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Leading-edge surgical treatments and innovative telemedicine for patients

Laleh Melstrom M.D.

Laleh Melstrom, M.D., M.S.

Remote Perioperative Telemonitoring of Patient-generated Physiologic Health Data and Patient-reported Outcomes

 
Patient-generated health data (PGHD) and patient-reported outcomes (PROs) are increasingly being used in routine cancer care as quality and value indicators. Unfortunately, these outcomes are not adequately understood nor routinely integrated in surgical oncology. Laleh Melstrom, M.D., M.S., chief of the Division of Surgical Oncology, and City of Hope are looking to bridge this critical gap in knowledge by conducting the first perioperative cancer care study that combines PGHD and PROs with nursing intervention to mitigate complications and improve outcomes. 
 
This is a prospective, single-group, pilot/feasibility study of remote perioperative telemonitoring in major abdominal/pelvic cancer surgery (GI, GU, GYN). City of Hope plans to enroll 20 (7 GI, 7 GU, 6 GYN) subjects overall over a 12-month period. City of Hope has also partnered with mTelehealthTM and Aetonix, two mobile and remote patient monitoring companies of PGHD and PROs, to provide subjects with tablets that will collect, store and report timely and accurate health information wherever a subject may be. PGHDs such as weight, temperature, oxygen saturation, heart rate and blood pressure will be captured. A Vivofit 4 (Garmin Company) pedometer will also be utilized to monitor daily steps.
 
Electronic PROs will be captured for symptoms (as measured by the MD Anderson Symptom Inventory), and quality of life (as measured by the EQ-5D-5L and PROMIS 4). A feedback system that triggers alerts when PGHDs and PROs exceed determined thresholds will allow health professionals to respond using the Aetonix secure digital patient engagement platform via real-time communication with patients by telephone for further assessments.
 
The feasibility of this study will be assessed by:
 
  • Overall accrual, retention, and attrition rates
  • Patient’s ability to use the remote perioperative monitoring equipment
  • Staff's ability to identify threshold healthcare parameters
  • Staff's ability to act on identified threshold healthcare parameters
 
Acceptability will be assessed through qualitative data analysis of exit interview data using the conventional content analysis approach. Average steps taken in the last five days (day 26 to day 30), change in symptom severity baseline to 30 days, and CCI at 30 days will be determined for all patients.
 
Through this study, City of Hope wants to test the feasibility and acceptability of remote perioperative telemonitoring of PGHD and PROs in order to improve our patient’s care after they leave the hospital.
 
To enroll a patient in this study please call 626-218-1133 or visit us at CityofHope.org/research/find-a-clinical-trial.
 
ALEX K. WONG, MD, FACS

Alex K. Wong, M.D

Innovative Surgical Interventions for Lymphedema

City of Hope is a National Cancer Institute-designated comprehensive cancer center that is leading the way in providing treatments to patients who are suffering from cancer. Dr. Alex Wong is a plastic surgeon at City of Hope who is providing leading-edge treatments to cancer patients. He is particularly focused on those suffering from lymphedema, which is swelling typically in the arms or legs. Lymphedema is often caused by lymph node removal or damage due to cancer treatment. This is an area of interest to Dr. Wong as he understands the physical and mental toll this condition may have on those who have already beaten a cancer diagnosis.
 
Dr. Wong specializes in providing multiple surgical interventions such as lymphovenous bypass, which is a process where lymphatic vessels are rerouted directly to the venous system, bypassing the damaged nodes. Dr. Wong is also able to perform lymph node transfers, which is the harvesting of lymph nodes from one area of the body and transferring them to an affected area.
 
Prophylactic interventions are also available for patients who have early-stage lymphedema or are at high risk of developing lymphedema. In these cases, patients may be candidates for a prophylactic lymphovenous anastomosis (LVA), where disrupted lymphatic channels are rerouted before lymphedema occurs. Evidence has shown that an LVA can reduce the risk of developing lymphedema by almost 30%.
 
Dr. Wong and his colleagues are also committed to treating lymphedema from every angle, as evidenced by their ongoing phase 2A trial exploring the use of LYT100, a deuterated form of pirfenidone, to block fibrosis from occurring in early-stage lymphedema. In addition, the use of retinoic acid to allow the body to create and reconnect lymphatics in damaged areas has shown promising early results in mice. When it comes to lymphedema, Dr. Wong and City of Hope are offering treatment for patients in the present as well as exploring solutions for the future.
 
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