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Mobile phone health apps are increasingly gaining attention in oncological care as potential tools for supporting cancer patients. Although the number of publications and health apps focusing on cancer is increasing, there are still few specifically designed for the most prevalent cancers diagnosed: breast and prostate cancers. There is a need to review the effect of these apps on breast and prostate cancer patients’ quality of life (QoL) and well-being.
The purposes of this study were to review the scientific literature on mobile phone apps targeting breast or prostate cancer patients and involving QoL and well-being (anxiety and depression symptoms) and analyze the clinical and technological characteristics, strengths, and weaknesses of these apps, as well as patients’ user experience with them.
We conducted a systematic review of peer-reviewed literature from The Cochrane Library, Excerpta Medica Database, PsycINFO, PubMed, Scopus, and MEDLINE to identify studies involving apps focused on breast and/or prostate cancer patients and QoL and/or well-being published between January 1, 2000, and July 12, 2017. Only trial studies which met the inclusion criteria were selected. The systematic review was completed with a critical analysis of the apps previously identified in the health literature research that were available from the official app stores.
The systematic review of the literature yielded 3862 articles. After removal of duplicates, 3229 remained and were evaluated on the basis of title and abstract. Of these, 3211 were discarded as not meeting the inclusion criteria, and 18 records were selected for full text screening. Finally, 5 citations were included in this review, with a total of 644 patients, mean age 52.16 years. Four studies targeted breast cancer patients and 1 focused on prostate cancer patients. Four studies referred to apps that assessed QoL. Only 1 among the 5 analyzed apps was available from the official app store. In 3 studies, an app-related intervention was carried out, and 2 of them reported an improvement on QoL. The lengths of the app-related interventions varied from 4 to 12 weeks. Because 2 of the studies only tracked use of the app, no effect on QoL or well-being was found.
Despite the existence of hundreds of studies involving cancer-focused mobile phone apps, there is a lack of rigorous trials regarding the QoL and/or well-being assessment in breast and/or prostate cancer patients. A strong and collective effort should be made by all health care providers to determine those cancer-focused apps that effectively represent useful, accurate, and reliable tools for cancer patients’ disease management.
PROSPERO CRD42017073069; https://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID= CRD42017073069 (Archived by WebCite at http://www.webcitation.org/6v38Clb9T)
The number of new cancer cases diagnosed every year worldwide is rapidly rising from 14.1 million in 2012 to well over 20 million predicted by 2030 [
Mobile phone health apps have the potential to revolutionize psychological science because they can collect behavioral data [
Apps are widely used by professionals and patients, and attention to them in health care environments is increasing daily [
In several systematic reviews on mobile phone health apps, authors urge different strategies that will result in higher quality evidence for app effectiveness and contents [
Attending to patients’ point of view about using mHealth apps, authors have commonly used survey studies to determine the user experience. In general, cancer patients positively value the use of Internet-based technologies for health care management and feel comfortable using them [
Although mHealth apps could be useful tools for cancer patients [
We developed a systematic search strategy to detect all relevant studies involving the use of mobile phone apps for QoL and/or well-being (anxiety and depression symptoms) in breast and/or prostate cancer on July 12, 2017. Once we determined these studies, we searched the identified apps on the online market to describe them. The systematic research protocol is registered at PROSPERO [CRD42017073069].
Articles were considered potentially relevant if they were trials or peer-reviewed studies published between January 1, 2000, and July 12, 2017, including a smartphone app focused on QoL and/or well-being (anxiety and depression symptoms) used by breast and/or prostate cancer patients.
We considered a smartphone “a mobile phone with Internet connectivity and the ability to download and run third-party software apps available from a commercial marketplace” [
The search strategy followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines [
Two of the authors of this study (ER and EG) independently reviewed the full text of the articles meeting the eligibility criteria. The interrater agreement (kappa value) was calculated with SPSS version 22 (IBM Corp). The following data were extracted from the selected papers: (1) general patient and study characteristics (year of publication, country of study, language, author affiliations, number of participants, mean age, and cancer type targeted), (2) clinical characteristics (QoL assessment, other variables measured, functionalities, type of validated questionnaire involved and timing for assessment, treatment offered, main clinical results, quality of the study, randomized controlled trial [RCT] design, social media inclusion, theoretical framework based, and quality of the journal), (3) clinical strengths and weaknesses, and (4) patients’ user experience (satisfaction level and comments regarding the apps used). Disagreements were rare and were easily resolved by consensus.
Two of the authors (ORR and ED) independently reviewed the full text of selected articles and extracted the following information: (1) technological characteristics (app name, platform, availability in markets, price, number of downloads, rating, patients targeted, and main features), (2) technological strengths and weaknesses, and (3) patients’ user experience (ratings, health certification obtained, and number of user comments). Disagreements were resolved by a third reviewer (FG). The quality of the included studies was assessed in terms of their design. Nonrandomized, observational, descriptive, and qualitative studies were considered low to medium quality. Quasi-randomized and interventional studies and studies with strongest design were considered of moderate to high quality.
In addition to the systematic review, 3 of the authors (ORR, ED, and CSB) downloaded the apps identified in the studies from the online store. They collected the following information: (1) technological characteristics, (2) technological strengths and weaknesses, and (3) patients’ user experience (satisfaction level and comments regarding the app used). An English language restriction was applied for the mobile phone apps downloaded.
The search of the electronic databases retrieved 3862 citations. After removal of duplicates, 3229 remained and were evaluated on the basis of title and abstract. Of these, 3211 were discarded because they clearly did not meet the inclusion criteria. Based on titles and abstracts, 18 records were selected for full text screening; 13 out of these 18 [
The 5 studies included a total of 644 patients, mean age 52.16 years (sample sizes and mean ages listed in
Regarding the clinical approach, 4 of the 5 included studies referred to apps that assessed QoL [
All studies allowed patients to collect patient-reported outcome measures [
Systematic review of the literature flowchart.
General characteristics of included studies (n=5).
Study | Publication year | Country/language | Participant number | Mean age | Cancer type |
Kim et al [ |
2016 | Korea/Korean | 78 | 44.35 | Breast |
McCarroll et al [ |
2015 | United States/English | 50 | 58.4 | Breast |
Min et al [ |
2014 | Korea/Korean | 30 | 45 | Breast |
Sundberg et al [ |
2017 | Sweden/Swedish | 130 | 69 | Prostate |
Uhm et al [ |
2017 | Korea/Korean | 356 | 50.3 | Breast |
The included studies measured QoL through different questionnaires such as the Functional Assessment of Cancer Therapy–General (FACT-G) [
Concerning the main clinical results, the adherence to the self-reporting measures was associated with higher accuracy of depression screening [
With regard to the quality of the studies, 3 were considered of low-to-medium level [
The study design involved 2 prospective, nonrandomized multicenter controlled trials [
Concerning the publication journals, 4 out of the 5 included studies [
With regard to technological characteristics, all of the 5 studies included provided the names of the mobile phone apps evaluated [
App functionalities included the following: (1) customization and personalization features (create a menu plan and calorie tracker [
Clinical characteristics of included studies (n=5).
QoLa |
|||||
PROb: daily mental health ratings over a 48-week period | PHQ-9c via app biweekly | ||||
FACT-Gd, WELe at baseline and at 4-week follow-up | |||||
BDIf, EQ-5D-3Lg via app on a daily basis for 90 days | |||||
PRO: daily, real-time assessment of symptoms and concerns during radiotherapy + interventionh | EORTC QLQ-C30i, EORTC QLQ-PR25j via app daily at any time during radiotherapy and 3 weeks after completion | ||||
PRO + interventionh | EORTC QLQ-C30, EORTC QLQ-BR23k at baseline and 12 weeks |
aQoL: quality of life.
bPRO: patient-reported outcome measures.
cPHQ-9: Patient Health Questionnaire–9.
dFACT-G: Functional Assessment of Cancer Therapy–General.
eWEL: Weight Efficacy Lifestyle questionnaire.
fBDI: Beck Depression Inventory.
gEQ-5D-3L: EuroQol 5-Dimension 3-Level survey.
hSignificant improvement in quality of life.
iEORTC QLQ-C30: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Core.
jEORTC QLQ-PR25: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Prostate.
kEORTC QLQ-BR23: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Breast Cancer.
Technological characteristics of included studies (n=5).
Study | App name | Platform | Available in markets | Price | Downloads | Ratings | Patients Targeted |
Kim et al [ |
Pit-a-Pat | Android/iOS | No | Unknown | Unknown | Unknown | Yes |
McCarroll et al [ |
LoseIt! | Android/iOS | Yes | free/premium | Android: 5,000,000-10,000,000 | Android: 4.4; iOS: 4.0 | No |
Min et al [ |
Pit-a-Pat | Android/iOS | No | Unknown | Unknown | Unknown | Yes |
Sundberg et al [ |
Interaktor | Unknown | No | Unknown | Unknown | Unknown | Yes |
Uhm et al [ |
Smart After Care | iOS | No | Unknown | Unknown | Unknown | Yes |
Regarding the studies’ strengths, 2 of them involved the same app called Pit-a-Pat [
LoseIt! [
Interaktor [
Smart After Care [
Among the main weaknesses could be cited the small samples of the studies [
Only 1 study [
Patient satisfaction levels provided by the health literature review and the online store search (n=5).
Ratings (OSRa) | ||||
Kim et al [ |
Unknown | Unknown | Unknown | Unknown |
Helix’s CLIAb certified and CAPc accredited lab | ||||
Min et al [ |
Unknown | Unknown | Unknown | Unknown |
Sundberg et al [ |
Unknown | Unknown | Unknown | Unknown |
Uhm et al [ |
Satisfied with use | Unknown | Unknown | Unknown |
aOSR: Online store research.
bCLIA: Certified Laboratory Improvement Amendments.
cCAP: College of American Pathologists.
The use of mobile phone apps for health purposes continues to increase [
The most recent reviews involving focused cancer apps started the searching methodology by looking for apps on the online stores, followed by searching bibliographic databases of health literature [
Despite the increase in the number of health care apps available [
Related research on health apps for cancer patients was identified but not included in the review due to the following reasons (see
We selected the QoL measure considering it has a wide range of variables involving other psychological measures (eg, cognitive, emotional, and social abilities) and not only as performance status and daily functional activities [
We have defined well-being as existing levels of general anxiety and depression symptoms and not only as perceived stress level [
In our review, only 1 of the selected papers provided information regarding patient satisfaction level [
Most of the apps referred to in the scientific literature targeted breast cancer, as in previous reviews [
With regard to the technological characteristics, it should be noted that the 3 apps specifically designed for cancer patients [
Regarding the studies’ strengths, the use of related-treatment mobile phone apps has resulted in a significant improvement in cancer patients’ QoL [
Participants using their own mobile phones have mentioned this as better than being provided with an additional device [
Among the main weaknesses could be (1) no cancer-focused apps are being used in studies involving cancer patients [
It is important to highlight the relevance of using cancer-focused apps in oncological settings, as cancer patients could be considered vulnerable recipients [
Although some encouraging results have been reported using apps in cancer patients [
Cancer patients and survivors could have cognitive deterioration due to treatments. Therefore, usability and accessibility are relevant aspects to be considered in the development process of these apps, especially when they are intended for older people. Apps not designed for cancer patients and survivors could entail difficult challenges for them, resulting in reduced adoption and engagement rates. Equally, the large variety of apps available makes it difficult to establish which of them are the most adequate for breast and prostate cancer patients and what is the best way to use them. Also, patients could become overwhelmed due to the huge number of cancer apps available [
In line with previous research [
Regarding patients’ satisfaction, it is noteworthy that only 1 app of the 3 reviewed reported a quality certification and showed user comments regarding its use. Moreover, it is relevant that this app was not cancer-focused and was the only one available for download at the online store. Only user-friendly and quality-certified apps should be provided to cancer patients. Thus, these health apps must be available for download at market stores once they are certified as useful tools for cancer patients. It would probably be helpful as well that these apps provide new users with comments about other patient’s experiences, in order to obtain a more powerful overview of the main features included in the app.
More evidence on the patient satisfaction level using health apps for QoL and/or well-being assessment in oncological settings is needed. In our review, only 1 study [
People affected by cancer are usually open to strategies that could have a positive influence on their disease [
Our study had certain limitations. Our selection criteria intentionally excluded apps that were not specifically focused on breast or prostate cancer patients. We considered only the assessment of 2 main psychological variables in psycho-oncological care: QoL and well-being (anxiety and depression symptoms). Additional studies could consider other psychological measures such as fatigue or the secondary symptoms produced by the cancer treatments. Although our data search represents a wide range of peer-reviewed journals, we might have missed studies that were not identified with our search terms or that were not published.
Despite the existence of hundreds of studies involving mobile phone health apps used by cancer patients, there is a lack of rigorous trials regarding QoL and/or well-being assessment in breast and/or prostate cancer patients. More evidence-based apps, which could be tested in future RCT protocols, are still needed. However, promising results are expected to be available from some RCTs that are still running. A strong and collective effort should be made by all health care providers to determine those cancer-focused apps that provide useful and reliable tools for cancer patients’ disease management.
Reasons for exclusion of studies.
Overview of the systematic review.
Beck Depression Inventory
College of American Pathologists
Clinical Laboratory Improvement Amendments
European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Core
European Organization for Research and Treatment of Cancer Quality of Life Questionnaire complementary module for breast cancer patients
European Organization for Research and Treatment of Cancer Quality of Life Questionnaire complementary module for prostate cancer patients
EuroQol 5-Dimension questionnaire
Functional Assessment of Cancer Therapy–General
health-related quality of life
mobile health
Patient Health Questionnaire–9
Preferred Reporting Items for Systematic Reviews and Meta-Analyses
patient-reported outcome measures
Perceived Stress Scale
quality of life
randomized controlled trial
online store research
Weight Efficacy Lifestyle questionnaire
This study received funding from the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement number 722012 (Cancer: Activating Technology for Connected Health). The authors would like to sincerely thank Dr Luis Fernandez-Luque for his guidance and support.
None declared.