Next Article in Journal
Nicotine-Free E-Cigarettes Might Promote Tobacco Smoking Reduction Better Than Nicotine Delivery Devices: Results of a Double-Blind Randomized Controlled Trial at 1 Year
Previous Article in Journal
Intimate Partner Violence against Mastectomized Women: Victims’ Experiences
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
Current Oncology
Volume 29
Issue 11
10.3390/curroncol29110675
curroncol-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Teleoncology: A Solution for Everyone? A Single-Center Experience with Telemedicine during the Coronavirus Disease 2019 (COVID-19) Pandemic

by
Paula Ribera
1,*,
Sandra Soriano
1,
Carla Climent
1,
Laia Vilà
1,
Ismael Macias
1,
Luis Antonio Fernández-Morales
1,
Julia Giner
1,
Enrique Gallardo
1,
Miquel Angel Segui Palmer
1 and
Carles Pericay
2
1
Department of Medical Oncology, Parc Taulí Hospital Universitari, 08208 Sabadell, Spain
2
Department of Medical Oncology, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2022, 29(11), 8565-8578; https://doi.org/10.3390/curroncol29110675
Submission received: 15 September 2022 / Revised: 3 November 2022 / Accepted: 8 November 2022 / Published: 11 November 2022
(This article belongs to the Section Palliative and Supportive Care)
Browse Figures
Review Reports Versions Notes

Abstract

:
Since the beginning of the COVID-19 pandemic, the use of telehealth was rapidly implemented without previous evidence. The ONCOTELEMD study aimed to evaluate the opinion of patients attended via telemedicine during this period and to study factors that condition patient preferences on its use. Included patients had a confirmed cancer diagnosis and were contacted by telephone between 13 March and 30 April 2020, in the Medical Oncology Service of Hospital Parc Taulí, Sabadell. A 12-question survey was presented to them between 4 February and 19 April 2021. Statistical analysis was carried out using chi-square and multivariable logistic regression tests. Six hundred forty-six patients were included; 487 responded to the survey. The median age was 68 years (27–90), 55.2% were female. Most patients had a surveillance visit (65.3%) and were diagnosed with colorectal or breast cancer (43% and 26.5%, respectively); 91.8% of patients were satisfied, and 60% would accept the use of telemedicine beyond the pandemic. Patients aged more than 50 years (OR 0.40; 95% CI, 0.19–0.81; p = 0.01) and diagnosed with breast cancer (OR 0.45; 95% CI, 0.26–0.69; p < 0.001) were less predisposed to adopt telehealth in the future. Patients agreed to be informed via telehealth of scan or lab results (62% and 84%, respectively) but not of new oral or endovenous treatments (52% and 33.5%, respectively). Additionally, 75% of patients had a medium or low-null technologic ability, and 51.3% would only use the telephone or video call to contact health professionals. However, differences were found according to age groups (p < 0.0001). In total, patients surveyed were satisfied with telemedicine and believed telehealth could have a role following the COVID-19 pandemic. Moreover, our results remark on the importance of individualizing the use of telehealth, showing relevant data on patient preferences and digital literacy.

1. Introduction

The coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) emerged in Wuhan in late 2019 and became a worldwide pandemic by March 2020 [1].
Since the virus spread, cancer patients were widely accepted as more at-risk due to their underlying disease and more significant immunosuppression [2]. Consequently, the symptoms caused by COVID-19 were more severe, and mortality was also higher compared to the community, reaching a 30% rate according to different series [3,4,5].
To reduce the risk of infection, oncologists were required to readapt cancer care models and evaluate the risks and benefits of outpatient visits in health care centers. Therefore, medical associations like the European Society of Medical Oncology (ESMO) and the American Society of Clinical Oncology (ASCO) recommended the use of telemedicine when it was feasible [6,7].
Telemedicine is defined by the World Health Organization as the delivery of health care services using information and communication technologies to exchange valid information for the diagnosis, treatment, and prevention of disease and injuries, research and evaluation, and the continuing education of health care providers [8].
For cancer care, telemedicine was primarily explored in the 1990s in Australia and the USA to guarantee health care services to rural and remote populations [9]. Afterward, tele-oncology application was not widespread, and its use was restricted to facilitate symptom control, treatment supervision, palliative care, and psychological provision [10,11,12,13,14].
The main drawbacks that have limited the use of telemedicine are the unfamiliarity of patients and caregivers with technology, the impossibility of an in-person physical examination, the compromise of patient–physician interaction and the difficulties for patients with impaired hearing, vision or cognition [15,16,17,18].
Nevertheless, its potential application within cancer care has been acknowledged for a long time. Tele-oncology has some clear benefits for patients and clinicians such as the improvement in punctuality, no need for transportation, lowered waiting time, and reduced time in the hospital environment [19,20,21].
With the arrival of COVID-19, telemedicine was implemented in 76.2% of European centers, and its use increased by 150% compared to 2019 [22,23]. This rapid growth in the provision of telemedicine was performed with limited preceding experience [24].
To support clinicians and health care systems, tele-oncology guidelines were quickly elaborated, recommending telemedicine for routine follow-up/survivorship visits, informing about laboratory and scan results, evaluating oral drug compliance, and managing long-term treatments [6,7,25].
The rapid transition towards telemedicine during the first wave of the COVID-19 pandemic raised concerns about patient acceptance, assessment accuracy, and possible inequalities between patient groups.
Many recent published works report high patient satisfaction with telemedicine during the first pandemic wave, and suggest that telemedicine could have a role in the future [26,27,28,29,30,31,32,33,34,35,36,37,38,39,40]. However, to ensure high-quality care following the pandemic, further investigations are needed to identify patient groups that can benefit more from this new healthcare delivery.
The ONCOTELEMED study was designed during the first wave of the COVID-19 pandemic with three main objectives:
  • Comprehending patient satisfaction with the telehealth visit during this period and finding differences between patient groups.
  • Knowing patient preferences on telemedicine use and identifying the within-group differences.
  • Analyzing the technological skills of our study population and its possible influence on patient preferences towards telemedicine.
With all the information obtained, we would like to answer the question of the optimal patients to receive telehealth care and in which context it should be used.

2. Materials and Methods

2.1. Study Design and Population

This single-institution descriptive cross-sectional study assessed patients with a reported cancer diagnosis who were contacted via telephone between 13 March and 30 April 2020, in Medical Oncology Service in Hospital Parc Taulí, Sabadell.
Eligible patients were aged 18 years or older. All solid tumours were included. Patients could have an early stage (I–III) or metastatic (IV) disease. Time from diagnosis was irrelevant. Telehealth visits could be for surveillance or treatment follow-up.
The experience with telemedicine was evaluated with a survey distributed between 4 February and 19 April 2021, ten months after the visit. Temporality was justified given the oversaturation of the Hospital during the first wave of the COVID-19 pandemic.
We contacted all the included patients by telephone or during an in-person visit (in case the patient had a face-to-face appointment during the survey period). All participants provided their verbal consent before answering the questionnaire. The survey was presented by a trained oncologist who was not involved in patient care. Each survey was filled out only once and anonymously by each participant.
The study was conducted in accordance with the Declaration of Helsinki, and approved by The Research Ethics Committee of Parc Taulí Hospital on 27 October 2020 with the code number 2020/661.

2.2. Survey

A group of different oncologists from our Hospital designed a new patient satisfaction survey. Unfortunately, we could not use a previously validated questionnaire since we could not find an optimal one to answer the primary objectives of our study. Previous works have addressed the satisfaction grade and future perspectives with telemedicine. However, no data existed on patient opinions about what information they should receive during a telemedicine visit. In addition, data on patient abilities with new technology and its influence on telehealth preferences was missing.
The survey contained 12 questions and addressed patient satisfaction with telemedicine, future perspectives, and technological skills. The questionnaire consisted of 7 categorical questions (yes/no/I don’t know), three scale questions, and two multiple-choice questions (Table S1).

2.3. Data Collection

Patient demographics and clinical data collection were extracted from the hospital medical records and recorded in a database created ad hoc, including demographics (age, sex), clinical characteristics (ECOG, cancer diagnosis and stage), treatment characteristics (type of treatment and route of administration), and type of visit (surveillance or treatment).

2.4. Statistical Analysis

All completed surveys were analyzed. Patient characteristics and survey responses were summarized using descriptive analysis. Mean differences between patient groups were tested for statistical significance using chi-square and logistic regression tests. Significance was considered when p < 0.05 (2-sided type I error). Statistical analysis was carried out using the SPSS Package v25.
The analysis of patient satisfaction and the possible differences between study groups was based on Question 2 (Q2: Did the oncologists’ telephone visit comfort you regarding your disease and its control?) and performed using a chi-square test.
To recognize variables associated with the willingness to use telemedicine in the future, we compared dichotomic answers to Question 4 (Q4: In the future, after the COVID-19 public health crisis, would you accept to switch some in-person visits to virtual?) using a logistic regression test.
Regarding the influence of patient technological abilities on their preferences towards telemedicine, we considered that age was the only variable of interest. Comparisons, in this case, were also performed using the chi-square test.

3. Results

Six hundred thirty-eight patients were contacted via telemedicine between 13 March and 30 April 2020. Four hundred eighty-seven (76.3%) responded to the survey: 57% via telephone and 43% during an in-person visit. The remaining 151 patients did not respond due to death/loss to follow-up (n = 102, 16%), refusal to participate (n = 38, 6%), or because of an idiomatic/technological barrier (n = 11, 1.7%) (Figure 1).
The median age was 68 years old (27–90). Of the respondents, 218 patients (44.8%) were men, and 269 (55.2%) were women. Almost all patients (n = 384, 78.9%) were ECOG 0. The most common cancer diagnoses were colorectal (n = 210, 43.1%) and breast (n = 129, 26.5%). Most patients (n = 395, 81%) were diagnosed with an early stage (I–II–III) disease, and only 92 (18.9%) were metastatic (stage IV).
Most patients had a routine surveillance visit (n = 318, 65.3%). The remaining 169 (34.7%) had a follow-up visit during active oncologic treatment, which in most cases was hormonotherapy (n = 82, 16.8%). Other respondent demographics, cancer, and treatment characteristics are described in Table 1.

3.1. Patients’ Satisfaction with the Use of Telemedicine

For Q2 (Did the oncologists’ telephone visit comfort you regarding your disease and its control?), almost all patients responded they felt very (n = 257, 52.8%) or normal (n = 190, 39%) comforted with the telephone call (Figure 2). The subgroup analysis found significant differences between sex (p = 0.003) and cancer type (p = 0.001). Our study found that women and breast cancer patients were less comfortable with the telephone visit than men and other cancer types (Figure 3).
No differences were found for the other variables analyzed (age, ECOG, clinical stage, type of visit, oncological treatment, route of administration, and drug type).

3.2. Patient Preferences towards Telemedicine and Future Perspectives

When asked for future perspectives (Q4: In the future, would you accept to switch some in-person to virtual visits? And Q5: Do you think telemedicine will play a role in the future?), 319 patients (65.5%) expressed they would like to switch some in-person to virtual visits, and 308 (63.2%) considered that telemedicine could be part of their health care delivery following the COVID19 pandemic.
The univariable analyses for factors associated with willingness to use telemedicine in the future (Q4) showed that women (p = 0.02), breast cancer patients (p < 0.001), and patients receiving hormonotherapy (p = 0.03) were less predisposed to using telehealth. However, in the multivariable analyses to control the expected confounding factors, patients aged more than 50 years (OR 0.40; 95% CI, 0.19–0.81; p = 0.01) and diagnosed with breast cancer (OR 0.45; 95% CI, 0.26–0.69; p < 0.001) were the less predisposed to changing to telehealth in comparison to younger patients or other cancer types (Figure 4).
Regarding the information given via telemedicine, we analyzed answers to Q6 (Would you agree to be informed via telemedicine of imaging test results?) Q7 (Would you agree to be notified via telemedicine of laboratory test results?), Q8 (Would you agree to be informed via telemedicine of an intravenous treatment that you have to start receiving?) and Q9 (Would you agree to be informed via telemedicine of an oral treatment that you have to start receiving?).
Most patients would generally accept being informed of radiological tests (n = 302, 62%) or laboratory test results (n = 410, 84%) during a telehealth visit. However, only 163 patients (33.5%) would like to discuss the indication of intravenous treatments via telemedicine, and 253 (52%) would accept it if treatments were oral (Figure 5). These preferences were similar throughout all groups (sex, age, cancer diagnosis, type of appointment, type of treatment, and route of administration), with statistically non-significant differences in the univariate analysis.

3.3. Patients’ Knowledge of New Technologies

Patients were asked about their abilities with new technologies (Q11: What is your knowledge of new technologies?) and the tools they would prefer to use to contact health professionals (Q12: Which tool would you like to use to reach your oncologist?).
For the first question, we observed that the familiarity of the study population with new technologies was poor: 170 patients (34.9%) responded it was medium, and 198 (40.7%) low-null. However, considerable variability throughout the responses was detected according to age groups (p = 0.0001). Younger patients (<50 years) were more accustomed to using technological tools (58.5% responded their level was very high-high). In contrast, older patients (>70 years) had more difficulties (64.3% answered their level was low-null) (Figure 6).
For Q12, we observed that, in general, patients would prefer to have multiple tools (telephone, video call, chat, APP, email) to contact their doctors (n = 237, 48.7%). However, in the subgroup analysis, we found statistically significant differences according to age groups (p = 0.0001). For example, most patients older than 70 years would prefer to use only telephone calls (n = 100, 47.6%), the majority of patients between 50 and 70 years would prefer only telephone calls (n = 62, 27.7%) or video calls (n = 53, 23.7%), and patients younger than 50 years would generally use different tools (n = 39, 73.6%) (Figure 7).

4. Discussion

The COVID-19 pandemic has caused a rapid transition toward telehealth during the last two years. To minimize the risk of infection, telemedicine was implemented for cancer care without previous experience. This fast adoption caused raising concerns about patient satisfaction/preferences and the possible role of tele-oncology in the future.
Numerous recently published works have analyzed patient opinions about the use of telehealth derived from the actual pandemic. In general, telemedicine was well accepted worldwide, reaching satisfaction levels that range from 75 to 92% according to different series [26,27,28,29,30,32,33,34,35,41,42,43]. Our report shows a similar positive telemedicine experience since 91.8% of patients felt comforted by the phone call and could resolve their doubts properly. These results reinforce the strategy adopted in our center during the first pandemic wave when 60% of face-to-face appointments were converted to telehealth visits.
Despite this wide acceptability of telemedicine, a non-negligible percentage of patients (approximately 40%) would not like to switch all in-person visits to teleconsultation and believe telemedicine will not replace existing standards in the future [31]. This information is relevant and suggests telemedicine is not a ‘one size fits all’ option; thus, its implementation requires careful consideration.
There is limited data on the optimal context or patients for which and for whom telemedicine works. In this sense, our work provides relevant and new information by understanding patient preferences and studying the potential inequalities between patient groups with telehealth use.
We report in the present work that willingness to use telemedicine was associated with age or cancer diagnoses: patients with breast cancer and older than age 50 are less predisposed to change.
Regarding breast cancer patients, insufficient evidence existed on telehealth use outcomes before the COVID-19 pandemic. Yan-Ya Chen et al. published a meta-analysis in 2017 showing that telemedicine improved quality of life and reduced psychological distress [44].
With the arrival of COVID-19, considerably more studies addressed breast cancer patients’ telemedicine experience. In general, it was altogether concluded that tele-oncology was effective, safe and that patients were highly satisfied and felt confident with their care [45,46,47,48,49,50,51]. Despite this overall approval, it is important to remark on the matter of the physical examination during a telehealth visit. Lina Cadili et al. [47] exposed in their work that patients with breast cancer felt more anxious due to the impossibility of being examined by the surgeon. The barrier of the physical examination is more limiting for breast cancer care than for other cancer types, given that it is essential to plan the surgery and to detect early recurrences. This limitation could justify that patients with breast cancer were less predisposed to accepting telemedicine as a part of their care delivery.
One of the most critical concerns about the rise of telehealth is equitable access to care, especially for the older adult population. Our results showed that elderly patients were less predisposed to adopting telehealth for cancer care beyond the COVID-19 pandemic. One main reason could be the limited digital access since 64.3% of those older than 70 reported that their familiarity with new technologies was low or null. Moreover, almost half of them would only use the telephone to contact their doctor. Other works have evidenced similar digital health literacy. For example, Lam et al. published a cross-section study in 2020 demonstrating that 38% of older adults were not prepared for video visits and 20% were not prepared for telephone visits, either [52]. Hoogland et al. have also reported that older patients are less likely to own and use smartphones or email addresses [53].
Thus, referring to the selection of optimal patients for telehealth visits and according to our work, patients with breast cancer needing physical examinations and older adults with limited digital access should continue with face-to-face appointments. To increment telehealth use in this scenario, it would be necessary to improve the remote physical exploration with video calls or images and enhance an interdisciplinary team collaboration with family members and caregivers of older adults to guarantee high-quality assistance.
Regarding the type of visit, no differences were found between treatment or surveillance appointments. Both groups were highly satisfied and expressed their willingness to use telemedicine in the future.
The use of telemedicine for surveillance is supported by substantial evidence, especially for managing physical symptoms and psychosocial effects [54]. However, less evidence exists on telehealth use for patients under treatment. Principal limitations are the difficulties in evaluating the performance status, the high acuity of complications, and complex toxicities due to the treatments used.
Concerning the information given via telemedicine visits, most patients expressed their unwillingness to be informed of new intravenous treatments. A non-negligible amount would neither accept to be informed of oral medications nor radiological results.
According to our work, we recommend using telemedicine for short follow-ups during active treatment and some surveillance visits, whereas new treatments and scan results visits require a face-to-face conversation.
Our results need to be interpreted considering the study occurred during the first wave of the COVID-19 pandemic. During that period, telemedicine was rapidly adopted and clinicians and patients did not have adequate knowledge and equipment to obtain the best from telemedicine. This emergency reaction was not planned carefully, so to what extent telemedicine will be a reality following the pandemic is not yet known.
Due to the COVID-19 pandemic and the increasing digitalization of society, telemedicine is likely to keep growing. Prospective data are needed focusing on specific populations and diseases. A key contributor to the applicability of tele-oncology will be digital literacy and appropriate access technology for patients. The principal healthcare system objectives should be the prevention of further inequality and the widening of the digital divide.
This study has some limitations. On the one hand, it is a single-center study, and patients could respond in two different ways: via telephone or during an in-person visit. We also had a small number of patients under treatment (which is not representative of our daily clinical practice), and some tumor types were not represented (gynecological and genitourinary). To conclude, telemedicine was generally accepted during the first wave of the COVID-19 pandemic. However, its use might disadvantage certain patient groups, such as those needing a physical examination, starting new treatments, needing to be informed of scan results, or having poor digital literacy.

5. Conclusions

In general, patients in our center were highly satisfied with the use of telemedicine during the COVID-19 pandemic. However, a non-negligible percentage of patients would prefer to continue with conventional care in the future. We found that older age and breast cancer were factors associated with the unwillingness to adopt telemedicine for cancer care. Furthermore, patients preferred to be informed of scan results or new treatment in person.
Although telemedicine will continue to play an essential role in the future, patient preferences and individual situations must be considered. For this reason, to ensure good healthcare, health systems must be encouraged to invest in teaching professionals and patients about the proper use of telehealth.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/curroncol29110675/s1, Table S1: Patient survey.

Author Contributions

Conceptualization, P.R. and C.P.; methodology, P.R., S.S., C.C., L.V., I.M. and J.G.; formal analysis, P.R.; data curation, P.R.; writing—original draft preparation, P.R. and C.P.; writing—review and editing, L.A.F.-M. and E.G.; supervision, C.P. and M.A.S.P. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by The Research Ethics Committee of Parc Taulí Hospital on 27 October 2020 with the code number 2020/661.

Informed Consent Statement

Not applicable.

Data Availability Statement

Data available on request from the corresponding author. The data are not public ally available due to privacy or ethical restrictions.

Acknowledgments

To all patients.

Conflicts of Interest

The authors declare no conflict of interest.

Abbreviations

DK/NO: Do not know/no opinion.

References

  1. World Health Organization. Available online: https://covid19.who.int/ (accessed on 11 September 2022).
  2. Al-Shamsi, H.O.; Alhazzani, W.; Alhuraiji, A.; Coomes, E.A.; Chemaly, R.F.; Almuhanna, M.; Wolff, R.A.; Ibrahim, N.K.; Chua, M.L.K.; Hotte, S.J.; et al. A Practical Approach to the Management of Cancer Patients During the Novel Coronavirus Disease 2019 (COVID-19) Pandemic: An International Collaborative Group. Oncologist 2020, 25, e936–e945. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  3. Yu, J.; Ouyang, W.; Chua, M.L.K.; Xie, C. SARS-CoV-2 Transmission in Patients With Cancer at a Tertiary Care Hospital in Wuhan, China. JAMA Oncol. 2020, 6, 1108. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  4. Liang, W.; Guan, W.; Chen, R.; Wang, W.; Li, J.; Xu, K.; Li, C.; Ai, Q.; Lu, W.; Liang, H.; et al. Cancer patients in SARS-CoV-2 infection: A nationwide analysis in China. Lancet Oncol. 2020, 21, 335–337. [Google Scholar] [CrossRef]
  5. Desai, A.; Gupta, R.; Advani, S.; Ouellette, L.; Kuderer, N.M.; Lyman, G.H.; Li, A. Mortality in hospitalized patients with cancer and coronavirus disease 2019: A systematic review and meta-analysis of cohort studies. Cancer 2021, 127, 1459–1468. [Google Scholar] [CrossRef]
  6. Curigliano, G.; Banerjee, S.; Cervantes, A.; Garassino, M.C.; Garrido, P.; Girard, N.; Haanen, J.; Jordan, K.; Lordick, F.; Machiels, J.P.; et al. Managing cancer patients during the COVID-19 pandemic: An ESMO multidisciplinary expert consensus. Ann. Oncol. 2020, 31, 1320–1335. [Google Scholar] [CrossRef]
  7. Zon, R.T.; Kennedy, E.B.; Adelson, K.; Blau, S.; Dickson, N.; Gill, D.; Laferriere, N.; Lopez, A.M.; Mulvey, T.M.; Patt, D.; et al. Telehealth in Oncology: ASCO Standards and Practice Recommendations. JCO Oncol. Pract. 2021, 17, 546–564. [Google Scholar] [CrossRef]
  8. World Health Organization. Telemedicine: Opportunities and Developments in Member States: Report on the Second Global Survey on eHealth; World Health Organization: Geneva, Switzerland, 2010. [Google Scholar]
  9. Sirintrapun, S.J.; Lopez, A.M. Telemedicine in Cancer Care. Am. Soc. Clin. Oncol. Educ. Book 2018, 38, 540–545. [Google Scholar] [CrossRef]
  10. Kofoed, S.; Breen, S.; Gough, K.; Aranda, S. Benefits of remote real-time side-effect monitoring systems for patients receiving cancer treatment. Oncol. Rev. 2012, 6, e7. [Google Scholar] [CrossRef] [Green Version]
  11. Cox, A.; Lucas, G.; Marcu, A.; Piano, M.; Grosvenor, W.; Mold, F.; Maguire, R.; Ream, E. Cancer Survivors’ Experience With Telehealth: A Systematic Review and Thematic Synthesis. J. Med. Internet Res. 2017, 19, e11. [Google Scholar] [CrossRef] [Green Version]
  12. Brunello, A.; Galiano, A.; Finotto, S.; Monfardini, S.; Colloca, G.; Balducci, L.; Zagonel, V. Older cancer patients and COVID-19 outbreak: Practical considerations and recommendations. Cancer Med. 2020, 9, 9193–9204. [Google Scholar] [CrossRef]
  13. Jhaveri, D.; Larkins, S.; Kelly, J.; Sabesan, S. Remote chemotherapy supervision model for rural cancer care: Perspectives of health professionals. Eur. J. Cancer Care 2016, 25, 93–98. [Google Scholar] [CrossRef] [PubMed]
  14. Worster, B.; Swartz, K. Telemedicine and Palliative Care: An Increasing Role in Supportive Oncology. Curr. Oncol. Rep. 2017, 19, 37. [Google Scholar] [CrossRef]
  15. Shirke, M.M.; Shaikh, S.A.; Harky, A. Tele-oncology in the COVID-19 Era: The Way Forward? Trends Cancer 2020, 6, 547–549. [Google Scholar] [CrossRef] [PubMed]
  16. Kitamura, C.; Zurawel-Balaura, L.; Wong, R.K. How effective is video consultation in clinical oncology? A systematic review. Curr. Oncol. 2010, 17, 17–27. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  17. Doolittle, G.C.; Spaulding, A.O.; Williams, A.R. The decreasing cost of telemedicine and telehealth. Telemed. J. E Health 2011, 17, 671–675. [Google Scholar] [CrossRef] [PubMed]
  18. Hassan, A.M.; Chu, C.K.; Liu, J.; Angove, R.; Rocque, G.; Gallagher, K.D.; Momoh, A.O.; Caston, N.E.; Williams, C.P.; Wheeler, S.; et al. Determinants of telemedicine adoption among financially distressed patients with cancer during the COVID-19 pandemic: Insights from a nationwide study. Support Care Cancer 2022, 30, 7665–7678. [Google Scholar] [CrossRef]
  19. Orlando, J.F.; Beard, M.; Kumar, S. Systematic review of patient and caregivers’ satisfaction with telehealth videoconferencing as a mode of service delivery in managing patients’ health. PLoS ONE 2019, 14, e0221848. [Google Scholar] [CrossRef] [Green Version]
  20. Marzorati, C.; Renzi, C.; Russell-Edu, S.W.; Pravettoni, G. Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review. J. Med. Internet Res. 2018, 20, e223. [Google Scholar] [CrossRef]
  21. Martinez, K.A.; Rood, M.; Jhangiani, N.; Kou, L.; Rose, S.; Boissy, A.; Rothberg, M.B. Patterns of Use and Correlates of Patient Satisfaction with a Large Nationwide Direct to Consumer Telemedicine Service. J. Gen. Intern. Med. 2018, 33, 1768–1773. [Google Scholar] [CrossRef] [Green Version]
  22. Koonin, L.M.; Hoots, B.; Tsang, C.A.; Leroy, Z.; Farris, K.; Jolly, B.; Antall, P.; McCabe, B.; Zelis, C.B.R.; Tong, I.; et al. Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic—United States, January–March 2020. MMWR. Morb. Mortal. Wkly. Rep. 2020, 69, 1595–1599. [Google Scholar] [CrossRef]
  23. Onesti, C.E.; Rugo, H.S.; Generali, D.; Peeters, M.; Zaman, K.; Wildiers, H.; Harbeck, N.; Martin, M.; Cristofanilli, M.; Cortes, J.; et al. Oncological care organisation during COVID-19 outbreak. ESMO Open 2020, 5, e000853. [Google Scholar] [CrossRef] [PubMed]
  24. Liu, R.; Sundaresan, T.; Reed, M.E.; Trosman, J.R.; Weldon, C.B.; Kolevska, T. Telehealth in Oncology During the COVID-19 Outbreak: Bringing the House Call Back Virtually. JCO Oncol. Pract. 2020, 16, 289–293. [Google Scholar] [CrossRef] [PubMed]
  25. Sabesan, S. Clinical Practice Guidelines for Teleoncology: Clinical Oncological Society of Australia. Available online: https://wiki.cancer.org.au/australia/COSA:Teleoncology (accessed on 6 September 2022).
  26. Fraser, A.; McNeill, R.; Robinson, J. Cancer care in a time of COVID: Lung cancer patient’s experience of telehealth and connectedness. Support Care Cancer 2022, 30, 1823–1830. [Google Scholar] [CrossRef] [PubMed]
  27. McCabe, H.M.; Smrke, A.; Cowie, F.; White, J.; Chong, P.; Lo, S.; Mahendra, A.; Gupta, S.; Ferguson, M.; Boddie, D.; et al. What Matters to Us: Impact of Telemedicine During the Pandemic in the Care of Patients With Sarcoma Across Scotland. JCO Glob. Oncol. 2021, 7, 1067–1073. [Google Scholar] [CrossRef]
  28. Wehrle, C.J.; Lee, S.W.; Devarakonda, A.K.; Arora, T.K. Patient and Physician Attitudes Toward Telemedicine in Cancer Clinics Following the COVID-19 Pandemic. JCO Clin. Cancer Inform. 2021, 5, 394–400. [Google Scholar] [CrossRef]
  29. Johnson, B.A.; Lindgren, B.R.; Blaes, A.H.; Parsons, H.M.; Larocca, C.J.; Farah, R.; Hui, J.Y.C. The New Normal? Patient Satisfaction and Usability of Telemedicine in Breast Cancer Care. Ann. Surg. Oncol. 2021, 28, 5668–5676. [Google Scholar] [CrossRef]
  30. Smrke, A.; Younger, E.; Wilson, R.; Husson, O.; Farag, S.; Merry, E.; Macklin-Doherty, A.; Cojocaru, E.; Arthur, A.; Benson, C.; et al. Telemedicine During the COVID-19 Pandemic: Impact on Care for Rare Cancers. JCO Glob. Oncol. 2020, 6, 1046–1051. [Google Scholar] [CrossRef]
  31. Zimmerman, B.S.; Seidman, D.; Berger, N.; Cascetta, K.P.; Nezolosky, M.; Trlica, K.; Ryncarz, A.; Keeton, C.; Moshier, E.; Tiersten, A. Patient Perception of Telehealth Services for Breast and Gynecologic Oncology Care during the COVID-19 Pandemic: A Single Center Survey-based Study. J. Breast Cancer 2020, 23, 542. [Google Scholar] [CrossRef]
  32. Grant, M.; Hockings, H.; Lapuente, M.; Adeniran, P.; Saud, R.A.; Sivajothi, A.; Amin, J.; Crusz, S.M.; Rashid, S.; Szabados, B.; et al. Learning from Crisis: A Multicentre Study of Oncology Telemedicine Clinics Introduced During COVID-19. J. Cancer Educ. 2021. [Google Scholar] [CrossRef]
  33. Loree, J.M.; Dau, H.; Rebić, N.; Howren, A.; Gastonguay, L.; McTaggart-Cowan, H.; Gill, S.; Raghav, K.; De Vera, M.A. Virtual Oncology Appointments during the Initial Wave of the COVID-19 Pandemic: An International Survey of Patient Perspectives. Curr. Oncol. 2021, 28, 671–677. [Google Scholar] [CrossRef]
  34. De Joode, K.; Dumoulin, D.W.; Engelen, V.; Bloemendal, H.J.; Verheij, M.; Van Laarhoven, H.W.M.; Dingemans, I.H.; Dingemans, A.C.; Van Der Veldt, A.A.M. Impact of the coronavirus disease 2019 pandemic on cancer treatment: The patients’ perspective. Eur. J. Cancer 2020, 136, 132–139. [Google Scholar] [CrossRef] [PubMed]
  35. Gondal, H.; Abbas, T.; Choquette, H.; Le, D.; Chalchal, H.I.; Iqbal, N.; Ahmed, S. Patient and Physician Satisfaction with Telemedicine in Cancer Care in Saskatchewan: A Cross-Sectional Study. Curr. Oncol. 2022, 29, 3870–3880. [Google Scholar] [CrossRef] [PubMed]
  36. Paige, S.R.; Campbell-Salome, G.; Alpert, J.; Markham, M.J.; Murphy, M.; Heffron, E.; Harle, C.; Yue, S.; Xue, W.; Bylund, C.L. Cancer patients’ satisfaction with telehealth during the COVID-19 pandemic. PLoS ONE 2022, 17, e0268913. [Google Scholar] [CrossRef] [PubMed]
  37. Kraus, E.J.; Nicosia, B.; Shalowitz, D.I. A qualitative study of patients’ attitudes towards telemedicine for gynecologic cancer care. Gynecol. Oncol. 2022, 165, 155–159. [Google Scholar] [CrossRef]
  38. Hasson, S.P.; Waissengrin, B.; Shachar, E.; Hodruj, M.; Fayngor, R.; Brezis, M.; Nikolaevski-Berlin, A.; Pelles, S.; Safra, T.; Geva, R.; et al. Rapid Implementation of Telemedicine During the COVID-19 Pandemic: Perspectives and Preferences of Patients with Cancer. Oncologist 2021, 26, e679–e685. [Google Scholar] [CrossRef]
  39. Cascella, M.; Coluccia, S.; Grizzuti, M.; Romano, M.C.; Esposito, G.; Crispo, A.; Cuomo, A. Satisfaction with Telemedicine for Cancer Pain Management: A Model of Care and Cross-Sectional Patient Satisfaction Study. Curr. Oncol. 2022, 29, 5566–5578. [Google Scholar] [CrossRef]
  40. Marotta, N.; Demeco, A.; Moggio, L.; Ammendolia, A. Why is telerehabilitation necessary? A pre-post COVID-19 comparative study of ICF activity and participation. J. Enabling Technol. 2021, 15, 117–121. [Google Scholar] [CrossRef]
  41. Di Lalla, V.; Patrick, H.; Siriani-Ayoub, N.; Kildea, J.; Hijal, T.; Alfieri, J. Satisfaction among Cancer Patients Undergoing Radiotherapy during the COVID-19 Pandemic: An Institutional Experience. Curr. Oncol. 2021, 28, 1507–1517. [Google Scholar] [CrossRef]
  42. Granberg, R.E.; Heyer, A.; Rising, K.L.; Handley, N.R.; Gentsch, A.T.; Binder, A.F. Medical Oncology Patient Perceptions of Telehealth Video Visits. JCO Oncol. Pract. 2021, 17, e1333–e1343. [Google Scholar] [CrossRef]
  43. Shaverdian, N.; Gillespie, E.F.; Cha, E.; Kim, S.Y.; Benvengo, S.; Chino, F.; Kang, J.J.; Li, Y.; Atkinson, T.M.; Lee, N.; et al. Impact of Telemedicine on Patient Satisfaction and Perceptions of Care Quality in Radiation Oncology. J. Natl. Compr. Cancer Netw. 2021, 19, 1174–1180. [Google Scholar] [CrossRef]
  44. Chen, Y.Y.; Guan, B.S.; Li, Z.K.; Li, X.Y. Effect of telehealth intervention on breast cancer patients’ quality of life and psychological outcomes: A meta-analysis. J. Telemed. Telecare 2018, 24, 157–167. [Google Scholar] [CrossRef] [PubMed]
  45. Khodaveisi, T.; Sadoughi, F.; Novin, K.; Hosseiniravandi, M.; Dehnad, A. Development and evaluation of a teleoncology system for breast cancer during the COVID-19 pandemic. Future Oncol. 2022, 18, 1437–1448. [Google Scholar] [CrossRef] [PubMed]
  46. Bizot, A.; Karimi, M.; Rassy, E.; Heudel, P.E.; Levy, C.; Vanlemmens, L.; Uzan, C.; Deluche, E.; Genet, D.; Saghatchian, M.; et al. Multicenter evaluation of breast cancer patients’ satisfaction and experience with oncology telemedicine visits during the COVID-19 pandemic. Br. J. Cancer 2021, 125, 1486–1493. [Google Scholar] [CrossRef] [PubMed]
  47. Cadili, L.; DeGirolamo, K.; Ma, C.S.; Chen, L.; McKevitt, E.; Pao, J.S.; Dingee, C.; Bazzarelli, A.; Warburton, R. The Breast Cancer Patient Experience of Telemedicine During COVID-19. Ann. Surg. Oncol. 2022, 29, 2244–2252. [Google Scholar] [CrossRef] [PubMed]
  48. Miziara, R.A.; Maesaka, J.Y.; Matsumoto, D.R.M.; Penteado, L.; Anacleto, A.; Accorsi, T.A.D.; Lima, K.A.; Cordioli, E.; GS, D.A. Teleoncology Orientation of Low-Income Breast Cancer Patients during the COVID-19 Pandemic: Feasibility and Patient Satisfaction. Rev. Bras. Ginecol. Obstet. 2021, 43, 840–846. [Google Scholar] [CrossRef]
  49. Stavrou, E.; Qiu, J.; Zafar, A.; Tramontano, A.C.; Isakoff, S.; Winer, E.; Schrag, D.; Manz, C. Breast Medical Oncologists’ Perspectives of Telemedicine for Breast Cancer Care: A Survey Study. JCO Oncol. Pract. 2022, 18, e1447–e1453. [Google Scholar] [CrossRef]
  50. McGrowder, D.A.; Miller, F.G.; Vaz, K.; Anderson Cross, M.; Anderson-Jackson, L.; Bryan, S.; Latore, L.; Thompson, R.; Lowe, D.; McFarlane, S.R.; et al. The Utilization and Benefits of Telehealth Services by Health Care Professionals Managing Breast Cancer Patients during the COVID-19 Pandemic. Healthcare 2021, 9, 1401. [Google Scholar] [CrossRef]
  51. Yildiz, F.; Oksuzoglu, B. Teleoncology or telemedicine for oncology patients during the COVID-19 pandemic: The new normal for breast cancer survivors? Future Oncol. 2020, 16, 2191–2195. [Google Scholar] [CrossRef]
  52. Lam, K.; Lu, A.D.; Shi, Y.; Covinsky, K.E. Assessing Telemedicine Unreadiness Among Older Adults in the United States During the COVID-19 Pandemic. JAMA Intern. Med. 2020, 180, 1389. [Google Scholar] [CrossRef]
  53. Hoogland, A.I.; Mansfield, J.; Lafranchise, E.A.; Bulls, H.W.; Johnstone, P.A.; Jim, H.S.L. eHealth literacy in older adults with cancer. J. Geriatr. Oncol. 2020, 11, 1020–1022. [Google Scholar] [CrossRef]
  54. Chan, R.J.; Crichton, M.; Crawford-Williams, F.; Agbejule, O.A.; Yu, K.; Hart, N.H.; De Abreu Alves, F.; Ashbury, F.D.; Eng, L.; Fitch, M.; et al. The efficacy, challenges, and facilitators of telemedicine in post-treatment cancer survivorship care: An overview of systematic reviews. Ann. Oncol. 2021, 32, 1552–1570. [Google Scholar] [CrossRef] [PubMed]
Curroncol 29 00675 g001 550
Figure 1. Patients’ flowchart. In total, 638 patients were visited via telemedicine, and 487 answered the survey.
Figure 1. Patients’ flowchart. In total, 638 patients were visited via telemedicine, and 487 answered the survey.
Curroncol 29 00675 g001
Curroncol 29 00675 g002 550
Figure 2. All patients answer to the second question (Q2). Did the oncologists’ telephone visit comfort you regarding your disease and its control?
Figure 2. All patients answer to the second question (Q2). Did the oncologists’ telephone visit comfort you regarding your disease and its control?
Curroncol 29 00675 g002
Curroncol 29 00675 g003a 550Curroncol 29 00675 g003b 550
Figure 3. Second question (Q2) regarding sex group (A) and cancer diagnosis (B). Q4: Did the oncologists’ telephone visit comfort you regarding your disease and its control?
Figure 3. Second question (Q2) regarding sex group (A) and cancer diagnosis (B). Q4: Did the oncologists’ telephone visit comfort you regarding your disease and its control?
Curroncol 29 00675 g003aCurroncol 29 00675 g003b
Curroncol 29 00675 g004 550
Figure 4. Multivariate logistic regression to assess predictors of telemedicine use willingness in the future. Q4: In the future, would you accept switching some in-person to virtual visits?
Figure 4. Multivariate logistic regression to assess predictors of telemedicine use willingness in the future. Q4: In the future, would you accept switching some in-person to virtual visits?
Curroncol 29 00675 g004
Curroncol 29 00675 g005 550
Figure 5. Preferences for the type of information given during a telemedicine visit. All patients. Q6–Q9. Would you agree to be informed via telemedicine of…?
Figure 5. Preferences for the type of information given during a telemedicine visit. All patients. Q6–Q9. Would you agree to be informed via telemedicine of…?
Curroncol 29 00675 g005
Curroncol 29 00675 g006 550
Figure 6. Knowledge of technology. Q11: What is your knowledge of new technologies?
Figure 6. Knowledge of technology. Q11: What is your knowledge of new technologies?
Curroncol 29 00675 g006
Curroncol 29 00675 g007 550
Figure 7. Preference for telemedicine tool. Q12: Which tool would you like to use to contact your oncologist?
Figure 7. Preference for telemedicine tool. Q12: Which tool would you like to use to contact your oncologist?
Curroncol 29 00675 g007
Table
Table 1. Participant demographics, cancer diagnosis, treatment characteristics, and type of visit.
Table 1. Participant demographics, cancer diagnosis, treatment characteristics, and type of visit.
Respondents n = 487 (%)
Age groups
≤50 years53 (10.9)
51–69 years224 (46)
≥70 years 210 (43.1)
Gender
Male218 (44.8)
Female269 (55.2)
ECOG
0384 (78.9)
199 (20.3)
≥24 (0.8)
Cancer diagnosis
Colorectal210 (43.1)
GI non-colorectal41 (8.4)
Thoracic29 (6)
Breast129 (26.5)
Others (GIST, melanoma, TNE)78 (16)
Clinical stage
I99 (20.3)
II124 (25.5)
III172 (35.3)
IV92 (18.9)
Type of visit
Surveillance320 (65.7)
Treatment167 (34.3)
Oncological treatment
No treatment320 (65.7)
Adjuvant 103 (21.1)
Neoadjuvant 13 (2.7)
Palliative 51 (10.5)
Route of administration
No treatment320 (65.7)
Intravenous61 (12.5)
Oral96 (19.8)
Others (subcutaneous, intramuscular)10 (2.1)
Drug type
No treatment320 (65.7)
Targeted therapy25 (5.1)
Hormonotherapy80 (16.4)
Immunotherapy24 (4.9)
Chemotherapy38 (7.8)
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Share and Cite

MDPI and ACS Style

Ribera, P.; Soriano, S.; Climent, C.; Vilà, L.; Macias, I.; Fernández-Morales, L.A.; Giner, J.; Gallardo, E.; Palmer, M.A.S.; Pericay, C. Teleoncology: A Solution for Everyone? A Single-Center Experience with Telemedicine during the Coronavirus Disease 2019 (COVID-19) Pandemic. Curr. Oncol. 2022, 29, 8565-8578. https://doi.org/10.3390/curroncol29110675

AMA Style

Ribera P, Soriano S, Climent C, Vilà L, Macias I, Fernández-Morales LA, Giner J, Gallardo E, Palmer MAS, Pericay C. Teleoncology: A Solution for Everyone? A Single-Center Experience with Telemedicine during the Coronavirus Disease 2019 (COVID-19) Pandemic. Current Oncology. 2022; 29(11):8565-8578. https://doi.org/10.3390/curroncol29110675

Chicago/Turabian Style

Ribera, Paula, Sandra Soriano, Carla Climent, Laia Vilà, Ismael Macias, Luis Antonio Fernández-Morales, Julia Giner, Enrique Gallardo, Miquel Angel Segui Palmer, and Carles Pericay. 2022. "Teleoncology: A Solution for Everyone? A Single-Center Experience with Telemedicine during the Coronavirus Disease 2019 (COVID-19) Pandemic" Current Oncology 29, no. 11: 8565-8578. https://doi.org/10.3390/curroncol29110675

Article Metrics

Back to TopTop