@Article{info:doi/10.2196/67108,
author="Lin, Yu Chen
and Hagen, Ryan
and Powers, Benjamin D
and Dineen, Sean P
and Milano, Jeanine
and Hume, Emma
and Sprow, Olivia
and Diaz-Carraway, Sophia
and Permuth, Jennifer B
and Deneve, Jeremiah
and Alishahi Tabriz, Amir
and Turner, Kea",
title="Digital Health Intervention to Reduce Malnutrition Among Individuals With Gastrointestinal Cancer Receiving Cytoreductive Surgery Combined With Hyperthermic Intraperitoneal Chemotherapy: Feasibility, Acceptability, and Usability Trial",
journal="JMIR Cancer",
year="2025",
month="Apr",
day="7",
volume="11",
pages="e67108",
keywords="gastrointestinal cancer; peritoneal disease; cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy; digital health intervention; nutrition; feasibility",
abstract="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. Trial Registration: ClinicalTrials.gov NCT05649969; https://clinicaltrials.gov/study/NCT05649969 ",
issn="2369-1999",
doi="10.2196/67108",
url="https://cancer.jmir.org/2025/1/e67108",
url="https://doi.org/10.2196/67108"
}