For cancer patients, telemedicine is appropriate for many consultations and follow-up visits.
Telemedicine provides physician practices with a safe method to interact with patients remotely during the coronavirus disease 2019 (COVID-19) pandemic. Telemedicine also enables physician practices to expand services for patient care such as virtual patient check-in capabilities and remote patient monitoring that collects biometric data.
"We feel it is not safe for patients to come directly to our office, or even to a hospital. In our clinic, we have set up multiple times during the day when we are doing telehealth consultations or follow-up visits. There are a select number of patients who fall very nicely into the category of being able to have their consultation done virtually," says Eric Brown, MD, breast program director at Michigan Healthcare Professionals in Farmington Hills, Michigan.
The telehealth visits are appropriate for cancer patients who have nonpalpable findings such as an abnormal mammogram, he says. "So, if you did not feel a lump and just had a screening mammogram and ended up getting diagnosed with breast cancer, those patients are appropriate to have their initial consultation done virtually."
Follow-up visits for cancer patients are well-suited to telehealth, Brown says. "Most of our telehealth visits have been follow-up visits: a check-in to see how things are going or a post-operative visit if the patient has no wound-specific issues. Some of our high-risk patient follow-ups have been done via telehealth."
All patients who have had virtual consultations also have had office visits, he says. "We did make arrangements for an in-person visit as well because that is an important component of what we do. Given the scenario, we were not able to do a physical exam on patients unless we had them come to the office."
Virtual visit best practices
Brown, who has been practicing for 27 years, says conducting consultations over the phone or via a video chat can be challenging. For example, if there is a loved one with the patient off camera, it can be difficult to "read the room," he says.
Engaging patients also can be problematic. "A lot of patients don't know where to look when they are on a video chat, so you are often not looking straight on to them," Brown says.
The key to telehealth visit success is adapting in-person skills to the virtual environment, he says.
"When it is a cancer consultation, you have to continue to provide the breadth of information that you would have if the patient was seen in the office. It was difficult at first to find my mojo; because when you do consultations in the office, you develop a pattern. You can see whether patients are understanding and engage them in the conversation. … By and large, you stick to the pattern, review the things you want to review, and engage patients in that way."
Virtual tumor board meetings
Brown says telehealth has been particularly useful in conducting tumor boards—multidisciplinary meetings his practice holds weekly to review cancer cases.
"As a group, we realized that meeting in person was risky for us because people were at risk for possible exposure in their offices and the community, or they had been moved to different positions in the hospital where they were subject to getting coronavirus," Brown says.
His practice adopted the OncoLens platform for tumor boards. "It has been a huge improvement in attendance. Most importantly, it has allowed us to continue the multidisciplinary approach to breast cancer care that patients deserve," he says.
With travel time cut out of tumor board meetings, attendance has doubled, Brown says. "Pre-pandemic, we would typically have eight to 12 people participate in the weekly tumor board. With the virtual platform, we have had no fewer than 20 and as many as 26 people participate."
The virtual platform has drawn plastic surgeons to the tumor board meetings, he says.
"Before, we would never have a plastic surgeon—even though they were invited—because they were operating and would not have time to participate. Now, we have had no fewer than four plastic surgeons on every tumor board. The more physicians that can participate, the better it is for the patients. You get more opinions, and everybody brings something to the table."
Christopher Cheney is the senior clinical care editor at HealthLeaders.
Initial consultations are appropriate via telehealth when cancer patients have nonpalpable findings such as an abnormal mammogram, a breast cancer specialist says.
In cancer care, best practices for virtual visits include sticking to the pattern of an in-person visit, the specialist says.
Telemedicine is well-suited for tumor boards—multidisciplinary meetings held regularly to review cancer cases.