Web-based self-management for cancer survivors: Efficacy, cost-utility and reach of Oncokompas

Research output: PhD ThesisPhD Thesis - Research VU Amsterdam, graduation VU Amsterdam

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Abstract

The web-based self-management application Oncokompas was developed with the aim to support cancer survivors in self-management by monitoring health-related quality of life (HRQOL) and cancer-generic and tumour-specific symptoms, providing feedback and information on their personal scores, as well as a personalized overview of supportive care options. The aim of this thesis was to investigate the web-based self-management application Oncokompas among cancer survivors, in terms of efficacy, cost-utility, and reach. Survivors diagnosed with head and neck cancer, colorectal cancer, or breast cancer, or (non-)Hodgkin lymphoma, who were treated with curative intent were invited for participation. Participants were randomised to the intervention group (direct access to Oncokompas), or the wait-list control group, (usual supportive care during the study, and access to Oncokompas after 6 months). In total, 625 cancer survivors were randomised to the intervention group (n = 320) or control group (n = 305). Linear mixed model analyses showed that the primary outcome patient activation was not statistically significant different between the intervention and control group over time. Oncokompas did improve the course of secondary outcomes HRQOL, and tumour-specific symptoms in head and neck cancer, and colorectal cancer and non-Hodgkin lymphoma survivors over time. No effects were found on the other secondary outcomes self-efficacy, personal control, mental adjustment to cancer and perceived efficacy in patient-physician interaction. Secondary analyses suggested that Oncokompas seems to be more effective in cancer survivors with low to moderate self-efficacy, higher personal control, and higher health literacy in terms of HRQOL. Also, cancer survivors with some degree of symptom burden at baseline seems to benefit from Oncokompas, and the intervention effect on head and neck cancer-specific symptoms colorectal cancer-specific symptom weight, became larger when the symptom burden was higher. No specific subgroups were identified that benefit from Oncokompas in terms of patient activation. Of the first 655 respondents of the RCT, 68% was eligible to use Oncokompas (they had access to the internet and an e-mail address). Of the 444 eligible cancer survivors, 201 (45%) agreed to participate in the RCT on Oncokompas. Factors associated with eligibility were male sex, younger age, higher health literacy, higher positive adjustment to cancer, no unmet needs regarding health system information and supportive care, and tumour type. Factors associated with participation were a medium education level, unmet supportive care needs for sexual problems, and a higher belief in control of health by powerful others. Cost-utility analyses were performed from a societal perspective. Mean cumulative costs and QALYs were compared for the intervention and control group. The incremental costs were −€163 (95% CI: −665 to 326), and incremental QALYs were 0.0017 (95% CI, −0.0121 to 0.0155) in the intervention group compared to the control group. The probability that, compared to usual cancer survivorship care, Oncokompas is more effective was 60%, less costly 73%, and both more effective and less costly 47%. Sensitivity analyses showed that incremental costs vary between −€40 and €69, and incremental QALYs vary between −0.0023 and −0.0057. In conclusion, Oncokompas has positive effects on HRQOL and symptom burden, but it did not improve cancer survivors’ knowledge, skills and confidence for self-management. In addition, it was shown that Oncokompas is not more expensive than usual cancer survivorship care. The main study limitations are that the RCT participants were performing relatively well at baseline, and that many analyses were performed for which statistical power was lacking. The efficacy, cost-utility and reach of Oncokompas has been comprehensively investigated in this thesis, and based on these findings, it is recommended to implement Oncokompas as it is likely to be a sustainable and affordable addition to high quality cancer survivorship care.
Original languageEnglish
QualificationPhD
Awarding Institution
  • Vrije Universiteit Amsterdam
Supervisors/Advisors
  • de Leeuw-Verdonck, IM, Supervisor
  • van de Poll-Franse, Lonneke, Supervisor, External person
  • van Uden-Kraan, Cornelia, Co-supervisor, External person
Award date2 Mar 2021
Print ISBNs9789464212037
Publication statusPublished - 2 Mar 2021

Keywords

  • eHealth, self-management, cancer survivorship, supportive care

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