Smart Healthcare Apps for Quality Cancer Patient Support

This﻿paper﻿analyzes﻿the﻿clinical﻿and﻿technological﻿characteristics﻿of﻿cancer﻿mobile﻿ apps﻿ that﻿ enable﻿ patients﻿ to﻿ securely﻿ record,﻿ manage,﻿ and﻿ share﻿ their﻿ information.﻿ It﻿proposes﻿an﻿integrated﻿approach﻿towards﻿developing﻿quality﻿mobile﻿health﻿apps﻿ for﻿ cancer﻿ and﻿ discusses﻿ issues﻿ relevant﻿ to﻿ the﻿ enhancement﻿ of﻿ patient﻿ experience﻿ and﻿acceptance,﻿adherence﻿to﻿treatment,﻿and﻿effective﻿support﻿of﻿coordinated﻿care.﻿ Regulation,﻿standardization,﻿and﻿interoperability﻿together﻿with﻿the﻿existence﻿of﻿useful,﻿ accurate,﻿and﻿reliable﻿tools﻿for﻿active﻿patient﻿engagement﻿are﻿important﻿aids﻿towards﻿ efficient﻿cancer﻿disease﻿management.﻿Improving﻿quality﻿of﻿life﻿and﻿well-being,﻿in﻿a﻿ secure﻿and﻿safe﻿manner﻿that﻿respects﻿the﻿patients’﻿privacy,﻿seems﻿to﻿be﻿a﻿key﻿challenge,﻿ together﻿with﻿the﻿exploitation﻿of﻿the﻿outcomes﻿of﻿recent﻿research﻿projects,﻿relevant﻿to﻿ end﻿user﻿digital﻿engagement﻿towards﻿an﻿integrated﻿approach﻿for﻿the﻿introduction﻿of﻿ trustworthy,﻿interoperable,﻿usable,﻿adaptable,﻿and﻿quality﻿mobile﻿health﻿apps.

Healthcare systems around the world are becoming increasingly interested in strengtheningtheroleofpatientsintheircare.Empowermentoccurswhenpatients increasetheircapacitytothinkcriticallyandmakeautonomous,informeddecisions.Inthatprocess,theroleofhealthcareproviders,technologyproviders,citizens,and policy-makers is of paramount importance.An increasing trend shows a shift of healthcaremodelstowardsprediction,earlydetectionandmonitoring.
Theshiftfromcancerasaterminalillnesstocancerasachronicillnessrequires that patients and their families assume a more central role in the management of the oncologic disease, healthcare professionals take a partnership with patients acceptingtoshareresponsibilities,andpolicymakersprovideadequatesupporttothe healthcaresystemsinimplementingnewmodels (McGuire,2016) European research projects such as the ones described above offer results that providevaluablescientificinsightsabouttheappropriatemodulesthatarenecessaryto enhancecancercareandpromotepatientempowermentandself-managementpractices.

IMPLeMeNTING SMART HeALTHCARe APPS FoR CANCeR
Research has shown that cancer patients value the use of apps for health care management and feel comfortable using them (Girault et al., 2015).Designing a user-centred,patient-focusedapp,tailoredtotheindividualuserneeds,requiresthe earlyinvolvementofbothpatientsandhealthcareprofessionalsinthedevelopment, implementation,andevaluationprocesses.Userinvolvementisveryimportantand needstobeestablishedfromtheapplicationconception.Userfeedbackfromdoctors andcancerpatientswillhelpdeterminewhichappsortypesofappsaremosteffective, andamongwhichgroupsofsurvivors.

Software Quality Assurance
Software quality assurance consists of methods and tools to monitor the software engineeringprocessesinordertoensurequality.Thedesignandevaluationofany app should adhere to certain principles of systems and software engineering, such asthe onesdefinedby International Organization for Standardization (ISO) 25000 series for systems and software quality requirements and evaluation (International OrganizationforStandardization,2014).ISO25000hasorganizedtherequirement into eight main categories, and its respective sub-categories, including functional suitability, performance efficiency, compatibility, usability, reliability, security maintainability and portability.Quality assurance through quality labelling is very importanttopromotethedesign,developmentandimplementationoffunctionaland effectiveapplications.
Employingparticipatorydesignwillleadtoanappthathasbeendesignedbythe end-usersfortheend-users; • An iterative design approach is required, incorporating user feedback until the devicereachesanacceptablelevelofusability; • The graphical user interface and usability are essential when building apps for patients.The interface should be simple, helping patients to focus on specific taskswithoutunnecessarymenusandinformation; • Amobileappshouldbepersonalizedtotheindividualpatientcharacteristics,such as presence of comorbidities, age, gender and others.Cancer is a multifaceted problemwithmanydifferenttreatmentoptionsandpaths.Mobileappsofferthe opportunityforlearningfromthedatainordertoprovideintelligentpersonalized support; • Allinformationshouldbereliable,basedonscientificallyandclinicallyvalidated knowledge.Healthcare providers need to be engaged in the design and the developmentoftheapp; • The app should comply with all protection of personal health information and securityrequirements,allowingtheuserstoeasilyunderstandwheretheirdata arestoredandwhocanusethem,graduallybuildingpatient'strust.
Asalreadyproposedby(President'sCancerPanel,2016)enablinginteroperability among institutions and individuals that support care delivery across the cancer continuum -from prevention through treatment, survivorship, and end-of-life care -isconsideredtobeessential.Doingsorequiresdeveloping,testing,disseminating and adopting technical standards for information related to cancer care across the continuuminordertooptimizetheflowofinformationtoservetheneedsofpatients, caregivers, and providers (Katehakis et al., 2017) Lefteris Koumakis (PhD) is a postdoctoral researcher with the Computational BioMedicine Laboratory of the Foundation for Research and Technology -Hellas (FORTH).He received his PhD degree in Computational Biology from the Technical University of Crete.He is biomedical informatics professional with expertise in computational biology, bioinformatics, data mining and software infrastructures for life sciences.He is the IT Architect of the Greek Biobanks network (BBMR-GR), responsible for the coordination and connection of the Greek biobank Centers and their linkage with collections in other European Center via the BBMRI-ERIC.He has extensive experience in participating and leading more than 15 European Projects and has published many papers in scientific journals, proceedings of international conferences & workshops, related to his fields of expertise.

Figure 1 .
Figure 1.Typical set of software modules required for cancer patient empowerment
AngelinaKouroubali (PhD)is a Collaborating Researcher at the Computational BioMedicine Laboratory and a research expert at the Centre of eHealth Applications and Services at the Institute of Computer Science, Foundation for Research and Technology-Hellas (FORTH).She holds a Ph.D. in Management of Medical Informatics from the Judge Business School, University of Cambridge, a Masters in Medical Informatics from Columbia University, NY, USA, and a Bachelors degree in Biology from Bard College, USA.Dr. Kouroubali has more than 20 years of professional experience in the field of Medical Informatics. 47