Many Patients With Cancer Consider Telemedicine Appointments Just as Effective as In-Office Visits

Many patients attending radiation oncology appointments via telemedicine during the COVID-19 pandemic were satisfied with the care they received and even preferred it over in-person office appointments, according to study results.

“Overall, I think the big takeaway is that both patients (and physicians from other studies) have found the experience of telemedicine better than expected,” Dr. Erin F. Gillespie, co-first author on this study and assistant attending in radiation oncology at Memorial Sloan Kettering Cancer Center in New York, said in an interview with CURE®.

Dr. Gillespie said that the COVID-19 pandemic offered an opportunity for patients to attend oncology appointments in their own space via telemedicine without coming into a clinic — something that was not an option before.

The study, which was published in the Journal of the National Comprehensive Cancer Network, evaluated the satisfaction of 1,077 patients with cancer who attended office visits (726 patients) or via telemedicine (351 patients; median age, 65 years).

Overall patient satisfaction was not significantly different when telemedicine was compared with in-person office visits. Most respondents selected the top score when rating their experience with an actual appointment versus expectations (82% in telemedicine and 84% in-office visits), quality of physician explanations (91% and 84%, respectively) and level of concern (92% and 95%) and friendliness (93% and 94%) shown by their physician.

One important finding from the study, however, exposes the potential for telemedicine to worsen disparities – patients with cancer who were able to see the physician through a video chat had a better understanding of the treatment plan. Our colleagues that practice in more rural areas have mentioned that phone (without video) is still the primary mode of telemedicine in their communities.

“It’s important to be aware that we could reduce the ability for patients to really optimally understand what’s happening with their cancer care,” Dr. Gillespie said. “It’s a difficult situation, obviously, because you want to be able to offer phone calls alone for people that wouldn’t have to come in at all, but you don’t necessarily want calls replacing in-person visits if there’s really critical information to be shared.”

Among patients who attended telemedicine appointments, 45% preferred it, 35% preferred in-office visits and 21% had no preference for the type of visit. Dr. Gillespie said “the fact that only 1 in 3 patients preferred to be seen in-person is remarkable.”

When further evaluating aspects of visits that seemed more influential, 66% of patients preferred telemedicine for treatment-related costs. Dr. Gillespie said that physically going to a doctor’s appointment can cost money for travel and opportunity cost of work and one’s other obligations, which may be an additional struggle for some patients.

She added that those who preferred telemedicine visits benefited from the flexibility to have an additional person participating in the appointment with them. Many patients with cancer were not permitted to bring a caregiver, family member or friend to their in-office doctors visit during the pandemic. However, this is vital for many patients to help them remember or understand treatment options, and other topics discussed in the appointment.

“This serves as a positive aspect of the remote visit that can be more challenging in person, to have someone else also take time off to accompany the patient in their visit,” she said. “In rehabilitation medicine, this increased engagement of one’s social network through telemedicine has, in preliminary studies, been correlated with better outcomes.”

Notably, those who were married or had a partner were more likely to prefer an in-person office appointment. Dr. Gillespie speculated this association could be related to fewer obstacles related to costs of travel, time off work, and/or child care for single parents, for example.

“On the other hand, patients with a lower performance status (who are generally more frail or less active) more often preferred telemedicine appointments, perhaps due to greater difficulty physically getting to a doctor’s appointment,” Dr. Gillespie added.

Most patients attending telemedicine appointments found their confidence in their physician (90%), understanding of the treatment plan (88%) and confidence in their treatment (87%) to be better or no different than with an office visit. Additionally, 60% of those patients found no difference between in-office visits and telemedicine in regard to a personal connection, whereas 30% believed an in-person visit was better for a personal connection. And most patients believed there was no difference when sharing personal information over telemedicine versus in person.

Due to the ongoing pandemic, 34% of patients felt their cancer care will be negatively impacted, and 8% felt that their cancer won’t be treated successfully. And among those who preferred telemedicine, 7% reported concern that their treatment success would be negatively impacted by the pandemic versus 5% of those who preferred in-office visits.

“Ultimately understanding the patient experience with telemedicine is important for providing patient-centered cancer care. It appears that continued access to telemedicine is important to some patients. It’s not for everybody, but it certainly should be an option and may have some financial and access-related benefit for select patients,” Gillespie concluded.

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