Effects and Implementation of a Mindfulness and Relaxation App for Patients With Cancer: Mixed Methods Feasibility Study.
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Abstract
BACKGROUND: Cancer diagnosis and cancer treatment can cause high levels of distress, which is often not sufficiently addressed in standard medical care. Therefore, a variety of supportive nonpharmacological treatments have been suggested to reduce distress in patients with cancer. However, not all patients use these interventions because of limited access or lack of awareness. To overcome these barriers, mobile health may be a promising way to deliver the respective supportive treatments. OBJECTIVE: The aim of this study is to evaluate the effects and implementation of a mindfulness and relaxation app intervention for patients with cancer as well as patients' adherence to such an intervention. METHODS: In this observational feasibility study with a mixed methods approach, patients with cancer were recruited through the web and through hospitals in Switzerland. All enrolled patients received access to a mindfulness and relaxation app. Patients completed self-reported outcomes (general health, health-related quality of life, anxiety, depression, distress, mindfulness, and fear of progression) at baseline and at weeks 4, 10, and 20. The frequency of app exercise usage was gathered directly through the app to assess the adherence of patients. In addition, we conducted interviews with 5 health professionals for their thoughts on the implementation of the app intervention in standard medical care. We analyzed patients' self-reported outcomes using linear mixed models (LMMs) and qualitative data with content analysis. RESULTS: A total of 100 patients with cancer (74 female) with a mean age of 53.2 years (SD 11.6) participated in the study, of which 25 patients used the app regularly until week 20. LMM analyses revealed improvements in anxiety (P=.04), distress (P<.001), fatigue (P=.01), sleep disturbance (P=.02), quality of life (P=.03), and mindfulness (P<.001) over the course of 20 weeks. Further LMM analyses revealed a larger improvement in distress (P<.001), a moderate improvement in anxiety (P=.001), and a larger improvement in depression (P=.03) in patients with high levels of symptoms at baseline in the respective domains. The interviews revealed that the health professionals perceived the app as a helpful addition to standard care. They also made suggestions for improvements, which could facilitate the implementation of and adherence to such an app. CONCLUSIONS: This study indicates that a mindfulness and relaxation app for patients with cancer can be a feasible and effective way to deliver a self-care intervention, especially for highly distressed patients. Future studies should investigate if the appeal of the app can be increased with more content, and the effectiveness of such an intervention needs to be tested in a randomized controlled trial.
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Being referred onto trial by treatment team was the most frequent recruitment strategy, followed by social media, cancer patient organisations, reviewing medical records, posters, and leaflets.
“Being referred onto trial by treatment team [33, 45, 55, 59, 67] was the most frequent employed strategy, followed by recruiting participants via social media [46, 55, 56, 61], cancer patient organisations [46, 54, 55, 61], reviewing medical records [57, 58, 60], exhibiting posters [46, 67], disseminating a leaflets [55].”
From Web-based interventions for fear of cancer recurrence: A scoping review with a focus on suggestions for the development and evaluation of future interventions (2024) · cites this paper as [55]
The Results > Implementation section (page unavailable) describes nurses telling patients about the app and an outpatient nurse handing out a flyer, which partly supports the treatment-team and leaflet elements. But Methods > Participants says the patient recruitment process is described elsewhere; this paper does not establish which trial recruitment strategies were used or their frequency ranking, and it does not document social-media or cancer-organisation recruitment. (LLM, conf=0.76)
Experimental — accuracy not yet measuredNo significant changes in FCR were reported in Mikolasek et al. study evaluating the feasibility and satisfaction of a mindfulness app.
“No significant changes in FCR were reported in Mikolasek et al. study evaluating the feasibility and satisfaction of a mindfulness app [55].”
Ten reviewed interventions were entirely self-guided.
“10 interventions were entirely self-guided. [33, 35, 36, 39–41, 47, 51, 54, 55].”
Lack of internet access and access to smartphones were mentioned as problems in reviewed studies.
“Lack of internet access [40] and access to smartphones [55] were mentioned as problems for rec.”
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“Therefore, mind–body intervention care should be diverse, with a large amount of technical content to increase attractiveness [31], thereby encouraging male cancer patients to actively participate in self-management.”
BackgroundOnline Mindfulness Intervention for Inflammatory Bowel Disease: Adherence and Efficacy
Forbes, L., & Johnson, S. K. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.709899 · Cited by 18 · see citing works
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“) control strategies [15–17], because lack of awareness is the most critical barrier for both health providers and patients [14].”
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Beenhakker, L., Witteveen, A., Wijlens, K. A. E., Siemerink, E., van der Lee, M. L., Bode, C., Siesling, S., & Vollenbroek-Hutten, M. M. R. (2022) · European Journal of Cancer Care · doi:10.1111/ecc.13754 · Cited by 12 · see citing works
“For mind–body interventions, this was the case in 4/7 interventions (Lengacher et al., 2018; Mikolasek et al., 2021; Price-Blackshear et al., 2020; Zernicke et al., 2014) and with regard to the psychological interventions, 9/13 found a significant effect on CRF (Abrahams et al., 2017; Bray et al.,…”
BackgroundMethodInfluentialTandon, A., Dhir, A., & Islam, N. (2023) · IEEE Transactions on Engineering Management · doi:10.1109/tem.2023.3243724 · Cited by 9 · see citing works
“Yet, few scholars have reported comparative responses of intervention users from different age groups [7], [14], [15], [77], [89].”
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Yılmazer, E., & Altınok, A. (2024) · Clinical Cancer Investigation Journal · doi:10.51847/lrpe9pz2wg · Cited by 9 · see citing works
“[37]”
Personalized Mind–Body Medicine in Integrative Oncology: Meeting the Moment with Each Patient
Mishra, K., Victorson, D. E., Mehta, D. H., & Vago, D. R. (2022) · Journal of Integrative and Complementary Medicine · doi:10.1089/jicm.2022.0562 · Cited by 7 · see citing works
“Furthermore, virtual delivery of MBM through meditation/ well-being mobile applications and online interventions holds new promise for equitable access and delivery.(28,29)”
Pereira, D. R., Silva, E. R., Carvalho-Maia, C., Monteiro-Reis, S., Lourenço, C., Calisto, R., Teixeira, R. J., Carlson, L. E., Bart, G., Vainio, S. J., et al. (2022) · Trials · doi:10.1186/s13063-022-06045-x · Cited by 6 · see citing works
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“…onto trial by treatment team [33, 45, 55, 59, 67] was the most frequent employed strategy, followed by recruiting participants via social media [46, 55, 56, 61], cancer patient organisations [46, 54, 55, 61], reviewing medical records [57, 58, 60], exhibiting posters [46, 67], disseminating a…”
BackgroundMethodInfluentialWu, Z., Luo, F., Wang, S., hu, X., & Chen, M. (2025) · JMIR Cancer · doi:10.2196/64754 · Cited by 4 · see citing works
“…Patient Health Questionnaire-8 [48], while anxiety was assessed using National Comprehensive Cancer Network Distress Thermometer [51], the Spielberger State-Trait Anxiety Scale (State-Trait Anxiety Inventory) [40], the Hamilton Anxiety Rating Scale [20], and the State-Trait Anxiety Inventory [26].”
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Kidney Cancer Integrative Oncology: Possible Options for Care
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Barth, J., Schläpfer, S., Schneider, F., Santhanam, P., Kowatsch, T., Heinz, P., Held, U., Eicher, M., & Witt, C. M. (2025) · npj Digital Medicine · doi:10.1038/s41746-025-01688-x · Cited by 4 · see citing works
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“Role-play can increase patients ’ and caregivers ’ confidence in using relaxation therapy to manage pain and anxiety related to cancer treatment and symptoms (Mikolasek et al., 2021; Sinha et al., 2021).”
Bai, Z., Xie, J., Wei, J., Liu, E., Xiong, Y., Jiang, H., Liu, F., & Zhou, J. (2025) · Cure & Care · doi:10.1016/j.ccwv.2025.100007
Older People, Long-Term Conditions and the Potential for New Technologies
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The Use of Technology to Provide Psychosocial Care in Palliative Care
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“However, the existing literature suggests that integrating new interventions early in treatment can be challenging due to stress and demanding treatment schedules [41,42].”
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Yan, X., Hassett, A. L., Waljee, J. F., Newman, M., Park, S. Y., Bei, R., & Carlozzi, N. E. (2026) · JMIR mhealth and uhealth · doi:10.2196/64278
“The final sample size (N=19) is consistent with prior mixed methods and feasibility studies examining mHealth engagement in clinical contexts [29,43].”
Spiritual self-care practice and mindfulness among patients with cancer: A cross-sectional study
Najmadini, A., Dukhaykh, S., Hattab, W. A. A., Cristia, J. F. E., Forouzi, M. A., & Dehghan, M. (2026) · Palliative & Supportive Care · doi:10.1017/s1478951526103745
“Mikolasek et al. (2021) showed that a mindfulness and relaxation software for cancer patients can serve as a practical and effective self-care intervention, especially for highly anxious patients (Mikolasek et al. 2021).”
- Authors
- Mikolasek, M., Witt, C. M., & Barth, J.
- Affiliations
- University of Zurich (CH)
- University of Maryland, Baltimore (US)
- Corresponding author
- Mikolasek, Michael
- Venue
- JMIR Cancer
- Publisher
- JMIR Publications Inc.
- Published
- 2021-01-13
- Volume
- 7
- Issue
- 1
- Pages
- e16785
- ISSN
- 2369-1999 (ISSN-L)
- PMC
- PMC7840285
- OpenAlex
- W3100763221
- Cited by
- 36
- References
- 57
- Citations by year
- 2026: 2 · 2025: 11 · 2024: 5 · 2023: 8 · 2022: 7 · 2021: 3
- FWCI
- 1.63
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Cancer (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, cc-by)
- Zurich Open Repository and Archive (University of Zurich)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- cancer, mindfulness apps, relaxation training, mobile health, cancer-related distress, anxiety, depression, fatigue, sleep disorders, health-related quality of life, fear of progression, self-care interventions, app adherence, health professionals' perceptions, feasibility and effectiveness, patient-reported outcomes, non-pharmacological treatment
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