Beating cancer-related fatigue with the Untire app

Simon Spahrkäs

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    Millions of cancer patients and survivors all around the globe suffer from cancer-related fatigue and experience a reduced quality of life due to their cancer and
    cancer treatment. With our large-scale international waiting-list RCT, including
    participants from four English-speaking countries (i.e., Australia, Canada, the
    United Kingdom, and the United States), we demonstrated that fatigue could
    be reduced and QoL improved by means of a self-management mHealth app
    (chapter 5). From March till October 2018, we recruited via 76 Facebook Ads
    and included 755 participants, of which 355 completed the follow-up measure
    12 weeks later, at the expense of €22.42 and €47.69 per participant, respectively
    (chapter 4). We saw that the most interested participants were female, middle-aged,
    and came from the UK. We think that reaching participants for international
    mHealth studies via Facebook Ads has potential but can be very costly, especially
    when more balanced sub-samples are desired. However, we believe that constant
    optimization and testing of ads can make an essential difference in reducing
    recruitment costs. Regarding the app’s effectiveness, we learned that participants
    do not need to engage excessively with the intervention since medium app
    use (3-8 days) was already significantly associated with fatigue reduction
    (chapter 5). Our findings on fatigue reduction were statistically significant and
    clinically relevant since more people recovered in the intervention group than
    the control group. We explored whether the effect of the intervention was related
    to specific age groups and saw that the intervention effect was significant across
    all age groups but even more pronounced in younger individuals (<56 years).
    Individuals with different education levels and both cancer patients and survivors
    seemed to benefit significantly from the app. We do not have enough data to
    compare outcomes between gender, cancer types, and treatment types and
    must acknowledge that our study sample is limited in its representativeness to
    Facebook users. We also explored several processes targeted by the app and their
    effect on fatigue reduction (chapter 6). We found that app access was significantly
    associated with reduced fatigue severity and interference via the mechanism of
    reduced fatigue catastrophizing, depression, sleep disruption, and increased
    mindfulness and physical activity. Besides, we described the experiences we had
    with applying for ethical approval in different countries (chapter 3). We believe
    that research guidelines could support scientists aiming to conduct international
    internet-based studies regarding whether these should be considered single or
    multi-center trials. We describe where researchers can apply for ethical approval
    across different countries.
    Original languageEnglish
    QualificationDoctor of Philosophy
    Awarding Institution
    • University of Groningen
    • Hagedoorn, Mariet, Supervisor
    • Sanderman, Robbert, Supervisor
    • Looijmans, Anne, Co-supervisor
    Award date24-Nov-2021
    Place of Publication[Groningen]
    Print ISBNs9789493270282
    Publication statusPublished - 2021


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