Effect of Mobile Phone App–Based Interventions on Quality of Life and Psychological Symptoms Among Adult Cancer Survivors: Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

Background Most patients with cancer experience psychological or physical distress, which can adversely affect their quality of life (QOL). Smartphone app interventions are increasingly being used to improve QOL and psychological outcomes in patients with cancer. However, there is insufficient evidence regarding the effect of this type of intervention, with conflicting results in the literature. Objective In this systematic review and meta-analysis, we investigated the effectiveness of mobile phone app interventions on QOL and psychological outcomes in adult patients with cancer, with a special focus on intervention duration, type of cancer, intervention theory, treatment strategy, and intervention delivery format. Methods We conducted a literature search of PubMed, Web of Science, the Cochrane Library, Embase, Scopus, China National Knowledge Infrastructure, and WanFang to identify studies involving apps that focused on cancer survivors and QOL or psychological symptoms published from inception to October 30, 2022. We selected only randomized controlled trials that met the inclusion criteria and performed systematic review and meta-analysis. The standardized mean difference (SMD) with a 95% CI was pooled when needed. Sensitivity and subgroup analyses were also conducted. Results In total, 30 randomized controlled trials with a total of 5353 participants were included in this meta-analysis. Compared with routine care, app interventions might improve QOL (SMD=0.39, 95% CI 0.27-0.51; P<.001); enhance self-efficacy (SMD=0.15, 95% CI 0.02-0.29; P=.03); and alleviate anxiety (SMD=−0.64, 95% CI −0.73 to −0.56; P<.001), depression (SMD=−0.33, 95% CI −0.58 to −0.08; P=.009), and distress (SMD=−0.34, 95% CI −0.61 to −0.08; P=.01). Short-term (duration of ≤3 months), physician-patient interaction (2-way communication using a smartphone app), and cognitive behavioral therapy interventions might be the most effective for improving QOL and alleviating adverse psychological effects. Conclusions Our study showed that interventions using mobile health apps might improve QOL and self-efficacy as well as alleviate anxiety, depression, and distress in adult cancer survivors. However, these results should be interpreted with caution because of the heterogeneity of the interventions and the study design. More rigorous trials are warranted to confirm the suitable duration and validate the different intervention theories as well as address methodological flaws in previous studies. Trial Registration PROSPERO CRD42022370599; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=370599

Patient motivation as a predictor of digital health intervention effects: A meta-epidemiological study of cancer trials

“…A total of 27 RCTs with 4,986 cancer patients were included in our study ( S3 Appendix ). The characteristics of these studies can be found in the original systematic review [ 27 ]. The ratings of the study participants’ motivations were as follows: for overall motivation, 19 studies (70%) were rated as high motivation, five studies (19%) were rated as moderate motivation, and three studies (11%) were rated as low motivation.…”

“…We applied the rating to RCTs that were included in a recently published systematic review and meta-analysis about the effect of mHealth app interventions on quality of life (QoL) and psychological outcomes in cancer patients [ 27 ]. The control groups in all studies received usual care, including waitlist control, conventional care, or health education delivered without the use of the mHealth app.…”

Unmet Supportive Care Needs of Prostate Cancer survivors in China: A Cross-Sectional Study

“…In terms of further research, there is a necessity for the exploration of more streamlined and effective methods to enhance consultation services and expand patients' avenues for information acquisition. Following the COVID-19 epidemic, mobile healthcare has assumed a significant role in patient management [29], and one study's findings [30] (QOL) and self-efficacy, while mitigating anxiety, depression, and distress among adult cancer survivors. Consequently, subsequent studies should endeavor to leverage this modality to fulfill the health system and information requisites of prostate cancer survivors.…”

Preferences and willingness to pay for health app assessments among healthcare stakeholders: a discrete choice experiment (Preprint)

“…Health apps provide a complement to in-person care and present an opportunity to ease the strain faced by clinicians and health systems which is partially due to a shortage of healthcare professionals 2,3 . A number of recent studies have demonstrated beneficial effects of health apps on health outcomes and quality of life 4 , including in condition areas such as mental health 5,6 , diabetes [7][8][9] , hypertension 7 , cancer 10,11 , and asthma 12 . Moreover, health apps can contribute to cost savings and to more efficient use of health system resources that are facing an increasing demand 13,14 .…”