Postpandemic Vision: Half of Cancer Visits via Telemedicine

Nick Mulcahy

March 19, 2021

In the postpandemic era, about half of all visits by cancer patients with oncologists could be successfully conducted via phone- and video-based telemedicine, according to a new poll of American cancer specialists.

After the pandemic, an estimated 33% of patients could be seen using video visits, and 13% could be seen using phone visits; thus, 46% of patient visits could be performed remotely, the survey found.

Dr Amye Tevaarwerk

"A substantial fraction of patient visits could be effectively, safely conducted using telemedicine," summarized the authors, led by Amye Tevaarwerk, MD, from the University of Wisconsin, Madison, Wisconsin.

The survey involved more than 1000 oncologists from National Comprehensive Cancer Network (NCCN) member institutions. It was presented as a poster at the NCCN annual meeting, currently underway online.

In the survey, oncologists were asked, "Absent any financial implications, approximately what percentage of your patients could reasonably be seen via telemedicine versus in-person visits after pandemic resolution?"

Survey results show that oncologists believe reimbursement is a "challenge" to implementing telemedicine. Another challenge is patients' access to technology.

An expert not involved in the study described the 46% projection for telemedicine visits for cancer patients as "provocative" but cautioned about making too much of the survey's findings.

Dr Cardinale Smith

"While the use and capability of telemedicine has been expanded during the COVID-19 pandemic, the best practice for when it can and should be used in place of an office visit still remains to be determined," said Cardinale Smith, MD, PhD, director of quality for cancer services at Mount Sinai Health System, New York City, in an email to Medscape Medical News.

A 20-item online survey was sent to 1038 oncologists. The aim of the survey was to assess provider perspectives on the current and future role of telemedicine in oncology.

Few respondents had participated in telemedicine visits of any kind prior to the COVID-19 pandemic (19%; 198/1038). At the time the survey was conducted, most had participated in both telephone and video-based visits (84%; 872/1038).

Notably, 93% of respondents reported "never" or "rarely" when asked how often they perceived an adverse outcome arising because of a telemedicine visit.

The participants were also queried about how phone and video compared with in-person visits in reference to a series of common clinical scenarios.

For reviewing benign or reassuring data, roughly 40% said both the telephone and video were much better/somewhat better than an office visit, while less than 20% said the office visit was much better/somewhat better. About 40% to 50% of respondents said there was no difference among the approaches.

The other clinical scenarios involved follow-up visits for patients on surveillance or maintenance therapy; explaining important malignancy-related clinical data; procedure decisions; therapy decisions; assessing complications of therapy; and establishing a personal connection with a patient/family.

"Telemedicine performed well for uncomplicated visit types and underperformed in in-person visits as care complexity increased," summarized the survey authors.

Details Matter

Mount Sinai's Smith said that the nitty-gritty of practice needs to be scrutinized to establish the optimal mode of patient-provider interaction, and in that regard, the current study fell short.

"This poster does not address the type of cancers treated by the surveyed oncologists or the types of treatments being received (oral vs infusional)," she observed, citing an example.

The majority of cancer patients are actively undergoing some form of infusional treatment, which requires in-person visits, Smith pointed out. But the proportion of patients who require infusional treatment varies by cancer type and stage. In short, there are a lot of variables that the broad questions in the survey could not tease out, including differences between patients receiving active treatment and those who are survivors, she said.

 

The authors acknowledge that after the pandemic, increased use of telemedicine will partly depend on agents beyond the world of white coats.

"Clinical workflows and best practices cannot emerge until regulatory, licensing and re-imbursement policies are addressed and should be re-examined as these policies become clearer and pandemic pressures ease," Tevaarwerk and coathors comment.

"Careful thought should be given to modifying regulations to maintain telemedicine for use post pandemic," they suggest.

2021 National Comprehensive Cancer Virtual Annual Conference: Presented March 18, 2021. Abstract BIO21-011

The authors and Smith have disclosed no relevant financial relationships.

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