Pioneering sustainable treatment delivery in childhood leukemia through synchronous telemedicine-A pilot study

Abstract

Cancer care places a heavy economic burden on families and health systems, driven by high treatment costs, lengthy hospital stays, and the necessity for extensive travel to specialized facilities. To address this challenge, an integrated health care network (IHCN) was implemented for maintenance treatment in acute leukemia. The IHCN encompassed outpatient services provided by local physicians and synchronous telemedicine consultation with pediatric oncologists. This study included twenty-two pediatric patients (eleven [50.0%] females; twenty [90.9%] with B-ALL and two [9.1%] with AML). The IHCN was offered to all rural patients (n = 17) with a one-way driving distance more than 30 km, while urban patients (n = 5) received regular cancer care. Throughout the study, rural patients had a total of 510 routine clinical visits, with 367 (72%) conducted through the IHCN. Physical examinations revealed similar frequency of new abnormal findings for urban and rural patients (22.4% vs. 17.8%; p = .31). Laboratory tests indicated no significant difference in the frequency of abnormal values for various parameters between both groups. Similarly, there was no discrepancy of drug modifications or interruption in maintenance therapy between the two settings (p = .85). Moreover, patients' health-related quality of life remained within the normative range, and user satisfaction with the IHCN was notably high. The implementation of the IHCN resulted in savings of 70,158 km, 950 h of travel, and 12,277 kg CO₂ emissions. This pilot study underscores the efficacy of a telemedicine-based IHCN, ensuring safety, quality of care, cost reduction, and satisfaction for both families and health care providers in pediatric leukemia management.

Keywords: acute leukemia; integrated health care network; telemedicine; travel burden.

FIGURE 1

Allocation of routine clinical visits during maintenance for childhood leukemia. Since March 1, 2023, the IHCN has been offered to all eligible rural patients and their families (n = 17). Five patients and their families with a one‐way travel distance <30 km (urban) remained in the regular cancer care. Number of weekly visits was allocated to (i) urban patients with regular cancer care (blue) and (ii) rural patients with telemedicine‐centered cancer care separated for in‐person visits at MUI (black) and telemedicine appointments (grey).

FIGURE 2

Quality of life assessment. Twelve parents (70.1%) completed the proxy version of the Pediatric Quality‐of‐Life Inventory (PedsQL) 4.0 Generic Core Scales (A) and PedsQL 3.0 Cancer Module (B). Items of the questionnaires were allocated to corresponding dimensions. Data from this cohort (black) and normative values from healthy sample (grey) are shown as mean with standard deviation.

FIGURE 3

Usability evaluation of IHCN according to the Telehealth Usability Questionnaire (TUQ). Parents of all 17 rural patients (A) and 11 health care providers (B) completed the survey anonymously. The TUQ consists of a 21‐item questionnaire assigned to six subscales as indicated by the respective grading “usefulness,” “ease of use and learnability,” “interface quality,” “interaction quality,” “reliability,” and “satisfaction and future use.” Each question was scored on a 7‐point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Data are shown as mean with standard deviation.