PROJECT SUMMARY Cancer remains the second leading cause of deaths in the U.S. Encouragingly, recent improvements in early diagnosis and treatment has led to significant increases in the survival rate of cancer patients. As cancer becomes a chronic but manageable disease for thousands of survivors, the long-term physical and psychological side effects of treatment protocols is becoming more apparent, as is the impact of these issues on disease-free or overall survival. As a result of this changing landscape, survivorship care programs and approaches that incorporate non-pharmacological lifestyle and mind-body interventions are becoming increasingly critical components of the patient treatment pathway. In this regard, aspects of meditation and yoga such as yogic breathing (YB), a collection of techniques to voluntarily regulate breathing, has emerged as an effective complementary therapy for cancer patients. YB is well-established to induce strong relaxation responses via vagal and parasympathetic stimulation. In this application, PranaScience seeks to develop a novel group video app for YB that is optimized for home-based delivery of a proscribed YB program that is maximally effective in reducing symptomatic conditions associated with cancer treatment and survival. This intervention is based on compelling preliminary studies conducted by the PI of this proposal demonstrating that specific YB exercises induce alterations in the levels of proteins associated with tumor suppression, immune regulation, neuromodulation, and stress response/ inflammation, as well as pilot studies performed in collaboration with the Medical University of South Carolina (MUSC) indicating that cancer survivors are interested in a YB intervention and perceive improvements in well-being after YB sessions. In this Phase I STTR, PranaScience will (1) build a first production version of a group video YB app and (2) partner with MUSC to pilot test the YB app in breast cancer survivors to evaluate adherence, feasibility, and acceptability of the app to support symptom management. App usage data will be collected and used to evaluate adherence to the program, and acceptability for symptom management will be evaluated using a series of defined biobehavioral measures at baseline and following a 12-week implementation period. Exploratory salivary and fingernail biomarker analysis focused on tumor suppressors, inflammatory cytokines, proteome level alterations, and stress hormones will be performed at baseline and at week 12. Structured, focused interviews of study participants will be used to assess technology perception/ program feasibility and will inform future design optimizations. Findings from this Phase I program will be synthesized to refine the group video YB app in preparation for large-scale evaluation in Phase II, ultimately resulting in a scalable, low-cost resource that accelerates recovery from treatment and supports sustainable health in all-site cancer survivors, wit...