TY - JOUR AU - Ma, Jinfei AU - Zou, Zihao AU - Pazo, Eric Emmanuel AU - Moutari, Salissou AU - Liu, Ye AU - Jin, Feng PY - 2021/3/2 TI - Comparative Analysis of Paper-Based and Web-Based Versions of the National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy-Breast Cancer Symptom Index (NFBSI-16) Questionnaire in Breast Cancer Patients: Randomized Crossover Study JO - JMIR Med Inform SP - e18269 VL - 9 IS - 3 KW - breast cancer KW - NFBSI-16 KW - patient-reported outcome KW - reproducibility KW - test-retest reliability KW - web-based questionnaire N2 - Background: Breast cancer remains the most common neoplasm diagnosed among women in China and globally. Health-related questionnaire assessments in research and clinical oncology settings have gained prominence. The National Comprehensive Cancer Network?Functional Assessment of Cancer Therapy?Breast Cancer Symptom Index (NFBSI-16) is a rapid and powerful tool to help evaluate disease- or treatment-related symptoms, both physical and emotional, in patients with breast cancer for clinical and research purposes. Prevalence of individual smartphones provides a potential web-based approach to administrating the questionnaire; however, the reliability of the NFBSI-16 in electronic format has not been assessed. Objective: This study aimed to assess the reliability of a web-based NFBSI-16 questionnaire in breast cancer patients undergoing systematic treatment with a prospective open-label randomized crossover study design. Methods: We recruited random patients with breast cancer under systematic treatment from the central hospital registry to complete both paper- and web-based versions of the questionnaires. Both versions of the questionnaires were self-assessed. Patients were randomly assigned to group A (paper-based first and web-based second) or group B (web-based first and paper-based second). A total of 354 patients were included in the analysis (group A: n=177, group B: n=177). Descriptive sociodemographic characteristics, reliability and agreement rates for single items, subscales, and total score were analyzed using the Wilcoxon test. The Lin concordance correlation coefficient (CCC) and Spearman and Kendall ? rank correlations were used to assess test-retest reliability. Results: Test-retest reliability measured with CCCs was 0.94 for the total NFBSI-16 score. Significant correlations (Spearman ?) were documented for all 4 subscales?Disease-Related Symptoms Subscale?Physical (?=0.93), Disease-Related Symptoms Subscale?Emotional (?=0.85), Treatment Side Effects Subscale (?=0.95), and Function and Well-Being Subscale (?=0.91)?and total NFBSI-16 score (?=0.94). Mean differences of the test and retest were all close to zero (?0.06). The parallel test-retest reliability of subscales with the Wilcoxon test comparing individual items found GP3 (item 5) to be significantly different (P=.02). A majority of the participants in this study (255/354, 72.0%) preferred the web-based over the paper-based version. Conclusions: The web-based version of the NFBSI-16 questionnaire is an excellent tool for monitoring individual breast cancer patients under treatment, with the majority of participants preferring it over the paper-based version. UR - https://medinform.jmir.org/2021/3/e18269 UR - http://dx.doi.org/10.2196/18269 UR - http://www.ncbi.nlm.nih.gov/pubmed/33650978 ID - info:doi/10.2196/18269 ER - TY - JOUR AU - Sabgul, Abdulnasir Afnan AU - Qattan, N. Ameerah M. AU - Hashmi, Rubayyat AU - Al-Hanawi, Khaled Mohammed PY - 2021/2/25 TI - Husbands? Knowledge of Breast Cancer and Their Wives? Attitudes and Practices Related to Breast Cancer Screening in Saudi Arabia: Cross-sectional Online Survey JO - J Med Internet Res SP - e25404 VL - 23 IS - 2 KW - attitude KW - breast cancer KW - husbands KW - knowledge KW - Saudi Arabia KW - screening N2 - Background: Despite Saudi Arabia?s free and well-established cancer care program, breast cancer incidence and mortality are rising. Husbands? knowledge, and wives? attitudes and practices related to breast cancer screening are not well understood in Saudi Arabia. Objective: The aim of this study was to investigate husbands? knowledge, and wives? attitudes and practices related to breast cancer screening in Saudi Arabia. Methods: This cross-sectional study collected data from 403 husbands in the holy city of Makkah through an online self-reported questionnaire over a period of 2 months, from May 6 to July 7, 2020. Tabulation, bivariate, and multiple regression analyses were the major tools used for data analysis. Multivariate logistic regressions were used to examine the association between husbands? knowledge and wives? behavior regarding breast cancer screening methods. Results: Husbands? knowledge score (a 1-point increase) was significantly associated with the wives? utilization of mammograms (adjusted odds ratio [AOR] 1.089, 95% CI 1.024-1.159) and breast self-examination (AOR 1.177, 95% CI 1.105-1.255). Husbands? knowledge also influenced the wives? attitudes toward learning about breast self-examination (AOR 1.138, 95% CI 1.084-1.195). There was no significant association between husbands? knowledge and wives? utilization of clinical breast examination. However, richer husbands showed a socioeconomic gradient concerning their wives? utilization of clinical breast examinations (AOR 2.603, 95% CI 1.269-5.341). Conclusions: Overall, husbands? knowledge of breast cancer influences wives? attitudes and practices related to breast cancer screening methods in Saudi Arabia. Thus, interventions delivered to husbands might increase breast cancer awareness and survival. UR - https://www.jmir.org/2021/2/e25404 UR - http://dx.doi.org/10.2196/25404 UR - http://www.ncbi.nlm.nih.gov/pubmed/33629959 ID - info:doi/10.2196/25404 ER - TY - JOUR AU - Sato, Ann AU - Haneda, Eri AU - Suganuma, Nobuyasu AU - Narimatsu, Hiroto PY - 2021/2/5 TI - Preliminary Screening for Hereditary Breast and Ovarian Cancer Using a Chatbot Augmented Intelligence Genetic Counselor: Development and Feasibility Study JO - JMIR Form Res SP - e25184 VL - 5 IS - 2 KW - artificial intelligence KW - augmented intelligence KW - hereditary cancer KW - familial cancer KW - IBM Watson KW - preliminary screening KW - cancer KW - genetics KW - chatbot KW - screening KW - feasibility N2 - Background: Breast cancer is the most common form of cancer in Japan; genetic background and hereditary breast and ovarian cancer (HBOC) are implicated. The key to HBOC diagnosis involves screening to identify high-risk individuals. However, genetic medicine is still developing; thus, many patients who may potentially benefit from genetic medicine have not yet been identified. Objective: This study?s objective is to develop a chatbot system that uses augmented intelligence for HBOC screening to determine whether patients meet the National Comprehensive Cancer Network (NCCN) BRCA1/2 testing criteria. Methods: The system was evaluated by a doctor specializing in genetic medicine and certified genetic counselors. We prepared 3 scenarios and created a conversation with the chatbot to reflect each one. Then we evaluated chatbot feasibility, the required time, the medical accuracy of conversations and family history, and the final result. Results: The times required for the conversation were 7 minutes for scenario 1, 15 minutes for scenario 2, and 16 minutes for scenario 3. Scenarios 1 and 2 met the BRCA1/2 testing criteria, but scenario 3 did not, and this result was consistent with the findings of 3 experts who retrospectively reviewed conversations with the chatbot according to the 3 scenarios. A family history comparison ascertained by the chatbot with the actual scenarios revealed that each result was consistent with each scenario. From a genetic medicine perspective, no errors were noted by the 3 experts. Conclusions: This study demonstrated that chatbot systems could be applied to preliminary genetic medicine screening for HBOC. UR - https://formative.jmir.org/2021/2/e25184 UR - http://dx.doi.org/10.2196/25184 UR - http://www.ncbi.nlm.nih.gov/pubmed/33544084 ID - info:doi/10.2196/25184 ER - TY - JOUR AU - Baik, H. Sharon AU - Oswald, B. Laura AU - Buscemi, Joanna AU - Buitrago, Diana AU - Iacobelli, Francisco AU - Perez-Tamayo, Alejandra AU - Guitelman, Judith AU - Penedo, J. Frank AU - Yanez, Betina PY - 2020/12/8 TI - Patterns of Use of Smartphone-Based Interventions Among Latina Breast Cancer Survivors: Secondary Analysis of a Pilot Randomized Controlled Trial JO - JMIR Cancer SP - e17538 VL - 6 IS - 2 KW - breast cancer KW - cancer survivorship KW - Hispanics/Latinas KW - eHealth KW - psychosocial intervention KW - mobile phone N2 - Background: Latina breast cancer survivors experience poorer health-related quality of life (HRQoL), greater symptom burden, and more psychosocial needs compared to non-Latina breast cancer survivors. eHealth platforms such as smartphone apps are increasingly being used to deliver psychosocial interventions to cancer survivors. However, few psychosocial eHealth interventions have been developed specifically for Latina breast cancer survivors. Further, little is known about how Latinas, in general, engage with eHealth interventions and whether specific participant characteristics are associated with app use in this population. We evaluated the use of 2 culturally informed, evidence-based smartphone apps for Latina breast cancer survivors?one that was designed to improve HRQoL and reduce symptom burden (My Guide) and the other to promote healthy lifestyle behaviors (My Health). Objective: The objectives of our study were to explore the patterns of use of the My Guide intervention app and My Health attention-control app among Latina breast cancer survivors. Methods: Eighty Latina breast cancer survivors were randomized to use the My Guide or My Health app for 6 weeks. Assessments were collected at baseline (T1), immediately after the 6-week intervention (T2), and 2 weeks after T2 (T3). Specific study outcomes included subdomains of HRQoL, symptom burden, cancer-specific distress, cancer-relevant self-efficacy, and breast cancer knowledge. Results: On average, participants used their assigned app for more than 1 hour per week. Sociodemographic or psychological characteristics were not significantly associated with app use, except for employment status in the My Health group. Content related to common physical and emotional symptoms of breast cancer survivors as well as recommendations for nutrition and physical activity were most frequently accessed by My Guide and My Health participants, respectively. Lastly, clinically meaningful improvements were demonstrated in breast cancer well-being among low app users (ie, <60 minutes of use/week) of My Guide and social well-being among high app users (ie, ?60 minutes of use/week) of My Health. Conclusions: The favorable rates of participant use across both apps suggest that Latina breast cancer survivors are interested in the content delivered across both My Guide and My Health. Furthermore, since sociodemographic variables, excluding employment status, and baseline HRQoL (psychological variable) were not related to app use, My Guide and My Health may be accessible to diverse Latina breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT03645005; https://clinicaltrials.gov/ct2/show/NCT03645005 UR - http://cancer.jmir.org/2020/2/e17538/ UR - http://dx.doi.org/10.2196/17538 UR - http://www.ncbi.nlm.nih.gov/pubmed/33289669 ID - info:doi/10.2196/17538 ER - TY - JOUR AU - Whitehead, Lisa AU - Emery, Laura AU - Kirk, Deborah AU - Twigg, Diane AU - Brown, Deborah AU - Dewar, Joanna PY - 2020/12/7 TI - Evaluation of a Remote Symptom Assessment and Management (SAM) System for People Receiving Adjuvant Chemotherapy for Breast or Colorectal Cancer: Mixed Methods Study JO - JMIR Cancer SP - e22825 VL - 6 IS - 2 KW - self-management KW - intervention KW - symptom management KW - breast cancer KW - colorectal cancer KW - cancer KW - symptom KW - monitoring KW - online intervention KW - development KW - implementation KW - evaluation N2 - Background: The Symptom Assessment and Management (SAM) program is a structured, online, nurse-supported intervention to support symptom self-management in people receiving adjuvant chemotherapy post surgery for breast or colorectal cancer. Objective: The objective of this study was to describe the development, implementation strategy, and evaluation of the SAM system. Methods: The development of the SAM program involved 3 phases. In phase 1, the web app was developed through consultation with consumers and clinicians and of the literature to ensure that the system was evidence-based and reflected the realities of receiving treatment and supporting patients through treatment. In phase 2, 7 participants recorded the severity of 6 symptoms daily over the course of 1 cycle of chemotherapy. In phase 3, 17 participants recorded their symptoms daily over the course of 3 cycles of chemotherapy. Once symptoms were recorded, participants received immediate feedback on the severity of their symptoms and self-management recommendations, which could include seeking immediate medical attention. Data on quality of life, symptom burden, anxiety and depression, distress, and self-efficacy were collected during treatment; participants? perceptions of the SAM program were evaluated following participation via interview. Results: The outcomes of the SAM project include the development of a system that is reliable and easy to use and navigate. Participants reported benefits related to using the SAM program that included feeling more in control of managing their symptoms and feeling reassured. Engagement with the system on a daily basis was variable, with some participants completing the symptom tracker daily and others engaging some of the time. The feedback from all participants was that the system was easy to navigate and the information was relevant and supportive. Conclusions: The SAM program has the potential to enhance the management of symptoms for people receiving chemotherapy treatment. The system creates an accurate repository of symptoms that can be accessed easily and highlight patterns in symptom experience. These can be shared with clinicians, with patient permission, to inform and support treatment plans. The potential to predict the risk of developing severe symptoms can be developed to anticipate the need for care and support. Further considerations on how to increase engagement with the system, the value of the system for people diagnosed with other tumor types and treatment regimes, and the incorporation of the system into everyday clinical practice are needed. UR - http://cancer.jmir.org/2020/2/e22825/ UR - http://dx.doi.org/10.2196/22825 UR - http://www.ncbi.nlm.nih.gov/pubmed/33284122 ID - info:doi/10.2196/22825 ER - TY - JOUR AU - Kapoor, Akshat AU - Nambisan, Priya PY - 2020/12/4 TI - Exploring Interactive Survivorship Care Plans to Support Breast Cancer Survivors: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e23414 VL - 9 IS - 12 KW - breast cancer KW - cancer survivorship KW - self-management KW - patient education N2 - Background: Breast cancer is the most common form of cancer among American women, accounting for 23% of all cancer survivors nationally. Yet, the availability of adequate resources and tools for supporting breast cancer survivors has not kept up with the rapid advancement in treatment options, resulting in unmet supportive care needs, particularly among low-income and minority populations. This study explores an alternative means of delivering breast cancer survivorship care plans (SCPs), with the aim of improving survivor morbidity, patient knowledge, and self-management of treatment-related symptoms, as well as addressing inconsistencies in follow-up care visits. Objective: The overall goal of this study is to improve the uptake of SCP recommendations via an educational intervention for breast cancer survivors, to improve treatment-related morbidity, patient knowledge, self-management, and adherence to follow-up visits. The specific aims of the study are to (1) evaluate the feasibility of the online SCP, and (2) assess the impact of the online SCP on survivorship outcomes. Methods: We will enroll 50 breast cancer survivors who have completed initial breast cancer treatment into a 2-armed, randomized, waitlist-controlled pilot trial, and collect data at baseline and 6 months. For the first aim, we will use mixed methods, including surveys and personal interviews among the intervention group, to determine the feasibility of providing an online, interactive SCP (called ACESO) based on the survivors? online user experience and their short-term adoption. For the secondary aim, we will compare the 2 groups to assess the primary outcomes of survivor knowledge, self-efficacy for self-management, perceived peer support, and adherence to SCP-recommended posttreatment follow-up visits to oncology and primary care; and the secondary outcomes of treatment-related morbidity (body weight, fatigue, depression, anxiety, sexual function, distress, and sleep quality). We assess these outcomes by using measurements from validated instruments with robust psychometric properties. Results: We have developed and refined the online breast cancer survivorship plan, ACESO, with consultation from breast cancer oncologists, nurses, and survivors. Approval for the study protocol has been obtained from the Institutional Review Board. An advisory board has also been established to provide oversight and recommendations on the conduct of the study. The study will be completed over a period of 2 years. Conclusions: The results of this pilot study will inform the feasibility and design of a larger-scale pragmatic trial to evaluate the impact of an online breast cancer SCP on treatment-related morbidity and self-efficacy for self-management. International Registered Report Identifier (IRRID): PRR1-10.2196/23414 UR - https://www.researchprotocols.org/2020/12/e23414 UR - http://dx.doi.org/10.2196/23414 UR - http://www.ncbi.nlm.nih.gov/pubmed/33274725 ID - info:doi/10.2196/23414 ER - TY - JOUR AU - Lee, Eunkyung AU - Hines, B. Robert AU - Wright, L. Jean AU - Nam, Eunji AU - Rovito, J. Michael AU - Liu, Xinliang PY - 2020/11/12 TI - Effects of Radiation Therapy and Comorbidity on Health-Related Quality of Life and Mortality Among Older Women With Low-Risk Breast Cancer: Protocol for a Retrospective Cohort Study JO - JMIR Res Protoc SP - e18056 VL - 9 IS - 11 KW - radiation therapy KW - comorbidity KW - health-related quality of life KW - survival KW - early-stage breast cancer KW - older women N2 - Background: The National Comprehensive Cancer Network Breast Cancer Guidelines Committee suggests that the omission of adjuvant radiation therapy (RT) after breast-conserving surgery can be a reasonable option among older women with low-risk breast cancer (early-stage, estrogen receptor-positive, and node-negative) if they are treated with endocrine therapy. However, RT usage in this group of women still exceeds 50%. Conversely, older women tend to forego RT (even when necessary) due to cost, inconvenience, and potential adverse responses associated with RT. Understanding health-related quality of life (HRQOL) change with receipt of RT among older women in the modern era is limited due to the under-representation of this population in clinical trials. Objective: The proposed study aims to examine the associations of RT with HRQOL trajectories as well as survival outcomes among older women with 5-10 years of follow-up. We will also assess whether prediagnosis comorbidity burden influences receipt of RT and whether the associations between RT and HRQOL trajectory and survival outcomes are modified by the comorbidity burden. Methods: We will use a retrospective cohort study design with the population-based Surveillance, Epidemiology, and End-Results database linked to the Medicare Health Outcomes Survey (SEER-MHOS). Older women (?65 years) who were diagnosed with low-risk breast cancer in 1998-2014, received breast-conserving surgery, and participated in MHOS 1998-2016 are eligible for this analysis. The latent class analysis clustering method will be used to identify each patient?s prediagnosis comorbidity burden, and HRQOL will be evaluated using the Short Form 36/Veterans RAND 12-Item Health Survey scales. The inverse-weighted estimates of the probability of treatment will be included to control for treatment selection bias and confounding effects in subsequent analysis. The association of RT with HRQOL trajectory will be evaluated using inverse-weighted multilevel growth mixture models. The inverse-weighted Cox regression model will be used to obtain hazard ratios with 95% CIs for the association of RT with survival outcomes. Differential effects of RT on both outcomes according to comorbidity burden class will also be evaluated. Results: As of October 2020, the study was approved by the institutional review board, and SEER-MHOS data were obtained from the National Cancer Institute. Women with low-risk breast cancer who met inclusion and exclusion criteria have been identified, and prediagnosis comorbidity burden class has been characterized using latent class analysis. Further data analysis will begin in November 2020, and the first manuscript will be submitted in a peer-reviewed journal in February 2021. Conclusions: This research can potentially improve clinical outcomes of older women with low-risk breast cancer by providing them additional information on the HRQOL trajectories when they make RT treatment decisions. It will facilitate informed, shared treatment decision making and cancer care planning to ultimately improve the HRQOL of older women with breast cancer. International Registered Report Identifier (IRRID): DERR1-10.2196/18056 UR - http://www.researchprotocols.org/2020/11/e18056/ UR - http://dx.doi.org/10.2196/18056 UR - http://www.ncbi.nlm.nih.gov/pubmed/33090111 ID - info:doi/10.2196/18056 ER - TY - JOUR AU - Zhong, Xiaorong AU - Luo, Ting AU - Deng, Ling AU - Liu, Pei AU - Hu, Kejia AU - Lu, Donghao AU - Zheng, Dan AU - Luo, Chuanxu AU - Xie, Yuxin AU - Li, Jiayuan AU - He, Ping AU - Pu, Tianjie AU - Ye, Feng AU - Bu, Hong AU - Fu, Bo AU - Zheng, Hong PY - 2020/11/9 TI - Multidimensional Machine Learning Personalized Prognostic Model in an Early Invasive Breast Cancer Population-Based Cohort in China: Algorithm Validation Study JO - JMIR Med Inform SP - e19069 VL - 8 IS - 11 KW - breast cancer KW - prognosis KW - machine learning KW - prediction model N2 - Background: Current online prognostic prediction models for breast cancer, such as Adjuvant! Online and PREDICT, are based on specific populations. They have been well validated and widely used in the United States and Western Europe; however, several validation attempts in non-European countries have revealed suboptimal predictions. Objective: We aimed to develop an advanced breast cancer prognosis model for disease progression, cancer-specific mortality, and all-cause mortality by integrating tumor, demographic, and treatment characteristics from a large breast cancer cohort in China. Methods: This study was approved by the Clinical Test and Biomedical Ethics Committee of West China Hospital, Sichuan University on May 17, 2012. Data collection for this project was started in May 2017 and ended in March 2019. Data on 5293 women diagnosed with stage I to III invasive breast cancer between 2000 and 2013 were collected. Disease progression, cancer-specific mortality, all-cause mortality, and the likelihood of disease progression or death within a 5-year period were predicted. Extreme gradient boosting was used to develop the prediction model. Model performance was assessed by calculating the area under the receiver operating characteristic curve (AUROC), and the model was calibrated and compared with PREDICT. Results: The training, test, and validation sets comprised 3276 (499 progressions, 202 breast cancer-specific deaths, and 261 all-cause deaths within 5-year follow-up), 1405 (211 progressions, 94 breast cancer-specific deaths, and 129 all-cause deaths), and 612 (109 progressions, 33 breast cancer-specific deaths, and 37 all-cause deaths) women, respectively. The AUROC values for disease progression, cancer-specific mortality, and all-cause mortality were 0.76, 0.88, and 0.82 for training set; 0.79, 0.80, and 0.83 for the test set; and 0.79, 0.84, and 0.88 for the validation set, respectively. Calibration analysis demonstrated good agreement between predicted and observed events within 5 years. Comparable AUROC and calibration results were confirmed in different age, residence status, and receptor status subgroups. Compared with PREDICT, our model showed similar AUROC and improved calibration values. Conclusions: Our prognostic model exhibits high discrimination and good calibration. It may facilitate prognosis prediction and clinical decision making for patients with breast cancer in China. UR - http://medinform.jmir.org/2020/11/e19069/ UR - http://dx.doi.org/10.2196/19069 UR - http://www.ncbi.nlm.nih.gov/pubmed/33164899 ID - info:doi/10.2196/19069 ER - TY - JOUR AU - Sasada, Shinsuke AU - Masumoto, Norio AU - Song, Hang AU - Emi, Akiko AU - Kadoya, Takayuki AU - Arihiro, Koji AU - Kikkawa, Takamaro AU - Okada, Morihito PY - 2020/10/19 TI - Microwave Breast Imaging Using Rotational Bistatic Impulse Radar for the Detection of Breast Cancer: Protocol for a Prospective Diagnostic Study JO - JMIR Res Protoc SP - e17524 VL - 9 IS - 10 KW - breast cancer KW - microwave imaging KW - diagnostic accuracy KW - screening KW - ultra-wideband radar N2 - Background: Mammography is the standard examination for breast cancer screening; however, it is associated with pain and exposure to ionizing radiation. Microwave breast imaging is a less invasive method for breast cancer surveillance. A bistatic impulse radar?based breast cancer detector has recently been developed. Objective: This study aims to present a protocol for evaluating the diagnostic accuracy of the novel microwave breast imaging device. Methods: This is a prospective diagnostic study. A total of 120 participants were recruited before treatment administration and divided into 2 cohorts: 100 patients diagnosed with breast cancer and 20 participants with benign breast tumors. The detector will be directly placed on each breast, while the participant is in supine position, without a coupling medium. Confocal images will be created based on the analyzed data, and the presence of breast tumors will be assessed. The primary endpoint will be the diagnostic accuracy, sensitivity, and specificity of the detector for breast cancer and benign tumors. The secondary endpoint will be the safety and detectability of each molecular subtype of breast cancer. For an exploratory endpoint, the influence of breast density and tumor size on tumor detection will be investigated. Results: Recruitment began in November 2018 and was completed by March 2020. We anticipate the preliminary results to be available by summer 2021. Conclusions: This study will provide insights on the diagnostic accuracy of microwave breast imaging using a rotational bistatic impulse radar. The collected data will improve the diagnostic algorithm of microwave imaging and lead to enhanced device performance. Trial Registration: Japan Registry of Clinical Trials jRCTs062180005; https://jrct.niph.go.jp/en-latest-detail/jRCTs062180005 International Registered Report Identifier (IRRID): DERR1-10.2196/17524 UR - http://www.researchprotocols.org/2020/10/e17524/ UR - http://dx.doi.org/10.2196/17524 UR - http://www.ncbi.nlm.nih.gov/pubmed/33074156 ID - info:doi/10.2196/17524 ER - TY - JOUR AU - Pan, Peng AU - Yu, Changhua AU - Li, Tao AU - Zhou, Xilei AU - Dai, Tingting AU - Tian, Hanhan AU - Xiong, Yaozu PY - 2020/9/29 TI - Xigua Video as a Source of Information on Breast Cancer: Content Analysis JO - J Med Internet Res SP - e19668 VL - 22 IS - 9 KW - breast cancer KW - internet KW - Xigua Video KW - content analysis N2 - Background: Seeking health information on the internet is a popular trend. Xigua Video, a short video platform in China, ranks among the most accessed websites in the country and hosts an increasing number of videos with medical information. However, the nature of these videos is frequently unscientific, misleading, or even harmful. Objective: Little is known about Xigua Video as a source of information on breast cancer. Thus, the study aimed to investigate the contents, quality, and reliability of breast cancer?related content on Xigua Video. Methods: On February 4, 2020, a Xigua Video search was performed using the keyword ?breast cancer.? Videos were categorized by 2 doctors based on whether the video content provided useful or misleading information. Furthermore, the reliability and quality of the videos were assessed using the 5-point DISCERN tool and 5-point global quality score criteria. Results: Out of the 170 videos selected for the study, 64 (37.6%) were classified as useful, whereas 106 (62.4%) provided misleading information. A total of 41.8% videos (71/170) were generated by individuals compared to 19.4% videos (33/170) contributed by health care professionals. The topics mainly covered etiology, anatomy, symptoms, preventions, treatments, and prognosis. The top topic was ?treatments? (119/170, 70%). The reliability scores and global quality scores of the videos in the useful information group were high (P<.001). No differences were observed between the 2 groups in terms of video length, duration in months, and comments. The number of total views was higher for the misleading information group (819,478.5 vs 647,940) but did not reach a level of statistical significance (P=.112). The uploading sources of the videos were mainly health care professionals, health information websites, medical advertisements, and individuals. Statistical differences were found between the uploading source groups in terms of reliability scores and global quality scores (P<.001). In terms of total views, video length, duration, and comments, no statistical differences were indicated among the said groups. However, a statistical difference was noted between the useful and misleading information video groups with respect to the uploading sources (P<.001). Conclusions: A large number of Xigua videos pertaining to breast cancer contain misleading information. There is a need for accurate health information to be provided on Xigua Video and other social media; health care professionals should address this challenge. UR - http://www.jmir.org/2020/9/e19668/ UR - http://dx.doi.org/10.2196/19668 UR - http://www.ncbi.nlm.nih.gov/pubmed/32883651 ID - info:doi/10.2196/19668 ER - TY - JOUR AU - Khana, Rajes AU - Mahinderjit Singh, Manmeet AU - Damanhoori, Faten AU - Mustaffa, Norlia PY - 2020/9/23 TI - Breast Self-Examination System Using Multifaceted Trustworthiness: Observational Study JO - JMIR Med Inform SP - e21584 VL - 8 IS - 9 KW - trust KW - trustworthiness KW - multifaceted trust KW - breast self-examination KW - breast cancer KW - health care system KW - social media N2 - Background: Breast cancer is the leading cause of mortality among women worldwide. However, female patients often feel reluctant and embarrassed about meeting physicians in person to discuss their intimate body parts, and prefer to use social media for such interactions. Indeed, the number of patients and physicians interacting and seeking information related to breast cancer on social media has been growing. However, a physician may behave inappropriately on social media by sharing a patient?s personal medical data excessively with colleagues or the public. Such an act would reduce the physician?s trustworthiness from the patient?s perspective. The multifaceted trust model is currently most commonly used for investigating social media interactions, which facilitates its enhanced adoption in the context of breast self-examination. The characteristics of the multifaceted trust model go beyond being personalized, context-dependent, and transitive. This model is more user-centric, which allows any user to evaluate the interaction process. Thus, in this study, we explored and evaluated use of the multifaceted trust model for breast self-examination as a more suitable trust model for patient-physician social media interactions in breast cancer screening. Objective: The objectives of this study were: (1) to identify the trustworthiness indicators that are suitable for a breast self-examination system, (2) design and propose a breast self-examination system, and (3) evaluate the multifaceted trustworthiness interaction between patients and physicians. Methods: We used a qualitative study design based on open-ended interviews with 32 participants (16 outpatients and 16 physicians). The interview started with an introduction to the research objective and an explanation of the steps on how to use the proposed breast self-examination system. The breast self-examination system was then evaluated by asking the patient to rate their trustworthiness with the physician after the consultation. The evaluation was also based on monitoring the activity in the chat room (interactions between physicians and patients) during daily meetings, weekly meetings, and the articles posted by the physician in the forum. Results: Based on the interview sessions with 16 physicians and 16 patients on using the breast self-examination system, honesty had a strong positive correlation (r=0.91) with trustworthiness, followed by credibility (r=0.85), confidence (r=0.79), and faith (r=0.79). In addition, belief (r=0.75), competency (r=0.73), and reliability (r=0.73) were strongly correlated with trustworthiness, with the lowest correlation found for reputation (r=0.72). The correlation among trustworthiness indicators was significant (P<.001). Moreover, the trust level of a patient for a particular physician was found to increase after several interactions. Conclusions: Multifaceted trustworthiness has a significant impact on a breast self-examination system. Evaluation of trustworthiness indicators helps to ensure a trustworthy system and ethical interaction between a patient and physician. A new patient can obtain a consultation by referring to the best physician according to preference of other patients. Patients can also trust a physician based on another patient?s recommendation regarding the physician?s trust level. The correlation analysis further showed that the most preferred trustworthiness indicator is honesty. UR - https://medinform.jmir.org/2020/9/e21584 UR - http://dx.doi.org/10.2196/21584 UR - http://www.ncbi.nlm.nih.gov/pubmed/32965225 ID - info:doi/10.2196/21584 ER - TY - JOUR AU - Monteiro-Guerra, Francisco AU - Signorelli, Ruiz Gabriel AU - Rivera-Romero, Octavio AU - Dorronzoro-Zubiete, Enrique AU - Caulfield, Brian PY - 2020/9/21 TI - Breast Cancer Survivors? Perspectives on Motivational and Personalization Strategies in Mobile App?Based Physical Activity Coaching Interventions: Qualitative Study JO - JMIR Mhealth Uhealth SP - e18867 VL - 8 IS - 9 KW - mHealth KW - mobile app KW - mobile phone KW - coaching KW - physical activity KW - breast cancer N2 - Background: Despite growing evidence supporting the vital benefits of physical activity (PA) for breast cancer survivors, the majority do not meet the recommended levels of activity. Mobile app?based PA coaching interventions might be a feasible strategy to facilitate adherence of breast cancer survivors to the PA guidelines. To engage these individuals, PA apps need to be specifically designed based on their needs and preferences and to provide targeted support and motivation. However, more information is needed to understand how these technologies can provide individual and relevant experiences that have the ability to increase PA adherence and retain the individual?s interest in the long term. Objective: The aim of this study is to explore insights from breast cancer survivors on motivational and personalization strategies to be used in PA coaching apps and interventions. Methods: A qualitative study was conducted, using individual semistructured interviews, with 14 breast cancer survivors. The moderator asked open-ended questions and made use of a slideshow presentation to elicit the participants? perspectives on potential mobile app?based intervention features. Transcribed interviews were evaluated by 3 reviewers using thematic content analysis. Results: Participants (mean age 53.3, SD 8.7 years) were White women. In total, 57% (8/14) of the participants did not adhere to the PA guidelines. In general, participants had access to and were interested in using technology. The identified themes included (1) barriers to PA, (2) psychological mediators of PA motivation, (3) needs and suggestions for reinforcing motivation support, (4) personalization aspects of the PA coaching experience, and (5) technology trustworthiness. Motivational determinants included perceived control, confidence and perceived growth, and connectedness. Participants were interested in having a straightforward app for monitoring and goal setting, which would include a prescribed activity program and schedule, and positive communication. Opinions varied in terms of social and game-like system possibilities. In addition, they expressed a desire for a highly personalized coaching experience based on as much information collected from them as possible (eg, disease stage, physical limitations, preferences) to provide individualized progress information, dynamic adjustment of the training plan, and context-aware activity suggestions (eg, based on weather and location). Participants also wanted the app to be validated or backed by professionals and were willing to share their data in exchange for a more personalized experience. Conclusions: This work suggests the need to develop simple, guiding, encouraging, trustworthy, and personalized PA coaching apps. The findings are in line with behavioral and personalization theories and methods that can be used to inform intervention design decisions. This paper opens new possibilities for the design of personalized and motivating PA coaching app experiences for breast cancer survivors, which might ultimately facilitate the sustained adherence of these individuals to the recommended levels of activity. UR - https://mhealth.jmir.org/2020/9/e18867 UR - http://dx.doi.org/10.2196/18867 UR - http://www.ncbi.nlm.nih.gov/pubmed/32955446 ID - info:doi/10.2196/18867 ER - TY - JOUR AU - Zhu, Haihua AU - Chen, Xiuwan AU - Yang, Jinqiu AU - Wu, Qiaoling AU - Zhu, Jiemin AU - Chan, Wai-Chi Sally PY - 2020/9/16 TI - Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 3): Secondary Data Analysis JO - JMIR Mhealth Uhealth SP - e18896 VL - 8 IS - 9 KW - breast cancer KW - chemotherapy KW - mobile app KW - mHealth N2 - Background: Many app-based interventions targeting women with breast cancer have been developed and tested for effectiveness. However, information regarding the evaluation of the usage of these interventions is scarce. A better understanding of usage data is important to determine how women use apps and how these interventions affect health outcomes. Objective: This study aimed to examine the usage duration and login frequency of an app-based intervention, the Breast Cancer e-Support (BCS) program, and to investigate the association between usage data and participants? demographic and medical characteristics. Methods: This study is a secondary data analysis of a randomized controlled trial assessing the effectiveness of the BCS program. The BCS program contains four modules: Learning Forum, Discussion Forum, Ask-the-Expert Forum, and Your Story Forum. A total of 57 women in the intervention group accessed the BCS program during their 12-week chemotherapy. The app?s background system tracked the usage duration and login frequency for each forum and the entire BCS program. Results: The total usage duration per participant ranged from 0 to 9371 minutes, and the login frequency per participant ranged from 0 to 774 times. The Discussion Forum and the Learning Forum were the most frequently used modules. The general linear model showed that age, education, family monthly income, and employment were associated with BCS usage duration and/or login frequency. Age (F1,45=10.09, P=.003, B=115.34, 95% CI 42.22-188.47) and education level (F1,45=7.22, P=.01, B=1949.63, 95% CI 487.76-3411.50) were positively associated with the usage duration of the entire BCS program. Family monthly income was positively associated with the usage duration of the Learning Forum (F1,45=11.85, P=.001, B=1488.55, 95% CI 617.58-2359.51) and the login frequency of the entire BCS program (F1,45=4.47, P=.04, B=113.68, 95% CI 5.33-222.03). Employment was negatively associated with the usage duration of the Ask-the-expert Forum (F1,45=4.50, P=.04, B=?971.87, 95% CI ?1894.66 to ?49.07) and the Your Story Forum (F1,45=5.36, P=.03, B=?640.71, 95% CI ?1198.30 to ?83.11) and positively associated with the login frequency of the entire BCS program (F1,45=10.86, P=.002, B=192.88, 95% CI 75.01-310.74). No statistical differences were found between BCS usage data and cancer stage, BMI, comorbidity, types of surgery, or cycles of chemotherapy. Conclusions: Overall, this study found considerable variability in the usage of app-based interventions. When health care professionals incorporate app-based interventions into their routine care for women with breast cancer, the learning and discussion functions of apps should be strengthened to promote engagement. Additionally, characteristics of women with breast cancer, such as age, level of education, income, and employment status, should be taken in consideration to develop tailored apps that address their particular needs and therefore improve their engagement with the app. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000639426; http://www.ANZCTR.org.au/ACTRN12616000639426.aspx UR - http://mhealth.jmir.org/2020/9/e18896/ UR - http://dx.doi.org/10.2196/18896 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936087 ID - info:doi/10.2196/18896 ER - TY - JOUR AU - Amadou, Amina AU - Coudon, Thomas AU - Praud, Delphine AU - Salizzoni, Pietro AU - Leffondre, Karen AU - Lévêque, Emilie AU - Boutron-Ruault, Marie-Christine AU - Danjou, N. Aurélie M. AU - Morelli, Xavier AU - Le Cornet, Charlotte AU - Perrier, Lionel AU - Couvidat, Florian AU - Bessagnet, Bertrand AU - Caudeville, Julien AU - Faure, Elodie AU - Mancini, Romana Francesca AU - Gulliver, John AU - Severi, Gianluca AU - Fervers, Béatrice PY - 2020/9/15 TI - Chronic Low-Dose Exposure to Xenoestrogen Ambient Air Pollutants and Breast Cancer Risk: XENAIR Protocol for a Case-Control Study Nested Within the French E3N Cohort JO - JMIR Res Protoc SP - e15167 VL - 9 IS - 9 KW - breast cancer KW - hormone receptor status KW - air pollution KW - endocrine disruptors KW - multipollutant KW - geographic information system KW - land use regression KW - chemistry-transport model KW - epigenetic KW - gene-environment interaction KW - prospective study N2 - Background: Breast cancer is the most frequent cancer in women in industrialized countries. Lifestyle and environmental factors, particularly endocrine-disrupting pollutants, have been suggested to play a role in breast cancer risk. Current epidemiological studies, although not fully consistent, suggest a positive association of breast cancer risk with exposure to several International Agency for Research on Cancer Group 1 air-pollutant carcinogens, such as particulate matter, polychlorinated biphenyls (PCB), dioxins, Benzo[a]pyrene (BaP), and cadmium. However, epidemiological studies remain scarce and inconsistent. It has been proposed that the menopausal status could modify the relationship between pollutants and breast cancer and that the association varies with hormone receptor status. Objective: The XENAIR project will investigate the association of breast cancer risk (overall and by hormone receptor status) with chronic exposure to selected air pollutants, including particulate matter, nitrogen dioxide (NO2), ozone (O3), BaP, dioxins, PCB-153, and cadmium. Methods: Our research is based on a case-control study nested within the French national E3N cohort of 5222 invasive breast cancer cases identified during follow-up from 1990 to 2011, and 5222 matched controls. A questionnaire was sent to all participants to collect their lifetime residential addresses and information on indoor pollution. We will assess these exposures using complementary models of land-use regression, atmospheric dispersion, and regional chemistry-transport (CHIMERE) models, via a Geographic Information System. Associations with breast cancer risk will be modeled using conditional logistic regression models. We will also study the impact of exposure on DNA methylation and interactions with genetic polymorphisms. Appropriate statistical methods, including Bayesian modeling, principal component analysis, and cluster analysis, will be used to assess the impact of multipollutant exposure. The fraction of breast cancer cases attributable to air pollution will be estimated. Results: The XENAIR project will contribute to current knowledge on the health effects of air pollution and identify and understand environmental modifiable risk factors related to breast cancer risk. Conclusions: The results will provide relevant evidence to governments and policy-makers to improve effective public health prevention strategies on air pollution. The XENAIR dataset can be used in future efforts to study the effects of exposure to air pollution associated with other chronic conditions. International Registered Report Identifier (IRRID): DERR1-10.2196/15167 UR - http://www.researchprotocols.org/2020/9/e15167/ UR - http://dx.doi.org/10.2196/15167 UR - http://www.ncbi.nlm.nih.gov/pubmed/32930673 ID - info:doi/10.2196/15167 ER - TY - JOUR AU - Felder, M. Tisha AU - Heiney, P. Sue AU - Hebert, R. James AU - Friedman, B. Daniela AU - Elk, Ronit AU - Franco, Regina AU - Gansauer, Lucy AU - Christensen, Barbara AU - Ford, E. Marvella PY - 2020/9/3 TI - Improving Adherence to Adjuvant Hormonal Therapy Among Disadvantaged Women Diagnosed with Breast Cancer in South Carolina: Proposal for a Multimethod Study JO - JMIR Res Protoc SP - e17742 VL - 9 IS - 9 KW - breast neoplasms KW - medicaid KW - medication adherence KW - vulnerable populations KW - hormonal therapy KW - endocrine therapy KW - qualitative methods N2 - Background: Current clinical guidelines recommend that hormone receptor?positive breast cancer survivors take adjuvant hormonal therapy (AHT) for 5 to 10 years, following the end of definitive treatment. However, fewer than half of patients adhere to the guidelines, and suboptimal adherence to AHT is associated with an increased risk of breast cancer mortality. Research has extensively documented sociodemographic and disease-specific factors associated with adherence to AHT, but very little evidence exists on behavioral factors (eg, knowledge, patient-provider communication) that can be modified and targeted by interventions. Objective: The goal of this study is to develop and test a theory-based, multilevel intervention to improve adherence to AHT among breast cancer survivors from racially and socioeconomically disadvantaged backgrounds (eg, Medicaid-insured). The specific aims are to (1) explore multilevel (eg, patient, health care system) factors that influence adherence to AHT; (2) develop a theory-based, multilevel intervention to improve adherence to AHT; and (3) pilot test and evaluate the intervention developed in Aim 2. Methods: For Aim 1, we will recruit breast cancer survivors and health care professionals to participate in semistructured interviews to gain their perspectives about barriers and facilitators to AHT use. We will conduct a directed content analysis of the Aim 1 qualitative interview data. For Aim 2, we will integrate Aim 1 findings and current literature into the design of a multilevel intervention using an Intervention Mapping approach. For Aim 3, we will recruit Medicaid-insured breast cancer survivors to assess the feasibility of the pilot intervention. Results: From May 2016 to July 2018, we completed interviews with 19 breast cancer survivors and 23 health care professionals in South Carolina. We will conduct a directed content analysis of the qualitative interview data. Results from this analysis will be used, in combination with current literature, to design (Aim 2) and pilot test a theory-based multilevel intervention (Aim 3) in Summer 2021. Results of the pilot are expected for Fall 2021. Conclusions: This study will provide a deeper understanding of how to improve adherence to AHT, using a novel and multilevel approach, among socioeconomically disadvantaged breast cancer survivors who often experience disproportionate breast cancer mortality. International Registered Report Identifier (IRRID): DERR1-10.2196/17742 UR - https://www.researchprotocols.org/2020/9/e17742 UR - http://dx.doi.org/10.2196/17742 UR - http://www.ncbi.nlm.nih.gov/pubmed/32880374 ID - info:doi/10.2196/17742 ER - TY - JOUR AU - A'mar, Teresa AU - Beatty, David J. AU - Fedorenko, Catherine AU - Markowitz, Daniel AU - Corey, Thomas AU - Lange, Jane AU - Schwartz, M. Stephen AU - Huang, Bin AU - Chubak, Jessica AU - Etzioni, Ruth PY - 2020/8/17 TI - Incorporating Breast Cancer Recurrence Events Into Population-Based Cancer Registries Using Medical Claims: Cohort Study JO - JMIR Cancer SP - e18143 VL - 6 IS - 2 KW - cancer registries KW - medical claims KW - cancer recurrence event KW - statistical learning KW - breast cancer KW - medical informatics KW - data mining N2 - Background: There is a need for automated approaches to incorporate information on cancer recurrence events into population-based cancer registries. Objective: The aim of this study is to determine the accuracy of a novel data mining algorithm to extract information from linked registry and medical claims data on the occurrence and timing of second breast cancer events (SBCE). Methods: We used supervised data from 3092 stage I and II breast cancer cases (with 394 recurrences), diagnosed between 1993 and 2006 inclusive, of patients at Kaiser Permanente Washington and cases in the Puget Sound Cancer Surveillance System. Our goal was to classify each month after primary treatment as pre- versus post-SBCE. The prediction feature set for a given month consisted of registry variables on disease and patient characteristics related to the primary breast cancer event, as well as features based on monthly counts of diagnosis and procedure codes for the current, prior, and future months. A month was classified as post-SBCE if the predicted probability exceeded a probability threshold (PT); the predicted time of the SBCE was taken to be the month of maximum increase in the predicted probability between adjacent months. Results: The Kaplan-Meier net probability of SBCE was 0.25 at 14 years. The month-level receiver operating characteristic curve on test data (20% of the data set) had an area under the curve of 0.986. The person-level predictions (at a monthly PT of 0.5) had a sensitivity of 0.89, a specificity of 0.98, a positive predictive value of 0.85, and a negative predictive value of 0.98. The corresponding median difference between the observed and predicted months of recurrence was 0 and the mean difference was 0.04 months. Conclusions: Data mining of medical claims holds promise for the streamlining of cancer registry operations to feasibly collect information about second breast cancer events. UR - http://cancer.jmir.org/2020/2/e18143/ UR - http://dx.doi.org/10.2196/18143 UR - http://www.ncbi.nlm.nih.gov/pubmed/32804084 ID - info:doi/10.2196/18143 ER - TY - JOUR AU - Crafoord, Marie-Therése AU - Fjell, Maria AU - Sundberg, Kay AU - Nilsson, Marie AU - Langius-Eklöf, Ann PY - 2020/8/10 TI - Engagement in an Interactive App for Symptom Self-Management during Treatment in Patients With Breast or Prostate Cancer: Mixed Methods Study JO - J Med Internet Res SP - e17058 VL - 22 IS - 8 KW - engagement KW - adherence KW - mHealth KW - mobile app KW - cancer supportive care KW - symptom management KW - usage metrics KW - breast cancer KW - prostate cancer N2 - Background: Using mobile technology for symptom management and self-care can improve patient-clinician communication and clinical outcomes in patients with cancer. The interactive app Interaktor has been shown to reduce symptom burden during cancer treatment. It includes symptom assessment, an alert system for contact with health care professionals, access to self-care advice, and visualization of symptom history. It is essential to understand how digital interventions operate; one approach is to examine engagement by assessing usage and exploring user experiences. Actual usage in relation to the intended use?adherence?is an essential factor of engagement. Objective: This study aimed to describe engagement with the Interaktor app among patients with breast or prostate cancer during treatment. Methods: Patients from the intervention groups of two separate randomized controlled trials were included: patients with breast cancer receiving neoadjuvant chemotherapy (n=74) and patients with locally advanced prostate cancer receiving treatment with radiotherapy (n=75). The patients reported their symptoms daily. Sociodemographic and clinical data were obtained from baseline questionnaires and medical records. Logged data usage was retrieved from the server and analyzed descriptively and with multiple regression analysis. Telephone interviews were conducted with patients about their perceptions of using the app and analyzed using content analysis. Results: The median adherence percentage to daily symptom reporting was 83%. Most patients used the self-care advice and free text message component. Among the patients treated for breast cancer, higher age predicted a higher total number of free text messages sent (P=.04). Among the patients treated for prostate cancer, higher age (P=.01) and higher education level (P=.04), predicted an increase in total views on self-care advice, while higher comorbidity (P=.004) predicted a decrease in total views on self-care advice. Being married or living with a partner predicted a higher adherence to daily symptom reporting (P=.02). Daily symptom reporting created feelings of having continuous contact with health care professionals, being acknowledged, and safe. Being contacted by a nurse after a symptom alert was considered convenient and highly valued. Treatment and time-related aspects influenced engagement. Daily symptom reporting was perceived as particularly meaningful at the beginning of treatment. Requests were made for advice on diet and psychological symptoms, as well as for more comprehensive and detailed information as the patient progressed through treatment. Conclusions: Patient engagement in the interactive app Interaktor was high. The app promoted patient participation in their care through continuous and convenient contact with health care professionals. The predictive ability of demographic variables differed between patient groups, but higher age and a higher educational level predicted higher usage of specific app functions for both patient groups. Patients? experience of relevance and interactivity influenced their engagement positively. UR - https://www.jmir.org/2020/8/e17058 UR - http://dx.doi.org/10.2196/17058 UR - http://www.ncbi.nlm.nih.gov/pubmed/32663140 ID - info:doi/10.2196/17058 ER - TY - JOUR AU - Dauphin, Cassy AU - Clark, Nikia AU - Cadzow, Renee AU - Saad-Harfouche, Frances AU - Rodriguez, Elisa AU - Glaser, Kathryn AU - Kiviniemi, Marc AU - Keller, Maria AU - Erwin, Deborah PY - 2020/8/10 TI - #BlackBreastsMatter: Process Evaluation of Recruitment and Engagement of Pregnant African American Women for a Social Media Intervention Study to Increase Breastfeeding JO - J Med Internet Res SP - e16239 VL - 22 IS - 8 KW - breastfeeding KW - breast cancer education KW - African American mothers KW - Facebook KW - mobile phone, social media N2 - Background: In the United States, there are lower rates of breastfeeding among African American mothers, particularly those who are younger women. Recent epidemiological studies have shown a strong association of more aggressive types of breast cancer (estrogen receptor negative) among African American women, with a higher risk in African American women who did not breastfeed their children. Objective: This study aims to describe the process evaluation of recruitment and educational strategies to engage pregnant African American participants for a pilot study designed to determine whether social media messaging about breast cancer risk reduction through breastfeeding may positively influence breastfeeding rates. Methods: This pilot study is conducted in collaboration with a local Women, Infants, and Children (WIC) organization and hospital and prenatal clinics of a local health care network. To engage African American women to enroll in the study, several methods and monitoring processes were explored, including WIC electronic text-based messages sent out to all phones of current WIC recipients (referred to as e-blasts); keyword responses to texts from flyers and posters in local community-based organizations, hospitals, and prenatal clinics; keyword responses using electronic links posted in established Facebook groups; and snowball recruitment of other pregnant women by current participants through Facebook. Once enrolled, participants were randomized to 2 study conditions: (1) an intervention group receiving messages about breast cancer risk reduction and breastfeeding or (2) a control group receiving breastfeeding-only messages. Data were obtained through electronic monitoring, SurveyMonkey, qualitative responses on Facebook, focus groups, and interviews. Results: More than 3000 text messages were sent and received through WIC e-blasts and keyword responses from flyers. A total of 472 women were recruited through WIC e-blast, and 161 responded to flyers and contacts through the local health care network, community-based organizations, Facebook, and friend referrals. A total of 633 women were assessed for eligibility to participate in the study. A total of 288 pregnant African American women were enrolled, consented, and completed presurvey assessments (102.8% of the goal), and 22 participants attended focus groups or interviews reporting on their experiences with Facebook and the educational messages. Conclusions: This process evaluation suggests that using electronic, smartphone apps with social media holds promise for both recruitment and conduct of health education intervention studies for pregnant African American women. Providing messaging and resources through social media to reinforce and educate women about breastfeeding and potentially provide lactation support is intriguing. Convenience (for researchers and participants) is an attribute of social media for this demographic of women and worthy of further research as an educational tool. Trial Registration: ClinicalTrials.gov NCT03680235; https://clinicaltrials.gov/ct2/show/NCT03680235 UR - https://www.jmir.org/2020/8/e16239 UR - http://dx.doi.org/10.2196/16239 UR - http://www.ncbi.nlm.nih.gov/pubmed/32773377 ID - info:doi/10.2196/16239 ER - TY - JOUR AU - Gra?i? Kuhar, Cvetka AU - Gortnar Cepeda, Tja?a AU - Kova?, Timotej AU - Kukar, Matja? AU - Ru?i? Gorenjec, Nina PY - 2020/8/4 TI - Mobile App for Symptom Management and Associated Quality of Life During Systemic Treatment in Early Stage Breast Cancer: Nonrandomized Controlled Prospective Cohort Study JO - JMIR Mhealth Uhealth SP - e17408 VL - 8 IS - 8 KW - breast cancer KW - systemic therapy KW - mobile application KW - patient-reported outcome KW - quality of life N2 - Background: Providing patients with cancer who are undergoing systemic therapy with useful information about symptom management is essential to prevent unnecessary deterioration of quality of life. Objective: The aim was to evaluate whether use of an app for symptom management was associated with any change in patient quality of life or use of health resources. Methods: Outpatients with early stage breast cancer receiving systemic therapy were recruited at the Institute of Oncology in Ljubljana, Slovenia. Patients who received systemic therapy between December 2017 and March 2018 (control group) and between April 2018 and September 2018 (intervention group) were eligible. All patients received standard care, but only those in the intervention group were asked to use mPRO Mamma, an Android-based smartphone app, in addition. The app supported daily tracking of 50 symptoms, allowed users to grade their symptom severity (as mild, moderate, or severe), and also provided in-depth descriptions and recommendations based on reported symptom level. Patient-reported outcomes in both groups were assessed through the European Organisation for Research and Treatment of Cancer (EORTC) core (C-30) and breast cancer (BR-23) questionnaires, as well as a questionnaire about health resources use. The primary outcomes were the difference in the global quality of life between groups and the difference in summary score of the EORTC C-30 questionnaire between groups after 3 time periods (the first week of treatment, the first treatment cycle, and the entire treatment). The secondary outcome was the use of health resources (doctor visits and hospitalizations) in each time period. Other scales were used for exploratory analysis. Results: The mean difference between the intervention group (n=46) and the control group (n=45) in global quality of life (adjusted for baseline and type of surgery) after the first week was 10.1 (95% CI 1.8 to 18.5, P=.02). The intervention group summary scores were significantly higher than those of the control group after the first week (adjusted mean difference: 8.9, 95% CI 3.1 to 14.7, P=.003) and at the end of treatment (adjusted mean difference: 10.6, 95% CI 3.9 to 17.3, P=.002). Use of health resources was not statistically significant between the groups in either the first week (P=.12) or the first treatment cycle (P=.13). Exploratory analysis findings demonstrated clinically important improvements (indicated by EORTC C-30 or BR-23 scale scores)?social, physical, role, and cognitive function were improved while pain, appetite loss, and systemic therapy side effects were reduced. Conclusions: Use of the app enabled patients undergoing systemic therapy for early stage breast cancer to better cope with symptoms which was demonstrated by a better global quality of life and summary score after the first week and by a better summary score at the end of treatment in the intervention group compared to those of the control group, but no change in the use of health resources was demonstrated. UR - https://mhealth.jmir.org/2020/8/e17408 UR - http://dx.doi.org/10.2196/17408 UR - http://www.ncbi.nlm.nih.gov/pubmed/32427567 ID - info:doi/10.2196/17408 ER - TY - JOUR AU - Brennan, Louise AU - Kessie, Threase AU - Caulfield, Brian PY - 2020/7/29 TI - Patient Experiences of Rehabilitation and the Potential for an mHealth System with Biofeedback After Breast Cancer Surgery: Qualitative Study JO - JMIR Mhealth Uhealth SP - e19721 VL - 8 IS - 7 KW - breast cancer KW - physiotherapy KW - rehabilitation KW - mHealth KW - biofeedback KW - user-centred design KW - cancer N2 - Background: Physiotherapy-led home rehabilitation after breast cancer surgery can protect against the development of upper limb dysfunction and other disabling consequences of surgery. A variety of barriers can limit physical rehabilitation outcomes, and patients may benefit from more support during this time. Mobile health (mHealth) systems can assist patients during rehabilitation by providing exercise support, biofeedback, and information. Before designing mHealth systems for a specific population, developers must first engage with users to understand their experiences and needs. Objective: The aims of this study were to explore patients? rehabilitation experiences and unmet needs during home rehabilitation after breast cancer surgery and to understand their experiences of mHealth technology and the requirements they desire from an mHealth system. Methods: This was the first stage of a user-centered design process for an mHealth system. We interviewed 10 breast cancer survivors under the two main topics of ?Rehabilitation? and ?Technology? and performed a thematic analysis on the interview data. Results: Discussions regarding rehabilitation focused on the acute and long-term consequences of surgery; unmet needs and lack of support; self-driven rehabilitation; and visions for high-quality rehabilitation. Regarding technology, participants reported a lack of mHealth options for this clinical context and using non-cancer?specific applications and wearables. Participants requested an mHealth tool from a reliable source that provides exercise support. Conclusions: There are unmet needs surrounding access to physiotherapy, information, and support during home rehabilitation after breast cancer surgery that could be addressed with an mHealth system. Breast cancer survivors are open to using an mHealth system and require that it comes from a reliable source and focuses on supporting exercise performance. UR - http://mhealth.jmir.org/2020/7/e19721/ UR - http://dx.doi.org/10.2196/19721 UR - http://www.ncbi.nlm.nih.gov/pubmed/32687476 ID - info:doi/10.2196/19721 ER - TY - JOUR AU - Lu, Hongru AU - Xie, Juan AU - Gerido, Hammond Lynette AU - Cheng, Ying AU - Chen, Ya AU - Sun, Lizhu PY - 2020/7/28 TI - Information Needs of Breast Cancer Patients: Theory-Generating Meta-Synthesis JO - J Med Internet Res SP - e17907 VL - 22 IS - 7 KW - breast cancer patients KW - information needs KW - incentives KW - moderating variables KW - meta-synthesis N2 - Background: Breast cancer has become one of the most frequently diagnosed carcinomas and the leading cause of cancer deaths. The substantial growth in the number of breast cancer patients has put great pressure on health services. Meanwhile, the information patients need has increased and become more complicated. Therefore, a comprehensive and in-depth understanding of their information needs is urgently needed to improve the quality of health care. However, previous studies related to the information needs of breast cancer patients have focused on different perspectives and have only contributed to individual results. A systematic review and synthesis of breast cancer patients? information needs is critical. Objective: This paper aims to systematically identify, evaluate, and synthesize existing primary qualitative research on the information needs of breast cancer patients. Methods: Web of Science, EBSCO, Scopus, ProQuest, PubMed, PsycINFO, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature were searched on February 12 and July 9, 2019, to collect relevant studies. A Google Scholar search, interpersonal network recommendations, and reference chaining were also conducted. Eligible studies included qualitative or mixed-methods studies focusing on the information needs (across the cancer continuum) of breast cancer patients or their social networks. Subsequently, a Critical Appraisals Skills Programme checklist was used to assess the quality of included research. The results, findings, and discussions were extracted. Data analysis was guided by the theory-generating meta-synthesis and grounded theory approach. Results: Three themes, 19 categories, and 55 concepts emerged: (1) incentives (physical abnormality, inquiry from others, subjective norm, and problems during appointments); (2) types of information needs (prevention, etiology, diagnosis, clinical manifestation, treatment, prognosis, impact and resumption of normal life, scientific research, and social assistance); (3) moderating variables (attitudes, health literacy, demographic characteristics, disease status, as well as political and cultural environment). The studies revealed that the information needs of breast cancer patients were triggered by different incentives. Subsequently, the patients sought a variety of information among different stages of the cancer journey. Five types of variables were also found to moderate the formation of information needs. Conclusions: This study contributes to a thorough model of information needs among breast cancer patients and provides practical suggestions for health and information professionals. UR - https://www.jmir.org/2020/7/e17907 UR - http://dx.doi.org/10.2196/17907 UR - http://www.ncbi.nlm.nih.gov/pubmed/32720899 ID - info:doi/10.2196/17907 ER - TY - JOUR AU - Pereira, Claudio Antonio Augusto AU - Destro, Regina Juliana AU - Picinin Bernuci, Marcelo AU - Garcia, França Lucas AU - Rodrigues Lucena, Franklin Tiago PY - 2020/7/21 TI - Effects of a WhatsApp-Delivered Education Intervention to Enhance Breast Cancer Knowledge in Women: Mixed-Methods Study JO - JMIR Mhealth Uhealth SP - e17430 VL - 8 IS - 7 KW - mHealth KW - WhatsApp KW - cancer education KW - breast cancer N2 - Background: Breast cancer is the leading cause of cancer-related death in the female population. Health education interventions based on the use of mobile technologies enable the development of health self-care skills and have emerged as alternative strategies for the control of breast cancer. In previous studies, WhatsApp has stood out as a useful tool in health education strategies; however, it has not yet been applied for breast cancer education. Objective: This study aimed to analyze the potential of WhatsApp as a health education tool used to improve women's knowledge on the risk reduction of breast cancer. It also aimed to understand how women feel sensitized within the WhatsApp group throughout the intervention and how they incorporate information posted to improve knowledge about early detection and risk reduction methods. Methods: The study involved a pre-post health educational intervention with 35 women (aged 45-69 years) included in a WhatsApp group to share information (audio, video, text, and images) over 3 weeks on the early detection and risk reduction of breast cancer. Data were collected through questionnaires on topics related to risk reduction, as well as qualitative content analysis of group interactions. Effectiveness and feasibility were analyzed through conversations and the comparison of the scores obtained in the questionnaires before and after the intervention. Results: A total of 293 messages were exchanged (moderator 120 and users 173). The average scores of the participants were 11.21 and 13.68 points before and after the educational intervention, respectively, with sufficient sample evidence that the difference was significant (P<.001). The intervention enabled women to improve their knowledge on all topics addressed, especially ?myths and truths,? ?incidence,? ?clinical manifestations,? and ?protective factors.? Some themes emerged from the interactions in the group, including group dynamics, general doubts, personal narratives, religious messages, daily news, and events. Conclusions: The use of groups for women in WhatsApp for health education purposes seems to be a viable alternative in strategies on breast cancer control, especially as it provides a space for the exchange of experiences and disinhibition. However, the need for a moderator to answer the questions and the constant distractions by members of the group represent important limitations that should be considered when improving this strategy. UR - http://mhealth.jmir.org/2020/7/e17430/ UR - http://dx.doi.org/10.2196/17430 UR - http://www.ncbi.nlm.nih.gov/pubmed/32706726 ID - info:doi/10.2196/17430 ER - TY - JOUR AU - Weiner, S. Lauren AU - Nagel, Stori AU - Su, Irene H. AU - Hurst, Samantha AU - Hartman, J. Sheri PY - 2020/7/8 TI - A Remotely Delivered, Peer-Led Physical Activity Intervention for Younger Breast Cancer Survivors (Pink Body Spirit): Protocol for a Feasibility Study and Mixed Methods Process Evaluation JO - JMIR Res Protoc SP - e18420 VL - 9 IS - 7 KW - physical activity KW - cancer survivors KW - peer mentors KW - quality of life KW - pilot study KW - breast cancer KW - fitness trackers KW - mobile phone N2 - Background: Younger breast cancer survivors consistently report a greater impact of their cancer experience on quality of life compared with older survivors, including higher rates of body image disturbances, sexual dysfunction, and fatigue. One potential strategy to improve quality of life is through physical activity, but this has been understudied in younger breast cancer survivors, who often decrease their activity during and after cancer treatment. Objective: The aim of this study is to explore the feasibility and acceptability of a technology-based, remotely delivered, peer-led physical activity intervention for younger breast cancer survivors. We will also assess the preliminary impact of the intervention on changes in physical activity and multiple aspects of quality of life. Methods: This study is a community-academic partnership between University of California, San Diego and Haus of Volta, a nonprofit organization that promotes positive self-image in younger breast cancer survivors. This ongoing pilot study aims to recruit 30 younger breast cancer survivors across the United States (<55 years old, >6 months post primary cancer treatment, self-report <60 min of moderate-to-vigorous-intensity physical activity [MVPA]) into a 3-month peer-delivered, fully remote exercise program. Participants will complete 6 biweekly video chat sessions with a trained peer mentor, a fellow younger breast cancer survivor. Participants will receive a Fitbit Charge 3; weekly feedback on Fitbit data from their peer mentor; and access to a private, in-app Fitbit Community to provide and receive support from other participants and all peer mentors. At baseline, 3 months, and 6 months, participants will complete quality of life questionnaires, and MVPA will be measured using the ActiGraph accelerometer. Feasibility and acceptability will be explored through a mixed methods approach (ie, quantitative questionnaires and qualitative interviews). Intervention delivery and adaptations by peer mentors will be tracked through peer mentor self-evaluations and reflections, review of video-recorded mentoring sessions, and monthly templated reflections by the research team. Results: Recruitment began in September 2019. As of February 2020, the physical activity intervention is ongoing. Final measures are expected to occur in summer 2020. Conclusions: This study explores the potential for physical activity to improve sexual function, body image, and fatigue, key quality of life issues in younger breast cancer survivors. Using peer mentors extends our reach into the young survivor community. The detailed process evaluation of intervention delivery and adaptations by mentors could inform a future hybrid-effectiveness implementation trial. Finally, remote delivery with commercially available technology could promote broader dissemination. Trial Registration: ClinicalTrials.gov NCT04064892; https://clinicaltrials.gov/ct2/show/NCT04064892 International Registered Report Identifier (IRRID): DERR1-10.2196/18420 UR - https://www.researchprotocols.org/2020/7/e18420 UR - http://dx.doi.org/10.2196/18420 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673270 ID - info:doi/10.2196/18420 ER - TY - JOUR AU - Lally, M. Robin AU - Kupzyk, Kevin AU - Gallo, Steve AU - Berry, Donna PY - 2020/7/6 TI - Use of an Unguided, Web-Based Distress Self-Management Program After Breast Cancer Diagnosis: Sub-Analysis of CaringGuidance Pilot Study JO - J Med Internet Res SP - e19734 VL - 22 IS - 7 KW - eHealth KW - psychoeducation KW - supportive oncology KW - distress KW - self-management KW - oncology KW - breast cancer N2 - Background: Unguided, web-based psychoeducational interventions are gaining interest as a way to reach patients while reducing pressure on clinical resources. However, there has been little research on how patients with cancer use these interventions. Objective: The objective of this analysis was to evaluate how women newly diagnosed with breast cancer used the unguided web-based, psychoeducational distress self-management program CaringGuidance After Breast Cancer Diagnosis while enrolled in a pilot feasibility study. Methods: Women with stage 0 to II breast cancer diagnosed within the prior three months were recruited from clinics primarily in the Northeastern United States for participation in a 12-week pilot study of CaringGuidance plus usual care versus usual care alone. Usage prompts included sets of emails sent weekly for 12 weeks; standardized congratulatory emails after every two hours of program use, and informative emails for each cognitive-behavioral exercise. Individual user activity on the site was automatically tracked by an analytics system and recorded directly in the CaringGuidance database. Results: Complete usage data were available for 54 subjects. Ninety-eight percent of the intervention group logged into CaringGuidance independently at least once. Thirty-eight (70%) logged in during all three months, 15 (28%) were intermittent users, and one (2%) was a non-user. Users (n=53) averaged 15.6 (SD 9.85) logins. Mean logins were greatest in month 1 (7.26, SD 4.02) and declined in months 2 (4.32, SD 3.66) and month 3 (4.02, SD 3.82). Eleven (21%) used CaringGuidance with both the frequency and activity level intended at study outset, 9 (17%) exceeded intended frequency and activity (high-high users), and 10 (19%) were below expected usage on both login frequency and activity (low-low users). Low-low users and high-high users differed significantly (P<.001) in the total number of views and unique views of all program components. Change in depressive symptoms and the number of sessions (r=.351) and logins (r=.348) between study months 1 and 2 were significantly correlated (P=.018, .019). Higher baseline distress was associated with more unique views of program resources (r=.281, P=.043). Change in intrusive/avoidant thoughts from baseline to month 3, and the number of users? unique exercise views were negatively correlated (r=?.319, P=.035) so that more unique exercise views, equated with greater decline in intrusive/avoidant thoughts from baseline to month 3. Conclusions: These findings favor the hypothesis that the key ingredient is not the amount of program use, but each user?s self-selected activity within the program. More research is needed on the ideal ways to maintain use, and capture and define engagement and enactment of behaviors by people with cancer accessing unguided, self-management web-based programs. UR - https://www.jmir.org/2020/7/e19734 UR - http://dx.doi.org/10.2196/19734 UR - http://www.ncbi.nlm.nih.gov/pubmed/32628117 ID - info:doi/10.2196/19734 ER - TY - JOUR AU - Chuang, Li-Yeh AU - Yang, Cheng-San AU - Yang, Huai-Shuo AU - Yang, Cheng-Hong PY - 2020/6/17 TI - Identification of High-Order Single-Nucleotide Polymorphism Barcodes in Breast Cancer Using a Hybrid Taguchi-Genetic Algorithm: Case-Control Study JO - JMIR Med Inform SP - e16886 VL - 8 IS - 6 KW - genetic algorithm KW - single-nucleotide polymorphism KW - breast cancer KW - case-control study N2 - Background: Breast cancer has a major disease burden in the female population, and it is a highly genome-associated human disease. However, in genetic studies of complex diseases, modern geneticists face challenges in detecting interactions among loci. Objective: This study aimed to investigate whether variations of single-nucleotide polymorphisms (SNPs) are associated with histopathological tumor characteristics in breast cancer patients. Methods: A hybrid Taguchi-genetic algorithm (HTGA) was proposed to identify the high-order SNP barcodes in a breast cancer case-control study. A Taguchi method was used to enhance a genetic algorithm (GA) for identifying high-order SNP barcodes. The Taguchi method was integrated into the GA after the crossover operations in order to optimize the generated offspring systematically for enhancing the GA search ability. Results: The proposed HTGA effectively converged to a promising region within the problem space and provided excellent SNP barcode identification. Regression analysis was used to validate the association between breast cancer and the identified high-order SNP barcodes. The maximum OR was less than 1 (range 0.870-0.755) for two- to seven-order SNP barcodes. Conclusions: We systematically evaluated the interaction effects of 26 SNPs within growth factor?related genes for breast carcinogenesis pathways. The HTGA could successfully identify relevant high-order SNP barcodes by evaluating the differences between cases and controls. The validation results showed that the HTGA can provide better fitness values as compared with other methods for the identification of high-order SNP barcodes using breast cancer case-control data sets. UR - https://medinform.jmir.org/2020/6/e16886 UR - http://dx.doi.org/10.2196/16886 UR - http://www.ncbi.nlm.nih.gov/pubmed/32554381 ID - info:doi/10.2196/16886 ER - TY - JOUR AU - Power, M. Julianne AU - Tate, F. Deborah AU - Valle, G. Carmina PY - 2020/6/8 TI - Experiences of African American Breast Cancer Survivors Using Digital Scales and Activity Trackers in a Weight Gain Prevention Intervention: Qualitative Study JO - JMIR Mhealth Uhealth SP - e16059 VL - 8 IS - 6 KW - African American KW - cancer survivors KW - digital tools KW - weight gain prevention KW - qualitative N2 - Background: The use of digital tools to promote daily self-weighing and daily activity tracking may be a promising strategy for weight control among African American breast cancer survivors (AABCS). There have been no studies exploring the acceptability and feasibility of using digital tools for weight control or qualitative studies characterizing perceptions of daily self-weighing and daily activity tracking among AABCS. Objective: This study aimed to explore the subjective experiences of daily self-weighing and daily activity tracking using digital tools, including wireless scales and activity trackers, in a sample of AABCS participating in two technology-based weight gain prevention interventions over 6 months. Methods: Semistructured interviews (N=21) were conducted in person or over the phone, were audio recorded, and then transcribed verbatim. Each transcript was read to identify key themes and develop a codebook. Each transcript was coded using Atlas.ti software, and code outputs were used to identify overarching themes and patterns in the data. Results: On average, participants were 52.6 (SD 8.3) years of age, with obesity at baseline (BMI 33.1 kg/m2, SD 5.9), and weighed on 123.4 (SD 48.0) days out of the 168 days (73.5%) in the study period. Women tended to attribute their weight gain to cancer treatment and framed program benefits in terms of improved quality of life and perceptions of prolonging their survival following treatment. Using the smart scale for daily self-weighing was viewed as the tool by which participants could control their weight and improve their health and well-being posttreatment. The activity tracker increased awareness of physical activity and motivated participants to be more active. Conclusions: Participants reported positive experiences and benefits from daily self-weighing and daily activity tracking. Findings suggest that daily self-weighing and daily activity tracking using digital tools are well-received, acceptable, and feasible intervention strategies for AABCS in the context of posttreatment weight management. UR - https://mhealth.jmir.org/2020/6/e16059 UR - http://dx.doi.org/10.2196/16059 UR - http://www.ncbi.nlm.nih.gov/pubmed/32510461 ID - info:doi/10.2196/16059 ER - TY - JOUR AU - Hou, Can AU - Zhong, Xiaorong AU - He, Ping AU - Xu, Bin AU - Diao, Sha AU - Yi, Fang AU - Zheng, Hong AU - Li, Jiayuan PY - 2020/6/8 TI - Predicting Breast Cancer in Chinese Women Using Machine Learning Techniques: Algorithm Development JO - JMIR Med Inform SP - e17364 VL - 8 IS - 6 KW - machine learning KW - XGBoost KW - random forest KW - deep neural network KW - breast cancer N2 - Background: Risk-based breast cancer screening is a cost-effective intervention for controlling breast cancer in China, but the successful implementation of such intervention requires an accurate breast cancer prediction model for Chinese women. Objective: This study aimed to evaluate and compare the performance of four machine learning algorithms on predicting breast cancer among Chinese women using 10 breast cancer risk factors. Methods: A dataset consisting of 7127 breast cancer cases and 7127 matched healthy controls was used for model training and testing. We used repeated 5-fold cross-validation and calculated AUC, sensitivity, specificity, and accuracy as the measures of the model performance. Results: The three novel machine-learning algorithms (XGBoost, Random Forest and Deep Neural Network) all achieved significantly higher area under the receiver operating characteristic curves (AUCs), sensitivity, and accuracy than logistic regression. Among the three novel machine learning algorithms, XGBoost (AUC 0.742) outperformed deep neural network (AUC 0.728) and random forest (AUC 0.728). Main residence, number of live births, menopause status, age, and age at first birth were considered as top-ranked variables in the three novel machine learning algorithms. Conclusions: The novel machine learning algorithms, especially XGBoost, can be used to develop breast cancer prediction models to help identify women at high risk for breast cancer in developing countries. UR - http://medinform.jmir.org/2020/6/e17364/ UR - http://dx.doi.org/10.2196/17364 UR - http://www.ncbi.nlm.nih.gov/pubmed/32510459 ID - info:doi/10.2196/17364 ER - TY - JOUR AU - Hirano, Tomonobu AU - Motohashi, Tomomitsu AU - Okumura, Kosuke AU - Takajo, Kentaro AU - Kuroki, Taiyo AU - Ichikawa, Daisuke AU - Matsuoka, Yutaka AU - Ochi, Eisuke AU - Ueno, Taro PY - 2020/6/2 TI - Data Validation and Verification Using Blockchain in a Clinical Trial for Breast Cancer: Regulatory Sandbox JO - J Med Internet Res SP - e18938 VL - 22 IS - 6 KW - blockchain KW - clinical trial KW - data management KW - validation KW - breast cancer KW - regulatory sandbox N2 - Background: The integrity of data in a clinical trial is essential, but the current data management process is too complex and highly labor-intensive. As a result, clinical trials are prone to consuming a lot of budget and time, and there is a risk for human-induced error and data falsification. Blockchain technology has the potential to address some of these challenges. Objective: The aim of the study was to validate a system that enables the security of medical data in a clinical trial using blockchain technology. Methods: We have developed a blockchain-based data management system for clinical trials and tested the system through a clinical trial for breast cancer. The project was conducted to demonstrate clinical data management using blockchain technology under the regulatory sandbox enabled by the Japanese Cabinet Office. Results: We verified and validated the data in the clinical trial using the validation protocol and tested its resilience to data tampering. The robustness of the system was also proven by survival with zero downtime for clinical data registration during a Amazon Web Services disruption event in the Tokyo region on August 23, 2019. Conclusions: We show that our system can improve clinical trial data management, enhance trust in the clinical research process, and ease regulator burden. The system will contribute to the sustainability of health care services through the optimization of cost for clinical trials. UR - https://www.jmir.org/2020/6/e18938 UR - http://dx.doi.org/10.2196/18938 UR - http://www.ncbi.nlm.nih.gov/pubmed/32340974 ID - info:doi/10.2196/18938 ER - TY - JOUR AU - Arem, Hannah AU - Scott, Remle AU - Greenberg, Daniel AU - Kaltman, Rebecca AU - Lieberman, Daniel AU - Lewin, Daniel PY - 2020/5/26 TI - Assessing Breast Cancer Survivors? Perceptions of Using Voice-Activated Technology to Address Insomnia: Feasibility Study Featuring Focus Groups and In-Depth Interviews JO - JMIR Cancer SP - e15859 VL - 6 IS - 1 KW - artificial intelligence KW - breast neoplasms KW - survivors KW - insomnia KW - cognitive behavioral therapy KW - mobile phones N2 - Background: Breast cancer survivors (BCSs) are a growing population with a higher prevalence of insomnia than women of the same age without a history of cancer. Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be effective in this population, but it is not widely available to those who need it. Objective: This study aimed to better understand BCSs? experiences with insomnia and to explore the feasibility and acceptability of delivering CBT-I using a virtual assistant (Amazon Alexa). Methods: We first conducted a formative phase with 2 focus groups and 3 in-depth interviews to understand BCSs? perceptions of insomnia as well as their interest in and comfort with using a virtual assistant to learn about CBT-I. We then developed a prototype incorporating participant preferences and CBT-I components and demonstrated it in group and individual settings to BCSs to evaluate acceptability, interest, perceived feasibility, educational potential, and usability of the prototype. We also collected open-ended feedback on the content and used frequencies to describe the quantitative data. Results: We recruited 11 BCSs with insomnia in the formative phase and 14 BCSs in the prototype demonstration. In formative work, anxiety, fear, and hot flashes were identified as causes of insomnia. After prototype demonstration, nearly 79% (11/14) of participants reported an interest in and perceived feasibility of using the virtual assistant to record sleep patterns. Approximately two-thirds of the participants thought lifestyle modification (9/14, 64%) and sleep restriction (9/14, 64%) would be feasible and were interested in this feature of the program (10/14, 71% and 9/14, 64%, respectively). Relaxation exercises were rated as interesting and feasible using the virtual assistant by 71% (10/14) of the participants. Usability was rated as better than average, and all women reported that they would recommend the program to friends and family. Conclusions: This virtual assistant prototype delivering CBT-I components by using a smart speaker was rated as feasible and acceptable, suggesting that this prototype should be fully developed and tested for efficacy in the BCS population. If efficacy is shown in this population, the prototype should also be adapted for other high-risk populations. UR - http://cancer.jmir.org/2020/1/e15859/ UR - http://dx.doi.org/10.2196/15859 UR - http://www.ncbi.nlm.nih.gov/pubmed/32348274 ID - info:doi/10.2196/15859 ER - TY - JOUR AU - Ure, Cathy AU - Cooper-Ryan, Mary Anna AU - Condie, Jenna AU - Galpin, Adam PY - 2020/5/25 TI - Exploring Strategies for Using Social Media to Self-Manage Health Care When Living With and Beyond Breast Cancer: In-Depth Qualitative Study JO - J Med Internet Res SP - e16902 VL - 22 IS - 5 KW - breast cancer KW - social media KW - internet KW - self-management KW - psychosocial health KW - survivorship N2 - Background: As breast cancer survival rates improve and structural health resources are increasingly being stretched, health providers require people living with and beyond breast cancer (LwBBC) to self-manage aspects of their care. Objective: This study aimed to explore how women use and experience social media to self-manage their psychosocial needs and support self-management across the breast cancer continuum. Methods: The experiences of 21 women (age range 27-64 years) were explored using an in-depth qualitative approach. The women varied in the duration of their experiences of LwBBC, which facilitated insights into how they evolve and change their self-management strategies over time. Semistructured interviews were analyzed inductively using a thematic analysis, a polytextual analysis, and voice-centered relational methods. Results: The use of multiple social media platforms, such as YouTube, Facebook, WhatsApp, and Twitter, enabled women to self-manage aspects of their care by satisfying needs for timely, relevant, and appropriate support, by navigating identities disrupted by diagnosis and treatment and by allowing them to (re)gain a sense of control. Women described extending their everyday use of multiple platforms to self-manage their care. However, women experienced social media as both empowering and dislocating, as their engagement was impacted by their everyday experiences of LwBBC. Conclusions: Health care professionals (HCPs) need to be more aware, and open to the possibilities, of women using multiple social media resources as self-management tools. It is important for HCPs to initiate value-free discussions and create the space necessary for women to share how social media resources support a tailored and timely self-managed approach to their unique psychosocial needs. UR - http://www.jmir.org/2020/5/e16902/ UR - http://dx.doi.org/10.2196/16902 UR - http://www.ncbi.nlm.nih.gov/pubmed/32364510 ID - info:doi/10.2196/16902 ER - TY - JOUR AU - Yongping, Liang AU - Juan, Zhang AU - Zhou, Ping AU - Yongfeng, Zhao AU - Liu, Wengang AU - Shi, Yifan PY - 2020/5/5 TI - Evaluation of the Quadri-Planes Method in Computer-Aided Diagnosis of Breast Lesions by Ultrasonography: Prospective Single-Center Study JO - JMIR Med Inform SP - e18251 VL - 8 IS - 5 KW - ultrasonography KW - breast neoplasm KW - breast imaging reporting and data system (bi-rads) KW - breast neoplasm diagnosis KW - cancer screening KW - computer-aided diagnosis KW - breast cancer N2 - Background: Computer-aided diagnosis (CAD) is a tool that can help radiologists diagnose breast lesions by ultrasonography. Previous studies have demonstrated that CAD can help reduce the incidence of missed diagnoses by radiologists. However, the optimal method to apply CAD to breast lesions using diagnostic planes has not been assessed. Objective: The aim of this study was to compare the performance of radiologists with different levels of experience when using CAD with the quadri-planes method to detect breast tumors. Methods: From November 2018 to October 2019, we enrolled patients in the study who had a breast mass as their most prominent symptom. We assigned 2 ultrasound radiologists (with 1 and 5 years of experience, respectively) to read breast ultrasonography images without CAD and then to perform a second reading while applying CAD with the quadri-planes method. We then compared the diagnostic performance of the readers for the 2 readings (without and with CAD). The McNemar test for paired data was used for statistical analysis. Results: A total of 331 patients were included in this study (mean age 43.88 years, range 17-70, SD 12.10), including 512 lesions (mean diameter 1.85 centimeters, SD 1.19; range 0.26-9.5); 200/512 (39.1%) were malignant, and 312/512 (60.9%) were benign. For CAD, the area under the receiver operating characteristic curve (AUC) improved significantly from 0.76 (95% CI 0.71-0.79) with the cross-planes method to 0.84 (95% CI 0.80-0.88; P<.001) with the quadri-planes method. For the novice reader, the AUC significantly improved from 0.73 (95% CI 0.69-0.78) for the without-CAD mode to 0.83 (95% CI 0.80-0.87; P<.001) for the combined-CAD mode with the quadri-planes method. For the experienced reader, the AUC improved from 0.85 (95% CI 0.81-0.88) to 0.87 (95% CI 0.84-0.91; P=.15). The kappa indicating consistency between the experienced reader and the novice reader for the combined-CAD mode was 0.63. For the novice reader, the sensitivity significantly improved from 60.0% for the without-CAD mode to 79.0% for the combined-CAD mode (P=.004). The specificity, negative predictive value, positive predictive value, and accuracy improved from 84.9% to 87.8% (P=.53), 76.8% to 86.7% (P=.07), 71.9% to 80.6% (P=.13), and 75.2% to 84.4% (P=.12), respectively. For the experienced reader, the sensitivity improved significantly from 76.0% for the without-CAD mode to 87.0% for the combined-CAD mode (P=.045). The NPV and accuracy moderately improved from 85.8% and 86.3% to 91.0% (P=.27) and 87.0% (P=.84), respectively. The specificity and positive predictive value decreased from 87.4% to 81.3% (P=.25) and from 87.2% to 93.0% (P=.16), respectively. Conclusions: S-Detect is a feasible diagnostic tool that can improve the sensitivity, accuracy, and AUC of the quadri-planes method for both novice and experienced readers while also improving the specificity for the novice reader. It demonstrates important application value in the clinical diagnosis of breast cancer. Trial Registration: ChiCTR.org.cn 1800019649; http://www.chictr.org.cn/showproj.aspx?proj=33094 UR - https://medinform.jmir.org/2020/5/e18251 UR - http://dx.doi.org/10.2196/18251 UR - http://www.ncbi.nlm.nih.gov/pubmed/32369039 ID - info:doi/10.2196/18251 ER - TY - JOUR AU - Jung, Miyeon AU - Lee, SaeByul AU - Kim, Jisun AU - Kim, HeeJeong AU - Ko, BeomSeok AU - Son, Ho Byung AU - Ahn, Sei-Hyun AU - Park, Rang Yu AU - Cho, Daegon AU - Chung, Haekwon AU - Park, Jin Hye AU - Lee, Minsun AU - Lee, Won Jong AU - Chung, Seockhoon AU - Chung, Yong Il PY - 2020/5/4 TI - A Mobile Technology for Collecting Patient-Reported Physical Activity and Distress Outcomes: Cross-Sectional Cohort Study JO - JMIR Mhealth Uhealth SP - e17320 VL - 8 IS - 5 KW - telemedicine KW - breast neoplasms KW - mobile apps KW - quality of life KW - validation KW - patient-reported outcome measures (PROMs) KW - questionnaire N2 - Background: Electronic patient-reported outcome (PROs) provides a fast and reliable assessment of a patient?s health-related quality of life. Nevertheless, using PRO in the traditional paper format is not practical for clinical practice due to the limitations associated with data analysis and management. A questionnaire app was developed to address the need for a practical way to group and use distress and physical activity assessment tools. Objective: The purpose of this study was to assess the level of agreement between electronic (mobile) and paper-and-pencil questionnaire responses. Methods: We validated the app version of the distress thermometer (DT), International Physical Activity Questionnaire (IPAQ), and Patient Health Questionnaire?9 (PHQ-9). A total of 102 participants answered the paper and app versions of the DT and IPAQ, and 96 people completed the PHQ-9. The study outcomes were the correlation of the data between the paper-and-pencil and app versions. Results: A total of 106 consecutive breast cancer patients were enrolled and analyzed for validation of paper and electronic (app) versions. The Spearman correlation values of paper and app surveys for patients who responded to the DT questionnaire within 7 days, within 3 days, and on the same day were .415 (P<.001), .437 (P<.001), and .603 (P<.001), respectively. Similarly, the paper and app survey correlation values of the IPAQ total physical activity metabolic equivalent of task (MET; Q2-6) were .291 (P=.003), .324 (P=.005), and .427 (P=.01), respectively. The correlation of the sum of the Patient Health Questionnaire?9 (Q1-9) according to the time interval between the paper-based questionnaire and the app-based questionnaire was .469 for 14 days (P<.001), .574 for 7 days (P<.001), .593 for 3 days (P<.001), and .512 for the same day (P=.03). These were all statistically significant. Similarly, the correlation of the PHQ (Q10) value according to the time interval between the paper-based questionnaire and the app-based questionnaire was .283 for 14 days (P=.005), .409 for 7 days (P=.001), .415 for 3 days (P=.009), and .736 for the same day (P=.001). These were all statistically significant. In the overall trend, the shorter the interval between the paper-and-pencil questionnaire and the app-based questionnaire, the higher the correlation value. Conclusions: The app version of the distress and physical activity questionnaires has shown validity and a high level of association with the paper-based DT, IPAQ (Q2-6), and PHQ-9. The app-based questionnaires were not inferior to their respective paper versions and confirm the feasibility for their use in clinical practice. The high correlation between paper and mobile app data allows the use of new mobile apps to benefit the overall health care system. Trial Registration: ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966 UR - https://mhealth.jmir.org/2020/5/e17320 UR - http://dx.doi.org/10.2196/17320 UR - http://www.ncbi.nlm.nih.gov/pubmed/32364508 ID - info:doi/10.2196/17320 ER - TY - JOUR AU - Hou, I-Ching AU - Lan, Min-Fang AU - Shen, Shan-Hsiang AU - Tsai, Yu Pei AU - Chang, Jen King AU - Tai, Hao-Chih AU - Tsai, Ay-Jen AU - Chang, Polun AU - Wang, Tze-Fang AU - Sheu, Shuh-Jen AU - Dykes, C. Patricia PY - 2020/4/30 TI - The Development of a Mobile Health App for Breast Cancer Self-Management Support in Taiwan: Design Thinking Approach JO - JMIR Mhealth Uhealth SP - e15780 VL - 8 IS - 4 KW - breast cancer KW - mobile health application KW - self-management KW - design thinking N2 - Background: Evidence has shown that breast cancer self-management support from mobile health (mHealth) apps can improve the quality of life of survivors. Although many breast cancer self-management support apps exist, few papers have documented the procedure for the development of a user-friendly app from the patient?s perspective. Objective: This study aimed to investigate the information needs of Taiwanese women with breast cancer to inform the development of a self-management support mHealth app. Methods: A 5-step design thinking approach, comprising empathy, define, ideate, prototype, and test steps, was used in the focus groups and individual interviews conducted to collect information on the requirements and expectations of Taiwanese women with breast cancer with respect to the app. A thematic analysis was used to identify information needs. Results: A total of 8 major themes including treatment, physical activity, diet, emotional support, health records, social resources, experience sharing, and expert consultation were identified. Minor themes included the desire to use the app under professional supervision and a trustworthy app manager to ensure the credibility of information. Conclusions: The strengths of the design thinking approach were user-centered design and cultural sensitivity. The results retrieved from each step contributed to the development of the app and reduction of the gap between end users and developers. An mHealth app that addresses these 8 main themes can facilitate disease self-management for Taiwanese women with breast cancer. UR - http://mhealth.jmir.org/2020/4/e15780/ UR - http://dx.doi.org/10.2196/15780 UR - http://www.ncbi.nlm.nih.gov/pubmed/32352390 ID - info:doi/10.2196/15780 ER - TY - JOUR AU - Janssen, Anna AU - Donnelly, Candice AU - Kay, Judy AU - Thiem, Peter AU - Saavedra, Aldo AU - Pathmanathan, Nirmala AU - Elder, Elisabeth AU - Dinh, Phuong AU - Kabir, Masrura AU - Jackson, Kirsten AU - Harnett, Paul AU - Shaw, Tim PY - 2020/4/21 TI - Developing an Intranet-Based Lymphedema Dashboard for Breast Cancer Multidisciplinary Teams: Design Research Study JO - J Med Internet Res SP - e13188 VL - 22 IS - 4 KW - eHealth KW - clinical informatics KW - human-centered design KW - data visualization N2 - Background: A large quantity of data is collected during the delivery of cancer care. However, once collected, these data are difficult for health professionals to access to support clinical decision making and performance review. There is a need for innovative tools that make clinical data more accessible to support health professionals in these activities. One approach for providing health professionals with access to clinical data is to create the infrastructure and interface for a clinical dashboard to make data accessible in a timely and relevant manner. Objective: This study aimed to develop and evaluate 2 prototype dashboards for displaying data on the identification and management of lymphedema. Methods: The study used a co-design framework to develop 2 prototype dashboards for use by health professionals delivering breast cancer care. The key feature of these dashboards was an approach for visualizing lymphedema patient cohort and individual patient data. This project began with 2 focus group sessions conducted with members of a breast cancer multidisciplinary team (n=33) and a breast cancer consumer (n=1) to establish clinically relevant and appropriate data for presentation and the visualization requirements for a dashboard. A series of fortnightly meetings over 6 months with an Advisory Committee (n=10) occurred to inform and refine the development of a static mock-up dashboard. This mock-up was then presented to representatives of the multidisciplinary team (n=3) to get preliminary feedback about the design and use of such dashboards. Feedback from these presentations was reviewed and used to inform the development of the interactive prototypes. A structured evaluation was conducted on the prototypes, using Think Aloud Protocol and semistructured interviews with representatives of the multidisciplinary team (n=5). Results: Lymphedema was selected as a clinically relevant area for the prototype dashboards. A qualitative evaluation is reported for 5 health professionals. These participants were selected from 3 specialties: surgery (n=1), radiation oncology (n=2), and occupational therapy (n=2). Participants were able to complete the majority of tasks on the dashboard. Semistructured interview themes were categorized into engagement or enthusiasm for the dashboard, user experience, and data quality and completeness. Conclusions: Findings from this study constitute the first report of a co-design process for creating a lymphedema dashboard for breast cancer health professionals. Health professionals are interested in the use of data visualization tools to make routinely collected clinical data more accessible. To be used effectively, dashboards need to be reliable and sourced from accurate and comprehensive data sets. While the co-design process used to develop the visualization tool proved effective for designing an individual patient dashboard, the complexity and accessibility of the data required for a cohort dashboard remained a challenge. UR - https://www.jmir.org/2020/4/e13188 UR - http://dx.doi.org/10.2196/13188 UR - http://www.ncbi.nlm.nih.gov/pubmed/32314968 ID - info:doi/10.2196/13188 ER - TY - JOUR AU - Li, Yan AU - Ye, Shan AU - Zhou, Yidong AU - Mao, Feng AU - Guo, Hailing AU - Lin, Yan AU - Zhang, Xiaohui AU - Shen, Songjie AU - Shi, Na AU - Wang, Xiaojie AU - Sun, Qiang PY - 2020/4/17 TI - Web-Based Medical Information Searching by Chinese Patients With Breast Cancer and its Influence on Survival: Observational Study JO - J Med Internet Res SP - e16768 VL - 22 IS - 4 KW - breast cancer KW - internet KW - disease-free survival KW - breast conserving therapy KW - online information KW - satisfaction level N2 - Background: The internet allows patients to easily look for health information. However, how Chinese patients with breast cancer use the internet has rarely been investigated, and there is a scarcity of information about the influence of internet use on survival. Objective: This observational study aimed to investigate the details of online medical information searching by Chinese patients with breast cancer and to determine whether internet use has any survival benefits. Methods: Patients who were diagnosed with invasive breast cancer at Peking Union Medical College Hospital between January 2014 and December 2015 were enrolled. We obtained information on their internet-searching behavior and gathered data from the patients? medical and follow-up records. The associations between internet use and other clinic-pathological factors were analyzed. A Cox proportional-hazards model and the Kaplan-Meier method were used for disease-free survival (DFS) analyses. Results: A total of 973 patients with invasive breast cancer who underwent definitive surgery took part in the study. Among them, 477 cases (49.0%) performed web-based breast cancer information searching before the initial treatment. A multivariate logistic regression analysis suggested that web-based breast cancer information searching was significantly associated with younger age (odds ratio [OR] 0.95, 95% CI 0.94-0.97, P<.001), higher education level (OR 1.37, 95% CI 1.01?1.86, P=.04), and breast conserving surgery (OR 1.35, 95% CI 1.04-1.77, P=.03). Baidu (73.4%, 350/477) and WeChat (66.7%, 318/477) were the two most popular online information sources for breast cancer; however, only 44.9% (214/477) felt satisfied with the online information. In contrast to the nonweb searching group, the web-using patients who were satisfied with online information showed significantly improved DFS (hazard ratio 0.26; 95% CI 0.08-0.88, P=.03). Conclusions: The patients who were most likely to search the internet for breast cancer information were younger and well-educated, and they were more likely to have breast conserving therapy. Web-using patients who were satisfied with the internet information showed significantly improved DFS. Patients should browse credible websites offering accurate and updated information, and website developers should provide high-quality and easy-to-understand information to better meet the needs of patients with breast cancer. UR - http://www.jmir.org/2020/4/e16768/ UR - http://dx.doi.org/10.2196/16768 UR - http://www.ncbi.nlm.nih.gov/pubmed/32301740 ID - info:doi/10.2196/16768 ER - TY - JOUR AU - Chow, I. Philip AU - Showalter, L. Shayna AU - Gerber, Matthew AU - Kennedy, M. Erin AU - Brenin, David AU - Mohr, C. David AU - Lattie, G. Emily AU - Gupta, Alisha AU - Ocker, Gabrielle AU - Cohn, F. Wendy PY - 2020/4/15 TI - Use of Mental Health Apps by Patients With Breast Cancer in the United States: Pilot Pre-Post Study JO - JMIR Cancer SP - e16476 VL - 6 IS - 1 KW - breast cancer KW - mental health KW - mHealth N2 - Background: Nearly half of the patients with breast cancer experience clinically significant mental distress within the first year of receiving their cancer diagnosis. There is an urgent need to identify scalable and cost-efficient ways of delivering empirically supported mental health interventions to patients with breast cancer. Objective: The aim of this study was to evaluate the feasibility of in-clinic recruitment for a mobile phone app study and to evaluate the usability and preliminary impact of a suite of mental health apps (IntelliCare) with phone coaching on psychosocial distress symptoms in patients recently diagnosed with breast cancer. Methods: This pilot study adopted a within-subject, 7-week pre-post study design. A total of 40 patients with breast cancer were recruited at a US National Cancer Institute?designated clinical cancer center. Self-reported distress (Patient Health Questionnaire-4) and mood symptoms (Patient-Reported Outcomes Measurement Information System depression and anxiety scales) were assessed at baseline and postintervention. App usability was assessed at postintervention. Results: The minimum recruitment threshold was met. There was a significant decrease in general distress symptoms, as well as symptoms of depression and anxiety, from baseline to postintervention. Overall, participants reported high levels of ease of app use and learning. Scores for app usefulness and satisfaction were reinforced by some qualitative feedback suggesting that tailoring the apps more for patients with breast cancer could enhance engagement. Conclusions: There is a dire need for scalable, supportive interventions in cancer. The results from this study inform how scalable mobile phone?delivered programs with additional phone support can be used to support patients with breast cancer. International Registered Report Identifier (IRRID): RR2-10.2196/11452 UR - http://cancer.jmir.org/2020/1/e16476/ UR - http://dx.doi.org/10.2196/16476 UR - http://www.ncbi.nlm.nih.gov/pubmed/32293570 ID - info:doi/10.2196/16476 ER - TY - JOUR AU - Hou, I-Ching AU - Lin, Hsin-Yi AU - Shen, Shan-Hsiang AU - Chang, King-Jen AU - Tai, Hao-Chih AU - Tsai, Ay-Jen AU - Dykes, C. Patricia PY - 2020/3/4 TI - Quality of Life of Women After a First Diagnosis of Breast Cancer Using a Self-Management Support mHealth App in Taiwan: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e17084 VL - 8 IS - 3 KW - breast cancer KW - mHealth app KW - self-management KW - quality of life N2 - Background: There are over 2 million newly diagnosed patients with breast cancer worldwide with more than 10,000 cases in Taiwan each year. During 2017-2018, the National Yang-Ming University, the Taiwan University of Science and Technology, and the Taiwan Breast Cancer Prevention Foundation collaborated to develop a breast cancer self-management support (BCSMS) mHealth app for Taiwanese women with breast cancer. Objective: The aim of this study was to investigate the quality of life (QoL) of women with breast cancer in Taiwan after using the BCSMS app. Methods: After receiving a first diagnosis of breast cancer, women with stage 0 to III breast cancer, who were recruited from social networking sites or referred by their oncologists or oncology case managers, were randomized 1:1 into intervention and control groups. Intervention group subjects used the BCSMS app and the control group subjects received usual care. Two questionnaires?the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Core 30 (QLQ-C30) and the EORTC Breast Cancer-Specific Quality-of-Life Questionnaire (QLQ-BR23)?were distributed to subjects in both arms. Paper-based questionnaires were used at baseline; paper-based or Web-based questionnaires were used at 1.5-month and 3-month follow-up evaluations. All evaluations were self-assessed and anonymous, and participants were blinded to their allocation groups. Descriptive analysis, the Pearson chi-square test, analysis of variance, and the generalized estimating equation were used to analyze the data. Missing values, with and without multi-imputation techniques, were used for sensitivity analysis. Results: A total of 112 women were enrolled and randomly allocated to either the experimental group (n=53) or control group (n=59). The follow-up completion rate was 89.3% (100/112). The demographic data showed homogeneity between the two groups in age (range 50-64 years), breast cancer stage (stage II), marital status (married), working status (employed), and treatment status (receiving treatments). The mean total QoL summary scores from the QLQ-C30 (83.45 vs 82.23, P=.03) and the QLQ-BR23 (65.53 vs 63.13, P=.04) were significantly higher among the experimental group versus the control group, respectively, at 3 months. Conclusions: This research provides support for using a mobile health care app to promote the QoL among women in Taiwan after a first diagnosis of breast cancer. The BCSMS app could be used to support disease self-management, and further evaluation of whether QoL is sustained is warranted. Trial Registration: ClinicalTrials.gov NCT004174248; https://clinicaltrials.gov/ct2/show/NCT04174248 UR - http://mhealth.jmir.org/2020/3/e17084/ UR - http://dx.doi.org/10.2196/17084 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130181 ID - info:doi/10.2196/17084 ER - TY - JOUR AU - Yongping, Liang AU - Zhou, Ping AU - Juan, Zhang AU - Yongfeng, Zhao AU - Liu, Wengang AU - Shi, Yifan PY - 2020/3/2 TI - Performance of Computer-Aided Diagnosis in Ultrasonography for Detection of Breast Lesions Less and More Than 2 cm: Prospective Comparative Study JO - JMIR Med Inform SP - e16334 VL - 8 IS - 3 KW - ultrasonography KW - breast neoplasm KW - breast imaging reporting and data system (BI-RADS) KW - breast neoplasms diagnosis KW - cancer screening KW - computer diagnostic aid N2 - Background: Computer-aided diagnosis (CAD) is used as an aid tool by radiologists on breast lesion diagnosis in ultrasonography. Previous studies demonstrated that CAD can improve the diagnosis performance of radiologists. However, the optimal use of CAD on breast lesions according to size (below or above 2 cm) has not been assessed. Objective: The aim of this study was to compare the performance of different radiologists using CAD to detect breast tumors less and more than 2 cm in size. Methods: We prospectively enrolled 261 consecutive patients (mean age 43 years; age range 17-70 years), including 398 lesions (148 lesions>2 cm, 79 malignant and 69 benign; 250 lesions?2 cm, 71 malignant and 179 benign) with breast mass as the prominent symptom. One novice radiologist with 1 year of ultrasonography experience and one experienced radiologist with 5 years of ultrasonography experience were each assigned to read the ultrasonography images without CAD, and then again at a second reading while applying the CAD S-Detect. We then compared the diagnostic performance of the readers in the two readings (without and combined with CAD) with breast imaging. The McNemar test for paired data was used for statistical analysis. Results: For the novice reader, the area under the receiver operating characteristic curve (AUC) improved from 0.74 (95% CI 0.67-0.82) from the without-CAD mode to 0.88 (95% CI 0.83-0.93; P<.001) at the combined-CAD mode in lesions?2 cm. For the experienced reader, the AUC improved from 0.84 (95% CI 0.77-0.90) to 0.90 (95% CI 0.86-0.94; P=.002). In lesions>2 cm, the AUC moderately decreased from 0.81 to 0.80 (novice reader) and from 0.90 to 0.82 (experienced reader). The sensitivity of the novice and experienced reader in lesions?2 cm improved from 61.97% and 73.23% at the without-CAD mode to 90.14% and 97.18% (both P<.001) at the combined-CAD mode, respectively. Conclusions: S-Detect is a feasible diagnostic tool that can improve the sensitivity for both novice and experienced readers, while also improving the negative predictive value and AUC for lesions?2 cm, demonstrating important application value in the clinical diagnosis of breast cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800019649; http://www.chictr.org.cn/showprojen.aspx?proj=33094 UR - https://medinform.jmir.org/2020/3/e16334 UR - http://dx.doi.org/10.2196/16334 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130149 ID - info:doi/10.2196/16334 ER - TY - JOUR AU - Baun, Christina AU - Vogsen, Marianne AU - Nielsen, Konge Marie AU - Høilund-Carlsen, Flemming Poul AU - Hildebrandt, Grubbe Malene PY - 2020/2/10 TI - Perspective of Patients With Metastatic Breast Cancer on Electronic Access to Scan Results: Mixed Methods Study JO - J Med Internet Res SP - e15723 VL - 22 IS - 2 KW - patient accessible electronic health record KW - electronic health records KW - patient access to records KW - scan result KW - breast cancer KW - patient perspective KW - breast neoplasms N2 - Background: Patient-accessible electronic health records give patients quick and easy access to their health care data, enabling them to view their test results online prior to a clinic visit. Hospital reports can be difficult for patients to understand, however, and can lead to unnecessary anxiety. Objective: We aimed to investigate the attitudes and experiences of Danish patients with metastatic breast cancer in using electronic health records to view their own scan results. Methods: We conducted a prospective mixed methods study in a sequential design at our institution during 2018. Participants were women with metastatic breast cancer who were having scans every 3 months (combined positron emission tomography and computed tomography or computed tomography alone) to monitor treatment effects. Participants first received an online questionnaire about their knowledge and use of online access to scan results. We then conducted semistructured interviews with 4 women who used the online access to view their scan results. Results: A total of 46 patients received the questionnaire (median age 66, SD 11.8, range 34-84 years). Of these women, 38 (83%) completed the survey (median age 69, SD 10.7, range 42-84 years). Most patients (34/38) were aware of the opportunity to access their reports online, but only 40% (15/38) used this access to read their scan results. Barriers to online access were (1) anxiety over reading the scan results in the absence of clinician support, and (2) a preference to receive all disease information at their next hospital appointment. The patients who read their scan result found that facilitators were greater transparency and empowerment, and barriers were the consequences of reading bad news, the feeling of dilemma about the access, and the medical terminology. Conclusions: Patients with metastatic breast cancer generally had a positive attitude toward electronic access to their scan results, and those who used this opportunity played a greater participatory role in their disease and its management. Others described the potential distress this opportunity caused. The study findings suggest that immediate online access to scan results should be available to patients, but it needs a support function alongside that ensures optimal patient care. UR - https://www.jmir.org/2020/2/e15723 UR - http://dx.doi.org/10.2196/15723 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/15723 ER - TY - JOUR AU - Delrieu, Lidia AU - Pialoux, Vincent AU - Pérol, Olivia AU - Morelle, Magali AU - Martin, Agnès AU - Friedenreich, Christine AU - Febvey-Combes, Olivia AU - Pérol, David AU - Belladame, Elodie AU - Clémençon, Michel AU - Roitmann, Eva AU - Dufresne, Armelle AU - Bachelot, Thomas AU - Heudel, Etienne Pierre AU - Touillaud, Marina AU - Trédan, Olivier AU - Fervers, Béatrice PY - 2020/1/28 TI - Feasibility and Health Benefits of an Individualized Physical Activity Intervention in Women With Metastatic Breast Cancer: Intervention Study JO - JMIR Mhealth Uhealth SP - e12306 VL - 8 IS - 1 KW - metastatic breast cancer KW - physical activity KW - activity trackers KW - feasibility KW - tumor progression N2 - Background: There is limited knowledge regarding the potential benefits of physical activity in patients with metastatic breast cancer. Objective: The Advanced stage Breast cancer and Lifestyle Exercise (ABLE) Trial aimed to assess the feasibility of a physical activity intervention in women with metastatic breast cancer and to explore the effects of physical activity on functional, psychological, and clinical parameters. Methods: The ABLE Trial was a single-arm, 6-month intervention study with a home-based, unsupervised, and personalized walking program using an activity tracker. At baseline and 6 months, we assessed anthropometrics, functional fitness, physical activity level, sedentary behavior, quality of life, fatigue, and tumor progression. Paired proportions were compared using the McNemar test and changes of parameters during the intervention were analyzed using the Wilcoxon signed-rank test, the Mann-Whitney test, and Spearman rank correlations. Results: Overall, 49 participants (mean age 55 years; recruitment rate 94%) were enrolled and 96% adhered to the exercise prescription (attrition rate 2%). Statistically significant improvements in the 6-minute walking distance test (+7%, P<.001) and isometric quadriceps strength (+22%, P<.001), as well as decreases in body mass index (-2.5%, P=.03) and hip circumference (-4.0%, P<.001) were observed at 6 months. Quality of life remained stable and a nonstatistically significant decrease (-16%, P=.07) in fatigue was observed. Conclusions: The high recruitment and adherence rates suggest the willingness of patients with metastatic breast cancer to participate in a physical activity program. The beneficial outcomes regarding physical fitness and anthropometry of this unsupervised physical activity program may encourage these patients to maintain a physically active lifestyle. Future randomized controlled trials with larger sample sizes are warranted. Trial Registration: ClinicalTrials.gov NCT03148886; https://clinicaltrials.gov/ct2/show/NCT03148886 UR - https://mhealth.jmir.org/2020/1/e12306 UR - http://dx.doi.org/10.2196/12306 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012082 ID - info:doi/10.2196/12306 ER - TY - JOUR AU - Kalke, Kerstin AU - Ginossar, Tamar AU - Bentley, M. Joshua AU - Carver, Hannah AU - Shah, Ali Sayyed Fawad AU - Kinney, Y. Anita PY - 2020/1/24 TI - Use of Evidence-Based Best Practices and Behavior Change Techniques in Breast Cancer Apps: Systematic Analysis JO - JMIR Mhealth Uhealth SP - e14082 VL - 8 IS - 1 KW - mHealth KW - breast cancer KW - mobile apps KW - health behavior KW - health apps N2 - Background: Theoretically designed mobile health (mHealth) breast cancer interventions are essential for achieving positive behavior change. In the case of breast cancer, they can improve the health outcomes of millions of women by increasing prevention and care efforts. However, little is known about the theoretical underpinnings of breast cancer apps available to the general public. Objective: Given that theories may strengthen mHealth interventions, this study aimed to identify breast cancer apps designed to support behavior change, to assess the extent to which they address content along the cancer care continuum and contain behavior change techniques, and to assess the degree to which star rating is related to theory-based design. Methods: Using a criteria-based screening process, we searched 2 major app stores for breast cancer apps designed to promote behavior change. Apps were coded for content along the cancer care continuum and analyzed for behavior change techniques. The Mann-Whitney U test was used to examine the relationship between star ratings and the use of behavior change techniques in apps with star ratings compared to those without ratings. Results: The search resulted in a total of 302 apps, of which 133 were identified as containing breast cancer content. Only 9.9% (30/302) of apps supported behavior change and were further analyzed. These apps were disproportionally focused on behaviors to enhance early detection, whereas only a few apps supported care management, treatment, and posttreatment behaviors. Regarding theories, 63% (19/30) of apps customized content to users, 70% (21/30) established a health-behavior link, and 80% (24/30) provided behavior change instructions. Of the 30 apps, 15 (50%) prompted intention formation whereas less than half of the apps included goal setting (9/30, 30%) and goal reviewing (7/30, 23%). Most apps did not provide information on peer behavior (7/30, 23%) or allow for social comparison (6/30, 20%). None of the apps mobilized social norms. Only half of the apps (15/30, 50%) were user rated. The results of the Mann-Whitney U test showed that apps with star ratings contained significantly more behavior change techniques (median 6.00) than apps without ratings. The analysis of behavior change techniques used in apps revealed their shortcomings in the use of goal setting and social influence features. Conclusions: Our findings indicate that commercially available breast cancer apps have not yet fully realized their potential to promote behavior change, with only a minority of apps focusing on behavior change, and even fewer including theoretical design to support behavior change along the cancer care continuum. These shortcomings are likely limiting the effectiveness of apps and their ability to improve public health. More attention needs to be paid to the involvement of professionals in app development and adherence to theories and best practices in app design to support individuals along the cancer care continuum. UR - https://mhealth.jmir.org/2020/1/e14082 UR - http://dx.doi.org/10.2196/14082 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012084 ID - info:doi/10.2196/14082 ER - TY - JOUR AU - Masi, Domitilla AU - Gomez-Rexrode, Elvira Amalia AU - Bardin, Rina AU - Seidman, Joshua PY - 2019/12/20 TI - The ?Preparation for Shared Decision-Making? Tool for Women With Advanced Breast Cancer: Qualitative Validation Study JO - J Participat Med SP - e16511 VL - 11 IS - 4 KW - shared decision making KW - clinical decision making KW - patient preferences KW - cancer KW - breast cancer KW - human-centered design KW - patient care planning N2 - Background: The range of decisions and considerations that women with advanced breast cancer (ABC) face can be overwhelming and difficult to manage. Research shows that most patients prefer a shared decision-making (SDM) approach as it provides them with the opportunity to be actively involved in their treatment decisions. The current engagement of these patients in their clinical decisions is suboptimal. Moreover, implementing SDM into routine clinical care can be challenging as patients may not always feel adequately prepared or may not expect to be involved in the decision-making process. Objective: Avalere Health developed the Preparation for Shared Decision-Making (PFSDM) tool to help patients with ABC feel prepared to communicate with their clinicians and engage in decision making aligned with their preferences. The goal of this study was to validate the tool for its acceptability and usability among this patient population. Methods: We interviewed a diverse group of women with ABC (N=30). Interviews were audiorecorded, transcribed, and double coded by using NVivo. We assessed 8 themes to understand the acceptability and usability of the tool. Results: Interviewees expressed that the tool was acceptable for preparing patients for decision making and would be useful for helping patients know what to expect in their care journey. Interviewees also provided useful comments to improve the tool. Conclusions: This validation study confirms the acceptability and usability of the PFSDM tool for women with ABC. Future research should assess the feasibility of the tool?s implementation in the clinical workflow and its impact on patient outcomes. UR - http://jopm.jmir.org/2019/4/e16511/ UR - http://dx.doi.org/10.2196/16511 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/16511 ER - TY - JOUR AU - Yanez, Betina AU - Baik, H. Sharon AU - Oswald, B. Laura AU - Buitrago, Diana AU - Buscemi, Joanna AU - Iacobelli, Francisco AU - Perez-Tamayo, Alejandra AU - Fajardo, Precilla AU - Serrano, Gabriela AU - Guitelman, Judith AU - Penedo, J. Frank PY - 2019/12/13 TI - An Electronic Health Intervention for Latina Women Undergoing Breast Cancer Treatment (My Guide for Breast Cancer Treatment): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e14339 VL - 8 IS - 12 KW - breast cancer KW - Latina KW - health-related quality of life KW - eHealth KW - randomized controlled trial N2 - Background: Among Latinas and Hispanics (henceforth referred to as Latinas), breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related deaths. However, few interventions have been developed to meet the needs of Latina women undergoing active treatment for breast cancer. Objective: This paper aims to describe the procedures and methods of My Guide for Breast Cancer Treatment and the plans for conducting a multisite randomized controlled trial to investigate the feasibility and preliminary efficacy of this smartphone-based app for Latina women in active treatment for breast cancer. Methods: Study participants will be randomized to the My Guide for Breast Cancer Treatment intervention or the enhanced usual care control condition for 12 weeks. Participants will have access to innovative features such as gamification via virtual awards to reinforce usage and an adaptive section that presents targeted material based on their self-reported concerns and needs. Using a stepped-care approach, intervention participants will also receive telecoaching to enhance their adherence to the app. Study outcomes and intervention targets will be measured at study enrollment (before randomization), 6 and 12 weeks after initial app use. General and disease-specific health-related quality of life (HRQoL) and symptom burden are the study?s primary outcomes, whereas anxiety, depression, fear of cancer recurrence, physical activity, and dietary intake are secondary outcomes. Results: Recruitment began in August 2019 and is expected to be completed by August 2020. We expect to submit study results for publication by fall 2020. Conclusions: My Guide for Breast Cancer Treatment has the potential to improve HRQoL and reduce symptom burden, and increase access to supportive care resources among Latina breast cancer patients. International Registered Report Identifier (IRRID): PRR1-10.2196/14339 UR - https://www.researchprotocols.org/2019/12/e14339 UR - http://dx.doi.org/10.2196/14339 UR - http://www.ncbi.nlm.nih.gov/pubmed/31833834 ID - info:doi/10.2196/14339 ER - TY - JOUR AU - Bibault, Jean-Emmanuel AU - Chaix, Benjamin AU - Guillemassé, Arthur AU - Cousin, Sophie AU - Escande, Alexandre AU - Perrin, Morgane AU - Pienkowski, Arthur AU - Delamon, Guillaume AU - Nectoux, Pierre AU - Brouard, Benoît PY - 2019/11/27 TI - A Chatbot Versus Physicians to Provide Information for Patients With Breast Cancer: Blind, Randomized Controlled Noninferiority Trial JO - J Med Internet Res SP - e15787 VL - 21 IS - 11 KW - chatbot KW - clinical trial KW - cancer N2 - Background: The data regarding the use of conversational agents in oncology are scarce. Objective: The aim of this study was to verify whether an artificial conversational agent was able to provide answers to patients with breast cancer with a level of satisfaction similar to the answers given by a group of physicians. Methods: This study is a blind, noninferiority randomized controlled trial that compared the information given by the chatbot, Vik, with that given by a multidisciplinary group of physicians to patients with breast cancer. Patients were women with breast cancer in treatment or in remission. The European Organisation for Research and Treatment of Cancer Quality of Life Group information questionnaire (EORTC QLQ-INFO25) was adapted and used to compare the quality of the information provided to patients by the physician or the chatbot. The primary outcome was to show that the answers given by the Vik chatbot to common questions asked by patients with breast cancer about their therapy management are at least as satisfying as answers given by a multidisciplinary medical committee by comparing the success rate in each group (defined by a score above 3). The secondary objective was to compare the average scores obtained by the chatbot and physicians for each INFO25 item. Results: A total of 142 patients were included and randomized into two groups of 71. They were all female with a mean age of 42 years (SD 19). The success rates (as defined by a score >3) was 69% (49/71) in the chatbot group versus 64% (46/71) in the physicians group. The binomial test showed the noninferiority (P<.001) of the chatbot?s answers. Conclusions: This is the first study that assessed an artificial conversational agent used to inform patients with cancer. The EORTC INFO25 scores from the chatbot were found to be noninferior to the scores of the physicians. Artificial conversational agents may save patients with minor health concerns from a visit to the doctor. This could allow clinicians to spend more time to treat patients who need a consultation the most. Trial Registration: Clinicaltrials.gov NCT03556813, https://tinyurl.com/rgtlehq UR - http://www.jmir.org/2019/11/e15787/ UR - http://dx.doi.org/10.2196/15787 UR - http://www.ncbi.nlm.nih.gov/pubmed/31774408 ID - info:doi/10.2196/15787 ER - TY - JOUR AU - Lognos, Béatrice AU - Carbonnel, François AU - Boulze Launay, Isabelle AU - Bringay, Sandra AU - Guerdoux-Ninot, Estelle AU - Mollevi, Caroline AU - Senesse, Pierre AU - Ninot, Gregory PY - 2019/11/27 TI - Complementary and Alternative Medicine in Patients With Breast Cancer: Exploratory Study of Social Network Forum Data JO - JMIR Cancer SP - e12536 VL - 5 IS - 2 KW - complementary and alternative medicine (CAM) KW - nonpharmacological interventions KW - cancer KW - social network KW - forum KW - patient N2 - Background: Patients and health care professionals are becoming increasingly preoccupied in complementary and alternative medicine (CAM) that can also be called nonpharmacological interventions (NPIs). In just a few years, this supportive care has gone from solutions aimed at improving the quality of life to solutions intended to reduce symptoms, supplement oncological treatments, and prevent recurrences. Digital social networks are a major vector for disseminating these practices that are not always disclosed to doctors by patients. An exploration of the content of exchanges on social networks by patients suffering from breast cancer can help to better identify the extent and diversity of these practices. Objective: This study aimed to explore the interest of patients with breast cancer in CAM from posts published in health forums and French-language social media groups. Methods: The retrospective study was based on a French database of 2 forums and 4 Facebook groups between June 3, 2006, and November 17, 2015. The extracted, anonymized, and compiled data (264,249 posts) were analyzed according to the occurrences associated with the NPI categories and NPI subcategories, their synonyms, and their related terms. Results: The results showed that patients with breast cancer use mainly physical (37.6%) and nutritional (31.3%) interventions. Herbal medicine is a subcategory that was cited frequently. However, the patients did not mention digital interventions. Conclusions: This exploratory study of the main French forums and discussion groups indicates a significant interest in CAM during and after treatments for breast cancer, with primarily physical and nutritional interventions complementing approved treatments. This study highlights the importance of accurate information (vs fake medicine), prescription and monitoring of these interventions, and the mediating role that health professionals must play in this regard. UR - http://cancer.jmir.org/2019/2/e12536/ UR - http://dx.doi.org/10.2196/12536 UR - http://www.ncbi.nlm.nih.gov/pubmed/31774404 ID - info:doi/10.2196/12536 ER - TY - JOUR AU - Mikal, P. Jude AU - Grande, W. Stuart AU - Beckstrand, J. Michael PY - 2019/10/24 TI - Codifying Online Social Support for Breast Cancer Patients: Retrospective Qualitative Assessment JO - J Med Internet Res SP - e12880 VL - 21 IS - 10 KW - social support KW - social networking KW - social media KW - health communication KW - breast cancer N2 - Background: Social media has emerged as the epicenter for exchanging health-related information, resources, and emotional support. However, despite recognized benefits of social media for advancing health-promoting support exchange, researchers have struggled to differentiate between the different ways social support occurs and is expressed through social media. Objective: The objective of this study was to develop a fuller understanding of social support exchange by examining the ways in which breast cancer patients discuss their health needs and reach out for support on Facebook and to develop a coding schema that can be useful to other social media researchers. Methods: We conducted a retrospective qualitative assessment of text-based social support exchanges through Facebook among 30 breast cancer survivors. Facebook wall data were systematically scraped, organized, coded, and characterized by whether and which types of support were exchanged. Research questions focused on how often participants posted related to cancer, how often cancer patients reached out for support, and the relative frequency of informational, instrumental, or socioemotional support requests broadcast by patients on the site. Results: A novel ground-up coding schema applied to unwieldy Facebook data successfully identified social support exchange in two critical transitions in cancer treatment: diagnosis and transition off cancer therapy. Explanatory coding, design, and analysis processes led to a novel coding schema informed by 100,000 lines of data, an a priori literature review, and observed online social support exchanges. A final coding schema permits a compelling analysis of support exchange as a type of peer community, where members act proactively to buffer stress effects associated with negative health experiences. The coding schema framed operational definitions of what support meant and the forms each type of support could take in social media spaces. Conclusions: Given the importance of social media in social interaction, support exchange, and health promotion, our findings provide insight and clarity for researchers into the different forms informational, resource, and emotional support may take in Web-based social environments. Findings support broader continuity for evaluating computer-mediated support exchange. UR - http://www.jmir.org/2019/10/e12880/ UR - http://dx.doi.org/10.2196/12880 UR - http://www.ncbi.nlm.nih.gov/pubmed/31651404 ID - info:doi/10.2196/12880 ER - TY - JOUR AU - Cruz, Marques Flávia Oliveira Almeida AU - Vilela, Alencar Ricardo AU - Ferreira, Barros Elaine AU - Melo, Santos Nilce AU - Reis, Dos Paula Elaine Diniz PY - 2019/08/27 TI - Evidence on the Use of Mobile Apps During the Treatment of Breast Cancer: Systematic Review JO - JMIR Mhealth Uhealth SP - e13245 VL - 7 IS - 8 KW - mobile applications KW - health education KW - nursing care KW - review KW - educational technology KW - breast neoplasms N2 - Background: Cancer is a major cause of morbidity, disability, and mortality worldwide, and breast cancer is the most common cause of death in women. Different modalities of cancer treatment can have adverse effects that reduce the quality of life of patients and lead to treatment interruptions, if not managed properly. The use of mobile technologies has brought innovative possibilities for improving health care. Mobile apps can help individuals manage their own health and well-being and may also promote healthy lifestyles and information access. Objective: The aim of this study was to identify available evidence on the use of mobile apps to provide information and facilitate communication regarding self-care management related to the adverse effects of toxicities owing to breast cancer therapy. Methods: This systematic review includes studies which were identified using a search strategy adapted for each electronic database: CINAHL, Cochrane Library, LILACS, LIVIVO, PubMed, SCOPUS, and Web of Science. In addition, a gray literature search was performed using Google Scholar. All the electronic database searches were conducted on April 17, 2019. Two investigators independently reviewed the titles and abstracts of the studies identified and then read the full text of all selected papers. The quality of the included studies was analyzed by the Cochrane Collaboration Risk of Bias Tool and the Methodological Index for Non-Randomized Studies. Results: A total of 9 studies which met the eligibility criteria?3 randomized clinical trials and 6 nonrandomized studies published in English from 2010 to 2018?were considered for this systematic review; 396 patients with breast cancer, as well as 40 experts in the medical and nursing fields, and 3 software engineers were included. Conclusions: The evidence from the studies included in this systematic review is currently limited but suggests that mobile apps for women with breast cancer might be an acceptable information source that can improve patient well-being; they can also be used to report symptoms and adverse treatment-related effects and promote self-care. There is a need to test more evidence-based apps in future randomized clinical trials. UR - http://mhealth.jmir.org/2019/8/e13245/ UR - http://dx.doi.org/10.2196/13245 UR - http://www.ncbi.nlm.nih.gov/pubmed/31456578 ID - info:doi/10.2196/13245 ER - TY - JOUR AU - Lozano-Lozano, Mario AU - Melguizo-Rodríguez, Lucia AU - Fernández-Lao, Carolina AU - Galiano-Castillo, Noelia AU - Cantarero-Villanueva, Irene AU - Martín-Martín, Lydia AU - Arroyo-Morales, Manuel PY - 2019/08/14 TI - Association Between the Use of a Mobile Health Strategy App and Biological Changes in Breast Cancer Survivors: Prospective Pre-Post Study JO - J Med Internet Res SP - e15062 VL - 21 IS - 8 KW - mHealth KW - interleukin-6 KW - C-reactive protein KW - breast cancer survivors KW - low-grade inflammatory N2 - Background: There is a bidirectional relationship between chronic low-grade inflammation and cancer. Inflammatory markers, such as interleukin-6 (IL-6), have been associated with both the malignant transformation of epithelial cells and tumor progression, thus linking low-grade inflammation with a higher risk of cancer and recurrence in the survival phase. Therefore, they are considered valuable prognostic biomarkers. Knowing and finding appropriate primary prevention strategies to modify these parameters is a major challenge in reducing the risk of cancer recurrence and increasing survival. Different therapeutic strategies have shown efficacy in the modification of these and other biological parameters, but with contradictory results. There are apparently no strategies in which telemedicine, and specifically mobile health (mHealth), are used as a means to potentially cause biological changes. Objective: The objectives of this study were to: (1) check whether it is feasible to find changes in inflammation biomarkers through an mHealth strategy app as a delivery mechanism of an intervention to monitor energy balance; and (2) discover potential predictors of change of these markers in breast cancer survivors (BCSs). Methods: A prospective quasi-experimental pre-post study was conducted through an mHealth energy balance monitoring app with 73 BCSs, defined as stage I-IIIA of breast cancer and at least six months from the completion of the adjuvant therapy. Measurements included were biological salivary markers (IL-6 and C-reactive protein [CRP]), self-completed questionnaires (the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, the user version of the Mobile Application Rating Scale [uMARS] and an ad hoc clinical and sociodemographic questionnaire) and physical objective measures (accelerometry, weight and height). In addition, using the logging data of the mHealth app, the rate of use (in days) was recorded during the entire experimental phase of the study. Using Stata software, a paired two-tailed t test, Pearson and Spearman correlations, and a stepwise multiple regression analysis were used to interpret the data. Results: Analyzing changes in inflammatory biomarker concentrations after using the mHealth app, differences between preassessment CRP (4899.04 pg/ml; SD 1085.25) and IL-6 (87.15 pg/ml; SD 33.59) and postassessment CRP (4221.24 pg/ml; SD 911.55) and IL-6 (60.53 pg/ml; SD 36.31) showed a significant decrease in both markers, with a mean difference of ?635.25 pg/ml (95% CI ?935.65 to ?334.85; P<.001) in CRP and ?26.61 pg/ml (95% CI ?42.51 to ?10.71; P=.002) in IL-6. Stepwise regression analyses revealed that changes in global quality of life, as well as uMARS score and hormonal therapy, were possible predictors of change in CRP concentration after using the mHealth app. In the same way, the type of tumor removal surgery conducted, as well as changes in weight and pain score, were possible predictors of change in IL-6 concentration after using the app. Conclusions: In conclusion, through the results of this study, we hypothesize that there is a possible association between an mHealth energy balance monitoring strategy and biological changes in BCSs. These changes could be explained by different biopsychosocial parameters, such as the use of the application itself, quality of life, pain, type of tumor removal surgery, hormonal treatment or obesity. UR - http://www.jmir.org/2019/8/e15062/ UR - http://dx.doi.org/10.2196/15062 UR - http://www.ncbi.nlm.nih.gov/pubmed/31414667 ID - info:doi/10.2196/15062 ER - TY - JOUR AU - Ariza-Garcia, Angelica AU - Lozano-Lozano, Mario AU - Galiano-Castillo, Noelia AU - Postigo-Martin, Paula AU - Arroyo-Morales, Manuel AU - Cantarero-Villanueva, Irene PY - 2019/07/24 TI - A Web-Based Exercise System (e-CuidateChemo) to Counter the Side Effects of Chemotherapy in Patients With Breast Cancer: Randomized Controlled Trial JO - J Med Internet Res SP - e14418 VL - 21 IS - 7 KW - breast cancer KW - chemotherapy KW - physical fitness KW - randomized control trial KW - telehealth KW - e-health KW - therapeutic exercise N2 - Background: Breast cancer patients have to face a high-risk state during chemotherapy, which involves deterioration of their health including extensive physical deterioration. Face-to-face physical exercise programs have presented low adherence rates during medical treatment, and telehealth systems could improve these adherence rates. Objective: This study aimed to evaluate the effectiveness of a Web-based exercise program (e-CuidateChemo) to mitigate the side effects of chemotherapy on the physical being, anthropometric aspects, and body composition. Methods: A total of 68 patients diagnosed with breast cancer, who were undergoing chemotherapy, were enrolled. The patients were categorized into two groups: e-CuidateChemo (n=34) and controls (n=34). The e-CuidateChemo group participated in an adapted 8-week tailored exercise program through a Web-based system. A blinded, trained researcher assessed functional capacity, strength, anthropometric parameters, and body composition. The intervention effects were tested using analysis of covariance and Cohen d tests. Results: Functional capacity improved significantly in the e-CuidateChemo group compared to the control group (6-minute walk test: 62.07 [SD 130.09] m versus ?26.34 [SD 82.21] m; 6-minute walk test % distance predicted: 10.81% [SD 22.69%] m versus ?4.60% [SD 14.58%]; between-group effect: P=.015 for both). The intervention group also showed significantly improved secondary outcomes such as between-group effects for abdominal (24.93 [SD 26.83] s vs ?18.59 [SD 38.69] s), back (12.45 [SD 10.20] kg vs 1.39 [10.72] kg), and lower body (?2.82 [SD 3.75] s vs 1.26 [SD 2.84] s) strength; all P<.001 compared to the control group. Conclusions: This paper showed that a Web-based exercise program was effective in reversing the detriment in functional capacity and strength due to chemotherapy. Trial Registration: ClinicalTrials.gov NCT02350582; https://clinicaltrials.gov/ct2/show/NCT02350582 UR - http://www.jmir.org/2019/7/e14418/ UR - http://dx.doi.org/10.2196/14418 UR - http://www.ncbi.nlm.nih.gov/pubmed/31342907 ID - info:doi/10.2196/14418 ER - TY - JOUR AU - Zhu, Xiaobao AU - Shi, Jing AU - Lu, Cuiyuan PY - 2019/07/23 TI - Cloud Health Resource Sharing Based on Consensus-Oriented Blockchain Technology: Case Study on a Breast Tumor Diagnosis Service JO - J Med Internet Res SP - e13767 VL - 21 IS - 7 KW - blockchain KW - cloud health KW - breast tumor diagnosis KW - k-nearest neighbors (KNN) KW - Proof of Authority (PoA) KW - consensus-oriented N2 - Background: In recent years, researchers have made significant efforts in advancing blockchain technology. This technology, with distinct features of decentralization and security, can be applied to many fields. In areas of health data and resource sharing, applications of blockchain technology are also emerging. Objective: In this study, we propose a cloud health resource-sharing model based on consensus-oriented blockchain technology and have developed a simulation study on breast tumor diagnosis. Methods: The proposed platform is built on a consortium or federated blockchain that possesses features of both centralization and decentralization. The consensus mechanisms generate operating standards for the proposed model. Open source Ethereum code is employed to provide the blockchain environment. Proof of Authority is selected as the consensus algorithm of block generation. Results: Based on the proposed model, a simulation case study for breast tumor classification is constructed. The simulation includes 9893 service requests from 100 users; 22 service providers are equipped with 22 different classification methods. Each request is fulfilled by a service provider recommended by the weighted k-nearest neighbors (KNN) algorithm. The majority of service requests are handled by 9 providers, and provider service evaluation scores tend to stabilize. Also, user priority on KNN weights significantly affects the system operation outcome. Conclusions: The proposed model is feasible based on the simulation case study for the cloud service of breast tumor diagnosis and has the potential to be applied to other applications. UR - http://www.jmir.org/2019/7/e13767/ UR - http://dx.doi.org/10.2196/13767 UR - http://www.ncbi.nlm.nih.gov/pubmed/31339106 ID - info:doi/10.2196/13767 ER - TY - JOUR AU - Masud, Rafia AU - Al-Rei, Mona AU - Lokker, Cynthia PY - 2019/07/18 TI - Computer-Aided Detection for Breast Cancer Screening in Clinical Settings: Scoping Review JO - JMIR Med Inform SP - e12660 VL - 7 IS - 3 KW - computer-aided detection KW - machine learning KW - screening mammography KW - breast cancer KW - radiology KW - implementation N2 - Background: With the growth of machine learning applications, the practice of medicine is evolving. Computer-aided detection (CAD) is a software technology that has become widespread in radiology practices, particularly in breast cancer screening for improving detection rates at earlier stages. Many studies have investigated the diagnostic accuracy of CAD, but its implementation in clinical settings has been largely overlooked. Objective: The aim of this scoping review was to summarize recent literature on the adoption and implementation of CAD during breast cancer screening by radiologists and to describe barriers and facilitators for CAD use. Methods: The MEDLINE database was searched for English, peer-reviewed articles that described CAD implementation, including barriers or facilitators, in breast cancer screening and were published between January 2010 and March 2018. Articles describing the diagnostic accuracy of CAD for breast cancer detection were excluded. The search returned 526 citations, which were reviewed in duplicate through abstract and full-text screening. Reference lists and cited references in the included studies were reviewed. Results: A total of nine articles met the inclusion criteria. The included articles showed that there is a tradeoff between the facilitators and barriers for CAD use. Facilitators for CAD use were improved breast cancer detection rates, increased profitability of breast imaging, and time saved by replacing double reading. Identified barriers were less favorable perceptions of CAD compared to double reading by radiologists, an increase in recall rates of patients for further testing, increased costs, and unclear effect on patient outcomes. Conclusions: There is a gap in the literature between CAD?s well-established diagnostic accuracy and its implementation and use by radiologists. Generally, the perceptions of radiologists have not been considered and details of implementation approaches for adoption of CAD have not been reported. The cost-effectiveness of CAD has not been well established for breast cancer screening in various populations. Further research is needed on how to best facilitate CAD in radiology practices in order to optimize patient outcomes, and the views of radiologists need to be better considered when advancing CAD use. UR - http://medinform.jmir.org/2019/3/e12660/ UR - http://dx.doi.org/10.2196/12660 UR - http://www.ncbi.nlm.nih.gov/pubmed/31322128 ID - info:doi/10.2196/12660 ER - TY - JOUR AU - Lozano-Lozano, Mario AU - Cantarero-Villanueva, Irene AU - Martin-Martin, Lydia AU - Galiano-Castillo, Noelia AU - Sanchez, Maria-José AU - Fernández-Lao, Carolina AU - Postigo-Martin, Paula AU - Arroyo-Morales, Manuel PY - 2019/06/25 TI - A Mobile System to Improve Quality of Life Via Energy Balance in Breast Cancer Survivors (BENECA mHealth): Prospective Test-Retest Quasiexperimental Feasibility Study JO - JMIR Mhealth Uhealth SP - e14136 VL - 7 IS - 6 KW - mHealth KW - energy balance KW - monitoring KW - breast cancer KW - survivors KW - quality of life N2 - Background: Energy balance is defined as the difference between energy expenditure and energy intake. The current state of knowledge supports the need to better integrate mechanistic approaches through effective studies of energy balance in the cancer population because of an observed significant lack of adherence to healthy lifestyle recommendations. To stimulate changes in breast cancer survivors? lifestyles based on energy balance, our group developed the BENECA (Energy Balance on Cancer) mHealth app. BENECA has been previously validated as a reliable energy balance monitoring system. Objective: Based on our previous results, the goal of this study was to investigate the feasibility of BENECA mHealth in an ecological clinical setting with breast cancer survivors, by studying (1) its feasibility and (2) pretest-posttest differences with regard to breast cancer survivor lifestyles, quality of life (QoL), and physical activity (PA) motivation. Methods: Eighty breast cancer survivors diagnosed with stage I to IIIA and with a body mass index over 25 kg/m2 were enrolled in this prospective test-retest quasi-experimental study. Patients used BENECA mHealth for 8 weeks and were assessed at baseline and the postintervention period. Feasibility main outcomes included percentage of adoption, usage, and attrition; user app quality perception measured with the Mobile App Rating Scale (MARS); satisfaction with the Net Promoter Score (NPS); and barriers and facilitators of its use. Clinical main outcomes included measuring QoL with the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORT QLQ-C30), PA assessment with accelerometry, PA motivation measure with a Spanish self-efficacy scale for physical activity (EAF), and body composition with dual-energy x-ray absorptiometry. Statistical tests (using paired-sample t tests) and Kaplan-Meier survival curves were analyzed. Results: BENECA was considered feasible by the breast cancer survivors in terms of use (76%, 58/76), adoption (69%, 80/116), and satisfaction (positive NPS). The app quality score did not make it one of the best-rated apps (mean 3.71, SD 0.47 points out of 5). BENECA mHealth improved the QoL of participants (global health mean difference [MD] 12.83, 95% CI 8.95-16.71, P<.001), and EAF score (global MD 36.99, 95% CI 25.52-48.46, P<.001), daily moderate-to-vigorous PA (MD 7.38, 95% CI 0.39-14.37, P=.04), and reduced body weight (MD ?1.42, 95% CI ?1.97 to ?0.87, P<.001). Conclusions: BENECA mHealth can be considered feasible in a real clinical context to promote behavioral changes in the lifestyles of breast cancer survivors, but it needs to be enhanced to improve user satisfaction with use and functionality. This study highlights the importance of the use of mobile apps based on energy balance and how the QoL of breast cancer survivors can be improved via monitoring. UR - http://mhealth.jmir.org/2019/6/e14136/ UR - http://dx.doi.org/10.2196/14136 UR - http://www.ncbi.nlm.nih.gov/pubmed/31237570 ID - info:doi/10.2196/14136 ER - TY - JOUR AU - Chen, Liang AU - Yang, Xiaodong AU - Fu, Lunrui AU - Liu, Xiaoming AU - Yuan, Congyi PY - 2019/06/24 TI - Using the Extended Parallel Process Model to Examine the Nature and Impact of Breast Cancer Prevention Information on Mobile-Based Social Media: Content Analysis JO - JMIR Mhealth Uhealth SP - e13987 VL - 7 IS - 6 KW - breast cancer KW - prevention information KW - mobile social media KW - EPPM N2 - Background: With the rise of mobile technology, an increasing number of people use mobile-based social media to access health information. Many scholars have explored the nature of health information on social media; however, the impact of such information on people was understudied. Objective: This study aimed to examine the nature and impact of health information on mobile-based social media. Specifically, we investigated how the levels of threat and efficacy of breast cancer prevention information affect individuals? engagement with the information, such as readings and likes. Methods: Breast cancer prevention articles posted on a Chinese mobile-based social media platform (ie, WeChat Subscription Account [WeChat SA]) from January 1 to December 31, 2017, were extracted using the Python Web Crawler. We used content analysis and analysis of covariance to analyze our data. Results: The results revealed that the vast majority of titles and main bodies of the articles involved one of the extended parallel process model components: threat or efficacy. Conclusions: Breast cancer prevention information on WeChat SA was well designed. Both threat and efficacy significantly affected the number of readings, whereas only efficacy had a significant effect on the number of likes. Moreover, breast cancer prevention information that contained both high levels of threat and efficacy gained the largest number of readings and likes. UR - http://mhealth.jmir.org/2019/6/e13987/ UR - http://dx.doi.org/10.2196/13987 UR - http://www.ncbi.nlm.nih.gov/pubmed/31237239 ID - info:doi/10.2196/13987 ER - TY - JOUR AU - Ramos Herrera, Martin Igor PY - 2019/6/12 TI - Policies and Programs for the Prevention and Control of Breast Cancer in Mexican and Latin American Women: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e12624 VL - 8 IS - 6 KW - breast neoplasms KW - public policies KW - primary health care KW - systematic review N2 - Background: Breast cancer has become a major public health problem around the world, especially in Mexico and Latin America. Screening for breast cancer, which involves self-examination, mammography, and clinical breast examination, is crucial for early diagnosis, which in turn is associated with improved outcomes and survival rates. Although breast cancer prevention and control activities are being implemented in Mexico and Latin America, as in many other countries, there are no comprehensive public reports that provide information on the number, type, and scope of these activities; the impact of the programs and actions implemented; and the policies that form the basis of these programs. Objective: This study aims to present the design of a protocol for a scoping review on the policies and action programs for breast cancer care in Mexico and Latin America, as well as their objectives and implementation plans. Methods: This scoping review is guided by the methodological reference framework proposed by Arksey and O?Malley. A systematic search of the following electronic databases will be performed: MEDLINE (PubMed), MEDLINE (EBSCOHost), CINAHL (EBSCOHost), Academic Search Complete (EBSCOHost), ERIC, ISI Web of Science (Science Citation Index) in English and Cochrane and MEDES-MEDicina in Spanish. A search will be conducted to identify relevant studies published between 2000 and 2018. Data will be analyzed and presented in descriptive statistics and qualitative content analyses with analysis matrices and semantic networks. The selected studies will be arranged according to the Specific Action Program, Prevention and Control of Female Cancer 2013-2018. Results: The intention is to perform this review during the first and second quarters of 2019 and present the results to health authorities by the first quarter of 2020. Results will also be sent for publication to an indexed journal by the second quarter of 2020. Conclusions: We present a protocol for a scoping review?type literature revision based on the Arksey and O?Malley methodology to be performed during the first quarter of 2019. According to this 6-stage methodology, we will identify the scientific publications that present or analyze first-level action policies and programs for breast cancer care in Mexican women, as well as the results of these policies and programs, if any. The outcome of this review will be used to define the basis of a research project intended to design an educational intervention strategy for the general public in Mexico to enable them to deal with this public health problem. International Registered Report Identifier (IRRID): PRR1-10.2196/12624 UR - http://www.researchprotocols.org/2019/6/e12624/ UR - http://dx.doi.org/10.2196/12624 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199301 ID - info:doi/10.2196/12624 ER - TY - JOUR AU - Alvarez-Mon, Angel Miguel AU - Llavero-Valero, María AU - Sánchez-Bayona, Rodrigo AU - Pereira-Sanchez, Victor AU - Vallejo-Valdivielso, Maria AU - Monserrat, Jorge AU - Lahera, Guillermo AU - Asunsolo del Barco, Angel AU - Alvarez-Mon, Melchor PY - 2019/05/28 TI - Areas of Interest and Stigmatic Attitudes of the General Public in Five Relevant Medical Conditions: Thematic and Quantitative Analysis Using Twitter JO - J Med Internet Res SP - e14110 VL - 21 IS - 5 KW - social stigma KW - social media KW - psychosis KW - breast cancer KW - HIV KW - dementia KW - public opinion KW - diabetes N2 - Background: Twitter is an indicator of real-world performance, thus, is an appropriate arena to assess the social consideration and attitudes toward psychosis. Objective: The aim of this study was to perform a mixed-methods study of the content and key metrics of tweets referring to psychosis in comparison with tweets referring to control diseases (breast cancer, diabetes, Alzheimer, and human immunodeficiency virus). Methods: Each tweet?s content was rated as nonmedical (NM: testimonies, health care products, solidarity or awareness and misuse) or medical (M: included a reference to the illness?s diagnosis, treatment, prognosis, or prevention). NM tweets were classified as positive or pejorative. We assessed the appropriateness of the medical content. The number of retweets generated and the potential reach and impact of the hashtags analyzed was also investigated. Results: We analyzed a total of 15,443 tweets: 8055 classified as NM and 7287 as M. Psychosis-related tweets (PRT) had a significantly higher frequency of misuse 33.3% (212/636) vs 1.15% (853/7419; P<.001) and pejorative content 36.2% (231/636) vs 11.33% (840/7419; P<.001). The medical content of the PRT showed the highest scientific appropriateness 100% (391/391) vs 93.66% (6030/6439; P<.001) and had a higher frequency of content about disease prevention. The potential reach and impact of the tweets related to psychosis were low, but they had a high retweet-to-tweet ratio. Conclusions: We show a reduced number and a different pattern of contents in tweets about psychosis compared with control diseases. PRT showed a predominance of nonmedical content with increased frequencies of misuse and pejorative tone. However, the medical content of PRT showed high scientific appropriateness aimed toward prevention. UR - http://www.jmir.org/2019/5/e14110/ UR - http://dx.doi.org/10.2196/14110 UR - http://www.ncbi.nlm.nih.gov/pubmed/31140438 ID - info:doi/10.2196/14110 ER - TY - JOUR AU - Vergani, Laura AU - Marton, Giulia AU - Pizzoli, Maria Silvia Francesca AU - Monzani, Dario AU - Mazzocco, Ketti AU - Pravettoni, Gabriella PY - 2019/03/19 TI - Training Cognitive Functions Using Mobile Apps in Breast Cancer Patients: Systematic Review JO - JMIR Mhealth Uhealth SP - e10855 VL - 7 IS - 3 KW - cognitive impairment KW - breast cancer KW - cognitive training KW - intervention KW - mobile-based interventions N2 - Background: Breast cancer is an invalidating disease and its treatment can bring serious side effects that have a physical and psychological impact. Specifically, cancer treatment generally has a strong impact on cognitive function. In recent years, new technologies and eHealth have had a growing influence on health care and innovative mobile apps can be useful tools to deliver cognitive exercise in the patient?s home. Objective: This systematic review gives an overview of the state-of-the-art mobile apps aimed at training cognitive functions to better understand whether these apps could be useful tools to counteract cognitive impairment in breast cancer patients. Methods: We searched in a systematic way all the full-text articles from the PubMed and Embase databases. Results: We found eleven studies using mobile apps to deliver cognitive training. They included a total of 819 participants. App and study characteristics are presented and discussed, including cognitive domains trained (attention, problem solving, memory, cognitive control, executive function, visuospatial function, and language). None of the apps were specifically developed for breast cancer patients. They were generally developed for a specific clinical population. Only 2 apps deal with more than 1 cognitive domain, and only 3 studies focus on the efficacy of the app training intervention. Conclusions: These results highlight the lack of empirical evidence on the efficacy of currently available apps to train cognitive function. Cognitive domains are not well defined across studies. It is noteworthy that no apps are specifically developed for cancer patients, and their applicability to breast cancer should not be taken for granted. Future studies should test the feasibility, usability, and effectiveness of available cognitive training apps in women with breast cancer. Due to the complexity and multidimensionality of cognitive difficulties in this cancer population, it may be useful to design, develop, and implement an ad hoc app targeting cognitive impairment in breast cancer patients. UR - https://mhealth.jmir.org/2019/3/e10855/ UR - http://dx.doi.org/10.2196/10855 UR - http://www.ncbi.nlm.nih.gov/pubmed/30888326 ID - info:doi/10.2196/10855 ER - TY - JOUR AU - Wright, Kevin AU - Fisher, Carla AU - Rising, Camella AU - Burke-Garcia, Amelia AU - Afanaseva, Dasha AU - Cai, Xiaomei PY - 2019/03/07 TI - Partnering With Mommy Bloggers to Disseminate Breast Cancer Risk Information: Social Media Intervention JO - J Med Internet Res SP - e12441 VL - 21 IS - 3 KW - breast cancer KW - environment and public health KW - risk reduction behavior KW - blogging KW - social networking KW - social media KW - health communication KW - information dissemination N2 - Background: Women are concerned about reducing their breast cancer risk, particularly if they have daughters. Social media platforms, such as blogs written by mothers, are increasingly being recognized as a channel that women use to make personal and family health?related decisions. Government initiatives (eg, Interagency Breast Cancer and Environmental Research Coordinating Committee) and researchers have called for scientists and the community to partner and disseminate scientifically and community-informed environmental risk information. Objective: We developed and evaluated a blog intervention to disseminate breast cancer and environmental risk information to mothers. We teamed with mommy bloggers to disseminate a message that we developed and tailored for mothers and daughters based on scientific evidence from the Breast Cancer and the Environment Research Program (BCERP). We posited that the intervention would influence women?s exposure to, acceptance of, and beliefs about environmental risks while promoting their intention to adopt risk-reducing behaviors. Methods: Using a quasi-experimental design, we recruited 75 mommy bloggers to disseminate the breast cancer risk message on their respective blogs and examined the impact of the intervention on (1) readers exposed to the intervention (n=445) and (2) readers not exposed to the intervention (comparison group; n=353). Results: Following the intervention, blog reader scores indicating exposure to the breast cancer risk and prevention information were greater than scores of blog readers who were not exposed (or did not recall seeing the message; mean 3.92, SD 0.85 and mean 3.45, SD 0.92, respectively; P<.001). Readers who recalled the intervention messages also had higher breast cancer risk and prevention information satisfaction scores compared with readers who did not see (or recall) the messages (mean 3.97, SD 0.75 and mean 3.57, SD 0.94, respectively; P<.001). Blog readers who recalled seeing the intervention messages were significantly more likely to share the breast cancer risk and prevention information they read, with their daughters specifically, than readers who did not recall seeing them (?21=8.1; P=.004). Those who recalled seeing the intervention messages reported significantly higher breast cancer risk and prevention information influence scores, indicative of behavioral intentions, than participants who did not recall seeing them (mean 11.22, SD 2.93 and mean 10.14, SD 3.24, respectively; P=.003). Most women ranked Facebook as their first choice for receiving breast cancer risk information. Conclusions: Results indicated that blog readers who were exposed to (and specifically recalled) the BCERP-adapted intervention messages from mommy bloggers had higher breast cancer risk and prevention information exposure scores and higher breast cancer risk and prevention information satisfaction and influence scores than those who did not see (or recall) them. Mommy bloggers may be important opinion leaders for some women and key to enhancing the messaging, delivery, and impact of environmental breast cancer risk information on mothers. UR - https://www.jmir.org/2019/3/e12441/ UR - http://dx.doi.org/10.2196/12441 UR - http://www.ncbi.nlm.nih.gov/pubmed/30843866 ID - info:doi/10.2196/12441 ER - TY - JOUR AU - Wu, San Hoi AU - Gal, Roxanne AU - van Sleeuwen, C. Niek AU - Brombacher, C. Aarnout AU - IJsselsteijn, A. Wijnand AU - May, M. Anne AU - Monninkhof, M. Evelyn PY - 2019/02/21 TI - Breast Cancer Survivors? Experiences With an Activity Tracker Integrated Into a Supervised Exercise Program: Qualitative Study JO - JMIR Mhealth Uhealth SP - e10820 VL - 7 IS - 2 KW - breast cancer KW - activity trackers KW - physical activity KW - sedentary behavior KW - qualitative research N2 - Background: There is growing evidence that physical activity is related to a better prognosis after a breast cancer diagnosis, whereas sedentary behavior is associated with worse outcomes. It is therefore important to stimulate physical activity and reduce sedentary time among patients with breast cancer. Activity trackers offer a new opportunity for interventions directed at stimulating physical activity behavior change. Objective: This study aimed to explore the experience of patients with breast cancer who used an activity tracker in addition to a supervised exercise intervention in the randomized UMBRELLA Fit trial. Methods: A total of 10 patients with breast cancer who completed cancer treatment participated in semistructured in-depth interviews about their experience with and suggestions for improvements for the Jawbone UP2 activity tracker. Results: The activity tracker motivated women to be physically active and created more awareness of their (sedentary) lifestyles. The women indicated that the automatically generated advice (received via the Jawbone UP app) lacked individualization and was not applicable to their personal situations (ie, having been treated for cancer). Furthermore, women felt that the daily step goal was one-dimensional, and they preferred to incorporate other physical activity goals. The activity tracker?s inability to measure strength exercises was a noted shortcoming. Finally, women valued personal feedback about the activity tracker from the physiotherapist. Conclusions: Wearing an activity tracker raised lifestyle awareness in patients with breast cancer. The women also reported additional needs not addressed by the system. Potential improvements include a more realistic total daily physical activity representation, personalized advice, and personalized goals. UR - https://mhealth.jmir.org/2019/2/e10820/ UR - http://dx.doi.org/10.2196/10820 UR - http://www.ncbi.nlm.nih.gov/pubmed/30789349 ID - info:doi/10.2196/10820 ER - TY - JOUR AU - Jongerius, Chiara AU - Russo, Selena AU - Mazzocco, Ketti AU - Pravettoni, Gabriella PY - 2019/02/11 TI - Research-Tested Mobile Apps for Breast Cancer Care: Systematic Review JO - JMIR Mhealth Uhealth SP - e10930 VL - 7 IS - 2 KW - breast cancer care KW - breast cancer management KW - breast cancer prevention KW - breast cancer survivorship KW - mobile applications KW - mHealth applications N2 - Background: The use of mobile health (mHealth) apps in clinical settings is increasing widely. mHealth has been used to promote prevention, improve early detection, manage care, and support survivors and chronic patients. However, data on the efficacy and utility of mHealth apps are limited. Objective: The main objective of this review was to provide an overview of the available research-tested interventions using mHealth apps and their impact on breast cancer care. Methods: A systematic search of Medline, PsycINFO, Embase, and Scopus was performed to identify relevant studies. From the selected studies, the following information was extracted: authors, publication date, study objectives, study population, study design, interventions? features, outcome measures, and results. Results: We identified 29 empirical studies that described a health care intervention using an mHealth app in breast cancer care. Of these, 7 studies were about the use of an mHealth application in an intervention for breast cancer prevention and early detection, 12 targeted care management, and 10 focused on breast cancer survivors. Conclusions: Our results indicate consistent and promising findings of interventions using mHealth apps that target care management in breast cancer. Among the categories of mHealth apps focusing on survivorship, mHealth-based interventions showed a positive effect by promoting weight loss, improving the quality of life, and decreasing stress. There is conflicting and less conclusive data on the effect of mHealth apps on psychological dimensions. We advocate further investigation to confirm and strengthen these findings. No consistent evidence for the impact of interventions using mHealth apps in breast cancer prevention and early detection was identified due to the limited number of studies identified by our search. Future research should continue to explore the impact of mHealth apps on breast cancer care to build on these initial recommendations. UR - http://mhealth.jmir.org/2019/2/e10930/ UR - http://dx.doi.org/10.2196/10930 UR - http://www.ncbi.nlm.nih.gov/pubmed/30741644 ID - info:doi/10.2196/10930 ER - TY - JOUR AU - Marcu, Afrodita AU - Muller, Cecile AU - Ream, Emma AU - Whitaker, L. Katriina PY - 2019/02/06 TI - Online Information-Seeking About Potential Breast Cancer Symptoms: Capturing Online Behavior With an Internet Browsing Tracking Tool JO - J Med Internet Res SP - e12400 VL - 21 IS - 2 KW - breast cancer KW - health information KW - internet search KW - online information seeking N2 - Background: People engage in health information-seeking online when experiencing unusual or unfamiliar bodily changes. It is not well understood how people consult the internet for health information after the onset of unfamiliar symptoms and before receiving a potential diagnosis and how online information-seeking can help people appraise their symptoms. This lack of evidence may be partly due to methodological limitations in capturing in real time the online information-seeking process. Objective: We explored women?s symptom attribution and online health information-seeking in response to a hypothetical and unfamiliar breast change suggestive of cancer (nipple rash). We also aimed to establish the feasibility of capturing in real time the online information-seeking process with a tool designed to track participant online searches and visited websites, the Vizzata browser tracker. Methods: An online survey was completed by 56 cancer-free women (mean age 60.34 [SD 7.73] years) responding to a scenario asking them to imagine noticing a red scaly rash on the nipple. Participants were asked to make symptom attributions when presented with the scenario (T1) and again after seeking information online (T2). The online tracking tool, embedded in the survey, was used to capture in real time participant search terms and accessed websites. Results: The tracking tool captured the search terms and accessed websites of most of the participants (46/56, 82%). For the rest (10/56, 18%), there was evidence of engagement in online information-seeking (eg, medical terminology and cancer attribution at T2) despite their searching activity not being recorded. A total of 25 participants considered cancer as a potential cause for the nipple rash at T1, yet only one of these used cancer as a search term. Most participants (40/46, 87%) used rash-related search terms, particularly nipple rash and rash on nipple. The majority (41/46, 89%) accessed websites containing breast cancer information, with the National Health Service webpage ?Paget disease of the nipple? being the most visited one. At T2, after engaging in the internet search task, more participants attributed the nipple rash to breast cancer than at T1 (37/46, 66% vs 25/46, 45%), although a small number of participants (6/46) changed from making a cancer attribution at T1 to a noncancer one at T2. Conclusions: Making a cancer attribution for an unfamiliar breast change did not necessarily translate into cancer-termed searches. Equally, not all internet searches led to a cancer attribution. The findings suggest that online information-seeking may not necessarily help women who experience unfamiliar breast cancer symptoms understand their condition. Despite some technical issues, this study showed that it is feasible to use an online browser tracking tool to capture in real time information-seeking about unfamiliar symptoms. UR - http://www.jmir.org/2019/2/e12400/ UR - http://dx.doi.org/10.2196/12400 UR - http://www.ncbi.nlm.nih.gov/pubmed/30724741 ID - info:doi/10.2196/12400 ER - TY - JOUR AU - Lee, Tzu-I AU - Sheu, Shuh-Jen AU - Chang, Hsueh-Chin AU - Hung, Yu-Ting AU - Tseng, Ling-Ming AU - Chou, Shin-Shang AU - Liang, Te-Hsin AU - Liu, Hui-Ju AU - Lu, Hui-Ling AU - Chen, Mei-Chun AU - Liu, Ying-Chun AU - Tsai, Chi-Shan AU - Sun, Jui-Chiung PY - 2019/02/04 TI - Developing a Web-Based Comic for Newly Diagnosed Women With Breast Cancer: An Action Research Approach JO - J Med Internet Res SP - e10716 VL - 21 IS - 2 KW - action research KW - breast cancer KW - comic KW - narrative N2 - Background: Personal narratives have been seen as a useful way of communicating about cancer treatment options and providing recovery information. Many printed versions of such material are available, including comics that explore the individual memories of patients who have gone through cancer treatment. These studies have been used to orientate patients, patients? relatives, and physicians. However, only a few Web-based comics have been specifically designed for patients with breast cancer and used as aids to decision making. Objective: We aimed to describe the developmental process of creating an animated comic as a Web-based surgery decision-making tool; the comic was aimed at illustrating the feelings, thoughts, and meanings when a patient suffers from breast cancer. This was done by recounting the symptoms, diagnostic process, treatments, and treatment effects of such women from the diagnosis stage onward. Methods: Using cycles of planning, action, evaluation, and reflection, which involved collaborative work, action research was conducted to develop a Web-based animated comic. The stages of action research consisted of (1) semistructured and in-depth interviews to collect experiences of women with breast cancer; (2) construction of an animated comic by editors, graphics designers, dubbers, and information technology engineers; (3) redrawing of pictures of the comic after gathering feedback from a breast surgeon; and (4) evaluation of the Web-based animated comic using 6 patient focus groups. Results: The comic was produced and showcased on the website ?The Network of Making-decision Aids for Breast Cancer Surgery?; the comic was accompanied by soft music and audio explanations. The comic functions as a personal statement that describes experiencing breast cancer. The animated comic consists of 8 chapters, based on the 8 themes deducted from the findings obtained during the analysis of relevant interviews. The 8 chapters include (1) the appearance of a lump; (2) confirmation by medical diagnosis; (3) the uncertainty of waiting (4) fear of life-threatening disease; (5) choosing life over despair; (6) being brave and deciding to undergo treatment; (7) choosing the type of surgery; and (8) being reborn. Conclusions: Using action research, this study illustrated that the comic that sheds light on issues of feelings, emotions, and thoughts that are present when a woman is diagnosed with breast cancer and provides a communication medium to explain the steps in the process. Meanwhile, it implies that hope will be able to overcome the challenges that will be faced. Within the Web-based decision aid for patients with breast cancer, the animated comic acts as an information resource and is aimed at patients? understanding of impacts of emotions arising when suffering from breast cancer. It is potentially applicable as a therapeutic tool that facilitates self-reflection and self-healing among newly diagnosed patients with breast cancer. UR - https://www.jmir.org/2019/2/e10716/ UR - http://dx.doi.org/10.2196/10716 UR - http://www.ncbi.nlm.nih.gov/pubmed/30714947 ID - info:doi/10.2196/10716 ER - TY - JOUR AU - Hung, Yu-Ting AU - Wu, Ching-Fang AU - Liang, Te-Hsin AU - Chou, Shin-Shang AU - Chen, Guan-Liang AU - Wu, Pei-Ni AU - Su, Guan-Rong AU - Jang, Tsuey-Huah AU - Liu, Chang-Yi AU - Wang, Ching-Yen AU - Tseng, Ling-Ming AU - Sheu, Shuh-Jen PY - 2019/02/04 TI - Developing a Decision-Aid Website for Breast Cancer Surgery: An Action Research Approach JO - J Med Internet Res SP - e10404 VL - 21 IS - 2 KW - breast cancer KW - surgery-related decision making KW - website KW - action research N2 - Background: Patients with early-stage breast cancer have numerous options when choosing the type of breast surgery method to be applied. Each of these options lead to a similar long-term survival rate, but result in significant differences in appearance, function, cost, recurrence rate, and various other relevant considerations. However, the time available for detailed communication with each patient is often limited in clinics, which puts these women under great psychological stress and can hinder their surgery-related decision making. Objective: The objective of this study was to develop a multipurpose surgery decision-making website providing medical information, psychological support, and decision-related simulation for women during breast cancer surgery-related decision making. Methods: Using the 4 steps of action research, which involve multigroup teamwork via regular team meetings, the following were performed: (1) Planning: searching, analyzing, and evaluating health websites to consensually decide the major infrastructure; (2) Action: work was performed simultaneously in 4 groups, which consisted of medical information collection and editing, patient interviews and data extraction, webpage content design, and programming to create or host the website; (3) Evaluation: the website was tested by clinical experts and focus groups of former breast cancer patients to assess its effectiveness and pinpoint appropriate improvements; and (4) Reflection: constant dialogue was conducted between the various participants at each step, which was used as the foundation and motivation of next plan-action-evaluation-reflection circle. Results: Using the action research approach, we completed the development of our website, which includes the following: (1) ?Woman?s Voice??an animated comic depicting the story of a female breast cancer patient with interspersed questions for the users that will help them better empathize with the experience; (2) ?Cancer Information Treasure House??providing breast cancer surgery-related information through text, tables, pictures and a presentation video; (3) ?Decision-making Simulator??helping patients think through and check the pros and cons of the different surgical options via visual-based interactions including ?Stairs Climbing? and ?Fruit of Hope?; and (4) ?Recommended Links??providing reliable websites for further reference. Additionally, we have further improved the website based on the feedback received from postsurgery breast cancer patients and clinicians. We hope to continue improving to better meet both the patients? and health providers? needs and become a practical decision-making aid for patients undergoing breast cancer surgery. Conclusions: We have created the first breast cancer surgery decision-making assistance tool in Taiwan using a ?Web-based? and multifunctional website design. This site aims to provide health care knowledge, psychological healing, and emotional support functions, as well as decision-making capability enhancement simulations. We look forward to assisting breast cancer patients in their decision-making process and expect our website to increase patient?s autonomy and improve their communication with clinicians. UR - https://www.jmir.org/2019/2/e10404/ UR - http://dx.doi.org/10.2196/10404 UR - http://www.ncbi.nlm.nih.gov/pubmed/30714941 ID - info:doi/10.2196/10404 ER - TY - JOUR AU - Matthies, Maria Lina AU - Taran, Florin-Andrei AU - Keilmann, Lucia AU - Schneeweiss, Andreas AU - Simoes, Elisabeth AU - Hartkopf, D. Andreas AU - Sokolov, N. Alexander AU - Walter, B. Christina AU - Sickenberger, Nina AU - Wallwiener, Stephanie AU - Feisst, Manuel AU - Gass, Paul AU - Lux, P. Michael AU - Schuetz, Florian AU - Fasching, A. Peter AU - Sohn, Christof AU - Brucker, Y. Sara AU - Graf, Joachim AU - Wallwiener, Markus PY - 2019/01/22 TI - An Electronic Patient-Reported Outcome Tool for the FACT-B (Functional Assessment of Cancer Therapy-Breast) Questionnaire for Measuring the Health-Related Quality of Life in Patients With Breast Cancer: Reliability Study JO - J Med Internet Res SP - e10004 VL - 21 IS - 1 KW - breast cancer KW - ePRO measurement KW - FACT-B KW - HRQoL KW - patient-reported outcomes KW - reliability of ePRO N2 - Background: The most frequent malignant disease in women is breast cancer. In the metastatic setting, quality of life is the primary therapeutic goal, and systematic treatment has only a limited effect on survival rates; therefore, the concept of the health-related quality of life (HRQoL) and measurement of patient-reported outcomes (PROs) are gaining more and more importance in the therapy setting of diseases such as breast cancer. One of the frequently used questionnaires for measuring the HRQoL in patients with breast cancer is the Functional Assessment of Cancer Therapy-Breast (FACT-B). Currently, paper-based surveys still predominate, as only a few reliable and validated electronic-based questionnaires are available. ePRO tools for the FACT-B questionnaire with proven reliability are missing so far. Objective: The aim of this study was to analyze the reliability of tablet-based measurement of FACT-B in the German language in adjuvant (curative) and metastatic breast cancer patients. Methods: Paper- and tablet-based questionnaires were completed by a total of 106 female adjuvant and metastatic breast cancer patients. All patients were required to complete the electronically based (ePRO) and paper-based version of the FACT-B. A frequency analysis was performed to determine descriptive sociodemographic characteristics. Both dimensions of reliability (parallel forms reliability using Wilcoxon test and test of internal consistency using Spearman ?) and agreement rates for single items, Kendall tau for each subscale, and total score were analyzed. Results: High correlations were shown for both dimensions of reliability (parallel forms reliability and internal consistency) in the patients? response behavior between paper-based and electronically based questionnaires. Regarding the reliability test of parallel forms, no significant differences were found in 35 of 37 single items, while significant correlations in the test for consistency were found in all 37 single items, in all 5 sum individual item subscale scores, as well as in total FACT-B score. Conclusions: The ePRO version of the FACT-B questionnaire is reliable for patients with breast cancer in both adjuvant and metastatic settings, showing highly significant correlations with the paper-based version in almost all questions all subscales and the total score. UR - http://www.jmir.org/2019/1/e10004/ UR - http://dx.doi.org/10.2196/10004 UR - http://www.ncbi.nlm.nih.gov/pubmed/30668517 ID - info:doi/10.2196/10004 ER - TY - JOUR AU - Karsten, M. Maria AU - Speiser, Dorothee AU - Hartmann, Claudia AU - Zeuschner, Nele AU - Lippold, Kai AU - Kiver, Verena AU - Gocke, Peter AU - Kirchberger, Valerie AU - Blohmer, Jens-Uwe PY - 2018/12/20 TI - Web-Based Patient-Reported Outcomes Using the International Consortium for Health Outcome Measurement Dataset in a Major German University Hospital: Observational Study JO - JMIR Cancer SP - e11373 VL - 4 IS - 2 KW - breast cancer KW - International Council Health Outcome Measurement KW - mobile phone KW - patient-reported outcomes N2 - Background: Collecting patient-reported outcome (PRO) data systematically enables objective evaluation of treatment and its related outcomes. Using disease-specific questionnaires developed by the International Consortium for Health Outcome Measurement (ICHOM) allows for comparison between physicians, hospitals, and even different countries. Objective: This pilot project aimed to establish a digital system to measure PROs for new patients with breast cancer who attended the Charité Breast Center This approach should serve as a blueprint to further expand the PRO measurement to other disease entities and departments. Methods: In November 2016, we implemented a Web-based system to collect PRO data at Charité Breast Center using the ICHOM dataset. All new patients at the Breast Center were enrolled and answered a predefined set of questions using a tablet computer. Once they started their treatment at Charité, automated emails were sent to the patients at predefined treatment points. Those emails contained a Web-based link through which they could access and answer questionnaires. Results: By now, 541 patients have been enrolled and 2470 questionnaires initiated. Overall, 9.4% (51/541) of the patients were under the age of 40 years, 49.7% (269/541) between 40 and 60 years, 39.6% (214/541) between 60 and 80 years, and 1.3% (7/541) over the age of 80 years. The average return rate of questionnaires was 67.0%. When asked about the preference regarding paper versus Web-based questionnaires, 6.0% (8/134) of the patients between 50 and 60 years, 6.0% (9/150) between 60 and 70 years, and 12.7% (9/71) over the age of 70 years preferred paper versions. Conclusions: Measuring PRO in patients with breast cancer in an automated electronic version is possible across all age ranges while simultaneously achieving a high return rate. UR - http://cancer.jmir.org/2018/2/e11373/ UR - http://dx.doi.org/10.2196/11373 UR - http://www.ncbi.nlm.nih.gov/pubmed/30573450 ID - info:doi/10.2196/11373 ER - TY - JOUR AU - Jones, Josette AU - Pradhan, Meeta AU - Hosseini, Masoud AU - Kulanthaivel, Anand AU - Hosseini, Mahmood PY - 2018/11/29 TI - Novel Approach to Cluster Patient-Generated Data Into Actionable Topics: Case Study of a Web-Based Breast Cancer Forum JO - JMIR Med Inform SP - e45 VL - 6 IS - 4 KW - data interpretation KW - natural language processing KW - patient-generated information KW - social media KW - statistical analysis KW - infodemiology N2 - Background: The increasing use of social media and mHealth apps has generated new opportunities for health care consumers to share information about their health and well-being. Information shared through social media contains not only medical information but also valuable information about how the survivors manage disease and recovery in the context of daily life. Objective: The objective of this study was to determine the feasibility of acquiring and modeling the topics of a major online breast cancer support forum. Breast cancer patient support forums were selected to discover the hidden, less obvious aspects of disease management and recovery. Methods: First, manual topic categorization was performed using qualitative content analysis (QCA) of each individual forum board. Second, we requested permission from the Breastcancer.org Community for a more in-depth analysis of the postings. Topic modeling was then performed using open source software Machine Learning Language Toolkit, followed by multiple linear regression (MLR) analysis to detect highly correlated topics among the different website forums. Results: QCA of the forums resulted in 20 categories of user discussion. The final topic model organized >4 million postings into 30 manageable topics. Using qualitative analysis of the topic models and statistical analysis, we grouped these 30 topics into 4 distinct clusters with similarity scores of ?0.80; these clusters were labeled Symptoms & Diagnosis, Treatment, Financial, and Family & Friends. A clinician review confirmed the clinical significance of the topic clusters, allowing for future detection of actionable items within social media postings. To identify the most significant topics across individual forums, MLR demonstrated that 6 topics?based on the Akaike information criterion values ranging from ?642.75 to ?412.32?were statistically significant. Conclusions: The developed method provides an insight into the areas of interest and concern, including those not ascertainable in the clinic. Such topics included support from lay and professional caregivers and late side effects of therapy that consumers discuss in social media and may be of interest to clinicians. The developed methods and results indicate the potential of social media to inform the clinical workflow with regards to the impact of recovery on daily life. UR - http://medinform.jmir.org/2018/4/e45/ UR - http://dx.doi.org/10.2196/medinform.9162 UR - http://www.ncbi.nlm.nih.gov/pubmed/30497991 ID - info:doi/10.2196/medinform.9162 ER - TY - JOUR AU - Lo, L. Louisa AU - Collins, M. Ian AU - Bressel, Mathias AU - Butow, Phyllis AU - Emery, Jon AU - Keogh, Louise AU - Weideman, Prue AU - Steel, Emma AU - Hopper, L. John AU - Trainer, H. Alison AU - Mann, B. Gregory AU - Bickerstaffe, Adrian AU - Antoniou, C. Antonis AU - Cuzick, Jack AU - Phillips, Kelly-Anne PY - 2018/11/07 TI - The iPrevent Online Breast Cancer Risk Assessment and Risk Management Tool: Usability and Acceptability Testing JO - JMIR Formativ Res SP - e24 VL - 2 IS - 2 KW - clinical decision support KW - breast cancer KW - BRCA1 gene KW - BRCA2 gene KW - risk KW - preventive health KW - screening N2 - Background: iPrevent estimates breast cancer (BC) risk and provides tailored risk management information. Objective: The objective of this study was to assess the usability and acceptability of the iPrevent prototype. Methods: Clinicians were eligible for participation in the study if they worked in primary care, breast surgery, or genetics clinics. Female patients aged 18-70 years with no personal cancer history were eligible. Clinicians were first familiarized with iPrevent using hypothetical paper-based cases and then actor scenarios; subsequently, they used iPrevent with their patients. Clinicians and patients completed the System Usability Scale (SUS) and an Acceptability questionnaire 2 weeks after using iPrevent; patients also completed measures of BC worry, anxiety, risk perception, and knowledge pre- and 2 weeks post-iPrevent. Data were summarized using descriptive statistics. Results: The SUS and Acceptability questionnaires were completed by 19 of 20 clinicians and 37 of 43 patients. Usability was above average (SUS score >68) for 68% (13/19) clinicians and 76% (28/37) patients. The amount of information provided by iPrevent was reported as ?about right? by 89% (17/19) clinicians and 89% (33/37) patients and 95% (18/19) and 97% (36/37), respectively, would recommend iPrevent to others, although 53% (10/19) clinicians and 27% (10/37) patients found it too long. Exploratory analyses suggested that iPrevent could improve risk perception, decrease frequency of BC worry, and enhance BC prevention knowledge without changing state anxiety. Conclusions: The iPrevent prototype demonstrated good usability and acceptability. Because concerns about length could be an implementation barrier, data entry has been abbreviated in the publicly available version of iPrevent. UR - http://formative.jmir.org/2018/2/e24/ UR - http://dx.doi.org/10.2196/formative.9935 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684421 ID - info:doi/10.2196/formative.9935 ER - TY - JOUR AU - Katapodi, C. Maria AU - Jung, Miyeon AU - Schafenacker, M. Ann AU - Milliron, J. Kara AU - Mendelsohn-Victor, E. Kari AU - Merajver, D. Sofia AU - Northouse, L. Laurel PY - 2018/04/13 TI - Development of a Web-based Family Intervention for BRCA Carriers and Their Biological Relatives: Acceptability, Feasibility, and Usability Study JO - JMIR Cancer SP - e7 VL - 4 IS - 1 KW - BRCA families KW - family-based intervention study KW - Web-based intervention study KW - psycho-educational and skills-building intervention study KW - communication and coping KW - patient decision-aid KW - genetic testing N2 - Background: Carriers of breast cancer gene (BRCA) mutations are asked to communicate genetic test results to their biological relatives to increase awareness of cancer risk and promote use of genetic services. This process is highly variable from family to family. Interventions that support communication of genetic test results, coping, and offer decision support in families harboring a pathogenic variant may contribute to effective management of hereditary cancer. Objective: The aim of this paper was to describe the development of the Family Gene Toolkit, a Web-based intervention targeting BRCA carriers and untested blood relatives, designed to enhance coping, family communication, and decision making. Methods: We present findings from focus groups regarding intervention acceptability and participant satisfaction and from a pre-post pilot study with random allocation to a wait-listed control group regarding intervention feasibility and usability. Results: The Family Gene Toolkit was developed by a multidisciplinary team as a psycho-educational and skills-building intervention. It includes two live webinar sessions and a follow-up phone call guided by a certified genetic counselor and a master?s prepared oncology nurse. Each live webinar includes two modules (total four modules) presenting information about BRCA mutations, a decision aid for genetic testing, and two skill-building modules for effective coping and family communication. Participants in focus groups (n=11) were highly satisfied with the intervention, reporting it to be useful and describing clearly the important issues. From the 12 dyads recruited in the pre-post pilot study (response rate 12/52, 23%), completion rate was 71% (10/14) for intervention and 40% (4/10) for wait-listed control groups. Conclusions: Acceptability and satisfaction with the Family Gene Toolkit is high. On the basis of the findings from usability and feasibility testing, modifications on timing, delivery mode, and recruitment methods have been implemented. Trial Registration: ClinicalTrials.gov NCT02154633; https://clinicaltrials.gov/ct2/show/NCT02154633 (Archived by WebCite at http://www.webcitation.org/6yYNvLPjv) UR - http://cancer.jmir.org/2018/1/e7/ UR - http://dx.doi.org/10.2196/cancer.9210 UR - http://www.ncbi.nlm.nih.gov/pubmed/29653920 ID - info:doi/10.2196/cancer.9210 ER - TY - JOUR AU - Tokosi, O. Temitope AU - Fortuin, Jill AU - Douglas, S. Tania PY - 2017/12/21 TI - The Impact of mHealth Interventions on Breast Cancer Awareness and Screening: Systematic Review Protocol JO - JMIR Res Protoc SP - e246 VL - 6 IS - 12 KW - mHealth KW - breast cancer KW - women KW - awareness KW - screening N2 - Background: Mobile health (mHealth) is the use of mobile communication technologies to promote health by supporting health care practices (eg, health data collection, delivery of health care information). mHealth technologies (such as mobile phones) can be used effectively by health care practitioners in the distribution of health information and have the potential to improve access to and quality of health care, as well as reduce the cost of health services. Current literature shows limited scientific evidence related to the benefits of mHealth interventions for breast cancer, which is the leading cause of cancer deaths in women worldwide and contributes a large proportion of all cancer deaths, especially in developing countries. Women, especially in low- and middle-income countries (LMICs), are faced with low odds of surviving breast cancer. This finding is likely due to multiple factors related to health systems: low priority of women?s health and cancer on national health agendas; lack of awareness that breast cancer can be effectively treated if detected early; and societal, cultural, and religious factors that are prevalent in LMICs. The proposed systematic review will examine the impact of mHealth interventions on breast cancer awareness and screening among women aged 18 years and older. Objective: The objectives of this study are to identify and describe the various mHealth intervention strategies that are used for breast cancer, and assess the impact of mHealth strategies on breast cancer awareness and screening. Methods: Literature from various databases such as MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials will be examined. Trial registers, reports, and unpublished theses will also be included. All mobile technologies such as cell phones, personal digital assistants, and tablets that have short message service, multimedia message service, video, and audio capabilities will be included. mHealth is the primary intervention. The search strategy will include keywords such as ?mHealth,? ?breast cancer,? ?awareness,? and ?screening,? among other medical subject heading terms. Articles published from January 1, 1964 to December 31, 2016 will be eligible for inclusion. Two authors will independently screen and select studies, extract data, and assess the risk of bias, with discrepancies resolved by dialogue involving a third author. We will assess statistical heterogeneity by examining the types of participants, interventions, study designs, and outcomes in each study, and pool studies judged to be statistically homogeneous. In the assessment of heterogeneity, a sensitivity analysis will be considered to explore statistical heterogeneity. Statistical heterogeneity will be investigated using the Chi-square test of homogeneity on Cochrane's Q statistic and quantified using the I-squared statistic. Results: The search strategy will be refined with the assistance of an information specialist from November 1, 2017 to January 31, 2018. Literature searches will take place from February 2018 to April 2018. Data extraction and capturing in Review Manager (RevMan, Version 5.3) will take place from May 1, 2018 to July 31, 2018. The final stages will include analyses and writing, which is anticipated occur between August 2018 and October 2018. Conclusions: The knowledge derived from this study will inform health care stakeholders, including researchers, policy makers, investors, health professionals, technologists, and engineers, on the impact of mHealth interventions on breast cancer screening and awareness. Trial Registration: Prospero registration number CRD42016050202 UR - http://www.researchprotocols.org/2017/12/e246/ UR - http://dx.doi.org/10.2196/resprot.8043 UR - http://www.ncbi.nlm.nih.gov/pubmed/29269341 ID - info:doi/10.2196/resprot.8043 ER - TY - JOUR AU - Puigpinos-Riera, Rosa AU - Continente, Xavier AU - Serral, Gemma AU - Bargalló, Xavi AU - Doménech, Montserrat AU - Espinosa-Bravo, Martín AU - Grau, Jaume AU - Macià, Francesc AU - Manzanera, Rafael AU - Pla, Margarida AU - Quintana, Jesus M. AU - Sala, Maria AU - Vidal, Eulalia PY - 2017/12/18 TI - Influence of Social Determinants, Lifestyle, Emotional Well-Being and the Use of Unconventional Therapies in Breast Cancer Progression in a Cohort of Women in Barcelona: Protocol for the DAMA Cohort JO - JMIR Res Protoc SP - e249 VL - 6 IS - 12 KW - breast cancer KW - cohort study N2 - Background: Breast cancer continues to be the most commonly diagnosed cancer in women. Breast cancer survivors face numerous problems, especially after completing the first year of intense treatment. We present the protocol for an ongoing study to analyze the impact of a series of factors on breast cancer survival related to lifestyle, emotional well-being, and use of complementary and alternative medicine (CAM). Objective: We aim to analyze the influence of social determinants, lifestyle changes, emotional well-being, and use of CAM in the progression of breast cancer in women diagnosed with breast cancer between 2003 and 2013 in Barcelona, Spain. Methods: We will perform a mixed cohort study (prospective and retrospective) of women diagnosed with breast cancer, created using a convenience sample in which we study the evolution of the disease (relapse, death, or remaining disease-free). Once identified, we sent the women information about the study and an informed consent form that they are required to sign in order to participate; a total of 2235 women were recruited. We obtained the following information from all participants: sociodemographic profile via a phone interview, and a self-administered survey of information about the study?s objectives (lifestyles, emotional well-being, health care services, and the use of CAM). Lastly, we examined clinical records to obtain data on the tumor at the time of diagnosis, the treatment received, the occurrence of relapses (if any), and the tumor typology. We present data on the women?s social profile based on descriptive data obtained from the telephone interview (welcome survey). Results: Based on the welcome survey, which was completed by 2712 women, 14.42% (391/2712) of respondents were <50 years of age, 45.50% (1234/2712) were between 50 and 65 years of age, and 40.08% (1087/2712) were >65 years of age. A total of 43.69% (1185/2712) belonged to the highest social classes (I and II), 31.27% (848/2712) to the middle class (III), and 23.49% (637/2712) to the working classes (IV and V). Approximately 22.71% (616/2712) lived alone, 38.31% (1039/2712) lived with one person, and 38.97% (1057/2712) lived with two or more people. Conclusions: We obtained information from a large cohort of women, but this study has limitations related to the convenience sampling strategy, one of which is reduced representativeness. Conversely, being a self-administered survey, the study introduces biases, especially from respondents that answered on paper. However, the information that the study provides will serve as the basis for designing future interventions aimed at improving the knowledge gaps indicated for women with breast cancer. UR - http://www.researchprotocols.org/2017/12/e249/ UR - http://dx.doi.org/10.2196/resprot.7653 UR - http://www.ncbi.nlm.nih.gov/pubmed/29254913 ID - info:doi/10.2196/resprot.7653 ER - TY - JOUR AU - Paxton, J. Raheem AU - Hajek, Richard AU - Newcomb, Patricia AU - Dobhal, Megha AU - Borra, Sujana AU - Taylor, C. Wendell AU - Parra-Medina, Deborah AU - Chang, Shine AU - Courneya, S. Kerry AU - Block, Gladys AU - Block, Torin AU - Jones, A. Lovell PY - 2017/09/21 TI - A Lifestyle Intervention via Email in Minority Breast Cancer Survivors: Randomized Parallel-Group Feasibility Study JO - JMIR Cancer SP - e13 VL - 3 IS - 2 KW - breast neoplasm KW - African Americans KW - diet KW - feasibility study KW - physical activity KW - posture KW - program evaluation KW - Internet KW - computer tailoring KW - email N2 - Background: Our data have indicated that minority breast cancer survivors are receptive to participating in lifestyle interventions delivered via email or the Web, yet few Web-based studies exist in this population. Objective: The aim of this study was to examine the feasibility and preliminary results of an email-delivered diet and activity intervention program, ?A Lifestyle Intervention Via Email (ALIVE),? delivered to a sample of racial and ethnic minority breast cancer survivors. Methods: Survivors (mean age: 52 years, 83% [59/71] African American) were recruited and randomized to receive either the ALIVE program?s 3-month physical activity track or its 3-month dietary track. The fully automated system provided tools for self-monitoring and goal setting, tailored content, and automated phone calls. Descriptive statistics and mixed-effects models were computed to examine the outcomes of the study. Results: Upon completion, 44 of 71 survivors completed the study. Our ?intention-to-treat? analysis revealed that participants in the physical activity track made greater improvements in moderate to vigorous activity than those in the dietary track (+97 vs. +49 min/week, P<.001). Similarly, reductions in total sedentary time among those in the physical activity track (?304 vs. ?59 min/week, P<.001) was nearly 5 times greater than that for participants in the dietary track. Our completers case analysis indicated that participants in the dietary track made improvements in the intake of fiber (+4.4 g/day), fruits and vegetables (+1.0 cup equivalents/day), and reductions in saturated fat (?2.3 g/day) and trans fat (?0.3 g/day) (all P<.05). However, these improvements in dietary intake were not significantly different from the changes observed by participants in the physical activity track (all P>.05). Process evaluation data indicated that most survivors would recommend ALIVE to other cancer survivors (97%), were satisfied with ALIVE (82%), and felt that ALIVE was effective (73%). However, survivors expressed concerns about the functionality of the interactive emails. Conclusions: ALIVE appears to be feasible for racial and ethnic minority cancer survivors and showed promising results for larger implementation. Although survivors favored the educational content, a mobile phone app and interactive emails that work on multiple email domains may help to boost adherence rates and to improve satisfaction with the Web-based platform. Trial Registration: ClinicalTrials.gov NCT02722850; https://clinicaltrials.gov/ct2/show/NCT02722850 (Archived by WebCite at http://www.webcitation.org/6tHN9VsPh) UR - http://cancer.jmir.org/2017/2/e13/ UR - http://dx.doi.org/10.2196/cancer.7495 UR - http://www.ncbi.nlm.nih.gov/pubmed/28935620 ID - info:doi/10.2196/cancer.7495 ER - TY - JOUR AU - Wallwiener, Markus AU - Matthies, Lina AU - Simoes, Elisabeth AU - Keilmann, Lucia AU - Hartkopf, D. Andreas AU - Sokolov, N. Alexander AU - Walter, B. Christina AU - Sickenberger, Nina AU - Wallwiener, Stephanie AU - Feisst, Manuel AU - Gass, Paul AU - Fasching, A. Peter AU - Lux, P. Michael AU - Wallwiener, Diethelm AU - Taran, Florin-Andrei AU - Rom, Joachim AU - Schneeweiss, Andreas AU - Graf, Joachim AU - Brucker, Y. Sara PY - 2017/09/14 TI - Reliability of an e-PRO Tool of EORTC QLQ-C30 for Measurement of Health-Related Quality of Life in Patients With Breast Cancer: Prospective Randomized Trial JO - J Med Internet Res SP - e322 VL - 19 IS - 9 KW - breast cancer KW - patient-reported outcomes KW - HRQoL KW - EORTC QLQ-C30 KW - reliability N2 - Background: Breast cancer represents the most common malignant disease in women worldwide. As currently systematic palliative treatment only has a limited effect on survival rates, the concept of health-related quality of life (HRQoL) is gaining more and more importance in the therapy setting of metastatic breast cancer. One of the major patient-reported outcomes (PROs) for measuring HRQoL in patients with breast cancer is provided by the European Organization for Research and Treatment of Cancer (EORTC). Currently, paper-based surveys still predominate, as only a few reliable and validated electronic-based questionnaires are available. Facing the possibilities associated with evolving digitalization in medicine, validation of electronic versions of well-established PRO is essential in order to contribute to comprehensive and holistic oncological care and to ensure high quality in cancer research. Objective: The aim of this study was to analyze the reliability of a tablet-based measuring application for EORTC QLQ-C30 in German language in patients with adjuvant and (curative) metastatic breast cancer. Methods: Paper- and tablet-based questionnaires were completed by a total of 106 female patients with adjuvant and metastatic breast cancer recruited as part of the e-PROCOM study. All patients were required to complete the electronic- (e-PRO) and paper-based versions of the HRQoL EORTC QLQ-C30 questionnaire. A frequency analysis was performed to determine descriptive sociodemographic characteristics. Both dimensions of reliability (parallel forms reliability [Wilcoxon test] and test of internal consistency [Spearman rho and agreement rates for single items, Pearson correlation and Kendall tau for each scale]) were analyzed. Results: High correlations were shown for both dimensions of reliability (parallel forms reliability and internal consistency) in the patient?s response behavior between paper- and electronic-based questionnaires. Regarding the test of parallel forms reliability, no significant differences were found in 27 of 30 single items and in 14 of 15 scales, whereas a statistically significant correlation in the test of consistency was found in all 30 single items and all 15 scales. Conclusions: The evaluated e-PRO version of the EORTC QLQ-C30 is reliable for patients with both adjuvant and metastatic breast cancer, showing a high correlation in almost all questions (and in many scales). Thus, we conclude that the validated paper-based PRO assessment and the e-PRO tool are equally valid. However, the reliability should also be analyzed in other prospective trials to ensure that usability is reliable in all patient groups. Trial Registration: ClinicalTrials.gov NCT03132506; https://clinicaltrials.gov/ct2/show/NCT03132506 (Archived by WebCite at http://www.webcitation.org/6tRcgQuou). UR - http://www.jmir.org/2017/9/e322/ UR - http://dx.doi.org/10.2196/jmir.8210 UR - http://www.ncbi.nlm.nih.gov/pubmed/28912116 ID - info:doi/10.2196/jmir.8210 ER -