Oncologist Perspectives on Telemedicine for Patients With Cancer: A National Comprehensive Cancer Network Survey

Abstract

PURPOSE: The use of telemedicine expanded dramatically in March 2020 following the COVID-19 pandemic. We sought to assess oncologist perspectives on telemedicine's present and future roles (both phone and video) for patients with cancer. METHODS: The National Comprehensive Cancer Network (NCCN) Electronic Health Record (EHR) Oncology Advisory Group formed a Workgroup to assess the state of oncology telemedicine and created a 20-question survey. NCCN EHR Oncology Advisory Group members e-mailed the survey to providers (surgical, hematology, gynecologic, medical, and radiation oncology physicians and clinicians) at their home institution. RESULTS: Providers (N = 1,038) from 26 institutions responded in Summer 2020. Telemedicine (phone and video) was compared with in-person visits across clinical scenarios (n = 766). For reviewing benign follow-up data, 88% reported video and 80% reported telephone were the same as or better than office visits. For establishing a personal connection with patients, 24% and 7% indicated video and telephone, respectively, were the same as or better than office visits. Ninety-three percent reported adverse outcomes attributable to telemedicine visits never or rarely occurred, whereas 6% indicated they occasionally occurred (n = 801). Respondents (n = 796) estimated 46% of postpandemic visits could be virtual, but challenges included (1) lack of patient access to technology, (2) inadequate clinical workflows to support telemedicine, and (3) insurance coverage uncertainty postpandemic. CONCLUSION: Telemedicine appears effective across a variety of clinical scenarios. Based on provider assessment, a substantial fraction of visits for patients with cancer could be effectively and safely conducted using telemedicine. These findings should influence regulatory and infrastructural decisions regarding telemedicine postpandemic for patients with cancer.

Exploring cancer patients’, caregivers’, and clinicians’ utilisation and experiences of telehealth services during COVID-19: A qualitative study

“…Most participants supported the future use of telehealth with a combination of face-to-face and telehealth consultations, and recent studies have demonstrated this desire to continue telehealth post-pandemic [21] , [28] , [32] , [33] , [51] , [56] . Participants in our study who experienced both telehealth modalities had mixed views regarding which was better.…”

“…Participants in our study who experienced both telehealth modalities had mixed views regarding which was better. A study using hypothetical clinical scenarios found that oncologists typically preferred video to telephone [56] . Both patient and clinician preferences should be accommodated where possible.…”

Patient, physician, and policy factors underlying variation in use of telemedicine for radiation oncology cancer care

“…Nevertheless, the conclusion in that study was that 5%–30% of cancer patients may still be better suited for in‐person physician evaluations to optimize treatment recommendations and planning 6 . Findings from a survey by the National Comprehensive Cancer Network Electronic Health Record Oncology Advisory Group demonstrate provider confidence that a substantial fraction of visits for cancer patients could be effectively and safely conducted using telemedicine 16 . Although patients and physicians have reported the belief that telemedicine could increase safety and convenience during the COVID‐19 pandemic, authors have also raised the consideration that certain subgroups, such as patients with impaired senses or cognition, those for whom physical examination could substantially alter management, those for whom sensitive discussions are needed, and those without access to smartphones and broadband internet may nevertheless prefer in‐person visits 35–38 .…”

“…6 T A B L E 3 Frequency of adverse events by telemedicine use confidence that a substantial fraction of visits for cancer patients could be effectively and safely conducted using telemedicine. 16 Although patients and physicians have reported the belief that telemedicine could increase safety and convenience during the COVID-19 pandemic, authors have also raised the consideration that certain subgroups, such as patients with impaired senses or cognition, those for whom physical examination could substantially alter management, those for whom sensitive discussions are needed, and those without access to smartphones and broadband internet may nevertheless prefer in-person visits. [35][36][37][38] Still unknown, however, is how social and demographic patient characteristics may modify an individual's comparative benefit from virtual versus in-person visits.…”

“…Although several early pandemic studies surveying oncology physicians and patients suggested that telemedicine was associated with high levels of user satisfaction, increased efficiency, and improved continuity of care, [7][8][9][10][11][12] other studies also identified potential drawbacks-limited physical examinations, patient perceptions of lower quality of care, and lack of patient access to or comfort with the technologies. [13][14][15][16] Thus, it remains to be seen whether future iterations of cancer telemedicine technologies and practice will effectively and strategically leverage its potential strengths to improve access to and equity in cancer care delivery-or whether its limitations may perpetuate disparities in care delivery.…”