of care platform design and delivery that may affect the potential for dissemination. Methods: We will enroll 120 survivors of ovarian cancer in a randomized controlled trial and collect data at 12 and 24 weeks. Each participant will be randomized to either the POSTCare platform or the standard of care process for survivorship. Our population will be derived from 3 clinics in Texas; each participant will have received some combination of treatment modalities; continued maintenance therapy is not exclusionary. Results: We will examine the impact of the POSTCare-O platform on QOL at 12 weeks after intervention as the primary end point. We will look at secondary outcomes, including depressive symptom burden, recurrence anxiety, and physical symptom burden. We will identify mediators important to the impact of the intervention to inform revisions of the intervention for subsequent studies. Data collection was initiated in November 2023 and will continue for approximately 2 years. We expect results from this study to be published in early 2026. Conclusions: This study will contribute to the body of survivorship science by testing a flexible platform for survivorship care delivery adapted for the specific survivorship needs of patients with ovarian cancer. The completion of this project will contribute to the growing body of science to guide survivorship care for persons living with cancer. Trial Registration: ClinicalTrials.gov NCT05752448; https://clinicaltrials.gov/study/NCT05752448 International Registered Report Identifier (IRRID): PRR1-10.2196/48069 %M 38335019 %R 10.2196/48069 %U https://www.researchprotocols.org/2024/1/e48069 %U https://doi.org/10.2196/48069 %U http://www.ncbi.nlm.nih.gov/pubmed/38335019 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50836 %T Age Differences in the Association of Sleep Duration Trajectory With Cancer Risk and Cancer-Specific Mortality: Prospective Cohort Study %A Liu,Chenan %A Zhang,Qingsong %A Liu,Chenning %A Liu,Tong %A Song,Mengmeng %A Zhang,Qi %A Xie,Hailun %A Lin,Shiqi %A Ren,Jiangshan %A Chen,Yue %A Zheng,Xin %A Shi,Jinyu %A Deng,Li %A Shi,Hanping %A Wu,Shouling %+ Department of Cardiology, Kailuan General Hospital, 57 Xinhua East Road, Lubei Street, Hebei, Tangshan, 063000, China, 86 15503631851, drwusl@163.com %K sleep duration %K aging %K cancer risk %K mortality %K sleep %K trajectory %K adult %D 2024 %7 7.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Baseline sleep duration is associated with cancer risk and cancer-specific mortality; however, the association between longitudinal patterns of sleep duration and these risks remains unknown. Objective: This study aimed to elucidate the association between sleep duration trajectory and cancer risk and cancer-specific mortality. Methods: The participants recruited in this study were from the Kailuan cohort, with all participants aged between 18 and 98 years and without cancer at baseline. The sleep duration of participants was continuously recorded in 2006, 2008, and 2010. Latent mixture modeling was used to identify shared sleep duration trajectories. Furthermore, the Cox proportional risk model was used to examine the association of sleep duration trajectory with cancer risk and cancer-specific mortality. Results: A total of 53,273 participants were included in the present study, of whom 40,909 (76.79%) were men and 12,364 (23.21%) were women. The average age of the participants was 49.03 (SD 11.76) years. During a median follow-up of 10.99 (IQR 10.27-11.15) years, 2705 participants developed cancers. Three sleep duration trajectories were identified: normal-stable (44,844/53,273, 84.18%), median-stable (5877/53,273, 11.03%), and decreasing low-stable (2552/53,273, 4.79%). Compared with the normal-stable group, the decreasing low-stable group had increased cancer risk (hazard ratio [HR] 1.39, 95% CI 1.16-1.65) and cancer-specific mortality (HR 1.54, 95% CI 1.18-2.06). Dividing the participants by an age cutoff of 45 years revealed an increase in cancer risk (HR 1.88, 95% CI 1.30-2.71) and cancer-specific mortality (HR 2.52, 95% CI 1.22-5.19) only in participants younger than 45 years, rather than middle-aged or older participants. Joint analysis revealed that compared with participants who had a stable sleep duration within the normal range and did not snore, those with a shortened sleep duration and snoring had the highest cancer risk (HR 2.62, 95% CI 1.46-4.70). Conclusions: Sleep duration trajectories and quality are closely associated with cancer risk and cancer-specific mortality. However, these associations differ with age and are more pronounced in individuals aged <45 years. Trial Registration: Chinese Clinical Trial Registry ChiCTR–TNRC–11001489; http://tinyurl.com/2u89hrhx %M 38324354 %R 10.2196/50836 %U https://publichealth.jmir.org/2024/1/e50836 %U https://doi.org/10.2196/50836 %U http://www.ncbi.nlm.nih.gov/pubmed/38324354 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e46116 %T Digital Health Psychosocial Intervention in Adult Patients With Cancer and Their Families: Systematic Review and Meta-Analysis %A Zhang,Yingzi %A Flannery,Marie %A Zhang,Zhihong %A Underhill-Blazey,Meghan %A Bobry,Melanie %A Leblanc,Natalie %A Rodriguez,Darcey %A Zhang,Chen %+ Magnet Program and Nursing Research Department, UT Southwestern Medical Center, 8200 Brookriver Dr, Dallas, TX, 75247, United States, 1 469 291 4808, yingzi.zhang@utsouthwestern.edu %K cancer %K anxiety %K decision-making %K depression %K digital health %K distress %K family %K mental health %K mortality %K psychosocial intervention %K quality of life %D 2024 %7 5.2.2024 %9 Review %J JMIR Cancer %G English %X 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 %M 38315546 %R 10.2196/46116 %U https://cancer.jmir.org/2024/1/e46116 %U https://doi.org/10.2196/46116 %U http://www.ncbi.nlm.nih.gov/pubmed/38315546 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e49353 %T User-Centered Design and Usability of a Culturally Adapted Virtual Survivorship Care App for Chinese Canadian Prostate Cancer Survivors: Qualitative Descriptive Study %A Young,Karen %A Xiong,Ting %A Lee,Rachel %A Banerjee,Ananya Tina %A Leslie,Myles %A Ko,Wellam Yu %A Pham,Quynh %+ Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto General Hospital, R. Fraser Elliott Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 (416) 340 4800 ext 4765, q.pham@uhn.ca %K digital health %K virtual care %K digital therapeutics %K prostate cancer %K cancer survivorship %K user-centred design %K usability %K supportive care %K cultural adaptation %K Chinese Canadians %D 2024 %7 1.1.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cultural adaptations of digital health innovations are a growing field. However, digital health innovations can increase health inequities. While completing exploratory work for the cultural adaptation of the Ned Clinic virtual survivorship app, we identified structural considerations that provided a space to design digitally connected and collective care. Objective: This study used a community-based participatory research and user-centered design process to develop a cultural adaptation of the Ned Clinic app while designing to intervene in structural inequities. Methods: The design process included primary data collection and qualitative analysis to explore and distill design principles, an iterative design phase with a multidisciplinary team, and a final evaluation phase with participants throughout the design process as a form of member checking and validation. Results: Participants indicated that they found the final adapted prototype to be acceptable, appropriate, and feasible for their use. The changes made to adapt the prototype were not specifically culturally Chinese. Instead, we identified ways to strengthen connections between the survivor and their providers; improve accessibility to resources; and honor participants’ desires for relationality, accountability, and care. Conclusions: We grounded the use of user-centered design to develop a prototype design that supports the acts of caring through digital technology by identifying and designing to resist structures that create health inequities in the lives of this community of survivors. By designing for collective justice, we can provide accessible, feasible, and relational care with digital health through the application of Indigenous and Black feminist ways of being and knowing. %M 38163295 %R 10.2196/49353 %U https://humanfactors.jmir.org/2024/1/e49353 %U https://doi.org/10.2196/49353 %U http://www.ncbi.nlm.nih.gov/pubmed/38163295 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e49934 %T Feasibility of a Health Coach Intervention to Reduce Sitting Time and Improve Physical Functioning Among Breast Cancer Survivors: Pilot Intervention Study %A Tam,Rowena M %A Zablocki,Rong W %A Liu,Chenyu %A Narayan,Hari K %A Natarajan,Loki %A LaCroix,Andrea Z %A Dillon,Lindsay %A Sakoulas,Eleanna %A Hartman,Sheri J %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 3855 Health Sciences Drive, #0901, La Jolla, CA, 92037, United States, 1 8585349235, sjhartman@ucsd.edu %K physical function %K sedentary behavior %K quality of life %K activPAL %K health coaching %K cancer survivors %K physical functions %K breast cancer %K survivors %K quality of life %K sitting time %K physical activity %K walking %K exercise %K fatigue %K sitting %D 2023 %7 19.12.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Sedentary behavior among breast cancer survivors is associated with increased risk of poor physical function and worse quality of life. While moderate to vigorous physical activity can improve outcomes for cancer survivors, many are unable to engage in that intensity of physical activity. Decreasing sitting time may be a more feasible behavioral target to potentially mitigate the impact of cancer and its treatments. Objective: The purpose of this study was to investigate the feasibility and preliminary impact of an intervention to reduce sitting time on changes to physical function and quality of life in breast cancer survivors, from baseline to a 3-month follow-up. Methods: Female breast cancer survivors with self-reported difficulties with physical function received one-on-one, in-person personalized health coaching sessions aimed at reducing sitting time. At baseline and follow-up, participants wore the activPAL (thigh-worn accelerometer; PAL Technologies) for 3 months and completed physical function tests (4-Meter Walk Test, Timed Up and Go, and 30-Second Chair Stand) and Patient-Reported Outcomes Measurement Information System (PROMIS) self-reported outcomes. Changes in physical function and sedentary behavior outcomes were assessed by linear mixed models. Results: On average, participants (n=20) were aged 64.5 (SD 9.4) years; had a BMI of 30.4 (SD 4.5) kg/m2; and identified as Black or African American (n=3, 15%), Hispanic or Latina (n=4, 20%), and non-Hispanic White (n=14, 55%). Average time since diagnosis was 5.8 (SD 2.2) years with participants receiving chemotherapy (n=8, 40%), radiotherapy (n=18, 90%), or endocrine therapy (n=17, 85%). The intervention led to significant reductions in sitting time: activPAL average daily sitting time decreased from 645.7 (SD 72.4) to 532.7 (SD 142.1; β=–112.9; P=.001) minutes and average daily long sitting bouts (bout length ≥20 min) decreased from 468.3 (SD 94.9) to 366.9 (SD 150.4; β=–101.4; P=.002) minutes. All physical function tests had significant improvements: on average, 4-Meter Walk Test performance decreased from 4.23 (SD 0.95) to 3.61 (SD 2.53; β=–.63; P=.002) seconds, Timed Up and Go performance decreased from 10.30 (SD 3.32) to 8.84 (SD 1.58; β=–1.46; P=.003) seconds, and 30-Second Chair Stand performance increased from 9.75 (SD 2.81) to 13.20 completions (SD 2.53; β=3.45; P<.001). PROMIS self-reported physical function score improved from 44.59 (SD 4.40) to 47.12 (SD 5.68; β=2.53; P=.05) and average fatigue decreased from 52.51 (SD 10.38) to 47.73 (SD 8.43; β=–4.78; P=.02). Conclusions: This 3-month pilot study suggests that decreasing time spent sitting may be helpful for breast cancer survivors experiencing difficulties with physical function and fatigue. Reducing sitting time is a novel and potentially more feasible approach to improving health and quality of life in cancer survivors. %M 38113082 %R 10.2196/49934 %U https://cancer.jmir.org/2023/1/e49934 %U https://doi.org/10.2196/49934 %U http://www.ncbi.nlm.nih.gov/pubmed/38113082 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e49735 %T Development of Quality of Life in Adolescents and Young Adults With Cancer Using a Patient Support Smartphone App: Prepost Interventional Study %A Bentsen,Line %A Hanghøj,Signe %A Hjerming,Maiken %A Bergmann,Mette Buur %A Thycosen,Marianne %A Borup,Anette %A Larsen,Camilla %A Pappot,Helle %+ Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark, 45 30113524, line.bentsen.01@regionh.dk %K adolescent %K young adult %K cancer %K quality of life %K eHealth %K smartphone application %K application %K development %K interventional study %K youth %K grief %K symptom tracker %K social community %K Denmark %K physical functioning %K treatment %K mobile phone %D 2023 %7 4.12.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Adolescents and young adults often experience existential concerns in addition to side effects during a cancer trajectory, which they often carry alone. Thus, cohesion with other adolescents and young adults with cancer is essential but difficult due to the relatively small, widely dispersed nationwide population. In cocreation, a smartphone app has been developed and includes an information bank, a symptom tracker, and a social community platform, aiming to improve the quality of life (QoL) in this patient group. Objective: This nationwide, multicenter study aimed to investigate the QoL in adolescents and young adults undergoing a cancer trajectory as they used the app for 6 weeks. Methods: Via youth support initiatives, participants were recruited from hospitals in all regions of Denmark. Inclusion criteria were patients with cancer aged 15-29 years who either initiated any cancer treatment or started follow-up after cancer treatment within 30 days. Participants used the adolescents and young adults cancer app for 6 weeks. Before and after the 6 weeks of app use, they completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The participants were divided into a treatment and a follow-up group for analysis. A high score for a functional scale or the global health or overall QoL represents a high or healthy level of functioning or high QoL, respectively; however, a high score for a symptom scale or item represents a high level of symptomatology. Results: Overall, 81 participants were recruited. However, 4 participants did not answer the questionnaire and 6 participants did not use the app. In the treatment group (n=36), significant improvement was found in 2 domains: “Role functioning” (baseline median 33.33, IQR 16.67-83.33 vs 6 weeks median 66.67, IQR 33.33-83.33; P=.04) and “Pain” (baseline median 33.33, IQR 16.67-50.00 vs 6 weeks median 16.67, IQR 0.00-33.33; P=.04). The “Global health/Overall QoL” scale remained stable (baseline median 58.33, IQR 45.83-77.08 vs 6 weeks median 62.50, IQR 41.67-75.00; P=.25). In the follow-up group (n=35), significant improvement was found in 3 domains: “Physical functioning” (baseline median 79.23, IQR 73.33-93.33 vs 6 weeks median 82.86, IQR 73.33-100.00; P=.03), “Cognitive functioning” (baseline median 62.38, IQR 50.00-83.33 vs 6 weeks median 69.52, IQR 50.00-100.00; P=.02), and “Social functioning” (baseline median 76.19, IQR 50.00-100.00 vs 6 weeks median 85.71, IQR 83.33-100.00; P=.05), as well as in the “Global health/Overall QoL” scale (baseline median 57.14, IQR 83.33-100.00 vs 6 weeks median 75.0, IQR 62.91-85.73; P<.001). Conclusions: In this study, we found an improvement in specific QoL scales for both participants in treatment and follow-up when using the app for 6 weeks. The global health or overall QoL score improved significantly in the follow-up group. In the treatment group, it remained stable. International Registered Report Identifier (IRRID): RR2-10.2196/10098 %M 38048144 %R 10.2196/49735 %U https://cancer.jmir.org/2023/1/e49735 %U https://doi.org/10.2196/49735 %U http://www.ncbi.nlm.nih.gov/pubmed/38048144 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e52315 %T Sleep Treatment Education Program for Young Adult Cancer Survivors (STEP-YA): Protocol for an Efficacy Trial %A Michaud,Alexis L %A Bice,Briana %A Miklos,Eva %A McCormick,Katherine %A Medeiros-Nancarrow,Cheryl %A Zhou,Eric S %A Recklitis,Christopher J %+ Perini Family Survivors' Center, Dana Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, United States, 1 617 632 3839, christopher_recklitis@dfci.harvard.edu %K insomnia %K cancer survivors %K young adults %K protocol %K coaching %K mood %D 2023 %7 29.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young adult cancer survivors (YACS) are at elevated risk for chronic insomnia, even years after completing treatment. In addition to potential health consequences, insomnia can interrupt social, educational, and vocational development just as they are trying to “make up” for time lost to cancer. Cognitive behavioral therapy for insomnia (CBTI) is recommended as first-line treatment for insomnia but remains largely unavailable to YACS due to several barriers (ie, shortage of trained providers, geographic limitations, financial limitations). Traditional CBTI has not been adapted to meet YACS’ unique developmental and circadian challenges. To improve availability of effective behavioral insomnia treatment for this population, we developed the Sleep Treatment Education Program for Young Adult Cancer Survivors (STEP-YA), a low-intensity educational intervention delivered virtually online. Objective: In this phase 2 “proof of concept” trial, primary aims are to test the efficacy of STEP-YA to improve insomnia symptoms and mood in YACS and assess the utility of individualized coaching to improve treatment effects. A secondary aim will explore participant variables associated with clinically significant response to STEP-YA. Methods: This 2-arm randomized prospective trial will enroll 74 off-treatment YACS aged 20 years to 39 years with clinically significant insomnia. Each participant completes the STEP-YA intervention in a 1-on-1 synchronous online session led by a trained interventionist following a structured outline. The 90-minute intervention presents educational information on the development of insomnia after cancer and offers specific suggestions for improving insomnia symptoms. During the session, participants review the suggestions and develop a personalized sleep action plan for implementing them. After the session, participants are randomized to either the coaching condition, in which they receive 2 telephone coaching sessions, or the no-coaching condition, which offers no subsequent coaching. The Insomnia Severity Index (ISI) and the Profile of Mood States: Short Form (POMS-SF) are assessed at baseline and 4 and 8 weeks postintervention. Results: Enrollment began in November 2022, with 28 participants currently enrolled. We anticipate recruitment will be completed in 2024. The primary endpoint is a change in ISI score from baseline to 8 weeks postintervention. The secondary endpoint is change in mood symptoms (POMS-SF) from baseline to 8 weeks postintervention. Change scores will be treated as continuous variables. Primary analyses will use ANOVA methods. A within-subjects analysis will examine if the STEP-YA intervention is associated with significant changes in insomnia and mood over time. A 2-way ANOVA will be used to evaluate the utility of coaching sessions to improve treatment effects. Conclusions: Chronic insomnia has significant negative effects on YACS’ medical, educational, and psychological functioning. STEP-YA aims to address their needs; study results will determine if the intervention warrants future effectiveness and dissemination studies and if individualized coaching is necessary for adequate treatment response. Trial Registration: ClinicalTrials.gov NCT05358951: https://clinicaltrials.gov/study/NCT05358951 International Registered Report Identifier (IRRID): DERR1-10.2196/52315 %R 10.2196/52315 %U https://www.researchprotocols.org/2023/1/e52315/ %U https://doi.org/10.2196/52315 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48925 %T Drug Repurposing for Cancers With Limited Survival: Protocol for a Retrospective Cohort Study %A Rodríguez-Molinero,Alejandro %A Pérez-López,Carlos %A Salazar González,Jose L %A Garcia-Lerma,Esther %A Álvarez-García,Juan A %A Soria Morillo,Luis M %A Salas Fernández,Tomás %+ Àrea de Recerca, Consorci Sanitari de l'Alt Penedès i Garraf, Avinguda de l’Espirall 61, Vilafranca del Penedès, 08720, Spain, 34 938960025 ext 47158, rodriguez.molinero@gmail.com %K cancer %K death %K drug repurposing %K epidemiology %K mortality %K oncology %K pharmacoepidemiology %K pharmacology %K side effects %K survival %K survivors %D 2023 %7 14.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Only 5% of the molecules tested in oncology phase 1 trials reach the market after an average of 7.5 years of waiting and at a cost of tens of millions of dollars. To reduce the cost and shorten the time of discovery of new treatments, “drug repurposing” (research with molecules already approved for another indication) and the use of secondary data (not collected for the purpose of research) have been proposed. Due to advances in informatics in clinical care, secondary data can, in some cases, be of equal quality to primary data generated through prospective studies. Objective: The objective of this study is to identify drugs currently marketed for other indications that may have an effect on the prognosis of patients with cancer. Methods: We plan to monitor a cohort of patients with high-lethality cancers treated in the public health system of Catalonia between 2006 and 2012, retrospectively, for survival for 5 years after diagnosis or until death. A control cohort, comprising people without cancer, will also be retrospectively monitored for 5 years. The following study variables will be extracted from different population databases: type of cancer (patients with cancer cohort), date and cause of death, pharmacological treatment, sex, age, and place of residence. During the first stage of statistical analysis of the patients with cancer cohort, the drugs consumed by the long-term survivors (alive at 5 years) will be compared with those consumed by nonsurvivors. In the second stage, the survival associated with the consumption of each relevant drug will be analyzed. For the analyses, groups will be matched for potentially confounding variables, and multivariate analyses will be performed to adjust for residual confounding variables if necessary. The control cohort will be used to verify whether the associations found are exclusive to patients with cancer or whether they also occur in patients without cancer. Results: We anticipate discovering multiple significant associations between commonly used drugs and the survival outcomes of patients with cancer. We expect to publish the initial results in the first half of 2024. Conclusions: This retrospective study may identify several commonly used drugs as candidates for repurposing in the treatment of various cancers. All analyses are considered exploratory; therefore, the results will have to be confirmed in subsequent clinical trials. However, the results of this study may accelerate drug discovery in oncology. International Registered Report Identifier (IRRID): DERR1-10.2196/48925 %M 37962929 %R 10.2196/48925 %U https://www.researchprotocols.org/2023/1/e48925 %U https://doi.org/10.2196/48925 %U http://www.ncbi.nlm.nih.gov/pubmed/37962929 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e51605 %T Exploring Online Crowdfunding for Cancer-Related Costs Among LGBTQ+ (Lesbian, Gay, Bisexual, Transgender, Queer, Plus) Cancer Survivors: Integration of Community-Engaged and Technology-Based Methodologies %A Waters,Austin R %A Turner,Cindy %A Easterly,Caleb W %A Tovar,Ida %A Mulvaney,Megan %A Poquadeck,Matt %A Johnston,Hailey %A Ghazal,Lauren V %A Rains,Stephen A %A Cloyes,Kristin G %A Kirchhoff,Anne C %A Warner,Echo L %+ Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Dr, Chapel Hill, NC, 27599, United States, 1 8016629517, awaters@unc.edu %K community-engaged %K LGBT %K SGM %K financial burden %K crowdfunding %K sexual monitory %K sexual minorities %K crowdfund %K fund %K funding %K fundraising %K fundraise %K engagement %K finance %K financial %K campaign %K campaigns %K web scraping %K cancer %K oncology %K participatory %K dictionary %K dictionary %K term %K terms %K terminology %K terminologies %K classification %K underrepresented %K equity %K inequity %K inequities %K cost %K costs %D 2023 %7 30.10.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancer survivors frequently experience cancer-related financial burdens. The extent to which Lesbian, Gay, Bisexual, Transgender, Queer, Plus (LGBTQ+) populations experience cancer-related cost-coping behaviors such as crowdfunding is largely unknown, owing to a lack of sexual orientation and gender identity data collection and social stigma. Web-scraping has previously been used to evaluate inequities in online crowdfunding, but these methods alone do not adequately engage populations facing inequities. Objective: We describe the methodological process of integrating technology-based and community-engaged methods to explore the financial burden of cancer among LGBTQ+ individuals via online crowdfunding. Methods: To center the LGBTQ+ community, we followed community engagement guidelines by forming a study advisory board (SAB) of LGBTQ+ cancer survivors, caregivers, and professionals who were involved in every step of the research. SAB member engagement was tracked through quarterly SAB meeting attendance and an engagement survey. We then used web-scraping methods to extract a data set of online crowdfunding campaigns. The study team followed an integrated technology-based and community-engaged process to develop and refine term dictionaries for analyses. Term dictionaries were developed and refined in order to identify crowdfunding campaigns that were cancer- and LGBTQ+-related. Results: Advisory board engagement was high according to metrics of meeting attendance, meeting participation, and anonymous board feedback. In collaboration with the SAB, the term dictionaries were iteratively edited and refined. The LGBTQ+ term dictionary was developed by the study team, while the cancer term dictionary was refined from an existing dictionary. The advisory board and analytic team members manually coded against the term dictionary and performed quality checks until high confidence in correct classification was achieved using pairwise agreement. Through each phase of manual coding and quality checks, the advisory board identified more misclassified campaigns than the analytic team alone. When refining the LGBTQ+ term dictionary, the analytic team identified 11.8% misclassification while the SAB identified 20.7% misclassification. Once each term dictionary was finalized, the LGBTQ+ term dictionary resulted in a 95% pairwise agreement, while the cancer term dictionary resulted in an 89.2% pairwise agreement. Conclusions: The classification tools developed by integrating community-engaged and technology-based methods were more accurate because of the equity-based approach of centering LGBTQ+ voices and their lived experiences. This exemplar suggests integrating community-engaged and technology-based methods to study inequities is highly feasible and has applications beyond LGBTQ+ financial burden research. %M 37902829 %R 10.2196/51605 %U https://cancer.jmir.org/2023/1/e51605 %U https://doi.org/10.2196/51605 %U http://www.ncbi.nlm.nih.gov/pubmed/37902829 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e44332 %T An Actionable Expert-System Algorithm to Support Nurse-Led Cancer Survivorship Care: Algorithm Development Study %A Pfisterer,Kaylen J %A Lohani,Raima %A Janes,Elizabeth %A Ng,Denise %A Wang,Dan %A Bryant-Lukosius,Denise %A Rendon,Ricardo %A Berlin,Alejandro %A Bender,Jacqueline %A Brown,Ian %A Feifer,Andrew %A Gotto,Geoffrey %A Saha,Shumit %A Cafazzo,Joseph A %A Pham,Quynh %+ Centre for Digital Therapeutics, University Health Network, Techna Institute, Toronto General Hospital/ R. Fraser Elliot Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 4765, q.pham@uhn.ca %K prostate cancer %K patient-reported outcomes %K nurse-led model of care %K expert system %K artificial intelligence–powered decision support %K digital health %K nursing %K algorithm development %K cancer treatment %K AI %K survivorship %K cancer %D 2023 %7 4.10.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Comprehensive models of survivorship care are necessary to improve access to and coordination of care. New models of care provide the opportunity to address the complexity of physical and psychosocial problems and long-term health needs experienced by patients following cancer treatment. Objective: This paper presents our expert-informed, rules-based survivorship algorithm to build a nurse-led model of survivorship care to support men living with prostate cancer (PCa). The algorithm is called No Evidence of Disease (Ned) and supports timelier decision-making, enhanced safety, and continuity of care. Methods: An initial rule set was developed and refined through working groups with clinical experts across Canada (eg, nurse experts, physician experts, and scientists; n=20), and patient partners (n=3). Algorithm priorities were defined through a multidisciplinary consensus meeting with clinical nurse specialists, nurse scientists, nurse practitioners, urologic oncologists, urologists, and radiation oncologists (n=17). The system was refined and validated using the nominal group technique. Results: Four levels of alert classification were established, initiated by responses on the Expanded Prostate Cancer Index Composite for Clinical Practice survey, and mediated by changes in minimal clinically important different alert thresholds, alert history, and clinical urgency with patient autonomy influencing clinical acuity. Patient autonomy was supported through tailored education as a first line of response, and alert escalation depending on a patient-initiated request for a nurse consultation. Conclusions: The Ned algorithm is positioned to facilitate PCa nurse-led care models with a high nurse-to-patient ratio. This novel expert-informed PCa survivorship care algorithm contains a defined escalation pathway for clinically urgent symptoms while honoring patient preference. Though further validation is required through a pragmatic trial, we anticipate the Ned algorithm will support timelier decision-making and enhance continuity of care through the automation of more frequent automated checkpoints, while empowering patients to self-manage their symptoms more effectively than standard care. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-045806 %M 37792435 %R 10.2196/44332 %U https://cancer.jmir.org/2023/1/e44332 %U https://doi.org/10.2196/44332 %U http://www.ncbi.nlm.nih.gov/pubmed/37792435 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e49968 %T Nasopharyngeal Cancer Incidence and Mortality in 185 Countries in 2020 and the Projected Burden in 2040: Population-Based Global Epidemiological Profiling %A Zhang,Yanting %A Rumgay,Harriet %A Li,Mengmeng %A Cao,Sumei %A Chen,Wanqing %+ Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical University, No.1 Xincheng Road, Dongguan, 523808, China, 86 076922896050, zhangyt@gdmu.edu.cn %K nasopharyngeal cancer %K incidence %K mortality %K epidemiology %K worldwide %D 2023 %7 20.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Nasopharyngeal cancer (NPC) is one of the most common head and neck cancers. Objective: This study describes the global epidemiological profiles of NPC incidence and mortality in 185 countries in 2020 and the projected burden in 2040. Methods: The estimated numbers of NPC cases and deaths were retrieved from the GLOBOCAN 2020 data set. Age-standardized incidence rates (ASIRs) and age-standardized mortality rates (ASMRs) were calculated using the world standard. The future number of NPC cases and deaths by 2040 were estimated based on global demographic projections. Results: Globally, approximately 133,354 cases and 80,008 deaths from NPC were estimated in 2020 corresponding to ASIRs and ASMRs of 1.5 and 0.9 per 100,000 person-years, respectively. The largest numbers of both global cases and deaths from NPC occurred in Eastern Asia (65,866/133,354, 49.39% and 36,453/80,008, 45.56%, respectively), in which China contributed most to this burden (62,444/133,354, 46.82% and 34,810/80,008, 43.50%, respectively). The ASIRs and ASMRs in men were approximately 3-fold higher than those in women. Incidence rates varied across world regions, with the highest ASIRs for both men and women detected in South-Eastern Asia (7.7 and 2.5 per 100,000 person-years, respectively) and Eastern Asia (3.9 and 1.5 per 100,000 person-years, respectively). The highest ASMRs for both men and women were found in South-Eastern Asia (5.4 and 1.5 per 100,000 person-years, respectively). By 2040, the annual number of cases and deaths will increase to 179,476 (46,122/133,354, a 34.58% increase from the year 2020) and 113,851 (33,843/80,008, a 42.29% increase), respectively. Conclusions: Disparities in NPC incidence and mortality persist worldwide. Our study highlights the urgent need to develop and accelerate NPC control initiatives to tackle the NPC burden in certain regions and countries (eg, South-Eastern Asia, China). %M 37728964 %R 10.2196/49968 %U https://publichealth.jmir.org/2023/1/e49968 %U https://doi.org/10.2196/49968 %U http://www.ncbi.nlm.nih.gov/pubmed/37728964 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48719 %T Digital Cognitive Behavioral- and Mindfulness-Based Stress-Management Interventions for Survivors of Breast Cancer: Development Study %A Børøsund,Elin %A Meland,Anders %A Eriksen,Hege R %A Rygg,Christine M %A Ursin,Giske %A Solberg Nes,Lise %+ Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, Oslo, 0424, Norway, 47 92667161, elin.borosund@rr-research.no %K cancer %K stress management %K mindfulness %K cognitive behavioral therapy %K digital %K eHealth %K mHealth %K app %K user-driven development %K usability %D 2023 %7 19.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychosocial stress-management interventions can reduce stress and distress and improve the quality of life for survivors of cancer. As these in-person interventions are not always offered or accessible, evidence-informed digital stress-management interventions may have the potential to improve outreach of psychosocial support for survivors of cancer. Few such digital interventions exist so far, few if any have been developed specifically for survivors of breast cancer, and few if any have attempted to explore more than 1 distinct type of intervention framework. Objective: This study aimed to develop 2 digital psychosocial stress-management interventions for survivors of breast cancer; 1 cognitive behavioral therapy-based intervention (CBI), and 1 mindfulness-based intervention (MBI). Methods: The development of the CBI and MBI interventions originated from the existing StressProffen program, a digital stress-management intervention program for survivors of cancer, based on a primarily cognitive behavioral therapeutic concept. Development processes entailed a multidisciplinary design approach and were iteratively conducted in close collaboration between key stakeholders, including experts within psychosocial oncology, cancer epidemiology, stress-management, and eHealth as well as survivors of breast cancer and health care providers. Core psychosocial oncology stress-management and cancer epidemiology experts first conducted a series of workshops to identify cognitive behavioral and mindfulness specific StressProffen content, overlapping psychoeducational content, and areas where development and incorporation of new material were needed. Following the program content adaptation and development phase, phases related to user testing of new content and technical, privacy, security, and ethical aspects and adjustments ensued. Intervention content for the distinct CBI and MBI interventions was refined in iterative user-centered design processes and adjusted to electronic format through stakeholder-centered iterations. Results: For the CBI version, the mindfulness-based content of the original StressProffen was removed, and for the MBI version, cognitive behavioral content was removed. Varying degrees of new content were created for both versions, using a similar layout as for the original StressProffen program. New content and new exercises in particular were tested by survivors of breast cancer and a project-related editorial team, resulting in subsequent user centered adjustments, including ensuring auditory versions and adequate explanations before less intuitive sections. Other improvements included implementing a standard closing sentence to round off every exercise, and allowing participants to choose the length of some of the mindfulness exercises. A legal disclaimer and a description of data collection, user rights and study contact information were included to meet ethical, privacy, and security requirements. Conclusions: This study shows how theory specific (ie, CBI and MBI) digital stress-management interventions for survivors of breast cancer can be developed through extensive collaborations between key stakeholders, including scientists, health care providers, and survivors of breast cancer. Offering a variety of evidence-informed stress-management approaches may potentially increase interest for outreach and impact of psychosocial interventions for survivors of cancer. International Registered Report Identifier (IRRID): RR2-10.2196/47195 %M 37725424 %R 10.2196/48719 %U https://formative.jmir.org/2023/1/e48719 %U https://doi.org/10.2196/48719 %U http://www.ncbi.nlm.nih.gov/pubmed/37725424 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47579 %T Cause of Death in Patients with Oropharyngeal Carcinoma by Human Papillomavirus Status: Comparative Data Analysis %A Zhang,Dong-Dong %A Lei,Min %A Wang,Yue %A Zeng,Pei-Ji %A Hong,Yong-Jun %A Cai,Cheng-Fu %+ Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Zhongshan Hospital, Xiamen University, Hubin South Road 201-209, Xiamen, 361003, China, 86 13616011099, caichengfuxmu@126.com %K oropharyngeal carcinomas %K human papillomavirus %K causes of death %K survival %K competing mortality %K human papillomavirus %K comparative data %K analysis %K cell death %K carcinoma %K oropharyngeal carcinoma %K surveillance %K database %K human papillomavirus-related tumor %D 2023 %7 29.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The incidence of oropharyngeal squamous cell carcinomas (OPSCC) has increased in recent decades, and human papillomavirus (HPV) infection is the main cause of OPSCC. The data regarding causes of death (CODs) are vitally important in informing follow-up strategies and revising treatment strategies to deal with any possible preventable treatment-related COD. However, limited studies have assessed the competing COD by HPV status in patients with OPSCC. Objective: We aimed to analyze the distribution of the competing COD according to HPV status in OPSCC. Methods: We retrospectively included stage I-IVB patients with OPSCC from the Surveillance, Epidemiology, and End Results database between 2010 and 2015. The association between HPV status and head and neck cancer–specific mortality (HNCSM), second primary cancer mortality (SPCM), and noncancer-caused mortality (NCCM) were analyzed. The chi-square test, Kaplan-Meier analysis, and Fine and Gray model were used for statistical analysis. Results: We included 5852 patients in this study and 73.2% (n=4283) of them had HPV-related tumors. A total of 1537 (26.3%) patients died, including 789 (51.3%), 333 (21.7%), and 415 (27%) patients who died from head and neck cancer, second cancer, and noncancer causes, respectively. The 5-year HNCSM, SPCM, NCCM, and overall mortality were 14.7%, 6.5%, 7.7%, and 26.4%, respectively. Those with HPV-positive disease had a lower cumulative incidence of HNCSM (subdistribution hazard ratio [sHR] 0.362, 95% CI 0.315-0.417; P<.001), SPCM (sHR 0.400, 95% CI 0.321-0.496; P<.001), and NCCM (sHR 0.460, 95% CI 0.378-0.560; P<.001) than those with HPV-negative disease. The 5-year risk of HNCSM was 26.9% and 10.7% in those with HPV-negative and HPV-positive disease, respectively (P<.001). The 5-year risk of SPCM was 12.4% and 4.6% in those with HPV-negative and HPV-positive disease, respectively (P<.001). The 5-year risk of NCCM of death was 13.7% and 5.8% in those with HPV-negative and HPV-positive disease, respectively (P<.001). Using the Fine and Gray competing-risks model, our results show that those with HPV-negative tumors had a significantly higher risk of HNCSM (P<.001), SPCM (P<.001), and NCCM (P<.001) than those with HPV-negative tumors. Conclusions: HPV-positive OPSCC has a lower NCSM, SPCM, and NCCM as compared to those with HPV-negative OPSCC. HPV positivity is a favorable prognostic factor in the context of overcoming cancer as well as in terms of reducing the risk of other CODs in OPSCC. Our finding supports the need to tailor patient follow-up based on the HPV status of patients with OPSCC. %M 37642982 %R 10.2196/47579 %U https://publichealth.jmir.org/2023/1/e47579 %U https://doi.org/10.2196/47579 %U http://www.ncbi.nlm.nih.gov/pubmed/37642982 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e38515 %T Smartphone-Based Psychotherapeutic Interventions in Blended Care of Cancer Survivors: Nested Randomized Clinical Trial %A Meinlschmidt,Gunther %A Grossert,Astrid %A Meffert,Cornelia %A Roemmel,Noa %A Hess,Viviane %A Rochlitz,Christoph %A Pless,Miklos %A Hunziker,Sabina %A Wössmer,Brigitta %A Geuter,Ulfried %A Schaefert,Rainer %+ Department of Psychosomatic Medicine, University Hospital Basel, Hebelstrasse 2, Basel, 4031, Switzerland, 41 61 328 63 10, gunther.meinlschmidt@unibas.ch %K digital therapeutics %K ecological momentary assessment (EMA) %K ecological momentary intervention (EMI) %K internet- and mobile-based intervention %K microintervention %K neoplasm %K smartphone-based intervention %K postcancer treatment %K body psychotherapy %K mobile phone %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancer is related to not only physical but also mental suffering. Notably, body image disturbances are highly relevant to cancer-related changes often persisting beyond recovery from cancer. Scalable and low-barrier interventions that can be blended with face-to-face psychotherapy for cancer survivors are highly warranted. Objective: The aim of the study is to investigate whether smartphone-based bodily interventions are more effective to improve the mood of patients with cancer than smartphone-based fairy tale interventions (control intervention). Methods: We recruited patients with cancer in 2 Swiss hospitals and conducted daily, fully automated smartphone-based interventions 6 times a week for 5 consecutive weeks, blended with weekly face-to-face group body psychotherapy. We applied 2 types of smartphone-based interventions using a within-subject design, randomly assigning patients daily to either bodily interventions or fairy tales. Each intervention type was presented 3 times a week. For this secondary analysis, 3-level mixed models were estimated with mood assessed by the 3 Multidimensional Mood Questionnaire subscales for good-bad mood, wakefulness, and calmness as key indicators. In addition, the effects on experience of presence, vitality, and burden assessed with visual analog scales were investigated. Results: Based on the data from s=732 interventions performed by 36 participants, good-bad mood improved (β=.27; 95% CI 0.062-0.483), and participants became calmer (β=.98; 95% CI 0.740-1.211) following smartphone-based interventions. Wakefulness did not significantly change from pre- to postsmartphone–based intervention (β=.17; 95% CI –0.081 to 0.412). This was true for both intervention types. There was no interaction effect of intervention type with change in good-bad mood (β=–.01; 95% CI –0.439 to 0.417), calmness (β=.22; 95% CI –0.228 to 0.728), or wakefulness (β=.14; 95% CI –0.354 to 0.644). Experience of presence (β=.34; 95% CI 0.271-0.417) and vitality (β=.35; 95% CI 0.268-0.426) increased from pre- to postsmartphone–based intervention, while experience of burden decreased (β=–0.40; 95% CI –0.481 to 0.311). Again, these effects were present for both intervention types. There were no significant interaction effects of intervention type with pre- to postintervention changes in experience of presence (β=.14; 95% CI –0.104 to 0.384), experience of vitality (β=.06; 95% CI –0.152 to 0.265), and experience of burden (β=–.16; 95% CI –0.358 to 0.017). Conclusions: Our results suggest that both smartphone-based audio-guided bodily interventions and fairy tales have the potential to improve the mood of cancer survivors. Trial Registration: ClinicalTrials.gov NCT03707548; https://clinicaltrials.gov/study/NCT03707548 International Registered Report Identifier (IRRID): RR2-10.1186/s40359-019-0357-1 %M 37639296 %R 10.2196/38515 %U https://cancer.jmir.org/2023/1/e38515 %U https://doi.org/10.2196/38515 %U http://www.ncbi.nlm.nih.gov/pubmed/37639296 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45212 %T Prediction Model for Postoperative Quality of Life Among Breast Cancer Survivors Along the Survivorship Trajectory From Pretreatment to 5 Years: Machine Learning–Based Analysis %A Kang,Danbee %A Kim,Hyunsoo %A Cho,Juhee %A Kim,Zero %A Chung,Myungjin %A Lee,Jeong Eon %A Nam,Seok Jin %A Kim,Seok Won %A Yu,Jonghan %A Chae,Byung Joo %A Ryu,Jai Min %A Lee,Se Kyung %+ Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, 82 2 3410 3478, zzangdoc@gmail.com %K breast cancer survivor %K quality of life %K machine learning %K trajectory %K predict %K develop %K breast cancer %K survivor %K cancer %K oncology %K algorithm %K model %K QoL %D 2023 %7 24.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Breast cancer is the most common cancer and the most common cause of cancer death in women. Although survival rates have improved, unmet psychosocial needs remain challenging because the quality of life (QoL) and QoL-related factors change over time. In addition, traditional statistical models have limitations in identifying factors associated with QoL over time, particularly concerning the physical, psychological, economic, spiritual, and social dimensions. Objective: This study aimed to identify patient-centered factors associated with QoL among patients with breast cancer using a machine learning (ML) algorithm to analyze data collected along different survivorship trajectories. Methods: The study used 2 data sets. The first data set was the cross-sectional survey data from the Breast Cancer Information Grand Round for Survivorship (BIG-S) study, which recruited consecutive breast cancer survivors who visited the outpatient breast cancer clinic at the Samsung Medical Center in Seoul, Korea, between 2018 and 2019. The second data set was the longitudinal cohort data from the Beauty Education for Distressed Breast Cancer (BEST) cohort study, which was conducted at 2 university-based cancer hospitals in Seoul, Korea, between 2011 and 2016. QoL was measured using European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 questionnaire. Feature importance was interpreted using Shapley Additive Explanations (SHAP). The final model was selected based on the highest mean area under the receiver operating characteristic curve (AUC). The analyses were performed using the Python 3.7 programming environment (Python Software Foundation). Results: The study included 6265 breast cancer survivors in the training data set and 432 patients in the validation set. The mean age was 50.6 (SD 8.66) years and 46.8% (n=2004) had stage 1 cancer. In the training data set, 48.3% (n=3026) of survivors had poor QoL. The study developed ML models for QoL prediction based on 6 algorithms. Performance was good for all survival trajectories: overall (AUC 0.823), baseline (AUC 0.835), within 1 year (AUC 0.860), between 2 and 3 years (AUC 0.808), between 3 and 4 years (AUC 0.820), and between 4 and 5 years (AUC 0.826). Emotional and physical functions were the most important features before surgery and within 1 year after surgery, respectively. Fatigue was the most important feature between 1 and 4 years. Despite the survival period, hopefulness was the most influential feature on QoL. External validation of the models showed good performance with AUCs between 0.770 and 0.862. Conclusions: The study identified important factors associated with QoL among breast cancer survivors across different survival trajectories. Understanding the changing trends of these factors could help to intervene more precisely and timely, and potentially prevent or alleviate QoL-related issues for patients. The good performance of our ML models in both training and external validation sets suggests the potential use of this approach in identifying patient-centered factors and improving survivorship care. %M 37309655 %R 10.2196/45212 %U https://publichealth.jmir.org/2023/1/e45212 %U https://doi.org/10.2196/45212 %U http://www.ncbi.nlm.nih.gov/pubmed/37309655 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47158 %T The Impact of a Mobile Support Group on Distress and Physical Activity in Breast Cancer Survivors: Randomized, Parallel-Group, Open-Label, Controlled Trial %A Jung,Miyeon %A Lee,Sae Byul %A Lee,Jong Won %A Park,Yu Rang %A Chung,Haekwon %A Min,Yul Ha %A Park,Hye Jin %A Lee,Minsun %A Chung,Seockhoon %A Son,Byung Ho %A Ahn,Sei-Hyun %A Chung,Il Yong %+ Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Olympicro 88 43gil, Seoul, 05505, Republic of Korea, 82 2 3010 3998, doorkeeper1@gmail.com %K breast neoplasms %K mental distress %K mobile apps %K mobile health intervention %K mobile phone %K physical activity %K randomized controlled trial %K RCT %K support group %K survivorship %K telemedicine %D 2023 %7 7.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: While mobile health apps have demonstrated their potential in revolutionizing health behavior changes, the impact of a mobile community built on these apps on the level of physical activity and mental well-being in cancer survivors remains unexplored. Objective: In this randomized controlled trial, we examine the effects of participation in a mobile health community specifically designed for breast cancer survivors on their physical activity levels and mental distress. Methods: We performed a single-center, randomized, parallel-group, open-label, controlled trial. This trial enrolled women between 20 and 60 years of age with stage 0 to III breast cancer, an Eastern Cooperative Oncology Group performance status of 0, and the capability of using their own smartphone apps. From January 7, 2019, to April 17, 2020, a total of 2,616 patients were consecutively screened for eligibility after breast cancer surgery. Overall, 202 patients were enrolled in this trial, and 186 patients were randomly assigned (1:1) to either the intervention group (engagement in a mobile peer support community using an app for tracking steps; n=93) or the control group (using the app for step tracking only; n=93) with a block size of 10 without stratification. The mobile app provides a visual interface of daily step counts, while the community function also provides rankings among its members and regular notifications encouraging physical activity. The primary end point was the rate of moderate to severe distress for the 24-week study period, measured through an app-based survey using the Distress Thermometer. The secondary end point was the total weekly steps during the 24-week period. Results: After excluding dropouts, 85 patients in the intervention group and 90 patients in the control group were included in the analysis. Multivariate analyses showed that patients in the intervention group had a significantly lower degree of moderate to severe distress (B=–0.558; odds ratio 0.572; P<.001) and a higher number of total weekly step counts (B=0.125; rate ratio 1.132; P<.001) during the 24-week period. Conclusions: Engagement in a mobile app–based patient community was effective in reducing mental distress and increasing physical activity in breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT03783481; https://classic.clinicaltrials.gov/ct2/show/NCT03783481 %M 37549004 %R 10.2196/47158 %U https://www.jmir.org/2023/1/e47158 %U https://doi.org/10.2196/47158 %U http://www.ncbi.nlm.nih.gov/pubmed/37549004 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48799 %T An mHealth Intervention to Improve Guardians’ Adherence to Children’s Follow-Up Care for Acute Lymphoblastic Leukemia in Tanzania (GuardiansCan Project): Protocol for a Development and Feasibility Study %A Chiwanga,Faraja S %A Woodford,Joanne %A Masika,Golden M %A Richards,David A %A Savi,Victor %A von Essen,Louise %+ Department of Women's and Children's health, Healthcare Sciences and e-Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 05, Sweden, 46 070 425 07 14, louise-von.essen@kbh.uu.se %K childhood cancer %K eHealth %K feasibility %K guardians %K intervention development %K low- and middle-income countries %K Tanzania %K mHealth %K mobile health %K public contribution %K public involvement %K mHealth intervention %K leukemia %K psychological distress %D 2023 %7 2.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer is a leading cause of death during childhood and in low- and middle-income countries survival rates can be as low as 20%. A leading reason for low childhood cancer survival rates in low- and middle-income countries such as Tanzania is treatment abandonment. Contributing factors include poor communication between health care providers and children’s guardians, insufficient cancer knowledge, and psychological distress. Objective: Our aim is to respond to Tanzanian guardians’ poor adherence to children’s follow-up care after treatment for acute lymphoblastic leukemia with the help of mobile health (mHealth) technology. Our goal is to increase guardians’ adherence to children’s medications and follow-up visits and to decrease their psychological distress. Methods: Following the Medical Research Council framework for developing and evaluating complex interventions, we will undertake the GuardiansCan project in an iterative phased approach to develop an mHealth intervention for subsequent testing. Public contribution activities will be implemented throughout via the establishment of a Guardians Advisory Board consisting of guardians of children with acute lymphoblastic leukemia. We will examine the acceptability, feasibility, and perceived impact of Guardians Advisory Board activities via an impact log and semistructured interviews (study I). In phase 1 (intervention development) we will explore guardians’ needs and preferences for the provision of follow-up care reminders, information, and emotional support using focus group discussions and photovoice (study II). We will then co-design the mHealth intervention with guardians, health care professionals, and technology experts using participatory action research (study III). In phase 2 (feasibility), we will examine clinical, methodological, and procedural uncertainties associated with the intervention and study procedures to prepare for the design and conduct of a future definitive randomized controlled trial using a single-arm pre-post mixed methods feasibility study (study IV). Results: Data collection for the GuardiansCan project is anticipated to take 3 years. We plan to commence study I by recruiting Guardians Advisory Board members in the autumn of 2023. Conclusions: By systematically following the intervention development and feasibility phases of the Medical Research Council Framework, and working alongside an advisory board of guardians, we intend to develop an acceptable, culturally appropriate, feasible, and relevant mHealth intervention with the potential to increase guardians’ adherence to children’s follow-up care after treatment of acute lymphoblastic leukemia, leading to a positive impact on children’s health and chances to survive, and reducing distress for guardians. International Registered Report Identifier (IRRID): PRR1-10.2196/48799 %M 37403706 %R 10.2196/48799 %U https://www.researchprotocols.org/2023/1/e48799 %U https://doi.org/10.2196/48799 %U http://www.ncbi.nlm.nih.gov/pubmed/37403706 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45804 %T Internet-Delivered Cognitive Behavioral Treatment for Chronic Pain in Adolescent Survivors of Childhood Cancer: Protocol for a Single-Group Feasibility Trial %A Patton,Michaela %A Carlson,Linda E %A Noel,Melanie %A Palermo,Tonya %A Forster,Victoria %A Cho,Sara %A Schulte,Fiona %+ Department of Psychology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada, 1 403 698 8103, fsmschul@ucalgary.ca %K pediatric oncology %K chronic pain %K cognitive behavioral therapy %K eHealth %K intervention %K late effects %K cancer survivorship %K pediatric cancer %K youth %K mental health %K psychological difficulties %K chronic health conditions %K pain management %K intervention %K cancer survivor %D 2023 %7 1.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: There are over 500,000 survivors of childhood cancer in North America alone. One in 4 survivors experiences chronic pain after treatment has been completed. Youths with chronic pain report increased anxiety, depression, activity limitations, and sleep disturbances. An 8-week web-based cognitive behavioral treatment for chronic pain (Web-Based Management of Adolescent Pain [WebMAP]) has demonstrated a reduction in pain in youths but has not yet been explored in survivors. Objective: The objectives of this study are to (1) test the feasibility and acceptability of WebMAP for a sample of survivors with chronic pain and their parents; (2) assess the acceptability of WebMAP using qualitative interviews; (3) assess WebMAP’s effect on activity limitations, pain intensity, depression and anxiety symptoms, and sleep disturbances; and (4) assess WebMAP’s effect on parent pain catastrophizing and parental response to their child’s pain. Methods: A single-arm mixed methods pre-post intervention study design will be used. Participants will be 34 survivors and at least one of their parents or caregivers. Inclusion criteria are (1) a cancer history, (2) current age of 10-17 years, (3) >2 years post treatment or >5 years post diagnosis, (4) pain present over prior 3 months impairing >1 area of daily life and occurring >1 time per month, and (5) computer access with broadband internet. Survivors will complete a pretreatment questionnaire, which will include the following: the Child Activity Limitations Interview, the pain intensity Numerical Rating Scale, Patient-Reported Outcomes Measurement Information System (PROMIS)–Pain Interference, Anxiety, Depression, Insomnia Severity Index, and Adolescent Sleep Wake Scale. Parents will complete the Pain Catastrophizing Scale–Parent Version and the Adult Responses to Child Symptoms. Upon completion of pretreatment questionnaires (T0), survivors will begin WebMAP. After the 8-week intervention, survivors will complete the same measures (T1), and at 3-month follow-up (T2). Posttreatment interviews will be conducted to determine acceptability. Feasibility will be assessed via recruitment and retention rates. Treatment engagement will be measured by number of modules completed. Pre-post outcome data will be assessed using linear mixed models. Qualitative data will be analyzed using thematic analysis. Patient partners will be involved in study design, recruitment, interpretation of results, and knowledge translation. Results: This study has been funded in January 2022. Data collection started in May 2022 and is projected to end in August 2023. We have enrolled 10 participants as of December 2022. Conclusions: Investigating whether WebMAP is useful to survivors will be an important step in improving pain management in this population. Trial Registration: ClinicalTrials.gov NCT05241717; https://clinicaltrials.gov/ct2/show/NCT05241717 International Registered Report Identifier (IRRID): DERR1-10.2196/45804 %M 37526959 %R 10.2196/45804 %U https://www.researchprotocols.org/2023/1/e45804 %U https://doi.org/10.2196/45804 %U http://www.ncbi.nlm.nih.gov/pubmed/37526959 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42852 %T Mobile Apps and Quality of Life in Patients With Breast Cancer and Survivors: Systematic Literature Review %A Saevarsdottir,Saeunn Rut %A Gudmundsdottir,Sigridur Lara %+ University of Iceland, Department of Health Promotion, Sport & Leisure Studies, Stakkahlid 1, Reykjavik, 105, Iceland, 354 5255950, srs33@hi.is %K mobile health %K mHealth %K breast cancer %K quality of life %K review %K systematic review %K cancer treatment %K mobile app %K patient care %K survivorship %K digital health intervention %K lifestyle intervention %K mobile phone %D 2023 %7 26.7.2023 %9 Review %J J Med Internet Res %G English %X Background: Side effects of breast cancer treatment may persist long into survivorship, reducing quality of life (QOL) in patients with breast cancer and survivors. There is growing evidence for the use of digital health technologies, such as mobile apps, to support self-management, decrease symptom burden, and improve QOL in patients with cancer. However, an updated overview of the effects of mobile apps on QOL and well-being in patients with breast cancer and survivors is needed. Objective: The aim of this review was to provide an overview of breast cancer–specific, mobile app–driven lifestyle or behavioral interventions in patient care through to survivorship and their impact on QOL and mental well-being. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted to identify relevant studies. The inclusion criteria were limited to original studies involving a trial of a mobile app–driven lifestyle or behavioral intervention for patients with breast cancer or survivors and using QOL or well-being measures. The results of the studies that met the inclusion criterion were then synthesized in text and table format. The quality of the evidence was assessed with the Cochrane risk-of-bias tool. Results: A total of 17 studies with the number of participants ranging from 23 to 356 met the inclusion criterion. Of the 17 reviewed studies, 7 (41%) delivered an app-only intervention, and 10 (59%) combined an app with additional supporting materials, such as SMS text messaging, telecoaching, wearables, or printed materials. Among the 17 reviewed studies, 6 (35%) focused on aiding patients with breast cancer during the active treatment phase (excluding ongoing hormone therapy), whereas the remaining 11 (65%) focused on survivorship. The majority of the studies (14/17, 82%) observed some positive effects on QOL or well-being measures. Conclusions: The results of the review indicate that mobile apps are a promising avenue for improving QOL and well-being in breast cancer care. Positive effects were observed in patients undergoing active treatment in all reviewed studies, but effects were less clear after chemotherapy and in long-term survivors. Although lifestyle and behavioral digital interventions are still being developed, and further research should still be pursued, the available data suggest that current mobile health apps aid patients with breast cancer and survivors. %M 37494111 %R 10.2196/42852 %U https://www.jmir.org/2023/1/e42852 %U https://doi.org/10.2196/42852 %U http://www.ncbi.nlm.nih.gov/pubmed/37494111 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46734 %T A Smartphone-Delivered Program (Anathema) to Promote the Sexual Health of Older Adults, Colorectal Cancer Survivors, and Stroke Survivors: Protocol for a Feasibility Pilot Randomized Controlled Trial %A Mendes-Santos,Cristina %A Quinta-Gomes,Ana Luísa %A Pereira,Raquel %A Vasconcelos,Priscila %A Nobre,Pedro %A Couto,Joana %A Correia de Barros,Ana %+ Fraunhofer Portugal Center for Assistive Information and Communication Solutions, R. Alfredo Allen 455, Porto, 4200-135, Portugal, 351 220430350, cristina.santos@fraunhofer.pt %K colorectal cancer %K internet interventions %K smartphone %K older adults %K participatory design %K randomized controlled trial %K stroke %K survivors %D 2023 %7 27.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the prevalence of sexual distress and dysfunction in older adults in general and stroke and colorectal cancer survivors in particular, access to specialized care is limited by organizational barriers and stigma, embarrassment, and discrimination. The internet allows reaching services that would otherwise be difficult or impossible to reach, and as smartphones are personal (intimate) technologies, they are a promising vehicle to close this gap. However, research focusing on smartphone-delivered sexual health promotion programs is scarce. Objective: This study aims to assess the acceptability, feasibility, and preliminary efficacy of Anathema, an 8-week, iOS/Android smartphone–delivered, individually tailored, cognitive-behavioral sexual health promotion program developed to improve relationship and sexual satisfaction, sexual functioning, sexual distress, sexual pleasure, and health-related quality of life (HRQoL) in older adults, colorectal cancer survivors, and stroke survivors compared to treatment as usual in a waiting-list control condition. Methods: Two-arm, parallel, open-label, waiting list, feasibility, pilot randomized controlled trials (RCTs) will be conducted involving older adults, stroke survivors, and colorectal cancer survivors. The primary outcomes are the acceptability, usability, and feasibility of Anathema. Sexual function, relationship and sexual satisfaction, sexual pleasure, sexual distress, anxiety, depression, and HRQoL are the secondary outcomes. This study has been reviewed and approved by the ethics committees of Instituto Português de Oncologia do Porto Francisco Gentil, Europacolon Portugal, Faculty of Psychology and Educational Sciences, University of Porto, and Sigmund Freud University (approval numbers: CES218R/021, CES19/023, and 2022/01-05b). Results: This project is funded by the European Commission through the Active and Assisted Living (AAL) Programme (reference: AAL-2020-7-133-CP) from April 2021 to December 2023. Recruitment for the pilot RCTs started on January 2023 in Portugal, Austria, and the Netherlands and is currently ongoing. As of May 2023, we randomized 49 participants in the trials. We expect to complete the RCTs in September 2023. The results on the acceptability, feasibility, and preliminary efficacy of Anathema are expected in the second semester of 2023. We expect Anathema to be highly accepted by the populations under study; to prove feasible to scale up to parent RCTs; and to be potentially efficacious in improving sexual functioning, relationship and sexual satisfaction, sexual distress, sexual pleasure, and HRQoL in older adults, colorectal cancer survivors, and stroke survivors compared to treatment as usual in a waiting-list control condition. The study results will be published in open-access venues according to COREQ (Consolidated Criteria for Reporting Qualitative Research) and CONSORT EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) guidelines. Conclusions: The study results will inform the refinement and scale-up of Anathema. Anathema’s wider-scale implementation can potentially promote the sexual health of largely neglected user groups such as older adults, colorectal cancer survivors, and stroke survivors. International Registered Report Identifier (IRRID): DERR1-10.2196/46734 %M 37368469 %R 10.2196/46734 %U https://www.researchprotocols.org/2023/1/e46734 %U https://doi.org/10.2196/46734 %U http://www.ncbi.nlm.nih.gov/pubmed/37368469 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47263 %T Exploring Acceptability of Employment Interventions to Support People Living With Cancer: Qualitative Study of Cancer Survivors, Health Care Providers, and Employers %A Forcino,Rachel C %A Rotenberg,Sivan %A Morrissette,Kali J %A Godzik,Cassandra M %A Lichtenstein,Jonathan D %A Schiffelbein,Jenna E %A Stevens,Courtney J %A Sundar,Vidya %A Brucker,Debra L %A Connolly,Deirdre %A Keysor,Julie %A Lyons,Kathleen Doyle %+ Occupational Therapy Department, Massachusetts General Hospital Institute of Health Professions, 36 First Ave, Boston, MA, 02129, United States, 1 (617) 643 5372, KLyons2@MGHIHP.EDU %K cancer %K employment %K intervention development %K intervention %K people living with cancer %K cancer survivor %K health care provider %D 2023 %7 26.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Employment contributes to cancer survivors’ quality of life, but this population faces a variety of challenges when working during and after treatment. Factors associated with work outcomes among cancer survivors include disease and treatment status, work environment, and social support. While effective employment interventions have been developed in other clinical contexts, existing interventions have demonstrated inconsistent effectiveness in supporting cancer survivors at work. We conducted this study as a preliminary step toward program development for employment support among survivors at a rural comprehensive cancer center. Objective: We aimed (1) to identify supports and resources that stakeholders (cancer survivors, health care providers, and employers) suggest may help cancer survivors to maintain employment and (2) to describe stakeholders’ views on the advantages and disadvantages of intervention delivery models that incorporate those supports and resources. Methods: We conducted a descriptive study collecting qualitative data from individual interviews and focus groups. Participants included adult cancer survivors, health care providers, and employers living or working in the Vermont–New Hampshire catchment area of the Dartmouth Cancer Center in Lebanon, New Hampshire. We grouped interview participants’ recommended supports and resources into 4 intervention delivery models, which ranged on a continuum from less to more intensive to deliver. We then asked focus group participants to discuss the advantages and disadvantages of each of the 4 delivery models. Results: Interview participants (n=45) included 23 cancer survivors, 17 health care providers, and 5 employers. Focus group participants (n=12) included 6 cancer survivors, 4 health care providers, and 2 employers. The four delivery models were (1) provision of educational materials, (2) individual consultation with cancer survivors, (3) joint consultation with both cancer survivors and their employers, and (4) peer support or advisory groups. Each participant type acknowledged the value of providing educational materials, which could be crafted to improve accommodation-related interactions between survivors and employers. Participants saw usefulness in individual consultation but expressed concern about the costs of program delivery and potential mismatches between consultant recommendations and the limits of what employers can provide. For joint consultation, employers liked being part of the solution and the possibility of enhanced communication. Potential drawbacks included additional logistical burden and its perceived generalizability to all types of workers and workplaces. Survivors and health care providers viewed the efficiency and potency of peer support as benefits of a peer advisory group but acknowledged the sensitivity of financial topics as a possible disadvantage of addressing work challenges in a group setting. Conclusions: The 3 participant groups identified both common and unique advantages and disadvantages of the 4 delivery models, reflecting varied barriers and facilitators to their potential implementation in practice. Theory-driven strategies to address implementation barriers should play a central role in further intervention development. %M 37358907 %R 10.2196/47263 %U https://formative.jmir.org/2023/1/e47263 %U https://doi.org/10.2196/47263 %U http://www.ncbi.nlm.nih.gov/pubmed/37358907 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41876 %T Cancer Resource and Information Support (CRIS) for Bladder Cancer Survivors and Their Caregivers: Development and Usability Testing Study %A Diefenbach,Michael A %A Marziliano,Allison %A Siembida,Elizabeth J %A Mistretta,Thomas %A Pfister,Halie %A Yacoub,Andrea %A Aibel,Kelli %A Patel,Priya %A Lapitan,Emmanuel %A Tagai,Erin K %A Smaldone,Marc %A Miller,Suzanne M %+ Institute of Health System Science, Feinstein Institutes for Medical Research, Northwell Health, 600 Community Drive, Suite 403 Manhasset, New York, NY, 11030, United States, 1 516 600 1440, mdiefenbach@northwell.edu %K muscle invasive bladder cancer %K behavioral intervention development %K ORBIT model %K usability testing %K web-based intervention %D 2023 %7 22.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Bladder cancer survivors and their caregivers face profound practical (eg, use of stoma appliances and care for urinary diversion methods) and psychosocial (eg, depression and anxiety) challenges after surgical treatment with cystectomy. Objective: To improve the health-related quality of life and postsurgical outcomes of both bladder cancer survivors and their caregivers, the team, in collaboration with Sourcetop, Inc (software design) and Dappersmith (graphic design), developed the Cancer Resource and Information Support (CRIS) software. The purpose of this manuscript is to report on the development and usability testing of the CRIS software. Methods: The development of the CRIS software was guided by the Obesity-Related Behavioral Intervention Trials (ORBIT) model for developing behavioral treatments for chronic diseases. The ORBIT model is unique in that it proposes a flexible and progressive process with prespecific clinically significant milestones for forward movement and returns to earlier stages for refinement, and it facilitates communication among diverse groups by using terminology from the drug development model. This paper focuses on 2 phases of the ORBIT model: phase IA: define and IB: refine. During phase IA, the study team developed solutions for the stated clinical problem—adjustment to life post cystectomy—by reviewing the literature and collecting feedback from clinicians, professional organizations, bladder cancer survivors, and their caregivers. During Phase IB, the study team focused on tailoring content in the CRIS software to the user as well as usability testing with 7 participants. Results: The finished product is CRIS, a web-based software for survivors of bladder cancer and their caregivers to serve as a health management and lifestyle resource after surgery. Overarching themes from phase IA (participant feedback) included how to use new medical equipment, tips and tricks for easier living with new medical equipment, questions about health maintenance, and questions about lifestyle modifications. To accommodate our target population, we also incorporated recommendations from the Americans with Disabilities Act for website design, such as large text size, large paragraph spacing, highly contrasting text and background colors, use of headings and labels to describe the purpose of the content, portrait orientation without the need for horizontal scrolling, multiple ways to access a web page within a set of pages, ability to navigate web pages in sequential order, and in-text links that are descriptive. Usability participants evaluated CRIS very positively, indicating that it was easy to use, the functions were well-integrated, and if available, they would use CRIS frequently. Conclusions: CRIS, developed over the course of 18 months by integrating feedback from experts, literature reviews, and usability testing, is the first web-based software developed for bladder cancer survivors and their caregivers to help them adjust to life following cystectomy. The efficacy of CRIS in improving patients’ and caregivers’ quality of life is currently being evaluated in a randomized controlled trial. %M 37347533 %R 10.2196/41876 %U https://formative.jmir.org/2023/1/e41876 %U https://doi.org/10.2196/41876 %U http://www.ncbi.nlm.nih.gov/pubmed/37347533 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43592 %T Designing a Dyad-Based Digital Health Intervention to Reduce Sedentary Time in Black Breast Cancer Survivors and Their First-degree Relatives: Human-Centered Design Study %A Blazey,Meghan %A Marinac,Catherine %A Whiteley,Jessica %A Peterson,Sarah %A Burns White,Karen %A Jacques,Cathyanah %A Lam,Helen %A Halpenny,Barbara %A Patel,Shree %A Lamothe,Raymond %A Wright,Julie %+ School of Nursing, University of Rochester, 601 Elmwood Ave, Box SON, Rochester, NY, 14642, United States, 1 585 276 6123, meghan_blazey@urmc.rochester.edu %K sedentary behavior %K digital health %K dyad-based intervention %K breast cancer risk %K breast cancer survivor %K social support %K mobile phone %D 2023 %7 24.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer, the most commonly diagnosed cancer and second leading cause of cancer-related death in women in the United States, disproportionately affects women from minoritized or low socioeconomic backgrounds. The average woman has an approximately 12% lifetime risk of developing breast cancer. Lifetime risk nearly doubles if a woman has a first-degree relative with breast cancer, and the risk increases as multiple family members are affected. Decreasing sedentary behaviors through moving more and sitting less reduces breast cancer risk and improves outcomes for cancer survivors and healthy adults. Digital health solutions, such as mobile apps that are culturally appropriate, designed with input from the target audience, and include social support, are effective at improving health behaviors. Objective: This study aimed to develop and evaluate the usability and acceptability of a prototype app designed with a human-centered approach to promote moving more and sitting less in Black breast cancer survivors and their first-degree relatives (parent, child, or sibling). Methods: This 3-phase study consisted of app development, user testing, and evaluation of user engagement and usability. Key community stakeholders were engaged in the first 2 (qualitative) phases to provide input into developing the prototype app (MoveTogether). After development and user testing, a usability pilot was conducted. Participants were adult breast cancer survivors who identified as Black and agreed to participate with a relative. Participants used the app and a step-tracking watch for 4 weeks. App components included goal setting and reporting, reminders, dyad messaging, and educational resources. Usability and acceptability were assessed with a questionnaire that included the System Usability Scale (SUS) and semistructured interviews. Data were analyzed with descriptive statistics and content analysis. Results: Participants in the usability pilot (n=10) were aged 30 to 50 years (6/10, 60%), not married (8/10, 80%), and college graduates (5/10, 50%). The app was used on average 20.2 (SD 8.9) out of 28 days—SUS score of 72 (range 55-95)—and 70% (7/10) agreed that the app was acceptable, helpful, and gave them new ideas. Additionally, 90% (9/10) found the dyad component helpful and would recommend the app to friends. Qualitative findings suggest that the goal-setting feature was helpful and that the dyad partner (buddy) provided accountability. Participants were neutral regarding the cultural appropriateness of the app. Conclusions: The MoveTogether app and related components were acceptable for promoting moving more in dyads of breast cancer survivors and their first-degree relatives. The human-centered approach, which involved engaging community members in the development, is a model for future technology development work. Future work should be done to further develop the intervention based on the findings and then test its efficacy to improve sedentary behavior while considering culturally informed strategies for adoption and implementation within the community. Trial Registration: ClinicalTrials.gov NCT05011279; https://clinicaltrials.gov/ct2/show/NCT05011279 %M 37223968 %R 10.2196/43592 %U https://formative.jmir.org/2023/1/e43592 %U https://doi.org/10.2196/43592 %U http://www.ncbi.nlm.nih.gov/pubmed/37223968 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47195 %T Coping After Breast Cancer: Protocol for a Randomized Controlled Trial of Stress Management eHealth Interventions %A Svendsen,Karianne %A Nes,Lise Solberg %A Meland,Anders %A Larsson,Ine Marie %A Gjelsvik,Ylva M %A Børøsund,Elin %A Rygg,Christine M %A Myklebust,Tor Åge %A Reinertsen,Kristin V %A Kiserud,Cecilie E %A Skjerven,Helle %A Antoni,Michael H %A Chalder,Trudie %A Mjaaland,Ingvil %A Carlson,Linda E %A Eriksen,Hege R %A Ursin,Giske %+ Cancer Registry of Norway, Oslo University Hospital, Ullernchausséen 64, Oslo, 0379, Norway, 47 99011452, gu@kreftregisteret.no %K breast cancer %K stress management %K mindfulness %K cognitive behavioral therapy %K psychosocial %K StressProffen %K RCT %K eHealth %K digital %K intervention %D 2023 %7 24.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: One-third or more of breast cancer survivors report stress and other psychological and physical complaints that can negatively impact their quality of life. Psychosocial stress management interventions, shown to mitigate the negative impact of these complaints, can now be delivered as accessible and convenient (for the patient and provider) eHealth interventions. In this randomized controlled trial (RCT), Coping After Breast Cancer (CABC), 2 modified versions of the stress management eHealth intervention program StressProffen were created: one with predominantly cognitive behavioral stress management content (StressProffen-cognitive behavioral therapy intervention [StressProffen-CBI]) and another with predominantly mindfulness-based stress management content (StressProffen-mindfulness-based intervention [StressProffen-MBI]). Objective: This study aims to investigate the effects in breast cancer survivors of using StressProffen-CBI and StressProffen-MBI compared with a control group (treatment as usual). Methods: Women diagnosed with breast cancer (stage I-III, unequivocally human epidermal growth factor receptor 2–positive or estrogen receptor-negative tumors) or ductal carcinoma in situ (DCIS) aged 21-69 years who completed the Cancer Registry of Norway–initiated health survey on quality of life are invited to the CABC trial about 7 months after diagnosis. Women who give consent to participate are randomized (1:1:1) to either the StressProffen-CBI, StressProffen-MBI, or control group. Both StressProffen interventions consist of 10 modules of stress management content delivered through text, sound, video, and images. The primary outcome is between-group changes in perceived stress at 6 months, assessed with Cohen 10-item Perceived Stress Scale. The secondary outcomes comprise changes in quality of life, anxiety, depression, fatigue, sleep, neuropathy, coping, mindfulness, and work-related outcomes approximately 1, 2, and 3 years after diagnosis. Long-term effects of the interventions on work participation, comorbidities, relapse or new cancers, and mortality will be assessed using data from national health registries. Results: Recruitment is scheduled from January 2021 to May 2023. The goal is to recruit 430 participants (100 in each group). As of April 14 2023, 428 participants have been enrolled. Conclusions: The CABC trial is possibly the largest ongoing psychosocial eHealth RCT in patients with breast cancer. If 1 or both interventions prove to be effective in reducing stress and improving psychosocial and physical complains, the StressProffen eHealth interventions could be beneficial, inexpensive, and easily implementable tools for breast cancer survivors when coping with late effects after cancer and cancer treatments. Trial Registration: Clinicaltrials.gov NCT04480203; https://clinicaltrials.gov/ct2/show/NCT04480203 International Registered Report Identifier (IRRID): DERR1-10.2196/47195 %M 37103493 %R 10.2196/47195 %U https://www.researchprotocols.org/2023/1/e47195 %U https://doi.org/10.2196/47195 %U http://www.ncbi.nlm.nih.gov/pubmed/37103493 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e41740 %T Navigating the Cancer Journey Using Web-Based Information: Grounded Theory Emerging From the Lived Experience of Cancer Patients and Informal Caregivers With Implications for Web-Based Content Design %A Thiessen,Maclean %A Raffin Bouchal,Shelly %A Tang,Patricia A %A Sinclair,Shane %+ Department of Internal Medicine, Rady Faculty of Health Sciences, University of Manitoba, ON2040 - 675 McDermot Ave., Winnipeg, MB, R3E 0W2, Canada, 1 204 787 4247, maclean.thiessen@umanitoba.ca %K health information behavior %K neoplasm %K theory %K internet %K information needs %K adults %D 2023 %7 17.5.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: The internet is an important source of information for many informal caregivers and patients living with cancer. A better understanding of how individuals use the internet to meet their informational needs is important for guiding intervention development. Objective: The objectives of this study were to develop a theory describing why individuals living with cancer use the internet to find information, characterize the challenges faced with existing web-based content, and provide recommendations for web-based content design. Methods: Adults (≥18 years) with a history of being patients with cancer or informal caregivers were recruited from Alberta, Canada. After providing informed consent, participants were engaged through digitally recorded one-on-one semistructured interviews, focus groups, a web-based discussion board, and emails. Classic grounded theory guided the study procedures. Results: A total of 21 participants took part in 23 one-on-one interviews and 5 focus groups. The mean age was 53 (SD 15.3) years. Breast, gynecological, and hematological cancers were the most common cancer types (4/21, 19% each). In total, 67% (14/21) of patients, 29% (6/21) of informal caregivers, and 5% (1/21) of individuals reporting both roles participated. Participants experienced many new challenges in their cancer journey and used the internet to become better oriented to them. For each challenge, internet searching attempted to address one or more of 3 key orientation questions: why the challenge was happening, what to expect, and options for managing it. Better orientation resulted in improved physical and psychosocial well-being. Content that was well laid out, concise, free of distractions, and that addressed the key orientation questions was identified as the most helpful in assisting with orientation. Creators of web-based content are encouraged to 1) clearly identify the cancer challenge and population the content is addressing, as well as the presence of any potentially distressing information; 2) provide versions of the content in different formats, including printer-friendly, audio, video, and alternative languages; 3) state who created the content, including the individuals, organizations, and processes involved; 4) place hyperlinks after the key orientation questions have been addressed; and 5) ensure that the content is optimized for discovery by search engines (ie, Google). Conclusions: Web-based content plays an essential role for many living with cancer. Clinicians are encouraged to take active steps to help patients and informal caregivers find web-based content that meets their informational needs. Content creators also have a responsibility to ensure that the content they create assists and does not hinder those navigating the cancer journey. Research is needed to better understand the many challenges that individuals living with cancer face, including how they are temporally related. In addition, how to optimize web-based content for specific cancer challenges and populations should be considered an important area for future research. %M 37195760 %R 10.2196/41740 %U https://cancer.jmir.org/2023/1/e41740 %U https://doi.org/10.2196/41740 %U http://www.ncbi.nlm.nih.gov/pubmed/37195760 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e39246 %T Association of the Extent of Internet Use by Patients With Cancer With Social Support Among Patients and Change in Patient-Reported Treatment Outcomes During Inpatient Rehabilitation: Cross-sectional and Longitudinal Study %A Lange-Drenth,Lukas %A Schulz,Holger %A Endsin,Gero %A Bleich,Christiane %+ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany, 49 040 7410 ext 56811, l.lange-drenth@uke.de %K internet %K internet use %K social support %K perceived social support %K inpatients %K patient-reported outcome measures %K cancer %K rehabilitation %K distress %K fatigue %K pain %D 2023 %7 17.5.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Given the increasing number of cancer survivors and their rising survival rates, rehabilitation plays an increasingly important role. Social support among patients is an essential element of inpatient and day care rehabilitation. The internet can empower patients with cancer to become more active health care consumers and facilitate information and supportive care needs. By contrast, therapists suspect that high internet use during rehabilitation may severely limit social interactions between patients, thus interfering with the patients’ rehabilitation program and jeopardizing treatment success. Objective: We hypothesized that the extent of internet use would be negatively related to social support among patients with cancer during their clinical stay as well as fewer improvements in patient-reported treatment outcomes from the first to the last day of their clinical stay. Methods: Patients with cancer participated during their inpatient rehabilitation. Cross-sectional data, such as the extent of participants’ internet use and perceived social support among patients, were collected during the last week of their clinic stay. The treatment outcomes, that is, participants’ levels of distress, fatigue, and pain, were collected on the first and last day of the clinic stay. We used multiple linear regression analysis to study the association between the extent of internet use and social support among patients with cancer. We used linear mixed model analyses to study the association between the extent of internet use by patients with cancer and the change in patient-reported treatment outcomes. Results: Of the 323 participants, 279 (86.4%) participants reported that they used the internet. The extent of the internet use (t315=0.78; P=.43) was not significantly associated with the perceived social support among the participants during their clinical stay. In addition, the extent of participants’ internet use during their clinical stay was not associated with changes in participants’ levels of distress (F1,299=0.12; P=.73), fatigue (F1,299=0.19; P=.67), and pain (F1,303=0.92; P=.34) from the first to the last day of their clinical stay. Conclusions: The extent of internet use does not seem to be negatively associated with the perceived social support among patients with cancer or with the change in patients’ levels of distress, fatigue, or pain from the first to the last day of their clinical stay. %M 37195742 %R 10.2196/39246 %U https://cancer.jmir.org/2023/1/e39246 %U https://doi.org/10.2196/39246 %U http://www.ncbi.nlm.nih.gov/pubmed/37195742 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46281 %T Telehealth-Based Music Therapy Versus Cognitive Behavioral Therapy for Anxiety in Cancer Survivors: Rationale and Protocol for a Comparative Effectiveness Trial %A Liou,Kevin T %A McConnell,Kelly M %A Currier,M Beatriz %A Baser,Raymond E %A MacLeod,Jodi %A Walker,Desiree %A Casaw,Camila %A Wong,Greta %A Piulson,Lauren %A Popkin,Karen %A Lopez,Ana Maria %A Panageas,Katherine %A Bradt,Joke %A Mao,Jun J %+ Memorial Sloan Kettering Cancer Center, 321 East 61st Street, New York, NY, 10065, United States, 1 646 608 8558, liouk@mskcc.org %K oncology %K anxiety %K cognitive behavioral therapy %K music therapy %K telehealth %K cancer survivorship %K mental health %K digital health %K mobile phone %D 2023 %7 27.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer survivors represent one of the fastest growing populations in the United States. Unfortunately, nearly 1 in 3 survivors experience anxiety symptoms as a long-term consequence of cancer and its treatment. Characterized by restlessness, muscle tension, and worry, anxiety worsens the quality of life; impairs daily functioning; and is associated with poor sleep, depressed mood, and fatigue. Although pharmacological treatment options are available, polypharmacy has become a growing concern for cancer survivors. Music therapy (MT) and cognitive behavioral therapy (CBT) are evidence-based, nonpharmacological treatments that have demonstrated effectiveness in treating anxiety symptoms in cancer populations and can be adapted for remote delivery to increase access to mental health treatments. However, the comparative effectiveness of these 2 interventions delivered via telehealth is unknown. Objective: The aims of the Music Therapy Versus Cognitive Behavioral Therapy for Cancer-related Anxiety (MELODY) study are to determine the comparative effectiveness of telehealth-based MT versus telehealth-based CBT for anxiety and comorbid symptoms in cancer survivors and to identify patient-level factors associated with greater anxiety symptom reduction for MT and CBT. Methods: The MELODY study is a 2-arm, parallel-group randomized clinical trial that aims to compare the effectiveness of MT versus CBT for anxiety and comorbid symptoms. The trial will enroll 300 English- or Spanish-speaking survivors of any cancer type or stage who have experienced anxiety symptoms for at least 1 month. Participants will receive 7 weekly sessions of MT or CBT delivered remotely via Zoom (Zoom Video Communications, Inc) over 7 weeks. Validated instruments to assess anxiety (primary outcome), comorbid symptoms (fatigue, depression, insomnia, pain, and cognitive dysfunction), and health-related quality of life will be administered at baseline and at weeks 4, 8 (end of treatment), 16, and 26. Semistructured interviews will be conducted at week 8 with a subsample of 60 participants (30 per treatment arm) to understand individual experiences with the treatment sessions and their impact. Results: The first study participant was enrolled in February 2022. As of January 2023, 151 participants have been enrolled. The trial is expected to be completed by September 2024. Conclusions: This study is the first and largest randomized clinical trial to compare the short- and long-term effectiveness of remotely delivered MT and CBT for anxiety in cancer survivors. Limitations include the lack of usual care or placebo control groups and the lack of formal diagnostic assessments for psychiatric disorders among trial participants. The study findings will help guide treatment decisions for 2 evidence-based, scalable, and accessible interventions to promote mental well-being during cancer survivorship. International Registered Report Identifier (IRRID): DERR1-10.2196/46281 %M 37103999 %R 10.2196/46281 %U https://www.researchprotocols.org/2023/1/e46281 %U https://doi.org/10.2196/46281 %U http://www.ncbi.nlm.nih.gov/pubmed/37103999 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e45382 %T Impact of Social Isolation, Physician-Patient Communication, and Self-perception on the Mental Health of Patients With Cancer and Cancer Survivors: National Survey Analysis %A Choudhury,Avishek %+ Industrial and Management Systems Engineering, Benjamin M Statler College of Engineering and Mineral Resources, West Virginia University, 1374 Evansdale Drive, 321 Engineering Sciences Building, Morgantown, WV, 26506, United States, 1 304 293 9431, avishek.choudhury@mail.wvu.edu %K cancer communication %K cancer stigma %K mental health %K social isolation %K cancer survivorship %K patient-centeredness %D 2023 %7 7.4.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Cancer is perceived as a life-threatening, fear-inducing, and stigmatized disease. Most patients with cancer and cancer survivors commonly experience social isolation, negative self-perception, and psychological distress. The heavy toll that cancer takes on patients continues even after treatment. It is common for many patients with cancer to feel uncertain about their future. Some undergo anxiety, loneliness, and fear of getting cancer again. Objective: This study examined the impact of social isolation, self-perception, and physician-patient communication on the mental health of patients with cancer and cancer survivors. The study also explored the impact of social isolation and physician-patient communication on self-perception. Methods: This retrospective study used restricted data from the 2021 Health Information National Trends Survey (HINTS), which collected data from January 11, 2021, to August 20, 2021. We used the partial least squares structural equation modeling (PLS-SEM) method for data analysis. We checked for quadratic effects among all the paths connecting social isolation, poor physician-patient communication, mental health (measured using the 4-item Patient Health Questionnaire [PHQ-4]), and negative self-perception. The model was controlled for confounding factors such as respondents’ annual income, education level, and age. Bias-corrected and accelerated (BCA) bootstrap methods were used to estimate nonparametric CIs. Statistical significance was tested at 95% CI (2-tailed). We also conducted a multigroup analysis in which we created 2 groups. Group A consisted of newly diagnosed patients with cancer who were undergoing cancer treatment during the survey or had received cancer treatment within the last 12 months (receipt of cancer treatment during the COVID-19 pandemic). Group B consisted of respondents who had received cancer treatment between 5 and 10 years previously (receipt of cancer treatment before the COVID-19 pandemic). Results: The analysis indicated that social isolation had a quadratic effect on mental health, with higher levels of social isolation associated with worse mental health outcomes up to a certain point. Self-perception positively affected mental health, with higher self-perception associated with better mental health outcomes. In addition, physician-patient communication significantly indirectly affected mental health via self-perception. Conclusions: The findings of this study provide important insights into the factors that affect the mental health of patients with cancer. Our results suggest that social isolation, negative self-perception, and communication with care providers are significantly related to mental health in patients with cancer. %M 37027201 %R 10.2196/45382 %U https://www.i-jmr.org/2023/1/e45382 %U https://doi.org/10.2196/45382 %U http://www.ncbi.nlm.nih.gov/pubmed/37027201 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e41441 %T Developing an e-Prehabilitation System of Care for Young Adults Diagnosed With Cancer: User-Centered Design Study %A McCann,Lisa %A Hewitt,Christopher %A McMillan,Kathryn A %+ Digital Health and Wellness Group, University of Strathclyde, Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XQ, United Kingdom, 44 1415483587, lisa.mccann@strath.ac.uk %K digital health %K human factors %K user-centered %K prehabilitation %K young adults %K cancer %D 2023 %7 30.3.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: A diagnosis of cancer in adolescence or young adulthood can pose many different and unique challenges for individuals, as well as their families and friends. Drawing on the concept of prehabilitation, the provision of high-quality, accessible, timely, reliable, and appropriate information, care, and support for young adults with cancer and their families is critical to ensure that they feel equipped and empowered to make informed decisions relating to their treatment and care. Increasingly, digital health interventions offer opportunities to augment current health care information and support provision. Co-designing these digital health interventions can help to ensure that they are meaningful and relevant to the patient cohort, thereby maximizing their accessibility and acceptability. Objective: This study had 4 primary interlinked objectives: understand the support needs of young adults with cancer at the time of diagnosis, understand the potential role of a digital health solution to assist in the delivery of prehabilitation for young adults with cancer, identify appropriate technologies and technological platforms for a digital prehabilitation system of care, and develop a prototype for a digital prehabilitation system of care. Methods: This was a qualitative study using interviews and surveys. Young adults aged 16 to 26 years diagnosed with cancer within the last 3 years were invited to participate in individual user-requirement interviews or surveys. Health care professionals specializing in the treatment and care of young adults with cancer and digital health professionals working in the industry were also interviewed or completed a survey. Consensus feedback interviews were conducted with 3 young adults and 2 health care professionals after the development of the first generation of the prototype app. Results: In total, 7 individual interviews and 8 surveys were completed with young adults with a range of cancer diagnoses. Moreover, 6 individual interviews and 9 surveys were completed with health care professionals, and 3 digital health professionals participated in one-on-one interviews. A prototype app with the working name of Cancer Helpmate was developed based on these collective participant data. Overall, feedback from participants across the data collection activities suggests that the concept for the app was positive during these developmental stages. Further insightful ideas for the app’s future development were also identified. Conclusions: Young adults with cancer and health care professionals are responsive to the need for more digitally driven services to be developed. Further development of an app such as Cancer Helpmate, which incorporates key features and functionalities directly informed by users, could help to augment the support provided to young adults with cancer. %M 36995740 %R 10.2196/41441 %U https://cancer.jmir.org/2023/1/e41441 %U https://doi.org/10.2196/41441 %U http://www.ncbi.nlm.nih.gov/pubmed/36995740 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e41203 %T Comorbidity Differences by Trajectory Groups as a Reference for Identifying Patients at Risk for Late Mortality in Childhood Cancer Survivors: Longitudinal National Cohort Study %A Kim,Hyery %A Kim,Hae Reong %A Kang,Sung Han %A Koh,Kyung-Nam %A Im,Ho Joon %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2228 2493, yurangpark@yuhs.ac %K cancer survivor %K childhood cancer %K mortality %K morbidity %K survival %K cancer %K children %K pediatrics %D 2023 %7 24.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Childhood cancer has a high long-term morbidity and mortality rate. Five years after the initial cancer diagnosis, approximately two-thirds of childhood cancer survivors experience at least one late complication, with one-quarter experiencing severe, life-threatening complications. Chronic health conditions can impact survivors’ life planning and daily activities, reducing their health-related quality of life. Comprehensive and longitudinal data are required for investigations of national claims data. Objective: This study aimed to address clinical and health policy interventions and improved survival rates. A comprehensive categorization of the long-term morbidities associated with childhood cancer survivorship is required. We analyzed the trajectory groups associated with long-term mortality among childhood cancer survivors. Methods: We collected data from a nationwide claims database of the entire Korean population. Between 2003 and 2007, patients diagnosed with and treated for cancer before the age of 20 years were included. With 8119 patients who survived >10 years, 3 trajectory groups were classified according to yearly changes in the number of diagnoses (the lowest in group 1 and the highest in group 3). Results: The patterns of most comorbidities and survival rates differed significantly between the trajectory groups. Group 3 had a higher rate of mental and behavioral disorders, neoplasms, and blood organ diseases than the other two groups. Furthermore, there was a difference in the number of diagnoses by trajectory groups over the entire decade, and the disparity increased as the survival period increased. If a patient received more than four diagnoses, especially after the fourth year, the patient was likely to be assigned to group 3, which had the worst prognosis. Group 1 had the highest overall survival rate, and group 3 had the lowest (P<.001). Group 3 had the highest hazard ratio of 4.37 (95% CI 2.57-7.42; P<.001) in a multivariate analysis of late mortality. Conclusions: Our findings show that the pattern of comorbidities differed significantly among trajectory groups for late death, which could help physicians identify childhood cancer survivors at risk for late mortality. Patients with neoplasms, blood organ diseases, or mental and behavioral disorders should be identified as having an increased risk of late mortality. Furthermore, vigilance and prompt action are essential to mitigate the potential consequences of a child cancer survivor receiving four or more diagnoses within a year. %M 36754630 %R 10.2196/41203 %U https://publichealth.jmir.org/2023/1/e41203 %U https://doi.org/10.2196/41203 %U http://www.ncbi.nlm.nih.gov/pubmed/36754630 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41831 %T Sexual Health Outcomes of Adolescent and Young Adult Colorectal Cancer Survivors and Their Partners: Protocol of a Dyadic Mixed Methods Study %A Acquati,Chiara %A Wittmann,Daniela %A Roth,Michael %A Rosen,Allison %A Carr,Lynley Christian %A Gresham,Zachary %A Ionescu,Elena %+ Graduate College of Social Work, University of Houston, 3511 Cullen Blvd, Houston, TX, 77204, United States, 1 713 743 4343, cacquati@central.uh.edu %K adolescent and young adult %K colorectal cancer %K oncology %K cancer %K couples %K dyadic research %K dyad %K sexual health %K sexual dysfunction %K reproductive health %K infertility-related distress %K mixed methods design %K mixed method %K adolescent %K adolescence %K young adult %K infertility %K fertility %D 2023 %7 23.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual dysfunction represents a critical aspect of quality of life for adolescent and young adult cancer survivors. Studies have consistently documented that adolescents and young adults report greater psychological and physical morbidity than older survivors and healthy peers, including elevated rates of sexual dysfunction, often accompanied by lower satisfaction with sex life and delays in meeting sexual milestones. Moreover, sexual dysfunction, body image concerns, and fertility status affect their confidence in being both physically and emotionally intimate. Despite this evidence, limited research has investigated the influence of psychosocial and interpersonal factors on sexual health outcomes reported by this group. This constitutes a significant gap in the provision of comprehensive sexual health care for adolescent- and young adult–onset cancer survivors, especially since greater emphasis has been recently placed on the biopsychosocial model of sexuality and dyadic approaches to intervention and treatment. In comparison to other cancer types, the incidence of colorectal cancer (CRC) has been increasing at an alarming rate for the adolescent and young adult group. Patients with early-onset CRC experience elevated rates of sexual dysfunction, psychological distress, and social and physical burden, often resulting from issues with bowel control, incontinence, and body image. Objective: This study uses an explanatory sequential mixed methods approach to (1) characterize sexual function, sexual distress, dyadic coping, infertility-related distress, relationship and mental health outcomes of adolescent and young adult CRC survivors within the first 5 years post diagnosis and their partners; (2) examine the reciprocal influence of sexual function and dyadic coping behaviors on sexual distress; and (3) identify interpersonal or couple characteristics associated with coping with sexual dysfunction and its associated distress. Methods: Participating couples (n=60) will complete a quantitative web-based survey investigating sexual function, sexual distress, dyadic coping, infertility-related distress, emotional functioning, relationship satisfaction, and body image (cancer survivors only). A subset of 20 couples will participate in an in-depth dyadic interview with 2 members of the research team to further explore couple-based strategies implemented to cope with cancer-related sexual dysfunction and distress. Results: The study received institutional review board approval. Recruitment and enrollment of couples began in July 2022. Conclusions: Results will provide a deeper understanding of the challenges couples experience as they navigate sexual intimacy after CRC treatment by highlighting the role of interpersonal processes. These findings will inform a dyadic intervention for young couples at risk of greater sexual distress in the aftermath of CRC. International Registered Report Identifier (IRRID): DERR1-10.2196/41831 %M 36951909 %R 10.2196/41831 %U https://www.researchprotocols.org/2023/1/e41831 %U https://doi.org/10.2196/41831 %U http://www.ncbi.nlm.nih.gov/pubmed/36951909 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45244 %T Effects of Aerobic Exercise on Cardiorespiratory Fitness, Cardiovascular Risk Factors, and Patient-Reported Outcomes in Long-Term Breast Cancer Survivors: Protocol for a Randomized Controlled Trial %A Nilsen,Tormod Skogstad %A Sæter,Mali %A Sarvari,Sebastian Imre %A Reinertsen,Kristin Valborg %A Johansen,Sara Hassing %A Edvardsen,Elisabeth Rustad %A Hallén,Jostein %A Edvardsen,Elisabeth %A Grydeland,May %A Kiserud,Cecilie Essholt %A Lie,Hanne Cathrine %A Solberg,Paul André %A Wisløff,Torbjørn %A Sharples,Adam Philip %A Raastad,Truls %A Haugaa,Kristina Hermann %A Thorsen,Lene %+ Department of Physical Performance, The Norwegian School of Sport Sciences, Postbox 4014, Oslo, 0806, Norway, 47 95069857, tormodsn@nih.no %K breast cancer %K cardiooncology %K cardiorespiratory fitness %K exercise medicine %D 2023 %7 15.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Anthracycline-based chemotherapy has been mainstay of adjuvant breast cancer therapy for decades. Although effective, anthracyclines place long-term breast cancer survivors at risk of late effects, such as reduced cardiorespiratory fitness and increased risk of cardiovascular disease. Previous research has shown beneficial effects of exercise training on cardiorespiratory fitness, but the effects of exercise on limiting factors for cardiorespiratory fitness, cardiovascular risk factors, and patient-reported outcomes in long-term survivors are less clear. Whether previous exposure to breast cancer therapy modulates the effects of exercise is also unknown. Objective: The primary aim of the CAUSE (Cardiovascular Survivors Exercise) trial is to examine the effect of aerobic exercise on cardiorespiratory fitness in anthracycline-treated long-term breast cancer survivors. Secondary aims are to examine effects of exercise training on limiting factors for cardiorespiratory fitness, cardiovascular risk factors, and patient-reported outcomes, and to compare baseline values and effects of exercise training between similar-aged women with and those without prior breast cancer. A third aim is to examine the 24-month postintervention effects of aerobic exercise on primary and secondary outcomes. Methods: The CAUSE trial is a 2-armed randomized controlled trial, where 140 long-term breast cancer survivors, 8-12 years post diagnosis, are assigned to a 5-month nonlinear aerobic exercise program with 3 weekly sessions or to standard care. Seventy similar-aged women with no history of cancer will undergo the same exercise program. Cardiorespiratory fitness measured as peak oxygen consumption (VO2peak), limiting factors for VO2peak (eg, cardiac function, pulmonary function, hemoglobin mass, blood volume, and skeletal muscle characteristics), cardiovascular risk factors (eg, hypertension, diabetes, dyslipidemia, obesity, physical activity level, and smoking status), and patient-reported outcomes (eg, body image, fatigue, mental health, and health-related quality of life) will be assessed at baseline, post intervention, and 24 months post intervention. Results: A total of 209 patients were included from October 2020 to August 2022, and postintervention assessments were completed in January 2023. The 24-month follow-up will be completed in February 2025. Conclusions: The findings from the CAUSE trial will provide novel scientific understanding of the potential benefits of exercise training in long-term breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT04307407; https://clinicaltrials.gov/ct2/show/NCT04307407 International Registered Report Identifier (IRRID): DERR1-10.2196/45244 %M 36920460 %R 10.2196/45244 %U https://www.researchprotocols.org/2023/1/e45244 %U https://doi.org/10.2196/45244 %U http://www.ncbi.nlm.nih.gov/pubmed/36920460 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43967 %T Projection of Premature Cancer Mortality in Hunan, China, Through 2030: Modeling Study %A Wu,Wenqiong %A Wang,Jing %A Liao,Xian-zhen %A Xu,Kekui %A Zou,Yanhua %A Shi,Zhaohui %A Hu,Yingyun %A Xiao,Haifan %A Li,Can %A Cao,Shiyu %A Wang,Shiyu %A Guo,Jia %A Luo,Zhicheng %A Liu,Mengjiao %A Xu,Mengyao %A Jin,Donghui %A Chen,Mengshi %A Fu,Zhongxi %A Yan,Shipeng %+ Department of Cancer Prevention and Control, Hunan Cancer Hospital, 283 Tongzipo Road, Changsha, 410013, China, 86 88651233, yanshipeng@hnca.org.cn %K cancer %K forecasting %K premature mortality %K risk factors %K Sustainable Development Goals %D 2023 %7 6.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The United Nations Sustainable Development Goals for 2030 include reducing premature mortality from noncommunicable diseases by one-third. Although previous modeling studies have predicted premature mortality from noncommunicable diseases, the predictions for cancer and its subcategories are less well understood in China. Objective: The aim of this study was to project premature cancer mortality of 10 leading cancers in Hunan Province, China, based on various scenarios of risk factor control so as to establish the priority for future interventions. Methods: We used data collected between 2009 and 2017 from the Hunan cancer registry annual report as empirical data for projections. The population-attributable fraction was used to disaggregate cancer deaths into parts attributable and unattributable to 10 risk factors: smoking, alcohol use, high BMI, diabetes, physical inactivity, low vegetable and fruit intake, high red meat intake, high salt intake, and high ambient fine particulate matter (PM2.5) levels. The unattributable deaths and the risk factors in the baseline scenario were projected using the proportional change model, assuming constant annual change rates through 2030. The comparative risk assessment theory was used in simulated scenarios to reflect how premature mortality would be affected if the targets for risk factor control were achieved by 2030. Results: The cancer burden in Hunan significantly increased during 2009-2017. If current trends for each risk factor continued to 2030, the total premature deaths from cancers in 2030 would increase to 97,787 in Hunan Province, and the premature mortality (9.74%) would be 44.47% higher than that in 2013 (6.74%). In the combined scenario where all risk factor control targets were achieved, 14.41% of premature cancer mortality among those aged 30-70 years would be avoided compared with the business-as-usual scenario in 2030. Reductions in the prevalence of diabetes, high BMI, ambient PM2.5 levels, and insufficient fruit intake played relatively important roles in decreasing cancer premature mortality. However, the one-third reduction goal would not be achieved for most cancers except gastric cancer. Conclusions: Existing targets on cancer-related risk factors may have important roles in cancer prevention and control. However, they are not sufficient to achieve the one-third reduction goal in premature cancer mortality in Hunan Province. More aggressive risk control targets should be adopted based on local conditions. %M 36877566 %R 10.2196/43967 %U https://publichealth.jmir.org/2023/1/e43967 %U https://doi.org/10.2196/43967 %U http://www.ncbi.nlm.nih.gov/pubmed/36877566 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44197 %T The Success of Cancer Crowdfunding Campaigns: Project and Text Analysis %A Zhang,Xupin %A Tao,Xinqi %A Ji,Bingxiang %A Wang,Renwu %A Sörensen,Silvia %+ Department of Information Management, Faculty of Economics and Management, East China Normal University, 3663 N Zhongshan Rd, Shanghai, 200062, China, 86 21 54344958, rwwang@infor.ecnu.edu.cn %K cancer %K GoFundme %K fundraising %K emotional content %K sentiment analysis %K campaign features %K crowdfunding %K gender %D 2023 %7 3.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Recent studies have analyzed the factors that contribute to variations in the success of crowdfunding campaigns for a specific cancer type; however, little is known about the influential factors among crowdfunding campaigns for multiple cancers. Objective: The purpose of this study was to examine the relationship between project features and the success of cancer crowdfunding campaigns and to determine whether text features affect campaign success for various cancers. Methods: Using cancer-related crowdfunding projects on the GoFundMe website, we transformed textual descriptions from the campaigns into structured data using natural language processing techniques. Next, we used penalized logistic regression and correlation analyses to examine the influence of project and text features on fundraising project outcomes. Finally, we examined the influence of campaign description sentiment on crowdfunding success using Linguistic Inquiry and Word Count software. Results: Campaigns were significantly more likely to be successful if they featured a lower target amount (Goal amount, β=−1.949, z score=−82.767, P<.001) for fundraising, a higher number of previous donations, agency (vs individual) organizers, project pages containing updates, and project pages containing comments from readers. The results revealed an inverted U-shaped relationship between the length of the text and the amount of funds raised. In addition, more spelling mistakes negatively affected the funds raised (Number of spelling errors, β=−1.068, z score=−38.79, P<.001). Conclusions: Difficult-to-treat cancers and high-mortality cancers tend to trigger empathy from potential donors, which increases the funds raised. Gender differences were observed in the effects of emotional words in the text on the amount of funds raised. For cancers that typically occur in women, links between emotional words used and the amount of funds raised were weaker than for cancers typically occurring among men. %M 36692283 %R 10.2196/44197 %U https://www.jmir.org/2023/1/e44197 %U https://doi.org/10.2196/44197 %U http://www.ncbi.nlm.nih.gov/pubmed/36692283 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42350 %T The Health Care Utilization and Medical Costs in Long-Term Follow-Up of Children Diagnosed With Leukemia, Solid Tumor, or Brain Tumor: Population-Based Study Using the National Health Insurance Claims Data %A Miser,James S %A Shia,Ben-Chang %A Kao,Yi-Wei %A Liu,Yen-Lin %A Chen,Shih-Yen %A Ho,Wan-Ling %+ Department of Pediatrics, Taipei Medical University Hospital, 252 Wuxing Street, Taipei, 11031, Taiwan, 886 2 2737 2181 ext 3715, 211002@h.tmu.edu.tw %K brain tumor %K cancer survivor %K children %K cost of care %K health care %K health resource %K leukemia %K long-term follow-up %K population-based study %K solid tumor %D 2023 %7 2.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Childhood cancer survivors are at a high risk of medical consequences of their disease and treatment. There is growing information about the long-term health issues of childhood cancer survivors; however, there are very few studies describing the health care utilization and costs for this unique population. Understanding their utilization of health care services and costs will provide the basis for developing strategies to better serve these individuals and potentially reduce the cost. Objective: This study aims to determine the utilization of health services and costs for long-term survivors of childhood cancer in Taiwan. Methods: This is a nationwide, population-based, retrospective case-control study. We analyzed the claims data of the National Health Insurance that covers 99% of the Taiwanese population of 25.68 million. A total of 33,105 children had survived for at least 5 years after the first appearance of a diagnostic code of cancer or a benign brain tumor before the age of 18 years from 2000 to 2010 with follow-up to 2015. An age- and gender-matched control group of 64,754 individuals with no cancer was randomly selected for comparison. Utilization was compared between the cancer and no cancer groups by χ2 test. The annual medical expense was compared by the Mann-Whitney U test and Kruskal-Wallis rank-sum test. Results: At a median follow-up of 7 years, childhood cancer survivors utilized a significantly higher proportion of medical center, regional hospital, inpatient, and emergency services in contrast to no cancer individuals: 57.92% (19,174/33,105) versus 44.51% (28,825/64,754), 90.66% (30,014/33,105) versus 85.70% (55,493/64,754), 27.19% (9000/33,105) versus 20.31% (13,152/64,754), and 65.26% (21,604/33,105) versus 59.36% (38,441/64,754), respectively (all P<.001). The annual total expense (median, interquartile range) of childhood cancer survivors was significantly higher than that of the comparison group (US $285.56, US $161.78-US $535.80 per year vs US $203.90, US $118.98-US $347.55 per year; P<.001). Survivors with female gender, diagnosis before the age of 3 years, and diagnosis of brain cancer or a benign brain tumor had significantly higher annual outpatient expenses (all P<.001). Moreover, the analysis of outpatient medication costs showed that hormonal and neurological medications comprised the 2 largest costs in brain cancer and benign brain tumor survivors. Conclusions: Survivors of childhood cancer and a benign brain tumor had higher utilization of advanced health resources and higher costs of care. The design of the initial treatment plan minimizing long-term consequences, early intervention strategies, and survivorship programs have the potential to mitigate costs of late effects due to childhood cancer and its treatment. %M 36862495 %R 10.2196/42350 %U https://publichealth.jmir.org/2023/1/e42350 %U https://doi.org/10.2196/42350 %U http://www.ncbi.nlm.nih.gov/pubmed/36862495 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e38758 %T Promoting Self-management and Patient Activation Through eHealth: Protocol for a Systematic Literature Review and Meta-analysis %A Moradian,Saeed %A Maguire,Roma %A Liu,Geoffrey %A Krzyzanowska,Monika K %A Butler,Marcus %A Cheung,Chantal %A Signorile,Marisa %A Gregorio,Nancy %A Ghasemi,Shiva %A Howell,Doris %+ University of Strathclyde, Office 13.15 Livingston Tower, 26 Richmond Street, Glasgow, G1 1XQ, United Kingdom, 44 548 3589, roma.maguire@strath.ac.uk %K digital health %K cancer supportive care %K cancer-related symptoms %K self-efficacy %K supported self-management %D 2023 %7 2.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Major advances in different cancer treatment modalities have been made, and people are now living longer with cancer. However, patients with cancer experience a range of physical and psychological symptoms during and beyond cancer treatment. New models of care are needed to combat this rising challenge. A growing body of evidence supports the effectiveness of eHealth interventions in the delivery of supportive care to people living with the complexities of chronic health conditions. However, reviews on the effects of eHealth interventions are scarce in the field of cancer-supportive care, particularly for interventions with the aim of empowering patients to manage cancer treatment–related symptoms. For this reason, this protocol has been developed to guide a systematic review and meta-analysis to assess the effectiveness of eHealth interventions for supporting patients with cancer in managing cancer-related symptoms. Objective: This systematic review with meta-analysis is conducted with the aim of identifying eHealth-based self-management intervention studies for adult patients with cancer and evaluating the efficacy of eHealth-based self-management tools and platforms in order to synthesize the empirical evidence on self-management and patient activation through eHealth. Methods: A systematic review with meta-analysis and methodological critique of randomized controlled trials is conducted following Cochrane Collaboration methods. Multiple data sources are used to identify all potential research sources for inclusion in the systematic review: (1) electronic databases such as MEDLINE, (2) forward reference searching, and (3) gray literature. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for conducting the review were followed. The PICOS (Population, Interventions, Comparators, Outcomes, and Study Design) framework is used to identify relevant studies. Results: The literature search yielded 10,202 publications. The title and abstract screening were completed in May 2022. Data will be summarized, and if possible, meta-analyses will be performed. It is expected to finalize this review by Winter 2023. Conclusions: The results of this systematic review will provide the latest data on leveraging eHealth interventions and offering effective and sustainable eHealth care, both of which have the potential to improve quality and efficiency in cancer-related symptoms. Trial Registration: PROSPERO 325582; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=325582 International Registered Report Identifier (IRRID): DERR1-10.2196/38758 %M 36862481 %R 10.2196/38758 %U https://www.researchprotocols.org/2023/1/e38758 %U https://doi.org/10.2196/38758 %U http://www.ncbi.nlm.nih.gov/pubmed/36862481 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e42250 %T Remote Monitoring of Colorectal Cancer Survivors Using a Smartphone App and Internet of Things–Based Device: Development and Usability Study %A Ayyoubzadeh,Seyed Mohammad %A Baniasadi,Tayebeh %A Shirkhoda,Mohammad %A Rostam Niakan Kalhori,Sharareh %A Mohammadzadeh,Niloofar %A Roudini,Kamran %A Ghalehtaki,Reza %A Memari,Fereidoon %A Jalaeefar,Amirmohsen %+ Peter L. Reichertz Institute for Medical Informatics (PLRI), Technical University of Braunschweig and Hannover Medical School, Mühlenpfordtstraße. 23, Braunschweig, 38106, Germany, 49 531 391 2128, sharareh.niakankalhori@plri.de %K eHealth %K telemedicine %K colorectal cancer %K cancer survivor %K IoT %K mHealth %K patient monitoring %K remote monitoring %K postdischarge care %K cancer %K patient care %K cancer care %K postoperative complications %D 2023 %7 15.2.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients with colorectal cancer who undergo surgery face many postoperative problems. These problems include the risk of relapse, side effects, and long-term complications. Objective: This study sought to design and develop a remote monitoring system as a technological solution for the postdischarge care of these patients. Methods: This research was conducted in 3 main steps: system feature extraction, system design, and evaluation. After feature extraction from a systematic review, the necessary features were defined by 18 clinical experts in Iran. In the next step, the architecture of the system was designed based on the requirements; the software and hardware parts of the system were embedded in the architecture, then the software system components were drawn using the unified modeling language diagrams, and the details of software system implementation were identified. Regarding the hardware design, different accessible hardware modules were evaluated, and suitable ones were selected. Finally, the usability of the system was evaluated by demonstrating it over a Skype virtual meeting session and using Nilsen’s usability principles. Results: A total of 21 mandatory features in 5 main categories, including patient information registration, periodic monitoring of health parameters, education, reminders, and assessments, were defined and validated for the system. The software was developed using an ASP.Net core backend, a Microsoft SQL Server database, and an Ionic frontend alongside the Angular framework, to build an Android app. The user roles of the system included 3 roles: physicians, patients, and the system administrator. The hardware was designed to contain an Esp8266 as the Internet of Things module, an MLX90614 infrared temperature sensor, and the Maxim Integrated MAX30101 sensor for sensing the heartbeat. The hardware was designed in the shape of a wristband device using SolidWorks 2020 and printed using a 3D printer. The firmware of the hardware was developed in Arduino with the capability of firmware over the air. In evaluating the software system from the perspective of usability, the system received an average score of 3.8 out of 5 from 4 evaluators. Conclusions: Sensor-based telemonitoring systems for patients with colorectal cancer after surgery are possible solutions that can make the process automatic for patients and caregivers. The apps for remote colorectal patient monitoring could be designed to be useful; however, more research regarding the developed system’s implementation in clinic settings and hospitals is required to understand the probable barriers and limitations. %M 36790851 %R 10.2196/42250 %U https://cancer.jmir.org/2023/1/e42250 %U https://doi.org/10.2196/42250 %U http://www.ncbi.nlm.nih.gov/pubmed/36790851 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 6 %N %P e39544 %T User Experiences in a Digital Intervention to Support Total Skin Self-examination by Melanoma Survivors: Nested Qualitative Evaluation Embedded in a Randomized Controlled Trial %A Reilly,Felicity %A Wani,Nuha %A Hall,Susan %A Morgan,Heather May %A Allan,Julia %A Constable,Lynda %A Ntessalen,Maria %A Murchie,Peter %+ Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Aberdeen, AB25 2ZD, United Kingdom, 44 01224 437222, p.murchie@abdn.ac.uk %K mobile apps %K melanoma %K early detection of cancer %K qualitative interviews %K cancer survivorship %D 2023 %7 13.2.2023 %9 Original Paper %J JMIR Dermatol %G English %X Background: Melanoma is a relatively common cancer type with a high survival rate, but survivors risk recurrences or second primaries. Consequently, patients receive regular hospital follow-up, but this can be burdensome to attend and not optimally timed to detect arising problems. Total skin self-examination (TSSE) supports improved clinical outcomes from melanoma via earlier detection of recurrences and second primaries, and digital technology has the potential to support TSSE. Recent research with app-based interventions aimed at improving the well-being of older adults has found that they can use the technology and benefit from it, supporting the use of digital health care in diverse demographic groups. Thus, the Achieving Self-directed Integrated Cancer Aftercare (ASICA) digital health care intervention was developed. The intervention provided melanoma survivors with a monthly prompt to perform a TSSE as well as access to a dermatology nurse who provided them with feedback on photographs and descriptions of their skin. Objective: We aimed to explore participants’ attitudes, beliefs, and experiences regarding TSSE practices. Furthermore, we explored how participants experienced technology and how it influenced their practice of TSSE. Finally, we explored the practical and technical experiences of ASICA users. Methods: This was a nested qualitative evaluation within a dual-center randomized controlled trial of the ASICA intervention. We conducted semistructured telephone interviews with the participants during a randomized controlled trial. The participants were purposively sampled to achieve a representative sample with representative proportions by age, sex, and residential geography. Interviews were transcribed verbatim and analyzed using a framework analysis approach applied within NVivo 12. Results: A total of 22 interviews were conducted with participants from both groups. In total, 40% (9/22) of the interviewed participants were from rural areas, and 60% (13/22) were from urban areas; 60% (13/22) were from the intervention group, and 40% (9/22) were from the control group. Themes evolved around skin-checking behavior, other people’s input into skin checking, contribution of health care professionals outside ASICA and its value, ideas around technology, practical experiences, and potential improvements. ASICA appeared to change participants’ perceptions of skin checking. Users were more likely to report routinely performing TSSE thoroughly. There was some variation in beliefs about skin checking and using technology for health care. Overall, ASICA was experienced positively by participants. Several practical suggestions were made for the improvement of ASICA. Conclusions: The ASICA intervention appeared to have positively influenced the attitudes and TSSE practices of melanoma survivors. This study provides important qualitative information about how a digital health care intervention is an effective means of prompting, recording, and responding to structured TSSE by melanoma survivors. Technical improvements are required, but the app offers promise for technologically enhanced melanoma follow-up in future. Trial Registration: ClinicalTrials.gov NCT03328247; https://clinicaltrials.gov/ct2/show/NCT03328247?term=ASICA&rank=1 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3453-x %M 37632942 %R 10.2196/39544 %U https://derma.jmir.org/2023/1/e39544 %U https://doi.org/10.2196/39544 %U http://www.ncbi.nlm.nih.gov/pubmed/37632942 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e39640 %T Facebook Intervention for Young-Onset Melanoma Survivors and Families: Protocol for a Randomized Controlled Trial %A Manne,Sharon %A Pagoto,Sherry %A Peterson,Susan %A Heckman,Carolyn %A Kashy,Deborah %A Berger,Adam %A Studts,Christina %A Negrón,Rosalyn %A Buller,David %A Paddock,Lisa %A Gallo,Joseph %A Kulik,Alexandria %A Frederick,Sara %A Pesanelli,Morgan %A Domider,Mara %A Grosso,Marissa %+ Behavioral Sciences, Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, 120 Albany Street, Tower II, New Brunswick, NJ, 08901, United States, 1 7323577978, mannesl@cinj.rutgers.edu %K cancer survivors %K melanoma survivors %K skin self-examination %K clinical skin examination %K sun protection %K behavioral intervention %K social media %D 2023 %7 24.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Individuals diagnosed with melanoma before the age of 40 years (young-onset melanoma survivors) and their first-degree relatives (FDRs) are a growing population at risk for developing recurrent melanoma or new melanomas. Regular surveillance using clinical skin examination (CSE) and skin self-examination (SSE) and engagement in preventive behaviors including sun protection are recommended. Given the growing population of survivors and their families who are at increased risk, it is surprising that no behavioral interventions have been developed and evaluated to improve risk-reduction behaviors. Objective: We describe the rationale and methodology for a randomized controlled trial evaluating the efficacy of a Facebook intervention providing information, goal setting, and peer support to increase CSE, SSE, and sun protection for young-onset melanoma survivors and their FDRs. Methods: Overall, 577 survivors and 577 FDRs will be randomly assigned to either the Young Melanoma Family Facebook Group or the Melanoma Family Healthy Lifestyle Facebook Group condition. Participants will complete measures of CSE, SSE, and sun protection, and mediator measures of attitudes and beliefs before and after the intervention. The primary aim is to evaluate the impact of the Young Melanoma Family Facebook intervention versus the Melanoma Family Healthy Lifestyle Facebook intervention on CSE, SSE frequency and comprehensiveness, and sun protection among FDRs. The secondary aims examine the efficacy of the Young Melanoma Family Facebook intervention on survivors’ SSE frequency and comprehensiveness and sun protection behaviors and mechanisms of intervention efficacy for intervention impact on FDR and survivor outcomes. The exploratory aim is to evaluate the efficacy of the 2 interventions on perceived stress, physical activity, and healthy eating. Results: This project was funded by the National Institutes of Health (R01CA221854). The project began in May 2018, and recruitment started in January 2019. We anticipate completing enrollment by November 2023. Power calculations recommended a sample size of 577 survivors and 577 FDRs. Multilevel modeling treating family as the upper-level sampling unit and individual as the lower-level sampling unit will be the primary data analytic approach. Fixed effect predictors in these models will include condition, role, sex, all 2- and 3-way interactions, and covariates. Conclusions: The Young Melanoma Family Facebook intervention aims to improve primary and secondary skin cancer prevention for young-onset melanoma survivors and their family members. The intervention’s delivery via a popular, freely available social media platform increases its impact because of the potential for dissemination in many contexts. If efficacious, this program could be disseminated by dermatologist practices, public health or nonprofit organizations focused on melanoma, and existing melanoma and skin cancer Facebook groups, thereby expanding its reach. This project will produce a content library of posts and a moderation guide for others. Trial Registration: ClinicalTrials.gov NCT03677739; https://clinicaltrials.gov/ct2/show/NCT03677739 International Registered Report Identifier (IRRID): DERR1-10.2196/39640 %M 36692933 %R 10.2196/39640 %U https://www.researchprotocols.org/2023/1/e39640 %U https://doi.org/10.2196/39640 %U http://www.ncbi.nlm.nih.gov/pubmed/36692933 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e39996 %T Enhancing Self-care Among Oral Cancer Survivors: Protocol for the Empowered Survivor Trial %A Manne,Sharon L %A Imanguli,Matin %A Kashy,Deborah %A Pesanelli,Morgan %A Frederick,Sara %A Van Cleave,Janet H %A Paddock,Lisa %A Hudson,Shawna %A Steinberg,Michael %A Clifford,Patrick %A Domider,Mara %A Singh,Neetu %+ Division of Medical Oncology, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, 08901, United States, 1 732 357 978, mannesl@cinj.rutgers.edu %K oral cancer %K cancer survivorship %K quality of life %K digital interventions %D 2023 %7 20.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Survivors of oral cavity and oropharyngeal cancer frequently experience difficulties in swallowing; tasting; speaking; chewing; and maintaining comfortable movements of the head, neck, and shoulder. Engagement in regular self-care can reduce further loss of function and mitigate late effects. Despite the substantial self-care requirements, there are no empirically based interventions to enhance the skills and confidence of these survivors in managing their ongoing care. Objective: The aim of this study is to describe the rationale and methodology for a randomized controlled trial evaluating Empowered Survivor (ES) versus Springboard Beyond Cancer, a general web-based program for cancer survivors, on self-efficacy in managing care, preparedness for managing survivorship, and health-related quality of life (QOL). Methods: This study will recruit a total of 600 individuals who were diagnosed with oral cavity or oropharyngeal cancer in the past 3 years and are currently cancer free primarily from state cancer registries; these individuals will be randomly assigned to either the ES or Springboard Beyond Cancer condition. The participants complete measures of self-efficacy in managing care, preparedness for survivorship, health-related QOL, and engagement in oral self-examination and head and neck strengthening and flexibility exercises at baseline and 2 and 6 months after baseline. The primary aim of this study is to evaluate the impact of ES versus Springboard Beyond Cancer on self-efficacy, preparedness, and health-related QOL. The secondary aim is to examine the mediators and moderators of ES’s impact on self-efficacy in managing care, preparedness, and health-related QOL at 6 months. The exploratory aim is to conduct a process evaluation of ES to identify potential oncology or community settings for future implementation. Results: Multilevel modeling will be used to examine whether there are significant differences between the ES and Springboard Beyond Cancer interventions over time. Mediational models will evaluate the indirect effects of ES on outcomes. Quantitative analyses will evaluate the predictors of ES use, and qualitative analyses will evaluate the preferred timing and settings for the implementation of ES. Conclusions: This randomized controlled trial evaluates a completely web-based intervention, ES, versus a general web-based program for cancer survivors, Springboard Beyond Cancer, on self-efficacy in managing care, preparedness for managing survivorship, and health-related QOL and identifies the putative mediators and moderators of the intervention’s effects. If an effect on the primary outcomes is illustrated, the next step could be an implementation trial to evaluate the intervention’s uptake in and impact on an oncology care setting or nonprofit organizations. Trial Registration: ClincalTrials.gov NCT04713449; https://clinicaltrials.gov/ct2/show/NCT04713449 International Registered Report Identifier (IRRID): DERR1-10.2196/39996 %M 36662561 %R 10.2196/39996 %U https://www.researchprotocols.org/2023/1/e39996 %U https://doi.org/10.2196/39996 %U http://www.ncbi.nlm.nih.gov/pubmed/36662561 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41354 %T Adaptation of a Personalized Electronic Care Planning Tool for Cancer Follow-up Care: Formative Study %A Sohl,Stephanie J %A Duncan,Pamela W %A Thakur,Elyse %A Puccinelli-Ortega,Nicole %A Salsman,John M %A Russell,Greg %A Pasche,Boris C %A Wentworth,Stacy %A Miller Jr,David P %A Wagner,Lynne I %A Topaloglu,Umit %+ Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem, NC, 27157, United States, 1 3367135093, ssohl@wakehealth.edu %K cancer survivorship %K cancer survivor %K colorectal cancer %K patient engagement %K shared decision-making %K follow-up care %K patient care planning %K electronic tool %K patient-reported outcomes %K behavior change %D 2023 %7 10.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Most patients diagnosed with colorectal cancer will survive for at least 5 years; thus, engaging patients to optimize their health will likely improve outcomes. Clinical guidelines recommend patients receive a comprehensive care plan (CP) when transitioning from active treatment to survivorship, which includes support for ongoing symptoms and recommended healthy behaviors. Yet, cancer care providers find this guideline difficult to implement. Future directions for survivorship care planning include enhancing information technology support for developing personalized CPs, using CPs to facilitate self-management, and assessing CPs in clinical settings. Objective: We aimed to develop an electronic tool for colorectal cancer follow-up care (CFC) planning. Methods: Incorporating inputs from health care professionals and patient stakeholders is fundamental to the successful integration of any tool into the clinical workflow. Thus, we followed the Integrate, Design, Assess, and Share (IDEAS) framework to adapt an existing application for stroke care planning (COMPASS-CP) to meet the needs of colorectal cancer survivors (COMPASS-CP CFC). Constructs from the Consolidated Framework for Implementation Research (CFIR) guided our approach. We completed this work in 3 phases: (1) gathering qualitative feedback from stakeholders about the follow-up CP generation design and workflow; (2) adapting algorithms and resource data sources needed to generate a follow-up CP; and (3) optimizing the usability of the adapted prototype of COMPASS-CP CFC. We also quantitatively measured usability (target average score ≥70; range 0-100), acceptability, appropriateness, and feasibility. Results: In the first phase, health care professionals (n=7), and patients and caregivers (n=7) provided qualitative feedback on COMPASS-CP CFC that informed design elements such as selection, interpretation, and clinical usefulness of patient-reported measures. In phase 2, we built a minimal viable product of COMPASS-CP CFC. This tool generated CPs based on the needs identified by patient-completed measures (including validated patient-reported outcomes) and electronic health record data, which were then matched with resources by zip code and preference to support patients’ self-management. Elements of the CFIR assessed revealed that most health care professionals believed the tool would serve patients’ needs and had advantages. In phase 3, the average System Usability Scale score was above our target score for health care professionals (n=5; mean 71.0, SD 15.2) and patients (n=5; mean 95.5, SD 2.1). Participants also reported high levels of acceptability, appropriateness, and feasibility. Additional CFIR-informed feedback, such as desired format for training, will inform future studies. Conclusions: The data collected in this study support the initial usability of COMPASS-CP CFC and will inform the next steps for implementation in clinical care. COMPASS-CP CFC has the potential to streamline the implementation of personalized CFC planning to enable systematic access to resources that will support self-management. Future research is needed to test the impact of COMPASS-CP CFC on patient health outcomes. %M 36626203 %R 10.2196/41354 %U https://formative.jmir.org/2023/1/e41354 %U https://doi.org/10.2196/41354 %U http://www.ncbi.nlm.nih.gov/pubmed/36626203 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e35750 %T An Assessment of the Predictive Performance of Current Machine Learning–Based Breast Cancer Risk Prediction Models: Systematic Review %A Gao,Ying %A Li,Shu %A Jin,Yujing %A Zhou,Lengxiao %A Sun,Shaomei %A Xu,Xiaoqian %A Li,Shuqian %A Yang,Hongxi %A Zhang,Qing %A Wang,Yaogang %+ School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, Tianjin, 300070, China, 86 02260361238, wangyg@tmu.edu.cn %K breast cancer %K machine learning %K risk prediction %K cancer %K oncology %K systemic review %K review %K meta-analysis %K cancer research %K risk model %D 2022 %7 29.12.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Several studies have explored the predictive performance of machine learning–based breast cancer risk prediction models and have shown controversial conclusions. Thus, the performance of the current machine learning–based breast cancer risk prediction models and their benefits and weakness need to be evaluated for the future development of feasible and efficient risk prediction models. Objective: The aim of this review was to assess the performance and the clinical feasibility of the currently available machine learning–based breast cancer risk prediction models. Methods: We searched for papers published until June 9, 2021, on machine learning–based breast cancer risk prediction models in PubMed, Embase, and Web of Science. Studies describing the development or validation models for predicting future breast cancer risk were included. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was used to assess the risk of bias and the clinical applicability of the included studies. The pooled area under the curve (AUC) was calculated using the DerSimonian and Laird random-effects model. Results: A total of 8 studies with 10 data sets were included. Neural network was the most common machine learning method for the development of breast cancer risk prediction models. The pooled AUC of the machine learning–based optimal risk prediction model reported in each study was 0.73 (95% CI 0.66-0.80; approximate 95% prediction interval 0.56-0.96), with a high level of heterogeneity between studies (Q=576.07, I2=98.44%; P<.001). The results of head-to-head comparison of the performance difference between the 2 types of models trained by the same data set showed that machine learning models had a slightly higher advantage than traditional risk factor–based models in predicting future breast cancer risk. The pooled AUC of the neural network–based risk prediction model was higher than that of the nonneural network–based optimal risk prediction model (0.71 vs 0.68, respectively). Subgroup analysis showed that the incorporation of imaging features in risk models resulted in a higher pooled AUC than the nonincorporation of imaging features in risk models (0.73 vs 0.61; Pheterogeneity=.001, respectively). The PROBAST analysis indicated that many machine learning models had high risk of bias and poorly reported calibration analysis. Conclusions: Our review shows that the current machine learning–based breast cancer risk prediction models have some technical pitfalls and that their clinical feasibility and reliability are unsatisfactory. %M 36426919 %R 10.2196/35750 %U https://publichealth.jmir.org/2022/12/e35750 %U https://doi.org/10.2196/35750 %U http://www.ncbi.nlm.nih.gov/pubmed/36426919 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 4 %P e42908 %T Identification and Potential Use of Clusters of Patients With Colorectal Cancer and Patients With Prostate Cancer in Clinical Practice: Explorative Mixed Methods Study %A Beuken,Maik J M %A Kanera,Iris M %A Ezendam,Nicole Paulina Maria %A Braun,Susy %A Zoet,Martijn %+ Faculty of Financial Management, Research Centre for Future Proof Financials, Zuyd University of Applied Sciences, Ligne 1, Sittard, 6231 MT, Netherlands, 31 682243809, maik.beuken@zuyd.nl %K colorectal cancer %K prostate cancer %K referral to aftercare %K patient clusters %K cluster analysis %K K-means cluster algorithm %K multiple-factor analysis %K expert panel group interviews %K interview %K cancer %K patient %K usability %K clinical %K colorectal %K recovery %D 2022 %7 27.12.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: A steady increase in colorectal and prostate cancer survivors and patients with these cancers is expected in the upcoming years. As a result of primary cancer treatments, patients have numerous additional complaints, increasing the need for cancer aftercare. However, referrals to appropriate cancer aftercare remain inadequate, despite a wide range of aftercare options. Caregivers and patients often do not know which aftercare is the most appropriate for the individual patient. Since characteristics and complaints of patients within a diagnosis group may differ, predefined patient clusters could provide substantive and efficient support for professionals in the conversation about aftercare. By using advanced data analysis methods, clusters of patients who are different from one another within a diagnosis group can be identified. Objective: This study had a 2-fold objective: (1) to identify, visualize, and describe potential patient clusters within the colorectal and prostate cancer population and (2) to explore the potential usability of these clusters in clinical practice. Methods: First, we used cross-sectional data from patients with colorectal cancer and patients with prostate cancer provided by the population-based PROFILES (Patient-Reported Outcomes Following Initial Treatment and Long-Term Evaluation of Survivorship) registry, which were originally collected between 2008 and 2012. To identify and visualize different clusters among the 2 patient populations, we conducted cluster analyses by applying the K-means algorithm and multiple-factor analyses. Second, in a qualitative study, we presented the patient clusters to patients with prostate, patients with colorectal cancer, and oncology professionals. To assess the usability of these clusters, we held expert panel group interviews. The interviews were video recorded and transcribed. Three researchers independently performed content-directed data analyses to understand and describe the qualitative data. Quotes illustrate the most important results. Results: We identified 3 patient clusters among colorectal cancer cases (n=3989) and 5 patient clusters among prostate cancer cases (n=696), which were described in tabular form. Patient experts (6/8, 75%) and professional experts (17/20, 85%) recognized the patient clustering based on distinguishing variables. However, the tabular form was evaluated as less applicable in clinical practice. Instead, the experts suggested the development of a conversation tool (eg, decision tree) to guide professionals through the hierarchy of variables. In addition, participants suggested that information about possible aftercare initiatives should be offered and integrated. This would also ensure a good overview and seemed to be a precondition for finding suitable aftercare. Conclusions: This study demonstrates that a fully data-driven approach can be used to identify distinguishable and recognizable (ie, in routine care) patient clusters in large data sets within cancer populations. Patient clusters can be a source of support for health professionals in the aftercare conversation. These clusters, when integrated into a smart digital conversation and referral tool, might be an opportunity to improve referral to cancer aftercare. Trial Registration: Netherlands Trial Register NL9226; https://trialsearch.who.int/Trial2.aspx?TrialID=NL9226 %M 36574281 %R 10.2196/42908 %U https://cancer.jmir.org/2022/4/e42908 %U https://doi.org/10.2196/42908 %U http://www.ncbi.nlm.nih.gov/pubmed/36574281 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e39799 %T Effect of Mobile Phone App–Based Interventions on Quality of Life and Psychological Symptoms Among Adult Cancer Survivors: Systematic Review and Meta-analysis of Randomized Controlled Trials %A Qin,Minghui %A Chen,Bo %A Sun,Shaohua %A Liu,Xiaodong %+ Information Center, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Art and Science, No 136, Jingzhou Street, Xiangcheng District, Xiangyang, 441021, China, 86 18602770213, lxd20000@163.com %K mobile health app %K mHealth app %K quality of life %K psychological symptoms %K cancer survivors %K systematic review and meta-analysis %K mobile phone %D 2022 %7 19.12.2022 %9 Review %J J Med Internet Res %G English %X Background: Most patients with cancer experience psychological or physical distress, which can adversely affect their quality of life (QOL). Smartphone app interventions are increasingly being used to improve QOL and psychological outcomes in patients with cancer. However, there is insufficient evidence regarding the effect of this type of intervention, with conflicting results in the literature. Objective: In this systematic review and meta-analysis, we investigated the effectiveness of mobile phone app interventions on QOL and psychological outcomes in adult patients with cancer, with a special focus on intervention duration, type of cancer, intervention theory, treatment strategy, and intervention delivery format. Methods: We conducted a literature search of PubMed, Web of Science, the Cochrane Library, Embase, Scopus, China National Knowledge Infrastructure, and WanFang to identify studies involving apps that focused on cancer survivors and QOL or psychological symptoms published from inception to October 30, 2022. We selected only randomized controlled trials that met the inclusion criteria and performed systematic review and meta-analysis. The standardized mean difference (SMD) with a 95% CI was pooled when needed. Sensitivity and subgroup analyses were also conducted. Results: In total, 30 randomized controlled trials with a total of 5353 participants were included in this meta-analysis. Compared with routine care, app interventions might improve QOL (SMD=0.39, 95% CI 0.27-0.51; P<.001); enhance self-efficacy (SMD=0.15, 95% CI 0.02-0.29; P=.03); and alleviate anxiety (SMD=−0.64, 95% CI −0.73 to −0.56; P<.001), depression (SMD=−0.33, 95% CI −0.58 to −0.08; P=.009), and distress (SMD=−0.34, 95% CI −0.61 to −0.08; P=.01). Short-term (duration of ≤3 months), physician-patient interaction (2-way communication using a smartphone app), and cognitive behavioral therapy interventions might be the most effective for improving QOL and alleviating adverse psychological effects. Conclusions: Our study showed that interventions using mobile health apps might improve QOL and self-efficacy as well as alleviate anxiety, depression, and distress in adult cancer survivors. However, these results should be interpreted with caution because of the heterogeneity of the interventions and the study design. More rigorous trials are warranted to confirm the suitable duration and validate the different intervention theories as well as address methodological flaws in previous studies. Trial Registration: PROSPERO CRD42022370599; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=370599 %M 36534460 %R 10.2196/39799 %U https://www.jmir.org/2022/12/e39799 %U https://doi.org/10.2196/39799 %U http://www.ncbi.nlm.nih.gov/pubmed/36534460 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 4 %P e39228 %T Meditation Mobile App Developed for Patients With and Survivors of Cancer: Feasibility Randomized Controlled Trial %A Huberty,Jennifer %A Bhuiyan,Nishat %A Puzia,Megan %A Joeman,Lynda %A Larkey,Linda %A Mesa,Ruben %+ Mays Cancer Center, University of Texas Health San Antonio MD Anderson, 7979 Wurzbach Rd., Phoenix, TX, 78229, United States, 1 402 301 1304, jenhubertyphd@gmail.com %K cancer %K mobile health %K mHealth %K meditation %K feasibility %K mobile phone %D 2022 %7 23.11.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: To address the unmet need for a commercial cancer-specific meditation app, we leveraged a long-standing partnership with a consumer-based app (ie, Calm) to develop the first commercial meditation app prototype adapted specifically for the needs of patients with cancer. Input was obtained at both the individual user and clinic levels (ie, patients with and survivors of cancer and health care providers). Objective: This study aimed to determine the feasibility of a cancer-specific meditation app prototype. Methods: Patients with and survivors of cancer who were recruited and enrolled in the feasibility randomized controlled trial were asked to use the prototype app daily (≥70 minutes per week) for 4 weeks. Participants completed web-based weekly questionnaires and a final poststudy questionnaire and were asked to participate in an optional web-based poststudy interview. The questionnaires and interviews covered the following feasibility categories: acceptability, demand, practicality, and adaptation. Results: A total of 36 patients with and survivors of cancer completed the baseline questionnaire, 18 completed the final questionnaire, and 6 completed the optional interviews. Weekly and poststudy questionnaires indicated high overall enjoyment, ease of use, and satisfaction with the app content, aesthetics, and graphics. The objective use data indicated that the average total app use rate was 73.39 (SD 7.12) minutes per week. Interviews (N=6) revealed positive and mixed responses to the app prototype and informative differences related to preferences for narrators, emotional content, and meditation teaching but an overall appreciation for the variety of options. Conclusions: The most likely candidates for moving from cancer-specific meditation apps to dissemination are through partnering with the industry, in which name recognition and market distribution are already established (even showing a base of users from the targeted population with cancer). This study established the feasibility of a cancer-specific mobile meditation app prototype for patients with and survivors of cancer, using a commercially available app. The quantitative and qualitative data demonstrated the acceptability, demand, practicality, and adaptation of the prototype. Improvements suggested by the participants will be considered in the final app design before testing the efficacy of the app in a future study. Trial Registration: Clinicaltrials.gov NCT05459168; https://clinicaltrials.gov/ct2/show/record/NCT05459168 %M 36416880 %R 10.2196/39228 %U https://cancer.jmir.org/2022/4/e39228 %U https://doi.org/10.2196/39228 %U http://www.ncbi.nlm.nih.gov/pubmed/36416880 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e40386 %T Stage-Specific Survival in Breast Cancer in Chinese and White Women: Comparative Data Analysis %A Wang,Jun %A Zhou,Juan %A Liu,Lei %A Wu,San-Gang %+ Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China, 86 5922139531, wusg@xmu.edu.cn %K breast cancer %K AJCC %K American Joint Committee on Cancer %K Chinese %K White American %K survival %K surveillance %K epidemiology %K staging %K pathological prognostic staging %K AJCC stage %K overall survival %K cancer-specific survival %D 2022 %7 15.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Stage-specific survival, according to the eighth edition of the American Joint Committee on Cancer (AJCC) pathological prognostic staging (PPS) on breast cancer (BC), between Chinese and White American women remains unclear. Objective: This study aimed to assess stage-specific survival in BC between Chinese and White American women according to the eighth AJCC PPS. Methods: We included Chinese and White American women with BC diagnosed between 2010 and 2018 from the Surveillance, Epidemiology, and End Results database. A chi-square test, the Kaplan–Meier method, a receiver operating characteristic (ROC) curve, and multivariate Cox proportional hazards models were used for data analysis. Results: We included 376,818 individuals in this study: 369,522 White American and 7296 Chinese. Of them, 149,452 (39.7%) migrated from the seventh AJCC anatomic staging (AS) to the eighth AJCC PPS, 22,516 (6.0%) were upstaged, and 126,936 (33.7%) were downstaged. With a median follow-up duration of 44 months, the 5-year overall survival and cancer-specific survival (CSS) for the entire group were 87.4% and 95.9%, respectively. The seventh AJCC AS (P<.001) and the eighth AJCC PPS (P<.001) could significantly predict the survival outcomes of BC, and multivariate analysis revealed that both staging systems were significant prognostic indicators of CSS. The ROC curve revealed that the PPS had a better discriminating ability than the AS (area under the curve [AUC] 0.769 vs 0.753, P<.001). Similar trends were observed after stratification by the 2 ethnic groups. The eighth AJCC PPS had better discriminating ability than the seventh AJCC AS among both White American (AUC 0.769 vs 0.753, P<.001) and Chinese patients (AUC 0.790 vs 0.776, P<.001). In the seventh AJCC AS, Chinese women had better CSS in stage IA (P=.02), stage IIA (P=.005), and stage IIIB (P=.04) disease than White American women, but no significant CSS was observed in stage IB, IIB, IIIA, and IIIC disease between the 2 ethnic groups. Regarding the eighth AJCC PPS, Chinese women had better CSS in stage IA (P=.002) and IIIA (P=.046) disease than White American women, and CSS was similar in Chinese and White American women in other substages. Conclusions: The eighth AJCC PPS has a similar discriminative ability between White American and Chinese individuals with BC compared with the seventh AJCC AS. Therefore, the eighth AJCC PPS is also applicable to Chinese individuals with BC. %M 36378507 %R 10.2196/40386 %U https://publichealth.jmir.org/2022/11/e40386 %U https://doi.org/10.2196/40386 %U http://www.ncbi.nlm.nih.gov/pubmed/36378507 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e39614 %T The Effects of the Use of Patient-Accessible Electronic Health Record Portals on Cancer Survivors’ Health Outcomes: Cross-sectional Survey Study %A Liu,Piper Liping %A Zhao,Xinshu %A Ye,Jizhou Francis %+ Department of Communication, Faculty of Social Sciences, University of Macau, Room 2051, Humanities & Social Sciences Building (E21B), Taipa, Macao, 853 8822 8837, xszhao@um.edu.mo %K electronic health record %K patient-centered care %K health self-efficacy %K cancer survivors %K physical health %K psychological health %D 2022 %7 24.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In the past decade, patient-accessible electronic health record (PAEHR) systems have emerged as an important tool for health management both at the hospital level and individual level. However, little is known about the effects of PAEHR portals on the survivorship of patients with chronic health conditions (eg, cancer). Objective: This study aims to investigate the effects of the use of PAEHR portals on cancer survivors’ health outcomes and to examine the mediation pathways through patient-centered communication (PCC) and health self-efficacy. Methods: Data for this study were derived from the Health Information National Trends Survey (HINTS 5, Cycle 4) collected from February 2020 to June 2020. This study only involved respondents who reported having been diagnosed with cancer (N=626). Descriptive analyses were performed, and the mediation models were tested using Model 6 from the SPSS macro PROCESS. Statistically significant relationships among PAEHR portal use, PCC, health self-efficacy, and physical and psychological health were examined using bootstrapping procedures. In this study, we referred to the regression coefficients generated by min-max normalization as percentage coefficients (bp). The 95% bootstrapped CIs were used with 10,000 resamplings. Results: No positive direct associations between PAEHR portal use and cancer survivors’ health outcomes were found. The results supported the indirect relationship between PAEHR portal use and cancer survivors’ psychological health via (1) PCC (bp=0.029; β=.023, 95% CI .009-.054), and (2) PCC and health self-efficacy in sequence (bp=0.006; β=.005, 95% CI .002-.014). Besides, the indirect association between PAEHR portal use and cancer survivors’ physical health (bp=0.006; β=.004, 95% CI .002-.018) via sequential mediators of PCC and health self-efficacy was also statistically acknowledged. Conclusions: This study offers empirical evidence about the significant role of PAEHR portals in delivering PCC, improving health self-efficacy, and ultimately contributing to cancer survivors’ physical and psychological health. %M 36279157 %R 10.2196/39614 %U https://www.jmir.org/2022/10/e39614 %U https://doi.org/10.2196/39614 %U http://www.ncbi.nlm.nih.gov/pubmed/36279157 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 4 %P e32153 %T A Web-Based Prostate Cancer–Specific Holistic Needs Assessment (CHAT-P): Multimethod Study From Concept to Clinical Practice %A Nanton,Veronica %A Appleton,Rebecca %A Ahmed,Nisar %A Loew,Joelle %A Roscoe,Julia %A Muthuswamy,Radha %A Patel,Prashant %A Dale,Jeremy %A Ahmedzai,Sam H %+ Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, United Kingdom, 44 2476 574025, v.nanton@warwick.ac.uk %K Holistic Needs Assessment %K prostate cancer %K survivorship %K cancer follow-up %K coproduction %K web-based communication %K care planning %D 2022 %7 19.10.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Men with prostate cancer experience immediate and long-term consequences of the disease and its treatment. They require both long-term monitoring for recurrence or progression and follow-up to identify and help manage psychosocial and physical impacts. Holistic Needs Assessment aims to ensure patient-centered continuing cancer care. However, paper-based generic tools have had limited uptake within cancer services, and there is little evidence of their impact. With the expansion of remote methods of care delivery and to enhance the value of generic tools, we developed a web-based Composite Holistic Needs Assessment Adaptive Tool-Prostate (CHAT-P) specifically for prostate cancer. Objective: This paper described the context, conceptual underpinning, and approach to design that informed the development of CHAT-P, starting from the initial concept to readiness for deployment. Through this narrative, we sought to contribute to the expanding body of knowledge regarding the coproduction process of innovative digital systems with potential for enhanced cancer care delivery. Methods: The development of CHAT-P was guided by the principles of coproduction. Men with prostate cancer and health care professionals contributed to each stage of the process. Testing was conducted iteratively over a 5-year period. An initial rapid review of patient-reported outcome measures identified candidate items for inclusion. These items were categorized and allocated to overarching domains. After the first round of user testing, further items were added, improvements were made to the adaptive branching system, and response categories were refined. A functioning version of CHAT-P was tested with 16 patients recruited from 3 outpatient clinics, with interviewers adopting the think-aloud technique. Interview transcripts were analyzed using a framework approach. Interviews and informal discussions with health care professionals informed the development of a linked care plan and clinician-facing platform, which were incorporated into a separate feasibility study of digitally enhanced integrated cancer care. Results: The findings from the interview study demonstrated the usability, acceptability, and potential value of CHAT-P. Men recognized the benefits of a personalized approach and the importance of a holistic understanding of their needs. Preparation for the consultation by the completion of CHAT-P was also recognized as empowering. The possible limitations identified were related to the importance of care teams responding to the issues selected in the assessment. The subsequent feasibility study highlighted the need for attention to men’s psychological concerns and demonstrated the ability of CHAT-P to capture red flag symptoms requiring urgent investigation. Conclusions: CHAT-P offers an innovative means by which men can communicate their concerns to their health care teams before a physical or remote consultation. There is now a need for a full evaluation of the implementation process and outcomes where CHAT-P is introduced into the clinical pathway. There is also scope for adapting the CHAT-P model to other cancers. %M 36260380 %R 10.2196/32153 %U https://cancer.jmir.org/2022/4/e32153 %U https://doi.org/10.2196/32153 %U http://www.ncbi.nlm.nih.gov/pubmed/36260380 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e34564 %T Predicting Effective Adaptation to Breast Cancer to Help Women BOUNCE Back: Protocol for a Multicenter Clinical Pilot Study %A Pettini,Greta %A Sanchini,Virginia %A Pat-Horenczyk,Ruth %A Sousa,Berta %A Masiero,Marianna %A Marzorati,Chiara %A Galimberti,Viviana Enrica %A Munzone,Elisabetta %A Mattson,Johanna %A Vehmanen,Leena %A Utriainen,Meri %A Roziner,Ilan %A Lemos,Raquel %A Frasquilho,Diana %A Cardoso,Fatima %A Oliveira-Maia,Albino J %A Kolokotroni,Eleni %A Stamatakos,Georgios %A Leskelä,Riikka-Leena %A Haavisto,Ira %A Salonen,Juha %A Richter,Robert %A Karademas,Evangelos %A Poikonen-Saksela,Paula %A Mazzocco,Ketti %+ Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Via G. Ripamonti 435, Milan, 20141, Italy, 39 0257489207, ketti.mazzocco@ieo.it %K resilience %K personality %K coping %K decision-making %K cancer %K quality of life %D 2022 %7 12.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the continued progress of medicine, dealing with breast cancer is becoming a major socioeconomic challenge, particularly due to its increasing incidence. The ability to better manage and adapt to the entire care process depends not only on the type of cancer but also on the patient’s sociodemographic and psychological characteristics as well as on the social environment in which a person lives and interacts. Therefore, it is important to understand which factors may contribute to successful adaptation to breast cancer. To our knowledge, no studies have been performed on the combination effect of multiple psychological, biological, and functional variables in predicting the patient’s ability to bounce back from a stressful life event, such as a breast cancer diagnosis. Here we describe the study protocol of a multicenter clinical study entitled “Predicting Effective Adaptation to Breast Cancer to Help Women to BOUNCE Back” or, in short, BOUNCE. Objective: The aim of the study is to build a quantitative mathematical model of factors associated with the capacity for optimal adjustment to cancer and to study resilience through the cancer continuum in a population of patients with breast cancer. Methods: A total of 660 women with breast cancer will be recruited from five European cancer centers in Italy, Finland, Israel, and Portugal. Biomedical and psychosocial variables will be collected using the Noona Healthcare platform. Psychosocial, sociodemographic, lifestyle, and clinical variables will be measured every 3 months, starting from presurgery assessment (ie, baseline) to 18 months after surgery. Temporal data mining, time-series prediction, sequence classification methods, clustering time-series data, and temporal association rules will be used to develop the predictive model. Results: The recruitment process stared in January 2019 and ended in November 2021. Preliminary results have been published in a scientific journal and are available for consultation on the BOUNCE project website. Data analysis and dissemination of the study results will be performed in 2022. Conclusions: This study will develop a predictive model that is able to describe individual resilience and identify different resilience trajectories along the care process. The results will allow the implementation of tailored interventions according to patients’ needs, supported by eHealth technologies. Trial Registration: ClinicalTrials.gov NCT05095675; https://clinicaltrials.gov/ct2/show/NCT05095675 International Registered Report Identifier (IRRID): DERR1-10.2196/34564 %M 36222801 %R 10.2196/34564 %U https://www.researchprotocols.org/2022/10/e34564 %U https://doi.org/10.2196/34564 %U http://www.ncbi.nlm.nih.gov/pubmed/36222801 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e36714 %T Comparing Transactional eHealth Literacy of Individuals With Cancer and Surrogate Information Seekers: Mixed Methods Study %A Vasquez,Taylor S %A Bylund,Carma L %A Alpert,Jordan %A Close,Julia %A Le,Tien %A Markham,Merry Jennifer %A Taylor,Greenberry B %A Paige,Samantha R %+ College of Journalism and Communications, University of Florida, 1885 Stadium Road, Gainesville, FL, 32608, United States, 1 3215370306, tsthelander@ufl.edu %K eHealth literacy %K cancer communication %K individuals with cancer %K surrogate seekers %K web-based information credibility appraisal %D 2022 %7 28.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The number of adults entering higher-risk age groups for receiving a cancer diagnosis is rising, with predicted numbers of cancer cases expected to increase by nearly 50% by 2050. Living with cancer puts exceptional burdens on individuals and families during treatment and survivorship, including how they navigate their relationships with one another. One role that a member of a support network may enact is that of a surrogate seeker, who seeks information in an informal capacity on behalf of others. Individuals with cancer and surrogate seekers often use the internet to learn about cancer, but differences in their skills and strategies have received little empirical attention. Objective: This study aimed to examine the eHealth literacy of individuals with cancer and surrogate information seekers, including an investigation of how each group evaluates the credibility of web-based cancer information. As a secondary aim, we sought to explore the differences that exist between individuals with cancer and surrogate seekers pertaining to eHealth literacies and sociodemographic contexts. Methods: Between October 2019 and January 2020, we conducted a web-based survey of 282 individuals with cancer (n=185) and surrogate seekers (n=97). We used hierarchical linear regression analyses to explore differences in functional, communicative, critical, and translational eHealth literacy between individuals with cancer and surrogate seekers using the Transactional eHealth Literacy Instrument. Using a convergent, parallel mixed methods design, we also conducted a thematic content analysis of an open-ended survey response to qualitatively examine how each group evaluates web-based cancer information. Results: eHealth literacy scores did not differ between individuals with cancer and surrogate seekers, even after adjusting for sociodemographic variables. Individuals with cancer and surrogate seekers consider the credibility of web-based cancer information based on its channel (eg, National Institutes of Health). However, in evaluating web-based information, surrogate seekers were more likely than individuals with cancer to consider the presence and quality of scientific references supporting the information. Individuals with cancer were more likely than surrogate seekers to cross-reference other websites and web-based sources to establish consensus. Conclusions: Web-based cancer information accessibility and evaluation procedures differ among individuals with cancer and surrogate seekers and should be considered in future efforts to design web-based cancer education interventions. Future studies may also benefit from more stratified recruitment approaches and account for additional contextual factors to better understand the unique circumstances experienced within this population. %M 36170007 %R 10.2196/36714 %U https://formative.jmir.org/2022/9/e36714 %U https://doi.org/10.2196/36714 %U http://www.ncbi.nlm.nih.gov/pubmed/36170007 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e37606 %T Developing a Provincial Surveillance and Support System for Childhood Cancer Survivors: Multiphase User-Centered Design Study %A Shuldiner,Jennifer %A Shah,Nida %A Reis,Catherine %A Chalmers,Ian %A Ivers,Noah %A Nathan,Paul %+ Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 (416) 323 6400, jennifer.shuldiner@wchospital.ca %K design %K cancer screening %K childhood cancer survivor %K late effects %K surveillance %K cancer %K cancer survivor %K morbidity %K mortality %K cancer treatment %K mammogram %K echocardiogram %D 2022 %7 13.9.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Survivors of childhood cancer are at lifelong risk of morbidity (such as new cancers or heart failure) and premature mortality due to their cancer treatment. These are termed late effects. Therefore, they require lifelong, risk-tailored surveillance. However, most adult survivors of childhood cancer do not complete recommended surveillance tests such as mammograms or echocardiograms. Objective: In partnership with survivors, family physicians, and health system partners, we are designing a provincial support system for high-priority tests informed by principles of implementation science, behavioral science, and design thinking. Methods: Our multiphase process was structured as follows. Step 1 consisted of a qualitative study to explore intervention components essential to accessing surveillance tests. Step 2 comprised a workshop with childhood cancer survivors, family physicians, and health system stakeholders that used the Step 1 findings and “personas” (a series of fictional but data-informed characters) to develop and tailor the intervention for different survivor groups. Step 3 consisted of intervention prototype development, and Step 4 involved iterative user testing. Results: The qualitative study of 30 survivors and 7 family physicians found a high desire for information on surveillance for late effects. Respondents indicated that the intervention should help patients book appointments when they are due in addition to providing personalized information. Insights from the workshop included the importance of partnering with both family physicians and survivorship clinics and providing emotional support for survivors who may experience distress upon learning of their risk for late effects. In our user-testing process, prototypes went through iterations that incorporated feedback from users regarding acceptability, usability, and functionality. We sought to address the needs of survivors and physicians while balancing the capacity and infrastructure available for a lifelong intervention via our health system partners. Conclusions: In partnership with childhood cancer survivors, family physicians, and health system partners, we elucidated the barriers and enablers to accessing guideline-recommended surveillance tests and designed a multifaceted solution that will support survivors and their family physicians. The next step is to evaluate the intervention in a pragmatic randomized controlled trial. %M 36099013 %R 10.2196/37606 %U https://humanfactors.jmir.org/2022/3/e37606 %U https://doi.org/10.2196/37606 %U http://www.ncbi.nlm.nih.gov/pubmed/36099013 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e37539 %T The Achieving Self-directed Integrated Cancer Aftercare Intervention for Detection of Recurrent and Second Primary Melanoma in Survivors of Melanoma: Pilot Randomized Controlled Trial %A Murchie,Peter %A Constable,Lynda %A Hall,Susan %A Brant,William %A Allan,Julia %A Johnston,Marie %A Masthoff,Judith %A Lee,Amanda %A Treweek,Shaun %A Ayansina,Dolapo %A Proby,Charlotte %A Rahman,Kaz %A Walter,Fiona %A Burrows,Nigel %A Durrani,Amer %A Maclennan,Graeme %+ Institute of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, United Kingdom, 44 01224437212, p.murchie@abdn.ac.uk %K primary care %K melanoma %K cancer %K randomized controlled trial %K survivorship %K self-directed care %K eHealth %K Achieving Self-directed Integrated Cancer Aftercare %K ASICA %K well-being %K quality of life %K mobile phone %D 2022 %7 8.9.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Melanoma is common with increasing incidence. Guidelines recommend monthly total skin self-examinations (TSSEs) by survivors to detect recurrent and new primary melanomas. TSSE is underperformed despite evidence of benefit. Objective: This study compares the effect on psychological well-being and TSSE practice of a self-directed digital intervention with treatment as usual in patients treated for a first stage 0 to IIC primary cutaneous melanoma within the preceding 60 months. Methods: This randomized clinical trial was conducted at 2 UK National Health Service hospitals (Aberdeen Royal Infirmary, Grampian, and Addenbrooke’s, Cambridge). Adults (≥18 years) diagnosed with a first 0 to IIC primary cutaneous melanoma were randomized to receive Achieving Self-directed Integrated Cancer Aftercare (ASICA), a tablet-based intervention prompting and supporting TSSE in survivors of melanoma, or to usual care. The hypothesis was that ASICA would increase TSSE practice in users affected by melanoma and compared with controls without affecting psychological well-being. The main primary outcomes were melanoma worry (Melanoma Worry Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and quality of life (EQ-5D-5L) as well as secondary outcomes collected using postal questionnaires 3, 6, and 12 months following randomization. Results: A total of 240 recruits were randomized (1:1) into the ASICA (n=121, 50.4%) or control (n=119, 49.6%) groups. There were no significant differences between groups for melanoma worry at 12 months (mean difference: 0.12, 95% CI −0.6 to 0.84; P=.74), 3 months (0.23, 95% CI −0.31 to 0.78; P=.40), or 6 months (−0.1, 95% CI −0.7 to 0.51; P=.76). The ASICA group had lower anxiety scores at 12 months (−0.54, 95% CI −1.31 to 0.230; P=.17), 3 months (−0.13, 95% CI −0.79 to 0.54; P=.71), and significantly at 6 months (−1.00, 95% CI −1.74 to −0.26; P=.009). Depression scores were similar, being lower at 12 months (−0.44, 95% CI −1.11 to 0.23; P=.20) and 3 months (−0.24, 95% CI −0.84 to 0.35; P=.42) but only significantly lower at 6 months (−0.77, 95% CI −1.41 to −0.12; P=.02). The ASICA group had significantly higher quality of life scores at 12 months (0.044, 95% CI 0.003-0.085; P=.04) and 6 months (0.070, 95% CI 0.032-0.107; P<.001) and nonsignificantly at 3 months (0.024, 95% CI −0.006 to 0.054; P=.11). ASICA users reported significantly more regular (>5) TSSEs during the study year and significantly higher levels of self-efficacy in conducting TSSE. They also reported significantly higher levels of planning and intention to perform TSSE in the future. Conclusions: Using ASICA for 12 months does not increase melanoma worry, can reduce anxiety and depression, and may improve quality of life. ASICA has the potential to improve the well-being and vigilance of survivors of melanoma and enable the benefits of regular TSSE. Trial Registration: ClinicalTrials.gov NCT03328247; https://clinicaltrials.gov/ct2/show/NCT03328247 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3453-x %M 36074560 %R 10.2196/37539 %U https://cancer.jmir.org/2022/3/e37539 %U https://doi.org/10.2196/37539 %U http://www.ncbi.nlm.nih.gov/pubmed/36074560 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e36889 %T Feasibility and Acceptability of an Active Video Game–Based Physical Activity Support Group (Pink Warrior) for Survivors of Breast Cancer: Randomized Controlled Pilot Trial %A Swartz,Maria C %A Lewis,Zakkoyya H %A Deer,Rachel R %A Stahl,Anna L %A Swartz,Michael D %A Christopherson,Ursela %A Basen-Engquist,Karen %A Wells,Stephanie J %A Silva,H Colleen %A Lyons,Elizabeth J %+ Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit: 0087, Houston, TX, 77030, United States, 1 713 745 3763, mchang1@mdanderson.org %K physical activity %K survivors of cancer %K pilot study %K breast cancer %K video games %K group intervention %K physical function %K motivation %K mobile phone %D 2022 %7 22.8.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Survivors of breast cancer with functional limitations have a 40% higher mortality rate than those without. Despite the known benefits of physical activity (PA), <40% of survivors of breast cancer meet the recommendations for PA. The combination of active video games (AVGs) and group-based PA counseling may hold potential for motivating PA adoption and improving physical function. However, this method has not been widely studied in survivors of breast cancer. Objective: We aimed to determine the feasibility and acceptability of a group AVG-based multicomponent PA intervention and estimate its effect size and variability on PA and physical function in female survivors of breast cancer in a clinic setting. Methods: Female survivors of breast cancer (N=60) were recruited through the clinic and randomly assigned to the intervention group (12 weekly sessions) or the control group (existing support group). The intervention group received game-based pedometers and participated in weekly group AVG sessions, PA behavioral coaching, and survivorship navigation discussions. A participant manual with weekly reflection worksheets was provided to reinforce the coaching lessons and promote self-led PA. The control group received conventional pedometers and participated in an existing breast cancer support group. Feasibility was assessed by enrollment rate (≥50%), retention rate (≥80%), group attendance rate (75% attending ≥9 sessions [intervention group]), and the number of technological issues and adverse events. Acceptability was measured by participants’ attitudes (from strongly disagree=1 to strongly agree=5) toward the use of AVGs and the overall program. The outcomes included PA (accelerometers) and physical function (Short Physical Performance Battery and gait speed). Analysis of covariance was used to determine differences in PA and physical function between the groups. The Cohen d and its 95% CI determined the effect size and variability, respectively. All the analyses followed the intention-to-treat principle. Results: Participants were an average of 57.4 (SD 10.5) years old, 70% (42/60) White, and 58% (35/60) off treatment. The enrollment rate was 55.9% (66/118). Despite substantial long-term hurricane-related disruptions, we achieved an 80% (48/60) retention. The intervention group’s attendance rate was 78% (14/18), whereas the control group’s attendance rate was 53% (9/17). Of the 26 game-based pedometers, 3 (12%) were damaged or lost. No study-related adverse events occurred. Acceptability items were highly rated. Steps (β=1621.64; P=.01; d=0.72), Short Physical Performance Battery (β=.47; P=.01; d=0.25), and gait speed (β=.12; P=.004; d=0.48) had a significant intervention effect. Conclusions: The intervention was feasible and acceptable in this population despite the occurrence of a natural disaster. Pilot results indicate that group AVG sessions, PA coaching, and survivorship navigation produced moderate effects on PA and physical functioning. AVGs with PA counseling can potentially be used in existing breast cancer support groups to encourage PA and improve physical function. Trial Registration: ClinicalTrials.gov NCT02750241; https://clinicaltrials.gov/ct2/show/NCT02750241 %M 35994321 %R 10.2196/36889 %U https://cancer.jmir.org/2022/3/e36889 %U https://doi.org/10.2196/36889 %U http://www.ncbi.nlm.nih.gov/pubmed/35994321 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e38367 %T A Digital Educational Intervention With Wearable Activity Trackers to Support Health Behaviors Among Childhood Cancer Survivors: Pilot Feasibility and Acceptability Study %A Ha,Lauren %A Wakefield,Claire E %A Mizrahi,David %A Diaz,Claudio %A Cohn,Richard J %A Signorelli,Christina %A Yacef,Kalina %A Simar,David %+ School of Health Sciences, UNSW Medicine and Health, UNSW Sydney, High St, Sydney, 2052, Australia, 61 9385 1000, lauren.ha@unsw.edu.au %K childhood cancer %K survivorship %K physical activity %K exercise %K activity tracker %K eHealth %K education %K behavior change %D 2022 %7 17.8.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Childhood cancer survivors are at increased risk of cardiometabolic complications that are exacerbated by poor health behaviors. Critically, many survivors do not meet physical activity guidelines. Objective: The primary aim was to evaluate the feasibility and acceptability of iBounce, a digital health intervention for educating and engaging survivors in physical activity. Our secondary aims were to assess the change in survivors’ physical activity levels and behaviors, aerobic fitness, and health-related quality of life (HRQoL) after participating in the iBounce program. Methods: We recruited survivors aged 8 to 13 years who were ≥12 months post cancer treatment completion. The app-based program involved 10 educational modules, goal setting, and home-based physical activities monitored using an activity tracker. We assessed objective physical activity levels and behaviors using cluster analysis, aerobic fitness, and HRQoL at baseline and after the intervention (week 12). Parents were trained to reassess aerobic fitness at home at follow-up (week 24). Results: In total, 30 participants opted in, of whom 27 (90%) completed baseline assessments, and 23 (77%) commenced iBounce. Our opt-in rate was 59% (30/51), and most (19/23, 83%) of the survivors completed the intervention. More than half (13/23, 57%) of the survivors completed all 10 modules (median 10, IQR 4-10). We achieved a high retention rate (19/27, 70%) and activity tracker compliance (15/19, 79%), and there were no intervention-related adverse events. Survivors reported high satisfaction with iBounce (median enjoyment score 75%; ease-of-use score 86%), but lower satisfaction with the activity tracker (median enjoyment score 60%). Parents reported the program activities to be acceptable (median score 70%), and their overall satisfaction was 60%, potentially because of technological difficulties that resulted in the program becoming disjointed. We did not observe any significant changes in physical activity levels or HRQoL at week 12. Our subgroup analysis for changes in physical activity behaviors in participants (n=11) revealed five cluster groups: most active, active, moderately active, occasionally active, and least active. Of these 11 survivors, 3 (27%) moved to a more active cluster group, highlighting their engagement in more frequent and sustained bouts of moderate-to-vigorous physical activity; 6 (56%) stayed in the same cluster; and 2 (18%) moved to a less active cluster. The survivors’ mean aerobic fitness percentiles increased after completing iBounce (change +17, 95% CI 1.7-32.1; P=.03) but not at follow-up (P=.39). Conclusions: We demonstrated iBounce to be feasible for delivery and acceptable among survivors, despite some technical difficulties. The distance-delivered format provides an opportunity to engage survivors in physical activity at home and may address barriers to care, particularly for regional or remote families. We will use these pilot findings to evaluate an updated version of iBounce. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000259842; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=ACTRN12621000259842 %M 35976683 %R 10.2196/38367 %U https://cancer.jmir.org/2022/3/e38367 %U https://doi.org/10.2196/38367 %U http://www.ncbi.nlm.nih.gov/pubmed/35976683 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e34851 %T Impact of a Personal Health Record Intervention Upon Surveillance Among Colorectal Cancer Survivors: Feasibility Study %A Vachon,Eric %A Robb,Bruce W %A Haggstrom,David A %+ School of Nursing, Indiana University, NU W427, 600 Barnhill Dr., Indianapolis, IN, 46202, United States, 1 317 278 6064, evachon@iu.edu %K personal health record %K colorectal cancer survivors %K surveillance %K health record %K survivor %K cancer %K oncology %K colorectal %K United States %K North America %K feasibility %K web-based %K patient belief %K patient attitude %K survival %D 2022 %7 11.8.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: There are currently an estimated 1.5 million individuals living in the United States with colorectal cancer (CRC), and although the 5-year survival rate has increased, survivors are at risk for recurrence, particularly within the first 2-3 years after treatment. National guidelines recommend continued surveillance after resection to identify recurrence early on. Adherence among survivors ranges from 23% to 94%. Novel interventions are needed to increase CRC survivors’ knowledge and confidence in managing their cancer and thus to increase adherence to follow-up surveillance. Objective: The objective of this study is to develop and test the feasibility and efficacy of a stand-alone, web-based personal health record (PHR) to increase surveillance adherence among CRC survivors, with patient beliefs about surveillance as secondary outcomes. Methods: A pre- and postintervention feasibility trial was conducted testing the efficacy of the colorectal cancer survivor (CRCS)–PHR, which had been previously developed using an iterative, user-centered design approach. Results: The average age of the sample was 58 (SD 9.9) years, with 57% (16/28) male and the majority married (20/28, 71%) and employed full-time (15/28, 54%). We observed a significant increase in adherence to colonoscopy (before: 11/21, 52% vs after: 18/21, 86%; P=.005) and CEA (14/21, 67% vs 20/21, 95%; P=.01), as well as a slight increase in CT scans (14/21, 67% vs 18/21, 86%; P=.10). The only significant impact on secondary outcome (patient beliefs) was benefits of CEA test (P=.04), as most of the beliefs were high at baseline. Conclusions: This feasibility study lays the groundwork for continued development of the CRCS-PHR to increase CRC surveillance. Patient-centered technologies, such as the CRCS-PHR, represent an important potential approach to improving the receipt of guideline-concordant care and follow-up surveillance, and not just for CRC survivors. Researchers should continue to develop patient-centered health technologies with clinician implementation in mind to increase patient self-efficacy and surveillance adherence. %M 35969424 %R 10.2196/34851 %U https://cancer.jmir.org/2022/3/e34851 %U https://doi.org/10.2196/34851 %U http://www.ncbi.nlm.nih.gov/pubmed/35969424 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e36879 %T Deploying the Behavioral and Environmental Sensing and Intervention for Cancer Smart Health System to Support Patients and Family Caregivers in Managing Pain: Feasibility and Acceptability Study %A LeBaron,Virginia %A Alam,Ridwan %A Bennett,Rachel %A Blackhall,Leslie %A Gordon,Kate %A Hayes,James %A Homdee,Nutta %A Jones,Randy %A Lichti,Kathleen %A Martinez,Yudel %A Mohammadi,Sahar %A Ogunjirin,Emmanuel %A Patel,Nyota %A Lach,John %+ University of Virginia School of Nursing, 225 Jeannette Lancaster Way, Charlottesville, VA, 22903, United States, 1 434 243 9291, vtl6k@virginia.edu %K mobile health %K mHealth %K smart health %K cancer %K pain %K palliative care %K family caregiver %K remote monitoring %K feasibility and acceptability %K rural %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Distressing cancer pain remains a serious symptom management issue for patients and family caregivers, particularly within home settings. Technology can support home-based cancer symptom management but must consider the experience of patients and family caregivers, as well as the broader environmental context. Objective: This study aimed to test the feasibility and acceptability of a smart health sensing system—Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C)—that was designed to support the monitoring and management of cancer pain in the home setting. Methods: Dyads of patients with cancer and their primary family caregivers were recruited from an outpatient palliative care clinic at an academic medical center. BESI-C was deployed in each dyad home for approximately 2 weeks. Data were collected via environmental sensors to assess the home context (eg, light and temperature); Bluetooth beacons to help localize dyad positions; and smart watches worn by both patients and caregivers, equipped with heart rate monitors, accelerometers, and a custom app to deliver ecological momentary assessments (EMAs). EMAs enabled dyads to record and characterize pain events from both their own and their partners’ perspectives. Sensor data streams were integrated to describe and explore the context of cancer pain events. Feasibility was assessed both technically and procedurally. Acceptability was assessed using postdeployment surveys and structured interviews with participants. Results: Overall, 5 deployments (n=10 participants; 5 patient and family caregiver dyads) were completed, and 283 unique pain events were recorded. Using our “BESI-C Performance Scoring Instrument,” the overall technical feasibility score for deployments was 86.4 out of 100. Procedural feasibility challenges included the rurality of dyads, smart watch battery life and EMA reliability, and the length of time required for deployment installation. Postdeployment acceptability Likert surveys (1=strongly disagree; 5=strongly agree) found that dyads disagreed that BESI-C was a burden (1.7 out of 5) or compromised their privacy (1.9 out of 5) and agreed that the system collected helpful information to better manage cancer pain (4.6 out of 5). Participants also expressed an interest in seeing their own individual data (4.4 out of 5) and strongly agreed that it is important that data collected by BESI-C are shared with their respective partners (4.8 out of 5) and health care providers (4.8 out of 5). Qualitative feedback from participants suggested that BESI-C positively improved patient-caregiver communication regarding pain management. Importantly, we demonstrated proof of concept that seriously ill patients with cancer and their caregivers will mark pain events in real time using a smart watch. Conclusions: It is feasible to deploy BESI-C, and dyads find the system acceptable. By leveraging human-centered design and the integration of heterogenous environmental, physiological, and behavioral data, the BESI-C system offers an innovative approach to monitor cancer pain, mitigate the escalation of pain and distress, and improve symptom management self-efficacy. International Registered Report Identifier (IRRID): RR2-10.2196/16178 %M 35943791 %R 10.2196/36879 %U https://cancer.jmir.org/2022/3/e36879 %U https://doi.org/10.2196/36879 %U http://www.ncbi.nlm.nih.gov/pubmed/35943791 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e36323 %T Development of a Self-management and Peer-Mentoring Intervention to Improve Transition Readiness Among Young Adult Survivors of Pediatric Cancer: Formative Qualitative Research Study %A Viola,Adrienne S %A Levonyan-Radloff,Kristine %A Masterson,Margaret %A Manne,Sharon L %A Hudson,Shawna V %A Devine,Katie A %+ Department of Pediatrics, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, United States, 1 732 235 7549, katie.devine@rutgers.edu %K self-management %K peer mentoring %K cancer survivorship %K long-term follow-up care %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Childhood cancer survivors require lifelong risk-based follow-up care. It should be noted that less than one-third of adult survivors of childhood cancer report any survivor-focused care, and fewer than 1 in 5 obtain risk-based follow-up care. It is thought that this may be due to inadequate transition readiness, including low levels of knowledge, skills, motivation, and resources to make the transition to independent self-management of follow-up care. Interventions that focus specifically on improving the transition from parent-managed to self-managed care are needed. Theory and prior research suggest that targeting self-management skills and using peer mentoring may be innovative strategies to improve transition readiness. Objective: This study aims to identify the content of a self-management intervention to improve transition readiness among adolescent and young adult (AYA) survivors. Methods: Intervention development occurred in 3 stages: formative research with AYA survivors to identify barriers and facilitators to obtaining risk-based survivorship care, content development using feedback from multiple stakeholders (AYA survivors, parents, and providers), and content refinement (usability testing) of the initial proposed educational modules for the program. Content analysis, guided by the social-ecological model of AYA readiness for transition, was used to identify themes and develop and refine the content for the intervention. Results: A total of 19 AYA survivors participated in the formative research stage, and 10 AYA survivors, parents, and health care providers participated in the content development and refinement stages. The major barrier and facilitator themes identified included knowledge of cancer history and risks; relationships with health care providers; relationships with family members involved in care; emotions about health, follow-up care, and transfer of care; and lifestyle behaviors and life transitions. These themes were translated into 5 self-management modules: understanding treatment history and the survivorship care plan, managing health care logistics and insurance, communicating with health care providers and family members involved in care, dealing with emotions, and staying healthy in the context of life transitions. Feedback from the key stakeholders indicated that the content was relevant but should include participative elements (videos and tailored feedback) to make the intervention more engaging. The AYA survivors were receptive to the idea of working with a peer mentor and expressed a preference for using SMS text messaging, telephone calls, or videoconference to communicate with their mentor. Conclusions: Incorporating AYA survivors, parents, and providers in the design was essential to developing the content of a self-management and peer-mentoring intervention. AYA survivors confirmed the important targets for the intervention and facilitated design decisions in line with our target users’ preferences. The next step will be to conduct a single-arm trial to determine the feasibility and acceptability of the proposed intervention among AYA survivors of childhood cancer. %M 35921137 %R 10.2196/36323 %U https://formative.jmir.org/2022/8/e36323 %U https://doi.org/10.2196/36323 %U http://www.ncbi.nlm.nih.gov/pubmed/35921137 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e36658 %T Assessing an Internet-Delivered, Emotion-Focused Intervention Compared With a Healthy Lifestyle Active Control Intervention in Improving Mental Health in Cancer Survivors: Protocol for a Randomized Controlled Trial %A Smith,Isabelle S %A Wallace,Rebecca %A Wellecke,Cornelia %A Bind,Marie-Abèle %A Weihs,Karen L %A Bei,Bei %A Wiley,Joshua F %+ School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, 18 Innovation Walk Monash University, Melbourne, 3800, Australia, 61 3 9905 9598, joshua.wiley@monash.edu %K cancer survivor %K depressive symptoms %K anxiety symptoms %K emotion regulation %K Unified Protocol %K transdiagnostic %K internet-delivered intervention %K quality of life %K eHealth %K randomized controlled trial %K psycho-oncology %K mobile phone %D 2022 %7 27.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer survivors are vulnerable to experiencing symptoms of anxiety and depression and may benefit from accessible interventions focused on improving emotion regulation. CanCope Mind (CM) was developed as an internet-delivered intervention adapted from the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders to improve emotion regulation and support the mental health of cancer survivors. Objective: This protocol aims to provide an outline of the CanCope Study, a trial comparing the efficacy of a Unified Protocol–adapted internet-delivered intervention (CM) designed for cancer survivors compared with an active control condition—an internet-delivered healthy lifestyle intervention, CanCope Lifestyle (CL). The primary aim is to assess and compare the efficacy of both interventions in improving emotion regulation, anxiety and depressive symptoms, and quality of life. The secondary aims involve assessing the mechanisms of the CM intervention. Methods: This trial is a 2-arm randomized controlled trial that allocates cancer survivors to either CM or CL. Both interventions comprise 4 web-based modules and are expected to take participants at least 8 weeks to complete. Participants’ mental and physical health will be assessed via self-reported surveys at baseline (T0), between each module (T1, T2, and T3), immediately after the intervention (T4), and at 3-month follow-up (T5). The study aims to recruit 110 participants who have completed T4. Results: The CanCope study began recruitment in September 2020. A total of 224 participants have been randomized to the CM (n=110, 49.1%) and CL (n=114, 50.9%) groups. Conclusions: This is one of the first trials to develop and investigate the efficacy of a web-based intervention for cancer survivors that specifically targets emotion regulation. Trial Registration: Australian Clinical Trials ACTRN12620000943943; https://tinyurl.com/b3z9cjsp International Registered Report Identifier (IRRID): DERR1-10.2196/36658 %M 35896021 %R 10.2196/36658 %U https://www.researchprotocols.org/2022/7/e36658 %U https://doi.org/10.2196/36658 %U http://www.ncbi.nlm.nih.gov/pubmed/35896021 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37706 %T Developing an mHealth App for Empowering Cancer Survivors With Disabilities: Co-design Study %A Adler,Rachel F %A Morales,Paulina %A Sotelo,Jocelyn %A Magasi,Susan %+ Department of Computer Science, Northeastern Illinois University, 5500 N Saint Louis Ave, Chicago, IL, 60625, United States, 1 7734424710, r-adler@neiu.edu %K user-centered design %K co-design %K mobile health %K mHealth %K cancer survivors %K disabilities %D 2022 %7 26.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The transition from active treatment to long-term cancer survivorship leaves the needs of many cancer survivors unaddressed as they struggle with physical, cognitive, psychological, and social consequences of cancer and its treatment. The lack of guidance after treatment has forced cancer survivors to manage long-term effects on their own, which has an impact on their overall health, quality of life, and social participation. Mobile health (mHealth) interventions can be used to promote self-management and evidence-informed education. Objective: This study aims to design an mHealth app for cancer survivors with disabilities that will offer interventions to improve their quality of life and increase their self-efficacy to manage cancer as a chronic condition. Methods: We organized 3 co-design workshops with cancer survivors (n=5). These workshops included persona development based on data from 25 interviews with cancer survivors with disabilities; prototype ideation, where we sketched ideas for the prototype; and prototype development, where participants critiqued, and suggested improvements for, the wireframes. Results: These workshops helped us to define the challenges that cancer survivors with disabilities face as well as important considerations when designing an mHealth app for cancer survivors with disabilities, such as the need for including flexibility, engagement, socialization, and a minimalistic design. We also outline guidelines for other researchers to follow when planning their own co-design workshops, which include allowing more time for discussion among participants, having small participant groups, keeping workshops engaging and inclusive, and letting participants dream big. Conclusions: Using a co-design process aided us in developing a prototype of an mHealth app for cancer survivors with disabilities as well as a list of guidelines that other researchers can use to develop their own co-design workshops and design their app. Furthermore, working together with cancer survivors ensured that the design team had a deeper sense of empathy toward the target users and kept the focus on our ultimate goal: creating something that cancer survivors would want to use and benefit from. Future work will include usability testing of a high-fidelity prototype based on the results of these workshops. %M 35881439 %R 10.2196/37706 %U https://formative.jmir.org/2022/7/e37706 %U https://doi.org/10.2196/37706 %U http://www.ncbi.nlm.nih.gov/pubmed/35881439 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e35736 %T Adapting and Developing an Academic and Community Practice Collaborative Care Model for Metastatic Breast Cancer Care (Project ADAPT): Protocol for an Implementation Science–Based Study %A Housten,Ashley J %A Okere,Uzoma Charles %A Colditz,Graham A %A Ma,Cynthia %A Liu,Jingxia %A Harriss,Courtney %A Lin,Nancy U %A Rooney,Melissa %A Dill,Jennifer %A Popalzai,Muhammad %A Badiu,Jennifer %A Huang,Kan %A Burton,Casey %A Peterson,Lindsay %+ Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave, St. Louis, MO, 63110, United States, 1 314 454 7940, ahousten@wustl.edu %K metastatic breast cancer %K care coordination %K Project ADAPT %K referral process %K implementation science %K oncology %K community practice %K academic institutions %K breast cancer %K cancer %K breast %K implementation %K science %D 2022 %7 25.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Metastatic breast cancer (MBC) remains incurable despite significant treatment advances. Coordinating care for patients with MBC can be challenging given the various treatment options, available clinical trials, and frequent need for ancillary services. To optimize MBC care, we designed a project for adapting and developing an academic and community practice collaborative care model for MBC care (Project ADAPT), based on the Ending Metastatic Breast Cancer for Everyone (EMBRACE) program developed at Dana Farber Cancer Institute. Objective: We aim to describe the implementation science–based study design and innovative components of Project ADAPT. Methods: Project ADAPT uses the Dynamic Adaptation Process informed by the Exploration, Preparation, Implementation, Sustainment framework. Washington University School of Medicine (WUSM) partnered with 3 community hospitals in the St. Louis region covering rural and urban settings. The exploration and preparation phases provide patient and provider feedback on current referral practices to finalize the approach for the implementation phase. At the implementation phase, we will enroll patients with MBC at these 3 community sites to evaluate potential collaborative care at WUSM and assess the impact of this collaborative care model on referral satisfaction and acceptability for patients with MBC and their providers. Patients may then return to their community site for care or continue to receive part of their care at WUSM. We are incorporating virtual and digital health strategies to improve MBC care coordination in order to minimize patient burden. Results: The exploration phase is ongoing. As of August 2021, we have recruited 21 patient and provider participants to complete surveys of the current collaborative care process at WUSM. Using a 2-tailed paired t test, 44 patients (including 10 patients from the exploration phase) and 32 oncologists are required to detect an effect size of 0.5 with 80% power at a level of significance of .05. Throughout this phase and in preparation for the implementation phase, we have iteratively updated and refined our surveys for the implementation phase based on testing of our data collection instruments. Our partner sites are in various stages of the single institutional review board (IRB) approval process. We have ongoing engagement with all partner sites, which has helped solidify our participant recruitment strategies and design patient-friendly recruitment materials. In addition, we have included a patient advocate on the research team. Members of the research team have launched a single IRB Support Network at WUSM to create a repository of the single IRB procedures in order to streamline the partner site onboarding process and facilitate enhanced collaboration across institutions. Conclusions: With this robust model, we expect that patients with MBC will receive optimal care regardless of geographical location and the model will improve patient and provider experiences when navigating the health system. International Registered Report Identifier (IRRID): DERR1-10.2196/35736 %M 35475732 %R 10.2196/35736 %U https://www.researchprotocols.org/2022/7/e35736 %U https://doi.org/10.2196/35736 %U http://www.ncbi.nlm.nih.gov/pubmed/35475732 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e36255 %T Web-Based Psychological Interventions for People Living With and Beyond Cancer: Meta-Review of What Works and What Does Not for Maximizing Recruitment, Engagement, and Efficacy %A Leslie,Monica %A Beatty,Lisa %A Hulbert-Williams,Lee %A Pendrous,Rosina %A Cartwright,Tim %A Jackson,Richard %A , %A Hulbert-Williams,Nicholas J %+ Department of Psychology, Edge Hill University, St Helens Road, Ormskirk, L39 4QP, United Kingdom, 44 01695 657684, hulbertwn@edgehill.ac.uk %K cancer %K neoplasms %K survivors %K psychosocial oncology %K internet-based intervention %K psychosocial intervention %D 2022 %7 8.7.2022 %9 Review %J JMIR Cancer %G English %X Background: Despite high levels of psychological distress experienced by many patients with cancer, previous research has identified several barriers to accessing traditional face-to-face psychological support. Web-based psychosocial interventions have emerged as a promising alternative. Objective: This meta-review aimed to synthesize evidence on recruitment challenges and enablers, factors that promote engagement and adherence to web-based intervention content, and factors that promote the efficacy of web-based psychosocial interventions for patients with cancer and cancer survivors. Methods: We conducted a systematic search of previous reviews that investigated the recruitment, engagement, and efficacy of web-based and app-based psychosocial interventions in adult patients with cancer and cancer survivors. We searched PubMed, CINAHL, PsycINFO, and the Cochrane Library database for relevant literature. The search terms focused on a combination of topics pertaining to neoplasms and telemedicine. Two independent authors conducted abstract screening, full text screening, and data extraction for each identified article. Results: A total of 20 articles met eligibility criteria. There was inconsistency in the reporting of uptake and engagement data; however, anxiety about technology and perceived time burden were identified as 2 key barriers. Web-based psychosocial oncology interventions demonstrated efficacy in reducing depression and stress but reported weak to mixed findings for distress, anxiety, quality of life, and well-being. Although no factors consistently moderated intervention efficacy, preliminary evidence indicated that multicomponent interventions and greater communication with a health care professional were preferred by participants and were associated with superior effects. Conclusions: Several consistently cited barriers to intervention uptake and recruitment have emerged, which we recommend future intervention studies address. Preliminary evidence also supports the superior efficacy of multicomponent interventions and interventions that facilitate communication with a health care professional. However, a greater number of appropriately powered clinical trials, including randomized trials with head-to-head comparisons, are needed to enable more confident conclusions regarding which web-based psychosocial oncology interventions work best and for whom. Trial Registration: PROSPERO CRD42020202633; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=202633 %M 35802418 %R 10.2196/36255 %U https://cancer.jmir.org/2022/3/e36255 %U https://doi.org/10.2196/36255 %U http://www.ncbi.nlm.nih.gov/pubmed/35802418 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e38722 %T Improving Clinical and Family Communication for Adult Child Caregivers of a Parent With a Blood Cancer: Single-Arm Pre-Post Pilot Intervention %A Bylund,Carma L %A Wollney,Easton N %A Campbell-Salome,Gemme %A Applebaum,Allison J %A Paige,Samantha R %A DeGruccio,Kennan %A Weiss,Elisa %A Sae-Hau,Maria %A Arnold,Jason %A Durante,Domenic %A Amin,Tithi B %A Hampton,Chelsea N %A Fisher,Carla L %+ Department of Health Outcomes & Biomedical Informatics, University of Florida, 2004 Mowry Rd, Gainesville, FL, 32610, United States, 1 352 627 9467, carma.bylund@ufl.edu %K caregiver %K clinician-patient communication %K healthy communication practice %K eHealth literacy %K family communication %K feasibility %K acceptability %K oncology %K blood cancer %K cancer patent %K web-based information seeking %K health information %K clinical communication %K smartphone %K mobile phone %D 2022 %7 5.7.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Adult child caregivers of parents with cancer may face challenges when communicating with the patient and other family members, communicating during clinical interactions, and navigating web-based information seeking. Objective: We developed and pilot-tested the Healthy Communication Practice program for adult child caregivers of parents with a blood cancer, which aims to help participants learn and implement communication skills central to caregiving. We assessed the feasibility and acceptability of the training. Methods: Eligible participants completed a preprogram survey. We assessed the feasibility of participants completing the intervention in the allotted time. Participants had 2 weeks to complete the 2-part, 90-minute online program and completed a postprogram survey that included program evaluation items and the Acceptability of Intervention Measure (AIM) using a 1-5 rating scale (5=strongly agree). Results: Of 50 caregivers who initially expressed interest, 34 consented, and 30 completed the program and both surveys (88% completion rate). Caregivers had a mean age of 45.07 (SD 11.96) years and provided care for parents who had a mean age of 73.31 (SD 9.38) years. Caregivers were primarily daughters (n=22, 73%). Overall, scores on the AIM scale were high (mean 4.48, SD 0.67). Specifically, caregivers felt the content met their communication needs (mean 4.58, SD 0.62) and their own needs as a caregiver of a parent with a blood cancer (mean 4.39, SD 0.72). Conclusions: We demonstrated the feasibility and acceptability of the Healthy Communication Practice program, which aims to enhance family and clinical communication skills among caregivers of a parent with a blood cancer. Future studies will examine the efficacy of the program and its impact on both caregiver and patient communication and health outcomes. %M 35788019 %R 10.2196/38722 %U https://cancer.jmir.org/2022/3/e38722 %U https://doi.org/10.2196/38722 %U http://www.ncbi.nlm.nih.gov/pubmed/35788019 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e35694 %T Self-monitoring of Physical Activity After Hospital Discharge in Patients Who Have Undergone Gastrointestinal or Lung Cancer Surgery: Mixed Methods Feasibility Study %A de Leeuwerk,Marijke Elizabeth %A Botjes,Martine %A van Vliet,Vincent %A Geleijn,Edwin %A de Groot,Vincent %A van Wegen,Erwin %A van der Schaaf,Marike %A Tuynman,Jurriaan %A Dickhoff,Chris %A van der Leeden,Marike %+ Rehabilitation Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, 1081 HV, Netherlands, 31 612640672, m.e.deleeuwerk@amsterdamumc.nl %K mobile phone %K physical activity %K self-monitoring %K fitness trackers %K telemedicine %K cancer %K physical therapy %D 2022 %7 24.6.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Self-monitoring of physical activity (PA) using an accelerometer is a promising intervention to stimulate PA after hospital discharge. Objective: This study aimed to evaluate the feasibility of PA self-monitoring after discharge in patients who have undergone gastrointestinal or lung cancer surgery. Methods: A mixed methods study was conducted in which 41 patients with cancer scheduled for lobectomy, esophageal resection, or hyperthermic intraperitoneal chemotherapy were included. Preoperatively, patients received an ankle-worn accelerometer and the corresponding mobile health app to familiarize themselves with its use. The use was continued for up to 6 weeks after surgery. Feasibility criteria related to the study procedures, the System Usability Scale, and user experiences were established. In addition, 6 patients were selected to participate in semistructured interviews. Results: The percentage of patients willing to participate in the study (68/90, 76%) and the final participation rate (57/90, 63%) were considered good. The retention rate was acceptable (41/57, 72%), whereas the rate of missing accelerometer data was relatively high (31%). The mean System Usability Scale score was good (77.3). Interviewed patients mentioned that the accelerometer and app were easy to use, motivated them to be more physically active, and provided postdischarge support. The technical shortcomings and comfort of the ankle straps should be improved. Conclusions: Self-monitoring of PA after discharge appears to be feasible based on good system usability and predominantly positive user experiences in patients with cancer after lobectomy, esophageal resection, or hyperthermic intraperitoneal chemotherapy. Solving technical problems and improving the comfort of the ankle strap may reduce the number of dropouts and missing data in clinical use and follow-up studies. %M 35749165 %R 10.2196/35694 %U https://cancer.jmir.org/2022/2/e35694 %U https://doi.org/10.2196/35694 %U http://www.ncbi.nlm.nih.gov/pubmed/35749165 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e37093 %T eHealth Interventions for Dutch Cancer Care: Systematic Review Using the Triple Aim Lens %A van Deursen,Liza %A Versluis,Anke %A van der Vaart,Rosalie %A Standaar,Lucille %A Struijs,Jeroen %A Chavannes,Niels %A Aardoom,Jiska J %+ Department of Quality of Care and Health Economics, Center for Nutrition, Prevention and Health Services, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, Netherlands, 31 30274 9111, liza.van.deursen@rivm.nl %K cancer %K eHealth %K digital care %K Triple Aim %K population health %K quality of care %K costs %K systematic review %K psychosocial %K intervention %K mobile phone %D 2022 %7 14.6.2022 %9 Review %J JMIR Cancer %G English %X Background: Globally, the burden of cancer on population health is growing. Recent trends such as increasing survival rates have resulted in a need to adapt cancer care to ensure a good care experience and manageable expenditures. eHealth is a promising way to increase the quality of cancer care and support patients and survivors. Objective: The aim of this systematic review was 2-fold. First, we aimed to provide an overview of eHealth interventions and their characteristics for Dutch patients with and survivors of cancer. Second, we aimed to provide an overview of the empirical evidence regarding the impact of eHealth interventions in cancer care on population health, quality of care, and per capita costs (the Triple Aim domains). Methods: The electronic databases Web of Science, PubMed, Cochrane, and Ovid PsycINFO were searched using 3 key search themes: eHealth interventions, cancer care, and the Netherlands. The identified interventions were classified according to predetermined criteria describing the intervention characteristics (eg, type, function, and target population). Their impact was subsequently examined using the Triple Aim framework. Results: A total of 38 interventions were identified. Most of these were web portals or web applications functioning to inform and self-manage, and target psychosocial factors or problems. Few interventions have been tailored to age, disease severity, or gender. The results of this study indicate that eHealth interventions could positively affect sleep quality, fatigue, and physical activity of patients with and survivors of cancer. Inconclusive results were found regarding daily functioning and quality of life, psychological complaints, and psychological adjustment to the disease. Conclusions: eHealth can improve outcomes in the Triple Aim domains, particularly in the population health and quality of care domains. Cancer-related pain and common symptoms of active treatment were not targeted in the included interventions and should receive more attention. Further research is needed to fully understand the impact of eHealth interventions in cancer care on participation, accessibility, and costs. The latter can be examined in economic evaluations by comparing eHealth interventions with care as usual. %M 35699991 %R 10.2196/37093 %U https://cancer.jmir.org/2022/2/e37093 %U https://doi.org/10.2196/37093 %U http://www.ncbi.nlm.nih.gov/pubmed/35699991 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e34183 %T Timing and Motivations for Alternative Cancer Therapy With Insights From a Crowdfunding Platform: Cross-sectional Mixed Methods Study %A Peterson,John %A Wilson,Trevor %A Gruhl,Joshua %A Davis,Sydney %A Olsen,Jaxon %A Parsons,Matthew %A Kann,Benjamin %A Fagerlin,Angela %A Watt,Melissa %A Johnson,Skyler %+ Department of Radiation Oncology, Huntsman Cancer Institute, University of Utah, 2000 Circle of Hope Drive, Salt Lake City, UT, 84112, United States, 1 801 581 8793, john.peterson@hsc.utah.edu %K internet %K health misinformation %K online crowdfunding %K alternative medicine %K internet research ethics %D 2022 %7 7.6.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Alternative cancer therapy is associated with increased mortality, but little is known about those who pursue it. Objective: We aimed to describe individuals’ motivations for using alternative cancer therapies and determine whether motivations differ based on individuals’ timing of seeking alternative therapies. Methods: We used data from 649 campaigns posted on the website GoFundMe between 2011 and 2019 for beneficiaries with cancer pursuing alternative therapy. The data were analyzed using a mixed methods approach. Campaigns were categorized by timing of alternative therapy (either before or after experiencing conventional therapy). Qualitative analysis identified motivational themes. Chi-square tests of independence and Fisher tests (all 2-sided) determined significant differences in the presence of motivational themes between groups. Results: The expression of concerns about the efficacy of conventional therapy was significantly more likely in campaigns for individuals who used conventional therapy first than in campaigns for individuals who started with alternative therapy (63.3% vs 41.7%; P<.001). Moreover, on comparing those who started with alternative therapy and those who switched from conventional to alternative therapy, those who started with alternative therapy more often expressed natural and holistic values (49.3% vs 27.0%; P<.001), expressed an unorthodox understanding of cancer (25.5% vs 16.4%; P=.004), referenced religious or spiritual beliefs (15.1% vs 8.9%; P=.01), perceived alternative treatment as efficacious (19.1% vs 10.2%; P=.001), and distrusted pharmaceutical companies (3.2% vs 0.5%; P=.04). Conclusions: Individuals sought treatments that reflected their values and beliefs, even if scientifically unfounded. Many individuals who reported prior conventional cancer therapy were motivated to pursue alternative treatments because they perceived the conventional treatments to be ineffective. %M 35671074 %R 10.2196/34183 %U https://cancer.jmir.org/2022/2/e34183 %U https://doi.org/10.2196/34183 %U http://www.ncbi.nlm.nih.gov/pubmed/35671074 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e29004 %T Development, Testing, and Implementation of the Belgian Patient Reported Experience Measure for Pancreatic Cancer Care (PREPARE) Project: Protocol for a Multi-Method Research Project %A Moens,Katrien %A Peeters,Marc %A Van den Bulcke,Marc %A Leys,Mark %A Horlait,Melissa %+ Cancer Centre, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Brussels, 1050, Belgium, 32 0495894851, Katrien.Moens@sciensano.be %K patient-centered care %K quality of health care %K interdisciplinary research %K decision-making %K pancreatic cancer %K quality %K outcome %K assessment %K cancer %K pancreas %K development %K testing %K implementation %K patient-reported %K experience %K protocol %K participatory medicine %D 2022 %7 6.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with pancreatic cancer do not feel involved in the development of their treatment and care plans. In Belgium, these plans are decided on during multidisciplinary team meetings. However, limited time is spent on the discussion of the preferences of the patient during these meetings. This research project aims to develop a patient-reported experience measure (PREM) for pancreatic cancer and assess if its use can support collaborative treatment decision-making. Objective: This paper aims to outline the protocol for a multi-method research project to improve person-centered pancreatic cancer care in Belgium. Three subobjectives are pursued: (1) to develop a PREM to assess the experiences of care-related aspects in pancreatic cancer care, (2) to validate the PREM, and (3) to develop and evaluate an educational intervention to support the use of the PREM’s results. Methods: For the development of the PREM, an exploratory mixed methods study design will be used. The study will start with a survey followed by a telephone interview involving patients with pancreatic cancer and digestive oncology health care professionals. Study two is the testing of the content and construct validity of the PREM. Study three involves the implementation study according to the Medical Research Council framework of a complex intervention introducing the PREM in practice. The effectiveness of the intervention will be investigated using a pragmatic randomized controlled trial study design. Results: The protocol presents the entire structure of the research project. Ethics approval to conduct the exploratory mixed methods study (objective 1) has been obtained, and recruitment has started since January 2022. Conclusions: The poor prognosis of patients with pancreatic cancer should not be considered a hurdle to not study this patient population group. Involving patients in the research and decision-making processes early on is key. This project aims to realize a scientifically sound research process providing research outputs that can easily and timely be implemented in the care trajectory of patients with pancreatic cancer. This research project will also lead to recommendations on how to involve patients with pancreatic cancer and how the methodology of this research project can be translated to other patient groups. International Registered Report Identifier (IRRID): PRR1-10.2196/29004 %M 35666559 %R 10.2196/29004 %U https://www.researchprotocols.org/2022/6/e29004 %U https://doi.org/10.2196/29004 %U http://www.ncbi.nlm.nih.gov/pubmed/35666559 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e33304 %T Development of a Web-Based Decision Aid and Planning Tool for Family Building After Cancer (Roadmap to Parenthood): Usability Testing %A Benedict,Catherine %A Dauber-Decker,Katherine L %A Ford,Jennifer S %A King,D'Arcy %A Spiegel,David %A Schapira,Lidia %A Simon,Pamela %A Diefenbach,Michael %+ Stanford University School of Medicine, 291 Campus Drive, Stanford, CA, 94305, United States, 1 650 723 2300, cbenedict@stanford.edu %K young adult cancer %K cancer survivorship %K decision-making %K decision aids %K fertility %K reproductive health %K mobile phone %D 2022 %7 31.5.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Owing to gonadotoxic cancer treatments, young adult female survivors often report uncertainty about their fertility, reproductive potential, and family-building options after treatment. Roadmap to Parenthood is a web-based decision aid and planning tool for family building after cancer. Objective: As part of a patient-centered development process, this study evaluated the usability of the decision aid website to inform design modifications and improve user experience. Methods: In total, 2 rounds of usability testing were conducted with the target population of young adult female cancer survivors. During the testing sessions, participants viewed the website twice; first, as a think-aloud exercise, and second, while a researcher interrupted at key points to obtain user feedback. Quantitative and qualitative data were collected to assess website usability. Quantitative measures included the System Usability Scale, WebQual, and eHealth Impact Questionnaire. An exit interview with open-ended questions gathered feedback on likes and dislikes and suggestions for improvement. Results: Participants (N=10) were young adult women, with average age of 30.9 (SD 4.51) years, and average time since treatment was 4.44 (SD 3.56) years. Website usability scores improved on the System Usability Scale from “acceptable” in round 1 to “excellent” in round 2 after making design changes based on user feedback (scores of 68 and 89.4, respectively). WebQual scores showed similar improvement from round 1 to round 2 of testing (mean 5.6 to 6.25; range 1-7). On the eHealth Impact Questionnaire, the information and presentation of the website was perceived as comprehensive, easy to understand, and trustworthy. Participants also reported improved confidence to discuss and manage fertility and family-building issues and felt encouraged to play a more active role in managing their fertility. In all, 3 usability themes were identified from the qualitative feedback: ease of use, visibility and navigation, and informational content and usefulness. Overall feedback was positive, and participants reported intentions to use the decision aid website in the future. In total, 10% (1/10) of the participants reported negative emotions when learning about infertility risks and potential family-building challenges. Conclusions: Website usability improved after design changes were made in response to user feedback. Young adult female survivors reported positive views about the website and indicated that the decision aid would be useful in decision-making about family building after cancer. Future studies will include further design modifications to consider the emotional experiences of users and any additional navigational features or content to optimize the ease of use and support provided by the tool. %M 35639461 %R 10.2196/33304 %U https://cancer.jmir.org/2022/2/e33304/ %U https://doi.org/10.2196/33304 %U http://www.ncbi.nlm.nih.gov/pubmed/35639461 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e34715 %T The Effect of a Web-Based Cervical Cancer Survivor’s Story on Parents' Behavior and Willingness to Consider Human Papillomavirus Vaccination for Daughters: Randomized Controlled Trial %A Suzuki,Yukio %A Sukegawa,Akiko %A Ueda,Yutaka %A Sekine,Masayuki %A Enomoto,Takayuki %A Melamed,Alexander %A Wright,Jason D %A Miyagi,Etsuko %+ Department of Obstetrics and Gynecology, Yokohama City University Graduate School of Medicine, 3-9, Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan, 81 45 787 2800, yetii@yokohama-cu.ac.jp %K human papilloma virus vaccination %K vaccination %K vaccine %K vaccine hesitancy %K cancer survivor %K narrative story %K web based %K randomized controlled trial %K RCT %K HPV %K human papilloma virus %K virus %K hesitancy %K cancer %K willingness %K behavior %K parent %D 2022 %7 25.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Providing adequate information to parents who have children eligible for human papillomavirus (HPV) vaccination is essential to overcoming vaccine hesitancy in Japan, where the government recommendation has been suspended. However, prior trials assessing the effect of brief educational tools have shown only limited effects on increasing the willingness of parents to vaccinate their daughters. Objective: The aim of this trial is to assess the effect of a cervical cancer survivor’s story on the willingness of parents to get HPV vaccination for their daughters. Methods: In this double-blinded, randomized controlled trial (RCT) implemented online, we enrolled 2175 participants aged 30-59 years in March 2020 via a webpage and provided them with a questionnaire related to the following aspects: awareness regarding HPV infection and HPV vaccination, and willingness for HPV vaccination. Participants were randomly assigned (1:1) to see a short film on a cervical cancer survivor or nothing, stratified by sex (male vs female) and willingness for HPV vaccination prior to randomization (yes vs no). The primary endpoint was the rate of parents who agreed for HPV vaccination for their daughters. The secondary endpoint was the rate of parents who agreed for HPV vaccination for their daughters and the HPV vaccination rate at 3 months. The risk ratio (RR) was used to assess the interventional effect. Results: Of 2175 participants, 1266 (58.2%) were men and 909 (41.8%) were women. A total of 191 (8.8%) participants were willing to consider HPV vaccination prior to randomization. Only 339 (15.6%) participants were aware of the benefits of HPV vaccination. In contrast, 562 (25.8%) participants were aware of the adverse events of HPV vaccination. Although only 476 (21.9%) of the respondents displayed a willingness to vaccinate their daughters for HPV, there were 7.5% more respondents in the intervention group with this willingness immediately after watching the short film (RR 1.41, 95% CI 1.20-1.66). In a subanalysis, the willingness in males to vaccinate daughters was significantly higher in the intervention group (RR 1.50, 95% CI 1.25-1.81); however, such a difference was not observed among females (RR 1.21, 95% CI 0.88-1.66). In the follow-up survey at 3 months, 1807 (83.1%) participants responded. Of these, 149 (8.2%) responded that they had had their daughters receive vaccination during the 3 months, even though we could not see the effect of the intervention: 77 (7.9%) in the intervention group and 72 (8.7%) in the control group. Conclusions: A cervical cancer survivor’s story increases immediate willingness to consider HPV vaccination, but the effect does not last for 3 months. Furthermore, this narrative approach to parents does not increase vaccination rates in children eligible for HPV vaccination. Trial Registration: UMIN Clinical Trials Registry UMIN000039273; https://tinyurl.com/bdzjp4yf %M 35421848 %R 10.2196/34715 %U https://publichealth.jmir.org/2022/5/e34715 %U https://doi.org/10.2196/34715 %U http://www.ncbi.nlm.nih.gov/pubmed/35421848 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e37709 %T The Impact of Resistance Exercise on Muscle Mass in Glioblastoma in Survivors (RESIST): Protocol for a Randomized Controlled Trial %A Keats,Melanie R %A Grandy,Scott A %A Blanchard,Christopher %A Fowles,Jonathon R %A Neyedli,Heather F %A Weeks,Adrienne C %A MacNeil,Mary V %+ Division of Kinesiology, School of Health and Human Performance, Dalhousie University, PO Box 15000, 6230 South Street, Halifax, NS, B3H 4R2, Canada, 1 902 494 7173, melanie.keats@dal.ca %K glioblastoma %K myopathy %K resistance exercise %K functional fitness %K quality of life %K intervention %K randomized controlled trial %D 2022 %7 4.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Glioblastoma is the most common primary brain malignancy in adults, accounting for approximately 48% of all brain tumors. Standard treatment includes radiation and temozolomide chemotherapy. Glioblastomas are highly vascular and can cause vasogenic brain edema and mass effect, which can worsen the neurologic symptoms associated with the disease. The steroid dexamethasone (DEX) is the treatment of choice to reduce vasogenic edema and intracranial pressure associated with glioblastoma. However high-dose DEX or long-term use can result in muscle myopathy in 10%-60% of glioblastoma patients, significantly reducing functional fitness and quality of life (QOL). There is a wealth of evidence to support the use of exercise as an adjuvant therapy to improve functional ability as well as help manage treatment-related symptoms. Specifically, resistance training has been shown to increase muscle mass, strength, and functional fitness in aging adults and several cancer populations. Although studies are limited, research has shown that exercise is safe and feasible in glioblastoma populations. However, it is not clear whether resistance training can be successfully used in glioblastoma to prevent or mitigate steroid-induced muscle myopathy and associated loss of function. Objective: The primary purpose of this study is to establish whether an individualized circuit-based program will reduce steroid-induced muscle myopathy, as indicated by maintained or improved functional fitness for patients on active treatment and receiving steroids. Methods: This is a 2-armed, randomized controlled trial with repeated measures. We will recruit 38 adult (≥18 years) patients diagnosed with either primary or secondary glioblastoma who are scheduled to receive standard radiation and concurrent and adjuvant temozolomide chemotherapy postsurgical debulking and received any dose of DEX through the neurooncology clinic and the Nova Scotia Health Cancer Center. Patients will be randomly allocated to a standard of care waitlist control group or standard of care + circuit-based resistance training exercise group. The exercise group will receive a 12-week individualized, group and home-based exercise program. The control group will be advised to maintain an active lifestyle. The primary outcome, muscle myopathy (functional fitness), will be assessed using the Short Physical Performance Battery and hand grip strength. Secondary outcome measures will include body composition, cardiorespiratory fitness, physical activity, QOL, fatigue, and cognitive function. All measures will be assessed pre- and postintervention. Participant accrual, exercise adherence, and safety will be assessed throughout the study. Results: This study has been funded by the Canadian Cancer Society Atlantic Cancer Research Grant and the J.D. Irving Limited–Excellence in Cancer Research Fund (grant number 707182). The protocol was approved by the Nova Scotia Health and Acadia University’s Research Ethics Boards. Enrollment is anticipated to begin in March 2022. Conclusions: This study will inform how individualized circuit-based resistance training may improve functional independence and overall QOL of glioblastoma patients. Trial Registration: ClinicalTrails.gov NCT05116137; https://www.clinicaltrials.gov/ct2/show/NCT05116137 International Registered Report Identifier (IRRID): DERR1-10.2196/37709 %M 35507403 %R 10.2196/37709 %U https://www.researchprotocols.org/2022/5/e37709 %U https://doi.org/10.2196/37709 %U http://www.ncbi.nlm.nih.gov/pubmed/35507403 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e31815 %T The Acceptability of an Electronically Delivered Acceptance- and Mindfulness-Based Physical Activity Intervention for Survivors of Breast Cancer: One-Group Pretest-Posttest Design %A Robertson,Michael C %A Cox-Martin,Emily %A Shegog,Ross %A Markham,Christine M %A Fujimoto,Kayo %A Durand,Casey P %A Brewster,Abenaa %A Lyons,Elizabeth J %A Liao,Yue %A Flores,Sara A %A Basen-Engquist,Karen M %+ Department of Nutrition, Metabolism, and Rehabilitation Sciences, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, United States, 1 409 772 3030, mcrobert@utmb.edu %K cancer survivors %K exercise %K mindfulness %K Acceptance and Commitment Therapy %K behavioral sciences %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of the internal barriers associated with physical activity. Objective: The primary aim of this study was to investigate the acceptability of an electronically delivered physical activity intervention for survivors of breast cancer, centered on ACT processes. Methods: This study used a 1-group pretest-posttest design. We recruited 80 insufficiently active female survivors of breast cancer using a web-based recruitment strategy. The 8-week intervention consisted of weekly modules that featured didactic lessons and experiential exercises targeting key ACT processes in the context of physical activity promotion (namely, values, committed action, acceptance, defusion, and contacting the present moment). We determined intervention acceptability according to study retention (≥70%), adherence rates (≥75% of the participants completing ≥50% of the modules), and posttest survey scores reflecting the perceived ease of use, perceived usefulness, and interest and enjoyment of the intervention (≥5 on a 7-point Likert-type scale). We also evaluated changes in self-reported aerobic and muscle strengthening–physical activity, physical activity acceptance, physical activity regulation, and health-related outcomes. Results: The retention rate (61/80, 76%), adherence rate (60/80, 75%), average perceived ease of use (6.17, SD 1.17), perceived usefulness (5.59, SD 1.40), and interest and enjoyment scores (5.43, SD 1.40) met the acceptability criteria. Participants increased their self-reported aerobic physical activity (Cohen d=1.04), muscle strengthening–physical activity (Cohen d=1.02), physical activity acceptance (cognitive acceptance: Cohen d=0.35; behavioral commitment: Cohen d=0.51), physical activity regulation (identified regulation: Cohen d=0.37; integrated regulation: Cohen d=0.66), increased their ability to participate in social roles and activities (Cohen d=0.18), and reported less fatigue (Cohen d=0.33) and sleep disturbance (Cohen d=0.53). Conclusions: Electronically delivered acceptance- and mindfulness-based interventions may be useful for promoting physical activity in survivors of breast cancer. Further research is needed to refine these approaches and evaluate their effectiveness. %M 35486425 %R 10.2196/31815 %U https://cancer.jmir.org/2022/2/e31815 %U https://doi.org/10.2196/31815 %U http://www.ncbi.nlm.nih.gov/pubmed/35486425 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e37009 %T Acceptability and Feasibility of a Return-to-Work Intervention for Posttreatment Breast Cancer Survivors: Protocol for a Co-design and Development Study %A Bilodeau,Karine %A Gouin,Marie-Michelle %A Lecours,Alexandra %A Lederer,Valérie %A Durand,Marie-José %A Kilpatrick,Kelley %A Lepage,David %A Ladouceur-Deslauriers,Lauriane %A Dorta,Tomas %+ Faculty of Nursing, University of Montreal, PO Box 6128, Station Centre-ville, Montreal, QC, H3C 3J7, Canada, 1 514 343 6111 ext 43254, karine.bilodeau.2@umontreal.ca %K co-design %K breast cancer %K intervention %K return-to-work %K primary care %K qualitative %D 2022 %7 22.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The mortality rate from breast cancer has been declining for many years, and the population size of working-age survivors is steadily increasing. However, the recurrent side effects of cancer and its treatment can result in multiple disabilities and disruptions to day-to-day life, including work disruptions. Despite the existing knowledge of best practices regarding return to work (RTW) for breast cancer survivors, only a few interdisciplinary interventions have been developed to address the individualized needs and multiple challenges of breast cancer survivors, health care professionals, and employer and insurer representatives. Thus, it seems appropriate to develop RTW interventions collaboratively by using a co-design approach with these specific stakeholders. Objective: This paper presents a protocol for developing and testing an innovative, interdisciplinary pilot intervention based on a co-design approach to better support RTW and job retention after breast cancer treatment. Methods: First, a participatory research approach will be used to develop the intervention in a co-design workshop with 12 to 20 participants, including people affected by cancer, employer and insurer representatives, and health care professionals. Next, a pilot intervention will be tested in a primary care setting with 6 to 8 women affected by breast cancer. The acceptability and feasibility of the pilot intervention will be pretested through semistructured interviews with participants, health care professionals, and involved patient partners. The transcribed data will undergo an iterative content analysis. Results: The first phase of the project—the co-design workshop—was completed in June 2021. The pilot test of the intervention will begin in spring 2022. The results from the test will be available in late 2022. Conclusions: The project will offer novel data regarding the use of the co-design approach for the development of innovative, co-designed interventions. In addition, it will be possible to document the acceptability and feasibility of the pilot intervention with a primary care team. Depending on the results obtained, the intervention could be implemented on a larger scale. International Registered Report Identifier (IRRID): DERR1-10.2196/37009 %M 35451972 %R 10.2196/37009 %U https://www.researchprotocols.org/2022/4/e37009 %U https://doi.org/10.2196/37009 %U http://www.ncbi.nlm.nih.gov/pubmed/35451972 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e34903 %T A Cancer Exercise Toolkit Developed Using Co-Design: Mixed Methods Study %A Dennett,Amy M %A Tang,Clarice Y %A Chiu,April %A Osadnik,Christian %A Granger,Catherine L %A Taylor,Nicholas F %A Campbell,Kristin L %A Barton,Christian %+ Allied Health Clinical Research Office, Eastern Health, Level 2, 5 Arnold St, Box Hill, 3128, Australia, 61 41128861, a.dennett@latrobe.edu.au %K cancer %K website %K online learning %K professional development %K physiotherapy %K exercise %K cancer survivorship %K cancer survivor %K digital health %K online health %K online toolkit %D 2022 %7 21.4.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Access to exercise therapy for cancer survivors is poor. Professional development to support exercise professionals in delivering these interventions is needed. Few online resources exist for exercise professionals to address this issue. Objective: To develop and evaluate a freely available online toolkit to support exercise professionals working with cancer survivors. Methods: A 2-phase, experience-based co-design approach was used to develop and evaluate the online toolkit. The two phases were as follows: 1) needs identification and co-design of resources and platform and 2) pilot evaluation. Four co-design workshops were conducted, transcribed, and thematically analyzed to identify key elements for the toolkit. For the pilot evaluation, a customized survey (the Determinants of Implementation Behavior Questionnaire) was distributed to exercise professionals at baseline and 3 months after launch of the online toolkit to determine its usability, utility, and effectiveness in improving their knowledge, confidence, and behavior. Results were reported as the median and interquartile range and changes were calculated using non-parametric tests. Website analytics described site usage after the initial evaluation. Results: Twenty-five exercise professionals participated in co-designing 8 key elements of the online Cancer Exercise Toolkit: the homepage and pages for getting started, screening and safety, assessment, exercise prescription, education, locations, and resources. For the pilot evaluation, 277/320 respondents (87% of whom were physiotherapists) from 26 countries completed the survey at baseline, with 58 exercise professionals completing follow-up surveys at 3 months. Exercise professionals’ knowledge, skills, and confidence in delivering exercise therapy to cancer survivors increased 3 months after baseline (items 1, 6, and 8: median score 5, IQR 3 to 6) to follow-up (items 1 and 6: median score 6, IQR 5 to 6; item 8: median score 5, IQR 5 to 7; P<.001) on a 1 to 7 Likert scale. Most participants (35/44, 80%) agreed or strongly agreed they would recommend the toolkit to colleagues. In the 6 months following the pilot evaluation, the toolkit received an average of 866 views per month. Conclusions: The co-designed online Cancer Exercise Toolkit was a useful resource for exercise professionals that may increase their knowledge, skills, and confidence in providing exercise therapy to cancer survivors. %M 35451966 %R 10.2196/34903 %U https://cancer.jmir.org/2022/2/e34903 %U https://doi.org/10.2196/34903 %U http://www.ncbi.nlm.nih.gov/pubmed/35451966 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e33633 %T Long-term Changes in the Premature Death Rate in Lung Cancer in a Developed Region of China: Population-based Study %A Ye,Wenjing %A Lu,Weiwei %A Li,Xiaopan %A Chen,Yichen %A Wang,Lin %A Zeng,Guangwang %A Xu,Cheng %A Ji,Chen %A Cai,Yuyang %A Yang,Ling %A Luo,Zheng %+ Shanghai University of Medicine & Health Sciences Affiliated Zhoupu Hospital, Pudong New Area, No.1500 Zhouyuan Rd, Shanghai, 201318, China, 86 18008497518, zhengluo86@foxmail.com %K lung cancer %K mortality %K years of life lost %K trend analysis %K decomposition method %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Lung cancer is a leading cause of death worldwide, and its incidence shows an upward trend. A study of the long-term changes in the premature death rate in lung cancer in a developed region of China has great exploratory significance to further clarify the effectiveness of intervention measures. Objective: This study examined long-term changes in premature lung cancer death rates in order to understand the changes in mortality and to design future prevention plans in Pudong New Area (PNA), Shanghai, China. Methods: Cancer death data were collected from the Mortality Registration System of PNA. We analyzed the crude mortality rate (CMR), age-standardized mortality rate by Segi’s world standard population (ASMRW), and years of life lost (YLL) of patients with lung cancer from 1973 to 2019. Temporal trends in the CMR, ASMRW, and YLL rate were calculated by joinpoint regression expressed as an average annual percentage change (AAPC) with the corresponding 95% CI. Results: All registered permanent residents in PNA (80,543,137 person-years) from 1973 to 2019 were enrolled in this study. There were 42,229 deaths from lung cancer. The CMR and ASMRW were 52.43/105 and 27.79/105 person-years, respectively. The YLL due to premature death from lung cancer was 481779.14 years, and the YLL rate was 598.16/105 person-years. The CMR and YLL rate showed significantly increasing trends in men, women, and the total population (P<.001). The CMR of the total population increased by 2.86% (95% CI 2.66-3.07, P<.001) per year during the study period. The YLL rate increased with an AAPC of 2.21% (95% CI 1.92-2.51, P<.001) per year. The contribution rates of increased CMR values caused by demographic factors were more evident than those caused by nondemographic factors. Conclusions: Lung cancer deaths showed an increasing trend in PNA from 1973 to 2019. Demographic factors, such as the aging population, contributed more to an increased CMR. Our research can help us understand the changes in lung cancer mortality and can be used for similar cities in designing future prevention plans. %M 35442209 %R 10.2196/33633 %U https://publichealth.jmir.org/2022/4/e33633 %U https://doi.org/10.2196/33633 %U http://www.ncbi.nlm.nih.gov/pubmed/35442209 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e36364 %T Implementing a Health Care Professional–Supported Digital Intervention for Survivors of Cancer in Primary Care: Qualitative Process Evaluation of the Renewed Intervention %A Smith,Jazzine %A Essery,Rosie %A Yardley,Lucy %A Richardson,Alison %A Slodkowska-Barabasz,Joanna %A Foster,Claire %A Watson,Eila %A Grimmett,Chloe %A Geraghty,Adam W A %A Little,Paul %A Bradbury,Katherine %+ Clinical and Community Applications of Health Psychology, School of Psychology, University of Southampton, B44 University Road, Southampton, SO17 1PS, United Kingdom, 44 02380 593843, js2c18@soton.ac.uk %K process evaluation %K digital intervention %K primary care %K health care professional %K web-based %K quality of life %K posttreatment %K oncology %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Primary care plays an important role in supporting survivors of cancer; however, support is limited because of practitioners’ perceived lack of expertise and time. A digital intervention for survivors of cancer could provide an efficient way for primary care staff to support survivors of cancer without the need to accumulate expertise and skills to help patients make behavior changes; providing very brief support alongside this could maximize adherence to digital interventions. Renewed is a digital intervention that combines web-based behavior change advice with brief health care practitioner support from a nurse or health care assistant. Knowledge about the views and experiences of primary care staff providing support alongside a digital intervention for survivors of cancer is sparse, limiting the understanding of the acceptability and feasibility of this type of intervention. Objective: This study aims to explore supporters’ experiences of providing support to survivors of cancer using Renewed, understand potential barriers to and facilitators of the implementation of Renewed in practice, and investigate the strengths and weaknesses of the intervention from the perspective of health care professionals. Methods: This was a qualitative process evaluation nested within a large trial evaluating Renewed. A total of 28 semistructured telephone interviews were conducted with nurses and health care assistants. Data were analyzed using inductive thematic analysis. Results: Four themes were developed during the analysis, which reflected the factors that supporters identified as hindering or enabling them to provide support alongside Renewed Online: Renewed Online as an acceptable digital tool with some improvements, confidence in enacting the supporter role, practicalities of delivering support alongside a digital intervention, and managing a patient-led approach. The analysis suggests that supporters perceived that a digital intervention such as Renewed would be beneficial in supporting survivors of cancer in primary care and fit within current practices. However, barriers to providing support alongside the intervention were also identified, including concerns about how to facilitate rapport building and, in a minority, concerns about using a nondirective approach, in which most advice and support is provided through digital interventions, with brief additional support provided by primary care staff. Conclusions: These findings add to the literature on how best to provide support alongside digital interventions, suggesting that although most practitioners cope well with a nondirective approach, a minority requires more training to feel confident in implementing this. This study suggests that the barriers to providing formal support to survivors of cancer in primary care could be successfully overcome with an approach such as Renewed, where a digital intervention provides most of the support and expertise, and health care practitioners provide additional brief human support to maximize engagement. Strategies to maximize the chances of successful implementation for this type of intervention are also discussed. %M 35363143 %R 10.2196/36364 %U https://cancer.jmir.org/2022/2/e36364 %U https://doi.org/10.2196/36364 %U http://www.ncbi.nlm.nih.gov/pubmed/35363143 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e26827 %T Exercise and Creatine Supplementation to Augment the Adaptation of Exercise Training Among Breast Cancer Survivors Completing Chemotherapy: Protocol for an Open-label Randomized Controlled Trial (the THRIVE Study) %A Patel,Darpan I %A Gonzalez,Angela %A Moon,Crisann %A Serra,Monica %A Bridges,Preston Blake %A Hughes,Daniel %A Clarke,Geoffrey %A Kilpela,Lisa %A Jiwani,Rozmin %A Musi,Nicolas %+ Biobehavioral Research Laboratory, School of Nursing, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States, 1 210 567 0362, pateld7@uthscsa.edu %K rehabilitation %K supplements %K resistant exercise %K oncology %K quality of life %K doxorubicin %D 2022 %7 1.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: In breast cancer survivors, chemotherapy-induced muscle loss has been shown to be attenuated with structured resistance exercise. Creatine supplementation can increase bioenergetics in skeletal muscle, which helps to improve overall strength and endurance and reduce muscular fatigue. Therefore, we hypothesize that adding creatinine supplementation to exercise training will accelerate improvements in strength, endurance, and bioenergetics in breast cancer survivors. Objective: The primary objective is to determine the effects of combining creatine supplementation with exercise on modulating strength and physical function in breast cancer survivors by comparing these effects to those of exercise alone. The secondary objectives are to determine if creatine supplementation and exercise can increase the intramuscular storage of creatine and improve body composition by comparing this intervention to exercise alone. Methods: We aim to test our hypothesis by conducting an open-label randomized controlled trial of 30 breast cancer survivors who have completed chemotherapy within 6 months of enrollment. Eligible participants will be equally randomized (1:1) to either a creatine and exercise group or an exercise-only group for this 12-week intervention. Individuals who are randomized to receive creatine will be initially dosed at 20 g per day for 7 days to boost the availability of creatine systemically. Thereafter, the dose will be reduced to 5 g per day for maintenance throughout the duration of the 12-week protocol. All participants will engage in 3 center-based exercise sessions, which will involve completing 3 sets of 8 to 12 repetitions on chest press, leg press, seated row, shoulder press, leg extension, and leg curl machines. The primary outcomes will include changes in strength, body composition, and physical function in breast cancer survivors. The secondary outcomes will be intramuscular concentrations of creatine and adenosine triphosphate in the vastus lateralis, midthigh cross-sectional area, and quality of life. Results: As of October 2021, a total of 9 patients have been enrolled into the study. No unexpected adverse events have been reported. Conclusions: Creatine is being studied as a potential agent for improving strength, endurance, and bioenergetics in breast cancer survivors following chemotherapy. The findings from our trial may have future implications for supporting breast cancer survivors in reversing the muscle loss experienced during chemotherapy and improving their physical function and quality of life. Trial Registration: ClinicalTrials.gov NCT04207359; https://clinicaltrials.gov/ct2/show/NCT04207359 International Registered Report Identifier (IRRID): PRR1-10.2196/26827 %M 35363152 %R 10.2196/26827 %U https://www.researchprotocols.org/2022/4/e26827 %U https://doi.org/10.2196/26827 %U http://www.ncbi.nlm.nih.gov/pubmed/35363152 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e33239 %T Efficacy of a Web-Based Psychoeducational Intervention for Young Adults With Fertility-Related Distress Following Cancer (Fex-Can): Randomized Controlled Trial %A Micaux,Claire %A Wiklander,Maria %A Eriksson,Lars E %A Wettergren,Lena %A Lampic,Claudia %+ Department of Women’s and Children’s Health, Karolinska Institutet, Tomtebodavägen 18A, Stockholm, 17177, Sweden, 46 790738998, claire.micaux@ki.se %K cancer %K fertility distress %K psychoeducation %K randomized controlled trial %K web-based %D 2022 %7 29.3.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Threatened fertility following cancer diagnosis in the reproductive age may severely impact emotional and psychosocial well-being in survivorship. Effective web-based interventions for fertility-related distress have been lacking. Objective: This study aims to test whether the Fertility and Sexuality following Cancer (Fex-Can) intervention is superior to standard care in reducing fertility-related distress and related psychosocial outcomes in young adults with cancer. Methods: This randomized controlled trial evaluated a 12-week, web-based, automated self-help intervention for fertility-related distress following cancer—Fex-Can Fertility. Individuals were identified via Swedish national quality registries, and those reporting fertility-related distress 1.5 years after diagnosis were invited. A total of 100 women and 24 men (aged 19-40 years) answered self-administered surveys at baseline (T0), directly after the intervention (T1), and 3 months later (T2). The main outcome was fertility-related distress, which was measured by using the 6-dimension Reproductive Concerns After Cancer (RCAC) scale. The secondary outcomes were health-related quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), emotional distress (Hospital Anxiety and Depression Scale), fertility-related knowledge, and fertility self-efficacy. In addition, the intervention group (IG) reported self-perceived changes in problems related to fertility after cancer (T1). 2-tailed t tests and linear mixed models, including intention-to-treat and subgroup analyses, were performed to compare the effects of the intervention with those of standard care. Results: Although 62% (31/50) of the participants in the IG stated that their concerns about fertility were fewer after the intervention, there were few statistically significant group differences in the main outcome (RCAC) at T1 and T2. Compared with controls, the IG rated lower distress concerning the dimension child’s health at T2 (P=.003; effect size [ES]=0.64). This difference was maintained when adding group and time interactions (intention-to-treat: P=.003; ES=0.58). The IG also had better self-perceived cancer-related fertility knowledge at T1 (P=.05; ES=0.35) and T2 (P=.01; ES=0.42) than the control group. Subgroup analyses based on dose or adherence and baseline RCAC scores did not substantially alter these results. Overall, the use of the web-based program was low. Conclusions: The Fex-Can intervention had small to moderate positive effects on cancer-related fertility knowledge and distress related to child’s health. The lack of group differences in other dimensions of fertility distress and related secondary outcomes contrasted with reports on self-perceived improvement after the intervention. The Fex-Can Fertility program may be a useful complement to routine psychosocial support in the clinical care of young women and men with cancer. Trial Registration: ISRCTN Registry 36621459; https://www.isrctn.com/ISRCTN36621459 %M 35348459 %R 10.2196/33239 %U https://cancer.jmir.org/2022/1/e33239 %U https://doi.org/10.2196/33239 %U http://www.ncbi.nlm.nih.gov/pubmed/35348459 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27890 %T Demographic and Psychosocial Characteristics Associated With Use of a Prostate Cancer Survivorship Website: Implications From a Multisite Randomized Controlled Trial %A Marziliano,Allison %A Diefenbach,Michael A %A Hudson,Shawna V %A Tagai,Erin K %A Handorf,Elizabeth A %A Bator,Alicja %A Miller,Suzanne M %+ Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, 333 Cottman Avenue, Philadelphia, PA, 19111, United States, 1 1 215 728 4069, Suzanne.Miller@fccc.edu %K prostate cancer %K cancer survivorship %K web-based resource %K monitoring style of coping %K cancer %K survivorship %K eHealth %K emotions %K interpersonal %D 2022 %7 21.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Many prostate cancer (PC) survivors experience disease and treatment-related symptomatology in both the physical and psychosocial domains. Although the benefits and barriers to using web-based resources for cancer patients are well-documented, less research has focused on the personal characteristics important for efficient tailoring and targeting of information that are associated with usage. Objective: We used the Cognitive-Social Health Information Processing (C-SHIP) framework to guide our exploration of personal characteristics associated with use of PROGRESS, an informational PC survivorship website that addresses physical, emotional, interpersonal, and practical concerns relevant for PC survivors. Methods: PC survivors (N=217) were randomized to the intervention arm (PROGRESS) of a randomized controlled trial. Of those randomized to the intervention arm, 84 used PROGRESS, and 133 did not use PROGRESS. Multivariable analyses evaluated demographic and psychosocial characteristics (eg, style of coping, health literacy, self-efficacy, affective states of depression, anxiety, and fatigue) associated with website use. Results: A larger proportion of non-Hispanic White (68/160, 42.5%), compared with non-Hispanic Black (9/40, 23%), participants used PROGRESS (P<.001). Further, PROGRESS users were older in age (P<.001), had a monitoring style of coping (P=.01), and were less depressed (P=.004), anxious (P=.02), and fatigued (P<.001) than nonusers. Education, income, health literacy, blunting style of coping, self-efficacy, and treatment type (radiation therapy or surgery) were not significantly related to use. On multivariable analyses, race (OR 0.28, P<.001), age (OR 1.05, P<.001), monitoring style of coping (OR 1.27, P=.02), and overall mood (OR 0.98, P<.001) remained significant. Conclusions: A combination of monitoring and low levels of negative affect were associated with website use. Additionally, users were older, non-Hispanic White survivors. To ensure that important survivorship-relevant information reaches users, future efforts need to focus on enhancing patient engagement. Trial Registration: ClinicalTrials.gov NCT02224482; https://clinicaltrials.gov/ct2/show/NCT02224482 %M 35311678 %R 10.2196/27890 %U https://www.jmir.org/2022/3/e27890 %U https://doi.org/10.2196/27890 %U http://www.ncbi.nlm.nih.gov/pubmed/35311678 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e24592 %T Pulmonary Screening Practices of Otolaryngology–Head and Neck Surgeons Across Saudi Arabia in the Posttreatment Surveillance of Squamous Cell Carcinoma: Cross-sectional Survey Study %A Alnefaie,Majed %A Alamri,Abdullah %A Saeedi,Asalh %A Althobaiti,Awwadh %A Alosaimi,Shahad %A Alqurashi,Yousuf %A Marzouki,Hani %A Merdad,Mazin %+ King Fahad Armed Forces Hospital, Medical Services of The Armed Forces, Al Kurnaysh Rd, Al Andalus, Jeddah, 23311, Saudi Arabia, 966 500900450, Majed.n.md@gmail.com %K squamous cell carcinoma of head and neck %K lung neoplasms %K radiography %K otolaryngology %K surgeons %K survey %D 2022 %7 18.3.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: With respect to patients with head and neck squamous cell carcinoma (HNSCC), posttreatment surveillance for distant disease has mostly focused on the lungs, as HNSCC distant metastasis occurs in this organ in 90% of HNSCC cases. Additionally, the incidence rate of primary tumors in the lungs is high due to the field cancerization of the entire upper aerodigestive tract. Objective: Our cross-sectional survey study aims to evaluate the current beliefs and pulmonary screening practices of otolaryngology–head and neck surgeons across Saudi Arabia with respect to the posttreatment surveillance of HNSCC. Methods: This nationwide cross-sectional survey was conducted among head and neck surgeon members of the Saudi Society of Otolaryngology from June 1 to June 30, 2020. A predesigned questionnaire was used for data collection, and a descriptive analysis was carried out. Results: This study included 22 participants and had a 78% (22/28) response rate. This study found that the majority of participants (9/22, 41%) used lung radiography for routine lung screening during posttreatment follow-ups, whereas 32% (7/22) used low-dose computed tomography (CT; 7/22, 32%). With regard to the number of years for which participants perform lung screening during follow-ups, the majority of participants (17/22, 77%) reported 5 years, and only 9% (2/22) have performed lifelong lung screening. With regard to the frequency of lung screening, 77% (17/22) of participants conduct screening annually, 18% (4/22) conduct screening half-yearly, and 5% (1/22) conduct screening biennially. With regard to beliefs about the effectiveness of screening procedures in reducing lung cancer mortality rates during follow-ups, 36% (8/22) of participants believed them to be very effective or somewhat effective, 18% (4/22) did not know, and only 9% (2/22) believed that they were not effective. Conclusions: The participants mainly used lung radiography (9/22, 41%), low-dose CT (7/22, 32%), or positron emission tomography/CT (6/22, 27%) as a routine lung screening method during the posttreatment follow-up of patients with head and neck cancer for 5 years (17/22, 77%) or 10 years (3/22, 14%), and only a small percentage of participants have performed lifelong lung screening (2/22, 9%). Lung screening was mostly conducted annually or half-yearly. Such screening was believed to be very effective or somewhat effective. %M 35302511 %R 10.2196/24592 %U https://www.i-jmr.org/2022/1/e24592 %U https://doi.org/10.2196/24592 %U http://www.ncbi.nlm.nih.gov/pubmed/35302511 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e31118 %T An Analysis of Health Care Team Communication Needs Among Younger vs Older Breast Cancer Survivors: Web-Based Survey %A Vollmer Dahlke,Deborah %A Yoshikawa,Aya %A McAdam,Molly %A Malatok,Sharyn %A Gonzales,Elaine D %+ Texas A&M Center for Population Health and Aging, Texas A&M University, 8402 Silver Mountain Cv, Austin, TX, 78737-3136, United States, 1 5126994493, deborahvd@gmail.com %K breast cancer %K breast cancer survivorship %K patient-physician communications %K patient-centric communication %K younger breast cancer patients %K patient communication %D 2022 %7 18.3.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Prior studies indicate that the age of onset of breast cancer is an important element in considering communication between patients and the health care team. Younger women aged 45 and under diagnosed with breast cancer are often at a higher risk of being more vulnerable to psychosocial issues compared to older women aged 46 years and above. Few studies have examined age differences in patient perceptions of treatment-related discussion and communication during transition with their health care team. Objective: The aims of this survey were (1) to better understand breast cancer survivors’ perspectives regarding communication with health care providers during treatment and during transition to posttreatment care; and (2) to determine the differences between younger women with breast cancer (≤45 years of age) and older women (≥46 years of age). It was hypothesized that (1) breast cancer survivors’ psychosocial and finance-related communications with health care providers may lack effectiveness; (2) younger women experience greater needs for patient-centered communication with physicians and health care providers, especially about psychosocial care and transition to posttreatment care; and (3) younger breast cancer patients (≤45 years of age) need more information on survivorship and follow-up care. Methods: An internet-based survey was conducted with 143 women in Central Texas with 35% (n=50) aged 45 years or under and 65% (n=93) aged 46 years and above. The Mann-Whitney U test was performed to assess differences in participants’ perceptions about communication with health care providers by age group: younger (≤45 years of age) and older (≥46 years of age) women. Results: Statistically significant results pertained to rating health care team and patient discussions about transition from treatment to posttreatment using scores of 0 as “no discussion” and 100 as “in-depth discussion.” For the questions about management of posttreatment care, the overall mean score of the groups was 56.26 and that of the younger group was 43.96; the mean score of the older group was 61.96 (P=.02). For the question about the timing of follow-up appointments, the overall mean score was 64.29; the mean score of the younger group was 54.44, and that of the older group was 68.88 (P=.05). All the group scores related to psychosocial and financial support discussions with health care providers were low, with a rollup average of only 30.02 out of 100, suggesting that this is an important area for improving patient-centered communication. Conclusions: For all patients, transition from treatment to posttreatment requires a greater level of engagement and communication with the health care team. It appears that younger patients aged ≤45 years require more in-depth and personalized messaging to better understand their posttreatment care requirements. %M 35302499 %R 10.2196/31118 %U https://cancer.jmir.org/2022/1/e31118 %U https://doi.org/10.2196/31118 %U http://www.ncbi.nlm.nih.gov/pubmed/35302499 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27588 %T Effectiveness, Cost-effectiveness, and Cost-Utility of a Digital Smoking Cessation Intervention for Cancer Survivors: Health Economic Evaluation and Outcomes of a Pragmatic Randomized Controlled Trial %A Mujcic,Ajla %A Blankers,Matthijs %A Boon,Brigitte %A Verdonck-de Leeuw,Irma M %A Smit,Filip %A van Laar,Margriet %A Engels,Rutger %+ Erasmus School of Social and Behavioural Sciences, Erasmus University, Burgemeester Oudlaan 50, Rotterdam, 3062PA, Netherlands, 31 30 29 59 256, amujcic@trimbos.nl %K smoking cessation %K cancer survivors %K effectiveness %K cost-effectiveness %K eHealth %D 2022 %7 17.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Smoking cessation (SC) interventions may contribute to better treatment outcomes and the general well-being of cancer survivors. Objective: This study aims to evaluate the effectiveness, cost-effectiveness, and cost-utility of a digital interactive SC intervention compared with a noninteractive web-based information brochure for cancer survivors. Methods: A health economic evaluation alongside a pragmatic 2-arm parallel-group randomized controlled trial was conducted with follow-ups at 3, 6, and 12 months. The study was conducted in the Netherlands over the internet from November 2016 to September 2019. The participants were Dutch adult smoking cancer survivors with the intention to quit smoking. In total, 165 participants were included and analyzed: 83 (50.3%) in the MyCourse group and 82 (49.7%) in the control group. In the intervention group, participants had access to a newly developed, digital, minimally guided SC intervention (MyCourse-Quit Smoking). Control group participants received a noninteractive web-based information brochure on SC. Both groups received unrestricted access to usual care. The primary outcome was self-reported 7-day smoking abstinence at the 6-month follow-up. Secondary outcomes were quality-adjusted life years gained, number of cigarettes smoked, nicotine dependence, and treatment satisfaction. For the health economic evaluation, intervention costs, health care costs, and costs stemming from productivity losses were assessed over a 12-month horizon. Results: At the 6-month follow-up, the quit rates were 28% (23/83) and 26% (21/82) in the MyCourse and control groups, respectively (odds ratio 0.47, 95% CI 0.03-7.86; P=.60). In both groups, nicotine dependence scores were reduced at 12 months, and the number of smoked cigarettes was reduced by approximately half. The number of cigarettes decreased more over time, and the MyCourse group demonstrated a significantly greater reduction at the 12-month follow-up (incidence rate ratio 0.87; 95% CI 0.76-1.00; P=.04). Intervention costs were estimated at US $193 per participant for the MyCourse group and US $74 for the control group. The mean per-participant societal costs were US $25,329 (SD US $29,137) and US $21,836 (SD US $25,792), respectively. In the cost-utility analysis, MyCourse was not preferred over the control group from a societal perspective. With smoking behavior as the outcome, the MyCourse group led to marginally better results per reduced pack-year against higher societal costs, with a mean incremental cost-effectiveness ratio of US $52,067 (95% CI US $32,515-US $81,346). Conclusions: At 6 months, there was no evidence of a differential effect on cessation rates; in both groups, approximately a quarter of the cancer survivors quit smoking and their number of cigarettes smoked was reduced by half. At 12 months, the MyCourse intervention led to a greater reduction in the number of smoked cigarettes, albeit at higher costs than for the control group. No evidence was found for a differential effect on quality-adjusted life years. Trial Registration: The Netherlands Trial Register NTR6011; https://www.trialregister.nl/trial/5434 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-018-4206-z %M 35297777 %R 10.2196/27588 %U https://www.jmir.org/2022/3/e27588 %U https://doi.org/10.2196/27588 %U http://www.ncbi.nlm.nih.gov/pubmed/35297777 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e33152 %T An mHealth App to Support Caregivers in the Medical Management of Their Child With Cancer: Co-design and User Testing Study %A Mueller,Emily L %A Cochrane,Anneli R %A Campbell,Madison E %A Nikkhah,Sarah %A Miller,Andrew D %+ Center for Pediatric and Adolescent Comparative Effectiveness Research, Indiana University, 705 Riley Hospital Dr, ROC 4340, Indianapolis, IN, 46202, United States, 1 312 399 0245, elmuelle@iu.edu %K child %K adolescent %K oncology %K supportive care %K mHealth %K mobile health %K cancer %K pediatrics %K children %K digital health %K health applications %K parent %K caregiver %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Caregivers face new challenges and tasks when their child is diagnosed with cancer, which can be overwhelming. Mobile technology has the capacity to provide immediate support at their fingertips to aid in tracking symptoms, managing medication, and planning for emergencies. Objective: The objective of this study is to engage directly with end users and proxies to co-design and create a mobile technology app to support caregivers in the medical management of their child with cancer. Methods: We engaged directly with caregivers of children with cancer and pediatric oncology nurse coordinators (proxy end users) to co-design and create the prototype of the Cope 360 mobile health app. Alpha testing was accomplished by walking the users through a series of predetermined tasks that encompassed all aspects of the app including tracking symptoms, managing medications, and planning or practicing for a medical emergency that required seeking care in the emergency department. Evaluation was accomplished through recorded semistructured interviews and quantitative surveys to capture demographic information and measure the system usability score. Interviews were transcribed and analyzed iteratively using NVivo (version 12; QSR International). Results: This study included 8 caregivers (aged 33-50 years) of children with cancer, with most children receiving chemotherapy, and 6 nurse coordinators, with 3 (50%) of them having 11 to 20 years of nursing experience. The mean system usability score given by caregivers was 89.4 (95% CI 80-98.8). Results were grouped by app function assessed with focus on specific attributes that were well received and those that required refinement. The major issues requiring refinement included clarity in the medical information and terminology, improvement in design of tasks, tracking of symptoms including adjusting the look and feel of certain buttons, and changing the visual graph used to monitor symptoms to include date anchors. Conclusions: The Cope 360 app was well received by caregivers of children with cancer but requires further refinement for clarity and visual representation. After refinement, testing among caregivers in a real-world environment is needed to finalize the Cope 360 app before its implementation in a randomized controlled trial. %M 35293867 %R 10.2196/33152 %U https://cancer.jmir.org/2022/1/e33152 %U https://doi.org/10.2196/33152 %U http://www.ncbi.nlm.nih.gov/pubmed/35293867 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e35768 %T Development of a Prognostic App (iCanPredict) to Predict Survival for Chinese Women With Breast Cancer: Retrospective Study %A Ma,Zhuo %A Huang,Sijia %A Wu,Xiaoqing %A Huang,Yinying %A Chan,Sally Wai-Chi %A Lin,Yilan %A Zheng,Xujuan %A Zhu,Jiemin %+ Department of Nursing, School of Medicine, Xiamen University, Room 222, Alice Lee Building, Xiangan Campus, Xiamen University, Xiang An South Road, Xiamen, 361005, China, 86 15960212649, jieminzhu@xmu.edu.cn %K app %K breast cancer %K survival prediction model %K iCanPredict %D 2022 %7 9.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Accurate prediction of survival is crucial for both physicians and women with breast cancer to enable clinical decision making on appropriate treatments. The currently available survival prediction tools were developed based on demographic and clinical data obtained from specific populations and may underestimate or overestimate the survival of women with breast cancer in China. Objective: This study aims to develop and validate a prognostic app to predict the overall survival of women with breast cancer in China. Methods: Nine-year (January 2009-December 2017) clinical data of women with breast cancer who received surgery and adjuvant therapy from 2 hospitals in Xiamen were collected and matched against the death data from the Xiamen Center of Disease Control and Prevention. All samples were randomly divided (7:3 ratio) into a training set for model construction and a test set for model external validation. Multivariable Cox regression analysis was used to construct a survival prediction model. The model performance was evaluated by receiver operating characteristic (ROC) curve and Brier score. Finally, by running the survival prediction model in the app background thread, the prognostic app, called iCanPredict, was developed for women with breast cancer in China. Results: A total of 1592 samples were included for data analysis. The training set comprised 1114 individuals and the test set comprised 478 individuals. Age at diagnosis, clinical stage, molecular classification, operative type, axillary lymph node dissection, chemotherapy, and endocrine therapy were incorporated into the model, where age at diagnosis (hazard ratio [HR] 1.031, 95% CI 1.011-1.051; P=.002), clinical stage (HR 3.044, 95% CI 2.347-3.928; P<.001), and endocrine therapy (HR 0.592, 95% CI 0.384-0.914; P=.02) significantly influenced the survival of women with breast cancer. The operative type (P=.81) and the other 4 variables (molecular classification [P=.91], breast reconstruction [P=.36], axillary lymph node dissection [P=.32], and chemotherapy [P=.84]) were not significant. The ROC curve of the training set showed that the model exhibited good discrimination for predicting 1- (area under the curve [AUC] 0.802, 95% CI 0.713-0.892), 5- (AUC 0.813, 95% CI 0.760-0.865), and 10-year (AUC 0.740, 95% CI 0.672-0.808) overall survival. The Brier scores at 1, 5, and 10 years after diagnosis were 0.005, 0.055, and 0.103 in the training set, respectively, and were less than 0.25, indicating good predictive ability. The test set externally validated model discrimination and calibration. In the iCanPredict app, when physicians or women input women’s clinical information and their choice of surgery and adjuvant therapy, the corresponding 10-year survival prediction will be presented. Conclusions: This survival prediction model provided good model discrimination and calibration. iCanPredict is the first tool of its kind in China to provide survival predictions to women with breast cancer. iCanPredict will increase women’s awareness of the similar survival rate of different surgeries and the importance of adherence to endocrine therapy, ultimately helping women to make informed decisions regarding treatment for breast cancer. %M 35262503 %R 10.2196/35768 %U https://www.jmir.org/2022/3/e35768 %U https://doi.org/10.2196/35768 %U http://www.ncbi.nlm.nih.gov/pubmed/35262503 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e19379 %T Comparing Survivors of Cancer in Population-Based Samples With Those in Online Cancer Communities: Cross-sectional Questionnaire Study %A van Eenbergen,Mies C %A Vromans,Ruben D %A Tick,Lidwine W %A Vreugdenhil,Gerard %A Krahmer,Emiel J %A Mols,Floortje %A van de Poll-Franse,Lonneke V %+ Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), Postbox 19079, Utrecht, 3501 DB, Netherlands, 31 650220313, m.vaneenbergen@iknl.nl %K internet use %K breast cancer %K prostate cancer %K lymphoma %K gynecological cancer %K cancer survivors %K online health community %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Most Western countries have websites that provide information on cancer and the opportunity to participate in online cancer communities (OCCs). The number of patients with cancer that participate in these OCCs is growing. These patients are relatively easy to approach for research purposes. Objective: The objective of this study is to determine the differences and similarities between survivors of cancer in population-based samples and survivors participating in OCCs who use the internet in relation to their illness. Methods: In 2017, we drew a sample of 539 population-based patients and 531 OCC patients. The population-based patients were sent a paper-based questionnaire, and the OCC patients were sent the same questionnaire on the web. In the questionnaire, we asked patients about their sociodemographics, internet use, sources of information, media use, and wishes regarding future internet use for health care–related purposes, and the effect of internet use on their health care consumption. Results: The response rate of population-based internet users was 47% (233/496), and that of the OCC group was 40.3% (214/531). The OCC group had a significantly higher education level (P<.001), was younger (P<.001), had more survivors that were employed (P<.001), and attached greater importance to the internet (171/214, 79.9% vs 126/233, 54.1%; P<.001) and fellow survivors (107/214, 50% vs 60/233, 25.8%; P<.001). Compared with the population-based group, the OCC group reported more intensive internet use immediately after diagnosis, during treatment, and during follow-up (P<.001 in each case). There were similarities in terms of the relative importance that survivors attach to the various sources of information, the topics on which they seek information, and their wishes for future eHealth possibilities. The OCC group reported a greater need to participate in a web-based class or chat with others (92/214, 43% vs 44/233, 18.9%). Conclusions: We conclude that survivors who are members of an OCC are not representative of survivors of cancer in general. There are significant differences in sociodemographic characteristics, internet use during their treatment journey, internet search frequency during their cancer journey, and participation wishes. Using web-based information and communication can support shared decision-making and may facilitate the active participation of patients during their treatment. For research purposes, it is important to take the bias in OCC groups into account. %M 35258460 %R 10.2196/19379 %U https://cancer.jmir.org/2022/1/e19379 %U https://doi.org/10.2196/19379 %U http://www.ncbi.nlm.nih.gov/pubmed/35258460 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35838 %T The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) Study: Protocol for an International Mixed Methods Study %A Lie,Hanne C %A Anderssen,Sigmund %A Rueegg,Corina Silvia %A Raastad,Truls %A Grydeland,May %A Thorsen,Lene %A Stensrud,Trine %A Edvardsen,Elisabeth %A Larsen,Marie Hamilton %A Torsvik,Ingrid Kristin %A Bovim,Lars Peder %A Götte,Miriam %A Lähteenmäki,Päivi Maria %A Kriemler,Susi %A Larsen,Hanne Bækgaard %A Fridh,Martin Kaj %A Ørstavik,Kristin %A Brun,Henrik %A Matthews,Iren %A Hornset,Else %A Ruud,Ellen %+ Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, P.B. 1111 Blindern, Oslo, 0317, Norway, 47 41360470, h.c.lie@medisin.uio.no %K childhood cancer survivor %K physical activity %K physical fitness %K barriers %K intervention %K quality of life %K fatigue %D 2022 %7 8.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Survivors of childhood cancer represent a growing population with a long life expectancy but high risks of treatment-induced morbidity and premature mortality. Regular physical activity (PA) may improve their long-term health; however, high-quality empirical knowledge is sparse. Objective: The Physical Activity and Fitness in Childhood Cancer Survivors (PACCS) study comprises 4 work packages (WPs) aiming for the objective determination of PA and self-reported health behavior, fatigue, and quality of life (WP 1); physical fitness determination (WP 2); the evaluation of barriers to and facilitators of PA (WP 1 and 3); and the feasibility testing of an intervention to increase PA and physical fitness (WP 4). Methods: The PACCS study will use a mixed methods design, combining patient-reported outcome measures and objective clinical and physiological assessments with qualitative data gathering methods. A total of 500 survivors of childhood cancer aged 9 to 18 years with ≥1 year after treatment completion will be recruited in follow-up care clinics in Norway, Denmark, Finland, Germany, and Switzerland. All participants will participate in WP 1, of which approximately 150, 40, and 30 will be recruited to WP 2, WP3, and WP 4, respectively. The reference material for WP 1 is available from existing studies, whereas WP 2 will recruit healthy controls. PA levels will be measured using ActiGraph accelerometers and self-reports. Validated questionnaires will be used to assess health behaviors, fatigue, and quality of life. Physical fitness will be measured by a cardiopulmonary exercise test, isometric muscle strength tests, and muscle power and endurance tests. Limiting factors will be identified via neurological, pulmonary, and cardiac evaluations and the assessment of body composition and muscle size. Semistructured, qualitative interviews, analyzed using systematic text condensation, will identify the perceived barriers to and facilitators of PA for survivors of childhood cancer. In WP 4, we will evaluate the feasibility of a 6-month personalized PA intervention with the involvement of local structures. Results: Ethical approvals have been secured at all participating sites (Norwegian Regional Committee for Medical Research Ethics [2016/953 and 2018/739]; the Oslo University Hospital Data Protection Officer; equivalent institutions in Finland, Denmark [file H-19032270], Germany, and Switzerland [Ethics Committee of Northwestern and Central Switzerland, project ID: 2019-00410]). Data collection for WP 1 to 3 is complete. This will be completed by July 2022 for WP 4. Several publications are already in preparation, and 2 have been published. Conclusions: The PACCS study will generate high-quality knowledge that will contribute to the development of an evidence-based PA intervention for young survivors of childhood cancer to improve their long-term care and health. We will identify physiological, psychological, and social barriers to PA that can be targeted in interventions with immediate benefits for young survivors of childhood cancer in need of rehabilitation. International Registered Report Identifier (IRRID): DERR1-10.2196/35838 %M 35258456 %R 10.2196/35838 %U https://www.researchprotocols.org/2022/3/e35838 %U https://doi.org/10.2196/35838 %U http://www.ncbi.nlm.nih.gov/pubmed/35258456 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e31395 %T The Effectiveness of Virtual Reality–Based Interventions in Rehabilitation Management of Breast Cancer Survivors: Systematic Review and Meta-analysis %A Bu,Xiaofan %A Ng,Peter H F %A Xu,Wenjing %A Cheng,Qinqin %A Chen,Peter Q %A Cheng,Andy S K %A Liu,Xiangyu %+ Department of Health Service Center, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Number 283, Tongzi Road, Changsha, 410013, China, 86 18674869736, 979596459@qq.com %K virtual reality %K rehabilitation management %K symptom %K motor function %K systematic review %K meta-analysis %D 2022 %7 28.2.2022 %9 Review %J JMIR Serious Games %G English %X Background: Breast cancer survivors (BCSs) can present with various physical and psychological symptoms and functional deficits that impact their quality of life. Virtual reality (VR) technology is being used in breast cancer rehabilitation management to improve the emotional, cognitive, and physical well-being of BCSs. Objective: This systematic review aimed to examine the effectiveness of VR-based interventions on health-related outcomes in BCSs. A meta-analysis was conducted to evaluate the effectiveness of VR-based interventions in the rehabilitation management of BCSs. Methods: A systematic search was conducted on PubMed, Web of Science, EMBASE, CINAHL with Full Text, the Cochrane Central Register of Controlled Trials, CNKI, WanFang, VIP, and CBM, from inception to May 25, 2021. The inclusion criteria of the selected studies were as follows: (1) adults diagnosed with breast cancer; (2) any type of VR-based interventions (immersive and nonimmersive virtual environment); (3) comparison of traditional rehabilitation methods; (4) outcomes including pain, depression, anxiety, fatigue, cognitive function, shoulder range of motion (ROM), hand grip strength, lymphedema, cybersickness symptoms, fear of movement, bleeding, effusion, and flap necrosis, both during and after treatment; and (5) randomized controlled trials (RCTs), case-controlled trials, and quasi-experimental studies. The Cochrane Collaboration Tool was used to evaluate the risk of bias. Review Manager version 5.3 (Cochrane Collaboration) was used to conduct the meta-analysis. The mean difference (MD) and SDs with 95% CIs were used to calculate continuous variables. Results: Twelve articles were included in this systematic review, of which 10 contributed information to the meta-analysis. A total of 604 participants were analyzed. The statistical analysis showed significant results for flexion (standard mean difference [SMD] 1.79; 95% CI 0.55 to 3.03; P=.005), extension (SMD 1.54; 95% CI 0.83 to 2.25; P<.001), abduction (MD 17.53; 95% CI 14.33 to 20.72; P<.001), adduction (MD 15.98; 95% CI 14.02 to 17.94; P<.001), internal rotation (MD 7.12; 95% CI 5.54 to 8.70; P<.001), external rotation (SMD 0.96; 95% CI 0.62 to 1.29; P<.001), anxiety (MD −6.47; 95% CI −7.21 to −5.73; P<.001), depression (MD −4.27; 95% CI −4.64 to −3.91; P<.001), pain (MD −1.32; 95% CI −2.56 to −0.09; P=.04), and cognitive function (MD 8.80; 95% CI 8.24 to 9.36; P<.001). The meta-analysis indicated little to no difference in hand grip strength (MD 1.96; 95% CI –0.93 to 4.85; P=.18). Conclusions: Findings of this review noted a weak but consistent positive association between VR-based interventions and outcomes. However, these results must be interpreted with caution due to the limited number of controlled trials analyzed, small sample sizes, and poor methodological quality. Well‐designed, large, high‐quality trials may have a significant impact on our confidence in the results. Future studies should identify specific aspects that improve the clinical impact of VR-based interventions on major outcomes in BCSs in the clinical setting. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021250727; https://tinyurl.com/2p89rmnk %M 35225817 %R 10.2196/31395 %U https://games.jmir.org/2022/1/e31395 %U https://doi.org/10.2196/31395 %U http://www.ncbi.nlm.nih.gov/pubmed/35225817 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e31756 %T Evaluation of the Pathways for Survivors Program to Address Breast Cancer Survivorship–Associated Distress: Survey Study %A Umashankar,Saumya %A Mamounas,Matina Elise %A Matthys,Madeline %A Hadeler,Edward Kenji %A Wong,Emily Claire %A Hicks,Greg %A Hwang,Jimmy %A Chien,Amy Jo %A Rugo,Hope S %A Hamolsky,Deborah %A Esserman,Laura %A Melisko,Michelle %+ Department of Medicine, University of California San Francisco, 1825 4th St, San Francisco, CA, 94158, United States, 1 4153537070, michelle.melisko@ucsf.edu %K breast cancer %K depression %K anxiety %K quality of life %K breast cancer survivors %K cancer survivorship %K mental health %K psychological health %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients with breast cancer frequently experience escalation of anxiety after completing curative treatment. Objective: This study evaluated the acceptability and psychological impact of a 1-day workshop to emphasize behavioral strategies involving intention and self-efficacy. Methods: Breast cancer survivors who attended a 1-day Pathways for Survivors workshop provided feedback and completed electronic quality of life (QOL) questionnaires at baseline, 1 and 6 weeks, and 6 months after the workshop. Attendees’ baseline QOL scores were compared to follow-up (FUP) scores. Scores from patients receiving routine FUP care were also compiled as a reference population. Results: In total, 77 patients attended 1 of 9 workshops. The mean satisfaction score was 9.7 out of 10 for the workshop and 9.96 out of 10 for the moderator. Participants’ baseline mean Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression scores were 57.8 (SD 6.9) and 55.3 (SD 7.5), respectively, which were significantly higher than those of patients receiving routine FUP care (49.1, SD 8.3 and 47.3 SD 8.0, respectively). PROMIS anxiety and depression scores decreased, and the Happiness Index Profile (HIP-10) score—measuring intention and resiliency—increased significantly at 1- and 6-week FUPs. Conclusions: The Pathways for Survivors program was favorably received. Anxiety and depression decreased significantly at 1- and 6-weeks after the workshop and remained below baseline at 6 months. Increased HIP-10 scores suggest that patients acquired and implemented skills from the workshop. A 1-day workshop led by a lay moderator significantly improved several psychological measures, suggesting that it may be a useful and time-efficient strategy to improve QOL in breast cancer survivors. We are investigating whether an abbreviated “booster” of the intervention at a later date could further improve and maintain QOL gains. %M 35212641 %R 10.2196/31756 %U https://cancer.jmir.org/2022/1/e31756 %U https://doi.org/10.2196/31756 %U http://www.ncbi.nlm.nih.gov/pubmed/35212641 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e33083 %T Health Promotion Among Mexican-Origin Survivors of Breast Cancer and Caregivers Living in the United States–Mexico Border Region: Qualitative Analysis From the Vida Plena Study %A Skiba,Meghan B %A Lopez-Pentecost,Melissa %A Werts,Samantha J %A Ingram,Maia %A Vogel,Rosi M %A Enriquez,Tatiana %A Garcia,Lizzie %A Thomson,Cynthia A %+ Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1294 N. Martin Ave, Tucson, AZ, 85719, United States, 1 520 940 1759, cthomson@email.arizona.edu %K Mexican-origin Hispanics %K breast cancer %K survivorship %K caregivers %K border health %K lifestyle %K diet %K physical activity %K health promotion %K mobile phone %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Hispanic survivors of cancer experience increased cancer burden. Lifestyle behaviors, including diet and physical activity, may reduce the cancer burden. There is limited knowledge about the posttreatment lifestyle experiences of Hispanic survivors of cancer living on the United States–Mexico border. Objective: This study aims to support the development of a stakeholder-informed, culturally relevant, evidence-based lifestyle intervention for Mexican-origin Hispanic survivors of cancer living in a border community to improve their dietary quality and physical activity. Methods: Semistructured interviews with 12 Mexican-origin Hispanic survivors of breast cancer and 7 caregivers were conducted through internet-based teleconferencing. The interviews explored the impact of cancer on lifestyle and treatment-related symptoms, perception of lifestyle as an influence on health after cancer, and intervention content and delivery preferences. Interviews were analyzed using a deductive thematic approach grounded in the Quality of Cancer Survivorship Care Framework. Results: Key survivor themes included perception of Mexican diet as unhealthy, need for reliable diet-related information, perceived benefits of physical activity after cancer treatment, family support for healthy lifestyles (physical and emotional), presence of cancer-related symptoms interfering with lifestyle, and financial barriers to living a healthy lifestyle. Among caregivers, key themes included effects of the cancer caregiving experience on caregivers’ lifestyle and cancer-preventive behaviors and gratification in providing support to the survivors. Conclusions: The interviews revealed key considerations to the adaptation, development, and implementation of a theory-informed, evidence-based, culturally relevant lifestyle program to support lifestyle behavior change among Mexican-origin Hispanic survivors of cancer living in border communities. Our qualitative findings highlight specific strategies that can be implemented in health promotion programming aimed at encouraging cancer protective behaviors to reduce the burden of cancer and comorbidities in Mexican-origin survivors of cancer living in border communities. %M 35200150 %R 10.2196/33083 %U https://cancer.jmir.org/2022/1/e33083 %U https://doi.org/10.2196/33083 %U http://www.ncbi.nlm.nih.gov/pubmed/35200150 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30974 %T Web-Based Lifestyle Interventions for Survivors of Cancer: Usability Study %A Williams,Victoria %A Brown,Nashira %A Moore,Justin Xavier %A Farrell,David %A Perumean-Chaney,Suzanne %A Schleicher,Erica %A Fontaine,Kevin %A Demark-Wahnefried,Wendy %A Pekmezi,Dori %+ Department of Health Behavior, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL, 35233, United States, 1 205 934 4993, contact@drvaw.com %K cancer survivors %K diet %K exercise %K lifestyle %K internet %K physical activity %K web-based %K website %K weight management %K digital health %K cancer %K online health %D 2022 %7 21.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-based lifestyle programs are increasingly being used to deliver health behavior change interventions to survivors of cancer. However, little is known about website use in this population or its association with healthy lifestyle changes. Objective: The aim of this study is to describe lifestyle intervention website use (log-ins, time on website, and page views) among survivors of cancer and patterns of use by participant characteristics. In addition, associations were explored between website use and changes in healthy lifestyle knowledge and practice. Methods: A total of 35 survivors of cancer were recruited between August 2017 and 2018 to participate in a 2-week, single-arm pilot test of the SurvivorSHINE lifestyle intervention website. Knowledge and practices related to healthy diet and physical activity behaviors were measured at baseline and follow-up. Website use (eg, time spent on the website, frequency of log-ins, and page views) were collected from the SurvivorSHINE administrative site during the intervention period. Patterns of use were examined by participants’ gender and race. Correlations between website use and changes in healthy lifestyle knowledge, physical activity, diet, and weight were explored. Mann–Whitney U tests were used to compare demographic factors on website use. Results: Participants logged into the SurvivorSHINE intervention website an average of 3.2 (SD 2) times over the 2-week period and spent a total average of 94 (SD 56) minutes viewing the website during the intervention. Examining website activity, 1905 page views were logged. The User Profile (344 page views) and Home sections (301 page views) were the most frequently visited components. No associations were observed between the frequency of log-ins or the total time on the website, improvements in knowledge related to healthy lifestyles, or changes in body weight or dietary intake. However, the total time on the website was positively correlated with improvements in accelerometer-measured physical activity (r=0.74; P=.02) and self-reported physical activity (r=0.35; P=.04). Conclusions: Survivors of cancer demonstrated clear interest in a diet and exercise intervention website, as evidenced by their frequency of log-ins, page views on numerous features, and total viewing time. Moreover, increased website use was correlated with improvements in physical activity. %M 35188468 %R 10.2196/30974 %U https://formative.jmir.org/2022/2/e30974 %U https://doi.org/10.2196/30974 %U http://www.ncbi.nlm.nih.gov/pubmed/35188468 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e27898 %T Cardiovascular Health Status And Genetic Risk In Survivors of Childhood Neuroblastoma and Nephroblastoma Treated With Doxorubicin: Protocol of the Pharmacogenetic Part of the LESS-Anthra Cross-Sectional Cohort Study %A Zolk,Oliver %A von dem Knesebeck,Annika %A Graf,Norbert %A Simon,Thorsten %A Hero,Barbara %A Abdul-Khaliq,Hashim %A Abd El Rahman,Mohamed %A Spix,Claudia %A Mayer,Benjamin %A Elsner,Susanne %A Gebauer,Judith %A Langer,Thorsten %+ Institute of Clinical Pharmacology, Brandenburg Medical School (Theodor Fontane), Immanuel Klinik Rüdersdorf, Seebad 82/83, Rüdersdorf, 15562, Germany, 49 33638 8 ext 3991, oliver.zolk@MHB-fontane.de %K cardiotoxicity %K anthracyclines %K childhood cancer survivors %K genetics %K polymorphisms %K cardiology %K cardiac health %K cancer %K survivors %K childhood %K children %K risk monitoring %K genetics %K cardiovascular health %K pediatrics %D 2022 %7 17.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: In childhood cancer survivors (survival of 5 years or more after diagnosis), cardiac toxicity is the most common nonmalignant cause of death attributed to treatment-related consequences. Identifying patients at risk of developing late cardiac toxicity is therefore crucial to improving treatment outcomes. The use of genetic markers has been proposed, together with clinical risk factors, to predict individual risk of cardiac toxicity from cancer therapies, such as doxorubicin. Objective: The primary aim of this study is to evaluate the value of multimarker genetic testing for RARG rs2229774, UGT1A6 rs17863783, and SLC28A3 rs7853758 for predicting doxorubicin-induced cardiotoxicity. The secondary aim is to replicate previously described associations of candidate genetic markers with doxorubicin-induced cardiotoxicity. Moreover, we will evaluate the prevalence of cardiovascular dysfunction in childhood cancer survivors after neuroblastoma or nephroblastoma. Methods: This is the pharmacogenetic substudy of the research project Structural Optimization for Children With Cancer After Anthracycline Therapy (LESS-Anthra). We invited 2158 survivors of childhood neuroblastoma or nephroblastoma treated with doxorubicin according to the trial protocols of SIOP 9/GPOH, SIOP 93-01/GPOH, SIOP 2001/GPOH, NB 90, NB 97, or NB 2004 to participate in this prospective cross-sectional cohort study. The study participants underwent a cardiological examination and were asked to provide a blood or saliva sample for genotyping. The study participants' health statuses and cardiovascular diagnoses were recorded using a questionnaire completed by the cardiologist. Digital echocardiographic data were centrally evaluated to determine the contractile function parameters. Medical data on the tumor diagnosis and treatment protocol were taken from the study documentation. Survivors were screened for variants of several candidate genes by TaqMan genotyping. Results: This study includes 657 survivors treated with doxorubicin for childhood cancer, the largest German cohort assembled to date to investigate cardiovascular late effects. Data analyses are yet to be completed. Conclusions: This study will define the genetic risk related to 3 marker genes proposed in a pharmacogenetic guideline for risk assessment. Moreover, the results of this study will show the prevalence of cardiovascular dysfunction in survivors of pediatric neuroblastoma or nephroblastoma who were treated with doxorubicin. The results will help to improve primary treatment and follow-up care, thus reducing cardiovascular late effects in the growing population of childhood cancer survivors. Trial Registration: German Clinical Trials Register DRKS00015084; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015084 International Registered Report Identifier (IRRID): DERR1-10.2196/27898 %M 35175211 %R 10.2196/27898 %U https://www.researchprotocols.org/2022/2/e27898 %U https://doi.org/10.2196/27898 %U http://www.ncbi.nlm.nih.gov/pubmed/35175211 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e33550 %T Development and Evaluation of the Usefulness, Usability, and Feasibility of iNNOV Breast Cancer: Mixed Methods Study %A Mendes-Santos,Cristina %A Nunes,Francisco %A Weiderpass,Elisabete %A Santana,Rui %A Andersson,Gerhard %+ Department of Culture and Society, Linköping University, Linköping, 581 83, Sweden, 46 917890798, cristina.mendes.santos@liu.se %K acceptance and commitment therapy %K anxiety %K breast cancer survivors %K cognitive behavioral therapy %K depression %K digital mental health %K e-mental health %K user-centered design %K internet interventions %K usability %K mobile phone %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Despite the efficacy of psychosocial interventions in minimizing psychosocial morbidity in breast cancer survivors (BCSs), intervention delivery across survivorship is limited by physical, organizational, and attitudinal barriers, which contribute to a mental health care treatment gap in cancer settings. Objective: The aim of this study is to develop iNNOV Breast Cancer (iNNOVBC), a guided, internet-delivered, individually tailored, acceptance and commitment therapy–influenced cognitive behavioral intervention program aiming to treat mild to moderate anxiety and depression in BCSs as well as to improve fatigue, insomnia, sexual dysfunction, and health-related quality of life in this group. This study also aims to evaluate the usefulness, usability, and preliminary feasibility of iNNOVBC. Methods: iNNOVBC was developed using a user-centered design approach involving its primary and secondary end users, that is, BCSs (11/24, 46%) and mental health professionals (13/24, 54%). We used mixed methods, namely in-depth semistructured interviews, laboratory-based usability tests, short-term field trials, and surveys, to assess iNNOVBC’s usefulness, usability, and preliminary feasibility among these target users. Descriptive statistics were used to characterize the study sample, evaluate performance data, and assess survey responses. Qualitative data were recorded, transcribed verbatim, and thematically analyzed. Results: Overall, participants considered iNNOVBC highly useful, with most participants reporting on the pertinence of its scope, the digital format, the relevant content, and the appropriate features. However, various usability issues were identified, and participants suggested that the program should be refined by simplifying navigation paths, using a more dynamic color scheme, including more icons and images, displaying information in different formats and versions, and developing smartphone and tablet versions. In addition, participants suggested that tables should be converted into plain textboxes and data visualization dashboards should be included to facilitate the tracking of progress. The possibility of using iNNOVBC in a flexible manner, tailoring it according to BCSs’ changing needs and along the cancer care continuum, was another suggestion that was identified. Conclusions: The study results suggest that iNNOVBC is considered useful by both BCSs and mental health professionals, configuring a promising point-of-need solution to bridge the psychological supportive care gap experienced by BCSs across the survivorship trajectory. We believe that our results may be applicable to other similar programs. However, to fulfill their full supportive role, such programs should be comprehensive, highly usable, and tailorable and must adopt a flexible yet integrated structure capable of evolving in accordance with survivors’ changing needs and the cancer continuum. %M 35166682 %R 10.2196/33550 %U https://cancer.jmir.org/2022/1/e33550 %U https://doi.org/10.2196/33550 %U http://www.ncbi.nlm.nih.gov/pubmed/35166682 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e32291 %T Cruciferous Vegetable Intervention to Reduce the Risk of Cancer Recurrence in Non–Muscle-Invasive Bladder Cancer Survivors: Development Using a Systematic Process %A Yeary,Karen H Kim %A Clark,Nikia %A Saad-Harfouche,Frances %A Erwin,Deborah %A Kuliszewski,Margaret Gates %A Li,Qiang %A McCann,Susan E %A Yu,Han %A Lincourt,Catherine %A Zoellner,Jamie %A Tang,Li %+ Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, United States, 1 716 845 1300 ext 6231, karen.yeary@roswellpark.org %K non–muscle invasive bladder cancer survivors %K dietary intervention %K cruciferous vegetable %K cancer survivorship %K cancer recurrence %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Bladder cancer is one of the top 10 most common cancers in the United States. Most bladder cancers (70%-80%) are diagnosed at early stages as non–muscle-invasive bladder cancer (NMIBC), which can be removed surgically. However, 50% to 80% of NMIBC cases recur within 5 years, and 15% to 30% progress with poor survival. Current treatments are limited and expensive. A wealth of preclinical and epidemiological evidence suggests that dietary isothiocyanates in cruciferous vegetables (Cruciferae) could be a novel, noninvasive, and cost-effective strategy to control NMIBC recurrence and progression. Objective: The aim of this study is to develop a scalable dietary intervention that increases isothiocyanate exposure through Cruciferae intake in NMIBC survivors. Methods: We worked with a community advisory board (N=8) to identify relevant factors, evidence-based behavior change techniques, and behavioral theory constructs used to increase Cruciferae intake in NMIBC survivors; use the PEN-3 Model focused on incorporating cultural factors salient to the group’s shared experiences to review the intervention components (eg, the saliency of behavioral messages); administer the revised intervention to community partners for their feedback; and refine the intervention. Results: We developed a multicomponent intervention for NMIBC survivors consisting of a magazine, tracking book, live telephone call script, and interactive voice messages. Entitled POW-R Health: Power to Redefine Your Health, the intervention incorporated findings from our adaptation process to ensure saliency to NMIBC survivors. Conclusions: This is the first evidence-based, theoretically grounded dietary intervention developed to reduce bladder cancer recurrence in NMIBC survivors using a systematic process for community adaptation. This study provides a model for others who aim to develop behavioral, community-relevant interventions for cancer prevention and control with the overall goal of wide-scale implementation and dissemination. %M 35166681 %R 10.2196/32291 %U https://cancer.jmir.org/2022/1/e32291 %U https://doi.org/10.2196/32291 %U http://www.ncbi.nlm.nih.gov/pubmed/35166681 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e32309 %T Web-Based Research Trends on Child and Adolescent Cancer Survivors Over the Last 5 Years: Text Network Analysis and Topic Modeling Study %A Kim,Hyun-Yong %A Kang,Kyung-Ah %A Han,Suk-Jung %A Chun,Jiyoung %+ College of Nursing, Sahmyook University, 815, Hwarang-ro, Nowon-gu, Seoul, 01795, Republic of Korea, 82 10 4709 4731, kangka@syu.ac.kr %K text network analysis %K topic modeling %K cancer survivors %K child %K adolescent %K research trends %K knowledge structures %D 2022 %7 1.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Being diagnosed with cancer during childhood or adolescence can disrupt important periods in an individual’s physical, psychosocial, and spiritual development and potentially reduce the quality of life (QOL) after treatment. Research is urgently required to improve the QOL for child and adolescent cancer survivors, and it is necessary to analyze the trends in prior research reported in international academic journals to identify knowledge structures. Objective: This study aims to identify the main keywords based on network centrality, subgroups (clusters) of keyword networks by using a cohesion analysis method, and the main theme of child and adolescent cancer survivor–related research abstracts through topic modeling. This study also aims to label the subgroups by comparing the results of the cohesion and topic modeling. Methods: A text network analysis method and topic modeling were used to explore the main trends in child and adolescent cancer survivor research by structuring a network of keyword (semantic morphemes) co-occurrence in the abstracts of articles published in 5 major web-based databases from 2016 to 2020. A total of 1677 child and adolescent cancer survivor–related studies were used for data analyses. Data selection, processing, and analyses were also conducted. Results: The top 5 keywords in terms of degree and eigenvector centrality were risk, control interval, radiation, childhood cancer treatment, and diagnosis. Of the 1677 studies used for data analyses, cluster 1 included 780 (46.51%) documents under risk management, cluster 2 contained 557 (33.21%) articles under health-related QOL and supportive care, and cluster 3 consisted of 340 (20.27%) studies under cancer treatment and complications. Conclusions: This study is significant in that it confirms the knowledge structure based on the main keywords and cross-disciplinary trends in child and adolescent cancer survivor research published in the last 5 years worldwide. The primary goal of child and adolescent cancer survivor research is to prevent and manage the various aspects of the problems encountered during the transition to a normal life and to improve the overall QOL. To this end, it is necessary to further revitalize the study of the multidisciplinary team approach for the promotion of age-specific health behaviors and the development of intervention strategies with increased feasibility for child and adolescent cancer survivors. %M 35103615 %R 10.2196/32309 %U https://www.jmir.org/2022/2/e32309 %U https://doi.org/10.2196/32309 %U http://www.ncbi.nlm.nih.gov/pubmed/35103615 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30095 %T Effectiveness, Cost-effectiveness, and Cost-Utility of a Digital Alcohol Moderation Intervention for Cancer Survivors: Health Economic Evaluation and Outcomes of a Pragmatic Randomized Controlled Trial %A Mujcic,Ajla %A Blankers,Matthijs %A Boon,Brigitte %A Berman,Anne H %A Riper,Heleen %A van Laar,Margriet %A Engels,Rutger %+ Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, Netherlands, 31 30 29 59 256, amujcic@trimbos.nl %K alcohol %K brief interventions %K cancer survivors %K effectiveness %K cost-effectiveness %K eHealth %K mobile phone %D 2022 %7 1.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol moderation (AM) interventions may contribute to better treatment outcomes and the general well-being of cancer survivors. Objective: This study evaluates the effectiveness, cost-effectiveness, and cost-utility of MyCourse, a digital AM intervention, compared with a noninteractive digital information brochure for cancer survivors. Methods: A health economic evaluation alongside a pragmatic 2-arm parallel-group randomized controlled trial was conducted with follow-ups at 3, 6, and 12 months after randomization. The study was conducted on the web in the Netherlands from 2016 to 2019. Participants were adult 10-year cancer survivors drinking over the Dutch-recommended drinking guidelines (≤7 standard units [10 g of alcohol] per week) with the intention to moderate or quit drinking. Overall, 103 participants were randomized and analyzed: 53 (51.5%) in the MyCourse group and 50 (48.5%) in the control group. In the MyCourse group, participants had access to a newly developed, digital, minimally guided AM intervention, MyCourse–Moderate Drinking. The primary outcome was the self-reported number of standard drinks (10 g of ethanol) consumed in the past 7 days at the 6-month follow-up. The secondary outcome measures were alcohol-related problems as measured by the Alcohol Use Disorders Identification Test (AUDIT) and treatment satisfaction. For the health economic evaluation, health care costs, costs because of productivity losses, and intervention costs were assessed over a 12-month horizon. Results: Alcohol use at the 6-month follow-up decreased by 38% in the MyCourse group and by 33% in the control group. No difference in 7-day alcohol use was found between the groups (B=2.1, 95% CI −7.6 to 3.1; P=.22) at any of the follow-ups. AUDIT scores for alcohol-related problems decreased over time in both groups, showing no significant difference between the groups (Cohen d=0.3, 95% CI −0.1 to 0.6; P=.21). Intervention costs per participant were estimated at US $279 for the MyCourse group and US $74 for the control group. The mean societal costs were US $18,092 (SD 25,662) and US $23,496 (SD 34,327), respectively. The MyCourse group led to fewer gained quality-adjusted life years at lower societal costs in the cost-utility analysis. In the cost-effectiveness analysis, the MyCourse group led to a larger reduction in drinking units over time at lower societal costs (incremental cost-effectiveness ratio per reduced drink: US $ −1158, 95% CI −1609 to −781). Conclusions: At 6 months, alcohol use was reduced by approximately one-third in both groups, with no significant differences between the digital intervention MyCourse and a noninteractive web-based brochure. At 12 months, cost-effectiveness analyses showed that MyCourse led to a larger reduction in drinking units over time, at lower societal costs. The MyCourse group led to marginally fewer gained quality-adjusted life years, also at lower societal costs. Trial Registration: Netherlands Trial Register NTR6010; https://www.trialregister.nl/trial/5433 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-018-4206-z %M 35103605 %R 10.2196/30095 %U https://www.jmir.org/2022/2/e30095 %U https://doi.org/10.2196/30095 %U http://www.ncbi.nlm.nih.gov/pubmed/35103605 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e31255 %T The Use of Telemedicine in Cancer Clinical Trials: Connect-Patient-to-Doctor Prospective Study %A Meghiref,Yasmine %A Parnot,Charles %A Duverger,Claire %A Difoum,Françoise Lilly %A Gourden,Audrey %A Yssaad,Halima %A Leiterer,Caroline %A Bedekovic,Caroline %A Blanchard,Julien %A Nait Ammar,Houria %A Schernberg,Antoine %A Vanquaethem,Hélène %A Helissey,Carole %+ Bégin Military Teaching Hospital, 69 avenue de Paris, Saint-Mandé, France, 33 143985319, carole.helissey@gmail.com %K telemedicine %K clinical trial %K neoplasms %K patient-reported outcome measures %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Telemedicine is currently being adopted for the management of patients in routine care. However, its use remains limited in the context of clinical trials. Objective: This study aimed to demonstrate the feasibility of telemonitoring and patient-reported outcomes collection in the context of clinical trials. Methods: The patients who were included in an interventional oncology clinical trial were eligible. The patients were registered with a digital tool to respond to a patient-reported outcomes questionnaire (ePRO) based on CTCAE (The Common Terminology Criteria for Adverse Events, National Cancer Institute), version 5.0, personalized to their pathology and treatment. An algorithm evaluated the health status of the patient based on the reported adverse events, with a classification in 4 different states (correct, compromise, state to be monitored, or critical state). The main objective was to evaluate the feasibility of remote monitoring via a connected platform of patients included in a clinical trial. Results: From July 1, 2020, to March 31, 2021, 39 patients were included. The median age was 71 years (range 41-94); 74% (n=29) were male, and 59% (n=23) had metastatic disease. Out of the 969 ePRO questionnaires completed over the course of the study, 77.0% (n=746) were classified as “correct,” 10.9% (n=106) as “compromised,” and 12.1% (n=117) as “to be monitored” or “critical.” The median response time was 7 days (IQR 7-15.5), and 76% (25/33) of the patients were compliant. Out of the 35 patients who answered a satisfaction questionnaire, 95% (n=33) were satisfied or very satisfied with the tool, and 85% (n=30) were satisfied with their relationship with the health care team. There were 5 unscheduled hospitalizations during the study period. Conclusions: Remote monitoring in clinical trials is feasible, with a high level of patient participation and satisfaction. It benefits patients, but it also ensures the high quality of the trial through the early management of adverse events and better knowledge of the tolerance profile of experimental treatments. This e-technology will likely be deployed more widely in our clinical trials. %M 34921544 %R 10.2196/31255 %U https://cancer.jmir.org/2022/1/e31255 %U https://doi.org/10.2196/31255 %U http://www.ncbi.nlm.nih.gov/pubmed/34921544 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e34033 %T Randomized Waitlist-Control Trial of a Web-Based Stress-Management and Resiliency Program for Adolescent and Young Adult Cancer Survivors: Protocol for the Bounce Back Study %A Mizrach,Helen %A Goshe,Brett %A Park,Elyse R %A Recklitis,Christopher %A Greer,Joseph A %A Chang,Yuchiao %A Frederick,Natasha %A Abrams,Annah %A Tower,Mary D %A Walsh,Emily A %A Huang,Mary %A Kenney,Lisa %A Homans,Alan %A Miller,Karen %A Denninger,John %A Usmani,Ghazala Naheed %A Peppercorn,Jeffrey %A Perez,Giselle K %+ Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States, 1 9084992113, hmizrach@mgh.harvard.edu %K cancer survivorship %K adolescent and young adult (AYA) %K resiliency %K stress management %K coping %D 2022 %7 26.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The emotional health of adolescent and young adult (AYA) cancer survivors is compromised both during and after cancer treatment. Targeted programs designed to support AYAs’ ability to cope with stress in the years following treatment completion are lacking. Mind-body programs may ameliorate the negative psychological and emotional effects of stress and assist AYAs with managing the psychosocial challenges of early survivorship. Objective: Our randomized waitlist-control trial aims to assess the feasibility, acceptability, and preliminary efficacy of a virtual group program (Bounce Back) to promote stress management and resiliency among posttreatment AYAs. Methods: Bounce Back is a stress management and resiliency program delivered via videoconference by a trained mental health clinician. Sessions were adapted from an evidence-based mind-body program (Stress Management and Resiliency Training - Relaxation Response Resiliency Program [SMART-3RP]) grounded in relaxation response elicitation, mindfulness, cognitive behavioral therapy, and positive psychology. Seventy-two AYAs (diagnosed with cancer between ages 14 years and 29 years and had completed cancer treatment within the last 5 years) were randomly assigned to the Bounce Back program or waitlist-control group and completed assessments at baseline, 3 months postbaseline, and 6 months postbaseline. The primary aim of the study is to determine the feasibility and acceptability of the Bounce Back program. Descriptive statistics, including means, frequencies, and ranges supplemented by qualitative exit interview feedback will be used to characterize the sample and to summarize feasibility and acceptability. The exploratory aims are to evaluate the preliminary effects of the program on stress coping and psychosocial outcome measures (ie, anxiety, depression) collected across the 3 time points. Results: This study was funded by the National Cancer Institute in July 2017. Study procedures were approved by the Dana-Farber Harvard Cancer Center Institutional Review Board in October 2018 (Protocol 18-428). The randomized trial was conducted from July 2019 to March 2021. Quantitative data collection is complete, and qualitative exit interview data collection is ongoing. Results are expected to be published in peer-reviewed journals and presented at local, national, or international meetings in the coming years. Conclusions: Few evidence-based programs exist that tackle the key transitional issues faced by AYA cancer survivors. Future analyses will help us determine the feasibility and acceptability of the Bounce Back program and its impact on AYA stress coping and psychological well-being. Trial Registration: ClinicalTrials.gov NCT03768336; https://clinicaltrials.gov/ct2/show/NCT03768336 International Registered Report Identifier (IRRID): DERR1-10.2196/34033 %M 35080500 %R 10.2196/34033 %U https://www.researchprotocols.org/2022/1/e34033 %U https://doi.org/10.2196/34033 %U http://www.ncbi.nlm.nih.gov/pubmed/35080500 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e34616 %T Telehealth Availability and Use of Related Technologies Among Medicare-Enrolled Cancer Survivors: Cross-sectional Findings From the Onset of the COVID-19 Pandemic %A Lama,Yuki %A Davidoff,Amy J %A Vanderpool,Robin C %A Jensen,Roxanne E %+ Outcomes Research Branch, Healthcare Delivery Research Program, National Cancer Institute, 9609 Medical Center Drive, Bethesda, MD, 20892-9761, United States, 1 240 276 7588, roxanne.jensen@nih.gov %K cancer survivor %K Medicare %K telehealth %K COVID-19 %K availability %K use %K elderly %K older adults %K cancer %K sociodemographic %K internet %K communication %K population %K access %D 2022 %7 25.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: There has been rapid integration of telehealth into care delivery during the COVID-19 pandemic. However, little is known about technology ownership, internet access and use for communication, and telehealth availability among cancer survivors, particularly those enrolled in Medicare. Objective: This study aims to identify sociodemographic associations with technology ownership, internet access and use for communication, and telehealth availability in a population-based sample of Medicare-enrolled cancer survivors. Methods: Data are from the Medicare Current Beneficiary Survey COVID-19 Summer 2020 Supplement administered between June 10 and July 15, 2020. Analyses were restricted to beneficiaries who reported a prior (nonskin) cancer diagnosis and a usual source of care (N=2044). Dichotomous outcomes included technology ownership, internet access, internet use for communication, and telehealth availability from providers. Sociodemographic correlates included sex, age, race/ethnicity, Medicare/Medicaid dual enrollment, rurality, census region, and self-reported comorbidities. Results: Over half (957/2044, 53%) of cancer survivors reported using the internet for communication purposes, and 62% (1218/2044) reported that their usual provider had telehealth services available. Using the internet for communication purposes was reported less frequently for rural compared to urban survivors (adjusted probability of 28% vs 46%; P<.001) and for Hispanic and Black survivors compared to non-Hispanic White survivors (29%, 31%, and 44%, respectively; all P<.01). Rural survivors reported lower telehealth availability (53% vs 63%; P<.001); no significant differences in telehealth availability were identified by race/ethnicity. Conclusions: During the COVID-19 pandemic, study findings highlight a complex digital divide among Medicare beneficiaries with a history of cancer related to device ownership necessary for telehealth, internet access and use for communication, and reports of providers having telehealth available. Multilevel approaches are needed to increase equitable telehealth availability and use for cancer survivors. Suggested strategies include increasing broadband internet access to providers and patients in at-risk communities, supporting telehealth implementation among providers that serve populations with known health disparities, raising awareness of providers’ available telehealth services among patients, and screening for technology use and provision of telehealth-related technical assistance among older and historically underserved cancer survivors. %M 34978531 %R 10.2196/34616 %U https://www.jmir.org/2022/1/e34616 %U https://doi.org/10.2196/34616 %U http://www.ncbi.nlm.nih.gov/pubmed/34978531 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e16447 %T Uses of Personal Health Records for Communication Among Colorectal Cancer Survivors, Caregivers, and Providers: Interview and Observational Study in a Human-Computer Interaction Laboratory %A Haggstrom,David A %A Carr,Thomas %+ VA HSR&D Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, 1481 West 10th Street, Indianapolis, IN, 46202, United States, 1 317 274 9304, dahaggst@iupui.edu %K personal health record %K communication %K cancer survivorship %K colorectal cancer %D 2022 %7 25.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Personal health records (PHRs) may be useful for patient self-management and participation in communication with their caregivers and health care providers. As each potential participant’s role is different, their perception of the best uses of a PHR may vary. Objective: The perspectives of patients, caregivers, and providers were all evaluated concurrently in relation to a PHR developed for colorectal cancer (CRC) survivors. Methods: We explored group perceptions of a CRC PHR prototype. Scenario-based testing across eight use cases, with semistructured follow-up interviews, was videotaped in a human-computer interaction laboratory with patients, caregivers, and health care providers. Providers included oncologists, gastroenterologists, and primary care physicians. Discrete observations underwent grounded theory visual affinity analysis to identify emergent themes. Results: Observations fell into three major themes: the network (who should be granted access to the PHR by the patient), functions (helpful activities the PHR enabled), and implementation (how to adopt the PHR into workflow). Patients wanted physician access to their PHR, as well as family member access, especially when they lived at a distance. All groups noted the added value of linking the PHR to an electronic health record, self-tracking, self-management, and secure messaging. Patients and caregivers also saw information in the PHR as a useful memory tool given their visits to multiple doctors. Providers had reservations about patients viewing raw data, which they were not prepared to interpret or might be inaccurate; patients and caregivers did not express any reservations about having access to more information. Patients saw PHR communication functions as a potential tool for relationship building. Patients and caregivers valued the journal as a tool for reflection and delivery of emotional support. Providers felt the PHR would facilitate patient-physician communication but worried that sharing journal access would make the doctor-patient relationship less professional and had reservations about the time burden of reviewing. Strategies suggested for efficient adoption into workflow included team delegation. Establishment of parameters for patient uses and provider responses was perceived as good standard practice. Conclusions: PHR perceptions differed by role, with providers seeing the PHR as informational, while patients and caregivers viewed the tool as more relational. Personal health records should be linked to electronic health records for ease of use. Tailoring access, content, and implementation of the PHR is essential. Technology changes have the potential to change the nature of the patient-physician relationship. Patients and providers should establish shared expectations about the optimal use of the PHR and explore how emerging patient-centered technologies can be successfully implemented in modern medical practice to improve the relational quality of care. %M 35076406 %R 10.2196/16447 %U https://humanfactors.jmir.org/2022/1/e16447 %U https://doi.org/10.2196/16447 %U http://www.ncbi.nlm.nih.gov/pubmed/35076406 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e29485 %T A Web- and Mobile-Based Intervention for Women Treated for Breast Cancer to Manage Chronic Pain and Symptoms Related to Lymphedema: Results of a Randomized Clinical Trial %A Fu,Mei Rosemary %A Axelrod,Deborah %A Guth,Amber A %A Scagliola,Joan %A Rampertaap,Kavita %A El-Shammaa,Nardin %A Qiu,Jeanna M %A McTernan,Melissa L %A Frye,Laura %A Park,Christopher S %A Yu,Gary %A Tilley,Charles %A Wang,Yao %+ School of Nursing-Camden, Rutgers University, 530 Federal Street, Camden, NJ, 08102, United States, 1 9739861758, mei.r.fu@rutgers.edu %K pain %K lymphatic exercises %K symptoms %K lymphedema %K breast cancer %K health behavior %K mHealth %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: The-Optimal-Lymph-Flow (TOLF) is a patient-centered, web- and mobile-based mHealth system that delivers safe, easy, and feasible digital therapy of lymphatic exercises and limb mobility exercises. Objective: The purpose of this randomized clinical trial (RCT) was to evaluate the effectiveness of the web- and mobile-based TOLF system for managing chronic pain and symptoms related to lymphedema. The primary outcome includes pain reduction, and the secondary outcomes focus on symptom relief, limb volume difference measured by infrared perometer, BMI, and quality of life (QOL) related to pain. We hypothesized that participants in the intervention group would have improved pain and symptom experiences, limb volume difference, BMI, and QOL. Methods: A parallel RCT with a control–experimental, pre- and posttest, and repeated-measures design were used. A total of 120 patients were recruited face-to-face at the point of care during clinical visits. Patients were randomized according to pain in a 1:1 ratio into either the arm precaution (AP) control group to improve limb mobility and arm protection or The-Optimal-Lymph flow (TOLF) intervention group to promote lymph flow and limb mobility. Trial outcomes were evaluated at baseline and at week 12 after the intervention. Descriptive statistics, Fisher exact tests, Wilcoxon rank-sum tests, t test, and generalized linear mixed effects models were performed for data analysis. Results: At the study endpoint of 12 weeks, significantly fewer patients in the TOLF intervention group compared with the AP control group reported chronic pain (45% [27/60] vs 70% [42/60]; odds ratio [OR] 0.39, 95% CI 0.17-0.90; P=.02). Patients who received the TOLF intervention were significantly more likely to achieve a complete reduction in pain (50% [23/46] vs 22% [11/51]; OR 3.56, 95% CI 1.39-9.76; P=.005) and soreness (43% [21/49] vs 22% [11/51]; OR 2.60, 95% CI 1.03-6.81; P=.03). Significantly lower median severity scores were found in the TOLF group for chronic pain (MedTOLF=0, IQR 0-1 vs MedAP=1, IQR 0-2; P=.02) and general bodily pain (MedTOLF=1, IQR=0-1.5 vs MedAP=1, IQR 1-3; P=.04). Compared with the AP control group, significantly fewer patients in the TOLF group reported arm/hand swelling (P=.04), heaviness (P=.03), redness (P=.03), and limited movement in shoulder (P=.02) and arm (P=.03). No significant differences between the TOLF and AP groups were found in complete reduction of aching (P=.12) and tenderness (P=.65), mean numbers of lymphedema symptom reported (P=.11), ≥5% limb volume differences (P=.48), and BMI (P=.12). Conclusions: The TOLF intervention had significant benefits for breast cancer survivors to manage chronic pain, soreness, general bodily pain, arm/hand swelling, heaviness, and impaired limb mobility. The intervention resulted in a 13% reduction (from 40% [24/60] to 27% [16/60]) in proportions of patients who took pain medications compared with the AP control group, which had a 5% increase (from 40% [24/60] to 45% [27/60]). A 12% reduction (from 27% [16/60] to 15% [9/60]) in proportions of patients with ≥5% limb volume differences was found in the TOLF intervention, while a 5% increase in the AP control group (from 40% [24/60] to 45% [27/60]) was found. In conclusion, the TOLF intervention can be a better choice for breast cancer survivors to reduce chronic pain and limb volume. Trial Registration: Clinicaltrials.gov NCT02462226; https://clinicaltrials.gov/ct2/show/NCT02462226 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.5104 %M 35037883 %R 10.2196/29485 %U https://cancer.jmir.org/2022/1/e29485 %U https://doi.org/10.2196/29485 %U http://www.ncbi.nlm.nih.gov/pubmed/35037883 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32458 %T Leveraging a Consumer-Based Product to Develop a Cancer-Specific Mobile Meditation App: Prototype Development Study %A Huberty,Jennifer %A Bhuiyan,Nishat %A Neher,Taylor %A Joeman,Lynda %A Mesa,Ruben %A Larkey,Linda %+ College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, United States, 1 480 406 2644, nbhuiyan@asu.edu %K cancer patients/survivors %K meditation %K mHealth %K app development %K qualitative research %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile meditation apps may offer a long-term, accessible, and effective solution for ongoing symptom management in cancer patients/survivors. However, there are currently no commercial cancer-specific meditation apps that reflect cancer specialist expertise, input from cancer patients/survivors, and features and content specific to cancer patients’/survivors’ needs. Objective: The aim of this study was to gain insight (via surveys, daily journals, and focus groups) from cancer patients/survivors, health care providers, and current subscribers of Calm (a consumer-based mobile meditation app) who were patients/survivors to develop a prototype of a mobile meditation app specifically designed for cancer patients/survivors. Methods: Participants were recruited via prior partnerships, word-of-mouth referrals, and recruitment posts on Facebook and Instagram. Cancer patients/survivors and health care providers were instructed to download and use the Calm app for at least 10 minutes a day for 7 days, complete an online daily journal for 7 days, and participate in a virtual focus group (one for cancer patients/survivors and one for providers). Current Calm subscribers who were cancer patients/survivors completed an online survey about different aspects of the Calm app and participated in a third virtual focus group. Data were qualitatively analyzed using a combination of deductive and inductive coding. Results: A total of 27 participants (11 cancer patients/survivors, 10 health care providers, 6 current Calm subscribers) completed the study. Similar themes and subthemes were found across surveys, daily journals, and focus groups, and fell into two major categories, content and functionality, with cancer-specific and noncancer-specific themes identified within each category. The majority of content preferences and suggestions that arose were cancer-specific, such as content related to negative emotions or feelings (eg, anxiety, grief, trauma/posttraumatic stress disorder, fear of recurrence, isolation), positive feelings and finding meaning (eg, gratitude, storytelling, acceptance), scenarios and experiences (eg, waiting, treatment-specific mediations), type and stage of cancer journey, and movement modifications. Some of the noncancer-specific themes under app content included sleep, music, and visualizations. In terms of app functionality, the majority of participants expressed interest in having a section/tab/area of the app that was specifically geared toward cancer patients/survivors. Preferences and suggestions for cancer-specific functionality features included options based on symptoms or journey, being able to communicate with other patients or survivors to share suggestions for specific meditations, and having an emergency toolkit for patients/survivors. Conclusions: Findings from cancer patients/survivors, health care providers, and current Calm subscribers who were patients/survivors to be incorporated into the development of the prototype fell into two major categories: (1) content of the app and (2) functionality of the app. The prototype’s form and function will be pilot-tested among 30 cancer patients/survivors in a 4-week study, and the resulting feasibility data will be used to inform the final app design and an efficacy study. %M 35029528 %R 10.2196/32458 %U https://formative.jmir.org/2022/1/e32458 %U https://doi.org/10.2196/32458 %U http://www.ncbi.nlm.nih.gov/pubmed/35029528 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e29745 %T Remote Psychological Interventions for Fear of Cancer Recurrence: Scoping Review %A Cincidda,Clizia %A Pizzoli,Silvia Francesca Maria %A Pravettoni,Gabriella %+ Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), via Ripamonti, 435, Milan, 20132, Italy, 39 0257489207, clizia.cincidda@ieo.it %K fear of cancer recurrence %K cognitive behavioral therapy %K acceptance and commitment therapy %K mindfulness %K eHealth %K blended intervention %D 2022 %7 11.1.2022 %9 Review %J JMIR Cancer %G English %X Background: Patients with cancer and survivors may experience the fear of cancer recurrence (FCR), a preoccupation with the progression or recurrence of cancer. During the spread of COVID-19 in 2019, patients and survivors experienced increased levels of FCR. Hence, there is a greater need to identify effective evidence-based treatments to help people cope with FCR. Remotely delivered interventions might provide a valuable means to address FCR in patients with cancer. Objective: The aim of this study is to first discuss the available psychological interventions for FCR based on traditional cognitive behavioral therapies (CBTs) or contemporary CBTs, in particular, mindfulness and acceptance and commitment therapy, and then propose a possible approach based on the retrieved literature. Methods: We searched key electronic databases to identify studies that evaluated the effect of psychological interventions such as CBT on FCR among patients with cancer and survivors. Results: Current evidence suggests that face-to-face psychological interventions for FCR are feasible, acceptable, and efficacious for managing FCR. However, there are no specific data on the interventions that are most effective when delivered remotely. Conclusions: CBT interventions can be efficacious in managing FCR, especially at posttreatment, regardless of whether it is delivered face to face, on the web, or using a blended approach. To date, no study has simultaneously compared the effectiveness of face-to-face, web-based, and blended interventions. On the basis of the retrieved evidence, we propose the hypothetical program of an intervention for FCR based on both traditional CBT and contemporary CBT, named Change Of Recurrence, which aims to improve the management of FCR in patients with cancer and survivors. %M 35014956 %R 10.2196/29745 %U https://cancer.jmir.org/2022/1/e29745 %U https://doi.org/10.2196/29745 %U http://www.ncbi.nlm.nih.gov/pubmed/35014956 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e18083 %T A Smartphone Remote Monitoring App to Follow Up Colorectal Cancer Survivors: Requirement Analysis %A Ayyoubzadeh,Seyed Mohammad %A Shirkhoda,Mohammad %A R Niakan Kalhori,Sharareh %A Mohammadzadeh,Niloofar %A Zakerabasali,Somayyeh %+ Peter L. Reichertz Institute for Medical Informatics, Technical University Braunschweig and Hannover Medical School, Mühlenpfordtstraße 23, Braunschweig, 38106, Germany, 49 531 391 2125, sharareh.niakankalhori@plri.de %K eHealth %K app %K colorectal cancer %K survivors %K requirements analysis %K MoSCoW %D 2022 %7 5.1.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Colorectal cancer survivors face multiple challenges after discharge. eHealth may potentially support them by providing tools such as smartphone apps. They have lots of capabilities to exchange information and could be used for remote monitoring of these patients. Objective: In this study, we addressed the required features for apps designed to follow up colorectal cancer patients based on survivors’ and clinical experts’ views. Methods: A mixed methods study was conducted. Features of related apps were extracted through the literature; the features were categorized, and then, they were modified. A questionnaire was designed containing the features listed and prioritized based on the MoSCoW (Must have, Should have, Could have, Won’t have) technique and an open question for each category. The link to the questionnaire was shared among clinical experts in Iran. The answers were analyzed using the content validity ratio (CVR), and based on the value of this measure, the minimum feature set of a monitoring app to follow up patients with colorectal cancer was addressed. In addition, a telephone interview with colorectal cancer survivors was conducted to collect their viewpoints regarding a remote monitoring system for colorectal cancer cases. Results: The questionnaire contained 10 sections evaluating 9 categories of features. The questionnaire was completed by 18 experts. The minimum set of features in the app was identified as patient information registration, sign and symptom monitoring, education, reminders, and patient evaluation (0.42 < CVR < 0.85). Features including physical activity, personalized advice, and social network did not achieve the minimum score (–0.11 < CVR < 0.39). We interviewed 9 colorectal cancer survivors. Information registration, sign and symptom monitoring, education, and personalized advice were the features with high priority from the survivors’ perspectives. Scheduling, shopping, and financial support features were emphasized by survivors in the interview. Conclusions: The requirement set could be used to design an app for the targeted population or patients affected by other cancers. As the views from both survivors and clinical experts were considered in this study, the remote system may more adequately fulfill the need for follow-up of survivors. This eases the patients’ and health care providers’ communication and interaction. %M 34989685 %R 10.2196/18083 %U https://cancer.jmir.org/2022/1/e18083 %U https://doi.org/10.2196/18083 %U http://www.ncbi.nlm.nih.gov/pubmed/34989685 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e34502 %T Evaluation of the Efficacy of a Smoking Cessation Intervention for Cervical Cancer Survivors and Women With High-Grade Cervical Dysplasia: Protocol for a Randomized Controlled Trial %A Jones,Sarah R %A Vidrine,Damon J %A Wetter,David W %A Shih,Ya-Chen Tina %A Sutton,Steven K %A Ramondetta,Lois M %A Elting,Linda S %A Walker,Joan L %A Smith,Katie M %A Frank-Pearce,Summer G %A Li,Yisheng %A Simmons,Vani N %A Vidrine,Jennifer I %+ Tobacco Research & Intervention Program, Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4115 E Fowler Avenue, Tampa, FL, 33617, United States, 1 813 745 8764, jennifer.vidrine@moffitt.org %K smoking cessation %K cervical cancer %K cancer survivor %K motivation %K tobacco treatment %K cancer %K smoking %K RCT %K randomized controlled trial %K cognitive behavior %K intervention %D 2021 %7 30.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of smoking among cervical cancer survivors is strikingly high, yet no smoking cessation interventions to date have specifically targeted this population. This paper describes the study design, methods, and data analysis plans for a randomized clinical trial designed to evaluate the efficacy of a theoretically and empirically based Motivation And Problem Solving (MAPS) approach for promoting and facilitating smoking cessation among cervical cancer survivors. MAPS is a comprehensive, dynamic, and holistic intervention that incorporates empirically supported cognitive behavioral and social cognitive theory–based treatment strategies within an overarching motivational framework. MAPS is designed to be appropriate for all smokers regardless of their motivation to change and views motivation as dynamically fluctuating from moment to moment throughout the behavior change process. Objective: This 2-group randomized controlled trial compares the efficacy of standard treatment to MAPS in facilitating smoking cessation among women with a history of high-grade cervical dysplasia or cervical cancer. Methods: Participants (N=202) are current smokers with a history of high-grade cervical dysplasia or cervical cancer recruited nationally and randomly assigned to one of two treatment conditions: (1) standard treatment (ST) or (2) MAPS. ST consists of repeated letters referring participants to their state’s tobacco cessation quitline, standard self-help materials, and free nicotine replacement therapy when ready to quit. MAPS has all ST components along with 6 proactive telephone counseling sessions delivered over 12 months. The primary outcome is abstinence from tobacco at 18 months. Secondary outcomes include abstinence over time across all assessment points, abstinence at other individual assessment time points, quit attempts, cigarettes per day, and use of state quitlines. Hypothesized treatment mechanisms and cost-effectiveness will also be evaluated. Results: This study was approved by the institutional review boards at the University of Texas MD Anderson Cancer Center, the University of Oklahoma Health Sciences Center, and Moffitt Cancer Center. Participant enrollment concluded at Moffitt Cancer Center in January 2020, and follow-up data collection was completed in July 2021. Data analysis is ongoing. Conclusions: This study will yield crucial information regarding the efficacy and cost-effectiveness of a MAPS approach for smoking cessation tailored to the specific needs of women with a history of high-grade cervical dysplasia or cervical cancer. Findings indicating that MAPS has substantially greater efficacy than existing evidence-based tobacco cessation treatments would have tremendous public health significance. Trial Registration: ClinicalTrials.gov NCT02157610; https://clinicaltrials.gov/ct2/show/NCT02157610 International Registered Report Identifier (IRRID): DERR1-10.2196/34502 %M 34967755 %R 10.2196/34502 %U https://www.researchprotocols.org/2021/12/e34502 %U https://doi.org/10.2196/34502 %U http://www.ncbi.nlm.nih.gov/pubmed/34967755 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27497 %T Information Patients With Melanoma Spontaneously Report About Health-Related Quality of Life on Web-Based Forums: Case Study %A Kalf,Rachel R J %A Delnoij,Diana M J %A Ryll,Bettina %A Bouvy,Marcel L %A Goettsch,Wim G %+ Department of Pharmacoepidemiology and Clinical Pharmacology, University Utrecht, Universiteitsweg 99, Utrecht, 3584 CG, Netherlands, 31 302537324, m.l.bouvy@uu.nl %K reimbursement decision-making %K QoL %K health care %K quality of life %D 2021 %7 7.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a general agreement on the importance of health-related quality of life (HRQoL). This type of information is becoming increasingly important for the value assessment of health technology assessment agencies in evaluating the benefits of new health technologies, including medicines. However, HRQoL data are often limited, and additional sources that provide this type of information may be helpful. Objective: We aim to identify the HRQoL topics important to patients with melanoma based on web-based discussions on public social media forums. Methods: We identified 3 public web-based forums from the United States and the United Kingdom, namely the Melanoma Patient Information Page, the Melanoma International Forum, and MacMillan. Their posts were randomly selected and coded using qualitative methods until saturation was reached. Results: Of the posts assessed, 36.7% (150/409) of posts on Melanoma International Forum, 45.1% (198/439) on MacMillan, and 35.4% (128/362) on Melanoma Patient Information Page focused on HRQoL. The 2 themes most frequently mentioned were mental health and (un)certainty. The themes were constructed based on underlying and more detailed codes. Codes related to fear, worry and anxiety, uncertainty, and unfavorable effects were the most-often discussed ones. Conclusions: Web-based forums are a valuable source for identifying relevant HRQoL aspects in patients with a given disease. These aspects could be cross-referenced with existing tools and they might improve the content validity of patient-reported outcome measures, including HRQoL questionnaires. In addition, web-based forums may provide health technology assessment agencies with a more holistic understanding of the external aspects affecting patient HRQoL. These aspects might support the value assessment of new health technologies and could therefore help inform topic prioritization as well as the scoping phase before any value assessment. %M 34878994 %R 10.2196/27497 %U https://www.jmir.org/2021/12/e27497 %U https://doi.org/10.2196/27497 %U http://www.ncbi.nlm.nih.gov/pubmed/34878994 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e30439 %T Language, Speech, and Facial Expression Features for Artificial Intelligence–Based Detection of Cancer Survivors’ Depression: Scoping Meta-Review %A Smrke,Urška %A Mlakar,Izidor %A Lin,Simon %A Musil,Bojan %A Plohl,Nejc %+ Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, Maribor, 2000, Slovenia, 386 31262861, urska.smrke@um.si %K artificial intelligence %K cancer %K depression %K facial expression %K language %K oncology %K review %K screening %K speech %K symptom %D 2021 %7 6.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: Cancer survivors often experience disorders from the depressive spectrum that remain largely unrecognized and overlooked. Even though screening for depression is recognized as essential, several barriers prevent its successful implementation. It is possible that better screening options can be developed. New possibilities have been opening up with advances in artificial intelligence and increasing knowledge on the connection of observable cues and psychological states. Objective: The aim of this scoping meta-review was to identify observable features of depression that can be intercepted using artificial intelligence in order to provide a stepping stone toward better recognition of depression among cancer survivors. Methods: We followed a methodological framework for scoping reviews. We searched SCOPUS and Web of Science for relevant papers on the topic, and data were extracted from the papers that met inclusion criteria. We used thematic analysis within 3 predefined categories of depression cues (ie, language, speech, and facial expression cues) to analyze the papers. Results: The search yielded 1023 papers, of which 9 met the inclusion criteria. Analysis of their findings resulted in several well-supported cues of depression in language, speech, and facial expression domains, which provides a comprehensive list of observable features that are potentially suited to be intercepted by artificial intelligence for early detection of depression. Conclusions: This review provides a synthesis of behavioral features of depression while translating this knowledge into the context of artificial intelligence–supported screening for depression in cancer survivors. %M 34874883 %R 10.2196/30439 %U https://mental.jmir.org/2021/12/e30439 %U https://doi.org/10.2196/30439 %U http://www.ncbi.nlm.nih.gov/pubmed/34874883 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29958 %T Using Patient-Generated Health Data From Twitter to Identify, Engage, and Recruit Cancer Survivors in Clinical Trials in Los Angeles County: Evaluation of a Feasibility Study %A Reuter,Katja %A Angyan,Praveen %A Le,NamQuyen %A Buchanan,Thomas A %+ Department of Public Health and Preventive Medicine, The State University of New York Upstate Medical University, 766 Irving Avenue, Syracuse, NY, 13210, United States, 1 3154641520, reuterk@upstate.edu %K breast cancer %K cancer %K clinical research %K clinical trial %K colon cancer %K infoveillance %K kidney cancer %K lung cancer %K lymphoma %K patient engagement %K prostate cancer %K recruitment %K Twitter %K social media %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Failure to find and attract clinical trial participants remains a persistent barrier to clinical research. Researchers increasingly complement recruitment methods with social media–based methods. We hypothesized that user-generated data from cancer survivors and their family members and friends on the social network Twitter could be used to identify, engage, and recruit cancer survivors for cancer trials. Objective: This pilot study aims to examine the feasibility of using user-reported health data from cancer survivors and family members and friends on Twitter in Los Angeles (LA) County to enhance clinical trial recruitment. We focus on 6 cancer conditions (breast cancer, colon cancer, kidney cancer, lymphoma, lung cancer, and prostate cancer). Methods: The social media intervention involved monitoring cancer-specific posts about the 6 cancer conditions by Twitter users in LA County to identify cancer survivors and their family members and friends and contacting eligible Twitter users with information about open cancer trials at the University of Southern California (USC) Norris Comprehensive Cancer Center. We reviewed both retrospective and prospective data published by Twitter users in LA County between July 28, 2017, and November 29, 2018. The study enrolled 124 open clinical trials at USC Norris. We used descriptive statistics to report the proportion of Twitter users who were identified, engaged, and enrolled. Results: We analyzed 107,424 Twitter posts in English by 25,032 unique Twitter users in LA County for the 6 cancer conditions. We identified and contacted 1.73% (434/25,032) of eligible Twitter users (127/434, 29.3% cancer survivors; 305/434, 70.3% family members and friends; and 2/434, 0.5% Twitter users were excluded). Of them, 51.4% (223/434) were female and approximately one-third were male. About one-fifth were people of color, whereas most of them were White. Approximately one-fifth (85/434, 19.6%) engaged with the outreach messages (cancer survivors: 33/85, 38% and family members and friends: 52/85, 61%). Of those who engaged with the messages, one-fourth were male, the majority were female, and approximately one-fifth were people of color, whereas the majority were White. Approximately 12% (10/85) of the contacted users requested more information and 40% (4/10) set up a prescreening. Two eligible candidates were transferred to USC Norris for further screening, but neither was enrolled. Conclusions: Our findings demonstrate the potential of identifying and engaging cancer survivors and their family members and friends on Twitter. Optimization of downstream recruitment efforts such as screening for digital populations on social media may be required. Future research could test the feasibility of the approach for other diseases, locations, languages, social media platforms, and types of research involvement (eg, survey research). Computer science methods could help to scale up the analysis of larger data sets to support more rigorous testing of the intervention. Trial Registration: ClinicalTrials.gov NCT03408561; https://clinicaltrials.gov/ct2/show/NCT03408561 %M 34842538 %R 10.2196/29958 %U https://formative.jmir.org/2021/11/e29958 %U https://doi.org/10.2196/29958 %U http://www.ncbi.nlm.nih.gov/pubmed/34842538 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e31966 %T A Digital Coaching Intervention for Cancer Survivors With Job Loss: Retrospective Study %A Lo,Jonathon %A Ballurkar,Kieran %A Fox,Simonie %A Tynan,Kate %A Luu,Nghiep %A Boyer,Michael %A Murali-Ganesh,Raghav %+ Faculty of Medicine, University of Melbourne, Grattan Street, Parkville, Melbourne, 3010, Australia, 61 400090532, lo.jonathon@gmail.com %K cancer survivors %K employment %K absenteeism %K mobile app %K software %K return to work %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Returning to work is a key unmet need for working-age cancer survivors. Objective: This study sought to evaluate return-to-work outcomes of a multidisciplinary intervention provided as routine employee support. Methods: In a retrospective cohort analysis, patients with cancer and more than 3 months of absence from work were provided with an intervention consisting of digital resources and calls with a health coach. Propensity score matching was used to define a similar cohort of cancer patients absent from work, who were not offered the coaching intervention. The return-to-work rate as a percentage of all participants and secondary outcomes, such as the rate of death, were measured. The median time to return to work was compared between the cohorts using the Kaplan-Meier method. Results: A total of 220 participants were enrolled in the intervention, of which 125 met the criteria for analysis. The median follow-up from cancer diagnosis was 79 weeks (IQR 60-106 weeks). In the matched control group, 22 (17.6%) participants returned to work compared with 38 (30.4%) in the intervention group (P=.02). Additionally, 19 (15.2%) matched controls died prior to claim closure compared with 13 (10.4%) in the intervention group (P=.26). The Kaplan-Meier estimated median time for the first 15% of the cohort to return to work was 87.1 weeks (95% CI 60.0-109.1 weeks) for the matched control group compared with 70.6 weeks (95% CI 52.6-79.6 weeks; P=.08) for the intervention group. Conclusions: Patients receiving a remotely delivered coaching program in a real-world setting returned to work at a higher frequency than did control participants receiving usual care. %M 34710853 %R 10.2196/31966 %U https://cancer.jmir.org/2021/4/e31966 %U https://doi.org/10.2196/31966 %U http://www.ncbi.nlm.nih.gov/pubmed/34710853 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e25976 %T Long-Term Survival Among Histological Subtypes in Advanced Epithelial Ovarian Cancer: Population-Based Study Using the Surveillance, Epidemiology, and End Results Database %A Yang,Shi-Ping %A Su,Hui-Luan %A Chen,Xiu-Bei %A Hua,Li %A Chen,Jian-Xian %A Hu,Min %A Lei,Jian %A Wu,San-Gang %A Zhou,Juan %+ Department of Obstetrics and Gynecology, The First Affiliated Hospital of Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China, 86 5922139531, zhoujuan@xmu.edu.cn %K ovarian epithelial carcinoma %K survivors %K histology %K survival rate %K survival %K ovarian %K cancer %K surveillance %K epidemiology %K women’s health %K reproductive health %K Surveillance, Epidemiology, and End Results %K ovary %K oncology %K survivorship %K long-term outcome %K epithelial %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Actual long-term survival rates for advanced epithelial ovarian cancer (EOC) are rarely reported. Objective: This study aimed to assess the role of histological subtypes in predicting the prognosis among long-term survivors (≥5 years) of advanced EOC. Methods: We performed a retrospective analysis of data among patients with stage III-IV EOC diagnosed from 2000 to 2014 using the Surveillance, Epidemiology, and End Results cancer data of the United States. We used the chi-square test, Kaplan–Meier analysis, and multivariate Cox proportional hazards model for the analyses. Results: We included 8050 patients in this study, including 6929 (86.1%), 743 (9.2%), 237 (2.9%), and 141 (1.8%) patients with serous, endometrioid, clear cell, and mucinous tumors, respectively. With a median follow-up of 91 months, the most common cause of death was primary ovarian cancer (80.3%), followed by other cancers (8.1%), other causes of death (7.3%), cardiac-related death (3.2%), and nonmalignant pulmonary disease (3.2%). Patients with the serous subtype were more likely to die from primary ovarian cancer, and patients with the mucinous subtype were more likely to die from other cancers and cardiac-related disease. Multivariate Cox analysis showed that patients with endometrioid (hazard ratio [HR] 0.534, P<.001), mucinous (HR 0.454, P<.001), and clear cell (HR 0.563, P<.001) subtypes showed better ovarian cancer-specific survival than those with the serous subtype. Similar results were found regarding overall survival. However, ovarian cancer–specific survival and overall survival were comparable among those with endometrioid, clear cell, and mucinous tumors. Conclusions: Ovarian cancer remains the primary cause of death in long-term ovarian cancer survivors. Moreover, the probability of death was significantly different among those with different histological subtypes. It is important for clinicians to individualize the surveillance program for long-term ovarian cancer survivors. %M 34787583 %R 10.2196/25976 %U https://publichealth.jmir.org/2021/11/e25976 %U https://doi.org/10.2196/25976 %U http://www.ncbi.nlm.nih.gov/pubmed/34787583 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e32395 %T Identification of Genetic Predispositions Related to Ionizing Radiation in Primary Human Skin Fibroblasts From Survivors of Childhood and Second Primary Cancer as Well as Cancer-Free Controls: Protocol for the Nested Case-Control Study KiKme %A Marron,Manuela %A Brackmann,Lara Kim %A Schwarz,Heike %A Hummel-Bartenschlager,Willempje %A Zahnreich,Sebastian %A Galetzka,Danuta %A Schmitt,Iris %A Grad,Christian %A Drees,Philipp %A Hopf,Johannes %A Mirsch,Johanna %A Scholz-Kreisel,Peter %A Kaatsch,Peter %A Poplawski,Alicia %A Hess,Moritz %A Binder,Harald %A Hankeln,Thomas %A Blettner,Maria %A Schmidberger,Heinz %+ Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstrasse 30, Bremen, Germany, 49 421 32856840, sec-epi@leibniz-bips.de %K fibroblast %K irradiation %K childhood cancer %K neoplasm %K second primary neoplasm %K second cancer %K study design %K participation %K feasibility %K cell line %D 2021 %7 11.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Therapy for a first primary neoplasm (FPN) in childhood with high doses of ionizing radiation is an established risk factor for second primary neoplasms (SPN). An association between exposure to low doses and childhood cancer is also suggested; however, results are inconsistent. As only subgroups of children with FPNs develop SPNs, an interaction between radiation, genetic, and other risk factors is presumed to influence cancer development. Objective: Therefore, the population-based, nested case-control study KiKme aims to identify differences in genetic predisposition and radiation response between childhood cancer survivors with and without SPNs as well as cancer-free controls. Methods: We conducted a population-based, nested case-control study KiKme. Besides questionnaire information, skin biopsies and saliva samples are available. By measuring individual reactions to different exposures to radiation (eg, 0.05 and 2 Gray) in normal somatic cells of the same person, our design enables us to create several exposure scenarios for the same person simultaneously and measure several different molecular markers (eg, DNA, messenger RNA, long noncoding RNA, copy number variation). Results: Since 2013, 101 of 247 invited SPN patients, 340 of 1729 invited FPN patients, and 150 of 246 invited cancer-free controls were recruited and matched by age and sex. Childhood cancer patients were additionally matched by tumor morphology, year of diagnosis, and age at diagnosis. Participants reported on lifestyle, socioeconomical, and anthropometric factors, as well as on medical radiation history, health, and family history of diseases (n=556). Primary human fibroblasts from skin biopsies of the participants were cultivated (n=499) and cryopreserved (n=3886). DNA was extracted from fibroblasts (n=488) and saliva (n=510). Conclusions: This molecular-epidemiological study is the first to combine observational epidemiological research with standardized experimental components in primary human skin fibroblasts to identify genetic predispositions related to ionizing radiation in childhood and SPNs. In the future, fibroblasts of the participants will be used for standardized irradiation experiments, which will inform analysis of the case-control study and vice versa. Differences between participants will be identified using several molecular markers. With its innovative combination of experimental and observational components, this new study will provide valuable data to forward research on radiation-related risk factors in childhood cancer and SPNs. International Registered Report Identifier (IRRID): DERR1-10.2196/32395 %M 34762066 %R 10.2196/32395 %U https://www.researchprotocols.org/2021/11/e32395 %U https://doi.org/10.2196/32395 %U http://www.ncbi.nlm.nih.gov/pubmed/34762066 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e28322 %T A Digital Self-management Program (Help to Overcome Problems Effectively) for People Living With Cancer: Feasibility Randomized Controlled Trial %A Wright,Hayley %A Martin,Faith %A Clyne,Wendy %A Clark,Cain C T %A Matouskova,Gabriela %A McGillion,Michael %A Turner,Andrew %+ Centre for Intelligent Healthcare, Research Institute for Health and Wellbeing, Coventry University, Priory Street, Coventry, CV1 5FB, United Kingdom, 44 7599782465, hsx116@coventry.ac.uk %K self-management %K cancer %K survivorship %K digital %K positive psychology %D 2021 %7 5.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: We present the results of a feasibility, randomized waitlist control group (CG) parallel design study with a 1:1 allocation ratio. Participants were randomized into an intervention group (IG) or a waitlist CG. The intervention was a 6-week digital self-management program, Help to Overcome Problems Effectively (HOPE), for people with cancer. Objective: This study aims to test the feasibility of a digitally delivered self-management program for people with cancer. This will inform the design of a definitive randomized controlled trial. In addition, a preliminary assessment of the impact of the HOPE program via secondary outcomes will be used to assess signals of efficacy in a trial context. Methods: Participants were drawn from an opportunity sample, referred by Macmillan Cancer Support, and were invited via email to participate in the study (N=61). Primary outcomes were rates of recruitment, retention, follow-up, completion and adherence, sample size and effect size estimation, and assessment of progression criteria for a definitive trial. Secondary outcomes were self-report measures of participants’ positive mental well-being, depression, anxiety, and patient activation (ie, confidence in managing their cancer). The intervention and data collection took place on the web. Results: The recruitment rate was 77% (47/61). A total of 41 participants completed the baseline questionnaires and were randomized to either the IG (n=21) or the waitlist CG (n=20). The retention rate (attending all program sessions) was greater than 50% (all: 21/41, 51%, IG: 10/21, 48%; and CG: 11/20, 55%). The follow-up rate (completing all questionnaires) was greater than 80% (all: 33/41, 80%; IG: 16/21, 76%; and CG: 17/20, 85%). The completion rate (attending ≥3 sessions and completing all questionnaires) was greater than 60% (all: 25/41, 61%; IG: 13/21, 62%; and CG: 12/20, 60%). Engagement data showed that participants viewed between half (5.1/10, 51%) and three-quarters (12.2/16, 76%) of the pages in each session. Conclusions: All progression criteria for a definitive trial were met, as supported by the primary outcome data. The IG showed improved postprogram scores on measures of positive mental well-being, depression, anxiety, and patient activation. A full-scale trial of the digital HOPE program for people with cancer will allow us to fully evaluate the efficacy of the intervention relative to a CG. Trial Registration: ISRCTN Registry ISRCTN79623250; http://www.isrctn.com/ISRCTN79623250 International Registered Report Identifier (IRRID): RR2-10.2196/24264 %M 34738912 %R 10.2196/28322 %U https://www.jmir.org/2021/11/e28322 %U https://doi.org/10.2196/28322 %U http://www.ncbi.nlm.nih.gov/pubmed/34738912 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e22809 %T Web-Based Information Seeking Behaviors of Low-Literacy Hispanic Survivors of Breast Cancer: Observational Pilot Study %A Iacobelli,Francisco %A Dragon,Ginger %A Mazur,Giselle %A Guitelman,Judith %+ Computer Science Department, Northeastern Illinois University, 5500 N. St. Louis Ave., Chicago, IL, 60625, United States, 1 7734424728, f-iacobelli@neiu.edu %K low literacy %K health literacy %K online searches %K Hispanic breast cancer survivors %D 2021 %7 27.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet searching is a useful tool for seeking health information and one that can benefit low-literacy populations. However, low-literacy Hispanic survivors of breast cancer do not normally search for health information on the web. For them, the process of searching can be frustrating, as frequent mistakes while typing can result in misleading search results lists. Searches using voice (dictation) are preferred by this population; however, even if an appropriate result list is displayed, low-literacy Hispanic women may be challenged in their ability to fully understand any individual article from that list because of the complexity of the writing. Objective: This observational study aims to explore and describe web-based search behaviors of Hispanic survivors of breast cancer by themselves and with their caregivers, as well as to describe the challenges they face when processing health information on the web. Methods: We recruited 7 Hispanic female survivors of breast cancer. They had the option to bring a caregiver. Of the 7 women, 3 (43%) did, totaling 10 women. We administered the Health LiTT health literacy test, a demographic survey, and a breast cancer knowledge assessment. Next, we trained the participants to search on the web with either a keyboard or via voice. Then, they had to find information about 3 guided queries and 1 free-form query related to breast cancer. Participants were allowed to search in English or in Spanish. We video and audio recorded the computer activity of all participants and analyzed it. Results: We found web articles to be written for a grade level of 11.33 in English and 7.15 in Spanish. We also found that most participants preferred searching using voice but struggled with this modality. Pausing while searching via voice resulted in incomplete search queries, as it confused the search engine. At other times, background noises were detected and included in the search. We also found that participants formulated overly general queries to broaden the results list hoping to find more specific information. In addition, several participants considered their queries satisfied based on information from the snippets on the result lists alone. Finally, participants who spent more time reviewing articles scored higher on the health literacy test. Conclusions: Despite the problems of searching using speech, we found a preference for this modality, which suggests a need to avoid potential errors that could appear in written queries. We also found the use of general questions to increase the chances of answers to more specific concerns. Understanding search behaviors and information evaluation strategies for low-literacy Hispanic women survivors of breast cancer is fundamental to designing useful search interfaces that yield relevant and reliable information on the web. %M 34704952 %R 10.2196/22809 %U https://formative.jmir.org/2021/10/e22809 %U https://doi.org/10.2196/22809 %U http://www.ncbi.nlm.nih.gov/pubmed/34704952 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e25659 %T Exploring Cancer Survivor Needs and Preferences for Communicating Personalized Cancer Statistics From Registry Data: Qualitative Multimethod Study %A Vromans,Ruben D %A van Eenbergen,Mies C %A Geleijnse,Gijs %A Pauws,Steffen %A van de Poll-Franse,Lonneke V %A Krahmer,Emiel J %+ Department of Communication and Cognition, Tilburg University, Warandelaan 2, Tilburg, 5037LE, Netherlands, 31 134663584, r.d.vromans@uvt.nl %K breast cancer %K cancer statistics %K personalization %K prostate cancer %K risk communication %K cancer registry %K cancer %K patient needs and preferences %D 2021 %7 25.10.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Disclosure of cancer statistics (eg, survival or incidence rates) based on a representative group of patients can help increase cancer survivors’ understanding of their own diagnostic and prognostic situation, and care planning. More recently, there has been an increasing interest in the use of cancer registry data for disclosing and communicating personalized cancer statistics (tailored toward personal and clinical characteristics) to cancer survivors and relatives. Objective: The aim of this study was to explore breast cancer (BCa) and prostate cancer (PCa) survivor needs and preferences for disclosing (what) and presenting (how) personalized statistics from a large Dutch population-based data set, the Netherlands Cancer Registry (NCR). Methods: To elicit survivor needs and preferences for communicating personalized NCR statistics, we created different (non)interactive tools visualizing hypothetical scenarios and adopted a qualitative multimethod study design. We first conducted 2 focus groups (study 1; n=13) for collecting group data on BCa and PCa survivor needs and preferences, using noninteractive sketches of what a tool for communicating personalized statistics might look like. Based on these insights, we designed a revised interactive tool, which was used to further explore the needs and preferences of another group of cancer survivors during individual think-aloud observations and semistructured interviews (study 2; n=11). All sessions were audio-recorded, transcribed verbatim, analyzed using thematic (focus groups) and content analysis (think-aloud observations), and reported in compliance with qualitative research reporting criteria. Results: In both studies, cancer survivors expressed the need to receive personalized statistics from a representative source, with especially a need for survival and conditional survival rates (ie, survival rate for those who have already survived for a certain period). Personalized statistics adjusted toward personal and clinical factors were deemed more relevant and useful to know than generic or average-based statistics. Participants also needed support for correctly interpreting the personalized statistics and putting them into perspective, for instance by adding contextual or comparative information. Furthermore, while thinking aloud, participants experienced a mix of positive (sense of hope) and negative emotions (feelings of distress) while viewing the personalized survival data. Overall, participants preferred simplicity and conciseness, and the ability to tailor the type of visualization and amount of (detailed) statistical information. Conclusions: The majority of our sample of cancer survivors wanted to receive personalized statistics from the NCR. Given the variation in patient needs and preferences for presenting personalized statistics, designers of similar information tools may consider potential tailoring strategies on multiple levels, as well as effective ways for providing supporting information to make sure that the personalized statistics are properly understood. This is encouraging for cancer registries to address this unmet need, but also for those who are developing or implementing personalized data-driven information tools for patients and relatives. %M 34694237 %R 10.2196/25659 %U https://cancer.jmir.org/2021/4/e25659 %U https://doi.org/10.2196/25659 %U http://www.ncbi.nlm.nih.gov/pubmed/34694237 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 4 %P e31150 %T Cytochrome P450 1B1 Overexpression in Cervical Cancers: Cross-sectional Study %A Alshammari,Fatemah O F O %A Al-saraireh,Yousef M %A Youssef,Ahmed M M %A Al-Sarayra,Yahya M %A Alrawashdeh,Hamzeh Mohammad %+ Department of Pharmacology, Faculty of Medicine, Mutah University, 3 Mutah University Street, Mutah, Al-Karak, 61710, Jordan, 962 799172658, yousef.sar@mutah.edu.jo %K cancer %K cervical cancer %K cytochrome P450 %K cytochrome 1B1 %K immunohistochemistry %K toxicity %K therapies %K molecular %K tumor %K cytochrome %K cervix %D 2021 %7 12.10.2021 %9 Original Paper %J Interact J Med Res %G English %X Background: Current standard treatments for patients with recurrent cervical cancer are not very effective and are associated with severe toxicity. Recently, the rational approach for the discovery of new therapies for cervical cancer is based on the alterations in the molecular biology of cancer cells. One of the emerging molecular changes in cancer cells is the aberrant expression of cytochrome P450 1B1 (CYP1B1). This unique enzyme has been reported to be selectively overexpressed in several cancers. Objective: The aim of this study was to examine CYP1B1 expression in cervical cancers and to assess the enzyme’s relationship with several clinicopathological features. Methods: Immunohistochemistry was performed to examine CYP1B1 expression in 100 patient samples with cervical cancer and 10 patient samples with normal healthy cervical tissues. Results: CYP1B1 was expressed in the majority of the cervical cancer samples (91/100, 91.0%) but not in normal healthy cervical samples. The difference in the expression of CYP1B1 between healthy and tumorous cervical tissues was significant (P=.01). Moreover, the frequency of CYP1B1 expression was found to be significantly higher in patients with advanced grades of the disease (P=.03) and in patients having metastasis to the lymph nodes (P=.01). Surprisingly, there was a significantly higher expression of CYP1B1 in patients with a high prevalence of human papilloma virus 16/18 (P=.04). Conclusions: The differential profile of CYP1B1 expression between cervical cancer tissues and normal cervical tissues suggests that CYP1B1 may be used as a target for future therapeutic exploitations. %M 34636736 %R 10.2196/31150 %U https://www.i-jmr.org/2021/4/e31150 %U https://doi.org/10.2196/31150 %U http://www.ncbi.nlm.nih.gov/pubmed/34636736 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e25776 %T Measuring the Time to Deterioration for Health-Related Quality of Life in Patients With Metastatic Breast Cancer Using a Web-Based Monitoring Application: Longitudinal Cohort Study %A Brusniak,Katharina %A Feisst,Manuel %A Sebesteny,Linda %A Hartkopf,Andreas %A Graf,Joachim %A Engler,Tobias %A Schneeweiss,Andreas %A Wallwiener,Markus %A Deutsch,Thomas Maximilian %+ Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, Heidelberg, Germany, 49 6221 56 36956, Markus.Wallwiener@med.uni-heidelberg.de %K eHealth %K breast cancer %K health-related quality of life %K quality of life %K time to deterioration %K EQ-VAS %K EQ-5D-5L %K EORTC QLQ-C30 %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Health-related quality of life (HRQoL) is used to evaluate the treatment of metastatic breast cancer. In a long-term therapy setting, HRQoL can be used as an important benchmark for treatment success. With the help of digital apps, HRQoL monitoring can be extended to more remote areas and be administered on a more frequent basis. Objective: This study aims to evaluate 3 common HRQoL questionnaires in metastasized breast cancer in terms of TTD in a digital, web-based setting. We further aim to examine the development of the HRQoL in different systemic treatment groups in each of these evaluation instruments. Methods: A total of 192 patients with metastatic breast cancer were analyzed in this bicentric prospective online cohort study at two German university hospitals. Patients completed questionnaires on HRQoL (EuroQol Visual Analog Scale [EQ-VAS], EuroQol 5 Dimension 5 Level [EQ-5D-5L], European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30 item [EORTC QLQ-C30]) via an online platform over a 6-month period. Treatment schedules and medical history were retrieved from medical records. Unadjusted Cox regression analysis on treatment-related factors was performed. We conducted subgroup analyses in regard to TTD events between different treatments. Results: The EQ-VAS showed a higher rate of deterioration after 8 weeks (84/179, 46.9%) than the EQ-5D-5L (47/163, 28.8%) and EORTC QLQ-C30 (65/176, 36.9%). Unadjusted Cox regression revealed significant connections between known metastases in the liver (P=.03, HR 1.64, 95% CI 1.06-2.52) and pleura (P=.04, HR 0.42, 95% CI 0.18-0.96) in the EQ-VAS. Significant relations between EQ-VAS events and single EQ-5D-5L items and the EQ-5D-5L summary score were demonstrated. All treatment groups significantly differed from the CDK4/6 inhibition subgroup in the EQ-VAS. Conclusions: Compared to the EQ-5D-5L and QLQ-C30, the EQ-VAS showed a higher rate of deterioration after 8 weeks. Significant connections to certain metastatic locations were only detected in the EQ-VAS. The EQ-VAS is capable of reflecting the distinctive HRQoL profiles of different systemic treatments as well as the different aspects of HRQoL presented in the EQ-5D-5L. TTD with the EQ-VAS is an adequate mean of examining longitudinal development of HRQoL among breast cancer patients. %M 34636732 %R 10.2196/25776 %U https://cancer.jmir.org/2021/4/e25776 %U https://doi.org/10.2196/25776 %U http://www.ncbi.nlm.nih.gov/pubmed/34636732 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e26226 %T Features That Middle-aged and Older Cancer Survivors Want in Web-Based Healthy Lifestyle Interventions: Qualitative Descriptive Study %A Ivankova,Nataliya V %A Rogers,Laura Q %A Herbey,Ivan I %A Martin,Michelle Y %A Pisu,Maria %A Pekmezi,Dorothy %A Thompson,Lieu %A Schoenberger-Godwin,Yu-Mei M %A Oster,Robert A %A Fontaine,Kevin %A Anderson,Jami L %A Kenzik,Kelly %A Farrell,David %A Demark-Wahnefried,Wendy %+ Department of Health Services Administration, University of Alabama at Birmingham, SHPB 569, 1720 2nd Avenue South, Birmingham, AL, 35294-1212, United States, 1 12059962422, nivankov@uab.edu %K cancer survivors %K diet %K physical activity %K lifestyle %K internet %K interventions %K qualitative %K eHealth %K mobile phone %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: With the increasing number of older cancer survivors, it is imperative to optimize the reach of interventions that promote healthy lifestyles. Web-based delivery holds promise for increasing the reach of such interventions with the rapid increase in internet use among older adults. However, few studies have explored the views of middle-aged and older cancer survivors on this approach and potential variations in these views by gender or rural and urban residence. Objective: The aim of this study was to explore the views of middle-aged and older cancer survivors regarding the features of web-based healthy lifestyle programs to inform the development of a web-based diet and exercise intervention. Methods: Using a qualitative descriptive approach, we conducted 10 focus groups with 57 cancer survivors recruited from hospital cancer registries in 1 southeastern US state. Data were analyzed using inductive thematic and content analyses with NVivo (version 12.5, QSR International). Results: A total of 29 male and 28 female urban and rural dwelling Black and White survivors, with a mean age of 65 (SD 8.27) years, shared their views about a web-based healthy lifestyle program for cancer survivors. Five themes emerged related to program content, design, delivery, participation, technology training, and receiving feedback. Cancer survivors felt that web-based healthy lifestyle programs for cancer survivors must deliver credible, high-quality, and individually tailored information, as recommended by health care professionals or content experts. Urban survivors were more concerned about information reliability, whereas women were more likely to trust physicians’ recommendations. Male and rural survivors wanted information to be tailored to the cancer type and age group. Privacy, usability, interaction frequency, and session length were important factors for engaging cancer survivors with a web-based program. Female and rural participants liked the interactive nature and visual appeal of the e-learning sessions. Learning from experts, an attractive design, flexible schedule, and opportunity to interact with other cancer survivors in Facebook closed groups emerged as factors promoting program participation. Low computer literacy, lack of experience with web program features, and concerns about Facebook group privacy were important concerns influencing cancer survivors’ potential participation. Participants noted the importance of technology training, preferring individualized help to standardized computer classes. More rural cancer survivors acknowledged the need to learn how to use computers. The receipt of regular feedback about progress was noted as encouragement toward goal achievement, whereas women were particularly interested in receiving immediate feedback to stay motivated. Conclusions: Important considerations for designing web-based healthy lifestyle interventions for middle-aged and older cancer survivors include program quality, participants’ privacy, ease of use, attractive design, and the prominent role of health care providers and content experts. Cancer survivors’ preferences based on gender and residence should be considered to promote program participation. %M 34612832 %R 10.2196/26226 %U https://cancer.jmir.org/2021/4/e26226 %U https://doi.org/10.2196/26226 %U http://www.ncbi.nlm.nih.gov/pubmed/34612832 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e25464 %T Characteristics of Participants and Nonparticipants in a Blended Internet-Based Physical Activity Trial for Breast and Prostate Cancer Survivors: Cross-sectional Study %A vd Wiel,Hester J %A Stuiver,Martijn M %A May,Anne M %A van Grinsven,Susan %A Benink,Marlou F A %A Aaronson,Neil K %A Oldenburg,Hester S A %A van der Poel,Henk G %A van Harten,Wim H %A Groen,Wim G %+ Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, Netherlands, 31 0205129111, w.v.harten@nki.nl %K internet-based intervention %K physical activity %K nonparticipants %K breast cancer survivors %K prostate cancer survivors %K RCT %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: As the number of cancer survivors is increasing, it is important to be able to offer exercise and physical activity (PA)–promoting interventions that are both effective and reasonably accessible. Internet-based interventions are typically less expensive and more accessible alternatives to on-site supervised interventions. Currently, little is known about the characteristics of nonparticipants in PA promotion trials in the cancer survivorship setting, both in general and specifically in trials using internet-supported interventions. Objective: This study aims to gain insight into the characteristics associated with nonparticipation in a blended internet-based supported intervention trial to promote PA. Methods: Breast and prostate cancer survivors, 3-36 months after primary curative treatment, were invited to participate in the PABLO trial; this trial compared an internet-based intervention to enhance PA levels, with or without additional support from a physical therapist, to usual care. Participants and nonparticipants were asked to complete a comprehensive questionnaire assessing sociodemographics, fatigue, and health-related quality of life. Baseline data for participants and nonparticipants were compared using the independent Student t test and chi-square test. Results: The inclusion rate in the trial was 11.03% (137/1242). Of the nonparticipants, 13.95% (154/1104) completed the questionnaire. Participants were more highly educated (P=.04), had a paid job less often (P=.03), and were on sick leave more often (P=.03). They reported less PA per week, both moderate (P=.03) and vigorous (P<.01), before diagnosis and during leisure time (P<.01, effect size [ES]=0.44). They reported a significantly lower stage of change (P≤.01), lower self-efficacy (P<.01, ES=0.61), perceived barriers to PA (P<.01, ES=0.54), and more general fatigue (P<.01, ES=0.60). Participants reported lower health-related quality of life for most domains (ES ranging from 0.34 for mental health to 0.48 for social functioning). No significant differences were found for other sociodemographics, mood state, or attitudes toward or perceived social support for PA. Conclusions: The participants who self-selected for trial participation reported lower PA levels before diagnosis and a stronger need for support compared with nonparticipants. The trial thus included those patients who might benefit the most from internet-based supportive PA interventions. Trial Registration: Netherlands trial register NTR6911; https://www.trialregister.nl/trial/6733 %M 34609311 %R 10.2196/25464 %U https://cancer.jmir.org/2021/4/e25464 %U https://doi.org/10.2196/25464 %U http://www.ncbi.nlm.nih.gov/pubmed/34609311 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26545 %T An Ostomy Self-management Telehealth Intervention for Cancer Survivors: Technology-Related Findings From a Randomized Controlled Trial %A Weinstein,Ronald S %A Holcomb,Michael J %A Mo,Julia %A Yonsetto,Peter %A Bojorquez,Octavio %A Grant,Marcia %A Wendel,Christopher S %A Tallman,Nancy J %A Ercolano,Elizabeth %A Cidav,Zuleyha %A Hornbrook,Mark C %A Sun,Virginia %A McCorkle,Ruth %A Krouse,Robert S %+ Arizona Telemedicine Program, The University of Arizona Health Sciences, 1501 N Campbell AHSL 1156, Tucson, AZ, 85724, United States, 1 5203733552, rweinstein@telemedicine.arizona.edu %K telehealth %K telemedicine %K cloud computing %K ostomy %K cancer survivors %K family caregivers %K self-management %K patient education %K videoconferencing %K mobile phone %D 2021 %7 27.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: An Ostomy Self-management Telehealth (OSMT) intervention by nurse educators and peer ostomates can equip new ostomates with critical knowledge regarding ostomy care. A telehealth technology assessment aim was to measure telehealth engineer support requirements for telehealth technology–related (TTR) incidents encountered during OSMT intervention sessions held via a secure cloud-based videoconferencing service, Zoom for Healthcare. Objective: This paper examines technology-related challenges, issues, and opportunities encountered in the use of telehealth in a randomized controlled trial intervention for cancer survivors living with a permanent ostomy. Methods: The Arizona Telemedicine Program provided telehealth engineering support for 105 OSMT sessions, scheduled for 90 to 120 minutes each, over a 2-year period. The OSMT groups included up to 15 participants, comprising 4-6 ostomates, 4-6 peer ostomates, 2 nurse educators, and 1 telehealth engineer. OSMT-session TTR incidents were recorded contemporaneously in detailed notes by the research staff. TTR incidents were categorized and tallied. Results: A total of 97.1% (102/105) OSMT sessions were completed as scheduled. In total, 3 OSMT sessions were not held owing to non–technology-related reasons. Of the 93 ostomates who participated in OSMT sessions, 80 (86%) completed their OSMT curriculum. TTR incidents occurred in 36.3% (37/102) of the completed sessions with varying disruptive impacts. No sessions were canceled or rescheduled because of TTR incidents. Disruptions from TTR incidents were minimized by following the TTR incident prevention and incident response plans. Conclusions: Telehealth videoconferencing technology can enable ostomates to participate in ostomy self-management education by incorporating dedicated telehealth engineering support. Potentially, OSMT greatly expands the availability of ostomy self-management education for new ostomates. Trial Registration: ClinicalTrials.gov NCT02974634; https://clinicaltrials.gov/ct2/show/NCT02974634 %M 34086595 %R 10.2196/26545 %U https://www.jmir.org/2021/9/e26545 %U https://doi.org/10.2196/26545 %U http://www.ncbi.nlm.nih.gov/pubmed/34086595 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30950 %T A Culturally Sensitive Social Support Intervention for Chinese American Breast Cancer Survivors (Joy Luck Academy): Protocol for a Randomized Controlled Trial %A Lu,Qian %A Warmoth,Krystal %A Chen,Lingjun %A Wu,Christine S %A Chu,Qiao %A Li,Yisheng %A Gallagher,Matthew W %A Stanton,Annette L %A Kagawa Singer,Marjorie %A Young,Lucy %A Loh,Alice %+ Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX, 77030, United States, 1 7137458324, qlu@mdanderson.org %K social support %K peer mentor support %K randomized controlled trial %K Chinese cancer survivors %K breast cancer %D 2021 %7 22.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Breast cancer is the most prevalent type of cancer among Asian American women. Chinese American immigrant breast cancer survivors face unique challenges because of cultural and socioecological factors. They report emotional distress and the need for social, emotional, and spiritual support. However, culturally and linguistically appropriate information for managing survivorship health care is often unavailable. Objective: To improve the health outcomes for this underserved and understudied population, we developed, designed, and launched a randomized controlled trial to test the health benefits of a culturally sensitive social support intervention (Joy Luck Academy). In this paper, we describe the research protocol. Methods: This randomized controlled trial will enroll Chinese-speaking, stage 0 to 3 breast cancer survivors who have completed treatment within the previous 36 months using a community-based participatory research approach. We will randomly assign 168 participants to the intervention or control group. The intervention arm will attend 7 weekly 3.5-hour peer mentor and educational sessions. The control group will receive the educational information. We will assess health outcomes at baseline, immediately after the Joy Luck Academy, and at 1- and 4-month follow-ups. The primary outcome is quality of life, as measured by the Functional Assessment of Cancer Therapy scale. Secondary outcomes include depressive symptoms, positive affect, fatigue, and perceived stress. We will also explore how the intervention influences cortisol levels. To identify how and to whom the program is effective, we will measure social and personal resources and theorized mechanisms and perform qualitative interviews with a subsample of participants to enhance the interpretation of quantitative data. Results: Recruitment began in February 2015, and data collection was completed in February 2019. We expect to complete data management by August 2021 and publish results in 2022. Conclusions: If the Joy Luck Academy is demonstrated to be effective, it may be easily disseminated as an intervention for other groups of Asian American immigrant breast cancer survivors. Furthermore, similar programs could be integrated into other diverse communities. Trial Registration: ClinicalTrials.gov NCT02946697; http://clinicaltrials.gov/ct2/show/NCT02946697. International Registered Report Identifier (IRRID): DERR1-10.2196/30950 %M 34550088 %R 10.2196/30950 %U https://www.researchprotocols.org/2021/9/e30950 %U https://doi.org/10.2196/30950 %U http://www.ncbi.nlm.nih.gov/pubmed/34550088 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e31976 %T The Finding My Way UK Clinical Trial: Adaptation Report and Protocol for a Replication Randomized Controlled Efficacy Trial of a Web-Based Psychological Program to Support Cancer Survivors %A Hulbert-Williams,Nicholas J %A Leslie,Monica %A Hulbert-Williams,Lee %A Koczwara,Bogda %A Watson,Eila K %A Hall,Peter S %A Ashley,Laura %A Coulson,Neil S %A Jackson,Richard %A Millington,Sue %A , %A Beatty,Lisa %+ Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ, United Kingdom, 44 1244511950, n.hulbertwilliams@chester.ac.uk %K cancer %K survivorship %K psychosocial intervention %K digital health %K quality of life %K protocol %K mobile phone %D 2021 %7 20.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer survivors frequently report a range of unmet psychological and supportive care needs; these often continue after treatment has finished and are predictive of psychological distress and poor health-related quality of life. Web-based interventions demonstrate good efficacy in addressing these concerns and are more accessible than face-to-face interventions. Finding My Way (FMW) is a web-based, psycho-educational, and cognitive behavioral therapy intervention for cancer survivors developed in Australia. Previous trials have demonstrated that FMW is acceptable, highly adhered to, and effective in reducing the impact of distress on quality of life while leading to cost savings through health resource use reduction. Objective: This study aims to adapt the Australian FMW website for a UK cancer care context and then undertake a single-blinded, randomized controlled trial of FMW UK against a treatment-as-usual waitlist control. Methods: To an extent, our trial design replicates the existing Australian randomized controlled trial of FMW. Following a comprehensive adaptation of the web resource, we will recruit 294 participants (147 per study arm) from across clinical sites in North West England and North Wales. Participants will have been diagnosed with cancer of any type in the last 6 months, have received anticancer treatment with curative intent, be aged ≥16 years, be proficient in English, and have access to the internet and an active email address. Participants will be identified and recruited through the National Institute for Health Research clinical research network. Measures of distress, quality of life, and health economic outcomes will be collected using a self-report web-based questionnaire at baseline, midtreatment, posttreatment, and both 3- and 6-month follow-up. Quantitative data will be analyzed using intention-to-treat mixed model repeated measures analysis. Embedded semistructured qualitative interviews will probe engagement with, and experiences of using, FMW UK and suggestions for future improvements. Results: The website adaptation work was completed in January 2021. A panel of cancer survivors and health care professionals provided feedback on the test version of FMW UK. Feedback was positive overall, although minor updates were made to website navigation, inclusivity, terminology, and the wording of the Improving Communication and Sexuality and Intimacy content. Recruitment for the clinical trial commenced in April 2021. We aim to report on findings from mid-2023. Conclusions: Replication studies are an important aspect of the scientific process, particularly in psychological and clinical trial literature, especially in different geographical settings. Before replicating the FMW trial in the UK setting, content updating was required. If FMW UK now replicates Australian findings, we will have identified a novel and cost-effective method of psychosocial care delivery for cancer survivors in the United Kingdom. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 14317248; https://www.isrctn.com/ISRCTN14317248 International Registered Report Identifier (IRRID): DERR1-10.2196/31976 %M 34542420 %R 10.2196/31976 %U https://www.researchprotocols.org/2021/9/e31976 %U https://doi.org/10.2196/31976 %U http://www.ncbi.nlm.nih.gov/pubmed/34542420 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e24515 %T Unique Features of a Web-Based Nutrition Website for Childhood Cancer Populations: Descriptive Study %A Wartenberg,Lisa %A Raber,Margaret %A Chandra,Joya %+ Department of Pediatrics Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 853, Houston, TX, 77030-4000, United States, 1 17135635405, jchandra@mdanderson.org %K pediatric oncology %K web-based resources %K oncology nutrition %K culinary education %K oncology %K children %K pediatric %K nutrition %K culinary %K education %D 2021 %7 13.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Children with cancer experience a myriad of nutritional challenges that impact their nutrition status during treatment and into survivorship. Growing evidence suggests that weight at diagnosis impacts cancer outcomes, but provider guidance on nutrition and diet during treatment varies. Nutrition literacy and culinary resources may help mitigate some common nutritional problems; however, many patients may face barriers to accessing in-person classes. Along with dietitian-led clinical interventions, web-based resources such as the newly updated electronic cookbook (e-cookbook) created by The University of Texas MD Anderson Cancer Center, @TheTable, may facilitate access to nutrition and culinary education during treatment and into survivorship. Objective: We sought to define and describe the features and content of the @TheTable e-cookbook and compare it with analogous resources for a lay audience of patients with childhood cancer and childhood cancer survivors as well as their families. Methods: We evaluated freely available web-based resources via a popular online search engine (ie, Google). These searches yielded three web-based resources analogous to @TheTable: the American Institute for Cancer Research’s Healthy Recipes, The Children’s Hospital of San Antonio’s Culinary Health Education for Families Recipe for Life, and Ann Ogden Gaffney and Fred Hutchinson Cancer Research Center’s Cook for Your Life. These sites were analyzed for the following: number of recipes, search functionality, child or family focus, cancer focus, specific dietary guidance, videos or other media, and miscellaneous unique features. Results: Cook for Your Life and Culinary Health Education for Families Recipe for Life were the most comparable to @TheTable with respect to cancer focus and family focus, respectively. Healthy Recipes is the least user-friendly, with few search options and no didactic videos. Conclusions: The @TheTable e-cookbook is unique in its offering of child- and family-focused content centered on the cancer and survivorship experience. %M 34515643 %R 10.2196/24515 %U https://www.jmir.org/2021/9/e24515 %U https://doi.org/10.2196/24515 %U http://www.ncbi.nlm.nih.gov/pubmed/34515643 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e28279 %T Stakeholders’ Perspectives on eHealth Support in Colorectal Cancer Survivorship: Qualitative Interview Study %A Husebø,Anne Marie Lunde %+ Department of Public Health, Faculty of Health Sciences, University of Stavanger, Universitetet i Stavanger, postboks 8600, Stavanger, 4036, Norway, 47 99262805, anne.m.husebo@uis.no %K cancer patients %K carers %K colorectal cancer %K digital competence %K eHealth %K health care professionals %K follow-up service %K web-based information seeking, self-management support %K treatment burden %K mobile phone %D 2021 %7 7.9.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: eHealth interventions may represent the way forward in following up patients with colorectal cancer (CRC) after hospital discharge to support them in coping with the illness, strengthen their self-management, and increase their quality of life. By involving end users of eHealth in cocreation processes when designing eHealth solutions, an acceptable and relevant product can be secured. Stakeholders’ perspectives could aid in closing the gap between research-developed products and the implementation of eHealth services in real-life scenarios. Objective: This study aims to explore the views of patients with CRC, their informal caregivers, and health care professionals (HCPs) on information technology and the design of eHealth support in CRC care. Methods: A qualitative, explorative design was used to conduct 31 semistructured individual interviews with 41% (13/31) patients with CRC, 29% (9/31) informal caregivers, and 29% (9/31) HCPs recruited from the gastrosurgical ward of a university hospital in southwestern Norway. A semistructured interview guide was used for data collection, and the data were analyzed by systematic text condensation. Results: Participants described the diverse experiences of patients with CRC seeking web-based information. Age and digital competence were highlighted as influencers of the use of information technology. Patients rarely received advice from HCPs about relevant and secure websites containing information on CRC diagnosis and treatment. Features of desired eHealth interventions in following up patients with CRC were patient education, health monitoring, and communication with HCPs. Conclusions: Several elements affect the activities of patients with CRC seeking health information. Age, inexperience with computer technology, and lack of access to web-based health information may reduce the ability of patients with CRC to engage in decision-making processes regarding illness and treatment. An eHealth service for patients with CRC should comprise features for information, education, and support for self-management and should aim to be individually adapted to the patient’s age and digital competence. Involving end users of eHealth services is necessary to ensure high-quality tailored services that are perceived as user friendly and relevant to the end users. %M 34491210 %R 10.2196/28279 %U https://cancer.jmir.org/2021/3/e28279 %U https://doi.org/10.2196/28279 %U http://www.ncbi.nlm.nih.gov/pubmed/34491210 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e28234 %T Using Social Media for Peer-to-Peer Cancer Support: Interviews With Young Adults With Cancer %A Lazard,Allison J %A Collins,Meredith K Reffner %A Hedrick,Ashley %A Varma,Tushar %A Love,Brad %A Valle,Carmina G %A Brooks,Erik %A Benedict,Catherine %+ Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, 384 Carroll Hall, Chapel Hill, NC, 27599, United States, 1 919 843 8304, lazard@unc.edu %K cancer survivors %K social support %K peer groups %K social media %K young adults %K pyscho-oncology %K mobile phone %D 2021 %7 2.9.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Web-based social support can address social isolation and unmet support needs among young adults with cancer (aged 18-39 years). Given that 94% of young adults own and use smartphones, social media can offer personalized, accessible social support among peers with cancer. Objective: This study aims to examine the specific benefits, downsides, and topics of social support via social media among young adults with cancer. Methods: We conducted semistructured interviews with young adults with cancer, aged between 18 and 39 years, who were receiving treatment or had completed treatment for cancer. Results: Most participants (N=45) used general audience platforms (eg, Facebook groups), and some cancer-specific social media (eg, Caring Bridge), to discuss relevant lived experiences for medical information (managing side effects and treatment uncertainty) and navigating life with cancer (parenting and financial issues). Participants valued socializing with other young adults with cancer, making connections outside their personal networks, and being able to validate their emotional and mental health experiences without time and physical constraints. However, using social media for peer support can be an emotional burden, especially when others post disheartening or harassing content, and can heighten privacy concerns, especially when navigating cancer-related stigma. Conclusions: Social media allows young adults to connect with peers to share and feel validated about their treatment and life concerns. However, barriers exist for receiving support from social media; these could be reduced through content moderation and developing more customizable, potentially cancer-specific social media apps and platforms to enhance one’s ability to find peers and manage groups. %M 34473063 %R 10.2196/28234 %U https://cancer.jmir.org/2021/3/e28234 %U https://doi.org/10.2196/28234 %U http://www.ncbi.nlm.nih.gov/pubmed/34473063 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e22608 %T Development of a Mobile Health App (TOGETHERCare) to Reduce Cancer Care Partner Burden: Product Design Study %A Oakley-Girvan,Ingrid %A Davis,Sharon Watkins %A Kurian,Allison %A Rosas,Lisa G %A Daniels,Jena %A Palesh,Oxana Gronskaya %A Mesia,Rachel J %A Kamal,Arif H %A Longmire,Michelle %A Divi,Vasu %+ Medable Inc, 525 University Avenue, Suite A 70, Palo Alto, CA, 94301, United States, 1 408 656 2948, ingrid@medable.com %K cancer %K oncology %K mHealth %K caregiver %K cancer survivor %K mobile app %K smartphone %K feasibility %K caregiver burden %K symptom reporting %D 2021 %7 13.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 6.1 million adults in the United States serve as care partners for cancer survivors. Studies have demonstrated that engaging cancer survivors and their care partners through technology-enabled structured symptom collection has several benefits. Given the high utilization of mobile technologies, even among underserved populations and in low resource areas, mobile apps may provide a meaningful access point for all stakeholders for symptom management. Objective: We aimed to develop a mobile app incorporating user preferences to enable cancer survivors’ care partners to monitor the survivors’ health and to provide care partner resources. Methods: An iterative information gathering process was conducted that included (1) discussions with 138 stakeholders to identify challenges and gaps in survivor home care; (2) semistructured interviews with clinicians (n=3), cancer survivors (n=3), and care partners (n=3) to identify specific needs; and (3) a 28-day feasibility field test with seven care partners. Results: Health professionals noted the importance of identifying early symptoms of adverse events. Survivors requested modules on medication, diet, self-care, reminders, and a version in Spanish. Care partners preferred to focus primarily on the patient’s health and not their own. The app was developed incorporating quality-of-life surveys and symptom reporting, as well as resources on home survivor care. Early user testing demonstrated ease of use and app feasibility. Conclusions: TOGETHERCare, a novel mobile app, was developed with user input to track the care partner’s health and report on survivor symptoms during home care. The following two clinical benefits emerged: (1) reduced anxiety among care partners who use the app and (2) the potential for identifying survivor symptoms noted by the care partner, which might prevent adverse events. Trial Registration: ClinicalTrials.gov NCT04018677; https://clinicaltrials.gov/ct2/show/NCT04018677 %M 34398787 %R 10.2196/22608 %U https://formative.jmir.org/2021/8/e22608 %U https://doi.org/10.2196/22608 %U http://www.ncbi.nlm.nih.gov/pubmed/34398787 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e24915 %T Examining the Impact of an mHealth Behavior Change Intervention With a Brief In-Person Component for Cancer Survivors With Overweight or Obesity: Randomized Controlled Trial %A Walsh,Jane C %A Richmond,Janice %A Mc Sharry,Jenny %A Groarke,AnnMarie %A Glynn,Liam %A Kelly,Mary Grace %A Harney,Owen %A Groarke,Jenny M %+ Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, David Keir Building, Belfast, BT7 1NN, United Kingdom, 44 02890974886, j.groarke@qub.ac.uk %K cancer survivors %K overweight %K obesity %K health behavior %K goals %K accelerometry %K text messaging %K technology %K Ireland %K self-management %K mobile phone %D 2021 %7 5.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cancer survivorship in Ireland is increasing in both frequency and longevity. However, a significant proportion of cancer survivors do not reach the recommended physical activity levels and have overweight. This has implications for both physical and psychological health, including an increased risk of subsequent and secondary cancers. Mobile health (mHealth) interventions demonstrate potential for positive health behavior change, but there is little evidence for the efficacy of mobile technology in improving health outcomes in cancer survivors with overweight or obesity. Objective: This study aims to investigate whether a personalized mHealth behavior change intervention improves physical and psychological health outcomes in cancer survivors with overweight or obesity. Methods: A sample of 123 cancer survivors (BMI≥25 kg/m2) was randomly assigned to the standard care control (n=61) or intervention (n=62) condition. Group allocation was unblinded. The intervention group attended a 4-hour tailored lifestyle education and information session with physiotherapists, a dietician, and a clinical psychologist to support self-management of health behavior. Over the following 12 weeks, participants engaged in personalized goal setting to incrementally increase physical activity (with feedback and review of goals through SMS text messaging contact with the research team). Direct measures of physical activity were collected using a Fitbit accelerometer. Data on anthropometric, functional exercise capacity, dietary behavior, and psychological measures were collected at face-to-face assessments in a single hospital site at baseline (T0), 12 weeks (T1; intervention end), and 24 weeks (T2; follow-up). Results: The rate of attrition was 21% (13/61) for the control condition and 14% (9/62) for the intervention condition. Using intent-to-treat analysis, significant reductions in BMI (F2,242=4.149; P=.02; ηp2=0.033) and waist circumference (F2,242=3.342; P=.04; ηp2=0.027) were observed in the intervention group. Over the 24-week study, BMI was reduced by 0.52 in the intervention condition, relative to a nonsignificant reduction of 0.11 in the control arm. Waist circumference was reduced by 3.02 cm in the intervention condition relative to 1.82 cm in the control condition. Physical activity level was significantly higher in the intervention group on 8 of the 12 weeks of the intervention phase and on 5 of the 12 weeks of the follow-up period, accounting for up to 2500 additional steps per day (mean 2032, SD 270). Conclusions: The results demonstrate that for cancer survivors with a BMI≥25 kg/m2, lifestyle education and personalized goal setting using mobile technology can yield significant changes in clinically relevant health indicators. Further research is needed to elucidate the mechanisms of behavior change and explore the capacity for mHealth interventions to improve broader health and well-being outcomes in the growing population of cancer survivors. Trial Registration: ISRCTN Registry ISRCTN18676721; https://www.isrctn.com/ISRCTN18676721 International Registered Report Identifier (IRRID): RR2-10.2196/13214 %M 36260394 %R 10.2196/24915 %U https://mhealth.jmir.org/2021/7/e24915 %U https://doi.org/10.2196/24915 %U http://www.ncbi.nlm.nih.gov/pubmed/36260394 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 2 %P e25569 %T Home-Based Telehealth Exercise Intervention in Early-On Survivors of Childhood Acute Lymphoblastic Leukemia: Feasibility Study %A Lambert,Genevieve %A Alos,Nathalie %A Bernier,Pascal %A Laverdière,Caroline %A Kairy,Dahlia %A Drummond,Kenneth %A Dahan-Oliel,Noémi %A Lemay,Martin %A Veilleux,Louis-Nicolas %+ Motion Analysis Center, Shriners Hospital for Children - Canada, 1003 Decarie Blvd, Montreal, QC, H4A 0A9, Canada, 1 514 282 7175, ln.veilleux@mcgill.ca %K exercise therapy %K rehabilitation %K acute lymphoblastic leukemia %K intervention study %K telehealth %K mobile phone %D 2021 %7 16.6.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Acute lymphoblastic leukemia is the most common type of pediatric cancer. Acute lymphoblastic leukemia causes an altered bone mineral homeostasis state, which can contribute to osteopenia, and bone fractures, most commonly vertebral fractures. With the increasing number of childhood cancer survivors, late adverse effects such as musculoskeletal comorbidities are often reported and are further influenced by inactive lifestyle habits. Physical activity has been shown to increase the mechanical workload of the bone, mitigating bone impairment in other cancer-specific populations. Objective: This interventional pilot study aims to investigate the use of telehealth to deliver a home-based exercise intervention for early-on survivors of bone marrow–related hematological malignancies and to assess its impact on survivors’ musculoskeletal and functional health. Methods: We aimed to recruit a group of 12 early-on survivors of acute lymphoblastic leukemia, within 6 months to 5 years of treatment, to participate in and complete the proposed telehealth intervention with a parent. The 16-week intervention included 40 potential home-based physical activity interventions supervised by a kinesiologist through a telehealth internet platform, with monthly progression. Patients were recruited to the cohort if they were able to participate in the intervention during the first month (minimum 12 weeks of intervention). Evaluation before and after the intervention protocol highlighted differences in functional capacities and musculoskeletal health of patients using mechanography, peripheral quantitative computed tomography, 6-minute walk test, and grip force test. Results: The recruitment rate for the intervention was low (12/57, 21% of contacted patients). Of 12 patients, 3 were excluded (1=relapse, 1=failure to meet technical requirements, and 1=abandoned). The 9 patients who completed the intervention (6 girls; mean age 10.93, SD 2.83 years; mean BMI 21.58, SD 6.55 kg/m2; mean time since treatment completion 36.67, SD 16.37 months) had a mean adherence of 89% and a completion rate of 75%. In addition, these patients showed functional improvements in lower limb muscle force and power as well as in the 6-minute walk test distance. Participants also showed improved bone health after the intervention on the following parameters: bone mineral content, stress-strain index, total and cortical cross-sectional area at the 14% site (P=.03, P=.01, P=.01, and P=.001, respectively) and 38% site of the tibia (P=.003, P=.04, P=.001, and P=.003, respectively). Conclusions: High adherence and participation rates suggest that telehealth is a feasible method to deliver exercise interventions to young early-on survivors of acute lymphoblastic leukemia. The proposed intervention seems promising in providing benefits to patients’ functional performance and bone health, but a large-scale study is needed to confirm this assumption. %M 34132645 %R 10.2196/25569 %U https://cancer.jmir.org/2021/2/e25569 %U https://doi.org/10.2196/25569 %U http://www.ncbi.nlm.nih.gov/pubmed/34132645 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e23884 %T Perceptions of Endocrine Therapy in African-American Breast Cancer Survivors: Mixed Methods Study %A Donevant,Sara %A Heiney,Sue P %A Wineglass,Cassandra %A Schooley,Benjamin %A Singh,Akanksha %A Sheng,Jingxi %+ College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, United States, 1 803 777 7672, Donevant@mailbox.sc.edu %K mHealth %K breast cancer survivors %K medication adherence %K cultural considerations %K mobile health applications %D 2021 %7 11.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although the incidence of breast cancer is lower in African-American women than in White women, African-American women have a decreased survival rate. The difference in survival rate may stem from poor endocrine therapy adherence, which increases breast cancer recurrence. Therefore, accessible and culturally sensitive interventions to increase endocrine therapy adherence are necessary. Objective: The purpose of this concurrent convergent mixed methods study was to provide further data to guide the development of the proposed culturally sensitive mHealth app, STORY+ for African-American women with breast cancer. Methods: We recruited 20 African-American women diagnosed with estrogen-positive breast cancer and currently prescribed endocrine therapy. We used a concurrent convergent data collection method to (1) assess the use of smartphones and computers related to health care and (2) identify foundational aspects to support endocrine therapy adherence for incorporation in a mobile health app. Results: Overwhelmingly, the participants preferred using smartphones to using computers for health care. Communicating with health care providers and pharmacies was the most frequent health care use of smartphones, followed by exercise tracking, and accessing the patient portal. We identified 4 aspects of adherence to endocrine therapy and smartphone use for incorporation in app development. The factors that emerged from the integrated qualitative and quantitative data were (1) willingness to use, (2) side effects, (3) social connection, and (4) beliefs about endocrine therapy. Conclusions: Further research is needed to develop a culturally sensitive app for African-American women with breast cancer to improve adherence to endocrine therapy. Our work strongly suggests that this population would use the app to connect with other African-American breast cancer survivors and manage endocrine therapy. %M 34114955 %R 10.2196/23884 %U https://formative.jmir.org/2021/6/e23884 %U https://doi.org/10.2196/23884 %U http://www.ncbi.nlm.nih.gov/pubmed/34114955 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 1 %P e22296 %T Electronic Health Records–Based Cardio-Oncology Registry for Care Gap Identification and Pragmatic Research: Procedure and Observational Study %A Chandra,Alvin %A Philips,Steven T %A Pandey,Ambarish %A Basit,Mujeeb %A Kannan,Vaishnavi %A Sara,Evan J %A Das,Sandeep R %A Lee,Simon J C %A Haley,Barbara %A Willett,DuWayne L %A Zaha,Vlad G %+ Cardiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8568, United States, 1 214 648 1400, vlad.zaha@utsouthwestern.edu %K electronic health records %K cardio-oncology %K patient registry %K heart failure %K screening %D 2021 %7 12.5.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: Professional society guidelines are emerging for cardiovascular care in cancer patients. However, it is not yet clear how effectively the cancer survivor population is screened and treated for cardiomyopathy in contemporary clinical practice. As electronic health records (EHRs) are now widely used in clinical practice, we tested the hypothesis that an EHR-based cardio-oncology registry can address these questions. Objective: The aim of this study was to develop an EHR-based pragmatic cardio-oncology registry and, as proof of principle, to investigate care gaps in the cardiovascular care of cancer patients. Methods: We generated a programmatically deidentified, real-time EHR-based cardio-oncology registry from all patients in our institutional Cancer Population Registry (N=8275, 2011-2017). We investigated: (1) left ventricular ejection fraction (LVEF) assessment before and after treatment with potentially cardiotoxic agents; and (2) guideline-directed medical therapy (GDMT) for left ventricular dysfunction (LVD), defined as LVEF<50%, and symptomatic heart failure with reduced LVEF (HFrEF), defined as LVEF<50% and Problem List documentation of systolic congestive heart failure or dilated cardiomyopathy. Results: Rapid development of an EHR-based cardio-oncology registry was feasible. Identification of tests and outcomes was similar using the EHR-based cardio-oncology registry and manual chart abstraction (100% sensitivity and 83% specificity for LVD). LVEF was documented prior to initiation of cancer therapy in 19.8% of patients. Prevalence of postchemotherapy LVD and HFrEF was relatively low (9.4% and 2.5%, respectively). Among patients with postchemotherapy LVD or HFrEF, those referred to cardiology had a significantly higher prescription rate of a GDMT. Conclusions: EHR data can efficiently populate a real-time, pragmatic cardio-oncology registry as a byproduct of clinical care for health care delivery investigations. %M 33797396 %R 10.2196/22296 %U https://cardio.jmir.org/2021/1/e22296 %U https://doi.org/10.2196/22296 %U http://www.ncbi.nlm.nih.gov/pubmed/33797396 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e22670 %T A Web-Based Lifestyle Intervention Aimed at Improving Cognition in Patients With Cancer Returning to Work in an Outpatient Setting: Protocol for a Randomized Controlled Trial %A Drijver,A Josephine %A Reijneveld,Jaap C %A Wesselman,Linda M P %A Klein,Martin %+ Department of Neurology, Amsterdam UMC, ZH 2 A 63, De Boelelaan 1117, Amsterdam, 1081 HV, Netherlands, 31 20444 4219, a.drijver@amsterdamumc.nl %K cancer %K cognitive functioning %K lifestyle %K web-based intervention %K RCT %K cancer-related cognitive impairment %D 2021 %7 26.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: A high percentage of patients with cancer experience cognitive impairment after cancer treatment, resulting in a decreased health-related quality of life and difficulty returning to work. Consequently, there is a need for effective treatment options to improve cognitive functioning in these patients. In a healthy aging population, multidomain web-based lifestyle interventions have been found to be effective in preventing cognitive decline and improving cognitive functioning. Objective: This study aims to investigate the feasibility and effectiveness of the web-based lifestyle intervention Mijn Fitte Brein (My Fit Brain [MFB]) on cognitive functioning in patients with cancer returning to work. Methods: The study consists of a feasibility study (N=10), followed by a randomized controlled trial (RCT; N=220). Patients will be recruited by their occupational physicians after their return to work following cancer treatment. Mijn Fitte Brein is organized into 4-week cycles in which patients set a lifestyle goal using the Goal Attainment Scale, receive weekly tips and support, and finally evaluate whether they succeeded in achieving this goal. Lifestyle goals are based on 6 domains: physical exercise, diet, sleep, stress, alcohol use, and smoking. In the feasibility study, data on user experience (structured interview) and usability, assessed with the Post-Study System Usability Scale, will be collected and used to optimize Mijn Fitte Brein. In the RCT, patients will be randomized 1:1 between an intervention group and a control group. Patients will be assessed at baseline, 3 months, and 6 months. The primary outcome measure is subjective cognitive functioning, assessed with the Functional Assessment of Cancer Therapy–Cognitive Function (FACT-Cog). Secondary outcome measures are lifestyle, objective cognitive functioning, and work and psychosocial factors. Results: Recruitment for the feasibility study has started in February 2020. As of July 2020, however, no patients have been enrolled (due to COVID-19 restrictions). The findings of the feasibility study will be used to optimize the Mijn Fitte Brein intervention. Enrollment for the RCT will continue when possible. The feasibility study will take 6 months (including making adjustments to the intervention), and the RCT will take 2 years. The final results are expected in 2024. The results of the feasibility study and the RCT will be published in peer-reviewed journals. Conclusions: This is the first time the feasibility and efficacy of a multidomain web-based lifestyle intervention will be studied in patients with cancer. If Mijn Fitte Brein is found to be effective in decreasing cognitive complaints in these patients returning to work, it will be a promising treatment option because of being both affordable and accessible. Trial Registration: Netherlands Trial Register NL8407; https://www.trialregister.nl/trial/8407 International Registered Report Identifier (IRRID): DERR1-10.2196/22670 %M 33900201 %R 10.2196/22670 %U https://www.researchprotocols.org/2021/4/e22670 %U https://doi.org/10.2196/22670 %U http://www.ncbi.nlm.nih.gov/pubmed/33900201 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 2 %P e18819 %T A Home-Based Mobile Health Intervention to Replace Sedentary Time With Light Physical Activity in Older Cancer Survivors: Randomized Controlled Pilot Trial %A Blair,Cindy K %A Harding,Elizabeth %A Wiggins,Charles %A Kang,Huining %A Schwartz,Matthew %A Tarnower,Amy %A Du,Ruofei %A Kinney,Anita Y %+ Department of Internal Medicine, University of New Mexico, 1 University of New Mexico, MSC07-4025, Albuquerque, NM, United States, 1 5059257907, CiBlair@salud.unm.edu %K light-intensity physical activity %K physical activity %K sedentary behavior %K mobile health %K cancer survivors %K consumer wearable %K activity monitor %K mobile phone %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Older cancer survivors are at risk of the development or worsening of both age- and treatment-related morbidity. Sedentary behavior increases the risk of or exacerbates these chronic conditions. Light-intensity physical activity (LPA) is more common in older adults and is associated with better health and well-being. Thus, replacing sedentary time with LPA may provide a more successful strategy to reduce sedentary time and increase physical activity. Objective: This study primarily aims to evaluate the feasibility, acceptability, and preliminary efficacy of a home-based mobile health (mHealth) intervention to interrupt and replace sedentary time with LPA (standing and stepping). The secondary objective of this study is to examine changes in objective measures of physical activity, physical performance, and self-reported quality of life. Methods: Overall, 54 cancer survivors (aged 60-84 years) were randomized in a 1:1:1 allocation to the tech support intervention group, tech support plus health coaching intervention group, or waitlist control group. Intervention participants received a Jawbone UP2 activity monitor for use with their smartphone app for 13 weeks. Tech support and health coaching were provided via 5 telephone calls during the 13-week intervention. Sedentary behavior and physical activity were objectively measured using an activPAL monitor for 7 days before and after the intervention. Results: Participants included survivors of breast cancer (21/54, 39%), prostate cancer (16/54, 30%), and a variety of other cancer types; a mean of 4.4 years (SD 1.6) had passed since their cancer diagnosis. Participants, on average, were 70 years old (SD 4.8), 55% (30/54) female, 24% (13/54) Hispanic, and 81% (44/54) overweight or obese. Malfunction of the Jawbone trackers occurred in one-third of the intervention group, resulting in enrollment stopping at 54 rather than the initial goal of 60 participants. Despite these technical issues, the retention in the intervention was high (47/54, 87%). Adherence was high for wearing the tracker (29/29, 100%) and checking the app daily (28/29, 96%) but low for specific aspects related to the sedentary features of the tracker and app (21%-25%). The acceptability of the intervention was moderately high (81%). There were no significant between-group differences in total sedentary time, number of breaks, or number of prolonged sedentary bouts. There were no significant between-group differences in physical activity. The only significant within-group change occurred within the health coaching group, which increased by 1675 daily steps (95% CI 444-2906; P=.009). This increase was caused by moderate-intensity stepping rather than light-intensity stepping (+15.2 minutes per day; 95% CI 4.1-26.2; P=.008). Conclusions: A home-based mHealth program to disrupt and replace sedentary time with stepping was feasible among and acceptable to older cancer survivors. Future studies are needed to evaluate the optimal approach for replacing sedentary behavior with standing and/or physical activity in this population. Trial Registration: ClinicalTrials.gov NCT03632694; https://clinicaltrials.gov/ct2/show/NCT03632694 %M 33847588 %R 10.2196/18819 %U https://cancer.jmir.org/2021/2/e18819 %U https://doi.org/10.2196/18819 %U http://www.ncbi.nlm.nih.gov/pubmed/33847588 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 2 %P e26010 %T A Novel Behavioral Intervention for Rural Appalachian Cancer Survivors (weSurvive): Participatory Development and Proof-of-Concept Testing %A Porter,Kathleen J %A Moon,Katherine E %A LeBaron,Virginia T %A Zoellner,Jamie M %+ Department of Public Health Sciences, School of Medicine, University of Virginia, , Christiansburg, VA, United States, 1 4342706599, kjporter@virginia.edu %K cancer survivors %K quality of life %K behavior change %K rural %K feasibility %K Appalachia %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Addressing the modifiable health behaviors of cancer survivors is important in rural communities that are disproportionately impacted by cancer (eg, those in Central Appalachia). However, such efforts are limited, and existing interventions may not meet the needs of rural communities. Objective: This study describes the development and proof-of-concept testing of weSurvive, a behavioral intervention for rural Appalachian cancer survivors. Methods: The Obesity-Related Behavioral Intervention Trials (ORBIT) model, a systematic model for designing behavioral interventions, informed the study design. An advisory team (n=10) of community stakeholders and researchers engaged in a participatory process to identify desirable features for interventions targeting rural cancer survivors. The resulting multimodal, 13-week weSurvive intervention was delivered to 12 participants across the two cohorts. Intervention components included in-person group classes and group and individualized telehealth calls. Indicators reflecting five feasibility domains (acceptability, demand, practicality, implementation, and limited efficacy) were measured using concurrent mixed methods. Pre-post changes and effect sizes were assessed for limited efficacy data. Descriptive statistics and content analysis were used to summarize data for other domains. Results: Participants reported high program satisfaction (acceptability). Indicators of demand included enrollment of cancer survivors with various cancer types and attrition (1/12, 8%), recruitment (12/41, 30%), and attendance (median 62%) rates. Dietary (7/12, 59%) and physical activity (PA; 10/12, 83%) behaviors were the most frequently chosen behavioral targets. However, the findings indicate that participants did not fully engage in action planning activities, including setting specific goals. Implementation indicators showed 100% researcher fidelity to delivery and retention protocols, whereas practicality indicators highlighted participation barriers. Pre-post changes in limited efficacy outcomes regarding cancer-specific beliefs and knowledge and behavior-specific self-efficacy, intentions, and behaviors were in desired directions and demonstrated small and moderate effect sizes. Regarding dietary and PA behaviors, effect sizes for fruit and vegetable intake, snacks, dietary fat, and minutes of moderate-to-vigorous activity were small (Cohen d=0.00 to 0.32), whereas the effect sizes for change in PA were small to medium (Cohen d=0.22 to 0.45). Conclusions: weSurvive has the potential to be a feasible intervention for rural Appalachian cancer survivors. It will be refined and further tested based on the study findings, which also provide recommendations for other behavioral interventions targeting rural cancer survivors. Recommendations included adding additional recruitment and engagement strategies to increase demand and practicality as well as increasing accountability and motivation for participant involvement in self-monitoring activities through the use of technology (eg, text messaging). Furthermore, this study highlights the importance of using a systematic model (eg, the ORBIT framework) and small-scale proof-of-concept studies when adapting or developing behavioral interventions, as doing so identifies the intervention’s potential for feasibility and areas that need improvement before time- and resource-intensive efficacy trials. This could support a more efficient translation into practice. %M 33843597 %R 10.2196/26010 %U https://cancer.jmir.org/2021/2/e26010 %U https://doi.org/10.2196/26010 %U http://www.ncbi.nlm.nih.gov/pubmed/33843597 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 2 %P e24828 %T Associations Among Wearable Activity Tracker Use, Exercise Motivation, and Physical Activity in a Cohort of Cancer Survivors: Secondary Data Analysis of the Health Information National Trends Survey %A De La Torre,Steven %A Spruijt-Metz,Donna %A Farias,Albert J %+ Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto St., Los Angeles, CA, 90033, United States, 1 323 442 7252, albertfa@usc.edu %K mHealth %K mobile health %K cancer survivors %K exercise %K physical activity %K motivation %K wearable electronic devices %K fitness trackers %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancer survivors who meet physical activity (PA) recommendations (≥150 minutes of moderate-to-vigorous physical activity [MVPA] per week) experience better health outcomes. With the growing availability of wearable activity trackers (WATs), it may be easier to track PA. However, it is unknown what motivates survivors to use these devices. Objective: The aim of this study is to investigate the associations among motivations for exercise, previous WAT use for tracking a health goal or activity, and meeting the recommended amount of PA among a cohort of cancer survivors. Methods: Data on WAT users who reported having a previous cancer diagnosis were analyzed from the National Cancer Institute’s Health Information National Trends Survey 5 Cycle 3. All survivors with complete information on demographics, exercise motivations (internal guilt, external pressure, physical appearance, and exercise enjoyment), previous WAT use (yes or no), and minutes of MVPA per week (N=608) were included. Multivariate logistic regression models were used to test these associations. A separate cluster analysis was conducted to identify the profiles of exercise motivation that were associated with reporting WAT use. Results: The mean age of the cohort was 66.9 years (SD 12.1). The majority were non-Hispanic White (473/608, 78.8%) and female (322/608, 54.9%), and skin cancer was the most commonly reported diagnosed cancer (154/608, 27.8%). Survivors who reported using WATs to track a health goal or activity were 1.6 times more likely to meet MVPA recommendations than those who did not use WATs (odds ratio [OR] 1.65, 95% CI 1.03-2.65; P=.04). When exercise motivations were assessed independently, survivors who reported not feeling any internal guilt as an exercise motivation were 73% less likely to report having used a WAT than those who felt any internal guilt (OR 0.27, 95% CI 0.14-0.54; P<.001). A total of 3 distinct motivational profiles emerged from the cluster analysis. WAT users had an increased probability of membership in profile 3, which was characterized as being strongly motivated to exercise by internal guilt, physical appearance, and exercise enjoyment (OR 4.5, 95% CI 2.1-9.7; P<.001). Conclusions: Among this cohort, survivors who reported using WATs to track a health goal or activity were significantly more likely to report meeting PA recommendations. Survivors who reported feeling internal guilt as an exercise motivation were significantly more likely to report using WATs to track a health goal or activity. When examining clusters of motivation, survivors who reported previous WAT use were more likely to report being motivated to exercise by a mix of intrinsic and extrinsic motivations, including internal guilt, exercise enjoyment, and physical appearance. Given the health benefits of PA for cancer survivors, technology-focused interventions that use WATs and target exercise motivation may aid in cancer survivors meeting the level of recommended PA. %M 33843595 %R 10.2196/24828 %U https://cancer.jmir.org/2021/2/e24828 %U https://doi.org/10.2196/24828 %U http://www.ncbi.nlm.nih.gov/pubmed/33843595 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 1 %P e23927 %T Use of mHealth to Increase Physical Activity Among Breast Cancer Survivors With Fatigue: Qualitative Exploration %A Martin,Elise %A Di Meglio,Antonio %A Charles,Cecile %A Ferreira,Arlindo %A Gbenou,Arnauld %A Blond,Marine %A Fagnou,Benoit %A Arvis,Johanna %A Pistilli,Barbara %A Saghatchian,Mahasti %A Vaz Luis,Ines %+ Institute Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, , France, 33 078 740 9282, INES-MARIA.VAZ-DUARTE-LUIS@gustaveroussy.fr %K mHealth %K physical activity %K breast cancer %K cancer-related fatigue %K qualitative study %K survivorship %D 2021 %7 22.3.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Physical activity has shown beneficial effects in the treatment of breast cancer fatigue; nevertheless, a significant portion of patients remain insufficiently physically active after breast cancer. Currently most patients have a smartphone, and therefore mobile health (mHealth) holds the promise of promoting health behavior uptake for many of them. Objective: In this study, we explored representations, levers, and barriers to physical activity and mHealth interventions among inactive breast cancer patients with fatigue. Methods: This was an exploratory, qualitative study including breast cancer patients from a French cancer center. A total of 4 focus groups were conducted with 9 patients; 2 independent groups of patients (groups A and B) were interviewed at 2 consecutive times (sessions 1 to 4), before and after their participation in a 2-week mHealth group experience consisting of (1) a competitive virtual exercise group activity (a fictitious world tour), (2) participation in a daily chat network, and (3) access to physical activity information and world tour classification feedback. We used a thematic content analysis. Results: Several physical activity levers emerged including (1) physical factors such as perception of physical benefit and previous practice, (2) psychological factors such as motivation increased by provider recommendations, (3) social factors such as group practice, and (4) organizational factors including preplanning physical activity sessions. The main barriers to physical activity identified included late effects of cancer treatment, lack of motivation, and lack of time. The lack of familiarity with connected devices was perceived as the main barrier to the use of mHealth as a means to promote physical activity. The tested mHealth group challenge was associated with several positive representations including well-being and good habit promotion and being a motivational catalyzer. Following feedback, modifications were implemented into the mHealth challenge. Conclusions: mHealth-based, easily accessed group challenges were perceived as levers for the practice of physical activity in this population. mHealth-based group challenges should be explored as options to promote physical activity in a population with fatigue after breast cancer. %M 33749606 %R 10.2196/23927 %U https://cancer.jmir.org/2021/1/e23927 %U https://doi.org/10.2196/23927 %U http://www.ncbi.nlm.nih.gov/pubmed/33749606 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e24667 %T A Mobile Patient-Facing App for Tracking Patient-Reported Outcomes in Head and Neck Cancer Survivors: Single-Arm Feasibility Study %A Teckie,Sewit %A Solomon,Jeffrey %A Kadapa,Karthik %A Sanchez,Keisy %A Orner,David %A Kraus,Dennis %A Kamdar,Dev P %A Pereira,Lucio %A Frank,Douglas %A Diefenbach,Michael %+ Academic Department of Radiation Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 130 East 77th Street, New York, NY, 10010, United States, 1 212 434 2919, steckie@northwell.edu %K mHealth %K ePROs %K head and neck cancer %K mobile phone %D 2021 %7 19.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with head and neck cancer (HNC) frequently experience disease-related symptoms and treatment adverse effects that impact their overall quality of life. Cancer-specific mobile health apps for patient-related outcomes allow patients to communicate with their clinicians and proactively track their symptoms, which have been shown to improve clinical management and disease outcomes. Objective: The purpose of this study was to evaluate the feasibility of LogPAL, a novel iPhone-based mobile health app designed to help HNC survivors track and manage their posttreatment symptoms. Methods: Patients who completed curative treatment for HNC in the preceding 24 months were recruited from 2 clinical sites within a single institution. Upon enrollment, participants completed a brief sociodemographic survey, downloaded the app onto their iPhone devices, and were asked to complete a series of biweekly questionnaires (based on the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events) via the app for an 8-week study period. The primary feasibility endpoints included retention (retaining >80% of the enrolled participants for the duration of the study period), adherence (>50% of the participants completing 100% of the questionnaires over the study period), and usability (a mean system usability scale [SUS] score >68). Additional postintervention questions were collected to assess perceived usefulness, acceptance, and overall satisfaction. Results: Between January and October 2019, 38 participants were enrolled in the study. Three participants dropped out, and 3 were classified as nonusers. The remaining 32 (87%) were eligible for analysis. Their mean age was 57.8 (SD 12.3) years (range 24-77 years, 81% [26/32] male). Overall, 375 of 512 (73.2%) questionnaires were completed, with 17 (53%) of the 32 participants adherent. Participant-reported usability was acceptable; the mean SUS score was 71.9 (95% CI 64.3-79.5) with high satisfaction of LogPAL usefulness and likelihood to recommend to other cancer survivors. Conclusions: This single-arm prospective pilot study showed that LogPAL is a feasible, regularly used, accepted app for HNC survivors, justifying a full-scale pilot. Based on the findings from this study, future iterations will aim to improve usability and test intervention efficacy. %M 33739291 %R 10.2196/24667 %U https://formative.jmir.org/2021/3/e24667 %U https://doi.org/10.2196/24667 %U http://www.ncbi.nlm.nih.gov/pubmed/33739291 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25056 %T Personal Accounts of Young-Onset Colorectal Cancer Organized as Patient-Reported Data: Protocol for a Mixed Methods Study %A Lamprell,Klay %A Fajardo Pulido,Diana %A Tran,Yvonne %A Nic Giolla Easpaig,Bróna %A Liauw,Winston %A Arnolda,Gaston %A Braithwaite,Jeffrey %+ Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, New South Wales, Sydney, 2109, Australia, 61 2 9850 2472, klay.lamprell@mq.edu.au %K colorectal cancer %K PROMs %K young-onset cancer %K cancer %K patient reported outcome %D 2021 %7 26.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young-onset colorectal cancer is a contemporary issue in need of substantial research input. The incidence of colorectal cancer in adults younger than 50 years is rising in contrast to the decreasing incidence of this cancer in older adults. People with young-onset colorectal cancer may be at that stage of life in which they are establishing their careers, building relationships with long-term partners, raising children, and assembling a financial base for the future. A qualitative study designed to facilitate triangulation with extant quantitative patient-reported data would contribute the first comprehensive resource for understanding how this distinct patient population experiences health services and the outcomes of care throughout the patient pathway. Objective: The aim of this study was to undertake a mixed-methods study of qualitative patient-reported data on young-onset colorectal cancer experiences and outcomes. Methods: This is a study of web-based unsolicited patient stories recounting experiences of health services and clinical outcomes related to young-onset colorectal cancer. Personal Recollections Organized as Data (PROD) is a novel methodology for understanding patients’ health experiences in order to improve care. PROD pivots qualitative data collection and analysis around the validated domains and dimensions measured in patient-reported outcome and patient-reported experience questionnaires. PROD involves 4 processes: (1) classifying attributes of the contributing patients, their disease states, their routes to diagnosis, and the clinical features of their treatment and posttreatment; (2) coding texts into the patient-reported experience and patient-reported outcome domains and dimensions, defined a priori, according to phases of the patient pathway; (3) thematic analysis of content within and across each domain; and (4) quantitative text analysis of the narrative content. Results: Relevant patient stories have been identified, and permission has been obtained for use of the texts in primary research. The approval for this study was granted by the Macquarie University Human Research Ethics Committee in June 2020. The analytical framework was established in September 2020, and data collection commenced in October 2020. We will complete the analysis in March 2021 and we aim to publish the results in mid-2021. Conclusions: The findings of this study will identify areas for improvement in the PROD methodology and inform the development of a large-scale study of young-onset colorectal cancer patient narratives. We believe that this will be the first qualitative study to identify and describe the patient pathway from symptom self-identification to help-seeking through to diagnosis, treatment, and to survivorship or palliation for people with young-onset colorectal cancer. International Registered Report Identifier (IRRID): DERR1-10.2196/25056 %M 33635274 %R 10.2196/25056 %U https://www.researchprotocols.org/2021/2/e25056 %U https://doi.org/10.2196/25056 %U http://www.ncbi.nlm.nih.gov/pubmed/33635274 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e18288 %T Acceptability of a Mobile Health Behavior Change Intervention for Cancer Survivors With Obesity or Overweight: Nested Mixed Methods Study Within a Randomized Controlled Trial %A Groarke,Jenny M %A Richmond,Janice %A Mc Sharry,Jenny %A Groarke,AnnMarie %A Harney,Owen M %A Kelly,Mary Grace %A Walsh,Jane C %+ Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, 18-30 Malone Road, Belfast, BT71NN, United Kingdom, 44 28 90974886, j.groarke@qub.ac.uk %K mHealth %K self-management %K text messaging %K activity tracker %K exercise %K diet %K overweight %K obesity %K cancer survivors %K qualitative research %K mobile phone %D 2021 %7 16.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A significant proportion of cancer survivors have overweight or obesity. Although this has negative implications for health, weight management is not a standard component of oncology aftercare. Mobile health (mHealth) technology, in combination with behavior change techniques (BCTs), has the potential to support positive lifestyle changes. Few studies have been carried out with cancer survivors; therefore, the acceptability of these tools and techniques requires further investigation. Objective: The aim of this study is to examine the acceptability of a behavior change intervention using mHealth for cancer survivors with a BMI of 25 or more and to gather constructive feedback from participants. Methods: The intervention consisted of educational sessions and an 8-week physical activity goal setting intervention delivered using mobile technology (ie, Fitbit activity monitor plus SMS contact). In the context of a two-arm randomized controlled trial, semistructured interviews were conducted to assess the retrospective acceptability of the intervention from the perspective of the recipients. The theoretical framework for the acceptability of health care interventions was used to inform a topic guide. The interviews were transcribed and analyzed using thematic analysis. A quantitative survey was also conducted to determine the acceptability of the intervention. A total of 13 participants were interviewed, and 36 participants completed the quantitative survey. Results: The results strongly support the acceptability of the intervention. The majority of the survey respondents held a positive attitude toward the intervention (35/36, 97%). In qualitative reports, many of the intervention components were enjoyed and the mHealth components (ie, Fitbit and goal setting through text message contact) were rated especially positively. Responses were mixed as to whether the burden of participating in the intervention was high (6/36, 17%) or low (5/36, 14%). Participants perceived the intervention as having high efficacy in improving health and well-being (34/36, 94%). Most respondents said that they understood how the intervention works (35/36, 97%), and qualitative data show that participants’ understanding of the aim of the intervention was broader than weight management and focused more on moving on psychologically from cancer. Conclusions: On the basis of the coherence of responses with theorized aspects of intervention acceptability, we are confident that this intervention using mHealth and BCTs is acceptable to cancer survivors with obesity or overweight. Participants made several recommendations concerning the additional provision of social support. Future studies are needed to assess the feasibility of delivery in clinical practice and the acceptability of the intervention to those delivering the intervention. International Registered Report Identifier (IRRID): RR2-10.2196/13214 %M 33591290 %R 10.2196/18288 %U http://mhealth.jmir.org/2021/2/e18288/ %U https://doi.org/10.2196/18288 %U http://www.ncbi.nlm.nih.gov/pubmed/33591290 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 1 %P e25317 %T Physical Activity, Mental Health, and Technology Preferences to Support Cancer Survivors During the COVID-19 Pandemic: Cross-sectional Study %A Faro,Jamie M %A Mattocks,Kristin M %A Nagawa,Catherine S %A Lemon,Stephenie C %A Wang,Bo %A Cutrona,Sarah L %A Sadasivam,Rajani S %+ Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, Worcester, MA, 01605, United States, 1 617 828 8093, Jamie.faro@umassmed.edu %K cancer %K COVID-19 %K digital %K physical activity %K support %K technology %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: COVID-19 has had significant health-related and behavioral impacts worldwide. Cancer survivors (hereafter referred to as “survivors”) are particularly prone to behavioral changes and are encouraged to be more vigilant and observe stricter social distancing measures. Objective: We explored (1) changes in physical activity and sedentary behaviors since the onset of COVID-19, along with changes in mental health status, and (2) alternative strategies to support survivors’ physical activity and social health during and after COVID-19, along with the role of digital health in such strategies. Methods: A questionnaire was distributed among survivors participating (currently or previously) in the community-based physical activity program LIVESTRONG at the Young Men’s Christian Association (YMCA), from 3 sites outside an urban area in Massachusetts. Questions addressed pre–COVID-19 vs current changes in physical activity and sedentary behavior. Anxiety and depression were assessed using the 2-item Generalized Anxiety Disorder scale (GAD-2) and 2-item Patient Health Questionnaire (PHQ-2), and scores ≥3 indicated a clinical diagnosis of anxiety or depression, respectively. Digital health preferences were assessed through closed-ended questions. Open-ended responses addressing other preferences for physical activity programs and social support were analyzed, coded, and categorized into themes. Results: Among 61 participants (mean age 62 [SD 10.4] years; females: 51/61 [83.6%]), 67.2% (n=41) reported decreased physical activity and 67.2% (n=41) reported prolonged sitting times since the onset of COVID-19. Further, 24.6% (n=15) and 26.2% (n=16) met the GAD-2 and PHQ-2 criteria for clinical anxiety and depression, respectively. All participants owned a cellphone; 90% (n=54) owned a smartphone. Preferences for physical activity programs (n=28) included three themes: (1) use of digital or remote platforms (Zoom, other online platforms, and video platforms), (2) specific activities and locations (eg, outdoor activities, walking, gardening, biking, and physical activities at the YMCA and at senior centers), and (3) importance of social support regardless of activity type (eg, time spent with family, friends, peers, or coaches). The survey revealed a mean score of 71.8 (SD 21.4; scale 0-100) for the importance of social support during physical activity programs. Social support preferences (n=15) revealed three themes: (1) support through remote platforms (eg, texting, Zoom, phone calls, emails, and Facebook), (2) tangible in-person support (YMCA and senior centers), and (3) social support with no specific platform (eg, small gatherings and family or friend visits). Conclusions: Physical activity and mental health are critical factors for the quality of life of survivors, and interventions tailored to their activity preferences are necessary. Digital or remote physical activity programs with added social support may help address the ongoing needs of survivors during and after the pandemic. %M 33471776 %R 10.2196/25317 %U http://cancer.jmir.org/2021/1/e25317/ %U https://doi.org/10.2196/25317 %U http://www.ncbi.nlm.nih.gov/pubmed/33471776 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e21256 %T Metabolic Syndrome Parameters, Determinants, and Biomarkers in Adult Survivors of Childhood Cancer: Protocol for the Dutch Childhood Cancer Survivor Study on Metabolic Syndrome (Dutch LATER METS) %A Pluimakers,Vincent %A Fiocco,Marta %A van Atteveld,Jenneke %A Hobbelink,Monique %A Bresters,Dorine %A Van Dulmen-den Broeder,Eline %A Van der Heiden-van der Loo,Margriet %A Janssens,Geert O %A Kremer,Leontien %A Loonen,Jacqueline %A Louwerens,Marloes %A Van der Pal,Helena %A Ronckers,Cécile %A Van Santen,Hanneke %A Versluys,Birgitta %A De Vries,Andrica %A Van den Heuvel-Eibrink,Marry %A Neggers,Sebastian %+ Princess Maxima Center for Pediatric Oncology, Heidelberglaan 25, Utrecht, 3584CS, Netherlands, 31 613348669, v.g.pluimakers@prinsesmaximacentrum.nl %K metabolic syndrome %K childhood cancer survivor %K Dutch Childhood Cancer Survivor Study %K methodology %K Dutch LATER METS %D 2021 %7 27.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Potential late effects of treatment for childhood cancer include adiposity, insulin resistance, dyslipidemia, and hypertension. These risk factors cluster together as metabolic syndrome and increase the risk for development of diabetes mellitus and cardio- and cerebrovascular disease. Knowledge on risk factors, timely diagnosis, and preventive strategies is of importance to prevent cardio- and cerebrovascular complications and improve quality of life. Currently, no national cohort studies on the prevalence and determinants of metabolic syndrome in childhood cancer survivors, including biomarkers and genetic predisposition, are available. Objective: The objectives of the Dutch LATER METS study are to assess 1) the prevalence and risk factors of metabolic syndrome and its separate components, and 2) the potential diagnostic and predictive value of additional biomarkers for surveillance of metabolic syndrome in the national cohort of adult long-term survivors of childhood cancer. Methods: This is a cross-sectional study based on recruitment of all survivors treated in the Netherlands between 1963 and 2002. Metabolic syndrome will be classified according to the definitions of the third Adult Treatment Panel Report of the National Cholesterol Education Program as well as the Joint Interim Statement and compared to reference data. Dual-energy x-ray absorptiometry scans were performed to assess body composition in more detail. The effect of patient characteristics, previous treatment, and genetic variation on the risk of metabolic syndrome will be assessed. The diagnostic and predictive value of novel biomarkers will be tested. Results: Patient accrual started in 2016 and lasted until April 2020. A total of 2380 survivors from 7 pediatric oncology hospitals have participated. From July 2020, biomarker testing, single nucleotide polymorphism analysis, and data analysis will be performed. Conclusions: The Dutch LATER METS study will provide knowledge on clinical and genetic determinants of metabolic syndrome and the diagnostic value of biomarkers in childhood cancer survivors. The results of this study will be used to optimize surveillance guidelines for metabolic syndrome in survivors based on enhanced risk stratification and screening strategies. This will improve diagnosis of metabolic syndrome and prevent complications. International Registered Report Identifier (IRRID): DERR1-10.2196/21256 %M 32750002 %R 10.2196/21256 %U https://www.researchprotocols.org/2021/1/e21256 %U https://doi.org/10.2196/21256 %U http://www.ncbi.nlm.nih.gov/pubmed/32750002 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e21851 %T Health-Related Quality of Life in European Childhood Cancer Survivors: Protocol for a Study Within PanCareLIFE %A Calaminus,Gabriele %A Baust,Katja %A Berger,Claire %A Byrne,Julianne %A Binder,Harald %A Casagranda,Leonie %A Grabow,Desiree %A Grootenhuis,Martha %A Kaatsch,Peter %A Kaiser,Melanie %A Kepak,Tomas %A Kepáková,Kateřina %A Kremer,Leontien C M %A Kruseova,Jarmila %A Luks,Ales %A Spix,Claudia %A van den Berg,Marleen %A van den Heuvel-Eibrink,Marry M M %A van Dulmen-den Broeder,Eline %A Kuonen,Rahel %A Sommer,Grit %A Kuehni,Claudia %+ Department of Paediatric Haematology and Oncology, University Hospital Bonn, Venusberg-Campus 1, Bonn, 53127, Germany, 49 228 287 ext 33389, gabriele.calaminus@ukbonn.de %K children %K adolescents %K neoplasms %K quality of life %K health status %K Europe %K epidemiology %K survivors of childhood cancer %D 2021 %7 25.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Survival after childhood cancer has improved to more than 80% during the last few years, leading to an increased number of childhood cancer survivors. Cancer itself, or its treatment, may cause chronic health conditions, including somatic and mental sequelae, which may affect survivors’ health-related quality of life (HRQoL). Objective: The project PanCareLIFE aims to establish a large database with comprehensive data on childhood cancer survivors from different European countries, including data on HRQoL. Within PanCareLIFE, this study aims to describe HRQoL in survivors, investigate predictors of HRQoL, and describe the association of HRQoL with hearing and female fertility impairment. This paper describes the design of the HRQoL study, the origin of data, strategies for data collection, and sampling characteristics of survivors from each contributing country. Methods: A total of 6 institutions from 5 European countries (the Czech Republic, France, Germany, the Netherlands, and Switzerland) provided data on HRQoL assessed with the Short Form 36 and on relevant predictors. The central PanCareLIFE data center aggregated the data and harmonized the variables between the institutions. Survivors were eligible if they received a diagnosis of cancer according to the 12 main groups of the International Classification of Childhood Cancer, 3rd edition, or Langerhans cell histiocytosis; were aged ≤18 years at the time of diagnosis; were residents of the respective country at the time of diagnosis; had survived ≥5 years after cancer diagnosis; were aged ≥18 years at the time of the questionnaire survey; and did not refuse to registration in the national or local childhood cancer cohort. Results: We identified 24,993 eligible survivors. Of those, 19,268 survivors received a questionnaire and 9871 survivors participated, resulting in response rates of 9871/24,993 (39.50%) of eligible survivors and of 9871/19,268 (51.23%) invited survivors. Most participants were diagnosed with cancer between the ages of 10 and 14 years (3448/9871, 34.93%) or <5 years (3201/9871, 32.43%). The median age was 8 years. Of the 9871 participants, 3157 (31.97%) were survivors of leukemia, 2075 (21.02%) lymphoma, and 1356 (13.7%) central nervous system (CNS) tumors. Most participants (9225/9871, 93.46%) had no history of a subsequent tumor; 77.45% (7645/9871) received chemotherapy with or without other treatments. More than half (5460/9871, 55.31%) were aged 25 to 34 years at the time of the HRQoL study. Participating survivors differed from nonparticipants; participants were more often women, survivors of leukemia or lymphoma, and less frequently, survivors of CNS tumors than nonparticipants. Conclusions: PanCareLIFE successfully assessed HRQoL and its predictors in 9871 European survivors of childhood cancer. This large population will permit detailed investigations of HRQoL after childhood cancer, particularly the impact of hearing and female fertility impairment on HRQoL. International Registered Report Identifier (IRRID): RR1-10.2196/21851 %M 33492237 %R 10.2196/21851 %U http://www.researchprotocols.org/2021/1/e21851/ %U https://doi.org/10.2196/21851 %U http://www.ncbi.nlm.nih.gov/pubmed/33492237 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e20841 %T A Decision Aid Intervention for Family Building After Cancer: Developmental Study on the Initial Steps to Consider When Designing a Web-Based Prototype %A Benedict,Catherine %A Dauber-Decker,Katherine L %A King,D'Arcy %A Hahn,Alexandria %A Ford,Jennifer S %A Diefenbach,Michael %+ Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94305-5718, United States, 1 2012077117, cbenedict@stanford.edu %K patient-centered care %K user-centered design %K decision support techniques %K decision aid %K cancer %K fertility %K internet-based intervention %K web-based intervention %K mobile phone %K psychosocial intervention %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: An important aspect of patient-centered care involves ensuring that patient-directed resources are usable, understandable, and responsive to patients’ needs. A user-centered design refers to an empathy-based framework and an iterative design approach for developing a product or solution that is based on an in-depth understanding of users’ needs, values, abilities, and limitations. Objective: This study presents the steps taken to develop a prototype for a patient resource for young women who have completed treatment for gonadotoxic cancer to support their decision making about follow-up fertility care and family building. Methods: User-centered design practices were used to develop Roadmap to Parenthood, a decision aid (DA) website for family building after cancer. A multidisciplinary steering group was assembled and input was provided. Guidelines from the International Patient DA Society and the Ottawa Decision Support Framework were used throughout the development process. In addition, guidelines for developing health DAs with respect to patient diversity and health literacy were also followed. Results: The Roadmap to Parenthood DA website prototype was systematically and iteratively developed. An extensive process of designing and developing solutions from the perspective of the end user was followed. The steps taken included formative work to identify user needs; determining goals, format, and delivery; design processes (eg, personas, storyboards, information architecture, user journey mapping, and wireframing); and content development. Additional design considerations addressed the unique needs of this patient population, including the emotional experiences related to this topic and decision-making context wherein decisions could be considered iteratively while involving a multistep process. Conclusions: The design strategies presented in this study describe important steps in the early phases of developing a user-centered resource, which will enhance the starting point for usability testing and further design modifications. Future research will pilot test the DA and a planning tool, and evaluate improvement in the decisional conflict regarding family building after cancer. Consistent with a patient-centered approach to health care, the strategies described here may be generalized and applied to the development of other patient resources and clinical contexts to optimize usability, empathy, and user engagement. %M 33480848 %R 10.2196/20841 %U http://formative.jmir.org/2021/1/e20841/ %U https://doi.org/10.2196/20841 %U http://www.ncbi.nlm.nih.gov/pubmed/33480848 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 1 %P e18396 %T Cardiovascular Assessment Tool for Breast Cancer Survivors and Oncology Providers: Usability Study %A Weaver,Kathryn E %A Klepin,Heidi D %A Wells,Brian J %A Dressler,Emily V %A Winkfield,Karen M %A Lamar,Zanetta S %A Avery,Tiffany P %A Pajewski,Nicholas M %A Hundley,W Gregory %A Johnson,Aimee %A Davidson,Eleanor C %A Lopetegui,Marcelo %A Foraker,Randi E %+ Institute for Informatics, Washington University in St Louis School of Medicine, 600 S Taylor Avenue, Suite 102, Campus Box 8102, St Louis, MO, 63110, United States, 1 314 273 2211, randi.foraker@wustl.edu %K electronic health records %K clinical decision support %K usability testing %K cardiovascular diseases %K cancer survivors %K breast cancer %D 2021 %7 21.1.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Cardiovascular health is of increasing concern to breast cancer survivors and their health care providers, as many survivors are more likely to die from cardiovascular disease than cancer. Implementing clinical decision support tools to address cardiovascular risk factor awareness in the oncology setting may enhance survivors’ attainment or maintenance of cardiovascular health. Objective: We sought to evaluate survivors’ awareness of cardiovascular risk factors and examine the usability of a novel electronic health record enabled cardiovascular health tool from the perspective of both breast cancer survivors and oncology providers. Methods: Breast cancer survivors (n=49) recruited from a survivorship clinic interacted with the cardiovascular health tool and completed pre and posttool assessments about cardiovascular health knowledge and perceptions of the tool. Oncologists, physician assistants, and nurse practitioners (n=20) who provide care to survivors also viewed the cardiovascular health tool and completed assessments of perceived usability and acceptability. Results: Enrolled breast cancer survivors (84% White race, 4% Hispanic ethnicity) had been diagnosed 10.8 years ago (SD 6.0) with American Joint Committee on Cancer stage 0, I, or II (45/49, 92%). Prior to viewing the tool, 65% of survivors (32/49) reported not knowing their level for one or more cardiovascular health factors (range 0-4). On average, only 45% (range 0%-86%) of survivors’ known cardiovascular health factors were at an ideal level. More than 50% of survivors had ideal smoking status (45/48, 94%) or blood glucose level (29/45, 64%); meanwhile, less than 50% had ideal blood pressure (12/49, 24%), body mass index (12/49, 24%), cholesterol level (17/35, 49%), diet (7/49, 14%), and physical activity (10/49. 20%). More than 90% of survivors thought the tool was easy to understand (46/47, 98%), improved their understanding (43/47, 91%), and was helpful (45/47, 96%); overall, 94% (44/47 survivors) liked the tool. A majority of survivors (44/47, 94%) thought oncologists should discuss cardiovascular health during survivorship care. Most (12/20, 60%) oncology providers (female: 12/20, 60%; physicians: 14/20, 70%) had been practicing for more than 5 years. Most providers agreed the tool provided useful information (18/20, 90%), would help their effectiveness (18/20, 90%), was easy to use (20/20, 100%), and presented information in a useful format (19/20, 95%); and 85% of providers (17/20) reported they would use the tool most or all of the time when providing survivorship care. Conclusions: These usability data demonstrate acceptability of a cardiovascular health clinical decision support tool in oncology practices. Oncology providers and breast cancer survivors would likely value the integration of such apps in survivorship care. By increasing awareness and communication regarding cardiovascular health, electronic health record–enabled tools may improve survivorship care delivery for breast cancer and ultimately patient outcomes. %M 33475511 %R 10.2196/18396 %U http://cancer.jmir.org/2021/1/e18396/ %U https://doi.org/10.2196/18396 %U http://www.ncbi.nlm.nih.gov/pubmed/33475511 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e17538 %T Patterns of Use of Smartphone-Based Interventions Among Latina Breast Cancer Survivors: Secondary Analysis of a Pilot Randomized Controlled Trial %A Baik,Sharon H %A Oswald,Laura B %A Buscemi,Joanna %A Buitrago,Diana %A Iacobelli,Francisco %A Perez-Tamayo,Alejandra %A Guitelman,Judith %A Penedo,Frank J %A Yanez,Betina %+ Department of Supportive Care Medicine, City of Hope, 1500 E Duarte Rd, Duarte, CA, 91010, United States, 1 626 256 4673, shbaik@coh.org %K breast cancer %K cancer survivorship %K Hispanics/Latinas %K eHealth %K psychosocial intervention %K mobile phone %D 2020 %7 8.12.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: Latina breast cancer survivors experience poorer health-related quality of life (HRQoL), greater symptom burden, and more psychosocial needs compared to non-Latina breast cancer survivors. eHealth platforms such as smartphone apps are increasingly being used to deliver psychosocial interventions to cancer survivors. However, few psychosocial eHealth interventions have been developed specifically for Latina breast cancer survivors. Further, little is known about how Latinas, in general, engage with eHealth interventions and whether specific participant characteristics are associated with app use in this population. We evaluated the use of 2 culturally informed, evidence-based smartphone apps for Latina breast cancer survivors—one that was designed to improve HRQoL and reduce symptom burden (My Guide) and the other to promote healthy lifestyle behaviors (My Health). Objective: The objectives of our study were to explore the patterns of use of the My Guide intervention app and My Health attention-control app among Latina breast cancer survivors. Methods: Eighty Latina breast cancer survivors were randomized to use the My Guide or My Health app for 6 weeks. Assessments were collected at baseline (T1), immediately after the 6-week intervention (T2), and 2 weeks after T2 (T3). Specific study outcomes included subdomains of HRQoL, symptom burden, cancer-specific distress, cancer-relevant self-efficacy, and breast cancer knowledge. Results: On average, participants used their assigned app for more than 1 hour per week. Sociodemographic or psychological characteristics were not significantly associated with app use, except for employment status in the My Health group. Content related to common physical and emotional symptoms of breast cancer survivors as well as recommendations for nutrition and physical activity were most frequently accessed by My Guide and My Health participants, respectively. Lastly, clinically meaningful improvements were demonstrated in breast cancer well-being among low app users (ie, <60 minutes of use/week) of My Guide and social well-being among high app users (ie, ≥60 minutes of use/week) of My Health. Conclusions: The favorable rates of participant use across both apps suggest that Latina breast cancer survivors are interested in the content delivered across both My Guide and My Health. Furthermore, since sociodemographic variables, excluding employment status, and baseline HRQoL (psychological variable) were not related to app use, My Guide and My Health may be accessible to diverse Latina breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT03645005; https://clinicaltrials.gov/ct2/show/NCT03645005 %M 33289669 %R 10.2196/17538 %U http://cancer.jmir.org/2020/2/e17538/ %U https://doi.org/10.2196/17538 %U http://www.ncbi.nlm.nih.gov/pubmed/33289669 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e24264 %T A Digital Program (Hope) for People Living With Cancer During the COVID-19 Pandemic: Protocol for a Feasibility Randomized Controlled Trial %A Wright,Hayley %A Martin,Faith %A Clyne,Wendy %A Clark,Cain C T %A McGillion,Michael %A Matouskova,Gabriela %A Turner,Andrew %+ Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Richard Crossman Building, Jordan Well, Coventry, CV1 5DE, United Kingdom, 44 2477657498, hsx116@coventry.ac.uk %K self-management %K survivorship %K cancer %K feasibility %K randomized controlled trial %K COVID-19 %K protocol %K digital health %K intervention %D 2020 %7 4.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the COVID-19 lockdown period in the United Kingdom that began on March 23, 2020, more than a quarter of a million people with cancer reported worsening mental health. Help to Overcome Problems Effectively (Hope) is a self-management program for people with cancer, designed to provide support for distress, unmet needs, and poor psychological health. In light of social distancing during the COVID-19 pandemic, digital delivery of the Hope Programme has become ever more vital for people with cancer. Previous pre-post studies of the digital Hope Programme have found reduced anxiety and depression and improved well-being for people with cancer. However, evaluation of this evidence has been limited by the lack of a control group in these previous studies. Objective: We now present a protocol for a feasibility randomized controlled trial of the digital Hope Programme for people with cancer during the COVID-19 pandemic. Primary outcomes will be recruitment, dropout, and adherence rates, and estimations of sample and effect size. To detect signals of efficacy, secondary outcomes will be participant mental health and well-being. Methods: Participants will be recruited by Macmillan Cancer Support (MCS) through their social media networks. The study will employ a feasibility wait-list randomized controlled trial (RCT) design, with people with cancer being randomized to join the digital Hope Programme immediately (intervention group [IG]) or join a 6-week waiting list (wait-list control group [WLCG]) with a 1:1 allocation ratio. Participants will complete digital measures of depression, anxiety, mental well-being, and confidence in managing their own health. Online questionnaires will be administered preprogram and 6 weeks postprogram. Results: All people who had requested access to the Hope Programme from MCS (N=61) will be invited to participate in the trial. Baseline data collection commenced in April 2020, and the Hope Programme began for the IG in May 2020 and for the WLCG in June 2020. Postprogram data collection was completed by the end of August 2020. Conclusions: This feasibility study will provide data to inform the design of a future definitive trial. Wider-scale provision of the digital Hope Programme has potential to improve the lives of thousands of people with cancer and reduce the burden on health care providers during these unprecedented times. Trial Registration: ISRCTN Registry ISRCTN79623250; http://www.isrctn.com/ISRCTN79623250 International Registered Report Identifier (IRRID): DERR1-10.2196/24264 %M 33237877 %R 10.2196/24264 %U https://www.researchprotocols.org/2020/12/e24264 %U https://doi.org/10.2196/24264 %U http://www.ncbi.nlm.nih.gov/pubmed/33237877 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e23414 %T Exploring Interactive Survivorship Care Plans to Support Breast Cancer Survivors: Protocol for a Randomized Controlled Trial %A Kapoor,Akshat %A Nambisan,Priya %+ Consumer Health Informatics Lab, Department of Health Services and Information Management, East Carolina University, 600 Moye Blvd MS 668, Greenville, NC, 27834-4300, United States, 1 252 744 6175, kapoora16@ecu.edu %K breast cancer %K cancer survivorship %K self-management %K patient education %D 2020 %7 4.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Breast cancer is the most common form of cancer among American women, accounting for 23% of all cancer survivors nationally. Yet, the availability of adequate resources and tools for supporting breast cancer survivors has not kept up with the rapid advancement in treatment options, resulting in unmet supportive care needs, particularly among low-income and minority populations. This study explores an alternative means of delivering breast cancer survivorship care plans (SCPs), with the aim of improving survivor morbidity, patient knowledge, and self-management of treatment-related symptoms, as well as addressing inconsistencies in follow-up care visits. Objective: The overall goal of this study is to improve the uptake of SCP recommendations via an educational intervention for breast cancer survivors, to improve treatment-related morbidity, patient knowledge, self-management, and adherence to follow-up visits. The specific aims of the study are to (1) evaluate the feasibility of the online SCP, and (2) assess the impact of the online SCP on survivorship outcomes. Methods: We will enroll 50 breast cancer survivors who have completed initial breast cancer treatment into a 2-armed, randomized, waitlist-controlled pilot trial, and collect data at baseline and 6 months. For the first aim, we will use mixed methods, including surveys and personal interviews among the intervention group, to determine the feasibility of providing an online, interactive SCP (called ACESO) based on the survivors’ online user experience and their short-term adoption. For the secondary aim, we will compare the 2 groups to assess the primary outcomes of survivor knowledge, self-efficacy for self-management, perceived peer support, and adherence to SCP-recommended posttreatment follow-up visits to oncology and primary care; and the secondary outcomes of treatment-related morbidity (body weight, fatigue, depression, anxiety, sexual function, distress, and sleep quality). We assess these outcomes by using measurements from validated instruments with robust psychometric properties. Results: We have developed and refined the online breast cancer survivorship plan, ACESO, with consultation from breast cancer oncologists, nurses, and survivors. Approval for the study protocol has been obtained from the Institutional Review Board. An advisory board has also been established to provide oversight and recommendations on the conduct of the study. The study will be completed over a period of 2 years. Conclusions: The results of this pilot study will inform the feasibility and design of a larger-scale pragmatic trial to evaluate the impact of an online breast cancer SCP on treatment-related morbidity and self-efficacy for self-management. International Registered Report Identifier (IRRID): PRR1-10.2196/23414 %M 33274725 %R 10.2196/23414 %U https://www.researchprotocols.org/2020/12/e23414 %U https://doi.org/10.2196/23414 %U http://www.ncbi.nlm.nih.gov/pubmed/33274725 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e24137 %T eHealth Practices in Cancer Survivors With BMI in Overweight or Obese Categories: Latent Class Analysis Study %A Lin,Annie Wen %A Baik,Sharon H %A Aaby,David %A Tello,Leslie %A Linville,Twila %A Alshurafa,Nabil %A Spring,Bonnie %+ Department of Nutrition, Benedictine University, 5700 College Road, Kindlon Hall, Room 224, Lisle, IL, 60532, United States, 1 630 829 1145, alin@ben.edu %K eHealth %K patient communication %K cancer survivorship %K obesity %K behavior %D 2020 %7 3.12.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: eHealth technologies have been found to facilitate health-promoting practices among cancer survivors with BMI in overweight or obese categories; however, little is known about their engagement with eHealth to promote weight management and facilitate patient-clinician communication. Objective: The objective of this study was to determine whether eHealth use was associated with sociodemographic characteristics, as well as medical history and experiences (ie, patient-related factors) among cancer survivors with BMI in overweight or obese categories. Methods: Data were analyzed from a nationally representative cross-sectional survey (National Cancer Institute’s Health Information National Trends Survey). Latent class analysis was used to derive distinct classes among cancer survivors based on sociodemographic characteristics, medical attributes, and medical experiences. Logistic regression was used to examine whether class membership was associated with different eHealth practices. Results: Three distinct classes of cancer survivors with BMI in overweight or obese categories emerged: younger with no comorbidities, younger with comorbidities, and older with comorbidities. Compared to the other classes, the younger with comorbidities class had the highest probability of identifying as female (73%) and Hispanic (46%) and feeling that clinicians did not address their concerns (75%). The older with comorbidities class was 6.5 times more likely than the younger with comorbidities class to share eHealth data with a clinician (odds ratio [OR] 6.53, 95% CI 1.08-39.43). In contrast, the younger with no comorbidities class had a higher likelihood of using a computer to look for health information (OR 1.93, 95% CI 1.10-3.38), using an electronic device to track progress toward a health-related goal (OR 2.02, 95% CI 1.08-3.79), and using the internet to watch health-related YouTube videos (OR 2.70, 95% CI 1.52-4.81) than the older with comorbidities class. Conclusions: Class membership was associated with different patterns of eHealth engagement, indicating the importance of tailored digital strategies for delivering effective care. Future eHealth weight loss interventions should investigate strategies to engage younger cancer survivors with comorbidities and address racial and ethnic disparities in eHealth use. %M 33156810 %R 10.2196/24137 %U http://cancer.jmir.org/2020/2/e24137/ %U https://doi.org/10.2196/24137 %U http://www.ncbi.nlm.nih.gov/pubmed/33156810 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e18364 %T Gamified Text Messaging Contingent on Device-Measured Steps: Randomized Feasibility Study of a Physical Activity Intervention for Cancer Survivors %A Robertson,Michael C %A Lyons,Elizabeth J %A Liao,Yue %A Baum,Miranda L %A Basen-Engquist,Karen M %+ Department of Behavioral Science, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, United States, 1 713 745 3123, kbasenen@mdanderson.org %K cancer survivors %K physical activity %K motivation %K self-control %K mobile health %K mobile phone %K technology %D 2020 %7 24.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity can confer diverse benefits on cancer survivors. Unfortunately, many cancer survivors are not sufficiently active. The efficacy of physical activity interventions for this population may be increased by grounding them in Self-Determination Theory (SDT). Combining game design elements with wearable technologies may be a useful and scalable approach to targeting SDT constructs to promote cancer survivors’ physical activity. Objective: The primary aim of this study is to evaluate the feasibility and acceptability of Steps2Health, a physical activity intervention for cancer survivors. It also aims to investigate the effects of the intervention on motivation, physical activity, and step count. Methods: We randomized 78 insufficiently active cancer survivors to an experimental or comparison group. All participants received a physical activity tracker. The experimental group participants also received a set sequence of multimedia messaging service messages that were triggered in real time by meeting predetermined cumulative step count totals. Messages presented information about a virtual journey and included photographs and vivid descriptions of locations to increase autonomous motivation. Additional messages targeted perceptions of relatedness (eg, role modeling) and competence (eg, facilitating mastery experiences). We administered pre- and postintervention surveys and conducted 15 individual interviews to evaluate the intervention. We performed directed content analysis of qualitative data and conducted mixed effects linear modeling to investigate participants’ changes in motivation, self-reported physical activity, and device-measured step counts. Results: There was minimal loss to follow-up (3/78, 4%), the device wear rate was high (2548/3044, 83.71% of days), and technical problems with messaging based on real-time step counts were limited. Our qualitative data analysis revealed 3 overarching themes: accessibility, autonomous motivation, and relatedness. Participants successfully navigated the technological aspects and game design elements of the intervention. Participants found messages targeting autonomous motivation and competence or self-efficacy to be enjoyable and compelling, but one feasibility criterion for participant engagement (response rate to text messages) was not met. Messages targeting relatedness were less highly rated than the messages targeting autonomous motivation and competence or self-efficacy. During the intervention, both groups increased their motivation for physical activity (B=0.16; 95% CI 0.01 to 0.30; P=.04; d=0.49), and assignment to the experimental group was associated with increased self-reported leisure activity score (B=10.78; 95% CI 3.54 to 18.02; P=.005; d=0.64). The experimental group had greater increases in daily step counts over time (B=322.08; 95% CI 54.01 to 590.15; P=.02; d=0.28). Conclusions: This study supports the feasibility of using real-time game design elements to target SDT constructs and increase cancer survivors’ physical activity. Overall, our findings support the acceptability of the Steps2Health intervention, but fostering active participant engagement and targeting relatedness may present additional challenges. Steps2Health may help cancer survivors increase their physical activity levels. %M 33231551 %R 10.2196/18364 %U https://mhealth.jmir.org/2020/11/e18364 %U https://doi.org/10.2196/18364 %U http://www.ncbi.nlm.nih.gov/pubmed/33231551 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e19362 %T Web-Based Lifestyle Interventions for Prostate Cancer Survivors: Qualitative Study %A Wang,Elizabeth Y %A Graff,Rebecca E %A Chan,June M %A Langlais,Crystal S %A Broering,Jeanette M %A Ramsdill,Justin W %A Kessler,Elizabeth R %A Winters-Stone,Kerri M %A Van Blarigan,Erin L %A Kenfield,Stacey A %+ University of California, San Francisco, 550 16th St, 6th Floor, Box 1695, San Francisco, CA, 94158, United States, 1 5622616634, eyw2107@cumc.columbia.edu %K cancer survivorship %K digital health %K technology-based intervention %K internet-based intervention %K usability %D 2020 %7 10.11.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: Exercise and a healthy diet can improve the quality of life and prognosis of prostate cancer survivors, but there have been limited studies on the feasibility of web-based lifestyle interventions in this population. Objective: This study aims to develop a data-driven grounded theory of web-based engagement by prostate cancer survivors based on their experience in the Community of Wellness, a 12-week randomized clinical trial designed to support healthy diet and exercise habits. Methods: TrueNTH’s Community of Wellness was a four-arm pilot study of men with prostate cancer (N=202) who received progressive levels of behavioral support (level 1: website; level 2: website with individualized diet and exercise recommendations; level 3: website with individualized diet and exercise recommendations, Fitbit, and text messages; and level 4: website with individualized diet and exercise recommendations, Fitbit and text messages, and separate phone calls with an exercise trainer and a registered dietitian). The primary aim of the study is to determine the feasibility and estimate the effects on behaviors (results reported in a separate paper). Following the 12-week intervention, we invited participants to participate in 4 focus groups, one for each intervention level. In this report, we used grounded theory analyses including open, axial, and selective coding to generate codes and themes from the focus group transcripts. Categories were refined across levels using embodied categorization and constant comparative methods. Results: In total, 20 men with prostate cancer participated in the focus groups: 5, 4, 5, and 6 men in levels 1, 2, 3, and 4, respectively. Participants converged on 5 common factors influencing engagement with the intervention: environment (home environment, competing priorities, and other lifestyle programs), motivation (accountability and discordance experienced within the health care system), preparedness (technology literacy, health literacy, trust, and readiness to change), program design (communication, materials, and customization), and program support (education, ally, and community). Each of these factors influenced the survivors’ long-term impressions and habits. We proposed a grounded theory associating these constructs to describe the components contributing to the intuitiveness of a web-based lifestyle intervention. Conclusions: These analyses suggest that web-based lifestyle interventions are more intuitive when we optimize participants’ technology and health literacy; tailor interface design, content, and feedback; and leverage key motivators (ie, health care providers, family members, web-based coach) and environmental factors (ie, familiarity with other lifestyle programs). Together, these grounded theory–based efforts may improve engagement with web-based interventions designed to support prostate cancer survivorship. %M 33170126 %R 10.2196/19362 %U http://cancer.jmir.org/2020/2/e19362/ %U https://doi.org/10.2196/19362 %U http://www.ncbi.nlm.nih.gov/pubmed/33170126 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21238 %T Development and Evaluation of a Digital Intervention for Fulfilling the Needs of Older Migrant Patients With Cancer: User-Centered Design Approach %A Sungur,Hande %A Yılmaz,Nida Gizem %A Chan,Brittany Ming Chu %A van den Muijsenbergh,Maria E T C %A van Weert,Julia C M %A Schouten,Barbara C %+ Department of Communication Science, Amsterdam School of Communication Research/ASCoR, University of Amsterdam, Postbus 15791, Amsterdam, 1001 NG, Netherlands, 31 20 525 3680, h.sungur@uva.nl %K cancer %K patient participation %K health services needs and demand %K eHealth %K migrants %K physician-patient relations %K culture %K mobile phone %D 2020 %7 26.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Older migrant patients with cancer face many language- and culture-related barriers to patient participation during medical consultations. To bridge these barriers, an eHealth tool called Health Communicator was developed in the Netherlands. Essentially used as a digital translator that can collect medical history information from patients, the Health Communicator did not include an oncological module so far, despite the fact that the prevalence of Dutch migrant patients with cancer is rising. Objective: This study aims to systematically develop, implement, and conduct a pilot evaluation of an oncological module that can be integrated into the Health Communicator to stimulate patient participation among older Turkish-Dutch and Moroccan-Dutch patients with cancer. Methods: The Spiral Technology Action Research model, which incorporates 5 cycles that engage key stakeholders in intervention development, was used as a framework. The listen phase consisted of a needs assessment. The plan phase consisted of developing the content of the oncological module, namely the question prompt lists (QPLs) and scripts for patient education videos. On the basis of pretests in the do phase, 6 audiovisual QPLs on patient rights, treatment, psychosocial support, lifestyle and access to health care services, patient preferences, and clinical trials were created. Additionally, 5 patient education videos were created about patient rights, psychosocial support, clinical trials, and patient-professional communication. In the study phase, the oncological module was pilot-tested among 27 older Turkish-Dutch and Moroccan-Dutch patients with cancer during their consultations. In the act phase, the oncological model was disseminated to practice. Results: The patient rights QPL was chosen most often during the pilot testing in the study phase. Patients and health care professionals perceived the QPLs as easy to understand and useful. There was a negative correlation between the tool’s ease of use and patient age. Patients reported that using the module impacted the consultations positively and thought they were more active compared with previous consultations. Health care professionals also found patients to be more active than usual. Health care professionals asked significantly more questions than patients during consultations. Patients requested to see the patients’ rights video most often. Patients rated the videos as easy to understand, useful, and informative. Most of the patients wanted to use the tool in the future. Conclusions: Older migrant patients with cancer, survivors, and health care professionals found the oncological module to be a useful tool and have shown intentions to incorporate it into future consultation sessions. Both QPLs and videos were evaluated positively, the latter indicating that the use of narratives to inform older, low-literate migrant patients with cancer about health-related topics in their mother tongue is a viable approach to increase the effectiveness of health care communication with this target group. %M 33104008 %R 10.2196/21238 %U http://www.jmir.org/2020/10/e21238/ %U https://doi.org/10.2196/21238 %U http://www.ncbi.nlm.nih.gov/pubmed/33104008 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e18491 %T Development and Evaluation of an Accelerometer-Based Protocol for Measuring Physical Activity Levels in Cancer Survivors: Development and Usability Study %A Crane,Tracy E %A Skiba,Meghan B %A Miller,Austin %A Garcia,David O %A Thomson,Cynthia A %+ Department of Biobehavioral Health Sciences, College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ, 85721, United States, 1 5203310120, tecrane@email.arizona.edu %K wearable electronic devices %K physical activity %K cancer survivors %K activity trackers %K mobile phone %D 2020 %7 24.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The collection of self-reported physical activity using validated questionnaires has known bias and measurement error. Objective: Accelerometry, an objective measure of daily activity, increases the rigor and accuracy of physical activity measurements. Here, we describe the methodology and related protocols for accelerometry data collection and quality assurance using the Actigraph GT9X accelerometer data collection in a convenience sample of ovarian cancer survivors enrolled in GOG/NRG 0225, a 24-month randomized controlled trial of diet and physical activity intervention versus attention control. Methods: From July 2015 to December 2019, accelerometers were mailed on 1337 separate occasions to 580 study participants to wear at 4 time points (baseline, 6, 12, and 24 months) for 7 consecutive days. Study staff contacted participants via telephone to confirm their availability to wear the accelerometers and reviewed instructions and procedures regarding the return of the accelerometers and assisted with any technology concerns. Results: We evaluated factors associated with wear compliance, including activity tracking, use of a mobile app, and demographic characteristics with chi-square tests and logistic regression. Compliant data, defined as ≥4 consecutive days with ≥10 hours daily wear time, exceeded 90% at all study time points. Activity tracking, but no other characteristics, was significantly associated with compliant data at all time points (P<.001). This implementation of data collection through accelerometry provided highly compliant and usable activity data in women who recently completed treatment for ovarian cancer. Conclusions: The high compliance and data quality associated with this protocol suggest that it could be disseminated to support researchers who seek to collect robust objective activity data in cancer survivors residing in a wide geographic area. %M 32969828 %R 10.2196/18491 %U http://mhealth.jmir.org/2020/9/e18491/ %U https://doi.org/10.2196/18491 %U http://www.ncbi.nlm.nih.gov/pubmed/32969828 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e18867 %T Breast Cancer Survivors’ Perspectives on Motivational and Personalization Strategies in Mobile App–Based Physical Activity Coaching Interventions: Qualitative Study %A Monteiro-Guerra,Francisco %A Signorelli,Gabriel Ruiz %A Rivera-Romero,Octavio %A Dorronzoro-Zubiete,Enrique %A Caulfield,Brian %+ Salumedia Tecnologías, Avda. República Argentina, nº 24 Edificio Torre de los Remedios, 5ª planta - módulo A, Seville, 41011, Spain, 34 672787858, francisco.guerra@ucdconnect.ie %K mHealth %K mobile app %K mobile phone %K coaching %K physical activity %K breast cancer %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite growing evidence supporting the vital benefits of physical activity (PA) for breast cancer survivors, the majority do not meet the recommended levels of activity. Mobile app–based PA coaching interventions might be a feasible strategy to facilitate adherence of breast cancer survivors to the PA guidelines. To engage these individuals, PA apps need to be specifically designed based on their needs and preferences and to provide targeted support and motivation. However, more information is needed to understand how these technologies can provide individual and relevant experiences that have the ability to increase PA adherence and retain the individual’s interest in the long term. Objective: The aim of this study is to explore insights from breast cancer survivors on motivational and personalization strategies to be used in PA coaching apps and interventions. Methods: A qualitative study was conducted, using individual semistructured interviews, with 14 breast cancer survivors. The moderator asked open-ended questions and made use of a slideshow presentation to elicit the participants’ perspectives on potential mobile app–based intervention features. Transcribed interviews were evaluated by 3 reviewers using thematic content analysis. Results: Participants (mean age 53.3, SD 8.7 years) were White women. In total, 57% (8/14) of the participants did not adhere to the PA guidelines. In general, participants had access to and were interested in using technology. The identified themes included (1) barriers to PA, (2) psychological mediators of PA motivation, (3) needs and suggestions for reinforcing motivation support, (4) personalization aspects of the PA coaching experience, and (5) technology trustworthiness. Motivational determinants included perceived control, confidence and perceived growth, and connectedness. Participants were interested in having a straightforward app for monitoring and goal setting, which would include a prescribed activity program and schedule, and positive communication. Opinions varied in terms of social and game-like system possibilities. In addition, they expressed a desire for a highly personalized coaching experience based on as much information collected from them as possible (eg, disease stage, physical limitations, preferences) to provide individualized progress information, dynamic adjustment of the training plan, and context-aware activity suggestions (eg, based on weather and location). Participants also wanted the app to be validated or backed by professionals and were willing to share their data in exchange for a more personalized experience. Conclusions: This work suggests the need to develop simple, guiding, encouraging, trustworthy, and personalized PA coaching apps. The findings are in line with behavioral and personalization theories and methods that can be used to inform intervention design decisions. This paper opens new possibilities for the design of personalized and motivating PA coaching app experiences for breast cancer survivors, which might ultimately facilitate the sustained adherence of these individuals to the recommended levels of activity. %M 32955446 %R 10.2196/18867 %U https://mhealth.jmir.org/2020/9/e18867 %U https://doi.org/10.2196/18867 %U http://www.ncbi.nlm.nih.gov/pubmed/32955446 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e18412 %T Optimizing Health Information Technologies for Symptom Management in Cancer Patients and Survivors: Usability Evaluation %A Lattie,Emily G %A Bass,Michael %A Garcia,Sofia F %A Phillips,Siobhan M %A Moreno,Patricia I %A Flores,Ann Marie %A Smith,JD %A Scholtens,Denise %A Barnard,Cynthia %A Penedo,Frank J %A Cella,David %A Yanez,Betina %+ Department of Medical Social Sciences, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 3741, emily.lattie@northwestern.edu %K cancer survivorship %K eHealth %K patient-reported outcomes %K digital health %K symptom management %K supportive care %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Unmanaged cancer symptoms and treatment-related side effects can compromise long-term clinical outcomes and health-related quality of life. Health information technologies such as web-based platforms offer the possibility to supplement existing care and optimize symptom management. Objective: This paper describes the development and usability of a web-based symptom management platform for cancer patients and survivors that will be implemented within a large health system. Methods: A web-based symptom management platform was designed and evaluated via one-on-one usability testing sessions. The System Usability Scale (SUS), After Scenario Questionnaire (ASQ), and qualitative analysis of semistructured interviews were used to assess program usability. Results: Ten cancer survivors and five cancer center staff members participated in usability testing sessions. The mean score on the SUS was 86.6 (SD 14.0), indicating above average usability. The mean score on the ASQ was 2.5 (SD 2.1), indicating relatively high satisfaction with the usability of the program. Qualitative analyses identified valued features of the program and recommendations for further improvements. Conclusions: Cancer survivors and oncology care providers reported high levels of acceptability and usability in the initial development of a web-based symptom management platform for cancer survivors. Future work will test the effectiveness of this web-based platform. %M 32955450 %R 10.2196/18412 %U http://formative.jmir.org/2020/9/e18412/ %U https://doi.org/10.2196/18412 %U http://www.ncbi.nlm.nih.gov/pubmed/32955450 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e17742 %T Improving Adherence to Adjuvant Hormonal Therapy Among Disadvantaged Women Diagnosed with Breast Cancer in South Carolina: Proposal for a Multimethod Study %A Felder,Tisha M %A Heiney,Sue P %A Hebert,James R %A Friedman,Daniela B %A Elk,Ronit %A Franco,Regina %A Gansauer,Lucy %A Christensen,Barbara %A Ford,Marvella E %+ College of Nursing, University of South Carolina, 1601 Greene Street, Room 620, Columbia, SC, 29208, United States, 1 8037779830, feldert@mailbox.sc.edu %K breast neoplasms %K medicaid %K medication adherence %K vulnerable populations %K hormonal therapy %K endocrine therapy %K qualitative methods %D 2020 %7 3.9.2020 %9 Proposal %J JMIR Res Protoc %G English %X Background: Current clinical guidelines recommend that hormone receptor–positive breast cancer survivors take adjuvant hormonal therapy (AHT) for 5 to 10 years, following the end of definitive treatment. However, fewer than half of patients adhere to the guidelines, and suboptimal adherence to AHT is associated with an increased risk of breast cancer mortality. Research has extensively documented sociodemographic and disease-specific factors associated with adherence to AHT, but very little evidence exists on behavioral factors (eg, knowledge, patient-provider communication) that can be modified and targeted by interventions. Objective: The goal of this study is to develop and test a theory-based, multilevel intervention to improve adherence to AHT among breast cancer survivors from racially and socioeconomically disadvantaged backgrounds (eg, Medicaid-insured). The specific aims are to (1) explore multilevel (eg, patient, health care system) factors that influence adherence to AHT; (2) develop a theory-based, multilevel intervention to improve adherence to AHT; and (3) pilot test and evaluate the intervention developed in Aim 2. Methods: For Aim 1, we will recruit breast cancer survivors and health care professionals to participate in semistructured interviews to gain their perspectives about barriers and facilitators to AHT use. We will conduct a directed content analysis of the Aim 1 qualitative interview data. For Aim 2, we will integrate Aim 1 findings and current literature into the design of a multilevel intervention using an Intervention Mapping approach. For Aim 3, we will recruit Medicaid-insured breast cancer survivors to assess the feasibility of the pilot intervention. Results: From May 2016 to July 2018, we completed interviews with 19 breast cancer survivors and 23 health care professionals in South Carolina. We will conduct a directed content analysis of the qualitative interview data. Results from this analysis will be used, in combination with current literature, to design (Aim 2) and pilot test a theory-based multilevel intervention (Aim 3) in Summer 2021. Results of the pilot are expected for Fall 2021. Conclusions: This study will provide a deeper understanding of how to improve adherence to AHT, using a novel and multilevel approach, among socioeconomically disadvantaged breast cancer survivors who often experience disproportionate breast cancer mortality. International Registered Report Identifier (IRRID): DERR1-10.2196/17742 %M 32880374 %R 10.2196/17742 %U https://www.researchprotocols.org/2020/9/e17742 %U https://doi.org/10.2196/17742 %U http://www.ncbi.nlm.nih.gov/pubmed/32880374 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e20834 %T Remote Assessment of Functional Mobility and Strength in Older Cancer Survivors: Protocol for a Validity and Reliability Study %A Blair,Cindy K %A Harding,Elizabeth %A Herman,Carla %A Boyce,Tawny %A Demark-Wahnefried,Wendy %A Davis,Sally %A Kinney,Anita Y %A Pankratz,Vernon S %+ Department of Internal Medicine, University of New Mexico, MSC07-4025, 2325 Camino de Salud NE, Albuquerque, NM, 87131, United States, 1 5059257907, CiBlair@salud.unm.edu %K physical function %K physical performance %K older adults %K remote assessment %K videoconferencing %K cancer survivors %K cancer %K elderly %K physical activity %K telehealth %D 2020 %7 1.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Older cancer survivors, faced with both age- and treatment-related morbidity, are at increased and premature risk for physical function limitations. Physical performance is an important predictor of disability, quality of life, and premature mortality, and thus is considered an important target of interventions designed to prevent, delay, or attenuate the physical functional decline. Currently, low-cost, valid, and reliable methods to remotely assess physical performance tests that are self-administered by older adults in the home-setting do not exist, thus limiting the reach, scalability, and dissemination of interventions. Objective: This paper will describe the rationale and design for a study to evaluate the accuracy, reliability, safety, and acceptability of videoconferencing and self-administered tests of functional mobility and strength by older cancer survivors in their own homes. Methods: To enable remote assessment, participants receive a toolkit and instructions for setting up their test course and communicating with the investigator. Two standard gerontologic performance tests are being evaluated: the Timed Up and Go test and the 30-second chair stand test. Phase 1 of the study evaluates proof-of-concept that older cancer survivors (age ≥60 years) can follow the testing protocol and use a tablet PC to communicate with the study investigator. Phase 2 evaluates the criterion validity of videoconference compared to direct observation of the two physical performance tests. Phase 3 evaluates reliability by enrolling 5-10 participants who agree to repeat the remote assessment (without direct observation). Phase 4 enrolls 5-10 new study participants to complete the remote assessment test protocol. Feedback from participants in each phase is used to refine the test protocol and instructions. Results: Enrollment began in December 2019. Ten participants completed the Phase 1 proof-of-concept. The study was paused in mid-March 2020 due to the COVID-19 pandemic. The study is expected to be completed by the end of 2020. Conclusions: This validity and reliability study will provide important information on the acceptability and safety of using videoconferencing to remotely assess two tests of functional mobility and strength, self-administered by older adults in their homes. Videoconferencing has the potential to expand the reach, scalability, and dissemination of interventions to older cancer survivors, and potentially other older adults, especially in rural areas. Trial Registration: ClinicalTrials.gov NCT04339959; https://clinicaltrials.gov/ct2/show/NCT04339959 International Registered Report Identifier (IRRID): DERR1-10.2196/20834 %M 32769075 %R 10.2196/20834 %U https://www.researchprotocols.org/2020/9/e20834 %U https://doi.org/10.2196/20834 %U http://www.ncbi.nlm.nih.gov/pubmed/32769075 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e15335 %T Cancer Survivors’ Receptiveness to Digital Technology–Supported Physical Rehabilitation and the Implications for Design: Qualitative Study %A Rossen,Sine %A Kayser,Lars %A Vibe-Petersen,Jette %A Christensen,Jesper Frank %A Ried-Larsen,Mathias %+ Copenhagen Centre for Cancer and Health, Municipality of Copenhagen, Nørre Allé 45, Copenhagen, DK-2200, Denmark, 45 60298218, kg58@kk.dk %K cancer %K rehabilitation %K physical activity %K digital technology %D 2020 %7 5.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical activity is associated with a positive prognosis in cancer survivors and may decrease the risk of adverse effects of treatment. Accordingly, physical activity programs are recommended as a part of cancer rehabilitation services. Digital technology may support cancer survivors in increasing their level of physical activity and increase the reach or efficiency of cancer rehabilitation services, yet it also comes with a range of challenges. Objective: The aim of this qualitative study was to explore cancer survivors’ receptiveness to using digital technology as a mode of support to increase their physical activity in a municipality-based cancer rehabilitation setting. Methods: Semistructured interviews were conducted with 11 cancer survivors (3 males, 8 females, age range 32-82 years) who were referred for cancer rehabilitation and had participated in a questionnaire survey using the Readiness and Enablement Index for Health Technology (READHY) questionnaire. Data analysis was based on the content analysis method. Results: Two themes were identified as important for the interviewees’ receptiveness to using digital technology services in connection with their physical activity during rehabilitation: their attitude toward physical activity and their attitude toward digital technology–assisted physical activity. Our results indicated that it is important to address the cancer survivors’ motivation for using technology for physical activity and their individual preferences in terms of the following: (1) incidental or structured (eg, cardiovascular and strength exercises or disease-specific rehabilitative exercises) physical activity; (2) social or individual context; and (3) instruction (know-how) or information (know-why). Conclusions: The identified preferences provide new insight that complements the cancer survivors’ readiness level and can likely help designers, service providers, and caregivers provide solutions that increase patient receptiveness toward technology-assisted physical activity. Combining digital technology informed by cancer survivors’ needs, preferences, and readiness with the capacity building of the workforce can aid in tailoring digital solutions to suit not only individuals who are receptive to using such technologies but also those reluctant to do so. %M 32755892 %R 10.2196/15335 %U https://www.jmir.org/2020/8/e15335 %U https://doi.org/10.2196/15335 %U http://www.ncbi.nlm.nih.gov/pubmed/32755892 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e18420 %T A Remotely Delivered, Peer-Led Physical Activity Intervention for Younger Breast Cancer Survivors (Pink Body Spirit): Protocol for a Feasibility Study and Mixed Methods Process Evaluation %A Weiner,Lauren S %A Nagel,Stori %A Su,H Irene %A Hurst,Samantha %A Hartman,Sheri J %+ Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive, Mail Code: 0901, La Jolla, CA, 92093, United States, 1 8585349235, sjhartman@ucsd.edu %K physical activity %K cancer survivors %K peer mentors %K quality of life %K pilot study %K breast cancer %K fitness trackers %K mobile phone %D 2020 %7 8.7.2020 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Younger breast cancer survivors consistently report a greater impact of their cancer experience on quality of life compared with older survivors, including higher rates of body image disturbances, sexual dysfunction, and fatigue. One potential strategy to improve quality of life is through physical activity, but this has been understudied in younger breast cancer survivors, who often decrease their activity during and after cancer treatment. Objective: The aim of this study is to explore the feasibility and acceptability of a technology-based, remotely delivered, peer-led physical activity intervention for younger breast cancer survivors. We will also assess the preliminary impact of the intervention on changes in physical activity and multiple aspects of quality of life. Methods: This study is a community-academic partnership between University of California, San Diego and Haus of Volta, a nonprofit organization that promotes positive self-image in younger breast cancer survivors. This ongoing pilot study aims to recruit 30 younger breast cancer survivors across the United States (<55 years old, >6 months post primary cancer treatment, self-report <60 min of moderate-to-vigorous-intensity physical activity [MVPA]) into a 3-month peer-delivered, fully remote exercise program. Participants will complete 6 biweekly video chat sessions with a trained peer mentor, a fellow younger breast cancer survivor. Participants will receive a Fitbit Charge 3; weekly feedback on Fitbit data from their peer mentor; and access to a private, in-app Fitbit Community to provide and receive support from other participants and all peer mentors. At baseline, 3 months, and 6 months, participants will complete quality of life questionnaires, and MVPA will be measured using the ActiGraph accelerometer. Feasibility and acceptability will be explored through a mixed methods approach (ie, quantitative questionnaires and qualitative interviews). Intervention delivery and adaptations by peer mentors will be tracked through peer mentor self-evaluations and reflections, review of video-recorded mentoring sessions, and monthly templated reflections by the research team. Results: Recruitment began in September 2019. As of February 2020, the physical activity intervention is ongoing. Final measures are expected to occur in summer 2020. Conclusions: This study explores the potential for physical activity to improve sexual function, body image, and fatigue, key quality of life issues in younger breast cancer survivors. Using peer mentors extends our reach into the young survivor community. The detailed process evaluation of intervention delivery and adaptations by mentors could inform a future hybrid-effectiveness implementation trial. Finally, remote delivery with commercially available technology could promote broader dissemination. Trial Registration: ClinicalTrials.gov NCT04064892; https://clinicaltrials.gov/ct2/show/NCT04064892 International Registered Report Identifier (IRRID): DERR1-10.2196/18420 %M 32673270 %R 10.2196/18420 %U https://www.researchprotocols.org/2020/7/e18420 %U https://doi.org/10.2196/18420 %U http://www.ncbi.nlm.nih.gov/pubmed/32673270 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e18781 %T A Web-Based Mobile App (INTERACCT App) for Adolescents Undergoing Cancer and Hematopoietic Stem Cell Transplantation Aftercare to Improve the Quality of Medical Information for Clinicians: Observational Study %A Lawitschka,Anita %A Buehrer,Stephanie %A Bauer,Dorothea %A Peters,Konrad %A Silbernagl,Marisa %A Zubarovskaya,Natalia %A Brunmair,Barbara %A Kayali,Fares %A Hlavacs,Helmut %A Mateus-Berr,Ruth %A Riedl,David %A Rumpold,Gerhard %A Peters,Christina %+ Stem Cell Transplantation-Outpatient and Aftercare Clinic, St. Anna Children’s Hospital, Medical University Vienna, Kinderspitalgasse 15, 1090 Vienna, Vienna, Austria, 43 1 40 170 ext 2900, anita.lawitschka@stanna.at %K mobile app %K adolescents %K cancer %K stem cell transplant %K self-reported heath status %K medical information exchange %K mobile phone %D 2020 %7 30.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A growing number of cancer and hematopoietic stem cell transplant (HSCT) survivors require long-term follow-up with optimal communication schemes, and patients' compliance is crucial. Adolescents have various unmet needs. Regarding self-report of symptoms and health status, users of mobile apps showed enhanced compliance. Currently, HSCT aftercare at the HSCT outpatient clinic of the St. Anna Children’s Hospital in Vienna, Austria, is based on handwritten diaries, carrying various disadvantages. Recently, we developed the prototype of a web-based, self-monitoring gamified mobile app tailored for adolescents: the INTERACCT (Integrating Entertainment and Reaction Assessment into Child Cancer Therapy) app. Objective: This observational, prospective study evaluated the usability of the INTERACCT app for tracking real-time self-reported symptoms and health status data in adolescent HSCT patients and a healthy matched control group. The primary outcome of the study was the quality of the self-reported medical information. We hypothesized that the mobile app would provide superior medical information for the clinicians than would the handwritten diaries. Methods: Health data were reported via paper diary and mobile app for 5 consecutive days each. The quality of medical information was rated on a 5-point scale independently and blinded by two HSCT clinicians, and the duration of use was evaluated. A total of 52 participant questionnaires were assessed for gaming patterns and device preferences, self-efficacy, users’ satisfaction, acceptability, and suggestions for improvement of the mobile app. Interrater reliability was calculated with the intraclass correlation coefficient, based on a two-way mixed model; one-way repeated-measures analysis of variance and t tests were conducted post hoc. Descriptive methods were used for correlation with participants’ demographics. For users’ satisfaction and acceptability of the mobile app, the median and the IQR were calculated. Results: Data from 42 participants—15 patients and 27 healthy students—with comparable demographics were evaluated. The results of our study indicated a superiority of the quality of self-reported medical data in the INTERACCT app over traditional paper-and-pencil assessment (mobile app: 4.14 points, vs paper-based diary: 3.77 points, P=.02). The mobile app outperformed paper-and-pencil assessments mainly among the patients, in particular among patients with treatment-associated complications (mobile app: 4.43 points, vs paper-based diary: 3.73 points, P=.01). The mobile app was used significantly longer by adolescents (≥14 years: 4.57 days, vs ≤13 years: 3.14 days, P=.03) and females (4.76 days for females vs 2.95 days for males, P=.004). This corresponds with a longer duration of use among impaired patients with comorbidities. User satisfaction and acceptability ratings for the mobile app were high across all groups, but adherence to entering a large amount of data decreased over time. Based on our results, we developed a case vignette of the target group. Conclusions: Our study was the first to show that the quality of patient-reported medical information submitted via the INTERACCT app embedded in a serious game is superior to that submitted via a handwritten diary. In light of these results, a refinement of the mobile app supported by a machine learning approach is planned within an international research project. %M 32602847 %R 10.2196/18781 %U http://mhealth.jmir.org/2020/6/e18781/ %U https://doi.org/10.2196/18781 %U http://www.ncbi.nlm.nih.gov/pubmed/32602847 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e17724 %T Diagnosing Preclinical Cardiac Dysfunction in Swiss Childhood Cancer Survivors: Protocol for a Single-Center Cohort Study %A Schindera,Christina %A Kuehni,Claudia Elisabeth %A Pavlovic,Mladen %A Haegler-Laube,Eva Simona %A Rhyner,Daniel %A Waespe,Nicolas %A Roessler,Jochen %A Suter,Thomas %A von der Weid,Nicolas Xavier %+ Childhood Cancer Registry, Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, 3012, Switzerland, 41 31631 ext 3771, christina.schindera@ispm.unibe.ch %K cardiotoxicity %K Switzerland %K echocardiography %K speckle tracking %K strain %K anthracyclines %K alkylating agents %K steroids %K cardiac radiation %D 2020 %7 10.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cardiovascular disease is the leading nonmalignant cause of late deaths in childhood cancer survivors. Cardiovascular disease and cardiac dysfunction can remain asymptomatic for many years, but eventually lead to progressive disease with high morbidity and mortality. Early detection and intervention are therefore crucial to improve outcomes. Objective: In our study, we aim to assess the prevalence of preclinical cardiac dysfunction in adult childhood cancer survivors using conventional and speckle tracking echocardiography; determine the association between cardiac dysfunction and treatment-related risk factors (anthracyclines, alkylating agents, steroids, cardiac radiation) and modifiable cardiovascular risk factors (abdominal obesity, hypertension); investigate the development of cardiac dysfunction longitudinally in a defined cohort; study the association between cardiac dysfunction and other health outcomes like pulmonary disease, endocrine disease, renal disease, quality of life, fatigue, strength and endurance, and physical activity; and gain experience conducting a clinical study of childhood cancer survivors that will be extended to a national, multicenter study of cardiac complications. Methods: For this retrospective cohort study, we will invite ≥5-year childhood cancer survivors who were treated at the University Children's Hospital Bern, Switzerland with any chemotherapy or cardiac radiation since 1976 and who are ≥18 years of age at the time of the study for a cardiac assessment at the University Hospital Bern. This includes 544 childhood cancer survivors, of whom about half were treated with anthracyclines and/or cardiac radiation and half with any other chemotherapy. The standardized cardiac assessment includes a medical history focusing on signs of cardiovascular disease and its risk factors, a physical examination, anthropometry, vital parameters, the 1-minute sit-to-stand test, and echocardiography including 2-dimensional speckle tracking. Results: We will invite 544 eligible childhood cancer survivors (median age at the time of the study, 32.5 years; median length of time since diagnosis, 25.0 years) for a cardiac assessment. Of these survivors, 300 (55%) are at high risk, and 244 (45%) are at standard risk of cardiac dysfunction. Conclusions: This study will determine the prevalence of preclinical cardiac dysfunction in Swiss childhood cancer survivors, inform whether speckle tracking echocardiography is more sensitive to cardiac dysfunction than conventional echocardiography, and give a detailed picture of risk factors for cardiac dysfunction. The results will help improve primary treatment and follow-up care of children with cancer. Trial Registration: ClinicalTrials.gov NCT03790943; https://clinicaltrials.gov/ct2/show/NCT03790943 International Registered Report Identifier (IRRID): DERR1-10.2196/17724 %M 32269016 %R 10.2196/17724 %U http://www.researchprotocols.org/2020/6/e17724/ %U https://doi.org/10.2196/17724 %U http://www.ncbi.nlm.nih.gov/pubmed/32269016 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 5 %P e17078 %T A Web-Based, Positive Emotion Skills Intervention for Enhancing Posttreatment Psychological Well-Being in Young Adult Cancer Survivors (EMPOWER): Protocol for a Single-Arm Feasibility Trial %A Salsman,John M %A McLouth,Laurie E %A Cohn,Michael %A Tooze,Janet A %A Sorkin,Mia %A Moskowitz,Judith T %+ Department of Social Sciences and Health Policy, Wake Forest Baptist Comprehensive Cancer Center, Wake Forest School of Medicine, Medical Center Boulevard, Winston Salem, NC, 27157, United States, 1 336 713 3613, jsalsman@wakehealth.edu %K emotions %K telemedicine %K happiness %K eHealth %K cancer %K young adult %K internet %K mobile phone %D 2020 %7 28.5.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescent and young adult cancer survivors (AYAs) experience clinically significant distress and have limited access to supportive care services. Interventions to enhance psychological well-being have improved positive affect and reduced depression in clinical and healthy populations but have not been routinely tested in AYAs. Objective: The aim of this protocol is to (1) test the feasibility and acceptability of a Web-based positive emotion skills intervention for posttreatment AYAs called Enhancing Management of Psychological Outcomes With Emotion Regulation (EMPOWER) and (2) examine proof of concept for reducing psychological distress and enhancing psychological well-being. Methods: The intervention development and testing are taking place in 3 phases. In phase 1, we adapted the content of an existing, Web-based positive emotion intervention so that it would be suitable for AYAs. EMPOWER targets 8 skills (noticing positive events, capitalizing, gratitude, mindfulness, positive reappraisal, goal setting, personal strengths, and acts of kindness) and is delivered remotely as a 5-week, Web-based intervention. Phase 2 consisted of a pilot test of EMPOWER in a single-arm trial to evaluate feasibility, acceptability, retention, and adherence and to collect data on psychosocial outcomes for proof of concept. In phase 3, we are refining study procedures and conducting a second pilot test. Results: The project was part of a career development award. Pilot work began in June 2015, and data collection was completed in March 2019. The analysis is ongoing, and results will be submitted for publication by May 2020. Conclusions: If this intervention proves feasible and acceptable, EMPOWER will be primed for a subsequent large, multisite randomized controlled trial. As a scalable intervention, it will be ideally suited for AYA survivors who would otherwise not have access to supportive care interventions to help manage posttreatment distress and enhance well-being. Trial Registration: ClinicalTrials.gov NCT02832154, https://clinicaltrials.gov/ct2/show/NCT02832154. International Registered Report Identifier (IRRID): DERR1-10.2196/17078 %M 32463014 %R 10.2196/17078 %U http://www.researchprotocols.org/2020/5/e17078/ %U https://doi.org/10.2196/17078 %U http://www.ncbi.nlm.nih.gov/pubmed/32463014 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 1 %P e15859 %T Assessing Breast Cancer Survivors’ Perceptions of Using Voice-Activated Technology to Address Insomnia: Feasibility Study Featuring Focus Groups and In-Depth Interviews %A Arem,Hannah %A Scott,Remle %A Greenberg,Daniel %A Kaltman,Rebecca %A Lieberman,Daniel %A Lewin,Daniel %+ Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Rm 514, Washington, DC, 20052, United States, 1 2029944676, hannaharem@gwu.edu %K artificial intelligence %K breast neoplasms %K survivors %K insomnia %K cognitive behavioral therapy %K mobile phones %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer survivors (BCSs) are a growing population with a higher prevalence of insomnia than women of the same age without a history of cancer. Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be effective in this population, but it is not widely available to those who need it. Objective: This study aimed to better understand BCSs’ experiences with insomnia and to explore the feasibility and acceptability of delivering CBT-I using a virtual assistant (Amazon Alexa). Methods: We first conducted a formative phase with 2 focus groups and 3 in-depth interviews to understand BCSs’ perceptions of insomnia as well as their interest in and comfort with using a virtual assistant to learn about CBT-I. We then developed a prototype incorporating participant preferences and CBT-I components and demonstrated it in group and individual settings to BCSs to evaluate acceptability, interest, perceived feasibility, educational potential, and usability of the prototype. We also collected open-ended feedback on the content and used frequencies to describe the quantitative data. Results: We recruited 11 BCSs with insomnia in the formative phase and 14 BCSs in the prototype demonstration. In formative work, anxiety, fear, and hot flashes were identified as causes of insomnia. After prototype demonstration, nearly 79% (11/14) of participants reported an interest in and perceived feasibility of using the virtual assistant to record sleep patterns. Approximately two-thirds of the participants thought lifestyle modification (9/14, 64%) and sleep restriction (9/14, 64%) would be feasible and were interested in this feature of the program (10/14, 71% and 9/14, 64%, respectively). Relaxation exercises were rated as interesting and feasible using the virtual assistant by 71% (10/14) of the participants. Usability was rated as better than average, and all women reported that they would recommend the program to friends and family. Conclusions: This virtual assistant prototype delivering CBT-I components by using a smart speaker was rated as feasible and acceptable, suggesting that this prototype should be fully developed and tested for efficacy in the BCS population. If efficacy is shown in this population, the prototype should also be adapted for other high-risk populations. %M 32348274 %R 10.2196/15859 %U http://cancer.jmir.org/2020/1/e15859/ %U https://doi.org/10.2196/15859 %U http://www.ncbi.nlm.nih.gov/pubmed/32348274 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16902 %T Exploring Strategies for Using Social Media to Self-Manage Health Care When Living With and Beyond Breast Cancer: In-Depth Qualitative Study %A Ure,Cathy %A Cooper-Ryan,Anna Mary %A Condie,Jenna %A Galpin,Adam %+ Directorate of Allied and Public Health, School of Health and Society, University of Salford, Allerton Building, Salford, Manchester, M6 6PU, United Kingdom, 44 (0)161 295 5094, c.m.ure1@salford.ac.uk %K breast cancer %K social media %K internet %K self-management %K psychosocial health %K survivorship %D 2020 %7 25.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: As breast cancer survival rates improve and structural health resources are increasingly being stretched, health providers require people living with and beyond breast cancer (LwBBC) to self-manage aspects of their care. Objective: This study aimed to explore how women use and experience social media to self-manage their psychosocial needs and support self-management across the breast cancer continuum. Methods: The experiences of 21 women (age range 27-64 years) were explored using an in-depth qualitative approach. The women varied in the duration of their experiences of LwBBC, which facilitated insights into how they evolve and change their self-management strategies over time. Semistructured interviews were analyzed inductively using a thematic analysis, a polytextual analysis, and voice-centered relational methods. Results: The use of multiple social media platforms, such as YouTube, Facebook, WhatsApp, and Twitter, enabled women to self-manage aspects of their care by satisfying needs for timely, relevant, and appropriate support, by navigating identities disrupted by diagnosis and treatment and by allowing them to (re)gain a sense of control. Women described extending their everyday use of multiple platforms to self-manage their care. However, women experienced social media as both empowering and dislocating, as their engagement was impacted by their everyday experiences of LwBBC. Conclusions: Health care professionals (HCPs) need to be more aware, and open to the possibilities, of women using multiple social media resources as self-management tools. It is important for HCPs to initiate value-free discussions and create the space necessary for women to share how social media resources support a tailored and timely self-managed approach to their unique psychosocial needs. %M 32364510 %R 10.2196/16902 %U http://www.jmir.org/2020/5/e16902/ %U https://doi.org/10.2196/16902 %U http://www.ncbi.nlm.nih.gov/pubmed/32364510 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e17824 %T Help to Overcome Problems Effectively for Cancer Survivors: Development and Evaluation of a Digital Self-Management Program %A Martin,Faith %A Wright,Hayley %A Moody,Louise %A Whiteman,Becky %A McGillion,Michael %A Clyne,Wendy %A Pearce,Gemma %A Turner,Andy %+ Faculty Research Centre for Intelligent Healthcare, Faculty of Health and Life Sciences, Coventry University, Priory Street, Coventry, CV1 5FB, United Kingdom, 44 02477657498, hsx116@coventry.ac.uk %K positive psychology %K self-management %K hope %K quality of life %K survivorship %K cancer %D 2020 %7 19.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: People living with cancer face numerous psychosocial challenges, including cancer-related fatigue, fear of recurrence, and depression. There is a lack of digital interventions tailored to the needs of people living with all types of cancer. We developed a 6-week, digital, peer-delivered, self-management program: iHOPE (Help to Overcome Problems Effectively; where ‘i’ indicates the digital version of the program). The program is underpinned by positive psychology and cognitive behavioral therapy to meet these psychosocial challenges. Objective: This study aimed to assess the feasibility of the iHOPE program among people living with cancer. Program adherence and satisfaction along with changes in psychological distress and positive well-being were measured. Methods: A pre-post, acceptability, and feasibility design was used. People living with cancer (N=114) were recruited via a national cancer charity in the United Kingdom and were given access to the iHOPE program. Demographic and other participant characteristics were recorded. Participants completed digital measures at baseline and the end of the 6-week program for depression, anxiety, cancer-related fatigue, cancer worry or fear of cancer recurrence, positive mental well-being, hope, gratitude, and health status. The website’s system recorded data on the usage of the program. Satisfaction with the program was also measured. Results: A total of 114 participants completed the baseline questionnaires. Of these, 70 people (61.4%) participated in all 6 sessions. The mean number of sessions undertaken was 5.0 (SD 1.5). Moreover, 44.7% (51/114) of participants completed at least three sessions and end-of-program outcome measures. A total of 59 participants completed the satisfaction questionnaire, where ≥90% (54/58) of participants reported that the program was easy to navigate and was well managed by the peer facilitators, and that they found the social networking tools useful. Preliminary efficacy testing among the 51 participants who completed baseline and postprogram outcome measures showed that postprogram scores decreased for depression, anxiety, cancer-related fatigue, and fear of recurrence (all P<.001) and increased for positive mental well-being (P<.001), hope (both P<.001), and gratitude (P=.02). Conclusions: The feasibility evidence is promising, showing that the peer-delivered digital iHOPE program is acceptable and practical. Implementation of the iHOPE program on a wider scale will incorporate further research and development to maximize the completion rates of the measures. Initial effectiveness data suggest positive impacts on important cancer-related quality of life and mental well-being outcomes. A randomized controlled trial design with a longer follow-up is needed to confirm the potential of the iHOPE program for improving mental and physical health outcomes for cancer survivors. %M 32209529 %R 10.2196/17824 %U http://www.jmir.org/2020/5/e17824/ %U https://doi.org/10.2196/17824 %U http://www.ncbi.nlm.nih.gov/pubmed/32209529 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 5 %P e15178 %T A Smartphone App–Based Mindfulness Intervention for Cancer Survivors: Protocol for a Randomized Controlled Trial %A Subnis,Utkarsh B %A Farb,Norman AS %A Piedalue,Katherine-Ann Laura %A Speca,Michael %A Lupichuk,Sasha %A Tang,Patricia A %A Faris,Peter %A Thoburn,Mark %A Saab,Bechara J %A Carlson,Linda E %+ Department of Oncology, University of Calgary, 2202 2 Street SW, Calgary, AB, T2S 3C1, Canada, 1 4034762465, utkarsh.subnis@ucalgary.ca %K mobile health %K psycho-oncology %K mindfulness %K mind-body therapies %D 2020 %7 11.5.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer patients transitioning to survivorship after completing cancer treatments need psychosocial interventions to manage stressors such as anxiety, depression, and fear of cancer recurrence. Mindfulness-based interventions (MBIs) are effective for treating these symptoms; however, cancer survivors are often unable to participate in face-to-face interventions because of difficulties such as work and family commitments, treatment-related side-effects, scheduling conflicts, and geography. Smartphone app–based MBIs are an innovative way to deliver psychosocial cancer care and can overcome several such difficulties, since patients can participate at their own convenience. Objective: The SEAMLESS (Smartphone App–Based Mindfulness Intervention for Cancer Survivors) study aims to evaluate the efficacy of a tailored app-based mindfulness intervention for cancer survivors (the Am Mindfulness-Based Cancer Survivorship—MBCS—Journey) for treating (1) symptoms of stress (primary outcome), as well as (2) fear of cancer recurrence, anxiety, depression, fatigue, and overall physical functioning (secondary outcomes). This is the first Canadian efficacy trial of a tailored mindfulness app intervention in cancer survivors. Methods: This is a randomized waitlist-controlled trial, which will evaluate the effectiveness of Am MBCS for impacting the primary and secondary outcomes in cancer survivors who have completed all their cancer treatments. Outcomes will be assessed using web-based surveys with validated psychometric instruments at (1) baseline, (2) mid-intervention (2 weeks later), (3) immediately postintervention (4 weeks), (4) 3 months postbaseline, (5) 6 months postbaseline, and (6) 12 months postbaseline. The waitlist group will complete all assessments and will cross over to the intervention condition after the 3-month assessment. In addition, data will be obtained by the smartphone app itself, which includes users’ engagement with the app-based intervention, their emotional state (eg, angry and elated) from a user-inputted digital emotion-mapping board, and psychobiometric data using photoplethysmography technology. Results: The study received ethics approval in September 2018 and recruitment commenced in January 2019. Participants are being recruited through a provincial cancer registry, and the majority of participants currently enrolled are breast (44/83, 53%) or colorectal (17/83, 20%) cancer survivors, although some survivors of other cancer are also present. Data collection for analysis of the primary outcome time-point will be complete by September 2019, and the follow-up data will be collected and analyzed by September 2020. Data will be analyzed to determine group differences using linear mixed modelling statistical techniques. Conclusions: Cancer care providers are uncertain about the efficacy of app-based mindfulness interventions for patients, which are available in great supply in today’s digital world. This study will provide rigorously evaluated efficacy data for an app-based mindfulness intervention for cancer survivors, which if helpful, could be made available for psychosocial care at cancer centers worldwide. Trial Registration: ClinicalTrials.gov NCT03484000; https://clinicaltrials.gov/ct2/show/NCT03484000 International Registered Report Identifier (IRRID): DERR1-10.2196/15178 %M 32390591 %R 10.2196/15178 %U https://www.researchprotocols.org/2020/5/e15178 %U https://doi.org/10.2196/15178 %U http://www.ncbi.nlm.nih.gov/pubmed/32390591 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16084 %T A User-Friendly, Web-Based Integrative Tool (ESurv) for Survival Analysis: Development and Validation Study %A Pak,Kyoungjune %A Oh,Sae-Ock %A Goh,Tae Sik %A Heo,Hye Jin %A Han,Myoung-Eun %A Jeong,Dae Cheon %A Lee,Chi-Seung %A Sun,Hokeun %A Kang,Junho %A Choi,Suji %A Lee,Soohwan %A Kwon,Eun Jung %A Kang,Ji Wan %A Kim,Yun Hak %+ Department of Anatomy, School of Medicine, Pusan National University, 49 Busandaehak-ro, Yangsan, 50612, Republic of Korea, 82 515108091, yunhak10510@pusan.ac.kr %K survival analysis %K grouped variable selection %K The Cancer Genome Atlas %K web-based tool %K user service %D 2020 %7 5.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Prognostic genes or gene signatures have been widely used to predict patient survival and aid in making decisions pertaining to therapeutic actions. Although some web-based survival analysis tools have been developed, they have several limitations. Objective: Taking these limitations into account, we developed ESurv (Easy, Effective, and Excellent Survival analysis tool), a web-based tool that can perform advanced survival analyses using user-derived data or data from The Cancer Genome Atlas (TCGA). Users can conduct univariate analyses and grouped variable selections using multiomics data from TCGA. Methods: We used R to code survival analyses based on multiomics data from TCGA. To perform these analyses, we excluded patients and genes that had insufficient information. Clinical variables were classified as 0 and 1 when there were two categories (for example, chemotherapy: no or yes), and dummy variables were used where features had 3 or more outcomes (for example, with respect to laterality: right, left, or bilateral). Results: Through univariate analyses, ESurv can identify the prognostic significance for single genes using the survival curve (median or optimal cutoff), area under the curve (AUC) with C statistics, and receiver operating characteristics (ROC). Users can obtain prognostic variable signatures based on multiomics data from clinical variables or grouped variable selections (lasso, elastic net regularization, and network-regularized high-dimensional Cox-regression) and select the same outputs as above. In addition, users can create custom gene signatures for specific cancers using various genes of interest. One of the most important functions of ESurv is that users can perform all survival analyses using their own data. Conclusions: Using advanced statistical techniques suitable for high-dimensional data, including genetic data, and integrated survival analysis, ESurv overcomes the limitations of previous web-based tools and will help biomedical researchers easily perform complex survival analyses. %M 32369034 %R 10.2196/16084 %U https://www.jmir.org/2020/5/e16084 %U https://doi.org/10.2196/16084 %U http://www.ncbi.nlm.nih.gov/pubmed/32369034 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 1 %P e15750 %T A Novel Mobile Phone App Intervention With Phone Coaching to Reduce Symptoms of Depression in Survivors of Women’s Cancer: Pre-Post Pilot Study %A Chow,Philip I %A Drago,Fabrizio %A Kennedy,Erin M %A Cohn,Wendy F %+ University of Virginia, 560 Ray C Hunt Dr, Charlottesville, VA, 22903, United States, 1 9244345401, philip.i.chow@gmail.com %K mobile apps %K mental health %K mHealth %K women %K cancer survivors %D 2020 %7 6.2.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: Psychological distress is a major issue among survivors of women’s cancer who face numerous barriers to accessing in-person mental health treatments. Mobile phone app–based interventions are scalable and have the potential to increase access to mental health care among survivors of women’s cancer worldwide. Objective: This study aimed to evaluate the acceptability and preliminary efficacy of a novel app-based intervention with phone coaching in a sample of survivors of women’s cancer. Methods: In a single-group, pre-post, 6-week pilot study in the United States, 28 survivors of women’s cancer used iCanThrive, a novel app intervention that teaches skills for coping with stress and enhancing well-being, with added phone coaching. The primary outcome was self-reported symptoms of depression (Center for Epidemiologic Studies Depression Scale). Emotional self-efficacy and sleep disruption were also assessed at baseline, 6-week postintervention, and 4 weeks after the intervention period. Feedback obtained at the end of the study focused on user experience of the intervention. Results: There were significant decreases in symptoms of depression and sleep disruption from baseline to postintervention. Sleep disruption remained significantly lower at 4-week postintervention compared with baseline. The iCanThrive app was launched a median of 20.5 times over the intervention period. The median length of use was 2.1 min. Of the individuals who initiated the intervention, 87% (20/23) completed the 6-week intervention. Conclusions: This pilot study provides support for the acceptability and preliminary efficacy of the iCanThrive intervention. Future work should validate the intervention in a larger randomized controlled study. It is important to develop scalable interventions that meet the psychosocial needs of different cancer populations. The modular structure of the iCanThrive app and phone coaching could impact a large population of survivors of women’s cancer. %R 10.2196/15750 %U http://cancer.jmir.org/2020/1/e15750/ %U https://doi.org/10.2196/15750 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 1 %P e14544 %T Development of a Core Set of Patient-Reported Outcomes for Population-Based Cancer Survivorship Research: Protocol for an Australian Consensus Study %A Ramsey,Imogen %A Corsini,Nadia %A Hutchinson,Amanda D %A Marker,Julie %A Eckert,Marion %+ Rosemary Bryant AO Research Centre, School of Nursing and Midwifery and UniSA Cancer Research Institute, University of South Australia, City East Campus, North Terrace, Adelaide, 5001, Australia, 61 883022129, imogen.ramsey@unisa.edu.au %K cancer survivorship %K quality of life %K patient-reported outcomes %K core outcome set %K Delphi study %K consensus %D 2020 %7 28.1.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Core outcome sets seek to improve the consistency and quality of research by providing agreed-upon recommendations regarding what outcomes should be measured as a minimum for a population and setting. The problems arising from a lack of outcome standardization in population-based cancer survivorship research indicate the need for agreement on a core set of patient-reported outcomes (PROs) to enhance data quality, consistency, and comparability. Objective: This study aims to identify a core set of PROs, representing the most important issues impacting on cancer survivors' long-term health, functioning and quality of life, to inform population-based research on cancer survivorship. Methods: In Phase I, a list of all potentially important outcomes will be generated through focus group discussions with cancer survivors and a review of measures for assessing quality of life in cancer survivorship. The consolidated list will be advanced to Phase II, where a stakeholder consensus process will be conducted with national experts in cancer survivorship to refine and prioritize the outcomes into a core outcome set. The process will consist of a two-round Delphi survey and a consensus meeting. Cancer survivors, oncology health care professionals, and potential end users of the core outcome set with expertise in cancer survivorship research or policy will be invited to participate. In Phase III, recommended measures for assessment of the core outcome set will be selected with advice from experts on the assessment, analysis, and interpretation of PROs. Results: As of April 2019, data collection for Phase I is complete and data analysis is underway. These data will inform the list of outcomes to be advanced into Phase II. Recruitment for Phase II will commence in June 2019, and it is anticipated that it will take 6 months to complete the three-step consensus process and identify a provisional core outcome set. The study results are expected to be published in early 2020. Conclusions: Expert consensus-driven recommendations on outcome measurement will facilitate the inclusion of survivorship outcomes considered important by cancer survivors and health professionals in future research. Adoption of the core outcome set will enable comparison and synthesis of evidence across studies and enhance the quality of PRO data collected in cancer survivorship research, particularly when applied to address macro-level questions. International Registered Report Identifier (IRRID): DERR1-10.2196/14544 %M 32012089 %R 10.2196/14544 %U http://www.researchprotocols.org/2020/1/e14544/ %U https://doi.org/10.2196/14544 %U http://www.ncbi.nlm.nih.gov/pubmed/32012089 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 2 %P e12090 %T Evaluation of a Technology-Based Survivor Care Plan for Breast Cancer Survivors: Pre-Post Pilot Study %A Laufer,Talya %A Lerner,Bryan %A Petrich,Anett %A Quinn,Anna M %A Ernst,Leah %A Roop,Alicin %A Knoblauch,Janet %A Leasure,Nick C %A Jaslow,Rebecca J %A Hegarty,Sarah %A Leader,Amy %A Barsevick,Andrea %+ Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, 834 Chestnut Street, Suite 314, Philadelphia, PA, 19107, United States, 1 215 955 7739, amy.leader@jefferson.edu %K cancer survivor %K care plan %K technology %K patient activation %D 2019 %7 20.12.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: As of 2016, almost 16 million individuals were cancer survivors, including over 3.5 million survivors of breast cancer. Because cancer survivors are living longer and have unique health care needs, the Institute of Medicine proposed a survivor care plan as a way to alleviate the many medical, emotional, and care coordination problems of survivors. Objective: This pilot study for breast cancer survivors was undertaken to: (1) examine self-reported changes in knowledge, confidence, and activation from before receipt to after receipt of a survivor care plan; and (2) describe survivor preferences for, and satisfaction with, a technology-based survivor care plan. Methods: A single group pretest-posttest design was used to study breast cancer survivors in an academic cancer center and a community cancer center during their medical visit after they completed chemotherapy. The intervention was a technology-based survivor care plan. Measures were taken before, immediately after, and 1 month after receipt of the survivor care plan. Results: A total of 38 breast cancer survivors agreed to participate in the study. Compared to baseline levels before receipt of the survivor care plan, participants reported increased knowledge both immediately after its receipt at the academic center (P<.001) and the community center (P<.001) as well as one month later at the academic center (P=.002) and the community center (P<.001). Participants also reported increased confidence immediately following receipt of the survivor care plan at the academic center (P=.63) and the community center (P=.003) and one month later at both the academic center (P=.63) and the community center (P<.001). Activation was increased from baseline to post-survivor care plan at both the academic center (P=.05) and community center (P<.001) as well as from baseline to 1-month follow-up at the academic center (P=.56) and the community center (P<.001). Overall, community center participants had lower knowledge, confidence, and activation at baseline compared with academic center participants. Overall, 22/38 (58%) participants chose the fully functional electronic survivor care plan. However, 12/23 (52%) in the community center group chose the paper version compared to 4/15 (27%) in the academic center group. Satisfaction with the format (38/38 participants) and the content (37/38 participants) of the survivor care plan was high for both groups. Conclusions: This study provides evidence that knowledge, confidence, and activation of survivors were associated with implementation of the survivor care plan. This research agrees with previous research showing that cancer survivors found the technology-based survivor care plan to be acceptable. More research is needed to determine the optimal approach to survivor care planning to ensure that all cancer survivors can benefit from it. %M 31859683 %R 10.2196/12090 %U http://cancer.jmir.org/2019/2/e12090/ %U https://doi.org/10.2196/12090 %U http://www.ncbi.nlm.nih.gov/pubmed/31859683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e13929 %T Investigating How Bowel Cancer Survivors Discuss Exercise and Physical Activity Within Web-Based Discussion Forums: Qualitative Analysis %A Olsen,Alicia %A Keogh,Justin %A Sargeant,Sally %+ Faculty of Health Sciences and Medicine, Bond University, University Drive, Robina, 4226, Australia, 61 0449821196, aolsen@bond.edu.au %K exercise %K physical activity %K cancer %K qualitative research %K patient portals %K internet %D 2019 %7 16.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Online cancer support group discussions enable patients to share their illness experience with others. The sharing of technical and emotional support information and the ability to ask for advice are some of the primary discussions shared online. People with bowel cancer can also use these forums to support each other by sharing information based on personal experiences. This type of support provides newly diagnosed patients with advice about several topics, including exercise from those who have been there. Information gathered from online discussion boards may complement the advice received by health professionals. Objective: This study aimed to explore the nature of information related to exercise and physical activity exchanged online for cancer survivors. Methods: A public open access bowel cancer discussion board was searched for threads containing information related to physical activity or exercise. Keywords such as exercise, physical activity, moving, walking, lifting, weights training, and resistance were used to search for threads (online conversations) related to exercise or physical activity. Only threads initiated by bowel cancer patients or survivors were included. From more than 6000 posts, the inclusion criteria yielded 75 threads for analysis. Inductive thematic analysis was conducted across all included threads. Results: Analysis yielded 3 main themes: level of exercise competence, beneficial dimensions of exercise, and faith in the knowledge. Level of exercise competence illustrated the varying definitions of exercise that members of the forum discussed in the forum. Beneficial dimensions of exercise revealed that forum members shared both the spiritual benefits associated with exercise as well as the physical benefits or goodness that they feel exercise or physical activity provides them. Faith in the knowledge of exercise demonstrated that forum members were aware of the general benefits of exercise but felt disappointed that it did not keep the cancer at bay. However, members also had faith that exercise would keep them healthy after diagnosis and treatment. Conclusions: The analysis revealed that people with bowel cancer discuss exercise and physical activity online and that they view exercise as having a mostly positive influence on their cancer journey. However, personal definitions of exercise became a source of conflict within the group. People with bowel cancer seeking information about exercise may benefit from participating in online support groups as it appears that there are many similar others willing to share their personal experiences with exercise. In addition, health care professionals responsible for caring for people with bowel cancer may use these findings to discuss exercise with their patients while being mindful of how they may view exercise. %M 31841117 %R 10.2196/13929 %U https://www.jmir.org/2019/12/e13929 %U https://doi.org/10.2196/13929 %U http://www.ncbi.nlm.nih.gov/pubmed/31841117 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e17045 %T Gimme My Damn Data (and Let Patients Help!): The #GimmeMyDamnData Manifesto %A deBronkart,Dave %A Eysenbach,Gunther %+ JMIR Publications, 130 Queens Quay E, Ste. 1100, Toronto, ON, Canada, 1 416 583 2040, editor@jmir.org %K data %K participatory medicine %K ehealth %D 2019 %7 22.11.2019 %9 Discussion Paper %J J Med Internet Res %G English %X Ten years ago, in 2009, “e-Patient Dave” deBronkart delivered an influential keynote speech at the Medicine 2.0 conference in Toronto, organized by the Journal of Medical Internet Research’s (JMIR’s) editor-in-chief Gunther Eysenbach, who themed the conference around the topics of participation, openness, collaboration, apomediation, and social networking to improve health care for the 21st century—with patient participation being a major component. Many see this as a defining event within the participatory medicine movement, perhaps the beginning of a social movement, similar to the women’s rights movement, with the title of Dave’s keynote “Gimme my damn data” becoming a rallying cry and hashtag for patients demanding more access to their electronic health records. On the occasion of the 20th anniversary of JMIR (and 10 years after the keynote), we are celebrating the impact of the keynote for the participatory medicine movement and #gimmemydamndata (also #GMDD) by publishing the transcript of these initial conversations as a manifesto of patients’ rights to access their data and their right to save their lives. %M 31755873 %R 10.2196/17045 %U http://www.jmir.org/2019/11/e17045/ %U https://doi.org/10.2196/17045 %U http://www.ncbi.nlm.nih.gov/pubmed/31755873 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 11 %P e14427 %T Nutritional Assessment of Childhood Cancer Survivors (the Swiss Childhood Cancer Survivor Study-Nutrition): Protocol for a Multicenter Observational Study %A Belle,Fabiën Naomi %A Beck Popovic,Maja %A Ansari,Marc %A Otth,Maria %A Kuehni,Claudia Elisabeth %A Bochud,Murielle %+ Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, 3012, Switzerland, 41 31 631 33 47, fabien.belle@ispm.unibe.ch %K child %K cancer survivors %K urine specimen collection %K diet surveys %K food frequency questionnaire %K Swiss Childhood Cancer Registry %K Switzerland %D 2019 %7 18.11.2019 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Childhood cancer survivors are at high risk of developing adverse late health effects. Poor nutritional intake may contribute to this risk, but information about dietary intake is limited. Objective: This study will assess childhood cancer survivors’ dietary intake and compare two dietary assessment tools: a self-reported food frequency questionnaire, and dietary measurements from urine spot samples. Methods: In a substudy of the Swiss Childhood Cancer Survivor Study (SCCSS), SCCSS-Nutrition, we assessed childhood cancer survivors’ dietary intake via a validated food frequency questionnaire. We sent a urine spot collection kit to a subset of 212 childhood cancer survivors from the French-speaking region of Switzerland to analyze urinary sodium, potassium, urea, urate, creatinine, and phosphate content. We will compare the food frequency questionnaire results with the urine spot analyses to quantify childhood cancer survivors’ intake of various nutrients. We collected data between March 2016 and March 2018. Results: We contacted 1599 childhood cancer survivors, of whom 919 (57.47%) returned a food frequency questionnaire. We excluded 11 childhood cancer survivors who were pregnant or were breastfeeding, 35 with missing dietary data, and 71 who had unreliable food frequency questionnaire data, resulting in 802 childhood cancer survivors available for food frequency questionnaire analyses. To a subset of 212 childhood cancer survivors in French-speaking Switzerland we sent a urine spot collection kit, and 111 (52.4%) returned a urine sample. We expect to have the results from analyses of these samples in mid-2019. Conclusions: The SCCSS-Nutrition study has collected in-depth dietary data that will allow us to assess dietary intake and quality and compare two dietary assessment tools. This study will contribute to the knowledge of nutrition among childhood cancer survivors and is a step toward surveillance guidelines and targeted nutritional recommendations for childhood cancer survivors in Switzerland. Trial Registration: ClinicalTrials.gov NCT03297034; https://clinicaltrials.gov/ct2/show/NCT03297034 International Registered Report Identifier (IRRID): DERR1-10.2196/14427 %M 31738177 %R 10.2196/14427 %U http://www.researchprotocols.org/2019/11/e14427/ %U https://doi.org/10.2196/14427 %U http://www.ncbi.nlm.nih.gov/pubmed/31738177 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e14360 %T A Research Roadmap: Connected Health as an Enabler of Cancer Patient Support %A Signorelli,Gabriel Ruiz %A Lehocki,Fedor %A Mora Fernández,Matilde %A O'Neill,Gillian %A O'Connor,Dominic %A Brennan,Louise %A Monteiro-Guerra,Francisco %A Rivero-Rodriguez,Alejandro %A Hors-Fraile,Santiago %A Munoz-Penas,Juan %A Bonjorn Dalmau,Mercè %A Mota,Jorge %A Oliveira,Ricardo B %A Mrinakova,Bela %A Putekova,Silvia %A Muro,Naiara %A Zambrana,Francisco %A Garcia-Gomez,Juan M %+ Oncoavanze, Calle Presidente Cardenas, 8 Local Oncoavanze, Seville, 41013, Spain, 34 954 231 459, gasignorelli@gmail.com %K cancer %K Connected Health %K mHealth %K eHealth %K mental health %K physical activity %K rehabilitation %K wearable %K Internet of Things %K quality of life %D 2019 %7 29.10.2019 %9 Viewpoint %J J Med Internet Res %G English %X The evidence that quality of life is a positive variable for the survival of cancer patients has prompted the interest of the health and pharmaceutical industry in considering that variable as a final clinical outcome. Sustained improvements in cancer care in recent years have resulted in increased numbers of people living with and beyond cancer, with increased attention being placed on improving quality of life for those individuals. Connected Health provides the foundations for the transformation of cancer care into a patient-centric model, focused on providing fully connected, personalized support and therapy for the unique needs of each patient. Connected Health creates an opportunity to overcome barriers to health care support among patients diagnosed with chronic conditions. This paper provides an overview of important areas for the foundations of the creation of a new Connected Health paradigm in cancer care. Here we discuss the capabilities of mobile and wearable technologies; we also discuss pervasive and persuasive strategies and device systems to provide multidisciplinary and inclusive approaches for cancer patients for mental well-being, physical activity promotion, and rehabilitation. Several examples already show that there is enthusiasm in strengthening the possibilities offered by Connected Health in persuasive and pervasive technology in cancer care. Developments harnessing the Internet of Things, personalization, patient-centered design, and artificial intelligence help to monitor and assess the health status of cancer patients. Furthermore, this paper analyses the data infrastructure ecosystem for Connected Health and its semantic interoperability with the Connected Health economy ecosystem and its associated barriers. Interoperability is essential when developing Connected Health solutions that integrate with health systems and electronic health records. Given the exponential business growth of the Connected Health economy, there is an urgent need to develop mHealth (mobile health) exponentially, making it both an attractive and challenging market. In conclusion, there is a need for user-centered and multidisciplinary standards of practice to the design, development, evaluation, and implementation of Connected Health interventions in cancer care to ensure their acceptability, practicality, feasibility, effectiveness, affordability, safety, and equity. %M 31663861 %R 10.2196/14360 %U http://www.jmir.org/2019/10/e14360/ %U https://doi.org/10.2196/14360 %U http://www.ncbi.nlm.nih.gov/pubmed/31663861 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 2 %P e13150 %T Mediators of a Physical Activity Intervention on Cognition in Breast Cancer Survivors: Evidence From a Randomized Controlled Trial %A Hartman,Sheri J %A Weiner,Lauren S %A Nelson,Sandahl H %A Natarajan,Loki %A Patterson,Ruth E %A Palmer,Barton W %A Parker,Barbara A %A Sears,Dorothy D %+ Department of Family Medicine and Public Health, University of California, San Diego, 3855 Health Sciences Drive, #0901, La Jolla, CA, 92037, United States, 1 8585349235, sjhartman@ucsd.edu %K cognitive function %K exercise %K anxiety %K neoplasms %D 2019 %7 11.10.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Emerging research suggests that increasing physical activity can help improve cognition among breast cancer survivors. However, little is known about the mechanism through which physical activity impacts cancer survivors’ cognition. Objective: The objective of this secondary analysis examined physical and psychological function potentially linking physical activity with changes in cognition among breast cancer survivors in a randomized controlled trial where the exercise arm had greater improvements in cognition than the control arm. Methods: A total of 87 sedentary breast cancer survivors were randomized to a 12-week physical activity intervention (n=43) or control condition (n=44). Objectively measured processing speed (National Institutes of Health Toolbox Oral Symbol Digit), self-reported cognition (patient-reported outcomes measurement information system [PROMIS] cognitive abilities), PROMIS measures of physical and psychological function (depression, anxiety, fatigue, and physical functioning), and plasma biomarkers (brain-derived neurotrophic factor, homeostatic model assessment 2 of insulin resistance, and C-reactive protein [CRP]) were collected at baseline and 12 weeks. Linear mixed-effects models tested intervention effects on changes in physical and psychological function variables and biomarkers. Bootstrapping was used to assess mediation. Exploratory analyses examined self-reported cognitive abilities and processing speed as mediators of the intervention effect on physical functioning. Results: Participants in the exercise arm had significantly greater improvements in physical functioning (beta=1.23; 95% CI 2.42 to 0.03; P=.049) and reductions in anxiety (beta=−1.50; 95% CI −0.07 to −2.94; P=.04) than those in the control arm. Anxiety significantly mediated the intervention effect on cognitive abilities (bootstrap 95% CI −1.96 to −0.06), whereas physical functioning did not (bootstrap 95% CI −1.12 to 0.10). Neither anxiety (bootstrap 95% CI −1.18 to 0.74) nor physical functioning (bootstrap 95% CI −2.34 to 0.15) mediated the intervention effect on processing speed. Of the biomarkers, only CRP had greater changes in the exercise arm than the control arm (beta=.253; 95% CI −0.04 to 0.57; P=.09), but CRP was not associated with cognition; therefore, none of the biomarker measures mediated the intervention effect on cognition. Neither cognitive abilities (bootstrap 95% CI −0.06 to 0.68) nor processing speed (bootstrap 95% CI −0.15 to 0.63) mediated the intervention effect on physical function. Conclusions: Physical activity interventions may improve self-reported cognition by decreasing anxiety. If supported by larger studies, reducing anxiety may be an important target for improving self-reported cognition among cancer survivors. Trial Registration: ClinicalTrials.gov NCT02332876; https://clinicaltrials.gov/ct2/show/NCT02332876 %M 31605514 %R 10.2196/13150 %U https://cancer.jmir.org/2019/2/e13150 %U https://doi.org/10.2196/13150 %U http://www.ncbi.nlm.nih.gov/pubmed/31605514 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e13463 %T An Assessment of Physical Activity Data Collected via a Smartphone App and a Smart Band in Breast Cancer Survivors: Observational Study %A Chung,Il Yong %A Jung,Miyeon %A Lee,Sae Byul %A Lee,Jong Won %A Park,Yu Rang %A Cho,Daegon %A Chung,Haekwon %A Youn,Soyoung %A Min,Yul Ha %A Park,Hye Jin %A Lee,Minsun %A Chung,Seockhoon %A Son,Byung Ho %A Ahn,Sei-Hyun %+ Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, 05505, Seoul,, Republic of Korea, 82 10 7209 4620, newstar153@hanmail.net %K telemedicine %K breast neoplasms %K mobile apps %K quality of life %K stress, psychological %K patient compliance %K smartphone %K mobile phone %K wearable electronic devices %K survivorship %D 2019 %7 06.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Although distress screening is crucial for cancer survivors, it is not easy for clinicians to recognize distress. Physical activity (PA) data collected by mobile devices such as smart bands and smartphone apps have the potential to be used to screen distress in breast cancer survivors. Objective: The aim of this study was to assess data collection rates of smartphone apps and smart bands in terms of PA data, investigate the correlation between PA data from mobile devices and distress-related questionnaires from smartphone apps, and demonstrate factors associated with data collection with smart bands and smartphone apps in breast cancer survivors. Methods: In this prospective observational study, patients who underwent surgery for breast cancer at Asan Medical Center, Seoul, Republic of Korea, between June 2017 and March 2018 were enrolled and asked to use both a smartphone app and smart band for 6 months. The overall compliance rates of the daily PA data collection via the smartphone walking apps and wearable smart bands were analyzed in a within-subject manner. The longitudinal daily collection rates were calculated to examine the dropout pattern. We also performed multivariate linear regression analysis to examine factors associated with compliance with daily collection. Finally, we tested the correlation between the count of daily average steps and distress level using Pearson correlation analysis. Results: A total of 160 female patients who underwent breast cancer surgeries were enrolled. The overall compliance rates for using a smartphone app and smart bands were 88.0% (24,224/27,513) and 52.5% (14,431/27,513), respectively. The longitudinal compliance rate for smartphone apps was 77.8% at day 180, while the longitudinal compliance rate for smart bands rapidly decreased over time, reaching 17.5% at day 180. Subjects who were young, with other comorbidities, or receiving antihormonal therapy or targeted therapy showed significantly higher compliance rates to the smartphone app. However, no factor was associated with the compliance rate to the smart band. In terms of the correlation between the count of daily steps and distress level, step counts collected via smart band showed a significant correlation with distress level. Conclusions: Smartphone apps or smart bands are feasible tools to collect data on the physical activity of breast cancer survivors. PA data from mobile devices are correlated with participants’ distress data, which suggests the potential role of mobile devices in the management of distress in breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966 %M 31493319 %R 10.2196/13463 %U https://www.jmir.org/2019/9/e13463 %U https://doi.org/10.2196/13463 %U http://www.ncbi.nlm.nih.gov/pubmed/31493319 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 2 %P e10692 %T Usefulness and Usability of a Personal Health Record and Survivorship Care Plan for Colorectal Cancer Survivors: Survey Study %A Tarver,Will L %A Robb,Bruce W %A Haggstrom,David A %+ VA Health Services Research and Development, Center for Health Information & Communication, Richard L Roudebush VA Medical Center, 1481 W 10th St, Indianapolis, IN, 46202, United States, 1 3179882616, willi.tarver@va.gov %K personal health record %K colorectal cancer %K survivorship %K digital health %K digital medicine %D 2019 %7 20.08.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: As a result of improvements in cancer screening, treatment, and supportive care, nearly two-thirds of individuals diagnosed with colorectal cancer (CRC) live for 5 years after diagnosis. An ever-increasing population of CRC survivors creates a need for effective survivorship care to help manage and mitigate the impact of CRC and its treatment. Personal health records (PHRs) and survivorship care plans provide a means of supporting the long-term care of cancer survivors. Objective: The purpose of this study is to characterize the usefulness of a CRC PHR and survivorship care plan and to describe the usability of these technologies in a population of CRC survivors. To our knowledge, this is the first study to assess a PHR and survivorship care plan specifically targeting CRC survivors. Methods: Twenty-two patients with CRC were recruited from surgery clinics of an academic medical center and Veterans Affairs hospital in Indianapolis and provided access to an online Colorectal Cancer Survivor’s Personal Health Record (CRCS-PHR). Survey data were collected to characterize the usefulness of the CRCS-PHR and describe its usability in a population of CRC survivors. CRC survivors were surveyed 6 months after being provided online access. Means and proportions were used to describe the usefulness and ease of using the CRC website. Open-ended questions were qualitatively coded using the constant comparative method. Results: CRC survivors perceived features related to their health care (ie, summary of cancer treatment history, follow-up care schedule, description of side effects, and list of community resources) to be more useful than communication features (ie, creating online relationships with family members or caregivers, communicating with doctor, and secure messages). CRC survivors typically described utilizing traditional channels (eg, via telephone or in person) to communicate with their health care provider. Participants had overall positive perceptions with respect to ease of use and overall satisfaction. Major challenges experienced by participants included barriers to system log-in, lack of computer literacy or experience, and difficulty entering their patient information. Conclusions: For CRC, survivors may find the greater value in a PHR’s medical content than the communication functions, which they have available elsewhere. These findings regarding the usefulness and usability of a PHR for the management of CRC survivorship provide valuable insights into how best to tailor these technologies to patients’ needs. These findings can inform future design and development of PHRs for purposes of both cancer and chronic disease management. %M 31432780 %R 10.2196/10692 %U https://cancer.jmir.org/2019/2/e10692/ %U https://doi.org/10.2196/10692 %U http://www.ncbi.nlm.nih.gov/pubmed/31432780 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 2 %P e13543 %T Feasibility of a Mobile Phone App and Telephone Coaching Survivorship Care Planning Program Among Spanish-Speaking Breast Cancer Survivors %A Nápoles,Anna María %A Santoyo-Olsson,Jasmine %A Chacón,Liliana %A Stewart,Anita L %A Dixit,Niharika %A Ortiz,Carmen %+ Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 9000 Rockville Pike, Bldg 3, 5/E08, Bethesda, MD, 20892-0001, United States, 1 301 496 3348, anna.napoles@nih.gov %K Hispanic Americans %K cancer survivors %K mobile apps %K feasibility studies %D 2019 %7 09.07.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Spanish-speaking Latina breast cancer survivors experience disparities in knowledge of breast cancer survivorship care, psychosocial health, lifestyle risk factors, and symptoms compared with their white counterparts. Survivorship care planning programs (SCPPs) could help these women receive optimal follow-up care and manage their condition. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of a culturally and linguistically suitable SCPP called the Nuevo Amanecer (New Dawn) Survivorship Care Planning Program for Spanish-speaking breast cancer patients in public hospital settings, approaching the end of active treatment. Methods: The 2-month intervention was delivered via a written bilingual survivorship care plan and booklet, Spanish-language mobile phone app with integrated activity tracker, and telephone coaching. This single-arm feasibility study used mixed methods to evaluate the intervention. Acceptability and feasibility were examined via tracking of implementation processes, debriefing interviews, and postintervention satisfaction surveys. Preliminary efficacy was assessed via baseline and 2-month interviews using structured surveys and pre- and postintervention average daily steps count based on activity tracker data. Primary outcomes were self-reported fatigue, health distress, knowledge of cancer survivorship care, and self-efficacy for managing cancer follow-up health care and self-care. Secondary outcomes were emotional well-being, depressive and somatic symptoms, and average daily steps. Results: All women (n=23) were foreign-born with limited English proficiency; 13 (57%) had an elementary school education or less, 16 (70%) were of Mexican origin, and all had public health insurance. Coaching calls lasted on average 15 min each (SD 3.4). A total of 19 of 23 participants (83%) completed all 5 coaching calls. The majority (n=17; 81%) rated the overall quality of the app as “very good” or “excellent” (all rated it as at least “good”). Women checked their daily steps graph on the app between 4.2 to 5.9 times per week. Compared with baseline, postintervention fatigue (B=–.26; P=.02; Cohen d=0.4) and health distress levels (B=–.36; P=.01; Cohen d=0.3) were significantly lower and knowledge of recommended follow-up care and resources (B=.41; P=.03; Cohen d=0.5) and emotional well-being improved significantly (B=1.42; P=.02; Cohen d=0.3); self-efficacy for managing cancer follow-up care did not change. Average daily steps increased significantly from 6157 to 7469 (B=1311.8; P=.02; Cohen d=0.5). Conclusions: We found preliminary evidence of program feasibility, acceptability, and efficacy, with significant 2-month improvements in fatigue, health distress, and emotional well-being and increased knowledge of recommended follow-up care and average daily steps. Tailored mobile phone and health coaching SCPPs could help to ensure equitable access to these services and improve symptoms and physical activity levels among Spanish-speaking Latina breast cancer survivors. %M 31290395 %R 10.2196/13543 %U http://cancer.jmir.org/2019/2/e13543/ %U https://doi.org/10.2196/13543 %U http://www.ncbi.nlm.nih.gov/pubmed/31290395 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e14136 %T A Mobile System to Improve Quality of Life Via Energy Balance in Breast Cancer Survivors (BENECA mHealth): Prospective Test-Retest Quasiexperimental Feasibility Study %A Lozano-Lozano,Mario %A Cantarero-Villanueva,Irene %A Martin-Martin,Lydia %A Galiano-Castillo,Noelia %A Sanchez,Maria-José %A Fernández-Lao,Carolina %A Postigo-Martin,Paula %A Arroyo-Morales,Manuel %+ Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Avda de la Ilustración, 60, Granada,, Spain, 34 958248764, irenecantarero@ugr.es %K mHealth %K energy balance %K monitoring %K breast cancer %K survivors %K quality of life %D 2019 %7 25.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Energy balance is defined as the difference between energy expenditure and energy intake. The current state of knowledge supports the need to better integrate mechanistic approaches through effective studies of energy balance in the cancer population because of an observed significant lack of adherence to healthy lifestyle recommendations. To stimulate changes in breast cancer survivors’ lifestyles based on energy balance, our group developed the BENECA (Energy Balance on Cancer) mHealth app. BENECA has been previously validated as a reliable energy balance monitoring system. Objective: Based on our previous results, the goal of this study was to investigate the feasibility of BENECA mHealth in an ecological clinical setting with breast cancer survivors, by studying (1) its feasibility and (2) pretest-posttest differences with regard to breast cancer survivor lifestyles, quality of life (QoL), and physical activity (PA) motivation. Methods: Eighty breast cancer survivors diagnosed with stage I to IIIA and with a body mass index over 25 kg/m2 were enrolled in this prospective test-retest quasi-experimental study. Patients used BENECA mHealth for 8 weeks and were assessed at baseline and the postintervention period. Feasibility main outcomes included percentage of adoption, usage, and attrition; user app quality perception measured with the Mobile App Rating Scale (MARS); satisfaction with the Net Promoter Score (NPS); and barriers and facilitators of its use. Clinical main outcomes included measuring QoL with the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORT QLQ-C30), PA assessment with accelerometry, PA motivation measure with a Spanish self-efficacy scale for physical activity (EAF), and body composition with dual-energy x-ray absorptiometry. Statistical tests (using paired-sample t tests) and Kaplan-Meier survival curves were analyzed. Results: BENECA was considered feasible by the breast cancer survivors in terms of use (76%, 58/76), adoption (69%, 80/116), and satisfaction (positive NPS). The app quality score did not make it one of the best-rated apps (mean 3.71, SD 0.47 points out of 5). BENECA mHealth improved the QoL of participants (global health mean difference [MD] 12.83, 95% CI 8.95-16.71, P<.001), and EAF score (global MD 36.99, 95% CI 25.52-48.46, P<.001), daily moderate-to-vigorous PA (MD 7.38, 95% CI 0.39-14.37, P=.04), and reduced body weight (MD −1.42, 95% CI −1.97 to −0.87, P<.001). Conclusions: BENECA mHealth can be considered feasible in a real clinical context to promote behavioral changes in the lifestyles of breast cancer survivors, but it needs to be enhanced to improve user satisfaction with use and functionality. This study highlights the importance of the use of mobile apps based on energy balance and how the QoL of breast cancer survivors can be improved via monitoring. %M 31237570 %R 10.2196/14136 %U http://mhealth.jmir.org/2019/6/e14136/ %U https://doi.org/10.2196/14136 %U http://www.ncbi.nlm.nih.gov/pubmed/31237570 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e12603 %T Pneumococcal Vaccination Utilization Among Hispanic Long-Term Colorectal Cancer Survivors: Cross-Sectional Assessment of Claims %A Moran,Ryan J %A Waalen,Jill %A Murphy,James %A Nalawade,Vinit %A Schiaffino,Melody %+ Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, Mail Code #0811, La Jolla, CA, 92093, United States, 1 8582258535, rjmoran@ucsd.edu %K Hispanic Americans %K cancer survivors %K medicare %K preventive medicine %K pneumococcal vaccines %D 2019 %7 13.05.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Colorectal cancer (CRC) is the second leading cancer-related cause of death in the United States. However, survivorship has been increasing. Both cancer survivors and underserved populations experience unique health-related challenges and disparities that may exist among long-term CRC survivors as it relates to routine preventive care, specifically pneumococcal (PNM) vaccination. Objective: The aim of this study was to explore the relationship between long-term CRC survival and the receipt of PNM vaccine among Hispanic Medicare recipients compared with non-Hispanic populations. Methods: This study is a cross-sectional analysis of the Surveillance, Epidemiology, and End Results (SEER)-Medicare claims data examining ethnic differences in the receipt of PNM vaccination among long-term CRC survivors. Multivariable logistic regression models considered Hispanic ethnicity while controlling for sociodemographic characteristics, comorbidity score, age, tumor stage, and SEER registry. Results: Our sample revealed 32,501 long-term CRC survivors, and 1509 identified as Hispanic (4.64%) based on an established SEER algorithm. In total, 16,252 CRC survivors, or 50.00% of our sample, received a PNM vaccination. We found that Hispanic CRC survivors had 10% decreased odds of having received a PNM vaccine compared with non-Hispanic survivors (P=.03). Conclusions: Disparities likely exist in the utilization of PNM vaccination among long-term CRC survivors. Among Medicare beneficiaries, the use of claims data regarding PNM vaccination highlights the relatively poor utilization of guideline-directed preventive care. %M 31094341 %R 10.2196/12603 %U http://publichealth.jmir.org/2019/2/e12603/ %U https://doi.org/10.2196/12603 %U http://www.ncbi.nlm.nih.gov/pubmed/31094341 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e11855 %T Predictors of Postal or Online Response Mode and Associations With Patient Experience and Satisfaction in the English Cancer Patient Experience Survey %A Pham,Tra My %A Abel,Gary A %A Gomez-Cano,Mayam %A Lyratzopoulos,Georgios %+ Epidemiology of Cancer Healthcare and Outcomes Group, Department of Behavioural Science and Health, University College London, , London,, United Kingdom, 44 2076791719, y.lyratzopoulos@ucl.ac.uk %K cancer %K patient survey %K satisfaction %K experience %K online response %K Web %K internet %D 2019 %7 02.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient experience surveys are important tools for improving the quality of cancer services, but the representativeness of responders is a concern. Increasingly, patient surveys that traditionally used postal questionnaires are incorporating an online response option. However, the characteristics and experience ratings of online responders are poorly understood. Objective: We sought to examine predictors of postal or online response mode, and associations with patient experience in the (English) Cancer Patient Experience Survey. Methods: We analyzed data from 71,186 patients with cancer recently treated in National Health Service hospitals who responded to the Cancer Patient Experience Survey 2015. Using logistic regression, we explored patient characteristics associated with greater probability of online response and whether, after adjustment for patient characteristics, the online response was associated with a more or less critical evaluation of cancer care compared to the postal response. Results: Of the 63,134 patients included in the analysis, 4635 (7.34%) responded online. In an adjusted analysis, male (women vs men: odds ratio [OR] 0.50, 95% confidence interval [CI] 0.46-0.54), younger (<55 vs 65-74 years: OR 3.49, 95% CI 3.21-3.80), least deprived (most vs least deprived quintile: OR 0.57, 95% CI 0.51-0.64), and nonwhite (nonwhite vs white ethnic group: OR 1.37, 95% CI 1.24-1.51) patients were more likely to respond online. Compared to postal responders, after adjustment for patient characteristics, online responders had a higher likelihood of reporting an overall satisfied experience of care (OR 1.24, 95% CI 1.16-1.32). For 34 of 49 other items, online responders more frequently reported a less than positive experience of care (8 reached statistical significance), and the associations were positive for the remaining 15 of 49 items (2 reached statistical significance). Conclusions: In the context of a national survey of patients with cancer, online and postal responders tend to differ in their characteristics and rating of satisfaction. Associations between online response and reported experience were generally small and mostly nonsignificant, but with a tendency toward less than positive ratings, although not consistently. Whether the observed associations between response mode and reported experience were causal needs to be examined using experimental survey designs. %M 31045503 %R 10.2196/11855 %U https://www.jmir.org/2019/5/e11855/ %U https://doi.org/10.2196/11855 %U http://www.ncbi.nlm.nih.gov/pubmed/31045503 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12547 %T Text Message Responsivity in a 2-Way Short Message Service Pilot Intervention With Adolescent and Young Adult Survivors of Cancer %A Psihogios,Alexandra M %A Li,Yimei %A Butler,Eliana %A Hamilton,Jessica %A Daniel,Lauren C %A Barakat,Lamia P %A Bonafide,Christopher P %A Schwartz,Lisa A %+ The Children's Hospital of Philadelphia, 3501 Civic Center Boulevard, Philadelphia, PA, 19104, United States, 1 267 314 0164, psihogiosa@email.chop.edu %K mHealth %K adolescents %K young adults %K cancer %K chronic illness %K self-management %D 2019 %7 18.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text message interventions hold promise for adolescents and young adults (AYAs) with chronic health conditions, including childhood cancer survivors; however, engagement is often suboptimal. Limited research has studied mobile health intervention outcomes beyond efficacy. Understanding responsivity to different types of text messages (ie, when a participant texts back) can provide practical, actionable information to optimize engagement in future projects.Objective: Within a 2-way text messaging study in AYAs who recently completed treatment for cancer, we sought to evaluate text message responsivity across different types of text messages. Methods: AYAs who recently completed treatment for cancer (n=26; mean age=16 years; 62% female, 16/26 participants) received 2-way text messages about survivorship health topics over a 16-week period. Using participants’ text message log data, we coded responsivity to text messages and evaluated trends in responsivity to unprompted text messages and prompted text messages of varying content (eg, medication reminders, appointment reminders, and texts about personal experiences as a cancer survivor). Results: Across prompted and unprompted text messages, responsivity rapidly decreased (P ≤.001 and =.01, respectively) and plateaued by the third week of the intervention. However, participants were more responsive to prompted text messages (mean responsivity=46% by week 16) than unprompted messages (mean responsivity=10% by week 16). They also demonstrated stable responsivity to certain prompted content: medication reminders, appointment reminders, goal motivation, goal progress, and patient experience texts. Conclusions: Our methodology of evaluating text message responsivity revealed important patterns of engagement in a 2-way text message intervention for AYA cancer survivors. %M 30998225 %R 10.2196/12547 %U http://mhealth.jmir.org/2019/4/e12547/ %U https://doi.org/10.2196/12547 %U http://www.ncbi.nlm.nih.gov/pubmed/30998225 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10918 %T Breast, Prostate, and Colorectal Cancer Survivors’ Experiences of Using Publicly Available Physical Activity Mobile Apps: Qualitative Study %A Roberts,Anna L %A Potts,Henry WW %A Koutoukidis,Dimitrios A %A Smith,Lee %A Fisher,Abigail %+ Research Department of Behavioural Science & Health, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 02076791723, anna.roberts.15@ucl.ac.uk %K physical activity %K health behavior %K cancer survivors %K mobile apps %K mHealth %K digital health %D 2019 %7 04.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity (PA) can improve a range of outcomes following a cancer diagnosis. These include an improvement in experience of side effects of treatment (eg, fatigue) and management of comorbid conditions. PA might also increase survival and reduce recurrence. Digital interventions have shown potential for PA promotion among cancer survivors, but most in a previous review were Web-based, and few studies used mobile apps. There are many PA apps available for general public use, but it is unclear whether these are suitable as a PA intervention after a cancer diagnosis. Objective: This study sought posttreatment nonmetastatic breast, prostate, and colorectal cancer survivors’ opinions of using smartphone apps to promote PA and gathered their views on existing publicly available PA apps to inform a future intervention. Methods: Each participant was randomly assigned to download 2 of 4 apps (Human, The Walk, The Johnson & Johnson Official 7 Minute Workout, and Gorilla Workout). Participants used each app for 1 week consecutively. In-depth semistructured telephone interviews were then conducted to understand participants’ experiences of using the apps and how app-based PA interventions could be developed for cancer survivors. The interviews were analyzed using thematic analysis. Results: Thirty-two participants took part: 50% (16/32) had prostate cancer, 25% (8/32) had breast cancer, and 25% (8/32) had colorectal cancer. Three core themes were identified. The first theme was that multiple factors affect engagement with PA apps and this is highly personalized. Factors affecting engagement included participants’ perceptions of (1) the advantages and disadvantages of using apps to support PA, (2) the relevance of the app to the user (eg, in terms of cancer-related factors, their PA goals, the difficulty level of the app, the way in which they interact with their mobile phone, and the extent to which the app fits with their self-identity), (3) the quality of the app (eg, usability, accuracy, quality of production, and scientific evidence-base), and (4) the behavior change techniques used to promote PA. In the second theme, participants recommended that apps that promote walking are most appealing, as walking removes many barriers to PA. Finally, the participants suggested that PA apps should be integrated into cancer care, as they valued guidance and recommendations from health care professionals. Conclusions: This sample of breast, prostate, and colorectal cancer survivors was receptive to the use of apps to promote PA. Although no publicly available PA app was deemed wholly suitable, many suggestions for adaptation and intervention development were provided. The results can inform the development of an app-based PA intervention for cancer survivors. They also highlight the wide-ranging and dynamic influences on engagement with digital interventions, which can be applied to other evaluations of mobile health products in other health conditions and other health behaviors. %M 30609982 %R 10.2196/10918 %U http://mhealth.jmir.org/2019/1/e10918/ %U https://doi.org/10.2196/10918 %U http://www.ncbi.nlm.nih.gov/pubmed/30609982 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e19 %T A Stress Management App Intervention for Cancer Survivors: Design, Development, and Usability Testing %A Børøsund,Elin %A Mirkovic,Jelena %A Clark,Matthew M %A Ehlers,Shawna L %A Andrykowski,Michael A %A Bergland,Anne %A Westeng,Marianne %A Solberg Nes,Lise %+ Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, PO Box 4950 Nydalen, Oslo, 0424, Norway, 47 92667262, elin.borosund@rr-research.no %K stress management %K mindfulness %K cancer %K eHealth %K mHealth %K mobile apps %K development %K usability %K user-centered design %K mobile phones %D 2018 %7 06.09.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Distress is prevalent in cancer survivors. Stress management interventions can reduce distress and improve quality of life for cancer patients, but many people with cancer are unfortunately not offered or able to attend such in-person stress management interventions. Objective: The objective of this study was to develop an evidence-based stress management intervention for patients living with cancer that can be delivered electronically with wide reach and dissemination. This paper describes the design and development process of a technology-based stress management intervention for cancer survivors, including the exploration phase, intervention content development, iterative software development (including design, development, and formative evaluation of low- and high-level prototypes), and security and privacy considerations. Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=48). In the exploration phase, identifying needs and requirements for the intervention, 28 participants gave input, including male and female cancer survivors (n=11) representing a wide age range (31-81 years) and cancer diagnoses, healthcare providers (n=8) including psychosocial oncology experts, and eHealth experts (n=9) including information technology design and developers. To ensure user involvement in each phase various user-centered design and service design methods were included, such as interviews, usability testing, and think aloud processes. Overall, participants were involved usability testing in the software development and formative evaluation phase, including cancer survivors (n=6), healthy volunteers (n=7), health care providers (n=2), and eHealth experts (n=5). Intervention content was developed by stress management experts based on well-known cognitive behavioral stress management strategies and adjusted to electronic format through multiple iterations with stakeholders. Privacy and security issues were considered throughout. Results: The design and development process identified a variety of stakeholder requirements. Cancer survivors preferred stress management through a mobile app rather than through a personal computer (PC) and identified usefulness, easy access, user friendliness, use of easily understandable language, and many brief sections rather than longer ones as important components of the intervention. These requirements were also supported by recommendations from health care providers and eHealth experts. The final intervention was named StressProffen and the hospital Privacy and Security Protection Committee was part of the final intervention approval to also ensure anchoring in the hospital organization. Conclusions: Interventions, even evidence-based, have little impact if not actively used. This study illustrates how user-centered design and service design can be applied to identify and incorporate essential stakeholder aspects in the entire design and development process. In combination with evidence-based concepts, this process facilitated development of a stress management intervention truly designed for the end users, in this case, cancer survivors. Trial Registration: ClinicalTrials.gov NCT02939612; https://clinicaltrials.gov/ct2/show/NCT02939612 (Archived at WebCite at http://www.webcitation.org/71l9HcfcB) %M 30684438 %R 10.2196/formative.9954 %U http://formative.jmir.org/2018/2/e19/ %U https://doi.org/10.2196/formative.9954 %U http://www.ncbi.nlm.nih.gov/pubmed/30684438 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e10 %T Assessing Unmet Information Needs of Breast Cancer Survivors: Exploratory Study of Online Health Forums Using Text Classification and Retrieval %A McRoy,Susan %A Rastegar-Mojarad,Majid %A Wang,Yanshan %A Ruddy,Kathryn J %A Haddad,Tufia C %A Liu,Hongfang %+ Department of Electrical Engineering and Computer Science, University of Wisconsin-Milwaukee, College of Engineering & Applied Science, PO Box 784, Milwaukee, WI, 53201, United States, 1 414 229 6695, mcroy@uwm.edu %K online health forum %K automated content analysis %K text retrieval %K text classification %D 2018 %7 15.05.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Patient education materials given to breast cancer survivors may not be a good fit for their information needs. Needs may change over time, be forgotten, or be misreported, for a variety of reasons. An automated content analysis of survivors' postings to online health forums can identify expressed information needs over a span of time and be repeated regularly at low cost. Identifying these unmet needs can guide improvements to existing education materials and the creation of new resources. Objective: The primary goals of this project are to assess the unmet information needs of breast cancer survivors from their own perspectives and to identify gaps between information needs and current education materials. Methods: This approach employs computational methods for content modeling and supervised text classification to data from online health forums to identify explicit and implicit requests for health-related information. Potential gaps between needs and education materials are identified using techniques from information retrieval. Results: We provide a new taxonomy for the classification of sentences in online health forum data. 260 postings from two online health forums were selected, yielding 4179 sentences for coding. After annotation of data and training alternative one-versus-others classifiers, a random forest-based approach achieved F1 scores from 66% (Other, dataset2) to 90% (Medical, dataset1) on the primary information types. 136 expressions of need were used to generate queries to indexed education materials. Upon examination of the best two pages retrieved for each query, 12% (17/136) of queries were found to have relevant content by all coders, and 33% (45/136) were judged to have relevant content by at least one. Conclusions: Text from online health forums can be analyzed effectively using automated methods. Our analysis confirms that breast cancer survivors have many information needs that are not covered by the written documents they typically receive, as our results suggest that at most a third of breast cancer survivors’ questions would be addressed by the materials currently provided to them. %M 29764801 %R 10.2196/cancer.9050 %U http://cancer.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/cancer.9050 %U http://www.ncbi.nlm.nih.gov/pubmed/29764801 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e67 %T Monitoring Energy Balance in Breast Cancer Survivors Using a Mobile App: Reliability Study %A Lozano-Lozano,Mario %A Galiano-Castillo,Noelia %A Martín-Martín,Lydia %A Pace-Bedetti,Nicolás %A Fernández-Lao,Carolina %A Arroyo-Morales,Manuel %A Cantarero-Villanueva,Irene %+ Department of Physical Therapy, University of Granada, Avenida de la Ilustración, 60, Granada, 18016, Spain, 34 958248765, marroyo@ugr.es %K telemedicine %K breast neoplasms %K survivors %K life style %K exercise %K diet %K mhealth %D 2018 %7 27.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The majority of breast cancer survivors do not meet recommendations in terms of diet and physical activity. To address this problem, we developed a mobile health (mHealth) app for assessing and monitoring healthy lifestyles in breast cancer survivors, called the Energy Balance on Cancer (BENECA) mHealth system. The BENECA mHealth system is a novel and interactive mHealth app, which allows breast cancer survivors to engage themselves in their energy balance monitoring. BENECA was designed to facilitate adherence to healthy lifestyles in an easy and intuitive way. Objective: The objective of the study was to assess the concurrent validity and test-retest reliability between the BENECA mHealth system and the gold standard assessment methods for diet and physical activity. Methods: A reliability study was conducted with 20 breast cancer survivors. In the study, tri-axial accelerometers (ActiGraphGT3X+) were used as gold standard for 8 consecutive days, in addition to 2, 24-hour dietary recalls, 4 dietary records, and sociodemographic questionnaires. Two-way random effect intraclass correlation coefficients, a linear regression-analysis, and a Passing-Bablok regression were calculated. Results: The reliability estimates were very high for all variables (alpha≥.90). The lowest reliability was found in fruit and vegetable intakes (alpha=.94). The reliability between the accelerometer and the dietary assessment instruments against the BENECA system was very high (intraclass correlation coefficient=.90). We found a mean match rate of 93.51% between instruments and a mean phantom rate of 3.35%. The Passing-Bablok regression analysis did not show considerable bias in fat percentage, portions of fruits and vegetables, or minutes of moderate to vigorous physical activity. Conclusions: The BENECA mHealth app could be a new tool to measure energy balance in breast cancer survivors in a reliable and simple way. Our results support the use of this technology to not only to encourage changes in breast cancer survivors' lifestyles, but also to remotely monitor energy balance. Trial Registration: ClinicalTrials.gov NCT02817724; https://clinicaltrials.gov/ct2/show/NCT02817724 (Archived by WebCite at http://www.webcitation.org/6xVY1buCc) %M 29588273 %R 10.2196/mhealth.9669 %U http://mhealth.jmir.org/2018/3/e67/ %U https://doi.org/10.2196/mhealth.9669 %U http://www.ncbi.nlm.nih.gov/pubmed/29588273 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e51 %T Enhancing Survivorship Care Planning for Patients With Localized Prostate Cancer Using a Couple-Focused mHealth Symptom Self-Management Program: Protocol for a Feasibility Study %A Song,Lixin %A Dunlap,Kaitlyn L %A Tan,Xianming %A Chen,Ronald C %A Nielsen,Matthew E %A Rabenberg,Rebecca L %A Asafu-Adjei,Josephine K %A Koontz,Bridget F %A Birken,Sarah A %A Northouse,Laurel L %A Mayer,Deborah K %+ School of Nursing, University of North Carolina, Carrington Hall, Chapel Hill, NC, 27599, United States, 1 9199663612, lsong@unc.edu %K survivorship %K prostate cancer %K symptom, randomized trial %K mHealth %K caregiver %K Patient Reported Outcome Measures %D 2018 %7 26.02.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: This project explores a new model of care that enhances survivorship care planning and promotes health for men with localized prostate cancer transitioning to posttreatment self-management. Survivorship care planning is important for patients with prostate cancer because of its high incidence rate in the United States, the frequent occurrence of treatment-related side effects, and reduced quality of life (QOL) for both men and their partners. A key component of comprehensive survivorship care planning is survivorship care plans (SCPs), documents that summarize cancer diagnosis, treatment, and plans for follow-up care. However, research concerning the effectiveness of SCPs on patient outcomes or health service use has thus far been inconclusive. SCPs that are tailored to individual patients’ needs for information and care may improve effectiveness. Objective: This study aims to examine the feasibility of an enhanced survivorship care plan (ESCP) that integrates a symptom self-management mHealth program called Prostate Cancer Education and Resources for Couples (PERC) into the existing standardized SCP. The specific aims are to (1) examine the feasibility of delivering ESCPs and (2) to estimate the magnitude of benefit of ESCPs. Methods: We will use a two-group randomized controlled pretest-posttest design and collect data at baseline (T1) and 4 months later (T2) among 50 patients completing initial treatment for localized prostate cancer and their partners. First, we will assess the feasibility of ESCP by recruitment, enrollment, and retention rates; program satisfaction with the ESCP; and perceived ease of use of the ESCP. To achieve the secondary aim, we will compare the ESCP users with the standardized SCP users and assess their primary outcomes of QOL (overall, physical, emotional, and social QOL); secondary outcomes (reduction in negative appraisals and improvement in self-efficacy, social support, and health behaviors to manage symptoms); and number of visits to posttreatment care services between T1 and T2. We will assess the primary and secondary outcomes using measurements with sound psychometrical properties. We will use a qualitative and quantitative mixed methods approach to achieve the research aims. Results: This project is ongoing and will be completed by the end of 2018. Conclusions: The results from this study will help design a definitive randomized trial to test the efficacy of the ESCPs, a potentially scalable program, to enhance supportive care for prostate cancer patients and their families. %M 29483070 %R 10.2196/resprot.9118 %U http://www.researchprotocols.org/2018/2/e51/ %U https://doi.org/10.2196/resprot.9118 %U http://www.ncbi.nlm.nih.gov/pubmed/29483070 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e27 %T Increasing Physical Activity Amongst Overweight and Obese Cancer Survivors Using an Alexa-Based Intelligent Agent for Patient Coaching: Protocol for the Physical Activity by Technology Help (PATH) Trial %A Hassoon,Ahmed %A Schrack,Jennifer %A Naiman,Daniel %A Lansey,Dina %A Baig,Yasmin %A Stearns,Vered %A Celentano,David %A Martin,Seth %A Appel,Lawrence %+ Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe Street, E6035, Baltimore, MD, 21205, United States, 1 443 287 2775, ahassoo1@jhu.edu %D 2018 %7 12.02.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Physical activity has established health benefits, but motivation and adherence remain challenging. Objective: We designed and launched a three-arm randomized trial to test artificial intelligence technology solutions to increase daily physical activity in cancer survivors. Methods: A single-center, three-arm randomized clinical trial with an allocation ration of 1:1:1: (A) control, in which participants are provided written materials about the benefits of physical activity; (B) text intervention, where participants receive daily motivation from a fully automated, data-driven algorithmic text message via mobile phone (Coachtext); and (C) Voice Assist intervention, where participants are provided with an in-home on demand autonomous Intelligent Agent using data driven Interactive Digital Voice Assist on the Amazon Alexa/Echo (MyCoach). Results: The study runs for 5 weeks: a one-week run-in to establish baseline, followed by 4 weeks of intervention. Data for study outcomes is collected automatically through a wearable sensor, and data are transferred in real-time to the study server. The recruitment goal is 42 participants, 14 in each arm. Electronic health records are used to prescreen candidates, with 39 participants recruited to date. Discussion: This study aims to investigate the effects of different types of intelligent technology solutions on promoting physical activity in cancer survivors. This innovative approach can easily be expanded and customized to other interventions. Early lessons from our initial participants are helping us develop additional advanced solutions to improve health outcomes. Trial Registration: Retrospectively registered on July 10, 2017 at ClinicalTrials.gov: NCT03212079; https://clinicaltrials.gov/ct2/show/NCT03212079 (Archived by WebCite at http://www.webcitation.org/6wgvqjTji) %M 29434016 %R 10.2196/resprot.9096 %U https://www.researchprotocols.org/2018/2/e27/ %U https://doi.org/10.2196/resprot.9096 %U http://www.ncbi.nlm.nih.gov/pubmed/29434016 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 1 %P e14 %T Activating Technology for Connected Health in Cancer: Protocol for a Research and Training Program %A Mountford,Nicola %A Dorronzoro Zubiete,Enrique %A Kessie,Threase %A Garcia-Zapirain,Begonya %A Nuño-Solinís,Roberto %A Coyle,David %A Munksgaard,Kristin B %A Fernandez-Luque,Luis %A Rivera Romero,Octavio %A Mora Fernandez,Matilde %A Valero Jimenez,Pedro %A Daly,Ailish %A Whelan,Ruth %A Caulfield,Brian %+ Insight Centre, University College Dublin, 3rd Floor, Science Centre East, Belfield, Dublin, 4, Ireland, 353 17162526, nicola.mountford@ucd.ie %K eHealth %K mHealth %K consumer health informatics %K cancer %K cancer rehabilitation %D 2018 %7 24.01.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: As cancer survival rates increase, the challenge of ensuring that cancer survivors reclaim their quality of life (QoL) becomes more important. This paper outlines the research element of a research and training program that is designed to do just that. Objective: Bridging sectors, disciplines, and geographies, it brings together eight PhD projects and students from across Europe to identify the underlying barriers, test different technology-enabled rehabilitative approaches, propose a model to optimize the patient pathways, and examine the business models that might underpin a sustainable approach to cancer survivor reintegration using technology. Methods: The program, funded under the European Union's Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement No 722012, includes deep disciplinary PhD projects, intersectoral and international secondments, interdisciplinary plenary training schools, and virtual subject-specific education modules. Results: The 8 students have now been recruited and are at the early stages of their projects. Conclusions: CATCH will provide a comprehensive training and research program by embracing all key elements—technical, social, and economic sciences—required to produce researchers and project outcomes that are capable of meeting existing and future needs in cancer rehabilitation. %M 29367184 %R 10.2196/resprot.8900 %U http://www.researchprotocols.org/2018/1/e14/ %U https://doi.org/10.2196/resprot.8900 %U http://www.ncbi.nlm.nih.gov/pubmed/29367184 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e1 %T Internet-Based Group Intervention for Ovarian Cancer Survivors: Feasibility and Preliminary Results %A Kinner,Ellen M %A Armer,Jessica S %A McGregor,Bonnie A %A Duffecy,Jennifer %A Leighton,Susan %A Corden,Marya E %A Gauthier Mullady,Janine %A Penedo,Frank J %A Lutgendorf,Susan K %+ Department of Psychological & Brain Sciences, University of Iowa, W322 Seashore Hall, Iowa City, IA, 52242, United States, 1 319 335 2432, susan-lutgendorf@uiowa.edu %K ovarian cancer %K quality of life %K feasibility studies %K eHealth %K psychological stress %D 2018 %7 15.01.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Development of psychosocial group interventions for ovarian cancer survivors has been limited. Drawing from elements of cognitive-behavioral stress management (CBSM), mindfulness-based stress reduction (MBSR), and acceptance and commitment therapy (ACT), we developed and conducted preliminary testing of an Internet-based group intervention tailored specifically to meet the needs of ovarian cancer survivors. The Internet-based platform facilitated home delivery of the psychosocial intervention to a group of cancer survivors for whom attending face-to-face programs could be difficult given their physical limitations and the small number of ovarian cancer survivors at any one treatment site. Objective: The aim of this study was to develop, optimize, and assess the usability, acceptability, feasibility, and preliminary intended effects of an Internet-based group stress management intervention for ovarian cancer survivors delivered via a tablet or laptop. Methods: In total, 9 ovarian cancer survivors provided feedback during usability testing. Subsequently, 19 survivors participated in 5 waves of field testing of the 10-week group intervention led by 2 psychologists. The group met weekly for 2 hours via an Internet-based videoconference platform. Structured interviews and weekly evaluations were used to elicit feedback on the website and intervention content. Before and after the intervention, measures of mood, quality of life (QOL), perceived stress, sleep, and social support were administered. Paired t tests were used to examine changes in psychosocial measures over time. Results: Usability results indicated that participants (n=9) performed basic tablet functions quickly with no errors and performed website functions easily with a low frequency of errors. In the field trial (n=19), across 5 groups, the 10-week intervention was well attended. Perceived stress (P=.03) and ovarian cancer-specific QOL (P=.01) both improved significantly during the course of the intervention. Trends toward decreased distress (P=.18) and greater physical (P=.05) and functional well-being (P=.06) were also observed. Qualitative interviews revealed that the most common obstacles participants experienced were technical issues and the time commitment for practicing the techniques taught in the program. Participants reported that the intervention helped them to overcome a sense of isolation and that they appreciated the ability to participate at home. Conclusions: An Internet-based group intervention tailored specifically for ovarian cancer survivors is highly usable and acceptable with moderate levels of feasibility. Preliminary psychosocial outcomes indicate decreases in perceived stress and improvements in ovarian cancer-specific QOL following the intervention. A randomized clinical trial is needed to demonstrate the efficacy of this promising intervention for ovarian cancer survivors. %M 29335233 %R 10.2196/cancer.8430 %U http://cancer.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/cancer.8430 %U http://www.ncbi.nlm.nih.gov/pubmed/29335233 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 1 %P e2 %T Research- and Practice-Based Nutrition Education and Cooking Workshops in Pediatric Oncology: Protocol for Implementation and Development of Curriculum %A Chaput,Cynthia %A Beaulieu-Gagnon,Sabrina %A Bélanger,Véronique %A Drouin,Simon %A Bertout,Laurence %A Lafrance,Lucie %A Olivier,Cinthia %A Robitaille,Marthe %A Laverdière,Caroline %A Sinnett,Daniel %A Marquis,Marie %A Marcil,Valérie %+ Research Center of Sainte-Justine University Health Center, 3175 Côte Ste-Catherine room 4.17.006, Montreal, QC, H3T 1C5, Canada, 1 514 345 4931 ext 3272, valerie.marcil@umontreal.ca %K child %K diet %K education %K neoplasms %K hospitals %K methods %D 2018 %7 09.01.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Progresses in childhood cancer treatment, diagnosis, and management have resulted in childhood cancer survival rates of over 80%. However, this therapeutic success comes with a heavy price: two-thirds of childhood cancer survivors will be affected by further complications, including cardiovascular and metabolic diseases. Adequate nutrition during cancer treatment is essential to ensure the child’s optimal development, improve tolerance to treatments, and can contribute to lower the risk of developing cardiometabolic diseases. Side effects of cancer treatments can negatively impact children’s nutritional intake and eating behaviors. Involving the families of childhood cancer patients in educational workshops could be a promising avenue to promote healthy eating during and after cancer treatment. Objective: The objectives of this study were to develop, validate, and implement a family-based nutrition education and cooking workshop curriculum in a pediatric oncology setting that addresses the nutritional issues encountered during treatments while promoting the adoption of healthy eating habits for the prevention of long-term cardiometabolic effects. Methods: The workshops were developed and validated following an 8-step iterative process, including a review of the literature and consultations with a steering committee. An evaluation tool was also developed. A nonrandomized study protocol was elaborated to implement the workshops and measure their impact. The themes of the 6 research- and practice-based lessons are as follows: meal fortification during cancer treatment, changes in taste during cancer therapy and their impact on children, adapting diet to eating-related side effects of treatments, nutritional support during cancer treatment, Mediterranean diet and health, and planning quick and economic meals. The validation process included consultations with the institution’s clinical nutrition professionals. Self-administered post questionnaires were developed according to the content of each workshop to measure short-term outcomes, namely, participants’ perception of knowledge acquisition, behavioral intention, and satisfaction. Medium-term outcomes that will be evaluated are participants’ anthropometric profile, quality of the diet, and circulating biomarkers of metabolic health. Results: The project was funded in 2016 and enrollment will be completed in 2021. Data analysis is currently under way and the first results are expected to be submitted for publication in 2019. Conclusions: This research- and practice-based nutrition education and cooking demonstration curriculum could be a valuable complement to a multidisciplinary lifestyle intervention for the prevention of long-term cardiometabolic complications in childhood cancer. %M 29317383 %R 10.2196/resprot.8302 %U http://www.researchprotocols.org/2018/1/e2/ %U https://doi.org/10.2196/resprot.8302 %U http://www.ncbi.nlm.nih.gov/pubmed/29317383 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 12 %P e238 %T Exploring Advance Care Planning in Taiwanese Indigenous Cancer Survivors: Proposal for a Pilot Case-Control Study %A Li,In-Fun %A Hsiung,Yvonne %+ Department of Nursing, Mackay Medical College, No 46, Sec 3, Zhongzheng Rd, Sanzhi District, New Taipei City, 252, Taiwan, 886 226360303 ext 1318, yvonnebear@mmc.edu.tw %K Taiwanese indigenous peoples %K advance care planning %K cancer survivors %D 2017 %7 21.12.2017 %9 Proposal %J JMIR Res Protoc %G English %X Background: Research on Taiwanese indigenous cancer survivors’ end-of-life (EOL) planning is still in its infancy, despite recent government and societal efforts to promote quality EOL care. Previous national studies in Taiwan have characterized indigenous peoples as a socioeconomically disadvantaged minority group. Compared with their mainstream cohorts, these remote residents are vulnerable to multiple social welfare problems, receiving and accessing little in the way of health care in rural mountain areas. Although advance care planning (ACP) has been shown to help patients achieve better quality of dying, very little is known about indigenous intentions for such interventions. Relevant studies are scarce in Taiwan, and programs for cancer survivors have been based almost entirely on nonindigenous populations. Since there has been no research on Taiwanese indigenous people’s aims for ACP, there is a need to understand the impact of survivorship on ACP readiness among those who are currently living with, through, and beyond cancer. Objective: We aim to identify differences in ACP intent and readiness among indigenous peoples with and without cancer diagnoses. We will identify the impact of factors such as tribal cultural beliefs and quality of life along with cancer exposure on the outcome of ACP readiness differences. In particular, we will examine the effects of ACP knowledge from previous ACP participation, EOL care experiences, and personal registry status of Do-Not-Resuscitate (DNR) in the national database. A secondary objective is to describe indigenous people’s intent to participate in public education related to EOL planning. Methods: A descriptive case-control study (N=200) is proposed where controls are matched to cases’ attributes of age, gender, and cancer diagnosis. This matching analysis allows assessment of cancer as an exposure while taking into account age and gender as confounding variables. We are currently in the process of training personnel and extracting clinical and administrative information from the health care system of collaborating facilities. This carefully designed study provides a unique opportunity because for the first time in Taiwan, cancer survivorship and ACP readiness for EOL planning will be examined among difficult-to-reach indigenous peoples. Results: We plan to complete this study in approximately 3 years. Conclusions: In this study, we expect to survey palliative care usage in the remote indigenous group, understand factors that influence ACP readiness, and later foster culturally appropriate ACP public participation and policies in order to facilitate collaboration between cancer health care providers in various Taiwanese subcultures. %M 29269340 %R 10.2196/resprot.5428 %U http://www.researchprotocols.org/2017/12/e238/ %U https://doi.org/10.2196/resprot.5428 %U http://www.ncbi.nlm.nih.gov/pubmed/29269340 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 10 %P e197 %T Adoption, Acceptability, and Effectiveness of a Mobile Health App for Personalized Prostate Cancer Survivorship Care: Protocol for a Realist Case Study of the Ned App %A Pham,Quynh %A Cafazzo,Joseph A %A Feifer,Andrew %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 4th Floor, 155 College St, Toronto, ON, M5T 3M6, Canada, 1 647 667 2573, q.pham@mail.utoronto.ca %K prostate-specific antigen %K prostate cancer survivorship %K prostate cancer %K patient-centered care %K mobile health %K mHealth %K telemedicine %K mobile health app %K realist evaluation %K case study %D 2017 %7 12.10.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: By 2030, prostate cancer will be the most commonly diagnosed cancer in North America. To mitigate this impending challenge, comprehensive support mechanisms for disease- and treatment-specific changes in health and well-being must be proactively designed and thoughtfully implemented for streamlined survivorship care. mHealth apps have been lauded as a promising complement to current outpatient treatment and monitoring strategies, but have not yet been widely used to support prostate cancer survivorship needs. A realist evaluation is needed to examine the impact of such apps on the prostate cancer survivorship experience. Objective: We seek to gain an understanding of how an mHealth app for prostate cancer survivorship care called Ned (No Evident Disease) is adopted and accepted by patients, caregivers, and clinicians. We also aim to determine the effect of Ned on health-related quality of life, satisfaction with cancer care, unmet needs, self-efficacy, and prostate cancer-related levels of anxiety. Methods: The Ned case study is a 12-month mixed-methods embedded single-case study with a nested within-group pre-post comparison of health outcomes. We will give 400 patients, 200 caregivers, and 10 clinicians access to Ned. Participants will be asked to complete study assessments at baseline, 2 months, 6 months, and 12 months. We will conduct 30 semistructured qualitative interviews with patients (n=20) and their caregivers (n=10) poststudy to gain insight into their experience with the app. Results: We recruited our first survivor in October 2017 and anticipate completing this study by May 2019. Conclusions: This will, to our knowledge, be the first realist case study to evaluate an app for prostate cancer survivorship care. Prostate cancer survivors are set to increase in number and longevity, heightening the need for integrated survivorship solutions to provide them with optimal and durable outcomes. The knowledge gained from this study will comprehensively inform how and why Ned works, for whom, and in what circumstances. Understanding the impact of digital health interventions such as Ned on how survivors care for themselves is critical to realizing patient-centered care. %M 29025699 %R 10.2196/resprot.8051 %U http://www.researchprotocols.org/2017/10/e197/ %U https://doi.org/10.2196/resprot.8051 %U http://www.ncbi.nlm.nih.gov/pubmed/29025699 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 2 %P e14 %T A Mobile Breast Cancer Survivorship Care App: Pilot Study %A Baseman,Janet %A Revere,Debra %A Baldwin,Laura-Mae %+ Department of Epidemiology, University of Washington, 1105 NE 45th Street Suite 400, Seattle, WA, 98105, United States, 1 206 616 1495, jbaseman@uw.edu %K breast neoplasms %K data collection %K feasibility studies %K mobile apps %K survivors %K telemedicine %D 2017 %7 26.09.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancer survivors living in rural areas experience unique challenges due to additional burdens, such as travel and limited access to specialists. Rural survivors of breast cancer have reported poorer outcomes, poorer mental health and physical functioning, and lower-than-average quality of life compared to urban survivors. Objective: To explore the feasibility and acceptability of developing a mobile health survivorship care app to facilitate care coordination; support medical, psychosocial, and practical needs; and improve survivors' long-term health outcomes. Methods: An interactive prototype app, SmartSurvivor, was developed that included recommended survivorship care plan components. The prototype's feasibility and acceptability were tested by a sample of breast cancer survivors (n=6), primary care providers (n=4), and an oncologist (n=1). Results: Overall, both survivors and providers felt that SmartSurvivor was a potentially valuable tool to support long-term survivorship care plan objectives. Portability, accessibility, and having one place for all contact, treatment, symptom tracking, and medication summaries was highly valued. Conclusions: Our pilot study indicates that SmartSurvivor is a feasible and acceptable approach to meeting survivorship care objectives and the needs of both breast cancer survivors and their health care providers. Exploration of mobile health options for supporting survivorship care plan needs is a promising area of research. %M 28951383 %R 10.2196/cancer.8192 %U http://cancer.jmir.org/2017/2/e14/ %U https://doi.org/10.2196/cancer.8192 %U http://www.ncbi.nlm.nih.gov/pubmed/28951383 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 2 %P e13 %T A Lifestyle Intervention via Email in Minority Breast Cancer Survivors: Randomized Parallel-Group Feasibility Study %A Paxton,Raheem J %A Hajek,Richard %A Newcomb,Patricia %A Dobhal,Megha %A Borra,Sujana %A Taylor,Wendell C %A Parra-Medina,Deborah %A Chang,Shine %A Courneya,Kerry S %A Block,Gladys %A Block,Torin %A Jones,Lovell A %+ Department of Community Medicine and Population Health, The University of Alabama, 1132 Northeast Medical Bldg, Tuscaloosa, AL, 35401, United States, 1 205 348 6857, rpaxton@ua.edu %K breast neoplasm %K African Americans %K diet %K feasibility study %K physical activity %K posture %K program evaluation %K Internet %K computer tailoring %K email %D 2017 %7 21.09.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: Our data have indicated that minority breast cancer survivors are receptive to participating in lifestyle interventions delivered via email or the Web, yet few Web-based studies exist in this population. Objective: The aim of this study was to examine the feasibility and preliminary results of an email-delivered diet and activity intervention program, “A Lifestyle Intervention Via Email (ALIVE),” delivered to a sample of racial and ethnic minority breast cancer survivors. Methods: Survivors (mean age: 52 years, 83% [59/71] African American) were recruited and randomized to receive either the ALIVE program’s 3-month physical activity track or its 3-month dietary track. The fully automated system provided tools for self-monitoring and goal setting, tailored content, and automated phone calls. Descriptive statistics and mixed-effects models were computed to examine the outcomes of the study. Results: Upon completion, 44 of 71 survivors completed the study. Our “intention-to-treat” analysis revealed that participants in the physical activity track made greater improvements in moderate to vigorous activity than those in the dietary track (+97 vs. +49 min/week, P<.001). Similarly, reductions in total sedentary time among those in the physical activity track (−304 vs. −59 min/week, P<.001) was nearly 5 times greater than that for participants in the dietary track. Our completers case analysis indicated that participants in the dietary track made improvements in the intake of fiber (+4.4 g/day), fruits and vegetables (+1.0 cup equivalents/day), and reductions in saturated fat (−2.3 g/day) and trans fat (−0.3 g/day) (all P<.05). However, these improvements in dietary intake were not significantly different from the changes observed by participants in the physical activity track (all P>.05). Process evaluation data indicated that most survivors would recommend ALIVE to other cancer survivors (97%), were satisfied with ALIVE (82%), and felt that ALIVE was effective (73%). However, survivors expressed concerns about the functionality of the interactive emails. Conclusions: ALIVE appears to be feasible for racial and ethnic minority cancer survivors and showed promising results for larger implementation. Although survivors favored the educational content, a mobile phone app and interactive emails that work on multiple email domains may help to boost adherence rates and to improve satisfaction with the Web-based platform. Trial Registration: ClinicalTrials.gov NCT02722850; https://clinicaltrials.gov/ct2/show/NCT02722850 (Archived by WebCite at http://www.webcitation.org/6tHN9VsPh) %M 28935620 %R 10.2196/cancer.7495 %U http://cancer.jmir.org/2017/2/e13/ %U https://doi.org/10.2196/cancer.7495 %U http://www.ncbi.nlm.nih.gov/pubmed/28935620 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 8 %P e165 %T Smartphone-Enabled Health Coaching Intervention (iMOVE) to Promote Long-Term Maintenance of Physical Activity in Breast Cancer Survivors: Protocol for a Feasibility Pilot Randomized Controlled Trial %A Ritvo,Paul %A Obadia,Maya %A Santa Mina,Daniel %A Alibhai,Shabbir %A Sabiston,Catherine %A Oh,Paul %A Campbell,Kristin %A McCready,David %A Auger,Leslie %A Jones,Jennifer Michelle %+ Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, PMB-B-148, 200 Elizabeth St, Toronto, ON, M5G 2C4, Canada, 1 416 581 8603, jennifer.jones@uhn.ca %K breast neoplasm %K exercise %K health coaching %K RCT %K telehealth %D 2017 %7 24.08.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although physical activity has been shown to contribute to long-term disease control and health in breast cancer survivors, a majority of breast cancer survivors do not meet physical activity guidelines. Past research has focused on promoting physical activity components for short-term breast cancer survivor benefits, but insufficient attention has been devoted to long-term outcomes and sustained exercise adherence. We are assessing a health coach intervention (iMOVE) that uses mobile technology to increase and sustain physical activity maintenance in initially inactive breast cancer survivors. Objective: This pilot randomized controlled trial (RCT) is an initial step in evaluating the iMOVE intervention and will inform development of a full-scale pragmatic RCT. Methods: We will enroll 107 physically inactive breast cancer survivors and randomly assign them to intervention or control groups at the University Health Network, a tertiary cancer care center in Toronto, Canada. Participants will be women (age 18 to 74 years) stratified by age (55 years and older/younger than 55 years) and adjuvant hormone therapy (AHT) exposure (AHT vs no AHT) following breast cancer treatment with no metastases or recurrence who report less than 60 minutes of preplanned physical activity per week. Both intervention and control groups receive the 12-week physical activity program with weekly group sessions and an individualized, progressive, home-based exercise program. The intervention group will additionally receive (1) 10 telephone-based health coaching sessions, (2) smartphone with data plan, if needed, (3) supportive health tracking software (Connected Wellness, NexJ Health Inc), and (4) a wearable step-counting device linked to a smartphone program. Results: We will be assessing recruitment rates; acceptability reflected in selective, semistructured interviews; and enrollment, retention, and adherence quantitative intervention markers as pilot outcome measures. The primary clinical outcome will be directly measured peak oxygen consumption. Secondary clinical outcomes include health-related quality of life and anthropometric measures. All outcome measures are administered at baseline, after exercise program (month 3), and 6 months after program (month 9). Conclusions: This pilot RCT will inform full-scale RCT planning. We will assess pilot procedures and interventions and collect preliminary effect estimates. Trial Registration: ClinicalTrials.gov NCT02620735; https://clinicaltrials.gov/ct2/show/NCT02620735 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02620735) %M 28838886 %R 10.2196/resprot.6615 %U http://www.researchprotocols.org/2017/8/e165/ %U https://doi.org/10.2196/resprot.6615 %U http://www.ncbi.nlm.nih.gov/pubmed/28838886 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e298 %T A Web-Based and Print-Based Computer-Tailored Physical Activity Intervention for Prostate and Colorectal Cancer Survivors: A Comparison of User Characteristics and Intervention Use %A Golsteijn,Rianne Henrica Johanna %A Bolman,Catherine %A Peels,Denise Astrid %A Volders,Esmee %A de Vries,Hein %A Lechner,Lilian %+ Department of Psychology and Educational Sciences, Open University of the Netherlands, PO Box 2960, Heerlen, 6401 DL, Netherlands, 31 455762539, rianne.golsteijn@ou.nl %K eHealth %K web-based intervention %K print-delivered intervention %K computer tailoring %K intervention usage %K physical activity %K prostate cancer %K colorectal cancer %K cancer survivorship %D 2017 %7 23.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Physical activity (PA) is beneficial in improving negative physical and psychological effects of cancer. The rapidly increasing number of cancer survivors, resulting from aging and improved cancer care, emphasizes the importance to develop and provide low cost, easy accessible PA programs. Such programs could be provided through the Internet, but that could result in the exclusion of cancer survivors not familiar with the Internet. Therefore, we developed a computer-tailored PA intervention for prostate and colorectal cancer survivors in which both Web-based and print materials are provided, and participants can choose their own preferred delivery mode. Objective: The aim of this study was to assess participants’ characteristics related to delivery mode and use of intervention materials. Methods: We studied characteristics of participants using Web-based and printed intervention materials in a randomized controlled trial (RCT). Prostate and colorectal cancer survivors recruited from hospitals were randomized to OncoActive (computer-tailored PA intervention) or a usual-care control group. OncoActive participants received both Web-based and printed materials. Participants were classified into initial print- or Web-based participants based on their preferred mode of completion of the first questionnaire, which was needed for the computer-tailored PA advice. Intervention material use during the remainder of the intervention was compared for initial print- or Web-based participants. Additionally, participants were classified into those using only print materials and those using Web-based materials. Differences in participant characteristics and intervention material use were studied through analysis of variance (ANOVAs), chi-square tests, and logistic regressions. Results: The majority of the participants in the intervention group were classified as initial Web-based participants (170/249, 68.3%), and 84.9% (191/249) used Web-based intervention materials. Dropout was low (15/249, 6.0%) and differed between initial Web-based (4/170, 2.4%) and print-based (11/79, 14%) participants. Participants were less likely to start Web-based with higher age (odds ratio [OR]=0.93), longer time since last treatment (OR=0.87), and higher fatigue (OR=0.96), and more likely with higher education (OR=4.08) and having completed treatments (OR=5.58). Those who were older (OR=0.93) and post treatment for a longer time (OR=0.86) were less likely to use Web-based intervention materials. Initial print-based participants predominantly used print-based materials, whereas initial Web-based participants used both print- and Web-based materials. Conclusions: To our knowledge, this is one of the first studies that assessed participant characteristics related to delivery mode in an intervention in which participants had a free choice of delivery modes. Use of print-based materials among the initial Web-based participants was substantial, indicating the importance of print-based materials. According to our findings, it may be important to offer Web- and print-based materials alongside each other. Providing Web-based materials only may exclude older, less educated, more fatigued, or currently treated participants; these groups are especially more vulnerable and could benefit most from PA interventions. %M 28835353 %R 10.2196/jmir.7838 %U http://www.jmir.org/2017/8/e298/ %U https://doi.org/10.2196/jmir.7838 %U http://www.ncbi.nlm.nih.gov/pubmed/28835353 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 2 %P e8 %T Cancer-Related Fatigue in Post-Treatment Cancer Survivors: Theory-Based Development of a Web-Based Intervention %A Corbett,Teresa %A Walsh,Jane C %A Groarke,AnnMarie %A Moss-Morris,Rona %A Morrissey,Eimear %A McGuire,Brian E %+ Centre for Clinical and Community Applications of Health Psychology (CCCAHP), School of Psychology, Faculty of Social, Human and Mathematical Sciences, University of Southampton, Southampton, SO17 1BJ, United Kingdom, 44 238059 ext 7045, T.K.Corbett@soton.ac.uk %K cancer %K survivor %K design %K person-based approach %K theory %D 2017 %7 04.07.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancer-related fatigue (CrF) is the most common and disruptive symptom experienced by cancer survivors. We aimed to develop a theory-based, interactive Web-based intervention designed to facilitate self-management and enhance coping with CrF following cancer treatment. Objective: The aim of our study was to outline the rationale, decision-making processes, methods, and findings which led to the development of a Web-based intervention to be tested in a feasibility trial. This paper outlines the process and method of development of the intervention. Methods: An extensive review of the literature and qualitative research was conducted to establish a therapeutic approach for this intervention, based on theory. The psychological principles used in the development process are outlined, and we also clarify hypothesized causal mechanisms. We describe decision-making processes involved in the development of the content of the intervention, input from the target patient group and stakeholders, the design of the website features, and the initial user testing of the website. Results: The cocreation of the intervention with the experts and service users allowed the design team to ensure that an acceptable intervention was developed. This evidence-based Web-based program is the first intervention of its kind based on self-regulation model theory, with the primary aim of targeting the representations of fatigue and enhancing self-management of CrF, specifically. Conclusions: This research sought to integrate psychological theory, existing evidence of effective interventions, empirically derived principles of Web design, and the views of potential users into the systematic planning and design of the intervention of an easy-to-use website for cancer survivors. %M 28676465 %R 10.2196/cancer.6987 %U http://cancer.jmir.org/2017/2/e8/ %U https://doi.org/10.2196/cancer.6987 %U http://www.ncbi.nlm.nih.gov/pubmed/28676465 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e161 %T Effects of Using Child Personas in the Development of a Digital Peer Support Service for Childhood Cancer Survivors %A Wärnestål,Pontus %A Svedberg,Petra %A Lindberg,Susanne %A Nygren,Jens M %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, 30118, Sweden, 46 35167863, jens.nygren@hh.se %K peer %K childhood %K cancer %K survivor %K participation %K user experience %K service design %D 2017 %7 18.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Peer support services have the potential to support children who survive cancer by handling the physical, mental, and social challenges associated with survival and return to everyday life. Involving the children themselves in the design process allows for adapting services to authentic user behaviors and goals. As there are several challenges that put critical requirements on a user-centered design process, we developed a design method based on personas adapted to the particular needs of children that promotes health and handles a sensitive design context. Objective: The purpose of this study was to evaluate the effects of using child personas in the development of a digital peer support service for childhood cancer survivors. Methods: The user group’s needs and behaviors were characterized based on cohort data and literature, focus group interviews with childhood cancer survivors (n=15, 8-12 years), stakeholder interviews with health care professionals and parents (n=13), user interviews, and observations. Data were interpreted and explained together with childhood cancer survivors (n=5) in three explorative design workshops and a validation workshop with children (n=7). Results: We present findings and insights on how to codesign child personas in the context of developing digital peer support services with childhood cancer survivors. The work resulted in three primary personas that model the behaviors, attitudes, and goals of three user archetypes tailored for developing health-promoting services in this particular use context. Additionally, we also report on the effects of using these personas in the design of a digital peer support service called Give Me a Break. Conclusions: By applying our progressive steps of data collection and analysis, we arrive at authentic child-personas that were successfully used to design and develop health-promoting services for children in vulnerable life stages. The child-personas serve as effective collaboration and communication aids for both internal and external purposes. %M 28526663 %R 10.2196/jmir.7175 %U http://www.jmir.org/2017/5/e161/ %U https://doi.org/10.2196/jmir.7175 %U http://www.ncbi.nlm.nih.gov/pubmed/28526663 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e130 %T Analyzing and Predicting User Participations in Online Health Communities: A Social Support Perspective %A Wang,Xi %A Zhao,Kang %A Street,Nick %+ Department of Management Sciences, The University of Iowa, S224 PBB, Iowa City, IA, 52242, United States, 1 3193353831, kang-zhao@uiowa.edu %K social support %K machine learning %K community networks %K patient engagement %K prediction %D 2017 %7 24.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Online health communities (OHCs) have become a major source of social support for people with health problems. Members of OHCs interact online with similar peers to seek, receive, and provide different types of social support, such as informational support, emotional support, and companionship. As active participations in an OHC are beneficial to both the OHC and its users, it is important to understand factors related to users’ participations and predict user churn for user retention efforts. Objective: This study aimed to analyze OHC users’ Web-based interactions, reveal which types of social support activities are related to users’ participation, and predict whether and when a user will churn from the OHC. Methods: We collected a large-scale dataset from a popular OHC for cancer survivors. We used text mining techniques to decide what kinds of social support each post contained. We illustrated how we built text classifiers for 5 different social support categories: seeking informational support (SIS), providing informational support (PIS), seeking emotional support (SES), providing emotional support (PES), and companionship (COM). We conducted survival analysis to identify types of social support related to users’ continued participation. Using supervised machine learning methods, we developed a predictive model for user churn. Results: Users’ behaviors to PIS, SES, and COM had hazard ratios significantly lower than 1 (0.948, 0.972, and 0.919, respectively) and were indicative of continued participations in the OHC. The churn prediction model based on social support activities offers accurate predictions on whether and when a user will leave the OHC. Conclusions: Detecting different types of social support activities via text mining contributes to better understanding and prediction of users’ participations in an OHC. The outcome of this study can help the management and design of a sustainable OHC via more proactive and effective user retention strategies. %M 28438725 %R 10.2196/jmir.6834 %U http://www.jmir.org/2017/4/e130/ %U https://doi.org/10.2196/jmir.6834 %U http://www.ncbi.nlm.nih.gov/pubmed/28438725 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 1 %P e4 %T An eHealth Intervention to Increase Physical Activity and Healthy Eating in Older Adult Cancer Survivors: Summative Evaluation Results %A Krebs,Paul %A Shtaynberger,Jonathan %A McCabe,Mary %A Iocolano,Michelle %A Williams,Katie %A Shuk,Elyse %A Ostroff,Jamie S %+ Department of Population Health, New York University School of Medicine, Translational Research Building, 7th Floor, 227 E 30th St, New York, NY, 10016, United States, 1 646 501 2637, Paul.Krebs@nyumc.org %K survivors %K diet %K food and nutrition %K breast neoplasms %K prostatic neoplasms %K eHealth %D 2017 %7 01.03.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: A healthy lifestyle is associated with improved quality of life among cancer survivors, yet adherence to health behavior recommendations is low. Objective: This pilot trial developed and tested the feasibility of a tailored eHealth program to increase fruit and vegetable consumption and physical activity among older, long-term cancer survivors. Methods: American Cancer Society (ACS) guidelines for cancer survivors were translated into an interactive, tailored health behavior program on the basis of Social Cognitive Theory. Patients (N=86) with a history of breast (n=83) or prostate cancer (n=3) and less than 5 years from active treatment were randomized 1:1 to receive either provider advice, brief counseling, and the eHealth program (intervention) or advice and counseling alone (control). Primary outcomes were self-reported fruit and vegetable intake and physical activity. Results: About half (52.7%, 86/163) of the eligible patients consented to participate. The most common refusal reasons were lack of perceived time for the study (32/163) and lack of interest in changing health behaviors (29/163). Furthermore, 72% (23/32) of the intervention group reported using the program and most would recommend it to others (56%, 14/25). Qualitative results indicated that the intervention was highly acceptable for survivors. For behavioral outcomes, the intervention group reported increased fruit and vegetable consumption. Self-reported physical activity declined in both groups. Conclusions: The brief intervention showed promising results for increasing fruit and vegetable intake. Results and participant feedback suggest that providing the intervention in a mobile format with greater frequency of contact and more indepth information would strengthen treatment effects. %M 28410171 %R 10.2196/cancer.6435 %U http://cancer.jmir.org/2017/1/e4/ %U https://doi.org/10.2196/cancer.6435 %U http://www.ncbi.nlm.nih.gov/pubmed/28410171 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 1 %P e3 %T Adolescent and Young Adult Cancer Survivorship Educational Programming: A Qualitative Evaluation %A Vollmer Dahlke,Deborah %A Fair,Kayla %A Hong,Yan Alicia %A Kellstedt,Debra %A Ory,Marcia G %+ Texas A&M School of Public Health, Health Promotion and Community Health Sciences, Texas A&M University, 8402 Silver Mountain Cove, Austin, TX,, United States, 1 512 699 4493, Deborahvd@gmail.com %K cancer survivorship %K adolescent and young adult %K qualitative %K mixed methods %K evaluation %D 2017 %7 10.02.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: This program evaluation considers the need for increased professional and patient education for adolescent and young adult (AYA) cancer survivorship. Due to the high incidence of late effects of cancer treatment among AYA cancer survivors, knowledge sharing and communications are needed throughout the transition from cancer care into community care. AYA survivors are likely to need developmentally appropriate psychosocial care as well as extensive follow-on surveillance by physicians who are educated and aware of the likely chronic conditions and late effects that may occur in these patients. Objective: The objective of this study was to evaluate the outcomes of the After Cancer Care Ends, Survivorship Starts for Adolescent and Young Adults (ACCESS AYA) programming. The intent of the ACCESS AYA program was to build health literacy around AYA survivorship issues and to stimulate improved communications between survivors and health care providers. This paper addresses the central research question of “How did the ACCESS AYA program increase health literacy, communications, and understanding among AYA survivors and providers?” Methods: The primarily qualitative evaluation included a brief introductory survey of participant awareness and effectiveness of the ACCESS AYA project serving as a recruitment tool. Survey respondents were invited to participate in in-depth interviews based on interview guides tailored to the different stakeholder groups. The evaluation used the Atlas Ti qualitative database and software for coding and key word analyses. Interrater reliability analyses were assessed using Cohen kappa analysis with Stata 12.1 (StataCorp LLC) software. Results: The key themes, which included survivor wellbeing, health care professional education, cancer advocates role and education, hospital and community-based resources, and the role of societal support, are presented in a concept map. The interrater reliability scores (ranging from 1 to minus 1) were .893 for first cycle coding and .784 for the second cycle. In the brief quantitative survey based on a scale of 1 to 5 with 5 as high, the 22 respondents rated their level of awareness of the project with a mean 3.2 (CI 3.02-3.45) and project effectiveness with a mean of 4 (CI 3.72-4.27). Conclusions: This study contributes to understanding of the ACCESS AYA survivor community in central Texas and the health care professionals and advocates who aid them in their efforts to a new normal life and wellbeing in their survivorship. The results of the evaluation highlight the need to continue to build both survivor and professional resources to address the unique impact of cancer on AYA cancer survivors. %M 28410172 %R 10.2196/cancer.5821 %U http://cancer.jmir.org/2017/1/e3/ %U https://doi.org/10.2196/cancer.5821 %U http://www.ncbi.nlm.nih.gov/pubmed/28410172 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 1 %P e2 %T Parent and Health Care Provider Perceptions for Development of a Web-Based Weight Management Program for Survivors of Pediatric Acute Lymphoblastic Leukemia: A Mixed Methods Study %A Folta,Sara %A Chang,Winnie %A Hill,Rachel %A Kelly,Michael %A Meagher,Susan %A Bowman,W Paul %A Zhang,Fang Fang %+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA,, United States, 1 617 636 3423, sara.folta@tufts.edu %K weight management %K childhood cancer survivors %K mixed methods %D 2017 %7 09.02.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: Survivors of pediatric acute lymphoblastic leukemia (ALL) may experience unhealthy weight gain during treatment, which has been associated with higher risk for chronic health issues. Objective: The purpose of this study was to obtain feedback on weight management in pediatric ALL survivors and on the content and implementation of a Web-based weight management program. Methods: Study participants included 54 parent survey respondents and 19 pediatric oncology professionals in 4 focus groups. Survey questions included report of child weight status and interest in participating in weight management programming at various time points. Pediatric oncology professionals were asked about the preferred topics and timing, as well as their role. Focus group data were analyzed by a multidisciplinary research team for common themes. Results: The mean age of survivors was 6.5 years. By parent report, 19% of children were overweight and 25% were obese. Preferred timing for weight management program participation was within 3 months of starting maintenance chemotherapy (23/53, 43%) or within 12 months after completion of all cancer treatments (18/53, 34%). Pediatric oncology professionals likewise considered the maintenance phase appropriate. They considered parenting to be an important topic to include and indicated that their most appropriate roles would be promotion and support. Conclusions: Parents and pediatric oncology professionals are interested in and supportive of early weight management in pediatric ALL survivors. Future research needs to identify strategies to integrate this into pediatric cancer care and to evaluate the feasibility and efficacy of these strategies. %M 28410182 %R 10.2196/cancer.6680 %U http://cancer.jmir.org/2017/1/e2/ %U https://doi.org/10.2196/cancer.6680 %U http://www.ncbi.nlm.nih.gov/pubmed/28410182 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 1 %P e3 %T Mobile Health Physical Activity Intervention Preferences in Cancer Survivors: A Qualitative Study %A Robertson,Michael C %A Tsai,Edward %A Lyons,Elizabeth J %A Srinivasan,Sanjana %A Swartz,Maria C %A Baum,Miranda L %A Basen-Engquist,Karen M %+ Center for Energy Balance, Department of Behavioral Science, MD Anderson Cancer Center, Cancer Prevention Building, Unit 1330, 1155 Pressler St, Houston, TX, 77030, United States, 1 713 745 3123, kbasenen@mdanderson.org %K mHealth %K physical activity %K survivors %K technology %K focus groups %K smartphone %D 2017 %7 24.01.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cancer survivors are at an elevated risk for several negative health outcomes, but physical activity (PA) can decrease those risks. Unfortunately, adherence to PA recommendations among survivors is low. Fitness mobile apps have been shown to facilitate the adoption of PA in the general population, but there are limited apps specifically designed for cancer survivors. This population has unique needs and barriers to PA, and most existing PA apps do not address these issues. Moreover, incorporating user preferences has been identified as an important priority for technology-based PA interventions, but at present there is limited literature that serves to establish these preferences in cancer survivors. This is especially problematic given the high cost of app development and because the majority of downloaded apps fail to engage users over the long term. Objective: The aim of this study was to take a qualitative approach to provide practical insight regarding this population’s preferences for the features and messages of an app to increase PA. Methods: A total of 35 cancer survivors each attended 2 focus groups; a moderator presented slide shows on potential app features and messages and asked open-ended questions to elicit participant preferences. All sessions were audio recorded and transcribed verbatim. Three reviewers independently conducted thematic content analysis on all transcripts, then organized and consolidated findings to identify salient themes. Results: Participants (mean age 63.7, SD 10.8, years) were mostly female (24/35, 69%) and mostly white (25/35, 71%). Participants generally had access to technology and were receptive to engaging with an app to increase PA. Themes identified included preferences for (1) a casual, concise, and positive tone, (2) tools for personal goal attainment, (3) a prescription for PA, and (4) an experience that is tailored to the user. Participants reported wanting extensive background data collection with low data entry burden and to have a trustworthy source translate their personal data into individualized PA recommendations. They expressed a desire for app functions that could facilitate goal achievement and articulated a preference for a more private social experience. Finally, results indicated that PA goals might be best established in the context of personally held priorities and values. Conclusions: Many of the desired features identified are compatible with both empirically supported methods of behavior change and the relative strengths of an app as a delivery vehicle for behavioral intervention. Participating cancer survivors’ preferences contrasted with many current standard practices for mobile app development, including value-based rather than numeric goals, private socialization in small groups rather than sharing with broader social networks, and interpretation of PA data rather than merely providing numerical data. Taken together, these insights may help increase the acceptability of theory-based mHealth PA interventions in cancer survivors. %M 28119278 %R 10.2196/mhealth.6970 %U http://mhealth.jmir.org/2017/1/e3/ %U https://doi.org/10.2196/mhealth.6970 %U http://www.ncbi.nlm.nih.gov/pubmed/28119278 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e11 %T Cancer Survivors’ Experience With Telehealth: A Systematic Review and Thematic Synthesis %A Cox,Anna %A Lucas,Grace %A Marcu,Afrodita %A Piano,Marianne %A Grosvenor,Wendy %A Mold,Freda %A Maguire,Roma %A Ream,Emma %+ School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Duke of Kent Building, Guildford, GU2 7XH, United Kingdom, 44 1483684626, a.cox@surrey.ac.uk %K neoplasms %K telemedicine %K systematic review %K survival %K patient satisfaction %K patient preference %D 2017 %7 09.01.2017 %9 Review %J J Med Internet Res %G English %X Background: Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors—individuals living with and beyond cancer—to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are “complex,” and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized. Objective: To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group. Methods: Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes. Analytical themes were developed through an iterative process of reflection on, and interpretation of, the descriptive themes within and across studies. Results: Across the 22 included papers, 3 analytical themes emerged, each with 3 descriptive subthemes: (1) influence of telehealth on the disrupted lives of cancer survivors (convenience, independence, and burden); (2) personalized care across physical distance (time, space, and the human factor); and (3) remote reassurance—a safety net of health care professional connection (active connection, passive connection, and slipping through the net). Telehealth interventions represent a convenient approach, which can potentially minimize treatment burden and disruption to cancer survivors’ lives. Telehealth interventions can facilitate an experience of personalized care and reassurance for those living with and beyond cancer; however, it is important to consider individual factors when tailoring interventions to ensure engagement promotes benefit rather than burden. Conclusions: Telehealth interventions can provide cancer survivors with independence and reassurance. Future telehealth interventions need to be developed iteratively in collaboration with a broad range of cancer survivors to maximize engagement and benefit. %M 28069561 %R 10.2196/jmir.6575 %U http://www.jmir.org/2017/1/e11/ %U https://doi.org/10.2196/jmir.6575 %U http://www.ncbi.nlm.nih.gov/pubmed/28069561 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e214 %T Developing a Web-Based Weight Management Program for Childhood Cancer Survivors: Rationale and Methods %A Zhang,Fang Fang %A Meagher,Susan %A Scheurer,Michael %A Folta,Sara %A Finnan,Emily %A Criss,Kerry %A Economos,Christina %A Dreyer,ZoAnn %A Kelly,Michael %+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Jaharis 235, Boston, MA, United States, 1 617 636 3704, fang_fang.zhang@tufts.edu %K weight management %K childhood cancer survivors %K obesity %K Web-based %K development %K nutrition %K physical activity %D 2016 %7 18.11.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Due to advances in the field of oncology, survival rates for children with cancer have improved significantly. However, these childhood cancer survivors are at a higher risk for obesity and cardiovascular diseases and for developing these conditions at an earlier age. Objective: In this paper, we describe the rationale, conceptual framework, development process, novel components, and delivery plan of a behavioral intervention program for preventing unhealthy weight gain in survivors of childhood acute lymphoblastic leukemia (ALL). Methods: A Web-based program, the Healthy Eating and Active Living (HEAL) program, was designed by a multidisciplinary team of researchers who first identified behaviors that are appropriate targets for weight management in childhood ALL survivors and subsequently developed the intervention components, following core behavioral change strategies grounded in social cognitive and self-determination theories. Results: The Web-based HEAL curriculum has 12 weekly self-guided sessions to increase parents’ awareness of the potential impact of cancer treatment on weight and lifestyle habits and the importance of weight management in survivors’ long-term health. It empowers parents with knowledge and skills on parenting, nutrition, and physical activity to help them facilitate healthy eating and active living soon after the child completes intensive cancer treatment. Based on social cognitive theory, the program is designed to increase behavioral skills (goal-setting, self-monitoring, and problem-solving) and self-efficacy and to provide positive reinforcement to sustain behavioral change. Conclusions: Lifestyle interventions are a priority for preventing the early onset of obesity and cardiovascular risk factors in childhood cancer survivors. Intervention programs need to meet survivors’ targeted behavioral needs, address specific barriers, and capture a sensitive window for behavioral change. In addition, they should be convenient, cost-effective and scalable. Future studies are needed to evaluate the feasibility of introducing weight management early in cancer care and the efficacy of early weight management on survivors’ health outcomes. %M 27864163 %R 10.2196/resprot.6381 %U http://www.researchprotocols.org/2016/4/e214/ %U https://doi.org/10.2196/resprot.6381 %U http://www.ncbi.nlm.nih.gov/pubmed/27864163 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 2 %N 2 %P e15 %T Alcohol Intake Among Breast Cancer Survivors: Change in Alcohol Use During a Weight Management Intervention %A Fazzino,Tera L %A Fleming,Kimberly %A Befort,Christie %+ Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, United States, 1 9135883030, tfazzino@kumc.edu %K alcohol drinking %K breast cancer %K weight loss %K weight reduction programs %K obesity %D 2016 %7 09.11.2016 %9 Original Paper %J JMIR Cancer %G English %X Background: Daily alcohol intake in quantities as small as half a drink/day significantly increases the risk of breast cancer recurrence for postmenopausal survivors. Interventions designed to modify alcohol use among survivors have not been studied; however, lifestyle interventions that target change in dietary intake may affect alcohol intake. Objective: To evaluate change in alcohol use during a weight loss intervention for obese, rural-dwelling breast cancer survivors. Methods: Data were derived from an 18-month trial that included a 6-month weight loss intervention delivered via group conference calls, followed by a 12-month randomized weight loss maintenance phase in which participants received continued group calls or mailed newsletters. Participants who reported regular alcohol use at baseline (N=37) were included in this study. Results: Mean daily alcohol intake significantly decreased from baseline to 6 months during the weight loss intervention (19.6-2.3 g; P=.001). Mean alcohol intake did not significantly increase (b=0.99, P=.12) during the weight loss maintenance phase (months 6-18) and did not depend on randomization group (b=0.32, P=.799). Conclusions: Findings provide preliminary evidence that a weight loss intervention may address obesity and alcohol use risk factors for cancer recurrence. Minimal mail-based contact post weight loss can maintain alcohol use reductions through 18 months, suggesting durability in these effects. These results highlight a possibility that lifestyle interventions for survivors may modify health behaviors that are not the main foci of an intervention but that coincide with intervention goals. Trial Registration: Clinicaltrials.gov NCT01441011; https://clinicaltrials.gov/ct2/show/NCT01441011 (Archived by WebCite at http://www.webcitation.org/6lsJ9dMa9) %M 28410181 %R 10.2196/cancer.6295 %U http://cancer.jmir.org/2016/2/e15/ %U https://doi.org/10.2196/cancer.6295 %U http://www.ncbi.nlm.nih.gov/pubmed/28410181 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 2 %N 2 %P e12 %T Comparing Web-Based Provider-Initiated and Patient-Initiated Survivorship Care Planning for Cancer Patients: A Randomized Controlled Trial %A Smith,Katherine Clegg %A Tolbert,Elliott %A Hannum,Susan M %A Radhakrishnan,Archana %A Zorn,Kelsey %A Blackford,Amanda %A Greco,Stephen %A Smith,Karen %A Snyder,Claire F %+ Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, United States, 1 410 502 0025, katecsmith@jhu.edu %K survivorship care plan %K mixed methods study %K randomized controlled trial %D 2016 %7 30.08.2016 %9 Original Paper %J JMIR Cancer %G English %X Background: Survivorship care plans (SCPs) are intended to facilitate communication and coordination between patients, oncologists, and primary care providers. Most SCP initiatives have focused on oncology providers initiating the SCP process, but time and resource barriers have limited uptake. Objective: This trial compares the feasibility and value of 2 Web-based SCP tools: provider-initiated versus patient-initiated. Methods: This mixed-methods study recruited clinicians from 2 academically-affiliated community oncology practices. Eligible patients were treated by a participating oncologist, had nonmetastatic cancer, completed acute treatment ≤ 2 months before enrollment, and had no evidence of disease. Patients were randomized 1:1 to either provider-initiated or patient-initiated SCPs—both are Web-based tools. We conducted qualitative interviews with providers at baseline and follow-up and with patients 2 months after enrollment. In addition, patients were administered the Preparing for Life as a (New) Survivor (PLANS) and Cancer Survivors’ Unmet Needs (CaSUN) surveys at baseline and 2 months. Results: A total of 40 providers were approached for the study, of whom 13 (33%) enrolled. Providers or clinic staff required researcher assistance to identify eligible patients; 41 patients were randomized, of whom 25 completed follow-up (61%; 13 provider-initiated, 12 patient-initiated). Of the 25, 11 (44%) had initiated the SCP; 5 (20%) provided the SCP to their primary care provider. On the Preparing for Life as a (New) Survivor and Cancer Survivors’ Unmet Needs, patients in both arms tended to report high knowledge and confidence and few unmet needs. In qualitative interviews, providers and patients discussed SCPs’ value. Conclusions: Regardless of patient- versus provider-initiated templates and the Web-based design of these tools, barriers to survivorship care planning persist. Further efforts should emphasize workflow functions for identifying and completing SCPs—regardless of the SCP form used. Trial Registration: ClinicalTrials.gov NCT02405819; https://clinicaltrials.gov/ct2/show/NCT02405819 (Archived by WebCite at http://www.webcitation.org/6jWqcWOvK) %M 28410187 %R 10.2196/cancer.5947 %U http://cancer.jmir.org/2016/2/e12/ %U https://doi.org/10.2196/cancer.5947 %U http://www.ncbi.nlm.nih.gov/pubmed/28410187 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e229 %T Use and Appreciation of a Tailored Self-Management eHealth Intervention for Early Cancer Survivors: Process Evaluation of a Randomized Controlled Trial %A Kanera,Iris Maria %A Willems,Roy A %A Bolman,Catherine A W %A Mesters,Ilse %A Zambon,Victor %A Gijsen,Brigitte CM %A Lechner,Lilian %+ Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Valkenburgerweg 177, Heerlen, 6401 DL, Netherlands, 31 455762448, iris.kanera@ou.nl %K eHealth %K web-based intervention %K computer tailoring %K cancer survivorship %K intervention usage %K appreciation %K multiple behavior intervention %K process evaluation %K self-management %D 2016 %7 23.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: A fully automated computer-tailored Web-based self-management intervention, Kanker Nazorg Wijzer (KNW [Cancer Aftercare Guide]), was developed to support early cancer survivors to adequately cope with psychosocial complaints and to promote a healthy lifestyle. The KNW self-management training modules target the following topics: return to work, fatigue, anxiety and depression, relationships, physical activity, diet, and smoking cessation. Participants were guided to relevant modules by personalized module referral advice that was based on participants’ current complaints and identified needs. Objective: The aim of this study was to evaluate the adherence to the module referral advice, examine the KNW module use and its predictors, and describe the appreciation of the KNW and its predictors. Additionally, we explored predictors of personal relevance. Methods: This process evaluation was conducted as part of a randomized controlled trial. Early cancer survivors with various types of cancer were recruited from 21 Dutch hospitals. Data from online self-report questionnaires and logging data were analyzed from participants allocated to the intervention condition. Chi-square tests were applied to assess the adherence to the module referral advice, negative binominal regression analysis was used to identify predictors of module use, multiple linear regression analysis was applied to identify predictors of the appreciation, and ordered logistic regression analysis was conducted to explore possible predictors of perceived personal relevance. Results: From the respondents (N=231; mean age 55.6, SD 11.5; 79.2% female [183/231]), 98.3% (227/231) were referred to one or more KNW modules (mean 2.9, SD 1.5), and 85.7% (198/231) of participants visited at least one module (mean 2.1, SD 1.6). Significant positive associations were found between the referral to specific modules (range 1-7) and the use of corresponding modules. The likelihoods of visiting modules were higher when respondents were referred to those modules by the module referral advice. Predictors of visiting a higher number of modules were a higher number of referrals by the module referral advice (β=.136, P=.009), and having a partner was significantly related with a lower number of modules used (β=-.256, P=.044). Overall appreciation was high (mean 7.5, SD 1.2; scale 1-10) and was significantly predicted by a higher perceived personal relevance (β=.623, P=.000). None of the demographic and cancer-related characteristics significantly predicted the perceived personal relevance. Conclusions: The KNW in general and more specifically the KNW modules were well used and highly appreciated by early cancer survivors. Indications were found that the module referral advice might be a meaningful intervention component to guide the users in following a preferred selection of modules. These results indicate that the fully automated Web-based KNW provides personal relevant and valuable information and support for early cancer survivors. Therefore, this intervention can complement usual cancer aftercare and may serve as a first step in a stepped-care approach. Trial Registration: Nederlands Trial Register: NTR3375; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3375 (Archived by WebCite at http://www.webcitation.org/6jo4jO7kb) %M 27554525 %R 10.2196/jmir.5975 %U http://www.jmir.org/2016/8/e229/ %U https://doi.org/10.2196/jmir.5975 %U http://www.ncbi.nlm.nih.gov/pubmed/27554525 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 7 %P e162 %T Paper-Based Survivorship Care Plans May be Less Helpful for Cancer Patients Who Search for Disease-Related Information on the Internet: Results of the Registrationsystem Oncological Gynecology (ROGY) Care Randomized Trial %A Nicolaije,Kim AH %A Ezendam,Nicole PM %A Pijnenborg,Johanna MA %A Boll,Dorry %A Vos,Maria Caroline %A Kruitwagen,Roy FPM %A van de Poll-Franse,Lonneke V %+ Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Warandelaan 2, PO Box 90153, Tilburg, 5000 LE, Netherlands, 31 134663118, k.a.h.schellekens-nicolaije@uu.nl %K Survivorship Care Plan %K Internet use %K pragmatic cluster randomized trial %K endometrial neoplasms %K patient-reported outcomes %K information provision %D 2016 %7 08.07.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The Institute of Medicine recommends Survivorship Care Plans (SCPs) for all cancer survivors. However, it is unclear whether certain patient groups may or may not benefit from SCPs. Objective: The aim was to assess whether the effects of an automatically generated paper SCP on patients’ satisfaction with information provision and care, illness perceptions, and health care utilization were moderated by disease-related Internet use. Methods: Twelve hospitals were randomized to either SCP care or usual care in the pragmatic cluster randomized Registrationsystem Oncological GYnecology (ROGY) Care trial. Newly diagnosed endometrial cancer patients completed questionnaires after diagnosis (N=221; response: 74.7%, 221/296), 6 months (n=158), and 12 months (n=147), including patients’ satisfaction with information provision and care, illness perceptions, health care utilization (how many times patients visited a medical specialist or primary care physician about their cancer in the past 6 months), and disease-related Internet use (whether patients used the Internet to look for information about cancer). Results: In total, 80 of 221 (36.2%) patients used the Internet to obtain disease-related information. Disease-related Internet use moderated the SCP care effect on the amount of information received about the disease (P=.03) and medical tests (P=.01), helpfulness of the information (P=.01), and how well patients understood their illness (P=.04). All stratified analyses were not statistically significant. However, it appeared that patients who did not seek disease-related information on the Internet in the SCP care arm reported receiving more information about their disease (mean 63.9, SD 20.1 vs mean 58.3, SD 23.7) and medical tests (mean 70.6, SD 23.5 vs mean 64.7, SD 24.9), finding the information more helpful (76.7, SD 22.9 vs mean 67.8, SD 27.2; scale 0-100), and understanding their illness better (mean 6.6, SD 3.0 vs mean 6.1, SD 3.2; scale 1-10) than patients in the usual care arm did. In addition, although all stratified analyses were not significant, patients who did seek disease-related information on the Internet in the SCP care arm appeared to receive less information about their disease (mean 65.7, SD 23.4 vs mean 67.1, SD 20.7) and medical tests (mean 72.4, SD 23.5 vs mean 75.3, SD 21.6), did not find the information more helpful (mean 78.6, SD 21.2 vs mean 76.0, SD 22.0), and reported less understanding of their illness (mean 6.3, SD 2.8 vs mean 7.1, SD 2.7) than patients in the usual care arm did. Conclusions: Paper SCPs appear to improve the amount of information received about the disease and medical tests, the helpfulness of the information, and understanding of the illness for patients who do not search for disease-related information on the Internet. In contrast, paper SCPs do not seem beneficial for patients who do seek disease-related information on the Internet. Trial Registration: ClinicalTrials.gov NCT01185626; https://clinicaltrials.gov/ct2/show/NCT01185626 (Archived by WebCite at http://www.webcitation.org/6fpaMXsDn) %M 27392550 %R 10.2196/jmir.4914 %U http://www.jmir.org/2016/7/e162/ %U https://doi.org/10.2196/jmir.4914 %U http://www.ncbi.nlm.nih.gov/pubmed/27392550 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 2 %P e118 %T Enhancing the Return to Work of Cancer Survivors: Development and Feasibility of the Nurse-Led eHealth Intervention Cancer@Work %A Tamminga,Sietske J %A van Hezel,Sanne %A de Boer,Angela GEM %A Frings-Dresen,Monique HW %+ Coronel Institute of Occupational Health, Academic Medical Center, Meibergdreef 9 / K0-110, Amsterdam, 1105 AZ, Netherlands, 31 205663279, s.j.tamminga@amc.nl %K cancer %K return to work %K eHealth %K survivorship %K feasibility studies %K self-management %D 2016 %7 10.06.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: It is important to enhance the return to work of cancer survivors with an appropriate intervention, as cancer survivors experience problems upon their return to work but consider it an essential part of their recovery. Objective: The objective of our study was to develop an eHealth intervention to enhance the return to work of cancer survivors and to test the feasibility of the eHealth intervention with end users. Methods: To develop the intervention we 1) searched the literature, 2) interviewed 7 eHealth experts, 3) interviewed 7 cancer survivors, 2 employers, and 7 occupational physicians, and 4) consulted experts. To test feasibility, we enrolled 39 cancer survivors, 9 supervisors, 7 occupational physicians, 9 general physicians and 2 social workers and gave them access to the eHealth intervention. We also interviewed participants, asked them to fill in a questionnaire, or both, to test which functionalities of the eHealth intervention were appropriate and which aspects needed improvement. Results: Cancer survivors particularly want information and support regarding the possibility of returning to work, and on financial and legal aspects of their situation. Furthermore, the use of blended care and the personalization of the eHealth intervention were preferred features for increasing compliance. The first version of the eHealth intervention consisted of access to a personal and secure website containing various functionalities for cancer survivors blended with support from their specialized nurse, and a public website for employers, occupational physicians, and general physicians. The eHealth intervention appeared feasible. We adapted it slightly by adding more information on different cancer types and their possible effects on return to work. Conclusions: A multistakeholder and mixed-method design appeared useful in the development of the eHealth intervention. It was challenging to meet all end user requirements due to legal and privacy constraints. The eHealth intervention appeared feasible, although implementation in daily practice needs to be subject of further research. ClinicalTrial: Dutch Trial Register number (NTR): 5190; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5190 (Archived by WebCite at http://www.webcitation.org/6hm4WQJqC) %M 27286819 %R 10.2196/resprot.5565 %U http://www.researchprotocols.org/2016/2/e118/ %U https://doi.org/10.2196/resprot.5565 %U http://www.ncbi.nlm.nih.gov/pubmed/27286819 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 2 %N 1 %P e7 %T Assessment of Cancer Survivors’ Experiences of Using a Publicly Available Physical Activity Mobile Application %A Puszkiewicz,Patrycja %A Roberts,Anna L %A Smith,Lee %A Wardle,Jane %A Fisher,Abigail %+ Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 02076791723, anna.roberts.15@ucl.ac.uk %K cancer survivors %K mobile applications %K mHealth %K physical activity %K sleep %D 2016 %7 31.05.2016 %9 Original Paper %J JMIR Cancer %G English %X Background: Regular participation in physical activity (PA) is associated with improved physical and psychosocial outcomes in cancer survivors. However, PA levels are low during and after cancer treatment. Interventions to promote PA in this population are needed. PA mobile apps are popular and have potential to increase PA participation, but little is known about how appropriate or relevant they are for cancer survivors. Objective: This study aims to (1) assess recruitment, study uptake, and engagement for a publicly available PA mobile app (GAINFitness) intervention in cancer survivors; (2) assess cancer survivors’ attitudes towards the app; (3) understand how the app could be adapted to better meet the needs of cancer survivors; and (4) to determine the potential for change in PA participation and psychosocial outcomes over a 6-week period of using the app. Methods: The present study was a one-arm, pre-post design. Cancer survivors (N=11) aged 33 to 62 years with a mean (SD) age of 45 (9.4), and 82% (9/11) female, were recruited (via community/online convenience sampling to use the app for 6 weeks). Engagement with the app was measured using self-reported frequency and duration of usage. Qualitative semi-structured telephone interviews were conducted after the 6-week study period and were analyzed using thematic analysis. PA, well-being, fatigue, quality of life (QOL), sleep quality, and anxiety and depression were self-reported at baseline and at a 6-week follow-up using the Godin Leisure Time Exercise Questionnaire (GLTEQ), the Functional Assessment of Cancer Therapy-General (FACT-G), the Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue Scale Questionnaire, the Health and Quality of Life Outcomes (EQ5D) Questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Hospital Anxiety and Depression Scale (HADS), respectively. Results: Of the people who responded to the study advertisement, 73% (16/22) agreed to participate and 100% (11/11) of the participants who started the study completed all baseline and follow-up outcome measures and the telephone interview. On average, participants used the app twice a week for 25 minutes per session. Four themes were identified from the qualitative interviews surrounding the suitability of the app for cancer survivors and how it could be adapted: (1) barriers to PA, (2) receiving advice about PA from reliable sources, (3) tailoring the application to one’s lifestyle, and (4) receiving social support from others. Pre-post comparison showed significant increases in strenuous PA, improvements in sleep quality, and reductions in mild PA. There were no significant changes in moderate PA or other psychosocial outcomes. Conclusions: All participants engaged with the app and qualitative interviews highlighted that the app was well-received. A generic PA mobile app could bring about positive improvements in PA participation and psychosocial outcomes among cancer survivors. However, a targeted PA app aimed specifically towards cancer survivors may increase the relevance and suitability of the app for this population. %M 28410168 %R 10.2196/cancer.5380 %U http://cancer.jmir.org/2016/1/e7/ %U https://doi.org/10.2196/cancer.5380 %U http://www.ncbi.nlm.nih.gov/pubmed/28410168 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 2 %N 1 %P e6 %T The Effects of Physical Activity on Health and Quality of Life in Adolescent Cancer Survivors: A Systematic Review %A Wurz,Amanda %A Brunet,Jennifer %+ School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Montpetit Hall, Room 339, 125 University Private, Ottawa, ON, K1N 6N5, Canada, 1 613 562 5800 ext 3068, jennifer.brunet@uottawa.ca %K exercise %K controlled clinical trial %K randomized controlled trial %K review %K treatment effectiveness %D 2016 %7 24.05.2016 %9 Original Paper %J JMIR Cancer %G English %X Background: There are numerous published controlled trials assessing the safety and the benefits of physical activity (PA) for child and adult cancer survivors. However, trials exclusively comprised of adolescent cancer survivors aged 13-19 years, who may experience different health and quality of life (QOL) effects as a function of their developmental status, are lacking. Rather, some trials have included both adolescent and child cancer survivors together. Objective: The aim of this systematic review was to synthesize the findings from randomized controlled trails (RCTs) and controlled clinical trials (CCTs) investigating the effects of PA on health and QOL outcomes in samples comprised of >50% adolescent cancer survivors to summarize the current state of evidence, identify knowledge gaps, and highlight areas in need of additional research within this population. Methods: Using a search strategy developed for this review, 10 electronic databases were searched for RCTs and CCTs that reported on the effects of PA on at least 1 health and/or QOL outcome in samples comprised of >50% adolescent cancer survivors. Results: From the 2249 articles identified, 2 CCTs met the predetermined eligibility criteria and were included in this review. Combined, 28 adolescents (of 41 participants) who were receiving active treatment participated in the 2 studies reviewed. A total of 4 health and QOL outcomes (ie, bone mass, fatigue, grip strength, QOL) were assessed pre- and post-PA intervention. Conclusions: On the basis of the 2 studies reviewed, PA appears to be safe and feasible. PA also shows promise to mitigate reductions in bone mass and might be a viable strategy to improve fatigue, grip strength, and QOL. High-quality controlled trials with larger samples exclusively comprised of adolescent cancer survivors that assess a wide range of outcomes are needed to determine the effects of PA on health and QOL outcomes in this population. %M 28410184 %R 10.2196/cancer.5431 %U http://cancer.jmir.org/2016/1/e6/ %U https://doi.org/10.2196/cancer.5431 %U http://www.ncbi.nlm.nih.gov/pubmed/28410184 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 2 %N 1 %P e4 %T Pilot and Feasibility Test of a Mobile Health-Supported Behavioral Counseling Intervention for Weight Management Among Breast Cancer Survivors %A M Quintiliani,Lisa %A Mann,Devin M %A Puputti,Marissa %A Quinn,Emily %A Bowen,Deborah J %+ Boston University, Department of Medicine, Section of General Internal Medicine, 801 Massachusetts Ave, Crosstown Center, Boston, MA, 02118, United States, 1 617 638 2777, lmquinti@bu.edu %K telemedicine %K survivors %K breast neoplasms %K health behavior %K body weight %D 2016 %7 09.05.2016 %9 Original Paper %J JMIR Cancer %G English %X Background: Health behavior and weight management interventions for cancer survivors have the potential to prevent future cancer recurrence and improve long-term health; however, their translation can be limited if the intervention is complex and involves high participant burden. Mobile health (mHealth) offers a delivery modality to integrate interventions into daily life routines. Objective: The objective of this study was to evaluate the effects of a one-group trial with a pre-post evaluation design on engagement (use and acceptability), physiological (weight), behavioral (diet and physical activity), and other secondary outcomes. Methods: The 10-week intervention consisted of mHealth components (self-monitoring of selected diet behaviors via daily text messages, wireless devices to automatically track weight and steps) and 4 motivational interviewing–based technology-assisted phone sessions with a nonprofessionally trained counselor. Participants were overweight breast cancer survivors who had completed treatment and owned a smartphone. Weight was measured objectively; diet and physical activity were measured with brief self-reported questionnaires. Results: Ten women participated; they had a mean age of 59 years (SD 6), 50% belonged to a racial or ethnic minority group, 50% had some college or less, and 40% reported using Medicaid health insurance. Engagement was high: out of 70 days in total, the mean number of days recording steps via the wristband pedometer was 64 (SD 7), recording a weight via the scale was 45 (SD 24), and responding to text messages was 60 (SD 13); 100% of participants completed all 4 calls with the counselor. Most (90%) were very likely to participate again and recommend the program to others. Mean weight in pounds decreased (182.5 to 179.1, mean change −3.38 [SD 7.67]), fruit and vegetable daily servings increased (2.89 to 4.42, mean change 1.53 [SD 2.82]), and self-reported moderate physical activity increased in metabolic equivalent of task (MET) minutes per week (2791 to 3336, mean change 545 [SD 1694]). Conclusions: Findings support the conduct of a fully powered trial to evaluate the efficacy of mHealth as a feasible intervention modality for breast cancer survivors. Future research should employ accelerometer-based physical activity assessment and consider development of an all-in-one app to integrate devices, messaging, and educational content and other mHealth approaches to support behavioral counselors conducting weight management interventions. Trial Registration: ClinicalTrials.gov NCT02387671; https://clinicaltrials.gov/ct2/show/NCT02387671 (Archived by WebCite at http://www.webcitation.org/6hGEuttbZ). %M 28410174 %R 10.2196/cancer.5305 %U http://cancer.jmir.org/2016/1/e4/ %U https://doi.org/10.2196/cancer.5305 %U http://www.ncbi.nlm.nih.gov/pubmed/28410174 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 2 %P e75 %T A Guided Workbook Intervention (WorkPlan) to Support Work-Related Goals Among Cancer Survivors: Protocol of a Feasibility Randomized Controlled Trial %A Woods,Pernille Luxhøj %A Schumacher,Lauren %A Sadhra,Steven S %A Sutton,Andrew J %A Zarkar,Anjali %A Rolf,Pauline %A Grunfeld,Elizabeth A %+ Coventry University, Centre for Technology Enabled Health Research, Richard Crossman Building (4th Floor), Priory Street, Coventry,, United Kingdom, 44 247 765 9968, beth.grunfeld@coventry.ac.uk %K oncology %K cancer %K return to work %K intervention %K protocol %K RCT %D 2016 %7 03.05.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Returning to and staying at work following illness is associated with better physical and psychological functioning. Not working has been shown to be associated with reduced self-esteem, lowered self-efficacy, and decreased belief in one's ability to return to the workplace. Although there is a growing body of research looking at what predicts return to work following cancer treatment, there are fewer studies examining interventions targeting return to work. Objective: The primary objective is to assess the feasibility and acceptability of a theoretically led workbook intervention designed to support cancer patients in returning to work to inform a fully powered randomized controlled trial (RCT). Methods: This is a multicenter feasibility RCT where the main analysis uses a qualitative approach. Sixty participants (aged 18-65 years) who have received a diagnosis of cancer and who intend to return to work will be randomized to either the WorkPlan intervention group or a usual care group (ratio 1:1). Participants in the intervention group will receive a guided workbook intervention (which contains activities aimed at eliciting thoughts and beliefs, identifying targets and actions, and concrete steps to achieve goals) and will receive telephone support over a 4-week period. The primary outcome measure is time taken to return to work (in days), and secondary outcome measures include mood, quality of life, illness perceptions, and job satisfaction. Data will be collected through postal questionnaires administered immediately postintervention and at 6- and 12-month follow-ups. In addition, interviews will be undertaken immediately postintervention (to explore acceptability of the intervention and materials) and at 12-month follow-up (to explore perceptions of participation in the trial and experiences of returning to work). Results: Enrollment for the study will be completed in May 2016. Data analysis will commence in April 2017, and the first results are expected to be submitted for publication in late 2017. Conclusions: Currently no standardized return-to-work intervention based on targeting cancer patient beliefs is in existence. If the intervention is shown to be feasible and acceptable, the results of this study will inform a future full RCT with the potential to provide a valuable and cost-efficient tool in supporting cancer survivors in the return-to-work process. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN56342476; http://www.isrctn.com/ISRCTN56342476 (Archived by WebCite at http://www.webcitation.org/6gblhEPXd). %M 27143229 %R 10.2196/resprot.5300 %U http://www.researchprotocols.org/2016/2/e75/ %U https://doi.org/10.2196/resprot.5300 %U http://www.ncbi.nlm.nih.gov/pubmed/27143229 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e54 %T A Systematic Review Protocol to Assess the Effects of Physical Activity on Health and Quality of Life Outcomes in Adolescent Cancer Survivors %A Wurz,Amanda %A Brunet,Jennifer %+ University of Ottawa, Faculty of Health Sciences, School of Human Kinetics, 339 MNT, 125 University Private, Ottawa, ON, K1N 6N5, Canada, 1 613 562 5800 ext 3068, jennifer.brunet@uottawa.ca %K controlled clinical trial %K randomized controlled trial %K adolescent %K oncology %K neoplasm %K exercise %K quality of life. %D 2016 %7 30.03.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The benefits of physical activity for child and adult cancer survivors have been summarized in previous systematic reviews. However, no review has summarized the evidence for adolescent cancer survivors. Objective: This paper describes the design of a protocol to conduct a systematic review of published studies examining the effects of physical activity on health and quality of life outcomes for adolescent cancer survivors. Methods: Several guidelines informed the development of this protocol. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines provided the structure by which to conduct and report the protocol; though some adaptations were made with regards to search terms, data synthesis, and evaluating the risk of bias. The Cochrane Handbook for Systematic Reviews of Interventions was used to guide research question development, search term selection, and the data extraction form. The Consolidated Standards of Reporting Trials guidelines helped inform the data extraction form. Lastly, the Guidance on the Conduct of Narrative Synthesis in Systematic Reviews informed the data synthesis. Ten electronic databases were identified and a search strategy was developed using a combination of Medical Subject Headings terms and keywords that were developed by the authors and peer reviewed by a university librarian. Both authors independently screened eligible studies for final inclusion, and data were abstracted using a form developed by the research team. A decision was made to synthesize all data narratively. Results: The review has now been completed, peer-reviewed, and accepted for publication in a forthcoming issue of JMIR Cancer. Conclusions: As this will be the first systematic review on this topic, outlining the protocol ensures transparency for the completed review. Further, this protocol illustrates how elements from several guidelines were incorporated to answer the research question (ie, what is the effect of physical activity on health and quality of life outcomes in adolescent cancer survivors). This flexible approach was necessary as a function of the paucity of available research on this topic. %M 27030210 %R 10.2196/resprot.5383 %U http://www.researchprotocols.org/2016/1/e54/ %U https://doi.org/10.2196/resprot.5383 %U http://www.ncbi.nlm.nih.gov/pubmed/27030210 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e34 %T A Community-Engaged Approach to Developing a Mobile Cancer Prevention App: The mCPA Study Protocol %A Smith,Selina Ann %A Whitehead,Mary Smith %A Sheats,Joyce %A Mastromonico,Jeff %A Yoo,Wonsuk %A Coughlin,Steven Scott %+ Institute of Public & Preventive Health, Department of Family Medicine Medical College of Georgia, Georgia Regents University, 1120 15th St., CJ2300, Augusta, GA, 30912, United States, 1 706 721 1104, SESMITH@gru.edu %K smartphone applications %K African Americans %K breast cancer survivors %K cancer prevention guidelines %K dietary intake %K physical activity %D 2016 %7 02.03.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Rapid growth of mobile technologies has resulted in a proliferation of lifestyle-oriented mobile phone apps. However, most do not have a theoretical framework and few have been developed using a community-based participatory research approach. A community academic team will develop a theory-based, culturally tailored, mobile-enabled, Web-based app—the Mobile Cancer Prevention App (mCPA)—to promote adherence to dietary and physical activity guidelines. Objective: The aim of this study is to develop mCPA content with input from breast cancer survivors. Methods: Members of SISTAAH (Survivors Involving Supporters to Take Action in Advancing Health) Talk (N=12), treated for Stages I-IIIc breast cancer for less than 1 year, 75 years of age or younger, and English-speaking and writing, will be recruited to participate in the study. To develop the app content, breast cancer survivors will engage with researchers in videotaped and audiotaped sessions, including (1) didactic instructions with goals for, benefits of, and strategies to enhance dietary intake and physical activity, (2) guided discussions for setting individualized goals, monitoring progress, and providing or receiving feedback, (3) experiential nutrition education through cooking demonstrations, and (4) interactive physical activity focused on walking, yoga, and strength training. Qualitative (focus group discussions and key informant interviews) and quantitative (sensory evaluation) methods will be used to evaluate the participatory process and outcomes. Results: Investigators and participants anticipate development of an acceptable (frequency and duration of usage) feasible (structure, ease of use, features), and accessible mobile app available for intervention testing in early 2017. Conclusions: Depending on the availability of research funding, mCPA testing, which will be initiated in Miami, will be extended to Chicago, Houston, Philadelphia, and Los Angeles. %M 26935995 %R 10.2196/resprot.5290 %U http://www.researchprotocols.org/2016/1/e34/ %U https://doi.org/10.2196/resprot.5290 %U http://www.ncbi.nlm.nih.gov/pubmed/26935995 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 2 %N 1 %P e1 %T Interest in Health Behavior Intervention Delivery Modalities Among Cancer Survivors: A Cross-Sectional Study %A Martin,Emily C %A Basen-Engquist,Karen %A Cox,Matthew G %A Lyons,Elizabeth J %A Carmack,Cindy L %A Blalock,Janice A %A Demark-Wahnefried,Wendy %+ University of Texas MD Anderson Cancer Center, Department of Behavioral Science, PO Box 301439, Unit 1330, Houston, TX, 77230-1439, United States, 1 713 745 0338, emilymar@gmail.com %K cancer survivor %K technology %K smartphone %K behavioral intervention %K physical activity %K diet %D 2016 %7 11.02.2016 %9 Original Paper %J JMIR Cancer %G English %X Background: Effective, broad-reaching channels are important for the delivery of health behavior interventions in order to meet the needs of the growing population of cancer survivors in the United States. New technology presents opportunities to increase the reach of health behavior change interventions and therefore their overall impact. However, evidence suggests that older adults may be slower in their adoption of these technologies than the general population. Survivors’ interest for more traditional channels of delivery (eg, clinic) versus new technology-based channels (eg, smartphones) may depend on a variety of factors, including demographics, current health status, and the behavior requiring intervention. Objective: The aim of this study was to determine the factors that predict cancer survivors’ interest in new technology-based health behavior intervention modalities versus traditional modalities. Methods: Surveys were mailed to 1871 survivors of breast, prostate, and colorectal cancer. Participants’ demographics, diet and physical activity behaviors, interest in health behavior interventions, and interest in intervention delivery modalities were collected. Using path analysis, we explored the relationship between four intervention modality variables (ie, clinic, telephone, computer, and smartphone) and potential predictors of modality interest. Results: In total, 1053 respondents to the survey (56.3% response rate); 847 provided complete data for this analysis. Delivery channel interest was highest for computer-based interventions (236/847, 27.9% very/extremely interested) and lowest for smartphone–based interventions (73/847, 8.6%), with interest in clinic-based (147/847, 17.3%) and telephone-delivered (143/847, 16.9%) falling in between. Use of other technology platforms, such as Web cameras and social networking sites, was positively predictive of interest in technology-based delivery channels. Older survivors were less likely to report interest in smartphone–based diet interventions. Physical activity, fruit and vegetable consumption, weight status, and age moderated relationships between interest in targeted intervention behavior and modality. Conclusions: This study identified several predictors of survivor interest in various health behavior intervention delivery modalities. Overall, computer-based interventions were found to be most acceptable, while smartphones were the least. Factors related to survivors’ current technology use and health status play a role in their interest for technology-based intervention versus more traditional delivery channels. Future health behavior change research in this population should consider participants’ demographic, clinical, and lifestyle characteristics when selecting a delivery channel. Furthermore, current health behavior interventions for older cancer survivors may be best delivered over the Internet. Smartphone interventions may be feasible in the future following further adoption and familiarization by this particular population. %M 28410164 %R 10.2196/cancer.5247 %U http://cancer.jmir.org/2016/1/e1/ %U https://doi.org/10.2196/cancer.5247 %U http://www.ncbi.nlm.nih.gov/pubmed/28410164 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e270 %T Empowerment of Cancer Survivors Through Information Technology: An Integrative Review %A Groen,Wim G %A Kuijpers,Wilma %A Oldenburg,Hester SA %A Wouters,Michel WJM %A Aaronson,Neil K %A van Harten,Wim H %+ The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Plesmanlaan 121, 1066 CX, Amsterdam, , Netherlands, 31 205122861, w.v.harten@nki.nl %K review %K neoplasms %K Internet %K technology %K health education %K chronic disease %K power (psychology) %D 2015 %7 27.11.2015 %9 Review %J J Med Internet Res %G English %X Background: Patient empowerment may be an effective approach to strengthen the role of cancer survivors and to reduce the burden on health care. However, it is not well conceptualized, notably in oncology. Furthermore, it is unclear to what extent information technology (IT) services can contribute to empowerment of cancer survivors. Objective: We aim to define the conceptual components of patient empowerment of chronic disease patients, especially cancer survivors, and to explore the contribution of existing and new IT services to promote empowerment. Methods: Electronic databases were searched to identify theoretical and empirical articles regarding empowerment. We extracted and synthesized conceptual components of patient empowerment (ie, attributes, antecedents, and consequences) according to the integrated review methodology. We identified recent IT services for cancer survivors by examining systematic reviews and a proposed inventory of new services, and we related their features and effects to the identified components of empowerment. Results: Based on 26 articles, we identified five main attributes of patient empowerment: (1) being autonomous and respected, (2) having knowledge, (3) having psychosocial and behavioral skills, (4) perceiving support from community, family, and friends, and (5) perceiving oneself to be useful. The latter two were specific for the cancer setting. Systematic reviews of IT services and our additional inventory helped us identify five main categories: (1) educational services, including electronic survivorship care plan services, (2) patient-to-patient services, (3) electronic patient-reported outcome (ePRO) services, (4) multicomponent services, and (5) portal services. Potential impact on empowerment included knowledge enhancement and, to a lesser extent, enhancing autonomy and skills. Newly developed services offer promising and exciting opportunities to empower cancer survivors, for instance, by providing tailored advice for supportive or follow-up care based on patients' input. Conclusions: We identified five main components of empowerment and showed that IT services may especially contribute to empowerment by providing knowledge. The components of empowerment could be used to develop IT services for cancer survivors. It is important to take into account patients’ needs, follow up on these needs, and create a service that is attractive and easy to use. %M 26614438 %R 10.2196/jmir.4818 %U http://www.jmir.org/2015/11/e270/ %U https://doi.org/10.2196/jmir.4818 %U http://www.ncbi.nlm.nih.gov/pubmed/26614438 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 2 %P e12 %T Feasibility and Preliminary Efficacy of an Online Intervention to Increase Physical Activity in Nova Scotian Cancer Survivors: A Randomized Controlled Trial %A Forbes,Cynthia C %A Blanchard,Chris M %A Mummery,W Kerry %A Courneya,Kerry S %+ University of Alberta, Van Vliet Complex, University Hall, Edmonton, AB, , Canada, 1 780 492 2829, kerry.courneya@ualberta.ca %K Web-based %K survivorship %K home-based %K exercise %K efficacy %K feasibility %D 2015 %7 23.11.2015 %9 Original Paper %J JMIR Cancer %G English %X Background: Physical activity (PA) behavior change interventions among cancer survivors have used face-to-face, telephone, email, and print-based methods. However, computer-tailored, Internet-delivered programs may be a more viable option to achieve PA behavior change. Objective: The objective of this study is to test the feasibility and preliminary efficacy of a Web-based PA behavior change program among cancer survivors. Methods: Nova Scotian cancer survivors (N=415) who previously expressed interest in a research study were approached. Interested participants were asked to complete an online assessment of PA and quality of life (QOL) before being randomized to either a theory-based PA behavior change program using the PA tracking website UWALK (UCAN; n=48) or usual care (UC; n=47). After the intervention (9 weeks), participants completed another online assessment of PA and QOL as well as measures to evaluate the program and website. Descriptive analyses from surveys and Web analytic software were used to assess feasibility and mean change scores were used to test efficacy. Results: Of all contacted survivors, 95 (22.3%, 95/415) completed baseline measures and were randomized with 84 (88%, 84/95) completing the 9-week assessment. The behavior change program and website were rated highly on the satisfaction items. Average logins were 10.3 (1.1 per week) and 26.0% (111/432) of the weekly modules were completed. Most participants (71%, 29/41) indicated they were more aware of their daily PA levels and 68% (28/41) found the site easily navigable. Adjusted group differences in total exercise minutes favored the UCAN group by an increase of 42 minutes (95% CI -65 to 150; P=.44, d=0.17). Results were more pronounced, though still nonsignificant, among those not meeting guidelines at baseline where UCAN increased PA by 52 minutes compared to a decrease of 15 minutes in UC (adjusted between group difference=75, 95% CI -95 to 244; P=.38, d=0.27). Conclusions: We found that Internet-delivery may be a feasible alternative to more costly methods to promote PA among Nova Scotian cancer survivors. Moreover, there was a trend toward increased PA among those in the UCAN group, especially among those who were not meeting PA guidelines at baseline. Future research should focus on recruiting inactive cancer survivors and engaging them in the website to determine the optimal potential of Web-based interventions for promoting PA in cancer survivors. %M 28410166 %R 10.2196/cancer.4586 %U http://cancer.jmir.org/2015/2/e12/ %U https://doi.org/10.2196/cancer.4586 %U http://www.ncbi.nlm.nih.gov/pubmed/28410166 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 10 %P e235 %T An eHealth Application in Head and Neck Cancer Survivorship Care: Health Care Professionals' Perspectives %A Duman-Lubberding,Sanne %A van Uden-Kraan,Cornelia F %A Peek,Niels %A Cuijpers,Pim %A Leemans,C René %A Verdonck-de Leeuw,Irma M %+ Department of Otolaryngology / Head and Neck Surgery, VU University Medical Center, PO Box 7057, Amsterdam, 1007 MB, Netherlands, 31 20 444 0931, s.lubberding@vumc.nl %K cancer %K tertiary prevention %K participatory design approach %K follow-up care %K supportive care %D 2015 %7 21.10.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Although many cancer survivors could benefit from supportive care, they often do not utilize such services. Previous studies have shown that patient-reported outcomes (PROs) could be a solution to meet cancer survivors’ needs, for example through an eHealth application that monitors quality of life and provides personalized advice and supportive care options. In order to develop an effective application that can successfully be implemented in current health care, it is important to include health care professionals in the development process. Objective: The aim of this study was to investigate health care professionals’ perspectives toward follow-up care and an eHealth application, OncoKompas, in follow-up cancer care that monitors quality of life via PROs, followed by automatically generated tailored feedback and personalized advice on supportive care. Methods: Health care professionals involved in head and neck cancer care (N=11) were interviewed on current follow-up care and the anticipated value of the proposed eHealth application (Step 1). A prototype of the eHealth application, OncoKompas, was developed (Step 2). Cognitive walkthroughs were conducted among health care professionals (N=21) to investigate perceived usability (Step 3). Interviews were recorded, transcribed verbatim, and analyzed by 2 coders. Results: Health care professionals indicated several barriers in current follow-up care including difficulties in detecting symptoms, patients’ perceived need for supportive care, and a lack of time to encourage survivors to obtain supportive care. Health care professionals expected the eHealth application to be of added value. The cognitive walkthroughs demonstrated that health care professionals emphasized the importance of tailoring care. They considered the navigation structure of OncoKompas to be complex. Health care professionals differed in their opinion toward the best strategy to implement the application in clinical practice but indicated that it should be incorporated in the HNC cancer care pathway to ensure all survivors would benefit. Conclusions: Health care professionals experienced several barriers in directing patients to supportive care. They were positive toward the development and implementation of an eHealth application and expected it could support survivors in obtaining supportive care tailored to their needs. The cognitive walkthroughs revealed several points for optimizing the application prototype and developing an efficient implementation strategy. Including health care professionals in an early phase of a participatory design approach is valuable in developing an eHealth application and an implementation strategy meeting stakeholders’ needs. %M 26489918 %R 10.2196/jmir.4870 %U http://www.jmir.org/2015/10/e235/ %U https://doi.org/10.2196/jmir.4870 %U http://www.ncbi.nlm.nih.gov/pubmed/26489918 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e115 %T An Internet-Based Means of Monitoring Quality of Life in Post-Prostate Radiation Treatment: A Prospective Cohort Study %A Parker,Brent %A Rajapakshe,Rasika %A Moldovan,Andrew %A Araujo,Cynthia %A Crook,Juanita %+ British Columbia Cancer Agency, Sindi Ahluwalia Hawkins Centre for the Southern Interior, 399 Royal Avenue, Kelowna, BC, , Canada, 1 250 712 3966 ext 686912, brent.parker2@interiorhealth.ca %K prostate cancer %K radiation oncology %K quality of life %K patient-reported outcomes %K Internet survey %K prospective study %D 2015 %7 28.09.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Widespread integration of the Internet has resulted in an increase in the feasibility of using Web-based technologies as a means of communicating with patients. It may be possible to develop secure and standardized systems that facilitate Internet-based patient-reported outcomes which could be used to improve patient care. Objective: This study investigates patient interest in participating in an online post-treatment disease outcomes and quality of life monitoring program developed specifically for patients who have received radiation treatment for prostate cancer at a regional oncology center. Methods: Patients treated for prostate cancer between 2007 and 2011 (N=1113) at the British Columbia Cancer Agency, Centre for the Southern Interior were invited by mail to participate in a standardized questionnaire related to their post-treatment health. Overall participation rates were calculated. In addition, demographics, access to broadband Internet services, and treatment modalities were compared between participants and nonparticipants. Results: Of the 1030 eligible invitees, 358 (358/1030, 34.7%) completed the online questionnaire. Participation rates were higher in individuals younger than age 60 when compared to those age 60 or older (42% vs 31%) and also for those living in urban areas compared with rural (37% vs 29%) and in those who received brachytherapy versus external beam radiotherapy (EBRT) (41% vs 31%). Better participation rates were seen in individuals who had access to Internet connectivity based on the different types of broadband services (DSL 35% for those with DSL connectivity vs 29% for those without DSL connectivity; cable 35% vs 32%; wireless 38% vs 26%). After adjusting for age, the model indicates that lack of access to wireless broadband connectivity, living in a rural area, and receiving EBRT were significant predictors of lower participation. Conclusions: This study demonstrates that participation rates vary in patient populations within the interior region of British Columbia, especially with older patients, those in rural areas, and those with limited access to quality Internet services. %M 26416584 %R 10.2196/resprot.3974 %U http://www.researchprotocols.org/2015/3/e115/ %U https://doi.org/10.2196/resprot.3974 %U http://www.ncbi.nlm.nih.gov/pubmed/26416584 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 2 %P e9 %T Lifestyle Modification Experiences of African American Breast Cancer Survivors: A Needs Assessment %A Smith,Selina A %A Claridy,Mechelle D %A Smith Whitehead,Mary %A Sheats,Joyce Q %A Yoo,Wonsuk %A Alema-Mensah,Ernest A %A Ansa,Benjamin E-O %A Coughlin,Steven S %+ Institute of Public & Preventive Health Georgia Regents University, Department of Family Medicine, Medical College of Georgia, 1120 15th Street, CJ2300, Augusta, GA, 30912, United States, 1 706 721 1104, SESMITH@gru.edu %K African Americans %K breast cancer %K cancer survivors %K nutrition %K physical activity %D 2015 %7 17.08.2015 %9 Original Paper %J JMIR Cancer %G English %X Background: Little is known about the rates of obesity among African American (AA) breast cancer survivors (BCSs), the availability and use of lifestyle modification methods suitable for this population, and the impact of changes in dietary intake and physical activity on health-related quality of life (HR-QoL). Objective: The objectives of the study were to describe obesity rates, dietary intake, and physical activity as lifestyle modification strategies; examine predictors of engagement in these strategies post diagnosis; and learn more about salient features of lifestyle interventions from AA BCSs participating in a breast cancer support group. Methods: The needs assessment included four components: (1) a literature review to determine existing lifestyle modification strategies of AA BCSs; (2) secondary data analysis of the 2010 National Health Interview Survey, Cancer Control Supplement to examine HR-QoL; (3) administration, to 200 AA BCSs, of an assessment tool relating to weight and breast cancer history, dietary intake, and physical activity through a variety of approaches (eg, Internet, mail, in-person, and telephone); and (4) focus group discussions to frame lifestyle interventions. Results: Preliminary findings indicate that AA BCSs are underrepresented in lifestyle intervention research, have disparities in HR-QoL outcomes, do not meet current cancer prevention guidelines, and have recommendations for effective strategies for lifestyle modification. Conclusions: As analyses of the needs assessment are completed, the research team is partnering with community coalitions and breast cancer support groups in Miami, Chicago, Houston, Los Angeles, and Philadelphia to develop community-engaged intervention approaches for promoting adherence to cancer prevention guidelines. %M 28410162 %R 10.2196/cancer.4892 %U http://cancer.jmir.org/2015/2/e9/ %U https://doi.org/10.2196/cancer.4892 %U http://www.ncbi.nlm.nih.gov/pubmed/28410162 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 1 %P e7 %T Efficacy of a Mobile-Enabled Web App (iCanFit) in Promoting Physical Activity Among Older Cancer Survivors: A Pilot Study %A Hong,Yan Alicia %A Goldberg,Daniel %A Ory,Marcia G %A Towne Jr,Samuel D %A Forjuoh,Samuel N %A Kellstedt,Debra %A Wang,Suojin %+ School of Public Health, Texas A&M University, 1266 TAMU, College Station, TX, 77843, United States, 1 979 436 9343, yhong@srph.tamhsc.edu %K physical activity %K mobile health %K older adults %K cancer survivors %K iCanFit %K pilot %D 2015 %7 26.6.2015 %9 Original Paper %J JMIR Cancer %G English %X Background: The benefits of physical activity for cancer survivors are well documented. However, few older cancer survivors are engaged in regular physical activity. Mobile technologies may be an effective method to deliver physical activity promotion programs for older cancer survivors. iCanFit, a mobile-enabled Web-based app, was developed based on formative research and usability testing. This app includes interactive features of physical activity, goal setting and tracking, and receiving personalized visual feedback. Objective: The aim of this study is to pilot test the initial efficacy of iCanFit. Methods: Older cancer survivors (N=30) were recruited online through our collaborative partnership with a cancer survivor's organization. After the participants completed an online baseline survey, they were asked to use the iCanFit website. Instructional videos on how to use the web app were available on the website. Participants were asked to complete a follow-up survey 2-3 months later. Participants’ physical activity, quality of life, and their experience with iCanFit were measured. Results: A total of 30 participants completed the baseline survey, and 26 of them (87%, 26/30) also completed a follow-up survey 2-3 months later. The median age of participants was 69 years (range 60-78). Participants’ quality of life and engagement in regular physical activity improved significantly after the use of iCanFit. Participants indicated a general affinity towards the key function “Goals” in iCanFit, which motivated continued activity. They also provided suggestions to further improve the app (eg, adding a reminder functionality, easier or alternative ways of entering activities). Conclusion: The interactive Web-based app iCanFit has demonstrated initial efficacy. Even though our study was limited by a small sample size, convenience sampling, and a short follow-up period, results suggest that using mobile tools to promote physical activity and healthy living among older cancer survivors holds promise. Next steps include refining iCanFit based on users’ feedback and developing versatile functionality to allow easier physical activity goal setting and tracking. We also call for more studies on developing and evaluating mobile and web apps for older cancer survivors. %M 28410158 %R 10.2196/cancer.4389 %U http://cancer.jmir.org/2015/1/e7/ %U https://doi.org/10.2196/cancer.4389 %U http://www.ncbi.nlm.nih.gov/pubmed/28410158 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e37 %T Developing a Healthy Web-Based Cookbook for Pediatric Cancer Patients and Survivors: Rationale and Methods %A Li,Rhea %A Raber,Margaret %A Chandra,Joya %+ MD Anderson Children’s Cancer Hospital, Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Unit 853, Houston, TX, 77030, United States, 1 713 563 5405, jchandra@mdanderson.org %K obesity %K pediatric cancer %K survivorship %K nutrition %K cooking %D 2015 %7 31.03.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Obesity has been a growing problem among children and adolescents in the United States for a number of decades. Childhood cancer survivors (CCS) are more susceptible to the downstream health consequences of obesity such as cardiovascular disease, endocrine issues, and risk of cancer recurrence due to late effects of treatment and suboptimal dietary and physical activity habits. Objective: The objective of this study was to document the development of a Web-based cookbook of healthy recipes and nutrition resources to help enable pediatric cancer patients and survivors to lead healthier lifestyles. Methods: The Web-based cookbook, named “@TheTable”, was created by a committee of researchers, a registered dietitian, patients and family members, a hospital chef, and community advisors and donors. Recipes were collected from several sources including recipe contests and social media. We incorporated advice from current patients, parents, and CCS. Results: Over 400 recipes, searchable by several categories and with accompanying nutritional information, are currently available on the website. In addition to healthy recipes, social media functionality and cooking videos are integrated into the website. The website also features nutrition information resources including nutrition and cooking tip sheets available on several subjects. Conclusions: The “@TheTable” website is a unique resource for promoting healthy lifestyles spanning pediatric oncology prevention, treatment, and survivorship. Through evaluations of the website’s current and future use, as well as incorporation into interventions designed to promote energy balance, we will continue to adapt and build this unique resource to serve cancer patients, survivors, and the general public. %M 25840596 %R 10.2196/resprot.3777 %U http://www.jmir.org/2015/1/e37/ %U https://doi.org/10.2196/resprot.3777 %U http://www.ncbi.nlm.nih.gov/pubmed/25840596 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e31 %T Apps Seeking Theories: Results of a Study on the Use of Health Behavior Change Theories in Cancer Survivorship Mobile Apps %A Vollmer Dahlke,Deborah %A Fair,Kayla %A Hong,Y Alicia %A Beaudoin,Christopher E %A Pulczinski,Jairus %A Ory,Marcia G %+ Texas A&M School of Public Health, Health Promotion and Community Health Sciences, Texas A&M University, 1266 TAMU, College Station, TX, TX, 77843, United States, 1 512 699 4493, Deborahvd@gmail.com %K mobile apps %K health behavior %K survivorship %K health promotion %K eHealth %K mobile health %D 2015 %7 27.03.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Thousands of mobile health apps are now available for use on mobile phones for a variety of uses and conditions, including cancer survivorship. Many of these apps appear to deliver health behavior interventions but may fail to consider design considerations based in human computer interface and health behavior change theories. Objective: This study is designed to assess the presence of and manner in which health behavior change and health communication theories are applied in mobile phone cancer survivorship apps. Methods: The research team selected a set of criteria-based health apps for mobile phones and assessed each app using qualitative coding methods to assess the application of health behavior change and communication theories. Each app was assessed using a coding derived from the taxonomy of 26 health behavior change techniques by Abraham and Michie with a few important changes based on the characteristics of mHealth apps that are specific to information processing and human computer interaction such as control theory and feedback systems. Results: A total of 68 mobile phone apps and games built on the iOS and Android platforms were coded, with 65 being unique. Using a Cohen’s kappa analysis statistic, the inter-rater reliability for the iOS apps was 86.1 (P<.001) and for the Android apps, 77.4 (P<.001). For the most part, the scores for inclusion of theory-based health behavior change characteristics in the iOS platform cancer survivorship apps were consistently higher than those of the Android platform apps. For personalization and tailoring, 67% of the iOS apps (24/36) had these elements as compared to 38% of the Android apps (12/32). In the area of prompting for intention formation, 67% of the iOS apps (34/36) indicated these elements as compared to 16% (5/32) of the Android apps. Conclusions: Mobile apps are rapidly emerging as a way to deliver health behavior change interventions that can be tailored or personalized for individuals. As these apps and games continue to evolve and include interactive and adaptive sensors and other forms of dynamic feedback, their content and interventional elements need to be grounded in human computer interface design and health behavior and communication theory and practice. %M 25830810 %R 10.2196/mhealth.3861 %U http://mhealth.jmir.org/2015/1/e31/ %U https://doi.org/10.2196/mhealth.3861 %U http://www.ncbi.nlm.nih.gov/pubmed/25830810 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 1 %P e2 %T Availability of Information About Lifestyle for Cancer Survivors in England: A Review of Statutory and Charitable Sector Organizations and Cancer Centers %A Williams,Kate %A Fisher,Abigail %A Beeken,Rebecca J %A Wardle,Jane %+ Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 1720, j.wardle@ucl.ac.uk %K cancer %K survivorship %K guideline %K health behavior %K lifestyle %K diet %K physical activity %K body weight %K smoking %K alcohol drinking %D 2015 %7 09.03.2015 %9 Original Paper %J JMIR Cancer %G English %X Background: Health behavior change following a cancer diagnosis has the potential to improve long-term outcomes. However, many patients do not receive professional advice about lifestyle and are therefore increasingly using the Internet to seek further information. The statutory and charitable sectors and cancer centers all play an important role in the provision of information and have been found to be favored by cancer survivors searching for information. However, to date there has been no systematic evaluation of the lifestyle information available online for cancer survivors. Objective: The purpose of this review was to identify the lifestyle information provided for cancer survivors by statutory and charitable sector organizations and cancer centers in the United Kingdom. We aimed to identify information on tobacco, physical activity, diet, weight, and alcohol designed for people who have been diagnosed with breast, prostate, or colorectal cancer. Methods: The National Health Service (NHS) website was the focus of the search for information provided by the statutory sector. Cancer centers were identified from the Organization of European Cancer Institutes and an Internet search, and charitable sector organizations were identified by searching the Charity Commission database. The three largest generic, breast, prostate, and colorectal cancer charitable organizations were included. A systematic search of the organizations was conducted to identify lifestyle information for cancer survivors. Results: Ten organizations had some lifestyle information for cancer survivors on their websites. The Christie NHS Foundation Trust, Macmillan Cancer Support, and Prostate Cancer UK had the most comprehensive guides, covering physical activity, diet, weight management, smoking, and alcohol. The NHS website did not provide any information but had a link to Cancer Research UK’s information about diet. Eight organizations suggested talking to a health professional before making any changes. Conclusions: The majority of organizations included in this review would benefit from updating their websites to include adequate information and advice about lifestyle for cancer survivors, or they risk cancer survivors turning to less reliable sources of information. Health professionals should be appropriately trained to deal with questions about lifestyle and to advise cancer survivors about lifestyle changes following their diagnosis. %M 28410175 %R 10.2196/cancer.3521 %U http://cancer.jmir.org/2015/1/e2/ %U https://doi.org/10.2196/cancer.3521 %U http://www.ncbi.nlm.nih.gov/pubmed/28410175