Cancer Apps Research Articles

Ethical implications of artificial intelligence in skin cancer diagnostics: use-case analyses.

Skin cancer is the most common cancer worldwide. Early diagnosis is crucial for improving patient survival and morbidity. Artificial intelligence (AI)-assisted smartphone applications (apps) for skin cancer potentially offer accessible, early risk assessment of suspicious skin lesions. However, the integration of novel technologies into dermatology pathways raises ethical concerns. Although ethical principles for AI governance are well known, how these principles should be applied to real-life AI apps readily available for public use is less well understood. We conducted an ethical use-case analysis of commercially available skin cancer apps to better understand the ethical issues arising from their development and use in a real-world context. Established methods for ethical analysis of clinical AI applications were applied to two popular skin cancer apps in the UK: SkinVision and Scanoma. Systematic searches of published literature, regulatory documents, and websites were conducted to review the evidence regarding app development, effectiveness, and use. Screening for inclusion was undertaken by two researchers independently. Ethical concerns were identified with reference to previously described ethical concerns and principles for AI-assisted healthcare. By conceptualising ethical principles within the use-context of skin cancer apps, we identified specific ethical issues arising throughout the AI lifecycle of both apps. One company provided extensive detail regarding algorithm development and decision-making, this information was insufficiently reported for the other app. Other concerns identified related to number, quality, and consistency of studies assessing algorithm efficacy. Limited efforts to address potential skin tone biases and exclusion of individuals with darker skin tones as target users by one app risks perpetuating existing inequalities. Inadequate regulatory oversight was identified. Findings from our ethical use-case analysis of two patient-facing AI-assisted skin cancer apps suggest inadequate incorporation of bioethical norms such as justice, responsibility and transparency into the development and deployment of both apps. Improved regulation should increase accountability. Ensuring ethics by design through integration between technology developers, dermatologists, ethicists, and the public is urgently needed to prevent the potential benefits of AI-assisted skin cancer apps being overshadowed by potential ethical harms.

Assessing the Quality, Privacy, and Security of Breast Cancer Apps for Arabic Speakers: Systematic Search and Review of Smartphone Apps.

Breast cancer is a widespread disease, and its incidence is rapidly increasing in the Middle East and North Africa region. With the increasing availability of smartphone apps for various health purposes, breast cancer apps have emerged as tools for raising awareness, providing support, and empowering women affected by this disease. These apps offer many features, including information on breast cancer risk factors, self-examination guides, appointment reminders, and community support groups or hotlines. Using apps raises the risk of privacy and security issues, and we hope that examining these features of the apps will contribute to the understanding of how technology can be used to improve these apps and provide insights for future development and improvement of breast cancer apps. This study aims to critically review the quality, privacy, and security of breast cancer apps available to Arabic speakers. Similar to several recent studies, we used a systematic search for apps available in Google Play and Apple App stores using both the web interface and the built-in native stores installed on smartphones. The search was conducted in mid-December 2022 in Arabic using the following keywords: سرطان الثدي - فحص سرطان الثدي - علاج سرطان الثدي - مرض سرطان الثدي - أعراض سرطان الثدي - فحص الثدي (breast cancer, breast cancer treatment, breast cancer disease, breast cancer symptoms, breast cancer screening, and breast test). These preidentified search terms are based on earlier work concerning the top searched breast cancer topics by Arabic speakers through Google's search engine. We excluded apps that did not have an Arabic interface, were developed for non-Arabic speakers, were paid, needed a subscription, or were directed toward health care workers. The Mobile App Rating Scale was used to evaluate the quality of the apps concerning their engagement, functionality, aesthetics, and information. A risk score was calculated for the apps to determine their security risk factors. Only 9 apps were included, with most (6/9, 67%) being supported by advertisements and categorized as informational. Overall, the apps had low numbers of downloads (>10 to >1000). The majority of the included apps (8/9, 89%) requested dangerous access permissions, including access to storage, media files, and the camera. The average security score of the included apps was 3.22, while only 2 apps provided information about data security and privacy. The included apps achieved an overall average quality score of 3.27, with individual dimension scores of 4.75 for functionality, 3.04 for information, 3.00 for aesthetics, and 2.32 for engagement. The limited availability of breast cancer apps available to Arabic speakers should be a call to action and prompt health care organizations and developers to join forces and collaboratively develop information-rich, usable, functional, engaging, and secure apps.

Experiences of Peer Communities in a Cancer Smartphone App Among Adolescents and Young Adults With Cancer

ObjectivesAdolescents and young adults (AYAs) with cancer have identified connection to online communities of same-age peers to be essential for psycho-social support. In this study, the aim was to explore AYAs with cancers' and AYA cancer survivors' use of the Kræftværket cancer app's social forum and experiences of peer communities in the forum. Differences due to gender and treatment status were investigated. Data SourcesIn all, 85 AYAs aged 15-29 were recruited: 46 on and 39 off cancer treatment. The use of the social forum was assessed by a questionnaire, which were analyzed using descriptive statistics, and telephone interviews were analyzed thematically by the Framework Method. ConclusionSome AYAs assessed the social forum to be more valuable at time of diagnosis, while others experienced meaningful peer-support after cancer. Women were more active and diligent users than men. The following themes were found: 1) Common understanding of each other's challenges; 2) Other AYAs' stories increase the feeling of comfort but can also be difficult to accommodate; 3) A temporary and unwanted community; and 4) The interaction is personal but quickly stalls. Implications for Nursing PracticeThe results are relevant to the development of AYA cancer apps, with a view to strengthening peer-to-peer relationships. Although the use of the Kræftværket app was temporary, it presented a meaningful community for AYAs with cancer. The community feeling reduced loneliness and increased the sense of togetherness. The app met AYAs' needs and wishes for peer-to-peer age-appropriate cancer support, which can be implemented and provided by nurses.

Breast cancer-related apps in Google Play and App store: evaluate their functionality and quality.

This study aimed to evaluate the functionality and quality of breast cancer apps that can be accessed from Turkey. In this study, a systematic search strategy was used to identify free mobile apps on breast cancer available in the App and Google Play stores. According to the study's PRISMA flowchart, 707 apps met the inclusion criteria. The Mobile App Rating Scale (MARS) assessed the quality of the apps. Mobile apps focused on the categories of communication, education, and treatment order/plan. The mean MARS quality score for all apps was 3.4, and according to the mean score of the subscales, they were categorized as functionality, aesthetics, information quality, and participation. In addition, the mean scores of the subscales were listed on MARS as functionality, aesthetics, knowledge quality, and participation. Nowadays, "e-health" apps are attracting attention in the treatment of health problems. While the apps in download stores appear to provide basic information about breast cancer, they offer limited and personalized problem management related to prevention, early detection, and screening. Support from healthcare professionals and further efforts can be made to develop innovative technologies and apps that include evidence-based informational content about breast cancer. In the process of breast cancer information, survivors can be encouraged to manage this process using e-health services.

An Evaluation of the Quality of Commercial Nutrition Apps for Cancer Survivors

ObjectivesMobile nutrition apps have the potential to address gaps within the cancer care continuum by providing nutrition education to shape one's knowledge. Few studies evaluate the quality of these cancer nutrition apps and the degree of clinician agreement on app quality. Thus, we investigated the quality of four cancer nutrition apps with knowledge shaping features.MethodsDuring December 2019, an initial search was conducted in the Apple App Store using keywords relevant to cancer and nutrition. Apps were chosen if they provided free cancer-specific nutrition education (i.e., knowledge shaping) regardless of accuracy (e.g., “anti-cancer” foods, recipes) and had a ≥3-star rating. Four apps with knowledge shaping features were evaluated: Eat AntiCancer, Get Well Soon, Untire, and Vegan Soul Belly. Five oncology dietitians used the validated App Quality Evaluation (AQEL) to rate apps in several domains, such as: knowledge shaping (knowledge acquisition, skill development) and app design (functionality, appropriateness for cancer survivorship). Domain scores ranged from 0 -10 (score ≥8 represented high quality). Interclass correlation coefficient (ICCs) analyses determined the interrater reliability between dietitians. An ICC ≥0.90 represented excellent agreement; 0.75 to < 0.90 as good; 0.50 to <0.75 as moderate; and <0.50 as poor. Fixed effects models were used to examine domain score differences between apps, adjusting for the rater. Statistical significance threshold was set at P <0.05.ResultsAll apps had good agreement with AQEL scores among the dietitians (ICC range = 0.75–0.82). When examining differences in AQEL scores among apps, Untire had the highest AQEL scores in the knowledge acquisition (mean: 8.0 ± 1.2; p = 0.02). There were no differences in skill development and app design between the cancer apps (p > 0.05). Only Untire scored highly in the knowledge acquisition, function, and appropriate for cancer survivorship domains (all AQEL ≥8). None of the apps received a high-quality score for skill development (AQEL <8).ConclusionsUntire received high-quality scores for knowledge acquisition and app design. None of the apps scored highly in skill development. Future cancer nutrition apps should consider including effective skill development features to assist with shaping knowledge for behavior change.Funding SourcesNo funding sources.

Evaluation of mobile health applications for cervical cancer in the digital marketplace.

ObjectiveTo assess the quality of mobile health (mHealth) applications (apps) for cervical cancer using the mobile app rating scale (MARS), APPLICATIONS scoring system, and app rating using specific statements.MethodsWe searched for cervical cancer apps on two major mobile operating systems (Google Play Store and Apple iTunes Store) in March 2021. Eligible apps were downloaded and assessed for quality by two independent reviewers using multimodal assessment tools.ResultsThe overall quality of the MARS score was 2.61±0.795. The highest scoring app was “The American Society for Colposcopy and Cervical Pathology (ASCCP) Management Guidelines” (3.98). Overall, apps scored highest in the functionality domain, followed by information, engagement, and aesthetics domains. The mean±standard deviation of the APPLICATIONS scoring system was 8.50±1.712. The highest-rated apps were “ASCCP Management Guidelines,” “The British Society for Colposcopy and Cervical Pathology (BSCCP),” and “Cervical Cancer Guide.” Apps scored the highest in the paid subscription and price domains. By contrast, apps scored poorly in the text search, literature, and subjective presentation domains. Concerning app content, many apps infrequently provided misconceptions regarding cervical cancer. The apps’ rating using specific statements was 7.81±4.562.ConclusionOverall, the apps analyzed using the MARS and APPLICATIONS scoring systems demonstrated above-average quality. However, there is a need to improve the essential information conveyed by these applications. Moreover, the assessment tools have influenced different app quality rating results, confirming the lack of standardized quality assessment tools for mHealth apps.

A1055 - The PIONEER watchful waiting for prostate cancer apps - a first practical application of using big data for prostate cancer

A1055 - The PIONEER watchful waiting for prostate cancer apps - a first practical application of using big data for prostate cancer

The Impact of Mobile Health on Breast Cancer Patient’s Life and Treatment: A Systematic Review

Introduction: Breast cancer rates have been increasing worldwide, particularly among young women, suggesting important interactions between genes and health behaviors. At the same time, mobile technology, including smartphones applications (apps), has emerged as a new tool for delivering healthcare and health-related services. In 2019, there were nearly 670 publicly available breast cancer apps designed to provide disease and treatment information, to manage disease, and raise overall awareness.Material and Methods: In order to conduct a review, the Medline, Scopus and PubMed databases were searched with the keywords "mobile health", "mobile health in electronics health", "breast cancer and electronic health"," mobile health and breast cancer"," mobile health and breast cancer qualify life" and their equivalent. Out of the 60 articles found, after the depth of the criteria Inclusion in the study, 16 articles remained, which were reviewed and given using PRISMA 2020 checklist. SPSS software v.22 was used for description analysis.Results: A total of 16 articles met the inclusion criteria and were included in this review. All studies have determined the positive impact of applications on cancer detection and clinical health outcomes. In addition, more than half of mobile applications have multiple functions, such as providing information, planning and education. Furthermore, most studies examining patient satisfaction and quality improvement have shown that users of healthcare applications are significantly more satisfied with life, leading to better quality.Conclusion: The evidence of the studies which are included in this systematic review is currently limited, but it suggests that the mobile apps might be an acceptable information source for women with breast cancer and lead to improved patient well-being.

Review of smartphone mobile applications for skin cancer detection: what are the changes in availability, functionality, and costs to users over time?

Smartphone applications (apps) are available to consumers for skin cancer prevention and early detection. This study aims to review changes over time in the skin cancer apps available to consumers as well as their functionality and costs. Apps for the prevention of skin cancer were searched on two major smartphone app stores (Android and iOS) in June 2019. The number, functionality, ratings, and price of the apps were described and compared to similar reviews of the skin cancer app market from 2014 to 2017. Overall, the June 2019 search identified 66 apps. Of 39 apps found in 2014, 30 were no longer available in 2019 representing an attrition rate of 77%; of 43 apps available in 2017, attrition was 46.5%. In 2019, 63.6% (n=42/66) of apps were free to download compared to 53.5% (n=23/43) in 2017. Input from clinician/professional bodies was evident for 47.0% (n=31/66) of the apps in 2019 compared to 34.9% (15/43) in 2017. The most common app functionality offered in 2019 was monitoring/tracking of lesions at 48.5% (n=32/66). Since 2014, there has been a steady increase in the number of apps available for the general public to support the prevention or early detection of skin cancers. There continues to be a high turnover of apps, and many apps still appear to lack clinician input and/or evidence for their safety and value.

Assessment of the Fairness of Privacy Policies of Mobile Health Apps: Scale Development and Evaluation in Cancer Apps.

BackgroundCancer patients are increasingly using mobile health (mHealth) apps to take control of their health. Many studies have explored their efficiency, content, usability, and adherence; however, these apps have created a new set of privacy challenges, as they store personal and sensitive data.ObjectiveThe purpose of this study was to refine and evaluate a scale based on the General Data Protection Regulation and assess the fairness of privacy policies of mHealth apps.MethodsBased on the experience gained from our previous work, we redefined some of the items and scores of our privacy scale. Using the new version of our scale, we conducted a case study in which we analyzed the privacy policies of cancer Android apps. A systematic search of cancer mobile apps was performed in the Spanish version of the Google Play website.ResultsThe redefinition of certain items reduced discrepancies between reviewers. Thus, use of the scale was made easier, not only for the reviewers but also for any other potential users of our scale. Assessment of the privacy policies revealed that 29% (9/31) of the apps included in the study did not have a privacy policy, 32% (10/31) had a score over 50 out of a maximum of 100 points, and 39% (12/31) scored fewer than 50 points.ConclusionsIn this paper, we present a scale for the assessment of mHealth apps that is an improved version of our previous scale with adjusted scores. The results showed a lack of fairness in the mHealth app privacy policies that we examined, and the scale provides developers with a tool to evaluate their privacy policies.

Assessing Apps for Patients with Genitourinary Tumors Using the Mobile Application Rating Scale (MARS): Systematic Search in App Stores and Content Analysis

BackgroundThe large number of available cancer apps and their impact on the population necessitates a transparent, objective, and comprehensive evaluation by app experts, health care professionals, and users. To date, there have been no analyses or classifications of apps for patients with genitourinary cancers, which are among the most prevalent types of cancer.ObjectiveThe objective of our study was to analyze the quality of apps for patients diagnosed with genitourinary cancers using the Mobile Application Rating Scale (MARS) and identify high-quality apps.MethodsWe performed an observational cross-sectional descriptive study of all smartphone apps for patients diagnosed with genitourinary cancers available on iOS and Android platforms. In July 2019, we searched for all available apps for patients with genitourinary cancers (bladder, prostate, cervical, uterine, endometrial, kidney, testicular, and vulvar) or their caregivers. Apps were downloaded and evaluated, and the general characteristics were entered into a database. The evaluation was performed by 2 independent researchers using the MARS questionnaire, which rates 23 evaluation criteria clustered in 5 domains (Engagement, Functionality, Esthetics, Information, and Subjective Quality) on a scale from 1 to 5.ResultsIn total, 46 apps were analyzed. Of these, 31 (67%) were available on Android, 6 (13%) on iOS, and 9 (20%) on both platforms. The apps were free in 89% of cases (41/46), and 61% (28/46) had been updated in the previous year. The apps were intended for prostate cancer in 30% of cases (14/46) and cervical cancer in 17% (8/46). The apps were mainly informative (63%, 29/46), preventive (24%, 11/46), and diagnostic (13%, 6/46). Only 7/46 apps (15%) were developed by health care organizations. The mean MARS score for the overall quality of the 46 apps was 2.98 (SD 0.77), with a maximum of 4.63 and a minimum of 1.95. Functionality scores were quite similar for most of the apps, with the greatest differences in Engagement and Esthetics, which showed acceptable scores in one-third of the apps. The 5 apps with the highest MARS score were the following: “Bladder cancer manager,” “Kidney cancer manager,” “My prostate cancer manager,” “Target Ovarian Cancer Symptoms Diary,” and “My Cancer Coach.” We observed statistically significant differences in the MARS score between the operating systems and the developer types (P<.001 and P=.01, respectively), but not for cost (P=.62).ConclusionsMARS is a helpful methodology to decide which apps can be prescribed to patients and to identify which features should be addressed to improve these tools. Most of the apps designed for patients with genitourinary cancers only try to provide data about the disease, without coherent interactivity. The participation of health professionals in the development of these apps is low; nevertheless, we observed that both the participation of health professionals and regular updates were correlated with quality.

Use of Evidence-Based Best Practices and Behavior Change Techniques in Breast Cancer Apps: Systematic Analysis.

BackgroundTheoretically designed mobile health (mHealth) breast cancer interventions are essential for achieving positive behavior change. In the case of breast cancer, they can improve the health outcomes of millions of women by increasing prevention and care efforts. However, little is known about the theoretical underpinnings of breast cancer apps available to the general public.ObjectiveGiven that theories may strengthen mHealth interventions, this study aimed to identify breast cancer apps designed to support behavior change, to assess the extent to which they address content along the cancer care continuum and contain behavior change techniques, and to assess the degree to which star rating is related to theory-based design.MethodsUsing a criteria-based screening process, we searched 2 major app stores for breast cancer apps designed to promote behavior change. Apps were coded for content along the cancer care continuum and analyzed for behavior change techniques. The Mann-Whitney U test was used to examine the relationship between star ratings and the use of behavior change techniques in apps with star ratings compared to those without ratings.ResultsThe search resulted in a total of 302 apps, of which 133 were identified as containing breast cancer content. Only 9.9% (30/302) of apps supported behavior change and were further analyzed. These apps were disproportionally focused on behaviors to enhance early detection, whereas only a few apps supported care management, treatment, and posttreatment behaviors. Regarding theories, 63% (19/30) of apps customized content to users, 70% (21/30) established a health-behavior link, and 80% (24/30) provided behavior change instructions. Of the 30 apps, 15 (50%) prompted intention formation whereas less than half of the apps included goal setting (9/30, 30%) and goal reviewing (7/30, 23%). Most apps did not provide information on peer behavior (7/30, 23%) or allow for social comparison (6/30, 20%). None of the apps mobilized social norms. Only half of the apps (15/30, 50%) were user rated. The results of the Mann-Whitney U test showed that apps with star ratings contained significantly more behavior change techniques (median 6.00) than apps without ratings. The analysis of behavior change techniques used in apps revealed their shortcomings in the use of goal setting and social influence features.ConclusionsOur findings indicate that commercially available breast cancer apps have not yet fully realized their potential to promote behavior change, with only a minority of apps focusing on behavior change, and even fewer including theoretical design to support behavior change along the cancer care continuum. These shortcomings are likely limiting the effectiveness of apps and their ability to improve public health. More attention needs to be paid to the involvement of professionals in app development and adherence to theories and best practices in app design to support individuals along the cancer care continuum.

Usability of a Mobile Phone App Aimed at Adolescents and Young Adults During and After Cancer Treatment: Qualitative Study.

BackgroundAdolescent and young adult (AYA) cancer patients are seldom involved in the process of testing cancer-related apps. As such, knowledge about youth-specific content, functionalities, and design is sparse. As a part of a co-creation process of developing the mobile phone app Kræftværket, AYAs in treatment for cancer and in follow-up participated in a usability think-aloud test of a prototype of the app. Thus, the app was initiated, created, and evaluated by AYAs with cancer experience.ObjectiveThe aim of this study was to explore the results of a think-aloud test administered to see how the prototype of the app Kræftværket was used by AYAs in treatment for cancer and in follow-up, and to investigate the strengths and weaknesses of the app.MethodsA total of 20 AYA cancer patients aged 16 to 29 years (n=10 on treatment, n=10 in follow-up) were provided with the first version of the co-created mobile phone app Kræftværket during a 6-week test period (April-May 2018). After the test period, 15 participated in individual usability think-aloud tests. The tests were video-recorded, transcribed verbatim, and analyzed using a thematic analysis approach.ResultsThe thematic analysis led to the following themes and subthemes: navigation (subthemes: intuition, features, buttons, home page, profile), visual and graphic design (subthemes: overview, text and colors, photos, videos, YouTube), and usefulness (subthemes: notifications, posts, adding). The analysis identified gender differences in app utilization—female participants seemed to be more familiar with parts of the app. The app seemed to be more relevant to AYAs receiving treatment due to app functions such as tracking symptoms and searching for relevant information. Lack of notifications and incorrect counting of posts were perceived as barriers to using the app.ConclusionsUsability testing is crucial to meet the needs of the AYA target audience. AYA cancer apps should preferably be relevant, targeted, and unique, and include a tracking function and AYA-produced videos. Notifications and correct marking and ordering of posts are critical to make apps engaging and dynamic. Further research is recommended to evaluate the Kræftværket app with the input of more AYAs.

Mobile Health Divide Between Clinicians and Patients in Cancer Care: Results From a Cross-Sectional International Survey.

BackgroundMobile technologies are increasingly being used to manage chronic diseases, including cancer, with the promise of improving the efficiency and effectiveness of care. Among the myriad of mobile technologies in health care, we have seen an explosion of mobile apps. The rapid increase in digital health apps is not paralleled by a similar trend in usage statistics by clinicians and patients. Little is known about how much and in what ways mobile health (mHealth) apps are used by clinicians and patients for cancer care, what variables affect their use of mHealth, and what patients’ and clinicians’ expectations of mHealth apps are.ObjectiveThis study aimed to describe the patient and clinician population that uses mHealth in cancer care and to provide recommendations to app developers and regulators to generally increase the use and efficacy of mHealth apps.MethodsThrough a cross-sectional Web-based survey, we explored the current utilization rates of mHealth in cancer care and factors that explain the differences in utilization by patients and clinicians across the United States and 5 different countries in Europe. In addition, we conducted an international workshop with more than 100 stakeholders and a roundtable with key representatives of international organizations of clinicians and patients to solicit feedback on the survey results and develop insights into mHealth app development practices.ResultsA total of 1033 patients and 1116 clinicians participated in the survey. The proportion of cancer patients using mHealth (294/1033, 28.46%) was far lower than that of clinicians (859/1116, 76.97%). Accounting for age and salary level, the marginal probabilities of use at means are still significantly different between the 2 groups and were 69.8% for clinicians and 38.7% for patients using the propensity score–based regression adjustment with weighting technique. Moreover, our analysis identified a gap between basic and advanced users, with a prevalent use for activities related to the automation of processes and the interaction with other individuals and a limited adoption for side-effect management and compliance monitoring in both groups.ConclusionsmHealth apps can provide access to clinical and economic data that are low cost, easy to access, and personalized. The benefits can go as far as increasing patients’ chances of overall survival. However, despite its potential, evidence on the actual use of mobile technologies in cancer care is not promising. If the promise of mHealth is to be fulfilled, clinician and patient usage rates will need to converge. Ideally, cancer apps should be designed in ways that strengthen the patient-physician relationship, ease physicians’ workload, be tested for validity and effectiveness, and fit the criteria for reimbursement.

A Systematic Review on Smartphone Skin Cancer Apps: Coherent Taxonomy, Motivations, Open Challenges and Recommendations, and New Research Direction

Objective: This research aims to survey the efforts of researchers in response to the new and disruptive technology of skin cancer apps, map the research landscape from the literature onto coherent taxonomy, and determine the basic characteristics of this emerging field. In addition, this research looks at the motivation behind using Smartphone apps in the diagnosis of skin cancer and in health care and the open challenges that impede the utility of this technology. This study offers valuable recommendations to improve the acceptance and use of medical apps in the literature. Methods: We conducted a comprehensive survey using the keywords “skin cancer,” “apps,” and “Smartphone” or “m-Health” in different variations to find all the relevant articles in three major databases: Web of Science, Science Direct, and IEEE Xplore. These databases broadly cover medical and technical literature. Results: We found 110 articles after a comprehensive survey of the literature. Out of the 110 articles, 46 present actual attempts to develop and design medical apps or share certain experiences of doing so. Twenty-eight articles consist of analytical studies on the incidence of skin cancer, the classification of malignant cancer or benign cancer, and the methods of prevention and diagnosis. Twenty-two articles comprise studies that range from the evaluative or comparative study of apps to the exploration of the desired features for skin cancer detection. Fourteen articles consist of reviews and surveys that refer to actual apps or the literature to describe medical apps for a specific specialty, disease, or skin cancer and provide a general overview of the technology. New research direction: With the exception of the 110 papers reviewed earlier in results section, the new directions of this research were described. In state-of-the-art, no particular study presenting watermarking and stenography approaches for any type of skin cancer images based on Smartphone apps is available. Discussion: Researchers have attempted to develop and improve skin cancer apps in several ways since 2011. However, several areas or aspects require further attention. All the articles, regardless of their research focus, attempt to address the challenges that impede the full utility of skin cancer apps and offer recommendations to mitigate their drawbacks. Conclusions: Research on skin cancer apps is active and efficient. This study contributes to this area of research by providing a detailed review of the available options and problems to allow other researchers and participants to further develop skin cancer apps, and the new directions of this research were described.

A biopsy of Breast Cancer mobile applications: state of the practice review

BackgroundBreast cancer is the most common cancer in women. The use of mobile software applications for health and wellbeing promotion has grown exponentially in recent years. We systematically reviewed the breast cancer apps available in today’s leading smartphone application stores and characterized them based on their features, evidence base and target audiences. MethodsA cross-sectional study was performed to characterize breast cancer apps from the two major smartphone app stores (iOS and Android). Apps that matched the keywords “breast cancer” were identified and data was extracted using a structured form. Reviewers independently evaluated the eligibility and independently classified the apps. ResultsA total of 1473 apps were a match. After removing duplicates and applying the selection criteria only 599 apps remained. Inter-rater reliability was determined using Fleiss-Cohen’s Kappa. The majority of apps were free 471 (78.63%). The most common type of application was Disease and Treatment information apps (29.22%), Disease Management (19.03%) and Awareness Raising apps (15.03%). Close to 1 out of 10 apps dealt with alternative or homeopathic medicine. The majority of the apps were intended for patients (75.79%). Only one quarter of all apps (24.54%) had a disclaimer about usage and less than one fifth (19.70%) mentioned references or source material. Gamification specialists determined that 19.36% contained gamification elements. ConclusionsThis study analyzed a large number of breast cancer-focused apps available to consumers. There has been a steady increase of breast cancer apps over the years. The breast cancer app ecosystem largely consists of start-ups and entrepreneurs. Evidence base seems to be lacking in these apps and it would seem essential that expert medical personnel be involved in the creation of medical apps

Qualitative evaluation of mobile cancer apps with particular attention to the target group, content, and advertising.

Medical apps are gaining importance rapidly. Also in the field of cancer care, apps are offered. Yet, so far little is known with respect to their quality. In a pilot phase we developed a rating tool based on formal and content-related criteria for the assessment of cancer apps. We used this instrument on cancer apps available in the App Store (iOS) concerning breast, prostate and colorectal cancer. The results were stratified according to target group, content and advertising. We assessed 41 mobile cancer apps. Six apps (14.63%) scored very high, fifteen apps (36.59%) high, seventeen apps (41.46%) were deficient, and three apps (7.32%) were insufficient. The largest group of apps represents those apps with the "deficient" rating. The very good to good apps had reliable sources, a concrete intent/ purpose in their app description, and a strict distinction of scientific content and advertisement. Apps with the predicates "deficient" or "insufficient" had particularly poor ratings, e.g. in the subscales "information on sources" and "data protection". Almost half of the tested apps were deficient or insufficient. In order to improve safety of patients using apps, some regulation seems mandatory. Putting apps under the legislation for medical products might be one way to better regulate and control quality. Second, efforts should focus on the development of checklists that make it easier for patients to search for suitable cancer apps.

Development of a Rating Tool for Mobile Cancer Apps: Information Analysis and Formal and Content-Related Evaluation of Selected Cancer Apps.

Mobile apps are offered in large numbers and have different qualities. The aim of this article was to develop a rating tool based on formal and content-related criteria for the assessment of cancer apps and to test its applicability on apps. After a thorough analysis of the literature, we developed a specific rating tool for cancer apps based on the MARS (mobile app rating system) and a rating tool for cancer websites. This instrument was applied to apps freely available in stores and focusing on some cancer topic. Ten apps were rated on the basis of 22 criteria. Sixty percent of the apps (6/10) were rated poor and insufficient. The rating by different scientists was homogenous. The good apps had reliable sources were regularly updated and had a concrete intent/purpose in their app description. In contrast, the apps that were rated poor had no distinction of scientific content and advertisement. In some cases, there was no imprint to identify the provider. As apps of poor quality can give misinformation and lead to wrong treatment decisions, efforts have to be made to increase usage of high-quality apps. Certification would help cancer patients to identify reliable apps, yet acceptance of a certification system must be backed up.

Content, Usability, and Utilization of Plain Language in Breast Cancer Mobile Phone Apps: A Systematic Analysis.

BackgroundBreast cancer is one of the leading contributors to preventable illness and death among women. Although mobile phone apps provide unprecedented opportunity to engage women along the cancer continuum, little is known about the availability, content, and usability of breast cancer mobile phone apps.ObjectiveThis study analyzed the content and adherence to literate design standards of all breast cancer-related apps available on the App Store and Google Play, as well as the relationship between their content, user ratings, and price.MethodsFollowing identification and downloading of all available breast cancer mobile phone apps in October 2015, 101 apps were confirmed as focusing on breast cancer. Based on prior research, we adapted and applied a content analysis scheme that was specific to breast cancer apps, including their main purpose, relevance to the cancer care continuum, and adherence to usability standards outlined by the Institute of Medicine (IOM).ResultsThe most common aim of apps was educational (73/101, 72.3%), followed by behavior change (24/101, 23.9%), fundraising (20/101, 19.8%), and advocacy (14/101, 13.9%). On the cancer continuum, primary prevention (strategies to prevent cancer cells from occurring) was mentioned in almost one-third of the apps (30/101, 29.7%). Less than half of the apps (46/101, 45.5%) presented information about mammography and/or breast clinical exam, and 53 apps (52.5%) discussed breast self-exam (which is no longer recommended). Symptoms of cancer prediagnosis, such as a lump, were discussed in almost half of the apps (48/101, 47.5%) and a similar number of apps included information about genetic risk for breast cancer (47/101, 46.5%). Information about breast cancer diagnosis was included in 42 apps (41.58%) and 43 (42.6%) apps discussed treatment options. Survivorship issues were addressed in 17 (16.8%) apps. Only one (1.0%) app discussed hospice. Adherence to usability recommendations was low. The median composite score was 3 (mean 2.60, SD 1.20) of the six recommended usability items. With eight plain language items, the median of the composite health literacy score was 5 (mean 5.06, SD 2.00). Most apps did not use easy-to-understand words (44/101, 43.6%) and few (24/101, 23.8%) defined key terms.ConclusionsCurrent breast cancer apps provide important information about breast cancer, but the most common topic covered is breast self-examination, a non-evidence-based screening strategy. Apps that focus on evidence-based strategies on the cancer continuum are needed, with a notable pressing need for apps that would address survivorship and end of life. Finally, developers of breast cancer apps should adhere to IOM standards to meet the needs of diverse populations and reduce current disparities.

Are Your Patients Using ‘Digital Supplements’?

Are Your Patients Using ‘Digital Supplements’?