eHealth and the burden of cancer survivorship.

Cancer survivorship is increasing year on year due to an aging population and improvements in cancer screening and treatments. The experience of survivorship can be challenging; individuals living with and beyond cancer can face a burden of survivorship. Cancer survivors not only experience symptom burden (the severity and impact of biopsychosocial consequences of disease and its treatment), there is also evidence that individuals living with chronic conditions experience treatment burden (the ‘work’ required of them in managing their condition and its symptoms). Traditional clinic-based approaches to relieving the burden of cancer survivors may not be sustainable or the most beneficial. eHealth interventions are developing exponentially and there is an expectation that they can improve the experience of cancer survivorship. This thesis considers the impact of eHealth supportive care interventions on the burden of those living with and beyond cancer, reporting the experience of adult cancer survivors and the perceptions of health care professionals (HCPs). Five publications form the body of this thesis. The first publication indicates that while most cancer survivors want to be fully informed many do not receive sufficient information in all areas (e.g. psychosocial issues), thus supporting the consideration of alternative approaches to providing cancer survivors with supportive care. Two publications report positive impact of a telephone follow-up intervention on the burden of survivorship. Two publications consider HCP perceptions of remote symptom monitoring and internet care plans. These papers report that HCPs perceive eHealth interventions to increase burden for specific groups of cancer survivors depending on individual patient factors, the context of their care, and the content of the intervention. This body of work supports the potential of eHealth to alleviate the burden of cancer survivors but acknowledges that the complexity of for whom and how these benefits occur warrants exploration through further research. Involving cancer survivors and HCPs in the development of eHealth supportive care interventions is key to creating and implementing sustainable effective solutions to relieving the burden of future cancer survivors