NCI Telehealth Research Centers of Excellence (TRACE)

TRACE Overview

In the United States, there has been a substantial increase in telehealth use in recent years. Research has shown that telehealth can improve healthcare access and quality, patient/provider communication, and health outcomes. Importantly, many aspects of cancer care can be delivered through telehealth, such as promotion of positive health behaviors and cancer screening, remote patient monitoring and management of symptoms during cancer treatment, and virtual survivorship follow-up care. However, large-scale research in diverse clinical settings is needed to optimize the use of telehealth and sustain it as a mode of cancer care delivery, as well as to ensure that cutting-edge findings are quickly adopted into effective and equitable practice.

The National Cancer Institute’s Telehealth Research Centers of Excellence (TRACE) Initiative, supported by the Cancer Moonshot^SM, funds multiple centers focused on improving people’s lives by:

• rapidly developing an evidence base of telehealth approaches to cancer care, spanning prevention to survivorship
• identifying and addressing disparities in access to and use of telehealth services for cancer-related care
• fostering innovations to improve cancer care delivery using new tools, research methods, and technologies
• evaluating the changing policy and payment environment and its impact on delivery of telehealth for cancer care

TRACE Centers

Overview of Projects

• Making Telehealth Delivery of Cancer Care at Home Effective and Safe (MATCHES) Research Center: The MATCHES Telehealth Research Center supports investigators and trainees from multiple disciplines to 1) conduct pragmatic and pilot trials across its’ integrated network of outpatient oncology practices; 2) leverage a substantial cache of observational data to build the evidence base necessary to establish best practices for telehealth-supported cancer care; and 3) investigate telehealth safety during cancer treatment and address the risk of exacerbating disparities in access to high quality healthcare. The center’s theme focuses on developing data science methods to integrate telehealth data with other complex data streams to measure outcomes and quality of care.
• Scalable TELeheaLth Cancer CARe (STELLAR) Research Center: The STELLAR team is integrating cancer risk behavior assessment into the electronic health record and automating referrals in order to make telehealth-enabled treatment of health risk behaviors accessible to cancer providers and patients throughout Northwestern’s clinical practice network. The STELLAR team's experience in developing evidence-based, technology-assisted risk behavior treatments, provides a foundation for their plan to refine and evaluate a tailored, cancer-specific, telehealth treatment program for multiple risk behaviors to be fully integrated into quality care.
• Telehealth Research and Innovation for Veterans with Cancer (THRIVE) Research Center: The THRIVE team is collaborating with the Veterans Health Administration (VA), the largest integrated health care system in the United States) – to examine how social determinants(e.g., race, ethnicity, poverty and rurality) affect telehealth use in cancer care. THRIVE aims to: 1) understand how social determinants impact the delivery of telehealth for cancer and 2) develop methods to address SDTH and thereby improve access and quality of cancer care for all patients.
• University of Pennsylvania Telehealth Research Center of Excellence (Penn TRACE): The Penn TRACE team is applying insights from communication science and behavioral economics to design and test synchronous telehealth strategies, supported by asynchronous elements, to improve effectiveness and equity across the cancer care continuum, with an emphasis on understanding mechanisms of action. Penn TRACE uses lung cancer care as an exemplar model for telehealth across the care continuum, from screening to treatment to survivorship. Penn TRACE aims to produce new fundamental knowledge regarding telehealth approaches, with the potential to transform cancer care delivery, equity, and health-related outcomes.

Monographs

Title: Integrating Telehealth into Cancer Care Delivery: Advancing a National Research Agenda
Journal: JNCI Monographs, Volume 2024, Issue 64, July 2024
Description: This issue of JNCI Monographs is dedicated to 1) presenting a comprehensive analysis of NCI’s telehealth research portfolio; 2) showcasing the four TRACE centers and highlighting their joint commitment to health equity; and 3) generating research ideas among researchers and clinicians to further inform the evidence base of telehealth-delivered cancer care. As such, the first article—authored by a team of NCI program staff—presents pre- and post-pandemic trends in synchronous patient-provider telehealth funding at NCI over a 7-year period. Subsequently, the four multidisciplinary TRACE teams detail their respective center’s research activities, clinical settings, lessons learned to date, and cross-center activities. Lastly, the issue concludes with the American Cancer Society and other thought leaders commenting on the state of telehealth and cancer research and reflections on future directions.

Publications

1. Senft Everson N, Jensen RE, Vanderpool RC. Disparities in Telehealth Offer and Use among U.S. Adults: 2022 Health Information National Trends Survey. Telemed J E Health. 2024 Jun 27. doi: 10.1089/tmj.2024.0014. Epub ahead of print. [View Abstract]
2. Jensen RE, Rohde JA, Muro AH, Schweppe CA, Vanderpool RC. Analysis of Telehealth Discussion Trends on Reddit (2019-2022). Telemed J E Health. 2024 Jun;30(6):e1790-e1797. doi: 10.1089/tmj.2023.0651. Epub 2024 Feb 23. [View Abstract]
3. Doshi SD, Bange EM, Daly B, Kuperman G, Panageas KS, Morris MJ. Telemedicine and Cancer Care: Barriers and Strategies to Optimize Delivery. Cancer J. 2024 Jan-Feb 01;30(1):8-15. doi: 10.1097/PPO.0000000000000691. [View Abstract]
4. Rendle KA, Steltz JP, Cohen S, Schapira MM, Wender RC, Bekelman JE, Vachani A. Estimating Pack-Year Eligibility for Lung Cancer Screening Using 2 Yes or No Questions. JAMA Netw Open. 2023 Aug 1;6(8):e2327363. doi: 10.1001/jamanetworkopen.2023.27363. [View Abstract]

Presentations

Improving cancer outcomes—Bringing research to rural communities
Rural communities need improved access to cancer research and clinical studies to reduce inequalities and end cancer as we know it. NCI hosted this virtual roundtable conversation as part of the White House Cancer Cabinet Community Conversations series from July 8–17, 2024. This series provides updates on progress to advance Biden Cancer Moonshot priority actions and receive input on efforts still needed to deliver on Cancer Moonshot goals. Telehealth and TRACE were highlighted as opportunities to reach rural communities.

NCI TRACE Staff

• Robin Vanderpool: Chief, Health Communication and Informatics Research Branch (HCIRB)
• Roxanne Jensen: Program Director, Outcomes Research Branch (ORB)