Telerehabilitation for Veteran Lung Cancer Survivors Following Curative Intent Therapy

该项目题为“治疗意向治疗后老年肺癌幸存者的远程康复”， 是职业发展奖(CDA)-2重新提交给退伍军人事务部(VA)康复研究 和开发(RR&D)服务(RFA RX-20-006)。候选人，医学博士，医学博士，MAS，是一名工作人员 洛基山地区退伍军人医学中心(RMR VAMC)的肺病学家和助理教授 科罗拉多大学安舒茨医学院(CU AMC)。哈博士已于#年完成硕士学位 肺运动生理学的临床研究、博士后研究和患者报告的结果，以及 发表了关于老年肺癌幸存者健康损害的第一作者、原创研究文章 遵循治疗性意图治疗。哈博士的职业发展目标是在1)获得深入的培训 定性研究，2)行为健康科学，3)临床试验的设计和实施，重点是 康复和锻炼。他的长期目标是评估康复服务，以改善 退伍军人肺癌幸存者成为退伍军人事务部内科研究员。 哈博士的主要导师罗伯特·L·基思博士是CU AMC的医学和癌症生物学教授 和RMR VAMC负责研究的副参谋长。基思博士是全国肺癌领域的领军人物， 在研究资助和指导方面有良好的记录。哈博士的合作导师(和他们的相关专业知识)是 David B.Bekelman博士，医学博士，公共卫生硕士，医学副教授(定性研究，支持性护理)， 杰米·L·斯塔茨博士，医学肿瘤学教授(行为健康科学，肺癌存活期)， 以及Jennifer E.Stevens-Lapsley，PT，博士，物理治疗(康复科学)教授。这个 环境是协作性的，有着悠久的教师发展历史。这包括RMR老年病 研究、教育和临床中心；以退伍军人为中心和价值驱动的护理创新中心； 肺精确肿瘤学计划；以及科罗拉多大学临床和翻译科学研究所。 肺癌是美国退伍军人中第二常见的癌症-超过8200起 每年都会诊断出病例。大约50%的肺癌是在I-III期诊断出来的，因此 有资格接受治疗性意向治疗。早期肺癌退伍军人的存活率有所提高 以及外科和放射技术的进步。在治疗性意图治疗之后，许多退伍军人 身体功能丧失，症状负担增加。因此，需要采取各种方法来 改善他们的功能和生活质量(QOL)。我们假设远程康复可以缓解这些症状。 不良影响。因此，我们寻求：(目标1)进行定性研究，以评估(A)陈旧性肺癌 治疗意向治疗后幸存者的健康目标，(B)对运动结果预期的了解 以及(C)自我效能感和对技术的障碍。参与者(N=30) 将接受社会认知理论指导下的半结构化面试。将对定性数据进行分析 以主题分析为指导。结果将用于指导远程康复规划。(目标2)开展 试点随机研究，以检查(A)可行性，(B)可接受性，和(C)探索a 对这些患者进行远程康复干预。参与者(N=40)将随机(1：1)获得12 进行数周的远程康复训练(实验组)或仅进行评估(对照组)。可行性将通过以下方式评估 登记、遵守和保留；系统可用性量表的可接受性；以及通过 线性混合效应模型比较组间功能、症状控制和生活质量的变化。 CDA-2项目将为量身定做远程康复的战略提供信息，并为 早期职业内科研究员建立独立性，目标是进行大规模随机试验(VA 优点)优化的远程康复计划，以改善身体和心理社会功能， 治疗意向治疗后退伍军人肺癌幸存者的独立性和生活质量。

This project entitled “Telerehabilitation for Veteran Lung Cancer Survivors Following Curative Intent Therapy”, is a Career Development Award (CDA) – 2 resubmission to the Veterans Affairs (VA) Rehabilitation Research and Development (RR&D) Service (RFA RX-20-006). The candidate, Dr. Duc M. Ha, MD, MAS, is a Staff Pulmonologist at the Rocky Mountain Regional VA Medical Center (RMR VAMC) and Assistant Professor at the University of Colorado Anschutz Medical Campus (CU AMC). Dr. Ha has completed a master’s degree in clinical research, postdoctoral research in pulmonary exercise physiology and patient-reported outcomes, and published first-authorship, original research articles on the health impairments of Veteran lung cancer survivors following curative intent therapy. Dr. Ha’s career development goals are to acquire in-depth training in 1) qualitative research, 2) behavioral health science, and 3) the design and conduct of clinical trials focused on rehabilitation and exercise. His longer-term goals are to evaluate rehabilitation services to improve the lives of Veteran lung cancer survivors as a VA physician investigator. Dr. Ha’s primary mentor, Dr. Robert L. Keith, MD, is Professor of Medicine and Cancer Biology at CU AMC and Associate Chief of Staff for Research at RMR VAMC. Dr. Keith is a national leader in lung cancer with a proven track record of research funding and mentoring. Dr. Ha’s co-mentors (and their relevant expertise) are Drs. David B. Bekelman, MD, MPH, Associate Professor of Medicine (qualitative research, supportive care), Jamie L. Studts, PhD, Professor of Medical Oncology (behavioral health science, lung cancer survivorship), and Jennifer E. Stevens-Lapsley, PT, PhD, Professor of Physical Therapy (rehabilitation science). The environment is collaborative with a long history of faculty development. This includes the RMR Geriatric Research, Education and Clinical Center; Center of Innovation for Veteran-Centered and Value-Driven Care; Lung Precision Oncology Program; and the University of Colorado Clinical and Translational Sciences Institute. Lung cancer is the second-most commonly diagnosed cancer among U.S. Veterans – over 8,200 incident cases are diagnosed each year. Approximately 50% of lung cancers are diagnosed at stage I-III and therefore eligible for curative intent therapy. Survival rates among Veterans with early stage lung cancer have increased along with advances in surgical and radiation techniques. Following curative intent therapy, many Veterans experience physical function loss and increased symptom burden. Consequently, approaches are needed to improve their function and quality of life (QoL). We hypothesize that telerehabilitation could mitigate these adverse effects. Therefore, we seek to: (Aim 1) Conduct a qualitative study to assess (a) Veteran lung cancer survivors’ health goals following curative intent therapy, (b) knowledge of outcome expectations for exercise and rehabilitation, and (c) perceived self-efficacy and impediments towards technology. Participants (N=30) will undergo semi-structured interviews guided by the Social Cognitive Theory. Qualitative data analysis will be guided by thematic analysis. Results will be used to guide telerehabilitation programming. (Aim 2) Conduct a pilot randomized study to examine the (a) feasibility, (b) acceptability, and (c) explore the effects of a telerehabilitation intervention with these patients. Participants (N=40) will be randomized (1:1) to receive 12 weeks of telerehabilitation (experimental arm) or assessment only (control arm). Feasibility will be assessed by enrollment, adherence, and retention; acceptability by System Usability Scales; and exploratory effects by linear mixed effects models comparing changes in function, symptom control, and QoL between groups. This CDA-2 project will inform strategies to tailor telerehabilitation and provide pilot data and training for an early career physician investigator to establish independence, with a goal of a large-scale randomized trial (VA Merit) of an optimized telerehabilitation program to improve the physical and psychosocial function, independence, and QoL of Veteran lung cancer survivors following curative intent therapy.