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. 2022 May 30;12(5):e057664. doi: 10.1136/bmjopen-2021-057664

Table 3.

Internet-based support interventions randomised controlled trials: study characteristics and results

Author/year/country Sample size (I/C) Intervention description Intervention characteristics Intervention content elements Duration Outcomes/
measurements		 Results
Lally et al
2020
USA16 		43/57 Name: Tailored self-mannagement psychoeducational programme
Structure: Five module of supportive oncology-based psychoeducation and cognitive-behavioural techniques, coping skills, problem solving, communication strategies and validation.		 Delivery: Web
Self-guided: √
Automated reminders: ×
Face-to-face contact: ×
Tailored: √		 Information support;
Psychological support;
Peer Support.		 12 weeks

  1. Psychological distress (DT, CES-D, IES）

 No significant outcomes.
Zhu et al
2018
China17 		57/57 Name: Mobile Breast Cancer e-Support Programme
Structure: Learning Forum (information related to breast cancer disease and symptom management), Discussion Forum (anonymous support group), Consult an Expert (online consultation) and Personal Stories (interview stories of breast cancer survivors).		 Delivery: Application
Self-guided: ×
Automated reminders: ×
Face-to-face contact: ×
Tailored: ×		 Information support;Interaction with healthcare professionals;
Peer support.		 3 months

  1. QOL (FACT-B)

  2. Symptom distress (MDASI)

  3. Self-efficacy (SICPA)

  4. Social support (MSPSS)

  5. Anxiety and depression (HADS)

  1. 6.64; 95% CI 0.77 to 12.50; p=0.03, d=0.46

  2. –0.73; 95% CI −1.35 to −0.11; p=0.002; d=−0.51

  3. 21.05; 95% CI 1.87 to 40.22; p=0.03; d=0.53

  4. No significant outcomes.

  5. No significant outcomes.
Korkmaz et al
2020 Turkey18 		24/24/
24		 Name: A web-based education programme
Structure: Provides education or coach to patients with breast cancer in the preoperative and postoperative process.		 Delivery: Web
Self-guided: √
Automated reminders: ×
Face-to-face contact: ×
Tailored: ×		 Information support. 1 month

  1. Anxiety (STAI)

  2. QOL (SF 36)

  1.  P<0.05

  2.  P<0.05
White et al
2018
Australia19 		177/202 Name: An information- based, breast cancer specific website
Structure: Information module, emotional responses, support services, family responses and life after cancer, a diary.		 Delivery: Web
Self-guided: √
Automated reminders: √
Face-to-face contact: ×
Tailored: ×		 Information support;
Psychological support.		 6 months

  1. Anxiety and Depression (HADS)

  2. QOL (FACT-B

  1. No significant outcomes.

  2. T1–T2 (χ2df=1=6.46, p=0.01)
Admiraal et al
2017 Netherlands20 		69/69 Name: Tailored self-mannagement psychoeducational programme
Structure: (1) problem orientation; and (2) fully automated and customised psychoeducation for reported problems; and (3) resources and services for reported problems.		 Delivery: Web
Self-guided: √
Automated reminders: ×
Face-to-face contact: ×
Tailored: √		 Information support;
Psychological support.		 12 weeks

  1. QOL (EORTC QLQ-C30 and the QLQ-BR23)

  2. Psychological distress (DT/PL)

 No significant outcomes.
Ventura et al
2017 Sweden21 		121/105 Name: Swedish Interactive Rehabilitation Information programme
Structure: Includes links to web pages and lectures last for 4 hours about two modules: medical issues arising and psychosocial aspects.		 Delivery: A computer-based programme
Self-guided: ×
Automated reminders: ×
Face-to-face contact: ×
Tailored: ×		 Information support. 9 months

  1. Anxiety and depression (HADS)

  2. Self-efficacy (CHESS)

 No significant outcomes.
Wheelock et al
2015
USA22 		41/59 Name: A web-based system for symptom management
Structure: Three routine clinical follow-up appointments, self-reported symptoms, with review by nurse practitioners, targeted education and triage.		 Delivery: Web +computer system
Self-guided：×
Automated reminders: ×
Face-to-face contact: ×
Tailored: √		 Information support;
Symptom management;
Interaction with healthcare professionals.		 18 months Symptom prevalence (patients self-reported) 7.36 vs 3.2; p=0.0045
Du and Yao 2021
China23 		40/40 Name: Follow-up management intervention based on clinical decision support system
Structure: Fills in the corresponding health status evaluation sheet, the system automatically interprets the results of the evaluation sheet and triggers an abnormal state alarm, the normal state gives a follow-up/treatment reminder, and the abnormal state pushes-related health education courses or intervention from medical staff.		 Delivery: A full-process information management system
Self-guided: ×
Automated reminders: √
Face-to-face contact: ×
Tailored: √		 Information support;
Symptom management;
Interaction with healthcare professionals.		 6 months

  1. Symptom severity (myelosuppression)

  2. Self-efficacy (SUPPH)

  1. P<0.05

  2. P<0.05
Hou et al
2020
Taiwan24 		59/53 Name: A Self-Management Support mHealth Application Intervention
Structure: Eight main features (1) evidence or knowledge about breast cancer, (2) exercise and rehabilitation after surgery, (3) diet and nutrition for breast cancer patients, (4) emotional support to prevent anxiety and depression, (5) personal health records to track treatment and side effects, (6) information on social resources, (7) experience sharing and (8) expert consulting.		 Delivery: Application
Self-guided: √
Automated reminders: √
Face-to-face contact: ×
Tailored: ×		 Information support;
Symptom management; Behaviour management
Psychological support;
Interaction with healthcare professionals;
Peer support.		 3 months

  1. QOL (QLQ-C30 andQLQ-BR23)

 83.45 vs 82.23, p=0.03 (QLQ-C30);
265.53 vs 63.13, p=0.04 (QLQ-BR23)
Graetz et al
2018
USA25 		25/23 Name: A mobile application for managing adverse symptoms.
Structure: Test the use of the application designed with and without weekly reminders for patients to report real-time symptoms and AI use outside of clinical visits with built-in alerts to patients’ oncology providers.		 Delivery: Application
Self-guided:√
Automated reminders:√
Face-to-face contact: ×
Tailored:√		 Information support
Symptom management; Behaviour management.		 8 weeks Symptom distress (FACT-ES) No significant outcomes.
Fjell et al
2020
Sweden26 		75/74 Name: An interactive application intervention
Structure: Symptom self- reporting, an alert system for contacting healthcare professionals, access to self-care advice and a visual chart of symptom history.		 Delivery: Application
Self-guided: √
Automated reminders: √
Face-to-face contact: ×
Tailored: √		 Information support;
Symptom management;
Interaction with healthcare professionals.		 2 weeks

  1. QOL (EORTC QLQ-C30)

  2. Symptom distress (MSAS)

  1. Emotional functioning (p=0.008); nausea and vomiting (p=0.007), appetite loss (p=0.027), constipation (p=0.007),

  2.  P=0.033, Effect size (0.26 to 0.34)
Handa et al
2020
Japan27 		52/50 Name: A breast cancer patient support system application.
Structure: Record the patient’s subjective and objective symptoms by time and number, provides tips for self-care, including advice on when the patient should go for check-ups, and ways to manage side effects.		 Delivery: Application
Self-guided: √
Automated reminders: × Face-to-face contact: ×
Tailored: ×		 Information support;
Symptom management.		 12 weeks Anxiety and depression (HADS) No significant outcomes.
Rosen et al
2018
USA28 		55/57 Name: Application-delivered mindfulness training intervention
Structure: Includes techniques for calming meditation (eg, focus on the breath) and insight meditation (eg, cultivating awareness, insight and compassion).		 Delivery: Application
Self-guided:√
Automated reminders: Face-to-face contact: ×
Tailored ×		 Information support;
Psychological support.		 8 weeks

  1. QOL (FACT-B)

 t (258.40)=3.09,
P<0.01, 95% CI (2.71 to 11.90)
Zhou et al
2019
China29 		66/66 Name: Cyclic adjustment training intervention
Structure: Relaxed deep breath training; music listening; anticancer stories reading/ listening/watching; adjust experiences and feelings sharing with peers;be instructed to self-ask the following questions.		 Delivery: WeChat
Self-guided: ×
Automated reminders: ×
Face-to-face contact: √
Tailored: ×		 Information support;
Psychological support;
Interaction with healthcare professionals;
Peer support.		 12 weeks

  1. Depression (SDS) Anxiety (SAS)

  1. F=26.32, p<0.001

  2. F=31.85, p<0.001
Zhou et al
2020 China30 		55/56 Name: WeChat-based multimodal nursing program
Structure: Provision of information, training, support, and counselling centred and oriented to the needs of breast cancer patients, involving physical, psychological and social adjustment distress.		 Delivery: WeChat
Self-guided: ×
Automated reminders: ×
Face-to-face contact: √
Tailored: ×		 Information support;
Psychological support;
Interaction with healthcare professionals;
Peer support.		 6 months

  1. QOL (FACT-B)

  2. Pain/fatigue/sleep symptom (NRS)

  1. F=16.28, p<0.001

  2. No significant outcomes.
Foley et al
2016
Ireland31 		26/13 Name: Patient accessed tailored information Intervention
Structure: Tailored surgical information pertaining to individual patients and the scripts were reviewed by the National Adult Literacy Agency and contain basic breast cancer biology, the different treatments used and surgical techniques.		 Delivery: Application
Self-guided: √
Automated reminders: ×
Face-to-face contact: ×
Tailored: √		 Information support. 2 weeks

  1. Anxiety and depression (HADS)

  1. P=0.022 (anxiety) P=0.029 (depression)
Wang et al
2019
China32 		44/44 Name: Continuous rehabilitation nursing support intervention
Structure: Knowledge sharing, health consultations, sharing of feelings and experiences between patients, relax training; cope with negative emotions.		 Delivery: WeChat
Self-guided: ×
Automated reminders: ×
Face-to-face contact: ×
Tailored: ×		 Information support;
Psychological support;
Interaction with healthcare professionals;
Peer support.		 6 months

  1. QOL (FACT-B)

  2. Pain, fatigue, and sleep severity (NRS)

  1. P<0.001

  2. No significant outcomes.
Sherman et al
2018 Australia33 		155/149 Name: Structured Online Writing Exercise Intervention
Structure: Individuals could describe their deepest thoughts and emotions with specific prompts focused on self-compassion according to a modified expressive writing prompt.		 Delivery: Web
Self-guided：√
Automated reminders：×
Face-to-face contact: ×
Tailored: ×		 Psychological support. NA

  1. Anxiety and depression (DASS)

  2. Body image distress (BIS)

  1. P=0.001 (depression); P=0.007 (anxiety)

  2. P=0.035
Villani et al
2018
Italy34 		14/15 Name: E-health Stress Inoculation Training (SIT) intervention
Structure: Face-to-face counselling with a psychologist, live videos simulating the chemotherapy process, watching live video interviews with women who have experienced breast cancer, relaxation videos with guided meditation audio.		 Delivery: Web
Self-guided: ×
Automated reminders:×
Face-to-face contact:√
Tailored: ×		 Psychological support;
Interaction with healthcare professionals;
Peer support.		 3 months

  1. QOL (FACT-B)

  2. Emotional Depression (ERQ)

  1. P<0.05 (3 months after the end of the intervention) P<0.05

  2. (3 months after the end of the intervention)
Liu et al 2019
China35 		50/50 Name: Innovative Follow-Up Intervention
Structure: Provide preoperative rehabilitation guidance, discharge follow-up form and endocrine medication survey form, health consultation.		 Delivery: WeChat
Self-guided: ×
Automated reminders: ×
Face-to-face contact: ×
Tailored: ×		 Information support;
Behaviour management;
Interaction with healthcare professionals;
Peer support.		 12 months Self-efficacy (GSES) P<0.05
Kim and Kim
2020
North- Korea36 		Name: A web-based expert support self-management programme (WEST)
Structure: Keep a health diary, self-diagnose lifestyle, learn health information and receive individualised feedback from a nurse, phone counselling with experts.		 Delivery: Application
Self-guided: √
Automated reminders: ×
Face-to-face contact: ×
Tailored: √		 Information support;
Behaviour management;
Interaction with healthcare professionals.		 6 months Self-efficacy
(health-specific self-efficacy scales)		 No significant outcomes.
Im et al
2020 USA38 		66/49 Name: Technology-Based Information and Coaching/
Support Programme on Pain and Symptoms
Structure: Online knowledge or education with cultural characteristics, online assistance resources, group and one-on-one guidance in the form of online forums on the website.		 Delivery: Web
Self-guided: ×
Automated reminders: ×
Face-to-face contact: ×
Tailored: √		 Information support;
Interaction with healthcare professionals;
Peer support.		 3 months

  1. Symptom distress (MSAS-SF)

 P=0.0229
Wang et al
2019
China39 		75/74/\ Name: Specialised case management intervention
Structure: Establish case management files, push the answers to patient questions, share knowledge, remind and supervise the implementation of the patient’s personal plan daily, including medication, symptoms, and weight.		 Delivery: WeChat
Self-guided: ×
Automated reminders: ×
Face-to-face contact: ×
Tailored: ×		 Information support;
Interaction with healthcare professionals;
Peer support.		 9 months Symptom severity (CTCAE) P<0.05
Visser et al
2018 Netherlands40 		50/59 Name: Group medical consultations (GMCs) and tablet-based online support group sessions
Structure: A face-to-face GMC and an online application, consisting of three tablet-based video GMCs, email, videos and additional information.		 Delivery: Application
Self-guided: ×
Automated reminders:√
Face-to-face contact: ×
Tailored: √		 Information support;
Interaction with healthcare professionals;
Peer support.		 3 months

  1. Psychological distress (SCL-90)

 No significant outcomes.
Peng et al 2020
China41 		59/58 Name: Online and offline rehabilitation intervention
Structure: online and offline rehabilitation volunteer support activities, case management file establishment and offline rehabilitation guidance, online rehabilitation knowledge guidance and rehabilitation consultation and Q&A.		 Delivery: WeChat
Self-guided: ×
Automated reminders: ×
Face-to-face contact: √
Tailored: ×		 Information support;
Psychological support;
Interaction with healthcare professionals;
Peer support.		 12 months

  1. QOL (QLQ-BR53)

  2. Body image distress (BIS)

  1. P<0.05

  2. P<0.05
Chee et al
2016
USA54 		30/35 Name: A culturally tailored internet cancer support group
Structure: (a) interactive online message board by moderated a registered nurse; (b) interactive online evidence-based educational sessions; and (c) online resources.		 Delivery: Web
Self-guided: ×
Automated reminders: ×
Face-to-face contact: ×
Tailored: ×		 Information support;
Interaction with healthcare professionals;
Peer support.		 1 month

  1. QoL (FACT-B)

  2. Symptom distress (MSAS-SF)

  3. Social support (PRQ)

  4. self-efficacy (CBI)

  1. P<0.10

  2. P<0.10

  3. No significant outcomes.

  4. No significant outcomes.
Wang et al 2017
China57 		320/
318/		 Name: Continuous nursing intervention
Structure: Regularly provides the service like medical information, care reminders, health monitoring and health education.		 Delivery: Application
Self-guided: ×
Automated reminders: ×
Face-to-face contact: ×
Tailored: ×		 Information support;
Symptom management;
Interaction with healthcare professionals;
Peer support.		 2 weeks

  1. QOL (QLSBC)

  2. Anxiety and depression (EESS)

  3. Prevalence of adverse reactions

  1. P<0.01

  2. P<0.01

  3. P<0.05
Li and Hanping 2018
China58 		60/60 Name: Management of chemotherapy adverse events
Structure: Information support, alert for chemotherapy adverse events, personalised management from a case manager or multidisciplinary expert, SMS alert feedback.		 Self-guided: √
Automated reminders: √
Face-to-face contact: ×
Tailored: √		 Information support;
Symptom management;
Interaction with healthcare professionals.		 2 weeks

  1. QOL (FACT-B)

  2. Symptom prevalence (CTCAE, V.4.0)

  1. P<0.05

  2. P<0.05
Chen et al
2015
China59 		45/45 Name: Tracking intervention based on network information platform
Structure: Through the system, follow-up nurses participate in the diagnosis and treatment process of the patient during the hospitalisation process, provide post-discharge patient greetings, rehabilitation guidance, reminders for follow-up and other nursing services.		 Delivery: Web
Self-guided: ×
Automated reminders: √
Face-to-face contact: √
Tailored: ×		 Information support;
Interaction with healthcare professionals
Peer support.		 3 months

  1. QOL (FACT-B)

  2. Depression (CES-D)

  1. P<0.05

  2. P<0.01
Egbring et al
2016
Switzerland60 		46/49/
44		 Name: A mobile and web-based application to record daily functional activity and adverse events.
Structure: Record functional activity and adverse events, and collaborate with physicians in the monitoring and review of patient-reported symptoms.		 Delivery: Application
Self-guided: √
Automated reminders: ×
Face-to-face contact: ×
Tailored: ×		 Information support; Symptom management; Interaction with healthcare professionals. 42 days Symptom prevalence
(patients self-reported)		 n=1033 (supervised application group) vs n=656 (questionnaire group).

BIS, Body Image Scale; CBI, Cancer Behavior Inventory; CES-D, Center for Epidemiological Survey-Depression Scale; CTCAE, Common Terminology Criteria for Adverse Events; DASS, Depression Anxiety Stress Scale; EESS, Eysenck Emotional Stability Scale; EORTC, The European Organization for Research and Treatment of Cancer; ERQ, The Emotion Regulation Questionnaire; FACT-B, Functional Assessment of Cancer Treatment-B; GSES, General Self-Efficacy Scale; HADS, The Hospital Anxiety and Depression Scale; MSAS-SF, The Memorial Symptom Assessment Scale–Short Form; NRS, Numerical Rating Scale; PRQ, Personal Resource Questionnaire; QLQ, quality of life questionnaire; QLSBC, quality of life scale of beast cancer; SAS, Self-Rating Anxiety Scale; SCL, Symptom Checklist; SDS, Self-Rating Depression Scale; SICPA, Stanford Inventory of Cancer Patient Adjustment; SMS, short message service; STAI, The State-Trait Anxiety Inventory; SUPPH, Strategies Used by People to Promote Health.