Abstract
BackgroundThere is a bidirectional relationship between chronic low-grade inflammation and cancer. Inflammatory markers, such as interleukin-6 (IL-6), have been associated with both the malignant transformation of epithelial cells and tumor progression, thus linking low-grade inflammation with a higher risk of cancer and recurrence in the survival phase. Therefore, they are considered valuable prognostic biomarkers. Knowing and finding appropriate primary prevention strategies to modify these parameters is a major challenge in reducing the risk of cancer recurrence and increasing survival. Different therapeutic strategies have shown efficacy in the modification of these and other biological parameters, but with contradictory results. There are apparently no strategies in which telemedicine, and specifically mobile health (mHealth), are used as a means to potentially cause biological changes.ObjectiveThe objectives of this study were to: (1) check whether it is feasible to find changes in inflammation biomarkers through an mHealth strategy app as a delivery mechanism of an intervention to monitor energy balance; and (2) discover potential predictors of change of these markers in breast cancer survivors (BCSs).MethodsA prospective quasi-experimental pre-post study was conducted through an mHealth energy balance monitoring app with 73 BCSs, defined as stage I-IIIA of breast cancer and at least six months from the completion of the adjuvant therapy. Measurements included were biological salivary markers (IL-6 and C-reactive protein [CRP]), self-completed questionnaires (the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, the user version of the Mobile Application Rating Scale [uMARS] and an ad hoc clinical and sociodemographic questionnaire) and physical objective measures (accelerometry, weight and height). In addition, using the logging data of the mHealth app, the rate of use (in days) was recorded during the entire experimental phase of the study. Using Stata software, a paired two-tailed t test, Pearson and Spearman correlations, and a stepwise multiple regression analysis were used to interpret the data.ResultsAnalyzing changes in inflammatory biomarker concentrations after using the mHealth app, differences between preassessment CRP (4899.04 pg/ml; SD 1085.25) and IL-6 (87.15 pg/ml; SD 33.59) and postassessment CRP (4221.24 pg/ml; SD 911.55) and IL-6 (60.53 pg/ml; SD 36.31) showed a significant decrease in both markers, with a mean difference of –635.25 pg/ml (95% CI –935.65 to –334.85; P<.001) in CRP and –26.61 pg/ml (95% CI –42.51 to –10.71; P=.002) in IL-6. Stepwise regression analyses revealed that changes in global quality of life, as well as uMARS score and hormonal therapy, were possible predictors of change in CRP concentration after using the mHealth app. In the same way, the type of tumor removal surgery conducted, as well as changes in weight and pain score, were possible predictors of change in IL-6 concentration after using the app.ConclusionsIn conclusion, through the results of this study, we hypothesize that there is a possible association between an mHealth energy balance monitoring strategy and biological changes in BCSs. These changes could be explained by different biopsychosocial parameters, such as the use of the application itself, quality of life, pain, type of tumor removal surgery, hormonal treatment or obesity.
Highlights
There is a bidirectional relationship between chronic low-grade inflammation and breast cancer, as a tumor can produce an inflammatory environment and a systemic immune response, but chronic inflammation can both precede and promote the development of cancer [1]
In conclusion, through the results of this study, we hypothesize that there is a possible association between an mobile health (mHealth) energy balance monitoring strategy and biological changes in breast cancer survivor body mass index (BMI) (BCS)
If this process of remission is interrupted by some circumstance, such as pathogens, toxins or other stimuli, healthy tissue could be damaged and produce what is known as persistent low-grade inflammation, or chronic inflammation [6]. It is the result of an immune system that overreacts so that the concentrations of inflammatory factors are higher than in a healthy population [5]. This systemic and chronic inflammation is widely associated with chronic diseases [6] and even symptomatology, as there is a positive association between increased levels of C-reactive protein (CRP) and excess of adipose mass, which is a factor that could be potentially modified with physical activity and diet [4,7]
Summary
There is a bidirectional relationship between chronic low-grade inflammation and breast cancer, as a tumor can produce an inflammatory environment and a systemic immune response, but chronic inflammation can both precede and promote the development of cancer [1]. This systemic and chronic inflammation is widely associated with chronic diseases [6] and even symptomatology, as there is a positive association between increased levels of CRP and excess of adipose mass (excess weight and obesity), which is a factor that could be potentially modified with physical activity and diet [4,7] Inflammatory markers such as IL-6 have been associated with the malignant transformation of epithelial cells and tumor progression, associating low-grade inflammation with a higher risk of cancer and recurrence in the survival phase. Inflammatory markers, such as interleukin-6 (IL-6), have been associated with both the malignant transformation of epithelial cells and tumor progression, linking low-grade inflammation with a higher risk of cancer and recurrence in the survival phase There are apparently no strategies in which telemedicine, and mobile health (mHealth), are used as a means to potentially cause biological changes
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