The efficacy of a mobile health (mHealth) behavioral cancer pain intervention designed to decrease pain and disability for breast cancer patients in medically underserved areas has not been investigated. The long-term goal of this work is to use mHealth technologies to facilitate wide-spread implementation of an efficacious behavioral cancer pain intervention – a non-pharmacological approach to pain management. The proposed project’s objective is to demonstrate the efficacy of an innovative mobile health Pain Coping Skills Training (mPCST-Community) designed to meet the needs of breast cancer patients with pain in medically underserved areas. mPCST-Community addresses intervention barriers for patients in medically underserved areas as it is delivered with video-conferencing in the patients’ community based oncology clinic by a remote therapist, is extended to the patients’ home environment using simple mHealth technology, and is low-literacy adapted. The central hypothesis is that mPCST-Community will result in decreased pain compared to a mHealth education attention control group (mHealth-Ed). The rationale of this proposal is that if mPCST-Community is shown to be efficacious it will rapidly increase intervention access for individuals who receive their oncology care in medically underserved areas and ultimately reduce pain-related suffering. Guided by strong preliminary data, a randomized controlled trial will be used to pursue three specific aims: 1) Test the extent to which the mPCST-Community intervention reduces pain, fatigue, disability, and distress, 2) Examine self-efficacy and pain catastrophizing as mediators through which the mPCST-Community leads to reductions in pain, fatigue, disability, and distress, and 3) To evaluate the cost-effectiveness of mPCST-Community. For Aim 1, based on the study team’s extensive work demonstrating the efficacy of in-person pain coping skills training protocols and pilot work showing promise for mPCST-Community, it is expected that mPCST-Community will lead to decreased pain as well as fatigue, disability, and distress compared to mHealth-Ed. For Aim 2, it is expected that the effects of mPCST-Community will be mediated by increased self-efficacy for pain control and decreased pain catastrophizing. For Aim 3, it is expected that mPCST-Community will demonstrate cost-effectiveness as assessed by all-cause medical resource use, participant and therapist time, and health utilities as well as successful overall accrual, high subject retention, and high intervention adherence. This innovative application proposes the first study to examine the efficacy of mPCST-Community that is designed to address pain in cancer patients in medically underserved areas. While improving access to care is critical, providing efficacious care is just as important. If mPCST- Community is shown to be efficacious, it will provide an intervention that can be rapidly implemented into the care of cancer patients with pain. Importantly, if efficacious this intervention could provide a needed model for non-pharmacological approaches to pain management for other populations of patients with chronic pain.

Relevance This research is relevant to public health because it aims to improve quality of life in the many US patients with cancer who live in medically underserved areas with a non-pharmacological approach to pain management. This innovative work will demonstrate the efficacy of a behavioral cancer pain intervention delivered by mHealth technology (i.e., video- conferencing with a remote therapist in the patients community based oncology clinic and home-extension with a basic smartphone) to decrease pain and disability; demonstration of efficacy has a high potential to lead to rapid wide-spread use, particularly benefiting individuals who face significant barriers (e.g., access, distance, financial, time, low literacy) to traditional behavioral interventions. The project is relevant to NIH’s mission because it aims to use a non-pharmacological approach reduce pain that incurs burden and disability and increase quality of life in patients with cancer.