Mobile application to support oncology patients during treatment on patient outcomes: Evidence from a randomized controlled trial

Abstract

Background: Cancer treatment requires substantial demands on patients and their caregivers. Mobile apps can provide support for self-management during oncology treatment, but few have been rigorously evaluated.

Methods: A 3-month randomized controlled trial was conducted at a large cancer center to evaluate the efficacy of an app (LivingWith®) that provides self-management support during cancer treatment on quality of life and health care utilization. Patients in chemotherapy treatment were randomized into the intervention (n = 113) and control group (n = 111). Intervention group participants agreed to use the app weekly for 3 months, and all participants completed a survey at enrollment and after 3 months to evaluate changes in quality of life and health care utilization.

Results: Retention rate was 75.4% with 169 participants completing the follow-up survey. The intervention group reported 0.74 fewer medical office visits (p = 0.043) and 0.24 fewer visits with a mental health professional (p = 0.061) during the 3 and month intervention compared with controls. There were no significant changes by study group in quality of life, or emergency room and urgent care visits. Among intervention participants, 75.3% reported using the app and on average, used it 11.7 times during the 3-month intervention. Reasons for not using the app among intervention participants included lack of time, lack of interest in apps, and usability challenges.

Conclusions and relevance: Apps are inexpensive and scalable tools that can provide additional support for individuals coping with complex cancer treatments. This trial provides evidence that a well-designed oncology support app used during chemotherapy resulted in fewer clinic visits. Still, nearly a quarter of participants randomized to the intervention arm reported never using the app due to personal preference and usability challenges, which points to future opportunities for calibrating target user population and improving user-centered design.

Clinicaltrials: gov identifier: NCT04331678.

Keywords: cancer treatment; chemotherapy; mobile health; randomized control trial; self-management support.

Conflict of interest statement

Dr. Vidal reported receiving personal fees from Roche/Genentech, Novartis, Eli Lilly, Immunometric, Puma, Pfizer, AstraZeneca, Biotheranautics, Daiichi Sankyo, Vector Oncology and research funding from Roche/Genentech, Puma, Celcuity, Merck, BMS, Eli Lilly, GTx Inc., AstraZeneca, Pfizer, Immunomedics, Tesaro, Halozyme, and ownership of Oncodisc. Dr. Schwartzberg reported receiving personal fees from Amgen, Pfizer, Helsinn, Genentech, Genomic Health, BMS, Myriad, AstraZeneca, Bayer, Spectrum, Napo and research support from Amgen, Pfizer. Dr. Graetz received research support from Pfizer. Ms. Hu received a dissertation grant from PhRMA Foundation. No other disclosures were reported.

© 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Figures

FIGURE 1

Screenshots of the LivingWith® app

FIGURE 2

Participant flow chart

FIGURE 3

Responses to App usefulness overall and by function among intervention participants (n = 81). Number of missing values not shown and ranged from 0 to 2 (0%–2.5%). Percent of “Useful” or “Very useful” responses combined was calculated among those who did not report “Never used.”

FIGURE 4

Perceived benefits and barriers for using App among intervention participants (n = 81). Number of missing responses for each question ranged from 2 to 7 (2%–9%). Percent of “Agree” or “Strongly Agree” responses combined in response to potential reasons for using and rarely using the app.

FIGURE 5

Changes in health care utilization before and after intervention. Number of missing responses for each question ranged from two for office visits at baseline (1.2%) to six for mental health visits at baseline and 3‐month follow‐up (3.6%).