StressProffen app-based interventions show no significant difference in perceived stress at 18 monthsApp based stress programs may help younger women with breast cancer

PURPOSE: Digital stress-management tools show promise, but their long-term impact remains unclear. In the Coping After Breast Cancer (CABC) trial, the app-based stress-management program StressProffen, with either cognitive behavioral therapy intervention (CBI) or a mindfulness-based intervention (MBI), showed no advantage over usual care after six months of access. However, benefits may emerge gradually, as users need time not only to become familiar with the content and techniques, but also to internalize, apply and automatize their use in response to real-life stressors. The a priori defined aims of the current study were to examine; 1) whether extended (18 months) access to the digital stress-management interventions CBI and MBI were associated with changes in perceived stress (stress) (primary outcome), measures of health-related quality of life, mindfulness, fatigue, coping, anxiety, depression, and sleep (secondary outcomes), 2) association between app use and changes in stress level and investigate baseline characteristics as moderators of change in stress in the intervention groups, and 3) identify predictors of change in stress among patients with breast cancer. METHODS: Of 430 patients randomized to MBI, CBI, or usual care, 76% (n = 327) completed the 18-month survey. Linear mixed-effects models were used to assess between-group differences in primary and secondary outcomes. Moderator analyses were performed to examine whether specific baseline characteristics modified the intervention effects on stress levels. Predictor analysis of change in stress was performed for the total sample. RESULTS: At 18 months, all three groups showed stable trends over time, with no significant difference between either intervention group and controls. A larger stress reduction was observed among younger participants (≤50 years) in both CBI and MBI compared to controls. Higher baseline stress levels predicted significantly larger stress reductions in the total sample, but the moderator analysis showed that the effects were only significant in the CBI group. CONCLUSION: Neither CBI nor MBI showed statistically significant improvements at 18 months compared to controls. The results however suggest that long-term access to stress management interventions may help young women with breast cancer and those with high initial stress to reduce their stress levels. CLINICALTRIALS: ClinicalTrials.gov identifier NCT04480203.