Table 4.

Intervention overview, engagement, and acceptability outcomes

Source (author and year)	Objectives and description	Engagement	Acceptability (satisfaction)	Conclusion
Huang et al., (2019) [36]	Objective: evaluate the effects of a web-based health education program on global QoL, QoL-related function, and symptom distress in patients diagnosed with advanced NSCLC The experimental group participated in the web-based education program twice a month for three months	Those who consented (55/60) completed all assessments	Satisfaction measures not discussed	The web-based program can improve global QoL, emotional function, and reduce top ten significant symptom distresses within the first three months post diagnosis and treatment of advanced-stage NSCLC patients Web-based health education can enhance self-learning to assist with coping with cancer, treatments, and side effects
Ji et al., (2019) [33]	Objective: explore the outcome of home-based pulmonary rehabilitation (PR) regarding exercise capacity, dyspnea symptoms, and QoL in patients being treated for NSCLC Participants were randomly allocated to a fixed exercise group or a fixed-interactive exercise group The fixed exercise group used only the fixed exercise program during the 12 weeks. The fixed-interactive exercise group received the app with the fixed exercise regimen for the first six weeks. Switching to an app with an interactive exercise regimen for the remaining six weeks	64 participants allocated to the two groups 49 made it to six weeks analysis; 43 made it to the 12 weeks analysis	Participant Satisfaction (Patient Global Assessment [PGA]): Week 6: n = 39, Mean (SD): 13.769 (3.681 Week 12: n = 39; Mean (SD): 15.077 (3.989)	Personalized mHealth PR can supplement traditional health care rehabilitation programs for NSCLC patients. Findings support the use of this technology to improve exercise capacity, dyspnea symptoms, and QoL
Denis et al., (2014) [32]	Objective: investigate whether patient self-evaluated symptoms transmitted via the internet could be used between pre-planned visits to indicate early disease relapse in lung cancer Patients report their weight and ten symptoms, such as appetite loss (anorexia), fatigue (asthenia), pain, cough, and breathlessness (dyspnea) weekly The physician would be notified via email when self-evaluated symptoms met a pre-specified criterion	564/691 of all forms were completed, which is 82% of the maximum Mean monthly compliance was 94% Mean weekly compliance was 79%	100% of participants felt reassured they were being followed by their oncologist	A weekly follow-up system using the internet deemed feasible to detect relapse or tumor progression with a high rate of compliance
Coats et al., (2019) [35]	Objective: investigate the feasibility, adherence, satisfaction, and technical issues of a home-based telerehabilitation intervention for patients with unresectable thoracic neoplasia receiving chemotherapy The intervention was an eight-week home-based telerehabilitation program (three sessions of ~ 75 min per week) using the eChez-Soi telerehabilitation platform. The platform provided a combination of interactive exercises with real-time physiological parameter acquisition Sessions started off supervised but with study progression reduced to mainly unsupervised	The mean duration of supervised sessions was 67 ± 12 min. Total duration of all 75 supervised exercises sessions was 85 h. Mean time for cardiovascular exercise was 247 ± 48 min over the 15 supervised exercise sessions and 223 ± 111 min over the 8.6 ± 3.0 unsupervised exercise sessions. Mean duration of each cardiovascular exercise session was 18 ± 6 min and 26 ± 9 min during supervised and unsupervised exercise sessions	5/5 patients reported being quite satisfied (score of 4) or very satisfied (score of 5) with all aspects of the home-based telerehabilitation platform. Mean satisfaction score: 4.7 ± 0.4	Findings support the feasibility of a Tele Rehabilitation program (TELERP) and suggest the intervention may help patients overcome barriers to pulmonary rehabilitation services Participation in TELERP may assist improvements or maintenance in muscle strength and functional capacity for lung cancer patients on chemotherapy treatment
Timmerman et al., (2017) [13]	Objective: evaluate the feasibility of a Tele-healthcare application for operable lung cancer patients Stage One: Prior to the start of the study, thoracic surgeons and pulmonologists were given a short presentation about content and possible benefits of the symptom and physical activity monitoring S&PAM module Physiotherapists were introduced to the web-accessible exercise program (WEP) during a two-hour workshop Stage Two: The Remote Monitoring and Treatment RMT it consists of two modules: (1) a symptom and physical activity monitoring (S&PAM) system, and (2) a web-accessible exercise program with remote supervision by a physiotherapist	Ambulant S&PAM system: 100% of patients used the S&PAM system at least once Mean usage: Five—six days per treatment period WEP: Eight patients (67%) used the exercise portal at least 1 week following lung resection. Patients started 4 (n = 3), 5 (n = 2), 6 (n = 2), or 7 (n = 1) weeks following resection	S&PAM: most patients indicated that the monitoring system had good usability. All felt competent using the module (perceived self-efficacy score > 5) WEP: most patients were satisfied with usability of the module, except for two (score < 5) stating the program was difficult to access on mobile phone All patients felt confident in their ability to use the module	Findings support that remote monitoring and treatment is feasible to lung cancer patients both pre- and post-surgery Patients actively used the S&PAM and WEP modules prior and following surgery and perceived both as a beneficial contribution to their care A low level of adoption by referring physicians may reduce successful implementation
Lafaro et al., (2019) [37]	Objectives: (1) determine the feasibility and acceptability of a personalized telehealth intervention, for physical activity perioperatively for GI and lung cancer patients and their caregivers. (2) describe the trends, trajectories, and patterns of both functional recovery and self-reported outcomes pre- and post-surgery The intervention consisted of five sessions. Session one was after baseline assessment and a minimum of seven—fourteen days prior to surgery via videoconferencing. Session two (in-person) functional re-assessment (6MWT, TUG, SPPB) and self-reported measures. Session two content was delivered post re-assessment. Sessions three, four, and five (telehealth) were completed at days two, seven, and two—four weeks post-discharge. All given outcomes were re-assessed at two—four weeks post-discharge. Acceptability was measured via a satisfaction survey. Pedometer data was collected throughout the study duration Strategies to overcome barriers to staying active after discharge were discussed	Preoperative pedometer adherence: 79%, post-discharge 68%. Median preoperative daily steps were 6324 The value decreased to 1050 during hospitalization, The value increased to 2927 in the first 2 weeks after discharge	Self-reported satisfaction: 3.2/4.0 93.3% of patients thought that the timing of the intervention was appropriate	The personalized telehealth perioperative physical activity intervention was feasible and acceptable for both adults undergoing GI or lung cancer surgery and their caregivers
Park et al. (2019) [34]	Objective: determine the feasibility and efficacy of smartphone app–based PR on QoL, exercise capacity, and symptom management for patients with advanced lung cancer who were undergoing chemotherapy Patients were provided with the Smart Aftercare app, an Internet of Things (IoT) wearable device, a portable pulse oximeter, thermometer, scale, and resistance bands. The to-do list provided an alarm notification for daily tasks related to taking medication, performing rehabilitation exercise, and visiting the clinic on schedule This study consisted of a 12-week rehabilitation program. The Smart Aftercare app provided animation videos on stretching exercises, aerobic exercises, muscle strengthening exercises, and finishing (stretching) exercises. The Smart Aftercare app provided an animation video on pain control, nutritional support, and symptom management	90 finished the rehab program 85/90 completed all 6MWT tests	Satisfaction: 77% (69/90) reported they were satisfied 88% (79/90) reported they would recommend it to others 96% (86/90) stated they were paying more attention to their health and disease status since using the app	12 weeks of comprehensive smartphone app–based individualized PR seems to be an effective and feasible approach for improving exercise capacity, symptom management, and distress in patients with advanced NSCLC undergoing systemic chemotherapy
Maguire et al. (2015) [15]	Objective: (a) explore the feasibility and acceptability of the Advanced Symptom Management System with patients with lung cancer receiving radiotherapy (ASyMS-R) and clinicians involved in their care; (b) assess changes in patient outcomes during implementation of the ASyMS-R in clinical practice Patients used the ASyMS-R at home during working hours (9 AM—5 PM), seven days a week, for the duration of their radiotherapy treatment in addition to one month after treatment. They were instructed to follow local procedures regarding out-of-hours care After completing the daily questionnaire on their mobile phone, patient’s daily symptom data were sent to a central study server, where an integrated risk model analysed the symptom reports	89% of participants reported the self-care system was easy to understand and user friendly	Nine patients indicated that they had received enough training to use the ASyMS-R handset 100% of patients reported that they never or very rarely encountered problems in using the handset (n = 10; 100%), answering and submitting questionnaires (n = 9; 90%), reading the self-care information after submitting a questionnaire or again later (n = 10; 100%), or finding cancer information pages (n = 8; 89%)	This study demonstrated the potential to provide an accurate and acceptable assessment of radiotherapy-related toxicity and management in clinical practice. Therefore, effectively responding to the needs of patients in this study and facilitating the delivery of timely interventions. Participants reported the ASyMS-R to positively impact on their care and promote the timely reporting and management of their symptoms

QoL, Quality of Life; NSCLC, Non-Small Cell Lung Cancer; PR, Pulmonary Rehabilitation; mHealth, Mobile Health; SD, Standard Deviation; TELERP, Tele Rehabilitation program; WEP, web-accessible exercise program; RMT, Remote Monitoring and Treatment; S&PAM, symptom and physical activity monitoring; GI, Gastrointestinal; 6MWT, 6 min walk test; TUG, Time Up and Go; SPPB, Short Physical Performance Battery; IoT, Internet of Things; ASyMS-R, Advanced Symptom Management System with patients with lung cancer receiving radiotherapy; PGA, Patient Global Assessment