Efficacy of YES, an mHealth intervention for adolescent and young adults (AYA) with breast cancer (BC), to address AYA survivorship concerns.

Abstract

12009 Background: AYA BC survivors often have unmet concerns that are understudied and sub-optimally addressed. Primary results from the YES trial (NCT04906200) demonstrated that YES, an AYA-focused mHealth intervention, improved quality of life and reduced specific symptoms in AYA BC survivors at 6 months (mo) post-enrollment. Here we report a pre-specified secondary analysis of YES on reducing AYA survivorship concerns. Methods: We conducted a multicenter (Dana-Farber Cancer Institute, The Ohio State University, Columbia University Medical Center) RCT of YES, an mHealth intervention which provides tailored information, resources and support in response to monthly electronic patient-reported outcome monitoring, a journal platform, and a chat room. Participants age ≤39 at diagnosis (dx) of stage 0-3 BC, < 3 years post-dx were randomized 1:1 to YES or Usual Care (UC). Survivorship concerns were measured at baseline, 3, and 6 mo with AYA HOPE survey items; participants rated their level of concern across a range of domains. Generalized linear mixed effects models analyzed the binary endpoint of somewhat/very vs no/low concern for each issue. Odds of being somewhat/very concerned about a domain at 6 mo were compared between arms, adjusting for baseline concern. Results: From 6/2021-12/2024, 360 participants were randomized (YES:179; UC: 181) following baseline survey completion. Participant characteristics were balanced between arms. Median time from dx was 19 (IQR: 12-27) mo. Median age at dx was 34 (IQR: 31-37) yrs; 61% had stage 2 or 3 BC. Overall, a majority of participants endorsed high levels of concern at baseline related to: long-term side effects of treatment (67%), long-term health effects of cancer (70%), recurrence (79%), checking for signs of recurrence (57%), possibility of a new cancer (67%), exercise (60%), nutrition (58%), familial cancer risk (51%), and body image (56%). Other endorsed concerns included: fertility (43%), financial support for medical care (37%), financial concerns (38%), talking about cancer experience with family/friends (27%), having enough information about treatment (25%), meeting other AYAs (22%), alcohol and cancer (15%), and smoking cessation (3%). At 6 mo, adjusting for baseline concern, the YES group (vs UC) had lower odds of being somewhat/very concerned about finances (OR: 0.36, 95% CI: 0.13 – 0.98, p = 0.05), financial support for medical care (OR 0.35, 95% CI 0.13-0.96, p = 0.04), family cancer risk (OR 0.36, 95% CI 0.17-0.77, p = 0.009), and alcohol and cancer (OR 0.15, 95% CI 0.03-0.75, p = 0.02). Conclusions: Concerns across a range of survivorship domains are prevalent in AYA BC survivors. The YES mHealth intervention reduced concerns about several survivorship issues, supporting the potential for this highly scalable intervention to help manage these concerns as an adjunct to routine clinical care for AYA BC survivors. Clinical trial information: NCT04906200 .