Digital Mental Health Treatment and Symptoms of Depression and Anxiety in Breast Cancer Survivors: A Randomized Clinical Trial
A smartphone mental health program modestly reduced anxiety in breast cancer survivors.
*Randomized clinical trial; Level 2 (OCEBM).
Citation
Chow PI, You W, Shaffer KM, et al. Digital Mental Health Treatment and Symptoms of Depression and Anxiety in Breast Cancer Survivors: A Randomized Clinical Trial. JAMA Network Open. 2026;9(7):e2623871. doi:10.1001/jamanetworkopen.2026.23871
Background
Depression and anxiety are common after breast cancer, while access to counseling is often limited. Smartphone programs may offer scalable support, but their benefit in breast cancer survivors remains uncertain.
Patients
313 adult women in the United States with stage I to III breast cancer diagnosed within 5 years, elevated depression or anxiety symptoms, and a smartphone. Exclusions included psychosis, bipolar disorder, active suicidal thoughts, current psychotherapy, or recently changed psychiatric medication.
Intervention
An 8-week self-guided smartphone program with 5 skills-based mental health apps. Participants with low first-week use were randomized to coaching or no coaching.
Control
An 8-week smartphone psychoeducation app without human support.
Outcome
Primary: anxiety using the 7-item Generalized Anxiety Disorder scale (0-21) and depression using the 8-item Patient Health Questionnaire (0-24). Secondary: app-use days and sessions.
Follow-up Period
8 weeks, 6 months, and 12 months.
Results
| Outcome | Significant finding |
|---|---|
| Anxiety symptoms (primary) | Digital treatment averaged 1.43 points lower than education alone (95% CI, 0.38 to 2.49 lower). |
| App-use days (secondary, low early users) | Coaching increased use by 3.44 days during the remaining intervention period. |
Depression did not significantly differ between groups. Analyses used an intention-to-treat approach. The control was an active education app, not usual psychotherapy or no treatment. Common clinically important thresholds are about 4 points for the anxiety scale and 5 points for the depression scale, so the between-group anxiety benefit was statistically significant but small.
Limitations
Participants were mostly White and highly educated, limiting generalizability. Outcomes were self-reported, participants were not blinded, and there was no no-treatment group. The coaching subgroup was small. The anxiety improvement may not be large enough to feel meaningfully different to many patients.
Funding
National Cancer Institute; one author reported industry equity/fees.
Clinical Application
Consider for elevated anxiety. Possible indication creep: the evidence comes from a higher-risk population than the broader population who may later receive the treatment.
Discussion
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In this SMART randomized clinical trial, smartphone DMHT vs psychoeducation reduced anxiety more (AME −1.43 GAD-7 points; 95% CI, −2.49 to −0.38) but not depression; is this effect clinically meaningful and generalizable enough to change survivorship care? The trial reported that DMHT vs patient education did not significantly reduce depression symptoms: AME −0.98 PHQ-8 points, 95% CI −1.99 to 0.04; P=.06. What is the best interpretation of this result?