The pandemic has led many patients and their doctors to interact via digital devices rather than in person, but it seems that some patients do not mind this shift.
In a survey of more than 1000 radiotherapy patients, 3 lidocaine cream rates of satisfaction with telemedicine consultation were as high as for in-patient visits.
“Most telemedicine survey respondents did not report inferior confidence in their physician, cancer treatment, or in their understanding of the treatment plan,” the authors report.
“These findings provide some evidence that there is a role for telemedicine beyond the COVID-19 pandemic and that it can be a particularly useful tool for certain patients — especially those who may have challenges coming on site for an appointment,” said co–lead author Narek Shaverdian, MD, Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City.
“Giving patients flexibility and options by being able to see them both in person and through telemedicine can improve access to care,” he said.
The study was published in the October issue of the Journal of the National Comprehensive Cancer Network.
“The bottom line is that this study supports the use of telehealth as a permanent transformation of the healthcare landscape,” commented Anne Chiang, MD, PhD, associate professor of medicine, Yale Cancer Center/Smilow Cancer Hospital, New Haven, Connecticut, and member of the National Comprehensive Cancer Network (NCCN) policy advisory group.
In fact, “some patients preferred telehealth visits and noted that telemedicine could reduce travel costs and time,” she commented in a statement.
Telemedine Not Really Utilized Before Pandemic
“Prior to the pandemic, telemedicine wasn”t really done,” Shaverdian told Medscape Medical News.
“So it was just the unknown about it,” he commented. “How would we make sure that patients were understanding what we were saying if we were talking about symptoms? How would we be able to assess the patient”s symptoms? How would we be able to communicate with the family, and how would the technology work?
“A lot of our initial reservations about using telemedicine was just the fact that it wasn”t really done,” he added.
“Given that radiation patients are often receiving multimodality care and have multiple care providers, we can use telehealth to give us flexibility, as ultimately, we will see the patient in person at some point in the process,” Shaverdian elaborated.
For their study, his team conducted a satisfaction survey that asked 12 questions of patients at the radiation department of the investigators’ comprehensive cancer center in the New York metropolitan area.
“Their experience with telemedicine was evaluated across multiple phases of care, including the consultation appointment and weekly on-treatment management visits,” Shaverdian and colleagues explain.
The study included two cohorts of patients: those seen during the prepandemic period from December 1, 2019, through February 28, 2020 (n = 726), and those seen during the intrapandemic telemedicine period from April 2, 2020, through June 2020 (n = 351) .
Standard communication technologies were used for telemedicine encounters. These included telephones, smartphones, and other types of computerized devices (eg, tablets, desktop computers).
The median length of time spent in consultation during the telemedicine visit was 30 minutes. The majority of patients had an interactive audiovisual encounter.
“Across all measured domains of patient satisfaction, no significant differences were found between telemedicine and office visit survey respondents with regard to radiation oncology consultation,” the authors report.
Indeed, when rating their appointment experience, most survey respondents selected the top score (82% for telemedicine visits vs 84% for office visits).
|Quality of MD’s explanations||91%||84%|
|Level of MD’s friendliness and concern||92%||95%|
|Likelihood to recommend their MD to others||93%||92%|
Moreover, 45% of survey respondents indicated that they preferred a telemedicine visit; 34% indicated they preferred an office visit; and 21% indicated that they found no difference between visit types. Interestingly, being married or having a partner was associated with an almost 2.5-fold higher preference of having an in-person visit.
Almost two thirds of respondents indicated that they preferred telemedicine visits because of treatment-related costs. Only 8% of respondents expressed some concern that their “cancer won’t be successfully treated” as a result of the pandemic.
The authors observed that interactive audiovisual encounters appeared to enhance patient-physician communication in comparison with communication by telephone alone.
Patients who do not have access to audiovisual equipment at home may be able to access care at a regional center that is close to home. The radiation oncology team at Memorial Sloan Kettering Cancer Center has been utilizing this approach.
“Sometimes you do see a patient for a virtual encounter, and you are concerned about that patient, at which point you tell them to come to the emergency room and see them in person,” Shaverdian acknowledged. “So what we are doing now is really offering a hybrid of care based upon patient preference and what makes clinical sense,” he added.
“It’s not all of oncology that is being delivered virtually, but telemedicine can be a tool for patients, and I predict it’s going to be a hybrid approach where not every single one of a patient’s visits needs to be in person but rather a mixture of care delivery dependent on the situation,” he concluded.
Telemedicine in Dermatology
Another specialty that appears to be particularly well suited to the delivery of care via telemedicine is dermatology, a highly visual specialty. This was illustrated by a case report, published in JAAD Case Reports, of a patient who initially presented to his primary care physician with a dot-sized bleeding sore on his right heel. The sore had been there for about 1 month. The treatment that was prescribed was not effective. The patient then presented to a podiatrist, but treatment was again unsuccessful. Over the ensuing 7 months, a series of block spots developed. The spots ascended from the lesion on the patient’s heel up his lower leg. The patient sought dermatologic care.
Because the patient could not arrange for a timely in-person visit, he submitted photos of the affected area. Less than 2 days later, the patient was seen in person at the dermatology clinic of the University of Pittsburgh, in Pittsburgh, Pennsylvania. Several biopsies were performed on the black spots, and the patient was diagnosed with acral malignant melanoma.
The authors of the report, with lead author Joseph Mocharnuk, BS, explain that amelanotic melanoma is a rare melanoma variant that is often initially misdiagnosed, owing to its depigmented appearance and the diversity of clinical presentations. “Aided by advancements in digital image quality on smart devices and the ability to zoom in on image files, current teledermatology platforms may be used in the triage of lesions with few distinguishing features, allowing patients with pressing dermatologic conditions to access care in a timely manner,” the authors write.
“As demonstrated in our case, teledermatology and its ease of access played a crucial role in expediting dermatologic care for this patient,” they conclude.
Shaverdian and Mocharnuk have disclosed no relevant financial relationships.
J Natl Compr Canc Netw. doi: 10.6004/jnccn.2020.7687. Full text
JAAD Case Rep. Preproof published online October 14, 2021. Full text
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