Cancer Pain Management: A Technology-Based Intervention for Asian American Breast Cancer Survivors

Up to 60% of breast cancer survivors report chronic pain that interferes with daily activities and is frequently associated with negative health outcomes such as fatigue, sleep disturbances, and decreased quality of life. Especially, those with depressive symptoms are more likely to have inadequate pain management due to their depression, and pain could further deteriorate depression. Furthermore, the recent opioid crisis has exacerbated their fear of addiction and reluctance to seek help for pain management. However, survivorship programs hardly address these needs of survivors who have transitioned to communities while considering their unique needs. A technology-based approach using computers and mobile devices promises to meet the needs with high flexibility, accessibility, and anonymity. Based on Preliminary Studies (PSs), the research team developed and pilot-tested an evidence-based Web App-based information and coaching/support program for cancer pain management (CAPA) using multiple unique features. However, CAPA rarely considered depressive symptoms accompanying pain in its design or components, and PSs indicated the necessity of further individualization of the intervention components of CAPA to address the unique needs of these survivors. The purpose of the proposed 2-phase study is to further develop CAPA with additional components for breast cancer survivors with depressive symptoms and the individual optimization functionality (CAI) and to test the efficacy of CAI in improving cancer pain experience. As the initial group to approach, Asian American breast cancer survivors with depressive symptoms (ABD) were selected as the target population, given their relatively higher rates of inadequate pain management and the associated lower quality of life compared to other groups. The specific aims are to: a) develop and evaluate CAI through an expert review and a usability test (R61 phase); b) determine whether the intervention group (that uses CAI and usual care) will show significantly greater improvements than the active control group (that uses CAPA and usual care) in primary outcomes (cancer pain management and cancer pain experience including depressive symptoms) from baseline to post 1-month and post 3-months; c) identify theory-based variables (attitudes, self-efficacy, perceived barriers, and social influences) that mediate the intervention effects of CAI on the primary outcomes; and d) determine whether the effects of CAI on the primary outcomes are moderated by selected background, disease, genetic, and situational factors. This study is guided by the Bandura’s Theory and the stress and coping framework by Lazarus and Folkman. The R61 phase includes: (a) the intervention development process, (b) a usability test among 15 ABD, 15 family members, and 15 community gatekeepers; and (c) an expert review among 10 experts. The R33 phase adopts a randomized repeated measures control group design among 300 ABD. Long-term goals are to scale the program across various settings and among the general U.S. population while advancing innovations and frameworks for highly customized technology-based interventions designed for cancer survivors.