Insights from a randomized controlled trial on a digital lifestyle intervention in non-small cell lung cancer survivors following inpatient rehabilitation

Introduction: Rehabilitation can improve health-related quality of life (HRQoL) in non-small cell lung cancer (NSCLC) survivors, but they lack structured aftercare to maintain these gains at home. This study aimed to assess the effectiveness of a co-created digital lifestyle intervention on HRQoL and health-related outcomes in NSCLC survivors following inpatient rehabilitation, alongside a comprehensive process evaluation. Methods: This multicenter randomized controlled trial allocated participants (1:1 ratio) to a 12-week self-managed digital lifestyle intervention delivered via a mobile application that targeted physical activity, nutrition, and breathing/relaxation (intervention group) or standard care (control group). The primary outcome was HRQoL and secondary outcomes included physical activity, exercise capacity, risk of low protein intake, appetite, cancer-related fatigue, psychological distress, and enablement. The process evaluation addressed implementation, mechanisms of impact, and contextual factors using app usage data, validated questionnaires, and qualitative interviews. Results: We included twenty individuals (13 females, mean age 66.9 ± 6.0 years), 30% of the target sample size (n = 66). We found no statistically significant between-group difference for HRQoL at follow-up (adjusted mean difference: 2.89, 95% CI: –17.76 to 23.53, p = 0.77). However, the intervention group showed a statistically significant greater improvement in exercise capacity measured by repetitions in the 1-min sit-to-stand test (adjusted mean difference: –6.64, 95% CI: –12.96 to –0.33, p = 0.04). The process evaluation revealed high acceptability, feasibility, and usability of the intervention, and all participants reported positive perceived effects in at least one lifestyle domain (physical activity, nutrition, breathing/relaxation) that they attributed to the intervention. We identified key participant-level barriers to recruitment, including perceived burden, low digital literacy, and uncertainty about needs after discharge. Conclusion: Recruitment challenges limited statistical power, precluding firm conclusions regarding HRQoL and health-related secondary outcomes. Overall, the findings indicate that tailored digital lifestyle interventions may support survivors in the transition from rehabilitation to long-term self-management.