Abstract
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.
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 language | English |
|---|---|
| Qualification | Doctor of Philosophy |
| Awarding Institution |
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| Supervisors/Advisors |
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| Award date | 24-Nov-2021 |
| Place of Publication | [Groningen] |
| Publisher | |
| Print ISBNs | 9789493270282 |
| DOIs | |
| Publication status | Published - 2021 |