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

Zhu, Jiemin; Ebert, Lyn; Liu, Xiangyu; Wei, Di; Chan, Sally Wai-Chi

doi:10.2196/mhealth.9438

Cited by 124Cancer survivorship and careMobile Health and mHealth ApplicationsDigital Mental Health Interventions

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

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Zhu, Jiemin, Ebert, Lyn, Liu, Xiangyu, Wei, Di, Chan, Sally Wai-Chi·2018·JMIR mHealth and uHealth

DOI 10.2196/mhealth.9438PMC PMC5952114

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Abstract

BACKGROUND: Women undergoing chemotherapy for the treatment of breast cancer have frequently reported unmet supportive care needs. Moreover, easily accessible and innovative support is lacking. OBJECTIVE: The purpose of this trial was to determine the effectiveness of an app-based breast cancer e-support program to address women's self-efficacy (primary outcome), social support, symptom distress, quality of life, anxiety, and depression. Secondary objectives included exploring the association between women's health outcomes and the breast cancer e-support usage data. METHODS: A multicenter, single-blinded, randomized controlled trial was conducted. A total of 114 women with breast cancer, who were commencing chemotherapy and were able to access internet through a mobile phone, were recruited in the clinics from 2 university-affiliated hospitals in China. Women were randomized either to the intervention group (n=57) receiving breast cancer e-support plus care as usual or the control group (n=57) receiving care as usual alone. The health care team and research assistants collecting data were blinded to the women's group allocation. Bandura's self-efficacy theory and the social exchange theory guided the development of the breast cancer e-support program, which has 4 components: (1) a Learning forum, (2) a Discussion forum, (3) an Ask-the-Expert forum, and (4) a Personal Stories forum. Moderated by an experienced health care professional, the breast cancer e-support program supported women for 12 weeks covering 4 cycles of chemotherapy. Health outcomes were self-assessed through paper questionnaires in clinics at baseline before randomization (T0), after 3 (T1), and 6 months (T2) of follow-ups. RESULTS: Fifty-five participants in the intervention group and 49 in the control group completed the follow-up assessments (response rate: 91.2%). During the 12-week intervention, the log-in frequency ranged from 0 to 774 times (mean 54.7; SD 131.4; median 11; interquartile range, IQR 5-27), and the total usage duration ranged from 0 to 9371 min (mean 1072.3; SD 2359.5; median 100; IQR 27-279). Repeated measures multivariate analysis of covariance (intention-to-treat) found that breast cancer e-support + care as usual participants had significant better health outcomes at 3 months regarding self-efficacy (21.05; 95% CI 1.87-40.22; P=.03; d=0.53), symptom interference (-0.73; 95% CI -1.35 to -.11; P=.02; d=-0.51), and quality of life (6.64; 95% CI 0.77-12.50; P=.03, d=0.46) but not regarding social support, symptom severity, anxiety, and depression compared with care as usual participants. These beneficial effects were not sustained at 6 months. Spearman rank-order correlation showed that the breast cancer e-support usage duration was positively correlated with self-efficacy (r=.290, P=.03), social support (r=.320, P=.02), and quality of life (r=.273, P=.04) at 3 months. CONCLUSIONS: The breast cancer e-support program demonstrated its potential as an effective and easily accessible intervention to promote women's self-efficacy, symptom interference, and quality of life during chemotherapy. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12616000639426; www.ANZCTR.org.au/ACTRN12616000639426.aspx (Archived by Webcite at http://www.webcitation.org/6v1n9hGZq).

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The Breast Cancer e-Support app-based intervention was more effective than usual care in promoting women's self-efficacy and quality of life and decreasing symptom burden during chemotherapy.
“The app-based intervention was found to be more effective than usual care in promoting women’s self-efficacy and quality of life and decreasing symptom burden during chemotherapy.”
From Research-Tested Mobile Apps for Breast Cancer Care: Systematic Review (2019) · cites this paper as [36]
The Breast Cancer e-Support app did not show any advantage over usual care in terms of social support, symptom severity, anxiety, and depression.
“The mHealth app did not show any advantage over usual care in terms of social support, symptom severity, anxiety, and depression.”
From Research-Tested Mobile Apps for Breast Cancer Care: Systematic Review (2019) · cites this paper as [36]

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Background
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Background
Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 1): Qualitative Study of Women’s Perceptions
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BackgroundMethodSelf-citation
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MethodSelf-citation
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Result

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Research works printed but not linked: 1

[13]Blau P Exchange in power in social life 1964 London Wiley and Sons

Sorted by citations

Research-Tested Mobile Apps for Breast Cancer Care: Systematic Review
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mHealth Interventions to Improve Cancer Screening and Early Detection: Scoping Review of Reviews
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Effect of mobile phone app-based training on the quality of life for women with breast cancer
Çınar, D., Karadakovan, A., & Erdoğan, A. P. (2021) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2021.101960 · Cited by 56 · see citing works
Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 1): Qualitative Study of Women’s Perceptions
Zhu, J., Ebert, L., Guo, D., Yang, S., Han, Q., & Chan, S. W.-C. (2018) · JMIR mHealth and uHealth · doi:10.2196/mhealth.9311 · Cited by 46 · see citing works
Self-citation
A systematic review of mobile health interventions in China: Identifying gaps in care
Yang, X., & Kovarik, C. (2019) · Journal of Telemedicine and Telecare · doi:10.1177/1357633x19856746 · Cited by 45 · see citing works
Mobilizing Breast Cancer Prevention Research Through Smartphone Apps: A Systematic Review of the Literature
Houghton, L. C., Howland, R. E., & McDonald, J. A. (2019) · Frontiers in Public Health · doi:10.3389/fpubh.2019.00298 · Cited by 44 · see citing works
Mobile App for Symptom Management and Associated Quality of Life During Systemic Treatment in Early Stage Breast Cancer: Nonrandomized Controlled Prospective Cohort Study
Kuhar, C. G., Cepeda, T. G., Kovač, T., Kukar, M., & Gorenjec, N. R. (2020) · JMIR mhealth and uhealth · doi:10.2196/17408 · Cited by 43 · see citing works
“Zhu et al [9] reported findings similar to ours, namely that the e-support group had better quality of life, self-efficacy, and symptom control than that of the group receiving standard care.”
BackgroundMethodResultInfluential
Untitled work
(2020) · Deakin Research Online (Deakin University) · Cited by 41 · see citing works
Effectiveness of internet-based support interventions on patients with breast cancer: A systematic review and narrative synthesis
Huang, Y., Li, Q., Zhou, F., & Song, J. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-057664 · Cited by 36 · see citing works
Usefulness of Smartphone Apps for Improving Nutritional Status of Pancreatic Cancer Patients: Randomized Controlled Trial
Keum, J., Chung, M. J., Kim, Y., Ko, H., Sung, M. J., Jo, J. H., Park, J. Y., Bang, S., Park, S. W., Song, S. Y., et al. (2021) · JMIR mhealth and uhealth · doi:10.2196/21088 · Cited by 39 · see citing works
“Digital health care systems, especially mobile apps, have the potential to provide readily accessible nutritional and psychological support for cancer patients [14-23].”
Effect of mobile health interventions for side effects management in patients undergoing chemotherapy: A systematic review
Sarbaz, M., Monazah, F. M., Eslami, S., Kimiafar, K., & Baigi, S. F. M. (2022) · Health Policy and Technology · doi:10.1016/j.hlpt.2022.100680 · Cited by 39 · see citing works
Mobile Health Application-Based Interventions to Improve Self-management of Chemotherapy-Related Symptoms Among People with Breast Cancer Who Are Undergoing Chemotherapy: A Systematic Review
Shi, N., Wong, A. K. C., Wong, F. K. Y., & Sha, L. (2022) · The Oncologist · doi:10.1093/oncolo/oyac267 · Cited by 37 · see citing works
“…N/A N/A 2.1 Not reported N/A N/A Post 2013 31 160 days N/A N/A 1.3 No limitation on frequency on the day before the treatment visit 2.1 Once per week N/A 4.1 Review in each treatment visit 4.2 Reminder once per week Zhu 2018 32 12 weeks 2 At month 3, month 6 1.2 Answering questions within 24 hours.”
BackgroundInfluential
Effect of <scp>mHealth</scp> interventions on psychological issues experienced by women undergoing chemotherapy for breast cancer: A systematic review and meta‐analysis
Akingbade, O., Nguyen, K. T., & Chow, K. M. (2023) · Journal of Clinical Nursing · doi:10.1111/jocn.16533 · Cited by 35 · see citing works
The effect of a mobile application on treatment adherence and symptom management in patients using oral anticancer agents: A randomized controlled trial
Eşer, A. K., & Ayaz‐Alkaya, S. (2021) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2021.101969 · Cited by 33 · see citing works
The Impact of Digital Technology on Self-Management in Cancer: Systematic Review
Lim, D. S. C., Kwok, B., Williams, P. A. H., & Koczwara, B. (2023) · JMIR Cancer · doi:10.2196/45145 · Cited by 31 · see citing works
“A total of 4 studies were conducted in the United States [17-20]; 4 were conducted in the Netherlands [21-24]; and there were single studies from Ireland [25], Finland [26], Sweden [27], and China [28].”
BackgroundInfluential
A systematic review of eHealth technologies for breast cancer supportive care
Gyawali, B., Bowman, M., Sharpe, I., Jalink, M., Srivastava, S., & Wijeratne, D. T. (2023) · Cancer Treatment Reviews · doi:10.1016/j.ctrv.2023.102519 · Cited by 28 · see citing works
Factors Associated With Digital Intervention Engagement and Adherence in Patients With Cancer: Systematic Review
Montalescot, L., Baussard, L., & Charbonnier, É. (2024) · Journal of Medical Internet Research · doi:10.2196/52542 · Cited by 33 · see citing works
“%) studies showed that patients with better quality of life were more adherent or more engaged [65,71,73], 1 (14”
Influential
Filling the gaps of patient information and comprehension
Ector, G. I. C. G., Hermens, R., & Blijlevens, N. M. A. (2020) · Current Opinion in Oncology · doi:10.1097/cco.0000000000000633 · Cited by 30 · see citing works
Feasibility, acceptability, and efficacy of online supportive care for individuals living with and beyond lung cancer: a systematic review
Curry, J., Patterson, M., Greenley, S. L., Pearson, M., & Forbes, C. C. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06274-x · Cited by 27 · see citing works
“This aligns with the larger body of literature among breast [48, 49], prostate [16, 50], colorectal cancer [51, 52], and chronic obstructive pulmonary disease (COPD) [53, 54], a progressive chronic lung disease which has similar symptoms and QoL impact to lung cancer [55].”
Background
Effects of the “AI-TA” Mobile App With Intelligent Design on Psychological and Related Symptoms of Young Survivors of Breast Cancer: Randomized Controlled Trial
Jiang, L., Xu, J., Wu, Y., Liu, Y., Wang, X., & Hu, Y. (2024) · JMIR mHealth and uHealth · doi:10.2196/50783 · Cited by 27 · see citing works
“Frequently undergoing treatments and grappling with severe side effects, young survivors likely found themselves with limited energy to engage with the AI-driven tool ( AI-TA ) or to communicate effectively with health care professionals [41].”
Background
Self‐Efficacy in People With Chronic Disease: An Evolutionary Concept Analysis
Saldaña, D. M. A., de Villalobos, M. M. D., & Fuentes-Ramírez, A. (2025) · Nursing Open · doi:10.1002/nop2.70276 · Cited by 25 · see citing works
“People with high self-efficacy to cope with their chronic diseases reflect a perceived ability to manage challenges related to their self-care and a sense of control over their lives (Bandura 1997; Zhu et al. 2018).”
Exploring the use of Mobile applications by cancer patients undergoing chemotherapy: A scoping review
Magalhães, B. M. B. D. S., Fernandes, C. S., Martínez‐Galiano, J. M., & Santos, C. (2020) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2020.104293 · Cited by 29 · see citing works
The effectiveness of an internet-based support program on maternal self-efficacy, postpartum depression and social support for primiparous women during the COVID-19 pandemic: Randomized controlled trial
Zhang, Y., Zhu, J., Li, S., Huang, L., Fang, Q., & Zheng, X. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1035872 · Cited by 27 · see citing works
Self-citation
Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 3): Secondary Data Analysis
Zhu, H., Chen, X., Yang, J., Wu, Q., Zhu, J., & Chan, S. W. (2020) · JMIR mhealth and uhealth · doi:10.2196/18896 · Cited by 23 · see citing works
“In cases where reduced app engagement may undermine the potential effectiveness of the interventions [9], engaging strategies should be developed, such as self-tailored content, targeting participants who do not use the app as often as expected.”
BackgroundResultInfluentialSelf-citation
Mobile applications for early breast cancer chemotherapy-related symptoms reporting and management: A scoping review
Suchodolska, G., & Senkus, E. (2022) · Cancer Treatment Reviews · doi:10.1016/j.ctrv.2022.102364 · Cited by 27 · see citing works
Perceived feasibility and usefulness of mHealth interventions for psychoeducational support among Nigerian women receiving chemotherapy for breast cancer: a focus group study
Akingbade, O., Adediran, V., Somoye, I. E., Alade, A. S., & Chow, K. M. (2022) · Supportive Care in Cancer · doi:10.1007/s00520-022-07403-w · Cited by 22 · see citing works
“This was similar to a study conducted among Chinese women where the participants recommended that their family members could be allowed to join the intervention so that they could help with interpretation [33].”
BackgroundResultInfluential
Support for Chronic Pain Management for Breast Cancer Survivors Through Novel Digital Health Ecosystems: Pilot Usability Study of the PainRELife Mobile App
Masiero, M. A., Filipponi, C., Fragale, E., Pizzoli, S. F. M., Munzone, E., Milani, A., Guido, L., Guardamagna, V. A., Marceglia, S. R. F., Prandin, R., et al. (2023) · JMIR Formative Research · doi:10.2196/51021 · Cited by 23 · see citing works
“Overall, digital health technology supports patients and the health care system to achieve several critical outcomes for better cancer clinical management [17-19].”
BackgroundResult
Effect of mobile health (mHealth) on improving anxiety, depression and quality of life in cancer patients: A systematic review and meta -analysis
Zhang, X., Sun, S., Jiangenuer, L., Zhao, P., Lei, H., Xu, Z. Q., & Wang, Z. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.01.016 · Cited by 26 · see citing works
Effects of Internet-Based Support Program on Parenting Outcomes for Primiparous Women: A Pilot Study
Huang, L., Shen, Q., Fang, Q., & Zheng, X. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18094402 · Cited by 23 · see citing works
“Therefore, suggesting women to retain the ISP access in longer-term may lead to different social support outcomes [33].”
Background
Filling the gaps of patient information needs and information perception in chronic myeloid leukemia with the patient-physician co-produced web-based platform CMyLife
Ector, G. I. C. G., Verweij, L., Hermens, R., & Blijlevens, N. M. A. (2021) · Patient Education and Counseling · doi:10.1016/j.pec.2021.06.025 · Cited by 20 · see citing works
Social media–based interventions for patients with cancer: a meta-analysis and meta-regression of randomised controlled trials
Siew, L. E. D., Teo, N. R., Ang, W. H. D., & Lau, Y. (2023) · Journal of Cancer Survivorship · doi:10.1007/s11764-022-01244-6 · Cited by 19 · see citing works
Evaluating a digital tool for supporting breast cancer patients: a randomized controlled trial protocol (ADAPT)
Lidington, E. K., McGrath, S., Noble, J. L., Stanway, S. J., Lucas, A. N., Mohammed, K., van der Graaf, W., & Husson, O. (2020) · Trials · doi:10.1186/s13063-019-3971-6 · Cited by 19 · see citing works
Feasibility and usability of a personalized mHealth app for self-management in the first year following breast cancer surgery
Lim, J. Y., Kim, Y., Yeo, S. M., Chae, B. J., Yu, J. H., & Hwang, J. H. (2023) · Health Informatics Journal · doi:10.1177/14604582231156476 · Cited by 21 · see citing works
The Use of Mobile Applications for Managing Care Processes During Chemotherapy Treatments: A Systematic Review
Magalhães, B. M. B. D. S., Fernandes, C. S., Santos, C., & Martínez‐Galiano, J. M. (2020) · Cancer Nursing · doi:10.1097/ncc.0000000000000823 · Cited by 21 · see citing works
“A moderate methodological quality is reported in only 3 of the studies.(29,30,32) Notably, the aspect highly contributing to categorization in the clinical trials was the criterion blinding, not ensuring double blinding for the intervention (app) for the researchers and participants.”
BackgroundMethodInfluential
A Modular Mobile Health App for Personalized Rehabilitation Throughout the Breast Cancer Care Continuum: Development Study
Lim, J. Y., Kim, J. K., Kim, Y., Ahn, S.-Y., Yu, J. H., & Hwang, J. H. (2021) · JMIR Formative Research · doi:10.2196/23304 · Cited by 18 · see citing works
Effectiveness of telemedicine-based psychosocial intervention for breast cancer patients: a systematic review and meta-analysis
Ma, Z., Shi, Y., Yao, S., Lu, N., & Cheng, F. (2023) · Supportive Care in Cancer · doi:10.1007/s00520-023-08052-3 · Cited by 17 · see citing works
“There were 15 website-based interventions ( n = 15) [24, 25, 28, 30, 32, 36, 38–40, 44, 46, 48–51], 3 telephone-based interventions ( n = 3) [29, 31, 43], and 8 app-based interventions ( n = 8) [26, 27, 35, 37, 41, 42, 45, 52].”
The efficacy of web or mobile-based interventions to alleviate emotional symptoms in people with advanced cancer: a systematic review and meta-analysis
Kamalumpundi, V., Saeidzadeh, S., Chi, N., Nair, R., & Gilbertson‐White, S. (2021) · Supportive Care in Cancer · doi:10.1007/s00520-021-06496-z · Cited by 16 · see citing works
“Overall, 33% of the pooled study population had advanced cancer; however, the number of people with advanced cancer ranged from 2% [23] to 100% [24] among studies.”
BackgroundMethodInfluential
Comparing the effects of smartphone-based and face-to-face pulmonary rehabilitation education on caregiver burden and quality of life among the family caregivers of patients with chronic obstructive pulmonary disease: a randomized controlled field trial
Bahadori, M., Sami, R., Abolhassani, S., & Atashi, V. (2023) · Trials · doi:10.1186/s13063-023-07239-7 · Cited by 16 · see citing works
“In contradiction to our findings, a study showed the insignificant effects of a smartphone-based breast cancer support program on QOL among women with breast cancer who received chemotherapy [38].”
Result
Mobile App for Gynecologic Cancer Support for Patients With Gynecologic Cancer Receiving Chemotherapy in China: Multicenter Randomized Controlled Trial
Lin, H., Ye, M., Lin, Y., Chen, F., Chan, S. W., Cai, H., & Zhu, J. (2023) · Journal of Medical Internet Research · doi:10.2196/49939 · Cited by 16 · see citing works
“This is consistent with results from our previous study on a mobile app program for Chinese patients with breast cancer undergoing chemotherapy [35].”
InfluentialSelf-citation
An opportunity for patient-centered care: Results from a secondary analysis of sex- and gender-based data in mobile health trials for chronic medical conditions
Wang, J., Barth, J., Göttgens, I., Emchi, K., Pach, D., & Oertelt‐Prigione, S. (2020) · Maturitas · doi:10.1016/j.maturitas.2020.05.003 · Cited by 15 · see citing works
Evaluating the Effectiveness of Mobile Health in Breast Cancer Care: A Systematic Review
Flaucher, M., Zakreuskaya, A., Nissen, M., Mocker, A., Fasching, P. A., Beckmann, M. W., Eskofier, B. M., & Leutheuser, H. (2023) · The Oncologist · doi:10.1093/oncolo/oyad217 · Cited by 15 · see citing works
“Five studies 22,25,34,36,41 used validated questionnaires to measure symptom burden.”
BackgroundMethodInfluential
Feasibility of a mobile health app-based self-management program for Chinese patients with breast cancer receiving chemotherapy: A randomized controlled pilot study
Shi, N., Wong, A. K. C., Wong, F. K. Y., Zhang, N., Zhu, W., Shen, K., Lai, X., Jin, Y., Gu, C., Nie, L., et al. (2024) · Digital Health · doi:10.1177/20552076241231560 · Cited by 15 · see citing works
“16 It is unclear regarding the mechanism of how the adherence of app usage in ﬂ uences the outcomes of mHealth app-based intervention.”
Background
Lymphedema self-management mobile application with nurse support for post breast cancer surgery survivors: description of the design process and prototype evaluation
Hemati, M., Rivaz, M., & Khademian, Z. (2024) · BMC Cancer · doi:10.1186/s12885-024-12744-2 · Cited by 14 · see citing works
“Zhu et al. stated that communication between patient and therapist using a mobile application, can increase the patients’ motivation to continue the treatment and improve their perception of disease [35].”
Background
Effects of using app-based interventions on quality of life among breast cancer patients: a systematic review with meta-analysis
Tian, L., Wen, Y., Li, T., Liu, C., & Fan, J. (2025) · Annals of Medicine · doi:10.1080/07853890.2025.2499027 · Cited by 17 · see citing works
“The non-WeChat subgroup with 10 studies [12,13,16,17,21,26,27,29–31] had an SMD of 0.74 (95% CI [0.28, 1.19], p = 0.001) and an I 2 as high as 91%.”
Influential
Effect of electronic health ( eHealth ) on quality of life in women with breast cancer: A systematic review and meta‐analysis of randomized controlled trials
Wen, T., Chen, C., Ren, W., Hu, S., Zhao, X., Zhao, F., & Zhao, Q. (2023) · Cancer Medicine · doi:10.1002/cam4.6094 · Cited by 18 · see citing works
Evaluating the Effectiveness of a Mobile App for Breast Cancer Self-Management on Self-Efficacy: Nonrandomized Intervention Trial
Kim, S. M., Kim, D. S., Jang, Y., Kim, M. K., Yu, E., Han, D. H., & Kim, H. J. (2025) · JMIR mhealth and uhealth · doi:10.2196/63989 · Cited by 15 · see citing works
“Moreover, researchers have reported on the self-efficacy–enhancing outcomes of web-or app-based interventions for survivors of breast cancer who completed primary treatment and were undergoing chemotherapy [56,57].”
The Effect of Informative Mobile App Use on Anxiety, Distress, and Quality of Life of Women With Breast Cancer
Salman, F., İLHAN, S. E., Kutun, S., & Kutlutürkan, S. (2024) · European Journal of Breast Health · doi:10.4274/ejbh.galenos.2024.2024-3-9 · Cited by 12 · see citing works
Effects of Remote Web-Based Interventions on the Physiological and Psychological States of Patients With Cancer: Systematic Review With Meta-Analysis
Tian, L., Wen, Y., Li, J., Guan, J., Li, T., & Fan, J. (2025) · JMIR mhealth and uhealth · doi:10.2196/71196 · Cited by 9 · see citing works
“As shown in Figure 3 [26-33, 40”
Influential
Impact of e-Health Interventions on Mental Health and Quality of Life in Breast Cancer Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Mitsis, A., Filis, P., Karanasiou, G. S., Georga, E. I., Mauri, D. N., Naka, K. Κ., Constantinidou, A., Keramida, K., Tsekoura, D., Mazzocco, K., et al. (2025) · Cancers · doi:10.3390/cancers17111780 · Cited by 9 · see citing works
“Nineteen studies [20,22–25, 27, 30 , 31,33–41, 45, 46 The subgroup analysis based on the delivery method showed that studies us-ing web-based interventions ( n = 6) [38–41, 45,46] yielded an”
Influential
Effect of a Mobile Health–Based Remote Interaction Management Intervention on the Quality of Life and Self-Management Behavior of Patients With Low Anterior Resection Syndrome: Randomized Controlled Trial
Zhou, P., Li, H., Pang, X., Wang, T., Wang, Y., He, H., Zhuang, D., Zhu, F., Zhu, R., & Hu, S. (2024) · Journal of Medical Internet Research · doi:10.2196/53909 · Cited by 8 · see citing works
“Unlike those of previous studies, our findings indicated that mHealth-based remote interaction management intervention could improve the social support levels in the short term; however, sustaining a stable long-term effect on social support was not realized [47].”
A Nurse-Led mHealth Self-Management Program (mChemotherapy) for Breast Cancer Patients Undergoing Chemotherapy: Study Protocol of a Randomized Controlled Pilot Study
Shi, N., Wong, A. K. C., Wong, F. K. Y., Zhang, N., Lai, X., & Gan, L. (2022) · Cancer Control · doi:10.1177/10732748221115469 · Cited by 8 · see citing works
The effect of an interactive nurse support program developed with a mobile application on patient outcomes in breast cancer patients who received outpatient chemotherapy: A randomized controlled trial
Özdemir, H., Demir, A., Bardakçı, M., & Uncu, D. (2025) · European Journal of Oncology Nursing · doi:10.1016/j.ejon.2025.102882 · Cited by 7 · see citing works
The Effectiveness of Telemedicine on Distress, Physical Function and Self‐Efficacy in Patients With Cancer: A Meta‐Analysis of Randomised Controlled Trials
Su, Y., Zhang, S., Duan, L., & Hu, X. (2025) · Journal of Clinical Nursing · doi:10.1111/jocn.70089 · Cited by 7 · see citing works
Clinical Practice Guidelines for mental health and well-being in patients with chronic medical illnesses
Grover, S., Avasthi, A., & Majid, A. (2024) · Indian Journal of Psychiatry · doi:10.4103/indianjpsychiatry.indianjpsychiatry_603_23 · Cited by 7 · see citing works
Telemedicine in Cancer Rehabilitation
Davidoff, C., & Cheville, A. L. (2023) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000002421 · Cited by 8 · see citing works
App-based interventions to improve cancer outcomes rely on informational support from professionals: a systematic review
Villinger, K., Berli, C., & Scholz, U. (2024) · Health Psychology Review · doi:10.1080/17437199.2024.2349617 · Cited by 8 · see citing works
“Across participants, 60% were women with two studies focusing solely on women (McCarroll et al., 2015; Zhu et al., 2018) and one study solely on men (Sundberg et al., 2017).”
Influential
The impact of a continuous care model utilizing a smartphone application on quality of life and anxiety levels among gynecologic cancer patients: a randomized controlled trial
Doosti, P., Etemadifar, S., & Aliakbari, F. (2024) · BMC Nursing · doi:10.1186/s12912-024-02391-0 · Cited by 8 · see citing works
Application of positive behavior management in patients after breast cancer surgery
Hao, Y.-J., Sun, H., Li, H., Chen, B.-J., Chen, X., Ma, L., & Li, Y. (2020) · World Journal of Clinical Cases · doi:10.12998/wjcc.v8.i4.689 · Cited by 7 · see citing works
Quality of life support in advanced cancer—web and technological interventions: systematic review and narrative synthesis
Kane, K., Kennedy, F., Absolom, K. L., Harley, C., & Velikova, G. (2021) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2020-002820 · Cited by 7 · see citing works
Effectiveness of a mobile application for tracking symptoms and enhancing symptom management among breast cancer patients receiving chemotherapy in Bangkok, Thailand: a non-randomized controlled trial
Kaveenuntachai, D., Jaiboon, S., Sumdaengrit, B., Silaguntsuti, C., Vittayatigonnasak, A., & Sailamai, P. (2025) · Journal of Korean Academy of Nursing · doi:10.4040/jkan.25011 · Cited by 6 · see citing works
“3.1.9.4 (Heinrich-Heine-Universität Düsseldorf), with a significance level of .05, power of .80, and an effect size of .46 based on a previous study [22].”
Influential
Exploring the Self-Efficacy of Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Assessment Focusing on a Low-Income, Less-Educated Community of Quetta City, Pakistan
Saleem, F., Haider, S., Iqbal, Q., Raziq, A., Farooqui, M., & Bashaar, M. (2025) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s524502 · Cited by 6 · see citing works
The Effect of Education Performed Using Mobile Application on Supportive Care Needs and Quality of Life in Women with Breast Cancer: Randomized Controlled Trial
Balcı, H., & Faydalı, S. (2024) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2024.151684 · Cited by 7 · see citing works
The Effect of Self-efficacy–Enhancing Interventions on Quality of Life of Cancer Survivors
Yan, K., Lengacher, C. A., Dandamrongrak, C., Wang, H., Hanson, A. R. M., & Beckie, T. M. (2024) · Cancer Nursing · doi:10.1097/ncc.0000000000001372 · Cited by 5 · see citing works
The unmet needs of women with breast cancer: a qualitative research.
Foà, C., Guarnieri, M. C., Basciu, V., Naldi, S., Scaravella, M., & Scirpoli, A. (2022) · Acta bio-medica dell'Ateneo parmense/Acta biomedica · doi:10.23750/abm.v93is2.12956 · Cited by 5 · see citing works
Mapping the Evidence on the Impact of mHealth Interventions on Patient-Reported Outcomes in Patients With Breast Cancer: A Systematic Review
Frid, S. A., Amat-Fernández, C., Expósito, M. A. F., Muñoz-Mateu, M., Valachis, A., Sisó‐Almirall, A., & Grau, I. (2024) · JCO Clinical Cancer Informatics · doi:10.1200/cci.24.00014 · Cited by 8 · see citing works
“In addition, Rosen et al 43 31-34,40, 43, 44, The evaluation of the nonrandomized studies using the MINORS tool (Appendix Table A5) showcased scores ranging from 12 to 14 for three non-comparative studies, 39,41,42 whereas the three comparative studies received scores ranging from 18 to 20.”
Method
Development and feasibility of an mHealth intervention for psychoeducational support of Nigerian women diagnosed with breast cancer undergoing chemotherapy: A pilot randomized controlled trial
Akingbade, O., Hong, K. Y., Ayo, O. S., Alade, A. S., Lawal, M. A., Somoye, I. E., Adediran, V., Sado, O., & Chow, K. M. (2024) · PLoS ONE · doi:10.1371/journal.pone.0314365 · Cited by 5 · see citing works
A multi‐centre randomized controlled trial of mobile gynaecological cancer support program for patients with gynaecological cancer undergoing chemotherapy: Study protocol
Lin, H., Chan, S. W., Ye, M., Wang, Y., Liu, H., Li, M., Liu, S., & Zhu, J. (2021) · Journal of Advanced Nursing · doi:10.1111/jan.14809 · Cited by 5 · see citing works
Self-citation
Digital Interventions and Mental Health Outcomes in Patients With Cancer: Systematic Review and Meta-Analysis
Wu, Z., Luo, F., Wang, S., hu, X., & Chen, M. (2025) · JMIR Cancer · doi:10.2196/64754 · Cited by 4 · see citing works
“[19,25,26,40,44,45,51].”
Influential
Development and assessment of a self-management intervention for urinary incontinence among patients with prostate cancer: protocol for a randomized feasibility study
Chien, C., Liu, K., Wu, C., Chuang, C., Yu, K., Lin, P., Huang, X., & Pang, S. (2023) · BMC Urology · doi:10.1186/s12894-023-01367-7 · Cited by 4 · see citing works
“Based on the results of a previous study, the effect size f is 0.27 for the outcome variable of self-efficacy [65].”
ResultInfluential
Effects of a Phone-Based Support Program for Women With Breast Cancer Undergoing Chemotherapy: A Pilot Study
Chen, X., Chaimongkol, N., & Hengudomsub, P. (2024) · SAGE Open Nursing · doi:10.1177/23779608241231176 · Cited by 4 · see citing works
“The PI developed the PBSP intervention based on self-ef ﬁ cacy theory (Bandura, 1997) and a modi ﬁ cation of the Breast Cancer e-Support program (Zhu et al., 2018).”
BackgroundMethod
Effectiveness of ReCOVery APP to improve the quality of life of Long COVID patients: a 6-month follow-up randomized clinical trialPreprint
Samper-Pardo, M., Oliván‐Blázquez, B., León-Herrera, S., Sánchez-Arizcuren, R., Casado‐Vicente, V., & Sánchez‐Recio, R. (2023) · medRxiv · doi:10.1101/2023.08.30.23294831 · Cited by 4 · see citing works
The Effect of a Mobile Application for Gynecological Cancer Patients on Their Physical and Psychosocial Adaptation: A Randomized Controlled Trial
Vardar, O., & Serçekuş, P. (2025) · Psycho-Oncology · doi:10.1002/pon.70194 · Cited by 3 · see citing works
“While several studies using mobile applications and web‐based interventions have shown a decrease in symptom severity in cancer patients [11, 12], others have revealed either relief of certain symptoms [16, 21] or no effects on symptoms [31, 42].”
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BackgroundMethodInfluential
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Self-citation

A mobile application of breast cancer e-support program versus routine Care in the treatment of Chinese women with breast cancer undergoing chemotherapy: study protocol for a randomized controlled trial
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Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 1): Qualitative Study of Women’s Perceptions
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Self-citation
A mobile application of a breast cancer e-support program for Chinese women with breast cancer undergoing chemotherapy
(3964751), J. Z. (2018) · Figshare
Development of a mobile application of Breast Cancer e-Support program for women with breast cancer undergoing chemotherapy
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Authors: Zhu, J., Ebert, L., Liu, X., Wei, D., & Chan, S. W.-C.
Affiliations: Xiamen University (CN)
University of Newcastle Australia (AU)
Central South University (CN)
Corresponding author: Zhu, Jiemin
ORCID: Zhu, Jiemin
Ebert, Lyn
Liu, Xiangyu
Wei, Di
Chan, Sally Wai-Chi
Venue: JMIR mHealth and uHealth
Publisher: JMIR Publications Inc.
Published: 2018-04-30
Volume: 6
Issue: 4
Pages: e104
ISSN: 2291-5222 (ISSN-L)
DOI: 10.2196/mhealth.9438
PMC: PMC5952114
OpenAlex: W2800575252
Cited by: 124
References: 37
Citations by year: 2026: 7 · 2025: 27 · 2024: 17 · 2023: 18 · 2022: 17 · 2021: 17 · 2020: 13 · 2019: 7 · 2018: 1
FWCI: 3.57
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
Locations: JMIR mhealth and uhealth (publishedVersion, cc-by)
Europe PMC (PubMed Central) (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
Cross Connect (Southern Cross University) (submittedVersion, cc-by)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Figshare (submittedVersion, cc-by)
NOVA (University of Newcastle Australia) (submittedVersion, other-oa)
NOVA (University of Newcastle Australia) (submittedVersion, cc-by)
Funders: Hunter Cancer Research Alliance
University of Newcastle Australia
National Natural Science Foundation of China (71503219)
Topics: Health Sciences › Medicine › Oncology › Cancer survivorship and care
Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords: breast cancer, chemotherapy, mobile health apps, self-efficacy, social support, symptom distress, quality of life, anxiety, depression, supportive care needs, Chinese women, app usage, moderated mediation, social exchange theory, self-efficacy theory, online learning forums, online forums

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