Provider and Patient-generated Remote Oro-Dental Health Electronic Data Capture for Algorithmic Longitudinal Evaluation and Risk-Assessment (PROHEALER)

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PROJECT SUMMARY/ABSTRACT Research. Oral cavity and oropharyngeal (OC/OPC) cancers afflict more than 53,000 individuals in the United States annually. Despite advancements in oncologic therapies, the majority of patients will experience significant toxicity burden during and after therapy, including moderate-severe xerostomia, dysphagia, reduced mouth opening (i.e. trismus), periodontal disease, and osteoradionecrosis. Remote electronic symptom monitoring through standardized assessment tools for patient reported outcomes (ePROs) is an evidence-based best practice, particularly in the COVID-19 era, yet few clinical practices have demonstrated sustainability of implementation efforts. To date, acute and chronic orodental complications afflicting OC/OPC survivors are largely managed on empirical knowledge with wide inter-provider management variability based on provider experience and available clinical information which is often incomplete, incorrect, or nonexistent. Therefore, standardization of electronic data capture of PROs and objective measures of provider-assessed orodental toxicity severity remains an unmet public health need. Our central hypothesis is that synchronous optimization of machine-readable patient- and provider-generated data collection can be achieved through prioritization of effective implementation strategies for longitudinal oro-systemic ePRO data collection (Aim 1) and creation of novel dental standards for accurate orodental toxicity reporting in both electronic health and dental records (Aim 2). As a subcomponent to Aim 2, we will also design and pilot a novel radiation odontogram to enhance treatment communication between providers. Accurate risk predictions of high-morbidity high-prevalence post-therapy orodental sequelae using high-quality electronic data from Aims 1 and 2 will be incorporated into a statistically robust machine-learning based model (Aim 3). In summary, the PROHEALER proposal fosters innovative and novel informatics approaches for data-driven risk assessment and algorithmic prevention and management of treatment-related oral health diseases afflicting OC/OPC survivors. Career Development & Training. Dr. Moreno's overarching goal is to become an internationally recognized independent research investigator with domain expertise in advanced radiation therapy techniques, clinical informatics and rigorous toxicity modeling methodologies as they pertain to improving patient quality of life and promoting precision prevention and risk-based interventions for orodental complications. This proposal presents Dr. Moreno's 5-year mentored career development plan which includes mentorship from prominent Established NIH Investigators who have committed to overseeing the progress of the proposed projects and Dr. Moreno's overall professional development. The outlined training activities build upon Dr. Moreno's clinical expertise as a Head and Neck Cancer Radiation Oncologist and her prior work in EHR utility enhancement with the inclusion of a comprehensive didactic and project-based curriculum focused on domain knowledge expansion in dental informatics, implementation science, and advanced statistical methods in risk prediction modeling.