Karmanos Cancer Institute CMO George Yoo is bullish on the future of telehealth in oncology care.
Telehealth is well-suited to providing a range of services for oncology patients, the chief medical officer of the Karmanos Cancer Institute says.
Telehealth has expanded exponentially during the coronavirus pandemic. However, in the long term, there is uncertainty about the future of telehealth, including whether government and commercial payers will continue to reimburse telehealth visits at rates comparable to in-person visits and which specialties will remain committed to utilizing telehealth.
Karmanos, which is part of Grand Blanc, Michigan–based McLaren Health Care, has 15 locations across Michigan. Karmanos CMO George Yoo, MD, is bullish on the future of telehealth in oncology care.
"Telehealth has become a great tool for many patients. Not everybody likes telehealth; but there are quite a few patients who like to use telehealth, especially patients who are frail and cannot travel or just live very far away from our main facility. Telehealth is a great tool, and it is going to stay in the future—it is not just going to be useful during the pandemic. Telehealth is a great way to give initial consults, for example," he says.
Convenience is a powerful driver for adoption of telehealth in oncology, Yoo says. "Telehealth is going to be a way for more and more patients to get oncology care from our institute. There are patients who do not want to travel three or four hours to our main facility in Detroit to see whether they really need a certain type of surgery, radiation, bone marrow transplant, or clinical trial. With telehealth, it is going to be much easier for patients to explore these services."
Telehealth is an excellent way to engage families when an oncology patient is facing advanced stages of cancer or end-of-life situations, he says. "When we have end-of-life discussions that are very sensitive, family input is tremendously important. With telehealth, the whole family can be present. It can be difficult to involve the family if the patient is coming into an office, clinic, or exam room, and they have to call their family members. With telehealth, family members can be present for the whole discussion."
As long as the possibility of coronavirus infection remains a concern, telehealth will remain an attractive care option for oncology patients, Yoo says.
"These patients are going through therapies that make them more immune-compromised than many other patients. The cancer itself can make patients immune-compromised. So, these patients are at risk if they get COVID—they get much sicker than other patients. Some patients are being very cautious and do not want to go out into a public environment where they could expose themselves to the coronavirus. So, they are finding it much more comfortable to stay in their home setting with telehealth."
About 90% of Karmanos' telehealth visits are conducted using video, says Scott McCarter, vice president of information technology. "There are some technology challenges that patients have—they may not have a cellphone that works like a smartphone. We have a very challenged population here in Detroit, where patients often do not have as much technology as other patients. It would be impossible to go to 100% video."
Oncology services fit for telehealth
There are several kinds of oncology patients and oncology services that are appropriate for telehealth, Yoo says.
1. Newly diagnosed patients: "For the new patient, telehealth is an excellent tool for a second opinion. It is an excellent tool for specialized care. Karmanos and McLaren Health Care have a network of cancer centers across the state. There is a lot of general treatment that can be done in these network sites. Telehealth visits can determine whether a patient has to come down to the main hospital in Detroit or not," he says.
2. Return patients: "For return patients, telehealth is a good tool when the care is mainly looking at results of tests; for example, a prostate cancer patient with a prostate-specific antigen test. If a patient is coming in for a yearly radiological test and they need to review the results, telehealth is an excellent tool," Yoo says.
3. Surgery consults: "Just about every type of surgical consult is appropriate for a telehealth visit. Some patients just want to get confirmation on whether a surgery can be performed. For example, I had a patient in Northern Michigan who wanted the surgery in Detroit, but she did not want to come down to the city twice. She did not want to come down just for a surgery consultation, then have to come down for the surgery," he says.
4. Radiation consults: "Telehealth is a good tool if the patient wants specialized radiation treatment. For example, we have a gamma knife, which is specialized delivery of radiation to the brain. Telehealth consultations are good for determining whether gamma knife or standard radiation is more appropriate. Any time when there are specialized services, it can be appropriate to have a telehealth visit for consultation. The patient does not want to travel just to be told that they are or are not a candidate for a specialized service," Yoo says.
5. Genetic consultations: "Right now, about 80% of our genetic consultations are being conducted via telehealth. A lot of information can be exchanged between the patient and the genetic counselor through questions. An exam is not necessarily important; and if any testing is ordered, the results can be followed up with the patient. There are certain specialties such as genetic counseling and palliative care that lend very well to telehealth," he says.
6. Psychological and palliative counseling: "Those services are provided through telehealth visits. It is up to the preference of the patient. A lot of patients still want to have face-to-face contact for palliative care and psychological care. But telehealth tends to work very well for those specialties because clinicians do not have to make physical contact in the evaluation of a patient. A lot of the care can be done verbally and by video," Yoo says.
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Christopher Cheney is the senior clinical care editor at HealthLeaders.
For newly diagnosed oncology patients, telehealth is an excellent tool for second opinions.
For return oncology patients, telehealth is appropriate to review test results.
Telehealth is appropriate for oncology surgery consults, radiation consults, and genetic consultation.