Usefulness of Smartphone Apps for Improving Nutritional Status of Pancreatic Cancer Patients: Randomized Controlled Trial

Abstract

Background Approximately 80% of pancreatic ductal adenocarcinoma (PDAC) patients suffer from anorexia, weight loss, and asthenia. Most PDAC patients receive chemotherapy, which often worsens their nutritional status owing to the adverse effects of chemotherapy. Malnutrition of PDAC patients is known to be associated with poor prognosis; therefore, nutritional management during chemotherapy is a key factor influencing the outcome of the treatment. Mobile apps have the potential to provide readily accessible nutritional support for patients with PDAC. Objective We aimed to evaluate the efficacy of a mobile app–based program, Noom, in patients receiving chemotherapy for PDAC. Methods We prospectively enrolled 40 patients who were newly diagnosed with unresectable PDAC from a single university-affiliated hospital in South Korea, and randomly assigned them into a Noom user group (n=20) and a non-Noom user group (n=20). The 12-week in-app interventions included meal and physical activity logging as well as nutritional education feedback from dietitians. The non-Noom user group did not receive any nutrition intervention. The primary outcomes were the changes in the nutritional status and quality of life (QoL) from the baseline to 12 weeks. The secondary outcomes included the changes in the skeletal muscle index (SMI) from the baseline to 12 weeks. The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Core Questionnaire (QLQ-C30) and the Patient-Generated Subjective Global Assessment (PG-SGA) were used as paper questionnaires to assess the QoL and nutritional status of the patients. Intention-to-treat and per-protocol analyses were conducted. Regarding the study data collection time points, we assessed the nutritional status and QoL at the baseline (T0), and at 4 (T1), 8 (T2), and 12 (T3) weeks. Abdominal computed tomography (CT) imaging was conducted at the baseline and after 8 weeks for tumor response and SMI evaluation. The skeletal muscle area (cm2) was calculated using routine CT images. The cross-sectional areas (cm2) of the L3 skeletal muscles were analyzed. Results Between February 2017 and January 2018, 48 patients were assessed for eligibility. Totally 40 patients with pancreatic cancer were included by random allocation. Only 17 participants in the Noom user group and 16 in the non-Noom user group completed all follow-ups. All the study participants showed a significant improvement in the nutritional status according to the PG-SGA score regardless of Noom app usage. Noom users showed statistically significant improvements on the global health status (GHS) and QoL scales compared to non-Noom users, based on the EORTC QLQ (P=.004). The SMI decreased in both groups during chemotherapy (Noom users, 49.08±12.27 cm2/m2 to 46.08±10.55 cm2/m2; non-Noom users, 50.60±9.05 cm2/m2 to 42.97±8.12 cm2/m2). The decrement was higher in the non-Noom user group than in the Noom user group, but it was not statistically significant (-13.96% vs. -3.27%; P=.11). Conclusions This pilot study demonstrates that a mobile app–based approach is beneficial for nutritional and psychological support for PDAC patients receiving chemotherapy. Trial Registration ClinicalTrials.gov NCT04109495; https://clinicaltrials.gov/ct2/show/NCT04109495.

Behavior Change Effectiveness Using Nutrition Apps in People With Chronic Diseases: Scoping Review

“…These studies can be found in Table 2 . Each app had different features, including digital diaries [ 7 , 44 - 49 ], coach feedback [ 7 , 44 - 47 , 49 - 51 ], personalized physical exercise programs and nutrition plans [ 49 , 50 ], general nutrition and physical exercise guidelines [ 45 , 51 ], psychological support courses [ 45 , 51 ], a secure message portal to their health care teams [ 7 , 48 ], health knowledge education [ 46 , 48 , 51 ], and daily tasks [ 48 , 51 ].…”

Content features and its implementation in novel app-based psycho-oncological interventions for cancer survivors: a narrative review

“…In addition, information about the disease and treatment, some apps also contain nutritional information or weight management information. The ‘Noom’ app for example is a weight management app commercially available on Google Playstore and Apple Appstore, that was adapted for pancreas cancer patients undergoing chemotherapy [36] and esophageal cancer patients with neoadjuvant chemotherapy [25 ▪▪ ]. The app version for pancreas cancer patients includes daily articles about health knowledge and how to organize the diet and caloric intake especially for pancreas cancer patients.…”

“…Only apps for adolescence and adult cancer patients were included. In total, we included 19 studies out of 564 for this narrative review [20,21 ▪ ,22–24,25 ▪▪ ,26,27 ▪▪ ,28 ▪ ,29 ▪ ,30–32,33 ▪ ,34 ▪▪ ,35,36,37 ▪▪ ,38].…”

Measuring What Is Meaningful in Cancer Cachexia Clinical Trials: A Path Forward With Digital Measures of Real-World Physical Behavior

“… 37 , 39 , 111 , 112 and have been used in assessing treatment effects and benefits. 113 As such, DHTs hold promise in patient-centered drug development, particularly in studying the impact of treatments on physical function, a primary focus in drug trials and multimodal interventional trials for cachexia.…”