# Pragmatic Trial - Telehealth Research and Innovation for Veterans with Cancer (THRIVE).

> **NIH NIH P50** · NEW YORK UNIVERSITY SCHOOL OF MEDICINE · 2024 · $316,684

## Abstract

Four cancers – lung, colorectal, prostate and breast – account for nearly half of all cancer deaths among men
and women in the United States. Social determinants of telehealth (SDTH), such as race/ethnicity, poverty and
rurality, individually and in additive or synergistic combinations play an important role in access to and
outcomes from cancer care, often accounting for the observed cancer care disparities. Veterans Health
Administration (VA) is the largest integrated provider of cancer care in the US and provides state of the art
cancer care to millions of veterans. Yet even within VA, routinely praised for its equal access to care model,
disparities in cancer care persist. However, while VA serves a population at risk for SDTH driven healthcare
disparities, it also leverages the advantages of an integrated national single-payer system, such as care
coordination and telehealth, to improve health equity.
Widespread use of telehelath in oncology creates both challenges and opportunities to expand access and
improve care. In some cases, however, reliance on telehealth may widen the “digital divide” for those with
limited ability to access it. A major knowledge gap exists regarding the optimal way to integrate telehealth into
oncology practice across the care continuum. Our overarching aim is to improve the quality and equity of
cancer care across the United States by leveraging lessons learned applying telehealth treating veterans with
cancer in VA’s integrated health care system.
The objective of the pragmatic trial to test the effectiveness of an existing, ongoing clinical service, the VA
National TeleOncology program (NTO), a multilevel telehealth population health management program. We
propose a stepped wedge, cluster randomized, hybrid effectiveness-implementation study of NTO among
veterans diagnosed with prostate, lung, colon and breast cancers in VA. Using the NIMHD Health Disparities
Research Framework, we will employ mixed methods to explore the association across SDTH between NTO
and 1) service delivery outcomes, 2) hierarchical cancer outcomes, and 3) implementation outcomes.
Specifically, the aims of the pragmatic trial are to: (1) Evaluate the effect of a comprehensive multilevel virtual
oncology program to promote telehealth engagement on stakeholder (patient, provider, administrator) cancer
care experience across SDTH; (2) Evaluate the effect of a comprehensive, multilevel virtual oncology program
on quality of cancer care in veterans diagnosed with lung, colorectal, prostate and breast cancer across SDTH;
and (3) Determine the impact and cost of a comprehensive multilevel teleoncology program.
Our proposed hybrid effectiveness implementation trial to evaluate a comprehensive virtual oncology program
to promote telehealth engagement and health equity has high potential for scalability and public health impact
both within and outside of VA.

## Key facts

- **NIH application ID:** 10903871
- **Project number:** 5P50CA271358-03
- **Recipient organization:** NEW YORK UNIVERSITY SCHOOL OF MEDICINE
- **Principal Investigator:** DANIL V. MAKAROV
- **Activity code:** P50 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $316,684
- **Award type:** 5
- **Project period:** 2022-08-15 → 2027-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10903871

## Citation

> US National Institutes of Health, RePORTER application 10903871, Pragmatic Trial - Telehealth Research and Innovation for Veterans with Cancer (THRIVE). (5P50CA271358-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10903871. Licensed CC0.

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