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Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 2): Multicenter Randomized Controlled Trial
Open accessPublished version of a preprint
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 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]
In the citing paper
“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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Cites
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“These usage data could be helpful to explain why the BCS program achieves or fails in the desired outcomes [34].”
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ResultWhat Happens Now? Psychosocial Care for Cancer Survivors After Medical Treatment Completion
Stanton, A. L. (2012) · Journal of Clinical Oncology · doi:10.1200/jco.2011.39.7406 · Cited by 229 · cited 1×
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“Moreover, literature shows inconsistent findings regarding the effects of eHealth on anxiety and depression for cancer patients [32], which needs to be addressed in the future research.”
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“Consistent with prior research [14,25], we demonstrated that the self-efficacy theory and social exchange theory are usable in guiding the development of an app-based program to enhance self-efficacy.”
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“A dropout rate ranging from 10% to 20% was reported in previous studies involving an app-based study [9,26].”
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“Access to a wide variety of knowledge related to breast cancer and chemotherapy may not relieve the women’s anxiety and depression [31].”
BackgroundZhu, 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 · cited 2×
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MethodSelf-citationZhu, J., Ebert, L. M., & Chan, S. W. (2017) · PubMed · doi:10.1188/17.onf.e42-e54 · Cited by 27 · cited 1×
“However, there remains a paucity of randomized controlled trials (RCTs) to evaluate the effectiveness of app-based programs targeting women with breast cancer undergoing chemotherapy [7].”
BackgroundSelf-citationFatigue self‐management: a survey of Chinese cancer patients undergoing chemotherapy
Lou, Y., Yates, P. M., McCarthy, A. L., & Wang, H. (2013) · Journal of Clinical Nursing · doi:10.1111/jocn.12174 · Cited by 22 · cited 1×
“Their current employment status and family income of the participants in this study were also similar to other studies on patients with breast cancer or other cancers during chemotherapy [25,36].”
Result
Research works printed but not linked: 1
- Blau, P, 1964, Exchange in power in social life
Cited by
Sorted by citations
Research-Tested Mobile Apps for Breast Cancer Care: Systematic Review
Jongerius, C., Russo, S., Mazzocco, K., & Pravettoni, G. (2019) · JMIR mHealth and uHealth · doi:10.2196/10930 · Cited by 146
“Zhu et al explored the effectiveness of Breast Cancer e-Support , an app-based program, to address women’s self-efficacy, social support, symptom distress, quality of life, anxiety, and depression [35,36].”
InfluentialElectronic Health Interventions for Patients With Breast Cancer: Systematic Review and Meta-Analyses
Singleton, A. C., Raeside, R., Hyun, K. K., Partridge, S. R., Tanna, G. L. D., Hafiz, N., Tu, Q., Tat-Ko, J., Sum, S. C. M., Sherman, K. A., et al. (2022) · Journal of Clinical Oncology · doi:10.1200/jco.21.01171 · Cited by 141
“1%) evaluated participants’ intervention engagement (logins, completed modules, and usage tracking).(34-36,38,39,41-50,52,53,56-59,61,62,64-67,69,72) Participants’ engagement was broad, completing 0%-100% modules.”
BackgroundInfluentialGhanbari, E., Yektatalab, S., & Mehrabi, M. (2021) · JMIR mHealth and uHealth · doi:10.2196/19262 · Cited by 104
“A simple app-based e-support program was also found to improve quality of life, self-efficacy, and symptom interference in women with breast cancer during their chemotherapy [59].”
BackgroundBunevičienė, I., Mekary, R. A., Smith, T. R., Onnela, J.-P. “., & Bunevičius, A. (2020) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2020.103123 · Cited by 117
“We identified 17 RCTs (Willems et al., 2017; Mendoza et al., 2017; Graetz et al., 2018; Ferrante et al., 2018; Admiraal et al., 2017; Compen et al., 2018; Frensham et al., 2018; Galiano-Castillo et al., 2016; Greer et al., 2019; Ham et al., 2019; Ji et al., 2019; Kubo et al., 2019; Rosen et al., 2018; Uhm et al., 2017…”
InfluentialChronic Disease Management, Self-Efficacy and Quality of Life
Chan, S. W. (2021) · Journal of Nursing Research · doi:10.1097/jnr.0000000000000422 · Cited by 110
“Patients with high self-efficacy in coping with their chronic diseases reflect a perceived ability to manage challenges related to their diseases and a sense of control over their lives (Zhu et al., 2018).”
BackgroundSelf-citation
Metadata
- 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
- Venue
- JMIR mHealth and uHealth
- Publisher
- JMIR Publications Inc.
- Published
- 2018-04-30
- Volume
- 6
- Issue
- 4
- Pages
- e104
- ISSN
- 2291-5222 (ISSN-L)
- 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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