How does the Untire app alleviate cancer‐related fatigue? A longitudinal mediation analysis

Abstract

Objective A waiting‐list randomized controlled trial supported the effectiveness of the multimodal Untire app in reducing cancer‐related fatigue (CRF) in cancer patients and survivors. However, little is known about the causal mechanisms of different app components through which the intervention effect was achieved. We aim to examine whether specifically targeted factors (i.e., fatigue catastrophizing, depression, mindfulness, sleep, and physical activity) mediated the intervention effects of the Untire app on fatigue outcomes. Methods Seven hundred ninety‐nine persons with CRF were randomized (2:1) into intervention (n = 519) and waiting‐list control (n = 280) groups. Self‐report data on the primary outcome fatigue severity and interference and the abovementioned potential mediators were collected at baseline and 12 weeks. Participants who completed the 12‐week assessment were included in the analyses (intervention = 159; control = 176). We performed longitudinal multi‐categorical multiple mediation analysis using PROCESS macro to examine whether the potential mediators explained the overall intervention effects. Results Improvements in fatigue catastrophizing (bootstrap 95% CI (−0.110; −0.011)), depression (bootstrap 95% CI (−0.082; −0.004)), and mindfulness (bootstrap 95% CI (−0.082; −0.002)), significantly mediated the intervention effect on fatigue severity, whereas sleep quality (bootstrap 95% CI (−0.081; 0.009)), sleep disturbance (bootstrap 95% CI (−0.038; 0.029)), and physical activity (bootstrap 95% CI (−0.068; 0.000)) did not. Similar associations were found for fatigue interference. Conclusions Untire app access reduces fatigue severity and interference mainly by decreasing fatigue catastrophizing, depression, and by increasing mindfulness. Supporting these psychological mechanisms is crucial for reducing fatigue among cancer patients and survivors.

Mobile Health Interventions for Cancer Care and Support: The Next Level of Digitalization in Healthcare?

“…Most studies have reported results for respondents from specific age groups, such as adolescents and young adults [5,16,39] and older individuals [19,37]. Yet, few scholars have reported comparative responses of intervention users from different age groups [7,14,15,78,90].…”

“…text messages [16,23,74], wearable devices [29,83], and mobile apps [14,27,41,84,85], as forms of delivery. Recent studies have also begun to integrate mHealth interventions with gamification [72,86] and other smartphone features like location sensing [87], thereby providing deeper insights into how these interventions influence participants.…”

“…Consequently, academic research on the efficacy and efficiency of mHealth interventions for cancer management has gained momentum. Such applications have focused on providing information and support to patients, survivors, and their caregivers through various methods, such as mobile apps [7,14,15] and SMS-based interventions [16][17][18]. For example, a recent study developed and tested the TouchStream app's feasibility for delivering geriatric assessment (GA)-driven interventions to older individuals with cancer [19].…”

Engagement With a Relaxation and Mindfulness Mobile App Among People With Cancer: Exploratory Analysis of Use Data and Self-Reports From a Randomized Controlled Trial

“…Despite this limitation, most mHealth apps in research settings provide human support at varying levels-from high support through guided interventions (ie, involving guidance from a trained professional, eg, through live videoconferencing or web-based workshops) to lower levels of support through study processes (eg, screening visits or telephone surveys conducted by the study team). In the rare studies available on unguided cancer-related mHealth apps with no human support [68][69][70], engagement rates were <50%. One reason could be that existing researcher-developed apps are not engaging enough and, therefore, need human support to motivate participants [18,71].…”

An eHealth App (CAPABLE) Providing Symptom Monitoring, Well-Being Interventions, and Educational Material for Patients With Melanoma Treated With Immune Checkpoint Inhibitors: Protocol for an Exploratory Intervention Trial

“…Furthermore, mindfulness-based clinical interventions and yoga appear to be feasible interventions, and beneficial effects have been reported on several physical and psychosocial symptoms in patients with cancer, such as patients' psychosocial adjustment to their disease and improvement of biomarkers of stress, inflammation, and immune function [35][36][37]. Encouraging physical exercise, psychoeducation, mindfulness-based interventions, and yoga have therefore been included in web-based programs and eHealth apps targeting CRF, with promising results [38][39][40][41].…”