Evaluation of the Effectiveness of Managing Chemotherapy Side Effects Using ePRO and a Standardized Telenursing Program for Cancer Patients

• Standardized Telenursing (Other): Within Smart Cancer Care Plus, predefined criteria are applied to trigger standardized telenursing interventions. When patients report symptoms of Grade 3 or higher severity, or when a scheduled weekly symptom report is not submitted within 48 hours of the designated reporting date, a structured telephone counseling session is initiated. This process is intended to ensure timely clinical follow-up, support appropriate self-management, and prevent the progression of unmanaged adverse events.
• Smart Cancer Care Plus (Other), also known as Smart Caner Care Plus: Smart Cancer Care Plus is a digital platform for patient-reported symptom monitoring and management, developed for individuals receiving chemotherapy. The system enables structured reporting of chemotherapy-related adverse events and provides standardized information regarding the severity grading of symptoms, accompanied by evidence-based self-management strategies. This intervention is intended to promote systematic symptom monitoring and to facilitate timely clinical responses to adverse events.

Primary outcomes

• Quality of life Measured by EORTC QLQ-C30 [12 weeks]: Quality of life will be assessed using the Global Health Status/Quality of Life scale of the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). The score for the Global Health Status/Quality of Life scale ranges from 0 to 100, with higher scores indicating better quality of life.

Secondary outcomes

• Self-management, which will be assessed using the SECD-6-K [6 months]: Self-management will be assessed using the Self-Efficacy for Chronic Disease Scale-6 Item, Korean Version (SECD-6-K). The SECD-6-K consists of 6 items, each rated on a 10-point Likert scale (1-10). The total score ranges from 6 to 60, with higher scores indicating better self-management.
• Self-rated overall health, which will be assessed using EQ-5D-VAS [6 months]: Self-rated overall health will be assessed using the EuroQol Visual Analogue Scale (EQ-5D-VAS). Participants rate their overall health on a visual analogue scale ranging from 0 to 100, where 0 represents the worst imaginable health state and 100 represents the best imaginable health state. Higher scores indicate better self-rated health.
• Adherence to ePROSW [6 months]: Adherence to ePROSW will be assessed by measuring the frequency of app usage over the entire 6-month study period. App adherence is defined as the total number of times participants accessed and used the ePROSW application during the study period.
• Chemotherapy Adherence [6 months]: Chemotherapy adherence will be evaluated by the percentage of planned chemotherapy completed. Adherence will be calculated as the ratio of the administered dose to the planned dose, expressed as a percentage.
• Healthcare Utilization [6 months]: Healthcare utilization will be assessed by the occurrence of unplanned hospital visits during the study period.
• Functional status, which will be assessed using EORTC-QLQ-C30 [6 months]: Functional status will be assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). The functional scales include physical functioning, role functioning, emotional functioning, cognitive functioning, and social functioning. Scores for each scale are linearly transformed to a 0-100 scale, with higher scores indicating better functioning.
• Symptom severity, which will be assessed using EORTC-QLQ-C30 [6 months]: Symptom severity will be assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30). The symptom scales include fatigue, nausea and vomiting, pain, dyspnea, insomnia, appetite loss, constipation, diarrhea, and financial difficulties. Scores for each symptom scale are linearly transformed to a 0-100 scale, with higher scores indicating greater symptom severity (worse outcome).
• Satisfaction, which will be assessed using system usability scale [6 months]: User satisfaction with the system will be assessed using the System Usability Scale (SUS), a validated 10-item questionnaire. Each item is rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). The total SUS score is calculated by multiplying the sum of item scores by 2.5, resulting in a range of 0 to 100, where higher scores indicate greater satisfaction (better usability).

Sex: All, ages: 19 Years to any

Inclusion Criteria:

* Adults aged 19 years or older
* Diagnosed with early or advanced gastric, lung, breast, or colon cancer
* Starting first-cycle chemotherapy with a new anticancer agent
* Able to use a smartphone without difficulty
* Willing to provide informed consent to participate in the study

Exclusion Criteria:

* Individuals who have difficulty communicating due to cognitive impairment, visual impairment, hearing impairment, or other reasons
* Individuals who cannot read, write, or understand Korean
* Other individuals deemed inappropriate for participation by the investigators

• Sujin Koh, Doctor of Philoshophy, Principal investigator, Ulsan University Hospital
• Keun Soek Lee, Doctor of Philoshophy, Principal investigator, National Cancer Center, Korea
• Sung Hoon Sim, Doctor of Philoshophy, Principal investigator, National Cancer Center, Korea
• Ji Hyung Hong, Doctor of Philoshophy, Principal investigator, National Cancer Center, Korea
• Sun Jin Sym, Doctor of Philoshophy, Principal investigator, Gachon University Gil Medical Center
• Jung Hun Kang, Doctor of Philoshophy, Principal investigator, Gyeongsang National University Hospital
• Seong Hoon Shin, Doctor of Philoshophy, Principal investigator, Kosin University Gospel Hospital