Holy Grail: Empowering cancer survivors to manage their heart health with SMS messages

Can you describe the aim of your research in 10 words? 

Lowering cancer survivors’ risks of heart disease via everyday technologies.

The journey so far: Where are you at in your research career and what are you working on at the moment?

I am an early-career researcher (< 3 months post-PhD). I led a clinical trial and national implementation pilot with over 1,000 breast cancer survivors, testing a heart-health support program that was delivered via text messages called EMPOWER-SMS. The studies found that EMPOWER-SMS helped women adhere to their treatment plans, motivated them to exercise and eat healthier and importantly, helped them feel supported between medical visits. I’m currently working on implementing EMPOWER-SMS in cancer clinics in NSW and translating the program to other cancers and countries (Canada).

That’s exciting! How does EMPOWER-SMS work?

EMPOWER-SMS messages were co-designed by breast cancer survivors, health professionals and researchers and are meant to be uplifting and supportive and provide practical tips that patients can start using immediately. The messages are semi-personalised, with the recipient’s nickname (e.g. Sharon could be ‘Shaz’ if she wanted), and sign off from their clinic.

Topics include getting active, ways to eat healthier, managing mental health, why it’s important to take their medication and where to find accurate health information. Around 1/3 of messages include weblinks to helpful resources and free local health programs. Some messages also encourage patients to speak to a health professional if they have questions about managing their condition.

When we trialled the program, participants received four messages randomly per week Monday–Saturday, mimicking how a loved one would text them (rather than the same time every day, which can be boring). Our co-design group felt four messages would be enough to feel supported and receive important information but not too much to be annoyed. We have run similar studies with > 5,000 patients, and 80–90% ‘agreed’ that four messages per week was ‘just right’. When patients finished the program, they often told us they wanted to continue receiving messages, but choose the number of messages they received per week. Personalising text message programs is an important next step to make sure everyone is happy!

It seems you’ve done a lot of work with app and text message support for cardiovascular disease patients. Can you tell us a bit about that?

I’m very passionate about making health support and education accessible. Most of us use mobile phones every day and hospitals already use text messages for appointment reminders. So, why not harness this technology to support patients between medical appointments and link them to free services that they may not be aware of. Our team, led by Professor Julie Redfern, has tested heart-health text message programs in clinical trials with > 10,000 chronic disease patients and found that they can improve cardiovascular disease (CVD) risk factors like blood pressure, LDL-cholesterol, exercise, diet and stress. Similarly, my research led by Dr Karla Santo found that mobile apps can improve medication adherence. Apps are ubiquitous among the next generation and we need to future-proof CVD support and education so that people are receiving evidence-based information in a way they feel comfortable with.

What drew you to this line of research?

I used to work in a research lab, but I was allergic to rats. When I moved to Australia in 2017, I met an amazing cardiologist and PhD student Dr Karla Santo who needed a research assistant to help her with a clinical trial testing whether apps could help people remember to take their medications. During my undergrad, I worked in a stroke rehabilitation research group, which I really enjoyed, so Karla’s trial sounded right up my alley. From there, the research team led by Professor Redfern and Professor Clara Chow were doing such incredible work supporting patients using digital health. I fell in love with seeing the immediate positive impact digital health could have in people’s lives.

How could your work impact patient care and how long until it does? 

My research has already had direct impacts on > 2,000 patients with breast cancer and lung disease. During the 2020 COVID-19 lockdowns, when in-person health support was closed across Australia, we provided free heart-health support via text messages. We advertise through breast cancer networks (McGrath Foundation, National Breast Cancer Foundation) and Lung Foundation Australia. People signed up from every state and territory, young and old (age 30–87) and 8% were from regional, rural or remote communities. Participants found the program easy to understand (99%), useful (83%), motivated them to eat healthier (70%) and get active (70%). Most importantly, they said it made them feel supported during a challenging time (86%). My goal is for this support to be available to all breast cancer survivors in Australia by December 2024.

You’ve been named Heart, Lung and Circulation’s Editorial Fellow for 2022. Can you tell us how that came about and what that entails? 

I feel very honoured to be named a 2022 Heart, Lung and Circulation (HLC) Editorial Fellow, alongside four impressive cardiologists. I have been a peer-reviewer since 2019 for many journals, including BMJ Open Heart and the Journal of Medical Internet Research. I’m passionate about high-quality peer-review processes and HLC is a shining example of excellence in this area. I was keen to join the team as an editorial fellow to learn the ropes of becoming an editor and all the hard work that goes on behind the scenes. I look at this opportunity as a first-step to my goal of becoming a journal editor. The role entails partnering with current editor Professor Julie Redfern and forming a Special Issue on Environment, Climate and Cardiovascular Health.

What’s your Holy Grail — the one thing you’d like to achieve in your research career?

The main goal of my research is to help people feel supported and improve their health in a way that is accessible and enjoyable. I’m already on the way to implementing my CVD support for breast cancer survivors into usual clinical care. But, I want to keep growing the work to other cancers and other countries. I’m currently working with a not-for-profit organisation Northwest Territories Breast Health/Breast Cancer Action Group to deliver heart health support via text messages to people living in rural, remote and Indigenous communities. Support and internet service are limited in those areas, so text messages offer a more accessible strategy.

What is your biggest research hurdle?

I’m sure many researchers can relate but maintaining funding to conduct new research or keep community-based programs available to everyone who wants to use them is very challenging. So far, I’ve been awarded > $80 K in grant funding as lead researcher from various organisations, including the Australian Health Research Alliance Women’s Health Research and Translation Network Early and Mid-Career Researcher Funded Awards ($15,000) and University of Sydney’s Cardiovascular Initiative ($10,000). I’m hoping to leverage past funding to gain larger, more long-term funding. I’m also learning new skills, like pitching for sponsors for community-based programs, which keeps things interesting.

Bonus question: What new hobby have you picked up during COVID?

I am now a volunteer puppy raiser with Guide Dogs Australia. Raising puppies Jewel and Yala during the pandemic helped my mental health and physical health in more ways than I can explain. Puppy snuggles between meetings, afternoon walks and non-stop laughs (and sometimes big messes) made working from home fun. Jewel is now undergoing testing to see what ‘career’ path she’ll take. Let’s all keep our fingers crossed that she’ll be a guide dog!

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