JMIR Publications

ABSTRACT

Background:

Patients undergoing gastrectomy usually experience post-gastrectomy syndrome and face difficulties in adapting to a regular diet. Human health coaching via a mobile application (app) has recently been applied to patients with chronic metabolic diseases, with significant improvements being observed in clinical outcomes.

Objective:

This study aimed to compare the quality of life (QoL) and nutritional outcomes of human health coaching via a mobile app with those of conventional face-to-face counselling in post-gastrectomy patients with gastric cancer.

Methods:

This is a prospective randomized controlled trial in which patients were enrolled between May 2020 and August 2022. In the mobile coaching group, patients received personalized health coaching for three months post-discharge. This coaching was delivered via a mobile app by assigned coaches and involved providing advice based on the patients’ self-recorded health data. In the conventional counselling group, patients underwent standard dietary consultations with a clinical dietitian at one and three months postoperatively. The primary endpoint used sample size calculation was the eating restriction score of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires (EORTC QLQ)-stomach module (STO22) assessed at one month postoperatively. Secondary endpoints included changes in other subscales of the EORTC QLQ-Core 30 and QLQ-STO22, as well as nutritional outcomes assessed preoperatively and at 1, 3, 6, and 12 months postoperatively.

Results:

Data from 160 of the 180 enrolled patients were analyzed after excluding dropouts. In the mobile coaching group (n=76), 50 (65.8%) patients who used the mobile app for ≥ 8 weeks were classified as active users. No significant difference in eating restriction at 1 month postoperatively was found between the mobile coaching and conventional counselling groups. However, the mobile coaching group reported less dyspnea during the entire period (P=.011), eating restriction at 6 months (P=.045), and negative body image at 3 months postoperatively (P=.036) than the conventional counselling group (n=84). Exploratory subgroup analyses based on age, sex, and operation type indicated that younger patients (age <60 years), female, and those who underwent distal gastrectomy had better QoL from mobile coaching. Within the mobile coaching group, exploratory subgroup analyses based on mobile activity showed that the active users had a better global health status than the inactive users (P=.005). However, no significant differences in body composition or nutritional parameters were observed between the mobile coaching and conventional counselling groups, or between active and inactive users within the mobile coaching group.

Conclusions:

Although this trial did not show a significant difference in eating restriction at 1 month postoperatively, human coaching via a mobile app was associated with fewer symptoms in some scales than the conventional counselling in post-gastrectomy patients for gastric cancer. The intervention might help patients manage their symptoms and adapt to their diet. Clinical Trial: ClinicalTrials.gov, NCT04394585, Registered on May 19, 2020 – Retrospectively registered, http://clinicaltrials.gov/ct2/show/NCT040394585