Quality of life support in advanced cancer—web and technological interventions: systematic review and narrative synthesis

Abstract

BackgroundAs treatments continue to progress, patients with advanced cancer are living longer. However, ongoing physical side-effects and psychosocial concerns can compromise quality of life (QoL). Patients and physicians increasingly look to the internet and other technologies to address diverse supportive needs encountered across this evolving cancer trajectory.Objectives1. To examine the features and delivery of web and technological interventions supporting patients with advanced cancer. 2. To explore their efficacy relating to QoL and psychosocial well-being.MethodsRelevant studies were identified through electronic database searches (MEDLINE, PsychINFO, Embase, CINAHL, CENTRAL, Web of Science and ProQuest) and handsearching. Findings were collated and explored through narrative synthesis.ResultsOf 5274 identified records, 37 articles were included. Interventions were evaluated within studies targeting advanced cancer (13) or encompassing all stages (24). Five subtypes emerged: Interactive Health Communication Applications (n=12), virtual programmes of support (n=11), symptom monitoring tools (n=8), communication conduits (n=3) and information websites (n=3). Modes of delivery ranged from self-management to clinically integrated. Support largely targeted psychosocial well-being, alongside symptom management and healthy living. Most studies (78%) evidenced varying degrees of efficacy through QoL and psychosocial measures. Intervention complexity made it challenging to distinguish the most effective components. Incomplete reporting limited risk of bias assessment.ConclusionWhile complex and varied in their content, features and delivery, most interventions led to improvements in QoL or psychosocial well-being across the cancer trajectory. Ongoing development and evaluation of such innovations should specifically target patients requiring longer-term support for later-stage cancer.PROSPERO registration numberCRD42018089153.

Digital health and telehealth in cancer care: a scoping review of reviews

“…The remaining 134 reviews met eligibility criteria and were included in the synthesis. 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 …”

“…Many reviews indicated that a meta-analysis was not done due to heterogeneity of methods and outcomes. 13 , 15 , 18 , 21 , 23 , 29 , 40 , 45 , 46 , 49 , 60 , 65 , 69 , 74 , 75 , 86 , 88 , 89 , 90 , 97 , 100 , 104 , 110 , 116 , 118 , 131 , 134 …”

The Extent of Engagement With Telehealth Approaches by Patients With Advanced Cancer: Systematic Review

“…Recent evidence suggests that digital health interventions could provide a degree of efficacy related to QOL and psychosocial well-being [ 16 ]. For this review, most included interventions focused on symptom management, with high levels of engagement that suggest potential for its use to support remote monitoring.…”

“…Emerging evidence is mixed, with a recent review that focused on all cancer stages demonstrating clinical equipoise, with no discernible difference between telehealth and usual care in improving QOL [ 15 ]. However, a recent systematic review focusing specifically on patients with advanced cancer and diverse web and technological interventions (largely providing psychosocial, self-management, and expert-guided support) found that most approaches suggested some degree of efficacy relating to QOL and psychosocial well-being [ 16 ]. However, we do not know how well people with advanced cancer engage with these interventions.…”

“…Past systematic reviews have sought to synthesize the evidence of telehealth interventions among patients with cancer and survivors but have not explored interventions solely intended for and tested on patients with advanced, incurable cancer [ 15 , 16 ]. Understanding patient engagement can help us evaluate and refine further design, development, and evaluation of telehealth approaches for people with advanced cancer.…”