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Telehealth visits are especially appropriate for treatment adherence to oral agents, survivorship, genetic counseling, supportive services, or education. Telehealth is an easy and safe model to enhance the communication between patient and physician when human contact and traveling are associated with significant risk for COVID-19 infection. CureCancer - mycancer.gr, is a tool for this easy and safe communication and gives the patient more time with their family. 

 The risk of infection  

Patients with cancer have been affected by the COVID-19 pandemic more than others. COVID risk is related to the type of cancer and cancer therapy. The adverse effects include the different prognosis of patients infected with covid-19 and the delays in cancer therapies, aiming to reduce the risk of infection and the interruption of projects and cancer research studies. Risk assessment, related to each patient and condition, is a challenge which has significantly assisted to the optimization of patient care and cancer therapy.

The new perspective on cancer care

COVID-19 brought new challenges in cancer therapy and re-oriented the model of cancer health. The role of medical care “from distance”, telehealth or telemedicine or teleoncology, emerged during this pandemic.

The Challenge

Επίπτωση του Covid-19 στους ασθενείς με καρκίνο

The number of cancer patients who are hospitalized in intensive care units is higher than that of other patient groups. In New York 6%-7% of patients who were hospitalized with COVID had active cancer. Biological and immune-related factors seem to be associated with the increased risk of infection in patients with cancer. It is also possible that this increased risk may be related to the more often visiting of cancer patients to the hospital and other patient care environment.

Thrombosis

Patients with cancer are particularly at risk of thrombotic complications, about 4 -7 times above that of the general population. The risk may vary depending on type of cancer and stage, cancer therapies and co-morbidities. The risk of thrombosis seems increasing with COVID-19 and this may be one of the reasons for the higher severity of COVID disease and the worse prognosis in cancer patients.

Clinical presentations and outcomes

The clinical presentation of COVID-19 in patients with cancer does not differ compared with patients without cancer. The symptoms of the COVID disease are, however, more severe and rates of death are higher. Thus, pro-active strategies to improve early detection and reduce likelihood of infection became top priorities for health care institutions providing oncologic care.

The perspective

Medicine “from a distance”, Telemedicine / Teleoncology

Telehealth has become the forefront of clinical care during the COVID-19 pandemic.

Medicare allows for expansion of coverage for telehealth services

On March 30, 2020, the USΤCenters for Medicare & Medicaid Services issued the 1135 waiver, loosing regulations and allowing for expansion of coverage for telehealth services to Medicare beneficiaries. Following Medicare, nearly all centers reconfigured care delivery models, focusing on the expansion of telehealth capabilities. The telehealth services were to be paid under the Physician Fee Schedule, same as in-person services. Many private payers and state Medicaid programs have announced extended coverage as well.

Evidence of effectiveness of telehealth

A brief, prepared for the Agency for Healthcare Research and Quality, showed evidence of the effectiveness of remote monitoring of patients, communication and counseling for patients with chronic conditions, and providing behavioral support and psychotherapy. In a Cochrane systematic review, an increase was found in quality of life for those allocated to telehealth compared with usual care and improved disease control in diabetes, hypercholisterolemia, and hypertension.

From the oncologic side, results, from another study, which assessed the effect of telehealth versus usual care in patients with breast cancer, showed that telehealth was associated with a higher quality of life and self-efficacy, and less depression and distress. Additional advantages of telehealth, specific to the pandemic include limiting exposure and reducing travel and wait times for patients. Both ASCO and ESMO suggest that patients not requiring an in-person exam, treatment, or diagnosis should have telehealth visits during the COVID-19 pandemic. Especially telehealth visits are appropriate for treatment adherence for oral agents, survivorship, genetic counseling, supportive services, or education.

Thus, telehealth and teleoncology has emerged as an important model to provide medical oncologic counseling during the COVID-19 pandemic. It is an easy and safe model for patients and physicians to communicate when human contact and traveling are associated with significant risk for COVID-19 infection. The appropriate selection of patients, who are to receive telehealth services is the key for the success of the provided therapy. The authors highlight to assess the tech literacy before scheduling telehealth services.

Guides and toolkits assist with telehealth programs

Implementation guides and toolkits are published to assist with the rapid integration of outpatient telehealth programs.

Πηγές

1. Bakouny Z et al. Covid-19 and Cancer: Current challenges and Perspectives. Cancer Cell 38, November 9, 2020, doi.org/10.1016/j.ccell.2020.09.018.
2. D. Galiti et al. CureCancer - mycancer.gr digital tool in the routine clinical oncology practice facilitates PROs, communicating with HCPs, treatment adherence and “distancing interventions” during covid-19 and reduces costs. A feasibility and satisfaction study. Annals of Oncology, Vol. 31, Supplement 4, September 1 2020, doi.org/10.1016/j.annonc.2020.08.1771
3. Smith Wr, et al. Implementation guide for rapid integration of an outpatient telemedicine program during COVID-19 pandemic. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2020.04.030.