Breast Medical Oncologists' Perspectives of Telemedicine for Breast Cancer Care: A Survey Study

Abstract

PURPOSE: The COVID-19 pandemic forced rapid adoption of telemedicine (TM) for breast oncology visits in the United States, but the appropriate role of postpandemic TM is uncertain. We sought to understand physician and advance practice practitioner perspectives on the use of TM for outpatient breast cancer care through an electronically administered survey. METHODS: Breast medical oncology clinicians at two academic cancer centers and five satellite locations affiliated with the Dana Farber Cancer Institute and the Massachusetts General Cancer Center were invited to respond to a 21-question survey administered in September 2021 about clinicians' perceptions and attitudes toward TM during the previous 12 months. RESULTS: Of the 71 survey invitations, 51 clinicians (36 physicians and 15 advance practice practitioners) provided survey responses (response rate = 72%). Ninety-two percent of respondents (n = 47) agreed that TM visits enhance patient care. Ninety-two percent of respondents (n = 46) also agreed that TM is valuable for early-stage breast cancer follow-up visits. Most respondents felt that there was no difference between TM and face-to-face (F2F) visits when it came to patient adherence, ease of ordering tests, ease of accessing patient records, and workflow outside of the visit (82%, 82%, 78%, and 53%, respectively). Fifty-one percent of respondents (n = 26) said that TM was better for timely access to follow-up appointments. Most respondents said that F2F visits were better for seeing physical problems, personal connection with patients, overall quality of visits, and patient-physician communication (100%, 75%, 65%, and 63%, respectively). CONCLUSION: Breast clinicians believe that TM is a valuable tool to enhance outpatient breast cancer care. TM was felt to be appropriate for routine follow-up visits and second opinion consultations and is as good as or better than F2F visits for several routine aspects of breast cancer care.

Teleoncology: A Solution for Everyone? A Single-Center Experience with Telemedicine during the Coronavirus Disease 2019 (COVID-19) Pandemic

“…With the arrival of COVID-19, considerably more studies addressed breast cancer patients’ telemedicine experience. In general, it was altogether concluded that tele-oncology was effective, safe and that patients were highly satisfied and felt confident with their care [ 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Despite this overall approval, it is important to remark on the matter of the physical examination during a telehealth visit.…”

The association between telemedicine, advance care planning, and unplanned hospitalizations among high‐risk patients with cancer

“…A common perception by clinicians is that telemedicine may result in missed opportunities to detect disease progression or treatment toxicity. 13,17,23,24 We found that unplanned hospitalizations were comparable between telemedicine and in-person visits (20% vs. 18%; aRR, 1.09; 95% CI, 0.92-1.28). This is consistent with reports by Hsiehchen et al, who found no association between telemedicine use and poorer patient outcomes, including oncologyrelated emergency department visits/hospitalizations, nonvisit telephone encounters, or time to treatment initiation.…”

“…24 The lack of physical examination has also raised concerns in the oncology community regarding the safety of telemedicine in patient care and the risk for missed cancer or treatment toxicity. 13,17,23,24 Furthermore, patients who lack access to or competency with video communication technology may be limited to telephone-based care, which could significantly diminish the quality of their discussions and clinical assessment. 17,[25][26][27][28][29][30] Recently published work has demonstrated discrepancies in access to telemedicine, especially videoenabled visits, among patients who are racial minorities, older, and of lower income.…”

“…Likewise, Stavrou et al. found that of 71 breast medical oncologists, 74% felt in‐person visits better facilitate connection with patients and 63% felt they improve the quality of communication 24 . The lack of physical examination has also raised concerns in the oncology community regarding the safety of telemedicine in patient care and the risk for missed cancer or treatment toxicity 13,17,23,24 .…”

Patient and healthcare professional acceptability of pharmacogenetic screening for DPYD and UGT1A1: A cross sectional survey

“…HCPs and patients were also accepting of receiving results via tele‐health, phone, or in‐person, supporting the concept of a flexible clinic structure to meet individual needs. Acceptance of “virtual clinics” has been reported widely in the literature, 8,11 particularly during the coronavirus disease 2019 (COVID‐19) pandemic where service model changes were rapidly implemented 12 . An Australian/European study reflecting on practices over the course of the pandemic found clinicians main concerns of “virtual clinics” related to inability to physically examine the patient, being more likely to miss a diagnosis, and reduced clinical assessment 13 .…”