%0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 1 %P e3 %T Evaluation of a Web-Based App Demonstrating an Exclusionary Algorithmic Approach to TNM Cancer Staging %A Kim,Matthew %+ Brigham and Women's Hospital, Division of Endocrinology, Diabetes and Hypertension, 221 Longwood Avenue, RF291, Boston, MA, 02115, United States, 1 617 732 5666, mikim@partners.org %K TNM staging %K neoplasms %K medical oncology %K instructional technology %D 2015 %7 02.04.2015 %9 Original Paper %J JMIR Cancer %G English %X Background: TNM staging plays a critical role in the evaluation and management of a range of different types of cancers. The conventional combinatorial approach to the determination of an anatomic stage relies on the identification of distinct tumor (T), node (N), and metastasis (M) classifications to generate a TNM grouping. This process is inherently inefficient due to the need for scrupulous review of the criteria specified for each classification to ensure accurate assignment. An exclusionary approach to TNM staging based on sequential constraint of options may serve to minimize the number of classifications that need to be reviewed to accurately determine an anatomic stage. Objective: Our aim was to evaluate the usability and utility of a Web-based app configured to demonstrate an exclusionary approach to TNM staging. Methods: Internal medicine residents, surgery residents, and oncology fellows engaged in clinical training were asked to evaluate a Web-based app developed as an instructional aid incorporating (1) an exclusionary algorithm that polls tabulated classifications and sorts them into ranked order based on frequency counts, (2) reconfiguration of classification criteria to generate disambiguated yes/no questions that function as selection and exclusion prompts, and (3) a selectable grid of TNM groupings that provides dynamic graphic demonstration of the effects of sequentially selecting or excluding specific classifications. Subjects were asked to evaluate the performance of this app after completing exercises simulating the staging of different types of cancers encountered during training. Results: Survey responses indicated high levels of agreement with statements supporting the usability and utility of this app. Subjects reported that its user interface provided a clear display with intuitive controls and that the exclusionary approach to TNM staging it demonstrated represented an efficient process of assignment that helped to clarify distinctions between tumor, node, and metastasis classifications. High overall usefulness ratings were bolstered by supplementary comments suggesting that this app might be readily adopted for use in clinical practice. Conclusions: A Web-based app that utilizes an exclusionary algorithm to prompt the assignment of tumor, node, and metastasis classifications may serve as an effective instructional aid demonstrating an efficient and informative approach to TNM staging. %M 28410163 %R 10.2196/cancer.4019 %U http://cancer.jmir.org/2015/1/e3/ %U https://doi.org/10.2196/cancer.4019 %U http://www.ncbi.nlm.nih.gov/pubmed/28410163 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 1 %P e1 %T YouTube Videos Related to Skin Cancer: A Missed Opportunity for Cancer Prevention and Control %A Basch,Corey H %A Basch,Charles E %A Hillyer,Grace Clarke %A Reeves,Rachel %+ William Paterson University, 143 H Wing, Wayne, NJ, 07470, United States, 1 973 720 2603, baschc@wpunj.edu %K skin cancer %K social media %K YouTube %D 2015 %7 02.03.2015 %9 Short Paper %J JMIR Cancer %G English %X Background: Early detection and treatment influence the mortality risk of skin cancer. Objective: The objective of this study was to analyze the content of the most viewed professional and consumer videos uploaded to YouTube related to skin cancer. Methods: A total of 140 professional and consumer videos uploaded between 2007 and 2014 were identified and coded. Coding involved identifying and sorting followed by gathering descriptive information, including length of the video, number of views, and year uploaded. A dichotomous coding scheme (ie, yes or no) was used in coding specific aspects of video content, including provision of information, type of skin cancer, age group, family history, risk reduction, risk factors, fear, and home remedies for skin cancer treatment. Results: The majority of videos provided information related to screening. Many consumer videos conveyed information related to the use of a black salve as a home remedy for skin cancer, despite the fact that there is no evidence that it is an effective treatment. Conclusions: Research is needed to identify characteristics of videos that are most likely to be viewed to inform the development of credible communications. %M 28410167 %R 10.2196/cancer.4204 %U http://cancer.jmir.org/2015/1/e1/ %U https://doi.org/10.2196/cancer.4204 %U http://www.ncbi.nlm.nih.gov/pubmed/28410167 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 1 %P e6 %T Age-Related Use and Perceptions of eHealth in Men With Prostate Cancer: A Web-Based Survey %A Rising,Camella J %A Bol,Nadine %A Kreps,Gary L %+ Center for Health and Risk Communication, Department of Communication, George Mason University, 4400 University Drive, MSN 3D6, Fairfax, VA, 22030, United States, 1 703 993 1090, crising@gmu.edu %K consumer health information %K prostate cancer %K age groups %K information-seeking behavior %K social support %K psychosocial aspects %D 2015 %7 25.06.2015 %9 Original Paper %J JMIR Cancer %G English %X Background: Men with prostate cancer require ample information and support along the continuum of care, and eHealth is one way to meet such critical information and support needs. Currently, evidence about how age influences use and perceptions about prostate cancer eHealth information and support is lacking. Objective: The aim of this paper is to explore use and perceptions about eHealth among men living with prostate cancer. Specifically, we aimed to analyze men with prostate cancer by age-specific cohorts to identify potential age-related differences in use and perceptions about prostate cancer eHealth information. Methods: We used survey methodology to examine how men under 65 years old with prostate cancer differ from those aged 65 years old or older in use and perceptions about prostate cancer eHealth information and support (n=289). Results: We found that men in the younger cohort used the Internet more often to be informed about treatment options (P=.04) and to learn more about staging/grading (P=.01) than men in the older cohort. Results also showed comparatively greater use of online prostate cancer information for emotional support and encouragement by the younger as compared to the older cohort (P=.001). Furthermore, the older cohort reported more negative psychosocial effects of eHealth (eg, more anxious, depressed) than younger men (P=.002). We also found that as a result of more frequent Internet use, younger men experienced more positive psychosocial effects (eg, more informed, in control) from accessing information about prostate cancer through eHealth channels (b=-0.10, 95% CI -0.28 to 0). Conclusions: Men with prostate cancer have different information and support needs; our findings suggest that these needs might vary by age. Future research is needed to unravel age-related factors underlying these differences to be better able to tailor prostate cancer eHealth information to men’s information and support needs. %M 28410165 %R 10.2196/cancer.4178 %U http://www.jmir.org/2015/1/e6/ %U https://doi.org/10.2196/cancer.4178 %U http://www.ncbi.nlm.nih.gov/pubmed/28410165 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 1 %P e4 %T Defining the Role of the Online Therapeutic Facilitator: Principles and Guidelines Developed for Couplelinks, an Online Support Program for Couples Affected by Breast Cancer %A Carter,Wendy %A Fergus,Karen %A Ahmad,Saunia %A McLeod,Deborah %A Stephen,Joanne %+ Department of Psychology, York University, 243 Behavioural Sciences, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 22986, Kfergus@yorku.ca %K couples %K cancer %K Internet %K online therapist %K psychosocial support %K therapeutic alliance %D 2015 %7 14.04.2015 %9 Viewpoint %J JMIR Cancer %G English %X Development of psychological interventions delivered via the Internet is a rapidly growing field with the potential to make vital services more accessible. However, there is a corresponding need for careful examination of factors that contribute to effectiveness of Internet-delivered interventions, especially given the observed high dropout rates relative to traditional in-person (IP) interventions. Research has found that the involvement of an online therapist in a Web-based intervention reduces treatment dropout. However, the role of such online therapists is seldom well articulated and varies considerably across programs making it difficult to discern processes that are important for online therapist involvement.In this paper, we introduce the concept of “therapeutic facilitation” to describe the role of the online therapist that was developed and further refined in the context of a Web-based, asynchronous psychosocial intervention for couples affected by breast cancer called Couplelinks. Couplelinks is structured into 6 dyadic learning modules designed to be completed on a weekly basis in consultation with a facilitator through regular, asynchronous, online text-based communication.Principles of therapeutic facilitation derived from a combination of theory underlying the intervention and pilot-testing of the first iteration of the program are described. Case examples to illustrate these principles as well as commonly encountered challenges to online facilitation are presented. Guidelines and principles for therapeutic facilitation hold relevance for professionally delivered online programs more broadly, beyond interventions for couples and cancer. %M 28410159 %R 10.2196/cancer.3887 %U http://cancer.jmir.org/2015/1/e4/ %U https://doi.org/10.2196/cancer.3887 %U http://www.ncbi.nlm.nih.gov/pubmed/28410159 %0 Journal Article %@ 2369-1999 %I JMIR Publications Inc. %V 1 %N 1 %P e5 %T Blog Posting After Lung Cancer Notification: Content Analysis of Blogs Written by Patients or Their Families %A Sato,Akira %A Aramaki,Eiji %A Shimamoto,Yumiko %A Tanaka,Shiro %A Kawakami,Koji %+ Design School, Kyoto University, 5th floor Bldg. #9 Kyoto Research Park 91 Awata-cho, Chudoji, Shimogyo-ku, Kyoto, 600-8813, Japan, 81 9040335481, eiji.aramaki@design.kyoto-u.ac.jp %K blog %K lung cancer %K notification %K content analysis %K communication %K Internet %D 2015 %7 18.05.2015 %9 Original Paper %J JMIR Cancer %G English %X Background: The advent and spread of the Internet has changed the way societies communicate. A portion of information on the Internet may constitute an important source of information concerning the experiences and thoughts of patients and their families. Patients and their families use blogs to obtain updated information, search for alternative treatments, facilitate communication with other patients, and receive emotional support. However, much of this information has yet to be actively utilized by health care professionals. Objective: We analyzed health-related information in blogs from Japan, focusing on the feelings and satisfaction levels of lung cancer patients or their family members after being notified of their disease. Methods: We collected 100 blogs written in Japanese by patients (or their families) who had been diagnosed with lung cancer by a physician. These 100 blogs posts were searchable between June 1 and June 30, 2013. We focused on blog posts that addressed the lung cancer notification event. We analyzed the data using two different approaches (Analysis A and Analysis B). Analysis A was blog content analysis in which we analyzed the content addressing the disease notification event in each blog. Analysis B was patient's dissatisfaction and anxiety analysis. Detailed blog content regarding patient's dissatisfaction and anxiety at the individual sentence level was coded and analyzed. Results: The 100 blog posts were written by 48 men, 46 women, and 6 persons whose sex was undisclosed. The average age of the blog authors was 52.4 years. With regard to cancer staging, there were 5 patients at Stage I, 3 patients at Stage II, 14 patients at Stage III, 21 patients at Stage IV, and 57 patients without a disclosed cancer stage. The results of Analysis A showed that the proportion of patients who were dissatisfied with the level of health care exceeded that of satisfied patients (22% vs 8%). From the 2499 sentences in the 100 blog posts analyzed, we identified expressions of dissatisfaction and anxiety in 495 sentences. Our results showed that there were substantially more posts concerning “Way of living, reasons for living, set of values” and “Relationships with medical staff (own hospital)” than in previous studies (Analysis B). Conclusions: This study provides insight into the feelings of dissatisfaction and anxieties held by lung cancer patients and their families, including those regarding the “Way of living, reasons for living, set of values” and “Relationship with medical staff (own hospital),” which were inaccessible in previous survey analyses. When comparing information obtained from patients’ voluntary records and those from previous surveys conducted by health care institutions, it is likely that the former would be more indicative of patients’ actual opinions and feelings. Therefore, it is important to utilize such records as an information resource. %M 28410169 %R 10.2196/cancer.3883 %U https://cancer.jmir.org/2015/1/e5/ %U https://doi.org/10.2196/cancer.3883 %U http://www.ncbi.nlm.nih.gov/pubmed/28410169 %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 %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