Telemedicine review in neuro-oncology: comparative experiential analysis for Barrow Neurological Institute and Geisinger Health during the 2020 COVID-19 pandemic

Abstract

Coronavirus disease 2019 (COVID-19) has grossly impacted how we deliver healthcare and how healthcare institutions derive value from the care provided. Adapting to new technologies and reimbursement patterns were challenges that had to be met by the institutions while patients struggled with decisions to prioritize concerns and to identify new pathways to care. With the implementation of social distancing practices, telemedicine plays an increasing role in patient care delivery, particularly in the field of Neurology. This is of particular concern in our cancer patient population given that these patients are often at increased infectious risk on immunosuppressive therapies and often have mobility limitations. We reviewed telemedicine practices in neurology pre-/post-COVID-19 and evaluated the neuro-oncology clinical practice approaches of two large care systems, Barrow Neurological Institute and Geisinger Health. Practice metrics were collected for impact on clinic volumes, institutional recovery techniques, and task force development to address COVID-19 specific issues. Neuro-Oncology divisions reached >67% of pre-pandemic capacity (patient visits and slot utilization) within 3-weeks and returned to >90% capacity within 6-weeks of initial closures due to COVID-19. The two health systems rapidly and effectively implemented telehealth practices to recover patient volumes. While telemedicine will not replace the in-person clinical visit, telemedicine will likely continue to be an integral part of neuro-oncologic care. Telemedicine has potential for expanding access in remote areas and provides a convenient alternative to patients with limited mobility, transportation, or other socioeconomic complexities that otherwise challenge patient visit adherence.

Practice Patterns in Surgical Neuro-Oncology Among Low- and Middle-Income Countries During the Coronavirus Disease 2019 Pandemic: A Scoping Review and Situational Report from the Philippines

“…Multiple neuro-oncology guidelines from high-volume centers in HICs have recommended the following: symptom-based and disease-based patient triaging; patient segregation based on COVID-19 status; PPE based on World Health Organization recommendations with emphasis on PAPR for level III; limiting aerosolizing procedures in the OR; use of negative-pressure ORs for COVID-19–positive patients; use of negative-pressure ICUs for postoperative patients (in case these patients develop COVID-19 infection); immediate postoperative step-down areas; the use of telemedicine for outpatient consults; the use of hypofractionated RT; and the use of less toxic chemotherapy protocols in managing neuro-oncology patients. 1 , 2 , 6 , 7 , 8 , 9 , 10 , 11 , 31 , 32 , 33 , 34 Our review has shown that the experience and practice patterns reported in LMICs were generally similar to these recommendations but had some differences attributed to resource availability and patient preferences.…”

“…The advent of the COVID-19 pandemic has seen the increase of telemedicine and its applications. 31 This was also the case in LMICs, although some centers continued FTF consults because of patient preference. 24 In the care of neuro-oncology patients, a few situations necessitate FTF consultation, such as the removal of staplers or sutures postoperatively.…”

“… 49 Direct meetings can also facilitate more accurate clinical assessment of preoperative patients so that they can be triaged properly 1 and can improve counseling and rapport, particularly for patients facing end-of-life care or those with debilitating signs and symptoms. 31 , 49 …”

How has the COVID-19 pandemic impacted clinical care and research in Neuro-Oncology?

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“…(50) Additionally, telemedicine reduces waiting times, increases flexibility and reduces productivity losses, whilst also positively impacting on patient experience (51)(53)(54)(55)(56)(57)(58) One centre found that patients who utilised telemedicine appointments had more stable brain tumours than patients who attended in-person appointments (40). Studies have suggested that telemedicine is suitable for Neuro-oncological examination of non-critical patients,(3,22,59,60) reducing the need for in-person visits.…”