Pilot Testing of a Multicomponent Cancer Pain-Cognitive Behavioral Therapy mHealth App for Patients With Advanced Cancer.

Abstract

Patients with advanced cancer often experience pain symptoms. Pain-cognitive behavioral therapy (pain-CBT) represents an effective psychological treatment for chronic pain, yet access remains limited. We conducted a pilot study to assess the feasibility and acceptability of a mobile health (mHealth) intervention that integrates pain-CBT with opioid education and tracking to improve chronic pain management in patients with advanced cancer. Adults with advanced cancer and pain (≥4/10, Numeric Rating Scale) using opioids tested the smartphone-based intervention for 28 days, completed baseline, end-of-study, and 2-week postintervention surveys, and participated in optional qualitative interviews. The intervention assessed pain, mood, catastrophizing, sleep, and opioid use, and provided tailored just-in-time adaptive interventions, and daily psychoeducation (articles, serious game). We assessed feasibility (≥50% app-use), acceptability (acceptability E-scale), and pre-post intervention changes in pain, and conducted thematic analysis of perceived impact and usefulness. Among 64 eligible patients, 32 (mean age, 55.41 years; 55% female; 32% rural-dwelling) enrolled. Of those, 59% (n = 19) used the app ≥50% of days on study, and rated the intervention with good acceptability (mean, 24.85; standard deviation, 3.72). Nonsignificant reductions in pain intensity, pain interference, and pain catastrophizing were observed from baseline to 4- and 6-week follow-ups. In debriefing interviews, patients described that the intervention contributed to pain self-management knowledge, promoted pain coping skills, and reduced opioid stigma. Study results support feasibility and acceptability of a pain-CBT intervention for patients with advanced cancer pain. Although exploratory analyses showed nonsignificant improvements in pain outcomes, qualitative findings indicate meaningful engagement and skill development. Future testing is needed to determine intervention efficacy.