Iris Kanera

Su 207 Summary SUMMARY The aim of this dissertation was to develop and evaluate the web-based Cancer Aftercare Guide (Kanker NazorgWijzer, KNW), a fully automated and easy accessible self-management intervention that includes lifestyle as well as psychosocial topics and targets survivors of various types of cancer. A reason for developing this comprehensive eHealth intervention is the steady increase of the number of individualswho survive cancer and the need for support during recovery from cancer. Additionally, cancer survivors are at higher risk of (long-term) physical, lifestyle, and psychosocial problems, as well as of developing comorbidities and new cancers. Adopting and maintaining a healthy lifestyle, such as being physically active, consuming a healthy diet, and refraining from smoking, is highly beneficial in reducing the risk of morbidity and mortality, and to improve quality of life. However, many cancer survivors do not adhere to healthy lifestyle recommendations, and they report to be in need of support to (re)gain a healthy lifestyle balance and to manage residual psychosocial problems. Therefore, behavioral support is needed to achieve sustainable lifestyle changes and to cope with psychosocial problems. In the Netherlands, cancer aftercare needs to be improved to offer adequate support for the growing numbers of cancer survivors, as concluded by the Health Council of theNetherlands in 2007. The subsequently developed guideline ‘Recovery from Cancer’ (Herstel na Kanker) pleads for a broad programmatic approach for oncology aftercare including attention for the early recognition of survivors’ psychosocial and lifestyle risks and needs during early cancer survivorship. Moreover, the guideline recommends stimulation of self-management, and applying a stepped care approach as an alternative care delivery system to provide more efficient and personalized aftercare. As the Internet is increasingly used as a source of health-related information, a stand-alone theory-grounded eHealth intervention was suggested to fill this important gap in current cancer aftercare. Advantages of web-based intervention are that they are accessible anytime and anywhere and that they can reach many survivors at once without involvement of health professionals. In the Netherlands, there is a lack of comprehensive web-based cancer aftercare interventions, while those interventions might provide “guided” self-help (i.e., self-management). However, existing research into the effect and usage of multi-behavior web-based interventions for cancer survivors is very scarce. Previous studies into the effectiveness of eHealth interventions included interventions which were mostly less comprehensive, included in-person contact with a health professional, or included a relatively short follow-up period. Thus, it was considered useful to test whether a fully automated multi-behavior cancer aftercare intervention might be effective in changing lifestyle behaviors, such as physical activity, diet behavior, and smoking behavior in the short and long term. Moreover, it was considered useful to study how cancer survivors would use and appreciate a stand-alone online cancer aftercare intervention that addresses a broad range of topics.