Amid the devastating human and economic toll of the COVID-19 health crisis, it is often difficult to find bright spots. For the healthcare system, one of the few positive developments resulting from the pandemic has been the rapid adoption of telehealth solutions, said Brian Leyland-Jones, MB, BS, PhD, Chief Medical Officer of the National Foundation for Cancer Research, who discussed this topic during the Association for Value-Based Cancer Care (AVBCC) August 18 webcast.
“The growth of telemedicine has been exponential,” he said, pointing to data from the communications and research firm Mercom Capital Group, which showed that investments in telehealth rose from $220 million in the first quarter of 2019 to $788 million in the first quarter of 2020. “Teladoc saw a 100,000-visit increase in just 1 week, and after its recent merger with Livongo, is now valued at $37 billion. And a recent Becker’s Hospital Review survey found that 67% of patients reported that their telehealth visits were as good as or better than a face-to-face visit.”
How can clinicians, administrators, and the healthcare system as a whole leverage the broad adoption of telehealth to improve care, particularly cancer care? This was the question that moderator Rick Lee, Founder of Quality Oncology, Value Health, Healthrageous, and MeYou Health, put to the panel of experts during the webcast.
Debra Patt, MD, PhD, MBA, Executive Vice President for Policy and Strategic Initiatives at Texas Oncology, noted the looming threat posed by patients avoiding screenings and routine care during the pandemic. A June 2020 study published in JAMA Oncology found that new diagnosis of several types of cancers, including breast, colorectal, lung, pancreatic, and gastric, had dropped precipitously. For example, there were more than 2200 new diagnoses of breast cancer per week at baseline; however, by mid-April, that number had been reduced by more than half—to approximately 1000 new diagnoses per week.
Follow-up visits have also declined. “Virtually all the breast cancer patients I see have delayed screening that I’ve already ordered during the pandemic,” Dr Patt said. “I’ve used my telemedicine visits with them to stress the fact that they really need these screening mammograms. We have to be aggressively informing patients that they will live longer if they are monitored.”
Telehealth can provide disruptive solutions that facilitate the co-management of cancers and other chronic conditions such as diabetes, said Chevon Rariy, MD, National Director for Telehealth with Cancer Treatment Centers of America. “Cancer or cancer treatment can exacerbate preexisting or newly diagnosed diabetes, whether it be via steroid use or specific chemotherapy agents, like P13k, AKT and mTOR inhibitors, or resection of pancreatic cancers and neuroendocrine tumors. This presents unique challenges to therapy, but the advent of telehealth has allowed us to reach these individuals more effectively, whereas in the pre-COVID state, our focus was mostly on management of urgent care issues or avoidance of the emergency department,” she said.
For example, telehealth tools such as food logging, dietary counseling and demonstration, exercise and weight tracking, medication and prescription refill reminders, remote monitoring and communication with the care team, and remote tracking of blood glucose with predictive modeling, allow for better and more consistent engagement of patients with diabetes. “With the advent of these telehealth and digital monitoring tools, you can directly affect patient behavior. And since it has been proposed that the cost of diabetes to the US healthcare system could be as high as $320 per year, if we are able to use telehealth to empower patients to take control of their health and improve their diabetes management, we can improve not only their health but the burden on the healthcare system,” Dr Rariy noted.
Bob Gold, Chief Behavioral Technologist and CEO for GoMo Health, a digital patient solutions provider, pointed to successful implementation of these solutions. “At one cancer center alone, we have had early detection leading to over 150 escalations to nurse navigation, resulting in the avoidance of an emergency department or readmit, just over the last 4 or 5 months. Half of those were caused by or exacerbated by behavioral state: anxiety and fatigue and hopelessness being at the top of the list,” he said.
Mr Gold said noted that GoMo is collecting more than 100 individual data points on patients’ physical, emotional, and practical issues—many of those weekly—on a longitudinal basis across the cancer journey. “We are able to see cause and effect at a much deeper level,” he said. “When people feel like they’ve lost control, as everyone does when they’re diagnosed with cancer, and you can use these digital tools and consistent messaging to ask for their feedback and adjust their care, that alleviates their anxiety and stress and gives them back a sense of control.”