Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 28, 2021
Date Accepted: Jul 21, 2021
A smartphone-based application to improve adjuvant treatment adherence to multidisciplinary decisions in early breast cancer patients: observational study
ABSTRACT
Background:
Multidisciplinary treatment (MDT) and adjuvant therapy for breast cancer improve survival. However, nonadherence to MDT decisions often occurs. We developed a smartphone-based application (app) that can facilitate the full-course management of patients after surgery.
Objective:
The current study aimed to investigate whether this smartphone-based app can improve the compliance rate with MDTs and its associated factors.
Methods:
Patients diagnosed with invasive breast cancer who underwent MDT between March 2013 and May 2019 were included. Patients were classified into three groups: Pre-App cohort: before the launch of the app (November 2017); App nonused: after November 2017 but not using the app; and App used: after November 2017 and using the app. Univariable and multivariable analyses were performed to identify factors related to MDT adherence. Compliance with specific adjuvant treatments, including chemotherapy, radiotherapy, endocrine therapy, and targeted therapy was also evaluated.
Results:
A total of 4475 patients were included. The Pre-App, App nonused, and App used cohorts had 2966 (62.3%), 861 (18.1%), and 648 (13.6%) patients, respectively. Overall, 695 (14.6%) patients did not receive MDT recommendations. Multivariable analysis demonstrated that app usage was independently associated with adjuvant treatment adherence. Compared with the Pre-App cohort, patients in the App used cohort were less likely to deviate from the MDT recommendations (OR = 0.61, 95% CI = 0.43-0.87, P = 0.007), whereas no significant difference was found in the App nonused cohort (P = 0.765). Moreover, compared with the Pre-App cohort, App usage decreased the noncompliance rate for adjuvant chemotherapy (OR = 0.41, 95% CI = 0.27-0.65, P <0.001) and radiotherapy (OR = 0.49, 95% CI = 0.25-0.96, P = 0.038) but not for anti-HER2 therapy (P = 0.756) or endocrine therapy (P = 0.393).
Conclusions:
This smartphone-based app can increase MDT adherence in terms of adjuvant therapy, which was more obvious for adjuvant chemotherapy and radiotherapy.
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