Development and Implementation of the REmote Telehealth User-Reported caNcer Surveillance (RETURNS) Program for Lung Cancer

摘要 虽然肺癌是美国癌症相关死亡的主要原因，但超过540，000 美国人通过治疗存活下来，使其成为癌症存活者的第四大诊断。 生存护理的重要组成部分，以检测复发性疾病和/或第二原发性肺癌，监测 治疗毒性，加强戒烟，并管理患者对潜在复发的恐惧。 随着肺癌治疗的最新进展，需要监测护理的新肺癌患者人数增加， 预计增加速度比任何其他癌症都要快，有资格接受治疗的肺癌幸存者将增加20%。 事实上，研究对改善癌症监测的重要性 被医学研究所确认为比较有效性研究的“前25个优先事项”。 共识监测指南建议进行监测访视，并进行胸部计算机断层扫描（CT） 在切除术后的前2年，每6个月进行一次症状回顾，此后每年进行一次。 不幸的是，只有26%的患者接受了指南推荐的CT检查，39%的患者全部丢失 肺癌切除术后的随访9 -11患者已经确定了许多监测访问的障碍， 包括旅行距离、离开工作的时间、费用和对家庭成员的不便， 对少数民族和低收入人口的影响尤其严重，可能会加剧贫困。 然而，复发的体征和症状可以使用远程监控从患者和护理人员那里收集。 患者报告结局（PRO）评估，例如患者报告结局测量 信息系统（PROMIS），在我们的机构开发13 -24和旅行和时间障碍可以减轻， 25然而，利用专业人员和远程保健进行癌症监测的情况仍然不佳。在 2019年，我们的团队实施了远程远程医疗用户报告的癌症监测（RETURNS）， PROMIS仪器，以远程引出选定的体征和症状，13-24异步审查电子 提交了胸部CT扫描，随后进行了远程保健访问。初步数据显示， 对使用远程保健进行监测的热情、提供者的高度参与和经济可行性。 然而，“一种尺寸不适合所有人”，因此，重要的是要确定哪些患者 远程PRO评估和远程保健访问的适当候选人。为此，我们将评估“结束” 用户（患者，护理人员，肺癌临床医生）的观点，在五个不同的医院，以告知用户- 决策辅助工具的中心化设计，以指导患者选择合适的RETURNS，并优化 返回的交付。最后，我们将评估RETURNS对患者和提供者满意度的影响， 它的潜力，以提高遵守监测准则，减少监测差距，并减少 患者和医疗保健系统成本。该提案与NOT-HS-16-015一致，并将提供基本的 信息，以促进适当的，公平的，以病人为中心，癌症幸存者的监测护理。

ABSTRACT Although lung cancer is the leading cause of cancer-related death in the United States, over 540,000 Americans survive with treatment, making it the 4th leading diagnosis of cancer survivors.1,2 Surveillance is an essential part of survivorship care to detect recurrent disease and/or a second primary lung cancer, monitor treatment toxicity, reinforce smoking cessation, and manage patient fear of potential recurrence.3,4 Given recent advances in lung cancer treatment, the number of new lung cancer patients needing surveillance care is expected to increase faster than for any other cancer with 20% more lung cancer survivors eligible for surveillance in 2022 than the decade prior.2 Indeed, the importance of research to improve cancer surveillance was recognized by the Institute of Medicine as a “top 25 priority” for comparative effectiveness research.5 Consensus surveillance guidelines recommend surveillance visits, with a chest computed tomography (CT) and symptom review, every 6 months for the first 2 years following resection and, then, yearly thereafter. Unfortunately, only 26% of patients receive the guideline-recommended CT and 39% are lost to all follow-up after lung cancer resection.9-11 Patients have identified numerous barriers to surveillance visits, including travel distance, time away from work, cost, and inconvenience to family members, factors that disproportionately affect minority and low income populations, and may exacerbate disparities.12 However, signs and symptoms of recurrence can be gathered from patients and caregivers using remote assessments of Patient-Reported Outcomes (PROs), such as the Patient-Reported Outcomes Measurement Information System (PROMIS), developed at our institution13-24 and travel and time barriers can be mitigated by telehealth.25 However, use of PROs and telehealth for cancer surveillance remains poorly optimized. In 2019, our group implemented a REmote Telehealth User-Reported caNcer Surveillance (RETURNS) that uses PROMIS instruments to remotely elicit select signs and symptoms,13-24 asynchronous review of electronically submitted chest CT scans, followed by a telehealth visit. Preliminary data demonstrate considerable patient enthusiasm for surveillance using telehealth, high degree of provider engagement, and economic feasibility.26 Nevertheless, “one size does not fit all” and it is, therefore, important to determine which patients are appropriate candidates for remote PRO assessment and a telehealth visit. To do so, we will assess “end” user (patients, caregivers, lung cancer clinicians) perspectives, at five diverse hospitals, to inform a user- centered design of a Decision Aid to guide appropriate patient selection for RETURNS and to optimize the delivery of RETURNS. Finally, we will evaluate the effect of RETURNS on patient and provider satisfaction and its potential to improve adherence to surveillance guidelines, reduce surveillance disparities, and reduce patient and healthcare system costs. The proposal aligns with NOT-HS-16-015 and will provide fundamental information to facilitate appropriate, equitable, patient-centered, surveillance care for cancer survivors.