Iris Kanera

18 Chapter 1 Most of the online programs focused on dealing with psychosocial issues. Kim and Park (2015) included 37 studies regarding web-based self-management interventions for cancer survivors between 2000 to 2014 in their recent review, and they reported that more than half of these studies were published in 2013 and 2014. Overall, the reported effects across all outcome measures such as fatigue, depression, anxiety, and QoL were small to moderate compared to usual care. Another recent review among cancer patients revealed only few rigorously evaluated online interventions reporting mixed effects on QoL and related measures, which indicates that the effectiveness of web-based interventions to achieve increases in QoL remains unclear (McAlpine, Joubert, Martin-Sanchez, Merolli, & Drummond, 2014). Only a few studies investigated the effect of web-based interventions for cancer survivors aimed at lifestyle behavior outcomes. These studies reported that web-based interventions could be effective among cancer survivors to change PA and diet outcomes (Goode, Lawler, Brakenridge, Reeves, & Eakin, 2015; Kuijpers, Groen, Aaronson, & van Harten, 2013; Short et al., 2016). The included behavior change methods were tailored feedback, education, self-monitoring, self-management training, personal exercise programs, and communication (e.g., chat, email) with either health care providers or fellow survivors, and links to other websites. Moreover, a web-based version of a smoking cessation intervention for cancer survivors achieved similar cessation rates compared to the original telephone- delivered intervention, which is in line with the significant effects of web-based smoking cessation interventions for the general population (Emmons et al., 2013; Grahamet al., 2016). Specifically, the number of published multi-behavior interventions that target psychosocial as well as lifestyle issues for cancer survivors is very scares and included relatively short follow-up periods (Bantumet al., 2014; Lee et al., 2014). These latter studies showed increases in PA and mixed results in diet change. The behavior change methods in these multi- behavior interventions included problem solving, action planning, decision-making, and computer tailoring. In sum, insight into the effects on lifestyle-related outcomes of web- based interventions for cancer survivors is still very limited, although promising. Given the growing demand for cancer aftercare and the potential of web-based interventions, it was considered useful to develop and evaluate a fully automated, comprehensive web-based cancer aftercare intervention, the Cancer Aftercare Guide (Kanker Nazorg Wijzer, KNW). The research project Kanker NazorgWijzer (Cancer Aftercare Guide) The present thesis is part of a larger research project. The research project aimed to develop and evaluate a web-based computer-tailored intervention for cancer survivors that fit well with the guideline Recovery from Cancer of the Netherlands Comprehensive Cancer Organisation (2011b). The new program should provide an assessment of needs and risks, and subsequent support for cancer survivors in learning to cope with difficulties and challenges they face after primary treatment completion. The present Ph.D. thesis