Feasibility study of “BENECA mHealth”: a mobile system to improve quality of life via energy balance in breast cancer survivors (Preprint)
BACKGROUND Energy balance is defined as the difference between energy expenditure and energy intake. The current state of knowledge supports the need to better integrate mechanistic approaches through effective studies of energy balance in cancer population, due to it is observed a significant lack of adherence to healthy lifestyle recommendations. In an attempt to stimulate changes in breast cancer survivors (BCS) lifestyles based on energy balance, our group developed BENECA mHealth application, which has been previously validated as a reliable energy balance monitoring system. OBJECTIVE Based on our previous results, the goal of this study was to investigate the feasibility of BENECA mHealth in an ecological clinical setting with breast cancer survivors, studying (1) its feasibility; and (2) pretest-posttest differences with regard to BCS’ lifestyles, quality of life (QoL), and physical activity (PA) motivation. METHODS Eighty BCS were enrolled in this prospective test-retest quasi-experimental study diagnosed with stage I to IIIA and with a body mass index over 25 kg/m2. Patients had to use BENECA mHealth for 8 weeks and were assessed at baseline and post-intervention period. Feasibility main outcomes included percentage of adoption, usage and attrition, user app-quality perception measured with the Mobile App Rating Scale (MARS), satisfaction with Net Promoter Score (NPS), and barriers and facilitators of its use. Clinical main outcomes included quality of life measure with EORT QLQ-C30, PA assess with accelerometry, PA motivation measure with the self-efficacy scale for physical activity (EAF), and body composition with a Dual-energy X-ray absorptiometry. Statistical (paired-sample t-tests was used) and Kaplan-Meier survival curve were analyzed. RESULTS BENECA was considered feasible by the BCS, in terms of use (76.3%; 58/76 BCS) adoption (69%; 80/116), and satisfaction (positive NPS). App quality score did not make it one of the best rated apps (3.71 ± 0.47 points out of 5). BENECA mHealth seems to improve the QoL of BCSs (global health mean difference (MD) 12.83, 95% CI 8.95–16.71, p<.001), as well as EAF score (global MD 36.99, 95% CI 25.52 – 48.46, p<.001), daily moderate-to-vigorous PA (MD 7.38, 95% CI 14.37–0.39, p=.039) and reduce body weight (MD -1.42, 95% CI -1.97 – -0.87, p<.001). CONCLUSIONS BENECA mHealth can be considered feasible in a real clinical context for being able to promote behavioral changes in the lifestyles of BCSs, but it needs to be optimized to improve user satisfaction with use and functionality. This study highlights the importance of the use of mobile applications based on energy balance and how the QoL of BCSs can be improved via monitoring.