Cancer Care Goes Virtual in Response to COVID-19

Few oncologists practiced “telemedicine” in the 1990s when Gary Doolittle, MD, of the University of Kansas (KU) Medical Center in Kansas City began offering interactive video consultations to patients in distant parts of the state. Even by the end of 2019, not many more had embraced the technology.

Now, amid concerns about the spread of COVID-19, oncology practices have “gone virtual,” scheduling video appointments for services that don't require diagnostic testing or treatment. These include symptom management, genetic counseling, psychiatric support, and follow-up assessments after treatment. For patients who require in-person care, oncologists are spacing out visits to minimize the number of people in waiting rooms.

“Right now, the most important thing is to get our patients the care they need,” while limiting potential exposures to SARS-CoV-2, says Doolittle, medical director of the KU Center for Telemedicine and Telehealth. However, he expects tele-oncology is here to stay. “This will continue long after we've dealt with the current pandemic,” he predicts.

In Seattle, WA, the initial epicenter of the U.S. outbreak, doctors had already dabbled in telemedicine, assisting prospective bone marrow transplant recipients in Hawaii and conducting virtual home visits for patients receiving palliative care. So, when COVID-19 struck, “we had a team that we could rapidly mobilize to get telehealth rolled out to more providers,” says Jennie Crews, MD, of the Seattle Cancer Care Alliance. Some clinicians needed technical support to get digital health tools working, but “by and large,” she says, the shift to online medicine has “worked extremely well.”

Although patients and health professionals say they appreciate the convenience of connecting digitally, the lack of physical presence can feel impersonal. It also limits the opportunity for hands-on care, notes Vida Passero, MD, head of hematology/oncology at VA Pittsburgh Healthcare System in Pennsylvania. “It's a bit of a compromise,” she says. Yet, under the circumstances, Passero says she is happy to forgo physical exams for added safety.

The need for virtual medical care is especially acute in oncology because patients with cancer are often immunosuppressed and routinely visit a hospital for treatment. That makes them particularly vulnerable to COVID-19. According to reports from China, the disease is more prevalent among those with cancer compared with the general population—and those with cancer and COVID-19 are far more likely to experience complications and die (JCO Global Oncol 2020;6:557–9; Ann Oncol 2020 Mar 26 [Epub ahead of print]).

To keep patients away from the hospital, the nurses on Passero's team call patients once or twice a week to ask about any health issues, rather than wait for problems to arise. “I call it the proactive telephone checkup,” Passero says.

The rapid expansion of tele-oncology followed March's $8.3 billion emergency spending bill, which loosened restrictions on reimbursements for video consults during a health crisis. Before that, insurance providers might cover e-visits only for patients living in sparsely populated areas who went to a nearby qualified site and spoke over secure video chat. Further, licensure, credentialing, and certification rules for clinicians often varied from state to state. “All that's gone away in the last few weeks,” says Doolittle.

When the coronavirus emergency ends, the red tape will return, but perhaps only temporarily, says Adam Dicker, MD, PhD, a radiation oncologist who leads Thomas Jefferson University's Center for Digital Health in Philadelphia, PA. In the past few weeks, he notes, doctors and patients have grown accustomed to telemedicine—and he anticipates they will demand greater access to it even under ordinary circumstances. “The genie is out of the bottle,” he says. “It's going to become the new normal.” –Elie Dolgin