Pain affects approximately two thirds of patients with advanced, incurable cancer, with rates approaching 90%
near the end-of-life. Advanced cancer pain can be notoriously severe, degrading patients' emotional, social,
and functional wellbeing. Advanced cancer pain is a multidimensional process that requires a holistic approach
to care. Unfortunately, in real world settings pharmacotherapy is often the only treatment available to patients.
Mindfulness has been defined as a directed, flexible cognitive process that allows a person to observe
thoughts and emotions in the moment, as opposed to reacting to them. Applied to chronic pain, mindfulness
seeks to decouple the sensory experience of pain from cognitive interpretations and emotional reactions – a
ideal strategy for advanced cancer pain given the close connection between pain sensations and cognitive-
affective responses (e.g. fears of cancer progression and death). Mindfulness has been proven effective for
chronic pain from a variety of non-cancer diagnoses, but studies of mindfulness for advanced cancer pain are
lacking. Traditional mindfulness programs, which involve 8 weeks of lengthy group-based trainings with daily
practice, are impractical and inaccessible to most advanced cancer patients. Moreover, existing programs are
not adapted to this populations' physical limitations, often intense emotional and existential distress, nor do
they support other vital aspects of self-management required to successfully cope with cancer pain at home.
The object of this proposal is to develop, refine and pilot CHAMP (Cancer Health Application for Mindfulness-
based Pain treatment), a novel smartphone application to deliver mobile mindfulness training tailored to the
needs of patients with advanced cancer pain. To complement mindfulness practice, CHAMP will integrate
multimedia cancer pain psychoeducation and medication support, maximizing patients' ability to cope and self-
manage. This project is made feasible by the team's ability to leverage mindfulness content, multi-media
cancer pain psychoeducation, and design features from two existing mHealth projects (R21 NR017745, and
R00 MD010468). In Aim 1a, the study team will develop and program CHAMP, involving the target patient
population for multiple levels of review and revision. In Aim 1b, a small pre-pilot will be conducted (N=5) in
order to refine the app prior a pilot study. In Aim 2, 20 patients with persistent pain from a variety of advanced
solid malignancies at a major academic cancer center will be assigned to use CHAMP for 8 weeks. Findings
will illuminate the feasibility of data collection, allow exploration of meaningful trends, and enable the design of
a future randomized trial to test the ability of CHAMP to improve pain and QOL for advanced cancer patients.
The sum result of this project will be a tailored, mindfulness intervention which - if proven effective - has great
potential to scale and make mind-body treatment available to a population that suffers disproportionately from
chronic pain and currently has extremely limited access to effective, non-pharmacologic management.