Telemedicine In Oncology Research Articles

Association between telehealth use in oncology and downstream utilization at a large academic health system.

While telemedicine has been beneficial in oncology by reducing infectious exposure and improving access for patients with poor functional status, it also has intrinsic limitations, including the inability to perform a physical exam, which could lead to increased downstream utilization in this population at high risk of medical decompensation. We conducted a retrospective cohort study investigating the relationship between telemedicine use in oncology and subsequent outpatient oncology encounters, emergency department (ED) visits, and hospitalizations. We included outpatient oncology encounters, including telemedicine and in-person visits, occurring between 1 January 2018 and 31 December 2022 at a large academic health system. Unadjusted descriptive statistics and multiple linear regressions were used to estimate subsequent outpatient oncology visits, ED visits, and hospitalizations within 30 days of an index visit based on modality (telemedicine versus in-person). The multiple regressions were adjusted for various demographic and clinical characteristics, including palliative care visits, baseline utilization, recent chemotherapy, and comorbidities. Our cohort included 63,722 patients with 689,356 outpatient encounters, of which 639,217 (92.7%) were in-person and 50,139 (7.3%) were telemedicine visits. Patients on average had 0.91 outpatient oncology visits, 0.04 ED visits, and 0.05 hospitalizations within 30 days following an index encounter. In our adjusted analyses, telemedicine was associated with 13.7 fewer downstream outpatient oncology visits (95% CI 12.5-14.9; p < 0.001) per 100 index encounters, 0.7 fewer ED visits (95% CI 0.4-1.0; p < 0.001) per 100 index encounters and 0.9 fewer hospitalizations (95% CI 0.6-1.3; p < 0.001) per 100 index encounters compared to in-person visits. Contrary to our hypothesis, oncology patients who had a telemedicine visit had fewer follow-up outpatient oncology encounters, ED visits and hospitalizations after 30 days than those with in-person visits. Future studies should further investigate the efficacy of telemedicine in oncology and outline specific scenarios for appropriate use in this and other populations.

Evaluation of Telemedicine Experience: Artificial Intelligence in Cancer Care

Background. To date, one of the key tasks of our time, which has yet to be solved, is to provide medical services remotely using constantly advancing information and communication technologies. It is medical sciences that urgently needs ICT tools for various scopes: providing medical care in remote regions, organizing continuous education of medical personnel, managing electronic patient records, implementing mobile diagnostic devices, and managing network of branches or medical facilities at the institutional level. Telemedicine is a necessity, especially for patients with comorbid chronic diseases like cancer. Objective. To evaluate utilization of digital technologies at various stages of cancer care, through the example of artificial intelligence. Materials and methods. A systematic literature review was conducted using PRISMA. The search was carried out in such databases as Elibrary, PubMed, MEDLINE, Google Scholar by keywords “Telemedicine in oncology”, “COVID-19 in oncology”, “Artificial Intelligence”, “Digital Technologies”, “Data Personalization”, and “Teleoncology”. Publications not primarily focused on evaluating telemedicine technologies in oncology were excluded from the review process. Results. The literature review was conducted to consider the rapid integration of telemedicine since the pandemic, the risks associated with the widespread use of telemedicine in oncology, and the use of artificial intelligence in oncology, including the early detection and diagnosis of cancer. In conclusion, it is noted that the digitalization of healthcare radically changes the clinical workflow by expanding the possibilities for obtaining information from both medical staff and patients. Experience-based medicine is being replaced by an evidence-based, patient-centered approach. The rapidly developing artificial intelligence technologies will continue to have a great impact on the oncology in the near future. Both medical staff and scientific community must be prepared for the coming changes.

Supporting complex oncology workflows with telemedicine.

521 Background: Telemedicine is now foundational in health care, including oncology. Cancer care is complex and requires an integrated care model that involves multiple participants. The use of telemedicine in oncology requires careful consideration of workflows and patients’ needs. Our team reviewed existing telemedicine technology options, but none fit the needs of ongoing, complex cancer care delivery. We describe the development and implementation of a home-grown telemedicine system to support complex oncology workflows in an efficient and scalable manner at a high-volume specialty cancer center. Methods: Using an internally developed application, MSK Telemedicine, we created a technology-enabled workflow that mimicked the positive aspects of an in-person interaction for the patient, the clinician, and administrative staff. The patient (i) can invite friends and family to the visit, (ii) are notified when the clinician is running late, (iii) can join the visit without downloading special software, (iv) can receive visit reminders based on their preferences, (v) can engage with the telemedicine platform in multiple languages (vi) have translators join the call, (vi) provide research consents and participate in clinical trials virtually, and (vii) have multiple clinicians join the virtual visit. We assessed telemedicine volume, duration of the remote encounter, patient satisfaction and help desk measures from August 1, 2021 to May 31, 2023. Patients could provide feedback immediately after the visit using star ratings on a scale of 1-5, 5 being the highest score. After the first telemedicine visit using MSK Telemedicine, patients also had the opportunity to answer a comprehensive patient satisfaction questionnaire. Results: Telemedicine represented 28% of the outpatient visit volume. During the study period, the platform supported a total of 483,499 visits with 67% including more than 2 people. Clinicians requested translator services for 1,289 of visits (Nov 2022 – May 2023) and 25,411 reminders were sent in languages other than English. Patients provided 5,635 research consents. The overall patient satisfaction was 4.84 (n=53,902). Patients reported high ease of use (4.83), audio quality (4.83) and video quality (4.84). 90% of patients would recommend telemedicine to other patients and 91% would have another telemedicine visit with their provider (n=29,804). Over 96% of telemedicine calls lasted over 3 minutes, a proxy to identify successful visits. Since the implementation of the platform, the monthly number of patient calls to the help desk decreased significantly (from 1,691 in March 2022 to 585 in March 2023). Conclusions: The MSK Telemedicine system is an example of a high performing system that is successfully meeting the unique and complex needs of cancer care delivery while providing a seamless patient experience. Future research is underway to evaluate the impact of this system on additional patient and provider outcomes.

The association between telemedicine visits and downstream utilization among patients with cancer at a large academic health center.

515 Background: The COVID-19 pandemic and associated policies such as lockdowns spurred the widespread adoption of telemedicine throughout the U.S. Telemedicine has played a particularly important role for oncology patients by reducing potential exposure to infection and improving access for patients with poor performance status. However, as policymakers consider extending payment for telemedicine into the post-pandemic era, it is important to understand the impact of telemedicine on downstream care utilization in this population. We conducted a retrospective cohort study investigating the relationship between telemedicine use in oncology and subsequent outpatient oncology encounters, emergency department (ED) visits and hospitalizations at a large academic health center. Methods: We studied all outpatient oncology encounters occurring between 2018 and 2022 at the University of California, Los Angeles (UCLA) Health system, including in-person visits and telemedicine (audio-visual &amp; audio-only) visits. We used multiple linear regression to predict the number of outpatient visits, ED visits, and hospitalizations within 30 days of an index visit based on visit modality, adjusting for demographic and clinical characteristics including patient age, race, ethnicity, sex, insurance, distance to clinic, distance to the nearest UCLA hospital, hospice referral, palliative care visits, median visit interval, appointment length, whether the visit occurred off the patient’s chemotherapy schedule, and the month and year of visit. Results: Our cohort included 62,815 patients with 672,427 outpatient encounters, of which 623,890 (92.7%) were in-person visits, 40,392 (6.0%) were video visits, and 8,145 (1.2%) were telephone visits. Overall, patients on average had 0.90 downstream outpatient visits, 0.16 ED visits, and 0.18 hospitalizations within 30 days of an index outpatient encounter. In our adjusted analyses, telemedicine encounters were associated with less outpatient utilization (270 fewer downstream visits [95% CI: 241 to 299] per 1000 encounters; p &lt; 0.001). Telemedicine was also associated with greater ED visits (42.1 more ED visits [95% CI 18.5 to 65.8] per 1000 encounters; p &lt; 0.001) and hospitalizations (54.8 more admissions [95% CI 33.6 to 76.1] per 1000 encounters; p &lt; 0.001). Conclusions: Oncology patients who had a telemedicine visit rather than an in-person visit were less likely to have a follow-up outpatient encounter but more likely to have an ED visit or hospitalization within 30 days. Our findings suggest that telemedicine has largely played a substitutive role in the outpatient setting, but patients may require higher levels of care after these visits when compared to in-person visits. Additional research should further evaluate the effectiveness of telemedicine in oncology and define appropriate contexts for telemedicine use in this population.

Telemedicine Adoption in an NCI-Designated Cancer Center During the COVID-19 Pandemic: A Report on Patient Experience of Care.

Patients with cancer require timely access to care so that healthcare providers can prepare an optimal treatment plan with significant implications for quality of life and mortality. The COVID-19 pandemic spurred rapid adoption of telemedicine in oncology, but study of patient experience of care with telemedicine in this population has been limited. We assessed overall patient experience of care with telemedicine at an NCI-designated Comprehensive Cancer Center during the COVID-19 pandemic and examined changes in patient experience over time. This was a retrospective study of outpatient oncology patients who received treatment at Moffitt Cancer Center. Press Ganey surveys were used to assess patient experience. Data from patients with appointments between April 1, 2020, and June 30, 2021, were analyzed. Patient experience was compared between telemedicine and in-person visits, and patient experience with telemedicine over time was described. A total of 33,318 patients reported Press Ganey data for in-person visits, and 5,950 reported Press Ganey data for telemedicine visits. Relative to patients with in-person visits, more patients with telemedicine visits gave higher satisfaction ratings for access (62.5% vs 75.8%, respectively) and care provider concern (84.2% vs 90.7%, respectively) (P<.001). When adjusted for age, race/ethnicity, sex, insurance, and clinic type, telemedicine visits consistently outperformed in-person visits over time regarding access and care provider concern (P<.001). There were no significant changes over time in satisfaction with telemedicine visits regarding access, care provider concern, telemedicine technology, or overall assessment (P>.05). In this study, a large oncology dataset showed that telemedicine resulted in better patient experience of care in terms of access and care provider concern compared with in-person visits. Patient experience of care with telemedicine visits did not change over time, suggesting that implementing telemedicine was effective.

Estimated Carbon Emissions Savings With Shifts From In-Person Visits to Telemedicine for Patients With Cancer

While the health care community advocates broadly for climate change policy, medical professionals can look within care practices to assess their contribution to carbon dioxide (CO2) emissions, and provide solutions wherever possible. Telemedicine can help in mitigating climate change by providing care from a distance. To assess the carbon savings achieved from telemedicine visits. This cross-sectional study of telemedicine visits was conducted at a single-institution National Cancer Institute (NCI)-designated comprehensive cancer center. Eligible patients were aged 18 years and above, completed telemedicine visits from April 1, 2020, to June 20, 2021, and had a Florida mailing address documented in their electronic medical record. Groups were divided between those within driving time of 60 minutes (1-way) to the cancer center vs those living beyond 60 minutes of drive time. Data were analyzed between April 2020 and June 2021. Carbon emission savings from telemedicine, measured in total and average per-visit savings. A total 49 329 telemedicine visits with 23 228 patients were conducted from April 1, 2020, to June 30, 2021. A total 21 489 visits were for patients with driving time of 60 minutes or less (median [IQR] age, 62.0 [52.0-71.0] years; 12 334 [57.4%] female; 1685 [7.8%] Black, 1500 [7.0%] Hispanic, 16 010 [74.5%] non-Hispanic White), while 27 840 visits were for patients with driving time greater than 60 minutes (median [IQR] age, 67.0 [57.0-74.0] years; 14 372 [51.6%] female; 1056 [3.8%] Black, 1364 [5.0%] Hispanic, 22 457 [80.7%] non-Hispanic White). For patients living within a driving time of 60 minutes from the cancer center, 424 471 kg CO2 emissions were saved (mean [SD] emissions savings, 19.8 [9.4] kg CO2 per visit) due to telemedicine-equivalent to 91.5 passenger vehicles driven for 1 year. For patients whose driving distance was greater than 60 minutes, 2 744 248 kg CO2 emissions were saved (mean emissions savings, 98.6 [54.8] kg CO2 per visit)-equivalent to 591 passenger vehicles driven for 1 year. Using a large data set, this cross-sectional analysis highlighted the carbon emissions savings due to telemedicine in oncology. This has important implications in reducing health care-related carbon footprint.

The Future of Telemedicine in Oncology

Abstract The COVID-19 pandemic has led to a massive surge in the use of telemedicine services in oncology. However, although telemedicine usage is not as high as it was early in the pandemic, it is not as low as it was before the pandemic, either, indicating that patients have a desire to receive care when, where, and how they want. Most oncology providers agree that telemedicine is beneficial and here to stay, but barriers hinder equitable delivery, such as racial/ethnic affiliations, older age, residing in a rural area, and lower socioeconomic status. The momentum created by the pandemic can serve to show the benefits of telemedicine and solidify its place in oncology care. However, addressing these disparities—and increasing widespread access to broadband and educating both patients and providers on how to use these technologies—is paramount.

Clinicians' Perceptions of the Benefits and Challenges of Teleoncology as Experienced Through the COVID-19 Pandemic: Qualitative Study.

BackgroundCOVID-19 thrust both patients and clinicians to use telemedicine in place of traditional in-person visits. Prepandemic, limited research had examined clinician-patient communication in telemedicine visits. The shift to telemedicine in oncology, or teleoncology, has placed attention on how the technology can be utilized to provide care for patients with cancer.ObjectiveOur objective was to describe oncology clinicians’ experiences with teleoncology and to uncover its benefits and challenges during the first 10 months of the COVID-19 pandemic.MethodsIn-depth, semistructured qualitative interviews were conducted with oncology clinicians. Using an inductive, thematic approach, the most prevalent themes were identified.ResultsIn total, 21 interviews with oncology clinicians revealed the following themes: benefits of teleoncology, such as (1) reducing patients’ travel time and expenses, (2) limiting COVID-19 exposure, and (3) enabling clinicians to “see” a patients’ lifestyle and environment, and challenges, such as (1) technological connection difficulties, (2) inability to physically examine patients, and (3) patients’ frustration related to clinicians being late to teleoncology appointments.ConclusionsTeleoncology has many benefits and is well suited for specific types of appointments. Challenges could be addressed through improved communication when scheduling appointments to make patients aware about what to expect. Ensuring patients have the proper technology to participate in teleoncology and an understanding about how it functions are necessary.

Impact of Telemedicine on Patient Satisfaction and Perceptions of Care Quality in Radiation Oncology.

The COVID-19 pandemic has transformed cancer care with the rapid expansion of telemedicine, but given the limited use of telemedicine in oncology, concerns have been raised about the quality of care being delivered. We assessed the patient experience with telemedicine in routine radiation oncology practice to determine satisfaction, quality of care, and opportunities for optimization. Patients seen within a multistate comprehensive cancer center for prepandemic office visits and intrapandemic telemedicine visits in December 2019 through June 2020 who completed patient experience questionnaires were evaluated. Patient satisfaction between office and telemedicine consultations were compared, patient visit-type preferences were assessed, and factors associated with an office visit preference were determined. In total, 1,077 patients were assessed (office visit, n=726; telemedicine, n=351). The telemedicine-consult survey response rate was 40%. No significant differences were seen in satisfaction scores between office and telemedicine consultations, including the appointment experience versus expectation, quality of physician's explanation, and level of physician concern and friendliness. Among telemedicine survey respondents, 45% and 34% preferred telemedicine and office visits, respectively, and 21% had no preference for their visit type. Most respondents found their confidence in their physician (90%), understanding of the treatment plan (88%), and confidence in their treatment (87%) to be better or no different than with an office visit. Patients with better performance status and who were married/partnered were more likely to prefer in-person office visit consultations (odds ratio [OR], 1.04 [95% CI, 1.00-1.08]; P=.047, and 2.41 [95% CI, 1.14-5.47]; P=.009, respectively). Patients with telephone-only encounters were more likely to report better treatment plan understanding with an office visit (OR, 2.25; 95% CI, 1.00-4.77; P=.04). This study is the first to assess telemedicine in routine radiation oncology practice, and found high patient satisfaction and confidence in their care. Optimization of telemedicine in oncology should be a priority, specifically access to audiovisual capabilities that can improve patient-oncologist communication.

The risks associated with the widespread use of telemedicine in oncology: Four cases and review of the literature.

BackgroundCOVID‐19 changed the way we practice oncology in multiple ways. Because most cancer patients are comorbid or immunocompromised, we are trying as much as possible to reduce their risk of infection. Marginal just 2 years ago, telemedicine quickly became preeminent with the pandemic to reduce hospital exposure. However, using only virtual visits in oncology patients risk delaying cancer diagnosis or the identification of a complication.Case seriesWe present here four cases where a serious medical problem evident on physical exam was overlooked during a virtual visit. Two of our patients experienced a delay in cancer diagnosis thus putting them at risk of local or distant spread. The two others were established oncology patients where a serious medical complication was missed on a virtual visit.ConclusionsNow more than a year into the pandemic, telemedicine has clearly been a useful tool by limiting unnecessary hospital visits. Yet, as our cases illustrate, its use in oncology without clear boundary can undermine the quality of care. Now that effective vaccines are reducing the transmission and the severity of infection, most oncology patients can be evaluated by a real‐time visit.

Communicating Effectively via Tele-oncology (Comskil TeleOnc): a Guide for Best Practices for Communication Skills in Virtual Cancer Care.

The emergence of a novel coronavirus (SARS-CoV-2, causing coronavirus disease 2019 or COVID-19) has disrupted the US medical care system. Telemedicine has rapidly emerged as a critical technology enabling health care visits to continue while supporting social distancing to reduce the risk of COVID-19 transmission among patients, families, and clinicians. This model of patient care is being utilized at major cancer centers around the USA—and tele-oncology (telemedicine in oncology) has rapidly become the primary method of providing cancer care. However, most clinicians have little experience and inadequate training in this new form of care delivery. Because many practicing oncology clinicians are not familiar with telemedicine technology and the best practices for virtual communication, we strongly believe that training in this field is essential. Utilizing best practices of communication skills training, this paper presents a brief tele-oncology communication guide (Comskil TeleOnc) to address the timely need to maximize high-quality care to patients with cancer. The goal of the Comskil TeleOnc Guide is to recognize, elicit, and effectively respond to patients’ medical needs and concerns while utilizing empathic responses to communicate understanding, alleviate distress, and provide support via videoconferencing. We recommend five strategies to achieve the communication goal outlined above: (1) Establish the clinician-patient relationship/create rapport, (2) set the agenda, (3) respond empathically to emotions, (4) deliver the information, and (5) effectively end the tele-oncology visit. The guide proposed in this paper is not all-encompassing and may not be applicable to all health care institutions; however, it provides a practical, patient-centered framework to conduct a tele-oncology visit.

Telemedicine in Oncology and Reimbursement Policy During COVID-19 and Beyond.

The first confirmed case of coronavirus disease 2019 (COVID-19) in the United States was reported on January 20, 2020. As of September 17, 2020, there were more than 6.6 million confirmed cases and 196,277 deaths. Limited data are available on outcomes of immunocompromised patients, but early published reports from China indicate that those with cancer have a 3.5 times higher risk of ICU admission, mechanical ventilation, or death than those without cancer. Because of the uncertain behavior of COVID-19, it has become imperative for practices to limit exposure to vulnerable patients. Telemedicine has been one of the cornerstones of caring for patients with cancer during the COVID-19 pandemic. This review provides an overview of reimbursement policy by public and private payers before and during the COVID-19 pandemic, describes implications in cancer care, and offers considerations for future reimbursement policy.

Biobanking in oncology and radiology

The first biobank in Russia was created in 1998 to investigate post-Chernobyl thyroid tumors. The number of biobanks in the world is growing. Infrastructure and collaboration are improving. Ethical, legal and methodological guidelines for biobanking have been developed and are regularly reviewed. Biobanking objects are now not only biological samples of patients but also their dynamic biomedical characteristics. Comparison of genetics, proteome and tumour metabolism and in vivo radiological visualization is necessary to improve personalized diagnostics, treatment and its effectiveness. The article focuses on international evidence-based experience of sample preparation and cryopreservation of biological samples, information logistics, and integration solutions in biobanking. Guiding principles and the model of a modern biobank, integrating up-to-date technologies of digital personalized medicine and telemedicine in oncology and radiology are reported. The article may be of interest to a wide range of experts in biomedicine, especially oncologists, radiologists, pathologists, geneticists, and IT specialists.

Telemedicine and tele-health services for cancer-care delivery in India

Non-communicable diseases including cancer are emerging as major public health problems in India. Awareness of cancer and its management are being taken as a high priority at the national level because of the increase in the incidence of the disease in the country. Telemedicine provides expert-based health care to understaffed remote sites and advanced emergency care through modern telecommunication and information technologies. The incidence of cancer can be reduced if the people are aware of cancer and its root causes. Recently, the introduction of telemedicine in oncology plays a vital role. Telemedicine helps in prevention, early detection, a faster cure, palliative care and rehabilitation in the management of cancer. The status of telemedicine services for cancer care in Kerala, India, and how telemedicine can be an effective solution of cancer-care delivery in India are explored.

Japanese experience of telemedicine in oncology

We started telemedicine projects from 1990 with a telepathology system within Tsukiji Campus of National Cancer Center. In 1994, we connected Tsukiji Campus and Kashiwa Campus by 6 Mbps optical fiber leased line using IP protocol for data transmission, for teleconference, telepathology, and teleradiology projects. We also started connection of regional cancer centers and are now forming a cancer center network of 14 cancer centers. We are at present organizing 130 teleconferences per year with an attendance of more than 16 000 people as summary. We have also used a high-resolution image transferring system, such as SHD (2000 pixels×2000 pixels resolution) system on one side, and an economical telemedicine system using JAVA and a WWW browser (NCC_image) on the other side. We think that providing information is another field of telemedicine. We began the experimental gopher and WWW service in 1993. We are now providing official up-to-date cancer information for patients and healthcare professionals. We are getting more than 400 000 hits per month. We are also providing a teleconference video session which is held every week on the Internet using a Real Video system with synchronized slide presentation on the WWW browser. We are also organizing a Cancer Image Reference Database System including DICOM images with viewer software. This paper is a summary of the telemedicine projects performed at the National Cancer Center.

On the Way to New Horizons: Telemedicine in Oncology

On the Way to New Horizons: Telemedicine in Oncology