New telehealth strategy will address three cancer risk behaviors at once

Once a person is diagnosed with cancer, their health risk behaviors (smoking, overeating and lack of physical activity) affect the likelihood of them not responding to treatment, experiencing side effects treatment and she gets a new cancer. They are also more likely to get heart disease or diabetes.

A first-of-its-kind trial, funded by the National Cancer Institute (NCI), part of the National Institutes of Health, will test whether a telehealth-based intervention that addresses all three behavioral risk factors at once can change patients with cancer’ lifestyles to improve their outcomes. The trial will recruit 3,000 participants from 11 Northwestern Medicine hospitals.

Many cancer patients are more likely to die from cardiovascular disease than from their cancer.

Bonnie Spring
Professor of Preventive Medicine at Northwestern University Feinberg School of Medicine

Northwestern’s program for Scalable TELehealth Cancer Care (STELLAR) is as part of a new initiative that funds four NCI Telehealth Cancer Research Centers of Excellence, and is supported by the Cancer Moonshot, a White House initiative first launched in 2016 and revived by President Biden in 2022 to accelerate the pace of progress against cancer. Northwestern will receive $5.5 million in funding over five years.

“These risky behaviors are the same for most chronic diseases, which is important because many cancer patients are more likely to die from cardiovascular disease than from their cancer,” said project leader Bonnie Spring, Professor in Preventive Medicine at Northwestern University Feinberg School of Medicine, Co-Lead of the Cancer Prevention Program at Northwestern University’s Robert H. Lurie Comprehensive Cancer Center, and Director of the Center for Behavior and Health at Feinberg.

The Spring center has previously developed evidence-based, technology-assisted telehealth interventions to separately address obesity, smoking, and lack of physical activity.

“Nothing like that exists,” Spring said. “Over the years, we have developed separate treatments for these risky behaviors. Now we bring them together. It is efficiency. Normally, it would be time-consuming and expensive to provide treatment for even one of these risky behaviors.”

The project reduces the cost of treatment by training license-level “health promoters” to mentor patients under the supervision of clinical health psychologists. Doctors and nurses don’t have the time to treat these behaviors, Spring said, and even if they did, the cost would be much higher.

$124.3 million

Patients who smoke or are obese add $124.3 million a year to the cost of cancer treatment at Northwestern Medicine

Patients who smoke or are obese add $124.3 million a year to the cost of cancer treatment at Northwestern Medicine, Spring said. These costs add up because obesity adds $3,216 per person per year to medical expenses for cancer survivors, and Northwestern’s 11 hospitals treat 27,024 cancer and obesity patients annually. The cost to overcome first-line treatment failures caused by smoking is $10,678 per patient, and Northwestern treats 3,500 cancer patients who smoke in a single year.

Participants are coached remotely by phone and trained in the use of an application that tracks their behavior. They self-report their diet and smoking, stand on a Wi-Fi scale, and wear a Fitbit. The data is sent to their trainer electronically. So when they have a coaching call every two weeks, the coach “is aware” of how the person is doing, Spring said.

“If they’re not losing weight, the trainer can see what’s causing it,” Spring said. “What high-calorie foods do they eat? Are they eating too late at night? Are they inactive? This is what makes coaching very effective and personalized.”

The remote telehealth aspect is critical to success, Spring said. “It’s important because we think it can be a way to reach more underserved people who can’t access treatment because they live far away, work multiple jobs, don’t have reliable transport, don’t may not have childcare or may not have time off work.

The data is integrated into the patient’s electronic health record, so the cancer team is kept informed.

“This allows the team of healthcare providers to encourage the patient to make healthy behavior changes,” Spring said. “It gives these doctors a service that they all think is valuable, but they haven’t had the time or the reimbursement to provide it.”

The pandemic has forced most health fields to try telehealth, Spring said.

“Unsurprisingly (to us), telehealth treatments have generally been effective and appear to have made it easier for underserved patients to access care,” Spring said. “Because it’s always tempting to go back to the old ways, we now need to build a strong research base to find out if telehealth works for cancer care. This is how the quality of cancer care can be improved and made more equitable. And that’s what NCI’s four Telehealth Cancer Research Centers of Excellence will do, and why they’re so important. »

STELLAR integrates Spring’s treatment for obesity with treatments for smoking and inactivity developed by project co-leads Brian Hitsman and Siobhan Phillips, both associate professors of preventive medicine at Northwestern. Co-lead Sofia Garcia, an associate professor of medical social sciences at Northwestern, helped with procedures to incorporate a patient’s data into the electronic health record. Hitsman, Phillips and Garcia are all members of the Lurie Cancer Center at Northwestern.

Irene B. Bowles