A collaborative research project between Indiana University Bloomington School of Public Health and Luddy School of Informatics, and the Indiana University School of Medicine is positioned to begin phase one of its work that will bring a mobile stress intervention to breast cancer survivors.
Breast cancer is the most common cancer in women, and for breast cancer survivors, depression and anxiety are significantly linked to higher mortality rates. Approximately 32 percent of breast cancer survivors experience depression and 42 percent experience anxiety.
The goal of the research project, said Evan Jordan, PhD, assistant professor and doctoral research coordinator in the Department of Health and Wellness Design at Indiana University Bloomington, is to support breast cancer survivors who undergo various levels of stress and anxiety with a “just in time” mobile stress intervention program. The program is designed to fill in the gaps between appointments with mental health professionals and provide immediate support in moments of need.
“This is a way for us to move toward precision medicine,” Jordan said. “We are using technology to fill the gaps and give people health care when they need it versus making them wait for an appointment that can sometimes take several weeks.”
The project is called MOSAIC (Mobile Stress Automated Intervention for Cancer), and its objectives in addressing the “time to stress intervention” gap include working collaboratively with cancer survivors and using the study data to provide feasibility and initial results for a larger National Institutes of Health (NIH) funded randomized controlled trial. MOSAIC will tailor mental health care to the cancer survivor population, individually identify when interventions is needed based on heart rate biofeedback and reduce burden on the mental healthcare system.
“There are just not enough mental health professionals with expertise in cancer to see every person suffering with cancer-related distress in a timely manner,” said Shelley Johns, PsyD, collaborator on the research project and associate professor of medicine at IU School of Medicine and Regenstrief Institute Research Scientist. “Approximately 400 unique patients are treated at the IU Simon Comprehensive Cancer Center every day, many of whom are understandably stressed. With a little coaching in how to use the MOSAIC app to the advantage, we hope survivors will be able to turn down the volume of their stress so they can focus on what truly matters to them.”
Jordan said the research team’s primary interest was getting people mental health care in the moment it is needed. MOSAIC won’t replace seeing a therapist, he added, but it will fill in the time gaps between the episode of stress or anxiety and when the patient can get in to see a professional.
The three-phase project is made possible by at two-year $100,000 Translational Public Health Research award, which is funded by the Indiana Clinical and Translational Sciences Institute (CTSI). It will produce preliminary pilot data and potentially early efficacy data to be used for eventual clinical trial testing the effectiveness of treatment and service interventions for cancer survivors experiencing stress and anxiety.
Jordan said he expects phase one of the project to begin in early August, which is co-designing and building the app with end users – breast cancer survivors. Phase two includes testing and iterative redesign of the app with 15 breast cancer survivors who will offer feedback on how to improve the program and app functions, and the final phase will entail recruiting 30 more survivors who will use a wearable heart monitor and the app to monitor and track changes in stress, anxiety, and depression for up to six weeks.
The app will collect data and if the subject’s heart rate variability falls below a specific threshold, she will be notified on her phone and can work through the stress incident through 2-3 minute user selected therapeutic exercises on the app designed to reduce stress.
“The idea is to take the burden off subjects in identifying if they are under stress,” Jordan explained. “Physical indicators of stress are signaled through the heart rate monitor to the app and subjects are alerted. They can seek immediate self-care through the app programs.”
Jordan has been conducting stress research for over 10 years and Johns has worked in cancer care for over 25 years. Johns is also a recipient of the Young Investigator Award from the Indiana CTSI. They are working with two other collaborators on the project who offer expertise in app creation and bioengineering:
- Greg Lewis, assistant professor of Intelligent Systems Engineering at Indiana University Bloomington Luddy School of Informatic, Computing, and Engineering. Lewis is an expert in bioengineering and has created the body sensors research subjects will use to monitor their heart rate correlating to stress levels.
- Patrick Shih, assistant professor of Informatics and director of Graduate Studies for Data Science at Indiana University Bloomington. Shih is the creator of the app that collects data from subjects and allows for the intervention to occur.
The research project subjects will be referred by the Indiana University Simon Comprehensive Cancer Center. Once completed, collective data results will be immediately submitted to conduct a clinical trial on a larger scale.
“We’re really at an inflection point today,” Jordan said. “Commercial mental health apps like ours do exist and they do okay. But cancer survivors would be better served by an app like ours that fully integrates biofeedback from wearable technology and better integrates with their current physical and mental healthcare plans.”