Abstract A006: A randomized controlled trial of a mobile symptom monitoring app and tailored messages: Differences in outcomes among Black and White women with breast cancer on adjuvant endocrine therapy
Authors: Graetz Ilana , Hu Xin , Krukowski Rebecca A. , Kocak Mehmet , Anderson Janeane N. , Waters Teresa M. , Curry Andrea N. , Robles Andrew , Paladino Andrew , Stepanski Edward , Vidal Gregory A. , Schwartzberg Lee S. 
Published: December 2023

Abstract
Black women with early-stage, hormone receptor-positive breast cancer have lower adjuvant endocrine therapy (AET) adherence and higher symptom burden than White women. We compared the effects of a symptom monitoring app and tailored messages on treatment-relevant outcomes among Black and White women with breast cancer starting AET. Patients prescribed AET for early-stage breast cancer at a cancer center from November 2018 until June 2021 were randomized into: (1) an “App” group that received instructions and access to the study app and weekly text reminders to use it (n=94); (2) an “App+Feedback (AF)” group that received additional weekly tailored messages about managing symptoms, adherence, and communication (n=100); or (3) a “Usual Care (UC)” group without app access (n=102). The intervention lasted 6-months, and participants completed surveys at enrollment and 12-months. Increasing/severe symptoms and missed doses triggered alerts that prompted follow-ups from the oncology team. Outcomes included AET adherence, captured with an electronically monitored pillbox, app use, alerts, symptom burden (FACT-ES), quality of life (SF-12), self-efficacy for managing symptoms (PROMIS 1.0), and healthcare utilization (6-month count of emergency department visits/urgent care/hospitalizations, and office visits). Analyses stratified by self-reported race. Overall, 102 (34%) Black and 194 (66%) White women were randomized. Retention at 12-months was 88%. Median age was higher among White participants (60 vs. 55 years, p&lt;0.01). Number of weeks with app use was higher among White intervention participants (15.5 vs. 11.8, p&lt;0.01), but resulted in fewer alerts (2.7 vs. 8.1, p&lt;0.01) compared with Black participants. AET adherence over 12-months was lower among Black women (69% vs 76%, p=0.06), and such difference was similar across study arms. Black AF participants had fewer higher cost healthcare encounters compared to UC (0.27 vs. 0.97, p=0.03) but not for App only vs. UC. Black App participants had more office visits 6 to 12-months post enrollment compared to UC (4.4. vs. 2.6, p=0.04). White App participants reported 4.3 points higher physical health scores compared to UC (51.7 vs. 47.4, p=0.04). There were no significant differences by study arm in AET adherence, mental health score, symptom burden, or self-efficacy for managing symptoms among White or Black participants. Although Black intervention participants used the symptom monitoring app less often, they were more likely to report severe symptoms that triggered an alert to their oncology team than White participants. Among Black participants, the app combined with tailored messages resulted in fewer higher cost healthcare encounters, while App only resulted in more frequent office visits compared to UC. White participants did not have any differences in healthcare utilization, but App only participants reported higher physical health compared with UC. Symptom monitoring apps with tailored text messages improved different outcomes among Black and White patients with breast cancer on AET.
Citation Format: Ilana Graetz, Xin Hu, Rebecca A. Krukowski, Mehmet Kocak, Janeane N. Anderson, Teresa M. Waters, Andrea N. Curry, Andrew Robles, Andrew Paladino, Edward Stepanski, Gregory A. Vidal, Lee S. Schwartzberg. A randomized controlled trial of a mobile symptom monitoring app and tailored messages: Differences in outcomes among Black and White women with breast cancer on adjuvant endocrine therapy [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A006.