Perioperative Telemonitoring to Optimize Cancer Care and Outcomes

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PROJECT SUMMARY The overall purpose of this proposal is to conduct a pilot randomized trial of a remote perioperative telemonitoring intervention to improve patient-centered outcomes, surgical outcomes and healthcare resource use in English and Spanish-speaking patients scheduled to undergo major abdominal gastrointestinal cancer surgery. This research is critical because after cancer surgery, patients experience abrupt declines in functional capacity, increase in symptoms and an overall dramatic decline in quality of life with the majority of postoperative care and recovery taking place at home. While at home, physical function can decline prior to the surgical team being notified leading up to one third of patients becoming symptomatic from a complication that may require readmission. Telemonitoring of symptoms in the perioperative period including vital signs, weight, steps taken and patient reported outcomes allows for an opportunity to intervene in the perioperative period to mitigate severity of complications and readmissions. The intervention is perioperative measurement of parameters in both groups with a nursing triage as the intervention to intercept complications and to improve patient reported outcomes. We will pilot test the intervention using a 1:1 randomization to pursue the following specific aims: Specific Aim 1: Assess the feasibility, retention, and acceptability of the remote perioperative telemonitoring intervention as measured by the percentage of patients who a) agree to participate; b) complete >70% of the telemonitoring; and c) report satisfaction with the intervention through structured exit interviews; Specific Aim 2: Determine the preliminary efficacy of the remote perioperative telemonitoring intervention on surgical outcomes, healthcare utilization, PROs, and functional recovery. This proposal is innovative because we are among the first and few to study methods of transforming patient-centered outcomes into actionable postoperative cancer care using objective and subjective measures in addition to using an existing digital health infrastructure (AetonixTM) leveraging a “real world” platform for expansion into surgical oncology. The interdisciplinary team which includes expertise in surgical oncology (Melstrom) and nursing science (Sun) is uniquely suited to conduct this research. The proposal is significant, with high scientific rigor and outcomes that are of critical importance in perioperative care to cancer patients, clinicians, healthcare systems and the National Cancer Institute. This research will address a critical gap in knowledge of how perioperative telemonitoring of objective and subjective data will improve outcomes and transitions of perioperative cancer care outside of the hospital setting. Our long-term objective is to conduct a multi-site, Phase III trial of the intervention to establish effectiveness.