JMIR Publications

ABSTRACT

Background:

Cancer survivors frequently face persistent nutrition-related challenges after treatment. Mobile health (mHealth) tools may extend access to dietary self-management support beyond clinic settings, but feasibility and preliminary effects remain insufficiently characterized in this population.

Objective:

To evaluate the feasibility, user engagement, and preliminary effects of a 4-week mobile nutrition application on dietary behavior and quality of life (QoL) among cancer survivors, and to explore whether higher engagement is associated with greater improvements.

Methods:

A single-arm, prospective pilot feasibility study was conducted at a tertiary cancer center in Korea. Participants used a mobile nutrition app that provided dietary feedback and self-monitoring features. In-app log data were analyzed to determine engagement metrics (session frequency, duration, and gap regularity) using an elbow-based 10-minute session threshold. Primary outcomes included the Nutrition Quotient for Adults (NQ-2021) and EORTC QLQ-C30 scores, measured before and after 4 weeks. Non-parametric paired analyses assessed changes, and exploratory correlations examined relationships between engagement and outcomes.

Results:

Among 27 enrolled participants, 24 cancer survivors (88.9%) completed the intervention and post-assessment; the majority were female (70.8%) with a mean age of 58.5 ± 8.7 years. Breast cancer was the most common diagnosis (45.8%), and most participants reported no diet-related adverse effects (83.3%) and stable body weight during the study period. Participants averaged 2.3 app sessions/day and a median cumulative use of 177.5 minutes. Retention was 88.9%, and median adherence to daily self-monitoring exceeded 85%. The NQ Moderation domain improved significantly (76.6 ± 17.5 → 81.0 ± 13.7, P=.018), while Balance and Dietary Behavior showed positive trends (63.7 ± 16.1 → 65.5 ± 13.3, P=.14; 64.9 ± 17.3 → 67.1 ± 15.9, P=.10). In QoL outcomes, appetite loss decreased (17.9 ± 22.0 → 7.7 ± 14.6, P=.03) and global health status increased modestly (68.5 ± 21.4 → 72.9 ± 20.1, P=.08). Higher engagement correlated with improved moderation (r = 0.46, P= 0.02) and reduced appetite loss (r = –0.42, P=.04). Exploratory subgroup analyses suggested stronger effects among participants aged ≥60 years (ΔNQ Moderation +7.9, P=.044) and those with longer cancer survivorship (>3 years, P=.047). No adverse events were reported.

Conclusions:

This pilot feasibility study demonstrates high user engagement, satisfactory retention, and preliminary improvements in nutritional behavior and QoL among cancer survivors using a mobile nutrition app. These findings indicate the feasibility of a larger controlled trial to confirm the app’s effectiveness and explore long-term adherence strategies.