Digital survivorship care planning through the eyes of cancer survivors: A qualitative analysis of a phase I/II randomized controlled trial

Background: Survivorship care plans (SCPs) help cancer survivors in the transition from active treatment to long-term survivorship. However, traditional SCPs are often underutilized due to their static format, limited institutional resources, and inconsistent follow-up after implementation. The POST-Treatment Health Outcomes of Cancer Survivors (POSTHOC) mobile application increases SCP accessibility, includes real-time tracking of health behaviors, evidence-based resources, and personalized recommendations for lifestyle modifications to enhance patient self-efficacy and independence post-cancer treatment. In a phase I/II clinical trial, use of POSTHOC led to a greater reduction in symptom burden after 12 weeks vs. usual care (James et al.). To further develop digital health tools that best address survivors' needs, the primary aim of this analysis was to explore cancer survivors' experiences with the digital SCP application. Methods: Twenty-nine interviews were conducted with cancer survivors who had recently completed curative treatment and were participants in the POSTHOC trial. Participants were interviewed through a semi-structured format via one-to-one telephone interviews. Recordings were transcribed and coded by two independent coders using NVivo. Main themes and subthemes were refined iteratively to develop the final codebook. Results: Eight key themes emerged: transition from active treatment to long-term survivorship, usefulness of SCPs, care team engagement, monitoring lifestyle behaviors, lifestyle support, digital health, self-management and independence, and financial burden of cancer. Although some participants reported fatigue, uncertainty, and a loss of structured medical support, most described relief with returning to normalcy. Engagement with care teams regarding lifestyle behaviors, such as exercise and nutrition, was valued but inconsistently addressed. Cancer survivors found the SCP application to be beneficial for promoting healthy behaviors and enhancing self-management of symptoms, physical activity, and diet. Suggested features to enhance the digital SCP include opportunities for community building, greater customization, and visual representations of their data. Financial strain emerged as a theme despite not being explicitly probed, highlighting the impact of medical expenses and income disruption. Conclusions: Our findings reinforce the characterization of survivorship as a distinct phase of care, requiring intentional planning and ongoing engagement from healthcare providers to ensure effective supportive care post-treatment. These insights demonstrate the importance of cancer survivorship interventions that are engaging, versatile, and foster both self-management and collaborative care. With further advancements in mobile health technologies, the SCP can become an adaptable, interactive tool that supports cancer survivors in the transition to long-term survivorship.