Abstract
Virtual care in cancer care existed in a limited fashion globally before the COVID-19 pandemic, mostly driven by geographic constraints. The pandemic has required dramatic shifts in health care delivery, including cancer care. We conducted a systematic review of comparative studies evaluating virtual versus in-person care in patients with cancer. Embase, APA PsycInfo, Ovid MEDLINE, and the Cochrane Library were searched for literature from January 2015 to 6 August 2020. We adhered to PRISMA guidelines and used the modified GRADE approach to evaluate the data. We included 34 full-text publications of 10 randomized controlled trials, 13 non-randomized comparative studies, and 5 ongoing randomized controlled trials. Evidence was divided into studies that provide psychosocial or genetic counselling and those that provide or assess medical and supportive care. The limited data in this review support that in the general field of psychological counselling, virtual or remote counselling can be equivalent to in-person counselling. In the area of genetic counselling, telephone counselling was more convenient and noninferior to usual care for all outcomes (knowledge, decision conflict, cancer distress, perceived stress, genetic counseling satisfaction). There are few data for clinical outcomes and supportive care. Future research should assess the role of virtual care in these areas. Protocol registration: PROSPERO CRD42020202871.
Highlights
Virtual care, defined as interaction between a patient and clinician(s) that is not in-person, is commonly referred to as remote care, telemedicine, or teleoncology, and is a subset of eHealth; the primary modalities are telephone and videoconferencing
This systematic review determined that oncology studies with direct comparison between virtual and in-person care are limited and generally provide low to very-low quality evidence, with the exception of RCTs that studied very specific situations: genetic counselling and endometrial cancer follow-up
While there is intense interest in understanding where virtual care may be at least equivalent to in-person care during active cancer management, this review found little published evidence that directly addressed this aspect of cancer care
Summary
Virtual care, defined as interaction between a patient and clinician(s) that is not in-person, is commonly referred to as remote care, telemedicine, or teleoncology, and is a subset of eHealth; the primary modalities are telephone and videoconferencing. Virtual care in patients with cancer existed in a limited fashion globally before the COVID19 pandemic, mostly driven by geography constraints. Evidence on virtual care is emerging but there remain numerous unknowns that need to be addressed to guide health care systems and cancer clinicians, as well as patients and caregivers, in understanding the potential for virtual care to substitute for in-person care. There has been rapid adoption of virtual care due to the COVID-19 pandemic. This transition to virtual care has occurred in the absence of evidence as to its equivalency to traditional care. The full review, including results of reports and publications addressing technical requirements, equity, inter-professional care, and healthcare provider compensation for optimal delivery of virtual cancer, is available on the Ontario Health (Cancer Care Ontario) website (https://www.cancercareontario.ca/en/ guidelines-advice/types-of-cancer/68836), accessed on 24 August 2021
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