1. Fuerst, Mark L.

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Nearly two-thirds of thoracic oncologists surveyed indicated they used telehealth tools for the first time during the COVID-19 pandemic, according to a report issued at the IASLC 2021 World Conference on Lung Cancer.

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"The COVID-19 pandemic resulted in countless challenges in delivery of health care. Face-to-face consultation became the exception rather than the norm. Many people experienced barriers to accessing care. Telehealth was employed to engage or monitor patients remotely, thus providing some continuity of care," said Anne-Marie Baird, PhD, of Trinity College Dublin in Ireland, and Chair of the IALSC Communications Committee.


To better assess the use of telehealth during the pandemic and the wider impact on thoracic care from the perspective of health care professionals, the IASLC Communications Committee developed an English language, 24-question survey covering two broad themes concerning the impact of the pandemic on the use of telehealth and lung cancer/mesothelioma care. The survey was administered between April 12, 2021, and May 31, 2021, via the IASLC and others through multiple modalities.


The majority of the 141 respondents were male, 41-60 years old, and based at an academic medical center. Half of them specialized in medical oncology. Most of the participants came from North America (37.6%), Europe (31.2%), and Asia (14.9%). Almost two-thirds (63%) reported they used telehealth for the first time while billing (where appropriate) at normal rates (48.2%). Nearly half (48.2%) reported that telehealth is here to stay.


The form of telehealth that was the most preferred was video via e-medical record, but a phone call was the one most used. The most common barriers to adoption of telehealth were lack of resources for patients (66%), regulatory limitations (56%), and lack of institutional resources (49%).


The top three advantages for providers versus patients were continuity of care (88% vs. 93%), maintenance of contact with patients (92% vs. 90%), and access to rural patients (78% vs. 81%). Other issues that came up included growing health care access for providers and reducing anxiety by patients, Baird noted.


Top disadvantages of telehealth for providers were lack of human contact (72%), lack of patient internet access/tech knowledge (71%), and missing informal aspects of face-to-face visits (71%). "There was no significant difference of these disadvantages by region," she said.


The majority of providers (55%) felt that patients were receptive to telehealth. However, responses on disparities were split. Some thought there was an increase in disparities (30%) and others felt there was a decrease (28%) in disparities. Another cohort thought there was no change (34%) in the rate of disparities, said Baird.


Most physicians felt that telehealth was appropriate for surveillance (94%), yet some felt it was not suitable for any point in care pathway (55%). When the researchers looked at the impact of COVID-19 on the care pathway, in general, 68 percent of participants thought it had a negative impact. In terms of diagnostics, they thought there were fewer patients presenting to clinics and centers and there were delays transitioning from primary care to the hospital. In terms of care, they believed there were delays accessing clinical trials and surgery.


The vast majority (74%) thought there was a reduction in the number of clinical trials offered and a halting of current trials (62%) at their centers. Two key items came up in basic and translational research: decrease in activity and reduced protected time to do research. Some 42 percent felt that there was also a decrease in numbers of patients presenting for lung cancer screening.


The take-home message, said Baird, is "issues exist with the use of telehealth. These issues may be addressed by guidelines to enable the best delivery of care for patients impacted by thoracic malignancies. Of course, these guidelines may have to look at a more hybrid model as the pandemic comes to an end."


For COVID-19, the researchers found significant impacts on all parts of the pathway, from research to care. "Overall, this will result in poorer outcomes for people impacted by thoracic malignancies," said Baird. "Much will need to be done to counteract the negative impacts on care, clinical trials, and research during the COVID-19 pandemic. Although telehealth has been widely adopted, issues remain such as health care access, point of use in the care pathway, and telehealth platform selection."


Mark L. Fuerst is a contributing writer.