Telemedicine in Cancer Care: Rewards and Risks

From the Editor's Desk
March 20, 2019
Lidia Schapira, MD, FASCO

Telemedicine, or telehealth, uses a variety of communication technologies to support clinical care. First introduced 50 years ago, it has evolved as new technologies have been discovered and refined. Telehealth can save lives by assisting in the diagnosis of conditions, such as strokes, that require an immediate evaluation of how quickly a person needs to be treated (what we call “triage”). Using telemedicine, an expert neurologist can guide a paramedic on site while responding to an emergency call about a stroke. And for an example in cancer care, a patient receiving a new cancer treatment can send a photo of a bothersome rash that just appeared and ask the advice of their oncologist. Telemedicine can also bring specialized services to people living in remote areas who would otherwise have to travel far to get medical advice. These concepts have been successfully implemented for consultations about results of genetic tests and other services that don’t require physical exams or contact.

When people think of telemedicine, they envision screens traveling on robots along hospital corridors, and telemedicine can involve this type of technology. But it also refers to other ways of using technology to facilitate the exchange of information and to keep clinicians, patients, and family caregivers connected.share on twitter Electronic patient portals are now emerging as important tools for transmitting health messages, information, test results, and education. The portals are also often available with smartphone applications, or apps. They allow patients to be more in control of their time and limit the calls and visits to medical centers. A patient can send a message to their nurse or doctor addressing all kinds of different issues, such as asking for a prescription refill, showing the health care team results of home glucose monitoring, or asking for advice about an exposure to a grandchild with a fever. Portals are not intended to be used for life-threatening emergencies, but they are great for questions or concerns that are best directed to a clinician who is familiar with the individual’s diagnosis and treatment plan.

Home-based programs include texting and messaging and are ideally suited to help cancer survivors who are need advice or coaching. As a medical oncologist who treats women with breast cancer, I see telemedicine as a very useful mechanism for answering questions about side effects of maintenance hormonal therapies or for advice on use of bone-strengthening medications. In some situations, video conferencing can replace an in-person visit and save a patient the stress, time, and cost required to attend an appointment.

Wearable technologies, like smartwatches, are being introduced to monitor vital signs. For example, for someone having chemotherapy and radiation therapy for throat cancer, the data from wearable technology can help them decide if they need intravenous hydration. For survivors working to regain control over their bodies, these devices and their related data may help them track calories, steps, and time spent sleeping. Smartphone apps have been developed to support lifestyle changes, wellness activities and programs, and also to help people take their medications. Emerging scientific research is providing new knowledge that will eventually allow us to integrate even more technologies into medical care. At the 2018 Palliative and Supportive Care in Oncology Symposium, for instance, we learned about an app that is being tested to improve pain management in people with cancer.

Telemedicine can also enable and support communication between different teams or specialists involved in a patient’s care. As clinicians and patients get comfortable with telemedicine, it is essential to remember that telemedicine is not well-suited for discussing sensitive information. Any discussion of a prognosis, which is the chance of recovery, or treatment plans needs the physical presence and closeness of the clinician. Telemedicine is not a substitute for in-person care, and, if used improperly, it may give patients and their loved ones the impression that their clinicians are insensitive and uncaring.

As we reflect on these opportunities and practices that are quickly changing our ideas of “team care,” it is worth noting that telemedicine offers opportunities to involve and support family caregivers. New practices that are currently being studied include giving caregivers access to a patient’s information (with the patient’s consent) and involving them in the communications with members of the health care team. Caregivers may have questions and concerns, and telemedicine seems an ideal way for these to be expressed and acknowledged with the patient’s clinicians. Information can help relieve fear and stress and also improve the way caregivers can care for their loved one without causing unnecessary and unwanted stress.