Teleoncology: current and future applications for improving cancer care globally

Abstract

Access to quality cancer care is often unavailable in low-income and middle-income countries, and also in rural or remote areas of high-income countries. Teleoncology-oncology applications of medical telecommunications, including pathology, radiology, and other related disciplines-has the potential to enhance access to and quality of clinical cancer care, and to improve education and training. Implementation of teleoncology in the developing world requires an approach tailored to priorities, resources, and needs. Teleoncology can best achieve its proposed goals through consistent and long-term application. We review teleoncology initiatives that have the potential to decrease cancer-care inequality between resource-poor and resource-rich institutions and offer guidelines for the development of teleoncology programmes in low-income and middle-income countries.

Figure 1

Teleoncology links ancient and new worlds. Left, the ancient city of Petra, Jordan. Right, the CN Tower, Toronto, Canada. Central images show a monthly videoconference that allows the neuro-oncology teams of King Hussein Cancer Center (Amman, Jordan; top) and Hospital for Sick Children (Toronto, Canada; bottom) to view and discuss complex brain tumor cases (center). The ongoing videoconference series began in 2004.

Figure 2

Presurgical ocular teleoncology consultation. A complex case of bilateral retinoblastoma was treated in Jordan. The policy at the Jordanian center required that cases be discussed with the mentoring St. Jude Children’s Research Hospital ocular oncology team before any major intervention. Images show the right eye after chemotherapy. (A) Retinal photographs show tumor (arrows) and retinal folds (arrowheads). (B) Doppler ultrasound images show tumor (arrows) and active blood flow (arrowheads). Because blood flow suggested viable tumor, enucleation was initially considered. The mentoring team recommended observation, as blood flow appeared to be localized in the retinal fold. Although the left eye required enucleation, the right eye was salvaged and the young patient retained useful vision.

Figure 3

Proposed multi-tier collaborative teleoncology scheme linking cancer centers. Teleoncology would be implemented at the international level between cancer centers in HIC and those in LIC/MIC (red arrows) and between cancer centers in different LIC/MIC (orange arrows). The scale of the programs would depend on the population and number of cancer centers; a more extensive program would be appropriate for a large LIC/MIC with more than one cancer center (example at lower right). The level of technology used would depend on needs and resources. The main centers within each country would communicate with each other via advanced teleoncology such as videoconferencing and (using less expensive technology) would mentor smaller cancer units (gray arrows).