Development of Quality of Life in Adolescents and Young Adults With Cancer Using a Patient Support Smartphone App: Prepost Interventional Study

Abstract

Background Adolescents and young adults often experience existential concerns in addition to side effects during a cancer trajectory, which they often carry alone. Thus, cohesion with other adolescents and young adults with cancer is essential but difficult due to the relatively small, widely dispersed nationwide population. In cocreation, a smartphone app has been developed and includes an information bank, a symptom tracker, and a social community platform, aiming to improve the quality of life (QoL) in this patient group. Objective This nationwide, multicenter study aimed to investigate the QoL in adolescents and young adults undergoing a cancer trajectory as they used the app for 6 weeks. Methods Via youth support initiatives, participants were recruited from hospitals in all regions of Denmark. Inclusion criteria were patients with cancer aged 15-29 years who either initiated any cancer treatment or started follow-up after cancer treatment within 30 days. Participants used the adolescents and young adults cancer app for 6 weeks. Before and after the 6 weeks of app use, they completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30). The participants were divided into a treatment and a follow-up group for analysis. A high score for a functional scale or the global health or overall QoL represents a high or healthy level of functioning or high QoL, respectively; however, a high score for a symptom scale or item represents a high level of symptomatology. Results Overall, 81 participants were recruited. However, 4 participants did not answer the questionnaire and 6 participants did not use the app. In the treatment group (n=36), significant improvement was found in 2 domains: “Role functioning” (baseline median 33.33, IQR 16.67-83.33 vs 6 weeks median 66.67, IQR 33.33-83.33; P=.04) and “Pain” (baseline median 33.33, IQR 16.67-50.00 vs 6 weeks median 16.67, IQR 0.00-33.33; P=.04). The “Global health/Overall QoL” scale remained stable (baseline median 58.33, IQR 45.83-77.08 vs 6 weeks median 62.50, IQR 41.67-75.00; P=.25). In the follow-up group (n=35), significant improvement was found in 3 domains: “Physical functioning” (baseline median 79.23, IQR 73.33-93.33 vs 6 weeks median 82.86, IQR 73.33-100.00; P=.03), “Cognitive functioning” (baseline median 62.38, IQR 50.00-83.33 vs 6 weeks median 69.52, IQR 50.00-100.00; P=.02), and “Social functioning” (baseline median 76.19, IQR 50.00-100.00 vs 6 weeks median 85.71, IQR 83.33-100.00; P=.05), as well as in the “Global health/Overall QoL” scale (baseline median 57.14, IQR 83.33-100.00 vs 6 weeks median 75.0, IQR 62.91-85.73; P<.001). Conclusions In this study, we found an improvement in specific QoL scales for both participants in treatment and follow-up when using the app for 6 weeks. The global health or overall QoL score improved significantly in the follow-up group. In the treatment group, it remained stable. International Registered Report Identifier (IRRID) RR2-10.2196/10098

Digital solutions supporting the quality of life of European cancer patients and their caregivers: a systematic literature review

“…The internet-based tailored rehabilitation exercise program e-CUIDATE improved functional capacity in terms of distance covered in the 6-min test and cognition in terms of memory in survivors that participated to the intervention 26,27 . The Danish smartphone app, Kræftværket, includes a tracking module for symptoms and activities, an information bank with both text and video material, and a social community platform that facilitates networking and sharing experiences; it showed improvement in QoL (quality of life) scales for young adults in treatment, and in physical, cognitive, and social functions for follow-up group 28 . The comparison of face-to-face and online psychotherapy or support groups for cancer survivors showed no significant difference, thereby suggesting the potential of online interventions to overcome geographical barriers 30,31 .…”

“…Among the digital interventions included in this systematic review, the rate of effectiveness, intended as the capability of such solutions to reach the intended outcomes for which they have been proposed to, varies depending on the area the interventions focuses on: the digital interventions for improving psychophysical well-being proved to be the most effective, with 80% (12 out of 15) of the proposed solutions 19–22,24–26,28,29,32,33 having a positive impact on mental health; followed by remote monitoring interventions, with 73% (8 out of 11) of included studies 42,44,45,48–53 resulting useful for patients for real-time self-reporting symptoms and vitals and assessing their quality of life; also digital interventions for managing physical side-effects of cancer treatments are quite effective with 71% (5 out of 7) of the solutions 26,34,35,37,40 helping coping with physical distress; finally, only the 17% (2 out of 12) solutions 62,64 proved to enhance empowerment and self-efficacy of cancer patients. Moreover, for the first two categories, the adherence rate is quite high, ranging from 59% to 100%, suggesting a correlation between the effectiveness and the adherence rate of such interventions whose causality could be mutual.…”