Virtual Prostate Cancer Clinic: Thumbs Up From Patients and Docs 

Roxanne Nelson RN, BSN

November 12, 2021

CHICAGO — A virtual prostate cancer clinic (VPCC) got high marks from patients who used its services.

Of the nearly 1400 men who had completed active prostate cancer treatment and who were enrolled in the virtual clinic, 94% reported that they were comfortable with being monitored virtually.

In addition, most the patients said that using the VPCC saved them time (92.4%) and reduced out-of-pocket expenses (87.3%).

The study results were presented here at the American Society for Radiation Oncology (ASTRO) Annual Meeting.

"The number of virtual follow-ups increased steadily each year, with a spike due to COVID-19," said lead author Richard Boyajian, MSN, RN, NP, from the Dana-Farber/Brigham and Women's Cancer Center, Boston, Massachusetts. "During the pandemic, the VPCC allowed for very rapid switching of patients from in-person follow-ups to virtual monitoring."

Cancer Diagnosis Impetus for VPCC

Although telemedicine got a huge boost during the COVID-19 pandemic, some patients with prostate cancer at Brigham and Women's Hospital and Dana-Farber Cancer Institute have been using this approach for several years.

Boyajian, a nurse practitioner who works in radiation oncology, came up with the idea of a virtual clinic in 1996, when he was diagnosed with leukemia. "I was waiting to get a stem cell transplant and spending a lot of time at Dana-Farber — and I didn't want to," he said. "I wanted to come up with a way that I could stay out of the clinic."

After his curative therapy, Boyajian returned to school to become a nurse practitioner and then went to work at Dana-Farber — the place he credits with saving his life.

He joined the genitourinary radiation oncology team in 2013, and was caring for patients being treated for prostate cancer. Boyajian noted that these patients are regularly followed for PSA testing and with physician visits to report any symptoms.

A great deal of time was spent in the follow-up process on repetitive tasks for physicians and staff, he explained. "From a patient perspective, it is also very time-consuming as they have to travel to the clinic," he said. "They have to deal with traffic, take off from work — they probably spend more time in the waiting room and traveling than they do with the doctor. We decided that there's got a better way."

Boyajian received a grant from the Brigham Care Redesign Incubator and Startup Program (BCRISP) to create the virtual program. He then developed a software program that allowed patients to have their PSA levels drawn at an affiliated lab that reported directly into the electronic health record (EHR) or at a local lab, and these results were combined with an electronically submitted questionnaire filled out by the patients. The digital health platform then analyzed PSA levels to indicate relapse or no relapse and provided symptom scores based on questionnaire responses.

Savings in Time and Money

Follow up was also virtual, either by telephone, secure email, or messaging through the electronic health record portal. Patients with posttreatment symptoms were generally managed virtually and those with evidence of PSA recurrence received appropriate scanning per guidelines along with discussions with the referring physician.

For the study to assess the impact of the VPCC, Boyajian and colleagues evaluated data from 1397 patients who had enrolled in the program from March 15, 2016 to July 31, 2020.

The majority of patients (94.3%) said they were comfortable with this form of monitoring, whereas 3.4% were neutral, and 2.3% reported that they were uncomfortable.

Most patients (92.4%) said that it saved them time, and more than half of this group (53.2%) reported that it saved more than 3 hours per visit.

In addition, 95.1% reported that it was important to have the team from Dana-Farber and Brigham and Women's monitoring them as opposed to outside providers, and 87.3% reported reduced out-of-pocket expenses.

Overall, 90% of patients said that VPCC made their healthcare easier and more flexible and convenient; met their medical needs; reduced travel-related stress; and that they received PSA results in a timely manner.

In fiscal year 2015, there were 702 in-person prostate cancer follow-up visits, but after the VPCC was established, the number steadily declined — there were 607 in 2016 and 533 (a 24% reduction) in 2019.

The VPCC also freed up clinician time, and thus increased access to care for new patients. The team notes that consultations for all malignancy types conducted by radiation oncologists that treat genitourinary cancer on the main campus steadily increased. There were 534 such consults in 2015, but after the VPCC opened, this number jumped to 771 (an increase of 44.4%) in 2016, and increased steadily up to 1129 (an increase of 110%) in 2019.

"By fiscal year 2019, consults had more than doubled because the doctors had more time," Boyajian said, "And we have treated 79.3% more patients with prostate cancer."

Even though there is no reimbursement for VPCC visits, the freeing up of physician time led to them seeing new patients, and that was associated with genitourinary radiation oncology revenue growth of 26.6% in 2016, which increased steadily up to 74.4% for 2019, when compared to pre-VPCC levels.  

"This approach allows a small number of providers to manage a larger patient population, while still ensuring the entire population receives the care they need," Boyajian said.

Broadly Implemented for the Future

Commenting on the study, Jessica Karen Wong, MD, MEng, assistant professor, Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, explained that the digital telehealth platform reflects a novel way to deliver follow-up care. "This can be particularly useful within the constraints of current COVID-19 restrictions," she said.

"The virtual prostate cancer clinic's digital health model led to high patient satisfaction and clinic time savings. This approach could be broadly implemented in the future to help streamline safe and convenient follow-up for patients in the future," she said.

The VPCC was funded form a Brigham Care Redesign Incubator & Startup Program (BCRISP) grant. Boyajian disclosed that he could have a potential financial benefit from royalties from VPCC DHP commercialization. Wong has disclosed no relevant financial relationships.

American Society for Radiation Oncology (ASTRO) Annual Meeting: Abstract 125. Presented October 26, 2021.

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