A Pilot Trial Using Telemedicine in Radiation Oncology: The Future of Health Care Is Virtual

Abstract

Background: Social determinants of health directly affect cancer survival. Driven by advances in technology and recent demands due to COVID-19, telemedicine has the ability to improve patient access to care, lower health care costs, and increase workflow efficiency. The role of telemedicine in radiation oncology is not established. Materials and Methods: We conducted an IRB-approved pilot trial using a telehealth platform for the first post-radiation visit in patients with any cancer diagnosis. The primary endpoint was feasibility of using telehealth defined by completion of five telehealth visits per month in a single department. Secondary endpoints included the ability to assess patients appropriately, patient and physician satisfaction. Physicians were surveyed again during the pandemic to determine whether viewpoints changed. Results: Between May 27, 2016 and August 1, 2018, 37 patients were enrolled in the Telehealth in Post-operative Radiation Therapy (TelePORT) trial, with 24 evaluable patients who completed their scheduled telehealth visit. On average, 1.4 patients were accrued per month. All patients were satisfied with their care, had enough time with their physician and 85.7% believed the telehealth communication was excellent. All physicians were able to accurately assess the patient's symptoms via telehealth, whereas 82.3% felt they could accurately assess treatment-related toxicity. Physicians assessing skin toxicity from breast radiation were those who did not feel they were able to assess toxicity. Discussion and Conclusions: Both health care providers and patients have identified telemedicine as a suitable platform for radiation oncology visits. Although there are limitations, telemedicine has significant potential for increasing access of cancer care delivery in radiation oncology.

Keywords: e-health; patient satisfaction; provider satisfaction; radiation oncology; telemedicine.

FIG. 1.

Patient accrual and visit completion. During the time that the study was open, a total of 598 patients completed radiation, 78 patients screened, and 37 patients were enrolled in the trial based on eligibility criteria. Of the 37 enrolled patients, 24 completed a telemedicine visit and 14 completed the questionnaire. The average number of patients accrued per month over the time period that the study was open for accrual was 1.4 patients.

FIG. 2.

PSCC questionnaire score. The PSCC is an 18-item questionnaire that addresses multiple domains, including: access/logistics, interpersonal skills of the provider, information gathering and reporting, and coordination of care on a Likert scale. The PSCC questionnaire has a score range between a minimum of 18 (best score) and a maximum of 90 (worst score). In this cohort, the scores ranged from 18 to 32 with a mean of 22.6 and a median of 21. PSCC, Patient Satisfaction with Cancer Care.

FIG. 3.

CAT questionnaire score. The CAT is a 14-item questionnaire that addresses patient satisfaction with key aspects of provider communication and interpersonal skills, and items are scored on a Likert scale. The CAT questionnaire has a score range between a minimum of 14 (worst score) and a maximum of 70 (best score). In this cohort, the scores ranged from 55 to 70 with a mean of 67.5 and a median of 70. CAT, Communication Assessment Tool.

FIG. 4.

Provider assessment of telemedicine platform. A total of 11 providers participated during the initial enrollment period, and a total of 17 responses were recorded (some providers submitted multiple entries). During the initial enrollment when only first post-treatment visits were being conducted via telemedicine, all providers (100%) felt that they were able to accurately assess the patient's symptoms via the platform, whereas 14 (82.3%) of the respondents felt that they could accurately assess treatment-related toxicity. Sixteen (94.1%) of the respondents were able to document the patient's KPS, and no provider (0%) required their patient to come in for a subsequent in-person encounter. KPS, Karnofsky Performance Status.