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

摘要 尽管肺癌是美国与癌症相关的死亡的主要原因，但超过54万人 美国人靠治疗存活下来，使其成为癌症幸存者的第四大诊断。1，2监测是一种 发现复发疾病和/或第二次原发肺癌的生存护理的基本部分，监测 治疗毒性，加强戒烟，并管理患者对潜在复发的恐惧。 肺癌治疗的最新进展，需要监测的新肺癌患者人数为 预计增长速度比任何其他癌症都快，肺癌幸存者有资格获得 2022年的监测比十年前的监测更重要2确实，研究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”。 共识监测指南建议使用胸部计算机断层扫描(CT)进行监测 术后头两年每6个月复查一次症状，之后每年复查一次。 不幸的是，只有26%的患者接受了指南推荐的CT，39%的患者全部失去了 肺癌切除后的随访。9-11患者发现了许多监视访问的障碍， 包括旅行距离、离开工作的时间、成本和对家庭成员的不便，这些因素 对少数群体和低收入人群造成不成比例的影响，并可能加剧差异。 然而，复发的迹象和症状可以从患者和照顾者那里使用远程 评估患者报告的结果(PRO)，例如患者报告的结果测量 我们机构开发的信息系统(PROIS)13-24，旅行和时间障碍可以通过以下方式缓解 远程保健。25然而，利用PRO和远程保健进行癌症监测仍然没有得到充分的优化。在……里面 2019年，我们的团队实施了远程远程医疗用户报告的癌症监控(RETURNS)，该监控使用 PROMIS仪器可远程获取选定的体征和症状，13-24小时以电子方式进行非同步检查 提交了胸部CT扫描，然后进行了远程医疗访问。初步数据显示有相当多的患者 对使用远程医疗进行监测的热情、高度的提供者参与度和经济可行性。26 然而，“一刀切”并不适用于所有人，因此，确定哪些患者是 适合进行远程专业评估和远程医疗访问的候选人。为此，我们将评估“end” 用户(患者、护理人员、肺癌临床医生)的观点，在五家不同的医院，以告知用户- 以决策帮助为中心的设计，以指导适当的患者选择退货并优化 递交申报表。最后，我们将评估退货对患者和提供者满意度的影响 它有可能改善对监测准则的遵守，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 促进对癌症幸存者进行适当、公平、以患者为中心的监督护理的信息。

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.