Practical Apps 16: Breast Cancer

author

Dr. Stephen Pomedli
Toronto, Ontario

Bio

Dr. Stephen Pomedli is a family physician and the co-founder of ConsultLoop, an online referral platform that helps connect family doctors with specialists and betters the referral process for patients. He studied medicine at Harvard Medical School and completed a Master’s in International Health Policy at the London School of Economics. After his residency at St. Michael’s Hospital, he undertook a Global Health fellowship at the University of Toronto, looking at best practices in family medicine in Canada, the United States and Brazil. As a previous Innovation Fellow at Women’s College Hospital, he worked with a group of clinicians, entrepreneurs, designers and policy-makers to find new approaches to designing healthcare services, especially for patients with complex health care needs.

Apps Reviewed:

phone
icon

MyBCTeam

App RatingFull starFull starFull starEmpty starEmpty star

MyBCTeam focuses on providing online support and a social network for individuals who have been diagnosed with breast cancer. This site is one of a number of diagnosis-specific websites and apps created by myhealthteams.com to provide forums for discussion and support related to specific conditions (other sites include “DiabetesTeam” and “MyParkinsonsTeam”). The forums provide an active place for patients to share status updates and create a “team” of supportive individuals to follow (or who might follow them) during their cancer journey, and it is heartening to see the support that individuals give to one another through this community. While this app has the greatest potential for users to develop an online support network with meaningful interactions, this app should be recommended with caution, as some content appears to be sponsored by third parties without clear disclosure.

EXPAND ALL COLLAPSE ALL
Features
Full starFull starFull starHalf starEmpty star

The core of this app is the discussion forum, where users can build a profile and respond to questions like “Given what I know now, I would recommend other women…” and “My life has changed in this way…”. Simple searches help individuals find “patients like me” — based on filters such as location, cancer type, and ongoing side effects — and follow or connect with others. Interactions are facilitated with simple ways to say “hi”, or give “hugs” or “likes”, or respond with text-based comments.

Effectiveness
Full starHalf starEmpty starEmpty starEmpty star

The forums do not appear to be moderated or vetted, so all content is provided by users. There is a small education section in the accompanying website that describes a select number of specific cancer treatments (mostly chemotherapy medications) that seem to be part of the company’s “Unbranded Condition Education” offerings, but they are not clearly labelled as such, which feels like an ethical lapse.

Usability
Full starFull starFull starHalf starEmpty star

The app has a very pleasant interface, is intuitive and not overly cluttered, and should be easy to use for anyone familiar with common social media platforms. The combination of structured and unstructured ways of sharing updates creates unintimidating ways to interact and encourages ongoing engagement with the platform.

Privacy & Security
Full starFull starFull starEmpty starEmpty star

There is a strong plain-language summary, which clearly explains how and when information is shared. The app uses profile information as a way to recruit individuals for clinical trials, but this is explicitly mentioned, and there is a clear opt-in process when signing up.

Reliability
Full starFull starEmpty starEmpty starEmpty star

Unfortunately, creating an account via the app was a buggy process. The app has been updated within the last year, but there is no indication as to when the “educational” sections were last updated. The few disclaimers that direct users to consult with medical professionals for advice are buried in the Terms of Use, and not present elsewhere.

Accessibility
Full starFull starHalf starEmpty starEmpty star

The app is available for both iOS and Android for free, but only in English. Most of the users (and the advice) is U.S.-centric, but there are several hundred Canadian users active in the discussion forums.

phone
icon

Beyond the Shock

App RatingFull starFull starHalf starEmpty starEmpty star

Billed as the “first and foremost resource for women who have been diagnosed with breast cancer”, Beyond the Shock is a basic and easy-to-use education and support iOS app. It is put out by the not-for-profit National Breast Cancer Foundation in the U.S., which does not seem to have particular ties to any industry groups (such as pharmaceutical companies). The app’s strength lies in providing a multilingual video series to explain the initial diagnosis of breast cancer, and in providing access to the narratives of others with breast cancer. A discussion forum enables users to discuss particular concerns, ask for advice, or view previously asked questions, but the forum isn’t particularly active, and doesn’t appear to be monitored for medical accuracy. As with most apps in this category, the educational focus is on diagnosis and treatment, with a notable lack of discussion regarding side effects related to cancer treatments, or symptom palliation.

EXPAND ALL COLLAPSE ALL
Features
 Full starFull starFull starEmpty starEmpty star

The app presents a good series of educational videos that explain some of the science behind a cancer diagnosis. They are nicely animated and use clear, basic language. A second video series highlights the experiences of several individuals with lived experience with breast cancer. There are opportunities to view and ask questions of one’s peers, though active discussion is sparse, which probably limits the likelihood that users will engage more than a few times with the app.

Effectiveness
Full starHalf starEmpty starEmpty starEmpty star

While the description claims that the app was developed “with the support of the finest medical experts, doctors, and researchers”, it is unclear who was involved and how the expertise was incorporated. Also, there is no apparent moderation or vetting of the content in the discussion forums, with a few “superusers” seeming to provide the bulk of the medical advice.

Usability
Full starFull starHalf starEmpty starEmpty star

The app is very simple and straightforward to use, with its main page guiding the user to “Learn”, “Ask” and “Hear.” The app has a dated aesthetic, and many sections rely on webpages, many of which aren’t tailored for the iOS environment, or are reliant on long blocks of small text to communicate their messages.

Privacy & Security
Full starFull starHalf starEmpty starEmpty star

While there is a clearly posted privacy policy that ensures that data isn’t shared with third parties, there isn’t an easily accessible plain-language summary. While no health-specific information is collected, comments made through the online forum may be retrievable via web search and linked to one’s username. This can be turned off, but it isn’t the default setting.

Reliability
Full starFull starHalf starEmpty starEmpty star

The app has been updated in the last year; much of the video content is several years old, however most of this content relates to basic explanations of cancer and cancer types and wouldn’t necessarily need regular updating. Creating an account and log-in to post and comment was a very buggy and inconsistent experience, both through the app and the related website.

Accessibility
Full starFull starFull starEmpty starEmpty star

The content is available in multiple languages (Spanish, French, Chinese, and Portuguese), but these simply load the desktop version of the accompanying website in the selected language, which significantly diminishes the in-app experience. Fortunately, videos are re-done in each language and subtitles are provided for patient narratives, which are shared by women of different ages and backgrounds. This app is free, but only available on iOS devices.

phone
icon

BECCA

App RatingFull starFull starHalf starEmpty starEmpty star

The BECCA app, developed by the Breast Cancer Care charity in the UK, provides links, resources and information to support individuals completing treatment for breast cancer via a series of browsable “flashcards”. While many of the flashcards provide interesting links and suggestions, the flashcard content feels quite random and leaves notable gaps, leading one to look elsewhere for more information. While the app design is clean and welcoming, most of the links are to external web-based resources and sites, some of which seem to be marketing particular products or services, with any financial relationships undisclosed. Many of the connected resources, including links to nurse support to answer specific questions, are UK-specific and thus less helpful for those living in other countries.

EXPAND ALL COLLAPSE ALL
Features
Full starFull starFull starEmpty starEmpty star

The flashcard topics range from combating fatigue, to finding a support group, to make-up tips for those who have lost their hair. The user can opt to receive “five of the best” suggestions per day. This app does an admiral job connecting the user with in-person (non-virtual) resources, including community-based centres, peer “meet-ups”, or live phone interactions with nurses. While these are fantastic features that bridge the digital world with the analog world, these are almost entirely for UK-based residents.

Effectiveness
Full starHalf starEmpty starEmpty starEmpty star

The app description states that “all information is checked by a panel prior to inclusion in the app,” though there is no mention as to who is on this panel, or how the content was reviewed. Several of the flashcard links connect to particular products or services, which raises a concern about the potential commercialization of certain aspects of the app.

Usability
Full starFull starFull starHalf starEmpty star

Very clean, up-to-date design. A simple onboarding process explains the basics of the app. Virtually all the content is delivered via links that open in a browser outside the app, creating a disjointed user experience. The content isn’t searchable, so finding resources for a specific question can be a bit of a task.

Privacy & Security
Full starFull starHalf starEmpty starEmpty star

A plain language privacy policy is easy to access and digest. The app does ask for information on overall diagnosis when creating an account, and no other information is collected.

Reliability
Full starFull starHalf starEmpty starEmpty star

The app was generally reliable but would often crash at inconsistent times. The app has been updated within the last year.

Accessibility
Full starFull starHalf starEmpty starEmpty star

The app is free and available for iOS and Android. No other languages besides English are supported.

phone
icon

My Cancer Coach

App RatingFull starFull starHalf starEmpty starEmpty star

My Cancer Coach, which includes the “My Breast Cancer Coach” stream within it, helps individuals understand the treatment options related to their specific diagnosis. By asking users to input disease-specific information from their breast cancer pathology report, the app then tailors a report that discusses types of treatments that may be most appropriate. There is a strong emphasis on curative modalities (chemotherapy, radiation, and surgeries), even when individuals indicate they have a Stage 4 diagnosis, with no mention of symptomatic treatment, palliative care or end-of-life therapies, which does patients a disservice. A major concern is that the app is built by a genetic diagnostics company, and the content often seems preoccupied with their proprietary testing and directs patients to affiliated websites without clearly declaring this sales slant.

EXPAND ALL COLLAPSE ALL
Features
Full starFull starFull starEmpty starEmpty star

Beyond the pathology-specific management plan, the app also offers simple ways to track upcoming appointments and make entries in a simple journal. A basic glossary is a nice addition to help define some of the basic terms related to a breast cancer diagnosis, but it feels overly clinical. A widget to keep track of questions for upcoming visits (and email them directly to one’s physician) is a good idea but might not be very practical.

Effectiveness
Full starFull starHalf starEmpty starEmpty star

The video series, discussing general principles around breast cancer, is narrated by Dr. Marisa Weiss, who is an oncologist and has lived experience with breast cancer. However, there isn’t any clear information on the source or reliability of the remainder of the content, despite this being one of the apps that includes the most specific and direct medical information. Further, there is strong concern for bias given the backing of this app, however no conflicts of interest are declared.

Usability
Full starFull starHalf starEmpty starEmpty star

The app has a fresh appearance, and most features are easy to understand. The treatment information, however, involves long paragraphs of small-font text and is hard to digest. The other features — including the calendar and journaling elements — seem like afterthoughts and aren’t particularly well developed.

Privacy & Security
Full starFull starFull starEmpty starEmpty star

A straightforward privacy policy indicates that information is only collected to improve the app over time, and to provide the user with accurate information related to their diagnosis. Despite the commercial bent of the app, it explicitly notes that it does not use the data for “advertising, direct marketing, or social networking purposes”.

Reliability
Full starFull starFull starEmpty starEmpty star

The app does advise users to utilize the app’s information in conjunction with direction from a medical professional, but this advice is buried among paragraphs of information. Helpfully, the app has been updated within the past year.

Accessibility
Full starFull starHalf starEmpty starEmpty star

The app is free and available for both iOS and Android, but only in English. Getting tailored information on one’s diagnosis requires entering information from one’s breast cancer pathology report, which is often hard for individuals to access or interpret.

References:

1. Drewes, C., Kirkovits, T., Schiltz, D., Schinkoethe, T., Haidinger, R., Goldmann-Posch, U., Wuerstlein, R. (2016). EHealth Acceptance and New Media Preferences for Therapy Assistance Among Breast Cancer Patients. JMIR Cancer, 2(2). doi:10.2196/cancer.5711

2. Canadian Cancer Society, Statistics Canada, Public Health Agency of Canada, and Public Health Agency of Canada (n.d.). Canadian Cancer Statistics 2016. Special topic: HPV-associated cancers (Canada, Government of Canada). Retrieved from http://www.cancer.ca/~/media/cancer.ca/CW/cancer%20information/cancer%20101/Canadian%20cancer%20statistics/Canadian-Cancer-Statistics-2016-EN.pdf?la=en

3. Maughan, K.L., Lutterbie, M.A. and P.S. Ham, P.S. Treatment of breast cancer. Am Fam Physician, 2010. 81(11): p. 1339-46.

4. Ginossar, T., Shah, S. F., West, A. J., Bentley, J. M., Caburnay, C. A., Kreuter, M. W., Kinney, A. Y. (2017). Content, Usability, and Utilization of Plain Language in Breast Cancer Mobile Phone Apps: A Systematic Analysis. JMIR mHealth and uHealth, 5(3). doi:10.2196/mhealth.7073

Printer-friendly version

Important Information about Practical Apps

OTN is making available articles and other information (“Information”) on various health-related apps that may be of value to patients, and their caregivers, with respect to a variety of medical conditions. While OTN and its content providers are endeavouring to provide helpful and accurate Information, the Information is subject to a number of restrictions and provisions. Read more...

About Practical Apps

Practical Apps is a collaboration between OTN and WIHV.

© 2018 Ontario Telemedicine Network. Use of this website constitutes acceptance of our Terms & Conditions. and Privacy Statement.