Scalable TELeheaLth Cancer CARe: The STELLAR Program to Treat Cancer Risk Behaviors

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Abstract The proposed research center for Scalable TELeheaLth Cancer CARe (STELLAR) is grounded in the Institute of Medicine (IOM) vision that quality cancer care includes not only treatment of the disease, but also promotion of the patient’s long-term health and quality of life. Cancer risk behaviors (e.g., smoking, physical inactivity, obesity1) are associated with poor treatment response, treatment-related side effects, heightened recurrence risk, decreased longevity, diminished quality of life (QOL), and increased treatment cost for many cancers2-8. These risk behaviors are at least as prevalent in cancer patients as they are in healthy adults, but referral pathways to treat them are not routinely integrated into cancer care. By integrating cancer risk behavior assessment into the EHR and automating referral, we plan to make telehealth-enabled treatment of health risk behaviors (a clinical service called health promotion) accessible to cancer providers and patients throughout Northwestern’s clinical practice network in a manner that is affordable, improves care quality, and is minimally disruptive to clinical workflow. The MPIs of this proposal have developed, and are experts at, remotely assessing patient symptoms and delivering effective, inexpensive, telehealth treatment of cancer’s most prevalent and potent, behavioral risk factors. physical inactivity9, obesity10, smoking11 Our preliminary data suggest that telehealth, as compared to in-person cancer care, may make treatment more accessible to older adults and minorities. With Cancer Moonshot and other funds, we have collectively developed patient-reported assessment, symptom management, and shared decision-making tools that are integrated into the single EHR (Epic) system that links the Northwestern Memorial HealthCare Corporation’s (NMHC)11-hospital healthcare delivery system. We also developed a smoking cessation program offered throughout NMHC. In response to demand from NM’s Cancer Quality Improvement group, we now propose to implement, optimize, evaluate, and disseminate a more comprehensive, fully integrated, patient-centered, technology-assisted telehealth risk behavior treatment program that proactively addresses physical inactivity, obesity, and tobacco use for cancer patients in the NMHC system. We plan a pragmatic trial to test its impact on equitable care access, health outcomes, care quality, care utilization, provider-patient communication, patient-reported outcomes, and cost. The STELLAR program will foster patients’ long-term health and quality of life by refining, disseminating, and sustaining the first cancer-specific telehealth treatment program for multiple risk behaviors to be fully integrated into quality cancer care.