Telehealth Ushering in a New Era in Cancer Care

Telehealth is now improving patient access and extending the geographic reach and expertise of clinicians and health care facilities to new heights. Telehealth includes a host of services and, thanks to these new technologies, oncology nurses are providing much more than telephone follow-up. “Telehealth solutions include digital health, artificial intelligence (AI), virtual care, remote monitoring, and digital therapeutics, as well as ‘store-and-forward’ or asynchronous technologies that securely transmit data collected from wearables, sensors, and other devices,” said Lana Adzhigirey, RN, of CHI Franciscan Health in Tacoma, Washington, and chair of the American Telemedicine Association (ATA) Nursing Special Interest Group (SIG).

Ms Adzhigirey said telehealth is helping inform clinicians’ decisions throughout diagnosis and treatment and providing millions of patients in both rural and urban areas access to safe, effective, and appropriate care when and where they need it. “In the case of tele-oncology, it can extend the benefits of multidisciplinary care to regional and rural patients and provide critical care and services to cancer patients including remote chemotherapy supervision, symptom management, survivorship care, and palliative care,” Ms Adzhigirey explained in an interview with Oncology Nurse Advisor.

A recent study examined the benefits of a 6-month, multicomponent rehabilitation program for patients with advanced cancer delivered through telehealth. In this study, collaborative telerehabilitation was found to modestly improve function and pain, help decrease length of hospital stay, and reduce the requirement for postacute care.¹ This study and others have demonstrated significant benefits with telehealth for a variety of patients.

Taking Down Barriers to Tele-oncology

On July 18, 2019, the ATA released its report “2019 State of the States Report: Coverage and Reimbursement,”a wide-ranging analysis of telehealth laws and policies across all 50 states and the District of Columbia. The report shows that more states are adopting telehealth solutions, but some lack the authority or resources to fully deploy telehealth across the state. The ATA supports expanding research opportunities to increase innovation and reduce costs and to help incentivize states to continue to adopt telehealth services.

The ATA report shows that 40 states and the District of Columbia have adopted substantive policies or received awards to expand telehealth coverage and reimbursement since 2017. In addition, 36 states and Washington, DC, have parity policies for private payer coverage. However, only 21 states and the District of Columbia have coverage parity policies in Medicaid. There are now 28 states with Medicaid payment parity policies and the majority of states have no restrictions regarding eligible provider types. Currently, 10 states have authorized 6 or more types of providers to treat patients through telehealth.

Adam P. Dicker, MD, PhD, chair of the Department of Radiation Oncology at Jefferson Medical College of Thomas Jefferson University, ​Philadelphia, Pennsylvania, said telehealth can keep patients with metastatic cancer out of the emergency department (ED) and significantly lower their risk for hospitalization. “Telephone tag is what usually goes on. You give the patient material; some call back and some don’t.  It is very inefficient,” Dr Dicker said in an interview with Oncology Nurse Advisor. “If you employ telehealth, then you take a more active approach. This might enable you to reduce the unexpected admissions and other complications that occur when patients are taking chemotherapy.”

Many of the barriers to adopting telehealth are coming down, in part, because of patient demand. Most patients have smartphones and have broadband access. “I think the consumer is driving this. Even the elderly have smart phones. Not everything requires a personal visit,” said Dr Dicker. “I think slowly the third party payers will see the advantages of telehealth. There is still a lot of discrepancy on what is covered and every company has a different policy.”