Abstract PR09: HT Helper: mHealth app to promote hormone therapy adherence among breast cancer patients
Authors: Muñoz Edgar , Despres Cliff , Sukumaran Pramod , Tiemann Illeana , Gutierrez Bianca , Paz Victoria , Inupakutica Devasena , Kaghyan Sahak , Akopian David , Ramirez Amelie G. , Chalela Patricia 
Published: December 2020

Abstract
Background: Adjuvant hormonal therapy (HT) is highly effective and appropriate for nearly all women with hormone receptor-positive tumors, making such treatment the most widely prescribed therapy for patients with this type of breast cancer. Despite its proven benefits in reducing cancer recurrence and improving survival, HT adherence is suboptimal (less than 80%). About 33% of patients do not take their medication as prescribed and are at increased risk of disease recurrence and lower survival. Purpose: We will present the development and betatesting of HT Helper, a theory-based, bilingual, interactive mHealth app in combination with patient navigation to improve adherence to HT among patients attending the breast clinic at the Mays Cancer Center, as part of the initial phase of a two-group randomized clinical trial study. Methods: As part of the formative research phase, we conducted 4 focus groups (n=21) with breast cancer patients receiving HT, and personal interviews (n=8) with oncologists, nurses, and patient navigators to assess barriers and facilitators to HT adherence, main side effects, app content, and features. Qualitative data informed the initial design and development of app mock-ups; these were assessed with two additional focus groups (n=10). Based on this feedback, we developed the phone app prototype and beta-tested it for two weeks with breast cancer patients (n=5) and research team members. (n=10). Results: Inputs from patients and healthcare team members helped to identify specific app content and features. Key suggestions included adding: educational content on HT, adherence, side effects and how to stay healthy to enhance management skills; a tool for side effects reporting and tracking and social networking with other patients; reminders and inspirational messages; testimonials from real patients; easy avenues to communicate with the study team; information on local resources including support groups; and technical support information. In addition to app colors and icon preferences, patients emphasized the need for a user-friendly app that is easy to navigate with simple and clear educational content. In general, beta-testers found the app easy to use, credible and trustworthy, and their reactions were very positive about app appearance, content, purpose, and usability. After minor technical issues were fixed, the study app was refined and finalized, and it is ready for recruitment. Conclusion: We followed an iterative and patient-centered design process to develop a bilingual, culturally tailored, and interactive mHealth app to be used in combination with patient navigation in a randomized control trial. The anticipated outcome of this innovative multi-communication intervention is a scalable, evidence-based, easily disseminated intervention with potentially broad use to patients using oral anticancer agents.
Citation Format: Edgar Muñoz, Cliff Despres, Pramod Sukumaran, Illeana Tiemann, Bianca Gutierrez, Victoria Paz, Devasena Inupakutica, Sahak Kaghyan, David Akopian, Amelie G. Ramirez, Patricia Chalela. HT Helper: mHealth app to promote hormone therapy adherence among breast cancer patients [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PR09.