At-home Breast Oncology Care Delivered With E-health Solutions

To compare changes in patient activation (assessed by Patient Activation Measure -13) over 1 year among newly diagnosed breast cancer patients between those using the Breast Cancer Treatment Application (BCTA) and those receiving standard care.

Difference in Patient Activation Measure (PAM) scores between pre/post intervention. PAM includes 13 questions, each with 4 response options, summed on a 0-100 scale, with higher scores indicating higher activation level.

Patient activation is defined as the knowledge, skills, and confidence a person has in managing their health and care. Studies have shown that higher patient activation is associated with improved health related quality of life (HRQoL) and lower health care utilization.

Number of participants with PTSD symptoms, such as distress in regards to their Breast Cancer diagnosis and treatment as assessed by IES-R.

Items are rated on a 5-point scale ranging from 0 ("not at all") to 4 ("extremely"). The IES-R yields a total score (ranging from 0 to 88); higher scores mean worse symptoms.

Number of participant with generalized anxiety around their breast cancer diagnosis and treatment assessed by GAD-7.

The GAD-7 is a 7-item scale used to measure or assess the severity of generalized anxiety disorder based on symptoms.

Number of participants with changes in their physical, psychological and social functions during and after their diagnosis and surgery, assessed by the EORTC QLQ-C30.

The EORTC Core Questionnaire (QLQ-C30) includes six clearly distinguishable functioning scales that have been thoroughly tested and validated on an international level and that are available in 110 different language versions. About the functional scale and the global health status, the higher the total score, the better the quality of life; the lower the score in the symptom scale, the better the quality of life.

Number of participants with changes in their quality of life after their breast cancer diagnosis and treatment journey assessed by the EORTC QLQ-BR23.

The survey includes functional scales (body image, sexual functioning, sexual enjoyment, and future perspective) and single item symptoms scales (systemic therapy side effects, breast symptoms, arm symptoms, and upset by hair loss). Questions used 4-point Likert scale (1 'Not at All' to 4 'Very Much'). Scores average and transformed to 0-100 scale. High score for functional scale=high/healthy level of functioning. High score for single item=high level of symptomatology/problems.

Number of participants and their reported identities assessed by the self-identification survey.

Number of participants and their satisfaction with information provided about treatment received assessed by the EORTC QLQ-INFO25.

The provisional 25-item information questionnaire is Questions used 4-point Likert scale (1 'Not at All' to 4 'Very Much'). Scores average and transformed to 0-100 scale. High score for functional scale=higher satisfaction with provided treatment information.

Number of participants and how comfortable they are with the patient educational programs provided throughout the patient's treatment journey, assessed by the heiQ at the beginning and 9 months post diagnosis.

heiQ is a validated, self-reported instrument with 8 domains to comprehensively evaluate patient education program and self-management intervention. Each domain score ranges from 1 to 4; a higher score indicates better outcome.

Number of participants and their experience of cancer care in teams of their receipt of useful and relevant information about cancer, assistance with service navigation, and support from their care team examined with the CEQ-INS half way and end of the study.

CEQ-INS is a self-reported instrument with questions used 4-point Likert scale (1 'Not at All' to 4 'Very Much'). Higher scores correlate with higher patient satisfaction with the information and support provided from their care team.

Number of participants and how frequently they use other e-health applications assessed by the OHA.

The OHA is a self reported questionnaire with an array question (yes, no, unsure) regarding the participants involvement with other e-health applications.

Number of participants and their functional capacity evaluated by the DASI at the beginning of the study.

The Duke Activity Status Index (DASI) is a 12-item questionnaire that utilized self-reported physical work capacity to estimate peak metabolic equivalents (METs) and has been shown to be a valid measurement of functional capacity.

A 25-item tool use to assess participants and the specific impact of result disclosure after genetic testing. The assessment administers 4 point Likert-type questions (never=0 to often=5) regarding how individuals feel after being told their genetic test results.

Distress subscale = Items 1-4, 7 & 8; Uncertainty subscale = Items 9-12, 14-17 & 20; Positive experiences subscale (reverse scored) = Items 5, 6, 18 & 19. Subscales are scored by summing circled numbers

The number of participants and their general cancer genetic knowledge after cancer genetic counseling and multigene panel testing.

Patient satisfaction with the app will be measured by utilizing the Breast Cancer Treatment Application Review Survey. The survey will be administered to participants using the application at the 12-month mark, to better understand any barriers to using the app and which aspects were most useful to patients. The 10 item assessment uses 5-point Likert-type questions (strongly disagree to strongly agree) to assess their experience on the application.

Investigators will measure relative changes in adverse symptom burden using the Functional Assessment Of Cancer Therapy-Endocrine Subscale (FACT-ES) questionnaire. The FACT-ES is a 46-item questionnaire asking participants to report how much they have been impacted by a variety of symptoms on a 5-point scale where 0 = not at all and 4 = very much. Total raw scores range from 0 to 184, with higher scores indicating greater impact from symptoms.

Usability will be assessed using the System Usability Scale (SUS). We wil collect the input of breast cancer patients to the SUS questions, using in-app surveys and will calculate the SUS score. We will assess overall satisfaction with the app by asking users to provide an answer to the question "How likely are you to recommend this product to a friend" on a scale of 0-10.

Participants will be asked to rate their level of distress over the past week on a scale from 0 to 10, where 0 represents no distress and 10 represents extreme distress.

Post-operative measures at one to 10 days after surgery, as assessed by our study-specific post-operative survey. This survey will ask patients on the app to report and rate symptoms that they may experience after surgery, including pain, numbness, fever, shortness of breath, tenderness around the incision site, fatigue, and anxiety.

Number of visits to the breast clinic, as captured by auditing our booking system.

Number of calls and emails to the breast clinic, as captured by auditing the breast triage line and email.

The number of emergency department visits recorded in the National Ambulatory Care Reporting System (NACRS) among ABODE study participants.

The number of unplanned hospital admissions recorded in NACRS for ABODE study participants.

The number of outpatient clinic visits documented in NACRS among ABODE study participants.

Daily step count recorded via Fitbit to assess trends in physical activity levels among study participants. Days without Fitbit data will be excluded from analysis.

Average heart rate recorded during exercise sessions as measured by Fitbit, providing insights into cardiovascular response and fitness levels among study participants. Days without Fitbit data will be excluded from analysis.

Total sleep duration (in hours) per night as recorded by Fitbit, providing insight into distress levels that may affect sleep quality. Days without Fitbit data will be excluded.

The number of hospital admissions recorded in the Discharge Abstract Database (DAD) among ABODE study participants.

Total number of days spent in the hospital per admission, as recorded in the DAD, to assess the duration of inpatient care.

The type of discharge (e.g., home, rehabilitation facility, or readmission) recorded in the DAD, providing insights into patient recovery.

The number of post-surgical complications (e.g., infections, readmissions due to complications) recorded in the DAD, contributing to the assessment of patient recovery.

The length of time from referral to procedure or discharge, as recorded in the Wait Times Information System (TIS), which tracks wait times for surgeries, diagnostic imaging (e.g., MRI, CT), and alternate level of care (ALC) in Ontario hospitals. This measure will assess differences in wait times between study groups, offering insight into system efficiency and access to care.