Due to cultural stigma attached to breast cancer, cultural stoicism toward pain and symptoms, and language barriers, Asian American breast cancer survivors tend to suffer unnecessarily from pain that could be easily managed using existing pharmacologic or non-pharmacologic strategies. Especially, Asian American breast cancer survivors with depressive symptoms (ABD) 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. The COVID19 pandemic has also placed an additional dimension of stress to this specific population. However, survivorship programs at cancer centers lack the staff and time to adequately address these unique needs of this population. A technology-based approach using computers and mobile devices promises to meet this necessity 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) that was culturally tailored to Asian American breast cancer survivors 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 due to diversities in the needs of ABD. The purpose of the proposed 2-phase study is to further develop CAPA with additional components for ABD and the individual optimization functionality (CAI) and to test the efficacy of CAI in improving cancer pain experience of ABD. 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 in oncology. The R33 phase adopts a randomized repeated measures control group design among 300 ABD. Long-term goals are: (a) to extend and test CAI in various healthcare settings with diverse subgroups of ABD, (b) examine the cost- effectiveness, sustainability, and scalability of CAI in the settings, and (c) translate CAI into health care for ABD.

This study will provide a prototype of a culturally tailored technology-based program for pain management of Asian American breast cancer survivors with depressive symptoms. This study will accelerate the translation of technology-based programs into health care and will be an important contribution in pain management of cancer survivors with depressive symptoms. Ultimately, this study will contribute to reducing ethnic disparities in health/disease experience by providing directions for culturally competent health care services, specifically for adequate pain and symptom management of racial/ethnic minority cancer survivors.