Abstract P5-13-03: The use of a behavior-modification clinical solution application to improve breast cancer survivors' accountability and health outcomes
Authors: Stubbins RE , Cheng TH , Yu X , Puppala M , Chen S , Valdivia Y Alvarado M , Niravath PA , Chang JC , Wong ST , Patel TA 
Published: February 2018

Abstract
Background: Studies have demonstrated that obesity increases the risk of breast cancer recurrence and death in survivors but only 34% of breast cancer survivors engage in the recommended level of physical activity. This low percentage is related to a lack of accountability and motivation. We hypothesize that using a mobile application (app) incorporating the concept of cognitive-behavioral therapy and dietary and physical activity recommendations will improve breast cancer survivors' accountability and help them reach their personalized health goals; specifically with diet and exercise. Methods: We have created an app, METHODIST HOSPITAL CANCER HEALTH APPLICATION (MOCHA) for the purpose of patient self-reinforcement through the daily accounting of activity and nutrition as well as group feedback and direct interaction with clinical dietician. To test the MOCHA app's feasibility, we enrolled 33 breast cancer survivors with a body mass index (BMI) over 25 who were at least 6 months post active treatment (surgery, chemotherapy, or radiation) for a 4 week feasibility trial. During these 4 weeks, the users used the app to track wellness (mood, sleep or pain), diet (calorie intake) and exercise (walking or steps). Our primary objective was to demonstrate adherence, defined as the number of days recorded on MOCHA during week 2 and 3 of the 4 week study period (14 days). A registered dietitian assigned personalized goals for each user and monitored their usage of the app and followed the progress of their goals. Additionally, the dietitian sent daily push notifications to encourage the user to stay on track. Results: Our results suggests a correlation between utilization of the app and achievement of the goals of weight loss and increased motivation to exercise. The average number of daily uses of the app was approximately 3.76 (0-12) and 50% of enrolled users lost average of 2.14 lbs (0-6lbs) weight during this short 4 week study; preliminary correlation analysis suggest a correlation coefficient of -0.42 between these two variables. This is noteworthy as traditionally we would expect weight increase in this group of users. Our secondary objective was to determine MOCHA's usability using System Usability Scale (SUS) scale. Our average score on the SUS scale is 77%, which is above average. Lastly, users have stated that access to the dietitian in the app improves their food choices and accountability. Conclusion: This study provides essential data that emphasizes the importance of using technology to improve patients' goal adherence by providing real-time feedback and accountability with their healthcare team. Most health mobile apps focus on data acquisition but without the engagement of the health care team, this aspect differentiates MOCHA from the other apps. Our future directions will focus on using our MOCHA app in breast cancer survivors in a long term behavior modification study.
Citation Format: Stubbins RE, Cheng TH, Yu X, Puppala M, Chen S, Valdivia Y Alvarado M, Niravath PA, Chang JC, Wong ST, Patel TA. The use of a behavior-modification clinical solution application to improve breast cancer survivors' accountability and health outcomes [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-13-03.