Mobile platform to empower cancer patients with fatigue

About Cancer Related Fatigue
The European Association for Palliative Care (EAPC) has produced a working definition of CRF, describing it as “a subjective feeling of tiredness, weakness or lack of energy”. CRF stands out from regular fatigue in its erratic onset and prolonged recovery periods. It has a co-morbidity with depression and anxiety of 30%. The US National Institutes of Health has identified treatment of CRF as a priority for advancing the care of cancer patients.

Many millions of (former) cancer patients suffer from CRF. Over 2 million European cancer patients (>50%) experience crippling fatigue as side effect of their illness and the onerous treatments involved. In 30% of cancer survivors severe fatigue persists for up to ten years and has a considerable impact on a patient's life. These numbers are expected to increase in the next decades as the number of people surviving cancer is increasing.

Mission Tired of Cancer BV
Tired of Cancer’s mission is to deliver an effective self-management tool for Cancer-Related Fatigue (CRF) and increase of quality of life (QoL) of all cancer patients that feel fatigued, independent the type of cancer or their prognosis. Tired of Cancer’s digital medicine, the Untire app is positioned to reach millions of clinically fatigued cancer patients. This project –mPOWER – is geared towards the commercialization of our therapy-in-an-app to realize our envisioned impact on Europe and on the rest of the world.

Insights gained in decades of academic research by the world leading Helen Dowling Institute for psycho-oncology have proven to be directly portable to effective online treatment protocols. At Tired of Cancer, we are driven by increase the reach of this therapy for CRF

Overall objectives mPower
Untire has three elements to generate fast growth and to address the problem of cancer related fatigue.
1. Untire will be proven effective.
2. Untire is easily accessible for any end user with a smartphone or tablet
3. The tool will be integrated into clinical practice to provide specialists with treatments

Within mPOWER, Tired of Cancer sets out to finalize the transformation of cognitive behavioural therapy (current best practice) into Untire and implement a market launch in major markets in Europe. We have identified four specific objectives in the route to a successful market entry. The main objectives are:
(1) to perform a clinical validation study – corroborating the efficacy shown in other studies
(2) to innovate Untire to personalized clinical implementation of the digital tool
(3) to pilot and implement four business models
(4) to launch Untire in Europe (Spain, Germany, and UK)

Conclusion of the action:
At the end of the mPOWER period we have made important steps towards Tired of Cancer’s mission; to help as many cancer patients as possible worldwide improve their energy levels and regain their quality of life.

We gained substantial knowledge about implementing a digital therapeutic tool in various languages and various markets. With hindsight we can say that developing, doing research, translating and implementing into various countries is maybe too ambitious (considering budget and timeframe). Also considering that the world of digital therapeutic is changing all the time, as it’s not mature yet. We know from our fast-growing network that all similar projects meet the same challenges.

We reached almost all of the goals of mPOWER and more important; we have grown from a startup into a scale up business able to attract important partners for a sustainable future and make impact in the lives of cancer patients struggling with cancer related fatigue.

From the beginning of mPower until now (May 2017 - May 2019) we have:
- Set up the research protocol together with University of Groningen (NL)
- Finalized all medical-ethical assessment committee reports and approval for participating countries
- Developed a worldwide recruiting strategy and roll out plan by social media
- Recruited participants for the study
- Constantly improved process of recruiting by social media
- Finalized a feasibility study
- Improved Untire after feasibility study
- Improved accessible language
- Improved learning methods
- Improved readability
- Improved intuitive and behavioral design
- Improved onboarding process
- Improved navigationStarted first sales in Google Play and App stores (untire.me)
- Concrete set up of cooperations with dissemination channels in The Netherlands.
- Review of European dissemination channels.
- Development of worldwide marketing and communication plans
- Created private communities, Dutch and English
- Generated PR in various on-line and off-line ways

Overview of the exploitations and dissemination of results:
We used a limited budget for (online) marketing activities. We have experimented with costs-per-click and conversion rates. For example, we see that recruiting Dutch patients more cost-effective than acquisition of users from other countries.
We have actively established partnerships with stakeholders, including published articles on fatigue in combination with Untire.
A lot of presentations were given to doctors, nurses, etc. Untire was presented, but also the importance of creating more awareness for CR.
In general awareness about CRF has increased, which leads to a higher overall uptake in downloads. Every month we receive more requests for flyers from healthcare professionals from all over Europe.
We see a growing private community sharing their personal experiences regarding fatigue and coping with their disease in general.

Cancer is a devastating disease with physical, emotional and psychological impact. In 2012, it affected over 14 million people worldwide of which approximately 4 million in Europe. These numbers will double in the next two decades. CRF is one of the most prevalent and distressing long-term consequences of cancer, irrespective of the subtype of the malignancy.

The economic impact of CRF is substantial. A recent European health economics study has indicated that over 75% of cancer patients who were employed changed their employment status and 28% stopped working altogether. A US study indicates that 30% of patients reduced their work hours (with an overall average of 4 days per month per patient). A third of all cancer patients’ experiences fatigue daily and have significantly affected daily routines.

Therefore, offering a solution for cancer patients suffering from fatigue will have a significant impact on the patients’ lives and on society as well.

The impact of the Untire App:
- The first-in-kind effective solution for CRF
- Proven effectivity (official publication will be later in 2019)
- An expected cost reduction per patient
- First steps of implementation by healthcare professionals and other stakeholders

The next step is full embedding in the healthcare eco system. We also see an uptake of interest from third potential partners who are interested in implementing the Untire app into their social economical and healthcare initiatives. E.g. we work together with a reintegration company. As we’re having discussions with companies about Untire’s benefit for employees, employers and costs, we are confident that with a new section about (returning to) work there are higher chances to establish partnerships.

Periodic Reporting for period 2 - mPOWER (Mobile platform to empower cancer patients with fatigue)

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