Exercise interventions are among the best-known interventions for cancer-related fatigue (CRF). Rural survivors of cancer, however, report specific barriers to engaging in exercise programs and lack overall access to effective programs. The purpose of this investigation was to assess the feasibility of a novel telehealth exercise program designed specifically for rural survivors of cancer with CRF. A single-arm clinical trial of the BfitBwell Telehealth Program was performed. Based on an established clinical program, this adapted 12-week program addressed barriers previously reported by rural survivors by providing synchronous videoconference exercise sessions (2 per program), asynchronous exercise sessions using a personal training smartphone or internet app (3-5 per week), and regular symptom (CRF) monitoring using automated emailed surveys (every 2 weeks). Personalized exercise prescriptions containing aerobic and resistance activities were implemented by cancer exercise specialists. Symptom-triggered synchronous sessions were initiated for participants failing to improve in CRF, as identified by a reference chart of CRF improvements observed during a supervised exercise program. Eligible participants were adult survivors of any cancer diagnosis who had completed treatment with curative intent in the past 12 months or had no planned changes in treatment for the duration of the study, lived in a rural area, and were currently experiencing CRF. Feasibility was assessed by objective measures of recruitment, data collection, intervention acceptability and suitability, and preliminary evaluations of participant responses. CRF was the primary clinical outcome (assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue Scale [FACIT-Fatigue]) and was measured before, after, and 6 months after program completion. In total, 19 participants enrolled in the study, 16 initiated the exercise program, and 15 completed the program. A total of 14 participants were recruited through internet advertisements, and the total recruitment rate peaked at 5 participants per month. Participants completed 100% of initial and final assessments (30 assessments across all participants) and 93% (70/75 possible surveys across all participants) of emailed surveys and attended 97% (29/30 possible sessions across all participants) of synchronous exercise sessions. In total, 6 participants initiated symptom-triggered sessions, with 6 of 7 initiated sessions attended. The mean FACIT-Fatigue scores significantly improved (P=.001) by 11.2 (SD 6.8) points following the completion of the program. A total of 13 participants demonstrated at least a minimal clinically important difference in FACIT-Fatigue scores (≥ +3 points) at this time. FACIT-Fatigue scores did not significantly change from program completion to 6-month follow-up (n=13; mean change -1.1, SD 3.4 points; P=.29). Results from this investigation support the feasibility of the BfitBwell Telehealth Program and a subsequent efficacy trial. Novel program components also provide potential models for improving exercise program efficacy and efficiency through asynchronous exercise prescription and symptom monitoring. ClinicalTrials.gov NCT04533165; https://clinicaltrials.gov/study/NCT04533165.

BackgroundDespite advances in radiation techniques, radiation cystitis (RC) remains a significant cause of morbidity from pelvic radiotherapy, which may affect patients’ quality of life (QoL). The pathophysiology of RC is not well understood, which limits the development of effective treatments.ObjectiveThe Radiotoxicity Bladder Biomarkers study aims to investigate the correlation between blood and urinary biomarkers and the intensity of acute RC symptoms and QoL in patients undergoing localized prostate cancer radiotherapy.MethodsThis study included patients with low- or intermediate-risk localized prostate cancer who were eligible for localized radiotherapy. Blood and urinary biomarkers were analyzed before radiotherapy was initiated and at weeks 4 and 12 of radiation therapy. Patients completed questionnaires related to RC symptoms and QoL (International Prostate Symptom Score and Functional Assessment of Cancer Therapy-Prostate [FACT-P]) using a digital remote monitoring platform. The information was processed by means of an algorithm, which classified patients according to the severity of symptoms and adverse events reported. Levels of blood and urinary biomarkers were tested with the severity of acute RC symptoms and patient-reported QoL.ResultsA total of 401 adverse events questionnaires were collected over the duration of this study from 20 patients. The most frequently reported adverse events at week 4 were pollakiuria, constipation, and diarrhea. In comparison with baseline, the mean FACT-P score decreased at week 4. A significant increase in the proportion of M2 phenotype cells (CD206+, CD163+, CD204+) at W12 compared to W0 was observed. An increase in serum and urine levels of macrophage colony-stimulating factor (M-CSF), hepatocyte growth factor, and macrophagic inflammatory protein was observed at week 12 compared to baseline levels. Baseline serum and urine M-CSF concentrations showed a significant negative correlation with FACT-P scores at weeks 4 and 12 (r=−0.65, P=.04, and r=−0.76, P=.02, respectively).ConclusionsThe Radiotoxicity Bladder Biomarkers study is the first to explore the overexpression of inflammatory proteins in blood and urine of patients with symptoms of acute RC. These preliminary findings suggest that serum and urine levels of hepatocyte growth factor, M-CSF, and macrophagic inflammatory protein, as well as macrophage polarization, are mobilized after prostate radiotherapy. The elevated M-CSF levels in serum and urine at baseline were associated with the deterioration of QoL during radiotherapy. The results of this study may help to develop mitigation strategies to limit radiation damage to the bladder.

Music-based interventions (MBIs) are evidence-based, nonpharmacological treatments that include music therapy (MT) delivered by board-certified music therapists, as well as music services (MS) delivered by other health professionals and volunteers. Despite MBI's growing evidence base in cancer symptom management, it remains unclear how MBI-related information is presented to the public. Over 80% of people with cancer use the internet to find health-related information. In the United States, the National Cancer Institute (NCI) identifies certain Cancer Centers (CCs) as NCI-designated CCs or Comprehensive Cancer Centers (CCCs) based on their excellence in research. As NCI-designated CCs and CCCs are considered the gold standard in cancer care, their websites are viewed by the public as important sources of information. We aimed to determine scope, findability, and quality of MBI-related information on public-facing websites of NCI-designated CCs/CCCs. We reviewed 64 NCI-designated CC/CCC websites (excluding basic laboratories) between November 2022 and January 2023. We extracted data on the scope of information: (1) type of MBI offered (MT or MS), (2) format (individual, group), (3) method of delivery (in person or remotely delivered), (4) setting (inpatient or outpatient), (5) target population (pediatric or adult), (6) MBI practitioner qualifications, (7) clinical indications or benefits, (8) presence of testimonials, (9) cost, and (10) scheduling or referral information. We also extracted data on findability (ie, presence of direct link or drop-down menu and the number of clicks to locate MBI-related information). Based on the scope and findability data, we rated the information quality as high, moderate, or low using an adapted scale informed by prior research. Thirty-one (48%) of the 64 CC/CCCs described MBIs on their websites. Of these, 6 (19%) mentioned both MT and MS, 16 (52%) mentioned MT only, and 9 (29%) mentioned MS only. The most common format was hybrid, involving individuals and groups (n=20, 65%). The most common delivery method was in person (n=16, 52%). The most common target population was adults (n=12, 39%). The most common MBI practitioners were board-certified music therapists (n=21, 68%). The most described indications or benefits were psychological. Twenty-eight (90%) websites lacked testimonials, and 26 (84%) lacked cost information. Twenty-six (84%) websites provided scheduling or referral information. MBI-related information was found with an average of 4 (SD 1) clicks. Nine (29%) websites were of high quality, 18 (58%) were moderate, and 4 (13%) were low. Based on public websites, MBIs were most commonly delivered in person by board-certified music therapists to outpatient and inpatient adults, using individual and group formats to provide psychological benefits. The findability and quality of this information should be improved to promote the dissemination of MBIs for cancer symptom management.

Tobacco use has been identified as a risk factor for oral cancer worldwide. However, relative oral cancer incidence among adults who smoke cigarettes, use smokeless tobacco products (ST), have transitioned from cigarettes to ST, quit cigarettes and/or ST ("quitters"), or never used tobacco has not been well studied. We aim to present population-based oral cancer incidence rates for adults who smoke cigarettes, use ST, are former smokers who now use ST, or quit. We estimated cross-sectional incidence rates and incidence rate ratios (IRRs) using data from statewide cancer registries (Colorado, Florida, North Carolina, and Texas) and population counts derived from national surveys using combined data from 2014-2017. A random-effect meta-analysis approach was used to summarize estimates among these groups, based on multiple imputation-based IRR estimates by state and age group while considering potential heterogeneity. A total of 19,536 oral cancer cases were identified among adult males 35 years and older in the study geographies and period. The oral cancer incidence rate among adults who smoke was significantly higher than the ST group (2.6 times higher, 95% CI 2.0-3.3, P<.001), 3.6 (95% CI 3.2-4.1, P<.001) times higher than the never users, and 2.4 (95% CI 1.8-3.1, P<.001) times higher compared to former smokers who now use ST. The IRR among the ST group relative to never users was 1.4 (95% CI 1.1-1.9, P=.02). The IRR between former smokers who now use ST and those who quit was 1.4 (95% CI 1.0-2.1, P=.08). Findings from this population-based study with a large number of oral cancer cases support significantly high oral cancer incidence among adults who smoke and a lower risk of oral cancer incidence among never users, quitters, users of ST, and former smokers who now use ST compared to cigarettes. Future studies with detailed control of tobacco history and other relevant confounders are needed to confirm these findings.

The treatment of acute myeloid leukemia (AML) in older or unfit patients typically involves a regimen of venetoclax plus azacitidine (ven/aza). Toxicity and treatment responses are highly variable following treatment initiation and clinical decision-making continually evolves in response to these as treatment progresses. To improve clinical decision support (CDS) following treatment initiation, predictive models based on evolving and dynamic toxicities, disease responses, and other features should be developed. This study aims to generate machine learning (ML)-based predictive models that incorporate individual predictors of overall survival (OS) for patients with AML, based on clinical events occurring after the initiation of ven/aza or 7+3 regimen. Data from 221 patients with AML, who received either the ven/aza (n=101 patients) or 7+3 regimen (n=120 patients) as their initial induction therapy, were retrospectively analyzed. We performed stratified univariate and multivariate analyses to quantify the association between toxicities, hospital events, and short-term disease responses and OS for the 7+3 and ven/aza subgroups separately. We compared the estimates of confounders to assess potential effect modifications by treatment. 17 ML-based predictive models were developed. The optimal predictive models were selected based on their predictability and discriminability using cross-validation. Uncertainty in the estimation was assessed through bootstrapping. The cumulative incidence of posttreatment toxicities varies between the ven/aza and 7+3 regimen. A variety of laboratory features and clinical events during the first 30 days were differentially associated with OS for the two treatments. An initial transfer to intensive care unit (ICU) worsened OS for 7+3 patients (aHR 1.18, 95% CI 1.10-1.28), while ICU readmission adversely affected OS for those on ven/aza (aHR 1.24, 95% CI 1.12-1.37). At the initial follow-up, achieving a morphologic leukemia free state (MLFS) did not affect OS for ven/aza (aHR 0.99, 95% CI 0.94-1.05), but worsened OS following 7+3 (aHR 1.16, 95% CI 1.01-1.31) compared to that of complete remission (CR). Having blasts over 5% at the initial follow-up negatively impacted OS for both 7+3 (P<.001) and ven/aza (P<.001) treated patients. A best response of CR and CR with incomplete recovery (CRi) was superior to MLFS and refractory disease after ven/aza (P<.001), whereas for 7+3, CR was superior to CRi, MLFS, and refractory disease (P<.001), indicating unequal outcomes. Treatment-specific predictive models, trained on 120 7+3 and 101 ven/aza patients using over 114 features, achieved survival AUCs over 0.70. Our findings indicate that toxicities, clinical events, and responses evolve differently in patients receiving ven/aza compared with that of 7+3 regimen. ML-based predictive models were shown to be a feasible strategy for CDS in both forms of AML treatment. If validated with larger and more diverse data sets, these findings could offer valuable insights for developing AML-CDS tools that leverage posttreatment clinical data.

Complementary and alternative (CAM) cancer treatment is often expensive and not covered by insurance. As a result, many people turn to crowdfunding to access this treatment. The aim of this study is to identify the rationales of patients with cancer seeking CAM treatment abroad by looking specifically at crowdfunding campaigns to support CAM cancer treatment in Tijuana, Mexico. We scraped the GoFundMe.com and GiveSendGo.com crowdfunding platforms for campaigns referencing CAM cancer clinics in Tijuana, initiated between January 1, 2022, and February 28, 2023. The authors created a coding framework to identify rationales for seeking CAM treatment in Tijuana. To supplement campaign metadata, we coded the beneficiary's cancer stage, type, age, specific treatment sought, whether the beneficiary died, gender, and race. Patients sought CAM cancer treatment in Tijuana because the (1) treatment offers the greatest efficacy (29.9%); (2) treatment offered domestically was not curative (23.2%); (3) the clinic treats the whole person, and addresses the spiritual dimension of the person (20.1%); (4) treatments are nontoxic, natural, or less invasive (18.2%); and (5) clinic offers the newest technology (8.5%). Campaigns raised US $5,275,268.37 and most campaign beneficiaries were women (69.7%) or White individuals (71.1%). These campaigns spread problematic misinformation about the likely efficacy of CAM treatments, funnel money and endorsements to CAM clinics in Tijuana, and leave many campaigners short of the money needed to pay for CAM treatments while costing beneficiaries and their loved one's time, privacy, and dignity. This study affirms that Tijuana, Mexico, is a very popular destination for CAM cancer treatment.

A digital diary in the form of a mobile messenger service offers a novel method for data collection in cancer research. Little is known about the things to consider when using this data collection method in clinical research for patients with cancer. In this Viewpoint paper, we discuss the lessons we learned from using a qualitative digital diary method via a mobile messenger service for data collection in oncology care. The lessons learned focus on three main topics: (1) data quality, (2) practical aspects, and (3) data protection. We hope to provide useful information to other researchers who consider this method for their research with patients. First, in this paper, we argue that the interactive nature of a digital diary via a messenger service is very well suited for the phenomenological approach and produces high-quality data. Second, we discuss practical issues of data collection with a mobile messenger service, including participant and researcher interaction. Third, we highlight corresponding aspects around technicalities, particularly those regarding data security. Our views on data privacy and information security are summarized in a comprehensive checklist to inform fellow researchers on the selection of a suitable messenger service for different scenarios. In our opinion, a digital diary via a mobile messenger service can provide high-quality data almost in real time and from participants' daily lives. However, some considerations must be made to ensure that patient data are sufficiently protected. The lessons we learned can guide future qualitative research using this relatively novel method for data collection in cancer research.

BackgroundExercise intensity (eg, target heart rate [HR]) is a fundamental component of exercise prescription to elicit health benefits in cancer survivors. Despite the validity of chest-worn monitors, their feasibility in community and unsupervised exercise settings may be challenging. As wearable technology continues to improve, consumer-based wearable sensors may represent an accessible alternative to traditional monitoring, offering additional advantages.ObjectiveThe purpose of this study was to examine the agreement between the Polar H10 chest monitor and Fitbit Inspire HR for HR measurement in breast cancer survivors enrolled in the intervention arm of a randomized, pilot exercise trial.MethodsParticipants included breast cancer survivors (N=14; aged 38-72 years) randomized to a 12-week aerobic exercise program. This program consisted of three 60-minute, moderate-intensity walking sessions per week, either in small groups or one-on-one, facilitated by a certified exercise physiologist and held at local community fitness centers. As originally designed, the exercise prescription included 36 supervised sessions at a fitness center. However, due to the COVID-19 pandemic, the number of supervised sessions varied depending on whether participants enrolled before or after March 2020. During each exercise session, HR (in beats per minute) was concurrently measured via a Polar H10 chest monitor and a wrist-worn Fitbit Inspire HR at 5 stages: pre-exercise rest; midpoint of warm-up; midpoint of exercise session; midpoint of cool-down; and postexercise recovery. The exercise physiologist recorded the participant’s HR from each device at the midpoint of each stage. HR agreement between the Polar H10 and Fitbit Inspire HR was assessed using Lin concordance correlation coefficient (rc) with a 95% CI. Lin rc ranges from 0 to 1.00, with 0 indicating no concordance and 1.00 indicating perfect concordance. Relative error rates were calculated to examine differences across exercise session stages.ResultsData were available for 200 supervised sessions across the sample (session per participant: mean 13.33, SD 13.7). By exercise session stage, agreement between the Polar H10 monitor and the Fitbit was highest during pre-exercise seated rest (rc=0.76, 95% CI 0.70-0.81) and postexercise seated recovery (rc=0.89, 95% CI 0.86-0.92), followed by the midpoint of exercise (rc=0.63, 95% CI 0.55-0.70) and cool-down (rc=0.68, 95% CI 0.60-0.74). The agreement was lowest during warm-up (rc=0.39, 95% CI 0.27-0.49). Relative error rates ranged from –3.91% to 3.09% and were greatest during warm-up (relative error rate: mean –3.91, SD 11.92%).ConclusionsThe Fitbit overestimated HR during peak exercise intensity, posing risks for overexercising, which may not be safe for breast cancer survivors’ fitness levels. While the Fitbit Inspire HR may be used to estimate exercise HR, precautions are needed when considering participant safety and data interpretation.Trial RegistrationClinicaltrials.gov NCT03980626; https://clinicaltrials.gov/study/NCT03980626?term=NCT03980626&rank=1

BackgroundTelehealth has emerged as a popular channel for providing outpatient services in many countries. However, the majority of telehealth systems focus on operational functions and offer only a sectional patient journey at most. Experiences with incorporating longitudinal real-world medical record data into telehealth are valuable but have not been widely shared. The feasibility and usability of such a telehealth platform, with comprehensive, real-world data via a live feed, for cancer patient care are yet to be studied.ObjectiveThe primary purpose of this study is to understand the feasibility and usability of cancer patient care using a telehealth platform with longitudinal, real-world data via a live feed as a supplement to hospital electronic medical record systems specifically from physician’s perspective.MethodsA telehealth platform was constructed and launched for both physicians and patients. Real-world data were collected and curated using a comprehensive data model. Physician activities on the platform were recorded as system logs and analyzed. In February 2023, a survey was conducted among the platform’s registered physicians to assess the specific areas of patient care and to quantify their before and after experiences, including the number of patients managed, time spent, dropout rate, visit rate, and follow-up data. Descriptive and inferential statistical analyses were performed on the data sets.ResultsOver a period of 15 months, 16,035 unique users (13,888 patients, 1539 friends and family members, and 174 physician groups with 608 individuals) registered on the platform. More than 382,000 messages including text, reminders, and pictures were generated by physicians when communicating with patients. The survey was completed by 78 group leaders (45% of the 174 physician groups). Of the participants, 84% (65.6/78; SD 8.7) reported a positive experience, with efficient communication, remote supervision, quicker response to questions, adverse event prevention, more complete follow-up data, patient risk reduction, cross-organization collaboration, and a reduction in in-person visits. The majority of the participants (59/78, 76% to 76/78, 97.4%) estimated improvements in time spent, number of patients managed, the drop-off rate, and access to medical history, with the average ranging from 57% to 105%. When compared with prior platforms, responses from physicians indicated better experiences in terms of time spent, the drop-off rate, and medical history, while the number of patients managed did not significantly change.ConclusionsThis study suggests that a telehealth platform, equipped with comprehensive, real-world data via a live feed, is feasible and effective for cancer patient care. It enhances inpatient management by improving time efficiencies, reducing drop-off rates, and providing easy access to medical history. Moreover, it fosters a positive experience in physician-patient interactions.

Make It Training is an e-mental health intervention designed for individuals with cancer that aims to reduce psychological distress and improve disease-related coping and quality of life. This study evaluated the experienced usefulness and usability of the web-based Make It Training intervention using a qualitative approach. In this study, semistructured interviews were conducted with participants at different cancer stages and with different cancer entities. All participants had previously taken part in the Reduct trial, a randomized controlled trial that assessed the efficacy of the Make It Training intervention. The data were coded deductively by 2 independent researchers and analyzed iteratively using thematic codebook analysis. Analysis of experienced usefulness resulted in 4 themes (developing coping strategies to reduce psychological distress, improvement in quality of life, Make It Training vs traditional psychotherapy, and integration into daily life) with 11 subthemes. Analysis of experienced usability resulted in 3 themes (efficiency and accessibility, user-friendliness, and recommendations to design the Make It Training intervention to be more appealing) with 6 subthemes. Make It Training was evaluated as a user-friendly intervention helpful for developing functional coping strategies to reduce psychological distress and improve quality of life. The consensus regarding Make It Training was that it was described as a daily companion that integrates well into daily life and that it has the potential to be routinely implemented within oncological health care either as a stand-alone intervention or in addition to psychotherapy. e-Mental health interventions such as Make It Training can target both the prevention of mental health issues and health promotion. Moreover, they offer a cost-efficient and low-threshold option to receive psycho-oncological support.