||3UM1CA233035-01S1 Interpret this number
||Northwestern University At Chicago
||Implementation and Evaluation of an Expanded Bilingual Electronic Symptom Management Program Across a Multi-Site, Fully-Integrated Comprehensive Cancer Center
Physical and functional symptom burden is high among cancer survivors and is an ideal target for chronic care
management. Cancer-related physical and functional side effects (PFs) include joint pain, fatigue, muscle
weakness, loss of range of motion, altered skin sensation and integrity, postural abnormality, and lymphedema.
Cancer survivors lack the knowledge and skills to prevent, detect, and manage PF side effects. Our research
shows that a majority of cancer survivors report 3 or more long-lasting PFs and that rehabilitation services are
under-utilized to treat them. Cancer rehabilitation interventions can reduce PFs and support functional ability.
However, our work shows that cancer survivors lack receptivity to and misunderstand the benefits of cancer
rehabilitation – even among those with cancer-related disability. Oncology providers also lack system support
for timely identification of PFs and referral to rehabilitation. Usual cancer care lacks ownership for effective
surveillance and management of PFs that can be done without interrupting clinical flow and overburdening
providers and patients. Early rehabilitation (pre-hab) could facilitate ownership of PFs by educating patients on
early detection and self-management of PFs, but this approach is completely absent from usual cancer care.
The parent grant has developed the Northwestern Medicine Patient Reported Outcome (NMPRO) symptom
monitoring system that prospectively monitors PFs severity with the Patient Reported Outcome Measurement
Information System - Physical Function (PROMIS-PF) survey. With this Diversity Supplement, we will be able
to: 1) leverage the parent grant to map the development of PFs across different cancer patient populations; 2)
develop a learning health systems mechanism to support oncology providers to match the right patient, at the
right time, with the right rehabilitation service, in the right location (4Rs Referral System); and 3) obtain
stakeholder feedback about implementation and dissemination strategies for multi-level (patient, provider,
community, system) prevention, detection, and management of cancer-related PFs and the development of risk
stratification models for rehabilitation referral. The results from this supplement will inform the planned R01
resubmission to the NCI to test the combination of NMPRO + 4Rs + pre-hab in a large-scale randomized
controlled trial. Our Specific Aims are: Aim 1: Map the trajectory and identify risk factors for development of
physical and functional impairment and for cancer rehabilitation services utilization from the point of cancer
diagnosis through at least the first year after diagnosis; Aim 2: Modify NMPRO to provide a decisional support
mechanism for early and timely cancer rehabilitation referral in response to electronic health record alerts
generated in the parent study; Aim 3: Identify realistic implementation, dissemination, and adaptation strategies
for future hybrid effectiveness trials of pre-habilitation interventions for different cancer patient populations.
None. See parent grant details.