Feasibility of an Interactive Health Coaching Mobile App to Prevent Malnutrition and Muscle Loss in Esophageal Cancer Patients Receiving Neoadjuvant Concurrent Chemoradiotherapy: Prospective Pilot Study

Abstract

Background Excessive muscle loss is an important prognostic factor in esophageal cancer patients undergoing neoadjuvant chemoradiotherapy (NACRT), as reported in our previous research. Objective In this pilot study, we prospectively tested the feasibility of a health coaching mobile app for preventing malnutrition and muscle loss in this patient population. Methods Between July 2019 and May 2020, we enrolled 38 male patients with esophageal cancer scheduled for NACRT. For 8 weeks from the start of radiotherapy (RT), the patients used Noom, a health coaching mobile app that interactively provided online advice about food intake, exercise, and weight changes. The skeletal muscle index (SMI) measured based on computed tomography and nutrition-related laboratory markers were assessed before and after RT. We evaluated the changes in the SMI, nutrition, and inflammatory factors between the patient group that used the mobile app (mHealth group) and our previous study cohort (usual care group). Additionally, we analyzed the factors associated with walk steps recorded in the app. Results Two patients dropped out of the study (no app usage; treatment changed to a definitive aim). The use (or activation) of the app was noted in approximately 70% (25/36) of the patients until the end of the trial. Compared to the 1:2 matched usual care group by propensity scores balanced with their age, primary tumor location, tumor stage, pre-RT BMI, and pre-RT SMI level, 30 operable patients showed less aggravation of the prognostic nutritional index (PNI) (–6.7 vs –9.8; P=.04). However, there was no significant difference in the SMI change or the number of patients with excessive muscle loss (∆SMI/50 days >10%). In patients with excessive muscle loss, the walk steps significantly decreased in the last 4 weeks compared to those in the first 4 weeks. Age affected the absolute number of walk steps (P=.01), whereas pre-RT sarcopenia was related to the recovery of the reduced walk steps (P=.03). Conclusions For esophageal cancer patients receiving NACRT, a health care mobile app helped nutritional self-care with less decrease in the PNI, although it did not prevent excessive muscle loss. An individualized care model with proper exercise as well as nutritional support may be required to reduce muscle loss and malnutrition.

Effects of Internet-Based Nutrition and Exercise Interventions on the Prevention and Treatment of Sarcopenia in the Elderly

“…A recent systematic revealed that older adults tend to use the Internet to search more disease-related health information than the adolescent and youth population [24]. Our study provided an app as a guiding tool for the elderly with sarcopenia to acquire accurate information in a convenient and low-cost approach [25]. The findings revealed that apps are effective, particularly for nutrition interventions.…”

Mobile applications in radiation oncology—current choices and future potentials

“…2018 [ 27 ] Teaching platform, tour of institute, interactive games (Proton U) Descriptive 0 Pediatric cancer patients receiving proton therapy (curative) Successful implementation of mobile app for pediatric cancer patients Yes (iOS) Yang et al. 2021 [ 47 ] Coaching app that interactively provides online advice about food intake, exercise, and weight changes during and after RCT, additional walk step count (Noom Inc) Single arm 38 Esophageal cancer patients receiving neoadjuvant RCT App can help nutritional self-care with less decrease in prognostic nutritional index but no prevention of excessive muscle loss Yes (iOS and Android) RT radiotherapy, RCT radiochemotherapy, ePRO electronic patient-reported outcome, HCP health care professional, QoL quality of life, EORTC European Organisation for Research and Treatment of Cancer, CTCAE Common Terminology Criteria for Adverse Effects a Abstract only b Number of patients with RT not presented …”

Behavior Change Effectiveness Using Nutrition Apps in People With Chronic Diseases: Scoping Review

“…These studies can be found in Table 2 . Each app had different features, including digital diaries [ 7 , 44 - 49 ], coach feedback [ 7 , 44 - 47 , 49 - 51 ], personalized physical exercise programs and nutrition plans [ 49 , 50 ], general nutrition and physical exercise guidelines [ 45 , 51 ], psychological support courses [ 45 , 51 ], a secure message portal to their health care teams [ 7 , 48 ], health knowledge education [ 46 , 48 , 51 ], and daily tasks [ 48 , 51 ].…”