A review of iPhone and Android apps for cancer patients and survivors: assessing their quality, nutrition information and behaviour change techniques

A qualitative analysis of nutritional needs and dietary changes during cancer treatment in Ireland

INTRODUCTION

Cancer and its associated side effects can cause changes in dietary intakes of people with cancer due to a variety of nutrition impact symptoms. These symptoms can lead to suboptimal dietary intakes which negatively affect muscle mass and therefore survivorship. The aim of this qualitative study was to assess the nutrition needs and dietary changes made by cancer patients in Ireland.

METHODS

Online focus groups were completed with cancer patients and caregivers, and demographic information was collected via an online questionnaire. An inductive thematic analysis approach was utilised to derive themes and subthemes from the data.

RESULTS

Four online focus groups were held with cancer patients and caregivers (n = 15) which reflected 18 total cancer experiences. Novel themes identified from this research included that symptoms were varied and transient-coming and going rapidly-and that patients were not satisfied with dietetic and broader nutrition services provided by hospitals. Themes that aligned with previous research were the severity and variety of nutrition impact symptoms and the variety of both evidence-based and non-evidence-based nutrition strategies used by patients to overcome nutrition impact symptoms, as general coping strategies, and potentially due to the belief that nutrition can be curative.

CONCLUSION

Treatment of nutrition impact symptoms must be rapid and responsive. The development of responsive self-management resources such as booklets and apps for patients is likely to be valuable to ensure that patients can access support for their nutrition impact symptoms as-and when-they occur. Nutrition support must be integrated across the multi-disciplinary team to optimise trust in nutrition strategies.

A Contemporary Review of Smart Phone Applications in Bariatric and Metabolic Surgery: an Underdeveloped Support Service

This study aims to be a contemporary review of mHealth apps in bariatric and metabolic surgery (BMS) to assess their quality using the Silberg scale as well as features, themes, usability, and medical/allied health professional involvement (MAPI). Apps were identified using search terms in the Android and Apple app stores. 52 apps were included. 42 (80.7%) apps main target users were patients. More than half, 27 (52%), targeted US based users. 29 (56%) had payment-restricted content. 42 (81%) had MAPI and the mean Silberg score was 5.2. Compared to previous studies the quality of BMS apps is improving with more MAPI and useful functionality. Wider use of mHealth apps for patient centred follow-up, management and care are yet to be widely implemented and explored.

Experiences of cancer patients in receiving dietary advice from healthcare professionals and of healthcare professionals in providing this advice-a systematic review

PURPOSE

This systematic review investigated qualitative and quantitative studies exploring patients and healthcare professionals' (HCP) experience of nutrition care throughout the cancer journey.

METHODS

Five databases were systematically searched for studies reporting on patient and healthcare professionals' experience of nutrition advice.

RESULTS

Fifteen studies including 374 patients and 471 healthcare professionals were included. Findings indicate that patients desire more specific nutrition advice supported by members of the multidisciplinary team and delivered in appropriate and understandable language. Healthcare professionals have highlighted a lack of time, funding, dietetic roles, and knowledge as barriers to integrating nutrition as a standard part of cancer care. Five themes were identified (current provision of nutrition advice, optimal provision of nutrition advice, tension between patient values and nutritional or HCP priorities, providing evidence-based nutrition care, and practical barriers to nutrition advice provision).

CONCLUSIONS

Further work is essential to better understand and address identified barriers and improve the provision of nutrition advice to this population.

IMPLICATIONS FOR CANCER SURVIVORS

Findings from this review will guide the delivery of nutrition advice for cancer survivors.

Systematic Evaluation of the Behavior Change Techniques and Quality of Commercially Available Cancer Self-Management Apps

PURPOSE

Apps have the potential to aid in cancer self-management, but there is limited guidance available for selecting among currently available options. The purpose of this study is to evaluate the behavior change techniques (BCTs) and quality of publicly available cancer self-management apps.

METHODS

Cancer self-management apps were identified from the Apple and Google Play stores in April 2022. Trained study team members coded the BCTs included in each app and rated its quality using the Mobile App Rating Scale (MARS). BCTs supported by previous literature were coded as cancer management BCTs.

RESULTS

The 39 apps meeting inclusion criteria included an average of 5.85 BCTs (standard deviation [SD], 3.49; range, 0-15) and 3.54 cancer management BCTs (SD, 1.90; range, 0-8). The most commonly included BCTs were educational or informational strategies: provide information about behavior-health link, provide instruction, and provide information on consequences. The overall app quality ranged from 1.69 to 4.20 (M, 3.29; SD, 0.67).

CONCLUSION

No cancer self-management apps were of excellent quality, and less than half included multiple cancer management BCTs beyond education. Clinical implications are discussed, and opportunities to improve the content and quality of apps to address the critical self-management needs of patients diagnosed with cancer are highlighted.

Patient-facing cancer mobile apps that enable patient reported outcome data to be collected: A systematic review of content, functionality, quality, and ability to integrate with electronic health records

PURPOSE

Enabling cancer patients to self-manage symptoms through mobile applications can result in more informed, autonomous patients who are partners in their care, consequently reducing the burden on health services. Electronic patient reported outcomes completed before a clinical review can increase the frequency and quality of holistic assessments, while integration into electronic health records can maximise clinical utility. The ability of apps to integrate with electronic health records is key to providing a real-time interface between patient reports and healthcare response. This review identifies patient-facing cancer apps which can record patient reported outcomes, and explores their purpose, functionality, quality, and ability to integrate with electronic health records.

METHODS

A systematic app review and content synthesis was conducted on patient-facing cancer apps available in the United Kingdom. Where applicable, the review aligned with the Preferred Reporting Items for Systematic Reviews and meta-Analysis. Two validated scales assessed functionality and quality: The IMS Institute for Healthcare Informatics functionality score and the Mobile App Rating Scale. Flesch-Kincaid metrics explored readability.

RESULTS

Apple App and Google Play stores identified 405 apps, of which 12 met the eligibility criteria. All were free to download, 1 (8%) had in-app purchases/subscriptions. Nine (75%) were affiliated with a professional health body/charity. Six (50%) analysed inputted data and provided medical advice based on answers. The average Flesch Reading Ease score was 42.7 out of 100. The apps had an average of 7.3 functions each and a mean MARS score of 4/5. None integrated with electronic health records.

CONCLUSION

While many cancer apps exist, few enable patient reported outcomes to be recorded and shared with clinicians in real-time. Further research is warranted to explore the feasibility of integrating with electronic health records, as this function can improve patient experience and outcomes, and increase efficiency of hospital resources through more proactive care.

Effectiveness of mHealth diet interventions in cancer survivors: A systematic review and meta-analysis of randomized controlled trials

Objective

To evaluate the effects of mobile health (mHealth) diet interventions on cancer survivors' diet intake, weight change, waist circumference, hip circumference, and quality of life (QoL).

Methods

The PubMed, Embase, Web of Science, Cochrane Library, Scopus, ProQuest, China National Knowledge Infrastructure, Wanfang, and SinoMed databases were searched from their inception to September 25, 2022. Randomized controlled trials (RCTs) on the effects of mHealth diet interventions in cancer survivors were identified. Two researchers independently selected the included studies and appraised their quality. The methodological quality of the included studies was assessed using the Revised Cochrane risk-of-bias tool for RCTs (RoB2).

Results

A total of 15 RCTs involving 2363 cancer survivors were included. MHealth diet interventions significantly improved fruit and vegetable intake (standardized mean difference [SMD] ​= ​0.19, 95% confidence interval [CI] [0.05, 0.33], P ​< ​0.01), and QoL (SMD ​= ​0.13, 95% CI [0.01, 0.26], P ​= ​0.04) and reduced fat intake (SMD ​= ​-0.22, 95% CI [-0.34, -0.11], P ​< ​0.01), weight (SMD ​= ​-0.35, 95% CI [-0.48, -0.22], P ​< ​0.01), waist circumference (MD ​= ​-1.43, 95% CI [-2.33, -0.53], P ​< ​0.01), and hip circumference (MD ​= ​-3.54, 95% CI [-4.88, -2.19], P < 0.01) in cancer survivors. No significant differences were observed in energy intake (P ​= ​0.46) or whole grain intake (P ​= ​0.14).

Conclusions

MHealth diet interventions may be an effective strategy for cancer survivors. Large-scale RCTs with rigorous study designs are needed to examine the effect of diet intervention delivered via mHealth.

Sentiment Analysis to Understand the Perception and Requirements of a Plant-Based Food App for Cancer Patients

Understanding human perception and requirements on food for cancer prevention and condition management is important so that food applications can be catered to cancer patients. In this paper, web scraping was conducted to understand the public’s perception, attitude, and requirements related to a plant-based diet as a recommended diet for cancer prevention and condition management. Text and sentiment analyses were carried out on results gathered from 82 social sites to determine whether noncancer and cancer patients use plant-based diets, how they have been consumed, their benefits in the prevention and condition management of cancers, the existing myths/fake news about cancer, and what do cancer patients need in a food app. The results of the text analysis highlighted gaps in existing apps, including a lack of credibility as there were a lot of fake news and myths about cancer and endorsement by professionals. Future food apps should provide personalized diets to include both plant-based diets as well as meat, symptom management, good user experience, credibility, and emotional and mental health support.

Use of digital technologies in the nutritional management of catabolism-prone chronic diseases: A rapid review

BACKGROUND

Diet and nutrition applications (apps) have become more readily accessible as smartphone ownership increases. These apps have the potential to improve nutritional outcomes, but it remains unclear whether they are effective in patients with catabolism-prone conditions and specialized nutritional needs.

AIMS

The primary aim of this rapid review was to determine if delivery of a nutrition intervention via an app was more effective than standard care in improving nutritional outcomes in patients with a selected set of catabolism-prone chronic diseases. Secondary aims included summarizing intervention components and reviewing adherence and acceptance.

METHODS

The research question was developed using the Population, Intervention, Comparison, Outcomes (PICO) framework. Comprehensive literature searches were conducted across three databases. Screening, study selection, extraction, and risk of bias (RoB) assessment were conducted for the included randomized controlled trials (RCTs).

RESULTS

15 articles were included, including 5 RCTs; 3/5 RCTs were judged to be at high RoB. The study aims, measured outcomes, and intervention components were diverse. Adherence and acceptance to the app interventions were encouraging.

CONCLUSIONS

Due to the heterogeneity of study design, nutrition interventions, outcomes, and reporting across studies, we were unable to aggregate data regarding the impact on nutritional outcomes. Reassuringly though, the available evidence suggests high adherence and acceptance, which needs to be interpreted in light of the associated personnel support provided within each study. The use of digital technology to deliver diet and nutrition interventions in catabolism-prone conditions is feasible, easy to adhere to, and well-accepted by participants.