Innovation & Technology
Cancer Nutrition

CanDi^TM: A Malaysian-Tailored Dietary Smartphone App for Cancer Patients and Survivors

Background and Rationale

Cancer remains one of the leading causes of death in Malaysia, with the total number of diagnosed cases increasing annually according to the Malaysian National Cancer Registry. Optimal nutrition is a critical component of cancer care: malnutrition affects an estimated 30–80% of cancer patients depending on cancer type and stage, and is independently associated with poorer treatment outcomes, reduced quality of life, and increased mortality. Despite this well-established evidence, many Malaysian cancer patients and survivors lack access to culturally appropriate dietary guidance.

The challenge is particularly acute in Malaysia’s multicultural context. Standard nutritional advice and existing smartphone applications are predominantly based on Western dietary patterns and food databases, which may bear limited relevance to the Malay, Chinese, Indian, and indigenous food traditions that characterise Malaysian cuisine. Cancer patients already struggling with appetite loss, taste alterations, nausea, and other treatment-related eating difficulties need guidance that is not only evidence-based but also practical within the context of locally available ingredients and cooking methods.

Smartphone technology offers a compelling platform for delivering dietary interventions. Malaysia’s smartphone penetration rate exceeded 80% at the time of this study, suggesting that mobile-based health applications could reach a broad population. Evidence from other chronic disease contexts demonstrates that theory-based health apps can facilitate long-term dietary behaviour change. However, validated mobile applications focusing on dietary monitoring and education for Malaysian cancer patients were essentially absent from the market when this project was initiated.

App Development and Features

The Cancer Dietary (CanDi^TM) app was developed as a collaborative effort between nutritional scientists, clinicians, and software developers at Universiti Sultan Zainal Abidin and Universiti Malaysia Terengganu. The development process followed established mHealth design principles, incorporating user-centred design, iterative testing, and clinical validation.

The app’s content architecture is organised into several primary functional components. The Healthy Eating Guide section provides advice spanning a spectrum from general healthy eating principles to cancer-specific concerns, including managing appetite loss, preventing unintended weight loss, and strategies for increasing protein and caloric intake during treatment. This content is grounded in guidelines from organisations including the American Cancer Society.

The Malaysian Recipes for Cancer Patients section represents one of the app’s most distinctive features. Rather than simply translating Western recipes, the development team curated and, where necessary, modified recipes from across Malaysia’s diverse culinary traditions — encompassing Malay, Chinese, and Indian styles of cooking, as well as dishes from the East Malaysian states of Sabah and Sarawak. Recipe modifications were designed to address the specific dietary requirements of cancer patients, such as increasing protein density while reducing preparation complexity for patients experiencing fatigue.

Additional features include a food diary section where patients can record daily intake, enabling both self-monitoring and clinical oversight. The Frequently Asked Questions module addresses common concerns that arise during cancer treatment and survivorship. The pilot version was developed in English to facilitate initial deployment through Google Play Store, with Malay-language versions planned for subsequent phases.

Clinical Context and Validation

The app was developed in collaboration with Hospital Sultanah Nur Zahirah in Kuala Terengganu, with ethical approval obtained under NMRR-14-1616-23717 (IIR). Professional dietetics input was provided to ensure that nutritional content met clinical standards. The involvement of clinical dietitians from the hospital ensured that the app’s recommendations were consistent with established cancer nutrition guidelines and appropriate for the Malaysian healthcare context.

An Acceptability Questionnaire was developed to assess user experience and satisfaction among the target population. This mixed-methods evaluation approach — combining quantitative usability metrics with qualitative feedback — reflects best practices in mHealth intervention development, where early-stage acceptability testing is essential before proceeding to efficacy trials.

Relevance to Cancer Nutrition Research

The CanDi^TM app addresses a critical gap at the intersection of cancer nutrition, mobile health technology, and culturally sensitive healthcare delivery. A systematic review of dietary smartphone apps for cancer patients published in JMIR mHealth and uHealth (2025) found preliminary evidence supporting the efficacy, feasibility, and acceptability of mobile app-based dietary interventions for cancer survivors. However, the review also highlighted that most existing apps were developed in Western contexts and may not be directly transferable to Asian populations with different dietary patterns and health beliefs.

Several features of CanDi^TM align with best practices identified in the mHealth literature. The provision of personalised dietary feedback, culturally relevant content, and self-monitoring tools are all associated with greater engagement and behaviour change in dietary interventions. The app’s focus on both patients undergoing active treatment and cancer survivors reflects the growing recognition that nutritional support needs to extend across the entire cancer care continuum.

Implications for Malaysian Public Health

For Malaysia’s healthcare system, the CanDi^TM app represents a potential model for technology-enabled nutritional support that could be scaled across the country’s network of oncology services. Malaysia’s public hospitals, which provide the majority of cancer treatment, often face resource constraints that limit the availability of individualised dietetic counselling. A validated, culturally appropriate smartphone app could supplement in-person dietary consultation, extending the reach of dietetic expertise to patients in rural and underserved areas.

The development methodology used — working with local food scientists, clinical dietitians, and software developers to create a contextually appropriate tool — offers a template for other culturally adapted health technologies in Southeast Asia. As the burden of cancer continues to grow across the region, the need for affordable, accessible, and culturally relevant supportive care interventions will only intensify.

Limitations

This publication describes the development and pilot testing phase of the app rather than a full randomised controlled trial of efficacy. The evidence presented relates primarily to acceptability and usability rather than clinical outcomes such as nutritional status improvement or quality of life enhancement. The pilot was conducted in English, which limits accessibility for Malay-speaking populations who constitute the majority of cancer patients in Terengganu. Sample sizes for the pilot evaluation were modest, and longer-term engagement and retention data were not yet available. Further research involving larger samples, Malay-language versions, and clinical outcome measures would be needed to establish the app’s effectiveness as a nutritional intervention tool.

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