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, integrative approaches such as yogic breathing (YB), a collection of techniques to voluntarily regulate breathing, have emerged as an effective complementary therapy for cancer patients. YB is well-established to induce strong relaxation responses via vagal and parasympathetic stimulation. YB is easy to practice using virtual tools such as mobile apps especially during the current scenario of COVID-19 pandemic and social distancing. 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 promoting peer support, and relieving symptomatic conditions associated with cancer treatment and survivorship. This intervention is based on compelling preliminary data generated 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 cancer survivors and other patient/general populations indicating that participants are interested in a YB intervention and perceive improvements in well-being after YB sessions. In this Phase I STTR, PranaScience (1) has built a first production version of a culturally neutral group video YB app and (2) partners with the Medical University of South Carolina (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 is 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, focus group interviews of study participants will be used to assess technology perception/ program feasibility and will inform future design optimizations. Information from the I-Corps supplemental work will be used to refine app in preparation ...