Achieving value in mobile health applications for cancer survivors



This study aimed to identify appropriate development and testing strategies for mobile health applications for cancer survivors.


In January of 2016, we conducted a PubMed search for mobile applications for cancer survivors. A total of 32 articles were selected for inclusion, including 13 review articles, and 19 articles describing an mHealth application or intervention. We assessed mobile app development and testing strategies and standards as described in these articles.


We identified seven elements of patient empowerment applications for cancer survivors, strategies for application development that take advantage of smartphone capabilities, issues for consideration in developing new applications, and steps for creating user-centered mobile health applications that provide meaningful value for cancer survivors. However, few mobile health apps implemented empowerment elements, underwent rigorous design approaches, or included assessment of use in the cancer survivor population.


There is tremendous potential for mobile health apps to benefit cancer survivors. However, there are specific issues for consideration in developing new applications and steps for creating user-centered applications which are not routinely used. This diminishes the value for the cancer survivor population but could be easily addressed through standardized development and testing procedures.

Implications for cancer survivors

Smartphone applications have the potential to improve the cancer survivorship experience, but users should look for evidence that the application was appropriately developed and tested.

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  1. 1.

    Institute of Medicine. Delivering high quality cancer care: charting a new course for a system in crisis: Institute of Medicine. 2013.

  2. 2.

    ACS. Cancer facts and figures 2015. Atlanta, GA: American Cancer Society; 2015.

    Google Scholar 

  3. 3.

    Dowling EC, Chawla N, Forsythe LP, de Moor J, McNeel T, Rozjabek HM, et al. Lost productivity and burden of illness in cancer survivors with and without other chronic conditions. Cancer. 2013;119(18):3393–401. doi:10.1002/cncr.28214.

    Article  PubMed  Google Scholar 

  4. 4.

    Weaver KE, Foraker RE, Alfano CM, Rowland JH, Arora NK, Bellizzi KM, et al. Cardiovascular risk factors among long-term survivors of breast, prostate, colorectal, and gynecologic cancers: a gap in survivorship care? J Cancer Surviv. 2013;7(2):253–61. doi:10.1007/s11764-013-0267-9.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Kent EE, Mitchell SA, Oakley-Girvan I, Arora NK. The importance of symptom surveillance during follow-up care of leukemia, bladder, and colorectal cancer survivors. Support Care Cancer. 2014;22(1):163–72. doi:10.1007/s00520-013-1961-x.

    Article  PubMed  Google Scholar 

  6. 6.

    Bloom JR, Stewart SL, Oakley-Girvan I, Banks PJ, Shema S. Quality of life of younger breast cancer survivors: persistence of problems and sense of well-being. Psychooncology. 2011; doi:10.1002/pon.1965.

    PubMed Central  Google Scholar 

  7. 7.

    Bellizzi KM, Aziz NM, Rowland JH, Weaver K, Arora NK, Hamilton AS, et al. Double jeopardy? Age, race, and HRQOL in older adults with cancer. J Cancer Epidemiol. 2012;2012:478642. doi:10.1155/2012/478642.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Hewitt M, Greenfield S, Stoval E. From cancer patient to cancer survivor: lost in transition. Washington: National Academies Press; 2006.

    Google Scholar 

  9. 9.

    Hoerger M, Epstein RM, Winters PC, Fiscella K, Duberstein PR, Gramling R, et al. Values and options in cancer care (VOICE): study design and rationale for a patient-centered communication and decision-making intervention for physicians, patients with advanced cancer, and their caregivers. BMC Cancer. 2013;13:188. doi:10.1186/1471-2407-13-188.

    Article  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Kent EE, Arora NK, Rowland JH, Bellizzi KM, Forsythe LP, Hamilton AS, et al. Health information needs and health-related quality of life in a diverse population of long-term cancer survivors. Patient Educ Couns. 2012;89(2):345–52. doi:10.1016/j.pec.2012.08.014.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Beckjord EB, Arora NK, McLaughlin W, Oakley-Girvan I, Hamilton AS, Hesse BW. Health-related information needs in a large and diverse sample of adult cancer survivors: implications for cancer care. J Cancer Surviv. 2008;2(3):179–89. doi:10.1007/s11764-008-0055-0.

    Article  PubMed  Google Scholar 

  12. 12.

    Arora NK, Jensen RE, Sulayman N, Hamilton AS, Potosky AL. Patient-physician communication about health-related quality-of-life problems: are non-Hodgkin lymphoma survivors willing to talk? J Clin Oncol. 2013;31(31):3964–70. doi:10.1200/JCO.2012.47.6705.

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Walsh J, Young JM, Harrison JD, Butow PN, Solomon MJ, Masya L, et al. What is important in cancer care coordination? A qualitative investigation. Eur J Cancer Care (Engl). 2011;20(2):220–7. doi:10.1111/j.1365-2354.2010.01187.x.

    CAS  Article  Google Scholar 

  14. 14.

    Klabunde CN, Han PK, Earle CC, Smith T, Ayanian JZ, Lee R, et al. Physician roles in the cancer-related follow-up care of cancer survivors. Fam Med. 2013;45(7):463–74.

    PubMed  PubMed Central  Google Scholar 

  15. 15.

    Arora NK, Reeve BB, Hays RD, Clauser SB, Oakley-Girvan I. Assessment of quality of cancer-related follow-up care from the cancer survivor’s perspective. J Clin Oncol. 2011;29(10):1280–9. doi:10.1200/JCO.2010.32.1554.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Haggstrom DA, Arora NK, Helft P, Clayman ML, Oakley-Girvan I. Follow-up care delivery among colorectal cancer survivors most often seen by primary and subspecialty care physicians. J Gen Intern Med. 2009;24(Suppl 2):S472–9. doi:10.1007/s11606-009-1017-6.

    Article  PubMed  Google Scholar 

  17. 17.

    Street Jr RL, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009;74(3):295–301. doi:10.1016/j.pec.2008.11.015.

    Article  PubMed  Google Scholar 

  18. 18.

    Arora NK, Weaver KE, Clayman ML, Oakley-Girvan I, Potosky AL. Physicians’ decision-making style and psychosocial outcomes among cancer survivors. Patient Educ Couns. 2009;77(3):404–12. doi:10.1016/j.pec.2009.10.004.

    Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Anderson M. Technology device ownership: 2015: pew research center. 2015.

  20. 20.

    Duggan M, Smith A. Cell internet use 2013: pew research center. 2013.

  21. 21.

    Fox Sa, Maeve D. The diagnosis difference: pew research center. 2013.

  22. 22.

    Smith A, McGeeney K, Duggan M, Rainie L, Keeter S. US Smart Phone Use in 2015 Washington, DC: Pew Research Center. 2015.

  23. 23.

    Smith A. A portrait of smart phone ownership: Pew Research Center. 2015.

  24. 24.

    Birur PN, Sunny SP, Jena S, Kandasarma U, Raghavan S, Ramaswamy B, et al. Mobile health application for remote oral cancer surveillance. J Am Dent Assoc. 2015;146(12):886–94. doi:10.1016/j.adaj.2015.05.020.

    Article  PubMed  Google Scholar 

  25. 25.

    Cook SE, Palmer LC, Shuler FD. Smartphone mobile applications to enhance diagnosis of skin cancer: a guide for the rural practitioner. W V Med J. 2015;111(5):22–8.

    PubMed  Google Scholar 

  26. 26.

    Mancuso M, Cesarman E, Erickson D. Detection of Kaposi’s sarcoma associated herpesvirus nucleic acids using a smartphone accessory. Lab Chip. 2014;14(19):3809–16. doi:10.1039/c4lc00517a.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  27. 27.

    Oakley-Girvan I, Londono C, Canchola A, Watkins Davis S. Text messaging may improve abnormal mammogram follow-up in Latinas. Oncol Nurs Forum. 2016;43(1):36–43. doi:10.1188/16.ONF.36-43.

    Article  PubMed  Google Scholar 

  28. 28.

    Davis SW, Oakley-Girvan I. mHealth education applications along the cancer continuum. J Cancer Educ. 2015;30(2):388–94. doi:10.1007/s13187-014-0761-4.

    Article  PubMed  Google Scholar 

  29. 29.

    Brier MJ, Schwartz LA, Kazak AE. Psychosocial, health-promotion, and neurocognitive interventions for survivors of childhood cancer: a systematic review. Health Psychol. 2015;34(2):130–48. doi:10.1037/hea0000119.

    Article  PubMed  Google Scholar 

  30. 30.

    Wesley KM, Fizur PJ. A review of mobile applications to help adolescent and young adult cancer patients. Adolesc Health Med Ther. 2015;6:141–8. doi:10.2147/AHMT.S69209.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Maguire R, Ream E, Richardson A, Connaghan J, Johnston B, Kotronoulas G, et al. Development of a novel remote patient monitoring system: the advanced symptom management system for radiotherapy to improve the symptom experience of patients with lung cancer receiving radiotherapy. Cancer Nurs. 2015;38(2):E37–47. doi:10.1097/NCC.0000000000000150.

    Article  PubMed  Google Scholar 

  32. 32.

    Larsen ME, Rowntree J, Young AM, Pearson S, Smith J, Gibson OJ, et al. Chemotherapy side-effect management using mobile phones. Conf Proc IEEE Eng Med Biol Soc. 2008;2008:5152–5. doi:10.1109/IEMBS.2008.4650374.

    PubMed  Google Scholar 

  33. 33.

    McCann L, Maguire R, Miller M, Kearney N. Patients’ perceptions and experiences of using a mobile phone-based advanced symptom management system (ASyMS) to monitor and manage chemotherapy related toxicity. Eur J Cancer Care (Engl). 2009;18(2):156–64. doi:10.1111/j.1365-2354.2008.00938.x.

    CAS  Article  Google Scholar 

  34. 34.

    Kearney N, McCann L, Norrie J, Taylor L, Gray P, McGee-Lennon M, et al. Evaluation of a mobile phone-based, advanced symptom management system (ASyMS) in the management of chemotherapy-related toxicity. Support Care Cancer. 2009;17(4):437–44. doi:10.1007/s00520-008-0515-0.

    CAS  Article  PubMed  Google Scholar 

  35. 35.

    Weaver A, Young AM, Rowntree J, Townsend N, Pearson S, Smith J, et al. Application of mobile phone technology for managing chemotherapy-associated side-effects. Ann Oncol. 2007;18(11):1887–92. doi:10.1093/annonc/mdm354.

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Min YH, Lee JW, Shin YW, Jo MW, Sohn G, Lee JH, et al. Daily collection of self-reporting sleep disturbance data via a smartphone app in breast cancer patients receiving chemotherapy: a feasibility study. J Med Internet Res. 2014;16(5):e135. doi:10.2196/jmir.3421.

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    Breen S, Ritchie D, Schofield P, Hsueh YS, Gough K, Santamaria N, et al. The patient remote intervention and symptom management system (PRISMS)–a telehealth- mediated intervention enabling real-time monitoring of chemotherapy side-effects in patients with haematological malignancies: study protocol for a randomised controlled trial. Trials. 2015;16:472. doi:10.1186/s13063-015-0970-0.

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    de Bruin JS, Schuh C, Seeling W, Luger E, Gall M, Hutterer E, et al. Assessing the feasibility of a mobile health-supported clinical decision support system for nutritional triage in oncology outpatients using Arden Syntax. Artif Intell Med. 2015; doi:10.1016/j.artmed.2015.10.001.

    Google Scholar 

  39. 39.

    Goode AD, Lawler SP, Brakenridge CL, Reeves MM, Eakin EG. Telephone, print, and web-based interventions for physical activity, diet, and weight control among cancer survivors: a systematic review. J Cancer Surviv. 2015;9(4):660–82. doi:10.1007/s11764-015-0442-2.

    Article  PubMed  Google Scholar 

  40. 40.

    Payne HE, Lister C, West JH, Bernhardt JM. Behavioral functionality of mobile apps in health interventions: a systematic review of the literature. JMIR Mhealth Uhealth. 2015;3(1):e20. doi:10.2196/mhealth.3335.

    Article  PubMed  PubMed Central  Google Scholar 

  41. 41.

    Kuijpers W, Groen WG, Aaronson NK, van Harten WH. A systematic review of web-based interventions for patient empowerment and physical activity in chronic diseases: relevance for cancer survivors. J Med Internet Res. 2013;15(2):e37. doi:10.2196/jmir.2281.

    Article  PubMed  PubMed Central  Google Scholar 

  42. 42.

    Wang J, Wang Y, Wei C, Yao NA, Yuan A, Shan Y, et al. Smartphone interventions for long-term health management of chronic diseases: an integrative review. Telemed J E Health. 2014;20(6):570–83. doi:10.1089/tmj.2013.0243.

    Article  PubMed  Google Scholar 

  43. 43.

    Becker S, Kribben A, Meister S, Diamantidis CJ, Unger N, Mitchell A. User profiles of a smartphone application to support drug adherence—experiences from the iNephro project. PLoS One. 2013;8(10):e78547. doi:10.1371/journal.pone.0078547.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Spoelstra SL, Given CW, Sikorskii A, Coursaris CK, Majumder A, DeKoekkoek T, et al. Feasibility of a text messaging intervention to promote self-Management for Patients Prescribed Oral Anticancer Agents. Oncol Nurs Forum. 2015;42(6):647–57. doi:10.1188/15.ONF.647-657.

    Article  PubMed  Google Scholar 

  45. 45.

    Burhenn PS, Smudde J. Using tools and technology to promote education and adherence to oral agents for cancer. Clin J Oncol Nurs. 2015;19(3 Suppl):53–9. doi:10.1188/15.S1.CJON.53-59.

    Article  PubMed  Google Scholar 

  46. 46.

    Galligioni E, Piras EM, Galvagni M, Eccher C, Caramatti S, Zanolli D, et al. Integrating mHealth in oncology: experience in the province of Trento. J Med Internet Res. 2015;17(5):e114. doi:10.2196/jmir.3743.

    Article  PubMed  PubMed Central  Google Scholar 

  47. 47.

    Agboola S, Flanagan C, Searl M, Elfiky A, Kvedar J, Jethwani K. Improving outcomes in cancer patients on oral anti-cancer medications using a novel mobile phone-based intervention: study design of a randomized controlled trial. JMIR Res Protoc. 2014;3(4):e79. doi:10.2196/resprot.4041.

    Article  PubMed  PubMed Central  Google Scholar 

  48. 48.

    Klasnja P, Hartzler A, Powell C, Phan G, Pratt W. Health weaver mobile: designing a mobile tool for managing personal health information during cancer care. AMIA Annu Symp Proc. 2010;2010:392–6.

    PubMed  PubMed Central  Google Scholar 

  49. 49.

    Okutsu A, Koiyabashi K. Effects of mobile phone usage in supporting leg lymphedema self-care. J Rural Med. 2014;9(2):74–85. doi:10.2185/jrm.2884.

    Article  PubMed  PubMed Central  Google Scholar 

  50. 50.

    Agboola S, Kamdar M, Flanagan C, Searl M, Traeger L, Kvedar J, et al. Pain management in cancer patients using a mobile app: study design of a randomized controlled trial. JMIR Res Protoc. 2014;3(4):e76. doi:10.2196/resprot.3957.

    Article  PubMed  PubMed Central  Google Scholar 

  51. 51.

    Girault A, Ferrua M, Lalloue B, Sicotte C, Fourcade A, Yatim F, et al. Internet-based technologies to improve cancer care coordination: current use and attitudes among cancer patients. Eur J Cancer. 2015;51(4):551–7. doi:10.1016/j.ejca.2014.12.001.

    Article  PubMed  Google Scholar 

  52. 52.

    Mirkovic J, Kaufman DR, Ruland CM. Supporting cancer patients in illness management: usability evaluation of a mobile app. JMIR Mhealth Uhealth. 2014;2(3):e33. doi:10.2196/mhealth.3359.

    Article  PubMed  PubMed Central  Google Scholar 

  53. 53.

    Groen WG, Kuijpers W, Oldenburg HS, Wouters MW, Aaronson NK, van Harten WH. Empowerment of cancer survivors through information technology: an integrative review. J Med Internet Res. 2015;17(11):e270. doi:10.2196/jmir.4818.

    Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Klasnja P, Pratt W. Healthcare in the pocket: mapping the space of mobile-phone health interventions. J Biomed Inform. 2012;45(1):184–98. doi:10.1016/j.jbi.2011.08.017.

    Article  PubMed  Google Scholar 

  55. 55.

    Bender JL, Yue RY, To MJ, Deacken L, Jadad AR. A lot of action, but not in the right direction: systematic review and content analysis of smartphone applications for the prevention, detection, and management of cancer. J Med Internet Res. 2013;15(12):e287. doi:10.2196/jmir.2661.

    Article  PubMed  PubMed Central  Google Scholar 

  56. 56.

    de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek V, Car J, Atun R. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database Syst Rev. 2012;12:CD007459. doi:10.1002/14651858.CD007459.pub2.

    PubMed  Google Scholar 

  57. 57.

    Vollmer Dahlke D, Fair K, Hong YA, Beaudoin CE, Pulczinski J, Ory MG. Apps seeking theories: results of a study on the use of health behavior change theories in cancer survivorship mobile apps. JMIR Mhealth Uhealth. 2015;3(1):e31. doi:10.2196/mhealth.3861.

    Article  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Mohammadzadeh N, Safdari R, Rahimi A. Cancer care management through a mobile phone health approach: key considerations. Asian Pac J Cancer Prev. 2013;14(9):4961–4.

    Article  PubMed  Google Scholar 

  59. 59.

    Kuijpers W, Groen WG, Oldenburg HS, Wouters MW, Aaronson NK, van Harten WH. Development of MijnAVL, an interactive portal to empower breast and lung cancer survivors: an iterative. Multi-Stakeholder Approach JMIR Res Protoc. 2015;4(1):e14. doi:10.2196/resprot.3796.

    Article  PubMed  Google Scholar 

  60. 60.

    Velicer WF, Rossi JS, Diclemente CC, Prochaska JO. A criterion measurement model for health behavior change. Addict Behav. 1996;21(5):555–84.

    CAS  Article  PubMed  Google Scholar 

  61. 61.

    Bandura A. Health promotion by social cognitive means. Health Educ Behav. 2004;31(2):143–64. doi:10.1177/1090198104263660.

    Article  PubMed  Google Scholar 

  62. 62.

    Heimendinger J, O'Neill C, Marcus AC, Wolfe P, Julesburg K, Morra M, et al. Multiple tailored messages are effective in increasing fruit and vegetable consumption among callers to the cancer information service. J Health Commun. 2005;10(Suppl 1):65–82. doi:10.1080/10810730500263646.

    Article  PubMed  Google Scholar 

  63. 63.

    Marcus AC, Mason M, Wolfe P, Rimer BK, Lipkus I, Strecher V, et al. The efficacy of tailored print materials in promoting colorectal cancer screening: results from a randomized trial involving callers to the National Cancer Institute’s cancer information service. J Health Commun. 2005;10(Suppl 1):83–104. doi:10.1080/10810730500257754.

    Article  PubMed  Google Scholar 

  64. 64.

    Strecher VJ, Marcus A, Bishop K, Fleisher L, Stengle W, Levinson A, et al. A randomized controlled trial of multiple tailored messages for smoking cessation among callers to the cancer information service. J Health Commun. 2005;10(Suppl 1):105–18. doi:10.1080/10810730500263810.

    Article  PubMed  Google Scholar 

  65. 65.

    Singh KBD, Drouin K, Newmark LP, Rozenblum R, Lee J, Landman A, et al. Developing a framework for evaluating the patient engagement, quality, and safety of mobile health applications: The Commonwealth Fund. Contract No.: 1863. 2016.

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A portion of Dr. Oakley-Girvan’s time was supported by the Stanford Cancer Institute. No other funding was obtained for this study.

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Correspondence to Ingrid Oakley-Girvan.

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The findings and conclusion in this paper are those of the authors and do not necessarily represent the official position of the Cancer Prevention Institute of California.

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The authors declare that they have no conflict of interest. Dr. Oakley-Girvan has stock ownership and provides consulting services for Medable Inc. on unrelated projects.

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This article does not contain any studies with human participants performed by any of the authors.

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Davis, S.W., Oakley-Girvan, I. Achieving value in mobile health applications for cancer survivors. J Cancer Surviv 11, 498–504 (2017).

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  • Digital technologies
  • Cancer survivorship
  • Review
  • Development
  • Testing