Digital Mental Health to Improve Breast Cancer Outcomes

Friends of the Dartmouth Cancer Center ‘Big Bet’

8/1/25-7/31/27

Madelyn Frumkin, PhD, Erika Moen, PhD, Paul Barr, PhD, Nicholas Jacobson, PhD (MPIs, Geisel School of Medicine at Dartmouth)

Mary Chamberlain (Co-Investigator), Lisa Marsch (Scientific Advisor), Christine Gunn (Scientific Advisor), Tracy Onega (Scientific Advisor), Anna Tosteson (Scientific Advisor)

Researchers in the Center for Technology and Behavioral Health and the Dartmouth Cancer Center will conduct four interconnected projects to accelerate the development and evaluation of digital mental health technology for patients with cancer. These projects focus on patients with breast cancer, as over 30% of patients exhibit clinical levels of anxiety and/or depression. In rural areas including New Hampshire, Vermont, and Maine, high prevalence of breast cancer coupled with severe mental health provider shortages creates significant unmet need.

Project 1: Effects of mental health treatment on cancer outcomes and projections of impact. Dr. Erika Moen will use SEER-Medicare linked data for patients with breast cancer and co-occurring anxiety and depression to identify multilevel factors associated with receipt of mental health care during cancer treatment. The project will then examine associations of mental health services with acute care utilization and survival. We will use these estimates to make projections of the impacts of expanding digital mental health tools.

Project 2: Shared decision making. Utilization of evidence-based behavioral health tools is limited by mental health literacy and treatment accessibility, both of which are exacerbated in rural settings. With support from NCI, Dr. Paul Barr has developed iPath*D, an interactive decision aid designed to increase depression screening as well as knowledge about, and access to, evidence-based treatment in patients with cancer. This project will focus on expanding iPath to include additional mental and behavioral health concerns common among patients with breast cancer (e.g., anxiety, chronic pain). We hypothesize that iPath will be acceptable, highly usable, and demonstrate preliminary impact on mental health literacy among patients with breast cancer.

Project 3: Digital intervention. Chatbots powered by generative AI hold promise for building highly personalized, effective mental health treatments at scale, while also addressing existing user engagement and retention issues common among digital therapeutics. Dr. Nicholas Jacobson has developed Therabot, an AI chatbot fine-tuned on expert-curated mental health dialogues to deliver personalized, evidence-based treatment. A recent RCT published in NEJM AI demonstrated significant reductions in symptoms of depression and anxiety. This project will focus on tailoring Therabot to the needs and preferences of patients with breast cancer. We hypothesize that Therabot will be feasible, acceptable, and demonstrate preliminary utility in reducing symptoms of anxiety and depression among patients with breast cancer.

Project 4: Digital assessment. Smartphones and wearable devices are increasingly being used to reduce reliance on infrequent retrospective self-report measures, objectively monitor key outcomes (e.g., sleep, physical activity), and facilitate generation of novel digital biomarkers. Dr. Madelyn Frumkin’s research has demonstrated the feasibility and utility of digital assessment for improved prediction of mental and physical health outcomes. However, there is significant untapped potential for leveraging digital technology to monitor response to digital interventions and identify mechanisms of change. We hypothesize that digital assessment will be feasible and demonstrate preliminary utility for monitoring response to Therabot.

Patients with cancer and co-occurring mental health problems have reduced quality of life, poorer cancer treatment adherence, greater healthcare utilization and expenditure, and worse survival. Over 30% of the U.S. population lives in a mental health professional shortage area. However, the vast majority of Americans (>91%) now own a smartphone. Digital mental health applications have significant potential to revolutionize mental healthcare for patients with cancer. Despite rapid development of these technologies in recent years, none are commonly used by patients with cancer due to barriers including low mental health literacy, unclear referral pathways, and a lack of interventions that are both engaging and effective long-term.