Teleoncology With No Physical Examination Has Little Impact on Care Management

The use of teleoncology care without the need for physical examination (PE) at every visit was supported by the results of a recent study conducted in Brazil. Study findings were reported in the journal JCO Clinical Cancer Informatics.

Teleoncology consultations have increased in popularity in recent years. A major distinction between in-person and virtual oncology care visits is whether or not PE is performed, the study investigators noted in their report. They sought to prospectively evaluate both the changes in PE that may influence clinical management and any clinical variables that may predict changes in PE that may impact clinical management.

The study was based at 2 hospitals in the Brazilian Public Health System and conducted from August to December of 2021. Included patients had been treated at clinical oncology outpatient clinics associated with these hospitals. The investigators analyzed possible connections between clinical variables, PE findings, and management plans developed at the end of a medical visit.

The analysis included 368 patients, reflecting 368 consultations. The mean age of the patients was 61 years (SD, 13.6). Among consultations, 33% involved follow-up, 34% involved curative treatment, 32% involved palliative care, and 1% involved supportive care.

Symptoms were present in 41% of patients who attended face-to-face appointments. Normal PE findings were reported in 76% of these patients, and abnormalities were reported during 11% of appointments. However, these abnormalities had also been observed in earlier visits. PE findings that had not been observed before occurred in 13% (49 patients) of visits.

The previously unobserved PE findings in these 49 patients did not appear to affect cancer management in the majority of cases (59%). In patients for whom treatment was altered based on these new PE findings, most involved further testing or referrals to subsequently guide management (15 patients), while fewer involved direct changes to treatment (5 patients). Ultimately, for the population of 368 patients overall, 3% of visits were associated with changes in oncologic management based on abnormal PE findings.

A multivariate analysis revealed significant predictors of PE changes that appeared associated with impacts on clinical management. These included the presence of symptoms (P <.01) and the reason for the consultation (P =.02).

“In conclusion, we believe that the absence of PE does not seem to affect the majority of oncological management, especially among patients in follow-up and without symptoms,” the study investigators wrote in their report. However, they noted that they did not consider teleoncology to be sufficient for patients who are symptomatic.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Nazareth Aguiar Jr P, Stival M, Magalhães Filho MAF, del Giglio A. Physical examination in medical oncology guiding the development of a protocol for teleoncology care in a public health care oncology service. JCO Clin Cancer Inform. 2023;7:e2200152. doi:10.1200/CCI.22.00152