Cancer research has grown exponentially in recent years. It is currently estimated that 40% of the chemotherapeutic drugs are oral antineoplastic agents (OAAs), which have changed the model for administration of chemotherapy. The treatment for cancer has changed from controlled administration in the day hospital to administration at home without the supervision of a health care professional, thus requiring greater autonomy on the part of the patient [1,2]. However, these treatments are subject to drug-related problems (DRPs), such as adherence, interactions with the usual medication, and side effects [3,4]. The Institute for Safe Medication Practices classifies OAAs as high-risk medications [5]. According to Walsh et al [6], up to 20% of the patients treated with OAAs experience severe side effects.

In this sense, information and communication technologies, specifically the area of mobile health, can provide patients with greater autonomy and facilitate communication with health care professionals. Similarly, mobile health can enable health care professionals to improve monitoring and patient care [7]. According to a study in more than 7800 patients, 83% considered the use of technology to be an essential or very important component of their health care. The majority valued the use of virtual care very positively in various scenarios such as receiving reminders for health promotion, taking medication, changing an appointment, and even follow-up on discharge and contacting their health care professional [8].

Since mobile apps are accessible by a vast majority of the population and since these apps facilitate the possibility of remote monitoring, they offer patients with cancer the opportunity to participate in the management of their disease and endow greater responsibility for the control of their health, thus favoring empowerment and improving the safety and quality of care [7].

According to the report “Global Oncology Trends 2018,” it is estimated that there are more than 2500 mobile health cancer-related apps and that their use in clinical practice is increasing, especially in the case of health care apps [9]. Nevertheless, evidence for the benefits that these apps can bring to patients is limited. In fact, 2015 was the first year that this advancement was addressed in the literature, with 5 studies analyzing the effectiveness of apps in oncology. All 5 studies reported positive results, although 2 showed efficacy similar to that in the standard of care. In a review of 17 studies on the use of apps and websites for patients with cancer, it was observed that most were focused exclusively on the design, feasibility, and acceptance of the app. There is hardly any evidence on the effect of apps intended for the patient on the improvement of their health outcomes [10].

Therefore, the objective of this study was to analyze the effect of an app for the pharmacotherapeutic follow-up of patients with oncohematological malignancies undergoing treatment with OAAs on their health outcomes. The secondary objective was to analyze the role of the app in communication with health care professionals and patient satisfaction with the app.

Principal Findings and Comparison With Previous Studies

To our knowledge, this is the first study to show that an app for the pharmacotherapeutic follow-up of patients with cancer treated with OAAs has a positive impact on their safety and adherence to treatment as well as on health-related quality of life. e-OncoSalud is a new app that includes a unique decision-making algorithm. Depending on the type and severity of the side effects registered by the patient, the app provides personalized recommendations instantly.

Although OAAs are not subject to the specific problems of intravenous chemotherapy, they are not without side effects [3,13]. In our study, the most common side effects reported by patients in both groups were characteristic of OAAs (asthenia, diarrhea, skin disorders, nausea, and vomiting) [3]. However, by having the decision-making algorithm, the patients in the intervention group were able to manage these symptoms from home. In a 3-module app [14] aimed at patients with nasopharyngeal carcinoma receiving chemoradiotherapy, one of the recommendations decreased the frequency of the complications associated with treatment. The incidence of mucositis, xerostomia, difficulty opening the mouth, and nasal congestion was lower in the patients who used the app (67 patients) than in those who did not (65 patients) [14]. In a clinical trial conducted in 76 patients with breast cancer [15], the authors analyzed the impact of the ILOVEBREAST app in reducing side effects, improving psychological status, and improving adherence to treatment. The patients were randomized in a 1:1 ratio to follow-up through the app (intervention group) or traditional follow-up (control group). Consistent with our findings, the results showed that the use of the app was associated with better quality of life, greater adherence, and fewer side effects such as nausea, fatigue, hand-foot syndrome, and hair loss. Although the differences were not significant in most cases, the incidence of grade 3 fatigue was significantly lower in patients who used the app (1 vs 13; P=.02) [15].

According to a study conducted at the Dana-Farber Cancer Institute, patients undergoing treatment with OAAs are more likely to be admitted to hospital with side effects. However, patients who were closely followed by their health care professional were significantly less likely to be admitted in the hospital [16]. Thus, information and communication technologies are demonstrating an improvement in the management of various conditions, with results that show a reduction in complications and hospital admissions. For example, a study that analyzed the use of text messages in patients with diabetes found a significant decrease in HbA_1c levels, improved medication adherence, and decreased emergency department visits [17]. Another study evaluated the effect of home telemonitoring in patients with heart failure and demonstrated a significant improvement in health outcomes [18]. However, we found no studies showing that apps for patients with cancer reduce their emergency visits or hospital admissions. Through e-OncoSalud, patients’ consumption of resources could be reduced from 49% to 36% (unscheduled consultations, emergency visits, or hospital admissions), although there was no statistically significant difference between the control and the intervention groups.

Side effects can also affect the quality of life of patients. According to Rincon et al [19], real-time monitoring and symptom management significantly improved emotional status, insomnia, and urinary tract symptoms. In another study that analyzed an app for the follow-up of patients with lung cancer, registration and follow-up of symptoms and subsequent management by the oncologist improved the quality of life [20]. According to the authors, this improvement was due to the early detection of side effects, complications, and signs or symptoms of progression [20]. In our study, follow-up based on the use of the e-OncoSalud app improved the health-related quality of life more than the traditional follow-up.

While patients with cancer face many challenges, adherence to OAAs is crucial if they are to maximize treatment outcomes and avoid complications [21]. In the follow-up based on e-OncoSalud, adherence at 6 months was 97.6% (SD 7.9), which is significantly higher than that of patients who did not receive home follow-up through the app (92.9% [SD 10.0]). These results agree with those reported in the literature, where the app is positioned as another strategy to improve adherence to treatment [22].

Regarding patient-pharmacist communication, 60% of the patients used the messaging module to communicate with the pharmacist. This percentage is similar to that reported with the WebChoice app [23], in which 61% of the patients used the messaging module to contact their nurse. However, we were unable to find studies that analyze the type of messages sent through an app between patients and health care professionals. This is not surprising, given that few electronic systems for patients with cancer incorporate messaging modules. A recently published review showed that only 6 (15%) of 40 electronic systems incorporated this modality [10]. Although several studies have shown that patients highly value this function, its complexity and maintenance limit its usability [10,24-26].

Finally, our results revealed a high degree of satisfaction with most of the aspects assessed. Those aspects that were the best rated were the ability to communicate with the pharmacist from anywhere, having the treatment registered with the notification system, the immediacy of the response by the pharmacist, and the ease of use. In addition, 100% of the patients agreed that they would recommend the app. These data are similar to those reported in studies that analyzed the app satisfaction of patients with cancer [15,25]. In order to assess the satisfaction of the ILOVEBREAST app, Kim et al [15] conducted a survey consisting of 8 questions that covered the ease of use and help with taking medication. Patients were also asked if they would recommend the app to others. The functions most highly valued by the patients were the ease of obtaining information and managing side effects. However, unlike our app, ease of use was one of the least valued aspects, possibly because it is an app based on an avatar type game. In their evaluation of the iCancerHealth app, Berry et al [25] observed that the aspects best valued by patients were ease of communication with their health care professional and the recording and monitoring of side effects.