Insights from a randomized controlled trial on a digital lifestyle intervention in non-small cell lung cancer survivors following inpatient rehabilitation.

INTRODUCTION

Rehabilitation can improve health-related quality of life (HRQoL) in non-small cell lung cancer (NSCLC) survivors, but they lack structured aftercare to maintain these gains at home. This study aimed to assess the effectiveness of a co-created digital lifestyle intervention on HRQoL and health-related outcomes in NSCLC survivors following inpatient rehabilitation, alongside a comprehensive process evaluation.

METHODS

This multicenter randomized controlled trial allocated participants (1:1 ratio) to a 12-week self-managed digital lifestyle intervention delivered via a mobile application that targeted physical activity, nutrition, and breathing/relaxation (intervention group) or standard care (control group). The primary outcome was HRQoL and secondary outcomes included physical activity, exercise capacity, risk of low protein intake, appetite, cancer-related fatigue, psychological distress, and enablement. The process evaluation addressed implementation, mechanisms of impact, and contextual factors using app usage data, validated questionnaires, and qualitative interviews.

RESULTS

We included twenty individuals (13 females, mean age 66.9 ± 6.0 years), 30% of the target sample size (n = 66). We found no statistically significant between-group difference for HRQoL at follow-up (adjusted mean difference: 2.89, 95% CI: -17.76 to 23.53, p = 0.77). However, the intervention group showed a statistically significant greater improvement in exercise capacity measured by repetitions in the 1-min sit-to-stand test (adjusted mean difference: -6.64, 95% CI: -12.96 to -0.33, p = 0.04). The process evaluation revealed high acceptability, feasibility, and usability of the intervention, and all participants reported positive perceived effects in at least one lifestyle domain (physical activity, nutrition, breathing/relaxation) that they attributed to the intervention. We identified key participant-level barriers to recruitment, including perceived burden, low digital literacy, and uncertainty about needs after discharge.

CONCLUSION

Recruitment challenges limited statistical power, precluding firm conclusions regarding HRQoL and health-related secondary outcomes. Overall, the findings indicate that tailored digital lifestyle interventions may support survivors in the transition from rehabilitation to long-term self-management.