‘Ensuring dignified life’: how an app keeps advanced cancer patients out of hospital

Advanced-stage cancer patients could spend half as long in hospital and avoid more than a third of unplanned admissions if a symptom-tracking mobile app is added to their routine care, according to new research from the University of Hong Kong.

The SUPPORT+ mobile app, developed by HKU’s clinical oncology department, provides symptom-management information and a direct line of communication with healthcare staff.

Launched in 2022 with private backing, the app has attracted 76,000 registered users, including 2,800 families with cancer patients.

“Advanced-stage cancer patients often experience severe, worsening symptoms such as pain, shortness of breath, fatigue and loss of appetite … if those problems were not handled early, it could increase the risk of hospitalisation and emergency department visits,” said Clinical Associate Professor of Practice Wendy Chan Wing-lok, who developed the app.

“Repeated hospitalisations will not only affect their quality of life but also cause a strain to their carers and the healthcare system.”

The two-year study, running from January 2023 to February 2025, covered more than 1,200 patients with advanced-stage cancer who had stopped anti-cancer treatment and were receiving community-based palliative care across six public hospitals.

Patients were randomly divided into two groups: one receiving standard care – regular clinic visits and nursing support – and the other receiving standard care plus app support.

App users submitted weekly symptom reports and received automated management advice, with severe symptoms triggering an alert and a nurse follow-up within one to two working days.

Over an 18-week period, the two groups were evaluated on quality of life, self-efficacy, emergency department visits, length of hospital stay and other outcomes.

“For most of our patients with advanced cancer who have stopped anti-cancer treatment, what matters most is not necessarily the length of their remaining life but rather maintaining a comfortable environment and ensuring a dignified, high quality of life moving forward,” Chan said.

Of the 1,214 patients enrolled, 633 contributed complete outcome data.

Patients receiving both standard care and app support reported a slower decline in quality of life and greater confidence in self-care.

About 29 per cent of patients receiving usual care experienced unplanned hospitalisations during the study period, compared with 17 per cent of those receiving app support – a 40 per cent reduction.

The standard-care group stayed in hospital for an average of 7.3 days, while the app-supported group averaged 3.4 days, a 50 per cent difference.

Emergency department visit rates were similar between the two groups.

Chan said she hoped the app could be more widely adopted in public hospitals, but that would require additional resources.

Currently, the team had only three nurses due to limited resources, with care focused on patients who had just begun anti-cancer treatment, as side effects often emerged in the first 12 weeks, she said.

“Our team needs more resources to hire more nurses, and we need experienced ones that are able to answer questions of patients or their carers on the phone and provide the best advice after looking at the medical records,” Chan said.

One carer who benefited from the app, surnamed Chan, is now looking after her 79-year-old mother, who was diagnosed with stomach cancer in March.

Chan recalled struggling to care for her mother after discharge, when she had a feeding tube and a gastric juice drainage tube.

On one occasion, she noticed the gastric juice volume in the collection bag had doubled and was mixed with blood. She contacted the nurse immediately and received clear instructions on when to monitor at home and when to go to hospital.

Beyond medical advice, the nursing team also monitored Chan’s mental well-being, reminding her that caring for herself was essential to caring for her mother.

“Without the app, I would have taken my mum to the emergency department a dozen times,” Chan said.