Skip to main content
Log in

The use of mobile technology and peer navigation to promote adolescent and young adult (AYA) cancer survivorship care: results of a randomized controlled trial

  • Original Research
  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

Adolescent and young adult (AYA) cancer survivors experience unique barriers that compromise receipt of survivorship care; therefore, development of innovative educational interventions to improve rates of AYA survivorship care is needed. The efficacy of text-messaging and peer navigation interventions was compared to standard-of-care survivorship educational materials to increase AYAs’ (1) late effects knowledge and (2) knowledge, attitudes, and self-efficacy towards seeking survivor-focused care.

Methods

This was a three-armed, prospective, randomized controlled trial with one control group and two intervention groups. The control group received current standard-of-care educational materials. One intervention group participated in a text-messaging program, and the second participated in a peer navigator program. Participants completed pre- and post-intervention questionnaires. Study outcome variables were quantified using Fisher exact tests, two-sample t tests, exact McNemar tests, conditional logistic regression models, and analysis of covariance.

Results

Seventy-one survivors completed the study (control n = 24; text-messaging n = 23; peer navigation n = 24). Late effects knowledge was high at baseline for all groups. The text-messaging group had increased survivorship care knowledge compared to the control group (p < 0.05); the peer navigation group had increased survivorship care self-efficacy compared to the control group; p < 0.05. Both intervention groups showed increased attitudes towards seeking survivor-focused care compared to the control group (text-messaging p < 0.05; peer navigation p < 0.05).

Conclusions

Each intervention demonstrated significant benefits compared to the control group.

Implications for Cancer Survivors

Given the preliminary effectiveness of both interventions, each can potentially be used in the future by AYA cancer survivors to educate and empower them to obtain needed survivorship care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Howlader N NA, Krapcho M, Garshell J, Neyman N, Altekruse SF, Kosary CL, Yu M, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Lewis DR, Chen HS, Feuer EJ, Cronin KA, editors. SEER Cancer Statistics Review, 1975-2010. In April 2013 Edition. https://seer.cancer.gov/archive/csr/1975_2010/. National Cancer Institute; 2013. Accessed 20 Sept 2017

  2. Oeffinger KC, Hudson MM. Long-term complications following childhood and adolescent cancer: foundations for providing risk-based health care for survivors. CA Cancer J Clin. 2004;54:208–36.

    Article  Google Scholar 

  3. Mertens AC, Liu Q, Neglia JP, Wasilewski K, Leisenring W, Armstrong GT, et al. Cause-specific late mortality among 5-year survivors of childhood cancer: the Childhood Cancer Survivor Study. J Natl Cancer Inst. 2008;100:1368–79.

    Article  Google Scholar 

  4. Oeffinger KC, Mertens AC, Hudson MM, Gurney JG, Casillas J, Chen H, et al. Health care of young adult survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. Ann Fam Med. 2004;2:61–70.

    Article  Google Scholar 

  5. Nathan PC, Greenberg ML, Ness KK, Hudson MM, Mertens AC, Mahoney MC, et al. Medical care in long-term survivors of childhood cancer: a report from the childhood cancer survivor study. J Clin Oncol. 2008;26:4401–9.

    Article  Google Scholar 

  6. Geenen MM, Cardous-Ubbink MC, Kremer LC, et al. Medical assessment of adverse health outcomes in long-term survivors of childhood cancer. JAMA. 2007;297:2705–15.

    Article  CAS  Google Scholar 

  7. Hudson MM, Mertens AC, Yasui Y, Hobbie W, Chen H, Gurney JG, et al. Health status of adult long-term survivors of childhood cancer: a report from the Childhood Cancer Survivor Study. JAMA. 2003;290:1583–92.

    Article  CAS  Google Scholar 

  8. Linabery AM, Ross JA. Childhood and adolescent cancer survival in the US by race and ethnicity for the diagnostic period 1975-1999. Cancer. 2008;113:2575–96.

    Article  Google Scholar 

  9. Mariotto AB, Rowland JH, Yabroff KR, Scoppa S, Hachey M, Ries L, et al. Long-term survivors of childhood cancers in the United States. Cancer Epidemiol Biomark Prev. 2009;18:1033–40.

    Article  Google Scholar 

  10. In Hewitt M, Weiner SL, Simone JV, editors. Childhood cancer survivorship: improving care and quality of life. Washington (DC); 2003.

  11. Kirchhoff AC, Lyles CR, Fluchel M, Wright J, Leisenring W. Limitations in health care access and utilization among long-term survivors of adolescent and young adult cancer. Cancer. 2012;118:5964–72.

    Article  Google Scholar 

  12. Medicine Io, Council NR. From cancer patient to cancer survivor: lost in transition. Washington, DC: The National Academies Press; 2006.

    Google Scholar 

  13. Smits-Seemann RR, Kaul S, Zamora ER, Wu YP, Kirchhoff AC. Barriers to follow-up care among survivors of adolescent and young adult cancer. J Cancer Surviv. 2017;11:126–32.

    Article  Google Scholar 

  14. Zebrack BJ, Eshelman DA, Hudson MM, Mertens AC, Cotter KL, Foster BM, et al. Health care for childhood cancer survivors: insights and perspectives from a Delphi panel of young adult survivors of childhood cancer. Cancer. 2004;100:843–50.

    Article  Google Scholar 

  15. Group CsO. Establishing and enhancing services for childhood cancer survivors: long-term follow-up program resource guide. Monrovia: Children’s Oncology Group; 2007.

    Google Scholar 

  16. Landier W, Bhatia S, Eshelman DA, Forte KJ, Sweeney T, Hester AL, et al. Development of risk-based guidelines for pediatric cancer survivors: the children’s oncology group long-term follow-up guidelines from the children’s oncology group late effects committee and nursing discipline. J Clin Oncol. 2004;22:4979–90.

    Article  Google Scholar 

  17. Berland GK, Elliott MN, Morales LS, Algazy JI, Kravitz RL, Broder MS, et al. Health information on the Internet: accessibility, quality, and readability in English and Spanish. JAMA. 2001;285:2612–21.

    Article  CAS  Google Scholar 

  18. Stinson JN, White M, Breakey V, Chong AL, Mak I, Low KK, et al. Perspectives on quality and content of information on the Internet for adolescents with cancer. Pediatr Blood Cancer. 2011;57:97–104.

    Article  Google Scholar 

  19. Walsh TM, Volsko TA. Readability assessment of Internet-based consumer health information. Respir Care. 2008;53:1310–5.

    PubMed  Google Scholar 

  20. RapidSMS. In https://www.rapidsms.org. 2013. Accessed 20 Sept 2017

  21. Lenhart A Teens and mobile phones over the past five years: Pew Internet looks back. In. http://www.pewinternet.org/2009/08/19/teens-and-mobile-phones-over-the-past-five-years-pew-internet-looks-back/. Pew Research Center; 2009. Accessed 20 Sept 2017

  22. Sharifi M, Dryden EM, Horan CM, Price S, Marshall R, Hacker K, et al. Leveraging text messaging and mobile technology to support pediatric obesity-related behavior change: a qualitative study using parent focus groups and interviews. J Med Internet Res. 2013;15:e272.

    Article  Google Scholar 

  23. Lester R, Karanja S. Mobile phones: exceptional tools for HIV/AIDS, health, and crisis management. Lancet Infect Dis. 2008;8:738–9.

    Article  Google Scholar 

  24. Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, et al. Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet. 2010;376:1838–45.

    Article  Google Scholar 

  25. Mbuagbaw L, Bonono-Momnougui RC, Thabane L. Considerations in using text messages to improve adherence to highly active antiretroviral therapy: a qualitative study among clients in Yaounde, Cameroon. HIV AIDS (Auckl). 2012;4:45–50.

    Google Scholar 

  26. Niederhauser V, Johnson M, Tavakoli AS. Vaccines4Kids: assessing the impact of text message reminders on immunization rates in infants. Vaccine. 2015;33:2984–9.

    Article  Google Scholar 

  27. Stockwell MS, Kharbanda EO, Martinez RA, Vargas CY, Vawdrey DK, Camargo S. Effect of a text messaging intervention on influenza vaccination in an urban, low-income pediatric and adolescent population: a randomized controlled trial. JAMA. 2012;307:1702–8.

    Article  CAS  Google Scholar 

  28. Casillas J, Goyal A, Bryman J, Alquaddoomi F, Ganz PA, Lidington E, et al. Development of a text messaging system to improve receipt of survivorship care in adolescent and young adult survivors of childhood cancer. J Cancer Surviv. 2017;11:505–16.

    Article  Google Scholar 

  29. de Jongh T, Gurol-Urganci I, Vodopivec-Jamsek V, et al. Mobile phone messaging for facilitating self-management of long-term illnesses. Cochrane Database Syst Rev. 2012;12:CD007459.

    PubMed  Google Scholar 

  30. Fjeldsoe BS, Marshall AL, Miller YD. Behavior change interventions delivered by mobile telephone short-message service. Am J Prev Med. 2009;36:165–73.

    Article  Google Scholar 

  31. Klasnja P, Hartzler A, Powell C, Pratt W. Supporting cancer patients’ unanchored health information management with mobile technology. AMIA Annu Symp Proc. 2011;2011:732–41.

    PubMed  PubMed Central  Google Scholar 

  32. McCann L, Maguire R, Miller M, Kearney N. Patients’ perceptions and experiences of using a mobile phone-based advanced symptom management system (ASyMS) to monitor and manage chemotherapy related toxicity. Eur J Cancer Care (Engl). 2009;18:156–64.

    Article  CAS  Google Scholar 

  33. UCSF Health eHeart Study. In https://www.health-eheartstudy.org. 2018. Accessed 23 Aug 2018

  34. Investigators CCSSCP. Principal investigator report. In: CCSS Investigator Meeting. Memphis, TN: CCSS; 2015.

  35. Freeman HP, Rodriguez RL. History and principles of patient navigation. Cancer. 2011;117:3539–42.

    Article  Google Scholar 

  36. Bush ML, Kaufman MR, Shackleford T. Adherence in the cancer care setting: a systematic review of patient navigation to traverse barriers. J Cancer Educ. 2018;33:1222–9.

    Article  Google Scholar 

  37. Gerber DE, Hamann HA, Santini NO, Abbara S, Chiu H, McGuire M, et al. Patient navigation for lung cancer screening in an urban safety-net system: protocol for a pragmatic randomized clinical trial. Contemp Clin Trials. 2017;60:78–85.

    Article  Google Scholar 

  38. Li Y, Carlson E, Villarreal R, et al. Cost-effectiveness of a patient navigation program to improve cervical cancer screening. Am J Manag Care. 2017;23:429–34.

    PubMed  Google Scholar 

  39. Vora S, Lau JD, Kim E, Sim SC, Oster A, Pong P. Patient navigation program for colorectal cancer screening in Chinese Americans at an Urban Community Health Center: lessons learned. J Health Care Poor Underserved. 2017;28:887–95.

    Article  Google Scholar 

  40. Berezowska A, Passchier E, Bleiker E. Evaluating a professional patient navigation intervention in a supportive care setting. Support Care Cancer. 2019.

  41. Nickell A, Stewart SL, Burke NJ, Guerra C, Cohen E, Lawlor C, et al. Engaging limited English proficient and ethnically diverse low-income women in health research: a randomized trial of a patient navigator intervention. Patient Educ Couns. 2019;102:1313–23.

    Article  Google Scholar 

  42. Bleyer A OLM, Barr R, Ries LAG, editors. Cancer epidemiology in older adolescents and young adults 15 to 29 years of age, Including SEER incidence and survival: 1975-2000. In: Institute NC (ed) Bethesda, MD; 2006.

  43. Adolescent and Young Adult Oncology Progress Review Group. Closing the gap: research and cancer care imperatives for adolescents and young adults with cancer (NIH Publication No. 06-6067). Department of Health and Human Services, National Institutes of Health, National Cancer Institute, LIVESTRONG Young Adult Alliance. Bethesda, MD; 2006. Accessed May 6, 2019. https://www.cancer.gov/types/aya/research/ayao-august-2006.pdf

  44. Doig GS, Simpson F. Randomization and allocation concealment: a practical guide for researchers. J Crit Care. 2005;20:187–91 discussion 191-183.

    Article  Google Scholar 

  45. UCLA Jonsson Comprehensive Cancer Center. In https://cancer.ucla.edu/. 2014. Accessed 23 Aug 2018

  46. Prochaska JO, DiClemente CC. Stages and processes of self-change of smoking: toward an integrative model of change. J Consult Clin Psychol. 1983;51:390–5.

    Article  CAS  Google Scholar 

  47. Rollnick SMW. What is motivational interviewing? Behav Cogn Psychother. Oct 1995;23:325–34.

    Article  Google Scholar 

  48. Cain SM, Moore R, Sturm L, Mason T, Fuhrman C, Smith R, et al. Clinical assessment and management of general surgery patients via synchronous telehealth. J Telemed Telecare. 2017;23:371–5.

    Article  Google Scholar 

  49. Casillas J, Syrjala KL, Ganz PA, Hammond E, Marcus AC, Moss KM, et al. How confident are young adult cancer survivors in managing their survivorship care? A report from the LIVESTRONG™ Survivorship Center of Excellence Network. J Cancer Surviv. 2011;5(4):371–81.

    Article  Google Scholar 

  50. Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale: L. Erlbaum Associates; 1988.

    Google Scholar 

  51. Rempel GR, Ballantyne RT, Magill-Evans J, Nicholas DB, Mackie AS. Texting teens in transition: the use of text messages in clinical intervention research. JMIR Mhealth Uhealth. 2014;2:e45.

    Article  Google Scholar 

  52. Oeffinger KC, Ford JS, Moskowitz CS, Diller LR, Hudson MM, Chou JF, et al. Breast cancer surveillance practices among women previously treated with chest radiation for a childhood cancer. JAMA. 2009;301:404–14.

    Article  CAS  Google Scholar 

  53. Landier W, Skinner R, Wallace WH, Hjorth L, Mulder RL, Wong FL, et al. Surveillance for late effects in childhood cancer survivors. J Clin Oncol. 2018;36:2216–22.

    Article  Google Scholar 

  54. Devine KA, Viola AS, Coups EJ, Wu YP. Digital health interventions for adolescent and young adult cancer survivors. JCO Clin Cancer Inform. 2018;2(2):1–15. https://doi.org/10.1200/CCI.17.00138.

    Article  Google Scholar 

  55. Corbett T, Singh K, Payne L, Bradbury K, Foster C, Watson E, et al. Understanding acceptability of and engagement with web-based interventions aiming to improve quality of life in cancer survivors: a synthesis of current research. Psychooncology. 2018 Jan;27(1):22–33. https://doi.org/10.1002/pon.4566.

    Article  PubMed  Google Scholar 

  56. Kopp LM, Gastelum Z, Guerrero CH, Howe CL, Hingorani P, Hingle M. Lifestyle behavior interventions delivered using technology in childhood, adolescent, and young adult cancer survivors: a systematic review. Pediatr Blood Cancer. 2017 Jan;64(1):13–7. https://doi.org/10.1002/pbc.26166.

    Article  PubMed  Google Scholar 

  57. Bradford NK, Chan RJ. Health promotion and psychological interventions for adolescent and young adult cancer survivors: a systematic literature review. Cancer Treat Rev. 2017 Apr;55:57–70. https://doi.org/10.1016/j.ctrv.2017.02.011.

    Article  PubMed  Google Scholar 

  58. Hahn EE, Wu YL, Munoz-Plaza CE, Garcia Delgadillo J, Cooper RM, Chao CR. Use of recommended posttreatment services for adolescent and young adult survivors of Hodgkin lymphoma. Cancer. 2019 May 1;125(9):1558–67. https://doi.org/10.1002/cncr.31953.

    Article  PubMed  Google Scholar 

  59. Prochaska JJ, Coughlin SS, Lyons EJ. Social media and mobile technology for cancer prevention and treatment. Am Soc Clin Oncol Educ Book. 2017;37:128–37. https://doi.org/10.14694/EDBK_173841.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Sirintrapun SJ, Lopez AM. Telemedicine in cancer care. Am Soc Clin Oncol Educ Book. 2018;38:540–5. https://doi.org/10.1200/EDBK_200141.

    Article  PubMed  Google Scholar 

  61. Tercyak KP, Donze JR, Prahlad S, Mosher RB, Shad AT. Identifying, recruiting, and enrolling adolescent survivors of childhood cancer into a randomized controlled trial of health promotion: preliminary experiences in the Survivor Health and Resilience Education (SHARE) Program. J Pediatr Psychol. 2006;31:252–61.

    Article  Google Scholar 

  62. Butterfield PG, Yates SM, Rogers B, Healow JM. Overcoming subject recruitment challenges: strategies for successful collaboration with novice research agencies. Appl Nurs Res. 2003;16:46–52.

    Article  Google Scholar 

  63. Bhatia S, Gibson TM, Ness KK, Liu Q, Oeffinger KC, Krull KR, et al. Childhood cancer survivorship research in minority populations: a position paper from the Childhood Cancer Survivor Study. Cancer. 2016 Aug 1;122(15):2426–39. https://doi.org/10.1002/cncr.30072.

    Article  PubMed  PubMed Central  Google Scholar 

  64. Cantrell MA, Conte T, Hudson M, Shad A, Ruble K, Herth K, et al. Recruitment and retention of older adolescent and young adult female survivors of childhood cancer in longitudinal research. Oncol Nurs Forum. 2012;39:483–90.

    Article  Google Scholar 

  65. Kadan-Lottick NS, Robison LL, Gurney JG, Neglia JP, Yasui Y, Hayashi R, et al. Childhood cancer survivors’ knowledge about their past diagnosis and treatment: Childhood Cancer Survivor Study. JAMA. 2002;287:1832–9.

    Article  Google Scholar 

  66. Syed IA, Klassen AF, Barr R, Wang R, Dix D, Nelson M, et al. Factors associated with childhood cancer survivors’ knowledge about their diagnosis, treatment, and risk for late effects. J Cancer Surviv. 2016;10:363–74.

    Article  Google Scholar 

Download references

Acknowledgments

The authors would like to acknowledge Andrew Shanholtzer and the organization Padres Contra El Cáncer for their contributions to this study.

Funding

This research was supported by the Administrative Supplement NOT-CA-10-026 from the National Cancer Institute (Recipient: Dr. Jacqueline Casillas; Judy Gasson PhD). Dr. Crespi was also supported by CA016042 from the National Cancer Institute.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Jacqueline N. Casillas.

Ethics declarations

This study was approved by the UCLA Institutional Review Board (UCLA IRB#11-002228).

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOCX 1092 kb)

ESM 2

(DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Casillas, J.N., Schwartz, L.F., Crespi, C.M. et al. The use of mobile technology and peer navigation to promote adolescent and young adult (AYA) cancer survivorship care: results of a randomized controlled trial. J Cancer Surviv 13, 580–592 (2019). https://doi.org/10.1007/s11764-019-00777-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-019-00777-7

Keywords

Navigation