Discussion
Innovative, standardized, efficient, cost effective, supportive cancer care methods should be administered to improve the QOL of patients. Mobile health apps are appealing to the patients because of their cost-effectiveness, flexible and high quality services for the benefit of the patients, presenting an opportunity for remote monitoring and training of patients, reachable at any place at any time26. Our study is the first made in Turkey which analyzes the effect of a mobile- app based training to improve the QOL of women with breast cancer using EHT.
It was determined after the intervention (T2) that FACT-ES QLS total points, physical well-being, emotional well-being and endocrine symptom mean scores were increased significantly for the treatment group to whom mobile- app based training was provided, compared with the control group. In addition, social/family well-being and functional well-being mean scores were found high although those were not statistically significant. While the QOL improved for the treatment group, there was a decline in the control group.
Sajjad et. al. mentioned that training provided to women with breast cancer by the nurses improved the QOL of patients 27. It was determined in a meta-analysis study conducted by Suh & Lee that telephone-based training provided by nurses improved quality of life21. Similar results were also found in our study. It was determined that psychological interventions by Badger et. al., provided with telephone training and individual consultancy to the breast cancer patients for whom a recent diagnosis was made, significantly decreased depression and physical symptoms of participants and increased social and spiritual well-being 19. Ryhänen et. al. found, in a randomized controlled study where QOL, anxiety and coping with side effects related to the treatment were assessed for the internet-based patient training program in order to strengthen women with breast cancer 20.,that internet-based patient training program did not decrease the anxiety level of women with breast cancer or side effects of the treatment and that it did not improve QOL sub dimensions. Our study differs from Ryhänen et. al. in the sense that mobile- app based training provided to the treatment group to whom EHT adjuvant was used, has improved the QOL20.
It was determined in the literature that sociodemographic and clinic characteristics such as age, education level, social support, financial status, working status, disease stage are factors affecting QOL21, 28. Our study also found that FACT-ES QLS mean score of patients who are provided with mobile- app based training significantly affected sociodemographic and clinic characteristics.
Distress results from physical, cognitive, behavioral, emotional, social, and spiritual factors and it is directly related to the sub dimensions of QOL 17, 18. While a decrease was noted for the distress level of the treatment group taking mobile- app based training, there was an increase in the control group. As a result, QOL was decreased for the participants whose distress level was increased. Visser et al. differs from our study, a tablet-based online app was observed to have no significant effect on distress 29. Rosen et al., mobile app-based mindfulness training improved QOL and decreased distress for women with breast cancer 11. In a study conducted by Zhu et al., women with breast cancer were less distressed as given professional support available with mobile app-based12. Similar results were also found in our study.
In a multi-centered prospective study made for the purpose of supportive care and provided with a mobile app to the cancer patients, it was noted that most of the participants were strongly interested in the use of mobile app 9. In our study most participants (87,1%) expressed that mobile- app based training was beneficial. Participants in the treatment group stated that the app was very beneficial in the sense that it was important to learn about the side effects of EHT and share their problems. The participants reported that the support of a specialist nurse was very comfortable at any moment. In addition, the participants added that they were pleased with receiving counseling and support by the nurse. These opinions are satisfactory, and it is thought that, besides the mobile app, regular telephone monitoring and assessment of the problems with a multidisciplinary team boosted participant’s satisfaction. In Zhu et al. too, participants emphasized that the mobile app strengthens information, increases the level of trust and supports emotional well-being. In addition, participants suggested implementing message reminders in Zhu et al. study12. Our study differs from Zhu et al in terms of sending the participants message reminders through the mobile app. These messages included advice about personal care and supportive care.