Development and Testing of a Mobile App for Pain Management Among Cancer Patients Discharged From Hospital Treatment: Randomized Controlled Trial

Abstract

BackgroundThe incidence of cancer pain increases in discharged patients because of discontinued standard treatments and reductions in medication adherence. Motivated by the need for better pain management in discharged patients, we developed a mobile phone app (Pain Guard) to provide continuous treatment information and feedback to discharged cancer patients suffering from pain.ObjectiveThe aim was to design, construct, and test the Pain Guard app in patients managing cancer pain, evaluate the total remission rate of pain and the improvement in quality of life (QoL) to improve pain management for cancer pain patients, and assess patient acceptance of the app.MethodsThis randomized controlled double-arm study involved 58 patients with cancer pain symptoms. Participants were randomly assigned to a group receiving care through the Pain Guard app (n=31) or to a control group (n=27) who received only traditional pharmaceutical care. In a pretest, participants were rated using a baseline cancer pain assessment and QoL evaluation. During treatment, the consumption levels of analgesic drugs were recorded every week. After a 4-week study period, another round of cancer pain assessment and QoL evaluation was conducted. The system’s usability, feasibility, app compliance, and satisfaction were also assessed. Our primary outcome was remission rate of pain, and secondary outcomes were medication adherence, improvements in QoL, frequency of breakthrough cancer pain (BTcP), incidence of adverse reactions, and satisfaction of patients.ResultsAll participants (N=58) successfully completed the study. There were no significant differences in baseline pain scores or baseline QoL scores between groups. At the end of the study, the rate of pain remission in the trial group was significantly higher than that in the control group (P<.001). The frequency of BTcP in the app group was considerably lower than that in the control group (P<.001). The rate of medication adherence in the trial group was considerably higher than that in the control group (P<.001). Improvements in global QoL scores in the trial group were also significantly higher than those in the control group (P<.001). The incidence of adverse reactions in the trial group (7/31) was lower than that in the control group (12/27), especially constipation, with significant differences (P=.01). The 31 participants in the trial group completed a satisfaction survey regarding Pain Guard: 23 (74%) indicated that they were satisfied with receiving pharmaceutical care by Pain Guard, 5 (16%) indicated that they were somewhat satisfied, 2 (6%) indicated neutral feelings, and 1 (3%) indicated that they were somewhat dissatisfied; no participants indicated that they were very dissatisfied.ConclusionsPain Guard was effective for the management of pain in discharged patients with cancer pain, and its operability was effective and easily accepted by patients.Trial RegistrationChinese Clinical Trials Registry ChiCTR1800016066; http://www.chictr.org.cn/showproj.aspx?proj=27153

Can mHealth interventions improve quality of life of cancer patients? A systematic review and meta-analysis

“… None 4 weeks FACT-G 70% No changes in HRQoL. Pain management (1 study) ( Yang et al, 2019 ) China Different types (patients with cancer pain) 58 / 34% women / 51 ± 9 (intervention), 54 ± 9 (control) RCT Mobile phone app providing continuous treatment information and feedback (Pain Guard) / n = 31 Traditional pharmacologic treatment / n = 27 4 weeks EORT QLQ-C30 100% Intervention group patients scored higher on cognitive, social and emotional functioning, sleeping disturbances, nausea and vomiting, constipation, fatigue, pain and global QoL domains EORTC BR23, breast cancer questionnaire; EORTC QLQ-C30, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30; EORTC QLQ-BR23 Quality of Life Questionnaire Breast Cancer Module 23; PedsQL, Pediatric Quality of Life Inventory; HRQoL, Health related quality of life; MBCT, mindfulness based cognitive therapy; RCT, randomized control trial; SF-36, 36-Item Short Form Health Survey, QLCAS, Quality of Life in Adult Cancer Survivors; VAS, visual analog scale. …”

“…We identified 17 RCTs ( Willems et al, 2017 ; Mendoza et al, 2017 ; Graetz et al, 2018 ; Ferrante et al, 2018 ; Admiraal et al, 2017 ; Compen et al, 2018 ; Frensham et al, 2018 ; Galiano-Castillo et al, 2016 ; Greer et al, 2019 ; Ham et al, 2019 ; Ji et al, 2019 ; Kubo et al, 2019 ; Rosen et al, 2018 ; Uhm et al, 2017 ; Urech et al, 2018 ; Yang et al, 2019 ; Zhu et al, 2018 ) and 8 pre-post design studies ( Børøsund et al, 2019 ; Cheong et al, 2018 ; Lozano-Lozano et al, 2019 ; McCarroll et al, 2015 ; Pappot et al, 2019 ; Park et al, 2019 ; Pope et al, 2019 ; Trinh et al, 2018 ). Nine studies (5 RCTs and 4 pre-post designs) tested physical activity / rehab / fitness interventions ( Mendoza et al, 2017 ; Frensham et al, 2018 ; Galiano-Castillo et al, 2016 ; Ji et al, 2019 ; Uhm et al, 2017 ; Cheong et al, 2018 ; Lozano-Lozano et al, 2019 ; Park et al, 2019 ; Trinh et al, 2018 ), six studies – CBT interventions (4 RCTs and 2 pre-post designs) ( McCarthy et al, 2018 ; Willems et al, 2017 ; Compen et al, 2018 ; Greer et al, 2019 ; Greer et al, 2019 ; Ham et al, 2019 ; Børøsund et al, 2019 ), three studies - mindfulness/stress management interventions (3 RCTs) ( Kubo et al, 2019 ; Rosen et al, 2018 ; Urech et al, 2018 ), two studies - social support (1 RCT and 1 pre-post design) ( Zhu et al, 2018 ; Pappot et al, 2019 ), two studies - information/psychoeducation (2 RCTs) ( Graetz et al, 2018 ; Admiraal et al, 2017 ), two studies – weight management (1 RCT and 1 pre-post design) ( Ferrante et al, 2018 ;…”

“…The majority of studies (15 RCTs and 7 pre-post designs) found that mHealth interventions were associated with improvement in at least one domain of HRQoL of cancer patients ( Willems et al, 2017 ; Graetz et al, 2018 ; Ferrante et al, 2018 ; Compen et al, 2018 ; Frensham et al, 2018 ; Galiano-Castillo et al, 2016 ; Greer et al, 2019 ; Greer et al, 2019 ; Ji et al, 2019 ; Kubo et al, 2019 ; Rosen et al, 2018 ; Uhm et al, 2017 ; Urech et al, 2018 ; Yang et al, 2019 ; Zhu et al, 2018 ; Børøsund et al, 2019 ; Cheong et al, 2018 ; Lozano-Lozano et al, 2019 ; McCarroll et al, 2015 ; Pappot et al, 2019 ; Park et al, 2019 ; Trinh et al, 2018 ).…”

“…Yang and colleagues (2019) randomized 58 patients with different cancer types to either receive an mHealth app providing continuous treatment information and feedback ( Pain Guard ) or to a control group who received a traditional pharmacologic treatment ( Yang et al, 2019 ). At 4-week of follow-up, compared to the control group, patients in the intervention group scored significantly higher on the EORTC QLQ-C30 emotional, cognitive, and social functioning domains as well as sleep, nausea/vomiting, constipation, fatigue and pain symptoms scales, and global QoL domain.…”

Mobile Health Usage, Preferences, Barriers, and eHealth Literacy in Rheumatology: Patient Survey Study

“…Once a diagnosis is established, mHealth tools enable patients to better monitor their symptoms passively through sensors [ 5 ] and actively by entering data [ 6 , 7 ]. Furthermore, electronic medication reminders can increase medication adherence [ 8 , 9 ], and supporting digital therapy can reduce pain [ 9 ] and improve important comorbidities (eg, depression) [ 10 ].…”