Kudos to Sophia Smith, associate professor, and Eric Elbogen (SOM) for the submission of their National Cancer Institute (NCI), Multi-PI application entitled “Integrating Technological Approaches for Pain Management in Adult Survivors of Childhood Cancer." This proposal requests funding for a five-year period with a start date of July 1, 2021.

About 1 in 3 survivors of childhood cancer report pain as moderate or severe resulting from curative therapies. Although it is critical to treat chronic pain effectively in these survivors, pharmacological treatments present with increased risk of opioid abuse and adverse clinical outcomes. To compound these challenges, cancer survivors with chronic pain are also more vulnerable to negative outcomes associated with pain medication. While non-pharmacologic therapies such as neurofeedback and cognitive behavioral therapy (CBT) are effective in treating pain and co-existing psychological distress in cancer survivors, they are often unavailable or difficult for patients to access.

Mobile health offers a platform for pain management that is cost-effective, accessible, and reduces these barriers to care. Preliminary results indicate neurofeedback and CBT can be implemented via mobile technology to address chronic pain in cancer survivors.

Our team developed Mobile Neurofeedback for Veterans with chronic pain, using a portable EEG headset and corresponding mobile app. Initial findings show Veterans with chronic pain have a significant reduction in pain intensity after three months (p<.001). And, no CBT-based apps have been developed specifically for cancer-related psychological distress; to address this gap, our team developed Cancer Distress Coach.

We found that 33% of participants had clinically significant reduction in posttraumatic stress symptoms after four weeks of use, making it equally effective to traditional CBT among cancer survivors. The proposed R01study offers a comprehensive approach to reducing pain among childhood cancer survivors by testing the effectiveness of a protocol that joins a mobile neurofeedback app with a CBT-based app.

We will determine the efficacy of our protocol by conducting a three-arm randomized controlled trial among 423adult survivors of childhood cancer with moderate to severe chronic pain who completed active treatment. Participants will be randomized to receive CBT alone, Mobile Neurofeedback alone, or a combination of both. We will then evaluate the additive effect of using both apps compared to Mobile Neurofeedback alone. Furthermore, we will identify moderators (e.g., participant characteristics, depression, anxiety, PTSD) and mediators (e.g., cognitions, self-efficacy) of intervention effects on pain outcomes.

Findings from this study have potential to improve pain and other clinical outcomes, such as depression, anxiety, and stress symptoms, among childhood cancer survivors using neurofeedback and CBT delivered via mobile technology. This study addresses one of 10 National Cancer Moonshot recommendations –symptom management – in a manner that reduces barriers to access, particularly among underserved populations. Also, this novel study is consistent with the congressional STAR act that was enacted to support research that aims to improve the care of and quality of life for childhood cancer survivors.

In summary, our protocol will offer a cost-effective self-management strategy for pain symptom management, enhanced access to care, and reduced risk of side effects that are associated with traditional, pharmacological interventions.