Your clients are downloading thousands of apps from the AppStore and GooglePlay to help them manage their symptoms, retrieve medical information, and encourage healthy behaviors like portion control and physical activity. For example, the American Heart Association (2015) reported that there were more than 6,300 exercise and 3,800 weight loss apps available in the AppStore. However, what do we really know about their effectiveness? Unfortunately, there is a dearth of research evidence and there are reports that some developers may be misleading consumers by inflating their apps’ capabilities.

In addition to concerns about the efficacy of medical apps, there are no cancer-specific distress tools in the AppStore and GooglePlay—despite the presence of general symptom-specific apps such as Headspace, Calm and PTSD Coach. Given this gap and that cancer survivors frequently suffer symptoms from post-traumatic stress disorder (PTSD) and related symptoms such as worry, fear and sadness, we partnered with the National Center for PTSD and reversioned their app into Cancer Distress Coach (CDC) for our population. We conducted usability testing followed by eight weeks of feasibility testing on iOS devices. Most participants (86%) reported that CDC provided practical solutions to their problems and almost half (48%) reported a PTSD Checklist-Specific (PCL-S) reduction ≥5 points (i.e., a minimum threshold for response).  CDC was well received and use of it was associated with significant reductions in PTSD and distress symptoms (Smith, Kuhn, O’Donnell, Koontz, Nelson, Molloy…Hoffman (in press).

Given these promising findings, the Duke Institute for Health Innovation (DIHI) applied new open source products to the CDC app—Apple’s ResearchKit and Android’s ResearchStack—to allow us to expand our recruitment across the U.S. These platforms have greatly assisted researchers in making it easier to enroll and randomize study participants and collect data. Since their introduction, the amount of data collected and the insights gained have been significant.

The iOS ResearchKit- and Android ResearchStack-designed CDC apps contain educational materials, standardized instruments, and tools such as guided imagery and meditation exercises to help patients and caregivers learn about symptoms and available resources, understand their level of distress and PTSD symptoms, build a network of support and gain coping skills to manage their distress in the moment. We are currently conducting a randomized clinical trial of the CDC app across the U.S. to examine efficacy and causality. The app is available (mid-May) now as a free download in the AppStore and GooglePlay, and enrollment of cancer survivors and caregivers will continue through Fall 2017. The vision for the app is that all survivors and their loved ones will have access to the supportive services they need to help them manage the trauma associated with cancer, no matter where they are in the cancer trajectory—newly diagnosed, in treatment, post-treatment survivorship or living with cancer as a chronic illness.

To learn more about the project, visit www.dukecancerinstitute.org/distresscoach or contact the study team at CancerDistressCoachApp@duke.edu.

References

American Heart Association. (2015). Retrieved from http://www.modernhealthcare.com/article/20151128/MAGAZINE/311289981

Smith, S.K., Kuhn, E., O’Donnell, J., Koontz, B.F., Nelson, N., Molloy, K., Chang, J., & Hoffman, J. (In press). Cancer Distress Coach: Pilot study of a mobile app for managing posttrautmatic stress. Psychooncology.