Health IT, Patient Engagement

What can be done to improve mobile apps for cancer survivors?

Few of the hundreds of mobile apps for cancer survivors were appropriately developed or tested, according to a new study by researchers from the Cancer Prevention Institute of California.


Few of the hundreds of mobile apps for cancer survivors were appropriately developed or tested, according to a new study.

In “Achieving Value in Mobile Health Applications for Cancer Survivors,” published in the Journal of Cancer Survivorship, researchers from the Cancer Prevention Institute of California conclude that “basic developmental and incremental testing steps have been skipped in the majority of cases.”

“Unfortunately, some applications for cancer survivors have been put on the app stores with what appears to be limited testing, and no clear involvement of cancer survivors in development or evaluation,” study author Ingrid Oakley-Girvan wrote in an email. “The number of apps is a constantly moving target; we do not currently have funding to evaluate which applications have been adequately tested.”

In January of 2016, the researchers conducted a PubMed search for mobile apps for cancer survivors. They studied 32 articles, including 13 review articles, and 19 articles describing a mobile health application or intervention. The majority of the apps (64 percent) did not describe their organizational affiliation. Of those that did, 63 percent were affiliated with a nonprofit, 26 percent with a commercial company, 9 percent with a university or medical institution, and one with the National Institutes of Health. Apps that did not disclose their affiliation were less likely to be free.

Well-designed apps have elements of patient empowerment, including education, self-monitoring, feedback, tailored information, self-management training, a personal exercise program, and communication with providers and/or other survivors via social networking, the authors say.

Cancer.Net Mobile, an app designed by the American Society of Clinical Oncology for cancer patients and survivors, enables patients to track symptoms by severity, record and link questions to scheduled appointments, save provider answers, and log medications. Pocket Cancer Care Guide, an app by the National Coalition for Cancer Survivorship, offers similar features. Journey Forward, a collaboration among Anthem Health, biotech company Genentech and a handful of oncology nonprofits, provides My Care Plan, an app designed to help survivors and their healthcare teams to manage ongoing symptoms and coordinate follow-up care.

Medical apps number about 265,000, many made without patient or doctor feedback, according to Dr. Ashish Atreja, who heads the in-house digital medicine innovation lab at Mount Sinai Health System, the Sinai AppLab. Atreja is also medical co-founder of Responsive Health, a Mount Sinai spinoff that built RxUniverse, an enterprise-wide platform that allows physicians to prescribe medically reviewed mobile health apps to patients.

Sinai AppLab has also launched the Network of Digital Evidence (NODE) Health, a consortium of health systems formed to clinically review digital medical technology, including apps, medical devices, artificial intelligence and machine learning.

“I never like to prescribe a medicine unless it is reviewed or approved by someone, so why would I want to do it with an app?” Atreja said in a phone interview.

He suggested a consortium of unbiased nonprofit organizations be formed to review apps for cancer survivors for security, efficacy, adoption and value proposition.

The first wave of patient-targeted healthcare apps made without scientific validation and proof of efficacy has yielded a lot of low-quality products, added Dr. John Torous, co-director of the digital psychiatry program at Beth Israel Deaconess Medical Center, Harvard Medical School.

“This study was clearly a cancer study, but this is a trend that I think we’re becoming more aware of,” Torous said. “Just because you can build an app doesn’t mean that it’s going to be useful.”

It’s difficult to determine which apps or types of apps are most effective, and among which groups of survivors. FDA’s website lists 11 pages of examples of regulated apps, some of which can be used by cancer survivors to take physiological measurements, Oakley-Girvan said.

It would be extremely useful to have studies done among different types of survivors, using different types of apps, but as far as we could find, there is currently no way of knowing which apps and which types of apps are the most effective,” she added. “There is a great need for partnerships and an innovative approach to developing, reviewing and testing mobile apps for cancer survivors.”

The researchers recommend randomized controlled trials to test the impact and cost with the target population of these apps over a period of time. State and federal agencies fund most randomized controlled trials for behavioral apps, she said. Whether they would be affected by President Donald Trump’s proposed $1.2 billion cuts to the National Institutes of Health’s budget remains to be seen. About $1 billion of those cuts would be from the National Cancer Institute, according to the American Cancer Society Cancer Action Network.

The National Cancer Institute also projects a 31 percent increase in cancer survivors, to 20.3 million, by 2026, an increase of more than 4 million survivors from 2016. By 2040, the number of survivors could balloon to 26.1 million. The aging of the population will account for most of those increases, according to Julia Rowland, director of the Office of Cancer Survivorship at NIH. The willingness of aging survivors to engage with apps remains to be seen, Rowland said in a phone interview.

“There’s great opportunity in this world of electronic devices, but the science hasn’t been brought to bear to it,” Rowland added. “I see this as an incredibly innovative frontier. I think we have only just begun to see its potential for use in improving the care and outcomes of cancer survivors over the long term.”

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