CANCER, COVID-19

Leveraging Telemedicine for Cancer Care During COVID-19

May 27, 2021 - Todd Ackerman

Cancer patients and doctors at Houston Methodist were satisfied with the quality of virtual care provided during the pandemic, according to a new study, the type of assessment expected to make telemedicine a mainstay of practice even after COVID-19 fades.

The study found the greatest enthusiasm among patients, who overwhelmingly opted for telemedicine appointments over in-person visits, then reported strong satisfaction with the experience in follow-up surveys. More than half said they'd be interested in all or most of their visits being virtual in the future.

"I was very surprised the patient satisfaction level and desire to continue telemedicine care was so high," says Dr. Jorge Darcourt, associate director of Houston Methodist Cancer Center and the study's principal investigator. "Given that appetite, we have a lot of work to do if we want to make telemedicine available to all on a regular basis."

How do we make telemedicine appealing to everyone?

Dr. Darcourt said such work particularly needs to involve the elderly and those of lower socioeconomic status — both who were less likely to use telemedicine during the study period. He stressed the need to figure out how to make sure both groups have the necessary technology and comfort level using it because they're the ones whose access and mobility issues may make telemedicine most beneficial.

Acceptance of telemedicine was not as strong among Houston Methodist oncologists, though the majority said they were satisfied with the care provided. Many expressed concern about the lack of physical examinations, not unexpected considering the importance of palpating tumors, lymph nodes and organs. They said they feared the absence of physical examinations could lead to key missed clinical clues about a patient's condition.

The research was published in January in JCO Oncology Practice, a journal of the American Society of Clinical Oncology. It is one of the first studies to report on cancer patients' experience with telemedicine during COVID-19.

Is telemedicine here to stay?

Telemedicine, with its promise of easier access to care and reduced costs, has long been touted as a solution to some of what ails medicine, but its implementation has been slow, hindered by regulatory issues and poor payer reimbursement. However, by necessity, it exploded during the pandemic and now seems here to stay.

At Houston Methodist's seven cancer centers, for instance, roughly 65% of appointments during the pandemic's peak were virtual. By contrast, according to Dr. Darcourt, zero patients used telemedicine prior to the pandemic. Currently, about 20% still do.

Dr. Darcourt says telemedicine holds particular promise in cancer care because so many patients are older and vulnerable, often on taxing treatment, sometimes alone. Many have difficulty traveling to health-care settings.

Are patients satisfied with telemedicine visits?

The study looked at the willingness and experience of those patients offered telemedicine appointments in the pandemic's first six weeks in Houston, March 16 through April 30. That was before the pandemic's peak in Houston.

During that period, 1,477 of 1,762 Houston Methodist cancer patients, 84%, chose a telemedicine appointment over an in-person visit. Patients downloaded a Houston Methodist video platform on their smart devices (iPhone or tablet) and a care team member was available to troubleshoot the appointment.

Of those responding to a survey, 92.6% said they were satisfied 83.4% were very satisfied with such appointments. Fifty-five percent indicated an interest in having all or most of their visits be via telehealth in the future.

Are doctors satisfied with telemedicine visits?

In contrast, slightly less than two-thirds of doctors were either satisfied or very satisfied with the telemedicine visits. Besides the fear of missing significant clinical findings (52%), their top concerns included a lack of meaningful physician-patient interaction (48%), a decrease in the quality of care (26%), an inability to get adequate information (26%) and potential medical liability (30%).

But the doctors liked the idea of continuing telemedicine for established patients. Nearly 75% said they'd be somewhat or highly likely to continue seeing patients virtually for follow-up appointments. For first encounters, only 30% said they'd be somewhat or highly likely to see first-time patients virtually.

Predictably, younger physicians were generally happier with telemedicine than older physicians, Dr. Darcourt says.

Dr. Darcourt expressed optimism about new technology to compensate for physical examinations. He said multiple tools being developed home electrocardiograms, vital sign monitors, sonograms will allow doctors to better assess a patient's condition remotely.

Though Houston Methodist hasn't yet developed a specific telehealth policy for the future, Dr. Darcourt says the system will continue offering such appointments, dependent on reimbursement models, onboarding processes being developed and emerging technology solutions. It will be doctor- and patient-driven, he says.

"Telemedicine is here to stay," says Dr. Darcourt. "We knew it was coming. COVID-19 just made it part of the landscape a decade ahead of schedule."