Recently, the number of web-based education programs and applications in the field of health has increased in parallel with the developments in technology. In the first stage of our study, a needs analysis was conducted for patients who received systemic chemotherapy for a web-based education program design. The results of the study indicated that the vast majority of the patients used the Internet to get health information. In a study, it was found that the most common source of information used by patients other than healthcare professionals was the Internet . These findings reveal the importance of web-based education programs and the necessity of developing and disseminating websites that contain evidence-based information.
The Internet is an important source that many people around the world use to get health information. Internet users prefer the Internet for obtaining information about diseases, treatments, seeking new or alternative treatment options, or searching for support groups [13, 30, 36]. It was determined that surviving patients with oral cancer wanted to get information especially about symptom management and were willing to use a web-based education program to increase their quality of life . Tele-health applications are a promising method for the future of self-management . The need for seeking information and symptom management online has increased, especially due to pandemic-related fear, anxiety, and social isolation worldwide.
The difference between the intervention and control groups was found to be significant according to symptom levels. Initial symptom intensities of the patients in both the intervention and control groups were found to be higher. The patients were included in the study after the second cycle of chemotherapy treatment, during the period when the symptoms were most intense. The problems related to the symptoms experienced by the intervention and control group patients decreased over time. This may have been due to factors, such as the decrease in the side effects of chemotherapy over time, the improvement in patients' coping skills, and the usefulness of the web-based education program in the intervention group. In the study, the symptom distress of the control group patients was found to be higher than that of the intervention group patients. According to these results, the web-based education program had positive effects on the symptom intensities of the patients in the intervention group.
It was found that oral mucositis, diarrhea, constipation, nausea, pain, fatigue, insomnia symptoms, unplanned hospital presentations, and hospitalizations of patients with cancer who received oral chemotherapy and whose symptoms were examined once a week according to the home care nursing model decreased significantly compared to patients with cancer who received standard care . However, home follow-up practices cannot be conducted effectively due to an inadequate number of healthcare professionals and high patient population and costs. For this reason, it is important to disseminate easily accessible and economical web-based education programs. It was determined that a 12-week individualized education program with online support was effective in preventing cancer-induced fatigue, reducing anxiety, and increasing health-related quality of life . It has been shown that follow-ups conducted with web support reduce the symptom burden [6, 26, 27], and pain and depression symptoms of patients .
In a study examining the effects of standard education and tele-monitoring on patient outcomes, it was stated that standard education was effective in symptoms such as pain, anxiety, and depression only in the first week and that education and tele-monitoring provided more and long-term improvement in patient outcomes . In patients with advanced non-small-cell lung cancer treated with chemotherapy, three months of web-based health education provided a significant reduction in the first 10 important symptoms according to the Symptom Distress Scale . The web-based education program and the availability of health professionals at any time are precious in symptom management and alleviating the symptom burden.
It was determined that there was a significant difference between the intervention and control groups in terms of quality of life. In the web-based study of Ruland et al. , the self-efficacy and health-related quality of life scores of patients in the control group decreased over time. Web-based education was found to affect on increasing the quality of life in patients with breast cancer , and a web-based health education implemented for three months had a significant effect on global quality of life and emotional functions in patients with lung cancer receiving chemotherapy treatment .
Our study results indicated that while the functional health status of the intervention and control group patients was better at the beginning, this situation deteriorated over time. The time-dependent difference between them was statistically significant. This result has been due to factors such as the progression of the disease over time and burnout observed in the patient and their relatives. It was found that the patients in the control group had more symptoms. Additionally, it was observed that the global health status and quality of life of the intervention group patients were better than those of the control group. The web-based education program has contributed to this outcome.
It was found that there was no difference between the intervention and control groups according to the self-efficacy status. Some studies have shown that the self-efficacy levels of patients with breast cancer do not change before and after chemotherapy treatment , and 30–60% of them have high levels of distress for six months after the completion of their treatment . Different factors, such as chronic characteristics of cancer, disease, and treatment-related symptom burden and psychological problems, and low socioeconomic status have affected the level of self-efficacy. It is recommended to develop and expand programs that can be implemented face-to-face or online to increase the level of self-efficacy in patients with cancer.
There was no difference between the intervention and control groups according to the depression status. While there was a mild level of depression in the intervention and control group patients at the beginning, the symptoms of depression decreased during the follow-up period. Although there was no difference in the level of depression between the intervention and control groups in the study findings, the decrease in depression levels in the intervention group, which included advanced-stage patients with high metastasis, despite the fact that the treatment and symptom burden, can be considered a significant clinical finding. It was determined that there was no significant difference between emotional functions, social functions, and depression, and fatigue levels in the initial, 6th-month, and 12th-month measurements of the effect of web-based interventions in patients with cancer . It was found that the web-based cognitive rehabilitation intervention in patients with cancer did not yield a significant effect on distress, quality of life, and perception of illness during the three-month follow-up period . The web-based education program has positive effects on depression and that these findings be promising.