Most Common Usage was for Prostate Cancer
In early 2020, during the pandemic, veterans attended about 25,000 telehealth video appointments each day, including oncology visits, which was a 1,000% increase from 2019. Halfway through the year, VA already surpassed the total number of telehealth encounters completed in 2019 by 7 million. Photo from July 3, 2020, VAntage Point blog
ANN ARBOR, MI — Prior to the onset of the COVID-19 outbreak in the United States, 2,749 face-to-face visits for medical oncology and 5,093 visits for radiation oncology occurred at the Ann Arbor, MI, VAMC from June 2019 to December 2019.
From March 2020 to June 2020, face-to-face visits for medical oncology dropped to 926, while visits for radiation oncology plummeted to 1,765. “The COVID-19 pandemic forced health systems to adopt telehealth measures to extend medical care to patients with cancer, which reduced the number of in-person visits,” explained authors of a new study available as part of the 2021 American Society of Clinical Oncology Annual meeting.
The result was a dramatic increase in telehealth usage in a healthcare system which had already adopted the technology more than most. Between June 2019 and December 2019, medical oncology had 27 telehealth visits—15 VA Video Connect (VVC) and 12 Clinical Video Telehealth (CVT)—and radiation oncology had 292 telehealth visits—171 telephone, 121 CVT, 0 VVC—at the Ann Arbor VAMC, the numbers shot up during March 2020 to June 2020, with 298 medical oncology visits—296 VVC and 2 CVT—and 244 radiation oncology visits—162 telephone, 15 CVT, 67 VVC) and 49 VVC surgical oncology.
Patients also used telehealth for ancillary services, with 30 nutrition visits and 30 palliative care visits. Telehealth was primarily used for prostate cancer visits, followed by gastrointestinal and lung cancers, noted the authors from the University of Michigan and the VA Ann Arbor Healthcare System.
“On the basis of the successful implementation of virtual chemotherapy delivery at VAPHS and the experience at the VA Ann Arbor Health System, we believe that telehealth can become a great adjunct to in-person visits for all aspects of cancer care,” they wrote.
The study also described what occurred at the VA Pittsburgh Healthcare System, (VAPHS) where the ongoing use of telehealth was expanded to facilitate chemotherapy administration. Again, the primary site of disease was prostate (19.1%), followed by colorectal (13.4%) and lung (9%).
The report pointed out that, while the VA had used telehealth as a solution for many different healthcare services, it had not been as widely used in cancer care. The authors argued that the situation should change.
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Using telehealth to deliver cancer care, whether because of COVID-19 or more mundane reasons such as a veterans’ distance from a specialist, the program has presented challenges.
“One of the main challenges is veteran access to Internet and devices that allow veterans to participate in telehealth services,” the authors explained. In response, the VA has partnered with Philips Healthcare and T-Mobile to expand access to the VVC app, while Philips Healthcare placed telehealth technology equipment at veterans’ service organizations, including the Veterans of Foreign Wars and the American Legion. In addition, a T-Mobile partnership provides veterans access to the VVC app on their mobile device without additional charges or reductions in plan data allotments, but only if they already have that service. For veterans in underserved or rural locations, the VA partnered with Walmart to provide access to VA telehealth services through systems in the retail stores.
Resistance to New Technology
Veterans with hearing disabilities, who have dementia or who are resistant to using new technology also present problems. Solutions include community-based outpatient clinics, technology to communicate without hearing or involving family members in telehealth visits, the study noted.
Still, the authors argued that the future of telehealth for cancer care is promising, adding, “Bottom of Form
Moving forward from the COVID-19 pandemic, we plan to continue to utilize telehealth as described herein for oncology patient care. We are currently collecting additional data to determine outcomes from implementation of telehealth. Through telehealth, the care of veterans with cancer could be greatly improved; however, there are limited studies that assess the satisfaction of veteran oncology patients with this modality of care.”
The authors cited one study that surveyed patients who interacted with surgical oncology through telehealth and found that, though data was limited, patients were satisfied with their telehealth visits.
The greatest challenge, they said, is the inability to conduct a physical examination. The plan is to have all patients collect their own vital signs at home and then report the data to their providers. That should be useful, according to the authors, because “vital sign abnormalities, including heart rate, temperature, systolic blood pressure, pulse oximetry and oxygen use, have been associated with death within 30 days among hospitalized patients with cancer. Additional research needs to be done on using vital sign data to predict and assess disease progression.”
Another difficulty is defining metrics of success, the study added.
“In conclusion, telehealth services are not a replacement for in-person visits, but they could be a good adjunct to providing quality in-person cancer care,” the authors explained. “Currently, there is a lack of research on telehealth and cancer care in the veteran population. The VAPHS successfully implemented video telehealth to deliver antineoplastic therapies to rural patients. On the basis of our assessment, there are many opportunities for telehealth to play a role in every step of the cancer care journey, from diagnosis to clinical trials.”