Table 1.
Clinical studies evaluating the applications of telehealth in prostate cancer management.
| Reference | Study design | Clinical setting | Cases | Studied intervention | Methods | Endpoint | Major findings |
|---|---|---|---|---|---|---|---|
| Any stage prostate cancer | |||||||
| Paterson (2016) [30] | Prospective series | All stages and treatments | 12 | Real-time data collection using mobile technology | Self-reports were collected for 31 d prompted by an audio alarm 3 times per day | To empirically test the propositions of social support theory in real time within individual men living with and beyond prostate cancer | Response rates were >90%. Men reported a lack of satisfaction with their support over time 16% identified the negative effects of social support. In 50%, the propositions of social support theory did not hold considering their within-person data |
| Trinh (2018) [42] | Prospective series | Localized or asymptomatic metastatic primary prostate cancer currently receiving androgen deprivation therapy | 46 | RiseTx website program | Through activity tracker (Jawbone) and access to the RiseTx website program, survivals were monitored to increase walking by 3000 daily steps above baseline levels over 12 wk | Measures of SED, MVPA, and daily steps were compared across the 12-wk intervention | Measurement completion rates were 97% and 65% at immediately after the intervention and 12-wk follow-up for all measures, respectively. Significant improvements in the weekly minutes of SED time (–455.4 min), weekly minutes of MVPA (+44.1 min), and step counts (+1535 steps) were observed after the intervention |
| Lee (2019) [48] | Randomized controlled trial | Not reported | 50 | Smartphone application to record physical activities | The smartphone application was used to record physical activities vs standard written report; participants also received weekly remote consultations based on the activity record from the app, without visiting a clinic | To compare the effectiveness of smartphone-based and conventional pedometer-based exercise monitoring systems in promoting home exercise among prostate cancer patients | There were no significant differences in the rates of uptake (80.0% vs 88.0%), adherence (92.5% vs 79.5%), or completion (76.0% vs 86.0%) between groups. Most physical functions were significantly improved in both groups without differences (except for weight) |
| 50 | Written record of physical activities | ||||||
| Nonmetastatic prostate cancer | |||||||
| Parsons (2008) [17] | Randomized controlled trial | Any nonmetastatic | 48 | Telephone-based dietary counseling | Dietary intake and plasma carotenoid levels were assessed at baseline and 6-mo follow-up | To evaluate the feasibility of implementing a diet-based intervention in men with nonmetastatic prostate cancer | In the intervention arm, mean daily intake of total vegetables, crucifers, tomato products, and beans/legumes increased by 76%, 143%, 292%, and 95%, respectively, whereas fat intake decreased by 12% (p < 0.02). In the control arm, there were no significant changes |
| 26 | Standardized, written nutritional information | Similarly, in the intervention arm, mean plasma levels of alpha-carotene, beta-carotene, lutein, lycopene, and total carotenoids increased by 33%, 36%, 19%, 30%, and 26%, respectively (p < 0.05). In the control arm, there were no significant changes | |||||
| Leahy (2013) [20] | Prospective study with retrospective control | Low- to intermediate-risk patients treated with radical radiotherapy | 86 | Nurse-led telephone consultation | Nurse-led telephone consultation vs standard medical follow-up was conducted in low- and intermediate-risk patients treated with radical radiotherapy | Participants completed the Satisfaction with Consultation Scale, the Brief Distress Thermometer and the EPIC | There was no statistically significant difference in patient satisfaction on any of the study measures. No differences were recorded in terms of distress (11% vs 10%), EPIC scale, and impact of symptoms |
| 83 | Standard medical follow-up | ||||||
| Viers (2015) [26] | Randomized controlled trial | Localized cancer treated by radical prostatectomy | 24 | Remote video visit | Video visits, with the patient at home or work, were included in the outpatient clinic calendar of urologists | The primary outcome was video visit efficiency, defined as differences in timing for the total patient-urologist encounter time minus any overlap with the resident or midlevel provider, as well as waiting time in the examination room, total patient-provider consultation time, and total time devoted to the patient’s care | Primary endpoint: no difference in: - Total time devoted to patient care (mean 17.9 vs 17.8 min). - Total patient face time (14.5 vs 14.3 min) |
| 22 | Traditional office visit | Traditional follow-up with office visit | Secondary outcomes, assessed via the patient questionnaire, included perceived efficiency, confidentiality, utility, and satisfaction | - Patient-staff face time (12.1 vs 11.8 min). - Patient waiting time (18.4 vs 13.0 min). Secondary outcomes: no differences in: - General health status, degree of patient activation, including taking an active role in their health care (mean Likert scale agreement 1.5 vs 1.4) and discussing concerns with their provider even when not asked (1.3 vs 1.2). - Patient trust of the provider (1.0 vs 1.0), perception of visit confidentiality (1.1 vs 1.0), or ability to share sensitive/personal information (1.3 vs 1.0). - Perceived efficiency (2.1 vs 1.4). - Quality of education provided (1.3 vs 1.4). - Overall satisfaction with the encounter (1.2 vs 1.1) The video visit group incurred significantly lower costs |
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| Lange (2017) [37] | Quasiexperimental | Localized cancer treated by radical prostatectomy | 18 | Guided chat group for outpatients with prostate cancer | Use chat group to exchange concerns and problems, and support the fellow patients vs standard approach | Effectiveness of the chat groups in psychosocial aftercare for outpatients with prostate cancer after prostatectomy in terms of distress, anxiety, depression, anger, need for help, quality of life, fear of progression, and coping with cancer | In the intervention group, scores for anger, coping with cancer, physical component of quality of life, and depression were poorer in comparison with the control group. Web-based chat groups may not be an effective way to decrease prostate cancer perceived distress even if the intervention participants seem to accept the intervention |
| 26 | Standard treatment | ||||||
| Galsky (2017) [35] | Prospective series | Clinical trial of metformin in nonmetastatic patients with failure of local treatments | 15 | Telehealth video visits (televisits) during the clinical trial | Televisits were conducted monthly by using a Health Insurance Portability and Accountability Act–compliant smartphone application | Determine the feasibility of telemedicine-enabled study visits and patient satisfaction | Of the televisits, 100% were completed by the participants. Patient satisfaction was very high |
| Schaffert (2018) [39] | Prospective series | Localized cancer, any treatment | 56 | Online tutorial objectives to support the decision-making process | Online tutorial and questionnaires (the first one 4 wk after the first login and the second one 3 mo after treatment decision). The surveys used the PDMS, the DCS, and the DRS | Patient satisfaction and effectiveness | Satisfaction with the online tutorial was very high. Three months after the decision, they felt that they were well prepared for the decision making (mean PDMS 75), had a low decisional conflict (mean DCS 9.6), and had almost no decisional regret (mean DRS 6.4) |
| Belarmino (2019) [45] | Prospective series | Localized cancer treated by radical prostatectomy | 20 | Adoption mobile application (app) | Push notification to perform Kegel exercise | Patient satisfaction and usability | Of the responders, 100% revealed that the app is easy to use and the questions are easy to understand. 93% revealed that the app is useful |
| Metastatic prostate cancer | |||||||
| Chambers (2017) [34] | Randomized controlled trial | Metastatic | 94 | Mindfulness-based cognitive therapy delivered by phone | Participants were assessed at baseline and were followed up at 3, 6, and 9 mo | Psychological distress, cancer-specific distress, and prostate-specific antigen anxiety | Mindfulness-based cognitive therapy delivered via phone was not more effective than minimally enhanced usual care in reducing distress in men with advanced PCa |
| 95 | Usual care | ||||||
DCS = Decisional Conflict Scale; DRS = Decisional Regret Scale; EPIC = Expanded Prostate Cancer Index Composite; MVPA = moderate-to-vigorous physical activity; PCa = prostate cancer; PDMS = Preparation for Decision Making Scale; SED = sedentary behavior.