The use of telehealth skyrocketed at the onset of the coronavirus pandemic. For example, one Centers for Disease Control and Prevention (CDC) analysis found a 154 percent increase in the number of telehealth visits in the United States during the last week of March 2020 compared to the number of telehealth visits in the U.S. within the same time period in 2019 (MMWR Morb Mortal Wkly Rep 2020; http://dx.doi.org/10.15585/mmwr.mm6943a3).
As the American Medical Association (AMA) noted in 2020, many regulatory barriers that hampered the use of telehealth were temporarily lowered in the midst of the COVID-19 pandemic (https://bit.ly/3C4USAO). The AMA has advocated for making many of those emergency policy changes permanent, with Todd Askew, AMA Senior Vice President of Advocacy, describing telehealth as "an increasingly important part of physician practices going forward."
New research suggests that close to half of cancer patients undergoing radiation therapy prefer telemedicine to in-office visits, with the study's authors saying the results offer evidence for the continued use of telemedicine once the pandemic has receded.
The analysis, which reviewed survey responses from 1,077 radiation oncology patients across Memorial Sloan Kettering Cancer Center's (MSK) main campus and six regional locations across New York and New Jersey, supports the continued use of telemedicine after the coronavirus pandemic subsides, according to authors of the study, which was recently published in the Journal of the National Comprehensive Cancer Network (2021; https://doi.org/10.6004/jnccn.2020.7687)
For the study, the researchers created questionnaires based on office and telemedicine visits between December 2019 and June 2020. Patients' experience with telemedicine was evaluated across multiple phases of care, including the consultation appointment and weekly on-treatment management visits. The survey that patients completed included 12 questions designed to assess the in-person consultation experience, and evaluated several domains, including appointment logistics, patient-physician communication and overall impressions using a five-point scale, with five being the highest possible score.
To compare the telemedicine and in-person experience, two cohorts of patients, pre-pandemic and intra-pandemic, were identified. The pre-pandemic period included patients seen in person from Dec. 1, 2019, through February 28, 2020. The intra-pandemic telemedicine period included patients seen via telemedicine from April 2, 2020, through June 10, 2020.
The team assessed patient satisfaction and preferences for telemedicine, with 45 percent of cancer patients expressing a preference for telemedicine. Thirty-four percent indicated they favored in-office visits, with 21 percent saying they did not prefer one over the other.
Erin Gillespie, MD, a radiation oncologist at MSK and a co-author of the study, described the percentage of patients saying they preferred telemedicine over in-person visits as "a bit surprising."
When patients were asked about individual domains that might account for this phenomenon, "it appears that treatment-related costs, i.e., travel, were a significant driver of the benefit of telemedicine," said Gillespie, whose areas of clinical expertise include breast cancer and metastatic disease. "This, of course, is consistent with prior literature that patients spend much more time and money in transit to appointments when in-person."
With regard to patient satisfaction, a large majority of patients (91%) reported no difference or improvement with telemedicine, in comparison to office visits. A nearly identical number (90%) said the same with respect to confidence in their physician, understanding their treatment plans (88%) and assurance that their cancer will be appropriately treated (87%).
In terms of mitigating treatment-related costs-travel and lost wages, for instance-two-thirds of patients found telemedicine to be the better option, with patient responses varying significantly with regard to video conferencing versus audio. Patients with telephone-only appointments were more likely to say that an in-person visit would be more beneficial for them, according to study authors.
Telemedicine does indeed offer cancer patients some benefits, said Gillespie. "Avoiding treatment-related costs [such as] travel, time off work or away from family is an advantage," she noted, adding that lower-performance patients that are generally sicker or have difficulty with activities in daily life were also less likely to prefer in-person visits.
"But beyond this, we found very few cancer-related factors that predicted a patient's preference for in-person or telemedicine visits, which indicated that it is important to ask patients for their preference and provide the option."
That said, other research has suggested that patients with symptoms may benefit from in-person visits, said Gillespie, referencing a separate study investigating radiation oncology physician preferences as an example (Int J Radiat Oncol Biol Phys 2020; doi: 10.1016/j.ijrobp.2020.07.007).
Ultimately, the findings from this MSK study underscore the importance of taking a patient-centered approach and providing patients the option of telemedicine even after the pandemic subsides, "especially given [the reality that] it can be difficult to predict who will benefit from lower treatment-related costs," said Gillespie.
"Data is most robust for telemedicine in the follow-up setting, but we found high satisfaction at the time of consultation as well. We found that video visits were better than phone only for understanding the treatment plan, which may be most critical at the time of consultation," she said. "However, access to video may be limited for some patients for technological reasons. Therefore, consideration of the risks and benefits of telemedicine, in context of a physician's preference for adequate assessment, is imperative."
Mark McGraw is a contributing writer.