Lifestyle Intervention for Veterans With Blood Cancer: Tele-Intervention

Background. Since the changes in care delivery brought about by the COVID-19 pandemic, around 12% of outpatient cancer care visits are now conducted via telehealth. This approach, known as tele-oncology, offers cancer patients more efficient, convenient, and crucially, accessible care options. For VA populations, tele-oncology provides opportunities for follow-up post-diagnosis visits, visits while undergoing therapy (replacing in-person visits on chemotherapy days), and ongoing health surveillance. Variations in digital literacy among veterans can introduce bias in essential research on telehealth-delivered care interventions. To tackle this issue, our team has created and tested the VVCMatch, a tailored telehealth readiness tool. The VVCMatch is intended to proactively identify various barriers to tele-oncology that veterans may face, such as communication impairments and cognitive changes related to chemotherapy or hormonal therapy, including memory, mental flexibility, and processing challenges.

The proposed study aims to assess the efficacy of a telehealth-mediated lifestyle intervention program specifically designed for veterans with blood cancer. The primary focus is on evaluating improvements in health-related quality of life, mental health, and pain outcomes. This initiative acknowledges the unique experiences and challenges faced by veterans, who constitute a distinct population with specific needs, particularly those residing in rural or underserved areas. We hypothesize that the telehealth-delivered lifestyle intervention will result in significant enhancements in health-related quality of life, reduction in depressive symptoms, improved functional capacity, and decreased pain levels among the veteran participants. Such improvements are crucial for this demographic, as they often face barriers to accessing consistent, high-quality healthcare services.

Methods. This pilot trial will enroll 30 veterans from the H. John Heinz III VA, including those currently receiving treatment (such as chemotherapy or radiation therapy) and those in post-treatment stages. This inclusive approach is intended to increase recruitment feasibility and provide comprehensive insights across different treatment timelines. Baseline measurements will be collected through web-based surveys that evaluate demographics, occupational performance via the Canadian Occupational Performance Measure, and telehealth preparedness using the VVCMatch assessment.

The intervention itself is composed of two main components: progressive resistance and aerobic exercises. These will be delivered through a distance model facilitated by a health coach. The intervention begins with an initial supervised live exercise session conducted via telehealth, followed by regular remote sessions lasting 30 to 45 minutes each. These sessions are carried out via telehealth through the Veteran's Video Connect (VVC) application, with scheduling tailored to each participant's availability. Between sessions, communication is maintained through email, allowing for the exchange of information regarding session schedules and graphical progress reports.

A critical feature of this study is its adaptability to the participants' real-time needs. The health coach can modify exercise intensity based on daily symptom assessments, ensuring that each session is both effective and safe. This responsiveness is particularly important given the fluctuating nature of symptoms in individuals with blood cancer. To address potential disparities in technology literacy, the VVCMatch assessment will categorize participants into either a "technology prepared" or "technology education" group. Those identified as needing additional support will receive comprehensive telehealth education, including a walkthrough of the VVC application, to ensure they can fully engage with the intervention.

In addition to the physical activity component of exercise, participants will also have access to dietary consultations provided by the Leukemia and Lymphoma Society (LLS). This service underscores the holistic approach of the intervention, addressing both physical and dietary aspects of health.

Outcome measures include a range of assessments conducted at baseline and post-intervention. These encompass symptoms (using the VA Symptom Assessment Scale), fatigue (measured by the Global Fatigue Index), functional capacity (assessed via the PROMIS-Physical Function Cancer Item Bank), mental health (evaluated with the Four-Item Patient Health Questionnaire for Anxiety and Depression), and pain (measured using the Numeric Pain Rating Scale and the McGill Pain Questionnaire Short-Form). The intervention's usability will also be assessed using the Technology Acceptance Model, focusing on perceived usability, usefulness, and ease of use.

Overall, this study aims to provide valuable insights into the feasibility and impact of telehealth-based lifestyle interventions for veterans with blood cancer, potentially offering a scalable model to enhance the quality of life for this underserved population.

Inclusion criteria

• Living with blood cancer
• Physically willing and able to perform 30-90 minutes of exercise a minimum of 2 times per week

Exclusion criteria

• Veterans who are unable to perform 30-90 minutes of exercise twice a week
• Veterans with significant disabilities related to balance or motion that would cause a safety risk
• Veterans without a smart personal device (smart phone, tablet, or computer) and internet connection (for example, cellular or WIFI connection)
• Veterans who are pregnant