Telehealth and mobile health are on the rise, with the potential to broaden the reach of top-notch medical expertise, and to make it more equitably accessible. It’s exciting.
It’s important. But it is also vital that health professionals become intimately involved in the development of these new platforms because they are ones who understand the complexities of using the data that will be collected.
In a pilot study, funded by both the Society for Surgery of the Alimentary Tract and The Center for Advanced Digestive Care, we are testing a new mobile app that could help transform postoperative patient monitoring. We were lucky to be able work with colleagues at Cornell Tech, who have set the gold standard for patient data security.
Now, thanks to a $450,000 grant from Damon Runyon Foundation, we will be performing a randomized trial for patients with gastrointestinal cancer using the app to document their health and recovery in the perioperative period.
Readmission rates for older adults undergoing colon and rectal resection can be as high as 30%, three-quarters of which may be preventable by identifying abnormal findings or pain early. The app will allow real-time biologic monitoring that until now has been too resource intensive and cost prohibitive to widely implement.
Patients download the app to their smartphone or tablet, and are given a wearable fitness tracking device to capture other metrics. Demographic and quality of life data are also collected, as well as regular photos.
For 4 weeks after the surgery, patients provide their doctors with qualitative and quantitative data, and they are instructed to contact their providers if metrics appear abnormal.
Patients and providers will be asked for feedback and possible improvements to the app. So far, patients have said they love the ability to communicate more directly and frequently with their doctor, feeling empowered by participating more fully in their recovery. Doctors have reported that they like the ability to access and interpret data, rather than relying on recall or subjective reports that can be affected by bias.
The benefits have already manifested themselves. Beyond patient satisfaction, we have been able to catch several complications early, and only 1 patient (of 13) has been readmitted. We’re hopeful that the postsurgical app can decrease readmission rates by at least 5% to 10%.
A Positive Fit
In addition to the GI cancer app, we are exploring the role of exercise and positive thinking on improved outcomes, via 2 studies: Strides for Life, funded by the Lung Cancer Research Foundation; and INSPIRE: Intervention to Support Participation in Regular Exercise in the Elderly, funded by the National Institutes of Health/ National Institute on Aging and the American Federation for Aging Research.
Historically, lung cancer is detected at an advanced stage and carries a poor prognosis. But thanks to scientific advancements, cancers are being discovered earlier and people are living longer. Up to 80% of stage I lung cancer patients are now cured after surgery alone, without the need for chemotherapy. However, many of these patients may have poor underlying lung function which impacts their quality of life. Additionally, there remains a stigma associated with lung cancer which may negatively impact patients’ own self perceptions. Incorporating physical activity in recovery is important across a range of chronic diseases, and positive reinforcement of health messages can provide the motivation patients need to achieve success, both physically and mentally.
Often, when we ask people to change their health behavior, we provide a type of negative reinforcement by reminding a person of all of the bad things that could happen to them if they don’t change their lifestyle or health behavior. Instead, our approach is to engage people in the positive things in their lives, and to ask them to link positive experiences or activities to their health.
For example, we ask people to tell us what makes them smile or things that make them happy. They might respond, “playing with my grandchildren.” When you ask a person about being more physically active and how that relates to playing with their grandchildren, it creates a positive, individualized perspective on health behavior change.
Our previous studies have found that positive affect —a feeling of happiness and well-being — can be powerfully effective in promoting healthy behaviors such as physical activity in adults with chronic illness.
Cancer is increasingly viewed and treated as a chronic disease, so we decided to adapt an intervention initially developed for elderly patients— PAIRE (Positive Affect Induction for Regular Exercise)—for lung cancer patients.
The Strides for Life trial is using fitness trackers and telephone outreach to follow 54 earlystage lung cancer patients after surgery in an effort to assess how physical activity and positive affect influences their recovery.
One group of patients will receive educational text messages about the importance of exercise and other healthy behaviors. The others will receive regular scripted telephone calls, during which they will be encouraged to think pleasant thoughts and look at photos of loved ones whenever they need motivation.
We think this approach will be particularly effective in cancer, and strongly believe that focusing on positive health behavior will improve long-term outcomes.
We need a greater focus on preventive medicine approaches to recovery and long-term health behaviors in cancer survivors. Just as we embrace the latest cutting-edge treatments, we should use the latest technological tools to help improve our patients’ lives. But we must do this in thoughtful ways, with teams that include not only technicians and clinicians, but also epidemiologists, sociologists, surgeons, and nurses.
Janey C. Peterson, MA, MS, RN, EdD, is an associate professor of clinical epidemiology in the Departments of Medicine; Cardiothoracic Surgery; and Integrative Medicine at Weill Cornell Medicine.
Brendon Stiles, MD, is an associate professor of Cardiothoracic Surgery at Weill Cornell Medicine, Sandra and Edward Meyer Cancer Center, and an associate attending cardiothoracic surgeon at NewYork-Presbyterian Hospital.
Heather Yeo, MD, MHS, is an assistant professor of surgery and Healthcare Policy & Research at Weill Cornell Medicine, Sandra and Edward Meyer Cancer Center, and an assistant attending surgeon at NewYork-Presbyterian Hospital.