Telerehabilitation for Veteran Lung Cancer Survivors Following Curative Intent Therapy

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.