Experts came together at the 2022 American Association for Cancer Research Annual Meeting to discuss lessons learned about the use of telemedicine in oncology during the pandemic and future opportunities (Session F005). Moderator of the session, Ana Maria Lopez, MD, Professor and Vice Chair of Medical Oncology and Chief of Cancer Services at Sidney Kimmel Cancer Center - Jefferson Health New Jersey, wants people to know the question is not: How do we sustain the progress made when it comes to increased use of oncology telemedicine since the start of the COVID-19 health crisis? The question now facing the field is: How do we optimize the lessons learned from using telemedicine for oncology during the pandemic and what will the digitization of medicine look like?
"I think that was the real innovation of the session," Lopez told Oncology Times. "We didn't limit our focus on how we can take telemedicine into what we've always done. But how we can take the lessons learned to really transform the way we think about health care delivery where telemedicine is a seamless part of medicine." Researchers presented results from clinical trials that had looked at the impact of telemedicine on clinical trial delivery, as well as variation in telehealth use by patient factors, pandemic phase, and clinic sites. And there was a discussion of these results and future opportunities. Lopez expounds on some of her key takeaways from the conversation.
1 What does the digitization of medicine in oncology look like? How is it different from sustaining progress made in telemedicine use since the pandemic?
"Our discussion was really about what the future looks like if we optimize the lessons that we've learned. Technology can really impact every aspect of patient care. For example, you can do tele-cancer genetics. A tumor board discussion of a treatment plan could take place through video conferencing. There could be telepathology to do tissue examination. There could be teleradiology to review a radiograph. Clinicians could gather via video conferencing to discuss novel molecular markers (a virtual molecular tumor board). You can have a patient who's eligible for a clinical trial have the assessment done from the patient's living room and the consent facilitated by digital means, so that when the patient comes to the cancer center for treatment, those steps are done and the patient can actually begin the investigational treatment.
"Some patients need to travel hours in one direction to get to the cancer center where they're receiving care. Even for the patients who live close by, there's a cost to getting into the clinic (in terms of time and expenses, like parking costs, childcare, elder care, time off work, and more). All of these things can take a toll on the patient when they're not feeling well."
2 What are the biggest benefits with this type of transformation of care?
"It cuts down on travel for the clinical team. And when it comes to the clinical trial piece, when you're able to do the assessment for that virtually, there's a huge benefit to the patient and the research team. You may find that the patient isn't eligible for the trial. Then the patient hasn't taken the time to come in and the research team does not need to take the time to do the rest of the screening. These visits can be done more promptly and more effectively.
"I think it could speed up how quickly care is delivered to patients. Previous research I worked on looked closely at breast cancer diagnosis and the impact of implementing tele-oncology, tele-radiology, and tele-pathology. We were able to demonstrate that a patient could come in the morning for a biopsy and, by the end of the day, they would have their diagnosis (Digital Mammography 2008; https://doi.org/10.1007/978-3-540-70538-3_72). And that's significant because, for the patient, the waiting is the hardest part.
"And then for rare tumors, sometimes there may only be a few people in the country or the world who have expertise in a specific area. Tele-access would allow a way to engage those people in the care of patients with rare tumors."
3 What are the biggest barriers in terms of making this digitization of medicine happen?
"Even though we've been doing more telemedicine over the past couple years of the pandemic, there's now a tendency to drift back to the ways things have always been done. So, we really need to jar our thinking in terms of how we can do it better.
"It's also going to require education of clinicians on these types of care delivery. There are very few programs that educate clinicians on how to engage patients in virtual visits. Where do you focus your eyes? How do you not speak over people? We're going to need to enhance our skills as clinicians so that we can help patients feel comfortable in these spaces.
"More research is needed, as well as advocacy. During the pandemic, we made about 70 years' worth of progress in a couple of months. But part of what made that possible was the policy modification regarding state licensure to facilitate telemedicine access and to support telemedicine reimbursement.
"Maybe going ahead, some of those changes temporarily put in place for the pandemic will continue-or maybe there's an opportunity to rethink our solutions. Different types of licensures may be developed, so there's an option for a telemedicine licensure for clinicians. What it looks like needs to be worked out, but advocacy needs to be part of enabling these changes to move forward. This change is happening and we need to be forward looking. How do we think about the benefits and how do we make this the new approach to health care overall?"