Sean Patrick Dineen

Postgraduate training to become a surgical oncologist involves a general surgery residency and a Complex General Surgical Oncology (CGSO) Fellowship, with

The coronavirus pandemic forced a rapid adoption of electronic education platforms, including a virtual approach for the Complex General Surgical Oncology

Palliative care is an important component of global oncology care, and palliative surgical oncology is becoming an increasingly significant part of surgica

Colorectal peritoneal metastases (CRPM) represent a significant treatment challenge for patients with colorectal cancer that significantly impact quality o

Background: Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) can improve survival outcomes for individuals with gastrointestinal (GI) cancer and peritoneal disease (PD). Individuals with GI cancer and PD receiving CRS-HIPEC are at increased risk for malnutrition. Despite the increased risk for malnutrition, there has been limited study of nutritional interventions for individuals receiving CRS-HIPEC. Objective: We aimed to test the feasibility, acceptability, and usability of Support Through Remote Observation and Nutrition Guidance (STRONG), a multilevel digital health intervention to improve nutritional management among individuals with GI cancer and PD receiving CRS-HIPEC. We also assessed patient-reported outcomes, including malnutrition risk, health-related quality of life, and weight-related measures. Methods: STRONG is a 12-week digital intervention in which participants received biweekly nutritional counseling with a dietitian, logged food intake using a Fitbit tracker, and reported nutrition-related outcomes. Dietitians received access to a web-based dashboard and remotely monitored patients’ reported food intake and nutrition-impact symptoms. Implementation outcomes were assessed against prespecified benchmarks consistent with benchmarks used in prior studies. Changes in patient-reported outcomes at baseline and follow-up were assessed using linear and ordered logistic regressions. Results: Participants (N=10) had a median age of 57.5 (IQR 54-69) years. Feasibility benchmarks were achieved for recruitment (10/17, 59% vs benchmark: 50%), study assessment completion (9/10, 90% vs benchmark: 60%), dietitian appointment attendance (7/10, 70% vs benchmark: 60%), daily food intake logging adherence (6/10, 60% vs benchmark: 60%), and participant retention (10/10, 100% vs benchmark: 60%). Most participants rated the intervention as acceptable (8/10, 80% vs benchmark: 70%) and reported a high level of usability for dietitian services (10/10, 100%). The benchmark usability for the Fitbit tracker to log food intake was not met. Compared to baseline, participants saw on average a 6.0 point reduction in malnutrition risk score (P=.01), a 20.5 point improvement in general health-related quality of life score (P=.002), and a 5.6 percentage point increase in 1-month weight change (P=.04) at the end of the study. Conclusions: The STRONG intervention demonstrated to be feasible, acceptable, and usable among individuals with GI cancer and PD receiving CRS-HIPEC. A fully powered randomized controlled trial is needed to test the effectiveness of STRONG for reducing malnutrition and improving patient outcomes.