mHealth app for caregiver instruction in manual therapy for chemotherapy-induced peripheral neuropathy

Chemotherapy-induced peripheral neuropathy (CIPN) is a common cancer treatment side effect that impairs quality of life and daily functioning. Some 30% of chemotherapy recipients are estimated to be living with CIPN at least six months beyond end of treatment, a number sure to grow as the population ages and incidence of chemotherapy treatment grows. Fortunately, in recent years research and practice in the field of Oncology Massage (OM) have demonstrated that specific manual therapy techniques can in fact reduce symptoms of CIPN. However, for the vast majority of cancer survivors at risk, access to such services is very limited due to the very small number of qualified practitioners, as well as cost and organizational constraints. This Phase II project will evaluate outcomes of a caregiver education mobile app that teaches lay caregivers how to use OM-informed massage techniques specific to CIPN in supportive care at home. The program to be tested is called “Peripheral Neuropathy Relief (PNR).” It will deliver accurate information about what CIPN is, how specific manual techniques can help reduce its symptoms, and step-by-step instruction in safe and effective techniques specific to CIPN. If successful, this eHealth app will enable wide dissemination of a family caregiver intervention leading to a major impact on quality of life and functioning for millions of cancer survivors and their family members. Phase II will integrate findings from our Phase I study that used a human-centered design approach in formative research to develop a “minimum viable product (MVP)” (prototype) of the PNR program for usability and feasibility testing. Feasibility was established by caregivers’ high usability scores and ratings of perceived value and intent to use the app in the caregiving role. Phase II will complete development and then evaluate the app’s impact on CIPN patients and caregivers in a three-arm randomized controlled trial with 150 patient/partner dyads, comparing PNR to attention control and usual care conditions. Specific aims are as follows: Aim 1. Produce a revised version of the instructional content based on Phase I outcomes. Aim 2. Complete development of the mobile application that will deliver the instructional program and related supplemental materials to patients and caregivers. Aim 3. Assess impact of home-based utilization of the PNR program on cancer survivors with CIPN and caregivers applying the instruction. Hypotheses. (1) In dyads using the PNR intervention, patients will report significant improvements over baseline in CIPN symptom and interference scores; and caregivers will report significant improvements over baseline in caregiver esteem and attitudes toward caregiving for CIPN. (2) Outcomes for dyads in the PNR intervention will be superior to those of the usual care and attention control conditions.