Telemedicine and Quality of Life in Patients With Lung Cancer

Telemedicine has become more crucial than ever in the continuing wake of the COVID-19 pandemic. Research from the US Centers for Disease Control and Prevention (CDC) showed that there was a 50% increase utilization of telehealth services in the first quarter of 2020 compared with 2019, and a 154% increase in week 13 of 2020 from 2019.¹ It has become a necessity for the provision of health care during this uncertain time.

However, telemedicine has existed for far longer than the pandemic. We know that it can be useful when in-person visitation ability is limited, but how beneficial can it be overall, and how beneficial for treatment of something like lung cancer? Patients with lung cancer can experience higher symptom burden than patients with other forms of cancer, which leads to higher risk of anxiety and depression. What can telemedicine do in terms of quality of life?

A recent study from Therapeutic Advances in Chronic Disease examined 8 clinical trials with a total of 635 patients with lung cancer with the intent of investigating the effectiveness of telemedicine for maintaining or improving quality of life in these patients.² These studies, conducted from 2014 to 2019 in several different countries, used the World Health Organization Quality of Life (WHOQOL) and the Functional Living Index-Cancer (FLIC), among other scales, to measure quality of life in patients who received care via telemedicine and patients who received usual care. Telemedicine options included telephone-based and website-based communication, and follow-up duration for these patients ranged from 3 weeks to 8 months.

The researchers found higher scores for quality of life in patients who received medicine via telemedicine compared with usual care. Due to high heterogeneity, the researchers created subgroups based on follow-up time; the subgroup with longer follow-up times (3 months or longer) showed much higher quality of life in the telemedicine group than usual care. The difference was seen as insignificant in the shorter follow-up subgroup, though the telemedicine group did have higher scores.

When broken into subgroups based on the type of telemedicine used, the researchers found that patients engaging in telephone-based communication reported higher quality of life than those in the usual-care group; patients engaging in website-based communication showed a slightly higher quality of life than the usual-care group that was not deemed significant.

In addition, levels of anxiety were studied among 347 patients across 4 studies. The telemedicine groups had lower levels of anxiety compared with the usual-care groups, and testing showed low heterogeneity. Depression levels were also lower when examined in 287 patients across 3 studies; however, testing did show high heterogeneity.

While the number of patients included and the varying levels of heterogeneity put limitations on what to take away from the study, telemedicine can provide specific and unique benefits to patients with lung cancer. Providing care in this manner helps remedy the inconvenience of distance between patients and physicians. It has the potential to relieve high levels of anxiety in patients, which is crucial as they experience severe symptoms and undergo extensive treatment.

References

1. Koonin LM, Hoots B, Tsang CA, 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(43):1595-1599. doi:10.15585/mmwr.mm6943a3
2. Pang L, Liu Z, Lin S, et al. The effects of telemedicine on the quality of life of patients with lung cancer: a systematic review and meta-analysis. Ther Adv Chronic Dis. 2020;11:204062232096159. doi:10.1177/2040622320961597