Beating cancer-related fatigue with the Untire app

Millions of cancer patients and survivors all around the globe suffer from cancer-related fatigue and experience a reduced quality of life due to their cancer andcancer treatment. With our large-scale international waiting-list RCT, includingparticipants from four English-speaking countries (i.e., Australia, Canada, theUnited Kingdom, and the United States), we demonstrated that fatigue couldbe reduced and QoL improved by means of a self-management mHealth app(chapter 5). From March till October 2018, we recruited via 76 Facebook Adsand included 755 participants, of which 355 completed the follow-up measure12 weeks later, at the expense of €22.42 and €47.69 per participant, respectively(chapter 4). We saw that the most interested participants were female, middle-aged,and came from the UK. We think that reaching participants for internationalmHealth studies via Facebook Ads has potential but can be very costly, especiallywhen more balanced sub-samples are desired. However, we believe that constantoptimization and testing of ads can make an essential difference in reducingrecruitment costs. Regarding the app’s effectiveness, we learned that participantsdo not need to engage excessively with the intervention since medium appuse (3-8 days) was already significantly associated with fatigue reduction(chapter 5). Our findings on fatigue reduction were statistically significant andclinically relevant since more people recovered in the intervention group thanthe control group. We explored whether the effect of the intervention was relatedto specific age groups and saw that the intervention effect was significant acrossall age groups but even more pronounced in younger individuals (<56 years).Individuals with different education levels and both cancer patients and survivorsseemed to benefit significantly from the app. We do not have enough data tocompare outcomes between gender, cancer types, and treatment types andmust acknowledge that our study sample is limited in its representativeness toFacebook users. We also explored several processes targeted by the app and theireffect on fatigue reduction (chapter 6). We found that app access was significantlyassociated with reduced fatigue severity and interference via the mechanism ofreduced fatigue catastrophizing, depression, sleep disruption, and increasedmindfulness and physical activity. Besides, we described the experiences we hadwith applying for ethical approval in different countries (chapter 3). We believethat research guidelines could support scientists aiming to conduct internationalinternet-based studies regarding whether these should be considered single ormulti-center trials. We describe where researchers can apply for ethical approvalacross different countries