key: cord-348570-plds5kbn
authors: Buneviciene, Inesa; Mekary, Rania A.; Smith, Timothy R.; Onnela, Jukka-Pekka; Bunevicius, Adomas
title: Can mHealth interventions improve quality of life of cancer patients? A systematic review and meta-analysis
date: 2020-10-20
journal: Crit Rev Oncol Hematol
DOI: 10.1016/j.critrevonc.2020.103123
sha: 
doc_id: 348570
cord_uid: plds5kbn

mHealth can be used to deliver interventions to optimize Health-related quality of life (HRQoL) of cancer patients. In this systematic-review and meta-analysis, we explored the possible impact of health interventions delivered via mHealth tools on HRQoL of cancer patients. The systematic literature search was performed on July 20, 2019, to identify studies that evaluated the impact of mHealth intervention on HRQoL of cancer patients. We identified 25 studies (17 randomized controlled trials and 8 pre-post design studies; 957 patients) that evaluated mHealth interventions. The most commonly studied mHealth interventions included physical activity/ fitness interventions (9 studies), cognitive behavioral therapy (6 studies), mindfulness/ stress management (3 studies). In the majority of studies, mHealth interventions were associated with an improved HRQoL of cancer patients. The meta-analysis of the identified studies supported the positive effect of mHealth interventions for HRQoL of cancer patients. mHealth interventions are promising for improving HRQoL of cancer patients.

mHealth technologies have become promising to improve health monitoring and delivery of health interventions. While no standardized definition has been established, the World Health Organization (WHO) defines mHealth as "medical or public health practice that is delivered with supports of mobile phones, patient monitoring devices, and other wireless devices" [1] . The number of available mHealth applications is growing with approximately 200 new mHealth applications added to app stores each day [2] . However, the lack of evidence of clinical efficacy of mHealth interventions raises valid doubts and skepticism among healthcare professionals as not all apps are developed by teams that include clinicians, adhere to treatment guidelines, or have regulatory approval [3] . Despite the lack of regulation and other potential barriers to adoption, such as concerns about privacy or inaccurate information, mHealth apps are a rising technology.

Advancement in early diagnosis, treatment strategies and life expectancy has resulted in a progressively increasing number of long-term cancer survivors [4] . Health-related quality of life (HRQoL) is a multifactorial construct that pertains to patients' perception across physical, social, mental, and functional domains. Poor HRQoL is associated with worse prognosis of cancer patients [5] . Preservation of HRQoL is important in the management of cancer patients and it is commonly used as a secondary outcome measure in clinical trials [6] . mHealth interventions in patients with cancer is under-studied albeit high-priority area of research. We aimed to systematically review studies that investigated the possible impact of health interventions delivered via mHealth tools on the HRQoL of patients with cancer and to pool the reported results from the original studies in a meta-analysis, when feasible.

A systematic review of the literature followed by a meta-analysis was implemented in accordance with the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement [7] .

The systematic search was performed on July 20, 2019, with the goal of identifying published studies that evaluated the association between mHealth intervention and HRQoL of patients with established cancer diagnosis or cancer survivors. Articles were identified from the Pubmed/MEDLINE and Web of Knowledge databases (for details see Appendix 1). Original research papers performed in humans and with their full texts available in English were considered for the review. Randomized controls trials (RCT) and observational studies were both considered for inclusion. Studies that did not provide research results in cancer patients, studies that evaluated interventions delivered via telephone (i.e., telehealth), and studies that evaluated HRQoL using non-validated scales were excluded.

Initial literature analysis was performed by reviewing titles and abstracts of identified papers. Literature analysis was performed by two authors (IB and AB) and disagreements were resolved via discussion. The following variables were extracted from each full text article: year and country of publication, cancer type, sample size, patients' age and gender, presence of control subjects, study design, study timing, mHealth intervention type, intervention duration, questionnaires that were used for assessment of HRQoL, study completion rate, and major study findings.

Two types of results were reported and analyzed separately. For studies that reported HRQoL change in the intervention group and the control group, a difference in mean scores comparing the treated arm to the control arm was calculated for each study. As for the studies that reported data on at least the treatment arm, the mean change in HRQoL was calculated in the treated arm before vs. after mHealth intervention. Both types of results were then pooled separately using the random-effects model by the DerSimonian and Laird method [8] , which takes into account within-and between-study variances. Forest plots were used to visualize summaries of individual studies and the pooled estimates. Cochrane Q test (p-level of significance set at 0.1) along with the I 2 value [9, 10] were used to assess between-study J o u r n a l P r e -p r o o f

heterogeneity. An I 2 value >50% was generally considered to be high [11] . In an effort to minimize heterogeneity sources, pooled results were stratified by questionnaire type (EORTC global health; SH-36 General; FACT-G). When feasible, further stratification within each questionnaire type was conducted by intervention type (cognitive behavioral therapy/ behavioral change; physical activity/ fitness; social support; weight management). A new I 2 value was calculated for each subgroup. In an attempt to have an overall pooled estimate of the efficacy of mHealth on quality of life from the comparative studies that provided data on both arms, a standardized difference in means was calculated for each of these original studies and was stratified by questionnaire type. Unless otherwise specified, a two-sided p-value <0.05 was considered statistically significant. All analyses were performed using Comprehensive Meta-Analysis (version 3).

The quality of RCTs and pre-post design studies was assessed using the Cochrane Collaboration' risk of bias tool [12] . This tool rates 7 domains as having a low, unclear, or high risk of bias. These domains consist of sequence generation, allocation concealment, participants'

and study personnel's blinding; outcome assessment blinding; outcome data completeness; selective outcomes' reporting; and other threats to validity, including intervention contamination, baseline imbalance, and carry-over effect in cross-over trials). Because there were fewer than 9-10 studies per specific outcome within each questionnaire type, publication bias assessment was not possible [13] .

Twenty-five studies evaluated the impact of different interventions delivered via mHealth on HRQoL in patients with cancer ( Figure 1 and Table 1 ). The majority of studies (n=9) were from the USA, Europe (n=8) and Asia (n=7). Sample sizes ranged from 18 [14] to 409 patients [15] .

Mean (or median) age of study participants ranged from 17 years [16] to 69 years [17] . The intervention duration ranged from 30 days [18] to 12 months [19] .

We identified 17 RCTs [15, 16, [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29] [30] [31] [32] and 8 pre-post design studies [33] [34] [35] [36] [37] [38] [39] [40] . Nine studies (5 RCTs and 4 pre-post designs) tested physical activity / rehab / fitness interventions [16, 22, 23, 26, 29, 34, 35, 38, 40] , six studies -CBT interventions (4 RCTs and 2 pre-post designs) [14, 15, 21, 24, 24, 25, 33] , three studies -mindfulness/stress management interventions (3 RCTs) [27, 28, 30] , two studies -social support (1 RCT and 1 pre-post design) [32, 37] , two studiesinformation/psychoeducation (2 RCTs) [18, 20] , two studies -weight management (1 RCT and 1

pre-post design) [19, 36] , and one study assessed a pain management intervention (1 RCT) [31] .

The most commonly used HRQoL assessment questionnaires were the European Organization for Research and Treatment (EORTC; 10 studies) and the Functional Assessment of Cancer Therapy (FACT;7 studies).

The majority of studies (15 RCTs and 7 pre-post designs) found that mHealth interventions were associated with improvement in at least one domain of HRQoL of cancer patients [15, 18, 19, [21] [22] [23] [24] 24, [26] [27] [28] [29] [30] [31] [32] [33] [34] [35] [36] [37] [38] 40 ].

Galiano-Castillo and colleagues randomized 81 women with breast cancer to an 8-week

Internet-based, tailored exercise program (e-CUIDATE) or to a control group that received written recommendations for exercise [23] . The intervention was associated with improved scores on the EORTC-QLQ-C30 global health status, physical, role, and cognitive function as opposed to the control group. Uhm and colleagues (2017) randomized 356 breast cancer patients to either an mHealth regimen of aerobic and resistance training exercise program (newly developed application) coupled with a pedometer or to a control group who received an exercise brochure [29] . They found significant improvements across all EORTC QLQ-C30 and QLQ-BR 23 subscales with the exception of insomnia, appetite, constipation, body image, and sexual enjoyment domains in both the mHealth intervention and the control groups without any significant between-group differences. In another RCT, 64 patients with non-small cell lung cancer were randomized to either an mHealth personalized pulmonary rehabilitation program or a fixed exercise regimen (control group) [26] . The EuroQoL visual analog scale score improved in both J o u r n a l P r e -p r o o f patient groups, without significant between-group differences. Similarly, an RCT in patients with different cancer types found improved SF-36 mental health, general health, and social functioning scores, but a worsened SF-36 bodily pain score in patients randomized to either a walking intervention (STRIDE online resource) or a control group, irrespective of group allocation [22] . Conversely, another RCT compared wearable physical activity tracking devices coupled with

Facebook peer-based virtual support group (mHealth intervention group) to usual care (control group), which consisted of clinical advice on physical activity as per the providers' discretion in 59 teenagers who were cancer survivors for 1 year. mHealth intervention was associated with a decrease in the social functioning score [16] .

A pre-post study used a mobile application and a wearable device that included a rehabilitation exercise program and information on the disease and treatment of 102 colorectal cancer patients undergoing chemotherapy [34] . After 12 weeks, there was an improvement in the EORTC symptoms of fatigue and nausea/ vomiting. A study in lung cancer patients found that physical rehabilitation program delivered via a mobile application was associated with improved scores on the ERTC-QLQ-C30 role, emotional and social functioning, fatigue, appetite, and diarrhea symptom subscales [38] . Another pre-post study found that the 12-week intervention that included a Web-based application combined with wearable accelerometer and activity tracker was associated with improved emotional well-being domain of the FACT-G [40] . Finally, a healthy eating and physical activity feedback app (BENECA) administered to 80 overweight or obese breast cancer patients improved global health perception, physical, emotional, cognitive and social functioning domains, in addition to fatigue dyspnea and insomnia symptom severity, as evaluated by the EORTC-QLQ-C30 questionnaire [35] .

In an RCT of African American breast cancer survivors, all study participants received a physical activity tracker (Fitbit Charge) and were randomized to either an intervention (commercially available SparkPeople app) or a waitlist control [19] . When compared to the control group, the intervention group participants achieved a significantly greater improvement in the HRQoL at 6 months as measured by the Quality of Life in Adult Cancer Survivors Scale J o u r n a l P r e -p r o o f (QLACS) scale, albeit the difference was not statistically significant at 3 months. In a pre-post design study of 50 overweight or obese breast or endometrial cancer, survivors tested a "beta" healthcare provider version of Web and mobile based application LoseIt! (Boston, MA) [36] ; there were no significant differences in FACT-G scores at 4 weeks when compared to baseline.

In women with incurable cancer and with elevated anxiety symptoms, a tablet-delivered CBT program (intervention) and health education program (control group) delivered via tablet computers were associated with a significant improvement in the FACT-General questionnaire

scores, yet without a statistically significant between-group differences [24]. Ham and colleagues found a similar between-group improvement of the SF-36 total score in cancer patients randomized to either a mobile-application-based CBT (HARUToday), a waitlist control group, or an attention control group [25] . Another RCT found that cancer patients randomized to either an

Internet-based mindfulness-based cognitive therapy or a face-to-face mindfulness based cognitive therapy had improved mental health, but not physical health, when compared to cancer patients who received treatment as usual [21] . Finally, Willems and colleagues found cancer patients with similar baseline EORTC QLQ-C30 scores, randomized to a Web-based intervention according to CBT along with problem-solving therapy principles or to a waitlist control, had improved emotional and social functioning when compared to waitlist controls [15] .

A single-arm pre-post design study (2019) in 25 survivors of different cancers found that an 8-week app-based cognitive behavioral stress management intervention (Stress Proffen app)

improved the perception of physical aspects, emotional aspects, vitality, and general health aspects of the HRQoL, as measured with the SF-36 questionnaire [33] . Another small study in 18 breast cancer patients found that CBT for insomnia intervention delivered via Internet videoconference on a computer was associated with an improved EORTC QLQ-C30 global health status score [14] .

Mindfulness mediation or stress management mHealth interventions in cancer patients were studied in 3 RCTs [27, 28] . In cancer patients receiving chemotherapy, patients who received a commercially available mindfulness app (Headspace) intervention delivered over an 8-week period reported a significant improvement in the FACT-G emotional well-being and the overall well-being dimensions [27] . In another study, breast cancer patients were randomized to either an 8-week intervention using a commercially available mindfulness training app (Headspace) or the waitlist control group. There were improved FACT-B scores in the mHealth intervention group, but not in the control group [28] . In an RCT of patients with different cancer types, a webbased stress management program was associated with higher improvement in FACIT-F scores relative to the waitlist control [30] .

One study in 114 breast cancer patients receiving chemotherapy randomized patients to either an app-based support program (mHealth intervention group) or to usual care (control group), which comprised a health supportive care during chemotherapy as inpatients. Women in the mHealth intervention group experienced significantly less deterioration in the total FACT-B scores at 3 months when compared to the control group; however, FACT-B scores at 6 months were not different between the two groups [32] . Another pre-post study in adolescent and young adults with cancer found a significant improvement in global HRQoL after 6 weeks of mHealth intervention, which included symptom diary, communication network, and information [37] .

Twenty-six women undergoing bilateral salpingo-oophorectomy for suspected gynecological cancer received some app-based postoperative instructions and real-time symptom monitoring and were randomized to either receive reminders (intervention group) or not (control group) [18] . At 30-day follow-up, women in the intervention group reported improved mental health but decreased physical health as measured by the SF-12 Mental Health and Physical Health questionnaires, respectively, when compared to controls; however, these differences were not statistically significant. Another RCT in women with breast cancer J o u r n a l P r e -p r o o f randomized women to either a Web-based tailored psychoeducational program (ENCOURAGE) or to standard care, which included regular visits to a medical specialist. Despite the reported improvements of HRQoL in both study groups, there was no statistically significant difference between the 2 groups [20] .

Yang and colleagues (2019) randomized 58 patients with different cancer types to either receive an mHealth app providing continuous treatment information and feedback (Pain Guard)

or to a control group who received a traditional pharmacologic treatment [31] . At 4-week of follow-up, compared to the control group, patients in the intervention group scored significantly higher on the EORTC QLQ-C30 emotional, cognitive, and social functioning domains as well as sleep, nausea/vomiting, constipation, fatigue and pain symptoms scales, and global QoL domain.

Sixteen studies reported scores on the EORTC QLQ-C30 Global Health Status (8 studies Table 2 .

Six studies reported scores on the EORTC QLQ- (Table 3 and Figure 3 ).

The main source of bias for RCTs was the absence of or unclearly defined blinding procedures of study participants or personnel for intervention or control group allocation (Appendix 2). Due to the paucity of studies in each of the subgroups, publication bias was not feasible to conduct.

mHealth interventions are promising for improving the HRQoL of patients with cancer.

The strongest evidence currently exists for physical activity/ fitness interventions, followed by CBT, and mindfulness. The evidence is more limited for weight management, health information, social support, and pain management mHealth interventions. physical functioning subscale when compared to waitlist controls [52] . We identified one RCT that reported improvement in HRQoL with an mHealth weight management intervention [19] , while another pre-post study did not find an impact of Web and mobile mHealth interventions on HRQoL [36] . These findings suggest that mHealth weight management interventions might improve HRQoL of cancer patients but remain to be further explored.

Mindfulness is a psychological state of being aware in the present moment and without judgment. Mindfulness-based interventions are structured 8-week programs that consist of group programs and individual practices. Mindfulness has a broad range of positive mental effects [53] and has been shown to be effective for depression, anxiety, pain, distress, and QoL Two RCTs found that mHealth CBT intervention was associated with a higher post-CBT HRQoL when compared to patients who did not receive an mHealth CBT intervention [15, 21] .

Two pre-post design studies also showed improvements in the HRQoL of patients with mHealth interventions [14, 33] . CBT is a structured form of psychotherapy that helps to cope with negative emotions by changing thoughts and behavior [61, 62] . A growing number of studies have documented numerous positive effects of CBT in patients with cancer that include decreased psychological distress, pain [63] , depression,fear of cancer recurrence [64] , and improvement in the HRQoL. Barriers of wider implementation of CBT training in clinical cancer care include limited institutional and system resources, patient preference for pharmacotherapy, and lack of interest and/or motivation [65] . Mobile apps could potentially help enhance wider adoption of CBT by patients [66, 67] . However, commercially available CBT apps do not foster patient-physician relationship; therefore, they should be adapted to healthcare systems and patient/physician needs before fostering their wider adoption in healthcare and by cancer patients [67] .

Findings regarding the effectiveness of mHealth-delivered information and psychoeducation interventions on the HRQoL of cancer patients are conflicting [18, 20] . However, mHealth information interventions for perioperative care of cancer patients could be a valuable tool to deliver patient-tailored, disease-stage, and treatment specific information about cancer

care, but delivered information should be carefully balanced to the context of patient health literacy and disease gravity [68] .

One RCT and another pre-post study found that mHealth social support program was associated with an improved HRQoL of cancer patients [32, 37, 69] . Perceived social support is an important determinant of life satisfaction, better mood symptoms, and better perceived HRQoL of patients with cancer [70, 71] . Coping strategies of cancer patients are important for the HRQoL of cancer patients [72] and can mediate the relationship between social support and HRQoL [73] .

In a systematic review, seeking for social support was identified as a major coping strategy of patients with cancer [74] . Therefore, social support delivered via mHealth interventions can be well accepted by cancer patients allowing them to optimize their HRQoL. mHealth tools should be further explored to enhance social support in patients with cancer.

Pain is experienced by over 80% of cancer patients, should be appropriately diagnosed, and is usually managed with pharmacological approaches that can be associated with an elevated risk of adverse events, such as opioid addiction [75] . mHealth pain management interventions J o u r n a l P r e -p r o o f can improve the HRQoL of cancer patients [31] , indicating that mHealth interventions can help manage cancer related pain and therefore should be explored in future studies.

In the majority of studies, HRQoL was evaluated using EORTC and FACT questionnaires that were specifically designed for cancer patient population, and were validated and widely used for assessment of HRQoL in patients with cancer [69, [76] [77] [78] . The use of widely accepted and validated instruments is an important strength of the identified studies, reinforcing the reliability and reproducibility of their findings. Only a fraction of the reviewed studies used generic HRQoL instruments, such as SF-36 [79] and SF-12 [80] that are also commonly used in cancer patients;

however, future studies examining the impact of mHealth interventions on the HRQoL of cancer patients should consider using cancer specific HRQoL instruments.

The meta-analysis of the identified studies supported the positive effect of various mHealth interventions on the HRQoL of cancer patients. A recent meta-analysis (7 studies, 1220 patients) found that internet based psycho-educational interventions were associated with improved fatigue and depression symptoms, but the effect of distress and HRQoL was not significant [81] . Our study results should be interpreted with caution given heterogeneity of studies included in the meta-analysis in patient populations and mHealth interventions.

Nevertheless, our findings support that mHealth interventions can help improve the HRQoL of cancer patients or prevent it from deteriorating, a phenomenon that is often inevitable given the progressive course of the disease [82] [83] [84] .

The COVID-19 pandemic further underscores the clinical significance of mHealth interventions for cancer patients given the high risk of COVID-19 related complications in patients with established cancer diagnoses and receiving active cancer treatment [85] . Notably, a delay in care for these cancer patients places them at an elevated risk for potentially avoidable complications [86] . COVID-19 pandemic has resulted in an explosion in digital healthcare adoption and consumption [87, 88] ; therefore, it is expected that the ongoing pandemic will place even more emphasis on remote cancer patient care using mHealth solutions.

This review study had limitations. The included studies were heterogenous in study design (RCTs vs. single-arm studies), sample size, types of mHealth interventions, cancer types, and methods of HRQoL assessment. Furthermore, we focused on publications in English and J o u r n a l P r e -p r o o f therefore did not capture non-English publications. Our results cannot be generalized to telemedicine interventions that consist of information and communication technologies that are administered by healthcare professionals as opposed to mHealth interventions that are used by patients and do not require any clinician's intervention. Despite these limitations, our study had several strengths. To our knowledge, this was the first systematic review and meta-analysis on this novel topic that included a large number of studies and an overall large number of patients with cancer who tested a myriad of mHealth interventions. A meticulous assessment of study quality for the different primary studies included in our review allowed us to identify the biases and weaknesses in the current literature and to provide useful recommendations for future studies. Despite the inherent above-mentioned heterogeneity, we tried our best to subgroup the results not only by questionnaire type, but also by intervention type, in order to pool the results of the original studies that provided such data. Additionally, we standardized the pooled effect estimated when combining different questionnaire types to further attenuate the heterogeneity issue.

The available evidence strongly suggest that mHealth interventions hold promise for TS=("quality of life" OR "health related quality of life") AND TS = ("cancer") AND TS=("mobile health" OR "mobile application" OR "mobile app" OR "mobile health app" OR "mhealth") 

WHO Global Observatory for eHealth, World Health Organization

A content analysis of smartphone-based applications for hypertension management

Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries

Quality of life data as prognostic indicators of survival in cancer patients: an overview of the literature from 1982 to

Analysing data from patient-reported outcome and quality of life endpoints for cancer clinical trials: a start in setting international standards

Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement

Random-effects model for meta-analysis of clinical trials: an update

Quantifying heterogeneity in a meta-analysis

Assessing heterogeneity in meta-analysis: Q statistic or I2 index?

Measuring inconsistency in metaanalyses

The Cochrane Collaboration's tool for assessing risk of bias in randomised trials

Bias in meta-analysis detected by a simple, graphical test

Feasibility of a Telemedicine-Delivered Cognitive Behavioral Therapy for Insomnia in Rural Breast Cancer Survivors

Short-term effectiveness of a web-based tailored intervention for cancer survivors on quality of life, anxiety, depression, and fatigue: randomized controlled trial

A Fitbit and Facebook mHealth intervention for promoting physical activity among adolescent and young adult childhood cancer survivors: A pilot study

Efficacy of a Mobile-Enabled Web App (iCanFit) in Promoting Physical Activity Among Older Cancer Survivors: A Pilot Study

Use of a web-based app to improve postoperative outcomes for patients receiving gynecological oncology care: A randomized controlled feasibility trial

Feasibility and potential efficacy of commercial mHealth/eHealth tools for weight loss in African American breast cancer survivors: pilot randomized controlled trial

Web-Based Tailored Psychoeducation for Breast Cancer Patients at the Onset of the Survivorship Phase: A Multicenter Randomized Controlled Trial

Face-to-Face and Internet-Based Mindfulness-Based Cognitive Therapy Compared With Treatment as Usual in Reducing Psychological Distress in Patients With Cancer: A Multicenter Randomized Controlled Trial

Effect of a 12-Week Online Walking Intervention on Health and Quality of Life in Cancer Survivors: A Quasi-Randomized Controlled Trial

Telehealth system: A randomized controlled trial evaluating the impact of an internet-based exercise intervention on quality of life, pain, muscle strength, and fatigue in breast cancer survivors

Preliminary Results From a Randomized Controlled Study for an App-Based Cognitive Behavioral Therapy Program for Depression and Anxiety in Cancer Patients

Mobile Health Management Platform-Based Pulmonary Rehabilitation for Patients With Non-Small Cell Lung Cancer: Prospective Clinical Trial

A Randomized Controlled Trial of mHealth Mindfulness Intervention for Cancer Patients and Informal Cancer Caregivers: A Feasibility Study Within an Integrated Health Care Delivery System

Quality of life among women diagnosed with breast Cancer: A randomized waitlist controlled trial of commercially available mobile app-delivered mindfulness training

Effects of exercise intervention in breast cancer patients: is mobile health (mHealth) with pedometer more effective than conventional program using brochure?

Web-Based Stress Management for Newly Diagnosed Patients With Cancer (STREAM): A Randomized, Wait-List Controlled Intervention Study

Development and Testing of a Mobile App for Pain Management Among Cancer Patients Discharged From Hospital Treatment: Randomized Controlled Trial

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

Pilot testing an app-based stress management intervention for cancer survivors

Efficacy of Mobile Health Care Application and Wearable Device in Improvement of Physical Performance in Colorectal Cancer Patients Undergoing Chemotherapy

A Mobile System to Improve Quality of Life Via Energy Balance in Breast Cancer Survivors (BENECA mHealth): Prospective Test-Retest Quasiexperimental Feasibility Study

Feasibility of a lifestyle intervention for overweight/obese endometrial and breast cancer survivors using an interactive mobile application

Health-Related Quality of Life Before and After Use of a Smartphone App for Adolescents and Young Adults With Cancer: Pre-Post Interventional Study

Mobile Phone App-Based Pulmonary Rehabilitation for Chemotherapy-Treated Patients With Advanced Lung Cancer: Pilot Study

Feasibility of smartphone application and social media intervention on breast cancer survivors' health outcomes

RiseTx: testing the feasibility of a web application for reducing sedentary behavior among prostate cancer survivors receiving androgen deprivation therapy

Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial

Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies

Physical activity and male colorectal cancer survival

Nutrition and physical activity guidelines for cancer survivors

American College of Sports Medicine roundtable on exercise guidelines for cancer survivors

Physical Activity and Cancer Survivorship

The use of social features in mobile health interventions to promote physical activity: a systematic review

OBESITY IN CANCER SURVIVAL

Overweight, Obesity, and Mortality from Cancer in a Prospectively Studied Cohort of U.S. Adults

Body mass index and survival in women with breast cancer-systematic literature review and metaanalysis of 82 follow-up studies

Reach out to enhance wellness home-based diet-exercise intervention promotes reproducible and sustainable long-term improvements in health behaviors, body weight, and physical functioning in older, overweight/obese cancer survivors

The psychological effects of meditation: a meta-analysis

Meditation programs for psychological stress and well-being: a systematic review and metaanalysis

Exploring the Promise of Mindfulness as Medicine

Randomizedcontrolled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results

The effects of mindfulness-based stress reduction on psychosocial outcomes and quality of life in early-stage breast cancer patients: a randomized trial

Digital Phenotyping in Patients with Spine Disease: A Novel Approach to Quantifying Mobility and Quality of Life

3 Digital Phenotyping: A Novel Method for Quality of Life Assessment in Patients with Brain Tumors

Opportunities and challenges in the collection and analysis of digital phenotyping data

Cognitive Behavior Therapy for Patients With Cancer

The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses

Cognitive behavioral therapy techniques for distress and pain in breast cancer patients: a meta-analysis

Efficacy of Blended Cognitive Behavior Therapy for High Fear of Recurrence in Breast, Prostate, and Colorectal Cancer Survivors: The SWORD Study, a Randomized Controlled Trial

Using cognitive behavioural therapy in practice: qualitative study of family physicians' experiences

There's an App for That: Information Technology Applications for Cognitive Behavioral Practitioners

Review of cognitive behavioural therapy mobile apps using a reference architecture embedded in the patient-provider relationship

Digital health and perioperative care

The Functional Assessment of Cancer Therapy scale: development and validation of the general measure

Life satisfaction in young adults with cancer and the role of sociodemographic, medical, and psychosocial factors: Results of a longitudinal study

Perceived social support and its impact on depression and health-related quality of life: a comparison between cancer patients and general population

The Relationship Between Coping Strategies, Quality of Life, and Mood in Patients with Incurable Cancer

Longitudinal Effects of Social Support and Adaptive Coping on the Emotional Well-Being of Survivors of Localized Prostate Cancer

Coping response following a diagnosis of breast cancer: A systematic review

Management of cancer pain: ESMO Clinical Recommendations

The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology

Choosing between the EORTC QLQ-C30 and FACT-G for measuring health-related quality of life in cancer clinical research: issues, evidence and recommendations

General population normative data for the EORTC QLQ-C30 health-related quality of life questionnaire based on 15,386 persons across 13 European countries, Canada and the Unites States

The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection

SF-12: How to score the SF-12 physical and mental health summary scales. Health Institute

Effects of Internet-based psycho-educational interventions on mental health and quality of life among cancer patients: a systematic review and meta-analysis. Support Care Cancer Off J Multinatl Assoc Support Care Cancer

Symptom Monitoring With Patient-Reported Outcomes During Routine Cancer Treatment: A Randomized Controlled Trial

Quality-of-life trajectories after stereotactic radiosurgery for brain metastases

Quality of life trajectory in patients with advanced cancer during the last year of life

Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study

The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study

Virtually Perfect? Telemedicine for Covid-19

Covid-19 and Health Care's Digital Revolution

European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30; FACT-G: Functional Assessment of Cancer Therapy-General; HRQol: Health-related quality of life; NA: not applicable; SF-36: Medical Outcomes Study 36-Item Short Form