Abstract
The proposed research center for Scalable TELeheaLth Cancer CARe (STELLAR) is grounded in the Institute
of Medicine (IOM) vision that quality cancer care includes not only treatment of the disease, but also promotion
of the patient’s long-term health and quality of life. Cancer risk behaviors (e.g., smoking, physical inactivity,
obesity1) are associated with poor treatment response, treatment-related side effects, heightened recurrence
risk, decreased longevity, diminished quality of life (QOL), and increased treatment cost for many cancers2-8.
These risk behaviors are at least as prevalent in cancer patients as they are in healthy adults, but referral
pathways to treat them are not routinely integrated into cancer care. By integrating cancer risk behavior
assessment into the EHR and automating referral, we plan to make telehealth-enabled treatment of health risk
behaviors (a clinical service called health promotion) accessible to cancer providers and patients throughout
Northwestern’s clinical practice network in a manner that is affordable, improves care quality, and is minimally
disruptive to clinical workflow. The MPIs of this proposal have developed, and are experts at, remotely
assessing patient symptoms and delivering effective, inexpensive, telehealth treatment of cancer’s most
prevalent and potent, behavioral risk factors. physical inactivity9, obesity10, smoking11 Our preliminary data
suggest that telehealth, as compared to in-person cancer care, may make treatment more accessible to older
adults and minorities. With Cancer Moonshot and other funds, we have collectively developed patient-reported
assessment, symptom management, and shared decision-making tools that are integrated into the single EHR
(Epic) system that links the Northwestern Memorial HealthCare Corporation’s (NMHC)11-hospital healthcare
delivery system. We also developed a smoking cessation program offered throughout NMHC. In response to
demand from NM’s Cancer Quality Improvement group, we now propose to implement, optimize, evaluate, and
disseminate a more comprehensive, fully integrated, patient-centered, technology-assisted telehealth risk
behavior treatment program that proactively addresses physical inactivity, obesity, and tobacco use for cancer
patients in the NMHC system. We plan a pragmatic trial to test its impact on equitable care access, health
outcomes, care quality, care utilization, provider-patient communication, patient-reported outcomes, and cost.
The STELLAR program will foster patients’ long-term health and quality of life by refining, disseminating, and
sustaining the first cancer-specific telehealth treatment program for multiple risk behaviors to be fully integrated
into quality cancer care.