Limitations
breast cancer
ADVERSE EFFECTS, BREAST CANCER
This study should be considered with the following limitations. First, this study is a single-centered study. Thus, the results of this trial may not be applicable in other settings. Second, we excluded patients undergoing chemotherapy and only included those who had completed preoperative chemotherapy. We applied these selection criteria considering that chemotherapy usually entails a range of adverse effects that could confound the assessment of the effect of mobile community engagement. Third, the data collection rate for distress decreased over time as it relied on self-reporting through the mobile app. Fourth, older patients were excluded in this study because it was not easy for them to perform the study protocols, such as checking app-based weekly distress thermometer questionnaires, based on which the primary outcome was. Although these patients were excluded, the results of our study can still be effective for older patients. Because the mobile community in this study does not require them to submit any reports. The app gathers participants’ daily activities automatically for these patients and gives feedback to enhance daily walking. Fifth, although walking is convenient compared to other forms of exercise and can be recommended to patients with breast cancer without significant burden, our study included walking as the only form of physical activity. Sixth, given the nature of step counts, which are reflective of individual behavioral patterns, it is deemed challenging for them to follow a normal distribution. Therefore, there is a limitation in our study regarding the potential for larger variance in the estimated coefficients. Last, the short follow-up period of the study does not provide evidence of long-lasting impact of peer community engagement on the mental distress and physical activity of breast cancer survivors.