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Telemedicine Expands Oncology Care Options

Wolfgang, Kelly

doi: 10.1097/01.COT.0000557852.06846.47
telemedicine; oncology

telemedicine; oncology

As technology breakthroughs continue to push the boundaries of care, telemedicine has opened new care avenues for patients and clinicians in oncology. From expanded access to specialists to patient support, remote monitoring, and more, telemedicine has become a trusted and efficient method for providing patient care, offering an opportunity for reaching patients like never before.

A recent study in Targeted Oncology detailed the benefits of telemedicine, finding that it provides opportunities for patient care that complement traditional visits. Study author Adam Dicker, MD, PhD, Enterprise VP, Professor and Chair of the Department of Radiation Oncology at the Sidney Kimmel Cancer Center—Jefferson Health and Director of the Jefferson Center for Digital Health, noted that while remote monitoring isn't a new development—having been used as early as NASA's initiatives to send monkeys and humans to space—recent technological advancements have allowed clinicians and patients to reach a new level of ease and accessibility in communication.

“The convergence of technology and consumerism has greatly increased the interest in telehealth approaches,” he noted. “For patients, there's a great convenience and for employers there's an increased access to providing care that promotes workplace health, decreases absenteeism, and has a lower cost for payers.”

In addition, Dicker said that common telehealth practices such as real-time virtual visits, remote patient monitoring, and asynchronous store and forward, which allows for digital storage of medical files that can be later accessed by clinicians, have allowed a greater access to knowledge.

“In traditional care, not everyone can have all the expertise in one room,” he stated. “With telemedicine, specialists can be consulted from anywhere.”

In addition to providing access to care for patients in remote areas, telemedicine opportunities include appointment reminders, nutritional advice, and patient education. The study found that 3.4 billion smartphone owners used a medical app in 2018, empowering patients to make strides in health care from their own homes.

“The idea of prescribing an app was foreign even 5 years ago, but now the FDA has been very proactive in having an area called digital therapeutics,” Dicker said. “For clinicians, there is a great opportunity to nudge patients into healthier physical, mental, and spiritual behavior. It allows you to help shift people in their thinking about illness and comorbid conditions and gently nudge them into a better place.”

For patients in oncology, that could mean anything from providing transportation assistance through Lyft or Uber if patients are too weak to drive themselves and may otherwise miss appointments, to patient education. “Depending on the clinical situation, telehealth can even help patients learn about maintenance, such as taking care of a port or intravenous administration,” Dicker noted.

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Aggregating Data for Patient Care

For those practicing in oncology, telehealth has a particular advantage in patient care. The study reported that overall, 84.3 percent of oncology care providers supported the use of apps to complement traditional treatment.

Advantages of telemedicine in oncology include better documentation of data and test results, increased patient compliance, improved continuous care for patients, and enhanced communication between provider and patient, the study noted.

Aggregated data can be collected remotely using sensors that monitor pillboxes, tremor frequency, vital signs, and imaging and laboratory tests, resulting in actionable data that can support drug adherence, reduce medication errors, save time during emergencies, and shape self-management, according to the study. For example, Dicker noted that during a real-time virtual visit, a physician could take a photo of a patient that could later be referenced through electronic medical records if necessary.

“If a patient had an issue regarding skin healing from radiation or surgery, she or he would be able to share that information with physicians who could reference the photo, instead of the patient describing it,” he said.

The emergence of wearable sensors for physical measures such as sleep, blood pressure, heart rate, blood levels, temperature, environmental exposure, and falls; data entry apps for diet, mood or stress levels, exercise, quality of life, social support, tobacco use, social support, functional status, and alcohol use; and ingestible, implantable, and biometric sticker sensors have allowed smartphones to be used as real-time data collection, more precise monitoring, and even medical devices such as otoscopes, ophthalmoscopes, and microscopes, the study noted.

Patient-used apps and sensors can also monitor weight, inhaler use, motor impairment, carbohydrate intake, and insulin dose, allowing clinicians to monitor comorbid conditions that could impact care, according to the study. “Telemedicine can help anyone and everyone,” noted Aditi Joshi, MD, MSc, Medical Director of JeffConnect and Assistant Professor in the Department of Emergency Medicine at Thomas Jefferson University Hospital. “Patients get better and easier access to care and providers have a higher level of consultation that allows them to provide patients with the highest level of care.”

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Enthusiastic Patient Adoption

For patients, adoption of telemedicine has proved a success. According to the study, half of patient participants wanted their care providers to send them a health reminder via text message or phone call, noting a high level of patient adoption of telehealth practices.

Emerging technologies have not only redefined health-related networking and the ability to provide support, information, and advocacy, but have curbed the increasing cost of out-of-pocket expenses, the study noted. For cancer survivors, the study found that telemedicine practices limited the disruption of their lives and enabled close and personal relationships between themselves and their care providers, giving patients a feeling that they had immediate access to professional advice for issues in treatment.

Telemedicine was found to increase quality of care and reduce costs by decreasing hospital readmission and emergency visits in rural communities, demonstrating greater access to the health care system, improved control of symptoms, and greater assurance for family members through early oncology interventions, according to the study.

“In my experience, [patients with cancer] have been very happy with telehealth visits,” Dicker said. “Patients may have a lot of anxiety when they notice something of concern, so to get immediate reassurance or care is very helpful.”

In most low-acuity situations, virtual consultations can save a person a trip and serve as a powerful tool in follow-up care, Dicker noted. “We're not trying to build a relationship from scratch with telehealth,” he explained. “But in oncology specifically, after you're built a relationship, telehealth can be a vital tool for things such as expert consultation or addressing survivorship issues.”

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Making the Transition to Telehealth

For clinicians considering introducing teleoncology to their practices, concerns regarding privacy, integration into existing electronic health records, and cultural or organizational barriers may seem intimidating. However, the transition is not as intimidating as it may seem, Joshi said.

“People tend to make a big deal [about telemedicine] until they try it and realize it's not that scary,” she said. “When thinking about telemedicine, video-based visits, and virtual care, providers should know that it's just going to be a sub-care of health care. As a physician, you're able to dictate how the video visit will go—it's still a professional patient/provider encounter—and it feels like it does in the clinic.”

Ultimately, telemedicine adoption will improve and be adjunct to your existing practice, Joshi added. “Don't be afraid. Telehealth leads to improved patient care, a better provider experience, and it should be implemented as soon as you have the resources,” she said.

For Dicker, the possibilities of telemedicine are limitless. “The evolution of telehealth is based only on the imaginations of the health care system and its providers.”

Kelly Wolfgang is a contributing writer.

Wolters Kluwer Health, Inc. All rights reserved.
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