SAN FRANCISCO-Getting cancer treatment and follow-up care to remote areas with basic health care facilities can be performed using telemedicine techniques, researchers reported here at the first Cancer Survivorship Symposium (Abstract 26).
"Telemedicine is an effective way to provide survivorship appointments and care plan delivery in remote geographic areas where patients do not otherwise have access to survivorship care," said Kelli Kristine Cole-Vadjic, MS, PA, at PeaceHealth St. Joseph Medical Center Cancer Center in Bellingham, Washington.
In the past year, the regional tertiary cancer center has been developing a telemedicine program that allows the mainland facility in Bellingham, which provides medical and radiation oncology services, to offer survivorship services for patients who live in remote, transportation-challenged outlying islands and communities in the Pacific Northwest.
"One of the barriers to survivorship programs is to get patients to drive long distances or to get them from remote locations to the tertiary care center," Cole-Vadjic told OT at her poster presentation. "It is an ordeal for a patient on these islands to get to Bellingham. They can take a ferry from Friday Harbor to Anacortes, then they have to drive around to Bellingham. These patients need to be seen by someone."
Telemedicine Program's Logistics
Cole-Vadjic reported on six patients in her presentation, but the telemedicine program now has enrolled 10 individuals. "It took a while to figure out how to get the schedulers at both clinics to coordinate, so there were some problems with logistics in getting it started and we missed a lot of potential patients. But now we are getting it to work," she said.
One of the major hurdles in making the telemedicine program work, Cole-Vadjic said, "is convincing patients whom I have never met that scheduling these telemedicine appointments are valuable."
She said that telemedicine is gaining traction as regulations define its use, how it impacts relationships between physician assistants and patients, and billing/reimbursement requirements.
"PeaceHealth has a grant for telemedicine for not only survivorship, but also for general oncology care and other specialties with Friday Harbor and Ketchikan, Alaska," Cole-Vadjic said.
She explained that the San Juan islands off the coast of Washington state "have small critical access hospitals with a small infusion team." An oncologist can fly there once a week so patients can get chemotherapy there. PeaceHealth Peace Island Medical Center is an affiliated medical center that provides limited medical oncology services in Friday Harbor on nearby San Juan Island.
"For the survivorship program, the patient is at the smaller hospital with the nurse," Cole-Vadjic said. "The patients can get the papers they need from me in the survivorship plan. The nurse can set up the camera for me, and she can do the billing there."
Previously, appointments for survivorship care plan delivery were available at the Bellingham facility, but not at Peace Island.
Patient Selection
Since January 2015, patients who are eligible for survivorship care plan delivery are identified by their medical oncologist or nurse upon completion of chemotherapy at Peace Island. They are scheduled for a one-hour survivorship telemedicine appointment with the survivorship physician assistant. The patients attend the appointment at Peace Island with a nurse present there to assist with logistics and deliver survivorship appointment materials. The physician assistant is at Bellingham and conducts the appointment through visual and audio telemedicine equipment.
During the telemedicine appointment, the survivorship care plan is reviewed and delivered; educational materials are provided and discussed; and referrals are initiated as needed based on a standardized patient distress screening questionnaire.
Between January and July 2015, six patients were identified for survivorship appointment eligibility upon completion of chemotherapy at Peace Island. Three have completed a survivorship telemedicine appointment; two patients are currently scheduled; and one patient declined to schedule an appointment.
"Although qualitative surveys have not yet been conducted, the patients who completed survivorship telemedicine appointments offered generally positive feedback about the experience," Cole-Vadjic said.
Patients who complete radiation therapy at Bellingham but live in the San Juan islands are now also being identified and scheduled for survivorship telemedicine appointments at Peace Island, she said.
Program Benefits
Commenting on the study at the poster presentation Kelly Neale, RN, a pediatric nurse practitioner at the University of California at San Francisco, told OT: "I think this is a terrific idea. One of the problems with survivorship programs is that patients may not see the value in coming for the sessions, or they may not want to come," adding that if the barrier of a long, difficult trip to the hospital can be overcome, more patients will get benefit from survivorship programming.
"I believe telemedicine is here already, albeit still in its nascent form," said Jacqueline Barrientos, investigator, Feinstein Institute for Medical Research, Manhasset, New York, and Assistant Professor of Medicine at Hofstra University-LIJ School of Medicine. "I routinely speak and discuss difficult-to-treat cases with colleagues from other countries, including countries with limited options of care, as you only need an Internet connection," she told OT in discussing the study. "We use email, telephone apps, and Skype. We also are able to deliver quality lectures about all these new agents via the Internet.
"Of course, the best option would be for a patient to be evaluated at our tertiary centers to determine a plan of care after careful review of the pathology, but if this is not a realistic possibility as it is for the majority of patients, we can create ways to interact with physicians in remote areas to help them deliver the best possible care locally, taking into account their limited resources," she said.
The symposium is co-sponsored by the American Academy of Family Medicine, the American College of Physicians, and the American Society of Clinical Oncology.