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

摘要

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.