DURHAM, NC —Long before COVID-19 pushed other healthcare systems to adopt telemedicine approaches, the VA had enabled and encouraged telemedicine to leverage the expertise of national specialists to provide high-quality care for veterans in rural parts of the country. Initially, the TeleOncology service managed oral therapies and watchful waiting and surveillance of veterans with cancer, but it has expanded to offer remote supervision for intravenous cancer treatments.
Researchers from the VA Salt Lake City Healthcare System, VHA National Oncology Program Office in Durham, N.C., and VA Pittsburgh Healthcare System compared remote supervision of treatments for aggressive lymphoma (AL) and metastatic lung cancer (mLC) to in-person care. Chenyu Lin, MD, of the Durham VAMC presented the results at the 2023 American Society of Clinical Oncology annual meeting in Chicago, June 2-6.1
The team focused on patients receiving first-line therapy for diffuse large B cell lymphoma (DLBCL) and stage IV non-small cell lung cancer (NSCLC) through the National TeleOncology Service (NTO) and compared them to control arms of veterans who received their care in person and were matched on a 1:4 basis by stage, age, PD-L1 status for NSCLC patients, and cytogenetics for DLBCL patients.
The researchers identified 140 veterans who received NTO treatment for an aggressive lymphoma (40 DLBCL, 13 Hodgkin, 2 Burkitt) or metastatic lung cancer (61 NSCLC, 24 small cell lung cancer) across 12 states. When compared to 7,561 veterans who received in-person care, the NTO group was more rural (56% vs. 34%, p < 0.001) and had more white patients (89% vs. 77%, p = 0.002).
At a median follow-up of 256 days, TeleOncology patients with mLC had a median of 15 telemedicine visits, while veterans with aggressive lymphoma had 17. Nearly one-quarter of the lymphoma patients and two-thirds of metastatic lung cancer patients cared for through NTO received at least one systemic therapy. Two of the lymphoma patients and seven veterans with mLC were referred for care outside the VHA.
Drilling down, 11 patients with DLBCL and 30 veterans with stage IV NSCLC began first-line therapy under NTO. The veterans in the NTO program and matched controls had similar mean times from referral to the first appointment and from diagnosis to treatment initiation. In addition, the team found no significant differences between the groups in progression-free survival for NSCLC (HR 1.1, 95% CI 0.7-1.8) or DLBCL (HR 0.5, 95% CI 0.1-2.3). In the first three months of treatment, NTO patients and controls had no significant difference in the rates of COVID infections and ED visits.
Based on these findings, the research team said that “the NTO service demonstrates the feasibility of infusional chemoimmunotherapy administration under the direction of a remote tele-oncologist. This model has the potential to improve access to specialized oncology care for rural populations and provides a framework for decentralized clinical trials.”
- Lin C, Zhou KI, Burningham ZR, Rowe KG, Anglin-Foote T, Maddox M, Friedman DR, Halwani AS, Passero VA, Kelley MJ, Rodgers TD. Telemedicine-supervised cancer therapy for patients with aggressive lymphoma and metastatic lung cancer in the U.S. Veterans Affairs National TeleOncology Service. 2023 ASCO annual meeting. June 2-6, 2023. Abstr 1602. J Clin Oncol 41, 2023 (suppl 16; abstr 1602).