Review article
Exploring the use of Mobile applications by cancer patients undergoing chemotherapy: A scoping review

https://doi.org/10.1016/j.ijmedinf.2020.104293Get rights and content

Highlights

  • Explores the current state of scientific knowledge related to the use of mobile applications, as support for cancer patients undergoing chemotherapy treatments.

  • Shows the progress on mobile applications technology to support the process of monitoring adherence to oral therapies, controlling toxicities or providing self-care guidelines to the user undergoing chemotherapy treatment.

  • Identifies the specific purposes of the applications that have been developed and what they are programmed to offer.

Abstract

Propose

Advancements in mobile technology, primarily through the use of applications, may support the process of monitoring adherence to oral therapies, controlling toxicities, or providing self-care guidelines to patients undergoing chemotherapy treatment. This study aims to assemble the available knowledge regarding the use of mobile applications by cancer patients undergoing chemotherapy treatment.

Methods

A literature review based on the Joanna Briggs Institute model(s) for Scoping Review was conducted. All articles published until 30 May 2019, were identified in the MEDLINE®, CINAHL®, and PsycINFO® electronic databases using the related Boolean logical operators and key terms. Extracted data included research aims, methodological design, application name, the functionalities of the applications, and major results.

Results

A total of 26 articles were included in this study. The search identified 16 different mobile applications, some of which were addressed in various publications, demonstrating different characteristics in design, use, and development.

Conclusion

The use of mobile applications can be seen as an important and effective way to monitor adherence and support in the self-management of complications associated with chemotherapy treatments. Notwithstanding, these applications should be tested outside the academic environment, outreaching this group of people to effectively investigate its applicability, allowing the assessment of the impact of this “new” technological intervention process.

Introduction

Cancer is currently a major societal challenge across all age groups and populations. Several therapeutic strategies are already available for effective disease control, many with expected cure rates. Chemotherapy is a therapeutic approach, often involving aggressive treatments with significant side effects [1]. This therapeutic intervention is common to most cases at some point during the disease course, causing numerous side effects [2], with a negative impact on patients and their caregivers [3]. Most frequently, the assessment and management of these side effects or complications are performed by the patient (or significant person) at home.

Although the assessment of symptoms by practitioners is a key factor in cancer treatment, regular and systematic approaches to symptom assessment are lacking [4,5]. Currently, the identification of chemotherapy-related symptoms is mainly based on a patient's retrospective report, which, in addition to being prone to recall and inaccuracy errors [6], can be of limited benefit owing to the delays in reporting clinically significant and potentially threatening symptoms [7] as they must attend a medical or nursing appointment. Ineffective symptom management results in disruptions to health-related quality of life (HR-QoL) and increases supportive care needs [8].

On the one hand, integrating patient-reported outcomes (PROs) into clinical practice is an increasingly promising strategy for improving symptoms, communication, and clinical outcomes [9,10]. Recent evidence shows that using an internet-based system to evaluate PROs, combined with email alerts for nurses, has produced better HR-QoL results, reduced visits to emergency services, reduced hospitalizations due to complications, and increased overall survival rates compared to usual care [10,11].

On the other hand, the widespread use of oral chemotherapy is changing the treatment paradigm in oncology. Self-administration of oral chemotherapy poses several challenges for patients and healthcare professionals for ensuring adherence to therapy as well as proper control of associated toxicities [12]. Non-adherence may reduce treatment effectiveness and lead to significant clinical and economic implications related to increased risk of hospitalization and the costs associated with treating complications from non-adherence [13], and may ultimately be fatal [14]. Adherence rates to oral antineoplastic agents may be as low as 46 % [15]. Nevertheless, most healthcare facilities do not use standardized patient compliance monitoring procedures [16].

The major challenge for these patients with increased responsibility in the management of the therapeutic regimen is maintaining a high level of compliance [15]. Thus, programs that incorporate interventions or strategies to improve adherence, both in the context of cancer and in all chronic diseases, can have a positive clinical and economic impact [17].

Early innovation at this level was centered on computer-based approaches to symptom monitoring, notably through a variety of platforms that efficiently captured patient-reported symptoms [18]. The viability and patient acceptability of such approaches have been widely studied, and overall were well-received [18,19]. The use of mobile phones/smartphones with running applications (apps) can help healthcare professionals monitor patients with chronic conditions at home. Moreover, this approach has proven acceptable reliability and validity [20] for the remote monitoring of symptoms [21]. In addition, the mobile phone market is continually evolving. The first digital mobile phone dates back to the early 1990s, and, since then, mobile technology has been refined, thanks to the development of new features and improved networks.

In line with this global digital reality, the concept of mHealth has emerged, described by the Global Observatory for eHealth of the World Health Organization (WHO) as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.” (pg. 6) [22]. The potential of mobile health solutions lies in their ability to enable chronic disease management and foster well-being [23,24]. By tracking the individual’s health and lifestyle data and providing actionable feedback, these tools stimulate the self-management process.

Compared with web-based interventions, apps offer immediate access to information and social support, without the need for a computer [25]. Over the past decade, mHealth has been steadily expanding with app technology aiming to meet the need for information and knowledge related to people’s health, without time and space constraints. In addition to reducing the barriers of time and space, it also enables the monetization of new forms of communication [26]. Such features add strategic and innovative value for upcoming information-era societies.

Therefore, the use of apps is firmly increasing as an efficient way to improve adherence to medical therapy [27]. It can also be a viable resource for providing a diverse range of educational and behavioral interventions while allowing health professionals to monitor behaviors and toxicities [28].

Thus, the main objective of this literature review is to identify and categorize existing research on the use of mobile apps by cancer patients during chemotherapy treatment. Furthermore, as secondary objectives, we aim to identify which apps have been developed, as well as their specific purposes and features.

Section snippets

Methods

A scoping review of scientific literature was performed, with the main objective of mapping scientific knowledge, based on the guidelines of the Joanna Briggs Institute for this type of study [29]. The PRISMA-model [30] was used to organize the information, and the recommendations described in PRISMA-ScR were followed [31].

Selection of studies

A total of 493 articles were extracted from the initial search carried out in the different databases. After removing the duplicates, 419 articles were selected for the first analysis by title and abstract. The full-text analysis included 46 articles, of which 26 were considered for this review (Fig. 1).

Characterization of the studies

Table 1 presents the summary information of the final studies analyzed, including authors, type of study, population, application name, language used, platform on which it is made available, and

Discussion

This analysis presents the ongoing research for a considerable number of apps and the respective research focusing on their use among cancer patients undergoing chemotherapy treatment.

Research on mHealth has been actively conducted since 2007/2008, with the introduction of new generation smartphones, such as the iPhone and similar devices, into the market [61]. However, the first studies appeared only in 2014 [38,47,54] and examined the use of this equipment to monitor patients during

Conclusion

The 16 different apps identified in the present study demonstrated significant technological advancements in surveillance of oncology treatments. The development of mobile apps during chemotherapy treatment has proven to be essential to support the process of monitoring adherence to oral therapies, controlling toxicities, or providing self-care guidelines to patients.

However, more research is needed to validate these resources, ensuring effectiveness and safety for users. The evaluation of the

Authors’ contributions

The search strategy was developed by BM and CF and approved by CS and JG. BM and CF performed the data extraction under the supervision of CS and JG.

Summary Table

What was already known about the topic:

  • Over the past ten years, the number of mHealth applications (apps) has rapidly increased.

  • No published studies have presented the development of mHealth apps in this area.

  • Research methodologies that have been used to develop mHealth solutions are unknown.

What this study added to our knowledge:

  • Information on evaluated content and the application development process as currently available in the scientific literature.

  • A list of the key application features

Declaration of Competing Interest

The authors declare that they have no conflicts of interest in the research.

Acknowledgments

The authors wish to thank Ingrid de Ruiter, MBChB, PhD, for English language editing and support.

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