We Don’t Need Another App
Why Digital Tools Fail Survivors and How We Can Build Better
After my recent piece on digital tools in survivorship, I invited Dr. John Librett, PhD, MPH to contribute to today’s post. He has spent more than two decades working at the exact intersection I wrote about — survivorship, behavioral science, and digital health.
John is a cancer survivor himself, a clinical epidemiologist, entrepreneur, and the Chief Science Officer at Survivor Healthcare, where he leads efforts to integrate evidence-based medicine, digital tools, and real-world data to improve survivor outcomes. He has advised organizations ranging from the White House to the World Health Organization, and he has built clinical programs and policy initiatives that shape how survivorship care is delivered today.
I asked him to share his perspective because he brings something rare: scientific rigor, policy experience, and lived experience all in one voice. His response was honest, insightful, and exactly the viewpoint this conversation needs.
Guest Perspective
By: Dr. John Librett, PhD, MPH, Chief Science Officer, Survivor Healthcare
Dr. Guida’s article describes a meeting of oncologists, digital health experts, and survivors who were all asking the same question: Can Digital Tools Help Survivors Live Better?
As a cancer survivor, clinical epidemiologist, health policy scientist, and entrepreneur, that question defines both my work and my lived experience. Dr. Guida’s article echoes a truth: technology adoption follows need, not novelty.
During my own cancer experience, I saw firsthand the power of digital tools, designed around the correct need. My cancer related fatigue (CRF) was misdiagnosed as depression. Fortunately, normative patient-reported outcomes that measure CRF and mental health as separate domains, revealed I had significant CRF, not depression. This digitally supported insight reframed my treatment approach, helping me to live better.
Cancer-related fatigue and depression can look very similar from the outside, but they are not the same problem. CRF is a whole-body exhaustion driven by cancer and its treatments that is not fixed by rest, whereas depression is primarily a mood disorder marked by persistent sadness, loss of interest or pleasure, and feelings of hopelessness. Many screening tools mix questions about sleep, appetite, low energy, and trouble concentrating – somatic symptoms from chemotherapy, radiation, and surgery as much as from depression.
In our cancer survivorship clinic, digital questionnaires that score fatigue and mood separately have shown that one out of three patients have a mismatch pattern (fatigue without depression, or depression without fatigue), demonstrating how easily a single blended score could point clinicians toward the wrong diagnosis and the wrong intervention.
For cancer survivors, families, and clinicians, a practical takeaway is to ask, “Are you measuring fatigue and my mood separately?” and “Could this be cancer-related fatigue, depression, or both?”
Genuine health care innovation depends on overcoming the inertia of entrenched practices. I often equate the implementation science effort to evolutionary biology, whereby successfully ‘crossing an adaptive valley’ means leaving a stable but suboptimal niche to reach a higher fitness peak. In a similar way to evolutionary biology, healthcare must navigate its own adaptive terrain to reach higher peaks of clinical and systemic outcomes.
Technology should fit into the rhythms of people’s lives, not demand new ones. We need digital tools designed with cancer survivors and clinicians, not for them. To this end, the greatest uptake happens when technology is developed to solve a particular user ask; not when technology is built first and then goes searching for users.
Within this framework, we begin with evidence-based guidelines, move through evidence-based medicine, and verify with evidence-based measures. When technology is built on this evidence-based chain, rather than apart from it, guidelines are turned into real-time decisions to systematically improve care for survivors.
Progress in survivorship care, like evolution, requires learning and adaptation.
We don’t need another app. We need to evolve.
Closing Reflections
By: Dr. Jennifer Guida, PhD, MPH
Reading John’s piece, I’m struck by how often survivorship care falls somewhere between good intentions and obsolete systems. The message here isn’t anti-technology, but rather a reminder that if we want to change the status quo, we have to change the assumptions we build with. Evidence before interfaces and trust before technology.
That’s the evolution survivors deserve and the one we should be building toward. Survivors don’t need more apps — they need better solutions.
A special thanks to Dr. John Librett for contributing to today’s post. If you enjoyed this post, please like, share, or comment below. We’d love to hear your thoughts.
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