%0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e31218 %T Designing Supportive e-Interventions for Partners of Men With Prostate Cancer Using Female Partners’ Experiences: Qualitative Exploration Study %A Winter,Natalie %A Green,Anna %A Jongebloed,Hannah %A Ralph,Nicholas %A Chambers,Suzanne %A Livingston,Patricia %+ Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, 3220, Australia, 61 3 5227 1100, n.heynsbergh@deakin.edu.au %K prostate cancer %K prostatic neoplasms %K e-intervention %K smartphone %K qualitative research %K caregivers %K mHealth %K mobile phone %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Partners of men living with prostate cancer (PCa) can experience a variety of unmet needs that are largely unaddressed by health care professionals. There is limited evidence to suggest which approach may be most effective in supporting partners’ unmet needs and further research is required to determine how to provide support to caregivers and how technology solutions can be designed. Objective: This study aims to explore the experience of partners of men living with PCa and their perceptions of the potential role of information technology in supporting their needs. Methods: A qualitative descriptive methodology using focus groups and phone interviews was used. Purposive sampling was used to recruit people attending a national conference supported by a national PCa organization. Interview guides were adapted from an existing evidence-based smartphone app for caregivers of people with colorectal cancer. Sessions were audio recorded and transcribed verbatim. A coding framework was developed, and transcripts were coded line by line into the framework. Codes within the framework were grouped into descriptive categories that were then developed into analytical themes. Results: A total of 17 female partners participated in the study, with an average age of 64 (SD 8.5) years. The following two main themes emerged: In the first theme, that is, How technology can be shaped to support female partners of prostate cancer survivors, the content and design of the smartphone app was discussed in addressing female partners’ needs. The following four subthemes were developed: getting support from social networks and resources, the lack of relevant information, demystifying future care expectations during and following a PCa diagnosis, and delivering the smartphone app—to whom and from whom. In the second theme, that is, The benefits and barriers of technology, the suitability of smartphone apps as a supportive modality for female partners was described. This included three subthemes: the smartphone app as an appropriate modality for supporting female partners, the future anticipated benefits of using the smartphone app, and concerns for storing and accessing information on the internet. Conclusions: A smartphone app may be a suitable modality for providing information and peer support to female partners of men living with PCa. There is a need to provide peer support for female partners in future interventions to ensure that female partners’ intimacy and daily practical needs are met. %M 35166677 %R 10.2196/31218 %U https://cancer.jmir.org/2022/1/e31218 %U https://doi.org/10.2196/31218 %U http://www.ncbi.nlm.nih.gov/pubmed/35166677 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e33355 %T The Extent of Engagement With Telehealth Approaches by Patients With Advanced Cancer: Systematic Review %A Goodman,William %A Bagnall,Anne-Marie %A Ashley,Laura %A Azizoddin,Desiree %A Muehlensiepen,Felix %A Blum,David %A Bennett,Michael I %A Allsop,Matthew %+ Leeds Institute of Health Sciences, University of Leeds, Worsley Building, Clarendon Way, Woodhouse, Leeds, LS2 9LU, United Kingdom, 44 1133434185, m.j.allsop@leeds.ac.uk %K systematic review %K advanced cancer %K engagement %K digital health %K telehealth %K mobile phone %D 2022 %7 17.2.2022 %9 Review %J JMIR Cancer %G English %X Background: Telehealth approaches are increasingly being used to support patients with advanced diseases, including cancer. Evidence suggests that telehealth is acceptable to most patients; however, the extent of and factors influencing patient engagement remain unclear. Objective: The aim of this review is to characterize the extent of engagement with telehealth interventions in patients with advanced, incurable cancer reported in the international literature. Methods: This systematic review was registered with PROSPERO (International Prospective Register of Systematic Reviews) and is reported in line with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. A comprehensive search of databases was undertaken for telehealth interventions (communication between a patient with advanced cancer and their health professional via telehealth technologies), including MEDLINE, Embase, CINAHL, PsycINFO, Cochrane Library, Sociological Abstracts, and Web of Science, from the inception of each electronic database up until December 31, 2020. A narrative synthesis was conducted to outline the design, population, and context of the studies. A conceptual framework of digital engagement comprising quantitative behavioral measures (frequency, amount, duration, and depth of use) framed the analysis of engagement with telehealth approaches. Frequency data were transformed to a percentage (actual patient engagement as a proportion of intended engagement), and the interventions were characterized by intensity (high, medium, and low intended engagement) and mode of delivery for standardized comparisons across studies. Results: Of the 19,676 identified papers, 40 (0.2%) papers covering 39 different studies were eligible for inclusion, dominated by US studies (22/39, 56%), with most being research studies (26/39, 67%). The most commonly reported measure of engagement was frequency (36/39, 92%), with substantial heterogeneity in the way in which it was measured. A standardized percentage of actual patient engagement was derived from 17 studies (17/39, 44%; n=1255), ranging from 51% to 100% with a weighted average of 75.4% (SD 15.8%). A directly proportional relationship was found between intervention intensity and actual patient engagement. Higher engagement occurred when a tablet, computer, or smartphone app was the mode of delivery. Conclusions: Understanding engagement for people with advanced cancer can guide the development of telehealth approaches from their design to monitoring as part of routine care. With increasing telehealth use, the development of meaningful and context- and condition-appropriate measures of telehealth engagement is needed to address the current heterogeneity in reporting while improving the understanding of optimal implementation of telehealth for oncology and palliative care. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42018117232; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018117232 %M 35175205 %R 10.2196/33355 %U https://cancer.jmir.org/2022/1/e33355 %U https://doi.org/10.2196/33355 %U http://www.ncbi.nlm.nih.gov/pubmed/35175205 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e29581 %T Assessment of the Quality, Understandability, and Reliability of YouTube Videos as a Source of Information on Basal Cell Carcinoma: Web-Based Analysis %A Steeb,Theresa %A Reinhardt,Lydia %A Harlaß,Matthias %A Heppt,Markus Vincent %A Meier,Friedegund %A Berking,Carola %+ Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 9131 8545852, Theresa.Steeb@uk-erlangen.de %K basal cell carcinoma %K YouTube %K videos %K patient education %K shared decision-making %K quality %K reliability %K internet %K information %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients with skin cancer increasingly watch online videos to acquire disease-related information. Until now, no scientific evaluation of the quality of videos available for German-speaking patients with basal cell carcinoma (BCC) has been performed. Objective: In this study, we aimed to identify and evaluate videos about BCC provided on YouTube. Methods: A video search on YouTube was conducted in July 2020, using German BCC-related keywords (eg, “Basalzellkarzinom,” “Basaliom,” “weißer hautkrebs,” and “heller hautkrebs”). The first three pages (ie, 60 videos) were searched by two independent researchers for each keyword. Two authors evaluated videos that met the predefined eligibility criteria. The quality of the information of the videos was evaluated using the DISCERN tool and the Global Quality Scale (GQS). The understandability and actionability were assessed with the Patient Education Materials Assessment Tool for Audiovisual Materials (PEMAT-A/V). The reliability was assessed with the JAMA (Journal of the American Medical Association) criteria score. Subgroup differences were identified using the Kruskal-Wallis test. Results: A total of 41 videos were included in the evaluation. The mean assessment scores were as follows: DISCERN, 3.3 (SD 0.80); GQS, 3.8 (SD 1.1); JAMA, 27.74% (SD 22.1%); understandability, 70.8% (SD 13.3%); and actionability, 45.9% (SD 43.7%). These values indicated that the videos were of medium to good quality and had good understandability, low actionability, and poor reliability. The quality of videos provided by health professionals was significantly higher than that of videos provided by laypersons. Conclusions: Optimization of health-related videos about BCC is desirable. In particular, adaptation to reliability criteria is necessary to support patient education and increase transparency. %M 35275067 %R 10.2196/29581 %U https://cancer.jmir.org/2022/1/e29581 %U https://doi.org/10.2196/29581 %U http://www.ncbi.nlm.nih.gov/pubmed/35275067 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e29289 %T Automated Clinical Practice Guideline Recommendations for Hereditary Cancer Risk Using Chatbots and Ontologies: System Description %A Ritchie,Jordon B %A Frey,Lewis J %A Lamy,Jean-Baptiste %A Bellcross,Cecelia %A Morrison,Heath %A Schiffman,Joshua D %A Welch,Brandon M %+ Department of Public Health Sciences, Medical University of South Carolina, 22 Westedge St, Ste 213, Charleston, SC, 29403, United States, 1 517 599 2123, ritchiej@musc.edu %K service-oriented architecture %K restful API %K hereditary cancer %K risk assessment %K clinical practice guidelines %K consumer health informatics %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Identifying patients at risk of hereditary cancer based on their family health history is a highly nuanced task. Frequently, patients at risk are not referred for genetic counseling as providers lack the time and training to collect and assess their family health history. Consequently, patients at risk do not receive genetic counseling and testing that they need to determine the preventive steps they should take to mitigate their risk. Objective: This study aims to automate clinical practice guideline recommendations for hereditary cancer risk based on patient family health history. Methods: We combined chatbots, web application programming interfaces, clinical practice guidelines, and ontologies into a web service–oriented system that can automate family health history collection and assessment. We used Owlready2 and Protégé to develop a lightweight, patient-centric clinical practice guideline domain ontology using hereditary cancer criteria from the American College of Medical Genetics and Genomics and the National Cancer Comprehensive Network. Results: The domain ontology has 758 classes, 20 object properties, 23 datatype properties, and 42 individuals and encompasses 44 cancers, 144 genes, and 113 clinical practice guideline criteria. So far, it has been used to assess >5000 family health history cases. We created 192 test cases to ensure concordance with clinical practice guidelines. The average test case completes in 4.5 (SD 1.9) seconds, the longest in 19.6 seconds, and the shortest in 2.9 seconds. Conclusions: Web service–enabled, chatbot-oriented family health history collection and ontology-driven clinical practice guideline criteria risk assessment is a simple and effective method for automating hereditary cancer risk screening. %M 35099392 %R 10.2196/29289 %U https://cancer.jmir.org/2022/1/e29289 %U https://doi.org/10.2196/29289 %U http://www.ncbi.nlm.nih.gov/pubmed/35099392 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e34392 %T Cancer Screening Recommendations During the COVID-19 Pandemic: Scoping Review %A Shah,Sumit K %A McElfish,Pearl A %+ College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Avenue, Fayetteville, AR, 72703, United States, 1 (479) 713 8680, pamcelfish@uams.edu %K COVID-19 %K cancer prevention and early detection %K cancer screenings %K breast cancer screening %K cervical cancer screening %K colorectal cancer screening %D 2022 %7 24.2.2022 %9 Review %J JMIR Cancer %G English %X Background: Cancer screening tests are recommended to prevent cancer-associated mortality by detecting precancerous and cancerous lesions in early stages. The COVID-19 pandemic disrupted the use of preventive health care services. Although there was an increase in the number of cancer screening tests beginning in late 2020, screenings remained 29% to 36% lower than in the prepandemic era. Objective: The aim of this review is to assist health care providers in identifying approaches for prioritizing patients and increasing breast, cervical, and colorectal cancer screening during the uncertainty of the COVID-19 pandemic. Methods: We used the scoping review framework to identify articles on PubMed and EBSCO databases. A total of 403 articles were identified, and 23 articles were selected for this review. The literature review ranged from January 1, 2020, to September 30, 2021. Results: The articles included two primary categories of recommendations: (1) risk stratification and triage to prioritize screenings and (2) alternative methods to conduct cancer screenings. Risk stratification and triage recommendations focused on prioritizing high-risk patients with an abnormal or suspicious result on the previous screening test, patients in certain age groups and sex, patients with a personal medical or family cancer history, patients that are currently symptomatic, and patients that are predisposed to hereditary cancers and cancer-causing mutations. Other recommended strategies included identifying areas facing the most disparities, creating algorithms and using artificial intelligence to create cancer risk scores, leveraging in-person visits to assess cancer risk, and providing the option of open access screenings where patients can schedule screenings and can be assigned a priority category by health care staff. Some recommended using telemedicine to categorize patients and determine screening eligibility for patients with new complaints. Several articles noted the importance of implementing preventive measures such as COVID-19 screening prior to the procedures, maintaining hygiene measures, and social distancing in waiting rooms. Alternative screening methods that do not require an in-person clinic visit and can effectively screen patients for cancers included mailing self-collection sampling kits for cervical and colorectal cancers, and implementing or expanding mobile screening units. Conclusions: Although the COVID-19 pandemic had devastating effects on population health globally, it could be an opportunity to adapt and evolve cancer screening methods. Disruption often creates innovation, and focus on alternative methods for cancer screenings may help reach rural and underresourced areas after the pandemic has ended. %M 35142621 %R 10.2196/34392 %U https://cancer.jmir.org/2022/1/e34392 %U https://doi.org/10.2196/34392 %U http://www.ncbi.nlm.nih.gov/pubmed/35142621 %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 e31263 %T Understanding the Information Needs of Patients With Ovarian Cancer Regarding Genetic Testing to Inform Intervention Design: Interview Study %A Zhang,Yan %A Yi,Siqi %A Trace,Ciaran B %A Williams-Brown,Marian Yvette %+ School of Information, The University of Texas at Austin, 1616 Guadalupe Street, Austin, TX, 78701, United States, 1 5124719448, yanz@utexas.edu %K patient information needs %K consumer health informatics %K ovarian cancer %K genetic testing %K genetic counseling %K mobile phone %D 2022 %7 8.2.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Experts in gynecological cancer care recommend that all patients with invasive or high-grade ovarian cancer (OC) undergo genetic testing. However, even patients who intend to take or have taken genetic tests have many unaddressed information needs regarding genetic testing. Existing genetic counseling falls short of adequately addressing this challenge. Objective: This study aims to investigate the genetic testing–related information needs of patients with OC to inform the design of interactive technology-based interventions that can enhance communication of genetic testing information to patients. Methods: We interviewed 20 patients with OC who had taken genetic tests and gathered genetic testing–related messages from an active OC web-based community. The interview transcripts and web-based community messages were analyzed using the qualitative content analysis method. Results: Data analyses produced a comprehensive taxonomy of the genetic testing–related information needs of patients with OC, which included five major topic clusters: knowledge of genetic testing as a medical test, genetic testing process, genetic testing implications for patients, implications for family members, and medical terminology. Findings indicated that patients wanted to receive information that was relevant, understandable, concise, usable, appropriate, sympathetic, and available when needed. They also preferred various channels to receive information, including internet-based technologies, print, and conversations with health care providers. Conclusions: Patients with OC need a range of information to address the uncertainties and challenges that they encounter while taking genetic tests. Their preferences for channels to receive information vary widely. A multichannel information delivery solution that combines both provider-led and peer-to-peer education models is needed to supplement existing genetic counseling to effectively meet the genetic testing–related information needs of patients with OC. %M 35133282 %R 10.2196/31263 %U https://cancer.jmir.org/2022/1/e31263 %U https://doi.org/10.2196/31263 %U http://www.ncbi.nlm.nih.gov/pubmed/35133282 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e25005 %T Web-Based Patient Educational Material on Osteosarcoma: Quantitative Assessment of Readability and Understandability %A Gulbrandsen,Trevor Robert %A Skalitzky,Mary Kate %A Shamrock,Alan Gregory %A Gao,Burke %A Hasan,Obada %A Miller,Benjamin James %+ Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA, 52242, United States, 1 435 659 4221, trevor-gulbrandsen@uiowa.edu %K osteosarcoma %K patient education %K health literacy %K web-based health information %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients often turn to web-based resources following the diagnosis of osteosarcoma. To be fully understood by average American adults, the American Medical Association (AMA) and National Institutes of Health (NIH) recommend web-based health information to be written at a 6th grade level or lower. Previous analyses of osteosarcoma resources have not measured whether text is written such that readers can process key information (understandability) or identify available actions to take (actionability). The Patient Education Materials Assessment Tool (PEMAT) is a validated measurement of understandability and actionability. Objective: The purpose of this study was to evaluate web-based osteosarcoma resources using measures of readability, understandability, and actionability. Methods: Using the search term “osteosarcoma,” two independent Google searches were performed on March 7, 2020 (by AGS), and March 11, 2020 (by TRG). The top 50 results were collected. Websites were included if they were directed at providing patient education on osteosarcoma. Readability was quantified using validated algorithms: Flesh-Kincaid Grade Ease (FKGE), Flesch-Kincaid Grade-Level (FKGL). A higher FKGE score indicates that the material is easier to read. All other readability scores represent the US school grade level. Two independent PEMAT assessments were performed with independent scores assigned for both understandability and actionability. A PEMAT score of 70% or below is considered poorly understandable or poorly actionable. Statistical significance was defined as P≤.05. Results: Two searches yielded 53 unique websites, of which 37 (70%) met the inclusion criteria. The mean FKGE and FKGL scores were 40.8 (SD 13.6) and 12.0 (SD 2.4), respectively. No website scored within the acceptable NIH or AHA recommended reading level. Only 4 (11%) and 1 (3%) website met the acceptable understandability and actionability threshold. Both understandability and actionability were positively correlated with FKGE (ρ=0.55, P<.001; ρ=0.60, P<.001), but were otherwise not significantly associated with other readability scores. There were no associations between readability (P=.15), understandability (P=.20), or actionability (P=.31) scores and Google rank. Conclusions: Overall, web-based osteosarcoma patient educational materials scored poorly with respect to readability, understandability, and actionability. None of the web-based resources scored at the recommended reading level. Only 4 achieved the appropriate score to be considered understandable by the general public. Authors of patient resources should incorporate PEMAT and readability criteria to improve web-based resources to support patient understanding. %M 35323117 %R 10.2196/25005 %U https://cancer.jmir.org/2022/1/e25005 %U https://doi.org/10.2196/25005 %U http://www.ncbi.nlm.nih.gov/pubmed/35323117 %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 %@ 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 %@ 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 %@ 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 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 %@ 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 %@ 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 %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e31388 %T Twitter Conversations About Pancreatic Cancer by Health Care Providers and the General Public: Thematic Analysis %A Grewal,Udhayvir Singh %A Gupta,Arjun %A Doggett,Jamie %A Lou,Emil %A Gusani,Niraj J %A Maitra,Anirban %A Beg,Muhammad Shaalan %A Ocean,Allyson J %+ Weill Cornell Medicine, New York Presbyterian Hospital, 525 E 68th St, New York, NY, 10065, United States, 1 646 962 6200, ajo9001@med.cornell.edu %K pancreatic cancer %K Twitter %K general public %K health care providers %K social media %K Creation Pinpoint %K thematic analysis %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Cancer %G English %X Background:  There is a growing interest in the pattern of consumption of health-related information on social media platforms. Objective: We evaluated the content of discussions around pancreatic cancer on Twitter to identify subtopics of greatest interest to health care providers and the general public.  Methods:  We used an online analytical tool (Creation Pinpoint) to quantify Twitter mentions (tweets and retweets) related to pancreatic cancer between January 2018 and December 2019. Keywords, hashtags, word combinations, and phrases were used to identify mentions. Health care provider profiles were identified using machine learning and then verified by a human analyst. Remaining user profiles were classified as belonging to the general public. Data from conversations were stratified qualitatively into 5 domains: (1) prevention, (2) survivorship, (3) treatment, (4) research, and (5) policy. We compared the themes of conversations initiated by health care providers and the general public and analyzed the impact of the Pancreatic Cancer Awareness Month and announcements by public figures of pancreatic cancer diagnoses on the overall volume of conversations.  Results:  Out of 1,258,028 mentions of pancreatic cancer, 313,668 unique mentions were classified into the 5 domains. We found that health care providers most commonly discussed pancreatic cancer research (10,640/27,031 mentions, 39.4%), while the general public most commonly discussed treatment (154,484/307,449 mentions, 50.2%). Health care providers were found to be more likely to initiate conversations related to research (odds ratio [OR] 1.75, 95% CI 1.70-1.79, P<.001) and prevention (OR 1.49, 95% CI 1.41-1.57, P<.001) whereas the general public took the lead in the domains of treatment (OR 1.63, 95% CI 1.58-1.69, P<.001) and survivorship (OR 1.17, 95% CI 1.13-1.21, P<.001). Pancreatic Cancer Awareness Month did not increase the number of mentions by health care providers in any of the 5 domains, but general public mentions increased temporarily in all domains except prevention and policy. Health care provider mentions did not increase with announcements by public figures of pancreatic cancer diagnoses. After Alex Trebek, host of the television show Jeopardy, received his diagnosis, general public mentions of survivorship increased, while Justice Ruth Bader Ginsburg’s diagnosis increased conversations on treatment.  Conclusions: Health care provider conversations on Twitter are not aligned with the general public. Pancreatic Cancer Awareness Month temporarily increased general public conversations about treatment, research, and survivorship, but not prevention or policy. Future studies are needed to understand how conversations on social media platforms can be leveraged to increase health care awareness among the general public. %M 35323123 %R 10.2196/31388 %U https://cancer.jmir.org/2022/1/e31388 %U https://doi.org/10.2196/31388 %U http://www.ncbi.nlm.nih.gov/pubmed/35323123 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e31576 %T Feasibility and Acceptability of a Physical Activity Tracker and Text Messages to Promote Physical Activity During Chemotherapy for Colorectal Cancer: Pilot Randomized Controlled Trial (Smart Pace II) %A Van Blarigan,Erin L %A Dhruva,Anand %A Atreya,Chloe E %A Kenfield,Stacey A %A Chan,June M %A Milloy,Alexandra %A Kim,Iris %A Steiding,Paige %A Laffan,Angela %A Zhang,Li %A Piawah,Sorbarikor %A Fukuoka,Yoshimi %A Miaskowski,Christine %A Hecht,Frederick M %A Kim,Mi-Ok %A Venook,Alan P %A Van Loon,Katherine %+ Department of Epidemiology and Biostatistics, University of California, San Francisco, UCSF Box 0560, 550 16th St. 2nd Floor, San Francisco, CA, 94158, United States, 1 415 476 1111 ext 13608, erin.vanblarigan@ucsf.edu %K exercise %K treatment %K colon cancer %K rectal cancer %K digital health %K wearables %K SMS %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: We conducted a pilot 2-arm randomized controlled trial to assess the feasibility of a digital health intervention to increase moderate-to-vigorous physical activity in patients with colorectal cancer (CRC) during chemotherapy. Objective: This study aimed to determine whether a digital health physical activity intervention is feasible and acceptable during chemotherapy for CRC. Methods: Potentially eligible patients with CRC expected to receive at least 12 weeks of chemotherapy were identified in person at the University of California, San Francisco, and on the web through advertising. Eligible patients were randomized 1:1 to a 12-week intervention (Fitbit Flex, automated SMS text messages) versus usual care. At 0 and 12 weeks, patients wore an Actigraph GT3X+ accelerometer for 7 days and completed surveys, body size measurements, and an optional 6-minute walk test. Participants could not be masked to their intervention arm, but people assessing the body size and 6-minute walk test outcomes were masked. The primary outcomes were adherence (eg, Fitbit wear and text response rate) and self-assessed acceptability of the intervention. The intervention would be considered feasible if we observed at least 80% complete follow-up and 70% adherence and satisfaction, a priori. Results: From 2018 to 2020, we screened 240 patients; 53.3% (128/240) of patients were ineligible and 26.7% (64/240) declined to participate. A total of 44 patients (44/240, 18%) were randomized to the intervention (n=22) or control (n=22) groups. Of these, 57% (25/44) were women; 68% (30/44) identified as White and 25% (11/44) identified as Asian American or Pacific Islander; and 77% (34/44) had a 4-year college degree. The median age at enrollment was 54 years (IQR 45-62 years). Follow-up at 12 weeks was 91% (40/44) complete. In the intervention arm, patients wore Fitbit devices on a median of 67 out of 84 (80%) study days and responded to a median of 17 out of 27 (63%) questions sent via SMS text message. Among 19 out of 22 (86%) intervention patients who completed the feedback survey, 89% (17/19) were satisfied with the Fitbit device; 63% (12/19) were satisfied with the SMS text messages; 68% (13/19) said the SMS text messages motivated them to exercise; 74% (14/19) said the frequency of SMS text messages (1-3 days) was ideal; and 79% (15/19) said that receiving SMS text messages in the morning and evening was ideal. Conclusions: This pilot study demonstrated that many people receiving chemotherapy for CRC are interested in participating in digital health physical activity interventions. Fitbit adherence was high; however, participants indicated a desire for more tailored SMS text message content. Studies with more socioeconomically diverse patients with CRC are required. Trial Registration: ClinicalTrials.gov NCT03524716; https://clinicaltrials.gov/ct2/show/NCT03524716 %M 35014958 %R 10.2196/31576 %U https://cancer.jmir.org/2022/1/e31576 %U https://doi.org/10.2196/31576 %U http://www.ncbi.nlm.nih.gov/pubmed/35014958 %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 %@ 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 %@ 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 %@ 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 e34895 %T Clinicians’ Perceptions of the Benefits and Challenges of Teleoncology as Experienced Through the COVID-19 Pandemic: Qualitative Study %A Alpert,Jordan M %A Taylor,Greenberry %A Hampton,Chelsea N %A Paige,Samantha %A Markham,Merry Jennifer %A Bylund,Carma L %+ College of Journalism and Communications, University of Florida, 2093 Weimer Hall, 1885 Stadium Road, Gainesville, FL, 32611, United States, 1 3523920453, jordan.alpert@ufl.edu %K teleoncology %K telemedicine %K qualitative %K COVID-19 %K telehealth %K cancer care %K cancer %K oncology %K digital health %K pandemic %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: COVID-19 thrust both patients and clinicians to use telemedicine in place of traditional in-person visits. Prepandemic, limited research had examined clinician-patient communication in telemedicine visits. The shift to telemedicine in oncology, or teleoncology, has placed attention on how the technology can be utilized to provide care for patients with cancer. Objective: Our objective was to describe oncology clinicians’ experiences with teleoncology and to uncover its benefits and challenges during the first 10 months of the COVID-19 pandemic. Methods: In-depth, semistructured qualitative interviews were conducted with oncology clinicians. Using an inductive, thematic approach, the most prevalent themes were identified. Results: In total, 21 interviews with oncology clinicians revealed the following themes: benefits of teleoncology, such as (1) reducing patients’ travel time and expenses, (2) limiting COVID-19 exposure, and (3) enabling clinicians to “see” a patients’ lifestyle and environment, and challenges, such as (1) technological connection difficulties, (2) inability to physically examine patients, and (3) patients’ frustration related to clinicians being late to teleoncology appointments. Conclusions: Teleoncology has many benefits and is well suited for specific types of appointments. Challenges could be addressed through improved communication when scheduling appointments to make patients aware about what to expect. Ensuring patients have the proper technology to participate in teleoncology and an understanding about how it functions are necessary. %M 35142622 %R 10.2196/34895 %U https://cancer.jmir.org/2022/1/e34895 %U https://doi.org/10.2196/34895 %U http://www.ncbi.nlm.nih.gov/pubmed/35142622