%0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e64747 %T An App-Based Intervention With Behavioral Support to Promote Brisk Walking in People Diagnosed With Breast, Prostate, or Colorectal Cancer (APPROACH): Process Evaluation Study %A Kennedy,Fiona %A Smith,Susan %A Beeken,Rebecca J %A Buck,Caroline %A Williams,Sarah %A Martin,Charlene %A Lally,Phillippa %A Fisher,Abi %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E7HB, United Kingdom, 44 2076791722, [email protected] %K cancer %K physical activity %K process evaluation %K randomized controlled trial %K intervention %K app %K habit %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Cancer %G English %X Background: The APPROACH pilot study explored the feasibility and acceptability of an app (NHS Active 10) with brief, habit-based, behavioral support calls and print materials intended to increase brisk walking in people diagnosed with cancer. Objective: Following UK Medical Research Council guidelines, this study assessed the implementation of the intervention, examined the mechanisms of impact, and identified contextual factors influencing engagement. Methods: Adults (aged ≥18 y) with breast, prostate, or colorectal cancer who reported not meeting the UK guidelines for moderate-to-vigorous physical activity (≥150 min/wk) were recruited from a single hospital site in Yorkshire, United Kingdom. They were randomly assigned to the intervention or control (usual care) arm and assessed via quantitative surveys at baseline (time point 0 [T0]) and 3-month follow-up (time point 1 [T1]) and qualitative exit interviews (36/44, 82%) at T1. The process evaluation included intervention participants only (n=44). Implementation was assessed using data from the T1 questionnaire exploring the use of the intervention components. The perceived usefulness of the app, leaflet, and behavioral support call was rated from 0 to 5. Behavioral support calls were recorded, and the fidelity of delivery of 25 planned behavior change techniques was rated from 0 to 5 using an adapted Dreyfus scale. Mechanisms of impact were identified by examining T0 and T1 scores on the Self-Reported Behavioural Automaticity Index and feedback on the leaflet, app, call, and planner in the T1 questionnaire and qualitative interviews. Contextual factors influencing engagement were identified through qualitative interviews. Results: The implementation of the intervention was successful: 98% (43/44) of the participants received a behavioral support call, 78% (32/41) reported reading the leaflet, 95% (39/41) reported downloading the app, and 83% (34/41) reported using the planners. The mean perceived usefulness of the app was 4.3 (SD 0.8) in participants still using the app at T1 (n=33). Participants rated the leaflet (mean 3.9, SD 0.6) and the behavioral support call (mean 4.1, SD 1) as useful. The intended behavior change techniques in the behavioral support calls were proficiently delivered (overall mean 4.2, SD 1.2). Mechanisms of impact included habit formation, behavioral monitoring, and support and reassurance from the intervention facilitator. Contextual factors impacting engagement included barriers, such as the impact of cancer and its treatment, and facilitators, such as social support. Conclusions: The APPROACH intervention was successfully implemented and shows promise for increasing brisk walking, potentially through promoting habit formation and enabling self-monitoring. Contextual factors will be important to consider when interpreting outcomes in the larger APPROACH randomized controlled trial. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-022-01028-w %M 39928926 %R 10.2196/64747 %U https://cancer.jmir.org/2025/1/e64747 %U https://doi.org/10.2196/64747 %U http://www.ncbi.nlm.nih.gov/pubmed/39928926 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65974 %T Impact of Online Interactive Decision Tools on Women’s Decision-Making Regarding Breast Cancer Screening: Systematic Review and Meta-Analysis %A Villain,Patricia %A Downham,Laura %A Le Bonniec,Alice %A Bauquier,Charlotte %A Mandrik,Olena %A Nadarzynski,Tom %A Donelle,Lorie %A Murillo,Raúl %A Tolma,Eleni L %A Johnson,Sonali %A Soler-Michel,Patricia %A Smith,Robert %+ International Agency for Research on Cancer, World Health Organization, 25 Avenue Tony Garnier CS 90627, Lyon, 69366, France, 33 4 72 73 84 40, [email protected] %K breast cancer screening %K decision-making %K online interactive %K decision aid %K average risk %K shared decision-making %K screening participation %K cognitive determinants %K women %D 2025 %7 29.1.2025 %9 Review %J J Med Internet Res %G English %X Background: The online nature of decision aids (DAs) and related e-tools supporting women’s decision-making regarding breast cancer screening (BCS) through mammography may facilitate broader access, making them a valuable addition to BCS programs. Objective: This systematic review and meta-analysis aims to evaluate the scientific evidence on the impacts of these e-tools and to provide a comprehensive assessment of the factors associated with their increased utility and efficacy. Methods: We followed the 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted a search of MEDLINE, PsycINFO, Embase, CINAHL, and Web of Science databases from August 2010 to April 2023. We included studies reporting on populations at average risk of breast cancer, which utilized DAs or related e-tools, and assessed women’s participation in BCS by mammography or other key cognitive determinants of decision-making as primary or secondary outcomes. We conducted meta-analyses on the identified randomized controlled trials, which were assessed using the revised Cochrane Risk of Bias 2 (RoB 2) tool. We further explored intermediate and high heterogeneity between studies to enhance the validity of our results. Results: In total, 22 different e-tools were identified across 31 papers. The degree of tailoring in the e-tools, specifically whether the tool was fully tailored or featured with tailoring, was the most influential factor in women’s decision-making regarding BCS. Compared with control groups, tailored e-tools significantly increased women’s long-term participation in BCS (risk ratio 1.14, 95% CI 1.07-1.23, P<.001, I2=0%). Tailored-to-breast-cancer-risk e-tools increased women’s level of worry (mean difference 0.31, 95% CI 0.13-0.48, P<.001, I2=0%). E-tools also improved women’s adequate knowledge of BCS, with features-with-tailoring e-tools designed and tested with the general population being more effective than tailored e-tools designed for or tested with non-BCS participants (χ21=5.1, P=.02). Features-with-tailoring e-tools increased both the rate of women who intended not to undergo BCS (risk ratio 1.88, 95% CI 1.43-2.48, P<.001, I2=0%) and the rate of women who had made an informed choice regarding their intention to undergo BCS (risk ratio 1.60, 95% CI 1.09-2.33, P=.02, I2=91%). Additionally, these tools decreased the proportion of women with decision conflict (risk ratio 0.77, 95% CI 0.65-0.91, P=.002, I2=0%). Shared decision-making was not formally evaluated. This review is limited by small sample sizes, including only a few studies in the meta-analysis, some with a high risk of bias, and high heterogeneity between the studies and e-tools. Conclusions: Features-with-tailoring e-tools could potentially negatively impact BCS programs by fostering negative intentions and attitudes toward BCS participation. Conversely, tailored e-tools may increase women’s participation in BCS but, when tailored to risk, they may elevate their levels of worry. To maximize the effectiveness of e-tools while minimizing potential negative impacts, we advocate for an “on-demand” layered approach to their design. %M 39879616 %R 10.2196/65974 %U https://www.jmir.org/2025/1/e65974 %U https://doi.org/10.2196/65974 %U http://www.ncbi.nlm.nih.gov/pubmed/39879616 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 6 %N %P e50712 %T Identifying Safeguards Disabled by Epstein-Barr Virus Infections in Genomes From Patients With Breast Cancer: Chromosomal Bioinformatics Analysis %A Friedenson,Bernard %K breast cancer %K cancer %K oncology %K ovarian %K virus %K viral %K Epstein-Barr %K herpes %K bioinformatics %K chromosome %K gene %K genetic %K chromosomal %K DNA %K genomic %K BRCA %K metastasis %K biology %D 2025 %7 29.1.2025 %9 %J JMIRx Med %G English %X Background: The causes of breast cancer are poorly understood. A potential risk factor is Epstein-Barr virus (EBV), a lifelong infection nearly everyone acquires. EBV-transformed human mammary cells accelerate breast cancer when transplanted into immunosuppressed mice, but the virus can disappear as malignant cells reproduce. If this model applies to human breast cancers, then they should have genome damage characteristic of EBV infection. Objective: This study tests the hypothesis that EBV infection predisposes one to breast cancer by causing permanent genome damage that compromises cancer safeguards. Methods: Publicly available genome data from approximately 2100 breast cancers and 25 ovarian cancers were compared to cancers with proven associations to EBV, including 70 nasopharyngeal cancers, 90 Burkitt lymphomas, 88 diffuse large B-cell lymphomas, and 34 gastric cancers. Calculation algorithms to make these comparisons were developed. Results: Chromosome breakpoints in breast and ovarian cancer clustered around breakpoints in EBV-associated cancers. Breakpoint distributions in breast and EBV-associated cancers on some chromosomes were not confidently distinguished (P>.05), but differed from controls unrelated to EBV infection. Viral breakpoint clusters occurred in high-risk, sporadic, and other breast cancer subgroups. Breakpoint clusters disrupted gene functions essential for cancer protection, which remain compromised even if EBV infection disappears. As CRISPR (clustered regularly interspaced short palindromic repeats)–like reminders of past infection during evolution, EBV genome fragments were found regularly interspaced between Piwi-interacting RNA (piRNA) genes on chromosome 6. Both breast and EBV-associated cancers had inactivated genes that guard piRNA defenses and the major histocompatibility complex (MHC) locus. Breast and EBV-associated cancer breakpoints and other variations converged around the highly polymorphic MHC. Not everyone develops cancer because MHC differences produce differing responses to EBV infection. Chromosome shattering and mutation hot spots in breast cancers preferentially occurred at incorporated viral sequences. On chromosome 17, breast cancer breakpoints that clustered around those in EBV-mediated cancers were linked to estrogen effects. Other breast cancer breaks affected sites where EBV inhibits JAK-STAT and SWI-SNF signaling pathways. A characteristic EBV-cancer gene deletion that shifts metabolism to favor tumors was also found in breast cancers. These changes push breast cancer into metastasis and then favor survival of metastatic cells. Conclusions: EBV infection predisposes one to breast cancer and metastasis, even if the virus disappears. Identifying this pathogenic viral damage may improve screening, treatment, and prevention. Immunizing children against EBV may protect against breast, ovarian, other cancers, and potentially even chronic unexplained diseases. %R 10.2196/50712 %U https://xmed.jmir.org/2025/1/e50712 %U https://doi.org/10.2196/50712 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e52886 %T Exploring the Social Media Discussion of Breast Cancer Treatment Choices: Quantitative Natural Language Processing Study %A Spiegel,Daphna Y %A Friesner,Isabel D %A Zhang,William %A Zack,Travis %A Yan,Gianna %A Willcox,Julia %A Prionas,Nicolas %A Singer,Lisa %A Park,Catherine %A Hong,Julian C %K breast cancer %K social media %K patient decision-making %K natural language processing %K breast conservation %K mastectomy %D 2025 %7 28.1.2025 %9 %J JMIR Cancer %G English %X Background: Early-stage breast cancer has the complex challenge of carrying a favorable prognosis with multiple treatment options, including breast-conserving surgery (BCS) or mastectomy. Social media is increasingly used as a source of information and as a decision tool for patients, and awareness of these conversations is important for patient counseling. Objective: The goal of this study was to compare sentiments and associated emotions in social media discussions surrounding BCS and mastectomy using natural language processing (NLP). Methods: Reddit posts and comments from the Reddit subreddit r/breastcancer and associated metadata were collected using pushshift.io. Overall, 105,231 paragraphs across 59,416 posts and comments from 2011 to 2021 were collected and analyzed. Paragraphs were processed through the Apache Clinical Text Analysis Knowledge Extraction System and identified as discussing BCS or mastectomy based on physician-defined Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) concepts. Paragraphs were analyzed with a VADER (Valence Aware Dictionary for Sentiment Reasoning) compound sentiment score (ranging from −1 to 1, corresponding to negativity or positivity) and GoEmotions scores (0‐1) corresponding to the intensity of 27 different emotions and neutrality. Results: Of the 105,231 paragraphs, there were 7306 (6.94% of those analyzed) paragraphs mentioning BCS and mastectomy (2729 and 5476, respectively). Discussion of both increased over time, with BCS outpacing mastectomy. The median sentiment score for all discussions analyzed in aggregate became more positive over time. In specific analyses by topic, positive sentiments for discussions with mastectomy mentions increased over time; however, discussions with BCS-specific mentions did not show a similar trend and remained overall neutral. Compared to BCS, conversations about mastectomy tended to have more positive sentiments. The most commonly identified emotions included neutrality, gratitude, caring, approval, and optimism. Anger, annoyance, disappointment, disgust, and joy increased for BCS over time. Conclusions: Patients are increasingly participating in breast cancer therapy discussions with a web-based community. While discussions surrounding mastectomy became increasingly positive, BCS discussions did not show the same trend. This mirrors national clinical trends in the United States, with the increasing use of mastectomy over BCS in early-stage breast cancer. Recognizing sentiments and emotions surrounding the decision-making process can facilitate patient-centric and emotionally sensitive treatment recommendations. %R 10.2196/52886 %U https://cancer.jmir.org/2025/1/e52886 %U https://doi.org/10.2196/52886 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e59882 %T Analyzing Geospatial and Socioeconomic Disparities in Breast Cancer Screening Among Populations in the United States: Machine Learning Approach %A Hashtarkhani,Soheil %A Zhou,Yiwang %A Kumsa,Fekede Asefa %A White-Means,Shelley %A Schwartz,David L %A Shaban-Nejad,Arash %K mammography %K breast neoplasms %K social determinants of health %K geographic information systems %K machine learning %D 2025 %7 16.1.2025 %9 %J JMIR Cancer %G English %X Background: Breast cancer screening plays a pivotal role in early detection and subsequent effective management of the disease, impacting patient outcomes and survival rates. Objective: This study aims to assess breast cancer screening rates nationwide in the United States and investigate the impact of social determinants of health on these screening rates. Methods: Data on mammography screening at the census tract level for 2018 and 2020 were collected from the Behavioral Risk Factor Surveillance System. We developed a large-scale dataset of social determinants of health, comprising 13 variables for 72,337 census tracts. Spatial analysis employing Getis-Ord Gi statistics was used to identify clusters of high and low breast cancer screening rates. To evaluate the influence of these social determinants, we implemented a random forest model, with the aim of comparing its performance to linear regression and support vector machine models. The models were evaluated using R2 and root mean squared error metrics. Shapley Additive Explanations values were subsequently used to assess the significance of variables and direction of their influence. Results: Geospatial analysis revealed elevated screening rates in the eastern and northern United States, while central and midwestern regions exhibited lower rates. The random forest model demonstrated superior performance, with an R2=64.53 and root mean squared error of 2.06, compared to linear regression and support vector machine models. Shapley Additive Explanations values indicated that the percentage of the Black population, the number of mammography facilities within a 10-mile radius, and the percentage of the population with at least a bachelor’s degree were the most influential variables, all positively associated with mammography screening rates. Conclusions: These findings underscore the significance of social determinants and the accessibility of mammography services in explaining the variability of breast cancer screening rates in the United States, emphasizing the need for targeted policy interventions in areas with relatively lower screening rates. %R 10.2196/59882 %U https://cancer.jmir.org/2025/1/e59882 %U https://doi.org/10.2196/59882 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e53969 %T Unveiling Sociocultural Barriers to Breast Cancer Awareness Among the South Asian Population: Case Study of Bangladesh and West Bengal, India %A Hamid,Fahmida %A Roy,Tania %+ , New College of Florida, 5800 Bay Shore Rd, Sarasota, FL, 34243, United States, 1 (941) 487 5000, [email protected] %K Bangladesh %K West Bengal %K India %K Asia %K breast cancer %K awareness %K early detection %K screening %K sociocultural barriers %K health knowledge %K cultural %K stigma %K social media %K socioeconomic %D 2025 %7 10.1.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Bangladesh and West Bengal, India, are 2 densely populated South Asian neighboring regions with many socioeconomic and cultural similarities. In dealing with breast cancer (BC)–related issues, statistics show that people from these regions are having similar problems and fates. According to the Global Cancer Statistics 2020 and 2012 reports, for BC (particularly female BC), the age-standardized incidence rate is approximately 22 to 25 per 100,000 people, and the age-standardized mortality rate is approximately 11 to 13 per 100,000 for these areas. In Bangladesh, approximately 90% of patients are at stages III or IV, compared with 60% in India. For the broader South Asian population, this figure is 16%, while it is 11% in the United States and the United Kingdom. These statistics highlight the need for an urgent investigation into the reasons behind these regions’ late diagnoses and treatment. Objective: Early detection is essential for managing BC and reducing its impact on individuals. However, raising awareness in diverse societies is challenging due to differing cultural norms and socioeconomic conditions. We aimed to interview residents to identify barriers to BC awareness in specific regions. Methods: We conducted semistructured interviews with 17 participants from West Bengal and Bangladesh through Zoom (Zoom Video Communications). These were later transcribed and translated into English for qualitative data analysis. All our participants were older than 18 years, primarily identified as female, and most were married. Results: We have identified 20 significant barriers to effective BC care across 5 levels—individual, family, local society, health care system, and country or region. Key obstacles include neglect of early symptoms, reluctance to communicate, societal stigma, financial fears, uncertainty about treatment costs, inadequate mental health support, and lack of comprehensive health insurance. To address these issues, we recommend context-specific solutions such as integrating BC education into middle and high-school curricula, providing updates through media channels like talk shows and podcasts, promoting family health budgeting, enhancing communication at cultural events and religious gatherings, offering installment payment plans from health care providers, encouraging regular self-examination, and organizing statewide awareness campaigns. In addition, social media can be a powerful tool for raising mass awareness while respecting cultural and socioeconomic norms. Conclusions: Fighting BC or any fatal disease is challenging and requires support from various dimensions. However, studies show that raising mass awareness is crucial for the early detection of BC. By adopting a sensitive and well-informed approach, we aim to improve the early detection of BC and help reduce its impact on South Asian communities. %M 39793010 %R 10.2196/53969 %U https://humanfactors.jmir.org/2025/1/e53969 %U https://doi.org/10.2196/53969 %U http://www.ncbi.nlm.nih.gov/pubmed/39793010 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 6 %N %P e66213 %T Applications of Indocyanine Green in Breast Cancer for Sentinel Lymph Node Mapping: Protocol for a Scoping Review %A Kurdi,Feryal %A Kurdi,Yahya %A Reshetov,Igor Vladimirovich %K indocyanine green %K ICG %K sentinel lymph node %K breast cancer %K fluorescence %K axillary lymph node mapping %K NIR %K surgical planning %K near-infrared %D 2025 %7 6.1.2025 %9 %J JMIRx Med %G English %X Introduction: Breast cancer is the leading cause of morbidity and mortality worldwide. Accurate sentinel lymph node (SLN) mapping is crucial for staging and treatment planning in early-stage breast cancer. Indocyanine green (ICG) has emerged as a promising agent for fluorescence imaging in SLN mapping. However, comprehensive assessment of its clinical utility, including accuracy and adverse effects, remains limited. This scoping review aims to consolidate evidence on the use of ICG in breast cancer SLN mapping. Objective: The objective of this scoping review is to evaluate the current literature on the use of ICG in SLN mapping for patients with breast cancer. This review aims to assess the accuracy, efficacy, and safety of ICG in this context and to identify gaps in the existing research. The outcomes will contribute to the development of further research as part of a PhD project. Methods: Five electronic databases will be searched (PubMed, Embase, MEDLINE, Web of Science, and Scopus) using search strategies developed in consultation with an academic supervisor. The search strategy is set to human studies published in English within the last 11 years. All retrieved citations will be imported to Zotero and then uploaded to Covidence for the screening of titles, abstracts, and full text according to prespecified inclusion criteria. Patients with early-stage breast cancer (T1 and T2), selected T3 cases where the SLN biopsy is accurate, and those with clinically node-negative breast cancer will be included. The intervention criterion includes studies using ICG for SLN mapping and studies on the assessment of fluorescence imaging cameras. Citations meeting the inclusion criteria for full-text review will have their data extracted by 2 independent reviewers, with disagreements resolved by discussion. A data extraction tool will be developed to capture full details about the participants, concept, and context, and findings relevant to the scoping review will be summarized. Results: The preliminary search began in December 2023. As of September 2024, papers have been screened and data are currently being extracted. Out of the 2130 references initially imported, 126 studies met the inclusion criteria after screening. The scoping review is expected to be published in January 2025. Conclusions: Although ICG technology has been used for SLN mapping in patients with breast cancer, initial searches in 2022 revealed limited data on this technique’s feasibility, safety, and effectiveness. At that time, preliminary search of Scopus, MEDLINE, Embase, and PubMed identified no current or forthcoming systematic reviews or scoping reviews on the topic. However, recent searches indicate a substantial increase in research and reviews, reflecting a growing interest and evidence in this area. %R 10.2196/66213 %U https://xmed.jmir.org/2025/1/e66213 %U https://doi.org/10.2196/66213 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65148 %T Optimizing Virtual Follow-Up Care: Realist Evaluation of Experiences and Perspectives of Patients With Breast and Prostate Cancer %A Scruton,Sarah %A Wong,Geoff %A Babinski,Stephanie %A Squires,Lauren R %A Berlin,Alejandro %A Easley,Julie %A McGee,Sharon %A Noel,Ken %A Rodin,Danielle %A Sussman,Jonathan %A Urquhart,Robin %A Bender,Jacqueline L %+ Cancer Rehabilitation and Survivorship, Department of Supportive Care, Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, MG5 2C1, Canada, 1 416 581 8606, [email protected] %K cancer %K follow-up %K virtual %K outcomes %K realist evaluation %K survivorship %D 2025 %7 3.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual follow-up (VFU) has the potential to enhance cancer survivorship care. However, a greater understanding is needed of how VFU can be optimized. Objective: This study aims to examine how, for whom, and in what contexts VFU works for cancer survivorship care. Methods: We conducted a realist evaluation of VFU among patients with breast cancer and prostate cancer at an urban cancer center during the COVID-19 pandemic. Realist evaluations examine how underlying causal processes of an intervention (mechanisms) in specific circumstances (contexts) interact to produce results (outcomes). Semistructured interviews were conducted with a purposive sample of patients ≤5 years after diagnosis. Interviews were audio-recorded and analyzed using a realist logic of analysis. Results: Participants (N=24; n=12, 50% with breast cancer and n=12, 50% with prostate cancer) had an average age of 59.6 (SD 10.7) years. Most participants (20/24, 83%) were satisfied with VFU and wanted VFU options to continue after the COVID-19 pandemic. However, VFU impacted patient perceptions of the quality of their care, particularly in terms of its effectiveness and patient centeredness. Whether VFU worked well for patients depended on patient factors (eg, needs, psychosocial well-being, and technological competence), care provider factors (eg, socioemotional behaviors and technological competence), and virtual care system factors (eg, modality, functionality, usability, virtual process of care, and communication workflows). Key mechanisms that interacted with contexts to produce positive outcomes (eg, satisfaction) were visual cues, effective and empathetic communication, and a trusting relationship with their provider. Conclusions: Patients value VFU; however, VFU is not working as well as it could for patients. To optimize VFU, it is critical to consider contexts and mechanisms that impact patient perceptions of the patient centeredness and effectiveness of their care. Offering patients the choice of in-person, telephone, or video visits when possible, coupled with streamlined access to in-person care when required, is important. Prioritizing and addressing patient needs; enhancing physician virtual socioemotional behaviors and technology competency; and enhancing VFU functionality, usability, and processes of care and communication workflows will improve patient perceptions of the patient centeredness and effectiveness of virtual care. %M 39752659 %R 10.2196/65148 %U https://www.jmir.org/2025/1/e65148 %U https://doi.org/10.2196/65148 %U http://www.ncbi.nlm.nih.gov/pubmed/39752659 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e55300 %T Evaluating Online Cannabis Health Information for Thai Breast Cancer Survivors Using the Quality Evaluation Scoring Tool (QUEST): Mixed Method Study %A Peerawong,Thanarpan %A Phenwan,Tharin %A Makita,Meiko %A Supanichwatana,Sojirat %A Puttarak,Panupong %A Siammai,Naowanit %A Sunthorn,Prakaidao %K cannabis %K medical cannabis %K Thailand %K critical discourse analysis %K mixed method study %K breast cancer %K digital literacy %K legislation %K health literacy %D 2024 %7 24.12.2024 %9 %J JMIR Cancer %G English %X Background: Following medical cannabis legalization in Thailand in 2019, more people are seeking medical cannabis–related information, including women living with breast cancer. The extent to which they access cannabis-related information from internet sources and social media platforms and the quality of such content are relatively unknown and need further evaluation. Objective: This study aims to analyze the factors determining cannabis-related content quality for breast cancer care from internet sources and on social media platforms and examine the characteristics of such content accessed and consumed by Thai breast cancer survivors. Methods: A mixed methods study was conducted between January 2021 and May 2022, involving a breast cancer survivor support group. The group identified medical cannabis–related content from frequently accessed internet sources and social media platforms. The contents were categorized based on content creators, platforms, content category, and upload dates. Four researchers used the Quality Evaluation Scoring Tool (QUEST) to assess content quality, with scores ranging from 0 to 28. Contents were expert-rated as either high or poor. The QUEST interobserver reliability was analyzed. Receiver-operating characteristic curve analysis with the Youden index was used to determine the QUEST score cut-off point. Statistical significance was set at P<.05. Fairclough Critical Discourse Analysis was undertaken to examine the underlying discourses around poor-quality content. Results: Sixty-two Thai-language cannabis-related items were evaluated. The content sources were categorized as follows: news channels (21/62, 34%), government sources (16/62, 26%), health care providers (12/62, 19%), and alternative medicine providers (12/62, 19%). Most of the contents (30/62, 48%) were uploaded to YouTube, whereas 31% (19/62) appeared on websites and Facebook. Forty of 62 content items (64%) were news-related and generic cannabis advertisements while 8 of 62 (13%) content items had no identifiable date. The interobserver QUEST score correlation was 0.86 (P<.001). The mean QUEST score was 12.1 (SD 7.6). Contents were considered “high” when the expert rating was >3. With a QUEST score of 15 as the threshold, the sensitivity and specificity for differentiating between high and poor content quality were 81% and 98%, respectively. Content creation was the only significant factor between high- and poor-quality content. Poor-quality contents were primarily created by alternative medicine providers and news channels. Two discourses were identified: advocacy for cannabis use normalization and cannabis romanticization as a panacea. These discourses overly normalize and romanticize the use of cannabis, focusing on indications and instructions for cannabis use, and medical cannabis promotion, while neglecting discussions on cannabis contraindications and potential side effects. Conclusions: The varying quality of medical cannabis–related information on internet sources and social media platforms accessed and shared by Thai breast cancer survivors is an issue of concern. Given that content creators are the sole predictive factors of high content quality, future studies should examine a wider range of cannabis-related sources accessible to both the public and patients to gain a more comprehensive understanding of the issue. %R 10.2196/55300 %U https://cancer.jmir.org/2024/1/e55300 %U https://doi.org/10.2196/55300 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e48170 %T Prototype of an App Designed to Support Self-Management for Health Behaviors and Weight in Women Living With Breast Cancer: Qualitative User Experience Study %A Lally,Phillippa %A May,Christine N %A Mitchell,E Siobhan %A McCallum,Meaghan %A Michaelides,Andreas %A Fisher,Abigail %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20276791722, [email protected] %K breast cancer %K self-management %K app %K health behaviors %K weight %K prototype %K user experience %K development %K application %K coaching %K peer support %K oncology %D 2024 %7 20.12.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Accessible self-management interventions are required to support people living with breast cancer. Objective: This was an industry-academic partnership study that aimed to collect qualitative user experience data of a prototype app with built-in peer and coach support designed to support the management of health behaviors and weight in women living with breast cancer. Methods: Participants were aged ≥18 years, were diagnosed with breast cancer of any stage within the last 5 years, had completed active treatment, and were prescribed oral hormone therapy. Participants completed demographic surveys and were asked to use the app for 4 weeks. Following this, they took part in in-depth qualitative interviews about their experiences. These were analyzed using thematic analysis. Results: Eight participants (mean age, 45 years; mean time since diagnosis, 32 months) were included. Of the 8 participants, 7 (88%) were white, 6 (75%) had a graduate degree or above, and 6 (75%) had stage I-III breast cancer. Four overarching themes were identified: (1) Support for providing an app earlier in the care pathway; (2) Desire for more weight-focused content tailored to the breast cancer experience; (3) Tracking of health behaviors that are generally popular; and (4) High value of in-app social support. Conclusions: This early user experience work showed that women with breast cancer found an app with integrated social and psychological support appealing to receive support for behavior change and weight management or self-management. However, many features were recommended for further development. This work is the first step in an academic-industry collaboration that would ultimately aim to develop and empirically test a supportive app that could be integrated into the cancer care pathway. %M 39705674 %R 10.2196/48170 %U https://cancer.jmir.org/2024/1/e48170 %U https://doi.org/10.2196/48170 %U http://www.ncbi.nlm.nih.gov/pubmed/39705674 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59426 %T Co-Designing the MOSAIC mHealth App With Breast Cancer Survivors: User-Centered Design Approach %A Nuseibeh,Betsey Zenk %A Johns,Shelley A %A Shih,Patrick C %A Lewis,Gregory F %A Gowan,Tayler M %A Jordan,Evan J %+ School of Public Health, Indiana University, 1025 East Seventh Street, Bloomington, IN, 47405, United States, 1 5132255577, [email protected] %K breast cancer survivors %K acceptance and commitment therapy %K mHealth app %K user-centered design %K depression %K anxiety %K therapy %K app %K breast cancer %K expert %K designer %K psychosocial %K need %K co-design %K MOSAIC %K mobile acceptance and commitment therapy stress intervention %K interviews %D 2024 %7 9.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer is the world’s most prevalent cancer. Although the 5-year survival rate for breast cancer in the United States is 91%, the stress and uncertainty of survivorship can often lead to symptoms of depression and anxiety. With nearly half of breast cancer survivors living with stress and symptoms of depression and anxiety, there are a significant number of unmet supportive care needs. New and potentially scalable approaches to meeting these supportive care needs are warranted. Objective: This study aimed to engage breast cancer survivors and acceptance and commitment therapy (ACT) content experts in user-centered design (UCD) to develop a mobile health app (MOSAIC [Mobile Acceptance and Commitment Therapy Stress Intervention]) using stress intervention strategies. Methods: We held 5 UCD sessions with 5 breast cancer survivors, 3 ACT content experts, 2 user experience design experts, and 1 stress expert facilitator over the course of 10 weeks. The sessions were developed to lead the 10 co-designers through the 5-step UCD process (eg, problem identification, solution generation, convergence, prototyping, and debriefing and evaluation). Following the fifth session, a prototype was generated and evaluated by the 5 breast cancer survivors and 3 ACT experts using the System Usability Scale, Acceptability E-scale, and a brief set of semistructured interview questions. Results: The 10 co-designers were present for each of the 5 co-design sessions. Co-designers identified 5 design characteristics: simple entry with use reminders (behavioral nudges), a manageable number of intervention choices, highly visual content, skill-building exercises, and social support. A total of 4 features were also identified as critical to the use of the tool: an ACT and breast cancer–specific onboarding process, clean navigation tools, clear organization of the interventions, and once-per-week behavioral nudges. These requirements created the foundation for the app prototype. The 5 breast cancer survivors and 3 ACT co-designers evaluated the app prototype for 1 week, using an Android smartphone. They rated the app as usable (mean 79.29, SD 19.83) on the System Usability Scale (a priori mean cutoff score=68) and acceptable (mean 24.28, SD 2.77) on the Acceptability E-scale (a priori mean cutoff score=24). Conclusions: Through the UCD process, we created an ACT app prototype with 5 breast cancer survivors, 3 ACT experts, and 2 UCD designers. The next step in our research is to continue the assessment and refining of the prototype with additional breast cancer survivors. Future work will pilot-test the app to examine the feasibility of a large-scale, randomized control trial. Studies will enroll increasingly diverse breast cancer survivors to broaden the generalizability of findings. %R 10.2196/59426 %U https://formative.jmir.org/2024/1/e59426 %U https://doi.org/10.2196/59426 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e52551 %T Identifying Factors Associated With Heightened Anxiety During Breast Cancer Diagnosis Through the Analysis of Social Media Data on Reddit: Mixed Methods Study %A Pierce,Joni %A Conway,Mike %A Grace,Kathryn %A Mikal,Jude %+ Department of Biomedical Informatics, University of Utah, 421 Wakara Way, #140, Salt Lake City, UT, 84108, United States, 1 8015889395, [email protected] %K breast cancer %K anxiety %K NLP %K natural language processing %K mixed methods study %K cancer diagnosis %K social media apps %K descriptive analysis %K diagnostic progression %K patient-centered care %D 2024 %7 5.12.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: More than 85% of patients report heightened levels of anxiety following breast cancer diagnosis. Anxiety may become amplified during the early stages of breast cancer diagnosis when ambiguity is high. High levels of anxiety can negatively impact patients by reducing their ability to function physically, make decisions, and adhere to treatment plans, with all these elements combined serving to diminish the quality of life. Objective: This study aimed to use individual social media posts about breast cancer experiences from Reddit (r/breastcancer) to understand the factors associated with breast cancer–related anxiety as individuals move from suspecting to confirming cancer diagnosis. Methods: We used a mixed method approach by combining natural language processing–based computational methods with descriptive analysis. Our team coded the entire corpus of 2170 unique posts from the r/breastcancer subreddit with respect to key variables, including whether the post was related to prediagnosis, diagnosis, or postdiagnosis concerns. We then used Linguistic Inquiry and Word Count (LIWC) to rank-order the codified posts as low, neutral, or high anxiety. High-anxiety posts were then retained for deep descriptive analysis to identify key themes relative to diagnostic progression. Results: After several iterations of data analysis and classification through both descriptive and computational methods, we identified a total of 448 high-anxiety posts across the 3 diagnostic categories. Our analyses revealed that individuals experience higher anxiety before a confirmed cancer diagnosis. Analysis of the high-anxiety posts revealed that the factors associated with anxiety differed depending on an individual’s stage in the diagnostic process. Prediagnosis anxiety was associated with physical symptoms, cancer-related risk factors, communication, and interpreting medical information. During the diagnosis period, high anxiety was associated with physical symptoms, cancer-related risk factors, communication, and difficulty navigating the health care system. Following diagnosis, high-anxiety posts generally discussed topics related to treatment options, physical symptoms, emotional distress, family, and financial issues. Conclusions: This study has practical, theoretical, and methodological implications for cancer research. Content analysis reveals several possible drivers of anxiety at each stage (prediagnosis, during diagnosis, and postdiagnosis) and provides key insights into how clinicians can help to alleviate anxiety at all stages of diagnosis. Findings provide insights into cancer-related anxiety as a process beginning before engagement with the health care system: when an individual first notices possible cancer symptoms. Uncertainty around physical symptoms and risk factors suggests the need for increased education and improved access to trained medical staff who can assist patients with questions and concerns during the diagnostic process. Assistance in understanding technical reports, scheduling, and patient-centric clinician behavior may pinpoint opportunities for improved communication between patients and providers. %M 39637371 %R 10.2196/52551 %U https://cancer.jmir.org/2024/1/e52551 %U https://doi.org/10.2196/52551 %U http://www.ncbi.nlm.nih.gov/pubmed/39637371 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e47856 %T Relationship Between Perceived COVID-19 Risk and Change in Perceived Breast Cancer Risk: Prospective Observational Study %A Baxter-King,Ryan %A Naeim,Arash %A Huang,Tina Q %A Sepucha,Karen %A Stanton,Annette %A Rudkin,Aaron %A Ryu,Rita %A Sabacan,Leah %A Vavreck,Lynn %A Esserman,Laura %A Stover Fiscalini,Allison %A Wenger,Neil S %+ Division of General Internal Medicine and Health Services Research, UCLA, 1100 Glendon Avenue, Suite 850, Los Angeles, CA, 90024, United States, 1 3107942288, [email protected] %K breast cancer %K COVID-19 risk perception %K cancer screening %K anxiety %K cancer %K COVID-19 %K prevention %K medical care %K screening %K survey %D 2024 %7 2.12.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Whether COVID-19 is associated with a change in risk perception about other health conditions is unknown. Because COVID-19 occurred during a breast cancer study, we evaluated the effect of COVID-19 risk perception on women’s breast cancer risk perception. Objective: This study aims to evaluate the relationship between perceived risk of COVID-19 and change in perceived breast cancer risk. We hypothesized that women who perceived greater COVID-19 risk would evidence increased perceived breast cancer risk and this risk would relate to increased anxiety and missed cancer screening. Methods: Women aged 40-74 years with no breast cancer history were enrolled in a US breast cancer prevention trial in outpatient settings. They had provided breast cancer risk perception and general anxiety before COVID-19. We performed a prospective observational study of the relationship between the perceived risk of COVID-19 and the change in perceived breast cancer risk compared to before the pandemic. Each woman was surveyed up to 4 times about COVID-19 and breast cancer risk perception, general anxiety, and missed medical care early in COVID-19 (May to December 2020). Results: Among 13,002 women who completed a survey, compared to before COVID-19, anxiety was higher during COVID-19 (mean T score 53.5 vs 49.7 before COVID-19; difference 3.8, 95% CI 3.6-4.0; P<.001) and directly related to perceived COVID-19 risk. In survey wave 1, anxiety increased by 2.3 T score points for women with very low perceived COVID-19 risk and 5.2 points for those with moderately or very high perceived COVID-19 risk. Despite no overall difference in breast cancer risk perception (mean 32.5% vs 32.5% before COVID-19; difference 0.24, 95% CI –0.47 to 0.52; P=.93), there was a direct relationship between change in perceived breast cancer risk with COVID-19 risk perception, ranging in survey wave 4 from a 2.4% decrease in breast cancer risk perception for those with very low COVID-19 risk perception to a 3.4% increase for women with moderately to very high COVID-19 risk perception. This was not explained by the change in anxiety or missed cancer screening. After adjustment for age, race, education, and survey wave, compared to women with very low perceived COVID-19 risk, perceived breast cancer risk increased by 1.54% (95% CI 0.75%-2.33%; P<.001), 4.28% (95% CI 3.30%-5.25%; P<.001), and 3.67% (95% CI 1.94%-5.40%; P<.001) for women with moderately low, neither high nor low, and moderately or very high perceived COVID-19 risk, respectively. Conclusions: Low perceived COVID-19 risk was associated with reduced perceived breast cancer risk, and higher levels of perceived COVID-19 risk were associated with increased perceived breast cancer risk. This natural experiment suggests that a threat such as COVID-19 may have implications beyond the pandemic. Preventive health behaviors related to perceived risk may need attention as COVID-19 becomes endemic. %M 39622037 %R 10.2196/47856 %U https://cancer.jmir.org/2024/1/e47856 %U https://doi.org/10.2196/47856 %U http://www.ncbi.nlm.nih.gov/pubmed/39622037 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48914 %T Preliminary Screening for Hereditary Breast and Ovarian Cancer Using an AI Chatbot as a Genetic Counselor: Clinical Study %A Sato,Ann %A Haneda,Eri %A Hiroshima,Yukihiko %A Narimatsu,Hiroto %+ Department of Genetic Medicine, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan, 81 045 520 2222, [email protected] %K hereditary cancer %K familial cancer %K IBM Watson %K family history %K medical history %K cancer %K feasibility %K social network %K screening %K breast cancer %K ovarian cancer %K artificial intelligence %K AI %K chatbot %K genetic %K counselling %K oncology %K conversational agent %K implementation %K usability %K acceptability %D 2024 %7 27.11.2024 %9 Research Letter %J J Med Internet Res %G English %X Background: Hereditary breast and ovarian cancer (HBOC) is a major type of hereditary cancer. Establishing effective screening to identify high-risk individuals for HBOC remains a challenge. We developed a prototype of a chatbot system that uses artificial intelligence (AI) for preliminary HBOC screening to determine whether individuals meet the National Comprehensive Cancer Network BRCA1/2 testing criteria. Objective: This study’s objective was to validate the feasibility of this chatbot in a clinical setting by using it on a patient population that visited a hospital. Methods: We validated the medical accuracy of the chatbot system by performing a test on patients who consecutively visited the Kanagawa Cancer Center. The participants completed a preoperation questionnaire to understand their background, including information technology literacy. After the operation, qualitative interviews were conducted to collect data on the usability and acceptability of the system and examine points needing improvement. Results: A total of 11 participants were enrolled between October and December 2020. All of the participants were women, and among them, 10 (91%) had cancer. According to the questionnaire, 6 (54%) participants had never heard of a chatbot, while 7 (64%) had never used one. All participants were able to complete the chatbot operation, and the average time required for the operation was 18.0 (SD 5.44) minutes. The determinations by the chatbot of whether the participants met the BRCA1/2 testing criteria based on their medical and family history were consistent with those by certified genetic counselors (CGCs). We compared the medical histories obtained from the participants by the CGCs with those by the chatbot. Of the 11 participants, 3 (27%) entered information different from that obtained by the CGCs. These discrepancies were caused by the participant’s omissions or communication errors with the chatbot. Regarding the family histories, the chatbot provided new information for 3 (27%) of the 11 participants and complemented information for the family members of 5 (45%) participants not interviewed by the CGCs. The chatbot could not obtain some information on the family history of 6 (54%) participants due to several reasons, such as being outside of the scope of the chatbot’s interview questions, the participant’s omissions, and communication errors with the chatbot. Interview data were classified into the following: (1) features, (2) appearance, (3) usability and preferences, (4) concerns, (5) benefits, and (6) implementation. Favorable comments on implementation feasibility and comments on improvements were also obtained. Conclusions: This study demonstrated that the preliminary screening system for HBOC using an AI chatbot was feasible for real patients. %M 39602801 %R 10.2196/48914 %U https://www.jmir.org/2024/1/e48914 %U https://doi.org/10.2196/48914 %U http://www.ncbi.nlm.nih.gov/pubmed/39602801 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e57964 %T Experiences of a Digital Behavior Change Intervention to Prevent Weight Gain and Promote Risk-Reducing Health Behaviors for Women Aged 18 to 35 Years at Increased Risk of Breast Cancer: Qualitative Interview Study %A Hawkes,Rhiannon E %A Pegington,Mary %A Davies,Alan %A Mueller,Julia %A Howell,Anthony %A Evans,D Gareth %A Howell,Sacha J %A French,David P %A Harvie,Michelle %+ Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 0161 275 2584, [email protected] %K breast cancer %K health behavior %K weight gain %K weight control %K BMI %K app %K acceptability %K feasibility %D 2024 %7 25.11.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer is the most common form of cancer in women. Adult weight gain and modifiable health behaviors, including smoking, alcohol intake, and lack of physical activity, are well-known risk factors. Most weight gain in women occurs between the ages of 18 and 35 years. Digital interventions have the potential to address logistical challenges that arise in reaching women in this age range. We designed a digital intervention targeting weight gain prevention and other modifiable health behaviors for young women at increased risk of breast cancer. Women aged 18 to 35 years were recruited to this single-arm intervention study over 2 months to test the acceptability and usability of the intervention, which comprised a group welcome event held via videoconferencing, app, and private Facebook group. Objective: This nested qualitative substudy explored women’s views and experiences of being part of the digital health intervention to inform future intervention development for a feasibility study. Methods: A total of 20 women aged 23 to 35 years who were at increased risk of breast cancer were interviewed via telephone within 1 month after completing the intervention, between February 2023 and March 2023. The women were asked about their experiences of the digital intervention and the extent to which it may have influenced their health behaviors. Data were analyzed thematically and organized using the framework approach. Results: The interviews lasted for a median of 37 (IQR 30-46) minutes. Overall, the women perceived the digital health intervention comprising education, tracking, and support to be acceptable for weight gain prevention. In total, 4 themes were generated. A “missed opportunity” in breast cancer prevention services encompasses the lack of services that currently exist for young women at increased risk of breast cancer. The pros and cons of being part of a community encompasses the divergent views that the women had regarding engaging with other women at increased risk. The importance of an interactive app focuses on features that the women would want from the app to promote engagement with the intervention. The different wants and needs of different age groups highlights that an intervention such as this one would need to be customizable to suit the needs of women at different life stages. Conclusions: There is an unmet need in prevention services for young women aged 18 to 35 years at increased risk of breast cancer. The women perceived the app to be an acceptable intervention for weight gain prevention but emphasized that the intervention would need to be customizable to meet the needs of different age groups within the group of women aged 18 to 35 years. The digital intervention could be a scalable behavior change strategy for UK family history clinics. %M 39586077 %R 10.2196/57964 %U https://cancer.jmir.org/2024/1/e57964 %U https://doi.org/10.2196/57964 %U http://www.ncbi.nlm.nih.gov/pubmed/39586077 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e57415 %T Exploring the Effects of Variety and Amount of Mindfulness Practices on Depression, Anxiety, and Stress Symptoms: Longitudinal Study on a Mental Health–Focused eHealth System for Patients With Breast or Prostate Cancer %A Malandrone,Francesca %A Urru,Sara %A Berchialla,Paola %A Rossini,Pierre Gilbert %A Oliva,Francesco %A Bianchi,Silvia %A Ottaviano,Manuel %A Gonzalez-Martinez,Sergio %A Carli,Vladimir %A Valenza,Gaetano %A Scilingo,Enzo Pasquale %A Carletto,Sara %A Ostacoli,Luca %K depression %K anxiety %K stress %K internet-based %K mental health %K mindfulness %K breast cancer %K prostate cancer %K cancer-related mental distress %K emotional distress %K psychological distress %K mindfulness-based interventions %K MBI %K e-MBI %K dispositional mindfulness %K self-compassion %K mental wellbeing %K mobile phone %D 2024 %7 21.11.2024 %9 %J JMIR Ment Health %G English %X Background: Patients with cancer often face depression and anxiety, and mindfulness-based interventions, including internet-based versions, can effectively reduce these symptoms and improve their quality of life. This study aims to investigate the impact of internet-based mindfulness-based interventions (e-MBIs) on anxiety, depression, and stress symptoms in patients with prostate or breast cancer. Objective: The primary aims are to assess the association between the amount and variety of e-MBI practices and symptom reduction. Second, this study aims to examine how baseline information such as sociodemographic characteristics, dispositional mindfulness (DM), and dispositional self-compassion (DSC) correlate with both app usage and symptom reduction. Methods: Participants included 107 patients with cancer (68 women with breast cancer and 38 men with prostate cancer) enrolled in a hospital setting. They were assigned to the intervention group of the NEVERMIND project, using the e-BMI module via the NEVERMIND app. A longitudinal design involved Pearson correlation analysis to determine the relationship between the amount and duration of e-MBI practices. Linear regression analysis was conducted to gauge the dose-response effect, evaluating the impact of DM and DSC on depression, anxiety, and stress. Negative binomial regression was conudcted to study sociodemographic factors’ influence on the amount of practice in e-MBIs. Results: The participants with more diverse and sustained mindfulness practices experienced significant reductions in depression, anxiety, and stress. A high correlation (0.94) between e-MBI practices and symptom reduction was also highlighted. Male, married, and highly educated patients were more likely to engage in mindfulness. Even if DM and DSC did not impact the amount or variety of practices correlated, they were correlated with symptom reduction, showing that higher levels were associated with significant reductions in depression, anxiety, and stress. Conclusions: While more e-MBI practice is linked to reduced anxiety, depression, and stress, this study emphasizes the crucial role of variety of practice over amount. DM and DSC are key in shaping intervention effectiveness and may act as protectors against psychological distress. Using app log data, our research provides a unique perspective on e-MBI impact, contributing to cancer care understanding and guiding future studies. %R 10.2196/57415 %U https://mental.jmir.org/2024/1/e57415 %U https://doi.org/10.2196/57415 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e53825 %T Effects of Virtual Reality Therapy for Patients With Breast Cancer During Chemotherapy: Randomized Controlled Trial %A Li,Mengdan %A Yu,Zhifu %A Li,Hui %A Cao,Li %A Yu,Huihui %A Deng,Ning %A Liu,Yunyong %K virtual reality %K breast neoplasms %K quality of life %K psychological distress %K longitudinal studies %D 2024 %7 17.10.2024 %9 %J JMIR Serious Games %G English %X Background: Patients with breast cancer endure high levels of psychological and physical pain. Virtual reality (VR) may be an acceptable, safe intervention to alleviate the negative emotions and pain of patients with cancer. Objective: We aimed to test the long-term effects of VR on psychological distress and quality of life (QOL) with traditional care in Chinese patients with breast cancer. We also explored the intervention mechanism and the acceptability of VR. Methods: A total of 327 eligible participants were randomly assigned to a VR intervention group or a control group. The Distress Thermometer, QLQ-C30 (Quality of Life Questionnaire version 3.0), and Virtual Reality Symptom Questionnaire were assessed at baseline, postintervention (3 mo), and follow-up (6 mo). Analysis followed the intention-to-treat (ITT) principle. The generalized estimating equations model was used to analyze the longitudinal data, and the PROCESS macro was used to analyze the mediating effect. Results: Compared with the control group, patients with breast cancer in the VR group had lower distress scores (P=.007), and higher health-related QOL scores (physical, role, emotional, cognitive, and social functioning) after 6 months (P<.05). Psychological distress had mediating effects on the longitudinal association between VR and the health-related QOL (indirect effect=4.572‐6.672, all P<.05). Conclusions: VR intervention technology may help reduce distress and improve QOL for patients with breast cancer over time. By incorporating a mediating analysis, we showed that the QOL benefits of VR intervention was manifested through positive effects on psychological distress risk factors. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000035049; https://www.chictr.org.cn/showproj.html?proj=53648 %R 10.2196/53825 %U https://games.jmir.org/2024/1/e53825 %U https://doi.org/10.2196/53825 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55792 %T Auricular Therapy to Control Pain in Women With Breast Cancer: Protocol for Systematic Review and Meta-Analysis %A Ruela,Ludmila Oliveira %A Moura,Caroline de Castro %A Shieu,Bianca %A Cho,Yu-Min %A Yeh,Chao Hsing %A Pimentel,Franklin Fernandes %A Stefanello,Juliana %+ Ribeirão Preto College of Nursing, University of São Paulo, Avenida Bandeirantes, 3900., Ribeirão Preto, 14040-902, Brazil, 55 16 3315 339, [email protected] %K breast neoplasms %K cancer pain %K pain %K auricular acupuncture %K auricular therapy %K systematic review %K meta-analysis %D 2024 %7 15.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The increased incidence of breast cancer implies the appearance of frequent symptoms associated with disease and treatments, such as pain. For the management of this issue, auricular therapy has been used in a complementary manner, especially for its safety and analgesic action. Objective: This systematic review aims to summarize available evidence on the effects of auricular therapy on pain in women undergoing breast cancer treatment. Methods: This is a systematic review that includes randomized controlled trials that evaluated the effects of auricular therapy on pain in women with breast cancer, as compared with other interventions (sham or placebo auricular therapy, other nonpharmacological interventions, and routine pain treatments) during the treatment of the disease. Pain, whether induced or not by cancer treatments, is the main outcome to be evaluated. The search for the studies was performed in the following databases: MEDLINE through PubMed, CINAHL, CENTRAL, Embase, Web of Science, Scopus, VHL, TCIM Americas Network, CNKI, and Wanfang Data. The reviewers have independently evaluated the full texts, and in the near future, they will extract the data and assess the risk of bias in the included studies. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), and a meta-analysis will be carried out to evaluate the intervention, considering the homogeneity of the results, using the Cochran Q test and quantified by the Higgins inconsistency index. The guidelines of the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) have been respected in the elaboration of this protocol. Results: The records screening stage has been completed, and the synthesis and meta-analysis were conducted in February 2024. We hope to have finished the preparation of the paper for publication by September 2024. Review reporting will follow standard guidelines for reporting systematic reviews. The results will be published in peer-reviewed scientific journals. Conclusions: This review will compile the strength of evidence for the use of auricular therapy in the management of pain in women with breast cancer during the treatment of the disease, identifying gaps in the available evidence as well as assisting health professionals in indicating the intervention for clinical practice. Trial Registration: PROSPERO CRD42022382433; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=382433 International Registered Report Identifier (IRRID): DERR1-10.2196/55792 %M 39405520 %R 10.2196/55792 %U https://www.researchprotocols.org/2024/1/e55792 %U https://doi.org/10.2196/55792 %U http://www.ncbi.nlm.nih.gov/pubmed/39405520 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56022 %T An Advanced Machine Learning Model for a Web-Based Artificial Intelligence–Based Clinical Decision Support System Application: Model Development and Validation Study %A Lin,Tai-Han %A Chung,Hsing-Yi %A Jian,Ming-Jr %A Chang,Chih-Kai %A Perng,Cherng-Lih %A Liao,Guo-Shiou %A Yu,Jyh-Cherng %A Dai,Ming-Shen %A Yu,Cheng-Ping %A Shang,Hung-Sheng %+ Division of Clinical Pathology, Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, No. 161, Sec. 6, Minquan E. Road, Neihu District, Taipei, 11490, Taiwan, 886 920713130, [email protected] %K breast cancer recurrence %K artificial intelligence–based clinical decision support system %K machine learning %K personalized treatment planning %K ChatGPT %K predictive model accuracy %D 2024 %7 4.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Breast cancer is a leading global health concern, necessitating advancements in recurrence prediction and management. The development of an artificial intelligence (AI)–based clinical decision support system (AI-CDSS) using ChatGPT addresses this need with the aim of enhancing both prediction accuracy and user accessibility. Objective: This study aims to develop and validate an advanced machine learning model for a web-based AI-CDSS application, leveraging the question-and-answer guidance capabilities of ChatGPT to enhance data preprocessing and model development, thereby improving the prediction of breast cancer recurrence. Methods: This study focused on developing an advanced machine learning model by leveraging data from the Tri-Service General Hospital breast cancer registry of 3577 patients (2004-2016). As a tertiary medical center, it accepts referrals from four branches—3 branches in the northern region and 1 branch on an offshore island in our country—that manage chronic diseases but refer complex surgical cases, including breast cancer, to the main center, enriching our study population’s diversity. Model training used patient data from 2004 to 2012, with subsequent validation using data from 2013 to 2016, ensuring comprehensive assessment and robustness of our predictive models. ChatGPT is integral to preprocessing and model development, aiding in hormone receptor categorization, age binning, and one-hot encoding. Techniques such as the synthetic minority oversampling technique address the imbalance of data sets. Various algorithms, including light gradient-boosting machine, gradient boosting, and extreme gradient boosting, were used, and their performance was evaluated using metrics such as the area under the curve, accuracy, sensitivity, and F1-score. Results: The light gradient-boosting machine model demonstrated superior performance, with an area under the curve of 0.80, followed closely by the gradient boosting and extreme gradient boosting models. The web interface of the AI-CDSS tool was effectively tested in clinical decision-making scenarios, proving its use in personalized treatment planning and patient involvement. Conclusions: The AI-CDSS tool, enhanced by ChatGPT, marks a significant advancement in breast cancer recurrence prediction, offering a more individualized and accessible approach for clinicians and patients. Although promising, further validation in diverse clinical settings is recommended to confirm its efficacy and expand its use. %M 39231422 %R 10.2196/56022 %U https://www.jmir.org/2024/1/e56022 %U https://doi.org/10.2196/56022 %U http://www.ncbi.nlm.nih.gov/pubmed/39231422 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54450 %T Strategies for Identifying and Recruiting Women at High Risk for Breast Cancer for Research Outside of Clinical Settings: Observational Study %A Conley,Claire C %A Rodriguez,Jennifer D %A McIntyre,McKenzie %A Niell,Bethany L %A O'Neill,Suzanne C %A Vadaparampil,Susan T %+ Department of Oncology, Georgetown University, 2115 Wisconsin Ave NW, Suite 300, Washington, DC, 20007, United States, 1 2026875086, [email protected] %K breast cancer %K high-risk populations %K risk management %K recruitment %K woman %K women %K high risk %K observational study %K cross-sectional %K Facebook %K Twitter %K flyer %K flyers %K community events %K community event %K genetic mutation %D 2024 %7 2.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Research is needed to understand and address barriers to risk management for women at high (≥20% lifetime) risk for breast cancer, but recruiting this population for research studies is challenging. Objective: This paper compares a variety of recruitment strategies used for a cross-sectional, observational study of high-risk women. Methods: Eligible participants were assigned female at birth, aged 25-85 years, English-speaking, living in the United States, and at high risk for breast cancer as defined by the American College of Radiology. Individuals were excluded if they had a personal history of breast cancer, prior bilateral mastectomy, medical contraindications for magnetic resonance imaging, or were not up-to-date on screening mammography per American College of Radiology guidelines. Participants were recruited from August 2020 to January 2021 using the following mechanisms: targeted Facebook advertisements, Twitter posts, ResearchMatch (a web-based research recruitment database), community partner promotions, paper flyers, and community outreach events. Interested individuals were directed to a secure website with eligibility screening questions. Participants self-reported method of recruitment during the eligibility screening. For each recruitment strategy, we calculated the rate of eligible respondents and completed surveys, costs per eligible participant, and participant demographics. Results: We received 1566 unique responses to the eligibility screener. Participants most often reported recruitment via Facebook advertisements (724/1566, 46%) and ResearchMatch (646/1566, 41%). Community partner promotions resulted in the highest proportion of eligible respondents (24/46, 52%), while ResearchMatch had the lowest proportion of eligible respondents (73/646, 11%). Word of mouth was the most cost-effective recruitment strategy (US $4.66 per completed survey response) and paper flyers were the least cost-effective (US $1448.13 per completed survey response). The demographic characteristics of eligible respondents varied by recruitment strategy: Twitter posts and community outreach events resulted in the highest proportion of Hispanic or Latina women (1/4, 25% and 2/6, 33%, respectively), and community partner promotions resulted in the highest proportion of non-Hispanic Black women (4/24, 17%). Conclusions: Although recruitment strategies varied in their yield of study participants, results overall support the feasibility of identifying and recruiting women at high risk for breast cancer outside of clinical settings. Researchers must balance the associated costs and participant yield of various recruitment strategies in planning future studies focused on high-risk women. %M 39222344 %R 10.2196/54450 %U https://www.jmir.org/2024/1/e54450 %U https://doi.org/10.2196/54450 %U http://www.ncbi.nlm.nih.gov/pubmed/39222344 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57781 %T Factorial Trial to Optimize an Internet-Delivered Intervention for Sexual Health After Breast Cancer: Protocol for the WF-2202 Sexual Health and Intimacy Enhancement (SHINE) Trial %A Shaffer,Kelly M %A Reese,Jennifer Barsky %A Dressler,Emily V %A Glazer,Jillian V %A Cohn,Wendy %A Showalter,Shayna L %A Clayton,Anita H %A Danhauer,Suzanne C %A Loch,Michelle %A Kadi,Mai %A Smith,Caleigh %A Weaver,Kathryn E %A Lesser,Glenn J %A Ritterband,Lee M %+ University of Virginia School of Medicine, PO Box 801075, Charlottesville, VA, 22902, United States, 1 434 982 1022, [email protected] %K breast neoplasms %K cancer survivorship %K clinical trial %K communication skills %K factorial trial %K internet interventions %K intimacy %K mobile phone %K multiphase optimization strategy %K sexual distress %K sexual functioning %K sexual health %D 2024 %7 19.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although most survivors of breast cancer report substantial sexual concerns following treatment, few receive support for these concerns. Delivering sexual health care to survivors of breast cancer via the internet could overcome many of the barriers to in-person treatment. Even when delivered remotely, survivor time constraints remain a leading barrier to sexual health intervention uptake. Objective: Guided by the multiphase optimization strategy methodological framework, the primary objective of this study is to identify the most efficient internet-delivered sexual health intervention package that is expected to provide survivors of breast cancer the greatest benefit with the fewest (and least-intensive) intervention components. This study aims to determine how intervention components work (mediators) and for whom they work best (moderators). Methods: Partnered, posttreatment adult female survivors of breast cancer (N=320) experiencing at least 1 bothersome sexual symptom (ie, pain with sex, vaginal dryness, low sexual desire, and difficulty with orgasm) related to their breast cancer treatment will be enrolled. Clinic-based recruitment will be conducted via the Wake Forest National Cancer Institute Community Oncology Research Program (NCORP) Research Base. Participants will be randomly assigned to 1 of 16 combinations of four intervention components with two levels each in this factorial trial: (1) psychoeducation about cancer-related sexual morbidity (receive either enhanced vs standard versions); (2) communication skills training for discussing concerns with health care providers (received vs not received); (3) communication skills training for discussing concerns with a partner (received vs not received); and (4) intimacy promotion skills training (received vs not received). Cores will be fully automated and implemented using a robust internet intervention platform with highly engaging elements such as animation, video, and automated email prompts. Survivors will complete web-based assessments at baseline (prerandomization time point) and again at 12 and 24 weeks later. The primary study aim will be achieved through a decision-making process based on systematically evaluating the main and interaction effects of components on sexual distress (Female Sexual Distress Scale–Desire, Arousal, Orgasm) and sexual functioning (Female Sexual Function Index) using a generalized linear model approach to ANOVA with effect coding. Mediation analyses will be conducted through a structural equation modeling approach, and moderation analyses will be conducted by extending the generalized linear model to include interaction effects. Results: This protocol has been reviewed and approved by the National Cancer Institute Central Institutional Review Board. Data collection is planned to begin in March 2024 and conclude in 2027. Conclusions: By identifying the combination of the fewest and least-intensive intervention components likely to provide survivors of breast cancer the greatest sexual health benefit, this study will result in the first internet intervention that is optimized for maximum impact on the undertreated, prevalent, and distressing problem of breast cancer–related sexual morbidity. Trial Registration: ClinicalTrials.gov NCT06216574; https://clinicaltrials.gov/study/NCT06216574 International Registered Report Identifier (IRRID): PRR1-10.2196/57781 %M 39159450 %R 10.2196/57781 %U https://www.researchprotocols.org/2024/1/e57781 %U https://doi.org/10.2196/57781 %U http://www.ncbi.nlm.nih.gov/pubmed/39159450 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e49197 %T Influence of Breast Cancer Awareness Month on Public Interest of Breast Cancer in High-Income Countries Between 2012 and 2022: Google Trends Analysis %A Ramadan,Majed %A Aboalola,Doaa %A Aouabdi,Sihem %A Alghamdi,Tariq %A Alsolami,Mona %A Samkari,Alaa %A Alsiary,Rawiah %+ Department of Cellular Therapy and Cancer Research, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, PO Box 9515, KSA Mail Code 6123, Jeddah, 21423, Saudi Arabia, 966 122246666 ext 46628, [email protected] %K Google Trends %K breast cancer %K pandemic %K awareness %K public interest %K cancer %K cancer awareness %K women %K mortality rate %K detection %K treatment %K social media %K tool %K education %K support %K internet users %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer is the most common cancer among women worldwide. High-income countries have a greater incidence and mortality rate of breast cancer than low-income countries. As a result, raising awareness about breast cancer is crucial in increasing the chances of early detection and treatment. Social media has evolved into an essential tool for Breast Cancer Awareness Month campaigns, allowing people to share their breast cancer stories and experiences while also providing a venue for education and support. Objective: The aim of this study was to assess the level of public interest in searches linked to breast cancer among a sample of high-income nations with a sizable internet user base from 2012 to 2022. We also sought to compare the proportional search volume for breast cancer during Breast Cancer Awareness Month with that during other months of the year. Methods: Google Trends was used to retrieve data on internet user search behaviors in the context of breast cancer from 2012 to 2022. Seven countries were evaluated in this study: Australia, Canada, Ireland, New Zealand, the United Kingdom, Saudi Arabia, and the United States, in addition to global data. Breast cancer relative search volume trends were analyzed annually, monthly, and weekly from 2012 to 2022. The annual percent change (APC) was calculated for each country and worldwide. Monthly and weekly data were used to identify potential trends. Results: A fluctuating pattern in APC rates was observed, with a notable increase in 2018 and a significant decrease in 2020, particularly in Saudi Arabia. Monthly analysis revealed a consistent peak in search volume during October (Breast Cancer Awareness Month) each year. Weekly trends over a 20-year period indicated significant decreases in Australia, Canada, New Zealand, and the United States, while increases were noted in Ireland. Heatmap analysis further highlighted a consistent elevation in median search volume during October across all countries. Conclusions: These findings underscore the impact of Breast Cancer Awareness Month and suggest potential influences of governmental COVID-19 pandemic control measures in 2020 on internet search behavior. %M 39133912 %R 10.2196/49197 %U https://cancer.jmir.org/2024/1/e49197 %U https://doi.org/10.2196/49197 %U http://www.ncbi.nlm.nih.gov/pubmed/39133912 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e55438 %T Assessing the Relationship Between Neighborhood Socioeconomic Disadvantage and Telemedicine Use Among Patients With Breast Cancer and Examining Differential Provisions of Oncology Services Between Telehealth and In-Person Visits: Quantitative Study %A Freeman,Jincong Q %A Zhao,Fangyuan %A Howard,Frederick M %A Nanda,Rita %A Olopade,Olufunmilayo I %A Huo,Dezheng %+ Department of Public Health Sciences, University of Chicago, MC2000, 5841 S Maryland Ave, Chicago, IL, 60637, United States, 1 773 702 2453, [email protected] %K telemedicine %K telehealth equity %K Area Deprivation Index %K neighborhood socioeconomic disadvantage %K disparities %K oncology services %K treatment consultation %K genetic counseling %K in-person visits %K breast cancer %K mobile phone %D 2024 %7 18.7.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Since the COVID-19 pandemic began, we have seen rapid growth in telemedicine use. However, telehealth care and services are not equally distributed, and not all patients with breast cancer have equal access across US regions. There are notable gaps in existing literature regarding the influence of neighborhood-level socioeconomic status on telemedicine use in patients with breast cancer and oncology services offered through telehealth versus in-person visits. Objective: We assessed the relationship between neighborhood socioeconomic disadvantage and telemedicine use among patients with breast cancer and examined differential provisions of oncology services between telehealth and in-person visits. Methods: Neighborhood socioeconomic disadvantage was measured using the Area Deprivation Index (ADI), with higher scores indicating greater disadvantages. Telemedicine and in-person visits were defined as having had a telehealth and in-person visit with a provider, respectively, in the past 12 months. Multivariable logistic regression was performed to examine the association between ADI and telemedicine use. The McNemar test was used to assess match-paired data on types of oncology services comparing telehealth and in-person visits. Results: The mean age of the patients with breast cancer (n=1163) was 61.8 (SD 12.0) years; 4.58% (52/1161) identified as Asian, 19.72% (229/1161) as Black, 3.01% (35/1161) as Hispanic, and 72.78% (845/1161) as White. Overall, 35.96% (416/1157) had a telemedicine visit in the past 12 months. Of these patients, 65% (266/409) had a videoconference visit only, 22.7% (93/409) had a telephone visit only, and 12.2% (50/409) had visits by both videoconference and telephone. Higher ADI scores were associated with a lower likelihood of telemedicine use (adjusted odds ratio [AOR] 0.89, 95% CI 0.82-0.97). Black (AOR 2.38, 95% CI 1.41-4.00) and Hispanic (AOR 2.65, 95% CI 1.07-6.58) patients had greater odds of telemedicine use than White patients. Compared to patients with high school or less education, those with an associate’s degree (AOR 2.67, 95% CI 1.33-5.35), a bachelor’s degree (AOR 2.75, 95% CI 1.38-5.48), or a graduate or professional degree (AOR 2.57, 95% CI 1.31-5.04) had higher odds of telemedicine use in the past 12 months. There were no significant differences in providing treatment consultation (45/405, 11.1% vs 55/405, 13.6%; P=.32) or cancer genetic counseling (11/405, 2.7% vs 19/405, 4.7%; P=.14) between telehealth and in-person visits. Of the telemedicine users, 95.8% (390/407) reported being somewhat to extremely satisfied, and 61.8% (254/411) were likely or very likely to continue using telemedicine. Conclusions: In this study of a multiethnic cohort of patients with breast cancer, our findings suggest that neighborhood-level socioeconomic disparities exist in telemedicine use and that telehealth visits could be used to provide treatment consultation and cancer genetic counseling. Oncology programs should address these disparities and needs to improve care delivery and achieve telehealth equity for their patient populations. %M 39024570 %R 10.2196/55438 %U https://cancer.jmir.org/2024/1/e55438 %U https://doi.org/10.2196/55438 %U http://www.ncbi.nlm.nih.gov/pubmed/39024570 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e51072 %T Applying the Unified Theory of Acceptance and Use of Technology to Identify Factors Associated With Intention to Use Teledelivered Supportive Care Among Recently Diagnosed Breast Cancer Survivors During COVID-19 in Hong Kong: Cross-Sectional Survey %A Yeung,Nelson C Y %A Lau,Stephanie T Y %A Mak,Winnie W S %A Cheng,Cecilia %A Chan,Emily Y Y %A Siu,Judy Y M %A Cheung,Polly S Y %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, Postgraduate Education Centre, Prince of Wales Hospital, Hong Kong, China (Hong Kong), 852 22528740, [email protected] %K telehealth %K tele-delivered supportive cancer care %K breast cancer %K COVID-19 %K technology acceptance %K UTAUT %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Many supportive cancer care (SCC) services were teledelivered during COVID-19, but what facilitates patients’ intentions to use teledelivered SCC is unknown. Objective: The study aimed to use the unified theory of acceptance and use of technology to investigate the factors associated with the intentions of breast cancer survivors (BCS) in Hong Kong to use various types of teledelivered SCC (including psychosocial care, medical consultation, complementary care, peer support groups). Favorable telehealth-related perceptions (higher performance expectancy, lower effort expectancy, more facilitating conditions, positive social influences), less technological anxiety, and greater fear of COVID-19 were hypothesized to be associated with higher intentions to use teledelivered SCC. Moreover, the associations between telehealth-related perceptions and intentions to use teledelivered SCC were hypothesized to be moderated by education level, such that associations between telehealth-related perceptions and intentions to use teledelivered SCC would be stronger among those with a higher education level. Methods: A sample of 209 (209/287, 72.8% completion rate) women diagnosed with breast cancer since the start of the COVID-19 outbreak in Hong Kong (ie, January 2020) were recruited from the Hong Kong Breast Cancer Registry to complete a cross-sectional survey between June 2022 and December 2022. Participants’ intentions to use various types of teledelivered SCC (dependent variables), telehealth-related perceptions (independent variables), and sociodemographic variables (eg, education, as a moderator variable) were measured using self-reported, validated measures. Results: Hierarchical regression analysis results showed that greater confidence using telehealth, performance expectancy (believing telehealth helps with daily tasks), social influence (important others encouraging telehealth use), and facilitating conditions (having resources for telehealth use) were associated with higher intentions to use teledelivered SCC (range: β=0.16, P=.03 to β=0.34, P<.001). Moreover, 2-way interactions emerged between education level and 2 of the telehealth perception variables. Education level moderated the associations between (1) performance expectancy and intention to use teledelivered complementary care (β=0.34, P=.04) and (2) facilitating conditions and intention to use teledelivered peer support groups (β=0.36, P=.03). The positive associations between those telehealth perceptions and intentions were only significant among those with a higher education level. Conclusions: The findings of this study implied that enhancing BCS’ skills at using telehealth, BCS’ and their important others’ perceived benefits of telehealth, and providing assistance for telehealth use could increase BCS’ intentions to use teledelivered SCC. For intentions to use specific types of SCC, addressing relevant factors (performance expectancy, facilitating conditions) might be particularly beneficial for those with a higher education level. %M 38935942 %R 10.2196/51072 %U https://cancer.jmir.org/2024/1/e51072 %U https://doi.org/10.2196/51072 %U http://www.ncbi.nlm.nih.gov/pubmed/38935942 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e51210 %T Heart Rate Monitoring Among Breast Cancer Survivors: Quantitative Study of Device Agreement in a Community-Based Exercise Program %A Page,Lindsey L %A Fanning,Jason %A Phipps,Connor %A Berger,Ann %A Reed,Elizabeth %A Ehlers,Diane %+ Department of Quantitative Health Sciences, Division of Epidemiology, Mayo Clinic Arizona, 200 First Street SW, Rochester, AZ, 55905, United States, 1 408 574 2739, [email protected] %K wearable devices %K exercise prescription %K validity %K photoplethysmography %K monitoring %K wearables %K devices %K exercise %K heart rate %K breast cancer %K cancer %K cancer survivor %K community %K chest monitor %K Fitbit %K recovery %K safety %D 2024 %7 20.6.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Exercise intensity (eg, target heart rate [HR]) is a fundamental component of exercise prescription to elicit health benefits in cancer survivors. Despite the validity of chest-worn monitors, their feasibility in community and unsupervised exercise settings may be challenging. As wearable technology continues to improve, consumer-based wearable sensors may represent an accessible alternative to traditional monitoring, offering additional advantages. Objective: The purpose of this study was to examine the agreement between the Polar H10 chest monitor and Fitbit Inspire HR for HR measurement in breast cancer survivors enrolled in the intervention arm of a randomized, pilot exercise trial. Methods: Participants included breast cancer survivors (N=14; aged 38-72 years) randomized to a 12-week aerobic exercise program. This program consisted of three 60-minute, moderate-intensity walking sessions per week, either in small groups or one-on-one, facilitated by a certified exercise physiologist and held at local community fitness centers. As originally designed, the exercise prescription included 36 supervised sessions at a fitness center. However, due to the COVID-19 pandemic, the number of supervised sessions varied depending on whether participants enrolled before or after March 2020. During each exercise session, HR (in beats per minute) was concurrently measured via a Polar H10 chest monitor and a wrist-worn Fitbit Inspire HR at 5 stages: pre-exercise rest; midpoint of warm-up; midpoint of exercise session; midpoint of cool-down; and postexercise recovery. The exercise physiologist recorded the participant’s HR from each device at the midpoint of each stage. HR agreement between the Polar H10 and Fitbit Inspire HR was assessed using Lin concordance correlation coefficient (rc) with a 95% CI. Lin rc ranges from 0 to 1.00, with 0 indicating no concordance and 1.00 indicating perfect concordance. Relative error rates were calculated to examine differences across exercise session stages. Results: Data were available for 200 supervised sessions across the sample (session per participant: mean 13.33, SD 13.7). By exercise session stage, agreement between the Polar H10 monitor and the Fitbit was highest during pre-exercise seated rest (rc=0.76, 95% CI 0.70-0.81) and postexercise seated recovery (rc=0.89, 95% CI 0.86-0.92), followed by the midpoint of exercise (rc=0.63, 95% CI 0.55-0.70) and cool-down (rc=0.68, 95% CI 0.60-0.74). The agreement was lowest during warm-up (rc=0.39, 95% CI 0.27-0.49). Relative error rates ranged from –3.91% to 3.09% and were greatest during warm-up (relative error rate: mean –3.91, SD 11.92%). Conclusions: The Fitbit overestimated HR during peak exercise intensity, posing risks for overexercising, which may not be safe for breast cancer survivors’ fitness levels. While the Fitbit Inspire HR may be used to estimate exercise HR, precautions are needed when considering participant safety and data interpretation. Trial Registration: Clinicaltrials.gov NCT03980626; https://clinicaltrials.gov/study/NCT03980626?term=NCT03980626&rank=1 %M 38900505 %R 10.2196/51210 %U https://cancer.jmir.org/2024/1/e51210 %U https://doi.org/10.2196/51210 %U http://www.ncbi.nlm.nih.gov/pubmed/38900505 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52494 %T Adapting an Efficacious Peer-Delivered Physical Activity Program for Survivors of Breast Cancer for Web Platform Delivery: Protocol for a 2-Phase Study %A Pinto,Bernardine M %A Patel,Ashwin %A Ostendorf,Danielle M %A Huebschmann,Amy G %A Dunsiger,Shira I %A Kindred,Madison M %+ College of Nursing, University of South Carolina, 1601 Greene Street, Rm 302B, Columbia, SC, 29208, United States, 1 8037779272, [email protected] %K physical activity adoption %K web platform %K breast cancer survivors %K design %K implementation %K cost-effectiveness %K mobile phone %D 2024 %7 19.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Interventions promoting physical activity (PA) among survivors of cancer improve their functioning, reduce fatigue, and offer other benefits in cancer recovery and risk reduction for future cancer. There is a need for interventions that can be implemented on a wider scale than that is possible in research settings. We have previously demonstrated that a 3-month peer-delivered PA program (Moving Forward Together [MFT]) significantly increased the moderate to vigorous PA (MVPA) of survivors of breast cancer. Objective: Our goal is to scale up the MFT program by adapting an existing peer mentoring web platform, Mentor1to1. InquistHealth’s web platform (Mentor1to1) has demonstrated efficacy in peer mentoring for chronic disease management. We will partner with InquisitHealth to adapt their web platform for MFT. The adaptation will allow for automating key resource-intensive components such as matching survivors with a coach via the web-based peer mentoring platform and collecting key indexes to prepare for large-scale implementation. The aim is to streamline intervention delivery, assure fidelity, and improve survivor outcomes. Methods: In phase 1 of this 2-phase study, we will interview 4 peer mentors or coaches with experience in delivering MFT and use their feedback to create Mentor1to1 web platform adapted for MFT (webMFT). Next, another 4 coaches will participate in rapid, iterative user-centered testing of webMFT. In phase 2, we will conduct a randomized controlled trial by recruiting and training 10 to 12 coaches from cancer organizations to deliver webMFT to 56 survivors of breast cancer, who will be assigned to receive either webMFT or MVPA tracking (control) for 3 months. We will assess effectiveness with survivors’ accelerometer-measured MVPA and self-reported psychosocial well-being at baseline and 3 months. We will assess implementation outcomes, including acceptability, feasibility, and program costs from the perspective of survivors, coaches, and collaborating organizations, as guided by the expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. Results: As of September 2023, phase 1 of the study was completed, and 61 survivors were enrolled in phase 2. Using newer technologies for enhanced intervention delivery, program management, and automated data collection has the exciting promise of facilitating effective implementation by organizations with limited resources. Adapting evidence-based MFT to a customized web platform and collecting data at multiple levels (coaches, survivors, and organizations) along with costs will provide a strong foundation for a robust multisite implementation trial to increase MVPA and its benefits among many more survivors of breast cancer. Conclusions: The quantitative and qualitative data collected from survivors of cancer, coaches, and organizations will be analyzed to inform a future larger-scale trial of peer mentoring for PA delivered by cancer care organizations to survivors. Trial Registration: ClinicalTrials.gov NCT05409664; https://clinicaltrials.gov/study/NCT05409664 International Registered Report Identifier (IRRID): DERR1-10.2196/52494 %M 38896452 %R 10.2196/52494 %U https://www.researchprotocols.org/2024/1/e52494 %U https://doi.org/10.2196/52494 %U http://www.ncbi.nlm.nih.gov/pubmed/38896452 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50224 %T Intensive Longitudinal Methods Among Adults With Breast or Lung Cancer: Scoping Review %A Geeraerts,Joran %A de Nooijer,Kim %A Pivodic,Lara %A De Ridder,Mark %A Van den Block,Lieve %+ End-of-Life Care Research Group, Vrije Universiteit Brussel, Laarbeeklaan 103, Brussels, 1090, Belgium, 32 2 477 47 56, [email protected] %K diary %K ecological momentary assessment %K neoplasms %K quality of life %K self-report %K telemedicine %K scoping review %K longitudinal methods %K breast cancer %K lung cancer %K patients with cancer %K cancer %K intensive monitoring %K advanced disease stages %K mobile phone %D 2024 %7 12.6.2024 %9 Review %J J Med Internet Res %G English %X Background: Intensive longitudinal methods offer a powerful tool for capturing daily experiences of individuals. However, its feasibility, effectiveness, and optimal methodological approaches for studying or monitoring experiences of oncology patients remain uncertain. Objective: This scoping review aims to describe to what extent intensive longitudinal methods with daily electronic assessments have been used among patients with breast or lung cancer and with which methodologies, associated outcomes, and influencing factors. Methods: We searched the electronic databases (PubMed, Embase, and PsycINFO) up to January 2024 and included studies reporting on the use of these methods among adults with breast or lung cancer. Data were extracted on population characteristics, intensive monitoring methodologies used, study findings, and factors influencing the implementation of these methods in research and clinical practice. Results: We identified 1311 articles and included 52 articles reporting on 41 studies. Study aims and intensive monitoring methodologies varied widely, but most studies focused on measuring physical and psychological symptom constructs, such as pain, anxiety, or depression. Compliance and attrition rates seemed acceptable for most studies, although complete methodological reporting was often lacking. Few studies specifically examined these methods among patients with advanced cancer. Factors influencing implementation were linked to both patient (eg, confidence with intensive monitoring system) and methodology (eg, option to use personal devices). Conclusions: Intensive longitudinal methods with daily electronic assessments hold promise to provide unique insights into the daily lives of patients with cancer. Intensive longitudinal methods may be feasible among people with breast or lung cancer. Our findings encourage further research to determine optimal conditions for intensive monitoring, specifically in more advanced disease stages. %M 38865186 %R 10.2196/50224 %U https://www.jmir.org/2024/1/e50224 %U https://doi.org/10.2196/50224 %U http://www.ncbi.nlm.nih.gov/pubmed/38865186 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e50783 %T Effects of the “AI-TA” Mobile App With Intelligent Design on Psychological and Related Symptoms of Young Survivors of Breast Cancer: Randomized Controlled Trial %A Jiang,Lulu %A Xu,Jiehui %A Wu,Yanwei %A Liu,Yanyan %A Wang,Xiyi %A Hu,Yun %+ School of Nursing, Shanghai Jiao Tong University, No.277 Chongqing South Roud, Huangpu District, Shanghai, 200025, China, 86 021 63546078, [email protected] %K mobile app %K artificial intelligence %K interactivity %K breast cancer %K psychological symptoms %K self-efficacy %K social support %K quality of life %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young women often face substantial psychological challenges in the initial years following cancer diagnosis, leading to a comparatively lower quality of life than older survivors. While mobile apps have emerged as potential interventions, their effectiveness remains inconclusive due to the diversity in intervention types and variation in follow-up periods. Furthermore, there is a particular dearth of evidence regarding the efficacy of these apps’ intelligent features in addressing psychological distress with these apps. Objective: This study aims to evaluate the effectiveness of a mobile app with intelligent design called “AI-TA” on cancer-related psychological health and ongoing symptoms with a randomized controlled design. Methods: Women aged 18 to 45 years diagnosed with breast cancer were randomly assigned to the intervention or control group. The intervention was AI-TA, which included 2-way web-based follow-up every 2 weeks. Both intention-to-treat (ITT) and per-protocol (PP) analyses employed repeated measurement analysis of variance. The participants’ background features, primary outcomes (psychological distress and frequency, self-efficacy, and social support), and secondary outcomes (quality of life) were measured using multiple instruments at 3 time points (baseline, 1-month intervention, and 3-month intervention). Results: A total of 124 participants were randomly allocated to the control group (n=62, 50%) or intervention group (n=62, 50%). In total, 92.7% (115/124) of the participants completed the intervention. Significant improvements in psychological symptoms (Memorial Symptom Assessment Scale-Short Form) were observed in the ITT group from baseline to 1-month intervention relative to the control group (ITT vs control: 1.17 vs 1.23; P<.001), which persisted at 3-month follow-up (ITT vs control: 0.68 vs 0.91; P<.001). Both the ITT and PP groups exhibited greater improvements in self-efficacy (Cancer Behavior Inventory-Brief Version) than the control group at 1-month (ITT vs PP vs control: 82.83 vs 77.12 vs 65.35; P<.001) and 3-month intervention (ITT vs PP vs control: 92.83 vs 89.30 vs 85.65; P<.001). However, the change in social support (Social Support Rating Scale) did not increase significantly until 3-month intervention (ITT vs control: 50.09 vs 45.10; P=.002) (PP vs control: 49.78 vs 45.10; P<.001). All groups also experienced beneficial effects on quality of life (Functional Assessment of Cancer Therapy-Breast), which persisted at 3-month follow-up (P<.001). Conclusions: The intelligent mobile app AI-TA incorporating intelligent design shows promise for reducing psychological and cancer-related symptoms among young survivors of breast cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200058823; https://www.chictr.org.cn/showproj.html?proj=151195 %M 38833298 %R 10.2196/50783 %U https://mhealth.jmir.org/2024/1/e50783 %U https://doi.org/10.2196/50783 %U http://www.ncbi.nlm.nih.gov/pubmed/38833298 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53872 %T Assessing the Content and Effect of Web-Based Decision Aids for Postmastectomy Breast Reconstruction: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Yu,Lin %A Gong,Jianmei %A Sun,Xiaoting %A Zang,Min %A Liu,Lei %A Yu,Shengmiao %+ School of Nursing, Liaoning University of Chinese Traditional Medicine, No.79 Chongshan Dong Road, Shenyang, 110000, China, 86 17824909908, [email protected] %K decision aids %K internet %K postmastectomy breast reconstruction %K decision conflicts %K mobile phone %D 2024 %7 27.5.2024 %9 Review %J J Med Internet Res %G English %X Background: Web-based decision aids have been shown to have a positive effect when used to improve the quality of decision-making for women facing postmastectomy breast reconstruction (PMBR). However, the existing findings regarding these interventions are still incongruent, and the overall effect is unclear. Objective: We aimed to assess the content of web-based decision aids and its impact on decision-related outcomes (ie, decision conflict, decision regret, informed choice, and knowledge), psychological-related outcomes (ie, satisfaction and anxiety), and surgical decision-making in women facing PMBR. Methods: This systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 6 databases, PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Web of Science Core Collection, were searched starting at the time of establishment of the databases to May 2023, and an updated search was conducted on April 1, 2024. MeSH (Medical Subject Headings) terms and text words were used. The Cochrane Risk of Bias Tool for randomized controlled trials was used to assess the risk of bias. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results: In total, 7 studies included 579 women and were published between 2008 and 2023, and the sample size in each study ranged from 26 to 222. The results showed that web-based decision aids used audio and video to present the pros and cons of PMBR versus no PMBR, implants versus flaps, and immediate versus delayed PMBR and the appearance and feel of the PMBR results and the expected recovery time with photographs of actual patients. Web-based decision aids help improve PMBR knowledge, decisional conflict (mean difference [MD]=–5.43, 95% CI –8.87 to –1.99; P=.002), and satisfaction (standardized MD=0.48, 95% CI 0.00 to 0.95; P=.05) but have no effect on informed choice (MD=–2.80, 95% CI –8.54 to 2.94; P=.34), decision regret (MD=–1.55, 95% CI –6.00 to 2.90 P=.49), or anxiety (standardized MD=0.04, 95% CI –0.50 to 0.58; P=.88). The overall Grading of Recommendations, Assessment, Development, and Evaluation quality of the evidence was low. Conclusions: The findings suggest that the web-based decision aids provide a modern, low-cost, and high dissemination rate effective method to promote the improved quality of decision-making in women undergoing PMBR. Trial Registration: PROSPERO CRD42023450496; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=450496 %M 38801766 %R 10.2196/53872 %U https://www.jmir.org/2024/1/e53872 %U https://doi.org/10.2196/53872 %U http://www.ncbi.nlm.nih.gov/pubmed/38801766 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55692 %T An Immersive Virtual Reality Intervention for Preoperative Anxiety and Distress Among Adults Undergoing Oncological Surgery: Protocol for a 3-Phase Development and Feasibility Trial %A El-Gabalawy,Renée %A Sommer,Jordana L %A Hebbard,Pamela %A Reynolds,Kristin %A Logan,Gabrielle S %A Smith,Michael S D %A Mutter,Thomas C %A Mutch,W Alan %A Mota,Natalie %A Proulx,Catherine %A Gagnon Shaigetz,Vincent %A Maples-Keller,Jessica L %A Arora,Rakesh C %A Perrin,David %A Benedictson,Jada %A Jacobsohn,Eric %+ Department of Clinical Health Psychology, University of Manitoba, PZ-339 771 Bannatyne Avenue, Winnipeg, MB, R3E 3N4, Canada, 1 (204) 787 4713, [email protected] %K virtual reality %K preoperative anxiety and distress %K perioperative mental health %K breast cancer %K oncological surgery %D 2024 %7 14.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Preoperative state anxiety (PSA) is distress and anxiety directly associated with perioperative events. PSA is associated with negative postoperative outcomes such as longer hospital length of stay, increased pain and opioid use, and higher rates of rehospitalization. Psychological prehabilitation, such as education, exposure to hospital environments, and relaxation strategies, has been shown to mitigate PSA; however, there are limited skilled personnel to deliver such interventions in clinical practice. Immersive virtual reality (VR) has the potential for greater accessibility and enhanced integration into an immersive and interactive experience. VR is rarely used in the preoperative setting, but similar forms of stress inoculation training involving exposure to stressful events have improved psychological preparation in contexts such as military deployment. Objective: This study seeks to develop and investigate a targeted PSA intervention in patients undergoing oncological surgery using a single preoperative VR exposure. The primary objectives are to (1) develop a novel VR program for patients undergoing oncological surgery with general anesthesia; (2) assess the feasibility, including acceptability, of a single exposure to this intervention; (3) assess the feasibility, including acceptability, of outcome measures of PSA; and (4) use these results to refine the VR content and outcome measures for a larger trial. A secondary objective is to preliminarily assess the clinical utility of the intervention for PSA. Methods: This study comprises 3 phases. Phase 1 (completed) involved the development of a VR prototype targeting PSA, using multidisciplinary iterative input. Phase 2 (data collection completed) involves examining the feasibility aspects of the VR intervention. This randomized feasibility trial involves assessing the novel VR preoperative intervention compared to a VR control (ie, nature trek) condition and a treatment-as-usual group among patients undergoing breast cancer surgery. Phase 3 will involve refining the prototype based on feasibility findings and input from people with lived experience for a future clinical trial, using focus groups with participants from phase 2. Results: This study was funded in March 2019. Phase 1 was completed in April 2020. Phase 2 data collection was completed in January 2024 and data analysis is ongoing. Focus groups were completed in February 2024. Both the feasibility study and focus groups will contribute to further refinement of the initial VR prototype (phase 3), with the final simulation to be completed by mid-2024. Conclusions: The findings from this work will contribute to the limited body of research examining feasible and broadly accessible interventions for PSA. Knowledge gained from this research will contribute to the final development of a novel VR intervention to be tested in a large population of patients with cancer before surgery in a randomized clinical trial. Trial Registration: ClinicalTrials.gov NCT04544618; https://www.clinicaltrials.gov/study/NCT04544618 International Registered Report Identifier (IRRID): DERR1-10.2196/55692 %M 38743939 %R 10.2196/55692 %U https://www.researchprotocols.org/2024/1/e55692 %U https://doi.org/10.2196/55692 %U http://www.ncbi.nlm.nih.gov/pubmed/38743939 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e51332 %T Differing Content and Language Based on Poster-Patient Relationships on the Chinese Social Media Platform Weibo: Text Classification, Sentiment Analysis, and Topic Modeling of Posts on Breast Cancer %A Zhang,Zhouqing %A Liew,Kongmeng %A Kuijer,Roeline %A She,Wan Jou %A Yada,Shuntaro %A Wakamiya,Shoko %A Aramaki,Eiji %+ School of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand, 64 3 369 4333, [email protected] %K cancer %K social media %K text classification %K topic modeling %K sentiment analysis %K Weibo %D 2024 %7 9.5.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer affects the lives of not only those diagnosed but also the people around them. Many of those affected share their experiences on social media. However, these narratives may differ according to who the poster is and what their relationship with the patient is; a patient posting about their experiences may post different content from someone whose friends or family has breast cancer. Weibo is 1 of the most popular social media platforms in China, and breast cancer–related posts are frequently found there. Objective: With the goal of understanding the different experiences of those affected by breast cancer in China, we aimed to explore how content and language used in relevant posts differ according to who the poster is and what their relationship with the patient is and whether there are differences in emotional expression and topic content if the patient is the poster themselves or a friend, family member, relative, or acquaintance. Methods: We used Weibo as a resource to examine how posts differ according to the different poster-patient relationships. We collected a total of 10,322 relevant Weibo posts. Using a 2-step analysis method, we fine-tuned 2 Chinese Robustly Optimized Bidirectional Encoder Representations from Transformers (BERT) Pretraining Approach models on this data set with annotated poster-patient relationships. These models were lined in sequence, first a binary classifier (no_patient or patient) and then a multiclass classifier (post_user, family_members, friends_relatives, acquaintances, heard_relation), to classify poster-patient relationships. Next, we used the Linguistic Inquiry and Word Count lexicon to conduct sentiment analysis from 5 emotion categories (positive and negative emotions, anger, sadness, and anxiety), followed by topic modeling (BERTopic). Results: Our binary model (F1-score=0.92) and multiclass model (F1-score=0.83) were largely able to classify poster-patient relationships accurately. Subsequent sentiment analysis showed significant differences in emotion categories across all poster-patient relationships. Notably, negative emotions and anger were higher for the “no_patient” class, but sadness and anxiety were higher for the “family_members” class. Focusing on the top 30 topics, we also noted that topics on fears and anger toward cancer were higher in the “no_patient” class, but topics on cancer treatment were higher in the “family_members” class. Conclusions: Chinese users post different types of content, depending on the poster- poster-patient relationships. If the patient is family, posts are sadder and more anxious but also contain more content on treatments. However, if no patient is detected, posts show higher levels of anger. We think that these may stem from rants from posters, which may help with emotion regulation and gathering social support. %M 38723250 %R 10.2196/51332 %U https://cancer.jmir.org/2024/1/e51332 %U https://doi.org/10.2196/51332 %U http://www.ncbi.nlm.nih.gov/pubmed/38723250 %0 Journal Article %@ 2291-9279 %I %V 12 %N %P e44025 %T Using Virtual Reality in a Rehabilitation Program for Patients With Breast Cancer: Phenomenological Study %A Wu,Shih-Chung %A Chuang,Chia-Wen %A Liao,Wen-Chun %A Li,Chung-Fang %A Shih,Hsin-Hsin %K breast cancer %K rehabilitation %K virtual reality %K VR %K virtual reality design process %K VR design process %K feasibility %K accessibility %D 2024 %7 16.4.2024 %9 %J JMIR Serious Games %G English %X Background: Surgery is an essential treatment for early-stage breast cancer. However, various side effects of breast cancer surgery, such as arm dysfunction and lymphedema, remain causes for concern. Rehabilitation exercises to prevent such side effects should be initiated within 24 hours after surgery. Virtual reality (VR) can assist the process of rehabilitation; however, the feasibility of applying VR for rehabilitation must be explored, in addition to experiences of this application. Objective: This study explored patients’ attitudes toward and experiences of using VR for their rehabilitation to determine the feasibility of such VR use and to identify potential barriers. Methods: A phenomenological qualitative study was conducted from September to December 2021. A total of 18 patients with breast cancer who had undergone surgical treatment were interviewed using open-ended questions. The Colaizzi 7-step procedure for phenomenological analysis was used for data analysis. To ensure high study reliability, this study followed previously reported quality criteria for trustworthiness. Results: Three themes were identified: (1) VR was powerful in facilitating rehabilitation, (2) early and repetitive upper limb movements were an advantage of VR rehabilitation, and (3) extensive VR use had challenges to be overcome. Most of the interviewed patients reported positive experiences of using VR for rehabilitation. Specifically, VR helped these patients identify appropriate motion and angle limits while exercising; in other words, knowledge gained through VR can play a key role in the rehabilitation process. In addition, the patients reported that the use of VR provided them company, similar to when a physiotherapist is present. Finally, the gamified nature of the VR system seemed to make VR-based rehabilitation more engaging than traditional rehabilitation, particularly with respect to early rehabilitation; however, the high cost of VR equipment made VR-based rehabilitation difficult to implement at home. Conclusions: The interviewed patients with breast cancer had positive experiences in using VR for rehabilitation. The high cost of both VR equipment and software development presents a challenge for applying VR-based rehabilitation. %R 10.2196/44025 %U https://games.jmir.org/2024/1/e44025 %U https://doi.org/10.2196/44025 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53301 %T Evaluating a Remotely Delivered Cardio-Oncology Rehabilitation Intervention for Patients With Breast Cancer (REMOTE-COR-B): Protocol for a Single-Arm Feasibility Trial %A Short,Camille E %A Rawstorn,Jonathan C %A Jones,Tamara L %A Edbrooke,Lara %A Hayes,Sandra C %A Maddison,Ralph %A Nightingale,Sophie %A Ismail,Hilmy %A De Boer,Richard %A Hegi-Johnson,Fiona %A Sverdlov,Aaron L %A Bell,Robyn %A Halligan,Irene %A Denehy,Linda %+ Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, The University of Melbourne, Tin Alley, Melbourne, 3010, Australia, 61 0408 288 786, [email protected] %K breast cancer survivor %K breast cancer %K cancer survivor %K cancer %K cardiac rehabilitation %K cardiac %K cardiotoxicity %K cardiovascular disease %K digital health %K efficacy %K exercise %K exercise %K feasibility %K fitness %K rehabilitation intervention %K rehabilitation %K safety %D 2024 %7 5.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Exercise rehabilitation is a promising strategy for reducing cardiovascular disease risk among patients with breast cancer. However, the evidence is primarily derived from programs based at exercise centers with in-person supervised delivery. Conversely, most patients report a preference for home-based rehabilitation. As such, there is a clear need to explore strategies that can provide real-time supervision and coaching while addressing consumer preferences. Evidence from cardiac rehabilitation has demonstrated the noninferiority of a smartphone-based telerehabilitation approach (REMOTE-CR) to improve cardiorespiratory fitness in people with cardiovascular disease compared to a center-based program. Objective: This study aims to assess the feasibility, safety, and preliminary efficacy of the REMOTE-CR program adapted for patients with breast cancer at risk of cardiotoxicity (REMOTE-COR-B). We will also assess the satisfaction and usability of REMOTE-COR-B. Methods: We will conduct a single-arm feasibility study of the REMOTE-COR-B program among patients with stage I-III breast cancer who are at risk of cardiotoxicity (taking treatment type and dose, as well as other common cardiovascular disease risk factors into account) and who are within 24 months of completing primary definitive treatment. Participants (target sample size of 40) will receive an 8-week smartphone-based telerehabilitation exercise program involving remotely delivered real-time supervision and behavior change support. The platform comprises a smartphone and wearable heart rate monitor, as well as a custom-built smartphone app and web application. Participants will be able to attend remotely monitored exercise sessions during set operating hours each week, scheduled in both the morning and evening. Adherence is the primary outcome of the trial, assessed through the number of remotely monitored exercise sessions attended compared to the trial target (ie, 3 sessions per week). Secondary outcomes include additional trial feasibility indicators (eg, recruitment and retention), safety, satisfaction, and usability, and objective and patient-reported efficacy outcomes (cardiovascular fitness, quality of life, fatigue, self-reported exercise, self-efficacy, habit strength, and motivation). Adherence, feasibility, and safety outcomes will be assessed during the intervention period; intervention satisfaction and usability will be assessed post intervention; and objective and patient-reported efficacy outcomes will be assessed at baseline, post intervention (2-month postbaseline assessment), and at follow-up (5-month postbaseline assessment). Results: Recruitment for this trial commenced in March 2023, and 7 participants had been recruited as of the submission of the manuscript. The estimated completion date for the project is October 2024, with results expected to be published in mid-2025. Conclusions: The REMOTE-COR-B intervention is a novel and promising approach to providing exercise therapy to patients with breast cancer at risk of cardiotoxicity who have unique needs and heightened safety risks. This project will provide important information on the extent to which this approach is satisfactory to patients with breast cancer, safe, and potentially effective, which is necessary before larger-scale research or clinical projects. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001557820; www.anzctr.org.au/ACTRN12621001557820.aspx International Registered Report Identifier (IRRID): DERR1-10.2196/53301 %M 38578682 %R 10.2196/53301 %U https://www.researchprotocols.org/2024/1/e53301 %U https://doi.org/10.2196/53301 %U http://www.ncbi.nlm.nih.gov/pubmed/38578682 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e54178 %T Comparison of the Real-World Reporting of Symptoms and Well-Being for the HER2-Directed Trastuzumab Biosimilar Ogivri With Registry Data for Herceptin in the Treatment of Breast Cancer: Prospective Observational Study (OGIPRO) of Electronic Patient-Reported Outcomes %A Trojan,Andreas %A Roth,Sven %A Atassi,Ziad %A Kiessling,Michael %A Zenhaeusern,Reinhard %A Kadvany,Yannick %A Schumacher,Johannes %A Kullak-Ublick,Gerd A %A Aapro,Matti %A Eniu,Alexandru %+ Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich, 8091, Switzerland, 41 76 34 30 200, [email protected] %K breast cancer %K biosimilar %K trastuzumab %K electronic patient-reported outcome %K ePRO %K medidux %K app %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Trastuzumab has had a major impact on the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC). Anti-HER2 biosimilars such as Ogivri have demonstrated safety and clinical equivalence to trastuzumab (using Herceptin as the reference product) in clinical trials. To our knowledge, there has been no real-world report of the side effects and quality of life (QoL) in patients treated with biosimilars using electronic patient-reported outcomes (ePROs). Objective: The primary objective of this prospective observational study (OGIPRO study) was to compare the ePRO data related to treatment side effects collected with the medidux app in patients with HER2-positive BC treated with the trastuzumab biosimilar Ogivri (prospective cohort) to those obtained from historical cohorts treated with Herceptin alone or combined with pertuzumab and/or chemotherapy (ClinicalTrials.gov NCT02004496 and NCT03578731). Methods: Patients were treated with Ogivri alone or combined with pertuzumab and/or chemotherapy and hormone therapy in (neo)adjuvant and palliative settings. Patients used the medidux app to dynamically record symptoms (according to the Common Terminology Criteria for Adverse Events [CTCAE]), well-being (according to the Eastern Cooperative Oncology Group Performance Status scale), QoL (using the EQ-5D-5L questionnaire), cognitive capabilities, and vital parameters over 6 weeks. The primary endpoint was the mean CTCAE score. Key secondary endpoints included the mean well-being score. Data of this prospective cohort were compared with those of the historical cohorts (n=38 patients; median age 51, range 31-78 years). Results: Overall, 53 female patients with a median age of 54 years (range 31-87 years) were enrolled in the OGIPRO study. The mean CTCAE score was analyzed in 50 patients with available data on symptoms, while the mean well-being score was evaluated in 52 patients with available data. The most common symptoms reported in both cohorts included fatigue, taste disorder, nausea, diarrhea, dry mucosa, joint discomfort, tingling, sleep disorder, headache, and appetite loss. Most patients experienced minimal (grade 0) or mild (grade 1) toxicities in both cohorts. The mean CTCAE score was comparable between the prospective and historical cohorts (29.0 and 30.3, respectively; mean difference –1.27, 95% CI –7.24 to 4.70; P=.68). Similarly, no significant difference was found for the mean well-being score between the groups treated with the trastuzumab biosimilar Ogivri and Herceptin (74.3 and 69.8, respectively; mean difference 4.45, 95% CI –3.53 to 12.44; P=.28). Conclusions: Treatment of patients with HER2-positive BC with the trastuzumab biosimilar Ogivri resulted in equivalent symptoms, adverse events, and well-being as found for patients treated with Herceptin as determined by ePRO data. Hence, integration of an ePRO system into research and clinical practice can provide reliable information when investigating the real-world tolerability and outcomes of similar therapeutic compounds. Trial Registration: ClinicalTrials.gov NCT05234021; https://clinicaltrials.gov/study/NCT05234021 %M 38573759 %R 10.2196/54178 %U https://cancer.jmir.org/2024/1/e54178 %U https://doi.org/10.2196/54178 %U http://www.ncbi.nlm.nih.gov/pubmed/38573759 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50931 %T Assessing Knowledge, Competence, and Performance Following Web-Based Education on Early Breast Cancer Management: Health Care Professional Questionnaire Study and Anonymized Patient Records Analysis %A Gnant,Michael %A Abdullah,Khatijah Lim %A Boyle,Frances %A Huang,Chiun-Sheng %A Bickford,Katie %A Neunie,Sola %A Noble,Alexander %A Nunn,Anne %A Sproat,Caroline %A Harbeck,Nadia %A Barrios,Carlos %+ Comprehensive Cancer Center, Medical University of Vienna, Spitalgasse 23, BT86/E01, Vienna, 1090, Austria, 43 1 40160 35602, [email protected] %K continuing medical education %K early breast cancer %K performance %K risk stratification %K shared decision-making %D 2024 %7 21.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based learning activities are key components of continuing medical education (CME) for health care professionals (HCPs). However, the published outcomes of web-based educational interventions for early breast cancer (EBC) are limited. Objective: This study aims to objectively assess knowledge, competence, and performance among HCPs following participation in 2 EBC-focused CME activities and to identify the remaining educational gaps. Methods: We developed 2 CME-accredited web-based educational activities addressing high-risk EBC, including integration of shared decision-making to optimize patient care (touchMDT) and stratification for early identification of high-risk patients and novel treatment strategies (touchPANEL DISCUSSION). Knowledge, competence, and performance were assessed before and after the activities against an expanded outcomes framework (levels 1-5) using self-reported questionnaires and an analysis of anonymized data extracted from patient records. Results: Six months after the launch of the activity, 7047 and 8989 HCP participants engaged with touchMDT and touchPANEL DISCUSSION, respectively. The overall satisfaction was 82% (a total score of 20.6 out of 25) for the touchMDT and 88% (a total score of 21.9 out of 25) for the touchPANEL DISCUSSION. For the evaluation of knowledge and competence (50 respondents before the activity and 50 learners after the activity), there was a significant increase in the mean number of correctly answered questions from pre- to postactivity (touchMDT: median 4.0, IQR 3.0-5.0 to median 5.5, IQR 4.0-7.0; mean 4.00, SD 1.39 to mean 5.30, SD 1.56 and touchPANEL DISCUSSION: median 4.0, IQR 4.0-5.0 to median 6.0, IQR 5.0-7.0; mean 4.32, SD 1.30 to mean 5.88, SD 1.49; both P<.001). A significant improvement in self-reported performance (50 respondents before the activity and 50 learners after the activity) was observed in a combined analysis of both activities (median 3.0, IQR 2.0-3.0 to median 4.0, IQR 3.0-5.0; mean 2.82, SD 1.08 to mean 4.16, SD 1.45; P<.001). Patient record analysis (50 respondents before the activity and 50 learners after the activity) showed that the HCPs used a range of measures to determine EBC recurrence risk and revealed no significant differences in adjuvant therapies used before and after the activity (P=.97 and P>.99 for Ki-67 <20% and Ki-67 ≥20% tumors, respectively). The remaining educational gaps included strategies for implementing shared decision-making in clinical practice and the use of genetic and biomarker testing to guide treatment selection. Conclusions: Brief, web-based CME activities on EBC were associated with an improvement in HCP knowledge, competence, and self-reported performance and can help identify unmet needs to inform the design of future CME activities. %M 38512328 %R 10.2196/50931 %U https://formative.jmir.org/2024/1/e50931 %U https://doi.org/10.2196/50931 %U http://www.ncbi.nlm.nih.gov/pubmed/38512328 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55662 %T Effectiveness of Chinese Herbal Medicine as a Complementary Treatment for Neutropenia Prevention and Immunity Modulation During Chemotherapy in Patients With Breast Cancer: Protocol for a Real-World Pragmatic Clinical Trial %A Wang,Kai-Hung %A Shen,Hsuan-Shu %A Chu,Sung-Chao %A Wang,Tso-Fu %A Lin,Ching-Wei %A Huang,Wei-Han %A Wu,Yi-Feng %A Ho,Ching-Chun %A Pang,Cheng-Yoong %A Li,Chi-Cheng %+ Center of Stem Cell and Precision Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Xie-Li Building, 4th Floor, No. 707, Section 3, Chung-Yang Road, Hualien, 970, Taiwan, 886 03 8561825 ext 18661, [email protected] %K complementary treatment for cancer %K neutropenia %K real-world study %K bedside to bench study %K immune cell profile %K programmed cell death protein 1 %K PD-1 %K breast cancer %K breast %K cancer %K oncology %K Chinese medicine %K herb %K herbs %K herbal %K complementary %K immunity %K immunology %K immunomodulation %K immunological %K neutrophil %K chemotherapy %K blood cell %K blood cells %D 2024 %7 11.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In recent years, advancements in cancer treatment have enabled cancer cell inhibition, leading to improved patient outcomes. However, the side effects of chemotherapy, especially leukopenia, impact patients’ ability to tolerate their treatments and affect their quality of life. Traditional Chinese medicine is thought to provide complementary cancer treatment to improve the quality of life and prolong survival time among patients with cancer. Objective: This study aims to evaluate the effectiveness of Chinese herbal medicine (CHM) as a complementary treatment for neutropenia prevention and immunity modulation during chemotherapy in patients with breast cancer. Methods: We will conduct a real-world pragmatic clinical trial to evaluate the effectiveness of CHM as a supplementary therapy to prevent neutropenia in patients with breast cancer undergoing chemotherapy. Patients will be classified into CHM or non-CHM groups based on whether they received CHM during chemotherapy. Using generalized estimating equations or repeated measures ANOVA, we will assess differences in white blood cell counts, absolute neutrophil counts, immune cells, and programmed cell death protein 1 (PD-1) expression levels between the 2 groups. Results: This study was approved by the research ethics committee of Hualien Tzu Chi Hospital (IRB 110-168-A). The enrollment process began in September 2021 and will stop in December 2024. A total of 140 patients will be recruited. Data cleaning and analysis are expected to finish in the middle of 2025. Conclusions: Traditional Chinese medicine is the most commonly used complementary medicine, and it has been reported to significantly alleviate chemotherapy-related side effects. This study’s findings may contribute to developing effective interventions targeting chemotherapy-related neutropenia among patients with breast cancer in clinical practice. Trial Registration: International Traditional Medicine Clinical Trial Registry ITMCTR2023000054; https://tinyurl.com/yc353hes International Registered Report Identifier (IRRID): DERR1-10.2196/55662 %M 38466979 %R 10.2196/55662 %U https://www.researchprotocols.org/2024/1/e55662 %U https://doi.org/10.2196/55662 %U http://www.ncbi.nlm.nih.gov/pubmed/38466979 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50926 %T Usability and User Experience of an mHealth App for Therapy Support of Patients With Breast Cancer: Mixed Methods Study Using Eye Tracking %A Anders,Carolin %A Moorthy,Preetha %A Svensson,Laura %A Müller,Julia %A Heinze,Oliver %A Knaup,Petra %A Wallwiener,Markus %A Deutsch,Thomas M %A Le,Thao-Vy %A Weinert,Lina %+ Institute of Medical Informatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 622156 ext 34651, [email protected] %K mobile health %K mHealth %K usability %K breast cancer %K eye tracking %K user interface %K mixed methods %K mobile phone %D 2024 %7 5.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Early identification of quality of life (QoL) loss and side effects is a key challenge in breast cancer therapy. Digital tools can be helpful components of therapeutic support. Enable, a smartphone app, was used in a multicenter, prospective randomized controlled trial in 3 breast cancer centers. The app simultaneously serves as a therapy companion (eg, by displaying appointments), a tool for documenting QoL (eg, by enabling data collection for QoL questionnaires), and documentation of patient-reported side effects. The need for digital tools is continually rising. However, evidence of the effects of long-term use of mobile health (mHealth) apps in aftercare for patients with breast cancer is limited. Therefore, evaluating the usability and understanding the user experience of this mHealth app could potentially contribute valuable insights in this field. Objective: A usability study was conducted to explore how patients with breast cancer receiving neoadjuvant, adjuvant, or palliative outpatient treatment rated their engagement with the app , the user experience, and the benefits of using the app. Methods: A mixed methods approach was chosen to combine subjective and objective measures, including an eye-tracking procedure, a standardized usability questionnaire (mHealth App Usability Questionnaire), and semistructured interviews. Participants were surveyed twice during the study period. Interviews were transcribed verbatim and analyzed using thematic analysis. Analysis of the eye-tracking data was carried out using the tracker-integrated software. Descriptive analysis was conducted for the quantitative data. Results: The mHealth App Usability Questionnaire results (n=105) indicated good overall usability for 2 different time points (4 wk: mean 89.15, SD 9.65; 20 wk: mean 85.57, SD 12.88). The qualitative analysis of the eye-tracking recordings (n=10) and interviews (n=16) showed that users found the Enable app easy to use. The design of the app, information about therapies and side effects, and usefulness of the app as a therapy companion were rated positively. Additionally, participants contributed requests for additional app features and suggestions for improving the content and usability of the app. Relevant themes included optimization of the appointment feature, updating the app’s content regularly, and self-administration. In contrast to the app’s current passive method of operation, participants expressed a desire for more active engagement through messaging, alarms, or emails. Conclusions: The results of this study demonstrate the good usability of the Enable app as well as the potential for further development. We concluded from patients’ feedback and requests that mHealth apps could benefit from giving patients a more active role (eg, being able to actively document side effects as they occur). Additionally, regular updates of app content could further contribute to encouraging continued use of mHealth apps. Our findings may also assist other researchers in tailoring their mHealth apps to the actual needs of patients undergoing breast cancer therapy. %M 38441959 %R 10.2196/50926 %U https://humanfactors.jmir.org/2024/1/e50926 %U https://doi.org/10.2196/50926 %U http://www.ncbi.nlm.nih.gov/pubmed/38441959 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e48860 %T Toxic Relationships Described by People With Breast Cancer on Reddit: Topic Modeling Study %A Davidson,Cara Anne %A Booth,Richard %A Jackson,Kimberley Teresa %A Mantler,Tara %+ Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada, 1 519 661 2111 ext 85541, [email protected] %K breast cancer %K intimate partner violence %K meaning extraction method %K Reddit %K sentiment analysis %K social media %K social support %K toxic relationships %K topic modelling %D 2024 %7 23.2.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Social support is essential to promoting optimal health outcomes for women with breast cancer. However, an estimated 12% of women with breast cancer simultaneously experience intimate partner violence (IPV; physical, psychological, or sexual abuse by an intimate partner). Women who experience IPV during breast cancer may lack traditional social support, and thus seek out alternative sources of support. Online community forums, such as Reddit, can provide accessible social connections within breast cancer–specific communities. However, it is largely unknown how women with breast cancer use Reddit to describe and seek support for experiences of IPV. Objective: This study aims to explore how patients with breast cancer describe toxic relationships with their partners and immediate family members on Reddit. Methods: This exploratory, cross-sectional, topic-modeling study analyzed textual data from 96 users in the r/breastcancer subreddit in February 2023. The meaning extraction method, inclusive of principal component analysis, was used to identify underlying components. Components were subjected to sentiment analysis and summative content analysis with emergent categorical development to articulate themes. Results: Seven themes emerged related to toxic relationships: (1) contextualizing storytelling with lymph nodes, (2) toxic behavior and venting emotions, (3) abandonment and abuse following diagnosis, (4) toxic relationships and social-related fears, (5) inner strength and navigating breast cancer over time, (6) assessing social relationships and interactions, and (7) community advice and support. Toxic relationships were commonly characterized by isolation, abandonment, and emotional abuse, which had profound emotional consequences for patients. Reddit facilitated anonymous venting about toxic relationships that helped patients cope with intense feelings and stress. Exchanging advice and support about navigating toxic relationships during breast cancer were core functions of the r/breastcancer community. Conclusions: Findings emphasized the value of Reddit as a source of social support for patients with breast cancer experiencing toxic relationships. Clinicians who understand that many patients with breast cancer experience toxic relationships and considerable psychological sequelae are better prepared to support their patients’ holistic well-being. Further investigation of Reddit as a possible resource for advice, information, and support has the potential to help inform clinical practice and subsequently, patient health outcomes. %M 38393769 %R 10.2196/48860 %U https://cancer.jmir.org/2024/1/e48860 %U https://doi.org/10.2196/48860 %U http://www.ncbi.nlm.nih.gov/pubmed/38393769 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e49549 %T Development of an App for Symptom Management in Women With Breast Cancer Receiving Maintenance Aromatase Inhibitors: Protocol for a Mixed Methods Feasibility Study %A Lund-Jacobsen,Trine %A Schwarz,Peter %A Martino,Gabriella %A Pappot,Helle %A Piil,Karin %+ Department of Endocrinology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark, 45 25318056, [email protected] %K acceptability %K aromatase inhibitors %K breast cancer %K cancer %K chemotherapy %K disease %K feasibility %K inhibitor %K management %K mHealth %K postmenopausal %K psychosocial %K QoL %K quality of life %K radiation therapy %K symptom management %K symptom %K tool %K treatment %K usability %K user-friendliness %D 2024 %7 15.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with postmenopausal nonmetastatic estrogen receptor–positive breast cancer often experience a reduced quality of life after primary treatment. The disease and treatment trajectory consists of surgery followed by chemotherapy or radiation therapy. Upon this, maintenance hormone therapy with an aromatase inhibitor can result in several physical and psychosocial symptoms. Optimal symptom control during maintenance therapy is central to maintaining the patient’s quality of life. Objective: This study aims to (1) develop an electronic symptom management tool for patients with postmenopausal early breast cancer receiving maintenance aromatase inhibitors with an endocrine aspect and (2) assess the feasibility, acceptability, and usability of the pilot version of the Bone@BC app. Furthermore, longitudinally, symptom prevalence and quality of life for patients with postmenopausal nonmetastatic estrogen receptor–positive breast cancer will be explored. Methods: This study follows a multistage research plan. In stage 1, a systematic literature review to establish an overview of aromatase inhibitor–related symptoms reported by postmenopausal women with nonmetastatic estrogen receptor–positive breast cancer will be completed. In stage 2, a comprehensive overview of symptoms related to aromatase inhibitors (letrozole, exemestane, and anastrozole) will be performed (eg, by reviewing medical leaflets and guidelines). In stage 3, an electronic app with a user-friendly Patient Concern Inventory list to comprise symptoms and concerns will be developed. Last, in stage 4, a convergent mixed methods feasibility study of the pilot version of the Bone@BC app will be conducted. A total of 45 patients with postmenopausal nonmetastatic estrogen receptor–positive breast cancer will use the app daily for symptom identification and respond to 6 serial patient-reported outcome measurements for 12 weeks. Finally, semistructured interviews will be performed. The primary outcome includes consent rate, attrition rate, retention rates, technical issues, and adherence, assessed using preestablished criteria on feasibility and a mixed methods approach for exploring acceptability. A patient advisory board consisting of 5 women with breast cancer is recruited to include their perspectives and experiences in the planning, organization, implementation, and dissemination of the research throughout the project. Results: At the time of submitting this paper (January 2024), a total of 23 patients have been included in the stage 2 medical audit over the recruitment period of 3 months (November 2022 to February 2023), and 19 patients have been enrolled in stage 2, the semistructured patient interviews. Conclusions: This protocol describes a study investigating the feasibility, acceptability, and usability of the symptom management tool Bone@BC developed for patients with breast cancer with an endocrine aspect. Trial Registration: ClinicalTrails.gov NCT05367830; https://clinicaltrials.gov/ct2/show/NCT05367830 International Registered Report Identifier (IRRID): DERR1-10.2196/49549 %M 38358787 %R 10.2196/49549 %U https://www.researchprotocols.org/2024/1/e49549 %U https://doi.org/10.2196/49549 %U http://www.ncbi.nlm.nih.gov/pubmed/38358787 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51057 %T Reflective Engagement With a Digital Physical Activity Intervention Among People Living With and Beyond Breast Cancer: Mixed Methods Study %A Robertson,Michael C %A Cox-Martin,Emily %A Basen-Engquist,Karen %A Lyons,Elizabeth J %+ Department of Family and Preventive Medicine, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Pkwy #400, Oklahoma City, OK, 73104, United States, 1 405 271 6872, [email protected] %K survivors of cancer %K exercise %K acceptance and commitment therapy %K fatigue %K mindfulness %K motivation %K behavioral sciences %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: People living with and beyond breast cancer can face internal barriers to physical activity (eg, fatigue and pain). Digital interventions that promote psychological acceptance and motivation may help this population navigate these barriers. The degree to which individuals (1) adhere to intervention protocols and (2) reflect on and internalize intervention content may predict intervention efficacy. Objective: The objective of this study was to characterize the nature of reflective processes brought about by an 8-week acceptance- and mindfulness-based physical activity intervention for insufficiently active survivors of breast cancer (n=75). Furthermore, we explored the potential utility of a metric of reflective processes for predicting study outcomes. Methods: Of the intervention’s 8 weekly modules, 7 (88%) included an item that asked participants to reflect on what they found to be most useful. Two coders conducted directed content analysis on participants’ written responses. They assessed each comment’s depth of reflection using an existing framework (ranging from 0 to 4, with 0=simple description and 4=fundamental change with consideration of social and ethical issues). The coders identified themes within the various levels of reflection. We fit multiple linear regression models to evaluate whether participants’ (1) intervention adherence (ie, number of modules completed) and (2) the mean level of the depth of reflection predicted study outcomes. Results: Participants were aged on average 57.2 (SD 11.2) years, mostly non-Hispanic White (58/75, 77%), and mostly overweight or obese (54/75, 72%). Of the 407 responses to the item prompting personal reflection, 70 (17.2%) were rated as reflection level 0 (ie, description), 247 (60.7%) were level 1 (ie, reflective description), 74 (18.2%) were level 2 (ie, dialogic reflection), 14 (3.4%) were level 3 (ie, transformative reflection), and 2 (0.5%) were level 4 (ie, critical reflection). Lower levels of reflection were characterized by the acquisition of knowledge or expressing intentions. Higher levels were characterized by personal insight, commentary on behavior change processes, and a change of perspective. Intervention adherence was associated with increases in self-reported weekly bouts of muscle-strengthening exercise (B=0.26, SE 0.12, 95% CI 0.02-0.50) and decreases in sleep disturbance (B=−1.04, SE 0.50, 95% CI −0.06 to −2.02). The mean level of reflection was associated with increases in psychological acceptance (B=3.42, SE 1.70, 95% CI 0.09-6.75) and motivation for physical activity (ie, integrated regulation: B=0.55, SE 0.25, 95% CI 0.06-1.04). Conclusions: We identified a useful method for understanding the reflective processes that can occur during digital behavior change interventions serving people living with and beyond breast cancer. Intervention adherence and the depth of reflection each predicted changes in study outcomes. Deeper reflection on intervention content was associated with beneficial changes in the determinants of sustained behavior change. More research is needed to investigate the relations among digital behavior change intervention use, psychological processes, and intervention efficacy. %M 38335025 %R 10.2196/51057 %U https://mhealth.jmir.org/2024/1/e51057 %U https://doi.org/10.2196/51057 %U http://www.ncbi.nlm.nih.gov/pubmed/38335025 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51021 %T Support for Chronic Pain Management for Breast Cancer Survivors Through Novel Digital Health Ecosystems: Pilot Usability Study of the PainRELife Mobile App %A Masiero,Marianna %A Filipponi,Chiara %A Fragale,Elisa %A Pizzoli,Silvia Francesca Maria %A Munzone,Elisabetta %A Milani,Alessandra %A Guido,Luca %A Guardamagna,Vittorio %A Marceglia,Sara %A Prandin,Roberto %A Prenassi,Marco %A Caruso,Annamaria %A Manzelli,Vania %A Savino,Chiara %A Conti,Costanza %A Rizzi,Federica %A Casalino,Alice %A Candiani,Giulia %A Memini,Francesca %A Chiveri,Luca %A Vitali,Andrea Luigi %A Corbo,Massimo %A Grasso,Roberto %A Didier,Florence %A Ferrucci,Roberta %A Pravettoni,Gabriella %+ Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, Milan, 20122, Italy, 39 0294372009, [email protected] %K chronic pain %K eHealth %K cancer %K decision-making %K survivorship %K self-efficacy %K pain %K oncology %K health ecosystem %K health ecosystems %K breast %K survivor %K survivors %K mHealth %K mobile health %K app %K apps %K applications %K MARS %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain is one of the most common and critical long-term effects of breast cancer. Digital health technologies enhance the management of chronic pain by monitoring physical and psychological health status and supporting pain self-management and patient treatment decisions throughout the clinical pathway. Objective: This pilot study aims to evaluate patients’ experiences, including usability, with a novel digital integrated health ecosystem for chronic pain named PainRELife. The sample included patients with breast cancer during survivorship. The PainRELife ecosystem comprises a cloud technology platform interconnected with electronic health records and patients' devices to gather integrated health care data. Methods: We enrolled 25 patients with breast cancer (mean age 47.12 years) experiencing pain. They were instructed to use the PainRELife mobile app for 3 months consecutively. The Mobile Application Rating Scale (MARS) was used to evaluate usability. Furthermore, pain self-efficacy and participation in treatment decisions were evaluated. The study received ethical approval (R1597/21-IEO 1701) from the Ethical Committee of the European Institute of Oncology. Results: The MARS subscale scores were medium to high (range: 3.31-4.18), and the total app quality score was 3.90. Patients with breast cancer reported reduced pain intensity at 3 months, from a mean of 5 at T0 to a mean of 3.72 at T2 (P=.04). The total number of times the app was accessed was positively correlated with pain intensity at 3 months (P=.03). The engagement (P=.03), information (P=.04), and subjective quality (P=.007) subscales were positively correlated with shared decision-making. Furthermore, participants with a lower pain self-efficacy at T2 (mean 40.83) used the mobile app more than participants with a higher pain self-efficacy (mean 48.46; P=.057). Conclusions: The data collected in this study highlight that digital health technologies, when developed using a patient-driven approach, might be valuable tools for increasing participation in clinical care by patients with breast cancer, permitting them to achieve a series of key clinical outcomes and improving quality of life. Digital integrated health ecosystems might be important tools for improving ongoing monitoring of physical status, psychological burden, and socioeconomic issues during the cancer survivorship trajectory. International Registered Report Identifier (IRRID): RR2-10.2196/41216 %M 38306176 %R 10.2196/51021 %U https://formative.jmir.org/2024/1/e51021 %U https://doi.org/10.2196/51021 %U http://www.ncbi.nlm.nih.gov/pubmed/38306176 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46367 %T Preoperative Virtual Reality to Expose Patients With Breast Cancer to the Operating Room Environment: Feasibility and Pilot Case Series Study %A Sommer,Jordana L %A Reynolds,Kristin %A Hebbard,Pamela %A Smith,Michael S D %A Mota,Natalie %A Mutch,W Alan C %A Maples-Keller,Jessica %A Roos,Leslie %A El-Gabalawy,Renée %+ Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, AE207 Harry Medovy House, 671 William Avenue, Winnipeg, MB, R3E 0Z2, Canada, 1 204 787 4713, [email protected] %K virtual reality %K preoperative anxiety and distress %K breast cancer surgery %K anesthesia %K feasibility %K pilot %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinically elevated preoperative distress and anxiety are common among patients undergoing cancer surgery. Preoperative interventions have been developed to mitigate this distress and anxiety but are inconsistent in efficacy and feasibility for broad implementation. Objective: This preliminary pilot study aims to assess the feasibility and utility of a newly developed virtual reality (VR) intervention to expose patients awaiting breast cancer surgery to the operating room environment and a simulation of anesthetic induction. Methods: Patients undergoing breast cancer surgery (N=7) were assigned to the VR intervention or control (treatment as usual) group and completed self-report measures of distress and anxiety before surgery, on the day of surgery, and after surgery (5 and 30 d postoperatively). Those in the intervention group trialed the VR simulation 1 to 2 weeks preoperatively and provided qualitative and quantitative feedback. We assessed the feasibility of recruitment capability and study design and evaluated participants’ impressions of the intervention using self-report rating scales and open-ended questions. We also descriptively examined distress and anxiety levels throughout the duration of the study. Results: Recruitment occurred between December 2021 and December 2022 and progressed slowly (rate: 1 participant/7 wk on average; some hesitancy because of stress and being overwhelmed). All participants who consented to participate completed the entire study. All participants were female and aged 56 (SD 10.56) years on average. In total, 57% (4/7) of the participants were assigned to the intervention group. On average, intervention participants spent 12 minutes engaged in the VR simulation. In general, the intervention was rated favorably (eg, clear information, enjoyable, and attractive presentation; mean% agreement 95.00-96.25, SD 4.79-10.00) and as helpful (mean% agreement 87.50, SD 25.00). Participants described the intervention as realistic (eg, “It was realistic to my past surgical experiences”), impacting their degree of preparedness and expectations for surgery (eg, “The sounds and sights and procedures give you a test run; they prepare you for the actual day”), and having a calming or relaxing effect (eg, “You feel more relaxed for the surgery”). Conclusions: This preoperative VR intervention demonstrated preliminary feasibility among a sample of patients undergoing breast cancer surgery. Results and participant feedback will inform modifications to the VR intervention and the study design of a large-scale randomized controlled trial to examine the efficacy of this intervention. Trial Registration: ClinicalTrials.gov NCT04544618; https://clinicaltrials.gov/study/NCT04544618 %M 38231570 %R 10.2196/46367 %U https://formative.jmir.org/2024/1/e46367 %U https://doi.org/10.2196/46367 %U http://www.ncbi.nlm.nih.gov/pubmed/38231570 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e48428 %T Assessing the Quality, Privacy, and Security of Breast Cancer Apps for Arabic Speakers: Systematic Search and Review of Smartphone Apps %A Alhuwail,Dari %A Alhouti,Aisha %A Alsarhan,Latifah %+ Information Science Department, College of Life Sciences, Kuwait University, P.O. Box 5969, Sabah AlSalem University City, Safat 13060, Kuwait, 965 24633214, [email protected] %K apps %K Arabic %K awareness %K breast cancer %K consumer health informatics %K education %K mHealth %K mobile health %K privacy %K quality %K security %K smartphone %K women %D 2024 %7 16.1.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer is a widespread disease, and its incidence is rapidly increasing in the Middle East and North Africa region. With the increasing availability of smartphone apps for various health purposes, breast cancer apps have emerged as tools for raising awareness, providing support, and empowering women affected by this disease. These apps offer many features, including information on breast cancer risk factors, self-examination guides, appointment reminders, and community support groups or hotlines. Using apps raises the risk of privacy and security issues, and we hope that examining these features of the apps will contribute to the understanding of how technology can be used to improve these apps and provide insights for future development and improvement of breast cancer apps. Objective: This study aims to critically review the quality, privacy, and security of breast cancer apps available to Arabic speakers. Methods: Similar to several recent studies, we used a systematic search for apps available in Google Play and Apple App stores using both the web interface and the built-in native stores installed on smartphones. The search was conducted in mid-December 2022 in Arabic using the following keywords: سرطان الثدي – فحص سرطان الثدي – علاج سرطان الثدي – مرض سرطان الثدي – أعراض سرطان الثدي – فحص الثدي (breast cancer, breast cancer treatment, breast cancer disease, breast cancer symptoms, breast cancer screening, and breast test). These preidentified search terms are based on earlier work concerning the top searched breast cancer topics by Arabic speakers through Google’s search engine. We excluded apps that did not have an Arabic interface, were developed for non-Arabic speakers, were paid, needed a subscription, or were directed toward health care workers. The Mobile App Rating Scale was used to evaluate the quality of the apps concerning their engagement, functionality, aesthetics, and information. A risk score was calculated for the apps to determine their security risk factors. Results: Only 9 apps were included, with most (6/9, 67%) being supported by advertisements and categorized as informational. Overall, the apps had low numbers of downloads (>10 to >1000). The majority of the included apps (8/9, 89%) requested dangerous access permissions, including access to storage, media files, and the camera. The average security score of the included apps was 3.22, while only 2 apps provided information about data security and privacy. The included apps achieved an overall average quality score of 3.27, with individual dimension scores of 4.75 for functionality, 3.04 for information, 3.00 for aesthetics, and 2.32 for engagement. Conclusions: The limited availability of breast cancer apps available to Arabic speakers should be a call to action and prompt health care organizations and developers to join forces and collaboratively develop information-rich, usable, functional, engaging, and secure apps. %M 38227353 %R 10.2196/48428 %U https://cancer.jmir.org/2024/1/e48428 %U https://doi.org/10.2196/48428 %U http://www.ncbi.nlm.nih.gov/pubmed/38227353 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e49934 %T Feasibility of a Health Coach Intervention to Reduce Sitting Time and Improve Physical Functioning Among Breast Cancer Survivors: Pilot Intervention Study %A Tam,Rowena M %A Zablocki,Rong W %A Liu,Chenyu %A Narayan,Hari K %A Natarajan,Loki %A LaCroix,Andrea Z %A Dillon,Lindsay %A Sakoulas,Eleanna %A Hartman,Sheri J %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 3855 Health Sciences Drive, #0901, La Jolla, CA, 92037, United States, 1 8585349235, [email protected] %K physical function %K sedentary behavior %K quality of life %K activPAL %K health coaching %K cancer survivors %K physical functions %K breast cancer %K survivors %K quality of life %K sitting time %K physical activity %K walking %K exercise %K fatigue %K sitting %D 2023 %7 19.12.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Sedentary behavior among breast cancer survivors is associated with increased risk of poor physical function and worse quality of life. While moderate to vigorous physical activity can improve outcomes for cancer survivors, many are unable to engage in that intensity of physical activity. Decreasing sitting time may be a more feasible behavioral target to potentially mitigate the impact of cancer and its treatments. Objective: The purpose of this study was to investigate the feasibility and preliminary impact of an intervention to reduce sitting time on changes to physical function and quality of life in breast cancer survivors, from baseline to a 3-month follow-up. Methods: Female breast cancer survivors with self-reported difficulties with physical function received one-on-one, in-person personalized health coaching sessions aimed at reducing sitting time. At baseline and follow-up, participants wore the activPAL (thigh-worn accelerometer; PAL Technologies) for 3 months and completed physical function tests (4-Meter Walk Test, Timed Up and Go, and 30-Second Chair Stand) and Patient-Reported Outcomes Measurement Information System (PROMIS) self-reported outcomes. Changes in physical function and sedentary behavior outcomes were assessed by linear mixed models. Results: On average, participants (n=20) were aged 64.5 (SD 9.4) years; had a BMI of 30.4 (SD 4.5) kg/m2; and identified as Black or African American (n=3, 15%), Hispanic or Latina (n=4, 20%), and non-Hispanic White (n=14, 55%). Average time since diagnosis was 5.8 (SD 2.2) years with participants receiving chemotherapy (n=8, 40%), radiotherapy (n=18, 90%), or endocrine therapy (n=17, 85%). The intervention led to significant reductions in sitting time: activPAL average daily sitting time decreased from 645.7 (SD 72.4) to 532.7 (SD 142.1; β=–112.9; P=.001) minutes and average daily long sitting bouts (bout length ≥20 min) decreased from 468.3 (SD 94.9) to 366.9 (SD 150.4; β=–101.4; P=.002) minutes. All physical function tests had significant improvements: on average, 4-Meter Walk Test performance decreased from 4.23 (SD 0.95) to 3.61 (SD 2.53; β=–.63; P=.002) seconds, Timed Up and Go performance decreased from 10.30 (SD 3.32) to 8.84 (SD 1.58; β=–1.46; P=.003) seconds, and 30-Second Chair Stand performance increased from 9.75 (SD 2.81) to 13.20 completions (SD 2.53; β=3.45; P<.001). PROMIS self-reported physical function score improved from 44.59 (SD 4.40) to 47.12 (SD 5.68; β=2.53; P=.05) and average fatigue decreased from 52.51 (SD 10.38) to 47.73 (SD 8.43; β=–4.78; P=.02). Conclusions: This 3-month pilot study suggests that decreasing time spent sitting may be helpful for breast cancer survivors experiencing difficulties with physical function and fatigue. Reducing sitting time is a novel and potentially more feasible approach to improving health and quality of life in cancer survivors. %M 38113082 %R 10.2196/49934 %U https://cancer.jmir.org/2023/1/e49934 %U https://doi.org/10.2196/49934 %U http://www.ncbi.nlm.nih.gov/pubmed/38113082 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48852 %T A Machine Learning Model to Predict Patients’ Adherence Behavior and a Decision Support System for Patients With Metastatic Breast Cancer: Protocol for a Randomized Controlled Trial %A Masiero,Marianna %A Spada,Gea Elena %A Sanchini,Virginia %A Munzone,Elisabetta %A Pietrobon,Ricardo %A Teixeira,Lucas %A Valencia,Mirtha %A Machiavelli,Aline %A Fragale,Elisa %A Pezzolato,Massimo %A Pravettoni,Gabriella %+ Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, Milan, 20122, Italy, 39 0294372099, [email protected] %K adherence %K metastatic breast cancer %K decision-making %K personality %K risk-predictive model %K decision support system %K oral therapies %K machine learning %K behavior %K cancer %K breast cancer %D 2023 %7 14.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adherence to oral anticancer treatments is critical in the disease trajectory of patients with breast cancer. Given the impact of nonadherence on clinical outcomes and the associated economic burden for the health care system, finding ways to increase treatment adherence is particularly relevant. Objective: The primary end point is to evaluate the effectiveness of a decision support system (DSS) and a machine learning web application in promoting adherence to oral anticancer treatments among patients with metastatic breast cancer. The secondary end point is to collect a set of new physical, psychological, social, behavioral, and quality of life predictive variables that could be used to refine the preliminary version of the machine learning model to predict patients’ adherence behavior. Methods: This prospective, randomized controlled study is nested in a large-scale international project named “Enhancing therapy adherence among metastatic breast cancer patients” (Pfizer 65080791), aimed to develop a predictive model of nonadherence and associated DSS and guidelines to foster patients’ engagement and therapy adherence. A web-based DSS named TREAT (treatment adherence support) was developed using a patient-driven approach, with 4 sections, that is, Section A: Metastatic Breast Cancer; Section B: Adherence to Cancer Therapies; Section C: Promoting Adherence; and Section D: My Adherence Diary. Moreover, a machine learning–based web application was developed to predict patients' risk factors of adherence to anticancer treatment, specifically pertaining to physical status and comorbid conditions, as well as short and long-term side effects. Overall, 100 patients consecutively admitted at the European Institute of Oncology (IEO) at the Division of Medical Senology will be enrolled; 50 patients with metastatic breast cancer will be exposed to the DSS and machine learning web application for 3 months (experimental group), and 50 patients will not be exposed to the intervention (control group). Each participant will fill a weekly medication diary and a set of standardized self-reports evaluating psychological and quality of life variables (Adherence Attitude Inventory, Beck Depression Inventory-II, Brief Pain Inventory, 13-item Sense of Coherence scale, Brief Italian version of Cancer Behavior Inventory, European Organization for Research and Treatment of Cancer Quality of Life 23-item Breast Cancer-specific Questionnaire, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, 8-item Morisky Medication Adherence Scale, State-Trait Anxiety Inventory forms I and II, Big Five Inventory, and visual analogue scales evaluating risk perception). The 3 assessment time points are T0 (baseline), T1 (1 month), T2 (2 months), and T3 (3 months). This study was approved by the IEO ethics committee (R1786/22-IEO 1907). Results: The recruitment process started in May 2023 and is expected to conclude on December 2023. Conclusions: The contribution of machine learning techniques through risk-predictive models integrated into DSS will enable medication adherence by patients with cancer. Trial Registration: ClinicalTrials.gov NCT06161181; https://clinicaltrials.gov/study/NCT06161181 International Registered Report Identifier (IRRID): DERR1-10.2196/48852 %M 38096002 %R 10.2196/48852 %U https://www.researchprotocols.org/2023/1/e48852 %U https://doi.org/10.2196/48852 %U http://www.ncbi.nlm.nih.gov/pubmed/38096002 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e46009 %T Safety of COVID-19 Vaccination in Patients With Breast Cancer: Cross-Sectional Study in China %A Zhang,Shaohua %A Li,Jianbin %A Xu,Ruonan %A Chen,Qianjun %A Sun,Gang %A Lin,Ying %A Cao,Yali %A Chen,Yiding %A Geng,Cuizhi %A Teng,Yuee %A Nie,Jianyun %A Li,Xinzheng %A Xu,Guiying %A Liu,Xinlan %A Jin,Feng %A Fan,Zhimin %A Luo,Ting %A Liu,Hong %A Wang,Fu-sheng %A Jiang,Zefei %+ Fifth Medical Center of Chinese People's Liberation Army General Hospital, East street of Fengtai District, Beijing, 100071, China, 86 18518277411, [email protected] %K breast cancer %K COVID-19 vaccines %K patients reported adverse events %K healthy population %K vaccine safety %D 2023 %7 7.12.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The widespread use of vaccines against the novel coronavirus disease (COVID-19) has become one of the most effective means to establish a population immune barrier. Patients with cancer are vulnerable to COVID-19 infection, adverse events, and high mortality, and should be the focus of epidemic prevention and treatment. However, real-world data on the safety of vaccines for patients with breast cancer are still scarce. Objective: This study aims to compare the safety of COVID-19 vaccines between patients vaccinated before or after being diagnosed with breast cancer. Methods: Patients with breast cancer who sought medical advice from October 2021 to December 2021 were screened. Those who received COVID-19 vaccines were enrolled in this study to analyze the safety of the vaccines. The primary outcome was patient-reported adverse events (AEs). All events after vaccine injection were retrospectively documented from the patients. Results: A total of 15,455 patients with breast cancer from 41 hospitals in 20 provinces in China were screened, and 5766 patients who received COVID-19 vaccines were enrolled. Of those enrolled, 45.1% (n=2599) of patients received vaccines before breast cancer diagnosis, 41.3% (n=2379) were vaccinated after diagnosis, and 13.6% (n=784) did not known the accurate date of vaccination or cancer diagnosis. Among the patients vaccinated after diagnosis, 85.4% (n=2032) were vaccinated 1 year after cancer diagnosis and 95.4% (n=2270) were vaccinated during early-stage cancer. Of all 5766 vaccinated patients, 93.9% (n=5415) received an inactivated vaccine, 3.7% (n=213) received a recombinant subunit vaccine, and 2.4% (n=138) received other vaccines, including adenovirus and mRNA vaccines. In the first injection of vaccines, 24.4% (n=10, 95% CI 11.2-37.5) of patients who received an adenovirus vaccine reported AEs, compared to only 12.5% (n=677, 95% CI 11.6-13.4) of those who received an inactivated vaccine. Patients with metastatic breast cancer reported the highest incidence of AEs (n=18, 16.5%, 95% CI 9.5-23.5). Following the second injection, patients who received an inactivated vaccine (n=464, 8.7%, 95% CI 8.0-9.5) and those who received a recombinant vaccine (n=25, 8.7%, 95% CI 5.5-12.0) reported the same incidence of AEs. No significant differences in patient-reported AEs were found between the healthy population and patients with breast cancer (16.4% vs 16.9%, respectively); the most common AEs were local pain (11.1% vs 9.1%, respectively), fatigue (5.5% vs 6.3%, respectively), and muscle soreness (2.3% vs 3.6%, respectively). The type of vaccine and time window of vaccination had little impact on patient-reported AEs. Conclusions: Compared with patients vaccinated before breast cancer diagnosis, there were no significant differences in patient-reported AEs in the patients vaccinated after diagnosis. Thus, it is safe for patients with breast cancer, especially for those in the early stage, to receive COVID-19 vaccines. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200055509; https://tinyurl.com/33zzj882 %M 38060302 %R 10.2196/46009 %U https://publichealth.jmir.org/2023/1/e46009 %U https://doi.org/10.2196/46009 %U http://www.ncbi.nlm.nih.gov/pubmed/38060302 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e53124 %T Implications of Agile Values in Software Engineering for Agility in Breast Cancer Treatment: Protocol for a Comparative Study %A Odeh,Yousra %A Al-Balas,Mahmoud %+ Software Engineering Department, Faculty of Information Technology, Philadelphia University, Jarash Road, Amman, 19392, Jordan, 962 64799000 ext 2508, [email protected] %K agile breast cancer treatment %K breast cancer %K breast cancer treatment %K agile %K software engineering %K agile software engineering %K oncology %K agile values %K multidisciplinary research %K agility in health care %K agile oncology practice %D 2023 %7 5.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Breast cancer treatment has been described as a dynamic and patient-centered approach that emphasizes adaptability and flexibility throughout the treatment process. Breast cancer is complex, with varying subtypes and stages, making it important to tailor treatment plans to each patient’s unique circumstances. Breast cancer treatment delivery relies on a multidisciplinary team of health care professionals who collaborate to provide personalized care and quick adaptation to changing conditions to optimize outcomes while minimizing side effects and maintaining the patient’s quality of life. However, agility in breast cancer treatment has not been defined according to common agile values and described in language comprehensible to breast cancer professionals. In the rapidly evolving landscape of breast cancer treatment, the incorporation of agile values from software engineering promises to enhance patient care. Objective: Our objective is to propose agile values for breast cancer treatment adopted and adapted from software engineering. We also aim to validate how these values conform to the concept of agility in the breast cancer context through referencing past work. Methods: We applied a structured research methodology to identify and validate 4 agile values for breast cancer treatment. In the elicitation phase, through 2 interviews, we identified 4 agile values and described them in language that resonates with breast cancer treatment professionals. The values were then validated by a domain expert and discussed in the context of supporting work from the literature. Final validation entailed a domain expert conducting a walkthrough of the 4 identified agile values to adjust them as per the reported literature. Results: Four agile values were identified for breast cancer treatment, and among them, we validated 3 that conformed to the concept of agility. The fourth value, documentation and the quality of documentation, is vital for breast cancer treatment planning and management. This does not conform to agility. However, its nonagility is vital for the agility of the other values. None of the identified agile values were validated as partially conforming to the concept of agility. Conclusions: This work makes a novel contribution to knowledge in identifying the first set of agile values in breast cancer treatment through multidisciplinary research. Three of these values were evaluated as conforming to the concept of agility, and although 1 value did not meet the concept of agility, it enhanced the agility of the other values. It is anticipated that these 4 agile values can drive oncology practice, strategies, policies, protocols, and procedures to enhance delivery of care. Moreover, the identified values contribute to identifying quality assurance and control practices to assess the concept of agility in oncology practice and breast cancer treatment and adjust corresponding actions. We conclude that breast cancer treatment agile values are not limited to 4. International Registered Report Identifier (IRRID): RR1-10.2196/53124 %M 38051558 %R 10.2196/53124 %U https://www.researchprotocols.org/2023/1/e53124 %U https://doi.org/10.2196/53124 %U http://www.ncbi.nlm.nih.gov/pubmed/38051558 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48576 %T Dobutamine and Goal-Directed Fluid Therapy for Improving Tissue Oxygenation in Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstruction Surgery: Protocol for a Randomized Controlled Trial %A Mizubuti,Glenio B %A Ho,Anthony M-H %A Phelan,Rachel %A DuMerton,Deborah %A Shelley,Jessica %A Vowotor,Elorm %A Xiong,Jessica %A Smethurst,Bethany %A McMullen,Michael %A Hopman,Wilma M %A Martou,Glykeria %A Edmunds,Robert Wesley %A Tanzola,Robert %+ Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston Health Sciences Centre, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada, 1 613 548 7827, [email protected] %K breast cancer %K breast cancer care %K breast reconstruction %K DIEP flap %K dobutamine %K epigastric perforator %K implant-based surgery %K flap surgery %K flap oxygenation %K fluid therapy %K goal-directed therapy %K oxygenation %K perioperative care %K tissue oxygenation %K treatment algorithm %D 2023 %7 22.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Breast reconstruction is an integral part of breast cancer care. There are 2 main types of breast reconstruction: alloplastic (using implants) and autologous (using the patient’s own tissue). The latter creates a more natural breast mound and avoids the long-term need for surgical revision—more often associated with implant-based surgery. The deep inferior epigastric perforator (DIEP) flap is considered the gold standard approach in autologous breast reconstruction. However, complications do occur with DIEP flap surgery and can stem from poor flap tissue perfusion/oxygenation. Hence, the development of strategies to enhance flap perfusion (eg, goal-directed perioperative fluid therapy) is essential. Current perioperative fluid therapy is traditionally guided by subjective criteria, which leads to wide variations in clinical practice. Objective: The main objective of this trial is to determine whether the use of minimally invasive cardiac output (CO) monitoring for guiding intravenous fluid administration, combined with low-dose dobutamine infusion (via a treatment algorithm), will increase tissue oxygenation in patients undergoing DIEP flap surgery. Methods: With appropriate institutional ethics board and Health Canada approval, patients undergoing DIEP flap surgery are randomly assigned to receive CO monitoring for the guidance of intraoperative fluid therapy in addition to a low-dose dobutamine infusion (which potentially improves flap oxygenation) versus the current standard of care. The primary outcome is tissue oxygenation measured via near-infrared spectroscopy at the perfusion zone furthest from the perforator vessels 45 minutes after vascular reanastomosis of the DIEP flap. Low dose (2.5 μg/kg/hr) dobutamine infusion continues for up to 4 hours postoperatively, provided there are no associated complications (ie, persistent tachycardia). Flap oxygenation, hemodynamic parameters, and any medication-associated side effects/complications are monitored for up to 48 hours postoperatively. Complications, rehospitalizations, and patient satisfaction are also collected until 30 days postoperatively. Results: Funding and regulatory approvals were obtained in 2019, but the study recruitment was interrupted by the COVID-19 pandemic. As of October 4, 2023, 34 participants have been recruited. Because of the significant delays associated with the pandemic, the expected completion date was extended. We expect the study to be completed and ready for potential news release (as appropriate) and publication by July 2024. No patients have suffered any adverse effects/complications from participating in this study, and none have been lost to follow-up. Conclusions: CO-directed fluid therapy in combination with a low-dose dobutamine infusion via a treatment algorithm has the potential to improve DIEP flap tissue oxygenation and reduce complications following DIEP flap breast reconstruction surgery. However, given that the investigators remain blinded to group randomization, no comment can be made regarding the efficacy of this intervention for improving tissue oxygenation at this time. Nevertheless, no patients have been withdrawn for safety concerns thus far, and compliance remains high. Trial Registration: Clinicaltrials.gov NCT04020172; https://clinicaltrials.gov/study/NCT04020172 %M 37991835 %R 10.2196/48576 %U https://www.researchprotocols.org/2023/1/e48576 %U https://doi.org/10.2196/48576 %U http://www.ncbi.nlm.nih.gov/pubmed/37991835 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e46474 %T Noninvasive Staging of Lymph Node Status in Breast Cancer Using Machine Learning: External Validation and Further Model Development %A Hjärtström,Malin %A Dihge,Looket %A Bendahl,Pär-Ola %A Skarping,Ida %A Ellbrant,Julia %A Ohlsson,Mattias %A Rydén,Lisa %+ Division of Oncology, Department of Clinical Sciences, Lund University, Scheeletorget 1, Lund, SE-223 81, Sweden, 46 737070404, [email protected] %K breast neoplasm %K sentinel lymph node biopsy %K SLNB %K noninvasive lymph node staging %K NILS %K prediction model %K multilayer perceptron %K MLP %K register data %K breast cancer %K cancer %K validation study %K machine learning %K model development %K therapeutic %K feasibility %K diagnostic %K lymph node %K mammography images %D 2023 %7 20.11.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Most patients diagnosed with breast cancer present with a node-negative disease. Sentinel lymph node biopsy (SLNB) is routinely used for axillary staging, leaving patients with healthy axillary lymph nodes without therapeutic effects but at risk of morbidities from the intervention. Numerous studies have developed nodal status prediction models for noninvasive axillary staging using postoperative data or imaging features that are not part of the diagnostic workup. Lymphovascular invasion (LVI) is a top-ranked predictor of nodal metastasis; however, its preoperative assessment is challenging. Objective: This paper aimed to externally validate a multilayer perceptron (MLP) model for noninvasive lymph node staging (NILS) in a large population-based cohort (n=18,633) and develop a new MLP in the same cohort. Data were extracted from the Swedish National Quality Register for Breast Cancer (NKBC, 2014-2017), comprising only routinely and preoperatively available documented clinicopathological variables. A secondary aim was to develop and validate an LVI MLP for imputation of missing LVI status to increase the preoperative feasibility of the original NILS model. Methods: Three nonoverlapping cohorts were used for model development and validation. A total of 4 MLPs for nodal status and 1 LVI MLP were developed using 11 to 12 routinely available predictors. Three nodal status models were used to account for the different availabilities of LVI status in the cohorts and external validation in NKBC. The fourth nodal status model was developed for 80% (14,906/18,663) of NKBC cases and validated in the remaining 20% (3727/18,663). Three alternatives for imputation of LVI status were compared. The discriminatory capacity was evaluated using the validation area under the receiver operating characteristics curve (AUC) in 3 of the nodal status models. The clinical feasibility of the models was evaluated using calibration and decision curve analyses. Results: External validation of the original NILS model was performed in NKBC (AUC 0.699, 95% CI 0.690-0.708) with good calibration and the potential of sparing 16% of patients with node-negative disease from SLNB. The LVI model was externally validated (AUC 0.747, 95% CI 0.694-0.799) with good calibration but did not improve the discriminatory performance of the nodal status models. A new nodal status model was developed in NKBC without information on LVI (AUC 0.709, 95% CI: 0.688-0.729), with excellent calibration in the holdout internal validation cohort, resulting in the potential omission of 24% of patients from unnecessary SLNBs. Conclusions: The NILS model was externally validated in NKBC, where the imputation of LVI status did not improve the model’s discriminatory performance. A new nodal status model demonstrated the feasibility of using register data comprising only the variables available in the preoperative setting for NILS using machine learning. Future steps include ongoing preoperative validation of the NILS model and extending the model with, for example, mammography images. %M 37983068 %R 10.2196/46474 %U https://cancer.jmir.org/2023/1/e46474 %U https://doi.org/10.2196/46474 %U http://www.ncbi.nlm.nih.gov/pubmed/37983068 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49508 %T Home-Based Treatment for Chronic Pain Combining Neuromodulation, Computer-Assisted Training, and Telemonitoring in Patients With Breast Cancer: Protocol for a Rehabilitative Study %A Conti,Lorenzo %A Marzorati,Chiara %A Grasso,Roberto %A Ferrucci,Roberta %A Priori,Alberto %A Mameli,Francesca %A Ruggiero,Fabiana %A Pravettoni,Gabriella %+ Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, via Ripamonti, 435, Milan, 20141, Italy, 39 0294375022, [email protected] %K telemedicine %K chronic pain %K breast cancer %K tDCS %K transcranial direct current stimulation %K home care treatment %K home care %K care %K training %K pain %K cancer %K quality of life %K rehabilitation %K telemonitoring %K web platform %K exercise %K therapy %D 2023 %7 16.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain is a disabling symptom frequently reported in patients with breast cancer with a prevalence ranging from 25% to 60%, representing a major health issue. It has negative consequences on health status, causing psychological distress and affecting quality of life. Furthermore, the clinical management of chronic pain is often inadequate, and many patients do not benefit from the administration of pharmacological treatments. Alternative therapeutic options have been implemented to improve the psychophysical well-being of patients, including neuromodulation and complementary interventions. Objective: We aimed to investigate the effectiveness of a home care strategy combining computerized rehabilitation, transcranial direct current stimulation (tDCS), and remote telemonitoring via a web-based platform in patients with breast cancer suffering for chronic pain. Methods: A web-based structured survey aimed at monitoring chronic pain and its effect on psychological functions will be delivered to patients with breast cancer through social media and email. In total, 42 patients with breast cancer affected by chronic pain will be recruited during the medical screening visit. The patients will be randomly divided into 3 treatment groups that will carry out either tDCS only, exercise therapy only, or a combination of both over a 3-week period. All the treatments will be delivered at the patients’ home through the use of a system including a tablet, wearable inertial sensors, and a tDCS programmable medical device. Using web-based questionnaires, the perception of pain (based on the pain self-efficacy questionnaire, visual analogue scale, pain catastrophizing scale, and brief pain inventory) and psychological variables (based on the hospital and anxiety depression scale and 12-item short form survey) will be assessed at the beginning of treatment, 1 week after the start of treatment, at the end of treatment, 1 month after the start of treatment, and 3 months after the start of treatment. The system’s usability (based on the mobile app rating scale and system usability scale) and its involvement in the decision-making process (based on the 9-item shared decision-making questionnaire) will be also evaluated. Finally, at the end of the treatment, a digital focus group will be conducted with the 42 patients to explore their unexpressed needs and preferences concerning treatment. Results: The study project is scheduled to start in June 2023, and it is expected to be completed by August 2025. Conclusions: We expect that the combination of tDCS and telemedicine programs will reduce pain perceived by patients with breast cancer and improve their mental well-being more effectively than single interventions. Furthermore, we assume that this home-based approach will also improve patients’ participation in routine clinical care, reducing disparities in accessing health care processes. This integrated home care strategy could be useful for patients with breast cancer who cannot find relief from chronic pain with pharmacological treatments or for those who have limited access to care due to poor mobility or geographical barriers, thus increasing the patients’ empowerment and reducing health care costs. International Registered Report Identifier (IRRID): PRR1-10.2196/49508 %M 37971805 %R 10.2196/49508 %U https://www.researchprotocols.org/2023/1/e49508 %U https://doi.org/10.2196/49508 %U http://www.ncbi.nlm.nih.gov/pubmed/37971805 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e45101 %T Content Quality of YouTube Videos About Metastatic Breast Cancer in Young Women: Systematic Assessment %A Morena,Nina %A Ahisar,Yitzchok %A Wang,Xena %A Nguyen,Diana %A Rentschler,Carrie A %A Meguerditchian,Ari N %+ Art History and Communication Studies, Faculty of Arts, McGill University, McCall McBain Arts Building, 853 Sherbrooke Street W., Montreal, QC, H3A 0G5, Canada, 1 514 398 2850, [email protected] %K social media %K YouTube %K metastatic breast cancer %K breast cancer %K patient education %K health education %K patient literacy %K media literacy %K health literacy %K consumer health information %K assessment tool %K treatment %K false information %K women %K videos %K web-based %D 2023 %7 14.11.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Young women with metastatic breast cancer (MBC) are part of a digitally connected generation yet are underserved in terms of information needs. YouTube is widely used to find and identify health information. The accessibility of health-related content on social media together with the rare and marginalized experiences of young women with MBC and the digital media practices of younger generations imply a considerable likelihood that young women with MBC will seek information and community on the internet. Objective: This study aims to assess the content quality of MBC YouTube videos and to identify themes in the experiences of young women with MBC based on YouTube videos. Methods: A systematic assessment of MBC YouTube videos using the search term “metastatic breast cancer young” was conducted in August 2021. The search was performed in an incognito browser and with no associated YouTube or Google account. Search results were placed in order from most to least views. Title, date uploaded, length, poster identity, number of likes, and number of comments were collected. Understandability and actionability were assessed using the Patient Education Materials Assessment Tool (PEMAT); information reliability and quality were assessed with DISCERN. Themes, sponsorships, and health care professionals’ and patients’ narratives were reported. Results: A total of 101 videos were identified. Of these, 78.2% (n=79) included sponsorships. The mean PEMAT scores were 78.8% (SD 15.3%) and 43.1% (SD 45.2%) for understandability and actionability, respectively. The mean DISCERN score was 2.44 (SD 0.7) out of 5. Identified themes included treatment (n=67, 66.3%), family relationship (n=46, 45.5%), and motherhood (n=38, 37.6%). Conclusions: YouTube videos about young women with MBC are highly understandable but demonstrate moderate rates of actionability, with low reliability and quality scores. Many have a commercial bias. While web-based materials have limitations, their potential to provide patient support is not fully developed. By acknowledging their patients’ media habits, health care professionals can further develop a trusting bond with their patients, provide a space for open and honest discussions of web-based materials, and avoid any potential instances of confusion caused by misleading, inaccurate, or false web-based materials. %M 37737837 %R 10.2196/45101 %U https://cancer.jmir.org/2023/1/e45101 %U https://doi.org/10.2196/45101 %U http://www.ncbi.nlm.nih.gov/pubmed/37737837 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e51090 %T German Version of the mHealth App Usability Questionnaire in a Cohort of Patients With Cancer: Translation and Validation Study %A Moorthy,Preetha %A Weinert,Lina %A Harms,Bendix Christian %A Anders,Carolin %A Siegel,Fabian %+ Department of Biomedical Informatics, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany, 49 621 383 8078, [email protected] %K usability %K mobile health %K mHealth app %K questionnaire validation %K questionnaire translation %K mHealth App Usability Questionnaire %K MAUQ %K mobile phone %D 2023 %7 1.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Good usability is important for the adoption and continued use of mobile health (mHealth) apps. In particular, high usability can support intuitive use by patients, which improves compliance and increases the app’s effectiveness. However, many usability studies do not use adequate tools to measure perceived usability. The mHealth App Usability Questionnaire (MAUQ) was developed specifically for end users in a medical context. MAUQ is a relatively new but increasingly used questionnaire to evaluate mHealth apps, but it is not yet available in German. Objective: This study aims to translate MAUQ into German and determine its internal consistency, reliability, and construct validity. Methods: This validation study was conducted as part of a usability evaluation project for an mHealth app used as a therapy support tool during breast cancer chemotherapy. MAUQ was translated into German through a rigorous forward-backward translation process, ensuring semantic and conceptual equivalence. Patient responses to MAUQ and System Usability Scale (SUS) were analyzed for validation. Descriptive analysis was performed for the MAUQ subscales and SUS standard scores. Significance tests and correlation coefficients assessed the relationship between the SUS and MAUQ results, confirming construct validity. Internal consistency was assessed for item reliability and consistency in measuring the target construct. Free-text questions assessed translation comprehensibility, with responses analyzed descriptively and qualitatively using content analysis. Results: In this study, 133 participants responded to the questionnaire, and the validation analysis showed substantially positive correlations between the overall MAUQ score and its subscales: ease of use (r=0.56), interface and satisfaction (r=0.75), and usefulness (r=0.83). These findings support the construct validity of MAUQ and emphasize the importance of these subscales in assessing the usability of the Enable app. The correlation coefficients ranging from 0.39 to 0.68 for the items further validate the questionnaire by aligning with the overall score and capturing the intended concept. The high internal consistency reliability of MAUQ (Cronbach α=.81) and its subscales further enhances the instrument’s robustness in accurately evaluating the usability of mHealth apps. Conclusions: We successfully validated the German translation of the MAUQ for stand-alone apps using a standardized approach in a cohort of patients with breast cancer. In our validation study, MAUQ exhibited strong internal consistency reliability (Cronbach α=.81) across its subscales, indicating reliable and consistent measurement. Furthermore, a significant positive correlation (P<.001) was found between the subscales and the overall score, supporting their consistent measurement of the intended construct. Therefore, MAUQ can be considered a reliable instrument for assessing the usability of mHealth apps among German-speaking adults. The availability of the German version of MAUQ will help other researchers in conducting usability studies of mHealth apps in German-speaking cohorts and allow for international comparability of their results. %M 37910144 %R 10.2196/51090 %U https://humanfactors.jmir.org/2023/1/e51090 %U https://doi.org/10.2196/51090 %U http://www.ncbi.nlm.nih.gov/pubmed/37910144 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48719 %T Digital Cognitive Behavioral- and Mindfulness-Based Stress-Management Interventions for Survivors of Breast Cancer: Development Study %A Børøsund,Elin %A Meland,Anders %A Eriksen,Hege R %A Rygg,Christine M %A Ursin,Giske %A Solberg Nes,Lise %+ Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4950 Nydalen, Oslo, 0424, Norway, 47 92667161, [email protected] %K cancer %K stress management %K mindfulness %K cognitive behavioral therapy %K digital %K eHealth %K mHealth %K app %K user-driven development %K usability %D 2023 %7 19.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychosocial stress-management interventions can reduce stress and distress and improve the quality of life for survivors of cancer. As these in-person interventions are not always offered or accessible, evidence-informed digital stress-management interventions may have the potential to improve outreach of psychosocial support for survivors of cancer. Few such digital interventions exist so far, few if any have been developed specifically for survivors of breast cancer, and few if any have attempted to explore more than 1 distinct type of intervention framework. Objective: This study aimed to develop 2 digital psychosocial stress-management interventions for survivors of breast cancer; 1 cognitive behavioral therapy-based intervention (CBI), and 1 mindfulness-based intervention (MBI). Methods: The development of the CBI and MBI interventions originated from the existing StressProffen program, a digital stress-management intervention program for survivors of cancer, based on a primarily cognitive behavioral therapeutic concept. Development processes entailed a multidisciplinary design approach and were iteratively conducted in close collaboration between key stakeholders, including experts within psychosocial oncology, cancer epidemiology, stress-management, and eHealth as well as survivors of breast cancer and health care providers. Core psychosocial oncology stress-management and cancer epidemiology experts first conducted a series of workshops to identify cognitive behavioral and mindfulness specific StressProffen content, overlapping psychoeducational content, and areas where development and incorporation of new material were needed. Following the program content adaptation and development phase, phases related to user testing of new content and technical, privacy, security, and ethical aspects and adjustments ensued. Intervention content for the distinct CBI and MBI interventions was refined in iterative user-centered design processes and adjusted to electronic format through stakeholder-centered iterations. Results: For the CBI version, the mindfulness-based content of the original StressProffen was removed, and for the MBI version, cognitive behavioral content was removed. Varying degrees of new content were created for both versions, using a similar layout as for the original StressProffen program. New content and new exercises in particular were tested by survivors of breast cancer and a project-related editorial team, resulting in subsequent user centered adjustments, including ensuring auditory versions and adequate explanations before less intuitive sections. Other improvements included implementing a standard closing sentence to round off every exercise, and allowing participants to choose the length of some of the mindfulness exercises. A legal disclaimer and a description of data collection, user rights and study contact information were included to meet ethical, privacy, and security requirements. Conclusions: This study shows how theory specific (ie, CBI and MBI) digital stress-management interventions for survivors of breast cancer can be developed through extensive collaborations between key stakeholders, including scientists, health care providers, and survivors of breast cancer. Offering a variety of evidence-informed stress-management approaches may potentially increase interest for outreach and impact of psychosocial interventions for survivors of cancer. International Registered Report Identifier (IRRID): RR2-10.2196/47195 %M 37725424 %R 10.2196/48719 %U https://formative.jmir.org/2023/1/e48719 %U https://doi.org/10.2196/48719 %U http://www.ncbi.nlm.nih.gov/pubmed/37725424 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48534 %T Estimating Patient Satisfaction Through a Language Processing Model: Model Development and Evaluation %A Matsuda,Shinichi %A Ohtomo,Takumi %A Okuyama,Masaru %A Miyake,Hiraku %A Aoki,Kotonari %+ Drug Safety Division, Chugai Pharmaceutical Co Ltd, 2-1-1 Nihonbashi-Muromachi, Chuo-ku, Tokyo, 103-8324, Japan, 81 8080105061, [email protected] %K breast cancer %K internet %K machine learning %K natural language processing %K natural language-processing model %K neural network %K NLP %K patient satisfaction %K textual data %D 2023 %7 14.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Measuring patient satisfaction is a crucial aspect of medical care. Advanced natural language processing (NLP) techniques enable the extraction and analysis of high-level insights from textual data; nonetheless, data obtained from patients are often limited. Objective: This study aimed to create a model that quantifies patient satisfaction based on diverse patient-written textual data. Methods: We constructed a neural network–based NLP model for this cross-sectional study using the textual content from disease blogs written in Japanese on the Internet between 1994 and 2020. We extracted approximately 20 million sentences from 56,357 patient-authored disease blogs and constructed a model to predict the patient satisfaction index (PSI) using a regression approach. After evaluating the model’s effectiveness, PSI was predicted before and after cancer notification to examine the emotional impact of cancer diagnoses on 48 patients with breast cancer. Results: We assessed the correlation between the predicted and actual PSI values, labeled by humans, using the test set of 169 sentences. The model successfully quantified patient satisfaction by detecting nuances in sentences with excellent effectiveness (Spearman correlation coefficient [ρ]=0.832; root-mean-squared error [RMSE]=0.166; P<.001). Furthermore, the PSI was significantly lower in the cancer notification period than in the preceding control period (−0.057 and −0.012, respectively; 2-tailed t47=5.392, P<.001), indicating that the model quantifies the psychological and emotional changes associated with the cancer diagnosis notification. Conclusions: Our model demonstrates the ability to quantify patient dissatisfaction and identify significant emotional changes during the disease course. This approach may also help detect issues in routine medical practice. %M 37707946 %R 10.2196/48534 %U https://formative.jmir.org/2023/1/e48534 %U https://doi.org/10.2196/48534 %U http://www.ncbi.nlm.nih.gov/pubmed/37707946 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44897 %T Construction of an Emotional Lexicon of Patients With Breast Cancer: Development and Sentiment Analysis %A Li,Chaixiu %A Fu,Jiaqi %A Lai,Jie %A Sun,Lijun %A Zhou,Chunlan %A Li,Wenji %A Jian,Biao %A Deng,Shisi %A Zhang,Yujie %A Guo,Zihan %A Liu,Yusheng %A Zhou,Yanni %A Xie,Shihui %A Hou,Mingyue %A Wang,Ru %A Chen,Qinjie %A Wu,Yanni %+ Nanfang Hospital, Southern Medical University, No 1838 Guangzhou Avenue North, Baiyun District, Guangdong Province, Guangzhou, 510515, China, 86 020 61641192, [email protected] %K breast cancer %K lexicon construction %K domain emotional lexicon %K sentiment analysis %K natural language processing %D 2023 %7 12.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The innovative method of sentiment analysis based on an emotional lexicon shows prominent advantages in capturing emotional information, such as individual attitudes, experiences, and needs, which provides a new perspective and method for emotion recognition and management for patients with breast cancer (BC). However, at present, sentiment analysis in the field of BC is limited, and there is no emotional lexicon for this field. Therefore, it is necessary to construct an emotional lexicon that conforms to the characteristics of patients with BC so as to provide a new tool for accurate identification and analysis of the patients’ emotions and a new method for their personalized emotion management. Objective: This study aimed to construct an emotional lexicon of patients with BC. Methods: Emotional words were obtained by merging the words in 2 general sentiment lexicons, the Chinese Linguistic Inquiry and Word Count (C-LIWC) and HowNet, and the words in text corpora acquired from patients with BC via Weibo, semistructured interviews, and expressive writing. The lexicon was constructed using manual annotation and classification under the guidance of Russell’s valence-arousal space. Ekman’s basic emotional categories, Lazarus’ cognitive appraisal theory of emotion, and a qualitative text analysis based on the text corpora of patients with BC were combined to determine the fine-grained emotional categories of the lexicon we constructed. Precision, recall, and the F1-score were used to evaluate the lexicon’s performance. Results: The text corpora collected from patients in different stages of BC included 150 written materials, 17 interviews, and 6689 original posts and comments from Weibo, with a total of 1,923,593 Chinese characters. The emotional lexicon of patients with BC contained 9357 words and covered 8 fine-grained emotional categories: joy, anger, sadness, fear, disgust, surprise, somatic symptoms, and BC terminology. Experimental results showed that precision, recall, and the F1-score of positive emotional words were 98.42%, 99.73%, and 99.07%, respectively, and those of negative emotional words were 99.73%, 98.38%, and 99.05%, respectively, which all significantly outperformed the C-LIWC and HowNet. Conclusions: The emotional lexicon with fine-grained emotional categories conforms to the characteristics of patients with BC. Its performance related to identifying and classifying domain-specific emotional words in BC is better compared to the C-LIWC and HowNet. This lexicon not only provides a new tool for sentiment analysis in the field of BC but also provides a new perspective for recognizing the specific emotional state and needs of patients with BC and formulating tailored emotional management plans. %M 37698914 %R 10.2196/44897 %U https://www.jmir.org/2023/1/e44897 %U https://doi.org/10.2196/44897 %U http://www.ncbi.nlm.nih.gov/pubmed/37698914 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e49775 %T Predictors of the Use of a Mental Health–Focused eHealth System in Patients With Breast and Prostate Cancer: Bayesian Structural Equation Modeling Analysis of a Prospective Study %A Petros,Nuhamin Gebrewold %A Alvarsson-Hjort,Jesper %A Hadlaczky,Gergö %A Wasserman,Danuta %A Ottaviano,Manuel %A Gonzalez-Martinez,Sergio %A Carletto,Sara %A Scilingo,Enzo Pasquale %A Valenza,Gaetano %A Carli,Vladimir %+ National Centre for Suicide Research and Prevention of Mental Ill-Health, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Grantis Väg 4, Stockholm, 171 65, Sweden, 46 707313324, [email protected] %K mental health %K eHealth system %K perceived usefulness %K structural equation modeling %K cancer %K NEVERMIND system %K usability %K digital health %K Technology Acceptance Model %D 2023 %7 12.9.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: eHealth systems have been increasingly used to manage depressive symptoms in patients with somatic illnesses. However, understanding the factors that drive their use, particularly among patients with breast and prostate cancer, remains a critical area of research. Objective: This study aimed to determine the factors influencing use of the NEVERMIND eHealth system among patients with breast and prostate cancer over 12 weeks, with a focus on the Technology Acceptance Model. Methods: Data from the NEVERMIND trial, which included 129 patients with breast and prostate cancer, were retrieved. At baseline, participants completed questionnaires detailing demographic data and measuring depressive and stress symptoms using the Beck Depression Inventory–II and the Depression, Anxiety, and Stress Scale–21, respectively. Over a 12-week period, patients engaged with the NEVERMIND system, with follow-up questionnaires administered at 4 weeks and after 12 weeks assessing the system’s perceived ease of use and usefulness. Use log data were collected at the 2- and 12-week marks. The relationships among sex, education, baseline depressive and stress symptoms, perceived ease of use, perceived usefulness (PU), and system use at various stages were examined using Bayesian structural equation modeling in a path analysis, a technique that differs from traditional frequentist methods. Results: The path analysis was conducted among 100 patients with breast and prostate cancer, with 66% (n=66) being female and 81% (n=81) having a college education. Patients reported good mental health scores, with low levels of depression and stress at baseline. System use was approximately 6 days in the initial 2 weeks and 45 days over the 12-week study period. The results revealed that PU was the strongest predictor of system use at 12 weeks (βuse at 12 weeks is predicted by PU at 12 weeks=.384), whereas system use at 2 weeks moderately predicted system use at 12 weeks (βuse at 12 weeks is predicted by use at 2 weeks=.239). Notably, there were uncertain associations between baseline variables (education, sex, and mental health symptoms) and system use at 2 weeks, indicating a need for better predictors for early system use. Conclusions: This study underscores the importance of PU and early engagement in patient engagement with eHealth systems such as NEVERMIND. This suggests that, in general eHealth implementations, caregivers should educate patients about the benefits and functionalities of such systems, thus enhancing their understanding of potential health impacts. Concentrating resources on promoting early engagement is also essential given its influence on sustained use. Further research is necessary to clarify the remaining uncertainties, enabling us to refine our strategies and maximize the benefits of eHealth systems in health care settings. %M 37698900 %R 10.2196/49775 %U https://cancer.jmir.org/2023/1/e49775 %U https://doi.org/10.2196/49775 %U http://www.ncbi.nlm.nih.gov/pubmed/37698900 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e42044 %T Categorization and Analysis of Primary Care mHealth Apps Related to Breast Health and Breast Cancer: Systematic Search in App Stores and Content Analysis %A Kanodia,Sweekrity %A Thalabard,Jean Christophe %A Lhoste,Kevin %+ System Engineering and Evolution Dynamics, Université Paris Cité, Inserm, 8 bis Rue Charles V, Paris, 75004, France, 33 0753458521, [email protected] %K breast cancer %K breast self-examination %K BSE %K primary care %K mobile applications %K mobile apps %K breast health %K early diagnosis %D 2023 %7 7.9.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer is the most common cause of cancer mortality among women globally. The use of mobile health tools such as apps and games is increasing rapidly, even in low- and middle-income countries, to promote early diagnosis and to manage care and support of survivors and patients. Objective: The primary objective of this review was to categorize selected mobile health apps related to breast health and prevention of breast cancer, based on features such as breast self-examination (BSE) training and reminders, and to analyze their current dissemination. An ancillary objective was to highlight the limitations of existing tools and suggest ways to improve them. Methods: We defined strict inclusion and exclusion criteria, which required apps to have titles or descriptions that suggest that they were designed for the general public, and not for patients with breast cancer or health workers. Apps that focused on awareness and primary care via self-check were included, while those that focused on topics such as alternative treatments and medical news were excluded. Apps that were not specifically related to breast cancer were also excluded. Apps (in any language) that appeared in the search with keywords were included. The database consisted of apps from AppAgg and Google Play Store. Only 85 apps met the inclusion criteria. Selected apps were categorized on the basis of their alleged interactive features. Descriptive statistics were obtained, and available language options, the number of downloads, and the cost of the apps were the main parameters reviewed. Results: The selected apps were categorized on the basis of the following features: education, BSE training, reminders, and recording. Of the 85 selected apps, 72 (84.7%) focused on disseminating breast cancer information. BSE training was provided by only 47% (n=40) of the apps, and very few had reminder (n=26, 30.5%) and recording (n=11, 12.9%) features. The median number of downloads was the highest for apps with recording features (>1000 downloads) than those with education, BSE training, reminder, and recording features (>5000 downloads). Most of these apps (n=74, 83.5%) were monolingual, and around 80.3% (n=49) of these apps were in English. Almost all the apps on Google Play Store were free of charge. Conclusions: Although there exist several apps on Google Play Store to promote awareness about breast health and cancer, the usefulness of most of them appears debatable. To provide a complete breast health package to the users, such apps must have all of the following features: reminders or notifications and symptom recording and tracking. There is still an urgent need to scientifically evaluate existing apps in the target populations in order to make them more functional and user-friendly. %M 37676704 %R 10.2196/42044 %U https://cancer.jmir.org/2023/1/e42044 %U https://doi.org/10.2196/42044 %U http://www.ncbi.nlm.nih.gov/pubmed/37676704 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e45547 %T Data-Efficient Computational Pathology Platform for Faster and Cheaper Breast Cancer Subtype Identifications: Development of a Deep Learning Model %A Bae,Kideog %A Jeon,Young Seok %A Hwangbo,Yul %A Yoo,Chong Woo %A Han,Nayoung %A Feng,Mengling %+ Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Tahir foundation MD1 #09-01, Singapore, 117549, Singapore, 65 65164984, [email protected] %K deep learning %K self-supervised learning %K immunohistochemical staining %K machine learning %K histology %K pathology %K computation %K predict %K diagnosis %K diagnose %K carcinoma %K cancer %K oncology %K breast cancer %D 2023 %7 5.9.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer subtyping is a crucial step in determining therapeutic options, but the molecular examination based on immunohistochemical staining is expensive and time-consuming. Deep learning opens up the possibility to predict the subtypes based on the morphological information from hematoxylin and eosin staining, a much cheaper and faster alternative. However, training the predictive model conventionally requires a large number of histology images, which is challenging to collect by a single institute. Objective: We aimed to develop a data-efficient computational pathology platform, 3DHistoNet, which is capable of learning from z-stacked histology images to accurately predict breast cancer subtypes with a small sample size. Methods: We retrospectively examined 401 cases of patients with primary breast carcinoma diagnosed between 2018 and 2020 at the Department of Pathology, National Cancer Center, South Korea. Pathology slides of the patients with breast carcinoma were prepared according to the standard protocols. Age, gender, histologic grade, hormone receptor (estrogen receptor [ER], progesterone receptor [PR], and androgen receptor [AR]) status, erb-B2 receptor tyrosine kinase 2 (HER2) status, and Ki-67 index were evaluated by reviewing medical charts and pathological records. Results: The area under the receiver operating characteristic curve and decision curve were analyzed to evaluate the performance of our 3DHistoNet platform for predicting the ER, PR, AR, HER2, and Ki67 subtype biomarkers with 5-fold cross-validation. We demonstrated that 3DHistoNet can predict all clinically important biomarkers (ER, PR, AR, HER2, and Ki67) with performance exceeding the conventional multiple instance learning models by a considerable margin (area under the receiver operating characteristic curve: 0.75-0.91 vs 0.67-0.8). We further showed that our z-stack histology scanning method can make up for insufficient training data sets without any additional cost incurred. Finally, 3DHistoNet offered an additional capability to generate attention maps that reveal correlations between Ki67 and histomorphological features, which renders the hematoxylin and eosin image in higher fidelity to the pathologist. Conclusions: Our stand-alone, data-efficient pathology platform that can both generate z-stacked images and predict key biomarkers is an appealing tool for breast cancer diagnosis. Its development would encourage morphology-based diagnosis, which is faster, cheaper, and less error-prone compared to the protein quantification method based on immunohistochemical staining. %M 37669090 %R 10.2196/45547 %U https://cancer.jmir.org/2023/1/e45547 %U https://doi.org/10.2196/45547 %U http://www.ncbi.nlm.nih.gov/pubmed/37669090 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46571 %T Evaluation of the Rosa Chatbot Providing Genetic Information to Patients at Risk of Hereditary Breast and Ovarian Cancer: Qualitative Interview Study %A Siglen,Elen %A Vetti,Hildegunn Høberg %A Augestad,Mirjam %A Steen,Vidar M %A Lunde,Ã…shild %A Bjorvatn,Cathrine %+ Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, Jonas Lies veg 61, Bergen, 5021, Norway, 47 99569845, [email protected] %K chatbot %K chatbots %K genetic %K trust %K acceptability %K perception %K perceived %K genetic counseling %K hybrid health care %K digital health tool %K digital information tool %K digital health technology %K virtual assistant %K hereditary breast and ovarian cancer %K hereditary %K genetic testing %K technology %K genetic clinic %K digital tool %K ovarian cancer %K breast cancer %K information retrieval %K women’s health %K breast %K ovarian %K cancer %K oncology %K mobile phone %D 2023 %7 1.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Genetic testing has become an integrated part of health care for patients with breast or ovarian cancer, and the increasing demand for genetic testing is accompanied by an increasing need for easy access to reliable genetic information for patients. Therefore, we developed a chatbot app (Rosa) that is able to perform humanlike digital conversations about genetic BRCA testing. Objective: Before implementing this new information service in daily clinical practice, we wanted to explore 2 aspects of chatbot use: the perceived utility and trust in chatbot technology among healthy patients at risk of hereditary cancer and how interaction with a chatbot regarding sensitive information about hereditary cancer influences patients. Methods: Overall, 175 healthy individuals at risk of hereditary breast and ovarian cancer were invited to test the chatbot, Rosa, before and after genetic counseling. To secure a varied sample, participants were recruited from all cancer genetic clinics in Norway, and the selection was based on age, gender, and risk of having a BRCA pathogenic variant. Among the 34.9% (61/175) of participants who consented for individual interview, a selected subgroup (16/61, 26%) shared their experience through in-depth interviews via video. The semistructured interviews covered the following topics: usability, perceived usefulness, trust in the information received via the chatbot, how Rosa influenced the user, and thoughts about future use of digital tools in health care. The transcripts were analyzed using the stepwise-deductive inductive approach. Results: The overall finding was that the chatbot was very welcomed by the participants. They appreciated the 24/7 availability wherever they were and the possibility to use it to prepare for genetic counseling and to repeat and ask questions about what had been said afterward. As Rosa was created by health care professionals, they also valued the information they received as being medically correct. Rosa was referred to as being better than Google because it provided specific and reliable answers to their questions. The findings were summed up in 3 concepts: “Anytime, anywhere”; “In addition, not instead”; and “Trustworthy and true.” All participants (16/16) denied increased worry after reading about genetic testing and hereditary breast and ovarian cancer in Rosa. Conclusions: Our results indicate that a genetic information chatbot has the potential to contribute to easy access to uniform information for patients at risk of hereditary breast and ovarian cancer, regardless of geographical location. The 24/7 availability of quality-assured information, tailored to the specific situation, had a reassuring effect on our participants. It was consistent across concepts that Rosa was a tool for preparation and repetition; however, none of the participants (0/16) supported that Rosa could replace genetic counseling if hereditary cancer was confirmed. This indicates that a chatbot can be a well-suited digital companion to genetic counseling. %M 37656502 %R 10.2196/46571 %U https://www.jmir.org/2023/1/e46571 %U https://doi.org/10.2196/46571 %U http://www.ncbi.nlm.nih.gov/pubmed/37656502 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45212 %T Prediction Model for Postoperative Quality of Life Among Breast Cancer Survivors Along the Survivorship Trajectory From Pretreatment to 5 Years: Machine Learning–Based Analysis %A Kang,Danbee %A Kim,Hyunsoo %A Cho,Juhee %A Kim,Zero %A Chung,Myungjin %A Lee,Jeong Eon %A Nam,Seok Jin %A Kim,Seok Won %A Yu,Jonghan %A Chae,Byung Joo %A Ryu,Jai Min %A Lee,Se Kyung %+ Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, 82 2 3410 3478, [email protected] %K breast cancer survivor %K quality of life %K machine learning %K trajectory %K predict %K develop %K breast cancer %K survivor %K cancer %K oncology %K algorithm %K model %K QoL %D 2023 %7 24.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Breast cancer is the most common cancer and the most common cause of cancer death in women. Although survival rates have improved, unmet psychosocial needs remain challenging because the quality of life (QoL) and QoL-related factors change over time. In addition, traditional statistical models have limitations in identifying factors associated with QoL over time, particularly concerning the physical, psychological, economic, spiritual, and social dimensions. Objective: This study aimed to identify patient-centered factors associated with QoL among patients with breast cancer using a machine learning (ML) algorithm to analyze data collected along different survivorship trajectories. Methods: The study used 2 data sets. The first data set was the cross-sectional survey data from the Breast Cancer Information Grand Round for Survivorship (BIG-S) study, which recruited consecutive breast cancer survivors who visited the outpatient breast cancer clinic at the Samsung Medical Center in Seoul, Korea, between 2018 and 2019. The second data set was the longitudinal cohort data from the Beauty Education for Distressed Breast Cancer (BEST) cohort study, which was conducted at 2 university-based cancer hospitals in Seoul, Korea, between 2011 and 2016. QoL was measured using European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 questionnaire. Feature importance was interpreted using Shapley Additive Explanations (SHAP). The final model was selected based on the highest mean area under the receiver operating characteristic curve (AUC). The analyses were performed using the Python 3.7 programming environment (Python Software Foundation). Results: The study included 6265 breast cancer survivors in the training data set and 432 patients in the validation set. The mean age was 50.6 (SD 8.66) years and 46.8% (n=2004) had stage 1 cancer. In the training data set, 48.3% (n=3026) of survivors had poor QoL. The study developed ML models for QoL prediction based on 6 algorithms. Performance was good for all survival trajectories: overall (AUC 0.823), baseline (AUC 0.835), within 1 year (AUC 0.860), between 2 and 3 years (AUC 0.808), between 3 and 4 years (AUC 0.820), and between 4 and 5 years (AUC 0.826). Emotional and physical functions were the most important features before surgery and within 1 year after surgery, respectively. Fatigue was the most important feature between 1 and 4 years. Despite the survival period, hopefulness was the most influential feature on QoL. External validation of the models showed good performance with AUCs between 0.770 and 0.862. Conclusions: The study identified important factors associated with QoL among breast cancer survivors across different survival trajectories. Understanding the changing trends of these factors could help to intervene more precisely and timely, and potentially prevent or alleviate QoL-related issues for patients. The good performance of our ML models in both training and external validation sets suggests the potential use of this approach in identifying patient-centered factors and improving survivorship care. %M 37309655 %R 10.2196/45212 %U https://publichealth.jmir.org/2023/1/e45212 %U https://doi.org/10.2196/45212 %U http://www.ncbi.nlm.nih.gov/pubmed/37309655 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42852 %T Mobile Apps and Quality of Life in Patients With Breast Cancer and Survivors: Systematic Literature Review %A Saevarsdottir,Saeunn Rut %A Gudmundsdottir,Sigridur Lara %+ University of Iceland, Department of Health Promotion, Sport & Leisure Studies, Stakkahlid 1, Reykjavik, 105, Iceland, 354 5255950, [email protected] %K mobile health %K mHealth %K breast cancer %K quality of life %K review %K systematic review %K cancer treatment %K mobile app %K patient care %K survivorship %K digital health intervention %K lifestyle intervention %K mobile phone %D 2023 %7 26.7.2023 %9 Review %J J Med Internet Res %G English %X Background: Side effects of breast cancer treatment may persist long into survivorship, reducing quality of life (QOL) in patients with breast cancer and survivors. There is growing evidence for the use of digital health technologies, such as mobile apps, to support self-management, decrease symptom burden, and improve QOL in patients with cancer. However, an updated overview of the effects of mobile apps on QOL and well-being in patients with breast cancer and survivors is needed. Objective: The aim of this review was to provide an overview of breast cancer–specific, mobile app–driven lifestyle or behavioral interventions in patient care through to survivorship and their impact on QOL and mental well-being. Methods: A systematic search of PubMed, Scopus, and Web of Science was conducted to identify relevant studies. The inclusion criteria were limited to original studies involving a trial of a mobile app–driven lifestyle or behavioral intervention for patients with breast cancer or survivors and using QOL or well-being measures. The results of the studies that met the inclusion criterion were then synthesized in text and table format. The quality of the evidence was assessed with the Cochrane risk-of-bias tool. Results: A total of 17 studies with the number of participants ranging from 23 to 356 met the inclusion criterion. Of the 17 reviewed studies, 7 (41%) delivered an app-only intervention, and 10 (59%) combined an app with additional supporting materials, such as SMS text messaging, telecoaching, wearables, or printed materials. Among the 17 reviewed studies, 6 (35%) focused on aiding patients with breast cancer during the active treatment phase (excluding ongoing hormone therapy), whereas the remaining 11 (65%) focused on survivorship. The majority of the studies (14/17, 82%) observed some positive effects on QOL or well-being measures. Conclusions: The results of the review indicate that mobile apps are a promising avenue for improving QOL and well-being in breast cancer care. Positive effects were observed in patients undergoing active treatment in all reviewed studies, but effects were less clear after chemotherapy and in long-term survivors. Although lifestyle and behavioral digital interventions are still being developed, and further research should still be pursued, the available data suggest that current mobile health apps aid patients with breast cancer and survivors. %M 37494111 %R 10.2196/42852 %U https://www.jmir.org/2023/1/e42852 %U https://doi.org/10.2196/42852 %U http://www.ncbi.nlm.nih.gov/pubmed/37494111 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45164 %T A National Health and Wellness SMS Text Message Program for Breast Cancer Survivors During COVID-19 (EMPOWER-SMS COVID-19): Mixed Methods Evaluation Using the RE-AIM Framework %A Singleton,Anna C %A Raeside,Rebecca %A Hyun,Karice K %A Hayes,Molly %A Sherman,Kerry A %A Elder,Elisabeth %A Redfern,Julie %A Partridge,Stephanie R %+ Engagement and Co-Design Research Hub, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Level 6 Block K Westmead Hospital, Sydney, 2753, Australia, 61 2 9351 2222, [email protected] %K digital health %K telemedicine %K SMS text messaging %K breast cancer %K implementation science %K cancer survivorship %K supportive care %K public health %K COVID-19 %D 2023 %7 25.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 lockdowns caused widespread closures of supportive care services for breast cancer survivors in Australia. In a randomized controlled trial, our team’s lifestyle-focused, evidence-based SMS text message support program (EMPOWER-SMS COVID-19) was found to be acceptable and useful for breast cancer survivors, and it was ready for rapid widespread delivery. Objective: This study aims to evaluate the reach (uptake) of an adapted 3-month lifestyle-focused SMS text message program (EMPOWER-SMS COVID-19) and barriers and enablers to implementation using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Methods: A mixed methods pre-post study was conducted to evaluate the EMPOWER-SMS COVID-19 program. The study evaluated the following aspects: (1) reach/representativeness, which refers to the proportion of participant enrollment (ie, number enrolled/number that visited the study website) and demographics (eg, age, sex, ethnicity, time since completing treatment, Index of Relative Socio-economic Advantage and Disadvantage [IRSAD; quintile 1, which refers to most disadvantaged areas, to quintile 5, which refers to least disadvantaged areas, and remoteness); (2) effectiveness, in which participant engagement and acceptability were evaluated using SMS text message reply data and a feedback survey (5-point Likert scale and free-text responses); (3) adoption, which corresponds to the proportion of organizations or health professionals who agreed to promote the program; (4) implementation fidelity and maintenance, which evaluated SMS text message delivery data, opt-outs, costs, and adaptations. Quantitative data were summarized using means and SDs or frequencies and percentages, while qualitative data were analyzed thematically. Results: With regard to the reach/representativeness of the program, 841/1340 (62.8%) participants enrolled and provided electronic consent. Participants had a mean age of 58.8 (SD 9.8; range 30-87) years. According to the data collected, most participants identified as female (837/840, 99.6%) and White (736/840, 87.6%) and nearly half (418/841, 49.7%) finished treatment ≤18 months ago. Most resided in major cities (574/838, 68.5%) and 30% (251/838) in IRSAD quintile 1 or 2. In terms of effectiveness, 852 replies were received from 511 unique participants (median 1; range 1-26). The most common replies were participants stating how they heard about the program (467/852, 54.8%) or “thank you” (131/852, 15.4%). None of the replies contained urgent safety concerns. Among participants who provided feedback (449/841, 53.4%), most “(strongly) agreed” the SMS text messages were easy to understand (445/448, 99.3%), useful (373/440, 84.8%), helped participants feel supported (388/448, 86.6%), and motivated participants to be physically active (312/445, 70.1%) and eat healthier (313/457, 68.5%). Free-text responses revealed 5 factors influencing engagement: (1) feeling supported and less alone, (2) motivation and reassurance for health self-management, (3) the variety of information, (4) weblinks to information and resources, and (5) the option to save the SMS text messages. Concerning adoption, 50% (18/36) of organizations/health professionals agreed to promote the program. With regard to implementation/maintenance, SMS text messages were delivered as planned (97.43% [41,257/42,344] of SMS text messages were successfully delivered) with minimal opt-outs (62/838, 7.4%) and low cost (Aus $15.40/participant; Aus $1=US $0.67). No adaptations were made during the intervention period. Postintervention adaptations included adding weblinks and participant-selected customizations. Conclusions: EMPOWER-SMS COVID-19 was implemented quickly, had a broad reach, and had high engagement and acceptability among socioeconomically diverse participants. The program had high fidelity, low cost, and required minimal staff oversight, which may facilitate future implementation. However, further research is needed to evaluate barriers and enablers to adoption and implementation for health professionals and strategies for long-term maintenance. %M 37490319 %R 10.2196/45164 %U https://www.jmir.org/2023/1/e45164 %U https://doi.org/10.2196/45164 %U http://www.ncbi.nlm.nih.gov/pubmed/37490319 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47851 %T Mobile Web App Intervention to Promote Breast Cancer Screening Among American Indian Women in the Northern Plains: Feasibility and Efficacy Study %A Roh,Soonhee %A Lee,Yeon-Shim %A Kenyon,DenYelle B %A Elliott,Amy J %A Petereit,Daniel G %A Gaba,Anu %A Lee,Hee Yun %+ Department of Social Work, University of South Dakota, 4801 N Career Ave, 145C, Sioux Falls, SD, 57107, United States, 1 6053571593, [email protected] %K American Indian women %K breast cancer %K mammogram %K mHealth %K mobile web app intervention %D 2023 %7 20.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer is the most common cancer in the United States and the second leading cause of death for American Indian women. American Indian women have lower rates of breast cancer screening than other racial groups, and disparities in breast cancer mortality and survival rates persist among them. To address this critical need, a culturally appropriate, accessible, and personalized intervention is necessary to promote breast cancer screening among American Indian women. This study used mobile health principles to develop a mobile web app-based mammogram intervention (wMammogram) for American Indian women in a remote, rural community in the Northern Plains. Objective: This study aimed to assess the feasibility and efficacy of the wMammogram intervention, which was designed to motivate American Indian women to undergo breast cancer screening, as compared with the control group, who received an educational brochure. Methods: Using community-based participatory research (CBPR) principles and a multipronged recruitment strategy in a randomized controlled trial design, we developed the wMammogram intervention. This study involved 122 American Indian women aged between 40 and 70 years, who were randomly assigned to either the intervention group (n=62) or the control group (n=60). Those in the intervention group received personalized and culturally appropriate messages through a mobile web app, while those in the control group received an educational brochure. We measured outcomes such as mammogram receipt, intention to receive breast cancer screening after the intervention, and participants’ satisfaction with and acceptance of the intervention. Results: A significantly higher proportion of women who received the wMammogram intervention (26/62, 42%; P=.009) completed mammograms by the 6-month follow-up than the control group (12/60, 20%). The wMammogram intervention group, compared with the control group, reported significantly higher ratings on perceived effectiveness of the intervention (t120=−5.22; P<.001), increase in knowledge (t120=−4.75; P<.001), and satisfaction with the intervention (t120=−3.61; P<.001). Moreover, compared with the brochure group, the intervention group expressed greater intention to receive a mammogram in the future when it is due (62/62, 100% vs 51/60, 85%) and were more willing to recommend the intervention they received to their friends (61/62, 98.4% vs 54/60, 90%) with statistically significant differences. Conclusions: This study shows the feasibility and efficacy of the wMammogram intervention to promote breast cancer screening for American Indian women in a remote, rural community-based setting. Findings suggest that, with advancements in technology and the ubiquity of mobile devices, mobile web apps could serve as a valuable health intervention tool that builds upon low-cost technology and enhances accessibility and sustainability of preventive care to help reduce breast health disparities experienced in hard-to-reach American Indian populations. Trial Registration: ClinicalTrials.gov NCT05530603; https://clinicaltrials.gov/ct2/show/NCT05530603 %M 37471115 %R 10.2196/47851 %U https://formative.jmir.org/2023/1/e47851 %U https://doi.org/10.2196/47851 %U http://www.ncbi.nlm.nih.gov/pubmed/37471115 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47110 %T Survival and Trends in Annualized Hazard Function by Age at Diagnosis Among Chinese Breast Cancer Patients Aged ≤40 Years: Case Analysis Study %A Wang,Jun %A Luo,Ting %A Xiang,Zhong-zheng %A He,Ming-min %A Zeng,Yuan-yuan %A Yang,Tian %A Wei,Xiao-yuan %A Yu,Siting %A Dai,Ze-lei %A Xu,Ning-yue %A Tan,Chen-feng %A Liu,Lei %+ Department of Head and Neck Oncology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610044, China, 86 18805053037, [email protected] %K breast cancer %K young age %K age strata %K survival %K annual hazard function %K China %D 2023 %7 18.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Young breast cancer patients are more likely to develop aggressive tumor characteristics and a worse prognosis than older women, and different races and ethnicities have distinct epidemiologies and prognoses. However, few studies have evaluated the clinical biological features and relapse patterns in different age strata of young women in Asia. Objective: We aimed to explore survival differences and the hazard function in young Chinese patients with breast cancer (BC) by age. Methods: The patients were enrolled from West China Hospital, Sichuan University. The chi-squared test, a Kaplan-Meier analysis, a log-rank test, a Cox multivariate hazards regression model, and a hazard function were applied for data analysis. Locoregional recurrence–free survival (LRFS), distant metastasis–free survival (DMFS), breast cancer–specific survival (BCSS), and overall survival (OS) were defined as end points. Results: We included 1928 young BC patients diagnosed between 2008 and 2019. Patients aged 18 to 25, 26 to 30, 31 to 35, and 36 to 40 years accounted for 2.7% (n=53), 11.8% (n=228), 27.7% (n=535), and 57.7% (n=1112) of the patients, respectively. The diagnosis of young BC significantly increased from 2008 to 2019. Five-year LRFS, DMFS, BCSS, and OS for the entire population were 98.3%, 93.4%, 94.4%, and 94%, respectively. Patients aged 18 to 25 years had significantly poorer 5-year LRFS (P<.001), 5-year DMFS (P<.001), 5-year BCSS (P=.04), and 5-year OS (P=.04) than those aged 31 to 35, 26 to 30, and 36 to 40 years. The hazard curves for recurrence and metastasis for the whole cohort continuously increased over the years, while the BC mortality risk peaked at 2 to 3 years and then slowly decreased. When stratified by age, the annualized hazard function for recurrence, metastasis, and BC mortality in different age strata showed significantly different trends, especially for BC mortality. Conclusions: The annual diagnosis of young BC seemed to increase in Chinese patients, and the distinct age strata of young BC patients did not differ in survival outcome or failure pattern. Our results might provide strategies for personalized management of young BC. %M 37463020 %R 10.2196/47110 %U https://publichealth.jmir.org/2023/1/e47110 %U https://doi.org/10.2196/47110 %U http://www.ncbi.nlm.nih.gov/pubmed/37463020 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43838 %T Personalized Risk Analysis to Improve the Psychological Resilience of Women Undergoing Treatment for Breast Cancer: Development of a Machine Learning–Driven Clinical Decision Support Tool %A C Manikis,Georgios %A Simos,Nicholas J %A Kourou,Konstantina %A Kondylakis,Haridimos %A Poikonen-Saksela,Paula %A Mazzocco,Ketti %A Pat-Horenczyk,Ruth %A Sousa,Berta %A Oliveira-Maia,Albino J %A Mattson,Johanna %A Roziner,Ilan %A Marzorati,Chiara %A Marias,Kostas %A Nuutinen,Mikko %A Karademas,Evangelos %A Fotiadis,Dimitrios %+ Foundation for Research and Technology-Hellas, Biomedical Research Institute, University campus of Ioannina, Building E5, Ioannina, GR 45110, Greece, 30 2651009006, [email protected] %K breast cancer %K classification %K machine learning %K mental health %K well-being %K explainability %K interventions %K risk assessment %D 2023 %7 12.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Health professionals are often faced with the need to identify women at risk of manifesting poor psychological resilience following the diagnosis and treatment of breast cancer. Machine learning algorithms are increasingly used to support clinical decision support (CDS) tools in helping health professionals identify women who are at risk of adverse well-being outcomes and plan customized psychological interventions for women at risk. Clinical flexibility, cross-validated performance accuracy, and model explainability permitting person-specific identification of risk factors are highly desirable features of such tools. Objective: This study aimed to develop and cross-validate machine learning models designed to identify breast cancer survivors at risk of poor overall mental health and global quality of life and identify potential targets of personalized psychological interventions according to an extensive set of clinical recommendations. Methods: A set of 12 alternative models was developed to improve the clinical flexibility of the CDS tool. All models were validated using longitudinal data from a prospective, multicenter clinical pilot at 5 major oncology centers in 4 countries (Italy, Finland, Israel, and Portugal; the Predicting Effective Adaptation to Breast Cancer to Help Women to BOUNCE Back [BOUNCE] project). A total of 706 patients with highly treatable breast cancer were enrolled shortly after diagnosis and before the onset of oncological treatments and were followed up for 18 months. An extensive set of demographic, lifestyle, clinical, psychological, and biological variables measured within 3 months after enrollment served as predictors. Rigorous feature selection isolated key psychological resilience outcomes that could be incorporated into future clinical practice. Results: Balanced random forest classifiers were successful at predicting well-being outcomes, with accuracies ranging between 78% and 82% (for 12-month end points after diagnosis) and between 74% and 83% (for 18-month end points after diagnosis). Explainability and interpretability analyses built on the best-performing models were used to identify potentially modifiable psychological and lifestyle characteristics that, if addressed systematically in the context of personalized psychological interventions, would be most likely to promote resilience for a given patient. Conclusions: Our results highlight the clinical utility of the BOUNCE modeling approach by focusing on resilience predictors that can be readily available to practicing clinicians at major oncology centers. The BOUNCE CDS tool paves the way for personalized risk assessment methods to identify patients at high risk of adverse well-being outcomes and direct valuable resources toward those most in need of specialized psychological interventions. %M 37307043 %R 10.2196/43838 %U https://www.jmir.org/2023/1/e43838 %U https://doi.org/10.2196/43838 %U http://www.ncbi.nlm.nih.gov/pubmed/37307043 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45455 %T Epidemiology and a Predictive Model of Prognosis Index Based on Machine Learning in Primary Breast Lymphoma: Population-Based Study %A Yu,Yushuai %A Xu,Zelin %A Shao,Tinglei %A Huang,Kaiyan %A Chen,Ruiliang %A Yu,Xiaoqin %A Zhang,Jie %A Han,Hui %A Song,Chuangui %+ Department of Breast Surgery, Fujian Medical University Union Hospital, 29 Xin Quan Road, Gulou District, Fuzhou, 350001, China, 86 13960709993, [email protected] %K primary breast lymphoma %K epidemiology %K prognosis %K machine learning %K disparities %D 2023 %7 8.6.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Primary breast lymphoma (PBL) is a rare disease whose epidemiological features, treatment principles, and factors used for the patients’ prognosis remain controversial. Objective: The aim of this study was to explore the epidemiology of PBL and to develop a better model based on machine learning to predict the prognosis for patients with primary breast lymphoma. Methods: The annual incidence of PBL was extracted from the surveillance, epidemiology, and end results database between 1975 and 2019 to examine disease occurrence trends using Joinpoint software (version 4.9; National Cancer Institute). We enrolled data from 1251 female patients with primary breast lymphoma from the surveillance, epidemiology, and end results database for survival analysis. Univariable and multivariable analyses were performed to explore independent prognostic factors for overall survival and disease-specific survival of patients with primary breast lymphoma. Eight machine learning algorithms were developed to predict the 5-year survival of patients with primary breast lymphoma. Results: The overall incidence of PBL increased drastically between 1975 and 2004, followed by a significant downward trend in incidence around 2004, with an average annual percent change (AAPC) of −0.8 (95% CI −1.1 to −0.6). Disparities in trends of PBL exist by age and race. The AAPC of the 65 years or older cohort was about 1.2 higher than that for the younger than 65 years cohort. The AAPC of White patients is 0.9 (95% CI 0.0-1.8), while that of Black patients was significantly higher at 2.1 (95% CI −2.5 to 6.9). We also identified that the risk of death from PBL is multifactorial and includes patient factors and treatment factors. Survival analysis revealed that the patients diagnosed between 2007 and 2015 had a significant risk reduction of mortality compared to those diagnosed between 1983 and 1990. The gradient booster model outperforms other models, with 0.752 for sensitivity and 0.817 for area under the curve. The important features established with the gradient booster model were the year of diagnosis, age, histologic type, and primary site, which were the 4 most relevant variables to explain 5-year survival status. Conclusions: The incidence of PBL started demonstrating a tendency to decrease after 2004, which varied by age and race. In recent years, the prognosis of patients with primary breast lymphoma has been remarkably improved. The gradient booster model had a promising performance. This model can help clinicians identify the early prognosis of patients with primary breast lymphoma and therefore improve the clinical outcome by changing management strategies and patient health care. %M 37169516 %R 10.2196/45455 %U https://publichealth.jmir.org/2023/1/e45455 %U https://doi.org/10.2196/45455 %U http://www.ncbi.nlm.nih.gov/pubmed/37169516 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e39105 %T Impact of COVID-19 on Public Interest in Breast Cancer Screening and Related Symptoms: Google Trends Analysis %A Tan,Si Ying %A Tang,Matilda Swee Sun %A Ong,Chin-Ann Johnny %A Tan,Veronique Kiak Mien %A Shannon,Nicholas Brian %+ Department of Breast Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital, Academia, 20 College Road, Department of Breast Surgery, Singapore, 169856, Singapore, 65 63266834, [email protected] %K breast cancer screening %K breast cancer symptoms %K COVID-19 %K public interest %K Google Trends %K screening %K breast cancer %K symptoms %K cancer %K trend %K mammography %K monitoring %D 2023 %7 6.6.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: The COVID-19 pandemic has led to a decrease in cancer screening due to the redeployment of health care resources and public avoidance of health care facilities. Breast cancer is the most common cancer diagnosed in female individuals, with improved survival rates from early detection. An avoidance of screening, resulting in late detection, greatly affects survival and increases health care resource burden and costs. Objective: This study aimed to evaluate if a sustained decrease in public interest in screening occurred and to evaluate other search terms, and hence interest, associated with that. Methods: This study used Google Trends to analyze public interest in breast cancer screening and symptoms. We queried search data for 4 keyword terms (“mammogram,” “breast pain,” “breast lump,” and “nipple discharge”) from January 1, 2019, to January 1, 2022. The relative search frequency metric was used to assess interest in these terms, and related queries were retrieved for each keyword to evaluate trends in search patterns. Results: Despite an initial drastic drop in interest in mammography from March to April 2020, this quickly recovered by July 2020. After this period, alongside the recovery of interest in screening, there was a rapid increase in interest for arranging for mammography. Relative search frequencies of perceived breast cancer–related symptoms such as breast lump, nipple discharge, and breast pain remained stable. There was increase public interest in natural and alternative therapy of breast lumps despite the recovery of interest in mammography and breast biopsy. There was a significant correlation between search activity and Breast Cancer Awareness Month in October. Conclusions: Online search interest in breast cancer screening experienced a sharp decline at the beginning of the COVID-19 pandemic, with a subsequent return to baseline interest in arranging for mammography followed this short period of decreased interest. %M 37163461 %R 10.2196/39105 %U https://cancer.jmir.org/2023/1/e39105 %U https://doi.org/10.2196/39105 %U http://www.ncbi.nlm.nih.gov/pubmed/37163461 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38073 %T Codevelopment of a Text Messaging Intervention to Support Adherence to Adjuvant Endocrine Therapy in Women With Breast Cancer: Mixed Methods Approach %A Green,Sophie M C %A French,David P %A Hall,Louise H %A Bartlett,Yvonne Kiera %A Rousseau,Nikki %A Raine,Erin %A Parbutt,Catherine %A Gardner,Benjamin %A , %A Smith,Samuel G %+ Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9LU, United Kingdom, 44 1133430892, [email protected] %K breast cancer %K medication adherence %K habit formation %K behavior change techniques %K SMS text messages %K intervention development %D 2023 %7 24.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Adjuvant endocrine therapy (AET) reduces breast cancer recurrence and mortality in women with early-stage breast cancer. Unintentional nonadherence to AET is common (eg, forgetting to take medication). Forming habits surrounding medication taking could reduce reliance on memory and improve AET adherence. SMS text messaging interventions may offer a low-cost approach for promoting medication-taking habits. To optimize the likely effectiveness of such SMS text messages, the content should be developed using a transparent approach to ensure fidelity to relevant psychological theory and with user input to increase acceptability. Objective: This study aimed to develop a pool of brief SMS text messages promoting habit formation to support AET adherence, which are acceptable to women with breast cancer and show fidelity to theory-based behavior change techniques (BCTs). Methods: According to published literature, we selected 6 BCTs derived from the habit formation model: action planning, habit formation, restructuring the physical environment, adding objects to the environment, prompts/cues, and self-monitoring of behavior. In study 1, behavior change experts (n=10) created messages, each based on 1 of the 6 BCTs, in a web-based workshop and rated the fidelity of the messages to the intended BCT. In study 2, women with experience of taking AET discussed the acceptability of the messages in a focus group (n=5), and the messages were refined following this. In study 3, women with breast cancer rated the acceptability of each message in a web-based survey (n=60). In study 4, additional behavior change experts rated the fidelity of the remaining messages to the intended BCT in a web-based survey (n=12). Finally, a consultant pharmacist reviewed a selection of messages to ensure that they did not contradict general medical advice. Results: In study 1, 189 messages were created targeting the 6 BCTs. In total, 92 messages were removed because they were repetitious, unsuitable, or >160 characters, and 3 were removed because of low fidelity (scoring <5.5/10 on a fidelity rating scale). Following study 2, we removed 13 messages considered unacceptable to our target population. In study 3, all remaining messages scored above the midpoint on an acceptability scale (1-5); therefore, no messages were removed (mean 3.9/5, SD 0.9). Following study 4, we removed 13 messages owing to low fidelity (scoring <5.5/10 on a fidelity rating scale). All the remaining messages showed fidelity to the intended BCTs (mean 7.9/10, SD 1.3). Following the pharmacist review, 2 messages were removed, and 3 were amended. Conclusions: We developed a pool of 66 brief SMS text messages targeting habit formation BCTs to support AET adherence. These showed acceptability to women with breast cancer and fidelity to the intended BCTs. The delivery of the messages will be further evaluated to assess their effect on medication adherence. %M 37223964 %R 10.2196/38073 %U https://www.jmir.org/2023/1/e38073 %U https://doi.org/10.2196/38073 %U http://www.ncbi.nlm.nih.gov/pubmed/37223964 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43592 %T Designing a Dyad-Based Digital Health Intervention to Reduce Sedentary Time in Black Breast Cancer Survivors and Their First-degree Relatives: Human-Centered Design Study %A Blazey,Meghan %A Marinac,Catherine %A Whiteley,Jessica %A Peterson,Sarah %A Burns White,Karen %A Jacques,Cathyanah %A Lam,Helen %A Halpenny,Barbara %A Patel,Shree %A Lamothe,Raymond %A Wright,Julie %+ School of Nursing, University of Rochester, 601 Elmwood Ave, Box SON, Rochester, NY, 14642, United States, 1 585 276 6123, [email protected] %K sedentary behavior %K digital health %K dyad-based intervention %K breast cancer risk %K breast cancer survivor %K social support %K mobile phone %D 2023 %7 24.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer, the most commonly diagnosed cancer and second leading cause of cancer-related death in women in the United States, disproportionately affects women from minoritized or low socioeconomic backgrounds. The average woman has an approximately 12% lifetime risk of developing breast cancer. Lifetime risk nearly doubles if a woman has a first-degree relative with breast cancer, and the risk increases as multiple family members are affected. Decreasing sedentary behaviors through moving more and sitting less reduces breast cancer risk and improves outcomes for cancer survivors and healthy adults. Digital health solutions, such as mobile apps that are culturally appropriate, designed with input from the target audience, and include social support, are effective at improving health behaviors. Objective: This study aimed to develop and evaluate the usability and acceptability of a prototype app designed with a human-centered approach to promote moving more and sitting less in Black breast cancer survivors and their first-degree relatives (parent, child, or sibling). Methods: This 3-phase study consisted of app development, user testing, and evaluation of user engagement and usability. Key community stakeholders were engaged in the first 2 (qualitative) phases to provide input into developing the prototype app (MoveTogether). After development and user testing, a usability pilot was conducted. Participants were adult breast cancer survivors who identified as Black and agreed to participate with a relative. Participants used the app and a step-tracking watch for 4 weeks. App components included goal setting and reporting, reminders, dyad messaging, and educational resources. Usability and acceptability were assessed with a questionnaire that included the System Usability Scale (SUS) and semistructured interviews. Data were analyzed with descriptive statistics and content analysis. Results: Participants in the usability pilot (n=10) were aged 30 to 50 years (6/10, 60%), not married (8/10, 80%), and college graduates (5/10, 50%). The app was used on average 20.2 (SD 8.9) out of 28 days—SUS score of 72 (range 55-95)—and 70% (7/10) agreed that the app was acceptable, helpful, and gave them new ideas. Additionally, 90% (9/10) found the dyad component helpful and would recommend the app to friends. Qualitative findings suggest that the goal-setting feature was helpful and that the dyad partner (buddy) provided accountability. Participants were neutral regarding the cultural appropriateness of the app. Conclusions: The MoveTogether app and related components were acceptable for promoting moving more in dyads of breast cancer survivors and their first-degree relatives. The human-centered approach, which involved engaging community members in the development, is a model for future technology development work. Future work should be done to further develop the intervention based on the findings and then test its efficacy to improve sedentary behavior while considering culturally informed strategies for adoption and implementation within the community. Trial Registration: ClinicalTrials.gov NCT05011279; https://clinicaltrials.gov/ct2/show/NCT05011279 %M 37223968 %R 10.2196/43592 %U https://formative.jmir.org/2023/1/e43592 %U https://doi.org/10.2196/43592 %U http://www.ncbi.nlm.nih.gov/pubmed/37223968 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47195 %T Coping After Breast Cancer: Protocol for a Randomized Controlled Trial of Stress Management eHealth Interventions %A Svendsen,Karianne %A Nes,Lise Solberg %A Meland,Anders %A Larsson,Ine Marie %A Gjelsvik,Ylva M %A Børøsund,Elin %A Rygg,Christine M %A Myklebust,Tor Ã…ge %A Reinertsen,Kristin V %A Kiserud,Cecilie E %A Skjerven,Helle %A Antoni,Michael H %A Chalder,Trudie %A Mjaaland,Ingvil %A Carlson,Linda E %A Eriksen,Hege R %A Ursin,Giske %+ Cancer Registry of Norway, Oslo University Hospital, Ullernchausséen 64, Oslo, 0379, Norway, 47 99011452, [email protected] %K breast cancer %K stress management %K mindfulness %K cognitive behavioral therapy %K psychosocial %K StressProffen %K RCT %K eHealth %K digital %K intervention %D 2023 %7 24.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: One-third or more of breast cancer survivors report stress and other psychological and physical complaints that can negatively impact their quality of life. Psychosocial stress management interventions, shown to mitigate the negative impact of these complaints, can now be delivered as accessible and convenient (for the patient and provider) eHealth interventions. In this randomized controlled trial (RCT), Coping After Breast Cancer (CABC), 2 modified versions of the stress management eHealth intervention program StressProffen were created: one with predominantly cognitive behavioral stress management content (StressProffen-cognitive behavioral therapy intervention [StressProffen-CBI]) and another with predominantly mindfulness-based stress management content (StressProffen-mindfulness-based intervention [StressProffen-MBI]). Objective: This study aims to investigate the effects in breast cancer survivors of using StressProffen-CBI and StressProffen-MBI compared with a control group (treatment as usual). Methods: Women diagnosed with breast cancer (stage I-III, unequivocally human epidermal growth factor receptor 2–positive or estrogen receptor-negative tumors) or ductal carcinoma in situ (DCIS) aged 21-69 years who completed the Cancer Registry of Norway–initiated health survey on quality of life are invited to the CABC trial about 7 months after diagnosis. Women who give consent to participate are randomized (1:1:1) to either the StressProffen-CBI, StressProffen-MBI, or control group. Both StressProffen interventions consist of 10 modules of stress management content delivered through text, sound, video, and images. The primary outcome is between-group changes in perceived stress at 6 months, assessed with Cohen 10-item Perceived Stress Scale. The secondary outcomes comprise changes in quality of life, anxiety, depression, fatigue, sleep, neuropathy, coping, mindfulness, and work-related outcomes approximately 1, 2, and 3 years after diagnosis. Long-term effects of the interventions on work participation, comorbidities, relapse or new cancers, and mortality will be assessed using data from national health registries. Results: Recruitment is scheduled from January 2021 to May 2023. The goal is to recruit 430 participants (100 in each group). As of April 14 2023, 428 participants have been enrolled. Conclusions: The CABC trial is possibly the largest ongoing psychosocial eHealth RCT in patients with breast cancer. If 1 or both interventions prove to be effective in reducing stress and improving psychosocial and physical complains, the StressProffen eHealth interventions could be beneficial, inexpensive, and easily implementable tools for breast cancer survivors when coping with late effects after cancer and cancer treatments. Trial Registration: Clinicaltrials.gov NCT04480203; https://clinicaltrials.gov/ct2/show/NCT04480203 International Registered Report Identifier (IRRID): DERR1-10.2196/47195 %M 37103493 %R 10.2196/47195 %U https://www.researchprotocols.org/2023/1/e47195 %U https://doi.org/10.2196/47195 %U http://www.ncbi.nlm.nih.gov/pubmed/37103493 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e39072 %T A Digital Solution for an Advanced Breast Tumor Board: Pilot Application Cocreation and Implementation Study %A Hodroj,Khalil %A Pellegrin,David %A Menard,Cindy %A Bachelot,Thomas %A Durand,Thierry %A Toussaint,Philippe %A Dufresne,Armelle %A Mery,Benoite %A Tredan,Olivier %A Goulvent,Thibaut %A Heudel,Pierre %+ Centre Leon Berard, 28 avenue Laënnec, Lyon, 69008, France, 33 0478782958, [email protected] %K digital health %K multidisciplinary meeting %K advanced breast cancer %K cancer %K breast cancer %K tumor %K clinician %K confidence %K treatment %K pathology %K genomic %K care %K patient %K software %K data %K neoplastic %K pain %K follow-up %K electronic medical records %K records %D 2023 %7 18.5.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancer treatment is constantly evolving toward a more personalized approach based on clinical features, imaging, and genomic pathology information. To ensure the best care for patients, multidisciplinary teams (MDTs) meet regularly to review cases. Notwithstanding, the conduction of MDT meetings is challenged by medical time restrictions, the unavailability of critical MDT members, and the additional administrative work required. These issues may result in members missing information during MDT meetings and postponed treatment. To explore and facilitate improved approaches for MDT meetings in France, using advanced breast cancers (ABCs) as a model, Centre Léon Bérard (CLB) and ROCHE Diagnostics cocreated an MDT application prototype based on structured data. Objective: In this paper, we want to describe how an application prototype was implemented for ABC MDT meetings at CLB to support clinical decisions. Methods: Prior to the initiation of cocreation activities, an organizational audit of ABC MDT meetings identified the following four key phases for the MDT: the instigation, preparation, execution, and follow-up phases. For each phase, challenges and opportunities were identified that informed the new cocreation activities. The MDT application prototype became software that integrated structured data from medical files for the visualization of the neoplastic history of a patient. The digital solution was assessed via a before-and-after audit and a survey questionnaire that was administered to health care professionals involved in the MDT. Results: The ABC MDT meeting audit was carried out during 3 MDT meetings, including 70 discussions of clinical cases before and 58 such discussions after the implementation of the MDT application prototype. We identified 33 pain points related to the preparation, execution, and follow-up phases. No issues were identified related to the instigation phase. Difficulties were grouped as follows: process challenges (n=18), technological limitations (n=9), and the lack of available resources (n=6). The preparation of MDT meetings was the phase in which the most issues (n=16) were seen. A repeat audit, which was undertaken after the implementation of the MDT application, demonstrated that (1) the discussion times per case remained comparable (2 min and 22 s vs 2 min and 14 s), (2) the capture of MDT decisions improved (all cases included a therapeutic proposal), (3) there was no postponement of treatment decisions, and (4) the mean confidence of medical oncologists in decision-making increased. Conclusions: The introduction of the MDT application prototype at CLB to support the ABC MDT seemed to improve the quality of and confidence in clinical decisions. The integration of an MDT application with the local electronic medical record and the utilization of structured data conforming to international terminologies could enable a national network of MDTs to support sustained improvements to patient care. %M 37200077 %R 10.2196/39072 %U https://cancer.jmir.org/2023/1/e39072 %U https://doi.org/10.2196/39072 %U http://www.ncbi.nlm.nih.gov/pubmed/37200077 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41216 %T Usability Testing of a New Digital Integrated Health Ecosystem (PainRELife) for the Clinical Management of Chronic Pain in Patients With Early Breast Cancer: Protocol for a Pilot Study %A Masiero,Marianna %A Filipponi,Chiara %A Pizzoli,Silvia Francesca Maria %A Munzone,Elisabetta %A Guido,Luca %A Guardamagna,Vittorio Andrea %A Marceglia,Sara %A Caruso,Annamaria %A Prandin,Roberto %A Prenassi,Marco %A Manzelli,Vania %A Savino,Chiara %A Conti,Costanza %A Rizzi,Federica %A Casalino,Alice %A Candiani,Giulia %A Memini,Francesca %A Chiveri,Luca %A Vitali,Andrea Luigi %A Corbo,Massimo %A Milani,Alessandra %A Grasso,Roberto %A Traversoni,Silvia %A Fragale,Elisa %A Didier,Florence %A Pravettoni,Gabriella %+ Department of Oncology and Hemato-oncology, University of Milan, Via Festa del Perdono 7, Milan, 20122, Italy, 39 0294372099, [email protected] %K decision-making %K decision aid %K chronic pain %K eHealth %K patient electronic health record %K clinical %K technology %K mobile application %K pilot study %K breast cancer %K chronic %K patient %K cancer %K pain %D 2023 %7 12.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic pain (CP) and its management are critical issues in the care pathway of patients with breast cancer. Considering the complexity of CP experience in cancer, the international scientific community has advocated identifying cutting-edge approaches for CP management. Recent advances in the field of health technology enable the adoption of a novel approach to care management by developing integrated ecosystems and mobile health apps. Objective: The primary end point of this pilot study is to evaluate patients’ usability experience at 3 months of a new digital and integrated technological ecosystem, PainRELife, for CP in a sample of patients with breast cancer. The PainRELife ecosystem is composed of 3 main technological assets integrated into a single digital ecosystem: Fast Healthcare Interoperability Resources–based cloud platform (Nu platform) that enables care pathway definition and data collection; a big data infrastructure connected to the Fast Healthcare Interoperability Resources server that analyzes data and implements dynamic dashboards for aggregate data visualization; and an ecosystem of personalized applications for patient-reported outcomes collection, digital delivery of interventions and tailored information, and decision support of patients and caregivers (PainRELife app). Methods: This is an observational, prospective pilot study. Twenty patients with early breast cancer and chronic pain will be enrolled at the European Institute of Oncology at the Division of Medical Senology and the Division of Pain Therapy and Palliative Care. Each patient will use the PainRELife mobile app for 3 months, during which data extracted from the questionnaires will be sent to the Nu Platform that health care professionals will manage. This pilot study is nested in a large-scale project named “PainRELife,” which aims to develop a cloud technology platform to interoperate with institutional systems and patients' devices to collect integrated health care data. The study received approval from the Ethical Committee of the European Cancer Institute in December 2021 (number R1597/21-IEO 1701). Results: The recruitment process started in May 2022 and ended in October 2022. Conclusions: The new integrated technological ecosystems might be considered an encouraging affordance to enhance a patient-centered approach to managing patients with cancer. This pilot study will inform about which features the health technological ecosystems should have to be used by cancer patients to manage CP. International Registered Report Identifier (IRRID): DERR1-10.2196/41216 %M 37171843 %R 10.2196/41216 %U https://www.researchprotocols.org/2023/1/e41216 %U https://doi.org/10.2196/41216 %U http://www.ncbi.nlm.nih.gov/pubmed/37171843 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e38487 %T Effect of the Red Bull Energy Drink on Perfusion-Related Variables in Women Undergoing Microsurgical Breast Reconstruction: Protocol and Analysis Plan for a Prospective, Multicenter Randomized Controlled Trial %A Speck,Nicole Edith %A Michalak,Michal %A Dreier,Kathrin %A Babst,Doris %A Lardi,Alessia Marisa %A Farhadi,Jian %+ Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Spitalstrasse 21, Basel, 4031, Switzerland, 41 061 265 73 00, [email protected] %K analysis %K blood pressure %K breast %K energy drinks %K heart rate %K mammaplasty %K microsurgery %K pain %K patient %K perfusion %K postoperative %K prospective studies %K reconstruction %K surgery %K systolic %K taurine %D 2023 %7 9.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Maintaining a sufficiently high systolic blood pressure is essential for free flap perfusion after microsurgical breast reconstruction. Yet, many women undergoing these procedures have low postoperative systolic blood pressure. Intravenous volume administration or vasopressors may be needed to maintain systolic blood pressure above a predefined threshold. However, excessive volume administration may lead to volume overload and flap stasis, and the postoperative use of vasopressors may be limited depending on institutional standards. Additional nonpharmacological measures to raise blood pressure might be beneficial. Evidence suggests that the Red Bull energy drink could raise blood pressure. It has been shown to increase systolic and diastolic blood pressure in healthy volunteers and athletes. Objective: The primary objective of this study is to determine the difference in systolic blood pressure between an intervention group receiving Red Bull and a control group receiving still water after microsurgical breast reconstruction. Secondary objectives include postoperative heart rate, 24-hour fluid balance, pain level, or necessity for revision surgery due to flap complications. Methods: The Red Bull study is a prospective, multicenter randomized controlled trial comparing the effect of postoperative ingestion of Red Bull energy drink against still water in female patients undergoing unilateral microsurgical breast reconstruction. A total of 250 mL of Red Bull (intervention group) or 250 mL of still water (control group) will be administered to the study participants 2 hours postoperatively as well as for breakfast and lunch on postoperative day 1, amounting to a total volume of 750 mL per 24 hours. Female patients between 18 and 70 years of age undergoing unilateral microsurgical breast reconstruction will be included. Exclusion criteria are a history of arterial hypertension, cardiac rhythm disorder, diabetes mellitus, gastric or duodenal ulcer, thyroid disease, and current use of antihypertensive or antiarrhythmic drugs or thyroid hormones, as well as intolerance to Red Bull. Results: Recruitment for the study started in June 2020 and was completed in December 2022. There is evidence that the Red Bull energy drink increases blood pressure in healthy volunteers and athletes. We hypothesize that postoperative ingestion of Red Bull will increase systolic blood pressure in women after microsurgical breast reconstruction. Red Bull could hence be used as a nonpharmacological adjunct to vasopressors or volume administration in women with hypotensive blood pressure after microsurgical breast reconstruction. Conclusions: This paper describes the Red Bull study trial protocol and analysis plan. The information will increase the transparency of the data analysis for the Red Bull study. Trial Registration: ClinicalTrials.gov NCT04397419; https://clinicaltrials.gov/ct2/show/NCT04397419 International Registered Report Identifier (IRRID): DERR1-10.2196/38487 %M 37159251 %R 10.2196/38487 %U https://www.researchprotocols.org/2023/1/e38487 %U https://doi.org/10.2196/38487 %U http://www.ncbi.nlm.nih.gov/pubmed/37159251 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41179 %T Paradigmatic Approach to Support Personalized Counseling With Digital Health (iKNOW) %A Speiser,Dorothee %A Heibges,Maren %A Besch,Laura %A Hilger,Caren %A Keinert,Marie %A Klein,Katharina %A Rauwolf,Gudrun %A Schmid,Christine %A Schulz-Niethammer,Sven %A Stegen,Steffi %A Westfal,Viola %A Witzel,Isabell %A Zang,Benedikt %A Kendel,Friederike %A Feufel,Markus A %+ Department of Gynecology with Breast Center, Hereditary Breast and Ovarian Cancer Center, Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 664 ext 263, [email protected] %K hereditary breast and ovarian cancer %K BRCA %K genetic counseling %K digital health %K online counseling tool %K user-centered design principles %K risk communication %K cancer risk %K hereditary cancer %K breast cancer %K ovarian cancer %D 2023 %7 21.4.2023 %9 Viewpoint %J JMIR Form Res %G English %X iKNOW is the first evidence-based digital tool to support personalized counseling for women in Germany with a hereditary cancer risk. The counseling tool is designed for carriers of pathogenic gBRCA (germline breast cancer gene) variants that increase the lifetime risk of breast and ovarian cancer. Carriers of pathogenic variants are confronted with complex, individualized risk information, and physicians must be able to convey this information in a comprehensible way to enable preference-sensitive health decisions. In this paper, we elaborate on the clinical, regulatory, and practical premises of personalized counseling in Germany. By operationalizing these premises, we formulate 5 design principles that, we suggest, are specific enough to develop a digital tool (eg, iKNOW), yet wide-ranging enough to inform the development of counseling tools for personalized medicine more generally: (1) digital counseling tools should implement the current standard of care (eg, based on guidelines); (2) digital counseling tools should help to both standardize and personalize the counseling process (eg, by enabling the preference-sensitive selection of counseling contents from a common information base); (3) digital counseling tools should make complex information easy to access both cognitively (eg, by using evidenced-based risk communication formats) and technically (eg, by means of responsive design for various devices); (4) digital counseling tools should respect the counselee’s data privacy rights (eg, through strict pseudonymization and opt-in consent); and (5) digital counseling tools should be systematically and iteratively evaluated with the users in mind (eg, using formative prototype testing to ensure a user-centric design and a summative multicenter, randomized controlled trial). On the basis of these paradigmatic design principles, we hope that iKNOW can serve as a blueprint for the development of more digital innovations to support personalized counseling approaches in cancer medicine. %M 37083496 %R 10.2196/41179 %U https://formative.jmir.org/2023/1/e41179 %U https://doi.org/10.2196/41179 %U http://www.ncbi.nlm.nih.gov/pubmed/37083496 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43002 %T The Chinese Version of the Breast Cancer Literacy Assessment Tool: Translation, Adaptation, and Validation Study %A Shan,Yi %A Ji,Meng %+ School of Languages and Cultures, The University of Sydney, A18 - Brennan MacCallum Building, Sydney, NSW 2006, Australia, 61 2 9351 4512, [email protected] %K breast cancer literacy assessment tool %K translation %K adaptation %K psychometric evaluation %K validity %K reliability %K breast cancer %K cancer %K tool %K women %K prevention %K detection %K intervention %K assessment %K education %K breast cancer literacy %K assessment tool %K cancer awareness %K health literacy %D 2023 %7 19.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer is the most common cancer among Chinese women, with an age-standardized prevalence of 21.6 cases per 100,000 women. Limited cancer health literacy reduces females’ ability to engage in cancer prevention and detection. It is necessary to assess Chinese women’s breast cancer literacy to deliver targeted interventions and effective education. However, there is no Breast Cancer Literacy Assessment Tool (B-CLAT) available in China currently. Objective: This study aimed to translate and linguistically and culturally adapt the B-CLAT into a simplified-Chinese version (C-B-CLAT), and then validate its psychometric properties by administering it to Chinese college students. Methods: First, we translated the B-CLAT into a simplified-Chinese version and verified its validity and reliability using rigorous translation and validation guidelines proposed in previous studies. We then evaluated the psychometric properties among 50 female participants with a mean age of 19.62 (SD 1.31) years recruited from Nantong University, China. Results: Items 1, 6, 8, 9, 10, 16, 17, 20, 21, 22, 23, 24, 25, 26, 29, and 30 were deleted to increase the relevant subscale internal consistency. Items 3, 12, 13, 14, 18, 20, 27, and 31 were deleted due to their Cronbach α being lower than .5 in the test-retest analysis. After deletion, the internal consistency of the entire scale was fair with α=.607. The prevention and control subscale had the highest internal consistency with α=.730, followed by the screening and knowledge subscale with α=.509, while the awareness subscale had the lowest internal consistency with α=.224. The intraclass correlation coefficient for the C-B-CLAT (items 2, 4, 5, 7, 11, 15, 28, 32, 33, and 34) was fair to excellent (odds ratio [OR] 0.88, 95% CI 0.503-0.808). The values of Cronbach α for items 2, 4, 5, 7, 11, 15, 28, 32, 33, and 34 ranged from .499 to .806, and the α value for the C-B-CLAT was .607. This indicates fair test-retest reliability. The mean difference in the C-B-CLAT scores between stage 1 and stage 2 was 0.47 (OR 0.67, 95% CI −0.53 to 1.47), which was not significantly different from zero (t48=0.945; P=.35). This result implies that the C-B-CLAT produced the same scores at stage 1 and stage 2 on average, thus showing good agreement in the C-B-CLAT scores between stage 1 and stage 2. The SD of the difference was 3.48. The 95% limits of agreement were −6.34 to 7.28. Conclusions: We developed a simplified-Chinese version of the B-CLAT through translation and adaptation. Psychometric properties testing has proven this version valid and reliable for assessing breast cancer literacy among Chinese college students. %M 37074784 %R 10.2196/43002 %U https://formative.jmir.org/2023/1/e43002 %U https://doi.org/10.2196/43002 %U http://www.ncbi.nlm.nih.gov/pubmed/37074784 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e39740 %T Improving Cognitive Function Through High-Intensity Interval Training in Breast Cancer Patients Undergoing Chemotherapy: Protocol for a Randomized Controlled Trial %A Wilson,Rebekah %A Kang,Dong-Woo %A Tahbaz,Meghan %A Norris,Mary %A Uno,Hajime %A Ligibel,Jennifer %A Guenette,Jeffrey %A Christopher,Cameron %A Dieli-Conwright,Christina %+ Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, United States, 1 (617) 582 8321, [email protected] %K cognitive function %K high-intensity interval training %K exercise %K breast cancer %K chemotherapy %K magnetic resonance imaging %K MRI %D 2023 %7 7.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: More than 75% of patients with breast cancer treated with chemotherapy experience cognitive impairments (eg, memory and attention problems), commonly known as chemo-brain. Exercise, especially aerobic high-intensity interval training (HIIT), is associated with better cognitive function in healthy populations. However, clinical trials testing the impact of exercise interventions on chemotherapy-induced cognitive decline in patients with cancer are lacking, and the mechanisms through which exercise could improve cognitive function are unclear. Objective: The objective of the Improving Cognitive Function Through High-Intensity Interval Training in Breast Cancer Patients Undergoing Chemotherapy trial is to examine the effects of HIIT on cognitive function in patients with breast cancer undergoing chemotherapy. Methods: This 2-arm, single-center, pilot randomized controlled trial will randomize 50 patients with breast cancer undergoing chemotherapy to HIIT or attention control. The HIIT group will perform a supervised 16-week, thrice-weekly intervention, with each session including a 5-minute warm-up at 10% maximal power output (POmax), 10 sets of alternating 1-minute high-intensity (90% POmax) and 1-minute recovery (10% POmax) intervals, and a 5-minute cooldown (10% POmax). The attention control group will receive a stretching program with no exercise components and be asked to maintain their exercise levels for 16 weeks. The primary outcomes of the study are executive function and memory measured using the National Institutes of Health toolbox and resting-state connectivity and diffusion tensor imaging microstructure evaluated using magnetic resonance imaging. The secondary and tertiary outcomes include cardiorespiratory fitness, body composition, physical fitness, and psychosocial health. The study has been approved by the institutional review board of the Dana-Farber Cancer Institute (20-222). Results: The trial was funded in January 2019, with recruitment started in June 2021. As of May 2022, a total of 4 patients have consented and been randomized (n=2, 50% to exercise; n=1, 25% to control; and n=1, 25% nonrandomized). Trial completion is expected in January 2024. Conclusions: This first-of-its-kind study incorporates a novel exercise intervention (ie, HIIT) and comprehensive cognitive measures. If positive, our findings will establish the pilot efficacy of HIIT on chemotherapy-induced cognitive function in patients with breast cancer, providing the foundation for future larger phase-II and phase-III trials to confirm the findings and potentially establish HIIT as a standard of care for women undergoing chemotherapy for breast cancer. Trial Registration: ClinicalTrials.gov NCT04724499; https://clinicaltrials.gov/ct2/show/NCT04724499 International Registered Report Identifier (IRRID): DERR1-10.2196/39740 %M 37027186 %R 10.2196/39740 %U https://www.researchprotocols.org/2023/1/e39740 %U https://doi.org/10.2196/39740 %U http://www.ncbi.nlm.nih.gov/pubmed/37027186 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42782 %T Susceptibility to Breast Cancer Misinformation Among Chinese Patients: Cross-sectional Study %A Shan,Yi %A Ji,Meng %A Xing,Zhaoquan %A Dong,Zhaogang %A Xu,Xiaofei %+ School of Languages and Cultures, The University of Sydney, A18 - Brennan MacCallum Building, Camperdown, Sydney, NSW 2006, Australia, 61 2 9351 4512, [email protected] %K susceptibility %K breast cancer misinformation %K Chinese patients %K logistic regression %K predicting factors %K cancer %K misinformation %K China %K breast cancer %K policy %K age %K gender %K education %K literacy %K clinical %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Currently, breast cancer is the most commonly diagnosed cancer and the sixth-leading cause of cancer-related deaths among Chinese women. Worse still, misinformation contributes to the aggravation of the breast cancer burden in China. There is a pressing need to investigate the susceptibility to breast cancer misinformation among Chinese patients. However, no study has been performed in this respect. Objective: This study aims to ascertain whether some demographics (age, gender, and education), some health literacy skills, and the internal locus of control are significantly associated with the susceptibility to misinformation about all types of breast cancers among randomly sampled Chinese patients of both genders in order to provide insightful implications for clinical practice, health education, medical research, and health policy making. Methods: We first designed a questionnaire comprising 4 sections of information: age, gender, and education (section 1); self-assessed disease knowledge (section 2); the All Aspects of Health Literacy Scale (AAHLS), the eHealth Literacy Scale (eHEALS), the 6-item General Health Numeracy Test (GHNT-6), and the “Internal” subscale of the Multidimensional Health Locus of Control (MHLC) scales (section 3); and 10 breast cancer myths collected from some officially registered and authenticated websites (section 4). Subsequently, we recruited patients from Qilu Hospital of Shandong University, China, using randomized sampling. The questionnaire was administered via wenjuanxing, the most popular online survey platform in China. The collected data were manipulated in a Microsoft Excel file. We manually checked the validity of each questionnaire using the predefined validity criterion. After that, we coded all valid questionnaires according to the predefined coding scheme, based on Likert scales of different point (score) ranges for different sections of the questionnaire. In the subsequent step, we calculated the sums of the subsections of the AAHLS and the sums of the 2 health literacy scales (the eHEALS and GHNT-6) and the 10 breast cancer myths. Finally, we applied logistic regression modeling to relate the scores in section 4 to the scores in sections 1-3 of the questionnaire to identify what significantly contributes to the susceptibility to breast cancer misinformation among Chinese patients. Results: All 447 questionnaires collected were valid according to the validity criterion. The participants were aged 38.29 (SD 11.52) years on average. The mean score for their education was 3.68 (SD 1.46), implying that their average educational attainment was between year 12 and a diploma (junior college). Of the 447 participants, 348 (77.85%) were women. The mean score for their self-assessed disease knowledge was 2.50 (SD 0.92), indicating that their self-assessed disease knowledge status was between “knowing a lot” and “knowing some.” The mean scores of the subconstructs in the AAHLS were 6.22 (SD 1.34) for functional health literacy, 5.22 (SD 1.54) for communicative health literacy, and 11.19 (SD 1.99) for critical health literacy. The mean score for eHealth literacy was 24.21 (SD 5.49). The mean score for the 6 questions in the GHNT-6 was 1.57 (SD 0.49), 1.21 (SD 0.41), 1.24 (SD 0.43), 1.90 (SD 0.30), 1.82 (SD 0.39), and 1.73 (SD 0.44), respectively. The mean score for the patients’ health beliefs and self-confidence was 21.19 (SD 5.63). The mean score for their response to each myth ranged from 1.24 (SD 0.43) to 1.67 (SD 0.47), and the mean score for responses to the 10 myths was 14.03 (SD 1.78). Through interpreting these descriptive statistics, we found that Chinese female patients’ limited ability to rebut breast cancer misinformation is mainly attributed to 5 factors: (1) lower communicative health literacy, (2) certainty about self-assessed eHealth literacy skills, (3) lower general health numeracy, (4) positive self-assessment of general disease knowledge, and (5) more negative health beliefs and lower levels of self-confidence. Conclusions: Drawing on logistic regression modeling, we studied the susceptibility to breast cancer misinformation among Chinese patients. The predicting factors of the susceptibility to breast cancer misinformation identified in this study can provide insightful implications for clinical practice, health education, medical research, and health policy making. %M 37018020 %R 10.2196/42782 %U https://formative.jmir.org/2023/1/e42782 %U https://doi.org/10.2196/42782 %U http://www.ncbi.nlm.nih.gov/pubmed/37018020 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 15 %N %P e42704 %T Acceptability of Automated Robotic Clinical Breast Examination: Survey Study %A Jenkinson,George P %A Houghton,Natasha %A van Zalk,Nejra %A Waller,Jo %A Bello,Fernando %A Tzemanaki,Antonia %+ Bristol Robotics Laboratory, Department of Mechanical Engineering, University of Bristol, T Block, UWE Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom, 44 0117 328 6913, [email protected] %K breast cancer detection %K automated diagnosis %K breast examination %K health care robotics %K patient and public involvement %K participatory design %K user acceptability %K mammography %K breast cancer %D 2023 %7 3.4.2023 %9 Original Paper %J J Particip Med %G English %X Background: In the United Kingdom, women aged 50 to 70 years are invited to undergo mammography. However, 10% of invasive breast cancers occur in women aged ≤45 years, representing an unmet need for young women. Identifying a suitable screening modality for this population is challenging; mammography is insufficiently sensitive, whereas alternative diagnostic methods are invasive or costly. Robotic clinical breast examination (R-CBE)—using soft robotic technology and machine learning for fully automated clinical breast examination—is a theoretically promising screening modality with early prototypes under development. Understanding the perspectives of potential users and partnering with patients in the design process from the outset is essential for ensuring the patient-centered design and implementation of this technology. Objective: This study investigated the attitudes and perspectives of women regarding the use of soft robotics and intelligent systems in breast cancer screening. It aimed to determine whether such technology is theoretically acceptable to potential users and identify aspects of the technology and implementation system that are priorities for patients, allowing these to be integrated into technology design. Methods: This study used a mixed methods design. We conducted a 30-minute web-based survey with 155 women in the United Kingdom. The survey comprised an overview of the proposed concept followed by 5 open-ended questions and 17 closed questions. Respondents were recruited through a web-based survey linked to the Cancer Research United Kingdom patient involvement opportunities web page and distributed through research networks’ mailing lists. Qualitative data generated via the open-ended questions were analyzed using thematic analysis. Quantitative data were analyzed using 2-sample Kolmogorov-Smirnov tests, 1-tailed t tests, and Pearson coefficients. Results: Most respondents (143/155, 92.3%) indicated that they would definitely or probably use R-CBE, with 82.6% (128/155) willing to be examined for up to 15 minutes. The most popular location for R-CBE was at a primary care setting, whereas the most accepted method for receiving the results was an on-screen display (with an option to print information) immediately after the examination. Thematic analysis of free-text responses identified the following 7 themes: women perceive that R-CBE has the potential to address limitations in current screening services; R-CBE may facilitate increased user choice and autonomy; ethical motivations for supporting R-CBE development; accuracy (and users’ perceptions of accuracy) is essential; results management with clear communication is a priority for users; device usability is important; and integration with health services is key. Conclusions: There is a high potential for the acceptance of R-CBE in its target user group and a high concordance between user expectations and technological feasibility. Early patient participation in the design process allowed the authors to identify key development priorities for ensuring that this new technology meets the needs of users. Ongoing patient and public involvement at each development stage is essential. %M 37010907 %R 10.2196/42704 %U https://jopm.jmir.org/2023/1/e42704 %U https://doi.org/10.2196/42704 %U http://www.ncbi.nlm.nih.gov/pubmed/37010907 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44867 %T A Brief Intervention for Improving Alcohol Literacy and Addressing Harmful Alcohol Use Among Women Attending an Australian Breast Screening Service (Health4her): Protocol for a Hybrid Effectiveness-Implementation Trial %A Grigg,Jasmin %A Manning,Victoria %A Lockie,Darren %A Giles,Michelle %A Bell,Robin %A Stragalinos,Peta %A Bernard,Chloe %A Volpe,Isabelle %A Greenwood,Christopher J %A Smith,Liam %A Bragge,Peter %A Lubman,Dan I %+ Turning Point, Eastern Health, 110 Church Street, Richmond, Melbourne, 3121, Australia, 61 8413 8413, [email protected] %K alcohol %K alcohol literacy %K alcohol brief intervention %K breast cancer %K women’s health %K randomized controlled trial %K hybrid effectiveness-implementation trial %K protocol %D 2023 %7 30.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol consumption is a major modifiable risk factor for female breast cancer, even in small amounts. However, awareness of this risk remains low. National breast screening programs are uniquely positioned to provide timely and targeted health information and behavior change strategies to improve alcohol literacy and reduce consumption. A breast screening service is a novel health care setting for brief alcohol intervention, with the potential for extensive reach. Objective: This study aimed to conduct a formative evaluation with breast screening service consumers to understand the need for, and acceptability of, brief alcohol intervention in the breast screening setting and collaboratively design a brief alcohol intervention (Health4Her); to test the effectiveness of Health4Her in improving knowledge of alcohol as a breast cancer risk factor (primary outcome), improving alcohol literacy, and reducing consumption among women attending a breast screening service; and to examine the implementation strategy through process evaluation. Methods: This was a hybrid type II effectiveness-implementation trial comprising a randomized controlled trial (RCT) alongside a mixed methods program evaluation guided by applicable elements of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and Consolidated Framework for Implementation Research. Formative evaluation comprised a retrospective analysis of alcohol consumption data (n=49,240), a web-based survey (n=391), and focus groups and interviews (n=31) with breast screening service consumers. Women attending routine mammography, drinking at any level, were recruited to the single-site, double-blind RCT (n=558), and completed a baseline assessment before randomization (1:1) to receive Health4Her (alcohol brief intervention + lifestyle information) or control (lifestyle information) via animation on an iPad. Follow-up assessments were performed 4 and 12 weeks after randomization. The process evaluation included evaluation of trial administrative data, participant quantitative (n=497) and qualitative feedback (n=30), and site staff qualitative feedback (n=11). Results: This research was funded in March and May 2019. Data collection for the formative evaluation and trial recruitment occurred between January and April 2020 and February and August 2021, respectively, with finalization of follow-up data collection in December 2021. Quantitative process evaluation data were collected during trial implementation, and collection of participant and staff feedback was finalized in December 2021. Results of the retrospective analysis of alcohol consumption data from breast screening service consumers is anticipated to be published in March 2023 and the results of the RCT to be published in March 2023. Conclusions: This study is anticipated to generate new substantial knowledge on the alcohol consumption and literacy needs of women attending breast screening and the extent to which these can be addressed using a novel, tailored brief alcohol intervention. The study design permits the evaluation of the effectiveness and implementation of Health4Her to predict and facilitate uptake in breast screening services. Trial Registration: ClinicalTrials.gov NCT04715516; https://clinicaltrials.gov/ct2/show/NCT04715516 International Registered Report Identifier (IRRID): RR1-10.2196/44867 %M 36995739 %R 10.2196/44867 %U https://www.researchprotocols.org/2023/1/e44867 %U https://doi.org/10.2196/44867 %U http://www.ncbi.nlm.nih.gov/pubmed/36995739 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43359 %T Preliminary Attainability Assessment of Real-World Data for Answering Major Clinical Research Questions in Breast Cancer Brain Metastasis: Framework Development and Validation Study %A Kim,Min Jeong %A Kim,Hyo Jung %A Kang,Danbee %A Ahn,Hee Kyung %A Shin,Soo-Yong %A Park,Seri %A Cho,Juhee %A Park,Yeon Hee %+ Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Ilwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, 82 10 9933 1780, [email protected] %K real-world data %K preliminary attainability assessment %K observational study %K clinical data warehouse %K PAR framework %K brain metastasis %K breast cancer %D 2023 %7 23.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent decades, real-world evidence (RWE) in oncology has rapidly gained traction for its potential to answer clinical questions that cannot be directly addressed by randomized clinical trials. Integrating real-world data (RWD) into clinical research promises to contribute to more sustainable research designs, including extension, augmentation, enrichment, and pragmatic designs. Nevertheless, clinical research using RWD is still limited because of concerns regarding the shortage of best practices for extracting, harmonizing, and analyzing RWD. In particular, pragmatic screening methods to determine whether the content of a data source is sufficient to answer the research questions before conducting the research with RWD have not yet been established. Objective: We examined the PAR (Preliminary Attainability Assessment of Real-World Data) framework and assessed its utility in breast cancer brain metastasis (BCBM), which has an unmet medical need for data attainability screening at the preliminary step of observational studies that use RWD. Methods: The PAR framework was proposed to assess data attainability from a particular data source during the early research process. The PAR framework has four sequential stages, starting with clinical question clarification: (1) operational definition of variables, (2) data matching (structural/semantic), (3) data screening and extraction, and (4) data attainability diagramming. We identified 5 clinical questions to be used for PAR framework evaluation through interviews and validated them with a survey of breast cancer experts. We used the Samsung Medical Center Breast Cancer Registry, a hospital-based real-time registry implemented in March 2021, leveraging the institution’s anonymized and deidentified clinical data warehouse platform. The number of breast cancer patients in the registry was 45,129; it covered the period from June 1995 to December 2021. The registry consists of 24 base data marts that represent disease-specific breast cancer characteristics and care pathways. The outcomes included screening results of the clinical questions via the PAR framework and a procedural diagram of data attainability for each research question. Results: Data attainability was tested for study feasibility according to the PAR framework with 5 clinical questions for BCBM. We obtained data sets that were sufficient to conduct studies with 4 of 5 clinical questions. The research questions stratified into 3 types when we developed data fields for clearly defined research variables. In the first, only 1 question could be answered using direct data variables. In the second, the other 3 questions required surrogate definitions that combined data variables. In the third, the question turned out to be not feasible for conducting further analysis. Conclusions: The adoption of the PAR framework was associated with more efficient preliminary clinical research using RWD from BCBM. Furthermore, this framework helped accelerate RWE generation through clinical research by enhancing transparency and reproducibility and lowering the entry barrier for clinical researchers. %M 36951923 %R 10.2196/43359 %U https://www.jmir.org/2023/1/e43359 %U https://doi.org/10.2196/43359 %U http://www.ncbi.nlm.nih.gov/pubmed/36951923 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45244 %T Effects of Aerobic Exercise on Cardiorespiratory Fitness, Cardiovascular Risk Factors, and Patient-Reported Outcomes in Long-Term Breast Cancer Survivors: Protocol for a Randomized Controlled Trial %A Nilsen,Tormod Skogstad %A Sæter,Mali %A Sarvari,Sebastian Imre %A Reinertsen,Kristin Valborg %A Johansen,Sara Hassing %A Edvardsen,Elisabeth Rustad %A Hallén,Jostein %A Edvardsen,Elisabeth %A Grydeland,May %A Kiserud,Cecilie Essholt %A Lie,Hanne Cathrine %A Solberg,Paul André %A Wisløff,Torbjørn %A Sharples,Adam Philip %A Raastad,Truls %A Haugaa,Kristina Hermann %A Thorsen,Lene %+ Department of Physical Performance, The Norwegian School of Sport Sciences, Postbox 4014, Oslo, 0806, Norway, 47 95069857, [email protected] %K breast cancer %K cardiooncology %K cardiorespiratory fitness %K exercise medicine %D 2023 %7 15.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Anthracycline-based chemotherapy has been mainstay of adjuvant breast cancer therapy for decades. Although effective, anthracyclines place long-term breast cancer survivors at risk of late effects, such as reduced cardiorespiratory fitness and increased risk of cardiovascular disease. Previous research has shown beneficial effects of exercise training on cardiorespiratory fitness, but the effects of exercise on limiting factors for cardiorespiratory fitness, cardiovascular risk factors, and patient-reported outcomes in long-term survivors are less clear. Whether previous exposure to breast cancer therapy modulates the effects of exercise is also unknown. Objective: The primary aim of the CAUSE (Cardiovascular Survivors Exercise) trial is to examine the effect of aerobic exercise on cardiorespiratory fitness in anthracycline-treated long-term breast cancer survivors. Secondary aims are to examine effects of exercise training on limiting factors for cardiorespiratory fitness, cardiovascular risk factors, and patient-reported outcomes, and to compare baseline values and effects of exercise training between similar-aged women with and those without prior breast cancer. A third aim is to examine the 24-month postintervention effects of aerobic exercise on primary and secondary outcomes. Methods: The CAUSE trial is a 2-armed randomized controlled trial, where 140 long-term breast cancer survivors, 8-12 years post diagnosis, are assigned to a 5-month nonlinear aerobic exercise program with 3 weekly sessions or to standard care. Seventy similar-aged women with no history of cancer will undergo the same exercise program. Cardiorespiratory fitness measured as peak oxygen consumption (VO2peak), limiting factors for VO2peak (eg, cardiac function, pulmonary function, hemoglobin mass, blood volume, and skeletal muscle characteristics), cardiovascular risk factors (eg, hypertension, diabetes, dyslipidemia, obesity, physical activity level, and smoking status), and patient-reported outcomes (eg, body image, fatigue, mental health, and health-related quality of life) will be assessed at baseline, post intervention, and 24 months post intervention. Results: A total of 209 patients were included from October 2020 to August 2022, and postintervention assessments were completed in January 2023. The 24-month follow-up will be completed in February 2025. Conclusions: The findings from the CAUSE trial will provide novel scientific understanding of the potential benefits of exercise training in long-term breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT04307407; https://clinicaltrials.gov/ct2/show/NCT04307407 International Registered Report Identifier (IRRID): DERR1-10.2196/45244 %M 36920460 %R 10.2196/45244 %U https://www.researchprotocols.org/2023/1/e45244 %U https://doi.org/10.2196/45244 %U http://www.ncbi.nlm.nih.gov/pubmed/36920460 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43522 %T Mobile Health Apps for Breast Cancer: Content Analysis and Quality Assessment %A Yang,Seongwoo %A Bui,Cam Nhung %A Park,Kyounghoon %+ HERINGS, The Institute of Advanced Clinical & Biomedical Research, 14F, 560, Eonju-ro, Gangnam-gu, Seoul, 06144, Republic of Korea, 82 269493523, [email protected] %K app %K breast cancer %K quality assessment %K mobile health %K mHealth %K digital health %K digital health intervention %K cancer management %K tablet %K prevention %K survivor %K peer-support %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The number of mobile health apps is rapidly increasing. This means that consumers are faced with a bewildering array of choices, and finding the benefit of such apps may be challenging. The significant international burden of breast cancer (BC) and the potential of mobile health apps to improve medical and public health practices mean that such apps will likely be important because of their functionalities in daily life. As the app market has grown exponentially, several review studies have scrutinized cancer- or BC-related apps. However, those reviews concentrated on the availability of the apps and relied on user ratings to decide on app quality. To minimize subjectivity in quality assessment, quantitative methods to assess BC-related apps are required. Objective: The purpose of this study is to analyze the content and quality of BC-related apps to provide useful information for end users and clinicians. Methods: Based on a stepwise systematic approach, we analyzed apps related to BC, including those related to prevention, detection, treatment, and survivor support. We used the keywords “breast cancer” in English and Korean to identify commercially available apps in the Google Play and App Store. The apps were then independently evaluated by 2 investigators to determine their eligibility for inclusion. The content and quality of the apps were analyzed using objective frameworks and the Mobile App Rating Scale (MARS), respectively. Results: The initial search identified 1148 apps, 69 (6%) of which were included. Most BC-related apps provided information, and some recorded patient-generated health data, provided psychological support, and assisted with medication management. The Kendall coefficient of concordance between the raters was 0.91 (P<.001). The mean MARS score (range: 1-5) of the apps was 3.31 (SD 0.67; range: 1.94-4.53). Among the 5 individual dimensions, functionality had the highest mean score (4.37, SD 0.42) followed by aesthetics (3.74, SD 1.14). Apps that only provided information on BC prevention or management of its risk factors had lower MARS scores than those that recorded medical data or patient-generated health data. Apps that were developed >2 years ago, or by individuals, had significantly lower MARS scores compared to other apps (P<.001). Conclusions: The quality of BC-related apps was generally acceptable according to the MARS, but the gaps between the highest- and lowest-rated apps were large. In addition, apps using personalized data were of higher quality than those merely giving related information, especially after treatment in the cancer care continuum. We also found that apps that had been updated within 1 year and developed by private companies had higher MARS scores. This may imply that there are criteria for end users and clinicians to help choose the right apps for better clinical outcomes. %M 36821352 %R 10.2196/43522 %U https://mhealth.jmir.org/2023/1/e43522 %U https://doi.org/10.2196/43522 %U http://www.ncbi.nlm.nih.gov/pubmed/36821352 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e37801 %T An Adapted Cancer Screening Education Program for Native American Women With Intellectual and Developmental Disabilities and Their Caregivers: Protocol for Feasibility and Acceptability Testing %A Armin,Julie S %A Williamson,Heather J %A Rothers,Janet %A Lee,Michele S %A Baldwin,Julie A %+ Department of Family & Community Medicine, The University of Arizona, 655 North Alvernon Way, Ste. 228, Tucson, AZ, 85711, United States, 1 5206264166, [email protected] %K community-engaged research %K community-engaged %K engagement %K cancer %K breast %K cervical %K screening %K breast cancer screening %K cervical cancer screening %K intellectual %K developmental %K cognitive %K disability %K disabilities %K Native American %K indigenous %K women’s health %K feasibility %K acceptability %K patient education %K prevention %K patient knowledge %K health knowledge %K health education %D 2023 %7 13.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Women with intellectual and developmental disabilities (IDD) do not undergo breast and cervical cancer screening at the same rate as women without IDD. IDDs are diagnosed in childhood, are lifelong, and involve difficulties in adaptive behaviors and intellectual functioning. Native American women also experience disparities in breast and cervical cancer screenings. Despite known disparities, women with IDD are often not included in health promotion programs, and there is a need for evidence-based programming for those with intersectional identities, such as Native American women with IDD. Objective: This study aims to assess the feasibility and acceptability of My Health My Choice (MHMC), an adaptation of the Women Be Healthy 2 program. There are 2 parts to the study: adaptation of the Women Be Healthy 2 program and feasibility and acceptability testing of MHMC. Methods: Individuals aged over 18 years who identify as Native American females with IDD and their caregivers (N=30 women-caregiver dyads) are eligible for the study. Participants, who are affiliated with 2 partnering sites in Arizona (1 rural and 1 urban), complete pre- and postsurveys assessing knowledge, self-efficacy, and screening expectations before and immediately after completing the program. In addition, all participants complete brief satisfaction surveys after each of the 6 educational sessions. A subsample of Native American women with an IDD (n=12), caregivers (n=12), and community health educators (n=2) who participate in the MHMC program will provide semistructured qualitative input regarding the content, delivery, and cultural relevance of the program. Results: The adaptation of the culturally responsive MHMC program was completed in August 2021. In November 2021, the project team began recruitment for feasibility and acceptability studies. Feasibility will be examined using participation metrics, and acceptability will be measured using satisfaction measures. Pre- and postmeasures in cancer screening knowledge, self-efficacy, and screening expectations will examine improvements among participants. Conclusions: The results of feasibility and acceptability testing of MHMC will guide future implementation studies of the program. International Registered Report Identifier (IRRID): DERR1-10.2196/37801 %M 36780214 %R 10.2196/37801 %U https://www.researchprotocols.org/2023/1/e37801 %U https://doi.org/10.2196/37801 %U http://www.ncbi.nlm.nih.gov/pubmed/36780214 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e42783 %T Use of Online Health Forums by People Living With Breast Cancer During the COVID-19 Pandemic: Thematic Analysis %A Sanger,Sally %A Duffin,Suzanne %A Gough,Rosemarie E %A Bath,Peter A %+ Information School, Faculty of Social Sciences, University of Sheffield, 211 Portobello, Sheffield, S1 4DP, United Kingdom, 44 114 222 ext 2646, [email protected] %K online health forum %K breast cancer %K COVID-19 %K pandemic %K discussion forum %K coronavirus %K web-based communities %K information use %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: At the time of the UK COVID-19 lockdowns, online health forums (OHFs) were one of the relatively few remaining accessible sources of peer support for people living with breast cancer. Cancer services were heavily affected by the pandemic in many ways, including the closure of many of the customary support services. Previous studies indicate that loneliness, anxiety, distress, and depression caused by COVID-19 were common among people living with breast cancer, and this suggests that the role of OHFs in providing users with support, information, and empathy could have been of increased importance at that time. Objective: This study aimed to examine how people living with breast cancer shared information, experiences, and emotions in an OHF during the COVID-19 pandemic. Methods: This qualitative study thematically analyzed posts from the discussion forums of an OHF provided by the UK charity, Breast Cancer Now. We selected 1053 posts from the time of 2 UK lockdowns: March 16, 2020, to June 15, 2020 (lockdown 1), and January 6, 2021, to March 8, 2021 (lockdown 3), for analysis, from 2 of the forum’s boards (for recently diagnosed people and for those undergoing chemotherapy). We analyzed the data using the original 6 steps for thematic analysis by Braun and Clarke but by following a codebook approach. Descriptive statistics for posts were also derived. Results: We found that COVID-19 amplified the forum’s value to its users. As patients with cancer, participants were in a situation that was “bad enough already,” and the COVID-19 pandemic heightened this difficult situation. The forum’s value, which was already high for the information and peer support it provided, increased because COVID-19 caused some special information needs that forum users were uniquely well placed to fulfill as people experiencing the combined effects of having breast cancer during the pandemic. The forum also met the emotional needs generated by the COVID-19 pandemic and was valued as a place where loneliness during the pandemic may be relieved and users’ spirits lifted in a variety of ways specific to this period. We found some differences in use between the 2 periods and the 2 boards—most noticeable was the great fear and anxiety expressed at the beginning of lockdown 1. Both the beginning and end of lockdown periods were particularly difficult for participants, with the ends seen as potentially increasing isolation. Conclusions: The forums were an important source of support and information to their users, with their value increasing during the lockdowns for a variety of reasons. Our findings will be helpful to organizations offering OHFs and to health care workers advising people living with breast cancer about sources of support. %M 36473015 %R 10.2196/42783 %U https://cancer.jmir.org/2023/1/e42783 %U https://doi.org/10.2196/42783 %U http://www.ncbi.nlm.nih.gov/pubmed/36473015 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38399 %T Predicting Openness of Communication in Families With Hereditary Breast and Ovarian Cancer Syndrome: Natural Language Processing Analysis %A Baroutsou,Vasiliki %A Cerqueira Gonzalez Pena,Rodrigo %A Schweighoffer,Reka %A Caiata-Zufferey,Maria %A Kim,Sue %A Hesse-Biber,Sharlene %A Ciorba,Florina M %A Lauer,Gerhard %A Katapodi,Maria %A , %+ Department of Clinical Research, University of Basel, Missionstrasse 64, Basel, 4055, Switzerland, 41 612070430, [email protected] %K cascade testing %K dictionary-based approach %K family communication %K hereditary breast and ovarian cancer %K HBOC %K sentiment analysis %K text mining %K natural language processing %K cancer %K hereditary %D 2023 %7 19.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In health care research, patient-reported opinions are a critical element of personalized medicine and contribute to optimal health care delivery. The importance of integrating natural language processing (NLP) methods to extract patient-reported opinions has been gradually acknowledged over the past years. One form of NLP is sentiment analysis, which extracts and analyses information by detecting feelings (thoughts, emotions, attitudes, etc) behind words. Sentiment analysis has become particularly popular following the rise of digital interactions. However, NLP and sentiment analysis in the context of intrafamilial communication for genetic cancer risk is still unexplored. Due to privacy laws, intrafamilial communication is the main avenue to inform at-risk relatives about the pathogenic variant and the possibility of increased cancer risk. Objective: The study examined the role of sentiment in predicting openness of intrafamilial communication about genetic cancer risk associated with hereditary breast and ovarian cancer (HBOC) syndrome. Methods: We used narratives derived from 53 in-depth interviews with individuals from families that harbor pathogenic variants associated with HBOC: first, to quantify openness of communication about cancer risk, and second, to examine the role of sentiment in predicting openness of communication. The interviews were conducted between 2019 and 2021 in Switzerland and South Korea using the same interview guide. We used NLP to extract and quantify textual features to construct a handcrafted lexicon about interpersonal communication of genetic testing results and cancer risk associated with HBOC. Moreover, we examined the role of sentiment in predicting openness of communication using a stepwise linear regression model. To test model accuracy, we used a split-validation set. We measured the performance of the training and testing model using area under the curve, sensitivity, specificity, and root mean square error. Results: Higher “openness of communication” scores were associated with higher overall net sentiment score of the narrative, higher fear, being single, having nonacademic education, and higher informational support within the family. Our results demonstrate that NLP was highly effective in analyzing unstructured texts from individuals of different cultural and linguistic backgrounds and could also reliably predict a measure of “openness of communication” (area under the curve=0.72) in the context of genetic cancer risk associated with HBOC. Conclusions: Our study showed that NLP can facilitate assessment of openness of communication in individuals carrying a pathogenic variant associated with HBOC. Findings provided promising evidence that various features from narratives such as sentiment and fear are important predictors of interpersonal communication and self-disclosure in this context. Our approach is promising and can be expanded in the field of personalized medicine and technology-mediated communication. %M 36656633 %R 10.2196/38399 %U https://formative.jmir.org/2023/1/e38399 %U https://doi.org/10.2196/38399 %U http://www.ncbi.nlm.nih.gov/pubmed/36656633 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e35750 %T An Assessment of the Predictive Performance of Current Machine Learning–Based Breast Cancer Risk Prediction Models: Systematic Review %A Gao,Ying %A Li,Shu %A Jin,Yujing %A Zhou,Lengxiao %A Sun,Shaomei %A Xu,Xiaoqian %A Li,Shuqian %A Yang,Hongxi %A Zhang,Qing %A Wang,Yaogang %+ School of Public Health, Tianjin Medical University, Qixiangtai Road 22, Heping District, Tianjin, 300070, China, 86 02260361238, [email protected] %K breast cancer %K machine learning %K risk prediction %K cancer %K oncology %K systemic review %K review %K meta-analysis %K cancer research %K risk model %D 2022 %7 29.12.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Several studies have explored the predictive performance of machine learning–based breast cancer risk prediction models and have shown controversial conclusions. Thus, the performance of the current machine learning–based breast cancer risk prediction models and their benefits and weakness need to be evaluated for the future development of feasible and efficient risk prediction models. Objective: The aim of this review was to assess the performance and the clinical feasibility of the currently available machine learning–based breast cancer risk prediction models. Methods: We searched for papers published until June 9, 2021, on machine learning–based breast cancer risk prediction models in PubMed, Embase, and Web of Science. Studies describing the development or validation models for predicting future breast cancer risk were included. The Prediction Model Risk of Bias Assessment Tool (PROBAST) was used to assess the risk of bias and the clinical applicability of the included studies. The pooled area under the curve (AUC) was calculated using the DerSimonian and Laird random-effects model. Results: A total of 8 studies with 10 data sets were included. Neural network was the most common machine learning method for the development of breast cancer risk prediction models. The pooled AUC of the machine learning–based optimal risk prediction model reported in each study was 0.73 (95% CI 0.66-0.80; approximate 95% prediction interval 0.56-0.96), with a high level of heterogeneity between studies (Q=576.07, I2=98.44%; P<.001). The results of head-to-head comparison of the performance difference between the 2 types of models trained by the same data set showed that machine learning models had a slightly higher advantage than traditional risk factor–based models in predicting future breast cancer risk. The pooled AUC of the neural network–based risk prediction model was higher than that of the nonneural network–based optimal risk prediction model (0.71 vs 0.68, respectively). Subgroup analysis showed that the incorporation of imaging features in risk models resulted in a higher pooled AUC than the nonincorporation of imaging features in risk models (0.73 vs 0.61; Pheterogeneity=.001, respectively). The PROBAST analysis indicated that many machine learning models had high risk of bias and poorly reported calibration analysis. Conclusions: Our review shows that the current machine learning–based breast cancer risk prediction models have some technical pitfalls and that their clinical feasibility and reliability are unsatisfactory. %M 36426919 %R 10.2196/35750 %U https://publichealth.jmir.org/2022/12/e35750 %U https://doi.org/10.2196/35750 %U http://www.ncbi.nlm.nih.gov/pubmed/36426919 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e37144 %T Effectiveness of Secondary Risk–Reducing Strategies in Patients With Unilateral Breast Cancer With Pathogenic Variants of BRCA1 and BRCA2 Subjected to Breast-Conserving Surgery: Evidence-Based Simulation Study %A Maksimenko,Jelena %A Rodrigues,Pedro Pereira %A Nakazawa-MiklaÅ¡eviča,Miki %A Pinto,David %A MiklaÅ¡evičs,Edvins %A Trofimovičs,Genadijs %A Gardovskis,Jānis %A Cardoso,Fatima %A Cardoso,Maria João %+ Institute of Oncology, Department of Surgery, Breast Unit, Pauls Stradiņš Clinical University Hospital, Riga Stradiņš University, Dzirciema 16, Riga, Latvia, 371 27038577, [email protected] %K BRCA1 and BRCA2 %K secondary prophylactic strategies %K breast-conserving therapy %K breast cancer %D 2022 %7 29.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 62% of patients with breast cancer with a pathogenic variant (BRCA1 or BRCA2) undergo primary breast-conserving therapy. Objective: The study aims to develop a personalized risk management decision support tool for carriers of a pathogenic variant (BRCA1 or BRCA2) who underwent breast-conserving therapy for unilateral early-stage breast cancer. Methods: We developed a Bayesian network model of a hypothetical cohort of carriers of BRCA1 or BRCA2 diagnosed with stage I/II unilateral breast cancer and treated with breast-conserving treatment who underwent subsequent second primary cancer risk–reducing strategies. Using event dependencies structured according to expert knowledge and conditional probabilities obtained from published evidence, we predicted the 40-year overall survival rate of different risk-reducing strategies for 144 cohorts of women defined by the type of pathogenic variants (BRCA1 or BRCA2), age at primary breast cancer diagnosis, breast cancer subtype, stage of primary breast cancer, and presence or absence of adjuvant chemotherapy. Results: Absence of adjuvant chemotherapy was the most powerful factor that was linked to a dramatic decline in survival. There was a negligible decline in the mortality in patients with triple-negative breast cancer, who received no chemotherapy and underwent any secondary risk–reducing strategy, compared with surveillance. The potential survival benefit from any risk-reducing strategy was more modest in patients with triple-negative breast cancer who received chemotherapy compared with patients with luminal breast cancer. However, most patients with triple-negative breast cancer in stage I benefited from bilateral risk-reducing mastectomy and risk-reducing salpingo-oophorectomy or just risk-reducing salpingo-oophorectomy. Most patients with luminal stage I/II unilateral breast cancer benefited from bilateral risk-reducing mastectomy and risk-reducing salpingo-oophorectomy. The impact of risk-reducing salpingo-oophorectomy in patients with luminal breast cancer in stage I/II increased with age. Most older patients with the BRCA1 and BRCA2 pathogenic variants in exons 12-24/25 with luminal breast cancer may gain a similar survival benefit from other risk-reducing strategies or surveillance. Conclusions: Our study showed that it is mandatory to consider the complex interplay between the types of BRCA1 and BRCA2 pathogenic variants, age at primary breast cancer diagnosis, breast cancer subtype and stage, and received systemic treatment. As no prospective study results are available at the moment, our simulation model, which will integrate a decision support system in the near future, could facilitate the conversation between the health care provider and patient and help to weigh all the options for risk-reducing strategies leading to a more balanced decision. %M 36580360 %R 10.2196/37144 %U https://formative.jmir.org/2022/12/e37144 %U https://doi.org/10.2196/37144 %U http://www.ncbi.nlm.nih.gov/pubmed/36580360 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e41246 %T Evaluating the Acceptance and Usability of an App Promoting Weight Gain Prevention and Healthy Behaviors Among Young Women With a Family History of Breast Cancer: Protocol for an Observational Study %A Pegington,Mary %A Davies,Alan %A Mueller,Julia %A Cholerton,Rachel %A Howell,Anthony %A Evans,D Gareth %A Howell,Sacha J %A French,David P %A Harvie,Michelle %+ Medical Research Council Epidemiology Unit, University of Cambridge, Box 285 Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom, 44 01223 330315, [email protected] %K breast cancer %K weight %K BMI %K weight gain %K health behavior %K weight maintenance %K women %K app %K ehealth %K interview %K mobile app %K women's health %K mHealth %D 2022 %7 16.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Breast cancer is the most common form of cancer in women, and around 20% of cases are associated with factors such as adult weight gain, overweight and obesity, and potentially modifiable health behaviors including high alcohol intake, smoking, lack of physical activity, and breastfeeding. Significant weight gain occurs between the ages of 18 and 35 years; hence, this age group could benefit from weight gain prevention interventions. Population studies have reported that women at increased risk of breast cancer account for a disproportionate amount of cases. Thus, there is a particular need to target weight gain prevention and other health behavior interventions for women at increased risk. A literature review identified no evidence-based apps that cover all relevant health behaviors. With patient and participant involvement from the target population, we have developed a new app to promote healthy behaviors among young women at increased risk of breast cancer. Alongside the app, a Facebook group provides peer support, and a virtual welcome event provides an overview of the project and the opportunity to meet the research team and other study participants. The aim of the intervention is to prevent weight gain via changes to eating habits and physical activity levels, and improve other health behaviors associated with breast cancer. The app includes goal setting and self-monitoring of health behaviors and provides education about breast cancer. Objective: This study aims to assess the acceptability and usability of the app in young women at increased risk of breast cancer, and the feasibility of the study procedures for a future, larger efficacy study. Methods: Young women (n=35, age 18-35 years) at increased risk of breast cancer (>17% lifetime risk) will be recruited via 2 recruitment procedures: mailed invite from the local breast cancer family history, risk and prevention clinic, and advertisements on social media and websites. Participants will have access to the app and the private Facebook group for 2 months. They will complete questionnaires regarding their health behaviors and breast cancer risk belief at the start and end of the study, complete app rating scales in the middle and at the end of the study, and be invited to give feedback on the app during the study period. Approximately 20 participants will have a semistructured interview at the end of the study regarding their views on the app and trial procedures. Results: The trial is ongoing, and the publication of results is anticipated in 2023. Conclusions: The trial will provide evidence regarding the acceptability and usability of the newly developed app for young women at increased risk of breast cancer. Feedback obtained will be used to improve the app. The trial will also assess the feasibility of the study procedures and how these can be refined for a future efficacy study. Trial Registration: ClinicalTrials.gov NCT05460650; https://clinicaltrials.gov/ct2/show/NCT05460650 International Registered Report Identifier (IRRID): PRR1-10.2196/41246 %M 36525287 %R 10.2196/41246 %U https://www.researchprotocols.org/2022/12/e41246 %U https://doi.org/10.2196/41246 %U http://www.ncbi.nlm.nih.gov/pubmed/36525287 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 4 %P e42245 %T How TikTok Is Being Used to Help Individuals Cope With Breast Cancer: Cross-sectional Content Analysis %A Basch,Corey H %A Hillyer,Grace C %A Yalamanchili,Bhavya %A Morris,Aldean %+ Department of Public Health, William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, United States, 1 973 720 2603, [email protected] %K TikTok %K breast cancer %K social media %K short video apps %K social support %K content analysis %K video %K patient support %K medical information %K health information %K peer support %K online conversation %K online health information %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Acknowledging the popularity of TikTok, how quickly medical information can spread, and how users seek support on social media, there is a clear lack of research on breast cancer conversations on TikTok. There is a paucity of information on how these videos can advocate for those impacted by breast cancer as a means to provide support and information as well as raise awareness. Objective: The purpose of this cross-sectional content analysis was to describe the content of videos from the hashtag #breastcancer on TikTok. Content related to breast cancer support and coping, cancer education, and heightening the awareness of breast cancer early detection, prevention, and treatment was evaluated. Methods: This study included 100 of the most viewed TikTok videos related to breast cancer through June 30, 2022. Videos were excluded if they were not in the English language or relevant to the topic being studied. Content was deductively coded into categories related to video characteristics and content topics using a screener based on expert breast cancer information sheets. Univariable analyses were conducted to evaluate differences in video characteristics and content when stratified as advocating or not advocating for breast cancer (yes or no) support, education, and awareness. Results: The cumulative number of views of the videos included in this study was 369,504,590. The majority (n=81, 81%) of videos were created by patients and loved ones of individuals with breast cancer, and the most commonly discussed topic was breast cancer support (n=88, 88%), followed by coping with the myriad issues surrounding breast cancer (n=79, 79%). Overall, <50% of the videos addressed important issues such as body image (n=48, 48%), surgery (n=46, 46%), medication and therapy (n=41, 41%), or the stigma associated with a breast cancer diagnosis (n=44, 44%); however, in videos that were advocacy oriented, body image (40/62, 64% vs 8/38, 21%; P<.001), stigma associated with breast cancer (33/62, 53% vs 11/38, 29%; P=.02), and breast cancer surgery (36/62, 58% vs 10/38, 26%; P=.002) were discussed significantly more often than in videos that did not specifically advocate for breast cancer. Conclusions: The use of videos to display health journeys can facilitate engagement by patients, family members, and loved ones interested in information about challenging conditions. Collectively, these findings highlight the level of peer-to-peer involvement on TikTok and may provide insights for designing breast cancer educational campaigns. %M 36472899 %R 10.2196/42245 %U https://cancer.jmir.org/2022/4/e42245 %U https://doi.org/10.2196/42245 %U http://www.ncbi.nlm.nih.gov/pubmed/36472899 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e42343 %T Feasibility of a Reinforcement Learning–Enabled Digital Health Intervention to Promote Mammograms: Retrospective, Single-Arm, Observational Study %A Bucher,Amy %A Blazek,E Susanne %A West,Ashley B %+ Lirio, 320 Corporate Drive, NW, Knoxville, TN, 37923, United States, 1 865 839 6158, [email protected] %K artificial intelligence %K reinforcement learning %K feasibility studies %K mammograms %K nudging %K behavioral intervention %K digital health %K email %K health equity %K cancer screening %D 2022 %7 28.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Preventive screenings such as mammograms promote health and detect disease. However, mammogram attendance lags clinical guidelines, with roughly one-quarter of women not completing their recommended mammograms. A scalable digital health intervention leveraging behavioral science and reinforcement learning and delivered via email was implemented in a US health system to promote uptake of recommended mammograms among patients who were 1 or more years overdue for the screening (ie, 2 or more years from last mammogram). Objective: The aim of this study was to establish the feasibility of a reinforcement learning–enabled mammography digital health intervention delivered via email. The research aims included understanding the intervention’s reach and ability to elicit behavioral outcomes of scheduling and attending mammograms, as well as understanding reach and behavioral outcomes for women of different ages, races, educational attainment levels, and household incomes. Methods: The digital health intervention was implemented in a large Catholic health system in the Midwestern United States and targeted the system’s existing patients who had not received a recommended mammogram in 2 or more years. From August 2020 to July 2022, 139,164 eligible women received behavioral science–based email messages assembled and delivered by a reinforcement learning model to encourage clinically recommended mammograms. Target outcome behaviors included scheduling and ultimately attending the mammogram appointment. Results: In total, 139,164 women received at least one intervention email during the study period, and 81.52% engaged with at least one email. Deliverability of emails exceeded 98%. Among message recipients, 24.99% scheduled mammograms and 22.02% attended mammograms (88.08% attendance rate among women who scheduled appointments). Results indicate no practical differences in the frequency at which people engage with the intervention or take action following a message based on their age, race, educational attainment, or household income, suggesting the intervention may equitably drive mammography across diverse populations. Conclusions: The reinforcement learning–enabled email intervention is feasible to implement in a health system to engage patients who are overdue for their mammograms to schedule and attend a recommended screening. In this feasibility study, the intervention was associated with scheduling and attending mammograms for patients who were significantly overdue for recommended screening. Moreover, the intervention showed proportionate reach across demographic subpopulations. This suggests that the intervention may be effective at engaging patients of many different backgrounds who are overdue for screening. Future research will establish the effectiveness of this type of intervention compared to typical health system outreach to patients who have not had recommended screenings as well as identify ways to enhance its reach and impact. %M 36441579 %R 10.2196/42343 %U https://formative.jmir.org/2022/11/e42343 %U https://doi.org/10.2196/42343 %U http://www.ncbi.nlm.nih.gov/pubmed/36441579 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e40059 %T Effect of a 4-Week Internet-Delivered Mindfulness-Based Cancer Recovery Intervention on the Symptom Burden and Quality of Life of Patients With Breast Cancer: Randomized Controlled Trial %A Wang,Luyao %A Chen,Xing %A Peng,Yueyang %A Zhang,Kun %A Ma,Jun %A Xu,Lin %A Liu,Zixuan %A Liu,Li %A Luo,Yang %A Gu,Can %+ Xiangya School of Nursing, Central South University, XiaoQian Bldg, 6th FI, 172 TongZiPo St, Changsha, 410013, China, 86 82650269, [email protected] %K mindfulness-based cancer recovery %K mindfulness-based intervention %K cancer-related symptom %K quality of life %K breast cancer %K internet-delivered intervention %K mobile phone %D 2022 %7 22.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Mindfulness-based interventions (MBIs) can improve the symptoms and psychological well-being of patients with breast cancer. However, standard MBIs are an 8-week program delivered face-to-face, which may be inconvenient for patients with cancer. Many attempts have been made to adapt MBIs to increase their accessibility for patients with cancer while maintaining their therapeutic components and efficacy. Objective: This study aimed to investigate the effectiveness of a 4-week internet-delivered mindfulness-based cancer recovery (iMBCR) program in reducing symptom burden and enhancing the health-related quality of life (HRQoL) of patients with breast cancer. Methods: A total of 103 postoperative patients with breast cancer (stages 0 to IV) were randomly assigned to an iMBCR group (4-week iMBCR; n=51, 49.5%) or a control group (usual care and 4-week program of health education information; n=52, 50.5%). The study outcomes included symptom burden and HRQoL, as measured by the MD Anderson Symptom Inventory and the Functional Assessment of Cancer Therapy-Breast scale. All data were collected at baseline (T0), after the intervention (T1), and at 1-month follow-up (T2). Data analysis followed the intention-to-treat principle. Linear mixed models were used to assess the effects over time of the iMBCR program. Results: Participants in the iMBCR group had significantly larger decreases in symptom burden than those in the control group at T1 (mean difference –11.67, 95% CI –16.99 to –6.36), and the decreases were maintained at T2 (mean difference –11.83, 95% CI –18.19 to –5.46). The HRQoL score in the iMBCR group had significantly larger improvements than that in the control group at T1 and T2 (mean difference 6.66, 95% CI 3.43-9.90 and mean difference 11.94, 95% CI 7.56-16.32, respectively). Conclusions: Our preliminary findings suggest that the iMBCR program effectively improved the symptom burden and HRQoL of patients with breast cancer, and the participants in the iMBCR group demonstrated good adherence and completion rates. These results indicate that the iMBCR intervention might be a promising way to reduce symptom burden and improve HRQoL of patients with cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000038980; http://www.chictr.org.cn/showproj.aspx?proj=62659 %M 36413385 %R 10.2196/40059 %U https://www.jmir.org/2022/11/e40059 %U https://doi.org/10.2196/40059 %U http://www.ncbi.nlm.nih.gov/pubmed/36413385 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e40386 %T Stage-Specific Survival in Breast Cancer in Chinese and White Women: Comparative Data Analysis %A Wang,Jun %A Zhou,Juan %A Liu,Lei %A Wu,San-Gang %+ Department of Radiation Oncology, the First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, 55 Zhenhai Road, Xiamen, 361003, China, 86 5922139531, [email protected] %K breast cancer %K AJCC %K American Joint Committee on Cancer %K Chinese %K White American %K survival %K surveillance %K epidemiology %K staging %K pathological prognostic staging %K AJCC stage %K overall survival %K cancer-specific survival %D 2022 %7 15.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Stage-specific survival, according to the eighth edition of the American Joint Committee on Cancer (AJCC) pathological prognostic staging (PPS) on breast cancer (BC), between Chinese and White American women remains unclear. Objective: This study aimed to assess stage-specific survival in BC between Chinese and White American women according to the eighth AJCC PPS. Methods: We included Chinese and White American women with BC diagnosed between 2010 and 2018 from the Surveillance, Epidemiology, and End Results database. A chi-square test, the Kaplan–Meier method, a receiver operating characteristic (ROC) curve, and multivariate Cox proportional hazards models were used for data analysis. Results: We included 376,818 individuals in this study: 369,522 White American and 7296 Chinese. Of them, 149,452 (39.7%) migrated from the seventh AJCC anatomic staging (AS) to the eighth AJCC PPS, 22,516 (6.0%) were upstaged, and 126,936 (33.7%) were downstaged. With a median follow-up duration of 44 months, the 5-year overall survival and cancer-specific survival (CSS) for the entire group were 87.4% and 95.9%, respectively. The seventh AJCC AS (P<.001) and the eighth AJCC PPS (P<.001) could significantly predict the survival outcomes of BC, and multivariate analysis revealed that both staging systems were significant prognostic indicators of CSS. The ROC curve revealed that the PPS had a better discriminating ability than the AS (area under the curve [AUC] 0.769 vs 0.753, P<.001). Similar trends were observed after stratification by the 2 ethnic groups. The eighth AJCC PPS had better discriminating ability than the seventh AJCC AS among both White American (AUC 0.769 vs 0.753, P<.001) and Chinese patients (AUC 0.790 vs 0.776, P<.001). In the seventh AJCC AS, Chinese women had better CSS in stage IA (P=.02), stage IIA (P=.005), and stage IIIB (P=.04) disease than White American women, but no significant CSS was observed in stage IB, IIB, IIIA, and IIIC disease between the 2 ethnic groups. Regarding the eighth AJCC PPS, Chinese women had better CSS in stage IA (P=.002) and IIIA (P=.046) disease than White American women, and CSS was similar in Chinese and White American women in other substages. Conclusions: The eighth AJCC PPS has a similar discriminative ability between White American and Chinese individuals with BC compared with the seventh AJCC AS. Therefore, the eighth AJCC PPS is also applicable to Chinese individuals with BC. %M 36378507 %R 10.2196/40386 %U https://publichealth.jmir.org/2022/11/e40386 %U https://doi.org/10.2196/40386 %U http://www.ncbi.nlm.nih.gov/pubmed/36378507 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e34600 %T The Use of Machine Learning to Reduce Overtreatment of the Axilla in Breast Cancer: Retrospective Cohort Study %A Jozsa,Felix %A Baker,Rose %A Kelly,Peter %A Ahmed,Muneer %A Douek,Michael %+ Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, WC1N 3BG, United Kingdom, 44 020 3456 7890, [email protected] %K breast cancer %K preoperative screening %K machine learning %K artificial intelligence %K artificial neural network %K breast %K cancer %K axillary node %K metastasis %K metastatic %K preoperative %K axillary clearance %K metastases %K oncology %D 2022 %7 15.11.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: Patients with early breast cancer undergoing primary surgery, who have low axillary nodal burden, can safely forego axillary node clearance (ANC). However, routine use of axillary ultrasound (AUS) leads to 43% of patients in this group having ANC unnecessarily, following a positive AUS. The intersection of machine learning with medicine can provide innovative ways to understand specific risks within large patient data sets, but this has not yet been trialed in the arena of axillary node management in breast cancer. Objective: The objective of this study was to assess if machine learning techniques could be used to improve preoperative identification of patients with low and high axillary metastatic burden. Methods: A single-center retrospective analysis was performed on patients with breast cancer who had a preoperative AUS, and the specificity and sensitivity of AUS were calculated. Standard statistical methods and machine learning methods, including artificial neural network, naive Bayes, support vector machine, and random forest, were applied to the data to see if they could improve the accuracy of preoperative AUS to better discern high and low axillary burden. Results: The study included 459 patients; 142 (31%) had a positive AUS; among this group, 88 (62%) had 2 or fewer macrometastatic nodes at ANC. Logistic regression outperformed AUS (specificity 0.950 vs 0.809). Of all the methods, the artificial neural network had the highest accuracy (0.919). Interestingly, AUS had the highest sensitivity of all methods (0.777), underlining its utility in this setting. Conclusions: We demonstrated that machine learning improves identification of the important subgroup of patients with no palpable axillary disease, positive ultrasound, and more than 2 metastatically involved nodes. A negative ultrasound in patients with no palpable lymphadenopathy is highly indicative of low axillary burden, and it is unclear whether sentinel node biopsy adds value in this situation. Further studies with larger patient numbers focusing on specific breast cancer subgroups are required to refine these techniques in this setting. %M 36378516 %R 10.2196/34600 %U https://periop.jmir.org/2022/1/e34600 %U https://doi.org/10.2196/34600 %U http://www.ncbi.nlm.nih.gov/pubmed/36378516 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 4 %P e38088 %T Supporting Shared Decision-making About Surveillance After Breast Cancer With Personalized Recurrence Risk Calculations: Development of a Patient Decision Aid Using the International Patient Decision AIDS Standards Development Process in Combination With a Mixed Methods Design %A Ankersmid,Jet Wies %A Siesling,Sabine %A Strobbe,Luc J A %A Meulepas,Johanna M %A van Riet,Yvonne E A %A Engels,Noel %A Prick,Janine C M %A The,Regina %A Takahashi,Asako %A Velting,Mirjam %A van Uden-Kraan,Cornelia F %A Drossaert,Constance H C %+ Department of Health Technology and Services Research, University of Twente, TechMed Centre, Hallenweg 5, Enschede, 7522 NH, Netherlands, 31 303073906, [email protected] %K patient decision aid %K PtDA %K breast cancer %K surveillance %K risk information %K shared decision-making %K SDM %D 2022 %7 14.11.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Although the treatment for breast cancer is highly personalized, posttreatment surveillance remains one-size-fits-all: annual imaging and physical examination for at least five years after treatment. The INFLUENCE nomogram is a prognostic model for estimating the 5-year risk for locoregional recurrences and second primary tumors after breast cancer. The use of personalized outcome data (such as risks for recurrences) can enrich the process of shared decision-making (SDM) for personalized surveillance after breast cancer. Objective: This study aimed to develop a patient decision aid (PtDA), integrating personalized risk calculations on risks for recurrences, to support SDM for personalized surveillance after curative treatment for invasive breast cancer. Methods: For the development of the PtDA, the International Patient Decision Aids Standards development process was combined with a mixed methods design inspired by the development process of previously developed PtDAs. In the development, 8 steps were distinguished: establishing a multidisciplinary steering group; definition of the end users, scope, and purpose of the PtDA; assessment of the decisional needs of end users; defining requirements for the PtDA; determining the format and implementation strategy for the PtDA; prototyping; alpha testing; and beta testing. The composed steering group convened during regular working-group sessions throughout the development process. Results: The “Breast Cancer Surveillance Decision Aid” consists of 3 components that support the SDM process: a handout sheet on which personalized risks for recurrences, calculated using the INFLUENCE-nomogram, can be visualized and which contains an explanation about the decision for surveillance and a login code for a web-based deliberation tool; a web-based deliberation tool, including a patient-reported outcome measure on fear of cancer recurrence; and a summary sheet summarizing patient preferences and considerations. The PtDA was assessed as usable and acceptable during alpha testing. Beta testing is currently ongoing. Conclusions: We developed an acceptable and usable PtDA that integrates personalized risk calculations for the risk for recurrences to support SDM for surveillance after breast cancer. The implementation and effects of the use of the “Breast Cancer Surveillance Decision Aid” are being investigated in a clinical trial. %M 36374536 %R 10.2196/38088 %U https://cancer.jmir.org/2022/4/e38088 %U https://doi.org/10.2196/38088 %U http://www.ncbi.nlm.nih.gov/pubmed/36374536 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e40811 %T Effects of High and Low-To-Moderate Intensity Exercise During (Neo-) Adjuvant Chemotherapy on Muscle Cells, Cardiorespiratory Fitness, and Muscle Function in Women With Breast Cancer: Protocol for a Randomized Controlled Trial %A Vikmoen,Olav %A Wiestad,Tor Helge %A Thormodsen,Inger %A Nordin,Karin %A Berntsen,Sveinung %A Demmelmaier,Ingrid %A Strandberg,Emelie %A Raastad,Truls %+ Department of Physical Performance, Norwegian School of Sport Sciences, Sognsveien 220, Oslo, 0863, Norway, 47 23262359, [email protected] %K resistance training %K endurance training %K muscle strength %K muscle endurance %K anthracyclines %K taxanes %D 2022 %7 11.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: (Neo-)adjuvant chemotherapy for breast cancer is effective but has deleterious side effects on muscle tissue, resulting in reduced skeletal muscle mass, muscle function, and cardiorespiratory fitness. Various exercise regimens during cancer treatment have been shown to counteract some of these side effects. However, no study has compared the effect of high-intensity training versus low-to-moderate intensity training on muscle tissue cellular outcomes and physical function in patients with breast cancer during chemotherapy. Objective: The aim of this substudy within the Physical Training in Cancer (Phys-Can) consortium is to evaluate and compare the effects of high and low-to-moderate intensity exercise on muscle cellular outcomes, muscle function, and cardiorespiratory fitness in women with breast cancer undergoing (neo-)adjuvant chemotherapy. We further aim to investigate if the effects of chemotherapy including taxanes on muscles will be different from those of taxane-free chemotherapy. Methods: Eighty women recently diagnosed with breast cancer scheduled to start (neo-)adjuvant chemotherapy will be randomized to a combination of strength and endurance training, either at high intensity or at low-to-moderate intensity. Testing of muscle function and cardiorespiratory fitness and collection of muscle biopsies from the vastus lateralis muscle will be performed before the first cycle of chemotherapy (or after 1 week, when not possible) (T0), halfway through chemotherapy (T1), and after completion of chemotherapy (T2). It is estimated that approximately 50% of the participants will be willing to undergo muscle biopsies. To separate the effect of the treatment itself, a usual care group with no supervised training will also be included, and in this group, testing and collection of muscle biopsies will be performed at T0 and T2 only. Results: This study is funded by Active Against Cancer (Aktiv mot kreft) (May 2013) and the Norwegian Cancer Society (December 2018). Inclusion started in December 2016 and the last participant is expected to be recruited in December 2022. As of June 2022, we enrolled 38 (19 with biopsies) participants to the high-intensity training group, 36 (19 with biopsies) participants to the low-to-moderate intensity training group, and 17 (16 with biopsies) participants to the usual care group. Data analyses will start in fall 2022. The first results are expected to be published in spring 2024. Conclusions: This study will generate new knowledge about the effects of different training intensities for women with breast cancer during chemotherapy treatment. It will give further insight into how chemotherapy affects the muscle tissue and how physical training at different intensities may counteract the treatment side effects in muscles. The results of this study will inform the development and refinement of exercise programs that are effective and compatible with the multidisciplinary management of breast cancer. Trial Registration: ClinicalTrials.gov NCT05218876; https://tinyurl.com/ysaj9dhm International Registered Report Identifier (IRRID): DERR1-10.2196/40811 %M 36367769 %R 10.2196/40811 %U https://www.researchprotocols.org/2022/11/e40811 %U https://doi.org/10.2196/40811 %U http://www.ncbi.nlm.nih.gov/pubmed/36367769 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e34564 %T Predicting Effective Adaptation to Breast Cancer to Help Women BOUNCE Back: Protocol for a Multicenter Clinical Pilot Study %A Pettini,Greta %A Sanchini,Virginia %A Pat-Horenczyk,Ruth %A Sousa,Berta %A Masiero,Marianna %A Marzorati,Chiara %A Galimberti,Viviana Enrica %A Munzone,Elisabetta %A Mattson,Johanna %A Vehmanen,Leena %A Utriainen,Meri %A Roziner,Ilan %A Lemos,Raquel %A Frasquilho,Diana %A Cardoso,Fatima %A Oliveira-Maia,Albino J %A Kolokotroni,Eleni %A Stamatakos,Georgios %A Leskelä,Riikka-Leena %A Haavisto,Ira %A Salonen,Juha %A Richter,Robert %A Karademas,Evangelos %A Poikonen-Saksela,Paula %A Mazzocco,Ketti %+ Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Via G. Ripamonti 435, Milan, 20141, Italy, 39 0257489207, [email protected] %K resilience %K personality %K coping %K decision-making %K cancer %K quality of life %D 2022 %7 12.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the continued progress of medicine, dealing with breast cancer is becoming a major socioeconomic challenge, particularly due to its increasing incidence. The ability to better manage and adapt to the entire care process depends not only on the type of cancer but also on the patient’s sociodemographic and psychological characteristics as well as on the social environment in which a person lives and interacts. Therefore, it is important to understand which factors may contribute to successful adaptation to breast cancer. To our knowledge, no studies have been performed on the combination effect of multiple psychological, biological, and functional variables in predicting the patient’s ability to bounce back from a stressful life event, such as a breast cancer diagnosis. Here we describe the study protocol of a multicenter clinical study entitled “Predicting Effective Adaptation to Breast Cancer to Help Women to BOUNCE Back” or, in short, BOUNCE. Objective: The aim of the study is to build a quantitative mathematical model of factors associated with the capacity for optimal adjustment to cancer and to study resilience through the cancer continuum in a population of patients with breast cancer. Methods: A total of 660 women with breast cancer will be recruited from five European cancer centers in Italy, Finland, Israel, and Portugal. Biomedical and psychosocial variables will be collected using the Noona Healthcare platform. Psychosocial, sociodemographic, lifestyle, and clinical variables will be measured every 3 months, starting from presurgery assessment (ie, baseline) to 18 months after surgery. Temporal data mining, time-series prediction, sequence classification methods, clustering time-series data, and temporal association rules will be used to develop the predictive model. Results: The recruitment process stared in January 2019 and ended in November 2021. Preliminary results have been published in a scientific journal and are available for consultation on the BOUNCE project website. Data analysis and dissemination of the study results will be performed in 2022. Conclusions: This study will develop a predictive model that is able to describe individual resilience and identify different resilience trajectories along the care process. The results will allow the implementation of tailored interventions according to patients’ needs, supported by eHealth technologies. Trial Registration: ClinicalTrials.gov NCT05095675; https://clinicaltrials.gov/ct2/show/NCT05095675 International Registered Report Identifier (IRRID): DERR1-10.2196/34564 %M 36222801 %R 10.2196/34564 %U https://www.researchprotocols.org/2022/10/e34564 %U https://doi.org/10.2196/34564 %U http://www.ncbi.nlm.nih.gov/pubmed/36222801 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e36889 %T Feasibility and Acceptability of an Active Video Game–Based Physical Activity Support Group (Pink Warrior) for Survivors of Breast Cancer: Randomized Controlled Pilot Trial %A Swartz,Maria C %A Lewis,Zakkoyya H %A Deer,Rachel R %A Stahl,Anna L %A Swartz,Michael D %A Christopherson,Ursela %A Basen-Engquist,Karen %A Wells,Stephanie J %A Silva,H Colleen %A Lyons,Elizabeth J %+ Department of Pediatrics-Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit: 0087, Houston, TX, 77030, United States, 1 713 745 3763, [email protected] %K physical activity %K survivors of cancer %K pilot study %K breast cancer %K video games %K group intervention %K physical function %K motivation %K mobile phone %D 2022 %7 22.8.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Survivors of breast cancer with functional limitations have a 40% higher mortality rate than those without. Despite the known benefits of physical activity (PA), <40% of survivors of breast cancer meet the recommendations for PA. The combination of active video games (AVGs) and group-based PA counseling may hold potential for motivating PA adoption and improving physical function. However, this method has not been widely studied in survivors of breast cancer. Objective: We aimed to determine the feasibility and acceptability of a group AVG-based multicomponent PA intervention and estimate its effect size and variability on PA and physical function in female survivors of breast cancer in a clinic setting. Methods: Female survivors of breast cancer (N=60) were recruited through the clinic and randomly assigned to the intervention group (12 weekly sessions) or the control group (existing support group). The intervention group received game-based pedometers and participated in weekly group AVG sessions, PA behavioral coaching, and survivorship navigation discussions. A participant manual with weekly reflection worksheets was provided to reinforce the coaching lessons and promote self-led PA. The control group received conventional pedometers and participated in an existing breast cancer support group. Feasibility was assessed by enrollment rate (≥50%), retention rate (≥80%), group attendance rate (75% attending ≥9 sessions [intervention group]), and the number of technological issues and adverse events. Acceptability was measured by participants’ attitudes (from strongly disagree=1 to strongly agree=5) toward the use of AVGs and the overall program. The outcomes included PA (accelerometers) and physical function (Short Physical Performance Battery and gait speed). Analysis of covariance was used to determine differences in PA and physical function between the groups. The Cohen d and its 95% CI determined the effect size and variability, respectively. All the analyses followed the intention-to-treat principle. Results: Participants were an average of 57.4 (SD 10.5) years old, 70% (42/60) White, and 58% (35/60) off treatment. The enrollment rate was 55.9% (66/118). Despite substantial long-term hurricane-related disruptions, we achieved an 80% (48/60) retention. The intervention group’s attendance rate was 78% (14/18), whereas the control group’s attendance rate was 53% (9/17). Of the 26 game-based pedometers, 3 (12%) were damaged or lost. No study-related adverse events occurred. Acceptability items were highly rated. Steps (β=1621.64; P=.01; d=0.72), Short Physical Performance Battery (β=.47; P=.01; d=0.25), and gait speed (β=.12; P=.004; d=0.48) had a significant intervention effect. Conclusions: The intervention was feasible and acceptable in this population despite the occurrence of a natural disaster. Pilot results indicate that group AVG sessions, PA coaching, and survivorship navigation produced moderate effects on PA and physical functioning. AVGs with PA counseling can potentially be used in existing breast cancer support groups to encourage PA and improve physical function. Trial Registration: ClinicalTrials.gov NCT02750241; https://clinicaltrials.gov/ct2/show/NCT02750241 %M 35994321 %R 10.2196/36889 %U https://cancer.jmir.org/2022/3/e36889 %U https://doi.org/10.2196/36889 %U http://www.ncbi.nlm.nih.gov/pubmed/35994321 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e38300 %T An Investigation of Virtual Reality Nature Experiences in Patients With Metastatic Breast Cancer: Secondary Analysis of a Randomized Controlled Trial %A Chin,Stanley %A Cavadino,Alana %A Akroyd,Amelia %A Tennant,Geraldine %A Dobson,Rosie %A Gautier,Adele %A Reynolds,Lisa %+ Department of Psychological Medicine, The University of Auckland, Private Bag 92019, Victoria Street West, Auckland, 1142, New Zealand, 64 9234938, [email protected] %K metastatic breast cancer %K virtual reality %K nature connectedness %K intervention %K quality of life %D 2022 %7 22.7.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Connection with nature has well-established physical and psychological benefits. However, women with metastatic breast cancer (MBC) are often unable to access nature because of physical limitations, psychological barriers, and treatment demands. Virtual reality (VR) nature experiences offer an alternative means of connecting with nature and may be of particular benefit to patients with cancer who are house- or hospital-bound. Objective: This study aims to explore whether VR nature experiences are associated with physical and psychological benefits for women with MBC who are disconnected with nature. Methods: This secondary analysis of a previous randomized controlled crossover trial recruited participants from the emailing lists of breast cancer support organizations. Participants were provided VR headsets for daily use in their homes for over 3 weeks. In the first week, participants used 1 of 2 VR nature experiences (Ripple or Happy Place) daily, followed by a 1-week washout period, before using the other VR experience every day for the final week. Outcomes assessed changes between baseline and postintervention scores in quality of life (EQ-5D-5L), pain (Brief Pain Inventory Short Form), fatigue (Functional Assessment of Chronic Illness Therapy-fatigue), depression (Depression, Anxiety, and Stress Scale-depression), anxiety (Depression, Anxiety, and Stress Scale-anxiety), and spiritual well-being (Functional Assessment of Chronic Illness Therapy- Spiritual Well-being) and investigated whether benefits were greater in participants who were not strongly connected with nature at baseline. Results: A total of 38 women with MBC completed the VR interventions and were included in the analyses. Participants reported significantly less fatigue (P=.001), less depression (P<.001), and greater quality of life (P=.02) following the interventions than at baseline. Women with a weaker connection to nature reported greater fatigue (P=.03), depression (P=.006), and anxiety (P=.001), and poorer spirituality (P=.004) than their strongly connected counterparts. Only those with a weaker baseline connection with nature showed improvements in depression following the intervention (P=.03), with similar trends observed in fatigue (P=.07) and quality of life (P=.10). Conclusions: This study provides preliminary evidence that feeling connected with nature is associated with better physical and psychological status in patients with MBC and that VR nature interventions might be beneficial for this clinical population. Future studies should focus on activities that encourage connection with nature (rather than simply exposure to nature) and investigate the aspects of VR nature interventions that have the greatest therapeutic potential. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001480178; https://tinyurl.com/et6z3vac %M 35867398 %R 10.2196/38300 %U https://cancer.jmir.org/2022/3/e38300 %U https://doi.org/10.2196/38300 %U http://www.ncbi.nlm.nih.gov/pubmed/35867398 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e39003 %T Exploring the Association of Cancer and Depression in Electronic Health Records: Combining Encoded Diagnosis and Mining Free-Text Clinical Notes %A Leis,Angela %A Casadevall,David %A Albanell,Joan %A Posso,Margarita %A Macià,Francesc %A Castells,Xavier %A Ramírez-Anguita,Juan Manuel %A Martínez Roldán,Jordi %A Furlong,Laura I %A Sanz,Ferran %A Ronzano,Francesco %A Mayer,Miguel A %+ Department of Medicine and Life Sciences, Universitat Pompeu Fabra, C/Aiguader 88, Barcelona, 08003, Spain, 34 933160539, [email protected] %K cancer %K depression %K electronic health records %K text mining %K natural language processing %D 2022 %7 11.7.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: A cancer diagnosis is a source of psychological and emotional stress, which are often maintained for sustained periods of time that may lead to depressive disorders. Depression is one of the most common psychological conditions in patients with cancer. According to the Global Cancer Observatory, breast and colorectal cancers are the most prevalent cancers in both sexes and across all age groups in Spain. Objective: This study aimed to compare the prevalence of depression in patients before and after the diagnosis of breast or colorectal cancer, as well as to assess the usefulness of the analysis of free-text clinical notes in 2 languages (Spanish or Catalan) for detecting depression in combination with encoded diagnoses. Methods: We carried out an analysis of the electronic health records from a general hospital by considering the different sources of clinical information related to depression in patients with breast and colorectal cancer. This analysis included ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) diagnosis codes and unstructured information extracted by mining free-text clinical notes via natural language processing tools based on Systematized Nomenclature of Medicine Clinical Terms that mentions symptoms and drugs used for the treatment of depression. Results: We observed that the percentage of patients diagnosed with depressive disorders significantly increased after cancer diagnosis in the 2 types of cancer considered—breast and colorectal cancers. We managed to identify a higher number of patients with depression by mining free-text clinical notes than the group selected exclusively on ICD-9-CM codes, increasing the number of patients diagnosed with depression by 34.8% (441/1269). In addition, the number of patients with depression who received chemotherapy was higher than those who did not receive this treatment, with significant differences (P<.001). Conclusions: This study provides new clinical evidence of the depression-cancer comorbidity and supports the use of natural language processing for extracting and analyzing free-text clinical notes from electronic health records, contributing to the identification of additional clinical data that complements those provided by coded data to improve the management of these patients. %M 35816382 %R 10.2196/39003 %U https://cancer.jmir.org/2022/3/e39003 %U https://doi.org/10.2196/39003 %U http://www.ncbi.nlm.nih.gov/pubmed/35816382 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e32370 %T Public Policies and Programs for the Prevention and Control of Breast Cancer in Latin American Women: Scoping Review %A Ramos Herrera,Igor Martín %A Lemus Flores,María Guadalupe %A Reyna Sevilla,Antonio %A González Castañeda,Miguel Ernesto %A Torres Gutiérrez,Fernando Adolfo %A Crocker Sagastume,René Cristóbal %A Robles Pastrana,Juan De Dios %A Vázquez Castellanos,José Luis %+ Department of Public Health, University of Guadalajara, Sierra Mojada 950, Guadalajara, 44290, Mexico, 52 3336262462, [email protected] %K breast cancer %K scoping review %K public policy %K prevention programs %K systematic review %D 2022 %7 6.7.2022 %9 Review %J JMIR Cancer %G English %X Background: Breast cancer has positioned itself worldwide as one of the main public health problems, especially in Latin America. In some countries, several programs for the prevention and control of breast cancer in women have been developed and implemented on a permanent basis, but there are no public reports on the policies that originated such programs. Objective: A scoping review of scientific publications that identify the type, extent, and scope of policies and programs for the prevention and control of breast cancer in Latin American women was performed, and the main results were presented in this paper. Methods: This scoping review was carried out according to the method by Arksey and O’Malley based on 3 fundamental questions about breast cancer prevention and control policies in Latin America: their type, extent and scope, and reference framework. The search period was from 2000 to 2019, and the search was carried out in the following databases: MEDLINE (PubMed), MEDLINE (EbscoHost), CINAHL (EbscoHost), Academic Search Complete (EbscoHost), ISI Web of Science (Science Citation Index), and Scopus in English, Spanish, and Portuguese, and Scielo, Cochrane, and MEDES-MEDicina in Spanish and Portuguese. Of the 743 studies found, 20 (2.7%) were selected, which were analyzed using descriptive statistics and qualitative content analysis. Results: The selected studies identified several Latin American countries that have generated policies and programs to prevent and control breast cancer in women, focusing mainly on risk communication, prevention and timely detection, effective access to health services, improvement of the screening process, and evaluation of screening programs. Evaluation criteria and greater participation of civil society in policy design and program execution are still lacking. This could undoubtedly help eliminate existing barriers to effective action. Conclusions: Although several Latin American countries have generated public policies and action programs for the prevention and control of breast cancer, a pending issue is the evaluation of the results to analyze the effectiveness and impact of their implementation given the magnitude of the public health problem it represents and because women and civil society play an important role in its prevention and control. International Registered Report Identifier (IRRID): RR2-10.2196/12624 %M 35793130 %R 10.2196/32370 %U https://cancer.jmir.org/2022/3/e32370 %U https://doi.org/10.2196/32370 %U http://www.ncbi.nlm.nih.gov/pubmed/35793130 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32354 %T Breast Cancer Physical Activity Mobile Intervention: Early Findings From a User Experience and Acceptability Mixed Methods Study %A Signorelli,Gabriel Ruiz %A Monteiro-Guerra,Francisco %A Rivera-Romero,Octavio %A Núñez-Benjumea,Francisco J %A Fernández-Luque,Luis %+ Adhera Health, Inc, Circuito II Bldg, Av de los Descubrimientos, s/n, Mairena del Aljarafe - Seville, Palo Alto, CA, United States, 1 656930901, [email protected] %K breast cancer %K BC %K mobile app %K physical activity %K mHealth %K acceptability %K user experience %K mobile phone %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical activity (PA) is the most well-established lifestyle factor associated with breast cancer (BC) survival. Even women with advanced BC may benefit from moderate PA. However, most BC symptoms and treatment side effects are barriers to PA. Mobile health coaching systems can implement functionalities and features based on behavioral change theories to promote healthier behaviors. However, to increase its acceptability among women with BC, it is essential that these digital persuasive systems are designed considering their contextual characteristics, needs, and preferences. Objective: This study aimed to examine the potential acceptability and feasibility of a mobile-based intervention to promote PA in patients with BC; assess usability and other aspects of the user experience; and identify key considerations and aspects for future improvements, which may help increase and sustain acceptability and engagement. Methods: A mixed methods case series evaluation of usability and acceptability was conducted in this study. The study comprised 3 sessions: initial, home, and final sessions. Two standardized scales were used: the Satisfaction with Life Scale and the International Physical Activity Questionnaire–Short Form. Participants were asked to use the app at home for approximately 2 weeks. App use and PA data were collected from the app and stored on a secure server during this period. In the final session, the participants filled in 2 app evaluation scales and took part in a short individual interview. They also completed the System Usability Scale and the user version of the Mobile App Rating Scale. Participants were provided with a waist pocket, wired in-ear headphones, and a smartphone. They also received printed instructions. A content analysis of the qualitative data collected in the interviews was conducted iteratively, ensuring that no critical information was overlooked. Results: The International Physical Activity Questionnaire–Short Form found that all participants (n=4) were moderately active; however, half of them did not reach the recommended levels in the guidelines. System Usability Scale scores were all >70 out of 100 (72.5, 77.5, 95, and 80), whereas the overall user version of the Mobile App Rating Scale scores were 4, 4.3, 4.4, and 3.6 out of 5. The app was perceived to be nice, user-friendly, straightforward, and easy to understand. Recognition of achievements, the possibility of checking activity history, and the rescheduling option were positively highlighted. Technical difficulties with system data collection, particularly with the miscount of steps, could make users feel frustrated. The participants suggested improvements and indicated that the app has the potential to work well for survivors of BC. Conclusions: Early results presented in this study point to the potential of this tool concept to provide a friendly and satisfying coaching experience to users, which may help improve PA adherence in survivors of BC. %M 35731554 %R 10.2196/32354 %U https://formative.jmir.org/2022/6/e32354 %U https://doi.org/10.2196/32354 %U http://www.ncbi.nlm.nih.gov/pubmed/35731554 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e37840 %T Extracting Multiple Worries From Breast Cancer Patient Blogs Using Multilabel Classification With the Natural Language Processing Model Bidirectional Encoder Representations From Transformers: Infodemiology Study of Blogs %A Watanabe,Tomomi %A Yada,Shuntaro %A Aramaki,Eiji %A Yajima,Hiroshi %A Kizaki,Hayato %A Hori,Satoko %+ Division of Drug Informatics, Keio University Faculty of Pharmacy, 1-5-30 Shibakouen, Minato-ku, Tokyo, 105-8512, Japan, 81 3 5400 2650, [email protected] %K breast neoplasm %K cancer %K natural language processing %K NLP %K artificial intelligence %K model %K machine learning %K content analysis %K text mining %K sentiment analysis %K oncology %K quality of life %K social media %K social support %K breast cancer %K BERT model %K peer support %K blog post %K patient data %D 2022 %7 3.6.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients with breast cancer have a variety of worries and need multifaceted information support. Their accumulated posts on social media contain rich descriptions of their daily worries concerning issues such as treatment, family, and finances. It is important to identify these issues to help patients with breast cancer to resolve their worries and obtain reliable information. Objective: This study aimed to extract and classify multiple worries from text generated by patients with breast cancer using Bidirectional Encoder Representations From Transformers (BERT), a context-aware natural language processing model. Methods: A total of 2272 blog posts by patients with breast cancer in Japan were collected. Five worry labels, “treatment,” “physical,” “psychological,” “work/financial,” and “family/friends,” were defined and assigned to each post. Multiple labels were allowed. To assess the label criteria, 50 blog posts were randomly selected and annotated by two researchers with medical knowledge. After the interannotator agreement had been assessed by means of Cohen kappa, one researcher annotated all the blogs. A multilabel classifier that simultaneously predicts five worries in a text was developed using BERT. This classifier was fine-tuned by using the posts as input and adding a classification layer to the pretrained BERT. The performance was evaluated for precision using the average of 5-fold cross-validation results. Results: Among the blog posts, 477 included “treatment,” 1138 included “physical,” 673 included “psychological,” 312 included “work/financial,” and 283 included “family/friends.” The interannotator agreement values were 0.67 for “treatment,” 0.76 for “physical,” 0.56 for “psychological,” 0.73 for “work/financial,” and 0.73 for “family/friends,” indicating a high degree of agreement. Among all blog posts, 544 contained no label, 892 contained one label, and 836 contained multiple labels. It was found that the worries varied from user to user, and the worries posted by the same user changed over time. The model performed well, though prediction performance differed for each label. The values of precision were 0.59 for “treatment,” 0.82 for “physical,” 0.64 for “psychological,” 0.67 for “work/financial,” and 0.58 for “family/friends.” The higher the interannotator agreement and the greater the number of posts, the higher the precision tended to be. Conclusions: This study showed that the BERT model can extract multiple worries from text generated from patients with breast cancer. This is the first application of a multilabel classifier using the BERT model to extract multiple worries from patient-generated text. The results will be helpful to identify breast cancer patients’ worries and give them timely social support. %M 35657664 %R 10.2196/37840 %U https://cancer.jmir.org/2022/2/e37840 %U https://doi.org/10.2196/37840 %U http://www.ncbi.nlm.nih.gov/pubmed/35657664 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 2 %P e31815 %T The Acceptability of an Electronically Delivered Acceptance- and Mindfulness-Based Physical Activity Intervention for Survivors of Breast Cancer: One-Group Pretest-Posttest Design %A Robertson,Michael C %A Cox-Martin,Emily %A Shegog,Ross %A Markham,Christine M %A Fujimoto,Kayo %A Durand,Casey P %A Brewster,Abenaa %A Lyons,Elizabeth J %A Liao,Yue %A Flores,Sara A %A Basen-Engquist,Karen M %+ Department of Nutrition, Metabolism, and Rehabilitation Sciences, The University of Texas Medical Branch, 301 University Blvd, Galveston, TX, 77555, United States, 1 409 772 3030, [email protected] %K cancer survivors %K exercise %K mindfulness %K Acceptance and Commitment Therapy %K behavioral sciences %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of the internal barriers associated with physical activity. Objective: The primary aim of this study was to investigate the acceptability of an electronically delivered physical activity intervention for survivors of breast cancer, centered on ACT processes. Methods: This study used a 1-group pretest-posttest design. We recruited 80 insufficiently active female survivors of breast cancer using a web-based recruitment strategy. The 8-week intervention consisted of weekly modules that featured didactic lessons and experiential exercises targeting key ACT processes in the context of physical activity promotion (namely, values, committed action, acceptance, defusion, and contacting the present moment). We determined intervention acceptability according to study retention (≥70%), adherence rates (≥75% of the participants completing ≥50% of the modules), and posttest survey scores reflecting the perceived ease of use, perceived usefulness, and interest and enjoyment of the intervention (≥5 on a 7-point Likert-type scale). We also evaluated changes in self-reported aerobic and muscle strengthening–physical activity, physical activity acceptance, physical activity regulation, and health-related outcomes. Results: The retention rate (61/80, 76%), adherence rate (60/80, 75%), average perceived ease of use (6.17, SD 1.17), perceived usefulness (5.59, SD 1.40), and interest and enjoyment scores (5.43, SD 1.40) met the acceptability criteria. Participants increased their self-reported aerobic physical activity (Cohen d=1.04), muscle strengthening–physical activity (Cohen d=1.02), physical activity acceptance (cognitive acceptance: Cohen d=0.35; behavioral commitment: Cohen d=0.51), physical activity regulation (identified regulation: Cohen d=0.37; integrated regulation: Cohen d=0.66), increased their ability to participate in social roles and activities (Cohen d=0.18), and reported less fatigue (Cohen d=0.33) and sleep disturbance (Cohen d=0.53). Conclusions: Electronically delivered acceptance- and mindfulness-based interventions may be useful for promoting physical activity in survivors of breast cancer. Further research is needed to refine these approaches and evaluate their effectiveness. %M 35486425 %R 10.2196/31815 %U https://cancer.jmir.org/2022/2/e31815 %U https://doi.org/10.2196/31815 %U http://www.ncbi.nlm.nih.gov/pubmed/35486425 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 2 %P e30988 %T Video-Based Communication Assessment of Physician Error Disclosure Skills by Crowdsourced Laypeople and Patient Advocates Who Experienced Medical Harm: Reliability Assessment With Generalizability Theory %A White,Andrew A %A King,Ann M %A D’Addario,Angelo E %A Brigham,Karen Berg %A Dintzis,Suzanne %A Fay,Emily E %A Gallagher,Thomas H %A Mazor,Kathleen M %+ Department of Medicine, University of Washington School of Medicine, Box 356429, 1959 Pacific St, Seattle, WA, 98195, United States, 1 206 616 1447, [email protected] %K medical error disclosure %K simulation studies %K communication assessment %K graduate medical education %K crowdsourcing %K patient-centered care %K generalizability theory %K medical education %K medical error %K communication %D 2022 %7 29.4.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: Residents may benefit from simulated practice with personalized feedback to prepare for high-stakes disclosure conversations with patients after harmful errors and to meet American Council on Graduate Medical Education mandates. Ideally, feedback would come from patients who have experienced communication after medical harm, but medical researchers and leaders have found it difficult to reach this community, which has made this approach impractical at scale. The Video-Based Communication Assessment app is designed to engage crowdsourced laypeople to rate physician communication skills but has not been evaluated for use with medical harm scenarios. Objective: We aimed to compare the reliability of 2 assessment groups (crowdsourced laypeople and patient advocates) in rating physician error disclosure communication skills using the Video-Based Communication Assessment app. Methods: Internal medicine residents used the Video-Based Communication Assessment app; the case, which consisted of 3 sequential vignettes, depicted a delayed diagnosis of breast cancer. Panels of patient advocates who have experienced harmful medical error, either personally or through a family member, and crowdsourced laypeople used a 5-point scale to rate the residents’ error disclosure communication skills (6 items) based on audiorecorded responses. Ratings were aggregated across items and vignettes to create a numerical communication score for each physician. We used analysis of variance, to compare stringency, and Pearson correlation between patient advocates and laypeople, to identify whether rank order would be preserved between groups. We used generalizability theory to examine the difference in assessment reliability between patient advocates and laypeople. Results: Internal medicine residents (n=20) used the Video-Based Communication Assessment app. All patient advocates (n=8) and 42 of 59 crowdsourced laypeople who had been recruited provided complete, high-quality ratings. Patient advocates rated communication more stringently than crowdsourced laypeople (patient advocates: mean 3.19, SD 0.55; laypeople: mean 3.55, SD 0.40; P<.001), but patient advocates’ and crowdsourced laypeople’s ratings of physicians were highly correlated (r=0.82, P<.001). Reliability for 8 raters and 6 vignettes was acceptable (patient advocates: G coefficient 0.82; crowdsourced laypeople: G coefficient 0.65). Decision studies estimated that 12 crowdsourced layperson raters and 9 vignettes would yield an acceptable G coefficient of 0.75. Conclusions: Crowdsourced laypeople may represent a sustainable source of reliable assessments of physician error disclosure skills. For a simulated case involving delayed diagnosis of breast cancer, laypeople correctly identified high and low performers. However, at least 12 raters and 9 vignettes are required to ensure adequate reliability and future studies are warranted. Crowdsourced laypeople rate less stringently than raters who have experienced harm. Future research should examine the value of the Video-Based Communication Assessment app for formative assessment, summative assessment, and just-in-time coaching of error disclosure communication skills. %M 35486423 %R 10.2196/30988 %U https://mededu.jmir.org/2022/2/e30988 %U https://doi.org/10.2196/30988 %U http://www.ncbi.nlm.nih.gov/pubmed/35486423 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e37009 %T Acceptability and Feasibility of a Return-to-Work Intervention for Posttreatment Breast Cancer Survivors: Protocol for a Co-design and Development Study %A Bilodeau,Karine %A Gouin,Marie-Michelle %A Lecours,Alexandra %A Lederer,Valérie %A Durand,Marie-José %A Kilpatrick,Kelley %A Lepage,David %A Ladouceur-Deslauriers,Lauriane %A Dorta,Tomas %+ Faculty of Nursing, University of Montreal, PO Box 6128, Station Centre-ville, Montreal, QC, H3C 3J7, Canada, 1 514 343 6111 ext 43254, [email protected] %K co-design %K breast cancer %K intervention %K return-to-work %K primary care %K qualitative %D 2022 %7 22.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The mortality rate from breast cancer has been declining for many years, and the population size of working-age survivors is steadily increasing. However, the recurrent side effects of cancer and its treatment can result in multiple disabilities and disruptions to day-to-day life, including work disruptions. Despite the existing knowledge of best practices regarding return to work (RTW) for breast cancer survivors, only a few interdisciplinary interventions have been developed to address the individualized needs and multiple challenges of breast cancer survivors, health care professionals, and employer and insurer representatives. Thus, it seems appropriate to develop RTW interventions collaboratively by using a co-design approach with these specific stakeholders. Objective: This paper presents a protocol for developing and testing an innovative, interdisciplinary pilot intervention based on a co-design approach to better support RTW and job retention after breast cancer treatment. Methods: First, a participatory research approach will be used to develop the intervention in a co-design workshop with 12 to 20 participants, including people affected by cancer, employer and insurer representatives, and health care professionals. Next, a pilot intervention will be tested in a primary care setting with 6 to 8 women affected by breast cancer. The acceptability and feasibility of the pilot intervention will be pretested through semistructured interviews with participants, health care professionals, and involved patient partners. The transcribed data will undergo an iterative content analysis. Results: The first phase of the project—the co-design workshop—was completed in June 2021. The pilot test of the intervention will begin in spring 2022. The results from the test will be available in late 2022. Conclusions: The project will offer novel data regarding the use of the co-design approach for the development of innovative, co-designed interventions. In addition, it will be possible to document the acceptability and feasibility of the pilot intervention with a primary care team. Depending on the results obtained, the intervention could be implemented on a larger scale. International Registered Report Identifier (IRRID): DERR1-10.2196/37009 %M 35451972 %R 10.2196/37009 %U https://www.researchprotocols.org/2022/4/e37009 %U https://doi.org/10.2196/37009 %U http://www.ncbi.nlm.nih.gov/pubmed/35451972 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e31887 %T Early Detection of Cardiotoxicity From Systemic and Radiation Therapy in Patients With Breast Cancer: Protocol for a Multi-Institutional Prospective Study %A Borgonovo,Giulia %A Vettus,Elen %A Greco,Alessandra %A Leo,Laura Anna %A Faletra,Francesco Fulvio %A Klersy,Catherine %A Curti,Moreno %A Valli,Mariacarla %+ Clinic of Radiation Oncology, Oncology Institute of Southern Switzerland, Via Gallino, Bellinzona, 6500, Switzerland, 41 918119430, [email protected] %K breast cancer %K cardiotoxicity %K cardiac diagnostic imaging %K radiotherapy %K chemotherapy %D 2022 %7 21.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The incidence of breast cancer is rising worldwide. Recent advances in systemic and local treatments have significantly improved survival rates of patients having early breast cancer. In the last decade, great attention has been paid to the prevention and early detection of cardiotoxicity induced by breast cancer treatments. Systemic therapy-related cardiac toxicities have been extensively studied. Radiotherapy, an essential component of breast cancer treatment, can also increase the risk of heart diseases. Consequently, it is important to balance the expected benefits of cancer treatment with cardiovascular risk and to identify strategies to prevent cardiotoxicity and improve long-term outcomes and quality of life for these patients. Objective: This CardioTox Breast study aims to investigate the use of cardiac imaging, based on cardiac magnetic resonance and echocardiography, and to identify associated circulating biomarkers to assess early tissue changes in chemo-induced and radiation-induced cardiotoxicity in the time window of 12 months after the end of radiotherapy in patients with breast cancer. Methods: The CardioTox Breast trial is a multicenter observational prospective longitudinal study. We aim to enroll 150 women with stage I-III unilateral breast cancer, treated with breast conserving surgery, who planned to receive radiotherapy with or without systemic therapy. Baseline and follow-up data include cardiac measurements based on cardiac magnetic resonance imaging, echocardiography, and circulating biomarkers of cardiac toxicity. Results: This study details the protocol of the CardioTox Breast trial. Recruitment started in September 2020. The results of this study will not be published until data are mature for the final analysis of the primary study end point. Conclusions: The CardioTox Breast study is designed to investigate the effects of systemic and radiation therapy on myocardial function and structure, thus providing additional evidence on whether cardiac magnetic resonance is the optimal screening imaging for cardiotoxicity. Trial Registration: ClinicalTrials.gov NCT04790266; https://clinicaltrials.gov/ct2/show/NCT04790266 International Registered Report Identifier (IRRID): DERR1-10.2196/31887 %M 35451989 %R 10.2196/31887 %U https://www.researchprotocols.org/2022/4/e31887 %U https://doi.org/10.2196/31887 %U http://www.ncbi.nlm.nih.gov/pubmed/35451989 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e26827 %T Exercise and Creatine Supplementation to Augment the Adaptation of Exercise Training Among Breast Cancer Survivors Completing Chemotherapy: Protocol for an Open-label Randomized Controlled Trial (the THRIVE Study) %A Patel,Darpan I %A Gonzalez,Angela %A Moon,Crisann %A Serra,Monica %A Bridges,Preston Blake %A Hughes,Daniel %A Clarke,Geoffrey %A Kilpela,Lisa %A Jiwani,Rozmin %A Musi,Nicolas %+ Biobehavioral Research Laboratory, School of Nursing, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States, 1 210 567 0362, [email protected] %K rehabilitation %K supplements %K resistant exercise %K oncology %K quality of life %K doxorubicin %D 2022 %7 1.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: In breast cancer survivors, chemotherapy-induced muscle loss has been shown to be attenuated with structured resistance exercise. Creatine supplementation can increase bioenergetics in skeletal muscle, which helps to improve overall strength and endurance and reduce muscular fatigue. Therefore, we hypothesize that adding creatinine supplementation to exercise training will accelerate improvements in strength, endurance, and bioenergetics in breast cancer survivors. Objective: The primary objective is to determine the effects of combining creatine supplementation with exercise on modulating strength and physical function in breast cancer survivors by comparing these effects to those of exercise alone. The secondary objectives are to determine if creatine supplementation and exercise can increase the intramuscular storage of creatine and improve body composition by comparing this intervention to exercise alone. Methods: We aim to test our hypothesis by conducting an open-label randomized controlled trial of 30 breast cancer survivors who have completed chemotherapy within 6 months of enrollment. Eligible participants will be equally randomized (1:1) to either a creatine and exercise group or an exercise-only group for this 12-week intervention. Individuals who are randomized to receive creatine will be initially dosed at 20 g per day for 7 days to boost the availability of creatine systemically. Thereafter, the dose will be reduced to 5 g per day for maintenance throughout the duration of the 12-week protocol. All participants will engage in 3 center-based exercise sessions, which will involve completing 3 sets of 8 to 12 repetitions on chest press, leg press, seated row, shoulder press, leg extension, and leg curl machines. The primary outcomes will include changes in strength, body composition, and physical function in breast cancer survivors. The secondary outcomes will be intramuscular concentrations of creatine and adenosine triphosphate in the vastus lateralis, midthigh cross-sectional area, and quality of life. Results: As of October 2021, a total of 9 patients have been enrolled into the study. No unexpected adverse events have been reported. Conclusions: Creatine is being studied as a potential agent for improving strength, endurance, and bioenergetics in breast cancer survivors following chemotherapy. The findings from our trial may have future implications for supporting breast cancer survivors in reversing the muscle loss experienced during chemotherapy and improving their physical function and quality of life. Trial Registration: ClinicalTrials.gov NCT04207359; https://clinicaltrials.gov/ct2/show/NCT04207359 International Registered Report Identifier (IRRID): PRR1-10.2196/26827 %M 35363152 %R 10.2196/26827 %U https://www.researchprotocols.org/2022/4/e26827 %U https://doi.org/10.2196/26827 %U http://www.ncbi.nlm.nih.gov/pubmed/35363152 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e31118 %T An Analysis of Health Care Team Communication Needs Among Younger vs Older Breast Cancer Survivors: Web-Based Survey %A Vollmer Dahlke,Deborah %A Yoshikawa,Aya %A McAdam,Molly %A Malatok,Sharyn %A Gonzales,Elaine D %+ Texas A&M Center for Population Health and Aging, Texas A&M University, 8402 Silver Mountain Cv, Austin, TX, 78737-3136, United States, 1 5126994493, [email protected] %K breast cancer %K breast cancer survivorship %K patient-physician communications %K patient-centric communication %K younger breast cancer patients %K patient communication %D 2022 %7 18.3.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Prior studies indicate that the age of onset of breast cancer is an important element in considering communication between patients and the health care team. Younger women aged 45 and under diagnosed with breast cancer are often at a higher risk of being more vulnerable to psychosocial issues compared to older women aged 46 years and above. Few studies have examined age differences in patient perceptions of treatment-related discussion and communication during transition with their health care team. Objective: The aims of this survey were (1) to better understand breast cancer survivors’ perspectives regarding communication with health care providers during treatment and during transition to posttreatment care; and (2) to determine the differences between younger women with breast cancer (≤45 years of age) and older women (≥46 years of age). It was hypothesized that (1) breast cancer survivors’ psychosocial and finance-related communications with health care providers may lack effectiveness; (2) younger women experience greater needs for patient-centered communication with physicians and health care providers, especially about psychosocial care and transition to posttreatment care; and (3) younger breast cancer patients (≤45 years of age) need more information on survivorship and follow-up care. Methods: An internet-based survey was conducted with 143 women in Central Texas with 35% (n=50) aged 45 years or under and 65% (n=93) aged 46 years and above. The Mann-Whitney U test was performed to assess differences in participants’ perceptions about communication with health care providers by age group: younger (≤45 years of age) and older (≥46 years of age) women. Results: Statistically significant results pertained to rating health care team and patient discussions about transition from treatment to posttreatment using scores of 0 as “no discussion” and 100 as “in-depth discussion.” For the questions about management of posttreatment care, the overall mean score of the groups was 56.26 and that of the younger group was 43.96; the mean score of the older group was 61.96 (P=.02). For the question about the timing of follow-up appointments, the overall mean score was 64.29; the mean score of the younger group was 54.44, and that of the older group was 68.88 (P=.05). All the group scores related to psychosocial and financial support discussions with health care providers were low, with a rollup average of only 30.02 out of 100, suggesting that this is an important area for improving patient-centered communication. Conclusions: For all patients, transition from treatment to posttreatment requires a greater level of engagement and communication with the health care team. It appears that younger patients aged ≤45 years require more in-depth and personalized messaging to better understand their posttreatment care requirements. %M 35302499 %R 10.2196/31118 %U https://cancer.jmir.org/2022/1/e31118 %U https://doi.org/10.2196/31118 %U http://www.ncbi.nlm.nih.gov/pubmed/35302499 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e35768 %T Development of a Prognostic App (iCanPredict) to Predict Survival for Chinese Women With Breast Cancer: Retrospective Study %A Ma,Zhuo %A Huang,Sijia %A Wu,Xiaoqing %A Huang,Yinying %A Chan,Sally Wai-Chi %A Lin,Yilan %A Zheng,Xujuan %A Zhu,Jiemin %+ Department of Nursing, School of Medicine, Xiamen University, Room 222, Alice Lee Building, Xiangan Campus, Xiamen University, Xiang An South Road, Xiamen, 361005, China, 86 15960212649, [email protected] %K app %K breast cancer %K survival prediction model %K iCanPredict %D 2022 %7 9.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Accurate prediction of survival is crucial for both physicians and women with breast cancer to enable clinical decision making on appropriate treatments. The currently available survival prediction tools were developed based on demographic and clinical data obtained from specific populations and may underestimate or overestimate the survival of women with breast cancer in China. Objective: This study aims to develop and validate a prognostic app to predict the overall survival of women with breast cancer in China. Methods: Nine-year (January 2009-December 2017) clinical data of women with breast cancer who received surgery and adjuvant therapy from 2 hospitals in Xiamen were collected and matched against the death data from the Xiamen Center of Disease Control and Prevention. All samples were randomly divided (7:3 ratio) into a training set for model construction and a test set for model external validation. Multivariable Cox regression analysis was used to construct a survival prediction model. The model performance was evaluated by receiver operating characteristic (ROC) curve and Brier score. Finally, by running the survival prediction model in the app background thread, the prognostic app, called iCanPredict, was developed for women with breast cancer in China. Results: A total of 1592 samples were included for data analysis. The training set comprised 1114 individuals and the test set comprised 478 individuals. Age at diagnosis, clinical stage, molecular classification, operative type, axillary lymph node dissection, chemotherapy, and endocrine therapy were incorporated into the model, where age at diagnosis (hazard ratio [HR] 1.031, 95% CI 1.011-1.051; P=.002), clinical stage (HR 3.044, 95% CI 2.347-3.928; P<.001), and endocrine therapy (HR 0.592, 95% CI 0.384-0.914; P=.02) significantly influenced the survival of women with breast cancer. The operative type (P=.81) and the other 4 variables (molecular classification [P=.91], breast reconstruction [P=.36], axillary lymph node dissection [P=.32], and chemotherapy [P=.84]) were not significant. The ROC curve of the training set showed that the model exhibited good discrimination for predicting 1- (area under the curve [AUC] 0.802, 95% CI 0.713-0.892), 5- (AUC 0.813, 95% CI 0.760-0.865), and 10-year (AUC 0.740, 95% CI 0.672-0.808) overall survival. The Brier scores at 1, 5, and 10 years after diagnosis were 0.005, 0.055, and 0.103 in the training set, respectively, and were less than 0.25, indicating good predictive ability. The test set externally validated model discrimination and calibration. In the iCanPredict app, when physicians or women input women’s clinical information and their choice of surgery and adjuvant therapy, the corresponding 10-year survival prediction will be presented. Conclusions: This survival prediction model provided good model discrimination and calibration. iCanPredict is the first tool of its kind in China to provide survival predictions to women with breast cancer. iCanPredict will increase women’s awareness of the similar survival rate of different surgeries and the importance of adherence to endocrine therapy, ultimately helping women to make informed decisions regarding treatment for breast cancer. %M 35262503 %R 10.2196/35768 %U https://www.jmir.org/2022/3/e35768 %U https://doi.org/10.2196/35768 %U http://www.ncbi.nlm.nih.gov/pubmed/35262503 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e31395 %T The Effectiveness of Virtual Reality–Based Interventions in Rehabilitation Management of Breast Cancer Survivors: Systematic Review and Meta-analysis %A Bu,Xiaofan %A Ng,Peter H F %A Xu,Wenjing %A Cheng,Qinqin %A Chen,Peter Q %A Cheng,Andy S K %A Liu,Xiangyu %+ Department of Health Service Center, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Number 283, Tongzi Road, Changsha, 410013, China, 86 18674869736, [email protected] %K virtual reality %K rehabilitation management %K symptom %K motor function %K systematic review %K meta-analysis %D 2022 %7 28.2.2022 %9 Review %J JMIR Serious Games %G English %X Background: Breast cancer survivors (BCSs) can present with various physical and psychological symptoms and functional deficits that impact their quality of life. Virtual reality (VR) technology is being used in breast cancer rehabilitation management to improve the emotional, cognitive, and physical well-being of BCSs. Objective: This systematic review aimed to examine the effectiveness of VR-based interventions on health-related outcomes in BCSs. A meta-analysis was conducted to evaluate the effectiveness of VR-based interventions in the rehabilitation management of BCSs. Methods: A systematic search was conducted on PubMed, Web of Science, EMBASE, CINAHL with Full Text, the Cochrane Central Register of Controlled Trials, CNKI, WanFang, VIP, and CBM, from inception to May 25, 2021. The inclusion criteria of the selected studies were as follows: (1) adults diagnosed with breast cancer; (2) any type of VR-based interventions (immersive and nonimmersive virtual environment); (3) comparison of traditional rehabilitation methods; (4) outcomes including pain, depression, anxiety, fatigue, cognitive function, shoulder range of motion (ROM), hand grip strength, lymphedema, cybersickness symptoms, fear of movement, bleeding, effusion, and flap necrosis, both during and after treatment; and (5) randomized controlled trials (RCTs), case-controlled trials, and quasi-experimental studies. The Cochrane Collaboration Tool was used to evaluate the risk of bias. Review Manager version 5.3 (Cochrane Collaboration) was used to conduct the meta-analysis. The mean difference (MD) and SDs with 95% CIs were used to calculate continuous variables. Results: Twelve articles were included in this systematic review, of which 10 contributed information to the meta-analysis. A total of 604 participants were analyzed. The statistical analysis showed significant results for flexion (standard mean difference [SMD] 1.79; 95% CI 0.55 to 3.03; P=.005), extension (SMD 1.54; 95% CI 0.83 to 2.25; P<.001), abduction (MD 17.53; 95% CI 14.33 to 20.72; P<.001), adduction (MD 15.98; 95% CI 14.02 to 17.94; P<.001), internal rotation (MD 7.12; 95% CI 5.54 to 8.70; P<.001), external rotation (SMD 0.96; 95% CI 0.62 to 1.29; P<.001), anxiety (MD −6.47; 95% CI −7.21 to −5.73; P<.001), depression (MD −4.27; 95% CI −4.64 to −3.91; P<.001), pain (MD −1.32; 95% CI −2.56 to −0.09; P=.04), and cognitive function (MD 8.80; 95% CI 8.24 to 9.36; P<.001). The meta-analysis indicated little to no difference in hand grip strength (MD 1.96; 95% CI –0.93 to 4.85; P=.18). Conclusions: Findings of this review noted a weak but consistent positive association between VR-based interventions and outcomes. However, these results must be interpreted with caution due to the limited number of controlled trials analyzed, small sample sizes, and poor methodological quality. Well‐designed, large, high‐quality trials may have a significant impact on our confidence in the results. Future studies should identify specific aspects that improve the clinical impact of VR-based interventions on major outcomes in BCSs in the clinical setting. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021250727; https://tinyurl.com/2p89rmnk %M 35225817 %R 10.2196/31395 %U https://games.jmir.org/2022/1/e31395 %U https://doi.org/10.2196/31395 %U http://www.ncbi.nlm.nih.gov/pubmed/35225817 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e31756 %T Evaluation of the Pathways for Survivors Program to Address Breast Cancer Survivorship–Associated Distress: Survey Study %A Umashankar,Saumya %A Mamounas,Matina Elise %A Matthys,Madeline %A Hadeler,Edward Kenji %A Wong,Emily Claire %A Hicks,Greg %A Hwang,Jimmy %A Chien,Amy Jo %A Rugo,Hope S %A Hamolsky,Deborah %A Esserman,Laura %A Melisko,Michelle %+ Department of Medicine, University of California San Francisco, 1825 4th St, San Francisco, CA, 94158, United States, 1 4153537070, [email protected] %K breast cancer %K depression %K anxiety %K quality of life %K breast cancer survivors %K cancer survivorship %K mental health %K psychological health %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients with breast cancer frequently experience escalation of anxiety after completing curative treatment. Objective: This study evaluated the acceptability and psychological impact of a 1-day workshop to emphasize behavioral strategies involving intention and self-efficacy. Methods: Breast cancer survivors who attended a 1-day Pathways for Survivors workshop provided feedback and completed electronic quality of life (QOL) questionnaires at baseline, 1 and 6 weeks, and 6 months after the workshop. Attendees’ baseline QOL scores were compared to follow-up (FUP) scores. Scores from patients receiving routine FUP care were also compiled as a reference population. Results: In total, 77 patients attended 1 of 9 workshops. The mean satisfaction score was 9.7 out of 10 for the workshop and 9.96 out of 10 for the moderator. Participants’ baseline mean Patient-Reported Outcomes Measurement Information System (PROMIS) anxiety and depression scores were 57.8 (SD 6.9) and 55.3 (SD 7.5), respectively, which were significantly higher than those of patients receiving routine FUP care (49.1, SD 8.3 and 47.3 SD 8.0, respectively). PROMIS anxiety and depression scores decreased, and the Happiness Index Profile (HIP-10) score—measuring intention and resiliency—increased significantly at 1- and 6-week FUPs. Conclusions: The Pathways for Survivors program was favorably received. Anxiety and depression decreased significantly at 1- and 6-weeks after the workshop and remained below baseline at 6 months. Increased HIP-10 scores suggest that patients acquired and implemented skills from the workshop. A 1-day workshop led by a lay moderator significantly improved several psychological measures, suggesting that it may be a useful and time-efficient strategy to improve QOL in breast cancer survivors. We are investigating whether an abbreviated “booster” of the intervention at a later date could further improve and maintain QOL gains. %M 35212641 %R 10.2196/31756 %U https://cancer.jmir.org/2022/1/e31756 %U https://doi.org/10.2196/31756 %U http://www.ncbi.nlm.nih.gov/pubmed/35212641 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29124 %T Novel Interactive Tool for Breast and Ovarian Cancer Risk Assessment (Bright Pink Assess Your Risk): Development and Usability Study %A Hibler,Elizabeth A %A Fought,Angela J %A Kershaw,Kiarri N %A Molsberry,Rebecca %A Nowakowski,Virginia %A Lindner,Deborah %+ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611, United States, 1 3125031178, [email protected] %K breast cancer %K ovarian cancer %K risk assessment %K genetic testing %D 2022 %7 24.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The lifetime risk of breast and ovarian cancer is significantly higher among women with genetic susceptibility or a strong family history. However, current risk assessment tools and clinical practices may identify only 10% of asymptomatic carriers of susceptibility genes. Bright Pink developed the Assess Your Risk (AYR) tool to estimate breast and ovarian cancer risk through a user-friendly, informative web-based quiz for risk assessment at the population level. Objective: This study aims to present the AYR tool, describe AYR users, and present evidence that AYR works as expected by comparing classification using the AYR tool with gold standard genetic testing guidelines. Methods: The AYR is a recently developed population-level risk assessment tool that includes 26 questions based on the National Comprehensive Cancer Network (NCCN) guidelines and factors from other commonly used risk assessment tools. We included all women who completed the AYR between November 2018 and January 2019, with the exception of self-reported cancer or no knowledge of family history. We compared AYR classifications with those that were independently created using NCCN criteria using measures of validity and the McNemar test. Results: There were 143,657 AYR completions, and most participants were either at increased or average risk for breast cancer or ovarian cancer (137,315/143,657, 95.59%). Using our estimates of increased and average risk as the gold standard, based on the NCCN guidelines, we estimated the sensitivity and specificity for the AYR algorithm–generated risk categories as 100% and 89.9%, respectively (P<.001). The specificity improved when we considered the additional questions asked by the AYR to define increased risk, which were not examined by the NCCN criteria. By race, ethnicity, and age group; we found that the lowest observed specificity was for the Asian race (85.9%) and the 30 to 39 years age group (87.6%) for the AYR-generated categories compared with the NCCN criteria. Conclusions: These results demonstrate that Bright Pink’s AYR is an accurate tool for use by the general population to identify women at increased risk of breast and ovarian cancer. We plan to validate the tool longitudinally in future studies, including the impact of race, ethnicity, and age on breast and ovarian cancer risk assessment. %M 35200148 %R 10.2196/29124 %U https://www.jmir.org/2022/2/e29124 %U https://doi.org/10.2196/29124 %U http://www.ncbi.nlm.nih.gov/pubmed/35200148 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e33083 %T Health Promotion Among Mexican-Origin Survivors of Breast Cancer and Caregivers Living in the United States–Mexico Border Region: Qualitative Analysis From the Vida Plena Study %A Skiba,Meghan B %A Lopez-Pentecost,Melissa %A Werts,Samantha J %A Ingram,Maia %A Vogel,Rosi M %A Enriquez,Tatiana %A Garcia,Lizzie %A Thomson,Cynthia A %+ Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, 1294 N. Martin Ave, Tucson, AZ, 85719, United States, 1 520 940 1759, [email protected] %K Mexican-origin Hispanics %K breast cancer %K survivorship %K caregivers %K border health %K lifestyle %K diet %K physical activity %K health promotion %K mobile phone %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Hispanic survivors of cancer experience increased cancer burden. Lifestyle behaviors, including diet and physical activity, may reduce the cancer burden. There is limited knowledge about the posttreatment lifestyle experiences of Hispanic survivors of cancer living on the United States–Mexico border. Objective: This study aims to support the development of a stakeholder-informed, culturally relevant, evidence-based lifestyle intervention for Mexican-origin Hispanic survivors of cancer living in a border community to improve their dietary quality and physical activity. Methods: Semistructured interviews with 12 Mexican-origin Hispanic survivors of breast cancer and 7 caregivers were conducted through internet-based teleconferencing. The interviews explored the impact of cancer on lifestyle and treatment-related symptoms, perception of lifestyle as an influence on health after cancer, and intervention content and delivery preferences. Interviews were analyzed using a deductive thematic approach grounded in the Quality of Cancer Survivorship Care Framework. Results: Key survivor themes included perception of Mexican diet as unhealthy, need for reliable diet-related information, perceived benefits of physical activity after cancer treatment, family support for healthy lifestyles (physical and emotional), presence of cancer-related symptoms interfering with lifestyle, and financial barriers to living a healthy lifestyle. Among caregivers, key themes included effects of the cancer caregiving experience on caregivers’ lifestyle and cancer-preventive behaviors and gratification in providing support to the survivors. Conclusions: The interviews revealed key considerations to the adaptation, development, and implementation of a theory-informed, evidence-based, culturally relevant lifestyle program to support lifestyle behavior change among Mexican-origin Hispanic survivors of cancer living in border communities. Our qualitative findings highlight specific strategies that can be implemented in health promotion programming aimed at encouraging cancer protective behaviors to reduce the burden of cancer and comorbidities in Mexican-origin survivors of cancer living in border communities. %M 35200150 %R 10.2196/33083 %U https://cancer.jmir.org/2022/1/e33083 %U https://doi.org/10.2196/33083 %U http://www.ncbi.nlm.nih.gov/pubmed/35200150 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 2 %P e33440 %T The Application and Comparison of Machine Learning Models for the Prediction of Breast Cancer Prognosis: Retrospective Cohort Study %A Xiao,Jialong %A Mo,Miao %A Wang,Zezhou %A Zhou,Changming %A Shen,Jie %A Yuan,Jing %A He,Yulian %A Zheng,Ying %+ Department of Cancer Prevention, Fudan University Shanghai Cancer Center, 270 Dong 'an Road, Xuhui District, Shanghai, 200000, China, 86 21 64175590, [email protected] %K breast cancer %K machine learning %K survival analysis %K random survival forest %K support vector machine %K medical informatics %K prediction models %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Over the recent years, machine learning methods have been increasingly explored in cancer prognosis because of the appearance of improved machine learning algorithms. These algorithms can use censored data for modeling, such as support vector machines for survival analysis and random survival forest (RSF). However, it is still debated whether traditional (Cox proportional hazard regression) or machine learning-based prognostic models have better predictive performance. Objective: This study aimed to compare the performance of breast cancer prognostic prediction models based on machine learning and Cox regression. Methods: This retrospective cohort study included all patients diagnosed with breast cancer and subsequently hospitalized in Fudan University Shanghai Cancer Center between January 1, 2008, and December 31, 2016. After all exclusions, a total of 22,176 cases with 21 features were eligible for model development. The data set was randomly split into a training set (15,523 cases, 70%) and a test set (6653 cases, 30%) for developing 4 models and predicting the overall survival of patients diagnosed with breast cancer. The discriminative ability of models was evaluated by the concordance index (C-index), the time-dependent area under the curve, and D-index; the calibration ability of models was evaluated by the Brier score. Results: The RSF model revealed the best discriminative performance among the 4 models with 3-year, 5-year, and 10-year time-dependent area under the curve of 0.857, 0.838, and 0.781, a D-index of 7.643 (95% CI 6.542, 8.930) and a C-index of 0.827 (95% CI 0.809, 0.845). The statistical difference of the C-index was tested, and the RSF model significantly outperformed the Cox-EN (elastic net) model (C-index 0.816, 95% CI 0.796, 0.836; P=.01), the Cox model (C-index 0.814, 95% CI 0.794, 0.835; P=.003), and the support vector machine model (C-index 0.812, 95% CI 0.793, 0.832; P<.001). The 4 models’ 3-year, 5-year, and 10-year Brier scores were very close, ranging from 0.027 to 0.094 and less than 0.1, which meant all models had good calibration. In the context of feature importance, elastic net and RSF both indicated that TNM staging, neoadjuvant therapy, number of lymph node metastases, age, and tumor diameter were the top 5 important features for predicting the prognosis of breast cancer. A final online tool was developed to predict the overall survival of patients with breast cancer. Conclusions: The RSF model slightly outperformed the other models on discriminative ability, revealing the potential of the RSF method as an effective approach to building prognostic prediction models in the context of survival analysis. %M 35179504 %R 10.2196/33440 %U https://medinform.jmir.org/2022/2/e33440 %U https://doi.org/10.2196/33440 %U http://www.ncbi.nlm.nih.gov/pubmed/35179504 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e33550 %T Development and Evaluation of the Usefulness, Usability, and Feasibility of iNNOV Breast Cancer: Mixed Methods Study %A Mendes-Santos,Cristina %A Nunes,Francisco %A Weiderpass,Elisabete %A Santana,Rui %A Andersson,Gerhard %+ Department of Culture and Society, Linköping University, Linköping, 581 83, Sweden, 46 917890798, [email protected] %K acceptance and commitment therapy %K anxiety %K breast cancer survivors %K cognitive behavioral therapy %K depression %K digital mental health %K e-mental health %K user-centered design %K internet interventions %K usability %K mobile phone %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Despite the efficacy of psychosocial interventions in minimizing psychosocial morbidity in breast cancer survivors (BCSs), intervention delivery across survivorship is limited by physical, organizational, and attitudinal barriers, which contribute to a mental health care treatment gap in cancer settings. Objective: The aim of this study is to develop iNNOV Breast Cancer (iNNOVBC), a guided, internet-delivered, individually tailored, acceptance and commitment therapy–influenced cognitive behavioral intervention program aiming to treat mild to moderate anxiety and depression in BCSs as well as to improve fatigue, insomnia, sexual dysfunction, and health-related quality of life in this group. This study also aims to evaluate the usefulness, usability, and preliminary feasibility of iNNOVBC. Methods: iNNOVBC was developed using a user-centered design approach involving its primary and secondary end users, that is, BCSs (11/24, 46%) and mental health professionals (13/24, 54%). We used mixed methods, namely in-depth semistructured interviews, laboratory-based usability tests, short-term field trials, and surveys, to assess iNNOVBC’s usefulness, usability, and preliminary feasibility among these target users. Descriptive statistics were used to characterize the study sample, evaluate performance data, and assess survey responses. Qualitative data were recorded, transcribed verbatim, and thematically analyzed. Results: Overall, participants considered iNNOVBC highly useful, with most participants reporting on the pertinence of its scope, the digital format, the relevant content, and the appropriate features. However, various usability issues were identified, and participants suggested that the program should be refined by simplifying navigation paths, using a more dynamic color scheme, including more icons and images, displaying information in different formats and versions, and developing smartphone and tablet versions. In addition, participants suggested that tables should be converted into plain textboxes and data visualization dashboards should be included to facilitate the tracking of progress. The possibility of using iNNOVBC in a flexible manner, tailoring it according to BCSs’ changing needs and along the cancer care continuum, was another suggestion that was identified. Conclusions: The study results suggest that iNNOVBC is considered useful by both BCSs and mental health professionals, configuring a promising point-of-need solution to bridge the psychological supportive care gap experienced by BCSs across the survivorship trajectory. We believe that our results may be applicable to other similar programs. However, to fulfill their full supportive role, such programs should be comprehensive, highly usable, and tailorable and must adopt a flexible yet integrated structure capable of evolving in accordance with survivors’ changing needs and the cancer continuum. %M 35166682 %R 10.2196/33550 %U https://cancer.jmir.org/2022/1/e33550 %U https://doi.org/10.2196/33550 %U http://www.ncbi.nlm.nih.gov/pubmed/35166682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e16128 %T Implementation of an Electronic Patient-Reported Outcome App for Health-Related Quality of Life in Breast Cancer Patients: Evaluation and Acceptability Analysis in a Two-Center Prospective Trial %A Graf,Joachim %A Sickenberger,Nina %A Brusniak,Katharina %A Matthies,Lina Maria %A Deutsch,Thomas M %A Simoes,Elisabeth %A Plappert,Claudia %A Keilmann,Lucia %A Hartkopf,Andreas %A Walter,Christina Barbara %A Hahn,Markus %A Engler,Tobias %A Wallwiener,Stephanie %A Schuetz,Florian %A Fasching,Peter A %A Schneeweiss,Andreas %A Brucker,Sara Yvonne %A Wallwiener,Markus %+ Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 06221 ext 56, [email protected] %K eHealth %K electronic patient-reported outcomes %K evaluation %K acceptability %K breast cancer %D 2022 %7 8.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: One in eight women is diagnosed with breast cancer in the course of their life. As systematic palliative treatment has only a limited effect on survival rates, the concept of health-related quality of life (HRQoL) was developed for measurement of patient-centered outcomes. Various studies have already demonstrated the reliability of paper-based patient-reported outcome (pPRO) and electronic patient-reported outcome (ePRO) surveys and that the 2 means of assessment are equally valid. Objective: The aim of this study was to analyze the acceptance and evaluation of a tablet-based ePRO app for breast cancer patients and to examine its suitability, effort, and difficulty in the context of HRQoL and sociodemographic factors. Methods: Overall, 106 women with adjuvant or advanced breast cancer were included in a 2-center study at 2 major university hospitals in Germany. Patients were asked to answer HRQoL and PRO questionnaires both on a tablet on-site using a specific eHealth assessment website and on paper. The suitability, effort, and difficulty of the app and self-reported technical skills were also assessed. Only the results of the electronically acquired data are presented here. The results of the reliability of the pPRO data have already been published elsewhere. Results: Patients regarded the ePRO assessment as more suitable (80/106, 75.5%), less stressful (73/106, 68.9%), and less difficult (69/106, 65.1%) than pPRO. The majority of patients stated that ePRO assessment improves health care in hospitals (87/106, 82.1%). However, evaluation of ePROs depended on the level of education (P=.003) in the dimensions of effort and difficulty (regression analysis). The app was rated highly in all categories. HRQoL data and therapy setting did not show significant correlations with the app’s evaluation parameters. Conclusions: The results indicate that ePRO surveys are feasible for measuring HRQoL in breast cancer patients and that those patients prefer ePRO assessment to pPRO assessment. It can also be seen that patients consider ePRO assessment to improve hospital health care. However, studies with larger numbers of patients are needed to develop apps that address the needs of patients with lower levels of education and technical skills. %M 35133288 %R 10.2196/16128 %U https://www.jmir.org/2022/2/e16128 %U https://doi.org/10.2196/16128 %U http://www.ncbi.nlm.nih.gov/pubmed/35133288 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e29485 %T A Web- and Mobile-Based Intervention for Women Treated for Breast Cancer to Manage Chronic Pain and Symptoms Related to Lymphedema: Results of a Randomized Clinical Trial %A Fu,Mei Rosemary %A Axelrod,Deborah %A Guth,Amber A %A Scagliola,Joan %A Rampertaap,Kavita %A El-Shammaa,Nardin %A Qiu,Jeanna M %A McTernan,Melissa L %A Frye,Laura %A Park,Christopher S %A Yu,Gary %A Tilley,Charles %A Wang,Yao %+ School of Nursing-Camden, Rutgers University, 530 Federal Street, Camden, NJ, 08102, United States, 1 9739861758, [email protected] %K pain %K lymphatic exercises %K symptoms %K lymphedema %K breast cancer %K health behavior %K mHealth %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: The-Optimal-Lymph-Flow (TOLF) is a patient-centered, web- and mobile-based mHealth system that delivers safe, easy, and feasible digital therapy of lymphatic exercises and limb mobility exercises. Objective: The purpose of this randomized clinical trial (RCT) was to evaluate the effectiveness of the web- and mobile-based TOLF system for managing chronic pain and symptoms related to lymphedema. The primary outcome includes pain reduction, and the secondary outcomes focus on symptom relief, limb volume difference measured by infrared perometer, BMI, and quality of life (QOL) related to pain. We hypothesized that participants in the intervention group would have improved pain and symptom experiences, limb volume difference, BMI, and QOL. Methods: A parallel RCT with a control–experimental, pre- and posttest, and repeated-measures design were used. A total of 120 patients were recruited face-to-face at the point of care during clinical visits. Patients were randomized according to pain in a 1:1 ratio into either the arm precaution (AP) control group to improve limb mobility and arm protection or The-Optimal-Lymph flow (TOLF) intervention group to promote lymph flow and limb mobility. Trial outcomes were evaluated at baseline and at week 12 after the intervention. Descriptive statistics, Fisher exact tests, Wilcoxon rank-sum tests, t test, and generalized linear mixed effects models were performed for data analysis. Results: At the study endpoint of 12 weeks, significantly fewer patients in the TOLF intervention group compared with the AP control group reported chronic pain (45% [27/60] vs 70% [42/60]; odds ratio [OR] 0.39, 95% CI 0.17-0.90; P=.02). Patients who received the TOLF intervention were significantly more likely to achieve a complete reduction in pain (50% [23/46] vs 22% [11/51]; OR 3.56, 95% CI 1.39-9.76; P=.005) and soreness (43% [21/49] vs 22% [11/51]; OR 2.60, 95% CI 1.03-6.81; P=.03). Significantly lower median severity scores were found in the TOLF group for chronic pain (MedTOLF=0, IQR 0-1 vs MedAP=1, IQR 0-2; P=.02) and general bodily pain (MedTOLF=1, IQR=0-1.5 vs MedAP=1, IQR 1-3; P=.04). Compared with the AP control group, significantly fewer patients in the TOLF group reported arm/hand swelling (P=.04), heaviness (P=.03), redness (P=.03), and limited movement in shoulder (P=.02) and arm (P=.03). No significant differences between the TOLF and AP groups were found in complete reduction of aching (P=.12) and tenderness (P=.65), mean numbers of lymphedema symptom reported (P=.11), ≥5% limb volume differences (P=.48), and BMI (P=.12). Conclusions: The TOLF intervention had significant benefits for breast cancer survivors to manage chronic pain, soreness, general bodily pain, arm/hand swelling, heaviness, and impaired limb mobility. The intervention resulted in a 13% reduction (from 40% [24/60] to 27% [16/60]) in proportions of patients who took pain medications compared with the AP control group, which had a 5% increase (from 40% [24/60] to 45% [27/60]). A 12% reduction (from 27% [16/60] to 15% [9/60]) in proportions of patients with ≥5% limb volume differences was found in the TOLF intervention, while a 5% increase in the AP control group (from 40% [24/60] to 45% [27/60]) was found. In conclusion, the TOLF intervention can be a better choice for breast cancer survivors to reduce chronic pain and limb volume. Trial Registration: Clinicaltrials.gov NCT02462226; https://clinicaltrials.gov/ct2/show/NCT02462226 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.5104 %M 35037883 %R 10.2196/29485 %U https://cancer.jmir.org/2022/1/e29485 %U https://doi.org/10.2196/29485 %U http://www.ncbi.nlm.nih.gov/pubmed/35037883 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e31092 %T Long-Term Effectiveness of a Decision Support App (Pink Journey) for Women Considering Breast Reconstruction Surgery: Pilot Randomized Controlled Trial %A Fang,Su-Ying %A Lin,Pin-Jun %A Kuo,Yao-Lung %+ Department of Nursing, College of Medicine, National Cheng Kung University, Number 1, University Road, Tainan, 701, Taiwan, 886 62353535 ext 6271, [email protected] %K breast cancer %K breast reconstruction surgery %K decision aid %K decision support %K mHealth %K app %K women %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Various kinds of breast reconstruction (BR) options, including implants and autologous, and surgery techniques, including traditional and endoscope assisted, can be used to perform surgery. All options have their own advantages and disadvantages. Women decide on an option depending on the values and preferences they emphasize. Lacking knowledge about BR or having decision difficulties during the treatment decision process makes women experience more decision regret, psychological distress, and poor body image. Delivering decision support with a values clarification exercise using eHealth approaches would be beneficial for patient outcomes. Objective: This study aims to examine the effects of a decision support app on decision-making quality and psychological morbidity for women considering BR surgery. Methods: This randomized controlled trial included women who were over 20 years of age and were newly diagnosed with breast cancer and candidates for mastectomy. Women having an option for breast conservation were excluded. After being referred from the outpatient physician, the women provided consent and completed the baseline assessment. Women allocated to the control group (CG) received usual care and were provided with a pamphlet with information about types of surgery and the advantages and disadvantages of different surgery types. Women allocated to the intervention group (IG) were given the same pamphlet and guided to use the Pink Journey app to support their decision. Then they were also prompted to discuss the opinions with their significant others. Finally, the decision-making process of using the app was printed out for women that they could take home. Decision conflict, anxiety, and depression were measured at baseline. At 1 week after the intervention (T1) and at 1 month (T2), 8 months (T3), and 12 months (T4) after surgery, the women completed decision conflict, decision regret, anxiety, depression, and body image scales. An intention-to-treat analysis was performed. Results: From February 2018 to July 2019, 96 women were randomly assigned to the CG (n=48) or the IG (n=48). Results revealed that body image distress declined significantly for the IG but increased for the CG. The interaction of time and group also reached significance, indicating a significant decrease in body image distress from baseline in the IG compared with the CG after the 12th month (T4) follow-up (β=–2.25, standard error=1.01, P=.027). However, there was no significant difference in decision conflict (P=.21-.87), decision regret (P=.44-.55), anxiety (P=.26-.33), and depression (P=.20-.75), indicating that the decrease in these outcomes in the IG was not greater than those in the CG. Conclusions: Although we found no effect on decision conflict, decision regret, anxiety, and depression, a decision aid that combines surgery information and values clarification can help women reduce their body image distress. Trial Registration: ClinicalTrials.gov NCT04190992; https://clinicaltrials.gov/ct2/show/NCT04190992 %M 34890354 %R 10.2196/31092 %U https://mhealth.jmir.org/2021/12/e31092 %U https://doi.org/10.2196/31092 %U http://www.ncbi.nlm.nih.gov/pubmed/34890354 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 12 %P e27072 %T The Effect of Automated Mammogram Orders Paired With Electronic Invitations to Self-schedule on Mammogram Scheduling Outcomes: Observational Cohort Comparison %A North,Frederick %A Nelson,Elissa M %A Buss,Rebecca J %A Majerus,Rebecca J %A Thompson,Matthew C %A Crum,Brian A %+ Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 284 2511, [email protected] %K electronic health record %K schedule %K patient appointment %K preventive health service %K office visit %K outpatient care %K mammogram %K software tool %K computer software application %K mobile applications %K self-schedule %K app %K EHR %K screening %K diagnostic %K cancer %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Screening mammography is recommended for the early detection of breast cancer. The processes for ordering screening mammography often rely on a health care provider order and a scheduler to arrange the time and location of breast imaging. Self-scheduling after automated ordering of screening mammograms may offer a more efficient and convenient way to schedule screening mammograms. Objective: The aim of this study was to determine the use, outcomes, and efficiency of an automated mammogram ordering and invitation process paired with self-scheduling. Methods: We examined appointment data from 12 months of scheduled mammogram appointments, starting in September 2019 when a web and mobile app self-scheduling process for screening mammograms was made available for the Mayo Clinic primary care practice. Patients registered to the Mayo Clinic Patient Online Services could view the schedules and book their mammogram appointment via the web or a mobile app. Self-scheduling required no telephone calls or staff appointment schedulers. We examined uptake (count and percentage of patients utilizing self-scheduling), number of appointment actions taken by self-schedulers and by those using staff schedulers, no-show outcomes, scheduling efficiency, and weekend and after-hours use of self-scheduling. Results: For patients who were registered to patient online services and had screening mammogram appointment activity, 15.3% (14,387/93,901) used the web or mobile app to do either some mammogram self-scheduling or self-cancelling appointment actions. Approximately 24.4% (3285/13,454) of self-scheduling occurred after normal business hours/on weekends. Approximately 9.3% (8736/93,901) of the patients used self-scheduling/cancelling exclusively. For self-scheduled mammograms, there were 5.7% (536/9433) no-shows compared to 4.6% (3590/77,531) no-shows in staff-scheduled mammograms (unadjusted odds ratio 1.24, 95% CI 1.13-1.36; P<.001). The odds ratio of no-shows for self-scheduled mammograms to staff-scheduled mammograms decreased to 1.12 (95% CI 1.02-1.23; P=.02) when adjusted for age, race, and ethnicity. On average, since there were only 0.197 staff-scheduler actions for each finalized self-scheduled appointment, staff schedulers were rarely used to redo or “clean up” self-scheduled appointments. Exclusively self-scheduled appointments were significantly more efficient than staff-scheduled appointments. Self-schedulers experienced a single appointment step process (one and done) for 93.5% (7553/8079) of their finalized appointments; only 74.5% (52,804/70,839) of staff-scheduled finalized appointments had a similar one-step appointment process (P<.001). For staff-scheduled appointments, 25.5% (18,035/70,839) of the finalized appointments took multiple appointment steps. For finalized appointments that were exclusively self-scheduled, only 6.5% (526/8079) took multiple appointment steps. The staff-scheduled to self-scheduled odds ratio of taking multiple steps for a finalized screening mammogram appointment was 4.9 (95% CI 4.48-5.37; P<.001). Conclusions: Screening mammograms can be efficiently self-scheduled but may be associated with a slight increase in no-shows. Self-scheduling can decrease staff scheduler work and can be convenient for patients who want to manage their appointment scheduling activity after business hours or on weekends. %M 34878997 %R 10.2196/27072 %U https://medinform.jmir.org/2021/12/e27072 %U https://doi.org/10.2196/27072 %U http://www.ncbi.nlm.nih.gov/pubmed/34878997 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e27893 %T Health-Related Quality of Life of Lebanese Women With Breast Cancer: Protocol for a Prospective Cohort Study %A El Haidari,Rana %A Anota,Amelie %A Abou-Abbas,Linda %A Nerich,Virginie %+ INSERM (French Institut of Health and Medical Research), EFS BFC (Etablissement français du sang Bourgogne Franche-Comté), UMR1098 (Interactions Greffon-Hôte-Tumeur/Ingénierie Cellulaire et Génique), University of Bourgogne Franche-Comté, RIGHT Interactio, 32 avenue de l'observatoire, Besancon, 25000, France, 33 71662058, [email protected] %K breast cancer %K cohort %K health-related quality of life %K Lebanese women %K prospective %D 2021 %7 23.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the past few decades, Lebanon has witnessed a significant increase in the incidence rates of women diagnosed with breast cancer. This increase, which is associated with the advancements in treatment modalities, emphasizes the need to evaluate the health-related quality of life (HRQoL) of women with breast cancer and to compare its patterns before and after breast-conserving surgery (BCS). Objective: This study aims to describe changes in HRQoL according to body image pre- and post-BCS and just before initiation of adjuvant therapy in newly diagnosed patients with breast cancer in Lebanon. Methods: A prospective cohort study targeting Lebanese women newly diagnosed with breast cancer and who have an indication for BCS will be conducted in 2 health care facilities. Baseline characteristics and clinical data will be collected. The European Organization for Research and Treatment of Cancer Quality-of-Life cancer-specific and breast cancer–specific questionnaires will be used to assess HRQoL. The outcomes will be measured at baseline and 1 day after breast surgery. The primary outcome will be the body image dimensions of the Quality-of-Life breast cancer–specific questionnaire. Statistical analyses will include descriptive statistics, paired 2-tailed t test, and stepwise multiple regression. A total of 120 patients will be required. Results: A total of 120 patients were enrolled in the study. Future outcomes will be published in professional peer-reviewed health-related research journals. Conclusions: This study is strengthened by its follow-up nature, allowing us to draw conclusions about causality. The results of this study will identify the most affected components of HRQoL, as well as the factors that could play a role in improving HRQoL among women undergoing BCS. The findings of this study will help decision makers, physicians, and social workers to design a comprehensive program with multidisciplinary components for the management and care of patients with breast cancer in Lebanon. International Registered Report Identifier (IRRID): DERR1-10.2196/27893 %M 34817382 %R 10.2196/27893 %U https://www.researchprotocols.org/2021/11/e27893 %U https://doi.org/10.2196/27893 %U http://www.ncbi.nlm.nih.gov/pubmed/34817382 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e25783 %T Assessing the Quality of Online Health Information About Breast Cancer from Chinese Language Websites: Quality Assessment Survey %A Sun,Weiwei %A Luo,Aijing %A Bian,Zhiwei %A Zhao,Bin %A Liu,Peng %A Wang,Kai %A Liu,Yuwen %A Xie,Wenzhao %A Wang,Fuzhi %+ School of Health Management, Bengbu Medical College, 2600#, Donghai Rd, Anhui, Bengbu, 233000, China, 86 18855202156, [email protected] %K online health information %K breast cancer %K Chinese language websites %K quantitative evaluations %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: In China, the internet has become one of the most important ways to obtain information about breast cancer. However, quantitative evaluations of the quality of Chinese health websites and the breast cancer treatment information they publish are lacking. Objective: This study aimed to evaluate the quality of Chinese breast cancer websites and the value, suitability, and accuracy of the breast cancer treatment information they publish. Methods: Chinese breast cancer health websites were searched and manually screened according to their Alexa and Baidu search engine rankings. For each website included in the survey, which was conducted on April 8, 2019, the three most recently published papers on the website that met the inclusion criteria were included for evaluation. Three raters assessed all materials using the LIDA, DISCERN, and Suitability Assessment of Materials (SAM) tools and the Michigan Checklist. Data analysis was completed with the Statistical Package for Social Sciences (SPSS) version 20.0 and Microsoft Excel 2010. Results: This survey included 20 Chinese breast cancer websites and 60 papers on breast cancer treatment. The LIDA tool was used to evaluate the quality of the 20 websites. The LIDA’s scores of the websites (mean=54.85, SD 3.498; total possible score=81) were low. In terms of the layout, color scheme, search facility, browsing facility, integration of nontextual media, submission of comments, declaration of objectives, content production method, and robust method, more than half of the websites scored 0 (never) or 1 (sometimes). For the online breast cancer treatment papers, the scores were generally low. Regarding suitability, 32 (53.33%) papers were evaluated as presenting unsuitable material. Regarding accuracy, the problems were that the papers were largely not original (44/60, 73%) and lacked references (46/60, 77%). Conclusions: The quality of Chinese breast cancer websites is poor. The color schemes, text settings, user comment submission functions, and language designs should be improved. The quality of Chinese online breast cancer treatment information is poor; the information has little value to users, and pictorial information is scarcely used. The online breast cancer treatment information is accurate but lacks originality and references. Website developers, governments, and medical professionals should play a full role in the design of health websites, the regulation of online health information, and the use of online health information. %M 34792471 %R 10.2196/25783 %U https://cancer.jmir.org/2021/4/e25783 %U https://doi.org/10.2196/25783 %U http://www.ncbi.nlm.nih.gov/pubmed/34792471 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e20964 %T Digital Technical and Informal Resources of Breast Cancer Patients From 2012 to 2020: Questionnaire-Based Longitudinal Trend Study %A Mallmann,Christoph A %A Domröse,Christian M %A Schröder,Lars %A Engelhardt,David %A Bach,Frederik %A Rueckel,Helena %A Abramian,Alina %A Kaiser,Christina %A Mustea,Alexander %A Faridi,Andree %A Malter,Wolfram %A Mallmann,Peter %A Rudlowski,Christian %A Zivanovic,Oliver %A Mallmann,Michael R %+ Department of Obstetrics & Gynecology, University Hospital of Cologne, Kerpener St 34, Cologne, 50924, Germany, 49 221 478 4910, [email protected] %K digitalization %K eHealth %K breast cancer %K internet %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Digitalization offers enormous potential in medicine. In the era of digitalization, the development of the use of digital, technical, and informal resources of breast cancer patients and factors influencing the degree of digitization of patients has been insufficiently researched. Objective: The aim of this study was to assess the development of the use of digital technical and informal resources in a well-defined patient cohort. Methods: A longitudinal study on 513 breast cancer patients from 2012 to 2020 was conducted using a questionnaire that included the main aspects of the degree of digitalization, including digital device availability and use, stationary and mobile internet access and use, and communication and information seeking regarding breast cancer diagnosis and treatment. Results: The majority of patients (421/513, 82.1%) owned the technical resources to benefit from eHealth, used the internet to obtain information (292/509, 57.4%), and were willing to use new eHealth solutions (379/426, 89%). Two-thirds of the patients discussed information about their cancer on the internet with their doctor, one-third found additional treatment options on the internet, and 15.3% (44/287) of the patients stated that this had changed their cancer therapy. The degree of digitization is increasing yet still significantly depends on 3 factors: (1) age (whereas 100% [39/39] of the <59-year-old group used the internet in 2020, 92% of the 60 to 69-year-old group [11/12] and only 47% [6/13] of the >70-year-old group used the internet), (2) education (internet use significantly depended on education, as only 51.8% [59/114] of patients with primary school education used the internet, but 82.4% [126/153] with middle school education and 90.3% [213/236] with high school education used the internet; P<.001), and (3) household size (67.7% [111/164] of patients living alone used the internet, whereas 84.7% [287/339] of patients living in a house with ≥2 people used the internet; P<.001). Conclusions: To implement digital solutions in health care, knowledge of the composition and degree of the use of digital technical and informal resources of the patient group for which the respective solution is developed is crucial for success. Trial Registration: German Register of Clinical Studies DRKS00012364; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012364 %M 34792468 %R 10.2196/20964 %U https://cancer.jmir.org/2021/4/e20964 %U https://doi.org/10.2196/20964 %U http://www.ncbi.nlm.nih.gov/pubmed/34792468 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e27073 %T Suggested Modifications to the Management of Patients With Breast Cancer During the COVID-19 Pandemic: Web-Based Survey Study %A Elsamany,Shereef %A Elbaiomy,Mohamed %A Zeeneldin,Ahmed %A Tashkandi,Emad %A Hassanin,Fayza %A Abdelhafeez,Nafisa %A O Al-Shamsi,Humaid %A Bukhari,Nedal %A Elemam,Omima %+ Oncology Center, King Abdullah Medical City, Muzdalifah Rd, Al Mashair, Makkah, 24246, Saudi Arabia, 966 558357452, [email protected] %K breast cancer %K COVID-19 %K pandemic %K web-based survey %K treatment modification %K oncology %K treatment %K modification %K risk %K infection %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Management of patients with cancer in the current era of the COVID-19 pandemic poses a significant challenge to health care systems. Breast cancer is the most common cancer internationally. Breast cancer is a disease that involves surgery, chemotherapy, hormonal therapy, targeted therapy, radiotherapy, and, more recently, immunotherapy in its management plan. The immune system requires months to recover from these medications, and this condition is even worse in patients with metastatic breast cancer who need ongoing treatment with these drugs. Some of these drugs, such as inhibitors of cyclin-dependent kinases 4 and 6, can cause rare but life-threating lung inflammation. Patients with breast cancer who have metastatic disease to the lungs can experience deterioration of disease symptoms with COVID-19 infection. Oncologists treating patients with breast cancer are facing a difficult situation regarding treatment choice. The impact that COVID-19 has had on breast cancer care is unknown, including how to provide the best care possible without compromising patient and community safety. Objective: The aim of this study was to explore the views of oncologists regarding the management of patients with breast cancer during the COVID-19 pandemic. Methods: A web-based SurveyMonkey questionnaire was submitted to licensed oncologists involved in breast cancer management in Saudi Arabia, Egypt, and United Arab Emirates. The survey focused on characteristics of the participants, infection risk among patients with cancer, and possible treatment modifications related to different types of breast cancer. Results: The survey was completed by 82 participants. For early hormone receptor (HR)–positive, human epidermal growth factor receptor 2 (HER2)–negative breast cancer, 61 of the 82 participants (74%) supported using neoadjuvant hormonal therapy in selected patients, and 58% (48/82) preferred giving 6 over 8 cycles of adjuvant chemotherapy when indicated. Only 43% (35/82) preferred inhibitors of cyclin-dependent kinases 4 and 6 with hormonal therapy as the first-line treatment in all patients with metastatic HR-positive disease. A total of 55 of the 82 participants (67%) supported using adjuvant trastuzumab for 6 instead of 12 months in selected patients with HER2-positive breast cancer. For metastatic HER2-positive, HR-positive breast cancer, 80% of participants (66/82) supported the use of hormonal therapy with dual anti-HER2 blockade in selected patients. The preferred choice of first-line treatment in metastatic triple negative patients with BRCA mutation and programmed cell death 1 ligand 1 (PD-L1) <1% was poly(adenosine diphosphate–ribose) polymerase inhibitor according to 41% (34/82) of the participants, and atezolizumab with nab-paclitaxel was preferred for PD-L1 >1% according to 71% (58/82) of the participants. Conclusions: Several modifications in breast cancer management were supported by the survey participants. These modifications need to be discussed on a local basis, taking into account the local infrastructure and available resources. %M 34726611 %R 10.2196/27073 %U https://cancer.jmir.org/2021/4/e27073 %U https://doi.org/10.2196/27073 %U http://www.ncbi.nlm.nih.gov/pubmed/34726611 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e32005 %T Medical Needs Extraction for Breast Cancer Patients from Question and Answer Services: Natural Language Processing-Based Approach %A Kamba,Masaru %A Manabe,Masae %A Wakamiya,Shoko %A Yada,Shuntaro %A Aramaki,Eiji %A Odani,Satomi %A Miyashiro,Isao %+ Division of Information Science, Graduate School of Science and Technology, Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma, Nara, 630 0192, Japan, 81 743 72 5111, [email protected] %K natural language processing %K internet use %K patient generated health data %K neoplasms %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: A large number of patient narratives are available on various web services. As for web question and answer services, patient questions often relate to medical needs, and we expect these questions to provide clues for a better understanding of patients’ medical needs. Objective: This study aimed to extract patients’ needs and classify them into thematic categories. Clarifying patient needs is the first step in solving social issues that patients with cancer encounter. Methods: For this study, we used patient question texts containing the key phrase “breast cancer,“ available at the Yahoo! Japan question and answer service, Yahoo! Chiebukuro, which contains over 60,000 questions on cancer. First, we converted the question text into a vector representation. Next, the relevance between patient needs and existing cancer needs categories was calculated based on cosine similarity. Results: The proportion of correct classifications in our proposed method was approximately 70%. Considering the results of classifying questions, we found the variation and the number of needs. Conclusions: We created 3 corpora to classify the problems of patients with cancer. The proposed method was able to classify the problems considering the question text. Moreover, as an application example, the question text that included the side effect signaling of drugs and the unmet needs of cancer patients could be extracted. Revealing these needs is important to fulfill the medical needs of patients with cancer. %M 34709187 %R 10.2196/32005 %U https://cancer.jmir.org/2021/4/e32005 %U https://doi.org/10.2196/32005 %U http://www.ncbi.nlm.nih.gov/pubmed/34709187 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e26691 %T Emerging Trends and Thematic Evolution of Breast Cancer: Knowledge Mapping and Co-Word Analysis %A Sadatmoosavi,Ali %A Tajedini,Oranus %A Esmaeili,Omid %A Abolhasani Zadeh,Firouzeh %A Khazaneha,Mahdiyeh %+ Department of Information Sciences and Medical Informatics, Kerman University of Medical Sciences, Medical University Campus, Haft-Bagh Highway, Kerman, 7616913555, Iran, 98 9138444409, [email protected] %K scientometrics %K breast cancer %K co-word analysis %K Scimat %K science mapping %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: One of the requirements for scientists and researchers to enter any field of science is to have a comprehensive and accurate understanding of that discipline. Objective: This study aims to draw a science map, provide structural analysis, explore the evolution, and determine new trends in research articles published in the field of breast cancer. Methods: This study comprised a descriptive survey with a scientometric approach. Data were collected from MEDLINE using a search strategy based on Medical Subject Heading (MeSH) terms. This study used science mapping, which provides a visual representation and a longitudinal evolution of possible interrelations between scientific areas, documents, or authors, thus reflecting the cognitive architecture of science mapping. For this scientometric evaluation of the topic of breast cancer research, a very long period was considered for data collection. Moreover, due to the availability of numerous publications in the database, the assessment was divided into three different periods ranging from 1988 to 2020. Results: A total of 12,577 records related to scientometric studies were extracted. The field of breast cancer research demonstrated three diagrams containing the most relevant themes for the three chronological periods evaluated. Each diagram was plotted based on the centrality and density linked to each research topic. The research output in the field was observed to revolve around 8 areas or themes: radiation injury, cardiovascular disease, fibroadenoma, antineoplastic agent, estrogen antagonistic, immunohistochemistry, soybean, and epitopes, each represented with different colors. Conclusions: In the strategic diagrams, the themes were both well developed and important for the structuring of a research field. The first quadrant comprised motor themes of the specialty, which present strong centrality and high density (eg, corticosteroid antineoplastic age, stem cell, T-lymphocyte, protein tyrosine kinase, dietary, and phosphatidyl inositol-3-kinase). In the second quadrant of diagram, themes have well-developed internal ties but unimportant external ties, as they are of only marginal importance for the field. These themes are very specialized and peripheral (eg, DNA-binding). In the third quadrant, themes are both weakly developed and marginal. The themes in this quadrant have low density and centrality and mainly represent either emerging or declining themes (eg, ovarian neoplasm). Themes in the fourth quadrant of the strategic diagram are considered important for a research field but are not fully developed. This quadrant contains transversal and general, basic themes (eg, immunohistochemistry). Scientometric analysis of breast cancer research can be regarded as a roadmap for future research and policymaking for this important field. %M 34709188 %R 10.2196/26691 %U https://cancer.jmir.org/2021/4/e26691 %U https://doi.org/10.2196/26691 %U http://www.ncbi.nlm.nih.gov/pubmed/34709188 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e22809 %T Web-Based Information Seeking Behaviors of Low-Literacy Hispanic Survivors of Breast Cancer: Observational Pilot Study %A Iacobelli,Francisco %A Dragon,Ginger %A Mazur,Giselle %A Guitelman,Judith %+ Computer Science Department, Northeastern Illinois University, 5500 N. St. Louis Ave., Chicago, IL, 60625, United States, 1 7734424728, [email protected] %K low literacy %K health literacy %K online searches %K Hispanic breast cancer survivors %D 2021 %7 27.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet searching is a useful tool for seeking health information and one that can benefit low-literacy populations. However, low-literacy Hispanic survivors of breast cancer do not normally search for health information on the web. For them, the process of searching can be frustrating, as frequent mistakes while typing can result in misleading search results lists. Searches using voice (dictation) are preferred by this population; however, even if an appropriate result list is displayed, low-literacy Hispanic women may be challenged in their ability to fully understand any individual article from that list because of the complexity of the writing. Objective: This observational study aims to explore and describe web-based search behaviors of Hispanic survivors of breast cancer by themselves and with their caregivers, as well as to describe the challenges they face when processing health information on the web. Methods: We recruited 7 Hispanic female survivors of breast cancer. They had the option to bring a caregiver. Of the 7 women, 3 (43%) did, totaling 10 women. We administered the Health LiTT health literacy test, a demographic survey, and a breast cancer knowledge assessment. Next, we trained the participants to search on the web with either a keyboard or via voice. Then, they had to find information about 3 guided queries and 1 free-form query related to breast cancer. Participants were allowed to search in English or in Spanish. We video and audio recorded the computer activity of all participants and analyzed it. Results: We found web articles to be written for a grade level of 11.33 in English and 7.15 in Spanish. We also found that most participants preferred searching using voice but struggled with this modality. Pausing while searching via voice resulted in incomplete search queries, as it confused the search engine. At other times, background noises were detected and included in the search. We also found that participants formulated overly general queries to broaden the results list hoping to find more specific information. In addition, several participants considered their queries satisfied based on information from the snippets on the result lists alone. Finally, participants who spent more time reviewing articles scored higher on the health literacy test. Conclusions: Despite the problems of searching using speech, we found a preference for this modality, which suggests a need to avoid potential errors that could appear in written queries. We also found the use of general questions to increase the chances of answers to more specific concerns. Understanding search behaviors and information evaluation strategies for low-literacy Hispanic women survivors of breast cancer is fundamental to designing useful search interfaces that yield relevant and reliable information on the web. %M 34704952 %R 10.2196/22809 %U https://formative.jmir.org/2021/10/e22809 %U https://doi.org/10.2196/22809 %U http://www.ncbi.nlm.nih.gov/pubmed/34704952 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e25659 %T Exploring Cancer Survivor Needs and Preferences for Communicating Personalized Cancer Statistics From Registry Data: Qualitative Multimethod Study %A Vromans,Ruben D %A van Eenbergen,Mies C %A Geleijnse,Gijs %A Pauws,Steffen %A van de Poll-Franse,Lonneke V %A Krahmer,Emiel J %+ Department of Communication and Cognition, Tilburg University, Warandelaan 2, Tilburg, 5037LE, Netherlands, 31 134663584, [email protected] %K breast cancer %K cancer statistics %K personalization %K prostate cancer %K risk communication %K cancer registry %K cancer %K patient needs and preferences %D 2021 %7 25.10.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Disclosure of cancer statistics (eg, survival or incidence rates) based on a representative group of patients can help increase cancer survivors’ understanding of their own diagnostic and prognostic situation, and care planning. More recently, there has been an increasing interest in the use of cancer registry data for disclosing and communicating personalized cancer statistics (tailored toward personal and clinical characteristics) to cancer survivors and relatives. Objective: The aim of this study was to explore breast cancer (BCa) and prostate cancer (PCa) survivor needs and preferences for disclosing (what) and presenting (how) personalized statistics from a large Dutch population-based data set, the Netherlands Cancer Registry (NCR). Methods: To elicit survivor needs and preferences for communicating personalized NCR statistics, we created different (non)interactive tools visualizing hypothetical scenarios and adopted a qualitative multimethod study design. We first conducted 2 focus groups (study 1; n=13) for collecting group data on BCa and PCa survivor needs and preferences, using noninteractive sketches of what a tool for communicating personalized statistics might look like. Based on these insights, we designed a revised interactive tool, which was used to further explore the needs and preferences of another group of cancer survivors during individual think-aloud observations and semistructured interviews (study 2; n=11). All sessions were audio-recorded, transcribed verbatim, analyzed using thematic (focus groups) and content analysis (think-aloud observations), and reported in compliance with qualitative research reporting criteria. Results: In both studies, cancer survivors expressed the need to receive personalized statistics from a representative source, with especially a need for survival and conditional survival rates (ie, survival rate for those who have already survived for a certain period). Personalized statistics adjusted toward personal and clinical factors were deemed more relevant and useful to know than generic or average-based statistics. Participants also needed support for correctly interpreting the personalized statistics and putting them into perspective, for instance by adding contextual or comparative information. Furthermore, while thinking aloud, participants experienced a mix of positive (sense of hope) and negative emotions (feelings of distress) while viewing the personalized survival data. Overall, participants preferred simplicity and conciseness, and the ability to tailor the type of visualization and amount of (detailed) statistical information. Conclusions: The majority of our sample of cancer survivors wanted to receive personalized statistics from the NCR. Given the variation in patient needs and preferences for presenting personalized statistics, designers of similar information tools may consider potential tailoring strategies on multiple levels, as well as effective ways for providing supporting information to make sure that the personalized statistics are properly understood. This is encouraging for cancer registries to address this unmet need, but also for those who are developing or implementing personalized data-driven information tools for patients and relatives. %M 34694237 %R 10.2196/25659 %U https://cancer.jmir.org/2021/4/e25659 %U https://doi.org/10.2196/25659 %U http://www.ncbi.nlm.nih.gov/pubmed/34694237 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e24865 %T A Mobile App (AMOR Mama) for Women With Breast Cancer Undergoing Radiation Therapy: Functionality and Usability Study %A Cruz,Flávia Oliveira de Almeida Marques da %A Faria,Edison Tostes %A Ghobad,Pabblo Cardelino %A Alves,Leandro Yukio Mano %A Reis,Paula Elaine Diniz dos %+ Interdisciplinary Laboratory of Research Applied to Clinical Practice in Oncology, School of Health Sciences, University of Brasilia (UnB), Darcy Ribeiro s/n - Asa Norte, Brasilia, 70910-900, Brazil, 55 61998552290, [email protected] %K mobile applications %K health education %K nursing care %K oncology nursing %K educational technology %K breast neoplasms %K radiation therapy %D 2021 %7 13.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile apps targeting women with breast cancer can facilitate access to information, improve well-being, and record reports of treatment-related symptoms. However, it is important to confirm the benefits of these apps before they are used as a tool in clinical care. Objective: The aim of this study was to evaluate the functionality and the usability of a mobile app created to guide and monitor patients with breast cancer undergoing radiation therapy. Methods: The evaluation process of the mobile app was performed in 2 steps with 8 professionals, including nurses, physician, medical physicists, and communication networks engineer. The first step was the focus group, which allowed obtaining suggestions proposed by the participants regarding the improvement of the mobile app. The second step was the individual filling in of an evaluation tool to obtain objective measures about the mobile app. A minimum concordance index of 80% was considered to ensure the adequacy of the material. Results: After the mobile app was evaluated by 8 professionals, only 1 item of the evaluation tool, that is, concerning the potentiality of the app to be used by users of different educational levels, obtained a concordance index <80%. Conclusions: The mobile app titled “AMOR Mama” was considered suitable, which suggests its contribution to an educational health technology to guide and monitor patients with breast cancer undergoing radiation therapy. More studies with this target population should be carried out to assess the performance and quality of the mobile app during its use. %M 34643531 %R 10.2196/24865 %U https://www.jmir.org/2021/10/e24865 %U https://doi.org/10.2196/24865 %U http://www.ncbi.nlm.nih.gov/pubmed/34643531 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e25776 %T Measuring the Time to Deterioration for Health-Related Quality of Life in Patients With Metastatic Breast Cancer Using a Web-Based Monitoring Application: Longitudinal Cohort Study %A Brusniak,Katharina %A Feisst,Manuel %A Sebesteny,Linda %A Hartkopf,Andreas %A Graf,Joachim %A Engler,Tobias %A Schneeweiss,Andreas %A Wallwiener,Markus %A Deutsch,Thomas Maximilian %+ Department of Gynecology and Obstetrics, University Hospital Heidelberg, Im Neuenheimer Feld 440, Heidelberg, Germany, 49 6221 56 36956, [email protected] %K eHealth %K breast cancer %K health-related quality of life %K quality of life %K time to deterioration %K EQ-VAS %K EQ-5D-5L %K EORTC QLQ-C30 %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Health-related quality of life (HRQoL) is used to evaluate the treatment of metastatic breast cancer. In a long-term therapy setting, HRQoL can be used as an important benchmark for treatment success. With the help of digital apps, HRQoL monitoring can be extended to more remote areas and be administered on a more frequent basis. Objective: This study aims to evaluate 3 common HRQoL questionnaires in metastasized breast cancer in terms of TTD in a digital, web-based setting. We further aim to examine the development of the HRQoL in different systemic treatment groups in each of these evaluation instruments. Methods: A total of 192 patients with metastatic breast cancer were analyzed in this bicentric prospective online cohort study at two German university hospitals. Patients completed questionnaires on HRQoL (EuroQol Visual Analog Scale [EQ-VAS], EuroQol 5 Dimension 5 Level [EQ-5D-5L], European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Core 30 item [EORTC QLQ-C30]) via an online platform over a 6-month period. Treatment schedules and medical history were retrieved from medical records. Unadjusted Cox regression analysis on treatment-related factors was performed. We conducted subgroup analyses in regard to TTD events between different treatments. Results: The EQ-VAS showed a higher rate of deterioration after 8 weeks (84/179, 46.9%) than the EQ-5D-5L (47/163, 28.8%) and EORTC QLQ-C30 (65/176, 36.9%). Unadjusted Cox regression revealed significant connections between known metastases in the liver (P=.03, HR 1.64, 95% CI 1.06-2.52) and pleura (P=.04, HR 0.42, 95% CI 0.18-0.96) in the EQ-VAS. Significant relations between EQ-VAS events and single EQ-5D-5L items and the EQ-5D-5L summary score were demonstrated. All treatment groups significantly differed from the CDK4/6 inhibition subgroup in the EQ-VAS. Conclusions: Compared to the EQ-5D-5L and QLQ-C30, the EQ-VAS showed a higher rate of deterioration after 8 weeks. Significant connections to certain metastatic locations were only detected in the EQ-VAS. The EQ-VAS is capable of reflecting the distinctive HRQoL profiles of different systemic treatments as well as the different aspects of HRQoL presented in the EQ-5D-5L. TTD with the EQ-VAS is an adequate mean of examining longitudinal development of HRQoL among breast cancer patients. %M 34636732 %R 10.2196/25776 %U https://cancer.jmir.org/2021/4/e25776 %U https://doi.org/10.2196/25776 %U http://www.ncbi.nlm.nih.gov/pubmed/34636732 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e25464 %T Characteristics of Participants and Nonparticipants in a Blended Internet-Based Physical Activity Trial for Breast and Prostate Cancer Survivors: Cross-sectional Study %A vd Wiel,Hester J %A Stuiver,Martijn M %A May,Anne M %A van Grinsven,Susan %A Benink,Marlou F A %A Aaronson,Neil K %A Oldenburg,Hester S A %A van der Poel,Henk G %A van Harten,Wim H %A Groen,Wim G %+ Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, Amsterdam, Netherlands, 31 0205129111, [email protected] %K internet-based intervention %K physical activity %K nonparticipants %K breast cancer survivors %K prostate cancer survivors %K RCT %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: As the number of cancer survivors is increasing, it is important to be able to offer exercise and physical activity (PA)–promoting interventions that are both effective and reasonably accessible. Internet-based interventions are typically less expensive and more accessible alternatives to on-site supervised interventions. Currently, little is known about the characteristics of nonparticipants in PA promotion trials in the cancer survivorship setting, both in general and specifically in trials using internet-supported interventions. Objective: This study aims to gain insight into the characteristics associated with nonparticipation in a blended internet-based supported intervention trial to promote PA. Methods: Breast and prostate cancer survivors, 3-36 months after primary curative treatment, were invited to participate in the PABLO trial; this trial compared an internet-based intervention to enhance PA levels, with or without additional support from a physical therapist, to usual care. Participants and nonparticipants were asked to complete a comprehensive questionnaire assessing sociodemographics, fatigue, and health-related quality of life. Baseline data for participants and nonparticipants were compared using the independent Student t test and chi-square test. Results: The inclusion rate in the trial was 11.03% (137/1242). Of the nonparticipants, 13.95% (154/1104) completed the questionnaire. Participants were more highly educated (P=.04), had a paid job less often (P=.03), and were on sick leave more often (P=.03). They reported less PA per week, both moderate (P=.03) and vigorous (P<.01), before diagnosis and during leisure time (P<.01, effect size [ES]=0.44). They reported a significantly lower stage of change (P≤.01), lower self-efficacy (P<.01, ES=0.61), perceived barriers to PA (P<.01, ES=0.54), and more general fatigue (P<.01, ES=0.60). Participants reported lower health-related quality of life for most domains (ES ranging from 0.34 for mental health to 0.48 for social functioning). No significant differences were found for other sociodemographics, mood state, or attitudes toward or perceived social support for PA. Conclusions: The participants who self-selected for trial participation reported lower PA levels before diagnosis and a stronger need for support compared with nonparticipants. The trial thus included those patients who might benefit the most from internet-based supportive PA interventions. Trial Registration: Netherlands trial register NTR6911; https://www.trialregister.nl/trial/6733 %M 34609311 %R 10.2196/25464 %U https://cancer.jmir.org/2021/4/e25464 %U https://doi.org/10.2196/25464 %U http://www.ncbi.nlm.nih.gov/pubmed/34609311 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30950 %T A Culturally Sensitive Social Support Intervention for Chinese American Breast Cancer Survivors (Joy Luck Academy): Protocol for a Randomized Controlled Trial %A Lu,Qian %A Warmoth,Krystal %A Chen,Lingjun %A Wu,Christine S %A Chu,Qiao %A Li,Yisheng %A Gallagher,Matthew W %A Stanton,Annette L %A Kagawa Singer,Marjorie %A Young,Lucy %A Loh,Alice %+ Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, 1400 Pressler Street, Unit 1440, Houston, TX, 77030, United States, 1 7137458324, [email protected] %K social support %K peer mentor support %K randomized controlled trial %K Chinese cancer survivors %K breast cancer %D 2021 %7 22.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Breast cancer is the most prevalent type of cancer among Asian American women. Chinese American immigrant breast cancer survivors face unique challenges because of cultural and socioecological factors. They report emotional distress and the need for social, emotional, and spiritual support. However, culturally and linguistically appropriate information for managing survivorship health care is often unavailable. Objective: To improve the health outcomes for this underserved and understudied population, we developed, designed, and launched a randomized controlled trial to test the health benefits of a culturally sensitive social support intervention (Joy Luck Academy). In this paper, we describe the research protocol. Methods: This randomized controlled trial will enroll Chinese-speaking, stage 0 to 3 breast cancer survivors who have completed treatment within the previous 36 months using a community-based participatory research approach. We will randomly assign 168 participants to the intervention or control group. The intervention arm will attend 7 weekly 3.5-hour peer mentor and educational sessions. The control group will receive the educational information. We will assess health outcomes at baseline, immediately after the Joy Luck Academy, and at 1- and 4-month follow-ups. The primary outcome is quality of life, as measured by the Functional Assessment of Cancer Therapy scale. Secondary outcomes include depressive symptoms, positive affect, fatigue, and perceived stress. We will also explore how the intervention influences cortisol levels. To identify how and to whom the program is effective, we will measure social and personal resources and theorized mechanisms and perform qualitative interviews with a subsample of participants to enhance the interpretation of quantitative data. Results: Recruitment began in February 2015, and data collection was completed in February 2019. We expect to complete data management by August 2021 and publish results in 2022. Conclusions: If the Joy Luck Academy is demonstrated to be effective, it may be easily disseminated as an intervention for other groups of Asian American immigrant breast cancer survivors. Furthermore, similar programs could be integrated into other diverse communities. Trial Registration: ClinicalTrials.gov NCT02946697; http://clinicaltrials.gov/ct2/show/NCT02946697. International Registered Report Identifier (IRRID): DERR1-10.2196/30950 %M 34550088 %R 10.2196/30950 %U https://www.researchprotocols.org/2021/9/e30950 %U https://doi.org/10.2196/30950 %U http://www.ncbi.nlm.nih.gov/pubmed/34550088 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 3 %P e27063 %T Gaps in Public Awareness About BRCA and Genetic Testing in Prostate Cancer: Social Media Landscape Analysis %A Loeb,Stacy %A Massey,Philip %A Leader,Amy E %A Thakker,Sameer %A Falge,Emily %A Taneja,Sabina %A Byrne,Nataliya %A Rose,Meredith %A Joy,Matthew %A Walter,Dawn %A Katz,Matthew S %A Wong,Risa L %A Selvan,Preethi %A Keith,Scott W %A Giri,Veda N %+ Department of Urology and Population Health, New York University School of Medicine, 227 E 30th Street #612, New York, NY, 10016, United States, 1 7182619100, [email protected] %K genetic testing %K BRCA %K prostate cancer %K breast cancer %K social media %K infodemiology %D 2021 %7 20.9.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Genetic testing, particularly for BRCA1/2, is increasingly important in prostate cancer (PCa) care, with impact on PCa management and hereditary cancer risk. However, the extent of public awareness and online discourse on social media is unknown, and presents opportunities to identify gaps and enhance population awareness and uptake of advances in PCa precision medicine. Objective: The objective of this study was to characterize activity and engagement across multiple social media platforms (Twitter, Facebook, and YouTube) regarding BRCA and genetic testing for PCa compared with breast cancer, which has a long history of public awareness, advocacy, and prominent social media presence. Methods: The Symplur Signals online analytics platform was used to obtain metrics for tweets about (1) #BRCA and #breastcancer, (2) #BRCA and #prostatecancer, (3) #genetictesting and #breastcancer, and (4) #genetictesting and #prostatecancer from 2016 to 2020. We examined the total number of tweets, users, and reach for each hashtag, and performed content analysis for a subset of tweets. Facebook and YouTube were queried using analogous search terms, and engagement metrics were calculated. Results: During a 5-year period, there were 10,005 tweets for #BRCA and #breastcancer, versus 1008 tweets about #BRCA and #prostatecancer. There were also more tweets about #genetictesting and #breastcancer (n=1748), compared with #genetic testing and #prostatecancer (n=328). Tweets about genetic testing (12,921,954) and BRCA (75,724,795) in breast cancer also had substantially greater reach than those about PCa (1,463,777 and 4,849,905, respectively). Facebook groups and pages regarding PCa and BRCA/genetic testing had fewer average members, new members, and new posts, as well as fewer likes and followers, compared with breast cancer. Facebook videos had more engagement than YouTube videos across both PCa and breast cancer content. Conclusions: There is substantially less social media engagement about BRCA and genetic testing in PCa compared with breast cancer. This landscape analysis provides insights into strategies for leveraging social media platforms to increase public awareness about PCa germline testing, including use of Facebook to share video content and Twitter for discussions with health professionals. %M 34542414 %R 10.2196/27063 %U https://cancer.jmir.org/2021/3/e27063 %U https://doi.org/10.2196/27063 %U http://www.ncbi.nlm.nih.gov/pubmed/34542414 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27576 %T A Smartphone-Based App to Improve Adjuvant Treatment Adherence to Multidisciplinary Decisions in Patients With Early-Stage Breast Cancer: Observational Study %A Yu,Jing %A Wu,Jiayi %A Huang,Ou %A Chen,Xiaosong %A Shen,Kunwei %+ Department of General Surgery, Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, 197 Ruijin Er Road, Shanghai, 200025, China, 86 13564497086, [email protected] %K breast cancer %K adherence %K multidisciplinary treatment %K adjuvant treatment %K smartphone-based app %K mobile phone %D 2021 %7 16.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Multidisciplinary treatment (MDT) and adjuvant therapy are associated with improved survival rates in breast cancer. However, nonadherence to MDT decisions is common in patients. We developed a smartphone-based app that can facilitate the full-course management of patients after surgery. Objective: This study aims to investigate the influence factors of treatment nonadherence and to determine whether this smartphone-based app can improve the compliance rate with MDTs. Methods: Patients who had received a diagnosis of invasive breast cancer and had undergone MDT between March 2013 and May 2019 were included. Patients were classified into 3 groups: Pre-App cohort (November 2017, before the launch of the app); App nonused, cohort (after November 2017 but not using the app); and App used cohort (after November 2017 and using the app). Univariate and multivariate analyses were performed to identify the factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy, was also evaluated. Results: A total of 4475 patients were included, with Pre-App, App nonused, and App used cohorts comprising 2966 (66.28%), 861 (19.24%), and 648 (14.48%) patients, respectively. Overall, 15.53% (695/4475) patients did not receive MDT recommendations; the noncompliance rate ranged from 27.4% (75/273) in 2013 to 8.8% (44/500) in 2019. Multivariate analysis demonstrated that app use was independently associated with adherence to adjuvant treatment. Compared with the patients in the Pre-App cohort, patients in the App used cohort were less likely to deviate from MDT recommendations (odds ratio [OR] 0.61, 95% CI 0.43-0.87; P=.007); no significant difference was found in the App nonused cohort (P=.77). Moreover, app use decreased the noncompliance rate for adjuvant chemotherapy (OR 0.41, 95% CI 0.27-0.65; P<.001) and radiotherapy (OR 0.49, 95% CI 0.25-0.96; P=.04), but not for anti-HER2 therapy (P=.76) or endocrine therapy (P=.39). Conclusions: This smartphone-based app can increase MDT adherence in patients undergoing adjuvant therapy; this was more obvious for adjuvant chemotherapy and radiotherapy. %M 34528890 %R 10.2196/27576 %U https://www.jmir.org/2021/9/e27576 %U https://doi.org/10.2196/27576 %U http://www.ncbi.nlm.nih.gov/pubmed/34528890 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27076 %T Co-designing a Lifestyle-Focused Text Message Intervention for Women After Breast Cancer Treatment: Mixed Methods Study %A Singleton,Anna %A Raeside,Rebecca %A Partridge,Stephanie R %A Hayes,Molly %A Maka,Katherine %A Hyun,Karice K %A Thiagalingam,Aravinda %A Chow,Clara K %A Sherman,Kerry A %A Elder,Elisabeth %A Redfern,Julie %+ Consumer Engagement and Codesign Research Hub, School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Level 6 Block K Westmead Hospital, Sydney, 2145, Australia, 61 288908181, [email protected] %K breast neoplasms %K cancer survivors %K text messaging %K telemedicine %K mobile health %K co-design %D 2021 %7 14.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Breast cancer is the most common cancer among women globally. Recovery from breast cancer treatment can be mentally and physically challenging. SMS text message programs offer a novel way to provide health information and support, but few programs are co-designed with consumer representatives. Objective: This study aims to report the procedures and outcomes of a co-design process of a lifestyle-focused SMS text message program to support women’s mental and physical health after breast cancer treatment. Methods: We followed an iterative mixed methods two-step process: (1) co-design workshop with consumers and health professionals and researchers to draft text messages and (2) evaluation of message content, which was scored (5-point Likert scale; 1=strongly disagree to 5=strongly agree) for ease of understanding, usefulness, and appropriateness, and readability (Flesch-Kincaid score). Additional free-text responses and semistructured interviews were coded into themes. Messages were edited or deleted based on the evaluations, with consumers’ evaluations prioritized. Results: In step 1, co-designed text messages (N=189) were semipersonalized, and the main content themes were (1) physical activity and healthy eating, (2) medications and side effects, (3) mental health, and (4) general breast cancer information. In step 2, consumers (n=14) and health professionals and researchers (n=14) provided 870 reviews of 189 messages and found that most messages were easy to understand (799/870, 91.8%), useful (746/870, 85.7%), and appropriate (732/870, 84.1%). However, consumers rated 50 messages differently from health professionals and researchers. On the basis of evaluations, 37.6% (71/189) of messages were deleted, 36.5% (69/189) were edited, and 12 new messages related to fatigue, self-care, and cognition were created. The final 130 text messages had a mean 7.12 (SD 2.8) Flesch-Kincaid grade level and 68.9 (SD 15.5) ease-of-reading score, which represents standard reading ease. Conclusions: Co-designing and evaluating a bank of evidence-based mental and physical health-themed text messages with breast cancer survivors, health professionals, and researchers was feasible and resulted in a bank of 130 text messages evaluated highly by participants. Some consumer evaluations differed from health professionals and researchers, supporting the importance of co-design. %M 34125072 %R 10.2196/27076 %U https://www.jmir.org/2021/6/e27076 %U https://doi.org/10.2196/27076 %U http://www.ncbi.nlm.nih.gov/pubmed/34125072 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e26264 %T Using a Tailored Digital Health Intervention for Family Communication and Cascade Genetic Testing in Swiss and Korean Families With Hereditary Breast and Ovarian Cancer: Protocol for the DIALOGUE Study %A Kim,Sue %A Aceti,Monica %A Baroutsou,Vasiliki %A Bürki,Nicole %A Caiata-Zufferey,Maria %A Cattaneo,Marco %A Chappuis,Pierre O %A Ciorba,Florina M %A Graffeo-Galbiati,Rossella %A Heinzelmann-Schwarz,Viola %A Jeong,Joon %A Jung,MiSook M %A Kim,Sung-Won %A Kim,Jisun %A Lim,Myong Cheol %A Ming,Chang %A Monnerat,Christian %A Park,Hyung Seok %A Park,Sang Hyung %A Pedrazzani,Carla A %A Rabaglio,Manuela %A Ryu,Jai Min %A Saccilotto,Ramon %A Wieser,Simon %A Zürrer-Härdi,Ursina %A Katapodi,Maria C %+ Department of Clinical Research, University of Basel, Missionstrasse 64, Basel, 4055, Switzerland, 41 61 207 0430, [email protected] %K HBOC %K proportion of informed at-risk relatives %K coping %K communicating %K decisional conflict %K cultural and linguistic adaptation %K implementation %K RE-AIM %K mobile phone %D 2021 %7 11.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In hereditary breast and ovarian cancer (HBOC), family communication of genetic test results is essential for cascade genetic screening, that is, identifying and testing blood relatives of known mutation carriers to determine whether they also carry the pathogenic variant, and to propose preventive and clinical management options. However, up to 50% of blood relatives are unaware of relevant genetic information, suggesting that potential benefits of genetic testing are not communicated effectively within family networks. Technology can facilitate communication and genetic education within HBOC families. Objective: The aims of this study are to develop the K-CASCADE (Korean–Cancer Predisposition Cascade Genetic Testing) cohort in Korea by expanding an infrastructure developed by the CASCADE (Cancer Predisposition Cascade Genetic Testing) Consortium in Switzerland; develop a digital health intervention to support the communication of cancer predisposition for Swiss and Korean HBOC families, based on linguistic and cultural adaptation of the Family Gene Toolkit; evaluate its efficacy on primary (family communication of genetic results and cascade testing) and secondary (psychological distress, genetic literacy, active coping, and decision making) outcomes; and explore its translatability using the reach, effectiveness, adoption, implementation, and maintenance framework. Methods: The digital health intervention will be available in French, German, Italian, Korean, and English and can be accessed via the web, mobile phone, or tablet (ie, device-agnostic). K-CASCADE cohort of Korean HBOC mutation carriers and relatives will be based on the CASCADE infrastructure. Narrative data collected through individual interviews or mini focus groups from 20 to 24 HBOC family members per linguistic region and 6-10 health care providers involved in genetic services will identify the local cultures and context, and inform the content of the tailored messages. The efficacy of the digital health intervention against a comparison website will be assessed in a randomized trial with 104 HBOC mutation carriers (52 in each study arm). The translatability of the digital health intervention will be assessed using survey data collected from HBOC families and health care providers. Results: Funding was received in October 2019. It is projected that data collection will be completed by January 2023 and results will be published in fall 2023. Conclusions: This study addresses the continuum of translational research, from developing an international research infrastructure and adapting an existing digital health intervention to testing its efficacy in a randomized controlled trial and exploring its translatability using an established framework. Adapting existing interventions, rather than developing new ones, takes advantage of previous valid experiences without duplicating efforts. Culturally sensitive web-based interventions that enhance family communication and understanding of genetic cancer risk are timely. This collaboration creates a research infrastructure between Switzerland and Korea that can be scaled up to cover other hereditary cancer syndromes. Trial Registration: ClinicalTrials.gov NCT04214210; https://clinicaltrials.gov/ct2/show/NCT04214210 and CRiS KCT0005643; https://cris.nih.go.kr/cris/ International Registered Report Identifier (IRRID): PRR1-10.2196/26264 %M 34114954 %R 10.2196/26264 %U https://www.researchprotocols.org/2021/6/e26264 %U https://doi.org/10.2196/26264 %U http://www.ncbi.nlm.nih.gov/pubmed/34114954 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e23884 %T Perceptions of Endocrine Therapy in African-American Breast Cancer Survivors: Mixed Methods Study %A Donevant,Sara %A Heiney,Sue P %A Wineglass,Cassandra %A Schooley,Benjamin %A Singh,Akanksha %A Sheng,Jingxi %+ College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, United States, 1 803 777 7672, [email protected] %K mHealth %K breast cancer survivors %K medication adherence %K cultural considerations %K mobile health applications %D 2021 %7 11.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although the incidence of breast cancer is lower in African-American women than in White women, African-American women have a decreased survival rate. The difference in survival rate may stem from poor endocrine therapy adherence, which increases breast cancer recurrence. Therefore, accessible and culturally sensitive interventions to increase endocrine therapy adherence are necessary. Objective: The purpose of this concurrent convergent mixed methods study was to provide further data to guide the development of the proposed culturally sensitive mHealth app, STORY+ for African-American women with breast cancer. Methods: We recruited 20 African-American women diagnosed with estrogen-positive breast cancer and currently prescribed endocrine therapy. We used a concurrent convergent data collection method to (1) assess the use of smartphones and computers related to health care and (2) identify foundational aspects to support endocrine therapy adherence for incorporation in a mobile health app. Results: Overwhelmingly, the participants preferred using smartphones to using computers for health care. Communicating with health care providers and pharmacies was the most frequent health care use of smartphones, followed by exercise tracking, and accessing the patient portal. We identified 4 aspects of adherence to endocrine therapy and smartphone use for incorporation in app development. The factors that emerged from the integrated qualitative and quantitative data were (1) willingness to use, (2) side effects, (3) social connection, and (4) beliefs about endocrine therapy. Conclusions: Further research is needed to develop a culturally sensitive app for African-American women with breast cancer to improve adherence to endocrine therapy. Our work strongly suggests that this population would use the app to connect with other African-American breast cancer survivors and manage endocrine therapy. %M 34114955 %R 10.2196/23884 %U https://formative.jmir.org/2021/6/e23884 %U https://doi.org/10.2196/23884 %U http://www.ncbi.nlm.nih.gov/pubmed/34114955 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e23839 %T Perceptions of Racially and Ethnically Diverse Women at High Risk of Breast Cancer Regarding the Use of a Web-Based Decision Aid for Chemoprevention: Qualitative Study Nested Within a Randomized Controlled Trial %A Jones,Tarsha %A Guzman,Ashlee %A Silverman,Thomas %A Freeman,Katherine %A Kukafka,Rita %A Crew,Katherine %+ Florida Atlantic University, 777 Glades Road, Boca Raton, FL, 33431, United States, 1 561 297 4975, [email protected] %K breast cancer %K chemoprevention %K qualitative %K decision support %K cancer %K estrogen receptor %K web-based %K cancer risk %D 2021 %7 8.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Chemopreventive agents such as selective estrogen receptor modulators and aromatase inhibitors have proven efficacy in reducing breast cancer risk by 41% to 79% in high-risk women. Women at high risk of developing breast cancer face the complex decision of whether to take selective estrogen receptor modulators or aromatase inhibitors for breast cancer chemoprevention. RealRisks is a patient-centered, web-based decision aid (DA) designed to promote the understanding of breast cancer risk and to engage diverse women in planning a preference-sensitive course of decision making about taking chemoprevention. Objective: This study aims to understand the perceptions of women at high risk of developing breast cancer regarding their experience with using RealRisks—a DA designed to promote the uptake of breast cancer chemoprevention—and to understand their information needs. Methods: We completed enrollment to a randomized controlled trial among 300 racially and ethnically diverse women at high risk of breast cancer who were assigned to standard educational materials alone or such materials in combination with RealRisks. We conducted semistructured interviews with a subset of 21 high-risk women enrolled in the intervention arm of the randomized controlled trial who initially accessed the tool (on average, 1 year earlier) to understand how they interacted with the tool. All interviews were audio recorded, transcribed verbatim, and compared with digital audio recordings to ensure the accuracy of the content. We used content analysis to generate themes. Results: The mean age of the 21 participants was 58.5 (SD 10.1) years. The participants were 5% (1/21) Asian, 24% (5/21) Black or African American, and 71% (15/21) White; 10% (2/21) of participants were Hispanic or Latina. All participants reported using RealRisks after being granted access to the DA. In total, 4 overarching themes emerged from the qualitative analyses: the acceptability of the intervention, specifically endorsed elements of the DA, recommendations for improvements, and information needs. All women found RealRisks to be acceptable and considered it to be helpful (21/21, 100%). Most women (13/21, 62%) reported that RealRisks was easy to navigate, user-friendly, and easily accessible on the web. The majority of women (18/21, 86%) felt that RealRisks improved their knowledge about breast cancer risk and chemoprevention options and that RealRisks informed their (17/21, 81%) decision about whether or not to take chemoprevention. Some women (9/21, 43%) shared recommendations for improvements, as they wanted more tailoring based on user characteristics, felt that the DA was targeting a narrow population of Hispanic or Latina by using graphic novel–style narratives, wanted more understandable terminology, and felt that the tool placed a strong emphasis on chemoprevention drugs. Conclusions: This qualitative study demonstrated the acceptability of the RealRisks web-based DA among a diverse group of high-risk women, who provided some recommendations for improvement. %M 34100769 %R 10.2196/23839 %U https://www.jmir.org/2021/6/e23839 %U https://doi.org/10.2196/23839 %U http://www.ncbi.nlm.nih.gov/pubmed/34100769 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e22970 %T Using a Mobile App–Based Video Recommender System of Patient Narratives to Prepare Women for Breast Cancer Surgery: Development and Usability Study Informed by Qualitative Data %A Ormel,Ilja %A Onu,Charles C %A Magalhaes,Mona %A Tang,Terence %A Hughes,John B %A Law,Susan %+ Department of Family Medicine, McGill University, 5858 Côte-des-Neiges Rd, Montréal, QC, H2T 1W1, Canada, 1 (514) 345 3511 ext 5060, [email protected] %K qualitative research %K illness narratives %K experiential information %K breast cancer %K surgery %K tailored information %K recommender system %K patient information and communication %K mobile app %K mobile phone %D 2021 %7 2.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Women diagnosed with breast cancer are often bombarded with information. Such information overload can lead to misunderstandings and hamper women’s capacity for making informed decisions about their care. For women with breast cancer, this uncertainty is particularly severe in the period before surgery. Personalized narratives about others’ experiences can help patients better understand the disease course, the quality and type of care to be expected, the clinical decision-making processes, and the strategies for coping. Existing resources and eHealth apps rarely include experiential information, and no tools exist that tailor information for individual preferences and needs—offering the right information at the right time and in the right format. Combining high-quality experiential evidence with novel technical approaches may contribute to patient-centered solutions in this area. Objective: This study aims to design and seek preliminary feedback on a mobile app that will improve information access about surgery for patients with breast cancer, by drawing on a qualitative collection of personal narratives from a diverse sample of Canadian women and using video and audio recordings or audio recordings from the Canadian Health Experiences Research Network. Methods: In a previous study, we conducted in-depth interviews with 35 Canadian women and used video and audio recordings or audio recordings to collect stories about the lived experiences of breast cancer. The participants highlighted the need for more specific information between diagnosis and surgery that was relevant to their personal situations and preferences. They also wanted to learn from other women’s experiences. We worked with patients, clinicians, and informatics experts to develop a mobile app that provides access to tailored experiential information relevant to women’s personal situations and preferences. We completed focus groups and qualitative interviews, conducted a further analysis of the original qualitative data, designed novel software using artificial intelligence, and sought preliminary feedback from users on a new app via focus groups and a survey. Results: The secondary analysis of the breast cancer narratives revealed key themes and their interconnections relevant to the experience of surgery, including preparation, treatment decisions, aftercare, reconstruction, prostheses, lumpectomy and mastectomy, and complications. These themes informed the development of the structure and content of the app. We developed a recommender system within the app by using content matching (user and speaker profiles and user interests and video content) and collaborative filtering to identify clips marked as relevant by the user and by similar users. A 2-minute animated introductory video for users was developed. Pilot testing revealed generally positive responses regarding the content and value of this type of e-tool. Conclusions: Developing reliable, evidence-based tools and apps that are based on diverse collections of people’s experiences of illness offers a novel approach to help manage the plethora of information that women face after a diagnosis of breast cancer. %M 34076582 %R 10.2196/22970 %U https://formative.jmir.org/2021/6/e22970 %U https://doi.org/10.2196/22970 %U http://www.ncbi.nlm.nih.gov/pubmed/34076582 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 6 %N 2 %P e23808 %T Neural Network Pattern Recognition of Ultrasound Image Gray Scale Intensity Histograms of Breast Lesions to Differentiate Between Benign and Malignant Lesions: Analytical Study %A Ramachandran,Arivan %A Kathavarayan Ramu,Shivabalan %+ Mahatma Gandhi Medical College and Research Institute, Medical College Road, Pillayarkuppam, Puducherry, 607402, India, 91 9999850584, [email protected] %K radiology %K imaging %K neural network %K images %D 2021 %7 2.6.2021 %9 Short Paper %J JMIR Biomed Eng %G English %X Background: Ultrasound-based radiomic features to differentiate between benign and malignant breast lesions with the help of machine learning is currently being researched. The mean echogenicity ratio has been used for the diagnosis of malignant breast lesions. However, gray scale intensity histogram values as a single radiomic feature for the detection of malignant breast lesions using machine learning algorithms have not been explored yet. Objective: This study aims to assess the utility of a simple convolutional neural network in classifying benign and malignant breast lesions using gray scale intensity values of the lesion. Methods: An open-access online data set of 200 ultrasonogram breast lesions were collected, and regions of interest were drawn over the lesions. The gray scale intensity values of the lesions were extracted. An input file containing the values and an output file consisting of the breast lesions’ diagnoses were created. The convolutional neural network was trained using the files and tested on the whole data set. Results: The trained convolutional neural network had an accuracy of 94.5% and a precision of 94%. The sensitivity and specificity were 94.9% and 94.1%, respectively. Conclusions: Simple neural networks, which are cheap and easy to use, can be applied to diagnose malignant breast lesions with gray scale intensity values obtained from ultrasonogram images in low-resource settings with minimal personnel. %M 38907375 %R 10.2196/23808 %U https://biomedeng.jmir.org/2021/2/e23808 %U https://doi.org/10.2196/23808 %U http://www.ncbi.nlm.nih.gov/pubmed/38907375 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e19262 %T Effects of Psychoeducational Interventions Using Mobile Apps and Mobile-Based Online Group Discussions on Anxiety and Self-Esteem in Women With Breast Cancer: Randomized Controlled Trial %A Ghanbari,Elaheh %A Yektatalab,Shahrzad %A Mehrabi,Manoosh %+ Department of Mental Health and Psychiatric Nursing, School of Nursing and Midwifery, Community-Based Psychiatric Care Research Center, Shiraz University of Medical Sciences, Zand Street, Namazee Square, Shiraz, Iran, 98 917 710 6721, [email protected] %K anxiety %K breast cancer %K education %K mobile app %K self-esteem %D 2021 %7 18.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Psychoeducation has turned into an effective tool in taking care of cancer patients and improving their psychophysical symptoms and quality of life. Despite the growing use of mobile phone apps in medical settings for improving health, evidence supporting their effectiveness in the psychoeducation of patients with breast cancer is rarely available. Objective: This study was conducted to investigate the effect of psychoeducational interventions on anxiety and self-esteem in women with breast cancer using a mobile app and an online support group. Methods: An unblinded randomized controlled trial based on mobile phones was conducted in Shiraz, Iran. A research assistant recruited 82 women with nonmetastatic breast cancer aged 20 to 60 years were from clinics during a face-to-face visit at the point of care and randomly assigned to an intervention group (n=41) and a wait-list control group (n=41) through blocked randomization. The intervention group received psychoeducational interventions through a mobile phone app and participated in nurse-assisted online mobile support sessions for a total four weeks, whereas the control group was put on a waiting list. The State-Trait Anxiety Inventory (STAI) and the Rosenberg Self-Esteem Scale (RSES) were used to measure the levels of anxiety and self-esteem as the main outcomes at baseline and one week after the intervention. Results: A total of 82 patients with a mean age of 46.45 (SD 9.29) years recruited in Winter 2016 were randomly assigned to a wait-list control group (n=41) and intervention group (n=41). Five patients dropped out for different reasons. Comparing the postintervention mean scores of anxiety and its subscales using the independent t test showed statistically significant differences between the mobile psychoeducation group and controls (P<.001). The paired t test used to compare the postintervention mean scores of anxiety with its preintervention scores in the intervention group showed significant reductions in the scores of anxiety (95% CI –17.44 to –8.90, P<.001, d=1.02) and its two subscales (state anxiety: 95% CI –9.20 to –4.21, P<.001, d=0.88 and trait anxiety: 95% CI –8.50 to –4.12, P<.001, d=0.94). Comparing the postintervention mean scores of self-esteem showed statistically insignificant differences between the control and intervention groups (16.87 vs 17.97, P=.24). In contrast with the controls, using the paired t test showed that the increase in the postintervention mean scores of self-esteem were statistically significant in the intervention group compared with the preintervention scores (mean difference 2.05, 95% CI 1.28 to 2.82, P<.001). Conclusions: This study demonstrated the key role of mobile apps in decreasing anxiety and improving self-esteem in women with breast cancer through psychoeducational interventions. Similar studies with longer follow-ups are recommended that be conducted in this context. Trial Registration: Iranian Registry of Clinical Trials IRCT2015072123279N2; https://en.irct.ir/trial/19882 %M 34003138 %R 10.2196/19262 %U https://mhealth.jmir.org/2021/5/e19262 %U https://doi.org/10.2196/19262 %U http://www.ncbi.nlm.nih.gov/pubmed/34003138 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e28668 %T A Breast Cancer Smartphone App to Navigate the Breast Cancer Journey: Mixed Methods Study %A Petrocchi,Serena %A Filipponi,Chiara %A Montagna,Giacomo %A Bonollo,Marta %A Pagani,Olivia %A Meani,Francesco %+ Department of Obstetrics and Gynecology, Centro di Senologia della Svizzera Italiana, Ente Ospedaliero Cantonale, Via Capelli 1, Viganello, 6962, Switzerland, 41 091 811 63 08, [email protected] %K breast cancer %K decision-making process %K breast cancer patient %K smartphone app %K empowerment %K breast cancer journey %K mobile app %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Several mobile apps have been designed for patients with a diagnosis of cancer. Unfortunately, despite the promising potential and impressive spread, their effectiveness often remains unclear. Most mobile apps are developed without any medical professional involvement and quality evidence-based assessment. Furthermore, they are often implemented in clinical care before any research is performed to confirm usability, appreciation, and clinical benefits for patients. Objective: We aimed to develop a new smartphone app (Centro di Senologia della Svizzera Italiana [CSSI]) specifically designed by breast care specialists and patients together to help breast cancer patients better understand and organize their journey through the diagnosis and treatment of cancer. We describe the development of the app and present assessments to evaluate its feasibility, usefulness, and capability to improve patient empowerment. Methods: A mixed method study with brief longitudinal quantitative data collection and subsequent qualitative semistructured interviews was designed. Twenty breast cancer patients participated in the study (mean age 51 years, SD 10 years). The usability of the app, the user experience, and empowerment were measured after 1 month. The semistructured interviews measured the utility of the app and the necessary improvements. Results: The app received good responses from the patients in terms of positive perception of the purpose of the app (7/20, 35%), organizing the cure path and being aware of the steps in cancer management (5/20, 25%), facilitating doctor-patient communication (4/20, 20%), and having detailed information about the resources offered by the hospital (2/20, 10%). Correlation and regression analyses showed that user experience increased the level of empowerment of patients (B=0.31, 95% CI 0.22-0.69; P=.009). The interviews suggested the need to constantly keep the app updated and to synchronize it with the hospital’s electronic agenda, and carefully selecting the best time to offer the tool to final users was considered crucial. Conclusions: Despite the very small number of participants in this study, the findings demonstrate the potential of the app and support a fully powered trial to evaluate the empowering effect of the mobile health app. More data will be gathered with an improved version of the app in the second phase involving a larger study sample. %M 33970120 %R 10.2196/28668 %U https://formative.jmir.org/2021/5/e28668 %U https://doi.org/10.2196/28668 %U http://www.ncbi.nlm.nih.gov/pubmed/33970120 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24254 %T A Technology-Based Physical Activity Intervention for Patients With Metastatic Breast Cancer (Fit2ThriveMB): Protocol for a Randomized Controlled Trial %A Phillips,Siobhan %A Solk,Payton %A Welch,Whitney %A Auster-Gussman,Lisa %A Lu,Marilyn %A Cullather,Erin %A Torre,Emily %A Whitaker,Madelyn %A Izenman,Emily %A La,Jennifer %A Lee,Jungwha %A Spring,Bonnie %A Gradishar,William %+ Northwestern University Feinberg School of Medicine, 680 N Lake Shore Drive, Suite 1400, Chicago, IL, 60611-4407, United States, 1 13125034235, [email protected] %K physical activity %K metastatic breast cancer %K technology %K randomized controlled trial %K mobile phone %D 2021 %7 23.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Increased incidence and life expectancy have resulted in a growing population of patients with metastatic breast cancer, and these patients experience high rates of morbidity and premature mortality. Increased physical activity (PA) is consistently associated with improved health and disease outcomes among early-stage survivors. However, there is a paucity of research on PA in patients with metastatic breast cancer, and existing PA interventions have exhibited low feasibility because of their focus on intense PA and/or requirement of on-site visits. Mobile health (mHealth)–based PA interventions may be particularly useful for patients with metastatic breast cancer because they allow for remote monitoring, which facilitates individual tailoring of PA recommendations to patients’ abilities and may minimize participant burden. However, no studies have examined mHealth PA interventions in patients with metastatic breast cancer. Objective: We aim to address these critical research gaps by testing a highly tailored technology-based intervention to promote PA of any intensity (ie, light, moderate, or vigorous) by increasing daily steps in patients with metastatic breast cancer. The primary aim of this study is to test the feasibility and acceptability of the Fit2ThriveMB intervention. We will also examine outcome patterns suggesting the efficacy of Fit2ThriveMB on symptom burden, quality of life, and functional performance. Methods: The Fit2ThriveMB trial is a two-arm pilot randomized controlled trial that will compare the effects of a smartphone-delivered, home-based PA intervention and an attention-control education condition on PA and quality of life in low-active female patients with metastatic breast cancer. A subsample (n=25) will also complete functional performance measures. This innovative trial will recruit 50 participants who will be randomized into the study’s intervention or control arm. The intervention will last 12 weeks. The Fit2ThriveMB intervention consists of a Fitbit, coaching calls, and the Fit2ThriveMB smartphone app that provides self-monitoring, a tailored goal-setting tool, real-time tailored feedback, app notifications, and a group message board. Assessments will occur at baseline and post intervention. Results: The Fit2ThriveMB study is ongoing. Data collection ended in February 2021. Conclusions: Data from this study will provide the preliminary effect sizes needed to assemble an intervention that is to be evaluated in a fully powered trial. In addition, these data will provide essential evidence to support the feasibility and acceptability of using a technology-based PA promotion intervention, a scalable strategy that could be easily integrated into care, among patients with metastatic breast cancer. Trial Registration: ClinicalTrials.gov NCT04129346; https://clinicaltrials.gov/ct2/show/NCT04129346 International Registered Report Identifier (IRRID): DERR1-10.2196/24254 %M 33890857 %R 10.2196/24254 %U https://www.researchprotocols.org/2021/4/e24254 %U https://doi.org/10.2196/24254 %U http://www.ncbi.nlm.nih.gov/pubmed/33890857 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e23304 %T A Modular Mobile Health App for Personalized Rehabilitation Throughout the Breast Cancer Care Continuum: Development Study %A Lim,Ji Young %A Kim,Jong Kwang %A Kim,Yoon %A Ahn,So-Yeon %A Yu,Jonghan %A Hwang,Ji Hye %+ Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Irwon-Ro 81, Gangnam-Gu, Seoul, 06351, Republic of Korea, 82 2 3410 2816, [email protected] %K breast cancer %K mobile health %K rehabilitation %K cancer continuum %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although many mobile health (mHealth) apps have evolved as support tools for self-management of breast cancer, limited studies have developed a comprehensive app and described the algorithms for personalized rehabilitation throughout the breast cancer care continuum. Objective: This study aimed to develop a comprehensive mobile app and to describe an algorithm that adjusts personalized content to facilitate self-management throughout the breast cancer care continuum. Methods: The development process of the modular mHealth app included the following 4 steps: (1) organizing expert teams, (2) defining evidence-based fundamental content and modules, (3) classifying user information for algorithms to personalize the content, and (4) creating the app platform and connectivity to digital health care devices. Results: We developed a modular mHealth app service, which took 18 months, including a review of related literature and guidelines and the development of the app and connectivity to digital health care devices. A total of 11 functionalities were defined in the app with weekly analysis. The user information classification was formulated for personalized rehabilitation according to 5 key criteria: general user information, breast operation type, lymph node surgery type, chemotherapy and hormonal therapy use, and change in treatment after surgery. The main modules for personalized content included a self-monitoring screen, personalized health information, personalized exercise, and diet management. Conclusions: The strength of this study was the development of a comprehensive mHealth app and algorithms to adjust content based on user medical information for personalized rehabilitation during the breast cancer care continuum. %M 33847589 %R 10.2196/23304 %U https://formative.jmir.org/2021/4/e23304 %U https://doi.org/10.2196/23304 %U http://www.ncbi.nlm.nih.gov/pubmed/33847589 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e27767 %T Accuracy of an Artificial Intelligence System for Cancer Clinical Trial Eligibility Screening: Retrospective Pilot Study %A Haddad,Tufia %A Helgeson,Jane M %A Pomerleau,Katharine E %A Preininger,Anita M %A Roebuck,M Christopher %A Dankwa-Mullan,Irene %A Jackson,Gretchen Purcell %A Goetz,Matthew P %+ Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 284 3731, [email protected] %K clinical trial matching %K clinical decision support system %K machine learning %K artificial intelligence %K screening %K clinical trials %K eligibility %K breast cancer %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Screening patients for eligibility for clinical trials is labor intensive. It requires abstraction of data elements from multiple components of the longitudinal health record and matching them to inclusion and exclusion criteria for each trial. Artificial intelligence (AI) systems have been developed to improve the efficiency and accuracy of this process. Objective: This study aims to evaluate the ability of an AI clinical decision support system (CDSS) to identify eligible patients for a set of clinical trials. Methods: This study included the deidentified data from a cohort of patients with breast cancer seen at the medical oncology clinic of an academic medical center between May and July 2017 and assessed patient eligibility for 4 breast cancer clinical trials. CDSS eligibility screening performance was validated against manual screening. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value for eligibility determinations were calculated. Disagreements between manual screeners and the CDSS were examined to identify sources of discrepancies. Interrater reliability between manual reviewers was analyzed using Cohen (pairwise) and Fleiss (three-way) κ, and the significance of differences was determined by Wilcoxon signed-rank test. Results: In total, 318 patients with breast cancer were included. Interrater reliability for manual screening ranged from 0.60-0.77, indicating substantial agreement. The overall accuracy of breast cancer trial eligibility determinations by the CDSS was 87.6%. CDSS sensitivity was 81.1% and specificity was 89%. Conclusions: The AI CDSS in this study demonstrated accuracy, sensitivity, and specificity of greater than 80% in determining the eligibility of patients for breast cancer clinical trials. CDSSs can accurately exclude ineligible patients for clinical trials and offer the potential to increase screening efficiency and accuracy. Additional research is needed to explore whether increased efficiency in screening and trial matching translates to improvements in trial enrollment, accruals, feasibility assessments, and cost. %M 33769304 %R 10.2196/27767 %U https://medinform.jmir.org/2021/3/e27767 %U https://doi.org/10.2196/27767 %U http://www.ncbi.nlm.nih.gov/pubmed/33769304 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 1 %P e23927 %T Use of mHealth to Increase Physical Activity Among Breast Cancer Survivors With Fatigue: Qualitative Exploration %A Martin,Elise %A Di Meglio,Antonio %A Charles,Cecile %A Ferreira,Arlindo %A Gbenou,Arnauld %A Blond,Marine %A Fagnou,Benoit %A Arvis,Johanna %A Pistilli,Barbara %A Saghatchian,Mahasti %A Vaz Luis,Ines %+ Institute Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, , France, 33 078 740 9282, [email protected] %K mHealth %K physical activity %K breast cancer %K cancer-related fatigue %K qualitative study %K survivorship %D 2021 %7 22.3.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Physical activity has shown beneficial effects in the treatment of breast cancer fatigue; nevertheless, a significant portion of patients remain insufficiently physically active after breast cancer. Currently most patients have a smartphone, and therefore mobile health (mHealth) holds the promise of promoting health behavior uptake for many of them. Objective: In this study, we explored representations, levers, and barriers to physical activity and mHealth interventions among inactive breast cancer patients with fatigue. Methods: This was an exploratory, qualitative study including breast cancer patients from a French cancer center. A total of 4 focus groups were conducted with 9 patients; 2 independent groups of patients (groups A and B) were interviewed at 2 consecutive times (sessions 1 to 4), before and after their participation in a 2-week mHealth group experience consisting of (1) a competitive virtual exercise group activity (a fictitious world tour), (2) participation in a daily chat network, and (3) access to physical activity information and world tour classification feedback. We used a thematic content analysis. Results: Several physical activity levers emerged including (1) physical factors such as perception of physical benefit and previous practice, (2) psychological factors such as motivation increased by provider recommendations, (3) social factors such as group practice, and (4) organizational factors including preplanning physical activity sessions. The main barriers to physical activity identified included late effects of cancer treatment, lack of motivation, and lack of time. The lack of familiarity with connected devices was perceived as the main barrier to the use of mHealth as a means to promote physical activity. The tested mHealth group challenge was associated with several positive representations including well-being and good habit promotion and being a motivational catalyzer. Following feedback, modifications were implemented into the mHealth challenge. Conclusions: mHealth-based, easily accessed group challenges were perceived as levers for the practice of physical activity in this population. mHealth-based group challenges should be explored as options to promote physical activity in a population with fatigue after breast cancer. %M 33749606 %R 10.2196/23927 %U https://cancer.jmir.org/2021/1/e23927 %U https://doi.org/10.2196/23927 %U http://www.ncbi.nlm.nih.gov/pubmed/33749606 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24926 %T Developing a Web-Based Shared Decision-Making Tool for Fertility Preservation Among Reproductive-Age Women With Breast Cancer: An Action Research Approach %A Tseng,Ling-Ming %A Lien,Pei-Ju %A Huang,Chen-Yu %A Tsai,Yi-Fang %A Chao,Ta-Chung %A Huang,Sheng-Miauh %+ MacKay Medical College, Department of Nursing, No. 46, Section 3, Zhongzheng Road, Sanzhi District, New Taipei City, 252, Taiwan, 886 2 26360303 ext 1316, [email protected] %K breast cancer %K shared decision making %K website %K action research %K fertility preservation %D 2021 %7 17.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The pregnancy rate after cancer treatment for female survivors is lower than that of the general population. Future infertility is a significant concern for patients with breast cancer and is associated with a poor quality of life. Reproductive-age patients with breast cancer have safe options when choosing a type of fertility preservation method to be applied. Better information and support resources aimed at women to support their decision making are needed. Objective: The objective of this study was to develop a web-based shared decision-making tool for helping patients with breast cancer make decisions on fertility preservation. Methods: We used the action research cycle of observing, reflecting, planning, and acting to develop a web-based shared decision-making tool. The following four phrases were applied: (1) observe and reflect—collect and analyze the decision-making experiences of patients and health care providers; (2) reflect and plan—apply the initial results to create a paper design and modify the content; (3) plan and act—brainstorm about the web pages and modify the content; (4) act and observe—evaluate the effectiveness and refine the website’s shared decision-making tool. Interviews, group meetings, and constant dialogue were conducted between the various participants at each step. Effectiveness was evaluated using the Preparation for Decision-Making scale. Results: Five major parts were developed with the use of the action research approach. The Introduction (part 1) describes the severity of cancer treatment and infertility. Options (part 2) provides the knowledge of fertility preservation. The shared decision-making tool was designed as a step-by-step process (part 3) that involves the comparison of options, patient values, and preferences; their knowledge regarding infertility and options; and reaching a collective decision. Resources (part 4) provides information on the hospitals that provide such services, and References (part 5) lists all the literature cited in the website. The results show the web-based shared decision-making meets both patients’ and health providers’ needs and helps reproductive-age patients with breast cancer make decisions about fertility preservation. Conclusions: We have created the first web-based shared decision-making tool for making fertility preservation decisions in Taiwan. We believe female patients of reproductive age will find the tool useful and its use will become widespread, which should increase patient autonomy and improve communication about fertility preservation with clinicians. Trial Registration: Clinicaltrials.gov NCT04602910; https://clinicaltrials.gov/ct2/show/NCT04602910 %M 33729164 %R 10.2196/24926 %U https://www.jmir.org/2021/3/e24926 %U https://doi.org/10.2196/24926 %U http://www.ncbi.nlm.nih.gov/pubmed/33729164 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 1 %P e26950 %T Effect of Collaborative Review of Electronic Patient-Reported Outcomes for Shared Reporting in Breast Cancer Patients: Descriptive Comparative Study %A Trojan,Andreas %A Bättig,Basil %A Mannhart,Meinrad %A Seifert,Burkhardt %A Brauchbar,Mathis N %A Egbring,Marco %+ OnkoZentrum Zürich, Seestrasse 259, Zürich, CH-8038, Switzerland, 41 763430200, [email protected] %K cancer %K Consilium Care %K smartphone app %K eHealth %K electronic patient-reported outcomes %K Common Terminology Criteria for Adverse Events %D 2021 %7 17.3.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Digital monitoring of treatment-related symptoms and self-reported patient outcomes is important for the quality of care among cancer patients. As mobile devices are ubiquitous nowadays, the collection of electronic patient-reported outcomes (ePROs) is gaining momentum. So far, data are lacking on the modalities that contribute to the quantity and quality of ePROs. Objective: The objective of our study was to compare the utilization of two versions of a subsequently employed mobile app for electronic monitoring of PROs and to test our hypothesis that a shared review of symptoms in patient-physician collaboration has an impact on the number of data entries. Methods: The Consilium Care app engages cancer patients to standardize reporting of well-being and treatment-related symptoms in outpatient settings. For descriptive comparison of the utilization of two slightly different app versions, data were obtained from an early breast cancer trial (version 1 of the app, n=86) and an ongoing study including patients with advanced disease (version 2 of the app, n=106). In both app versions, patients and doctors were allowed to share the information from data entries during consultations. Version 2 of the app, however, randomly selected symptoms that required a detailed and shared regular patient-doctor review in order to focus on the collection and appropriate interpretation regarding awareness and guidance for severity grading. The numbers and types of symptom entries, satisfaction with both app versions, and patients’ perceived effects during consultations were included for analysis. Results: Symptom severity grading was performed according to the Common Terminology Criteria for Adverse Events (CTCAE) using a horizontal slider and was indicated in descriptive terminology in both apps, while a graphical display facilitated the illustration of symptom history charts. In total, 192 patients electronically reported 11,437 data entries on well-being and 33,380 data entries on individual symptoms. Overall, 628 (of 872 intended) requested patient-doctor symptom reviews were performed in version 2 of the app. Both the amount of data entries per patient and day for well-being (version 1 vs version 2: 0.3 vs 1.0; P<.001) and symptoms (version 1 vs version 2: 1.3 vs 1.9; P=.04) appeared significantly increased in version 2 of the app. Overall satisfaction with both app versions was high, although version 2 of the app was perceived to be more helpful in general. Conclusions: Version 2 of the app showed much better results than version 1 of the app. A request for collaborative patient-doctor symptom review is likely to affect the number of digital symptom data entries. This app shows high potential to improve the patient-doctor experience. Trial Registration: ClinicalTrials.gov NCT02004496; https://clinicaltrials.gov/ct2/show/NCT02004496 and ClinicalTrials.gov NCT03578731; https://clinicaltrials.gov/ct2/show/NCT03578731 %M 33729162 %R 10.2196/26950 %U https://cancer.jmir.org/2021/1/e26950 %U https://doi.org/10.2196/26950 %U http://www.ncbi.nlm.nih.gov/pubmed/33729162 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e18325 %T Cognitive Bias Modification Training to Improve Implicit Vitality in Patients With Breast Cancer: App Design Using a Cocreation Approach %A Wolbers,Roos %A Bode,Christina %A Siemerink,Ester %A Siesling,Sabine %A Pieterse,Marcel %+ Centre for eHealth and Wellbeing Research, University of Twente, P.O. Box 217, Enschede, 7500 AE, Netherlands, 31 534896044, [email protected] %K breast cancer %K cognitive bias modification %K eHealth %K fatigue %K oncology %K psychology %K vitality %D 2021 %7 10.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: More than 50% of all patients with breast cancer experience fatigue symptoms during and after their treatment course. Recent evidence has shown that fatigue is partly driven by cognitive biases such as the self-as-fatigued identity bias, which may be corrected with computer-based cognitive bias modification (CBM) techniques. Objective: The aim of this study was to design a CBM-training app by adopting a cocreation approach. Methods: Semistructured interviews were conducted with 7 health care professionals, 3 patients with breast cancer, and 2 patient advocates. The aim of the interviews was to collect input for the design of the CBM training, taking the values and preferences of the stakeholders into account, and to determine the timing and implementation of the training in the treatment course. Results: Overall, the interviews showed that the concept of CBM was accepted among all stakeholders. Important requirements were revealed such as the training needs to be simple and undemanding, yet engaging and persuasive. Based on the results, an eHealth app IVY (Implicit VitalitY) was created. The findings from the interviews suggested that IVY should be offered early in the breast cancer treatment course and should be carefully aligned with clinical treatment. Conclusions: The findings of this study show that using CBM as a preventive approach to target cancer-related fatigue is an innovative technique, and this approach was embraced by breast cancer stakeholders. Our study suggests that CBM training has several benefits such as being easy to use and potentially increasing perceived self-control in patients. %M 33688833 %R 10.2196/18325 %U https://formative.jmir.org/2021/3/e18325 %U https://doi.org/10.2196/18325 %U http://www.ncbi.nlm.nih.gov/pubmed/33688833 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e18269 %T Comparative Analysis of Paper-Based and Web-Based Versions of the National Comprehensive Cancer Network-Functional Assessment of Cancer Therapy-Breast Cancer Symptom Index (NFBSI-16) Questionnaire in Breast Cancer Patients: Randomized Crossover Study %A Ma,Jinfei %A Zou,Zihao %A Pazo,Emmanuel Eric %A Moutari,Salissou %A Liu,Ye %A Jin,Feng %+ Department of Breast Surgery, The First Affiliated Hospital of China Medical University, No 155 Nanjing Road, Heping District, Shenyang, 110001, China, 86 18040031101, [email protected] %K breast cancer %K NFBSI-16 %K patient-reported outcome %K reproducibility %K test-retest reliability %K web-based questionnaire %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Breast cancer remains the most common neoplasm diagnosed among women in China and globally. Health-related questionnaire assessments in research and clinical oncology settings have gained prominence. The National Comprehensive Cancer Network–Functional Assessment of Cancer Therapy–Breast Cancer Symptom Index (NFBSI-16) is a rapid and powerful tool to help evaluate disease- or treatment-related symptoms, both physical and emotional, in patients with breast cancer for clinical and research purposes. Prevalence of individual smartphones provides a potential web-based approach to administrating the questionnaire; however, the reliability of the NFBSI-16 in electronic format has not been assessed. Objective: This study aimed to assess the reliability of a web-based NFBSI-16 questionnaire in breast cancer patients undergoing systematic treatment with a prospective open-label randomized crossover study design. Methods: We recruited random patients with breast cancer under systematic treatment from the central hospital registry to complete both paper- and web-based versions of the questionnaires. Both versions of the questionnaires were self-assessed. Patients were randomly assigned to group A (paper-based first and web-based second) or group B (web-based first and paper-based second). A total of 354 patients were included in the analysis (group A: n=177, group B: n=177). Descriptive sociodemographic characteristics, reliability and agreement rates for single items, subscales, and total score were analyzed using the Wilcoxon test. The Lin concordance correlation coefficient (CCC) and Spearman and Kendall Ï„ rank correlations were used to assess test-retest reliability. Results: Test-retest reliability measured with CCCs was 0.94 for the total NFBSI-16 score. Significant correlations (Spearman ρ) were documented for all 4 subscales—Disease-Related Symptoms Subscale–Physical (ρ=0.93), Disease-Related Symptoms Subscale–Emotional (ρ=0.85), Treatment Side Effects Subscale (ρ=0.95), and Function and Well-Being Subscale (ρ=0.91)—and total NFBSI-16 score (ρ=0.94). Mean differences of the test and retest were all close to zero (≤0.06). The parallel test-retest reliability of subscales with the Wilcoxon test comparing individual items found GP3 (item 5) to be significantly different (P=.02). A majority of the participants in this study (255/354, 72.0%) preferred the web-based over the paper-based version. Conclusions: The web-based version of the NFBSI-16 questionnaire is an excellent tool for monitoring individual breast cancer patients under treatment, with the majority of participants preferring it over the paper-based version. %M 33650978 %R 10.2196/18269 %U https://medinform.jmir.org/2021/3/e18269 %U https://doi.org/10.2196/18269 %U http://www.ncbi.nlm.nih.gov/pubmed/33650978 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25404 %T Husbands’ Knowledge of Breast Cancer and Their Wives’ Attitudes and Practices Related to Breast Cancer Screening in Saudi Arabia: Cross-sectional Online Survey %A Sabgul,Afnan Abdulnasir %A Qattan,Ameerah M N %A Hashmi,Rubayyat %A Al-Hanawi,Mohammed Khaled %+ Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, University Building 125, Faculties Street, Jeddah, 80200, Saudi Arabia, 966 556522222, [email protected] %K attitude %K breast cancer %K husbands %K knowledge %K Saudi Arabia %K screening %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite Saudi Arabia’s free and well-established cancer care program, breast cancer incidence and mortality are rising. Husbands’ knowledge, and wives’ attitudes and practices related to breast cancer screening are not well understood in Saudi Arabia. Objective: The aim of this study was to investigate husbands’ knowledge, and wives’ attitudes and practices related to breast cancer screening in Saudi Arabia. Methods: This cross-sectional study collected data from 403 husbands in the holy city of Makkah through an online self-reported questionnaire over a period of 2 months, from May 6 to July 7, 2020. Tabulation, bivariate, and multiple regression analyses were the major tools used for data analysis. Multivariate logistic regressions were used to examine the association between husbands’ knowledge and wives’ behavior regarding breast cancer screening methods. Results: Husbands’ knowledge score (a 1-point increase) was significantly associated with the wives’ utilization of mammograms (adjusted odds ratio [AOR] 1.089, 95% CI 1.024-1.159) and breast self-examination (AOR 1.177, 95% CI 1.105-1.255). Husbands’ knowledge also influenced the wives’ attitudes toward learning about breast self-examination (AOR 1.138, 95% CI 1.084-1.195). There was no significant association between husbands’ knowledge and wives’ utilization of clinical breast examination. However, richer husbands showed a socioeconomic gradient concerning their wives’ utilization of clinical breast examinations (AOR 2.603, 95% CI 1.269-5.341). Conclusions: Overall, husbands’ knowledge of breast cancer influences wives’ attitudes and practices related to breast cancer screening methods in Saudi Arabia. Thus, interventions delivered to husbands might increase breast cancer awareness and survival. %M 33629959 %R 10.2196/25404 %U https://www.jmir.org/2021/2/e25404 %U https://doi.org/10.2196/25404 %U http://www.ncbi.nlm.nih.gov/pubmed/33629959 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e25184 %T Preliminary Screening for Hereditary Breast and Ovarian Cancer Using a Chatbot Augmented Intelligence Genetic Counselor: Development and Feasibility Study %A Sato,Ann %A Haneda,Eri %A Suganuma,Nobuyasu %A Narimatsu,Hiroto %+ Department of Genetic Medicine, Kanagawa Cancer Center, 2-3-2 Nakao, Asahi-ku, Yokohama, Kanagawa, 241-8515, Japan, 81 045 520 2222, [email protected] %K artificial intelligence %K augmented intelligence %K hereditary cancer %K familial cancer %K IBM Watson %K preliminary screening %K cancer %K genetics %K chatbot %K screening %K feasibility %D 2021 %7 5.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Breast cancer is the most common form of cancer in Japan; genetic background and hereditary breast and ovarian cancer (HBOC) are implicated. The key to HBOC diagnosis involves screening to identify high-risk individuals. However, genetic medicine is still developing; thus, many patients who may potentially benefit from genetic medicine have not yet been identified. Objective: This study’s objective is to develop a chatbot system that uses augmented intelligence for HBOC screening to determine whether patients meet the National Comprehensive Cancer Network (NCCN) BRCA1/2 testing criteria. Methods: The system was evaluated by a doctor specializing in genetic medicine and certified genetic counselors. We prepared 3 scenarios and created a conversation with the chatbot to reflect each one. Then we evaluated chatbot feasibility, the required time, the medical accuracy of conversations and family history, and the final result. Results: The times required for the conversation were 7 minutes for scenario 1, 15 minutes for scenario 2, and 16 minutes for scenario 3. Scenarios 1 and 2 met the BRCA1/2 testing criteria, but scenario 3 did not, and this result was consistent with the findings of 3 experts who retrospectively reviewed conversations with the chatbot according to the 3 scenarios. A family history comparison ascertained by the chatbot with the actual scenarios revealed that each result was consistent with each scenario. From a genetic medicine perspective, no errors were noted by the 3 experts. Conclusions: This study demonstrated that chatbot systems could be applied to preliminary genetic medicine screening for HBOC. %M 33544084 %R 10.2196/25184 %U https://formative.jmir.org/2021/2/e25184 %U https://doi.org/10.2196/25184 %U http://www.ncbi.nlm.nih.gov/pubmed/33544084 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e17538 %T Patterns of Use of Smartphone-Based Interventions Among Latina Breast Cancer Survivors: Secondary Analysis of a Pilot Randomized Controlled Trial %A Baik,Sharon H %A Oswald,Laura B %A Buscemi,Joanna %A Buitrago,Diana %A Iacobelli,Francisco %A Perez-Tamayo,Alejandra %A Guitelman,Judith %A Penedo,Frank J %A Yanez,Betina %+ Department of Supportive Care Medicine, City of Hope, 1500 E Duarte Rd, Duarte, CA, 91010, United States, 1 626 256 4673, [email protected] %K breast cancer %K cancer survivorship %K Hispanics/Latinas %K eHealth %K psychosocial intervention %K mobile phone %D 2020 %7 8.12.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: Latina breast cancer survivors experience poorer health-related quality of life (HRQoL), greater symptom burden, and more psychosocial needs compared to non-Latina breast cancer survivors. eHealth platforms such as smartphone apps are increasingly being used to deliver psychosocial interventions to cancer survivors. However, few psychosocial eHealth interventions have been developed specifically for Latina breast cancer survivors. Further, little is known about how Latinas, in general, engage with eHealth interventions and whether specific participant characteristics are associated with app use in this population. We evaluated the use of 2 culturally informed, evidence-based smartphone apps for Latina breast cancer survivors—one that was designed to improve HRQoL and reduce symptom burden (My Guide) and the other to promote healthy lifestyle behaviors (My Health). Objective: The objectives of our study were to explore the patterns of use of the My Guide intervention app and My Health attention-control app among Latina breast cancer survivors. Methods: Eighty Latina breast cancer survivors were randomized to use the My Guide or My Health app for 6 weeks. Assessments were collected at baseline (T1), immediately after the 6-week intervention (T2), and 2 weeks after T2 (T3). Specific study outcomes included subdomains of HRQoL, symptom burden, cancer-specific distress, cancer-relevant self-efficacy, and breast cancer knowledge. Results: On average, participants used their assigned app for more than 1 hour per week. Sociodemographic or psychological characteristics were not significantly associated with app use, except for employment status in the My Health group. Content related to common physical and emotional symptoms of breast cancer survivors as well as recommendations for nutrition and physical activity were most frequently accessed by My Guide and My Health participants, respectively. Lastly, clinically meaningful improvements were demonstrated in breast cancer well-being among low app users (ie, <60 minutes of use/week) of My Guide and social well-being among high app users (ie, ≥60 minutes of use/week) of My Health. Conclusions: The favorable rates of participant use across both apps suggest that Latina breast cancer survivors are interested in the content delivered across both My Guide and My Health. Furthermore, since sociodemographic variables, excluding employment status, and baseline HRQoL (psychological variable) were not related to app use, My Guide and My Health may be accessible to diverse Latina breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT03645005; https://clinicaltrials.gov/ct2/show/NCT03645005 %M 33289669 %R 10.2196/17538 %U http://cancer.jmir.org/2020/2/e17538/ %U https://doi.org/10.2196/17538 %U http://www.ncbi.nlm.nih.gov/pubmed/33289669 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e22825 %T Evaluation of a Remote Symptom Assessment and Management (SAM) System for People Receiving Adjuvant Chemotherapy for Breast or Colorectal Cancer: Mixed Methods Study %A Whitehead,Lisa %A Emery,Laura %A Kirk,Deborah %A Twigg,Diane %A Brown,Deborah %A Dewar,Joanna %+ Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027, Australia, 61 63042641 ext 2641, [email protected] %K self-management %K intervention %K symptom management %K breast cancer %K colorectal cancer %K cancer %K symptom %K monitoring %K online intervention %K development %K implementation %K evaluation %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: The Symptom Assessment and Management (SAM) program is a structured, online, nurse-supported intervention to support symptom self-management in people receiving adjuvant chemotherapy post surgery for breast or colorectal cancer. Objective: The objective of this study was to describe the development, implementation strategy, and evaluation of the SAM system. Methods: The development of the SAM program involved 3 phases. In phase 1, the web app was developed through consultation with consumers and clinicians and of the literature to ensure that the system was evidence-based and reflected the realities of receiving treatment and supporting patients through treatment. In phase 2, 7 participants recorded the severity of 6 symptoms daily over the course of 1 cycle of chemotherapy. In phase 3, 17 participants recorded their symptoms daily over the course of 3 cycles of chemotherapy. Once symptoms were recorded, participants received immediate feedback on the severity of their symptoms and self-management recommendations, which could include seeking immediate medical attention. Data on quality of life, symptom burden, anxiety and depression, distress, and self-efficacy were collected during treatment; participants’ perceptions of the SAM program were evaluated following participation via interview. Results: The outcomes of the SAM project include the development of a system that is reliable and easy to use and navigate. Participants reported benefits related to using the SAM program that included feeling more in control of managing their symptoms and feeling reassured. Engagement with the system on a daily basis was variable, with some participants completing the symptom tracker daily and others engaging some of the time. The feedback from all participants was that the system was easy to navigate and the information was relevant and supportive. Conclusions: The SAM program has the potential to enhance the management of symptoms for people receiving chemotherapy treatment. The system creates an accurate repository of symptoms that can be accessed easily and highlight patterns in symptom experience. These can be shared with clinicians, with patient permission, to inform and support treatment plans. The potential to predict the risk of developing severe symptoms can be developed to anticipate the need for care and support. Further considerations on how to increase engagement with the system, the value of the system for people diagnosed with other tumor types and treatment regimes, and the incorporation of the system into everyday clinical practice are needed. %M 33284122 %R 10.2196/22825 %U http://cancer.jmir.org/2020/2/e22825/ %U https://doi.org/10.2196/22825 %U http://www.ncbi.nlm.nih.gov/pubmed/33284122 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e23414 %T Exploring Interactive Survivorship Care Plans to Support Breast Cancer Survivors: Protocol for a Randomized Controlled Trial %A Kapoor,Akshat %A Nambisan,Priya %+ Consumer Health Informatics Lab, Department of Health Services and Information Management, East Carolina University, 600 Moye Blvd MS 668, Greenville, NC, 27834-4300, United States, 1 252 744 6175, [email protected] %K breast cancer %K cancer survivorship %K self-management %K patient education %D 2020 %7 4.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Breast cancer is the most common form of cancer among American women, accounting for 23% of all cancer survivors nationally. Yet, the availability of adequate resources and tools for supporting breast cancer survivors has not kept up with the rapid advancement in treatment options, resulting in unmet supportive care needs, particularly among low-income and minority populations. This study explores an alternative means of delivering breast cancer survivorship care plans (SCPs), with the aim of improving survivor morbidity, patient knowledge, and self-management of treatment-related symptoms, as well as addressing inconsistencies in follow-up care visits. Objective: The overall goal of this study is to improve the uptake of SCP recommendations via an educational intervention for breast cancer survivors, to improve treatment-related morbidity, patient knowledge, self-management, and adherence to follow-up visits. The specific aims of the study are to (1) evaluate the feasibility of the online SCP, and (2) assess the impact of the online SCP on survivorship outcomes. Methods: We will enroll 50 breast cancer survivors who have completed initial breast cancer treatment into a 2-armed, randomized, waitlist-controlled pilot trial, and collect data at baseline and 6 months. For the first aim, we will use mixed methods, including surveys and personal interviews among the intervention group, to determine the feasibility of providing an online, interactive SCP (called ACESO) based on the survivors’ online user experience and their short-term adoption. For the secondary aim, we will compare the 2 groups to assess the primary outcomes of survivor knowledge, self-efficacy for self-management, perceived peer support, and adherence to SCP-recommended posttreatment follow-up visits to oncology and primary care; and the secondary outcomes of treatment-related morbidity (body weight, fatigue, depression, anxiety, sexual function, distress, and sleep quality). We assess these outcomes by using measurements from validated instruments with robust psychometric properties. Results: We have developed and refined the online breast cancer survivorship plan, ACESO, with consultation from breast cancer oncologists, nurses, and survivors. Approval for the study protocol has been obtained from the Institutional Review Board. An advisory board has also been established to provide oversight and recommendations on the conduct of the study. The study will be completed over a period of 2 years. Conclusions: The results of this pilot study will inform the feasibility and design of a larger-scale pragmatic trial to evaluate the impact of an online breast cancer SCP on treatment-related morbidity and self-efficacy for self-management. International Registered Report Identifier (IRRID): PRR1-10.2196/23414 %M 33274725 %R 10.2196/23414 %U https://www.researchprotocols.org/2020/12/e23414 %U https://doi.org/10.2196/23414 %U http://www.ncbi.nlm.nih.gov/pubmed/33274725 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e18056 %T Effects of Radiation Therapy and Comorbidity on Health-Related Quality of Life and Mortality Among Older Women With Low-Risk Breast Cancer: Protocol for a Retrospective Cohort Study %A Lee,Eunkyung %A Hines,Robert B %A Wright,Jean L %A Nam,Eunji %A Rovito,Michael J %A Liu,Xinliang %+ College of Health Professions and Sciences, University of Central Florida, 4364 Scorpius Street, Orlando, FL, 32816, United States, 1 4078233365, [email protected] %K radiation therapy %K comorbidity %K health-related quality of life %K survival %K early-stage breast cancer %K older women %D 2020 %7 12.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The National Comprehensive Cancer Network Breast Cancer Guidelines Committee suggests that the omission of adjuvant radiation therapy (RT) after breast-conserving surgery can be a reasonable option among older women with low-risk breast cancer (early-stage, estrogen receptor-positive, and node-negative) if they are treated with endocrine therapy. However, RT usage in this group of women still exceeds 50%. Conversely, older women tend to forego RT (even when necessary) due to cost, inconvenience, and potential adverse responses associated with RT. Understanding health-related quality of life (HRQOL) change with receipt of RT among older women in the modern era is limited due to the under-representation of this population in clinical trials. Objective: The proposed study aims to examine the associations of RT with HRQOL trajectories as well as survival outcomes among older women with 5-10 years of follow-up. We will also assess whether prediagnosis comorbidity burden influences receipt of RT and whether the associations between RT and HRQOL trajectory and survival outcomes are modified by the comorbidity burden. Methods: We will use a retrospective cohort study design with the population-based Surveillance, Epidemiology, and End-Results database linked to the Medicare Health Outcomes Survey (SEER-MHOS). Older women (≥65 years) who were diagnosed with low-risk breast cancer in 1998-2014, received breast-conserving surgery, and participated in MHOS 1998-2016 are eligible for this analysis. The latent class analysis clustering method will be used to identify each patient’s prediagnosis comorbidity burden, and HRQOL will be evaluated using the Short Form 36/Veterans RAND 12-Item Health Survey scales. The inverse-weighted estimates of the probability of treatment will be included to control for treatment selection bias and confounding effects in subsequent analysis. The association of RT with HRQOL trajectory will be evaluated using inverse-weighted multilevel growth mixture models. The inverse-weighted Cox regression model will be used to obtain hazard ratios with 95% CIs for the association of RT with survival outcomes. Differential effects of RT on both outcomes according to comorbidity burden class will also be evaluated. Results: As of October 2020, the study was approved by the institutional review board, and SEER-MHOS data were obtained from the National Cancer Institute. Women with low-risk breast cancer who met inclusion and exclusion criteria have been identified, and prediagnosis comorbidity burden class has been characterized using latent class analysis. Further data analysis will begin in November 2020, and the first manuscript will be submitted in a peer-reviewed journal in February 2021. Conclusions: This research can potentially improve clinical outcomes of older women with low-risk breast cancer by providing them additional information on the HRQOL trajectories when they make RT treatment decisions. It will facilitate informed, shared treatment decision making and cancer care planning to ultimately improve the HRQOL of older women with breast cancer. International Registered Report Identifier (IRRID): DERR1-10.2196/18056 %M 33090111 %R 10.2196/18056 %U http://www.researchprotocols.org/2020/11/e18056/ %U https://doi.org/10.2196/18056 %U http://www.ncbi.nlm.nih.gov/pubmed/33090111 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 11 %P e19069 %T Multidimensional Machine Learning Personalized Prognostic Model in an Early Invasive Breast Cancer Population-Based Cohort in China: Algorithm Validation Study %A Zhong,Xiaorong %A Luo,Ting %A Deng,Ling %A Liu,Pei %A Hu,Kejia %A Lu,Donghao %A Zheng,Dan %A Luo,Chuanxu %A Xie,Yuxin %A Li,Jiayuan %A He,Ping %A Pu,Tianjie %A Ye,Feng %A Bu,Hong %A Fu,Bo %A Zheng,Hong %+ Laboratory of Molecular Diagnosis of Cancer, Clinical Research Center for Breast, West China Hospital, Sichuan University, 37 Guoxuexiang, Wuhou District, Chengdu, China, 86 2885422685, [email protected] %K breast cancer %K prognosis %K machine learning %K prediction model %D 2020 %7 9.11.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Current online prognostic prediction models for breast cancer, such as Adjuvant! Online and PREDICT, are based on specific populations. They have been well validated and widely used in the United States and Western Europe; however, several validation attempts in non-European countries have revealed suboptimal predictions. Objective: We aimed to develop an advanced breast cancer prognosis model for disease progression, cancer-specific mortality, and all-cause mortality by integrating tumor, demographic, and treatment characteristics from a large breast cancer cohort in China. Methods: This study was approved by the Clinical Test and Biomedical Ethics Committee of West China Hospital, Sichuan University on May 17, 2012. Data collection for this project was started in May 2017 and ended in March 2019. Data on 5293 women diagnosed with stage I to III invasive breast cancer between 2000 and 2013 were collected. Disease progression, cancer-specific mortality, all-cause mortality, and the likelihood of disease progression or death within a 5-year period were predicted. Extreme gradient boosting was used to develop the prediction model. Model performance was assessed by calculating the area under the receiver operating characteristic curve (AUROC), and the model was calibrated and compared with PREDICT. Results: The training, test, and validation sets comprised 3276 (499 progressions, 202 breast cancer-specific deaths, and 261 all-cause deaths within 5-year follow-up), 1405 (211 progressions, 94 breast cancer-specific deaths, and 129 all-cause deaths), and 612 (109 progressions, 33 breast cancer-specific deaths, and 37 all-cause deaths) women, respectively. The AUROC values for disease progression, cancer-specific mortality, and all-cause mortality were 0.76, 0.88, and 0.82 for training set; 0.79, 0.80, and 0.83 for the test set; and 0.79, 0.84, and 0.88 for the validation set, respectively. Calibration analysis demonstrated good agreement between predicted and observed events within 5 years. Comparable AUROC and calibration results were confirmed in different age, residence status, and receptor status subgroups. Compared with PREDICT, our model showed similar AUROC and improved calibration values. Conclusions: Our prognostic model exhibits high discrimination and good calibration. It may facilitate prognosis prediction and clinical decision making for patients with breast cancer in China. %M 33164899 %R 10.2196/19069 %U http://medinform.jmir.org/2020/11/e19069/ %U https://doi.org/10.2196/19069 %U http://www.ncbi.nlm.nih.gov/pubmed/33164899 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e17524 %T Microwave Breast Imaging Using Rotational Bistatic Impulse Radar for the Detection of Breast Cancer: Protocol for a Prospective Diagnostic Study %A Sasada,Shinsuke %A Masumoto,Norio %A Song,Hang %A Emi,Akiko %A Kadoya,Takayuki %A Arihiro,Koji %A Kikkawa,Takamaro %A Okada,Morihito %+ Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan, 81 82 257 5869, [email protected] %K breast cancer %K microwave imaging %K diagnostic accuracy %K screening %K ultra-wideband radar %D 2020 %7 19.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mammography is the standard examination for breast cancer screening; however, it is associated with pain and exposure to ionizing radiation. Microwave breast imaging is a less invasive method for breast cancer surveillance. A bistatic impulse radar–based breast cancer detector has recently been developed. Objective: This study aims to present a protocol for evaluating the diagnostic accuracy of the novel microwave breast imaging device. Methods: This is a prospective diagnostic study. A total of 120 participants were recruited before treatment administration and divided into 2 cohorts: 100 patients diagnosed with breast cancer and 20 participants with benign breast tumors. The detector will be directly placed on each breast, while the participant is in supine position, without a coupling medium. Confocal images will be created based on the analyzed data, and the presence of breast tumors will be assessed. The primary endpoint will be the diagnostic accuracy, sensitivity, and specificity of the detector for breast cancer and benign tumors. The secondary endpoint will be the safety and detectability of each molecular subtype of breast cancer. For an exploratory endpoint, the influence of breast density and tumor size on tumor detection will be investigated. Results: Recruitment began in November 2018 and was completed by March 2020. We anticipate the preliminary results to be available by summer 2021. Conclusions: This study will provide insights on the diagnostic accuracy of microwave breast imaging using a rotational bistatic impulse radar. The collected data will improve the diagnostic algorithm of microwave imaging and lead to enhanced device performance. Trial Registration: Japan Registry of Clinical Trials jRCTs062180005; https://jrct.niph.go.jp/en-latest-detail/jRCTs062180005 International Registered Report Identifier (IRRID): DERR1-10.2196/17524 %M 33074156 %R 10.2196/17524 %U http://www.researchprotocols.org/2020/10/e17524/ %U https://doi.org/10.2196/17524 %U http://www.ncbi.nlm.nih.gov/pubmed/33074156 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19668 %T Xigua Video as a Source of Information on Breast Cancer: Content Analysis %A Pan,Peng %A Yu,Changhua %A Li,Tao %A Zhou,Xilei %A Dai,Tingting %A Tian,Hanhan %A Xiong,Yaozu %+ Department of Radiation Oncology, The Affiliated Huaian No 1 People's Hospital of Nanjing Medical University, Jiangsu province, Radiotherapy Department Building, 4th floor, Huaian , China, 86 517 8490 7286, [email protected] %K breast cancer %K internet %K Xigua Video %K content analysis %D 2020 %7 29.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Seeking health information on the internet is a popular trend. Xigua Video, a short video platform in China, ranks among the most accessed websites in the country and hosts an increasing number of videos with medical information. However, the nature of these videos is frequently unscientific, misleading, or even harmful. Objective: Little is known about Xigua Video as a source of information on breast cancer. Thus, the study aimed to investigate the contents, quality, and reliability of breast cancer–related content on Xigua Video. Methods: On February 4, 2020, a Xigua Video search was performed using the keyword “breast cancer.” Videos were categorized by 2 doctors based on whether the video content provided useful or misleading information. Furthermore, the reliability and quality of the videos were assessed using the 5-point DISCERN tool and 5-point global quality score criteria. Results: Out of the 170 videos selected for the study, 64 (37.6%) were classified as useful, whereas 106 (62.4%) provided misleading information. A total of 41.8% videos (71/170) were generated by individuals compared to 19.4% videos (33/170) contributed by health care professionals. The topics mainly covered etiology, anatomy, symptoms, preventions, treatments, and prognosis. The top topic was “treatments” (119/170, 70%). The reliability scores and global quality scores of the videos in the useful information group were high (P<.001). No differences were observed between the 2 groups in terms of video length, duration in months, and comments. The number of total views was higher for the misleading information group (819,478.5 vs 647,940) but did not reach a level of statistical significance (P=.112). The uploading sources of the videos were mainly health care professionals, health information websites, medical advertisements, and individuals. Statistical differences were found between the uploading source groups in terms of reliability scores and global quality scores (P<.001). In terms of total views, video length, duration, and comments, no statistical differences were indicated among the said groups. However, a statistical difference was noted between the useful and misleading information video groups with respect to the uploading sources (P<.001). Conclusions: A large number of Xigua videos pertaining to breast cancer contain misleading information. There is a need for accurate health information to be provided on Xigua Video and other social media; health care professionals should address this challenge. %M 32883651 %R 10.2196/19668 %U http://www.jmir.org/2020/9/e19668/ %U https://doi.org/10.2196/19668 %U http://www.ncbi.nlm.nih.gov/pubmed/32883651 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 9 %P e21584 %T Breast Self-Examination System Using Multifaceted Trustworthiness: Observational Study %A Khana,Rajes %A Mahinderjit Singh,Manmeet %A Damanhoori,Faten %A Mustaffa,Norlia %+ Universiti Sains Malaysia, Jalan Sungai Dua, Gelugor, Penang, 11800, Malaysia, 60 46533888, [email protected] %K trust %K trustworthiness %K multifaceted trust %K breast self-examination %K breast cancer %K health care system %K social media %D 2020 %7 23.9.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Breast cancer is the leading cause of mortality among women worldwide. However, female patients often feel reluctant and embarrassed about meeting physicians in person to discuss their intimate body parts, and prefer to use social media for such interactions. Indeed, the number of patients and physicians interacting and seeking information related to breast cancer on social media has been growing. However, a physician may behave inappropriately on social media by sharing a patient’s personal medical data excessively with colleagues or the public. Such an act would reduce the physician’s trustworthiness from the patient’s perspective. The multifaceted trust model is currently most commonly used for investigating social media interactions, which facilitates its enhanced adoption in the context of breast self-examination. The characteristics of the multifaceted trust model go beyond being personalized, context-dependent, and transitive. This model is more user-centric, which allows any user to evaluate the interaction process. Thus, in this study, we explored and evaluated use of the multifaceted trust model for breast self-examination as a more suitable trust model for patient-physician social media interactions in breast cancer screening. Objective: The objectives of this study were: (1) to identify the trustworthiness indicators that are suitable for a breast self-examination system, (2) design and propose a breast self-examination system, and (3) evaluate the multifaceted trustworthiness interaction between patients and physicians. Methods: We used a qualitative study design based on open-ended interviews with 32 participants (16 outpatients and 16 physicians). The interview started with an introduction to the research objective and an explanation of the steps on how to use the proposed breast self-examination system. The breast self-examination system was then evaluated by asking the patient to rate their trustworthiness with the physician after the consultation. The evaluation was also based on monitoring the activity in the chat room (interactions between physicians and patients) during daily meetings, weekly meetings, and the articles posted by the physician in the forum. Results: Based on the interview sessions with 16 physicians and 16 patients on using the breast self-examination system, honesty had a strong positive correlation (r=0.91) with trustworthiness, followed by credibility (r=0.85), confidence (r=0.79), and faith (r=0.79). In addition, belief (r=0.75), competency (r=0.73), and reliability (r=0.73) were strongly correlated with trustworthiness, with the lowest correlation found for reputation (r=0.72). The correlation among trustworthiness indicators was significant (P<.001). Moreover, the trust level of a patient for a particular physician was found to increase after several interactions. Conclusions: Multifaceted trustworthiness has a significant impact on a breast self-examination system. Evaluation of trustworthiness indicators helps to ensure a trustworthy system and ethical interaction between a patient and physician. A new patient can obtain a consultation by referring to the best physician according to preference of other patients. Patients can also trust a physician based on another patient’s recommendation regarding the physician’s trust level. The correlation analysis further showed that the most preferred trustworthiness indicator is honesty. %M 32965225 %R 10.2196/21584 %U https://medinform.jmir.org/2020/9/e21584 %U https://doi.org/10.2196/21584 %U http://www.ncbi.nlm.nih.gov/pubmed/32965225 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e18867 %T Breast Cancer Survivors’ Perspectives on Motivational and Personalization Strategies in Mobile App–Based Physical Activity Coaching Interventions: Qualitative Study %A Monteiro-Guerra,Francisco %A Signorelli,Gabriel Ruiz %A Rivera-Romero,Octavio %A Dorronzoro-Zubiete,Enrique %A Caulfield,Brian %+ Salumedia Tecnologías, Avda. República Argentina, nº 24 Edificio Torre de los Remedios, 5ª planta - módulo A, Seville, 41011, Spain, 34 672787858, [email protected] %K mHealth %K mobile app %K mobile phone %K coaching %K physical activity %K breast cancer %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite growing evidence supporting the vital benefits of physical activity (PA) for breast cancer survivors, the majority do not meet the recommended levels of activity. Mobile app–based PA coaching interventions might be a feasible strategy to facilitate adherence of breast cancer survivors to the PA guidelines. To engage these individuals, PA apps need to be specifically designed based on their needs and preferences and to provide targeted support and motivation. However, more information is needed to understand how these technologies can provide individual and relevant experiences that have the ability to increase PA adherence and retain the individual’s interest in the long term. Objective: The aim of this study is to explore insights from breast cancer survivors on motivational and personalization strategies to be used in PA coaching apps and interventions. Methods: A qualitative study was conducted, using individual semistructured interviews, with 14 breast cancer survivors. The moderator asked open-ended questions and made use of a slideshow presentation to elicit the participants’ perspectives on potential mobile app–based intervention features. Transcribed interviews were evaluated by 3 reviewers using thematic content analysis. Results: Participants (mean age 53.3, SD 8.7 years) were White women. In total, 57% (8/14) of the participants did not adhere to the PA guidelines. In general, participants had access to and were interested in using technology. The identified themes included (1) barriers to PA, (2) psychological mediators of PA motivation, (3) needs and suggestions for reinforcing motivation support, (4) personalization aspects of the PA coaching experience, and (5) technology trustworthiness. Motivational determinants included perceived control, confidence and perceived growth, and connectedness. Participants were interested in having a straightforward app for monitoring and goal setting, which would include a prescribed activity program and schedule, and positive communication. Opinions varied in terms of social and game-like system possibilities. In addition, they expressed a desire for a highly personalized coaching experience based on as much information collected from them as possible (eg, disease stage, physical limitations, preferences) to provide individualized progress information, dynamic adjustment of the training plan, and context-aware activity suggestions (eg, based on weather and location). Participants also wanted the app to be validated or backed by professionals and were willing to share their data in exchange for a more personalized experience. Conclusions: This work suggests the need to develop simple, guiding, encouraging, trustworthy, and personalized PA coaching apps. The findings are in line with behavioral and personalization theories and methods that can be used to inform intervention design decisions. This paper opens new possibilities for the design of personalized and motivating PA coaching app experiences for breast cancer survivors, which might ultimately facilitate the sustained adherence of these individuals to the recommended levels of activity. %M 32955446 %R 10.2196/18867 %U https://mhealth.jmir.org/2020/9/e18867 %U https://doi.org/10.2196/18867 %U http://www.ncbi.nlm.nih.gov/pubmed/32955446 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e18896 %T Mobile Breast Cancer e-Support Program for Chinese Women With Breast Cancer Undergoing Chemotherapy (Part 3): Secondary Data Analysis %A Zhu,Haihua %A Chen,Xiuwan %A Yang,Jinqiu %A Wu,Qiaoling %A Zhu,Jiemin %A Chan,Sally Wai-Chi %+ Department of Nursing, School of Medicine, Xiamen University, Room 222, Alice Lee building, School of Medicine, Xiamen University, Xiangan Nan Road, Xiangan District, Xiamen, 361102, China, 86 15960212649, [email protected] %K breast cancer %K chemotherapy %K mobile app %K mHealth %D 2020 %7 16.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many app-based interventions targeting women with breast cancer have been developed and tested for effectiveness. However, information regarding the evaluation of the usage of these interventions is scarce. A better understanding of usage data is important to determine how women use apps and how these interventions affect health outcomes. Objective: This study aimed to examine the usage duration and login frequency of an app-based intervention, the Breast Cancer e-Support (BCS) program, and to investigate the association between usage data and participants’ demographic and medical characteristics. Methods: This study is a secondary data analysis of a randomized controlled trial assessing the effectiveness of the BCS program. The BCS program contains four modules: Learning Forum, Discussion Forum, Ask-the-Expert Forum, and Your Story Forum. A total of 57 women in the intervention group accessed the BCS program during their 12-week chemotherapy. The app’s background system tracked the usage duration and login frequency for each forum and the entire BCS program. Results: The total usage duration per participant ranged from 0 to 9371 minutes, and the login frequency per participant ranged from 0 to 774 times. The Discussion Forum and the Learning Forum were the most frequently used modules. The general linear model showed that age, education, family monthly income, and employment were associated with BCS usage duration and/or login frequency. Age (F1,45=10.09, P=.003, B=115.34, 95% CI 42.22-188.47) and education level (F1,45=7.22, P=.01, B=1949.63, 95% CI 487.76-3411.50) were positively associated with the usage duration of the entire BCS program. Family monthly income was positively associated with the usage duration of the Learning Forum (F1,45=11.85, P=.001, B=1488.55, 95% CI 617.58-2359.51) and the login frequency of the entire BCS program (F1,45=4.47, P=.04, B=113.68, 95% CI 5.33-222.03). Employment was negatively associated with the usage duration of the Ask-the-expert Forum (F1,45=4.50, P=.04, B=–971.87, 95% CI –1894.66 to –49.07) and the Your Story Forum (F1,45=5.36, P=.03, B=–640.71, 95% CI –1198.30 to –83.11) and positively associated with the login frequency of the entire BCS program (F1,45=10.86, P=.002, B=192.88, 95% CI 75.01-310.74). No statistical differences were found between BCS usage data and cancer stage, BMI, comorbidity, types of surgery, or cycles of chemotherapy. Conclusions: Overall, this study found considerable variability in the usage of app-based interventions. When health care professionals incorporate app-based interventions into their routine care for women with breast cancer, the learning and discussion functions of apps should be strengthened to promote engagement. Additionally, characteristics of women with breast cancer, such as age, level of education, income, and employment status, should be taken in consideration to develop tailored apps that address their particular needs and therefore improve their engagement with the app. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616000639426; http://www.ANZCTR.org.au/ACTRN12616000639426.aspx %M 32936087 %R 10.2196/18896 %U http://mhealth.jmir.org/2020/9/e18896/ %U https://doi.org/10.2196/18896 %U http://www.ncbi.nlm.nih.gov/pubmed/32936087 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e15167 %T Chronic Low-Dose Exposure to Xenoestrogen Ambient Air Pollutants and Breast Cancer Risk: XENAIR Protocol for a Case-Control Study Nested Within the French E3N Cohort %A Amadou,Amina %A Coudon,Thomas %A Praud,Delphine %A Salizzoni,Pietro %A Leffondre,Karen %A Lévêque,Emilie %A Boutron-Ruault,Marie-Christine %A Danjou,Aurélie M N %A Morelli,Xavier %A Le Cornet,Charlotte %A Perrier,Lionel %A Couvidat,Florian %A Bessagnet,Bertrand %A Caudeville,Julien %A Faure,Elodie %A Mancini,Francesca Romana %A Gulliver,John %A Severi,Gianluca %A Fervers,Béatrice %+ Department of Prevention Cancer Environment, Centre Léon Bérard, Lyon, France, 33 4 78 78 28 01, [email protected] %K breast cancer %K hormone receptor status %K air pollution %K endocrine disruptors %K multipollutant %K geographic information system %K land use regression %K chemistry-transport model %K epigenetic %K gene-environment interaction %K prospective study %D 2020 %7 15.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Breast cancer is the most frequent cancer in women in industrialized countries. Lifestyle and environmental factors, particularly endocrine-disrupting pollutants, have been suggested to play a role in breast cancer risk. Current epidemiological studies, although not fully consistent, suggest a positive association of breast cancer risk with exposure to several International Agency for Research on Cancer Group 1 air-pollutant carcinogens, such as particulate matter, polychlorinated biphenyls (PCB), dioxins, Benzo[a]pyrene (BaP), and cadmium. However, epidemiological studies remain scarce and inconsistent. It has been proposed that the menopausal status could modify the relationship between pollutants and breast cancer and that the association varies with hormone receptor status. Objective: The XENAIR project will investigate the association of breast cancer risk (overall and by hormone receptor status) with chronic exposure to selected air pollutants, including particulate matter, nitrogen dioxide (NO2), ozone (O3), BaP, dioxins, PCB-153, and cadmium. Methods: Our research is based on a case-control study nested within the French national E3N cohort of 5222 invasive breast cancer cases identified during follow-up from 1990 to 2011, and 5222 matched controls. A questionnaire was sent to all participants to collect their lifetime residential addresses and information on indoor pollution. We will assess these exposures using complementary models of land-use regression, atmospheric dispersion, and regional chemistry-transport (CHIMERE) models, via a Geographic Information System. Associations with breast cancer risk will be modeled using conditional logistic regression models. We will also study the impact of exposure on DNA methylation and interactions with genetic polymorphisms. Appropriate statistical methods, including Bayesian modeling, principal component analysis, and cluster analysis, will be used to assess the impact of multipollutant exposure. The fraction of breast cancer cases attributable to air pollution will be estimated. Results: The XENAIR project will contribute to current knowledge on the health effects of air pollution and identify and understand environmental modifiable risk factors related to breast cancer risk. Conclusions: The results will provide relevant evidence to governments and policy-makers to improve effective public health prevention strategies on air pollution. The XENAIR dataset can be used in future efforts to study the effects of exposure to air pollution associated with other chronic conditions. International Registered Report Identifier (IRRID): DERR1-10.2196/15167 %M 32930673 %R 10.2196/15167 %U http://www.researchprotocols.org/2020/9/e15167/ %U https://doi.org/10.2196/15167 %U http://www.ncbi.nlm.nih.gov/pubmed/32930673 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e17742 %T Improving Adherence to Adjuvant Hormonal Therapy Among Disadvantaged Women Diagnosed with Breast Cancer in South Carolina: Proposal for a Multimethod Study %A Felder,Tisha M %A Heiney,Sue P %A Hebert,James R %A Friedman,Daniela B %A Elk,Ronit %A Franco,Regina %A Gansauer,Lucy %A Christensen,Barbara %A Ford,Marvella E %+ College of Nursing, University of South Carolina, 1601 Greene Street, Room 620, Columbia, SC, 29208, United States, 1 8037779830, [email protected] %K breast neoplasms %K medicaid %K medication adherence %K vulnerable populations %K hormonal therapy %K endocrine therapy %K qualitative methods %D 2020 %7 3.9.2020 %9 Proposal %J JMIR Res Protoc %G English %X Background: Current clinical guidelines recommend that hormone receptor–positive breast cancer survivors take adjuvant hormonal therapy (AHT) for 5 to 10 years, following the end of definitive treatment. However, fewer than half of patients adhere to the guidelines, and suboptimal adherence to AHT is associated with an increased risk of breast cancer mortality. Research has extensively documented sociodemographic and disease-specific factors associated with adherence to AHT, but very little evidence exists on behavioral factors (eg, knowledge, patient-provider communication) that can be modified and targeted by interventions. Objective: The goal of this study is to develop and test a theory-based, multilevel intervention to improve adherence to AHT among breast cancer survivors from racially and socioeconomically disadvantaged backgrounds (eg, Medicaid-insured). The specific aims are to (1) explore multilevel (eg, patient, health care system) factors that influence adherence to AHT; (2) develop a theory-based, multilevel intervention to improve adherence to AHT; and (3) pilot test and evaluate the intervention developed in Aim 2. Methods: For Aim 1, we will recruit breast cancer survivors and health care professionals to participate in semistructured interviews to gain their perspectives about barriers and facilitators to AHT use. We will conduct a directed content analysis of the Aim 1 qualitative interview data. For Aim 2, we will integrate Aim 1 findings and current literature into the design of a multilevel intervention using an Intervention Mapping approach. For Aim 3, we will recruit Medicaid-insured breast cancer survivors to assess the feasibility of the pilot intervention. Results: From May 2016 to July 2018, we completed interviews with 19 breast cancer survivors and 23 health care professionals in South Carolina. We will conduct a directed content analysis of the qualitative interview data. Results from this analysis will be used, in combination with current literature, to design (Aim 2) and pilot test a theory-based multilevel intervention (Aim 3) in Summer 2021. Results of the pilot are expected for Fall 2021. Conclusions: This study will provide a deeper understanding of how to improve adherence to AHT, using a novel and multilevel approach, among socioeconomically disadvantaged breast cancer survivors who often experience disproportionate breast cancer mortality. International Registered Report Identifier (IRRID): DERR1-10.2196/17742 %M 32880374 %R 10.2196/17742 %U https://www.researchprotocols.org/2020/9/e17742 %U https://doi.org/10.2196/17742 %U http://www.ncbi.nlm.nih.gov/pubmed/32880374 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e18143 %T Incorporating Breast Cancer Recurrence Events Into Population-Based Cancer Registries Using Medical Claims: Cohort Study %A A'mar,Teresa %A Beatty,J David %A Fedorenko,Catherine %A Markowitz,Daniel %A Corey,Thomas %A Lange,Jane %A Schwartz,Stephen M %A Huang,Bin %A Chubak,Jessica %A Etzioni,Ruth %+ Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA, United States, 1 206 667 5000, [email protected] %K cancer registries %K medical claims %K cancer recurrence event %K statistical learning %K breast cancer %K medical informatics %K data mining %D 2020 %7 17.8.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: There is a need for automated approaches to incorporate information on cancer recurrence events into population-based cancer registries. Objective: The aim of this study is to determine the accuracy of a novel data mining algorithm to extract information from linked registry and medical claims data on the occurrence and timing of second breast cancer events (SBCE). Methods: We used supervised data from 3092 stage I and II breast cancer cases (with 394 recurrences), diagnosed between 1993 and 2006 inclusive, of patients at Kaiser Permanente Washington and cases in the Puget Sound Cancer Surveillance System. Our goal was to classify each month after primary treatment as pre- versus post-SBCE. The prediction feature set for a given month consisted of registry variables on disease and patient characteristics related to the primary breast cancer event, as well as features based on monthly counts of diagnosis and procedure codes for the current, prior, and future months. A month was classified as post-SBCE if the predicted probability exceeded a probability threshold (PT); the predicted time of the SBCE was taken to be the month of maximum increase in the predicted probability between adjacent months. Results: The Kaplan-Meier net probability of SBCE was 0.25 at 14 years. The month-level receiver operating characteristic curve on test data (20% of the data set) had an area under the curve of 0.986. The person-level predictions (at a monthly PT of 0.5) had a sensitivity of 0.89, a specificity of 0.98, a positive predictive value of 0.85, and a negative predictive value of 0.98. The corresponding median difference between the observed and predicted months of recurrence was 0 and the mean difference was 0.04 months. Conclusions: Data mining of medical claims holds promise for the streamlining of cancer registry operations to feasibly collect information about second breast cancer events. %M 32804084 %R 10.2196/18143 %U http://cancer.jmir.org/2020/2/e18143/ %U https://doi.org/10.2196/18143 %U http://www.ncbi.nlm.nih.gov/pubmed/32804084 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17058 %T Engagement in an Interactive App for Symptom Self-Management during Treatment in Patients With Breast or Prostate Cancer: Mixed Methods Study %A Crafoord,Marie-Therése %A Fjell,Maria %A Sundberg,Kay %A Nilsson,Marie %A Langius-Eklöf,Ann %+ Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Stockholm, 14183, Sweden, 46 8524 837 49, [email protected] %K engagement %K adherence %K mHealth %K mobile app %K cancer supportive care %K symptom management %K usage metrics %K breast cancer %K prostate cancer %D 2020 %7 10.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Using mobile technology for symptom management and self-care can improve patient-clinician communication and clinical outcomes in patients with cancer. The interactive app Interaktor has been shown to reduce symptom burden during cancer treatment. It includes symptom assessment, an alert system for contact with health care professionals, access to self-care advice, and visualization of symptom history. It is essential to understand how digital interventions operate; one approach is to examine engagement by assessing usage and exploring user experiences. Actual usage in relation to the intended use—adherence—is an essential factor of engagement. Objective: This study aimed to describe engagement with the Interaktor app among patients with breast or prostate cancer during treatment. Methods: Patients from the intervention groups of two separate randomized controlled trials were included: patients with breast cancer receiving neoadjuvant chemotherapy (n=74) and patients with locally advanced prostate cancer receiving treatment with radiotherapy (n=75). The patients reported their symptoms daily. Sociodemographic and clinical data were obtained from baseline questionnaires and medical records. Logged data usage was retrieved from the server and analyzed descriptively and with multiple regression analysis. Telephone interviews were conducted with patients about their perceptions of using the app and analyzed using content analysis. Results: The median adherence percentage to daily symptom reporting was 83%. Most patients used the self-care advice and free text message component. Among the patients treated for breast cancer, higher age predicted a lower total number of free text messages sent (P=.04). Among the patients treated for prostate cancer, higher age (P=.01) and higher education level (P=.04), predicted an increase in total views on self-care advice, while higher comorbidity (P=.004) predicted a decrease in total views on self-care advice. Being married or living with a partner predicted a higher adherence to daily symptom reporting (P=.02). Daily symptom reporting created feelings of having continuous contact with health care professionals, being acknowledged, and safe. Being contacted by a nurse after a symptom alert was considered convenient and highly valued. Treatment and time-related aspects influenced engagement. Daily symptom reporting was perceived as particularly meaningful at the beginning of treatment. Requests were made for advice on diet and psychological symptoms, as well as for more comprehensive and detailed information as the patient progressed through treatment. Conclusions: Patient engagement in the interactive app Interaktor was high. The app promoted patient participation in their care through continuous and convenient contact with health care professionals. The predictive ability of demographic variables differed between patient groups, but higher age and a higher educational level predicted usage of specific app functions for both patient groups. Patients’ experience of relevance and interactivity influenced their engagement positively. %M 32663140 %R 10.2196/17058 %U https://www.jmir.org/2020/8/e17058 %U https://doi.org/10.2196/17058 %U http://www.ncbi.nlm.nih.gov/pubmed/32663140 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e16239 %T #BlackBreastsMatter: Process Evaluation of Recruitment and Engagement of Pregnant African American Women for a Social Media Intervention Study to Increase Breastfeeding %A Dauphin,Cassy %A Clark,Nikia %A Cadzow,Renee %A Saad-Harfouche,Frances %A Rodriguez,Elisa %A Glaser,Kathryn %A Kiviniemi,Marc %A Keller,Maria %A Erwin,Deborah %+ Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14263, United States, 1 716 845 2927, [email protected] %K breastfeeding %K breast cancer education %K African American mothers %K Facebook %K mobile phone, social media %D 2020 %7 10.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In the United States, there are lower rates of breastfeeding among African American mothers, particularly those who are younger women. Recent epidemiological studies have shown a strong association of more aggressive types of breast cancer (estrogen receptor negative) among African American women, with a higher risk in African American women who did not breastfeed their children. Objective: This study aims to describe the process evaluation of recruitment and educational strategies to engage pregnant African American participants for a pilot study designed to determine whether social media messaging about breast cancer risk reduction through breastfeeding may positively influence breastfeeding rates. Methods: This pilot study is conducted in collaboration with a local Women, Infants, and Children (WIC) organization and hospital and prenatal clinics of a local health care network. To engage African American women to enroll in the study, several methods and monitoring processes were explored, including WIC electronic text-based messages sent out to all phones of current WIC recipients (referred to as e-blasts); keyword responses to texts from flyers and posters in local community-based organizations, hospitals, and prenatal clinics; keyword responses using electronic links posted in established Facebook groups; and snowball recruitment of other pregnant women by current participants through Facebook. Once enrolled, participants were randomized to 2 study conditions: (1) an intervention group receiving messages about breast cancer risk reduction and breastfeeding or (2) a control group receiving breastfeeding-only messages. Data were obtained through electronic monitoring, SurveyMonkey, qualitative responses on Facebook, focus groups, and interviews. Results: More than 3000 text messages were sent and received through WIC e-blasts and keyword responses from flyers. A total of 472 women were recruited through WIC e-blast, and 161 responded to flyers and contacts through the local health care network, community-based organizations, Facebook, and friend referrals. A total of 633 women were assessed for eligibility to participate in the study. A total of 288 pregnant African American women were enrolled, consented, and completed presurvey assessments (102.8% of the goal), and 22 participants attended focus groups or interviews reporting on their experiences with Facebook and the educational messages. Conclusions: This process evaluation suggests that using electronic, smartphone apps with social media holds promise for both recruitment and conduct of health education intervention studies for pregnant African American women. Providing messaging and resources through social media to reinforce and educate women about breastfeeding and potentially provide lactation support is intriguing. Convenience (for researchers and participants) is an attribute of social media for this demographic of women and worthy of further research as an educational tool. Trial Registration: ClinicalTrials.gov NCT03680235; https://clinicaltrials.gov/ct2/show/NCT03680235 %M 32773377 %R 10.2196/16239 %U https://www.jmir.org/2020/8/e16239 %U https://doi.org/10.2196/16239 %U http://www.ncbi.nlm.nih.gov/pubmed/32773377 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e17408 %T Mobile App for Symptom Management and Associated Quality of Life During Systemic Treatment in Early Stage Breast Cancer: Nonrandomized Controlled Prospective Cohort Study %A GraÅ¡ič Kuhar,Cvetka %A Gortnar Cepeda,TjaÅ¡a %A Kovač,Timotej %A Kukar,Matjaž %A Ružić Gorenjec,Nina %+ Department of Medical Oncology, Institute of Oncology Ljubljana, ZaloÅ¡ka 2, Ljubljana, SI-1000, Slovenia, 386 1 5879 287, [email protected] %K breast cancer %K systemic therapy %K mobile application %K patient-reported outcome %K quality of life %D 2020 %7 4.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Providing patients with cancer who are undergoing systemic therapy with useful information about symptom management is essential to prevent unnecessary deterioration of quality of life. Objective: The aim was to evaluate whether use of an app for symptom management was associated with any change in patient quality of life or use of health resources. Methods: Outpatients with early stage breast cancer receiving systemic therapy were recruited at the Institute of Oncology in Ljubljana, Slovenia. Patients who received systemic therapy between December 2017 and March 2018 (control group) and between April 2018 and September 2018 (intervention group) were eligible. All patients received standard care, but only those in the intervention group were asked to use mPRO Mamma, an Android-based smartphone app, in addition. The app supported daily tracking of 50 symptoms, allowed users to grade their symptom severity (as mild, moderate, or severe), and also provided in-depth descriptions and recommendations based on reported symptom level. Patient-reported outcomes in both groups were assessed through the European Organisation for Research and Treatment of Cancer (EORTC) core (C-30) and breast cancer (BR-23) questionnaires, as well as a questionnaire about health resources use. The primary outcomes were the difference in the global quality of life between groups and the difference in summary score of the EORTC C-30 questionnaire between groups after 3 time periods (the first week of treatment, the first treatment cycle, and the entire treatment). The secondary outcome was the use of health resources (doctor visits and hospitalizations) in each time period. Other scales were used for exploratory analysis. Results: The mean difference between the intervention group (n=46) and the control group (n=45) in global quality of life (adjusted for baseline and type of surgery) after the first week was 10.1 (95% CI 1.8 to 18.5, P=.02). The intervention group summary scores were significantly higher than those of the control group after the first week (adjusted mean difference: 8.9, 95% CI 3.1 to 14.7, P=.003) and at the end of treatment (adjusted mean difference: 10.6, 95% CI 3.9 to 17.3, P=.002). Use of health resources was not statistically significant between the groups in either the first week (P=.12) or the first treatment cycle (P=.13). Exploratory analysis findings demonstrated clinically important improvements (indicated by EORTC C-30 or BR-23 scale scores)—social, physical, role, and cognitive function were improved while pain, appetite loss, and systemic therapy side effects were reduced. Conclusions: Use of the app enabled patients undergoing systemic therapy for early stage breast cancer to better cope with symptoms which was demonstrated by a better global quality of life and summary score after the first week and by a better summary score at the end of treatment in the intervention group compared to those of the control group, but no change in the use of health resources was demonstrated. %M 32427567 %R 10.2196/17408 %U https://mhealth.jmir.org/2020/8/e17408 %U https://doi.org/10.2196/17408 %U http://www.ncbi.nlm.nih.gov/pubmed/32427567 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e19721 %T Patient Experiences of Rehabilitation and the Potential for an mHealth System with Biofeedback After Breast Cancer Surgery: Qualitative Study %A Brennan,Louise %A Kessie,Threase %A Caulfield,Brian %+ Physiotherapy Department, Beacon Hospital, Sandyford Business Park, Dublin, Ireland, 353 851437364, [email protected] %K breast cancer %K physiotherapy %K rehabilitation %K mHealth %K biofeedback %K user-centred design %K cancer %D 2020 %7 29.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physiotherapy-led home rehabilitation after breast cancer surgery can protect against the development of upper limb dysfunction and other disabling consequences of surgery. A variety of barriers can limit physical rehabilitation outcomes, and patients may benefit from more support during this time. Mobile health (mHealth) systems can assist patients during rehabilitation by providing exercise support, biofeedback, and information. Before designing mHealth systems for a specific population, developers must first engage with users to understand their experiences and needs. Objective: The aims of this study were to explore patients’ rehabilitation experiences and unmet needs during home rehabilitation after breast cancer surgery and to understand their experiences of mHealth technology and the requirements they desire from an mHealth system. Methods: This was the first stage of a user-centered design process for an mHealth system. We interviewed 10 breast cancer survivors under the two main topics of “Rehabilitation” and “Technology” and performed a thematic analysis on the interview data. Results: Discussions regarding rehabilitation focused on the acute and long-term consequences of surgery; unmet needs and lack of support; self-driven rehabilitation; and visions for high-quality rehabilitation. Regarding technology, participants reported a lack of mHealth options for this clinical context and using non-cancer–specific applications and wearables. Participants requested an mHealth tool from a reliable source that provides exercise support. Conclusions: There are unmet needs surrounding access to physiotherapy, information, and support during home rehabilitation after breast cancer surgery that could be addressed with an mHealth system. Breast cancer survivors are open to using an mHealth system and require that it comes from a reliable source and focuses on supporting exercise performance. %M 32687476 %R 10.2196/19721 %U http://mhealth.jmir.org/2020/7/e19721/ %U https://doi.org/10.2196/19721 %U http://www.ncbi.nlm.nih.gov/pubmed/32687476 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17907 %T Information Needs of Breast Cancer Patients: Theory-Generating Meta-Synthesis %A Lu,Hongru %A Xie,Juan %A Gerido,Lynette Hammond %A Cheng,Ying %A Chen,Ya %A Sun,Lizhu %+ School of Information Management, Nanjing University, 163 Xianlin Avenue, Nanjing, China, 86 138 5183 8364, [email protected] %K breast cancer patients %K information needs %K incentives %K moderating variables %K meta-synthesis %D 2020 %7 28.7.2020 %9 Review %J J Med Internet Res %G English %X Background: Breast cancer has become one of the most frequently diagnosed carcinomas and the leading cause of cancer deaths. The substantial growth in the number of breast cancer patients has put great pressure on health services. Meanwhile, the information patients need has increased and become more complicated. Therefore, a comprehensive and in-depth understanding of their information needs is urgently needed to improve the quality of health care. However, previous studies related to the information needs of breast cancer patients have focused on different perspectives and have only contributed to individual results. A systematic review and synthesis of breast cancer patients’ information needs is critical. Objective: This paper aims to systematically identify, evaluate, and synthesize existing primary qualitative research on the information needs of breast cancer patients. Methods: Web of Science, EBSCO, Scopus, ProQuest, PubMed, PsycINFO, The Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature were searched on February 12 and July 9, 2019, to collect relevant studies. A Google Scholar search, interpersonal network recommendations, and reference chaining were also conducted. Eligible studies included qualitative or mixed-methods studies focusing on the information needs (across the cancer continuum) of breast cancer patients or their social networks. Subsequently, a Critical Appraisals Skills Programme checklist was used to assess the quality of included research. The results, findings, and discussions were extracted. Data analysis was guided by the theory-generating meta-synthesis and grounded theory approach. Results: Three themes, 19 categories, and 55 concepts emerged: (1) incentives (physical abnormality, inquiry from others, subjective norm, and problems during appointments); (2) types of information needs (prevention, etiology, diagnosis, clinical manifestation, treatment, prognosis, impact and resumption of normal life, scientific research, and social assistance); (3) moderating variables (attitudes, health literacy, demographic characteristics, disease status, as well as political and cultural environment). The studies revealed that the information needs of breast cancer patients were triggered by different incentives. Subsequently, the patients sought a variety of information among different stages of the cancer journey. Five types of variables were also found to moderate the formation of information needs. Conclusions: This study contributes to a thorough model of information needs among breast cancer patients and provides practical suggestions for health and information professionals. %M 32720899 %R 10.2196/17907 %U https://www.jmir.org/2020/7/e17907 %U https://doi.org/10.2196/17907 %U http://www.ncbi.nlm.nih.gov/pubmed/32720899 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17430 %T Effects of a WhatsApp-Delivered Education Intervention to Enhance Breast Cancer Knowledge in Women: Mixed-Methods Study %A Pereira,Antonio Augusto Claudio %A Destro,Juliana Regina %A Picinin Bernuci,Marcelo %A Garcia,Lucas França %A Rodrigues Lucena,Tiago Franklin %+ Departamento de Fundamentos da Educação, Universidade Estadual de Maringá, Av Colombo, 5790 - Bloco I-12, Maringá, 87020-900, Brazil, 55 44991034777, [email protected] %K mHealth %K WhatsApp %K cancer education %K breast cancer %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Breast cancer is the leading cause of cancer-related death in the female population. Health education interventions based on the use of mobile technologies enable the development of health self-care skills and have emerged as alternative strategies for the control of breast cancer. In previous studies, WhatsApp has stood out as a useful tool in health education strategies; however, it has not yet been applied for breast cancer education. Objective: This study aimed to analyze the potential of WhatsApp as a health education tool used to improve women's knowledge on the risk reduction of breast cancer. It also aimed to understand how women feel sensitized within the WhatsApp group throughout the intervention and how they incorporate information posted to improve knowledge about early detection and risk reduction methods. Methods: The study involved a pre-post health educational intervention with 35 women (aged 45-69 years) included in a WhatsApp group to share information (audio, video, text, and images) over 3 weeks on the early detection and risk reduction of breast cancer. Data were collected through questionnaires on topics related to risk reduction, as well as qualitative content analysis of group interactions. Effectiveness and feasibility were analyzed through conversations and the comparison of the scores obtained in the questionnaires before and after the intervention. Results: A total of 293 messages were exchanged (moderator 120 and users 173). The average scores of the participants were 11.21 and 13.68 points before and after the educational intervention, respectively, with sufficient sample evidence that the difference was significant (P<.001). The intervention enabled women to improve their knowledge on all topics addressed, especially “myths and truths,” “incidence,” “clinical manifestations,” and “protective factors.” Some themes emerged from the interactions in the group, including group dynamics, general doubts, personal narratives, religious messages, daily news, and events. Conclusions: The use of groups for women in WhatsApp for health education purposes seems to be a viable alternative in strategies on breast cancer control, especially as it provides a space for the exchange of experiences and disinhibition. However, the need for a moderator to answer the questions and the constant distractions by members of the group represent important limitations that should be considered when improving this strategy. %M 32706726 %R 10.2196/17430 %U http://mhealth.jmir.org/2020/7/e17430/ %U https://doi.org/10.2196/17430 %U http://www.ncbi.nlm.nih.gov/pubmed/32706726 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e18420 %T A Remotely Delivered, Peer-Led Physical Activity Intervention for Younger Breast Cancer Survivors (Pink Body Spirit): Protocol for a Feasibility Study and Mixed Methods Process Evaluation %A Weiner,Lauren S %A Nagel,Stori %A Su,H Irene %A Hurst,Samantha %A Hartman,Sheri J %+ Moores Cancer Center, University of California, San Diego, 3855 Health Sciences Drive, Mail Code: 0901, La Jolla, CA, 92093, United States, 1 8585349235, [email protected] %K physical activity %K cancer survivors %K peer mentors %K quality of life %K pilot study %K breast cancer %K fitness trackers %K mobile phone %D 2020 %7 8.7.2020 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Younger breast cancer survivors consistently report a greater impact of their cancer experience on quality of life compared with older survivors, including higher rates of body image disturbances, sexual dysfunction, and fatigue. One potential strategy to improve quality of life is through physical activity, but this has been understudied in younger breast cancer survivors, who often decrease their activity during and after cancer treatment. Objective: The aim of this study is to explore the feasibility and acceptability of a technology-based, remotely delivered, peer-led physical activity intervention for younger breast cancer survivors. We will also assess the preliminary impact of the intervention on changes in physical activity and multiple aspects of quality of life. Methods: This study is a community-academic partnership between University of California, San Diego and Haus of Volta, a nonprofit organization that promotes positive self-image in younger breast cancer survivors. This ongoing pilot study aims to recruit 30 younger breast cancer survivors across the United States (<55 years old, >6 months post primary cancer treatment, self-report <60 min of moderate-to-vigorous-intensity physical activity [MVPA]) into a 3-month peer-delivered, fully remote exercise program. Participants will complete 6 biweekly video chat sessions with a trained peer mentor, a fellow younger breast cancer survivor. Participants will receive a Fitbit Charge 3; weekly feedback on Fitbit data from their peer mentor; and access to a private, in-app Fitbit Community to provide and receive support from other participants and all peer mentors. At baseline, 3 months, and 6 months, participants will complete quality of life questionnaires, and MVPA will be measured using the ActiGraph accelerometer. Feasibility and acceptability will be explored through a mixed methods approach (ie, quantitative questionnaires and qualitative interviews). Intervention delivery and adaptations by peer mentors will be tracked through peer mentor self-evaluations and reflections, review of video-recorded mentoring sessions, and monthly templated reflections by the research team. Results: Recruitment began in September 2019. As of February 2020, the physical activity intervention is ongoing. Final measures are expected to occur in summer 2020. Conclusions: This study explores the potential for physical activity to improve sexual function, body image, and fatigue, key quality of life issues in younger breast cancer survivors. Using peer mentors extends our reach into the young survivor community. The detailed process evaluation of intervention delivery and adaptations by mentors could inform a future hybrid-effectiveness implementation trial. Finally, remote delivery with commercially available technology could promote broader dissemination. Trial Registration: ClinicalTrials.gov NCT04064892; https://clinicaltrials.gov/ct2/show/NCT04064892 International Registered Report Identifier (IRRID): DERR1-10.2196/18420 %M 32673270 %R 10.2196/18420 %U https://www.researchprotocols.org/2020/7/e18420 %U https://doi.org/10.2196/18420 %U http://www.ncbi.nlm.nih.gov/pubmed/32673270 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19734 %T Use of an Unguided, Web-Based Distress Self-Management Program After Breast Cancer Diagnosis: Sub-Analysis of CaringGuidance Pilot Study %A Lally,Robin M %A Kupzyk,Kevin %A Gallo,Steve %A Berry,Donna %+ College of Nursing, Fred & Pamela Buffett Cancer Center, University of Nebraska Medical Center, UNMC College of Nursing Center For Nursing Science, 985330 Nebraska Medical Center, Omaha, NE, 68198-0001, United States, 1 4025595464, [email protected] %K eHealth %K psychoeducation %K supportive oncology %K distress %K self-management %K oncology %K breast cancer %D 2020 %7 6.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Unguided, web-based psychoeducational interventions are gaining interest as a way to reach patients while reducing pressure on clinical resources. However, there has been little research on how patients with cancer use these interventions. Objective: The objective of this analysis was to evaluate how women newly diagnosed with breast cancer used the unguided web-based, psychoeducational distress self-management program CaringGuidance After Breast Cancer Diagnosis while enrolled in a pilot feasibility study. Methods: Women with stage 0 to II breast cancer diagnosed within the prior three months were recruited from clinics primarily in the Northeastern United States for participation in a 12-week pilot study of CaringGuidance plus usual care versus usual care alone. Usage prompts included sets of emails sent weekly for 12 weeks; standardized congratulatory emails after every two hours of program use, and informative emails for each cognitive-behavioral exercise. Individual user activity on the site was automatically tracked by an analytics system and recorded directly in the CaringGuidance database. Results: Complete usage data were available for 54 subjects. Ninety-eight percent of the intervention group logged into CaringGuidance independently at least once. Thirty-eight (70%) logged in during all three months, 15 (28%) were intermittent users, and one (2%) was a non-user. Users (n=53) averaged 15.6 (SD 9.85) logins. Mean logins were greatest in month 1 (7.26, SD 4.02) and declined in months 2 (4.32, SD 3.66) and month 3 (4.02, SD 3.82). Eleven (21%) used CaringGuidance with both the frequency and activity level intended at study outset, 9 (17%) exceeded intended frequency and activity (high-high users), and 10 (19%) were below expected usage on both login frequency and activity (low-low users). Low-low users and high-high users differed significantly (P<.001) in the total number of views and unique views of all program components. Change in depressive symptoms and the number of sessions (r=.351) and logins (r=.348) between study months 1 and 2 were significantly correlated (P=.018, .019). Higher baseline distress was associated with more unique views of program resources (r=.281, P=.043). Change in intrusive/avoidant thoughts from baseline to month 3, and the number of users’ unique exercise views were negatively correlated (r=–.319, P=.035) so that more unique exercise views, equated with greater decline in intrusive/avoidant thoughts from baseline to month 3. Conclusions: These findings favor the hypothesis that the key ingredient is not the amount of program use, but each user’s self-selected activity within the program. More research is needed on the ideal ways to maintain use, and capture and define engagement and enactment of behaviors by people with cancer accessing unguided, self-management web-based programs. %M 32628117 %R 10.2196/19734 %U https://www.jmir.org/2020/7/e19734 %U https://doi.org/10.2196/19734 %U http://www.ncbi.nlm.nih.gov/pubmed/32628117 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 6 %P e16886 %T Identification of High-Order Single-Nucleotide Polymorphism Barcodes in Breast Cancer Using a Hybrid Taguchi-Genetic Algorithm: Case-Control Study %A Chuang,Li-Yeh %A Yang,Cheng-San %A Yang,Huai-Shuo %A Yang,Cheng-Hong %+ Department of Electronic Engineering, National Kaohsiung University of Science and Technology, No. 415 Jiangong Road, San-Min District, Kaohsiung City, 82778, Taiwan, 886 7 381 4526, [email protected] %K genetic algorithm %K single-nucleotide polymorphism %K breast cancer %K case-control study %D 2020 %7 17.6.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Breast cancer has a major disease burden in the female population, and it is a highly genome-associated human disease. However, in genetic studies of complex diseases, modern geneticists face challenges in detecting interactions among loci. Objective: This study aimed to investigate whether variations of single-nucleotide polymorphisms (SNPs) are associated with histopathological tumor characteristics in breast cancer patients. Methods: A hybrid Taguchi-genetic algorithm (HTGA) was proposed to identify the high-order SNP barcodes in a breast cancer case-control study. A Taguchi method was used to enhance a genetic algorithm (GA) for identifying high-order SNP barcodes. The Taguchi method was integrated into the GA after the crossover operations in order to optimize the generated offspring systematically for enhancing the GA search ability. Results: The proposed HTGA effectively converged to a promising region within the problem space and provided excellent SNP barcode identification. Regression analysis was used to validate the association between breast cancer and the identified high-order SNP barcodes. The maximum OR was less than 1 (range 0.870-0.755) for two- to seven-order SNP barcodes. Conclusions: We systematically evaluated the interaction effects of 26 SNPs within growth factor–related genes for breast carcinogenesis pathways. The HTGA could successfully identify relevant high-order SNP barcodes by evaluating the differences between cases and controls. The validation results showed that the HTGA can provide better fitness values as compared with other methods for the identification of high-order SNP barcodes using breast cancer case-control data sets. %M 32554381 %R 10.2196/16886 %U https://medinform.jmir.org/2020/6/e16886 %U https://doi.org/10.2196/16886 %U http://www.ncbi.nlm.nih.gov/pubmed/32554381 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e16059 %T Experiences of African American Breast Cancer Survivors Using Digital Scales and Activity Trackers in a Weight Gain Prevention Intervention: Qualitative Study %A Power,Julianne M %A Tate,Deborah F %A Valle,Carmina G %+ Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 302 Rosenau Hall, CB #7440, 135 Dauer Drive, Chapel Hill, NC, 27514, United States, 1 9199665852 ext 2, [email protected] %K African American %K cancer survivors %K digital tools %K weight gain prevention %K qualitative %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of digital tools to promote daily self-weighing and daily activity tracking may be a promising strategy for weight control among African American breast cancer survivors (AABCS). There have been no studies exploring the acceptability and feasibility of using digital tools for weight control or qualitative studies characterizing perceptions of daily self-weighing and daily activity tracking among AABCS. Objective: This study aimed to explore the subjective experiences of daily self-weighing and daily activity tracking using digital tools, including wireless scales and activity trackers, in a sample of AABCS participating in two technology-based weight gain prevention interventions over 6 months. Methods: Semistructured interviews (N=21) were conducted in person or over the phone, were audio recorded, and then transcribed verbatim. Each transcript was read to identify key themes and develop a codebook. Each transcript was coded using Atlas.ti software, and code outputs were used to identify overarching themes and patterns in the data. Results: On average, participants were 52.6 (SD 8.3) years of age, with obesity at baseline (BMI 33.1 kg/m2, SD 5.9), and weighed on 123.4 (SD 48.0) days out of the 168 days (73.5%) in the study period. Women tended to attribute their weight gain to cancer treatment and framed program benefits in terms of improved quality of life and perceptions of prolonging their survival following treatment. Using the smart scale for daily self-weighing was viewed as the tool by which participants could control their weight and improve their health and well-being posttreatment. The activity tracker increased awareness of physical activity and motivated participants to be more active. Conclusions: Participants reported positive experiences and benefits from daily self-weighing and daily activity tracking. Findings suggest that daily self-weighing and daily activity tracking using digital tools are well-received, acceptable, and feasible intervention strategies for AABCS in the context of posttreatment weight management. %M 32510461 %R 10.2196/16059 %U https://mhealth.jmir.org/2020/6/e16059 %U https://doi.org/10.2196/16059 %U http://www.ncbi.nlm.nih.gov/pubmed/32510461 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 6 %P e17364 %T Predicting Breast Cancer in Chinese Women Using Machine Learning Techniques: Algorithm Development %A Hou,Can %A Zhong,Xiaorong %A He,Ping %A Xu,Bin %A Diao,Sha %A Yi,Fang %A Zheng,Hong %A Li,Jiayuan %+ Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, No.16 Ren Min Nan Lu, Chengdu, China, 86 189 8060 1830, [email protected] %K machine learning %K XGBoost %K random forest %K deep neural network %K breast cancer %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Risk-based breast cancer screening is a cost-effective intervention for controlling breast cancer in China, but the successful implementation of such intervention requires an accurate breast cancer prediction model for Chinese women. Objective: This study aimed to evaluate and compare the performance of four machine learning algorithms on predicting breast cancer among Chinese women using 10 breast cancer risk factors. Methods: A dataset consisting of 7127 breast cancer cases and 7127 matched healthy controls was used for model training and testing. We used repeated 5-fold cross-validation and calculated AUC, sensitivity, specificity, and accuracy as the measures of the model performance. Results: The three novel machine-learning algorithms (XGBoost, Random Forest and Deep Neural Network) all achieved significantly higher area under the receiver operating characteristic curves (AUCs), sensitivity, and accuracy than logistic regression. Among the three novel machine learning algorithms, XGBoost (AUC 0.742) outperformed deep neural network (AUC 0.728) and random forest (AUC 0.728). Main residence, number of live births, menopause status, age, and age at first birth were considered as top-ranked variables in the three novel machine learning algorithms. Conclusions: The novel machine learning algorithms, especially XGBoost, can be used to develop breast cancer prediction models to help identify women at high risk for breast cancer in developing countries. %M 32510459 %R 10.2196/17364 %U http://medinform.jmir.org/2020/6/e17364/ %U https://doi.org/10.2196/17364 %U http://www.ncbi.nlm.nih.gov/pubmed/32510459 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e18938 %T Data Validation and Verification Using Blockchain in a Clinical Trial for Breast Cancer: Regulatory Sandbox %A Hirano,Tomonobu %A Motohashi,Tomomitsu %A Okumura,Kosuke %A Takajo,Kentaro %A Kuroki,Taiyo %A Ichikawa,Daisuke %A Matsuoka,Yutaka %A Ochi,Eisuke %A Ueno,Taro %+ SUSMED Inc, 3-8-5 Honcho, Nihonbashi, Chuo-ku, Tokyo, , Japan, 81 3 3527 3593, [email protected] %K blockchain %K clinical trial %K data management %K validation %K breast cancer %K regulatory sandbox %D 2020 %7 2.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The integrity of data in a clinical trial is essential, but the current data management process is too complex and highly labor-intensive. As a result, clinical trials are prone to consuming a lot of budget and time, and there is a risk for human-induced error and data falsification. Blockchain technology has the potential to address some of these challenges. Objective: The aim of the study was to validate a system that enables the security of medical data in a clinical trial using blockchain technology. Methods: We have developed a blockchain-based data management system for clinical trials and tested the system through a clinical trial for breast cancer. The project was conducted to demonstrate clinical data management using blockchain technology under the regulatory sandbox enabled by the Japanese Cabinet Office. Results: We verified and validated the data in the clinical trial using the validation protocol and tested its resilience to data tampering. The robustness of the system was also proven by survival with zero downtime for clinical data registration during a Amazon Web Services disruption event in the Tokyo region on August 23, 2019. Conclusions: We show that our system can improve clinical trial data management, enhance trust in the clinical research process, and ease regulator burden. The system will contribute to the sustainability of health care services through the optimization of cost for clinical trials. %M 32340974 %R 10.2196/18938 %U https://www.jmir.org/2020/6/e18938 %U https://doi.org/10.2196/18938 %U http://www.ncbi.nlm.nih.gov/pubmed/32340974 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 1 %P e15859 %T Assessing Breast Cancer Survivors’ Perceptions of Using Voice-Activated Technology to Address Insomnia: Feasibility Study Featuring Focus Groups and In-Depth Interviews %A Arem,Hannah %A Scott,Remle %A Greenberg,Daniel %A Kaltman,Rebecca %A Lieberman,Daniel %A Lewin,Daniel %+ Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Rm 514, Washington, DC, 20052, United States, 1 2029944676, [email protected] %K artificial intelligence %K breast neoplasms %K survivors %K insomnia %K cognitive behavioral therapy %K mobile phones %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer survivors (BCSs) are a growing population with a higher prevalence of insomnia than women of the same age without a history of cancer. Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be effective in this population, but it is not widely available to those who need it. Objective: This study aimed to better understand BCSs’ experiences with insomnia and to explore the feasibility and acceptability of delivering CBT-I using a virtual assistant (Amazon Alexa). Methods: We first conducted a formative phase with 2 focus groups and 3 in-depth interviews to understand BCSs’ perceptions of insomnia as well as their interest in and comfort with using a virtual assistant to learn about CBT-I. We then developed a prototype incorporating participant preferences and CBT-I components and demonstrated it in group and individual settings to BCSs to evaluate acceptability, interest, perceived feasibility, educational potential, and usability of the prototype. We also collected open-ended feedback on the content and used frequencies to describe the quantitative data. Results: We recruited 11 BCSs with insomnia in the formative phase and 14 BCSs in the prototype demonstration. In formative work, anxiety, fear, and hot flashes were identified as causes of insomnia. After prototype demonstration, nearly 79% (11/14) of participants reported an interest in and perceived feasibility of using the virtual assistant to record sleep patterns. Approximately two-thirds of the participants thought lifestyle modification (9/14, 64%) and sleep restriction (9/14, 64%) would be feasible and were interested in this feature of the program (10/14, 71% and 9/14, 64%, respectively). Relaxation exercises were rated as interesting and feasible using the virtual assistant by 71% (10/14) of the participants. Usability was rated as better than average, and all women reported that they would recommend the program to friends and family. Conclusions: This virtual assistant prototype delivering CBT-I components by using a smart speaker was rated as feasible and acceptable, suggesting that this prototype should be fully developed and tested for efficacy in the BCS population. If efficacy is shown in this population, the prototype should also be adapted for other high-risk populations. %M 32348274 %R 10.2196/15859 %U http://cancer.jmir.org/2020/1/e15859/ %U https://doi.org/10.2196/15859 %U http://www.ncbi.nlm.nih.gov/pubmed/32348274 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16902 %T Exploring Strategies for Using Social Media to Self-Manage Health Care When Living With and Beyond Breast Cancer: In-Depth Qualitative Study %A Ure,Cathy %A Cooper-Ryan,Anna Mary %A Condie,Jenna %A Galpin,Adam %+ Directorate of Allied and Public Health, School of Health and Society, University of Salford, Allerton Building, Salford, Manchester, M6 6PU, United Kingdom, 44 (0)161 295 5094, [email protected] %K breast cancer %K social media %K internet %K self-management %K psychosocial health %K survivorship %D 2020 %7 25.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: As breast cancer survival rates improve and structural health resources are increasingly being stretched, health providers require people living with and beyond breast cancer (LwBBC) to self-manage aspects of their care. Objective: This study aimed to explore how women use and experience social media to self-manage their psychosocial needs and support self-management across the breast cancer continuum. Methods: The experiences of 21 women (age range 27-64 years) were explored using an in-depth qualitative approach. The women varied in the duration of their experiences of LwBBC, which facilitated insights into how they evolve and change their self-management strategies over time. Semistructured interviews were analyzed inductively using a thematic analysis, a polytextual analysis, and voice-centered relational methods. Results: The use of multiple social media platforms, such as YouTube, Facebook, WhatsApp, and Twitter, enabled women to self-manage aspects of their care by satisfying needs for timely, relevant, and appropriate support, by navigating identities disrupted by diagnosis and treatment and by allowing them to (re)gain a sense of control. Women described extending their everyday use of multiple platforms to self-manage their care. However, women experienced social media as both empowering and dislocating, as their engagement was impacted by their everyday experiences of LwBBC. Conclusions: Health care professionals (HCPs) need to be more aware, and open to the possibilities, of women using multiple social media resources as self-management tools. It is important for HCPs to initiate value-free discussions and create the space necessary for women to share how social media resources support a tailored and timely self-managed approach to their unique psychosocial needs. %M 32364510 %R 10.2196/16902 %U http://www.jmir.org/2020/5/e16902/ %U https://doi.org/10.2196/16902 %U http://www.ncbi.nlm.nih.gov/pubmed/32364510 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 5 %P e18251 %T Evaluation of the Quadri-Planes Method in Computer-Aided Diagnosis of Breast Lesions by Ultrasonography: Prospective Single-Center Study %A Yongping,Liang %A Juan,Zhang %A Zhou,Ping %A Yongfeng,Zhao %A Liu,Wengang %A Shi,Yifan %+ The Xiangya Medical School, Central South University, 172 Laodong W Rd, Tianxin District, Changsha, Hunan, 410015, China, 86 731 88618403, [email protected] %K ultrasonography %K breast neoplasm %K breast imaging reporting and data system (bi-rads) %K breast neoplasm diagnosis %K cancer screening %K computer-aided diagnosis %K breast cancer %D 2020 %7 5.5.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Computer-aided diagnosis (CAD) is a tool that can help radiologists diagnose breast lesions by ultrasonography. Previous studies have demonstrated that CAD can help reduce the incidence of missed diagnoses by radiologists. However, the optimal method to apply CAD to breast lesions using diagnostic planes has not been assessed. Objective: The aim of this study was to compare the performance of radiologists with different levels of experience when using CAD with the quadri-planes method to detect breast tumors. Methods: From November 2018 to October 2019, we enrolled patients in the study who had a breast mass as their most prominent symptom. We assigned 2 ultrasound radiologists (with 1 and 5 years of experience, respectively) to read breast ultrasonography images without CAD and then to perform a second reading while applying CAD with the quadri-planes method. We then compared the diagnostic performance of the readers for the 2 readings (without and with CAD). The McNemar test for paired data was used for statistical analysis. Results: A total of 331 patients were included in this study (mean age 43.88 years, range 17-70, SD 12.10), including 512 lesions (mean diameter 1.85 centimeters, SD 1.19; range 0.26-9.5); 200/512 (39.1%) were malignant, and 312/512 (60.9%) were benign. For CAD, the area under the receiver operating characteristic curve (AUC) improved significantly from 0.76 (95% CI 0.71-0.79) with the cross-planes method to 0.84 (95% CI 0.80-0.88; P<.001) with the quadri-planes method. For the novice reader, the AUC significantly improved from 0.73 (95% CI 0.69-0.78) for the without-CAD mode to 0.83 (95% CI 0.80-0.87; P<.001) for the combined-CAD mode with the quadri-planes method. For the experienced reader, the AUC improved from 0.85 (95% CI 0.81-0.88) to 0.87 (95% CI 0.84-0.91; P=.15). The kappa indicating consistency between the experienced reader and the novice reader for the combined-CAD mode was 0.63. For the novice reader, the sensitivity significantly improved from 60.0% for the without-CAD mode to 79.0% for the combined-CAD mode (P=.004). The specificity, negative predictive value, positive predictive value, and accuracy improved from 84.9% to 87.8% (P=.53), 76.8% to 86.7% (P=.07), 71.9% to 80.6% (P=.13), and 75.2% to 84.4% (P=.12), respectively. For the experienced reader, the sensitivity improved significantly from 76.0% for the without-CAD mode to 87.0% for the combined-CAD mode (P=.045). The NPV and accuracy moderately improved from 85.8% and 86.3% to 91.0% (P=.27) and 87.0% (P=.84), respectively. The specificity and positive predictive value decreased from 87.4% to 81.3% (P=.25) and from 87.2% to 93.0% (P=.16), respectively. Conclusions: S-Detect is a feasible diagnostic tool that can improve the sensitivity, accuracy, and AUC of the quadri-planes method for both novice and experienced readers while also improving the specificity for the novice reader. It demonstrates important application value in the clinical diagnosis of breast cancer. Trial Registration: ChiCTR.org.cn 1800019649; http://www.chictr.org.cn/showproj.aspx?proj=33094 %M 32369039 %R 10.2196/18251 %U https://medinform.jmir.org/2020/5/e18251 %U https://doi.org/10.2196/18251 %U http://www.ncbi.nlm.nih.gov/pubmed/32369039 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17320 %T A Mobile Technology for Collecting Patient-Reported Physical Activity and Distress Outcomes: Cross-Sectional Cohort Study %A Jung,Miyeon %A Lee,SaeByul %A Kim,Jisun %A Kim,HeeJeong %A Ko,BeomSeok %A Son,Byung Ho %A Ahn,Sei-Hyun %A Park,Yu Rang %A Cho,Daegon %A Chung,Haekwon %A Park,Hye Jin %A Lee,Minsun %A Lee,Jong Won %A Chung,Seockhoon %A Chung,Il Yong %+ Division of Breast Surgery, Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, , Republic of Korea, 82 2 3010 3998, [email protected] %K telemedicine %K breast neoplasms %K mobile apps %K quality of life %K validation %K patient-reported outcome measures (PROMs) %K questionnaire %D 2020 %7 4.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Electronic patient-reported outcome (PROs) provides a fast and reliable assessment of a patient’s health-related quality of life. Nevertheless, using PRO in the traditional paper format is not practical for clinical practice due to the limitations associated with data analysis and management. A questionnaire app was developed to address the need for a practical way to group and use distress and physical activity assessment tools. Objective: The purpose of this study was to assess the level of agreement between electronic (mobile) and paper-and-pencil questionnaire responses. Methods: We validated the app version of the distress thermometer (DT), International Physical Activity Questionnaire (IPAQ), and Patient Health Questionnaire–9 (PHQ-9). A total of 102 participants answered the paper and app versions of the DT and IPAQ, and 96 people completed the PHQ-9. The study outcomes were the correlation of the data between the paper-and-pencil and app versions. Results: A total of 106 consecutive breast cancer patients were enrolled and analyzed for validation of paper and electronic (app) versions. The Spearman correlation values of paper and app surveys for patients who responded to the DT questionnaire within 7 days, within 3 days, and on the same day were .415 (P<.001), .437 (P<.001), and .603 (P<.001), respectively. Similarly, the paper and app survey correlation values of the IPAQ total physical activity metabolic equivalent of task (MET; Q2-6) were .291 (P=.003), .324 (P=.005), and .427 (P=.01), respectively. The correlation of the sum of the Patient Health Questionnaire–9 (Q1-9) according to the time interval between the paper-based questionnaire and the app-based questionnaire was .469 for 14 days (P<.001), .574 for 7 days (P<.001), .593 for 3 days (P<.001), and .512 for the same day (P=.03). These were all statistically significant. Similarly, the correlation of the PHQ (Q10) value according to the time interval between the paper-based questionnaire and the app-based questionnaire was .283 for 14 days (P=.005), .409 for 7 days (P=.001), .415 for 3 days (P=.009), and .736 for the same day (P=.001). These were all statistically significant. In the overall trend, the shorter the interval between the paper-and-pencil questionnaire and the app-based questionnaire, the higher the correlation value. Conclusions: The app version of the distress and physical activity questionnaires has shown validity and a high level of association with the paper-based DT, IPAQ (Q2-6), and PHQ-9. The app-based questionnaires were not inferior to their respective paper versions and confirm the feasibility for their use in clinical practice. The high correlation between paper and mobile app data allows the use of new mobile apps to benefit the overall health care system. Trial Registration: ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966 %M 32364508 %R 10.2196/17320 %U https://mhealth.jmir.org/2020/5/e17320 %U https://doi.org/10.2196/17320 %U http://www.ncbi.nlm.nih.gov/pubmed/32364508 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e15780 %T The Development of a Mobile Health App for Breast Cancer Self-Management Support in Taiwan: Design Thinking Approach %A Hou,I-Ching %A Lan,Min-Fang %A Shen,Shan-Hsiang %A Tsai,Pei Yu %A Chang,King Jen %A Tai,Hao-Chih %A Tsai,Ay-Jen %A Chang,Polun %A Wang,Tze-Fang %A Sheu,Shuh-Jen %A Dykes,Patricia C %+ School of Nursing, National Yang-Ming University, No 155, Sec 2, Li-Nong Street, Beitou, Taipei, 11221, Taiwan, 886 28267000 ext 7315, [email protected] %K breast cancer %K mobile health application %K self-management %K design thinking %D 2020 %7 30.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Evidence has shown that breast cancer self-management support from mobile health (mHealth) apps can improve the quality of life of survivors. Although many breast cancer self-management support apps exist, few papers have documented the procedure for the development of a user-friendly app from the patient’s perspective. Objective: This study aimed to investigate the information needs of Taiwanese women with breast cancer to inform the development of a self-management support mHealth app. Methods: A 5-step design thinking approach, comprising empathy, define, ideate, prototype, and test steps, was used in the focus groups and individual interviews conducted to collect information on the requirements and expectations of Taiwanese women with breast cancer with respect to the app. A thematic analysis was used to identify information needs. Results: A total of 8 major themes including treatment, physical activity, diet, emotional support, health records, social resources, experience sharing, and expert consultation were identified. Minor themes included the desire to use the app under professional supervision and a trustworthy app manager to ensure the credibility of information. Conclusions: The strengths of the design thinking approach were user-centered design and cultural sensitivity. The results retrieved from each step contributed to the development of the app and reduction of the gap between end users and developers. An mHealth app that addresses these 8 main themes can facilitate disease self-management for Taiwanese women with breast cancer. %M 32352390 %R 10.2196/15780 %U http://mhealth.jmir.org/2020/4/e15780/ %U https://doi.org/10.2196/15780 %U http://www.ncbi.nlm.nih.gov/pubmed/32352390 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e13188 %T Developing an Intranet-Based Lymphedema Dashboard for Breast Cancer Multidisciplinary Teams: Design Research Study %A Janssen,Anna %A Donnelly,Candice %A Kay,Judy %A Thiem,Peter %A Saavedra,Aldo %A Pathmanathan,Nirmala %A Elder,Elisabeth %A Dinh,Phuong %A Kabir,Masrura %A Jackson,Kirsten %A Harnett,Paul %A Shaw,Tim %+ Research in Implementation Science and eHealth Group, Faculty of Health Sciences, The University of Sydney, Charles Perkins Centre (D17), Sydney, 2006, Australia, 61 9036 9406, [email protected] %K eHealth %K clinical informatics %K human-centered design %K data visualization %D 2020 %7 21.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: A large quantity of data is collected during the delivery of cancer care. However, once collected, these data are difficult for health professionals to access to support clinical decision making and performance review. There is a need for innovative tools that make clinical data more accessible to support health professionals in these activities. One approach for providing health professionals with access to clinical data is to create the infrastructure and interface for a clinical dashboard to make data accessible in a timely and relevant manner. Objective: This study aimed to develop and evaluate 2 prototype dashboards for displaying data on the identification and management of lymphedema. Methods: The study used a co-design framework to develop 2 prototype dashboards for use by health professionals delivering breast cancer care. The key feature of these dashboards was an approach for visualizing lymphedema patient cohort and individual patient data. This project began with 2 focus group sessions conducted with members of a breast cancer multidisciplinary team (n=33) and a breast cancer consumer (n=1) to establish clinically relevant and appropriate data for presentation and the visualization requirements for a dashboard. A series of fortnightly meetings over 6 months with an Advisory Committee (n=10) occurred to inform and refine the development of a static mock-up dashboard. This mock-up was then presented to representatives of the multidisciplinary team (n=3) to get preliminary feedback about the design and use of such dashboards. Feedback from these presentations was reviewed and used to inform the development of the interactive prototypes. A structured evaluation was conducted on the prototypes, using Think Aloud Protocol and semistructured interviews with representatives of the multidisciplinary team (n=5). Results: Lymphedema was selected as a clinically relevant area for the prototype dashboards. A qualitative evaluation is reported for 5 health professionals. These participants were selected from 3 specialties: surgery (n=1), radiation oncology (n=2), and occupational therapy (n=2). Participants were able to complete the majority of tasks on the dashboard. Semistructured interview themes were categorized into engagement or enthusiasm for the dashboard, user experience, and data quality and completeness. Conclusions: Findings from this study constitute the first report of a co-design process for creating a lymphedema dashboard for breast cancer health professionals. Health professionals are interested in the use of data visualization tools to make routinely collected clinical data more accessible. To be used effectively, dashboards need to be reliable and sourced from accurate and comprehensive data sets. While the co-design process used to develop the visualization tool proved effective for designing an individual patient dashboard, the complexity and accessibility of the data required for a cohort dashboard remained a challenge. %M 32314968 %R 10.2196/13188 %U https://www.jmir.org/2020/4/e13188 %U https://doi.org/10.2196/13188 %U http://www.ncbi.nlm.nih.gov/pubmed/32314968 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16768 %T Web-Based Medical Information Searching by Chinese Patients With Breast Cancer and its Influence on Survival: Observational Study %A Li,Yan %A Ye,Shan %A Zhou,Yidong %A Mao,Feng %A Guo,Hailing %A Lin,Yan %A Zhang,Xiaohui %A Shen,Songjie %A Shi,Na %A Wang,Xiaojie %A Sun,Qiang %+ Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, 1, Shuaifuyuan, Dongcheng District, Beijing, 100730, China, 1 69158721, [email protected] %K breast cancer %K internet %K disease-free survival %K breast conserving therapy %K online information %K satisfaction level %D 2020 %7 17.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet allows patients to easily look for health information. However, how Chinese patients with breast cancer use the internet has rarely been investigated, and there is a scarcity of information about the influence of internet use on survival. Objective: This observational study aimed to investigate the details of online medical information searching by Chinese patients with breast cancer and to determine whether internet use has any survival benefits. Methods: Patients who were diagnosed with invasive breast cancer at Peking Union Medical College Hospital between January 2014 and December 2015 were enrolled. We obtained information on their internet-searching behavior and gathered data from the patients’ medical and follow-up records. The associations between internet use and other clinic-pathological factors were analyzed. A Cox proportional-hazards model and the Kaplan-Meier method were used for disease-free survival (DFS) analyses. Results: A total of 973 patients with invasive breast cancer who underwent definitive surgery took part in the study. Among them, 477 cases (49.0%) performed web-based breast cancer information searching before the initial treatment. A multivariate logistic regression analysis suggested that web-based breast cancer information searching was significantly associated with younger age (odds ratio [OR] 0.95, 95% CI 0.94-0.97, P<.001), higher education level (OR 1.37, 95% CI 1.01–1.86, P=.04), and breast conserving surgery (OR 1.35, 95% CI 1.04-1.77, P=.03). Baidu (73.4%, 350/477) and WeChat (66.7%, 318/477) were the two most popular online information sources for breast cancer; however, only 44.9% (214/477) felt satisfied with the online information. In contrast to the nonweb searching group, the web-using patients who were satisfied with online information showed significantly improved DFS (hazard ratio 0.26; 95% CI 0.08-0.88, P=.03). Conclusions: The patients who were most likely to search the internet for breast cancer information were younger and well-educated, and they were more likely to have breast conserving therapy. Web-using patients who were satisfied with the internet information showed significantly improved DFS. Patients should browse credible websites offering accurate and updated information, and website developers should provide high-quality and easy-to-understand information to better meet the needs of patients with breast cancer. %M 32301740 %R 10.2196/16768 %U http://www.jmir.org/2020/4/e16768/ %U https://doi.org/10.2196/16768 %U http://www.ncbi.nlm.nih.gov/pubmed/32301740 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 1 %P e16476 %T Use of Mental Health Apps by Patients With Breast Cancer in the United States: Pilot Pre-Post Study %A Chow,Philip I %A Showalter,Shayna L %A Gerber,Matthew %A Kennedy,Erin M %A Brenin,David %A Mohr,David C %A Lattie,Emily G %A Gupta,Alisha %A Ocker,Gabrielle %A Cohn,Wendy F %+ Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, 560 Ray C Hunt Dr, Charlottesville, VA, United States, 1 4349245401, [email protected] %K breast cancer %K mental health %K mHealth %D 2020 %7 15.4.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: Nearly half of the patients with breast cancer experience clinically significant mental distress within the first year of receiving their cancer diagnosis. There is an urgent need to identify scalable and cost-efficient ways of delivering empirically supported mental health interventions to patients with breast cancer. Objective: The aim of this study was to evaluate the feasibility of in-clinic recruitment for a mobile phone app study and to evaluate the usability and preliminary impact of a suite of mental health apps (IntelliCare) with phone coaching on psychosocial distress symptoms in patients recently diagnosed with breast cancer. Methods: This pilot study adopted a within-subject, 7-week pre-post study design. A total of 40 patients with breast cancer were recruited at a US National Cancer Institute–designated clinical cancer center. Self-reported distress (Patient Health Questionnaire-4) and mood symptoms (Patient-Reported Outcomes Measurement Information System depression and anxiety scales) were assessed at baseline and postintervention. App usability was assessed at postintervention. Results: The minimum recruitment threshold was met. There was a significant decrease in general distress symptoms, as well as symptoms of depression and anxiety, from baseline to postintervention. Overall, participants reported high levels of ease of app use and learning. Scores for app usefulness and satisfaction were reinforced by some qualitative feedback suggesting that tailoring the apps more for patients with breast cancer could enhance engagement. Conclusions: There is a dire need for scalable, supportive interventions in cancer. The results from this study inform how scalable mobile phone–delivered programs with additional phone support can be used to support patients with breast cancer. International Registered Report Identifier (IRRID): RR2-10.2196/11452 %M 32293570 %R 10.2196/16476 %U http://cancer.jmir.org/2020/1/e16476/ %U https://doi.org/10.2196/16476 %U http://www.ncbi.nlm.nih.gov/pubmed/32293570 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e17084 %T Quality of Life of Women After a First Diagnosis of Breast Cancer Using a Self-Management Support mHealth App in Taiwan: Randomized Controlled Trial %A Hou,I-Ching %A Lin,Hsin-Yi %A Shen,Shan-Hsiang %A Chang,King-Jen %A Tai,Hao-Chih %A Tsai,Ay-Jen %A Dykes,Patricia C %+ School of Nursing, National Yang-Ming University, Number 155, Section 2, Linong Street, Beitou District, Taipei City, 11221, Taiwan, 886 28267000 ext 7315, [email protected] %K breast cancer %K mHealth app %K self-management %K quality of life %D 2020 %7 4.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are over 2 million newly diagnosed patients with breast cancer worldwide with more than 10,000 cases in Taiwan each year. During 2017-2018, the National Yang-Ming University, the Taiwan University of Science and Technology, and the Taiwan Breast Cancer Prevention Foundation collaborated to develop a breast cancer self-management support (BCSMS) mHealth app for Taiwanese women with breast cancer. Objective: The aim of this study was to investigate the quality of life (QoL) of women with breast cancer in Taiwan after using the BCSMS app. Methods: After receiving a first diagnosis of breast cancer, women with stage 0 to III breast cancer, who were recruited from social networking sites or referred by their oncologists or oncology case managers, were randomized 1:1 into intervention and control groups. Intervention group subjects used the BCSMS app and the control group subjects received usual care. Two questionnaires—the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Core 30 (QLQ-C30) and the EORTC Breast Cancer-Specific Quality-of-Life Questionnaire (QLQ-BR23)—were distributed to subjects in both arms. Paper-based questionnaires were used at baseline; paper-based or Web-based questionnaires were used at 1.5-month and 3-month follow-up evaluations. All evaluations were self-assessed and anonymous, and participants were blinded to their allocation groups. Descriptive analysis, the Pearson chi-square test, analysis of variance, and the generalized estimating equation were used to analyze the data. Missing values, with and without multi-imputation techniques, were used for sensitivity analysis. Results: A total of 112 women were enrolled and randomly allocated to either the experimental group (n=53) or control group (n=59). The follow-up completion rate was 89.3% (100/112). The demographic data showed homogeneity between the two groups in age (range 50-64 years), breast cancer stage (stage II), marital status (married), working status (employed), and treatment status (receiving treatments). The mean total QoL summary scores from the QLQ-C30 (83.45 vs 82.23, P=.03) and the QLQ-BR23 (65.53 vs 63.13, P=.04) were significantly higher among the experimental group versus the control group, respectively, at 3 months. Conclusions: This research provides support for using a mobile health care app to promote the QoL among women in Taiwan after a first diagnosis of breast cancer. The BCSMS app could be used to support disease self-management, and further evaluation of whether QoL is sustained is warranted. Trial Registration: ClinicalTrials.gov NCT004174248; https://clinicaltrials.gov/ct2/show/NCT04174248 %M 32130181 %R 10.2196/17084 %U http://mhealth.jmir.org/2020/3/e17084/ %U https://doi.org/10.2196/17084 %U http://www.ncbi.nlm.nih.gov/pubmed/32130181 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 3 %P e16334 %T Performance of Computer-Aided Diagnosis in Ultrasonography for Detection of Breast Lesions Less and More Than 2 cm: Prospective Comparative Study %A Yongping,Liang %A Zhou,Ping %A Juan,Zhang %A Yongfeng,Zhao %A Liu,Wengang %A Shi,Yifan %+ The Third Xiangya Hospital, Central South University, 138 Tongzipo Road, Hexiyuelu District, Changsha, Hunan, 410013, China, 86 13974809881, [email protected] %K ultrasonography %K breast neoplasm %K breast imaging reporting and data system (BI-RADS) %K breast neoplasms diagnosis %K cancer screening %K computer diagnostic aid %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Computer-aided diagnosis (CAD) is used as an aid tool by radiologists on breast lesion diagnosis in ultrasonography. Previous studies demonstrated that CAD can improve the diagnosis performance of radiologists. However, the optimal use of CAD on breast lesions according to size (below or above 2 cm) has not been assessed. Objective: The aim of this study was to compare the performance of different radiologists using CAD to detect breast tumors less and more than 2 cm in size. Methods: We prospectively enrolled 261 consecutive patients (mean age 43 years; age range 17-70 years), including 398 lesions (148 lesions>2 cm, 79 malignant and 69 benign; 250 lesions≤2 cm, 71 malignant and 179 benign) with breast mass as the prominent symptom. One novice radiologist with 1 year of ultrasonography experience and one experienced radiologist with 5 years of ultrasonography experience were each assigned to read the ultrasonography images without CAD, and then again at a second reading while applying the CAD S-Detect. We then compared the diagnostic performance of the readers in the two readings (without and combined with CAD) with breast imaging. The McNemar test for paired data was used for statistical analysis. Results: For the novice reader, the area under the receiver operating characteristic curve (AUC) improved from 0.74 (95% CI 0.67-0.82) from the without-CAD mode to 0.88 (95% CI 0.83-0.93; P<.001) at the combined-CAD mode in lesions≤2 cm. For the experienced reader, the AUC improved from 0.84 (95% CI 0.77-0.90) to 0.90 (95% CI 0.86-0.94; P=.002). In lesions>2 cm, the AUC moderately decreased from 0.81 to 0.80 (novice reader) and from 0.90 to 0.82 (experienced reader). The sensitivity of the novice and experienced reader in lesions≤2 cm improved from 61.97% and 73.23% at the without-CAD mode to 90.14% and 97.18% (both P<.001) at the combined-CAD mode, respectively. Conclusions: S-Detect is a feasible diagnostic tool that can improve the sensitivity for both novice and experienced readers, while also improving the negative predictive value and AUC for lesions≤2 cm, demonstrating important application value in the clinical diagnosis of breast cancer. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800019649; http://www.chictr.org.cn/showprojen.aspx?proj=33094 %M 32130149 %R 10.2196/16334 %U https://medinform.jmir.org/2020/3/e16334 %U https://doi.org/10.2196/16334 %U http://www.ncbi.nlm.nih.gov/pubmed/32130149 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e15723 %T Perspective of Patients With Metastatic Breast Cancer on Electronic Access to Scan Results: Mixed Methods Study %A Baun,Christina %A Vogsen,Marianne %A Nielsen,Marie Konge %A Høilund-Carlsen,Poul Flemming %A Hildebrandt,Malene Grubbe %+ Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark, 45 21374221, [email protected] %K patient accessible electronic health record %K electronic health records %K patient access to records %K scan result %K breast cancer %K patient perspective %K breast neoplasms %D 2020 %7 10.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient-accessible electronic health records give patients quick and easy access to their health care data, enabling them to view their test results online prior to a clinic visit. Hospital reports can be difficult for patients to understand, however, and can lead to unnecessary anxiety. Objective: We aimed to investigate the attitudes and experiences of Danish patients with metastatic breast cancer in using electronic health records to view their own scan results. Methods: We conducted a prospective mixed methods study in a sequential design at our institution during 2018. Participants were women with metastatic breast cancer who were having scans every 3 months (combined positron emission tomography and computed tomography or computed tomography alone) to monitor treatment effects. Participants first received an online questionnaire about their knowledge and use of online access to scan results. We then conducted semistructured interviews with 4 women who used the online access to view their scan results. Results: A total of 46 patients received the questionnaire (median age 66, SD 11.8, range 34-84 years). Of these women, 38 (83%) completed the survey (median age 69, SD 10.7, range 42-84 years). Most patients (34/38) were aware of the opportunity to access their reports online, but only 40% (15/38) used this access to read their scan results. Barriers to online access were (1) anxiety over reading the scan results in the absence of clinician support, and (2) a preference to receive all disease information at their next hospital appointment. The patients who read their scan result found that facilitators were greater transparency and empowerment, and barriers were the consequences of reading bad news, the feeling of dilemma about the access, and the medical terminology. Conclusions: Patients with metastatic breast cancer generally had a positive attitude toward electronic access to their scan results, and those who used this opportunity played a greater participatory role in their disease and its management. Others described the potential distress this opportunity caused. The study findings suggest that immediate online access to scan results should be available to patients, but it needs a support function alongside that ensures optimal patient care. %R 10.2196/15723 %U https://www.jmir.org/2020/2/e15723 %U https://doi.org/10.2196/15723 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e12306 %T Feasibility and Health Benefits of an Individualized Physical Activity Intervention in Women With Metastatic Breast Cancer: Intervention Study %A Delrieu,Lidia %A Pialoux,Vincent %A Pérol,Olivia %A Morelle,Magali %A Martin,Agnès %A Friedenreich,Christine %A Febvey-Combes,Olivia %A Pérol,David %A Belladame,Elodie %A Clémençon,Michel %A Roitmann,Eva %A Dufresne,Armelle %A Bachelot,Thomas %A Heudel,Pierre Etienne %A Touillaud,Marina %A Trédan,Olivier %A Fervers,Béatrice %+ Department of Cancer and Environment, Léon Bérard Cancer Center, 28 rue Laënnec, Lyon, 69008, France, 33 0478782800, [email protected] %K metastatic breast cancer %K physical activity %K activity trackers %K feasibility %K tumor progression %D 2020 %7 28.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is limited knowledge regarding the potential benefits of physical activity in patients with metastatic breast cancer. Objective: The Advanced stage Breast cancer and Lifestyle Exercise (ABLE) Trial aimed to assess the feasibility of a physical activity intervention in women with metastatic breast cancer and to explore the effects of physical activity on functional, psychological, and clinical parameters. Methods: The ABLE Trial was a single-arm, 6-month intervention study with a home-based, unsupervised, and personalized walking program using an activity tracker. At baseline and 6 months, we assessed anthropometrics, functional fitness, physical activity level, sedentary behavior, quality of life, fatigue, and tumor progression. Paired proportions were compared using the McNemar test and changes of parameters during the intervention were analyzed using the Wilcoxon signed-rank test, the Mann-Whitney test, and Spearman rank correlations. Results: Overall, 49 participants (mean age 55 years; recruitment rate 94%) were enrolled and 96% adhered to the exercise prescription (attrition rate 2%). Statistically significant improvements in the 6-minute walking distance test (+7%, P<.001) and isometric quadriceps strength (+22%, P<.001), as well as decreases in body mass index (-2.5%, P=.03) and hip circumference (-4.0%, P<.001) were observed at 6 months. Quality of life remained stable and a nonstatistically significant decrease (-16%, P=.07) in fatigue was observed. Conclusions: The high recruitment and adherence rates suggest the willingness of patients with metastatic breast cancer to participate in a physical activity program. The beneficial outcomes regarding physical fitness and anthropometry of this unsupervised physical activity program may encourage these patients to maintain a physically active lifestyle. Future randomized controlled trials with larger sample sizes are warranted. Trial Registration: ClinicalTrials.gov NCT03148886; https://clinicaltrials.gov/ct2/show/NCT03148886 %M 32012082 %R 10.2196/12306 %U https://mhealth.jmir.org/2020/1/e12306 %U https://doi.org/10.2196/12306 %U http://www.ncbi.nlm.nih.gov/pubmed/32012082 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 1 %P e14082 %T Use of Evidence-Based Best Practices and Behavior Change Techniques in Breast Cancer Apps: Systematic Analysis %A Kalke,Kerstin %A Ginossar,Tamar %A Bentley,Joshua M %A Carver,Hannah %A Shah,Sayyed Fawad Ali %A Kinney,Anita Y %+ Department of Communication Studies, Northwestern University, 633 Clark St, Evanston, IL, 60208, United States, 1 5054489363, [email protected] %K mHealth %K breast cancer %K mobile apps %K health behavior %K health apps %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Theoretically designed mobile health (mHealth) breast cancer interventions are essential for achieving positive behavior change. In the case of breast cancer, they can improve the health outcomes of millions of women by increasing prevention and care efforts. However, little is known about the theoretical underpinnings of breast cancer apps available to the general public. Objective: Given that theories may strengthen mHealth interventions, this study aimed to identify breast cancer apps designed to support behavior change, to assess the extent to which they address content along the cancer care continuum and contain behavior change techniques, and to assess the degree to which star rating is related to theory-based design. Methods: Using a criteria-based screening process, we searched 2 major app stores for breast cancer apps designed to promote behavior change. Apps were coded for content along the cancer care continuum and analyzed for behavior change techniques. The Mann-Whitney U test was used to examine the relationship between star ratings and the use of behavior change techniques in apps with star ratings compared to those without ratings. Results: The search resulted in a total of 302 apps, of which 133 were identified as containing breast cancer content. Only 9.9% (30/302) of apps supported behavior change and were further analyzed. These apps were disproportionally focused on behaviors to enhance early detection, whereas only a few apps supported care management, treatment, and posttreatment behaviors. Regarding theories, 63% (19/30) of apps customized content to users, 70% (21/30) established a health-behavior link, and 80% (24/30) provided behavior change instructions. Of the 30 apps, 15 (50%) prompted intention formation whereas less than half of the apps included goal setting (9/30, 30%) and goal reviewing (7/30, 23%). Most apps did not provide information on peer behavior (7/30, 23%) or allow for social comparison (6/30, 20%). None of the apps mobilized social norms. Only half of the apps (15/30, 50%) were user rated. The results of the Mann-Whitney U test showed that apps with star ratings contained significantly more behavior change techniques (median 6.00) than apps without ratings. The analysis of behavior change techniques used in apps revealed their shortcomings in the use of goal setting and social influence features. Conclusions: Our findings indicate that commercially available breast cancer apps have not yet fully realized their potential to promote behavior change, with only a minority of apps focusing on behavior change, and even fewer including theoretical design to support behavior change along the cancer care continuum. These shortcomings are likely limiting the effectiveness of apps and their ability to improve public health. More attention needs to be paid to the involvement of professionals in app development and adherence to theories and best practices in app design to support individuals along the cancer care continuum. %M 32012084 %R 10.2196/14082 %U https://mhealth.jmir.org/2020/1/e14082 %U https://doi.org/10.2196/14082 %U http://www.ncbi.nlm.nih.gov/pubmed/32012084 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 11 %N 4 %P e16511 %T The “Preparation for Shared Decision-Making” Tool for Women With Advanced Breast Cancer: Qualitative Validation Study %A Masi,Domitilla %A Gomez-Rexrode,Amalia Elvira %A Bardin,Rina %A Seidman,Joshua %+ Avalere Health, Center for Healthcare Transformation, 1201 New York Avenue, NW, Washington, DC, 20005, United States, 1 2024596315, [email protected] %K shared decision making %K clinical decision making %K patient preferences %K cancer %K breast cancer %K human-centered design %K patient care planning %D 2019 %7 20.12.2019 %9 Original Paper %J J Participat Med %G English %X Background: The range of decisions and considerations that women with advanced breast cancer (ABC) face can be overwhelming and difficult to manage. Research shows that most patients prefer a shared decision-making (SDM) approach as it provides them with the opportunity to be actively involved in their treatment decisions. The current engagement of these patients in their clinical decisions is suboptimal. Moreover, implementing SDM into routine clinical care can be challenging as patients may not always feel adequately prepared or may not expect to be involved in the decision-making process. Objective: Avalere Health developed the Preparation for Shared Decision-Making (PFSDM) tool to help patients with ABC feel prepared to communicate with their clinicians and engage in decision making aligned with their preferences. The goal of this study was to validate the tool for its acceptability and usability among this patient population. Methods: We interviewed a diverse group of women with ABC (N=30). Interviews were audiorecorded, transcribed, and double coded by using NVivo. We assessed 8 themes to understand the acceptability and usability of the tool. Results: Interviewees expressed that the tool was acceptable for preparing patients for decision making and would be useful for helping patients know what to expect in their care journey. Interviewees also provided useful comments to improve the tool. Conclusions: This validation study confirms the acceptability and usability of the PFSDM tool for women with ABC. Future research should assess the feasibility of the tool’s implementation in the clinical workflow and its impact on patient outcomes. %R 10.2196/16511 %U http://jopm.jmir.org/2019/4/e16511/ %U https://doi.org/10.2196/16511 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 12 %P e14339 %T An Electronic Health Intervention for Latina Women Undergoing Breast Cancer Treatment (My Guide for Breast Cancer Treatment): Protocol for a Randomized Controlled Trial %A Yanez,Betina %A Baik,Sharon H %A Oswald,Laura B %A Buitrago,Diana %A Buscemi,Joanna %A Iacobelli,Francisco %A Perez-Tamayo,Alejandra %A Fajardo,Precilla %A Serrano,Gabriela %A Guitelman,Judith %A Penedo,Frank J %+ Northwestern University Feinberg School of Medicine, 633 N Saint Clair St, Chicago, IL, 60611-3234, United States, 1 312 503 5341, [email protected] %K breast cancer %K Latina %K health-related quality of life %K eHealth %K randomized controlled trial %D 2019 %7 13.12.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Among Latinas and Hispanics (henceforth referred to as Latinas), breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related deaths. However, few interventions have been developed to meet the needs of Latina women undergoing active treatment for breast cancer. Objective: This paper aims to describe the procedures and methods of My Guide for Breast Cancer Treatment and the plans for conducting a multisite randomized controlled trial to investigate the feasibility and preliminary efficacy of this smartphone-based app for Latina women in active treatment for breast cancer. Methods: Study participants will be randomized to the My Guide for Breast Cancer Treatment intervention or the enhanced usual care control condition for 12 weeks. Participants will have access to innovative features such as gamification via virtual awards to reinforce usage and an adaptive section that presents targeted material based on their self-reported concerns and needs. Using a stepped-care approach, intervention participants will also receive telecoaching to enhance their adherence to the app. Study outcomes and intervention targets will be measured at study enrollment (before randomization), 6 and 12 weeks after initial app use. General and disease-specific health-related quality of life (HRQoL) and symptom burden are the study’s primary outcomes, whereas anxiety, depression, fear of cancer recurrence, physical activity, and dietary intake are secondary outcomes. Results: Recruitment began in August 2019 and is expected to be completed by August 2020. We expect to submit study results for publication by fall 2020. Conclusions: My Guide for Breast Cancer Treatment has the potential to improve HRQoL and reduce symptom burden, and increase access to supportive care resources among Latina breast cancer patients. International Registered Report Identifier (IRRID): PRR1-10.2196/14339 %M 31833834 %R 10.2196/14339 %U https://www.researchprotocols.org/2019/12/e14339 %U https://doi.org/10.2196/14339 %U http://www.ncbi.nlm.nih.gov/pubmed/31833834 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e15787 %T A Chatbot Versus Physicians to Provide Information for Patients With Breast Cancer: Blind, Randomized Controlled Noninferiority Trial %A Bibault,Jean-Emmanuel %A Chaix,Benjamin %A Guillemassé,Arthur %A Cousin,Sophie %A Escande,Alexandre %A Perrin,Morgane %A Pienkowski,Arthur %A Delamon,Guillaume %A Nectoux,Pierre %A Brouard,Benoît %+ ENT Department, Hôpital Gui de Chauliac, Université Montpellier 1, 60 Avenue Augustin Fliche, Montpellier, 34264, France, 33 0467336872, [email protected] %K chatbot %K clinical trial %K cancer %D 2019 %7 27.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The data regarding the use of conversational agents in oncology are scarce. Objective: The aim of this study was to verify whether an artificial conversational agent was able to provide answers to patients with breast cancer with a level of satisfaction similar to the answers given by a group of physicians. Methods: This study is a blind, noninferiority randomized controlled trial that compared the information given by the chatbot, Vik, with that given by a multidisciplinary group of physicians to patients with breast cancer. Patients were women with breast cancer in treatment or in remission. The European Organisation for Research and Treatment of Cancer Quality of Life Group information questionnaire (EORTC QLQ-INFO25) was adapted and used to compare the quality of the information provided to patients by the physician or the chatbot. The primary outcome was to show that the answers given by the Vik chatbot to common questions asked by patients with breast cancer about their therapy management are at least as satisfying as answers given by a multidisciplinary medical committee by comparing the success rate in each group (defined by a score above 3). The secondary objective was to compare the average scores obtained by the chatbot and physicians for each INFO25 item. Results: A total of 142 patients were included and randomized into two groups of 71. They were all female with a mean age of 42 years (SD 19). The success rates (as defined by a score >3) was 69% (49/71) in the chatbot group versus 64% (46/71) in the physicians group. The binomial test showed the noninferiority (P<.001) of the chatbot’s answers. Conclusions: This is the first study that assessed an artificial conversational agent used to inform patients with cancer. The EORTC INFO25 scores from the chatbot were found to be noninferior to the scores of the physicians. Artificial conversational agents may save patients with minor health concerns from a visit to the doctor. This could allow clinicians to spend more time to treat patients who need a consultation the most. Trial Registration: Clinicaltrials.gov NCT03556813, https://tinyurl.com/rgtlehq %M 31774408 %R 10.2196/15787 %U http://www.jmir.org/2019/11/e15787/ %U https://doi.org/10.2196/15787 %U http://www.ncbi.nlm.nih.gov/pubmed/31774408 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 2 %P e12536 %T Complementary and Alternative Medicine in Patients With Breast Cancer: Exploratory Study of Social Network Forum Data %A Lognos,Béatrice %A Carbonnel,François %A Boulze Launay,Isabelle %A Bringay,Sandra %A Guerdoux-Ninot,Estelle %A Mollevi,Caroline %A Senesse,Pierre %A Ninot,Gregory %+ Research Unit EA4556 Epsylon, University of Montpellier, University Paul Valéry, Rue Henri Serre, Montpellier, 34000, France, 33 434433500, [email protected] %K complementary and alternative medicine (CAM) %K nonpharmacological interventions %K cancer %K social network %K forum %K patient %D 2019 %7 27.11.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients and health care professionals are becoming increasingly preoccupied in complementary and alternative medicine (CAM) that can also be called nonpharmacological interventions (NPIs). In just a few years, this supportive care has gone from solutions aimed at improving the quality of life to solutions intended to reduce symptoms, supplement oncological treatments, and prevent recurrences. Digital social networks are a major vector for disseminating these practices that are not always disclosed to doctors by patients. An exploration of the content of exchanges on social networks by patients suffering from breast cancer can help to better identify the extent and diversity of these practices. Objective: This study aimed to explore the interest of patients with breast cancer in CAM from posts published in health forums and French-language social media groups. Methods: The retrospective study was based on a French database of 2 forums and 4 Facebook groups between June 3, 2006, and November 17, 2015. The extracted, anonymized, and compiled data (264,249 posts) were analyzed according to the occurrences associated with the NPI categories and NPI subcategories, their synonyms, and their related terms. Results: The results showed that patients with breast cancer use mainly physical (37.6%) and nutritional (31.3%) interventions. Herbal medicine is a subcategory that was cited frequently. However, the patients did not mention digital interventions. Conclusions: This exploratory study of the main French forums and discussion groups indicates a significant interest in CAM during and after treatments for breast cancer, with primarily physical and nutritional interventions complementing approved treatments. This study highlights the importance of accurate information (vs fake medicine), prescription and monitoring of these interventions, and the mediating role that health professionals must play in this regard. %M 31774404 %R 10.2196/12536 %U http://cancer.jmir.org/2019/2/e12536/ %U https://doi.org/10.2196/12536 %U http://www.ncbi.nlm.nih.gov/pubmed/31774404 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e12880 %T Codifying Online Social Support for Breast Cancer Patients: Retrospective Qualitative Assessment %A Mikal,Jude P %A Grande,Stuart W %A Beckstrand,Michael J %+ Division of Health Policy and Management, School of Public Health, University of Minnesota, Mayo Building and Additions, 420 Delaware St SE, Minneapolis, MN, 55455, United States, 1 6126264182, [email protected] %K social support %K social networking %K social media %K health communication %K breast cancer %D 2019 %7 24.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media has emerged as the epicenter for exchanging health-related information, resources, and emotional support. However, despite recognized benefits of social media for advancing health-promoting support exchange, researchers have struggled to differentiate between the different ways social support occurs and is expressed through social media. Objective: The objective of this study was to develop a fuller understanding of social support exchange by examining the ways in which breast cancer patients discuss their health needs and reach out for support on Facebook and to develop a coding schema that can be useful to other social media researchers. Methods: We conducted a retrospective qualitative assessment of text-based social support exchanges through Facebook among 30 breast cancer survivors. Facebook wall data were systematically scraped, organized, coded, and characterized by whether and which types of support were exchanged. Research questions focused on how often participants posted related to cancer, how often cancer patients reached out for support, and the relative frequency of informational, instrumental, or socioemotional support requests broadcast by patients on the site. Results: A novel ground-up coding schema applied to unwieldy Facebook data successfully identified social support exchange in two critical transitions in cancer treatment: diagnosis and transition off cancer therapy. Explanatory coding, design, and analysis processes led to a novel coding schema informed by 100,000 lines of data, an a priori literature review, and observed online social support exchanges. A final coding schema permits a compelling analysis of support exchange as a type of peer community, where members act proactively to buffer stress effects associated with negative health experiences. The coding schema framed operational definitions of what support meant and the forms each type of support could take in social media spaces. Conclusions: Given the importance of social media in social interaction, support exchange, and health promotion, our findings provide insight and clarity for researchers into the different forms informational, resource, and emotional support may take in Web-based social environments. Findings support broader continuity for evaluating computer-mediated support exchange. %M 31651404 %R 10.2196/12880 %U http://www.jmir.org/2019/10/e12880/ %U https://doi.org/10.2196/12880 %U http://www.ncbi.nlm.nih.gov/pubmed/31651404 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13245 %T Evidence on the Use of Mobile Apps During the Treatment of Breast Cancer: Systematic Review %A Cruz,Flávia Oliveira Almeida Marques %A Vilela,Ricardo Alencar %A Ferreira,Elaine Barros %A Melo,Nilce Santos %A Reis,Paula Elaine Diniz Dos %+ School of Health Sciences, University of Brasilia, Asa Norte, Brasilia, 70910-900, Brazil, 55 613107 3300, [email protected] %K mobile applications %K health education %K nursing care %K review %K educational technology %K breast neoplasms %D 2019 %7 27.08.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Cancer is a major cause of morbidity, disability, and mortality worldwide, and breast cancer is the most common cause of death in women. Different modalities of cancer treatment can have adverse effects that reduce the quality of life of patients and lead to treatment interruptions, if not managed properly. The use of mobile technologies has brought innovative possibilities for improving health care. Mobile apps can help individuals manage their own health and well-being and may also promote healthy lifestyles and information access. Objective: The aim of this study was to identify available evidence on the use of mobile apps to provide information and facilitate communication regarding self-care management related to the adverse effects of toxicities owing to breast cancer therapy. Methods: This systematic review includes studies which were identified using a search strategy adapted for each electronic database: CINAHL, Cochrane Library, LILACS, LIVIVO, PubMed, SCOPUS, and Web of Science. In addition, a gray literature search was performed using Google Scholar. All the electronic database searches were conducted on April 17, 2019. Two investigators independently reviewed the titles and abstracts of the studies identified and then read the full text of all selected papers. The quality of the included studies was analyzed by the Cochrane Collaboration Risk of Bias Tool and the Methodological Index for Non-Randomized Studies. Results: A total of 9 studies which met the eligibility criteria—3 randomized clinical trials and 6 nonrandomized studies published in English from 2010 to 2018—were considered for this systematic review; 396 patients with breast cancer, as well as 40 experts in the medical and nursing fields, and 3 software engineers were included. Conclusions: The evidence from the studies included in this systematic review is currently limited but suggests that mobile apps for women with breast cancer might be an acceptable information source that can improve patient well-being; they can also be used to report symptoms and adverse treatment-related effects and promote self-care. There is a need to test more evidence-based apps in future randomized clinical trials. %M 31456578 %R 10.2196/13245 %U http://mhealth.jmir.org/2019/8/e13245/ %U https://doi.org/10.2196/13245 %U http://www.ncbi.nlm.nih.gov/pubmed/31456578 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e15062 %T Association Between the Use of a Mobile Health Strategy App and Biological Changes in Breast Cancer Survivors: Prospective Pre-Post Study %A Lozano-Lozano,Mario %A Melguizo-Rodríguez,Lucia %A Fernández-Lao,Carolina %A Galiano-Castillo,Noelia %A Cantarero-Villanueva,Irene %A Martín-Martín,Lydia %A Arroyo-Morales,Manuel %+ Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Avda de la Ilustracion, 60, Granada, 18016, Spain, 34 958242070, [email protected] %K mHealth %K interleukin-6 %K C-reactive protein %K breast cancer survivors %K low-grade inflammatory %D 2019 %7 14.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a bidirectional relationship between chronic low-grade inflammation and cancer. Inflammatory markers, such as interleukin-6 (IL-6), have been associated with both the malignant transformation of epithelial cells and tumor progression, thus linking low-grade inflammation with a higher risk of cancer and recurrence in the survival phase. Therefore, they are considered valuable prognostic biomarkers. Knowing and finding appropriate primary prevention strategies to modify these parameters is a major challenge in reducing the risk of cancer recurrence and increasing survival. Different therapeutic strategies have shown efficacy in the modification of these and other biological parameters, but with contradictory results. There are apparently no strategies in which telemedicine, and specifically mobile health (mHealth), are used as a means to potentially cause biological changes. Objective: The objectives of this study were to: (1) check whether it is feasible to find changes in inflammation biomarkers through an mHealth strategy app as a delivery mechanism of an intervention to monitor energy balance; and (2) discover potential predictors of change of these markers in breast cancer survivors (BCSs). Methods: A prospective quasi-experimental pre-post study was conducted through an mHealth energy balance monitoring app with 73 BCSs, defined as stage I-IIIA of breast cancer and at least six months from the completion of the adjuvant therapy. Measurements included were biological salivary markers (IL-6 and C-reactive protein [CRP]), self-completed questionnaires (the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, the user version of the Mobile Application Rating Scale [uMARS] and an ad hoc clinical and sociodemographic questionnaire) and physical objective measures (accelerometry, weight and height). In addition, using the logging data of the mHealth app, the rate of use (in days) was recorded during the entire experimental phase of the study. Using Stata software, a paired two-tailed t test, Pearson and Spearman correlations, and a stepwise multiple regression analysis were used to interpret the data. Results: Analyzing changes in inflammatory biomarker concentrations after using the mHealth app, differences between preassessment CRP (4899.04 pg/ml; SD 1085.25) and IL-6 (87.15 pg/ml; SD 33.59) and postassessment CRP (4221.24 pg/ml; SD 911.55) and IL-6 (60.53 pg/ml; SD 36.31) showed a significant decrease in both markers, with a mean difference of –635.25 pg/ml (95% CI –935.65 to –334.85; P<.001) in CRP and –26.61 pg/ml (95% CI –42.51 to –10.71; P=.002) in IL-6. Stepwise regression analyses revealed that changes in global quality of life, as well as uMARS score and hormonal therapy, were possible predictors of change in CRP concentration after using the mHealth app. In the same way, the type of tumor removal surgery conducted, as well as changes in weight and pain score, were possible predictors of change in IL-6 concentration after using the app. Conclusions: In conclusion, through the results of this study, we hypothesize that there is a possible association between an mHealth energy balance monitoring strategy and biological changes in BCSs. These changes could be explained by different biopsychosocial parameters, such as the use of the application itself, quality of life, pain, type of tumor removal surgery, hormonal treatment or obesity. %M 31414667 %R 10.2196/15062 %U http://www.jmir.org/2019/8/e15062/ %U https://doi.org/10.2196/15062 %U http://www.ncbi.nlm.nih.gov/pubmed/31414667 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e14418 %T A Web-Based Exercise System (e-CuidateChemo) to Counter the Side Effects of Chemotherapy in Patients With Breast Cancer: Randomized Controlled Trial %A Ariza-Garcia,Angelica %A Lozano-Lozano,Mario %A Galiano-Castillo,Noelia %A Postigo-Martin,Paula %A Arroyo-Morales,Manuel %A Cantarero-Villanueva,Irene %+ Department of Physical Therapy, University of Granada, Avda de la Ilustración, 60, Granada,, Spain, 34 958248765, [email protected] %K breast cancer %K chemotherapy %K physical fitness %K randomized control trial %K telehealth %K e-health %K therapeutic exercise %D 2019 %7 24.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Breast cancer patients have to face a high-risk state during chemotherapy, which involves deterioration of their health including extensive physical deterioration. Face-to-face physical exercise programs have presented low adherence rates during medical treatment, and telehealth systems could improve these adherence rates. Objective: This study aimed to evaluate the effectiveness of a Web-based exercise program (e-CuidateChemo) to mitigate the side effects of chemotherapy on the physical being, anthropometric aspects, and body composition. Methods: A total of 68 patients diagnosed with breast cancer, who were undergoing chemotherapy, were enrolled. The patients were categorized into two groups: e-CuidateChemo (n=34) and controls (n=34). The e-CuidateChemo group participated in an adapted 8-week tailored exercise program through a Web-based system. A blinded, trained researcher assessed functional capacity, strength, anthropometric parameters, and body composition. The intervention effects were tested using analysis of covariance and Cohen d tests. Results: Functional capacity improved significantly in the e-CuidateChemo group compared to the control group (6-minute walk test: 62.07 [SD 130.09] m versus –26.34 [SD 82.21] m; 6-minute walk test % distance predicted: 10.81% [SD 22.69%] m versus –4.60% [SD 14.58%]; between-group effect: P=.015 for both). The intervention group also showed significantly improved secondary outcomes such as between-group effects for abdominal (24.93 [SD 26.83] s vs –18.59 [SD 38.69] s), back (12.45 [SD 10.20] kg vs 1.39 [10.72] kg), and lower body (–2.82 [SD 3.75] s vs 1.26 [SD 2.84] s) strength; all P<.001 compared to the control group. Conclusions: This paper showed that a Web-based exercise program was effective in reversing the detriment in functional capacity and strength due to chemotherapy. Trial Registration: ClinicalTrials.gov NCT02350582; https://clinicaltrials.gov/ct2/show/NCT02350582 %M 31342907 %R 10.2196/14418 %U http://www.jmir.org/2019/7/e14418/ %U https://doi.org/10.2196/14418 %U http://www.ncbi.nlm.nih.gov/pubmed/31342907 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e13767 %T Cloud Health Resource Sharing Based on Consensus-Oriented Blockchain Technology: Case Study on a Breast Tumor Diagnosis Service %A Zhu,Xiaobao %A Shi,Jing %A Lu,Cuiyuan %+ Department of Mechanical and Materials Engineering, University of Cincinnati, 2600 Clifton Ave, Cincinnati, OH,, United States, 1 513 556 2380, [email protected] %K blockchain %K cloud health %K breast tumor diagnosis %K k-nearest neighbors (KNN) %K Proof of Authority (PoA) %K consensus-oriented %D 2019 %7 23.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, researchers have made significant efforts in advancing blockchain technology. This technology, with distinct features of decentralization and security, can be applied to many fields. In areas of health data and resource sharing, applications of blockchain technology are also emerging. Objective: In this study, we propose a cloud health resource-sharing model based on consensus-oriented blockchain technology and have developed a simulation study on breast tumor diagnosis. Methods: The proposed platform is built on a consortium or federated blockchain that possesses features of both centralization and decentralization. The consensus mechanisms generate operating standards for the proposed model. Open source Ethereum code is employed to provide the blockchain environment. Proof of Authority is selected as the consensus algorithm of block generation. Results: Based on the proposed model, a simulation case study for breast tumor classification is constructed. The simulation includes 9893 service requests from 100 users; 22 service providers are equipped with 22 different classification methods. Each request is fulfilled by a service provider recommended by the weighted k-nearest neighbors (KNN) algorithm. The majority of service requests are handled by 9 providers, and provider service evaluation scores tend to stabilize. Also, user priority on KNN weights significantly affects the system operation outcome. Conclusions: The proposed model is feasible based on the simulation case study for the cloud service of breast tumor diagnosis and has the potential to be applied to other applications. %M 31339106 %R 10.2196/13767 %U http://www.jmir.org/2019/7/e13767/ %U https://doi.org/10.2196/13767 %U http://www.ncbi.nlm.nih.gov/pubmed/31339106 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 3 %P e12660 %T Computer-Aided Detection for Breast Cancer Screening in Clinical Settings: Scoping Review %A Masud,Rafia %A Al-Rei,Mona %A Lokker,Cynthia %+ Health Information Research Unit, Department of Health Research Methods, Evidence, and Impact, McMaster University, CRL 137, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 22208, [email protected] %K computer-aided detection %K machine learning %K screening mammography %K breast cancer %K radiology %K implementation %D 2019 %7 18.07.2019 %9 Review %J JMIR Med Inform %G English %X Background: With the growth of machine learning applications, the practice of medicine is evolving. Computer-aided detection (CAD) is a software technology that has become widespread in radiology practices, particularly in breast cancer screening for improving detection rates at earlier stages. Many studies have investigated the diagnostic accuracy of CAD, but its implementation in clinical settings has been largely overlooked. Objective: The aim of this scoping review was to summarize recent literature on the adoption and implementation of CAD during breast cancer screening by radiologists and to describe barriers and facilitators for CAD use. Methods: The MEDLINE database was searched for English, peer-reviewed articles that described CAD implementation, including barriers or facilitators, in breast cancer screening and were published between January 2010 and March 2018. Articles describing the diagnostic accuracy of CAD for breast cancer detection were excluded. The search returned 526 citations, which were reviewed in duplicate through abstract and full-text screening. Reference lists and cited references in the included studies were reviewed. Results: A total of nine articles met the inclusion criteria. The included articles showed that there is a tradeoff between the facilitators and barriers for CAD use. Facilitators for CAD use were improved breast cancer detection rates, increased profitability of breast imaging, and time saved by replacing double reading. Identified barriers were less favorable perceptions of CAD compared to double reading by radiologists, an increase in recall rates of patients for further testing, increased costs, and unclear effect on patient outcomes. Conclusions: There is a gap in the literature between CAD’s well-established diagnostic accuracy and its implementation and use by radiologists. Generally, the perceptions of radiologists have not been considered and details of implementation approaches for adoption of CAD have not been reported. The cost-effectiveness of CAD has not been well established for breast cancer screening in various populations. Further research is needed on how to best facilitate CAD in radiology practices in order to optimize patient outcomes, and the views of radiologists need to be better considered when advancing CAD use. %M 31322128 %R 10.2196/12660 %U http://medinform.jmir.org/2019/3/e12660/ %U https://doi.org/10.2196/12660 %U http://www.ncbi.nlm.nih.gov/pubmed/31322128 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e14136 %T A Mobile System to Improve Quality of Life Via Energy Balance in Breast Cancer Survivors (BENECA mHealth): Prospective Test-Retest Quasiexperimental Feasibility Study %A Lozano-Lozano,Mario %A Cantarero-Villanueva,Irene %A Martin-Martin,Lydia %A Galiano-Castillo,Noelia %A Sanchez,Maria-José %A Fernández-Lao,Carolina %A Postigo-Martin,Paula %A Arroyo-Morales,Manuel %+ Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Avda de la Ilustración, 60, Granada,, Spain, 34 958248764, [email protected] %K mHealth %K energy balance %K monitoring %K breast cancer %K survivors %K quality of life %D 2019 %7 25.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Energy balance is defined as the difference between energy expenditure and energy intake. The current state of knowledge supports the need to better integrate mechanistic approaches through effective studies of energy balance in the cancer population because of an observed significant lack of adherence to healthy lifestyle recommendations. To stimulate changes in breast cancer survivors’ lifestyles based on energy balance, our group developed the BENECA (Energy Balance on Cancer) mHealth app. BENECA has been previously validated as a reliable energy balance monitoring system. Objective: Based on our previous results, the goal of this study was to investigate the feasibility of BENECA mHealth in an ecological clinical setting with breast cancer survivors, by studying (1) its feasibility and (2) pretest-posttest differences with regard to breast cancer survivor lifestyles, quality of life (QoL), and physical activity (PA) motivation. Methods: Eighty breast cancer survivors diagnosed with stage I to IIIA and with a body mass index over 25 kg/m2 were enrolled in this prospective test-retest quasi-experimental study. Patients used BENECA mHealth for 8 weeks and were assessed at baseline and the postintervention period. Feasibility main outcomes included percentage of adoption, usage, and attrition; user app quality perception measured with the Mobile App Rating Scale (MARS); satisfaction with the Net Promoter Score (NPS); and barriers and facilitators of its use. Clinical main outcomes included measuring QoL with the European Organization for Research and Treatment of Cancer QoL Questionnaire Core 30 (EORT QLQ-C30), PA assessment with accelerometry, PA motivation measure with a Spanish self-efficacy scale for physical activity (EAF), and body composition with dual-energy x-ray absorptiometry. Statistical tests (using paired-sample t tests) and Kaplan-Meier survival curves were analyzed. Results: BENECA was considered feasible by the breast cancer survivors in terms of use (76%, 58/76), adoption (69%, 80/116), and satisfaction (positive NPS). The app quality score did not make it one of the best-rated apps (mean 3.71, SD 0.47 points out of 5). BENECA mHealth improved the QoL of participants (global health mean difference [MD] 12.83, 95% CI 8.95-16.71, P<.001), and EAF score (global MD 36.99, 95% CI 25.52-48.46, P<.001), daily moderate-to-vigorous PA (MD 7.38, 95% CI 0.39-14.37, P=.04), and reduced body weight (MD −1.42, 95% CI −1.97 to −0.87, P<.001). Conclusions: BENECA mHealth can be considered feasible in a real clinical context to promote behavioral changes in the lifestyles of breast cancer survivors, but it needs to be enhanced to improve user satisfaction with use and functionality. This study highlights the importance of the use of mobile apps based on energy balance and how the QoL of breast cancer survivors can be improved via monitoring. %M 31237570 %R 10.2196/14136 %U http://mhealth.jmir.org/2019/6/e14136/ %U https://doi.org/10.2196/14136 %U http://www.ncbi.nlm.nih.gov/pubmed/31237570 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13987 %T Using the Extended Parallel Process Model to Examine the Nature and Impact of Breast Cancer Prevention Information on Mobile-Based Social Media: Content Analysis %A Chen,Liang %A Yang,Xiaodong %A Fu,Lunrui %A Liu,Xiaoming %A Yuan,Congyi %+ School of Journalism and Communication, Shandong University, No.57 Shanda South Road, Jinan, 250100, China, 86 531 88361159, [email protected] %K breast cancer %K prevention information %K mobile social media %K EPPM %D 2019 %7 24.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the rise of mobile technology, an increasing number of people use mobile-based social media to access health information. Many scholars have explored the nature of health information on social media; however, the impact of such information on people was understudied. Objective: This study aimed to examine the nature and impact of health information on mobile-based social media. Specifically, we investigated how the levels of threat and efficacy of breast cancer prevention information affect individuals’ engagement with the information, such as readings and likes. Methods: Breast cancer prevention articles posted on a Chinese mobile-based social media platform (ie, WeChat Subscription Account [WeChat SA]) from January 1 to December 31, 2017, were extracted using the Python Web Crawler. We used content analysis and analysis of covariance to analyze our data. Results: The results revealed that the vast majority of titles and main bodies of the articles involved one of the extended parallel process model components: threat or efficacy. Conclusions: Breast cancer prevention information on WeChat SA was well designed. Both threat and efficacy significantly affected the number of readings, whereas only efficacy had a significant effect on the number of likes. Moreover, breast cancer prevention information that contained both high levels of threat and efficacy gained the largest number of readings and likes. %M 31237239 %R 10.2196/13987 %U http://mhealth.jmir.org/2019/6/e13987/ %U https://doi.org/10.2196/13987 %U http://www.ncbi.nlm.nih.gov/pubmed/31237239 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 6 %P e12624 %T Policies and Programs for the Prevention and Control of Breast Cancer in Mexican and Latin American Women: Protocol for a Scoping Review %A Ramos Herrera,Igor Martin %+ Center for Research on Health Information Systems and Management, Department of Public Health, University of Guadalajara, Sierra Mojada 950, Colonia Independencia, Guadalajara, 44340, Mexico, 52 (33)1058200 ext 33900, [email protected] %K breast neoplasms %K public policies %K primary health care %K systematic review %D 2019 %7 12.6.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Breast cancer has become a major public health problem around the world, especially in Mexico and Latin America. Screening for breast cancer, which involves self-examination, mammography, and clinical breast examination, is crucial for early diagnosis, which in turn is associated with improved outcomes and survival rates. Although breast cancer prevention and control activities are being implemented in Mexico and Latin America, as in many other countries, there are no comprehensive public reports that provide information on the number, type, and scope of these activities; the impact of the programs and actions implemented; and the policies that form the basis of these programs. Objective: This study aims to present the design of a protocol for a scoping review on the policies and action programs for breast cancer care in Mexico and Latin America, as well as their objectives and implementation plans. Methods: This scoping review is guided by the methodological reference framework proposed by Arksey and O’Malley. A systematic search of the following electronic databases will be performed: MEDLINE (PubMed), MEDLINE (EBSCOHost), CINAHL (EBSCOHost), Academic Search Complete (EBSCOHost), ERIC, ISI Web of Science (Science Citation Index) in English and Cochrane and MEDES-MEDicina in Spanish. A search will be conducted to identify relevant studies published between 2000 and 2018. Data will be analyzed and presented in descriptive statistics and qualitative content analyses with analysis matrices and semantic networks. The selected studies will be arranged according to the Specific Action Program, Prevention and Control of Female Cancer 2013-2018. Results: The intention is to perform this review during the first and second quarters of 2019 and present the results to health authorities by the first quarter of 2020. Results will also be sent for publication to an indexed journal by the second quarter of 2020. Conclusions: We present a protocol for a scoping review–type literature revision based on the Arksey and O’Malley methodology to be performed during the first quarter of 2019. According to this 6-stage methodology, we will identify the scientific publications that present or analyze first-level action policies and programs for breast cancer care in Mexican women, as well as the results of these policies and programs, if any. The outcome of this review will be used to define the basis of a research project intended to design an educational intervention strategy for the general public in Mexico to enable them to deal with this public health problem. International Registered Report Identifier (IRRID): PRR1-10.2196/12624 %M 31199301 %R 10.2196/12624 %U http://www.researchprotocols.org/2019/6/e12624/ %U https://doi.org/10.2196/12624 %U http://www.ncbi.nlm.nih.gov/pubmed/31199301 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e14110 %T Areas of Interest and Stigmatic Attitudes of the General Public in Five Relevant Medical Conditions: Thematic and Quantitative Analysis Using Twitter %A Alvarez-Mon,Miguel Angel %A Llavero-Valero,María %A Sánchez-Bayona,Rodrigo %A Pereira-Sanchez,Victor %A Vallejo-Valdivielso,Maria %A Monserrat,Jorge %A Lahera,Guillermo %A Asunsolo del Barco,Angel %A Alvarez-Mon,Melchor %+ Department of Psychiatry, Clinica Universidad de Navarra, Avda Pio XII, 36, Pamplona, 31008, Spain, 34 948255400, [email protected] %K social stigma %K social media %K psychosis %K breast cancer %K HIV %K dementia %K public opinion %K diabetes %D 2019 %7 28.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Twitter is an indicator of real-world performance, thus, is an appropriate arena to assess the social consideration and attitudes toward psychosis. Objective: The aim of this study was to perform a mixed-methods study of the content and key metrics of tweets referring to psychosis in comparison with tweets referring to control diseases (breast cancer, diabetes, Alzheimer, and human immunodeficiency virus). Methods: Each tweet’s content was rated as nonmedical (NM: testimonies, health care products, solidarity or awareness and misuse) or medical (M: included a reference to the illness’s diagnosis, treatment, prognosis, or prevention). NM tweets were classified as positive or pejorative. We assessed the appropriateness of the medical content. The number of retweets generated and the potential reach and impact of the hashtags analyzed was also investigated. Results: We analyzed a total of 15,443 tweets: 8055 classified as NM and 7287 as M. Psychosis-related tweets (PRT) had a significantly higher frequency of misuse 33.3% (212/636) vs 1.15% (853/7419; P<.001) and pejorative content 36.2% (231/636) vs 11.33% (840/7419; P<.001). The medical content of the PRT showed the highest scientific appropriateness 100% (391/391) vs 93.66% (6030/6439; P<.001) and had a higher frequency of content about disease prevention. The potential reach and impact of the tweets related to psychosis were low, but they had a high retweet-to-tweet ratio. Conclusions: We show a reduced number and a different pattern of contents in tweets about psychosis compared with control diseases. PRT showed a predominance of nonmedical content with increased frequencies of misuse and pejorative tone. However, the medical content of PRT showed high scientific appropriateness aimed toward prevention. %M 31140438 %R 10.2196/14110 %U http://www.jmir.org/2019/5/e14110/ %U https://doi.org/10.2196/14110 %U http://www.ncbi.nlm.nih.gov/pubmed/31140438 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e10855 %T Training Cognitive Functions Using Mobile Apps in Breast Cancer Patients: Systematic Review %A Vergani,Laura %A Marton,Giulia %A Pizzoli,Silvia Francesca Maria %A Monzani,Dario %A Mazzocco,Ketti %A Pravettoni,Gabriella %+ Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, Milan, 20122, Italy, 39 029 4372099, [email protected] %K cognitive impairment %K breast cancer %K cognitive training %K intervention %K mobile-based interventions %D 2019 %7 19.03.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Breast cancer is an invalidating disease and its treatment can bring serious side effects that have a physical and psychological impact. Specifically, cancer treatment generally has a strong impact on cognitive function. In recent years, new technologies and eHealth have had a growing influence on health care and innovative mobile apps can be useful tools to deliver cognitive exercise in the patient’s home. Objective: This systematic review gives an overview of the state-of-the-art mobile apps aimed at training cognitive functions to better understand whether these apps could be useful tools to counteract cognitive impairment in breast cancer patients. Methods: We searched in a systematic way all the full-text articles from the PubMed and Embase databases. Results: We found eleven studies using mobile apps to deliver cognitive training. They included a total of 819 participants. App and study characteristics are presented and discussed, including cognitive domains trained (attention, problem solving, memory, cognitive control, executive function, visuospatial function, and language). None of the apps were specifically developed for breast cancer patients. They were generally developed for a specific clinical population. Only 2 apps deal with more than 1 cognitive domain, and only 3 studies focus on the efficacy of the app training intervention. Conclusions: These results highlight the lack of empirical evidence on the efficacy of currently available apps to train cognitive function. Cognitive domains are not well defined across studies. It is noteworthy that no apps are specifically developed for cancer patients, and their applicability to breast cancer should not be taken for granted. Future studies should test the feasibility, usability, and effectiveness of available cognitive training apps in women with breast cancer. Due to the complexity and multidimensionality of cognitive difficulties in this cancer population, it may be useful to design, develop, and implement an ad hoc app targeting cognitive impairment in breast cancer patients. %M 30888326 %R 10.2196/10855 %U https://mhealth.jmir.org/2019/3/e10855/ %U https://doi.org/10.2196/10855 %U http://www.ncbi.nlm.nih.gov/pubmed/30888326 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e12441 %T Partnering With Mommy Bloggers to Disseminate Breast Cancer Risk Information: Social Media Intervention %A Wright,Kevin %A Fisher,Carla %A Rising,Camella %A Burke-Garcia,Amelia %A Afanaseva,Dasha %A Cai,Xiaomei %+ George Mason University, Northeast Module, Room 102, Fairfax, VA,, United States, 1 413 362 5611, [email protected] %K breast cancer %K environment and public health %K risk reduction behavior %K blogging %K social networking %K social media %K health communication %K information dissemination %D 2019 %7 07.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Women are concerned about reducing their breast cancer risk, particularly if they have daughters. Social media platforms, such as blogs written by mothers, are increasingly being recognized as a channel that women use to make personal and family health–related decisions. Government initiatives (eg, Interagency Breast Cancer and Environmental Research Coordinating Committee) and researchers have called for scientists and the community to partner and disseminate scientifically and community-informed environmental risk information. Objective: We developed and evaluated a blog intervention to disseminate breast cancer and environmental risk information to mothers. We teamed with mommy bloggers to disseminate a message that we developed and tailored for mothers and daughters based on scientific evidence from the Breast Cancer and the Environment Research Program (BCERP). We posited that the intervention would influence women’s exposure to, acceptance of, and beliefs about environmental risks while promoting their intention to adopt risk-reducing behaviors. Methods: Using a quasi-experimental design, we recruited 75 mommy bloggers to disseminate the breast cancer risk message on their respective blogs and examined the impact of the intervention on (1) readers exposed to the intervention (n=445) and (2) readers not exposed to the intervention (comparison group; n=353). Results: Following the intervention, blog reader scores indicating exposure to the breast cancer risk and prevention information were greater than scores of blog readers who were not exposed (or did not recall seeing the message; mean 3.92, SD 0.85 and mean 3.45, SD 0.92, respectively; P<.001). Readers who recalled the intervention messages also had higher breast cancer risk and prevention information satisfaction scores compared with readers who did not see (or recall) the messages (mean 3.97, SD 0.75 and mean 3.57, SD 0.94, respectively; P<.001). Blog readers who recalled seeing the intervention messages were significantly more likely to share the breast cancer risk and prevention information they read, with their daughters specifically, than readers who did not recall seeing them (χ21=8.1; P=.004). Those who recalled seeing the intervention messages reported significantly higher breast cancer risk and prevention information influence scores, indicative of behavioral intentions, than participants who did not recall seeing them (mean 11.22, SD 2.93 and mean 10.14, SD 3.24, respectively; P=.003). Most women ranked Facebook as their first choice for receiving breast cancer risk information. Conclusions: Results indicated that blog readers who were exposed to (and specifically recalled) the BCERP-adapted intervention messages from mommy bloggers had higher breast cancer risk and prevention information exposure scores and higher breast cancer risk and prevention information satisfaction and influence scores than those who did not see (or recall) them. Mommy bloggers may be important opinion leaders for some women and key to enhancing the messaging, delivery, and impact of environmental breast cancer risk information on mothers. %M 30843866 %R 10.2196/12441 %U https://www.jmir.org/2019/3/e12441/ %U https://doi.org/10.2196/12441 %U http://www.ncbi.nlm.nih.gov/pubmed/30843866 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e10820 %T Breast Cancer Survivors’ Experiences With an Activity Tracker Integrated Into a Supervised Exercise Program: Qualitative Study %A Wu,Hoi San %A Gal,Roxanne %A van Sleeuwen,Niek C %A Brombacher,Aarnout C %A IJsselsteijn,Wijnand A %A May,Anne M %A Monninkhof,Evelyn M %+ Julius Center of Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, STR 6.131, PO Box 85500, Utrecht, 3508 GA, Netherlands, 31 887569624, [email protected] %K breast cancer %K activity trackers %K physical activity %K sedentary behavior %K qualitative research %D 2019 %7 21.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is growing evidence that physical activity is related to a better prognosis after a breast cancer diagnosis, whereas sedentary behavior is associated with worse outcomes. It is therefore important to stimulate physical activity and reduce sedentary time among patients with breast cancer. Activity trackers offer a new opportunity for interventions directed at stimulating physical activity behavior change. Objective: This study aimed to explore the experience of patients with breast cancer who used an activity tracker in addition to a supervised exercise intervention in the randomized UMBRELLA Fit trial. Methods: A total of 10 patients with breast cancer who completed cancer treatment participated in semistructured in-depth interviews about their experience with and suggestions for improvements for the Jawbone UP2 activity tracker. Results: The activity tracker motivated women to be physically active and created more awareness of their (sedentary) lifestyles. The women indicated that the automatically generated advice (received via the Jawbone UP app) lacked individualization and was not applicable to their personal situations (ie, having been treated for cancer). Furthermore, women felt that the daily step goal was one-dimensional, and they preferred to incorporate other physical activity goals. The activity tracker’s inability to measure strength exercises was a noted shortcoming. Finally, women valued personal feedback about the activity tracker from the physiotherapist. Conclusions: Wearing an activity tracker raised lifestyle awareness in patients with breast cancer. The women also reported additional needs not addressed by the system. Potential improvements include a more realistic total daily physical activity representation, personalized advice, and personalized goals. %M 30789349 %R 10.2196/10820 %U https://mhealth.jmir.org/2019/2/e10820/ %U https://doi.org/10.2196/10820 %U http://www.ncbi.nlm.nih.gov/pubmed/30789349 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e10930 %T Research-Tested Mobile Apps for Breast Cancer Care: Systematic Review %A Jongerius,Chiara %A Russo,Selena %A Mazzocco,Ketti %A Pravettoni,Gabriella %+ Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1100 DD, Netherlands, 31 205667787, [email protected] %K breast cancer care %K breast cancer management %K breast cancer prevention %K breast cancer survivorship %K mobile applications %K mHealth applications %D 2019 %7 11.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of mobile health (mHealth) apps in clinical settings is increasing widely. mHealth has been used to promote prevention, improve early detection, manage care, and support survivors and chronic patients. However, data on the efficacy and utility of mHealth apps are limited. Objective: The main objective of this review was to provide an overview of the available research-tested interventions using mHealth apps and their impact on breast cancer care. Methods: A systematic search of Medline, PsycINFO, Embase, and Scopus was performed to identify relevant studies. From the selected studies, the following information was extracted: authors, publication date, study objectives, study population, study design, interventions’ features, outcome measures, and results. Results: We identified 29 empirical studies that described a health care intervention using an mHealth app in breast cancer care. Of these, 7 studies were about the use of an mHealth application in an intervention for breast cancer prevention and early detection, 12 targeted care management, and 10 focused on breast cancer survivors. Conclusions: Our results indicate consistent and promising findings of interventions using mHealth apps that target care management in breast cancer. Among the categories of mHealth apps focusing on survivorship, mHealth-based interventions showed a positive effect by promoting weight loss, improving the quality of life, and decreasing stress. There is conflicting and less conclusive data on the effect of mHealth apps on psychological dimensions. We advocate further investigation to confirm and strengthen these findings. No consistent evidence for the impact of interventions using mHealth apps in breast cancer prevention and early detection was identified due to the limited number of studies identified by our search. Future research should continue to explore the impact of mHealth apps on breast cancer care to build on these initial recommendations. %M 30741644 %R 10.2196/10930 %U http://mhealth.jmir.org/2019/2/e10930/ %U https://doi.org/10.2196/10930 %U http://www.ncbi.nlm.nih.gov/pubmed/30741644 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e12400 %T Online Information-Seeking About Potential Breast Cancer Symptoms: Capturing Online Behavior With an Internet Browsing Tracking Tool %A Marcu,Afrodita %A Muller,Cecile %A Ream,Emma %A Whitaker,Katriina L %+ School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Duke of Kent Building, Guildford, GU2 7XH, United Kingdom, 44 0148 36 82515, [email protected] %K breast cancer %K health information %K internet search %K online information seeking %D 2019 %7 06.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: People engage in health information-seeking online when experiencing unusual or unfamiliar bodily changes. It is not well understood how people consult the internet for health information after the onset of unfamiliar symptoms and before receiving a potential diagnosis and how online information-seeking can help people appraise their symptoms. This lack of evidence may be partly due to methodological limitations in capturing in real time the online information-seeking process. Objective: We explored women’s symptom attribution and online health information-seeking in response to a hypothetical and unfamiliar breast change suggestive of cancer (nipple rash). We also aimed to establish the feasibility of capturing in real time the online information-seeking process with a tool designed to track participant online searches and visited websites, the Vizzata browser tracker. Methods: An online survey was completed by 56 cancer-free women (mean age 60.34 [SD 7.73] years) responding to a scenario asking them to imagine noticing a red scaly rash on the nipple. Participants were asked to make symptom attributions when presented with the scenario (T1) and again after seeking information online (T2). The online tracking tool, embedded in the survey, was used to capture in real time participant search terms and accessed websites. Results: The tracking tool captured the search terms and accessed websites of most of the participants (46/56, 82%). For the rest (10/56, 18%), there was evidence of engagement in online information-seeking (eg, medical terminology and cancer attribution at T2) despite their searching activity not being recorded. A total of 25 participants considered cancer as a potential cause for the nipple rash at T1, yet only one of these used cancer as a search term. Most participants (40/46, 87%) used rash-related search terms, particularly nipple rash and rash on nipple. The majority (41/46, 89%) accessed websites containing breast cancer information, with the National Health Service webpage “Paget disease of the nipple” being the most visited one. At T2, after engaging in the internet search task, more participants attributed the nipple rash to breast cancer than at T1 (37/46, 66% vs 25/46, 45%), although a small number of participants (6/46) changed from making a cancer attribution at T1 to a noncancer one at T2. Conclusions: Making a cancer attribution for an unfamiliar breast change did not necessarily translate into cancer-termed searches. Equally, not all internet searches led to a cancer attribution. The findings suggest that online information-seeking may not necessarily help women who experience unfamiliar breast cancer symptoms understand their condition. Despite some technical issues, this study showed that it is feasible to use an online browser tracking tool to capture in real time information-seeking about unfamiliar symptoms. %M 30724741 %R 10.2196/12400 %U http://www.jmir.org/2019/2/e12400/ %U https://doi.org/10.2196/12400 %U http://www.ncbi.nlm.nih.gov/pubmed/30724741 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e10716 %T Developing a Web-Based Comic for Newly Diagnosed Women With Breast Cancer: An Action Research Approach %A Lee,Tzu-I %A Sheu,Shuh-Jen %A Chang,Hsueh-Chin %A Hung,Yu-Ting %A Tseng,Ling-Ming %A Chou,Shin-Shang %A Liang,Te-Hsin %A Liu,Hui-Ju %A Lu,Hui-Ling %A Chen,Mei-Chun %A Liu,Ying-Chun %A Tsai,Chi-Shan %A Sun,Jui-Chiung %+ Institute of Community Health Care, School of Nursing, National Yang-Ming University, Nursing Building Room 404, Number155, Section 2, Linong Street, Taipei, 112, Taiwan, 886 2 28267271, [email protected] %K action research %K breast cancer %K comic %K narrative %D 2019 %7 04.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Personal narratives have been seen as a useful way of communicating about cancer treatment options and providing recovery information. Many printed versions of such material are available, including comics that explore the individual memories of patients who have gone through cancer treatment. These studies have been used to orientate patients, patients’ relatives, and physicians. However, only a few Web-based comics have been specifically designed for patients with breast cancer and used as aids to decision making. Objective: We aimed to describe the developmental process of creating an animated comic as a Web-based surgery decision-making tool; the comic was aimed at illustrating the feelings, thoughts, and meanings when a patient suffers from breast cancer. This was done by recounting the symptoms, diagnostic process, treatments, and treatment effects of such women from the diagnosis stage onward. Methods: Using cycles of planning, action, evaluation, and reflection, which involved collaborative work, action research was conducted to develop a Web-based animated comic. The stages of action research consisted of (1) semistructured and in-depth interviews to collect experiences of women with breast cancer; (2) construction of an animated comic by editors, graphics designers, dubbers, and information technology engineers; (3) redrawing of pictures of the comic after gathering feedback from a breast surgeon; and (4) evaluation of the Web-based animated comic using 6 patient focus groups. Results: The comic was produced and showcased on the website “The Network of Making-decision Aids for Breast Cancer Surgery”; the comic was accompanied by soft music and audio explanations. The comic functions as a personal statement that describes experiencing breast cancer. The animated comic consists of 8 chapters, based on the 8 themes deducted from the findings obtained during the analysis of relevant interviews. The 8 chapters include (1) the appearance of a lump; (2) confirmation by medical diagnosis; (3) the uncertainty of waiting (4) fear of life-threatening disease; (5) choosing life over despair; (6) being brave and deciding to undergo treatment; (7) choosing the type of surgery; and (8) being reborn. Conclusions: Using action research, this study illustrated that the comic that sheds light on issues of feelings, emotions, and thoughts that are present when a woman is diagnosed with breast cancer and provides a communication medium to explain the steps in the process. Meanwhile, it implies that hope will be able to overcome the challenges that will be faced. Within the Web-based decision aid for patients with breast cancer, the animated comic acts as an information resource and is aimed at patients’ understanding of impacts of emotions arising when suffering from breast cancer. It is potentially applicable as a therapeutic tool that facilitates self-reflection and self-healing among newly diagnosed patients with breast cancer. %M 30714947 %R 10.2196/10716 %U https://www.jmir.org/2019/2/e10716/ %U https://doi.org/10.2196/10716 %U http://www.ncbi.nlm.nih.gov/pubmed/30714947 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e10404 %T Developing a Decision-Aid Website for Breast Cancer Surgery: An Action Research Approach %A Hung,Yu-Ting %A Wu,Ching-Fang %A Liang,Te-Hsin %A Chou,Shin-Shang %A Chen,Guan-Liang %A Wu,Pei-Ni %A Su,Guan-Rong %A Jang,Tsuey-Huah %A Liu,Chang-Yi %A Wang,Ching-Yen %A Tseng,Ling-Ming %A Sheu,Shuh-Jen %+ Institute of Community Health Care, School of Nursing, National Yang-Ming University, Nursing Building Room 404, Number 155, Section 2, Linong Street, Taipei, 11221, Taiwan, 886 2 28267271, [email protected] %K breast cancer %K surgery-related decision making %K website %K action research %D 2019 %7 04.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with early-stage breast cancer have numerous options when choosing the type of breast surgery method to be applied. Each of these options lead to a similar long-term survival rate, but result in significant differences in appearance, function, cost, recurrence rate, and various other relevant considerations. However, the time available for detailed communication with each patient is often limited in clinics, which puts these women under great psychological stress and can hinder their surgery-related decision making. Objective: The objective of this study was to develop a multipurpose surgery decision-making website providing medical information, psychological support, and decision-related simulation for women during breast cancer surgery-related decision making. Methods: Using the 4 steps of action research, which involve multigroup teamwork via regular team meetings, the following were performed: (1) Planning: searching, analyzing, and evaluating health websites to consensually decide the major infrastructure; (2) Action: work was performed simultaneously in 4 groups, which consisted of medical information collection and editing, patient interviews and data extraction, webpage content design, and programming to create or host the website; (3) Evaluation: the website was tested by clinical experts and focus groups of former breast cancer patients to assess its effectiveness and pinpoint appropriate improvements; and (4) Reflection: constant dialogue was conducted between the various participants at each step, which was used as the foundation and motivation of next plan-action-evaluation-reflection circle. Results: Using the action research approach, we completed the development of our website, which includes the following: (1) “Woman’s Voice”—an animated comic depicting the story of a female breast cancer patient with interspersed questions for the users that will help them better empathize with the experience; (2) “Cancer Information Treasure House”—providing breast cancer surgery-related information through text, tables, pictures and a presentation video; (3) “Decision-making Simulator”—helping patients think through and check the pros and cons of the different surgical options via visual-based interactions including “Stairs Climbing” and “Fruit of Hope”; and (4) “Recommended Links”—providing reliable websites for further reference. Additionally, we have further improved the website based on the feedback received from postsurgery breast cancer patients and clinicians. We hope to continue improving to better meet both the patients’ and health providers’ needs and become a practical decision-making aid for patients undergoing breast cancer surgery. Conclusions: We have created the first breast cancer surgery decision-making assistance tool in Taiwan using a “Web-based” and multifunctional website design. This site aims to provide health care knowledge, psychological healing, and emotional support functions, as well as decision-making capability enhancement simulations. We look forward to assisting breast cancer patients in their decision-making process and expect our website to increase patient’s autonomy and improve their communication with clinicians. %M 30714941 %R 10.2196/10404 %U https://www.jmir.org/2019/2/e10404/ %U https://doi.org/10.2196/10404 %U http://www.ncbi.nlm.nih.gov/pubmed/30714941 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e10004 %T An Electronic Patient-Reported Outcome Tool for the FACT-B (Functional Assessment of Cancer Therapy-Breast) Questionnaire for Measuring the Health-Related Quality of Life in Patients With Breast Cancer: Reliability Study %A Matthies,Lina Maria %A Taran,Florin-Andrei %A Keilmann,Lucia %A Schneeweiss,Andreas %A Simoes,Elisabeth %A Hartkopf,Andreas D %A Sokolov,Alexander N %A Walter,Christina B %A Sickenberger,Nina %A Wallwiener,Stephanie %A Feisst,Manuel %A Gass,Paul %A Lux,Michael P %A Schuetz,Florian %A Fasching,Peter A %A Sohn,Christof %A Brucker,Sara Y %A Graf,Joachim %A Wallwiener,Markus %+ Hospital for General Obstetrics and Gynecology, Gynecologic Oncology, National Center for Tumor Diseases, University Hospital Heidelberg, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 (0)6221 5636956, [email protected] %K breast cancer %K ePRO measurement %K FACT-B %K HRQoL %K patient-reported outcomes %K reliability of ePRO %D 2019 %7 22.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The most frequent malignant disease in women is breast cancer. In the metastatic setting, quality of life is the primary therapeutic goal, and systematic treatment has only a limited effect on survival rates; therefore, the concept of the health-related quality of life (HRQoL) and measurement of patient-reported outcomes (PROs) are gaining more and more importance in the therapy setting of diseases such as breast cancer. One of the frequently used questionnaires for measuring the HRQoL in patients with breast cancer is the Functional Assessment of Cancer Therapy-Breast (FACT-B). Currently, paper-based surveys still predominate, as only a few reliable and validated electronic-based questionnaires are available. ePRO tools for the FACT-B questionnaire with proven reliability are missing so far. Objective: The aim of this study was to analyze the reliability of tablet-based measurement of FACT-B in the German language in adjuvant (curative) and metastatic breast cancer patients. Methods: Paper- and tablet-based questionnaires were completed by a total of 106 female adjuvant and metastatic breast cancer patients. All patients were required to complete the electronically based (ePRO) and paper-based version of the FACT-B. A frequency analysis was performed to determine descriptive sociodemographic characteristics. Both dimensions of reliability (parallel forms reliability using Wilcoxon test and test of internal consistency using Spearman ρ) and agreement rates for single items, Kendall tau for each subscale, and total score were analyzed. Results: High correlations were shown for both dimensions of reliability (parallel forms reliability and internal consistency) in the patients’ response behavior between paper-based and electronically based questionnaires. Regarding the reliability test of parallel forms, no significant differences were found in 35 of 37 single items, while significant correlations in the test for consistency were found in all 37 single items, in all 5 sum individual item subscale scores, as well as in total FACT-B score. Conclusions: The ePRO version of the FACT-B questionnaire is reliable for patients with breast cancer in both adjuvant and metastatic settings, showing highly significant correlations with the paper-based version in almost all questions all subscales and the total score. %M 30668517 %R 10.2196/10004 %U http://www.jmir.org/2019/1/e10004/ %U https://doi.org/10.2196/10004 %U http://www.ncbi.nlm.nih.gov/pubmed/30668517 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 2 %P e11373 %T Web-Based Patient-Reported Outcomes Using the International Consortium for Health Outcome Measurement Dataset in a Major German University Hospital: Observational Study %A Karsten,Maria M %A Speiser,Dorothee %A Hartmann,Claudia %A Zeuschner,Nele %A Lippold,Kai %A Kiver,Verena %A Gocke,Peter %A Kirchberger,Valerie %A Blohmer,Jens-Uwe %+ Klinik für Gynäkologie mit Brustzentrum, Charité Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30450664279, [email protected] %K breast cancer %K International Council Health Outcome Measurement %K mobile phone %K patient-reported outcomes %D 2018 %7 20.12.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Collecting patient-reported outcome (PRO) data systematically enables objective evaluation of treatment and its related outcomes. Using disease-specific questionnaires developed by the International Consortium for Health Outcome Measurement (ICHOM) allows for comparison between physicians, hospitals, and even different countries. Objective: This pilot project aimed to establish a digital system to measure PROs for new patients with breast cancer who attended the Charité Breast Center This approach should serve as a blueprint to further expand the PRO measurement to other disease entities and departments. Methods: In November 2016, we implemented a Web-based system to collect PRO data at Charité Breast Center using the ICHOM dataset. All new patients at the Breast Center were enrolled and answered a predefined set of questions using a tablet computer. Once they started their treatment at Charité, automated emails were sent to the patients at predefined treatment points. Those emails contained a Web-based link through which they could access and answer questionnaires. Results: By now, 541 patients have been enrolled and 2470 questionnaires initiated. Overall, 9.4% (51/541) of the patients were under the age of 40 years, 49.7% (269/541) between 40 and 60 years, 39.6% (214/541) between 60 and 80 years, and 1.3% (7/541) over the age of 80 years. The average return rate of questionnaires was 67.0%. When asked about the preference regarding paper versus Web-based questionnaires, 6.0% (8/134) of the patients between 50 and 60 years, 6.0% (9/150) between 60 and 70 years, and 12.7% (9/71) over the age of 70 years preferred paper versions. Conclusions: Measuring PRO in patients with breast cancer in an automated electronic version is possible across all age ranges while simultaneously achieving a high return rate. %M 30573450 %R 10.2196/11373 %U http://cancer.jmir.org/2018/2/e11373/ %U https://doi.org/10.2196/11373 %U http://www.ncbi.nlm.nih.gov/pubmed/30573450 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 4 %P e45 %T Novel Approach to Cluster Patient-Generated Data Into Actionable Topics: Case Study of a Web-Based Breast Cancer Forum %A Jones,Josette %A Pradhan,Meeta %A Hosseini,Masoud %A Kulanthaivel,Anand %A Hosseini,Mahmood %+ Health Informatics, BioHealth Informatics Department, Indiana University, Indianapolis, 535 West Michigan Street, Indianapolis, IN, 46202, United States, 1 3172748059, [email protected] %K data interpretation %K natural language processing %K patient-generated information %K social media %K statistical analysis %K infodemiology %D 2018 %7 29.11.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: The increasing use of social media and mHealth apps has generated new opportunities for health care consumers to share information about their health and well-being. Information shared through social media contains not only medical information but also valuable information about how the survivors manage disease and recovery in the context of daily life. Objective: The objective of this study was to determine the feasibility of acquiring and modeling the topics of a major online breast cancer support forum. Breast cancer patient support forums were selected to discover the hidden, less obvious aspects of disease management and recovery. Methods: First, manual topic categorization was performed using qualitative content analysis (QCA) of each individual forum board. Second, we requested permission from the Breastcancer.org Community for a more in-depth analysis of the postings. Topic modeling was then performed using open source software Machine Learning Language Toolkit, followed by multiple linear regression (MLR) analysis to detect highly correlated topics among the different website forums. Results: QCA of the forums resulted in 20 categories of user discussion. The final topic model organized >4 million postings into 30 manageable topics. Using qualitative analysis of the topic models and statistical analysis, we grouped these 30 topics into 4 distinct clusters with similarity scores of ≥0.80; these clusters were labeled Symptoms & Diagnosis, Treatment, Financial, and Family & Friends. A clinician review confirmed the clinical significance of the topic clusters, allowing for future detection of actionable items within social media postings. To identify the most significant topics across individual forums, MLR demonstrated that 6 topics—based on the Akaike information criterion values ranging from −642.75 to −412.32—were statistically significant. Conclusions: The developed method provides an insight into the areas of interest and concern, including those not ascertainable in the clinic. Such topics included support from lay and professional caregivers and late side effects of therapy that consumers discuss in social media and may be of interest to clinicians. The developed methods and results indicate the potential of social media to inform the clinical workflow with regards to the impact of recovery on daily life. %M 30497991 %R 10.2196/medinform.9162 %U http://medinform.jmir.org/2018/4/e45/ %U https://doi.org/10.2196/medinform.9162 %U http://www.ncbi.nlm.nih.gov/pubmed/30497991 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e24 %T The iPrevent Online Breast Cancer Risk Assessment and Risk Management Tool: Usability and Acceptability Testing %A Lo,Louisa L %A Collins,Ian M %A Bressel,Mathias %A Butow,Phyllis %A Emery,Jon %A Keogh,Louise %A Weideman,Prue %A Steel,Emma %A Hopper,John L %A Trainer,Alison H %A Mann,Gregory B %A Bickerstaffe,Adrian %A Antoniou,Antonis C %A Cuzick,Jack %A Phillips,Kelly-Anne %+ Department of Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Victoria, 8006, Australia, 61 3 85597860, [email protected] %K clinical decision support %K breast cancer %K BRCA1 gene %K BRCA2 gene %K risk %K preventive health %K screening %D 2018 %7 07.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: iPrevent estimates breast cancer (BC) risk and provides tailored risk management information. Objective: The objective of this study was to assess the usability and acceptability of the iPrevent prototype. Methods: Clinicians were eligible for participation in the study if they worked in primary care, breast surgery, or genetics clinics. Female patients aged 18-70 years with no personal cancer history were eligible. Clinicians were first familiarized with iPrevent using hypothetical paper-based cases and then actor scenarios; subsequently, they used iPrevent with their patients. Clinicians and patients completed the System Usability Scale (SUS) and an Acceptability questionnaire 2 weeks after using iPrevent; patients also completed measures of BC worry, anxiety, risk perception, and knowledge pre- and 2 weeks post-iPrevent. Data were summarized using descriptive statistics. Results: The SUS and Acceptability questionnaires were completed by 19 of 20 clinicians and 37 of 43 patients. Usability was above average (SUS score >68) for 68% (13/19) clinicians and 76% (28/37) patients. The amount of information provided by iPrevent was reported as “about right” by 89% (17/19) clinicians and 89% (33/37) patients and 95% (18/19) and 97% (36/37), respectively, would recommend iPrevent to others, although 53% (10/19) clinicians and 27% (10/37) patients found it too long. Exploratory analyses suggested that iPrevent could improve risk perception, decrease frequency of BC worry, and enhance BC prevention knowledge without changing state anxiety. Conclusions: The iPrevent prototype demonstrated good usability and acceptability. Because concerns about length could be an implementation barrier, data entry has been abbreviated in the publicly available version of iPrevent. %M 30684421 %R 10.2196/formative.9935 %U http://formative.jmir.org/2018/2/e24/ %U https://doi.org/10.2196/formative.9935 %U http://www.ncbi.nlm.nih.gov/pubmed/30684421 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e7 %T Development of a Web-based Family Intervention for BRCA Carriers and Their Biological Relatives: Acceptability, Feasibility, and Usability Study %A Katapodi,Maria C %A Jung,Miyeon %A Schafenacker,Ann M %A Milliron,Kara J %A Mendelsohn-Victor,Kari E %A Merajver,Sofia D %A Northouse,Laurel L %+ Department of Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, Room 113, Basel, 4056, Switzerland, 41 79 109 5163, [email protected] %K BRCA families %K family-based intervention study %K Web-based intervention study %K psycho-educational and skills-building intervention study %K communication and coping %K patient decision-aid %K genetic testing %D 2018 %7 13.04.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Carriers of breast cancer gene (BRCA) mutations are asked to communicate genetic test results to their biological relatives to increase awareness of cancer risk and promote use of genetic services. This process is highly variable from family to family. Interventions that support communication of genetic test results, coping, and offer decision support in families harboring a pathogenic variant may contribute to effective management of hereditary cancer. Objective: The aim of this paper was to describe the development of the Family Gene Toolkit, a Web-based intervention targeting BRCA carriers and untested blood relatives, designed to enhance coping, family communication, and decision making. Methods: We present findings from focus groups regarding intervention acceptability and participant satisfaction and from a pre-post pilot study with random allocation to a wait-listed control group regarding intervention feasibility and usability. Results: The Family Gene Toolkit was developed by a multidisciplinary team as a psycho-educational and skills-building intervention. It includes two live webinar sessions and a follow-up phone call guided by a certified genetic counselor and a master’s prepared oncology nurse. Each live webinar includes two modules (total four modules) presenting information about BRCA mutations, a decision aid for genetic testing, and two skill-building modules for effective coping and family communication. Participants in focus groups (n=11) were highly satisfied with the intervention, reporting it to be useful and describing clearly the important issues. From the 12 dyads recruited in the pre-post pilot study (response rate 12/52, 23%), completion rate was 71% (10/14) for intervention and 40% (4/10) for wait-listed control groups. Conclusions: Acceptability and satisfaction with the Family Gene Toolkit is high. On the basis of the findings from usability and feasibility testing, modifications on timing, delivery mode, and recruitment methods have been implemented. Trial Registration: ClinicalTrials.gov NCT02154633; https://clinicaltrials.gov/ct2/show/NCT02154633 (Archived by WebCite at http://www.webcitation.org/6yYNvLPjv) %M 29653920 %R 10.2196/cancer.9210 %U http://cancer.jmir.org/2018/1/e7/ %U https://doi.org/10.2196/cancer.9210 %U http://www.ncbi.nlm.nih.gov/pubmed/29653920 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 9 %N 3 %P e8084 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2017 %7 ..2017 %9 %J Online J Public Health Inform %G English %X Objectives: To measure and interactively visualize female breast cancer (FBC) incidence rates in Missouri by age, race, stage and grade, and senate district of residence at diagnosis from 2008 to 2012.Methods: An observational epidemiological study. The FBC cases in counties split by senate districts were geocoded. Population database was created. A database was created within SEER*Stat. The incidence rates and the 95% Confidence Interval (CI) were age standardized using US 2000 Standard Population. The Census Bureau’s Cartographic Boundary Files were used to create maps showing Missouri senate districts. Incidence results were loaded along with the maps into InstantAtlasâ„¢ software to produce interactive reports.Results: Cancer profiles were created for all 34 Missouri senate districts. An area profile and a double map that included interactive maps, graphs, and tables for the 34 Missouri senate districts were built.Conclusion: The results may provide an estimation of social inequality within the state and could provide clues about the impact of level of coverage and accessibility to screening and health care services on disease prevention and early diagnosis.Key Words: Female Breast Cancer, Incidence, Interactive Mapping, Missouri, Senate Districts. %M 29403576 %R 10.5210/ojphi.v9i3.8084 %U %U https://doi.org/10.5210/ojphi.v9i3.8084 %U http://www.ncbi.nlm.nih.gov/pubmed/29403576 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 12 %P e246 %T The Impact of mHealth Interventions on Breast Cancer Awareness and Screening: Systematic Review Protocol %A Tokosi,Temitope O %A Fortuin,Jill %A Douglas,Tania S %+ Division of Biomedical Engineering, Department of Human Biology, University of Cape Town, Anzio Road, Observatory, Cape Town, 7925, South Africa, +27 21 4066571, [email protected] %K mHealth %K breast cancer %K women %K awareness %K screening %D 2017 %7 21.12.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mobile health (mHealth) is the use of mobile communication technologies to promote health by supporting health care practices (eg, health data collection, delivery of health care information). mHealth technologies (such as mobile phones) can be used effectively by health care practitioners in the distribution of health information and have the potential to improve access to and quality of health care, as well as reduce the cost of health services. Current literature shows limited scientific evidence related to the benefits of mHealth interventions for breast cancer, which is the leading cause of cancer deaths in women worldwide and contributes a large proportion of all cancer deaths, especially in developing countries. Women, especially in low- and middle-income countries (LMICs), are faced with low odds of surviving breast cancer. This finding is likely due to multiple factors related to health systems: low priority of women’s health and cancer on national health agendas; lack of awareness that breast cancer can be effectively treated if detected early; and societal, cultural, and religious factors that are prevalent in LMICs. The proposed systematic review will examine the impact of mHealth interventions on breast cancer awareness and screening among women aged 18 years and older. Objective: The objectives of this study are to identify and describe the various mHealth intervention strategies that are used for breast cancer, and assess the impact of mHealth strategies on breast cancer awareness and screening. Methods: Literature from various databases such as MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Central Register of Controlled Trials will be examined. Trial registers, reports, and unpublished theses will also be included. All mobile technologies such as cell phones, personal digital assistants, and tablets that have short message service, multimedia message service, video, and audio capabilities will be included. mHealth is the primary intervention. The search strategy will include keywords such as “mHealth,” “breast cancer,” “awareness,” and “screening,” among other medical subject heading terms. Articles published from January 1, 1964 to December 31, 2016 will be eligible for inclusion. Two authors will independently screen and select studies, extract data, and assess the risk of bias, with discrepancies resolved by dialogue involving a third author. We will assess statistical heterogeneity by examining the types of participants, interventions, study designs, and outcomes in each study, and pool studies judged to be statistically homogeneous. In the assessment of heterogeneity, a sensitivity analysis will be considered to explore statistical heterogeneity. Statistical heterogeneity will be investigated using the Chi-square test of homogeneity on Cochrane's Q statistic and quantified using the I-squared statistic. Results: The search strategy will be refined with the assistance of an information specialist from November 1, 2017 to January 31, 2018. Literature searches will take place from February 2018 to April 2018. Data extraction and capturing in Review Manager (RevMan, Version 5.3) will take place from May 1, 2018 to July 31, 2018. The final stages will include analyses and writing, which is anticipated occur between August 2018 and October 2018. Conclusions: The knowledge derived from this study will inform health care stakeholders, including researchers, policy makers, investors, health professionals, technologists, and engineers, on the impact of mHealth interventions on breast cancer screening and awareness. Trial Registration: Prospero registration number CRD42016050202 %M 29269341 %R 10.2196/resprot.8043 %U http://www.researchprotocols.org/2017/12/e246/ %U https://doi.org/10.2196/resprot.8043 %U http://www.ncbi.nlm.nih.gov/pubmed/29269341 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 12 %P e249 %T Influence of Social Determinants, Lifestyle, Emotional Well-Being and the Use of Unconventional Therapies in Breast Cancer Progression in a Cohort of Women in Barcelona: Protocol for the DAMA Cohort %A Puigpinos-Riera,Rosa %A Continente,Xavier %A Serral,Gemma %A Bargalló,Xavi %A Doménech,Montserrat %A Espinosa-Bravo,Martín %A Grau,Jaume %A Macià,Francesc %A Manzanera,Rafael %A Pla,Margarida %A Quintana,M Jesus %A Sala,Maria %A Vidal,Eulalia %+ Servei d'Avaluació i Mètodes d'Intervenció, Agència de Salut Pública de Barcelona, Pça. Lesseps, 1, Barcelona, 08023, Spain, 34 932027787, [email protected] %K breast cancer %K cohort study %D 2017 %7 18.12.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Breast cancer continues to be the most commonly diagnosed cancer in women. Breast cancer survivors face numerous problems, especially after completing the first year of intense treatment. We present the protocol for an ongoing study to analyze the impact of a series of factors on breast cancer survival related to lifestyle, emotional well-being, and use of complementary and alternative medicine (CAM). Objective: We aim to analyze the influence of social determinants, lifestyle changes, emotional well-being, and use of CAM in the progression of breast cancer in women diagnosed with breast cancer between 2003 and 2013 in Barcelona, Spain. Methods: We will perform a mixed cohort study (prospective and retrospective) of women diagnosed with breast cancer, created using a convenience sample in which we study the evolution of the disease (relapse, death, or remaining disease-free). Once identified, we sent the women information about the study and an informed consent form that they are required to sign in order to participate; a total of 2235 women were recruited. We obtained the following information from all participants: sociodemographic profile via a phone interview, and a self-administered survey of information about the study’s objectives (lifestyles, emotional well-being, health care services, and the use of CAM). Lastly, we examined clinical records to obtain data on the tumor at the time of diagnosis, the treatment received, the occurrence of relapses (if any), and the tumor typology. We present data on the women’s social profile based on descriptive data obtained from the telephone interview (welcome survey). Results: Based on the welcome survey, which was completed by 2712 women, 14.42% (391/2712) of respondents were <50 years of age, 45.50% (1234/2712) were between 50 and 65 years of age, and 40.08% (1087/2712) were >65 years of age. A total of 43.69% (1185/2712) belonged to the highest social classes (I and II), 31.27% (848/2712) to the middle class (III), and 23.49% (637/2712) to the working classes (IV and V). Approximately 22.71% (616/2712) lived alone, 38.31% (1039/2712) lived with one person, and 38.97% (1057/2712) lived with two or more people. Conclusions: We obtained information from a large cohort of women, but this study has limitations related to the convenience sampling strategy, one of which is reduced representativeness. Conversely, being a self-administered survey, the study introduces biases, especially from respondents that answered on paper. However, the information that the study provides will serve as the basis for designing future interventions aimed at improving the knowledge gaps indicated for women with breast cancer. %M 29254913 %R 10.2196/resprot.7653 %U http://www.researchprotocols.org/2017/12/e249/ %U https://doi.org/10.2196/resprot.7653 %U http://www.ncbi.nlm.nih.gov/pubmed/29254913 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 2 %P e13 %T A Lifestyle Intervention via Email in Minority Breast Cancer Survivors: Randomized Parallel-Group Feasibility Study %A Paxton,Raheem J %A Hajek,Richard %A Newcomb,Patricia %A Dobhal,Megha %A Borra,Sujana %A Taylor,Wendell C %A Parra-Medina,Deborah %A Chang,Shine %A Courneya,Kerry S %A Block,Gladys %A Block,Torin %A Jones,Lovell A %+ Department of Community Medicine and Population Health, The University of Alabama, 1132 Northeast Medical Bldg, Tuscaloosa, AL, 35401, United States, 1 205 348 6857, [email protected] %K breast neoplasm %K African Americans %K diet %K feasibility study %K physical activity %K posture %K program evaluation %K Internet %K computer tailoring %K email %D 2017 %7 21.09.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: Our data have indicated that minority breast cancer survivors are receptive to participating in lifestyle interventions delivered via email or the Web, yet few Web-based studies exist in this population. Objective: The aim of this study was to examine the feasibility and preliminary results of an email-delivered diet and activity intervention program, “A Lifestyle Intervention Via Email (ALIVE),” delivered to a sample of racial and ethnic minority breast cancer survivors. Methods: Survivors (mean age: 52 years, 83% [59/71] African American) were recruited and randomized to receive either the ALIVE program’s 3-month physical activity track or its 3-month dietary track. The fully automated system provided tools for self-monitoring and goal setting, tailored content, and automated phone calls. Descriptive statistics and mixed-effects models were computed to examine the outcomes of the study. Results: Upon completion, 44 of 71 survivors completed the study. Our “intention-to-treat” analysis revealed that participants in the physical activity track made greater improvements in moderate to vigorous activity than those in the dietary track (+97 vs. +49 min/week, P<.001). Similarly, reductions in total sedentary time among those in the physical activity track (−304 vs. −59 min/week, P<.001) was nearly 5 times greater than that for participants in the dietary track. Our completers case analysis indicated that participants in the dietary track made improvements in the intake of fiber (+4.4 g/day), fruits and vegetables (+1.0 cup equivalents/day), and reductions in saturated fat (−2.3 g/day) and trans fat (−0.3 g/day) (all P<.05). However, these improvements in dietary intake were not significantly different from the changes observed by participants in the physical activity track (all P>.05). Process evaluation data indicated that most survivors would recommend ALIVE to other cancer survivors (97%), were satisfied with ALIVE (82%), and felt that ALIVE was effective (73%). However, survivors expressed concerns about the functionality of the interactive emails. Conclusions: ALIVE appears to be feasible for racial and ethnic minority cancer survivors and showed promising results for larger implementation. Although survivors favored the educational content, a mobile phone app and interactive emails that work on multiple email domains may help to boost adherence rates and to improve satisfaction with the Web-based platform. Trial Registration: ClinicalTrials.gov NCT02722850; https://clinicaltrials.gov/ct2/show/NCT02722850 (Archived by WebCite at http://www.webcitation.org/6tHN9VsPh) %M 28935620 %R 10.2196/cancer.7495 %U http://cancer.jmir.org/2017/2/e13/ %U https://doi.org/10.2196/cancer.7495 %U http://www.ncbi.nlm.nih.gov/pubmed/28935620 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e322 %T Reliability of an e-PRO Tool of EORTC QLQ-C30 for Measurement of Health-Related Quality of Life in Patients With Breast Cancer: Prospective Randomized Trial %A Wallwiener,Markus %A Matthies,Lina %A Simoes,Elisabeth %A Keilmann,Lucia %A Hartkopf,Andreas D %A Sokolov,Alexander N %A Walter,Christina B %A Sickenberger,Nina %A Wallwiener,Stephanie %A Feisst,Manuel %A Gass,Paul %A Fasching,Peter A %A Lux,Michael P %A Wallwiener,Diethelm %A Taran,Florin-Andrei %A Rom,Joachim %A Schneeweiss,Andreas %A Graf,Joachim %A Brucker,Sara Y %+ Gynecologic Oncology, National Center for Tumor Diseases, Hospital for General Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, Heidelberg,, Germany, 49 (0)6221563, [email protected] %K breast cancer %K patient-reported outcomes %K HRQoL %K EORTC QLQ-C30 %K reliability %D 2017 %7 14.09.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Breast cancer represents the most common malignant disease in women worldwide. As currently systematic palliative treatment only has a limited effect on survival rates, the concept of health-related quality of life (HRQoL) is gaining more and more importance in the therapy setting of metastatic breast cancer. One of the major patient-reported outcomes (PROs) for measuring HRQoL in patients with breast cancer is provided by the European Organization for Research and Treatment of Cancer (EORTC). Currently, paper-based surveys still predominate, as only a few reliable and validated electronic-based questionnaires are available. Facing the possibilities associated with evolving digitalization in medicine, validation of electronic versions of well-established PRO is essential in order to contribute to comprehensive and holistic oncological care and to ensure high quality in cancer research. Objective: The aim of this study was to analyze the reliability of a tablet-based measuring application for EORTC QLQ-C30 in German language in patients with adjuvant and (curative) metastatic breast cancer. Methods: Paper- and tablet-based questionnaires were completed by a total of 106 female patients with adjuvant and metastatic breast cancer recruited as part of the e-PROCOM study. All patients were required to complete the electronic- (e-PRO) and paper-based versions of the HRQoL EORTC QLQ-C30 questionnaire. A frequency analysis was performed to determine descriptive sociodemographic characteristics. Both dimensions of reliability (parallel forms reliability [Wilcoxon test] and test of internal consistency [Spearman rho and agreement rates for single items, Pearson correlation and Kendall tau for each scale]) were analyzed. Results: High correlations were shown for both dimensions of reliability (parallel forms reliability and internal consistency) in the patient’s response behavior between paper- and electronic-based questionnaires. Regarding the test of parallel forms reliability, no significant differences were found in 27 of 30 single items and in 14 of 15 scales, whereas a statistically significant correlation in the test of consistency was found in all 30 single items and all 15 scales. Conclusions: The evaluated e-PRO version of the EORTC QLQ-C30 is reliable for patients with both adjuvant and metastatic breast cancer, showing a high correlation in almost all questions (and in many scales). Thus, we conclude that the validated paper-based PRO assessment and the e-PRO tool are equally valid. However, the reliability should also be analyzed in other prospective trials to ensure that usability is reliable in all patient groups. Trial Registration: ClinicalTrials.gov NCT03132506; https://clinicaltrials.gov/ct2/show/NCT03132506 (Archived by WebCite at http://www.webcitation.org/6tRcgQuou). %M 28912116 %R 10.2196/jmir.8210 %U http://www.jmir.org/2017/9/e322/ %U https://doi.org/10.2196/jmir.8210 %U http://www.ncbi.nlm.nih.gov/pubmed/28912116 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 5 %N 3 %P e4982 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2014 %7 ..2014 %9 %J Online J Public Health Inform %G English %X OBJECTIVE: To determine whether the availability of mammography resources affected breast cancer incidence rates, stage of disease at initial diagnosis, mortality rates and/or mortality-to-incidence ratios throughout Mississippi.METHODS: Mammography facilities were geocoded and the numbers of residents residing within a thirty minute drive of a mammography facility were calculated. Other data were extracted from the Mississippi Cancer Registry, the U.S. Census, and the Mississippi Behavioral Risk Factor Surveillance Survey (BRFSS).RESULTS & DISCUSSION: There were no statistically-significant differences between breast cancer incidence rates in Black versus White females in Mississippi; however, there were significant differences in the use of mammography, percentages of advanced-stage initial diagnoses, mortality rates, and mortality-to-incidence ratios, where Black females fared worse in each category. Both the use and availability of mammography were negatively correlated with advanced stage of disease at initial diagnosis. No significant correlation was observed between breast cancer mortality and the availability of mammography facilities. By combining Black and White subsets, a correlation between mammography use and improved survival was detected; this was not apparent in either subset alone. There was also a correlation between breast cancer mortality-to-incidence ratios and the percentage of the population living below the poverty level.CONCLUSIONS: The accessibility and use of mammography resources has a greater impact on breast cancer in Mississippi than does the geographic resource distribution per se. Therefore, intensified mammography campaigns to reduce the percentage of advanced-stage breast cancers initially diagnosed in Black women, especially in communities with high levels of poverty, are warranted in Mississippi. %M 24678379 %R 10.5210/ojphi.v5i3.4982 %U %U https://doi.org/10.5210/ojphi.v5i3.4982 %U http://www.ncbi.nlm.nih.gov/pubmed/24678379