{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T15:49:45Z","timestamp":1791906585805,"version":"4.3.4"},"reference-count":58,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Cancer"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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\u2019 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n 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 (\n P<\/jats:italic>\n =.01), a 20.5 point improvement in general health-related quality of life score (\n P<\/jats:italic>\n =.002), and a 5.6 percentage point increase in 1-month weight change (\n P<\/jats:italic>\n =.04) at the end of the study.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/67108","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T17:50:07Z","timestamp":1740073807000},"page":"e67108-e67108","source":"Crossref","is-referenced-by-count":7,"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"],"prefix":"10.2196","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-6808-6615","authenticated-orcid":false,"given":"Yu 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