Jun 05, 2015
By Adaugo Amobi, MD, MPH, Harvard Medical School and Harvard School of Public Health, and Larissa Nekhlyudov, MD, MPH, Harvard Medical School
More than one-half of all Americans now own smartphones,1 and there is an increasing number of medically focused applications (apps) designed for both health care practitioners and patients. A recent report by the IMS Institute for Healthcare Informatics, an organization dedicated to furthering the role of information in health care decision-making through research, demonstrated that a large number of health care applications are available for smartphones; however, more work is needed to incorporate these applications into patient care systems.2
Cancer care is a complex endeavor that involves significant patient education, care coordination, and follow-up. Smartphone applications could provide pragmatic assistance in achieving these core tasks. To date, two reviews focusing on cancer-related applications have been published,3,4 but were limited in their scope and/or applicability to the United States. In this report, we summarize our review of the applications that are currently available in this field, with the goal of enabling clinicians and patients to gain a better understanding of how various applications may be utilized in clinical practice.
We searched the iTunes Store on October 5, 2013, using the terms “cancer” and “oncology.” We conducted the search terms on the Google Play Android app store, and found that the majority of Android cancer applications were also found in the iTunes Store. We therefore did not separately and systematically review the Android applications or application stores in other mobile markets.
We found 514 applications. Of those, 125 were excluded based on the specified criteria (Fig. 1), resulting in 398 applications. We categorized the applications into target audience (i.e., patient, provider), phase of care (prevention, screening, etc.), and intended use (education, social networking, etc.).
Overall, we found that the applications targeted patients more often than health care providers (214 patient-focused apps versus 141 provider-focused apps). The most common phase-of-care applications focused on diagnosis (62 apps) and treatment (61 apps), while the most common usage purpose was to provide education (161 apps).
Phase of Care: Prevention to Survivorship (Table 1)
Many of the prevention applications were focused on the lifestyle changes of sun protection, nutrition, and smoking cessation. The majority of screening applications were for breast and skin cancer. The breast cancer screening applications ranged from applications designed to teach patients how to perform breast self-examinations (for example, Are You Dense and Breast Self Examination) to applications that provided a multifactorial risk assessment (such as Breast Cancer Risk Assessment). Some skin cancer screening applications, such as Melanoma ABCD Rule, explained how to spot a risky mole. There were several applications that helped patients track cancer screening efforts, such as Your Skin Diary, which tracks skin lesions, and My PSA Tracker, which keeps a record of laboratory results. The majority of applications that addressed cancer screening were geared towards patients, not health care providers.
Thirty-six of the 62 diagnosis applications were geared towards patients, while the other half had a provider focus. Only one diagnosis application, Cancer Conditions and Treatment, was targeted at both patients and providers. The applications in the diagnosis category also had breast and skin as the most common cancer types addressed. Lung cancer, prostate cancer, thyroid cancer, and lymphoma were represented among the diagnosis applications, but to a much lesser degree. Of note, 15 applications within the diagnosis category focused on how to correctly give a staging diagnosis; examples of such apps include Stage It Lung Cancer Staging, TNM Urology, and FIGO Staging.
Of the 61 treatment applications, 33 were aimed at patients and 28 at providers. Four applications targeted both audiences. The applications within the treatment category touched on a wide variety of cancers; breast cancer was the most frequent focus. Other cancers in the treatment applications included prostate, lung, kidney, bone, and hematologic cancers. Thirteen applications dealt with chemotherapy (for example, iChemoprotocols, Chemo Calc, and Chemotherapy Advisor). Two specifically focused on the side effects of cancer treatment: MASCC Antiemesis Tool and Cancer Side Effects Finder. Four applications provided information and guidance about surgical treatment. Among the phase-of-care categories, survivorship applications were least common, with only nine applications. All survivorship applications were targeted at patients.
Intended Use: Education, Care Coordination, Social Networking, Psychosocial Support
Applications in the “Education” category were thought to improve users’ knowledge about cancer (and may have applied to any phase of care outlined above). This category had the largest number of applications (161 apps). Most of these applications were geared towards patients (127 apps); 38 were targeted to providers, with some overlap of the two audiences. These applications dealt with a wide range of cancers, including breast, skin, lung, and cervical cancers, and provided information across the cancer care continuum. Of note, there were seven applications that served as dictionaries or glossaries.
There were 22 applications in the care coordination category. For example, some applications aimed to help patients and providers organize clinical visits (Cancer Concierge for Patients and My Breast Cancer Team) and promote communication between patients and providers (Rex Cancer Care). Others were specifically designed by the cancer center and provided contact information (City of Hope Guide).
We found 17 social networking applications designed to foster community or collaboration between patients with cancer, survivors, and/or health care professionals. This category included applications such as Care Zone, which (in addition to coordinating care) had functions such as “phone tree,” which enables users to quickly inform up to 100 people with updates. Another application within this category, My Cancer Circle, enables patients to construct their own private digital network of friends, family, and caregivers to facilitate communication.
We found 17 applications that served a psychosocial function, aiming to provide users with emotional support such as dealing with the cancer diagnosis or their symptoms. The application categorizations were not mutually exclusive. Several of these applications, such as Cancer Zapper and Cancer Wars, used games to help patients visualize killing their cancer. Other applications, such as Promise and Progress and My Cancer Manager, combined educational articles on cancer with stories of other patients with cancer. My Cancer Manager also allowed patients to journal their physical symptoms as well as their emotions. Applications such as My Lifeline.org provided psychosocial support through social networking. Some applications, such as Cleveland Clinic Cancer Trials, did not directly provide psychosocial support but provided information about cancer support groups.
We systematically reviewed available applications focusing on cancer care and found that while there are numerous applications, there are disparities in the categories of intended uses and cancer types. There were numerous applications focusing on diagnosis and treatment, but a lack of applications geared towards survivorship. Likewise, while most applications aimed to provide users with education about cancer topics, few addressed psychosocial aspects of cancer and care coordination. Our review suggests potential for expanding future development of applications, specifically targeting certain areas of cancer care.
Considering that smartphones and applications have gained popularity relatively recently, the number of applications available in health care—and for cancer care in particular—is significant. In fact, the large number of applications available for cancer care can be problematic, potentially giving users a feeling of “app overload.”5 Providers and patients generally only have the application store descriptions and customer ratings for guidance about which applications are the most useful or have the most accurate information.
DG Apps, an application developed for health care professionals, aims to review for quality and organize available provider-oriented applications.6 To our knowledge, such applications are not currently available for patients. For patients, particularly those with cancer, navigating the health care system can be confusing on its own. The wide array of applications, many of which have the similar functions, can add to that confusion. Providers can play an important role in helping guide patients towards high-quality patient-centered applications. van Velsen et al. suggest that “gateway applications” could be a useful solution for app overload.5 In the case of cancer care, for example, having one or two peer-reviewed applications that can help organize other applications and direct users to trusted health content would streamline the user experience.
While there is a need for focused development of new applications, existing applications have the potential to provide helpful guidance for health care providers and patients. In addition to the full list that we reviewed, we provided a summary table with selected applications (Table 2).
Dr. Amobi is currently a resident physician at Massachusetts General Hospital focusing on primary care and women’s health. She has designed and implemented research examining the relationship between primary care physicians and oncologists in caring for patients with cancer.
Dr. Nekhlyudov is an Associate Professor in the Department of Population Medicine at Harvard Medical School and a general internist in Boston, MA. She has led research studies, educational programs, and clinical initiatives aiming to improve the care of cancer survivors. Dr. Nekhlyudov is particularly interested in the interplay between primary and oncology care providers, and has developed a website offering cancer survivorship resources to primary care providers.
1. Mobile Future. Mobile Year in Review 2012 Infographic. Accessed February 3, 2013.
2. IMS Institute for Health Care Informatics. Patient Applications for Improved Healthcare: From Novelty to Mainstream. Accessed February 3, 2013.
6. DG Apps. Accessed February 10, 2014.
Cancer-Related Smartphone Application Review Process