Table 1.
Description of study characteristics.
| Study, year | Study design | Location, study population, and number of participants (n) | Intervention description, duration, and follow-up (when applicable) | Measurements | Control condition | Key outcomes | |
| Mobile apps during active treatment | |||||||
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Ghanbari et al [51], 2021 | RCTa | Iran; 82 patients with nonmetastatic breast cancer; intervention group: 41 and control group: 41 | An mHealthb self-management psychoeducational app for breast cancer care, including information on breast cancer and treatment, stress management techniques, self-esteem promotion, and anger management techniques; patients in the intervention group could interact with each other and with a psychiatric nurse; intervention duration: 4 weeks; no follow-up | Spielberger STAIc, RSESd, and an app satisfaction survey | Usual care | The intervention group showed a significant reduction in anxiety (P<.001) compared with the control group and a significant increase in self-esteem (P<.001) compared with the control group |
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Fjell et al [52], 2020 | RCT | Sweden; 149 patients with breast cancer undergoing neoadjuvant chemotherapy; intervention group: 74 and control group: 75 | A cancer care mHealth app called Interaktor intended for early identification and management of symptoms as well as interaction with health care professionals; the app included self-reporting of symptoms, as well as education and information regarding symptom self-management; intervention duration: varied depending on length of chemotherapy; measurements were taken at baseline and 2 weeks after end of chemotherapy; no follow-up | MSASe and EORTC QLQ-C30f | Usual care | The intervention group reported significantly lower prevalence of symptoms on the QOLg scales: nausea and vomiting (P=.007), appetite loss (P=.03), constipation (P=.007), and feeling sad, as well as significantly higher emotional functioning (P=.008) and lower symptom distress (P=.004) |
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Hou et al [53], 2020 | RCT | Taiwan; 112 newly diagnosed patients with breast cancer (stages 0-III); intervention group: 53 and control group: 59 | An mHealth app intended for breast cancer self-management support, which included education, exercise and rehabilitation, diet and nutrition, emotional support, symptom and side effect tracking, social resources, and experience sharing, as well as expert consulting; intervention duration: 12 weeks, measurements at 6 and 12 weeks; no follow-up | EORTC QLQ-C30 and EORTC QLQ-BR23h | Usual care | At 12 weeks, both groups showed improvement in total QOL; the intervention group had a higher score in total QOL and total breast cancer–specific QOL; (P=.04) no difference was found at the 6-week measurement |
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Grašič Kuhar et al [54], 2020 | Nonrandomized controlled prospective cohort study | Slovenia; 104 patients with nonmetastatic breast cancer undergoing chemotherapy; intervention group: 55 and control group: 49 | An mHealth app, mPro Mamma, that recorded symptoms and, depending on symptom severity, presented symptom self-management or advised seeking professional help, with symptom reports forwarded to an oncologist; intervention duration: varied depending on length of treatment, with measurements at 1 week after commencement of treatment and at completion of treatment; no follow-up | EORTC QLQ-C30, EORTC QLQ-BR23, and self-reported use of health care resources | Usual care | Global QOL (P=.02) and summary scores (P=.003) improved significantly in the intervention group compared with scores in the control group in the first week, and summary scores were still higher in the intervention group at the end of treatment (P=.002); no difference was observed in use of health care resources |
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Zhu et al [55], 2018 | RCT | China; 114 patients with breast cancer about to commence chemotherapy; intervention group: 57 and control group: 57 | An mHealth breast cancer e-support app that included a learning forum, a discussion forum, an ask-the-expert forum, and a personal stories forum, as well as evidence-based information on breast cancer and symptom management; intervention duration: 12 weeks; 6-month follow-up | SICPAi, MSPSSj, MD Anderson Symptom Inventory, FACT-Bk, HADSl, and app use data, including log-in frequency and use time | Usual care | Decrease in self-efficacy (P=.03) and QOL (P=.03) after chemotherapy was significantly less in the intervention group; symptom interference was significantly less in the intervention group (P=.02); no significant difference in symptom severity; no difference observed for social support, anxiety, and depression; at 6-month follow-up, no differences were found between the groups in any health outcomes |
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Kim et al [56], 2018 | RCT | South Korea; 76 patients with metastatic breast cancer about to receive chemotherapy; intervention group: 36 and control group: 40 | A mobile game with the intention to improve symptom self-management and reduce side effects of chemotherapy, with educational content on side effects and their prevention, as well as management of an avatar that was rewarded for performing activities such as exercise; intervention length: 3 weeks; no follow-up | App satisfaction survey, use data, MARSm (Korean version), BDIn, Spielberger STAI, and WHOQOL-BREFo scale | Usual care | The intervention group showed increased QOL (P=.01), but no difference was found in depression or anxiety; in addition, the intervention group showed increased medication adherence compared with the control group (P<.001) as well as lower rates in reported adverse events (P=.02) |
| Mobile apps for breast cancer survivors | |||||||
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Ochi et al [57], 2022 | RCT | Japan; 50 breast cancer survivors (stages I-IIa) who had recently completed primary treatment; intervention group: 25 and control group: 25 | A home-based exercise program (habit-B), designed to incrementally increase level of strength, delivered via an mHealth app and a smartwatch, along with counseling or exercise guidance and support provided via email and the app; intervention duration: 12 weeks; no follow-up | Cardiorespiratory fitness (VO2peakp) measured by incremental multistage load on a bicycle ergometer, 6-minute walk test, 1-repetition maximum strength, chair-stand test, resting heart rate, blood pressure, body composition, Global Physical Activity Questionnaire score, Cancer Fatigue Scale-12, and health-related QOL; exercise adherence was measured via the app, and heart rate was measured using a smartwatch | Control group was given a smartwatch to wear but did not receive access to the app | No differences in QOL measurements or fatigue; the intervention group showed a significant improvement in VO2peak and leg strength (P=.01), but no significant differences were found for other physical functions |
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Fu et al [58], 2022 | RCT | United States; 120 breast cancer survivors who had undergone surgical treatment at least 3 months before enrollment, reported pain, and may or may not report lymphedema symptoms or have a history of lymphedema; intervention group: 60 and control group: 60 | A web- and mobile-based intervention called The-Optimal-Lymph-Flow (TOLF); the web-based platform included information on lymphedema, self-care, and lymphatic exercises, as well as a section where patients could ask an expert questions, whereas the mHealth app offered an additional way of practicing the lymphatic exercises; intervention duration: 12 weeks; no follow-up | Lymphedema and Breast Cancer Symptom Experience Index (Part I), limb volume difference measured with an infrared Perometer, and PIQ-6q, as well as height, body weight, BMI, and the Risk Reduction Behavior Checklist | Control group: access to web and mobile limb mobility exercises, with a focus on precautionary lifestyle behaviors | The intervention group reported significantly fewer cases and lower severity of chronic pain (P=.02), as well as fewer cases of arm or hand swelling (P=.04), heaviness (P=.03), redness (P=.03), and limited mobility in the shoulder (P=.02) and arm (P=.03); number of lymphedema symptoms did not differ between the groups |
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Çınar et al [59], 2021 | RCT | Turkey; 64 patients with breast cancer undergoing adjuvant endocrine hormone therapy; intervention group: 33 and control group: 31 | An mHealth app with educational content, relaxation exercises, guided imagery, symptom diary, and question module where patients could send questions to specialist nurses; the app included RPMr; intervention duration: 12 weeks; no follow-up | FACT-ESs quality-of-life scale, NCCNt Distress Thermometer, and an app satisfaction survey | Usual care | The intervention group saw a positive impact on the majority of QOL measurements, including total (P=.003), emotional (P=.007), and functional well-being (P=.01), as well as endocrine symptom s (P=.004); no difference between the groups for social or family well-being scores; distress scores in the intervention group were lower than those in the control group (P=.004) |
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Lozano-Lozano et al [60], 2020 | RCT | Spain; 80 breast cancer survivors (stages I-IIIA) who were overweight or obese at time of diagnosis; intervention group: 40 and control group: 40 | An mHealth app, BENECA, as well as a 2-month in-person group rehabilitation program; the app allowed for energy feedback monitoring through user-recorded daily dietary and physical activity habits; the rehabilitation program focused on symptoms, therapeutic exercises, and psychomotricity; intervention duration: 8 weeks; follow-up at 6 months | Primary measurements were EORTC QLQ-C30 (version 3.0) and EORTC QLQ-BR23; secondary measurements were DASHu, AROMv of the shoulder using a goniometer, and upper body muscular strength using a digital handgrip; dual-energy x-ray absorptiometry was used to measure BMI, percentage fat mass, and bone mineral density | mHealth app and usual care | Both groups saw an improvement in QOL measures, but a more significant increase was seen in the intervention group (mHealth and rehabilitation); AROM and upper limb functionality were better in the intervention group (P<.001); effects were maintained at 6-month follow-up (P<.05), apart from those for emotional functioning, social functioning, systemic therapy side effects, and breast symptoms |
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Yanez et al [61], 2020 | Pilot study | United States; 80 Latinx breast cancer survivors (stages 0-III) within 2 to 24 months of completing primary treatment; intervention group: 40 and control group: 40 | An mHealth app, MyGuide, designed to reduce symptom burden and improve health-related QOL through coping strategies, ongoing medication adherence, cancer knowledge, optimizing social support, psychosocial adaptation, and stress management; participants also received telecoaching; intervention duration: 6 weeks; follow-up at 2 weeks | BCPTw symptom checklist (25 items), FACT-B (36 items), as well as acceptability and feasibility | An mHealth app, MyHealth, promoting healthy lifestyle behaviors; controls also received telecoaching | No difference was observed between the groups; improvements in breast cancer well-being were observed in both groups and maintained at the 2-week follow-up (P=.02); breast cancer symptom burden declined at the end of the intervention in both groups (P=.03) but was not sustained at the 2-week follow-up |
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Nápoles et al [62], 2019 | Feasibility study | United States; 23 Spanish-speaking breast cancer survivors who completed primary treatment within 1 year | A Spanish language mHealth app, trackC, with integrated activity tracker (Fitbit Zip), a hard copy survivor care planning program and information booklet, and health coaching telephone calls; the app provided information on potential side effects, healthy lifestyles, and survivorship resources; intervention duration: 2 months; no follow-up | Primary measurements: adapted version of the PROMISx Cancer Fatigue Scale, adapted version of the MOSy Health Distress Scale, knowledge of cancer questionnaires, and an 8-item self-efficacy scale; secondary measurements: the 6-item Emotional Well-Being Scale from the Functional Assessment of Cancer Treatment-General, the Patient Health Questionnaire (8-item version), and the 6-item Brief Symptom Inventory Somatization Scale | N/Az | Fatigue (P=.02) and health distress (P=.01) levels were lower, self-reported knowledge of cancer care and resources increased (P=.03), and emotional well-being (P=.02) and daily steps (P=.02) increased; no change was found in the other secondary measurements or in self-efficacy |
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Krok-Schoen et al [63], 2019 | Pilot study | United States; 39 postmenopausal breast cancer survivors (stages 0-III) who had completed primary treatment and were eligible for receiving adjuvant hormone therapy | Daily medication reminders as well as weekly medication adherence reporting reminders via SMS text message; medication adherence was reported using an mHealth adherence app; intervention duration: 3 months; no follow-up | BCPT symptom checklist, Concerns About Recurrence Scale, 12-item Communication and Attitudinal Self-Efficacy-cancer scale, Center for Epidemiologic Studies Depression Scale, Brief Pain Inventory interference subscale, 7-item Fatigue Symptom Inventory interference subscale, Short Form-8 Health Survey (version 2), 14-item Perceived Stress Scale, 5-item Social Desirability Response Set, 20-item MOS Social Support Questionnaire, and medication adherence | N/A | No changes were observed for depressive symptoms, fatigue, pain interference, and physical functioning; however, study power was insufficient for these end points; improvements were observed in mental health functioning (P=.007) and perceived stress (P=.04); self-reported medication adherence increased (P=.02); and decreases in estradiol, estrogen, and estrone hormone levels were observed from baseline (P<.001; supporting the accuracy of the self-reported medication adherence scores); no other changes were observed; the majority of participants (P<.001) and physicians (100%) reported satisfaction with the intervention |
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Imai et al [64], 2019 | Pilot study | Japan; 38 breast cancer survivors >6 months after surgery | Problem-solving therapy delivered via an mHealth app aimed to reduce the fear of recurrence; intervention duration: 8 weeks; no follow-up | Concerns About Recurrence Scale (Japanese version), HADS, EQ-5D, Functional Assessment of Chronic Illness Therapy–Spiritual Well-being 12-item Scale, Supportive Care Needs Survey-Short Form 34, and Social Problem-Solving Inventory–Revised Short Form | N/A | Improvements were observed for the index score (P=.02) and the visual analog scale score (P=.002) on the EQ-5D; spiritual well-being scores (Functional Assessment of Chronic Illness Therapy–Spiritual Well-being 12-item Scale) increased (P=.01); psychological subscale (P=.05) and physical and daily living subscales (P=.003) scores of the Supportive Care Needs Survey-Short Form 34 reduced; and overall fear of recurrence decreased (P=.01); no other measurements observed reached significance |
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Visser et al [65], 2018 | RCT | The Netherlands; 122 survivors of nonmetastatic breast cancer who had completed primary treatment; intervention group: 63 and control group: 59 | Face-to-face group medical consultation as well as access to mHealth app (myGMC); each patient received an iPad with the myGMC app, video chat app FaceTalk, reading app (iBooks), and contact information app (Contacts); the myGMC app included 13 short videos of interviews with breast cancer survivors; the other apps were used for online support group sessions, survivorship information, and contact information for the other members of the support group (a clinical nurse and the researcher); intervention duration: 3 months; follow-up at 6 months | The Symptom Checklist-90, the Empowerment Questionnaire for patients with breast cancer, the 8-item Cancer Worry Scale, EORTC QLQ-C30 (version 3.0) and EORTC QLQ-BR23), and MARS; in addition, feasibility, acceptability, and practicability of myGMC were measured, along with self-reported use statistics | Usual care | QOL did not differ between groups and neither did cancer worry, distress, or empowerment; improvements in medication adherence were observed but not sustained at the 6-month follow-up; more peer support was reported in the peer-support meetings than in the online support group meetings; overall app satisfaction was low |
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Graetz et al [66], 2018 | Randomized pilot study | United States; 48 breast cancer survivors (stages 0-III) who had completed primary treatment and been prescribed aromatase inhibitors; intervention group: 23 and control group: 25 | An mHealth app along with weekly reminders via SMS text message, email, or both; the app encouraged tracking medication adherence and treatment-related symptoms; intervention duration: 8 weeks; no follow-up | Morisky Medication Adherence Scale-4, FACT-ES, app use log, and user feedback | App only | Both groups showed an increase in symptom burden after initiation of aromatase inhibitors; although the increase was less in the intervention group, it did not reach statistical significance; the intervention group had a higher proportion of app log-ins and higher medication adherence than the control group’ participants reported satisfaction with the app |
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Uhm et al [67], 2017 | Prospective quasi-randomized trial | South Korea; 356 breast cancer survivors who had completed primary treatment; intervention group: 179 and control group: 177 | An mHealth app and pedometer with a 12-week regimen of aerobic and resistance exercise; intervention duration: 12 weeks; no follow-up | Various physical measurements, International Physical Activity Questionnaire–Short Form, EORTC QLQ-C30 and EORTC QLQ-BR23, and mHealth user satisfaction survey | Same 12-week regimen of aerobic and resistance exercise but in brochure form | Physical functioning, QOL, and self-reported physical activity increased in both groups; the intervention group reported high satisfaction regarding the mHealth app |
aRCT: randomized controlled trial.
bmHealth: mobile health.
cSTAI: State-Trait Anxiety Inventory.
dRSES: Rosenberg Self-Esteem Scale.
eMSAS: Memorial Symptom Assessment Scale.
fEORTC QLQ-C30: European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30.
gQOL: quality of life.
hEORTC QLQ-BR23: European Organization for Research and Treatment of Cancer Breast Cancer–Specific Quality-of-Life Questionnaire.
iSICPA: Stanford Inventory of Cancer Patient Adjustment.
jMSPSS: Multidimensional Scale of Perceived Social Support.
kFACT-B: Functional Assessment of Cancer Treatment-Breast.
lHADS: Hospital Anxiety and Depression Scale.
mMARS: Medication Adherence Rating Scale.
nBDI: Beck Depression Inventory.
oWHOQOL-BREF: World Health Organization Quality of Life-Brief Version scale.
pVO2peak: peak oxygen uptake.
qPIQ-6: Pain Impact Questionnaire-6.
rRPM: remote patient monitoring.
sFACT-ES: Functional Assessment of Cancer Therapy-Endocrine Symptoms.
tNCCN: National Comprehensive Cancer Network.
uDASH: Disabilities of the Arm, Shoulder, and Hand.
vAROM: active range of motion.
wBCPT: Breast Cancer Prevention Trial.
xPROMIS: Patient-Reported Outcomes Measurement Information System.
yMOS: Medical Outcomes Study.
zN/A: not applicable.