Mobile Phone Apps for symptom management in Cancer Survivors: A Systematic Review and Meta-analysis of Randomized Controlled Trials (Preprint)

Abstract

BACKGROUND Most cancer patients have psychological or physical distress. This distress can harm their quality of life (QOL). Smartphone application (app) interventions are increasingly being used to improve QOL and psychological outcomes in cancer patients. However, there are still conflicting results in the literature about its effect. OBJECTIVE This review and meta-analysis investigated the effectiveness of mobile phone app interventions on QOL and psychological outcomes in cancer patients, with a special focus on the format of intervention delivery. METHODS We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) from PubMed, The Cochrane Library, Embase, CENTRAL, and China National Knowledge Infrastructure (CNKI), to identify studies involving apps focused on cancer survivors and QoL and/or psychological or physical symptom published from inception to 13 January 2022. Only trial studies which met the inclusion criteria were selected. Standardized mean difference (SMD) with a corresponding 95% confidence interval (95% CI) was pooled when needed. Sensitivity analysis and subgroup analysis were also conducted. RESULTS Twenty five RCTs with a total of 3456 participants were included into this meta-analysis. Compared with routine care, app intervention was associated with higher QOL (SMD = 0.45; 95%CI: 0.28, 0.61; p < 0.05), with less anxiety (SMD = -1.04; 95%CI: -1.67, -0.41; P < 0.001), depression (SMD = -0.36; 95%CI: -0.62, -0.11; P < 0.01), distress (SMD = -0.41; 95%CI: -0.72, -0.10; p < 0.01), fatigue (SMD = -0.42; 95% CI: -0.64, -0.20, p < 0.01), and pain (SMD = -0.33; 95% CI: -0.47, -0.19, p < 0.01). However, anxiety and depression score did not differ significantly between the two groups in breast cancer survivors and in didactic format studies. CONCLUSIONS Our study shows that mobile apps intervention can improve QOL and alleviate anxiety, depression, distress, fatigue, and pain in cancer patients. However, these results should be recognized cautiously due to between-study heterogeneity, indicating that more methodological and well-designed applied research is needed to understand how to better utilize this digital technology to help cancer patients. CLINICALTRIAL This review did not require informed consent or ethical approval because the data derived from previously published studies.