Studies have shown that most breast cancer survivors who don't die of their cancer may die from other conditions, such as heart disease, that could be managed through lifestyle changes or screening.

To prevent this, cancer patients receive a survivorship care plan after treatment ends to track their health status and long-term care needs. However, some experts question whether this strategy is effective, while others are concerned about reaching the most vulnerable survivors, such as those who live in rural areas.

Researchers from the UW School of Public Health say, ‘There’s an app for that.’

Researchers developed and successfully pilot-tested a mobile application, most commonly referred to as an app, called SmartSurvivor, which incorporated components of a survivorship care plan into a mobile interface. The app met survivorship care objectives and the needs of both breast cancer survivors and their health care providers.

"It was poignant to hear a patient say that, if she had a tool like this, she could show her doctor something concrete, such as a graph showing day-to-day change in fatigue, rather than just say she was tired,” said Debra Revere, a research scientist and clinical instructor in the Department of Health Services, who designed and led the app usability sessions.

On the other side, providers were excited about having a tool to help them make decisions, particularly for rural patients who often have to drive 250 miles to see a specialist, Revere added. “We could see that developing this app could be truly useful and make a difference in survivorship care," she said.

To design the app, researchers worked with a graphic designer to mock up a paper prototype and build out the steps to navigate through survivorship care plan components, which were recommended by the National Academy of Medicine in 2006.

Researchers then used a rapid prototyping tool to generate a downloadable mobile app and HTML website, which created a functional prototype with the look and feel of the actual app. For testing, the final prototype was uploaded on a smartphone and the HTML version was loaded onto a laptop on a website.

Breast cancer survivors, primary care providers and an oncologist were recruited to test the mobile app. Survivors ranged between two months and five years post-treatment and lived in an urban area. All primary care providers had prior experience working in rural settings in which they saw breast cancer patients for ongoing care.

Survivors and providers were asked about the app features, utility, resources and overall ease of use. They were also asked to talk aloud about their interactive experience while navigating through the screens. Additionally, providers were asked to comment on how the app might integrate with their care delivery strategies.

Overall, both survivors and providers were positive about the value of using SmartSurvivor to support survivorship care objectives. They also thought it would be easy to use and viewed the app as a way to make care planning more accessible and useful.

Six primary themes emerged from the analysis, published Sept. 26 in the Journal of Medical Internet Research - Cancer, including the following findings:

• Having one place to file all contact and treatment information is supportive of coordination of care and provider-provider communication.
• Survivors and providers can both be empowered by better tracking and communication.
• A portable device can ensure routine, timely data entry.
• There is a need for a SmartSurvivor app to integrate with other information sources.
• Being reminded by a device that you are a survivor is a concern.
• Developing SmartSurvivor for rural users will require tailoring to meet unique needs.

“Those living in rural areas experience unique challenges in their survivorship care,” the researchers wrote. “Although mobile health technologies have the potential to mitigate some of those challenges, the unique needs of rural survivors identified in this study, such as health literacy levels, need to be addressed in building an mHealth app for this population.”

The study team is led by Janet Baseman, associate chair and associate professor in the Department of Epidemiology, and includes Laura-Mae Baldwin, professor of family medicine at UW Medicine.

“We believe that this pilot study establishes the foundation for future work on SmartSurvivor that will include a larger sample of rural survivors and providers to explore efficacy,” the researchers wrote. A proposal is in process to conduct a randomized trial to explore the utility of SmartSurvivor further.