Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 2): Multicenter Randomized Controlled Trial

Abstract

BackgroundWomen undergoing chemotherapy for the treatment of breast cancer have frequently reported unmet supportive care needs. Moreover, easily accessible and innovative support is lacking.ObjectiveThe purpose of this trial was to determine the effectiveness of an app-based breast cancer e-support program to address women’s self-efficacy (primary outcome), social support, symptom distress, quality of life, anxiety, and depression. Secondary objectives included exploring the association between women’s health outcomes and the breast cancer e-support usage data.MethodsA multicenter, single-blinded, randomized controlled trial was conducted. A total of 114 women with breast cancer, who were commencing chemotherapy and were able to access internet through a mobile phone, were recruited in the clinics from 2 university-affiliated hospitals in China. Women were randomized either to the intervention group (n=57) receiving breast cancer e-support plus care as usual or the control group (n=57) receiving care as usual alone. The health care team and research assistants collecting data were blinded to the women’s group allocation. Bandura’s self-efficacy theory and the social exchange theory guided the development of the breast cancer e-support program, which has 4 components: (1) a Learning forum, (2) a Discussion forum, (3) an Ask-the-Expert forum, and (4) a Personal Stories forum. Moderated by an experienced health care professional, the breast cancer e-support program supported women for 12 weeks covering 4 cycles of chemotherapy. Health outcomes were self-assessed through paper questionnaires in clinics at baseline before randomization (T0), after 3 (T1), and 6 months (T2) of follow-ups.ResultsFifty-five participants in the intervention group and 49 in the control group completed the follow-up assessments (response rate: 91.2%). During the 12-week intervention, the log-in frequency ranged from 0 to 774 times (mean 54.7; SD 131.4; median 11; interquartile range, IQR 5-27), and the total usage duration ranged from 0 to 9371 min (mean 1072.3; SD 2359.5; median 100; IQR 27-279). Repeated measures multivariate analysis of covariance (intention-to-treat) found that breast cancer e-support + care as usual participants had significant better health outcomes at 3 months regarding self-efficacy (21.05; 95% CI 1.87-40.22; P=.03; d=0.53), symptom interference (−0.73; 95% CI −1.35 to −.11; P=.02; d=−0.51), and quality of life (6.64; 95% CI 0.77-12.50; P=.03, d=0.46) but not regarding social support, symptom severity, anxiety, and depression compared with care as usual participants. These beneficial effects were not sustained at 6 months. Spearman rank-order correlation showed that the breast cancer e-support usage duration was positively correlated with self-efficacy (r=.290, P=.03), social support (r=.320, P=.02), and quality of life (r=.273, P=.04) at 3 months.ConclusionsThe breast cancer e-support program demonstrated its potential as an effective and easily accessible intervention to promote women’s self-efficacy, symptom int...

Effectiveness of e‐health based self‐management to improve cancer‐related fatigue, self‐efficacy and quality of life in cancer patients: Systematic review and meta‐analysis

“…The trials were published between 2005–2018. Trials were undertaken in the USA (Bantum et al, ; Owen et al, ; Smith et al, ; Somers et al, ; Syrjala et al, ), Netherlands (Admiraal et al, ; van der Berg et al, ; Boele et al, ; Golsteijn et al, ; Willems et al, ), UK (Foster et al, ), Canada (Vallerand et al, ), China (Zhang et al, ; Zhu et al, ), and South Korea (Lee et al, ).…”

“…Participants in four trials were patients with any cancer (Foster et al, ; Bantum et al, ; Somers et al, ; Willems et al, ). The other eleven trials focused on specific cancers: breast cancer (Admiraal et al, ; van den Berg et al, ; Lee et al, ; Owen et al, ; Smith et al, ; Zhu et al, ), glioma (Boele et al, ), haematological cancer (Syrjala et al, ; Vallerand et al, ), rectal cancer (Zhang et al, ), and both colorectal cancer and prostate cancer (Golsteijn et al, ). Nine trials reported participants who completed primary treatment (Admiraal et al, ; van der Berg et al, ; Foster et al, ; Lee et al, ; Bantum et al, ; Somers et al, ; Syrjala et al, ; Willems et al, ; Zhang et al, ); the time since treatment completion was 4 weeks to 18 years.…”

“…Nine trials reported participants who completed primary treatment (Admiraal et al, ; van der Berg et al, ; Foster et al, ; Lee et al, ; Bantum et al, ; Somers et al, ; Syrjala et al, ; Willems et al, ; Zhang et al, ); the time since treatment completion was 4 weeks to 18 years. One trial included participants undergoing treatment (Zhu et al, ), while another one included both undergoing treatment and primary treatment completed (Golsteijn et al, ). Other four trials failed to report the duration since primary treatment completed or whether undergoing treatment (Boele et al, ; Owen et al, ; Smith et al, ; Vallerand et al, ).…”

“…Interventions in trials focused on behaviour change (Golsteijn et al, ; Lee et al, ; Bantum et al, ; Vallerand et al, ), medical management (Foster et al, ; Smith et al, ; Somers et al, ; Zhang et al, ; Zhu et al, ), and psychological management (Admiraal et al, ; van der Berg et al, ; Boele et al, ; Owen et al, ; Syrjala et al, ) while one trial focused on both behaviour and psychological management (Willems et al, ). Most studies were web‐based (Admiraal et al, ; van der Berg et al, ; Boele et al, ; Foster et al, ; Golsteijn et al, ; Lee et al, ; Bantum et al, ; Owen et al, ; Smith et al, ; Somers et al, ; Syrjala et al, ; Willems et al, ) and two trial was telephone‐based (Vallerand et al, ; Zhang et al, ), and one was APP‐based (Zhu et al, ). The intervention duration lasted for 4 weeks to 6 months.…”

“…The intervention duration lasted for 4 weeks to 6 months. Interventions were implemented according to a regular schedule by week (Boele et al, ; Foster et al, ; Lee et al, ; Bantum et al, ; Vallerand et al, ; Zhang et al, ) or by month (Golsteijn et al, ), while other interventions were accessible at any time study completion (Admiraal et al, ; van der Berg et al, ; Owen et al, ; Somers et al, ; Syrjala et al, ; Willems et al, ; Zhu et al, ).…”