A Smartphone App Designed to Help Cancer Patients Stop Smoking: Results From a Pilot Randomized Trial on Feasibility, Acceptability, and Effectiveness

Tobacco Cessation Interventions in Non-Respiratory Cancers: A Systematic Review With Meta-analysis of Randomized Controlled Trials

BACKGROUND

Considering the high rates of persistent tobacco use, effective cessation interventions are needed for cancer patients and caregivers. Despite the need, there is a significant lack of research on tobacco cessation, especially for non-respiratory cancers (breast, prostate, colorectal, cervical, and bladder cancer).

PURPOSE

The objective was to evaluate tobacco use and tobacco cessation interventions among patients and caregivers for non-respiratory cancers.

METHODS

Randomized controlled trials assessing tobacco cessation interventions were identified. Five electronic databases were searched in accordance with the Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines through July 2023. Studies exclusive to lung, oral, thoracic, and head and neck cancers were excluded. Effect sizes were estimated; risk of bias was assessed.

RESULTS

Of 3,304 studies, 17 were included. Interventions included behavioral (n = 6), pharmacotherapy (n = 2), and a combination (n = 9) treatment. Eight studies included a health behavior model; mean behavioral change techniques were 5.57. Pooled magnitude of the odds of cessation was positive and significant (odds ratio = 1.24, 95% confidence interval [Lower Limit 1.02, Upper Limit 1.51]) relative to usual care/placebo. Cumulative meta-analysis examined the accumulation of results over-time and demonstrated that studies have been significant since 2020. Two studies included caregivers' who were involved in the provision of social support.

CONCLUSIONS

Current interventions have the potential to reduce tobacco use in non-respiratory cancers. Results may be beneficial for promoting tobacco cessation among non-respiratory cancers. There is a considerable lack of dyadic interventions for cancer survivors and caregivers; researchers are encouraged to explore dyadic approaches.

Meaningful consumer involvement in cancer care: a systematic review on co-design methods and processes

OBJECTIVE

Although the benefits of consumer involvement in research and health care initiatives are known, there is a need to optimize this for all people with cancer. This systematic review aimed to synthesize and evaluate the application of co-design in the oncology literature and develop recommendations to guide the application of optimal co-design processes and reporting in oncology research, practice, and policy.

METHODS

A systematic review of co-design studies in adults with cancer was conducted, searching MEDLINE, CINAHL, Embase, and PsycINFO databases and included studies focused on 2 concepts, co-design and oncology.

RESULTS

A total of 5652 titles and abstracts were screened, resulting in 66 eligible publications reporting on 51 unique studies. Four frameworks were applied to describe the co-design initiatives. Most co-design initiatives were designed for use in an outpatient setting (n = 38; 74%) and were predominantly digital resources (n = 14; 27%) or apps (n = 12; 23%). Most studies (n = 25; 49%) used a co-production approach to consumer engagement. Although some studies presented strong co-design methodology, most (n = 36; 70%) did not report the co-design approach, and 14% used no framework. Reporting was poor for the participant level of involvement, the frequency, and time commitment of co-design sessions. Consumer participation level was predominantly collaborate (n = 25; 49%).

CONCLUSIONS

There are opportunities to improve the application of co-design in oncology research. This review has generated recommendations to guide 1) methodology and frameworks, 2) recruitment and engagement of co-design participants, and 3) evaluation of the co-design process. These recommendations can help drive appropriate, meaningful, and equitable co-design, leading to better cancer research and care.

The effectiveness of interventions to reduce cancer-related stigma: An integrative review

AIMS

The clinical significance of cancer-related stigma on patients' well-being has been widely established. Stigma can be perceived and internalised by cancer patients or implemented by the general population and healthcare workers. Various interventions have been carried out to reduce cancer-related stigma, but their effectiveness is not well-understood. This review aims to synthesise evidence on the effectiveness of interventions to reduce cancer-related stigma.

DESIGN

An integrative review.

METHODS

This integrative review combined both qualitative and quantitative studies and followed five steps to identify problems, search for the literature, appraise the literature quality, analyse data, and present data. Mixed Methods Appraisal Tool (version 2018) was applied to evaluate the quality of the included studies.

DATA SOURCES

Databases included Web of Science, MEDLINE, SpringerLink, Wiley Online Journals, Cochrane Library, ScienceDirect, OVID, and China National Knowledge Infrastructure (from the inception of each database to 30 April 2021).

RESULTS

Eighteen quantitative, six qualitative, and five mixed-methods studies were included in this review. Cultural factors should be considered when conducting interventions to reduce cancer-related stigma. For cancer patients, multi-component interventions have demonstrated a positive effect on their perceived stigma. For general population, interactive interventions show promise to reduce their implemented stigma towards cancer patients. For healthcare workers, there is a paucity of studies to reduce their implemented stigma. Existing studies reported inconclusive evidence, partially due to the lack of a robust study design with an adequate sample size.

CONCLUSIONS

Multi-component and interactive interventions show promise to relieve cancer-related stigma. More methodologically robust studies should be conducted in different cultures to elucidate the most appropriate interventions for different populations to reduce cancer-related stigma.

IMPLICATION FOR THE PROFESSION AND PATIENT CARE

These findings will facilitate healthcare workers to design and implement interventions to reduce cancer-related stigma, thus improving the quality of life for cancer patients.

PATIENT AND PUBLIC CONTRIBUTION

No patient and public contribution.

Digital Smoking Cessation Intervention for Cancer Survivors: Analysis of Predictors and Moderators of Engagement and Outcome Alongside a Randomized Controlled Trial

BACKGROUND

Recent studies have shown positive, though small, clinical effects of digital smoking cessation (SC) interventions for cancer survivors. However, research on associations among participant characteristics, intervention engagement, and outcomes is limited.

OBJECTIVE

This study aimed to explore the predictors and moderators of engagement and outcome of MyCourse-Quit Smoking (in Dutch: "MijnKoers-Stoppen met Roken"), a digital minimally guided intervention for cancer survivors.

METHODS

A secondary analysis of data from the randomized controlled trial was performed. The number of cigarettes smoked in the past 7 days at 6-month follow-up was the primary outcome measure. We analyzed interactions among participant characteristics (11 variables), intervention engagement (3 variables), and outcome using robust linear (mixed) modeling.

RESULTS

In total, 165 participants were included in this study. Female participants accessed the intervention less often than male participants (B=-11.12; P=.004). A higher Alcohol Use Disorders Identification Test score at baseline was associated with a significantly higher number of logins (B=1.10; P<.001) and diary registrations (B=1.29; P<.001). A higher Fagerström Test for Nicotine Dependence score at baseline in the intervention group was associated with a significantly larger reduction in tobacco use after 6 months (B=-9.86; P=.002). No other associations and no moderating effects were found.

CONCLUSIONS

Overall, a limited number of associations was found between participant characteristics, engagement, and outcome, except for gender, problematic alcohol use, and nicotine dependence. Future studies are needed to shed light on how this knowledge can be used to improve the effects of digital SC programs for cancer survivors.

TRIAL REGISTRATION

Netherlands Trial register NTR6011/NL5434; https://onderzoekmetmensen.nl/nl/trial/22832.

The effectiveness of smoking cessation interventions after cancer diagnosis: A systematic review and meta-analysis

OBJECTIVES

patients with cancer who smoke have more side effects during and after treatment, and a lower survival rate than patients with cancer who quit smoking. Supporting patients with cancer to quit smoking should be standard care. The aim of this systematic review was to determine the most effective smoking cessation method for patients diagnosed with cancer.

METHODS

PubMed, Embase, Web of Science and Google Scholar were systematically searched. Included were randomized controlled trials and observational studies published after January 2000 with any smoking cessation intervention in patients with any type of cancer. Result of these studies were evaluated in a meta-analysis.

RESULTS

A total of 18,780 papers were retrieved. After duplicate removal and exclusion based on title and abstract, 72 publications were left. After full text screening, 19 (randomized) controlled trials and 20 observational studies were included. The overall methodological quality of the included studies, rated by GRADE criteria, was very low. Two out of 21 combined intervention trials showed a statistical significant effect. Meta-analysis of 18 RCTs and 3 observational studies showed a significant benefit of combined modality interventions (OR 1.67, 95% C.I.: 1.24-2.26, p = 0.0008) and behavioural interventions (OR 1.33, 95% C.I.: 1.02 - 1.74, p = 0.03), but not for single modality pharmacological interventions (OR 1.11; 95% C.I.: 0.69-1.78, p = 0.66).

CONCLUSION

A combination of pharmacological and behavioural interventions may be the most effective intervention for smoking cessation in patients with cancer.

Technology-based interventions for tobacco smoking prevention and treatment: a 20-year bibliometric analysis (2003-2022)

BACKGROUND

Substance abuse, particularly tobacco smoking, is a significant global public health concern. Efforts have been made to reduce smoking prevalence and promote cessation, but challenges, such as nicotine addiction, marketing tactics by tobacco industry, and cultural acceptability hinder progress. Technology has emerged as a potential tool to address these challenges by providing innovative scalable interventions. The objective of the study was to analyze and map scientific literature on technology-based intervention for tobacco prevention and treatment.

METHODS

A bibliometric methodology was conducted. Scopus database was used to retrieve relevant research articles published between 2003 and 2022. The analysis included publication trends, key contributors, research hotspots, research themes, the most impactful articles, and emerging research topics.

RESULTS

A total of 639 articles were found, with a slow and fluctuating growth pattern observed after 2011. The Journal of Medical Internet Research was the most prominent journal in the field. The United States was the leading country in the field, followed up by the United Kingdom, and the Netherlands. Research hotspots included smoking cessation, randomized controlled trials, and technology-based methods such as internet, mHealth, smartphone apps, text messages, and social media. Four primary research themes were identified: development of smartphone applications, efficacy of text messaging interventions, acceptance and effectiveness of smartphone applications, and interventions targeting young adults and students using mobile phone and social media platforms. The top 10 cited articles demonstrated effectiveness of digital interventions in promoting smoking cessation rates and reducing relapse rates. Emerging research topics included the use of virtual reality interventions, interventions for specific populations through personalized tools, and technology-based interventions in non-Western countries.

CONCLUSIONS

The findings of the current study highlight the potential of technology to address the challenges associated with tobacco smoking. Further future research in this area is warranted to continue advancing the field and developing effective and evidence-based interventions to combat tobacco smoking.

[Effect of Smoking on Cancer Surgery Outcomes and Recommendations for Perioperative Smoking Cessation Intervention]

Smoking, a common behavior that causes health risks among adults around the world, is closely associated with the risks of developing various kinds of cancers. Nevertheless, the impact of smoking on preoperative risks and postoperative outcomes of cancer surgeries has been largely overlooked. Extensive basic medical and clinical research findings and prognosis data demonstrate that smoking is associated with increased risks of multiple perioperative complications, and that smoking affects the general prognosis of patients. Smoking cessation during the preoperative and perioperative periods effectively reduces these risks and improves the long-term postoperative outcomes of cancer patients. At present, health workers and patients are not giving adequate attention to smoking cessation interventions and the quality of interventions available is poor. Herein, we discussed the necessity of comprehensive and standardized smoking cessation services and made recommendations regarding the implementation of comprehensive and standardized smoking cessation services, providing support for cancer patients to access evidence-based care during the perioperative period.

User evaluation and feasibility test of an app designed for smoking cessation in Italian people who smoke: preliminary findings from an uncontrolled pre-test post-test open study

BACKGROUND

mHealth is a public health practice that exploits the use of mobile devices, including smartphone applications. We will describe an uncontrolled pre-test post-test open pilot study concerning the feasibility evaluation of a smartphone App designed to help in smoking cessation. The aim of this study is to evaluate the feasibility of a smartphone app as a tool for smoking cessation. This study is necessary to the literature because smoking is a major public health concern and has been linked to various health issues such as cardiovascular disease, respiratory disease, and cancer. While there are several smoking cessation interventions available, the use of mobile devices to aid in smoking cessation is a relatively new and innovative approach that requires further investigation.

METHODS

The App "Smoke Free" was configured on the devices of N = 30 participants who smoked combustible cigarette, 13 males and 17 females aged 18 to 55 years, with the indications to use it for 90 days, describe their experience, suggest new features, and report any critical aspect. The study consisted of an initial screening visit to select participants that reflected the inclusion criteria and 4 study visits: a baseline visit, two follow-up visits, and one final visit. We used descriptive stats to summarize results. Repeated measures ANOVA and Wilcoxon test were used to test differences in smoking consumption, self-reported craving, and measured eCO level. Statistical software Jamovi was used for analysis. Interviews were conducted via phone or in-person and analyzed using qualitative description principles.

RESULTS

Participants evaluated the app as having good aesthetic appeal and user-friendliness but being moderately useful, despite some quitting or reducing their smoking behavior. To improve it, participants have proposed features such as more notifications, social network integration, and damage caused by smoking to the body over time for future app updates.

CONCLUSIONS

The application was moderately useful with good feasibility, with several suggestions for future updates that could improve its effectiveness.

Mobile health interventions for cancer patient education: A scoping review

INTRODUCTION

Mobile health (mHealth) is using mobile devices and applications to deliver health information and services. mHealth has been increasingly applied in cancer care to support patients in various aspects of their disease journey. This scoping review aimed to explore the current evidence on the use of mHealth interventions for cancer patient education.

METHODS

This scoping review followed the Joanna Briggs Institute (JBI) methodology for scoping reviews. We searched four electronic databases (PubMed, Web of Science, CINAHL, and Cochrane) using a combination of keywords related to mHealth, cancer, and education. After finding articles at the initial search the screening has been done based on the inclusion and exclusion criteria. We included only original research articles and excluded all other types of publications, such as review papers, reports, editorials, letters to the editor, book reviews, short communications, conference proceedings, graduate dissertations, protocols, and commentaries. We extracted data on the characteristics and outcomes of the included studies using a standardized form. We conducted a narrative synthesis and inductive content analysis to summarize and categorize the evidence.

RESULTS

Out of 2131 records found in the initial search, 28 full-text articles reported on the use of mHealth educational interventions for cancer patients. The majority of the studies focused on breast cancer patients (n = 21, 75%). The most common type of mHealth intervention was exercise-based education delivered through various media such as text messages, videos, audio, images, and social networks. The main objectives of mHealth educational interventions were to enhance self-management skills, improve psychological well-being, and promote healthy lifestyle behaviors among cancer patients. The reported outcomes of mHealth interventions included reduced chemotherapy-related side effects, improved mental health, improved quality of life and lifestyle, and better pain management.

CONCLUSION

This scoping review showed that mHealth is a promising and feasible modality for delivering educational interventions to cancer patients. However, more rigorous and diverse studies are needed to evaluate the effectiveness and cost-effectiveness of mHealth interventions for different types of cancers, stages, and settings.

Efficacy of smartphone applications to help cancer patients quit smoking: Protocol of the Quit2Heal randomized controlled trial

Cigarette smoking is highly prevalent among cancer patients in the United States (US), with up to half of cancer patients smoking at the time of their initial cancer diagnosis. However, evidence-based cessation programs are rarely implemented in oncology care, and smoking is not consistently treated in cancer treatment settings. Consequently, there is an urgent need for accessible and efficacious cessation treatments that are uniquely tailored to the needs of cancer patients. Here we describe the design and implementation of a randomized controlled trial (RCT) testing the efficacy of a smartphone app (Quit2Heal) versus a US Clinical Practice Guidelines-based app (QuitGuide) for smoking cessation among a planned sample of 422 cancer patients. Quit2Heal is designed to address cancer-related shame, stigma, depression, anxiety, and knowledge about the consequences of smoking/quitting. Quit2Heal is based on the principles of Acceptance and Commitment Therapy, a behavioral therapy that teaches skills for accepting cravings to smoke without smoking, values-driven motivation to quit, and preventing relapse. The primary aim of the RCT is to determine whether Quit2Heal has significantly higher self-reported 30-day point prevalence abstinence at 12 months relative to QuitGuide. The trial will also determine whether Quit2Heal's effect on cessation is (1) mediated by improvements in cancer-related shame, stigma, depression, anxiety, and knowledge about the consequences of smoking/quitting; and (2) moderated by baseline factors (e.g., cancer type, stage, time since diagnosis). If successful, Quit2Heal will offer a more efficacious, broadly scalable smoking cessation treatment that could be implemented alongside existing oncology care, thereby improving cancer outcomes.

Testing the Outcomes of a Smoking Cessation Smartphone App for Nondaily Smokers: Protocol for a Proof-of-concept Randomized Controlled Trial

BACKGROUND

Nondaily smoking is a widespread, increasingly prevalent pattern of smoking, particularly in ethnic minority and vulnerable populations. To date, no effective treatment approach for this type of smokers has been identified.

OBJECTIVE

This study aims to use a randomized controlled trial to evaluate proof-of-concept markers of the Smiling instead of Smoking (SiS) app, a smoking cessation smartphone app designed specifically for nondaily smokers. This app was developed iteratively and is now in its third version. Previous studies have demonstrated acceptability and feasibility when participants were onboarded in person (study 1) and remotely (study 2) and showed within-person changes in line with hypothesized mechanisms of change. This is the first randomized test of this app.

METHODS

In total, 225 adult nondaily smokers will be asked to undertake a quit attempt while using smoking cessation support materials for a period of 7 weeks. Participants will be randomized to use the SiS smartphone app, the National Cancer Institute smartphone app QuitGuide, or the National Cancer Institute smoking cessation brochure "Clearing the Air." Participants will take part in a 15-minute scripted onboarding phone call during which study staff will introduce participants to their support materials. Survey links will be sent 2, 6, 12, and 24 weeks after the participants' initially chosen quit date. The primary outcome is self-efficacy to remain abstinent from smoking at treatment end, measured using the Smoking Self-Efficacy Questionnaire. Secondary outcomes cover several domains relevant to treatment development and implementation: treatment acceptability (eg, satisfaction with smoking cessation support, measured using the Client Satisfaction Questionnaire, and app usability, measured using the System Usability Scale); treatment feasibility (eg, measured using the number of days participants used the SiS or QuitGuide app during the prescribed treatment period); and, in an exploratory way, treatment efficacy assessed using self-reported 30-day point prevalence abstinence.

RESULTS

Recruitment began in January 2021 and ended June 2022. The final 24-week follow-up was completed in January 2023. This trial is funded by the American Cancer Society.

CONCLUSIONS

This study is designed to test whether the prescribed use of the SiS app results in greater self-efficacy to abstain from smoking in nondaily smokers than commonly recommended alternative treatments and whether the SiS app treatment is acceptable and feasible. Positive results will mean that the SiS app warrants testing in a large-scale randomized controlled trial to test its effectiveness in supporting smoking cessation in nondaily smokers. The design of this study also provides insights into issues pertinent to smoking cessation smartphone app treatment development and implementation by measuring, in a randomized design, markers of treatment satisfaction, engagement with the technology and content of the treatment, and adherence to the treatment plan.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04672239; https://clinicaltrials.gov/ct2/show/NCT04672239.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/40867.

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.

Systematic Review of Smoking Cessation Interventions for Smokers Diagnosed with Cancer

The detrimental impact of smoking on health and wellbeing are irrefutable. Additionally, smoking is associated with the development of cancer, a reduction treatment outcomes and poorer health outcomes. Nevertheless, a significant number of people continue to smoke following a cancer diagnosis. Little is understood of the smoking cessation services provided to smokers with cancer or their engagement with them. This systematic review aimed to identify existing smoking cessation interventions for this cohort diagnosed with breast, head and neck, lung and cervical cancers (linked to risk). Systematic searches of Pubmed, Embase, Psych Info and CINAHL from 1 January 2015 to 15 December 2020 were conducted. Included studies examined the characteristics of smoking cessation interventions and impact on referrals and quit attempts. The impact on healthcare professionals was included if reported. Included studies were restricted to adults with a cancer diagnosis and published in English. No restriction was placed on study designs, and narrative data synthesis was conducted due to heterogeneity. A review protocol was registered on PROSPERO CRD 42020214204, and reporting adheres to PRISMA reporting guidelines. Data were screened, extracted in duplicate and an assessment of the quality of evidence undertaken using Mixed Methods Assessment Tool. 23 studies met the inclusion criteria, representing USA, Canada, England, Lebanon, Australia and including randomized controlled trials (9), observational studies (10), quality improvement (3), and one qualitative study. Hospital and cancer clinics [including a dental clinic] were the settings for all studies. 43% (10/23) of studies reported interventions for smokers diagnosed with head and neck cancer, 13% (3/23) for smokers diagnosed with lung cancer, one study provides evidence for breast cancer, and the remaining nine studies (39%) report on multiple cancers including the ones specified in this review. Methodological quality was variable. There were limited data to identify one optimal intervention for this cohort. Key elements included the timing and frequency of quit conversations, use of electronic records, pharmacotherapy including extended use of varenicline, increased counselling sessions and a service embedded in oncology departments. More studies are required to ensure tailored smoking cessation pathways are co-developed for smokers with a diagnosis of cancer to support this population.

The Tobacco Endgame—A New Paradigm for Smoking Cessation in Cancer Clinics

Smoking cessation represents an untapped resource for cancer therapy. Many people who smoke and have cancer (tobacco-related or otherwise) struggle to quit and as a result, jeopardise response to treatment, recovery after surgery and long-term survival. Many health care practitioners working in cancer medicine feel undertrained, unprepared and unsupported to provide effective smoking cessation therapy. Many institutions and healthcare systems do provide smoking cessation programs, guidelines and referral pathways for cancer patients, but these may be unevenly applied. The growing body of evidence, from both retrospective and prospective clinical studies, confirms the benefit of smoking cessation and will provide much needed evidence for the best and most effective interventions in cancer clinics. In addition to reducing demand, helping cancer patients quit and treating addiction, a firm commitment to developing smoke free societies may transform cancer medicine in the future. While the Framework Convention for Tobacco Control (FCTC) has dominated global tobacco control for the last two decades, many jurisdictions are starting to develop plans to make their communities tobacco free, to introduce the tobacco endgame. Characterised by downward pressure on tobacco supply, limited sales, limited access and denormalization of smoking, these policies may radically change the milieu in which people with cancer receive treatment, in which health care practitioners refine skills and which may ultimately foster dramatic improvements in cancer outcomes.

Feature-level analysis of a smoking cessation smartphone app that uses a positive psychology approach (Preprint)

Background

Smoking cessation smartphone apps have emerged as highly accessible tools to support smoking cessation efforts. It is unknown how specific app features contribute to user engagement over time and relate to smoking outcomes.

Objective

To provide a feature-level analysis of the Smiling Instead of Smoking app (version 2) and to link feature use to subsequent smoking cessation.

Methods

Nondaily smokers (N=100) used the app for a period of 49 days (1 week before quitting and 6 weeks after quitting). Participants self-reported 30-day point-prevalence abstinence at the end of this period and at a 6-month follow up (the survey response rate was 94% and 89% at these points, respectively). Self-reported 30-day point prevalence abstinence rates were 40% at the end of treatment and 56% at the 6-month follow up. The app engaged users in both positive psychology content and traditional behavioral smoking cessation content. The app sent push notifications to prompt participants to complete prescribed content (ie, a “happiness exercise” every day and a “behavioral challenge” to use the app’s smoking cessation tools on 15 out of 49 days). Actions that participants took within the app were timestamped and recorded.

Results

Participants used the app on 24.7 (SD 13.8) days out of the 49 prescribed days, interacting with the happiness content on more days than the smoking content (23.8, SD 13.8 days vs 17.8, SD 10.3 days; t₉₉=9.28 [2-tailed]; P<.001). The prescribed content was frequently completed (45% of happiness exercises; 57% of behavioral challenges) and ad libitum tools were used on ≤7 days. Most participants used each ad libitum smoking cessation tool at least once, with higher use of personalized content (≥92% used “strategies,” “cigarette log,” “smoke alarms,” and “personal reasons”) than purely didactic content (79% viewed “benefits of quitting smoking”). The number of days participants used the app significantly predicted 30-day point-prevalence abstinence at the end of treatment (odds ratio [OR] 1.05, 95% CI 1.02-1.09; P=.002) and at the 6-month follow up (OR 1.04, 95% CI 1.008-1.07; P=.01). The number of days participants engaged with the happiness content significantly predicted smoking abstinence at the end of treatment (OR 1.05, 95% CI 1.02-1.08; P=.002) and at the 6-month follow up (OR 1.04, 95% CI 1.007-1.07; P=.02). This effect was not significant for the number of days participants engaged with the smoking cessation content of the app, either at the end of treatment (OR 1.04, 95% CI 0.996-1.08, P=.08) or at the 6-month follow up (OR 1.02, 95% CI 0.98-1.06; P=.29).

Conclusions

Greater app usage predicted greater odds of self-reported 30-day point-prevalence abstinence at both the end of treatment and over the long term, suggesting that the app had a therapeutic benefit. Positive psychology content and prescriptive clarity may promote sustained app engagement over time.

Trial Registration

ClinicalTrials.gov NCT03951766; https://clinicaltrials.gov/ct2/show/NCT03951766

Effectiveness, Cost-effectiveness, and Cost-Utility of a Digital Smoking Cessation Intervention for Cancer Survivors: Health Economic Evaluation and Outcomes of a Pragmatic Randomized Controlled Trial

Background

Smoking cessation (SC) interventions may contribute to better treatment outcomes and the general well-being of cancer survivors.

Objective

This study aims to evaluate the effectiveness, cost-effectiveness, and cost-utility of a digital interactive SC intervention compared with a noninteractive web-based information brochure for cancer survivors.

Methods

A health economic evaluation alongside a pragmatic 2-arm parallel-group randomized controlled trial was conducted with follow-ups at 3, 6, and 12 months. The study was conducted in the Netherlands over the internet from November 2016 to September 2019. The participants were Dutch adult smoking cancer survivors with the intention to quit smoking. In total, 165 participants were included and analyzed: 83 (50.3%) in the MyCourse group and 82 (49.7%) in the control group. In the intervention group, participants had access to a newly developed, digital, minimally guided SC intervention (MyCourse-Quit Smoking). Control group participants received a noninteractive web-based information brochure on SC. Both groups received unrestricted access to usual care. The primary outcome was self-reported 7-day smoking abstinence at the 6-month follow-up. Secondary outcomes were quality-adjusted life years gained, number of cigarettes smoked, nicotine dependence, and treatment satisfaction. For the health economic evaluation, intervention costs, health care costs, and costs stemming from productivity losses were assessed over a 12-month horizon.

Results

At the 6-month follow-up, the quit rates were 28% (23/83) and 26% (21/82) in the MyCourse and control groups, respectively (odds ratio 0.47, 95% CI 0.03-7.86; P=.60). In both groups, nicotine dependence scores were reduced at 12 months, and the number of smoked cigarettes was reduced by approximately half. The number of cigarettes decreased more over time, and the MyCourse group demonstrated a significantly greater reduction at the 12-month follow-up (incidence rate ratio 0.87; 95% CI 0.76-1.00; P=.04). Intervention costs were estimated at US $193 per participant for the MyCourse group and US $74 for the control group. The mean per-participant societal costs were US $25,329 (SD US $29,137) and US $21,836 (SD US $25,792), respectively. In the cost-utility analysis, MyCourse was not preferred over the control group from a societal perspective. With smoking behavior as the outcome, the MyCourse group led to marginally better results per reduced pack-year against higher societal costs, with a mean incremental cost-effectiveness ratio of US $52,067 (95% CI US $32,515-US $81,346).

Conclusions

At 6 months, there was no evidence of a differential effect on cessation rates; in both groups, approximately a quarter of the cancer survivors quit smoking and their number of cigarettes smoked was reduced by half. At 12 months, the MyCourse intervention led to a greater reduction in the number of smoked cigarettes, albeit at higher costs than for the control group. No evidence was found for a differential effect on quality-adjusted life years.

Trial Registration

The Netherlands Trial Register NTR6011; https://www.trialregister.nl/trial/5434

International Registered Report Identifier (IRRID)

RR2-10.1186/s12885-018-4206-z

Update on Cyber Health Psychology: Virtual Reality and Mobile Health Tools in Psychotherapy, Clinical Rehabilitation, and Addiction Treatment

(1) Background: we investigated and analyzed the most recent implementations of technology in the fields of psychotherapy, clinical rehabilitation, and addiction treatment. (2) Methods: from December 2021 to January 2022, we conducted a review aimed at identifying the recent implementations of technology in cyber health psychology, with particular reference to Virtual Reality in psychotherapy, mHealth tools in clinical rehabilitation, and smartphone applications in the treatment of addiction to substances of abuse, searching for relevant studies in the databases PubMed, Web of Science, Google Scholar, Health & Medical Collection, and APA PsycArticles. (3) Results: the tools analyzed are in constant development and are increasingly used, with good results, and further technological progress could lead to even better treatment outcomes; as far as mHealth tools and smartphone applications are concerned, anti-smoking Apps are the most widespread, followed by those for the treatment of alcohol use disorder, and there is no presence of Apps for the treatment of heroin, cocaine, or crack addiction. (4) Conclusions: the results of the review indicate that these technological tools are increasingly used and are, in principle, effective and have numerous advantages, including low cost and versatility.

Challenges in Participant Engagement and Retention using Mobile Health Apps: A Literature Review (Preprint)

Background

Mobile health (mHealth) apps are revolutionizing the way clinicians and researchers monitor and manage the health of their participants. However, many studies using mHealth apps are hampered by substantial participant dropout or attrition, which may impact the representativeness of the sample and the effectiveness of the study. Therefore, it is imperative for researchers to understand what makes participants stay with mHealth apps or studies using mHealth apps.

Objective

This study aimed to review the current peer-reviewed research literature to identify the notable factors and strategies used in adult participant engagement and retention.

Methods

We conducted a systematic search of PubMed, MEDLINE, and PsycINFO databases for mHealth studies that evaluated and assessed issues or strategies to improve the engagement and retention of adults from 2015 to 2020. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Notable themes were identified and narratively compared among different studies. A binomial regression model was generated to examine the factors affecting retention.

Results

Of the 389 identified studies, 62 (15.9%) were included in this review. Overall, most studies were partially successful in maintaining participant engagement. Factors related to particular elements of the app (eg, feedback, appropriate reminders, and in-app support from peers or coaches) and research strategies (eg, compensation and niche samples) that promote retention were identified. Factors that obstructed retention were also identified (eg, lack of support features, technical difficulties, and usefulness of the app). The regression model results showed that a participant is more likely to drop out than to be retained.

Conclusions

Retaining participants is an omnipresent challenge in mHealth studies. The insights from this review can help inform future studies about the factors and strategies to improve participant retention.

Using Digital Technologies to Reach Tobacco Users Who Want to Quit: Evidence From the National Cancer Institute's Smokefree.gov Initiative

The rapid growth of smartphone ownership and broadband access has created new opportunities to reach smokers with cessation information and support using digital technologies. These technologies can both complement and be integrated with traditional support modalities such as telephone quitlines and 1-on-1 clinical cessation counseling. The National Cancer Institute's Smokefree.gov Initiative provides free, evidence-based cessation support to the public through a multimodal suite of digital interventions, including several mobile-optimized websites, text messaging programs, and 2 mobile applications. In addition to digital resources directed at the general population, the Smokefree.gov Initiative includes population-specific resources targeted to adolescents, women, military veterans, Spanish speakers, older adults, and other populations. This paper describes the reach and use of the Smokefree.gov Initiative's resources over a 5-year period between 2014 and 2018, including how users interact with the program's digital content in ways that facilitate engagement with live counseling support. Use of Smokefree.gov Initiative resources has grown steadily over time; in 2018 alone, approximately 7-8 million people accessed Smokefree.gov Initiative web- and mobile-based resources. Smokefree.gov Initiative utilization data show that people take advantage of the full range of technology tools and options offered as part of the Smokefree.gov Initiative's multiplatform intervention. The Smokefree.gov Initiative experience suggests that offering different, complementary technology options to meet the needs and preferences of smokers has the potential to meaningfully expand the reach of cessation treatment.

Healthy Behaviors: Prevalence of Uptake Among Cancer Survivors

BACKGROUND

Although most cancer survivors adhere to recommendations to refrain from tobacco and minimize alcohol use, survivors of certain cancers are not meeting these recommendations. In addition, most cancer survivors do not achieve optimal recommendations for diet and physical activity, further decreasing survivor health and quality of life. Sun protective and sleep behaviors also tend to be suboptimal among survivors. Uptake of age-appropriate vaccinations is variable among survivors.

OBJECTIVES

The purpose of this article is to review the prevalence of healthy behavior uptake among cancer survivors and provide nurses with an overview of effective interventions, strategies, and resources to help patients improve these behaviors.

METHODS

An expert panel was convened to conduct an integrative review and synthesis on the state of the science of healthy behavior uptake among cancer survivors.

FINDINGS

Not meeting recommendations for healthy lifestyle behaviors increases the risk of second cancers and mortality and decreases overall health and quality of life. Healthy lifestyle behaviors can contribute to improved function, quality of life, and overall survival for cancer survivors. Nurses can help survivors to understand and improve their behaviors.

The Stop-Tabac smartphone application for smoking cessation: study protocol for a randomized controlled trial in the general population

Background

Smartphone-based support can reach thousands of smokers and help those who would otherwise try to quit smoking by themselves with little chance of success. Nicotine medications double the chances of quitting smoking, but few smokers use them, and they often use them for too short a time and at an insufficient dose. It is therefore important to increase access to support for smoking cessation and compliance with nicotine therapy. The objectives of this study are to assess whether the Stop-Tabac application (app) is effective for smoking cessation and to examine whether the outcome is influenced by the personal characteristics of participants.

Methods

Trial design: this is a two-arm, parallel-group, superiority, individually randomized, “placebo” controlled trial in 5200 smokers, with follow up after 1 week, 1 month and 6 months. The participants are adult daily smokers (N = 5200) enrolled on the Internet, living in France or Switzerland. The intervention is the Stop-tabac fully-automated app for smartphones, which was launched in 2012 and continuously improved thereafter. It includes fact sheets; calculators of cigarettes not smoked, money saved, and years of life gained; an interactive “coach” that provides automated, individually tailored counseling messages based on the user’s personal profile, sent regularly for 6 months; immediate feedback during episodes of craving and tobacco withdrawal symptoms; a discussion forum (“The Tribe”) where participants provide and receive social support; a quiz that informs users in a playful way; and a module on nicotine therapy that includes personalized feedback and follow up. The outcome is self-reported smoking cessation after 6 months (no puff of tobacco in the past 4 weeks), and after 1 week and 1 month (no puff in the past 7 days). Participants will be randomized automatically based on a list of random numbers. Participants, assistants in charge of collecting follow-up data and data analysts will be blinded to allocation. Funding is provided by the Swiss National Science Foundation, CHF 194,942 (EUR 182,200, USD 200,700), grant 32003_179369. JFE’s salary is paid by the University of Geneva, YK’s salary is paid by the Lausanne University Hospitals.

Discussion

There is little evidence from randomized trials of the impact of health apps in general and of smoking cessation apps in particular. This study will fill this gap.

Trial registration

ISRCTN Registry: ISRCTN11318024. Registered on 17 May 2018.