ASCO recently released a new set of standards and practice recommendations specific to telehealth in oncology.1 These new standards provide guidance for which patients can be seen through telehealth; the establishment of the doctor-physician relationship; the role of allied health professionals and advanced practice providers; and the conduct of multidisciplinary cancer conferences and teletrials.
ASCO’s Quality of Care Council established the Expert Panel on Telemedicine to assist in developing these evidence-based standards to assure appropriate methods of organizational care for oncology practices, health-care practitioners, patients, and caregivers.
“Despite the recognized promise of telemedicine, utilization was gaining traction in some oncology practices, but was not widely used in the U.S. oncology space due, in part, to lack of education, lack of public and private payer allowances to cover all of oncology patient populations, lack of technology access, and lack of consideration of telemedicine as an essential part of care management,” said Robin T. Zon, MD, FACP, FASCO, of Michiana Hematology Oncology, and expert panel Co-Chair.
ASCO members globally strive to deliver the highest-quality, equitable care possible [for] every patient, every day, everywhere. This intervention has great potential to improve high-quality cancer care and assist in supporting equitable care.— Robin T. Zon, MD, FACP, FASCO
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However, as a result of the COVID-19 pandemic, the Centers for Medicare and Medicaid Services implemented policy changes that ensured telemedicine was available to more practitioners and patients during the public health emergency. Subsequently, telemedicine rose as an ASCO priority and was featured in the ASCO Interim Position Statement: Telemedicine in Cancer Care,2 in the ASCO Road to Recovery Strategy,3 and in the ASCO Special Report: A Guide to Cancer Care Delivery During the COVID-19 Pandemic.4
Patient Selection, Multidisciplinary Care, Clinical Trials
The expert panel identified areas specific to oncology that could benefit from additional guidance beyond those provided by the American Medical Association’s Telehealth Implementation Playbook5 and the American Telemedicine Association’s Quick-Start Guide to Telehealth During a Crisis.6
“This was a massive endeavor,” said Ray D. Page, DO, PhD, FACOI, FASCO, of The Center for Cancer and Blood Disorders, and expert panel Co-Chair. “We wanted to distill all the available information down into standards and suggestions in a way that was pertinent and relevant for oncology practices.”
Ray D. Page, DO, PhD, FACOI, FASCO
The standards are organized into six areas specific to oncology. The first area relates to patient selection and implementation of telehealth in oncology and includes the most detailed recommendations. For example, one standard calls for the availability of a staff member or external technology support person to troubleshoot technology issues and facilitate workflow, and another details the type of information that should be documented during a telehealth visit.
The second area is the establishment of the doctor-patient relationship. Here the standard states that state and federal policies permitting telemedicine to cross state lines should include a provision requiring that the doctor-patient relationship be established prior to provision of any telemedicine service.
In addition, the expert panel addressed the role of advanced practice providers, recommending that practices develop standards, algorithms, or policies that govern when patients may see advanced practice providers and when telehealth visits require a physician.
The role of allied health professionals is also discussed, with the expert panel endorsing recommendations from the Clinical Oncological Society of Australia’s clinical practice guidelines for teleoncology.7
Next, the expert panel provided some detail on the conduct of virtual multidisciplinary cancer conferences. Among the recommendations were the finalization of an agenda and cases at least 1 day prior to the conference, prioritization of advanced or complicated cases earlier in the meeting, and documentation of the discussion in the patient’s electronic medical record
Finally, the Panel issued recommendations regarding telehealth and/or virtual participation in oncology clinical trials. Recommendations included incorporating remote methods of reviewing symptoms and adverse events, remote study initiation and monitoring from sponsors, shipping of oral drugs, allowing laboratory tests and biopsies at sites local to the participants, and reconsidering the necessity of frequent testing, including imaging. The recommendations apply beyond the timeframe of the COVID-19 pandemic, the panel noted.
A Rapidly Evolving Field
“Telehealth is still very new with rapidly evolving methods of effective utilization, and I think there are a lot of people looking for better guidance,” Dr. Page said. He added that although practice managers and physician leaders are the most likely to examine the granular details of the recommendations, all oncologists should read and get a feel for the important elements of telehealth discussed.
Dr. Zon noted that these new recommendations are not meant to serve as any kind of certification tool. The standards are intended to educate and inform members on how to deliver quality cancer care through telehealth, she added.
“ASCO members globally strive to deliver the highest-quality, equitable care possible [for] every patient, every day, everywhere. This intervention has great potential to improve high-quality cancer care and assist in supporting equitable care,” Dr. Zon said. “Telehealth should deliver the same high-quality care that face-to-face visits deliver with accountability. In addition, telehealth as a care delivery tool can help address current gaps in care and education, thereby improving the value of care our patients want and deserve.”
REFERENCES
1. Zon RT, Kennedy EB, Adelson K, et al: Telehealth in oncology: ASCO standards and practice recommendations. JCO Oncol Pract. July 28, 2021 (early release online).
2. ASCO: ASCO interim position statement: Telemedicine in cancer care. Available at https://www.asco.org/sites/new-www.asco.org/files/content-files/advocacy-and-policy/documents/2020-Interim-Position-Statement-Telemedicine.pdf. Accessed August 23, 2021.
3. Pennell NA, Dillmon M, Levit LA, et al: American Society of Clinical Oncology Road to Recovery Report: Learning from the COVID-19 experience to improve clinical research and cancer care. J Clin Oncol 39:155-169, 2021.
4. ASCO Special Report: A guide to cancer care delivery during the COVID-19 pandemic. ASCO.org. Available at https://www.asco.org/sites/new-www.asco.org/files/content-files/2020-ASCO-Guide-Cancer-COVID19.pdf. Accessed July 13, 2021.
5. American Medical Association: Telehealth implementation playbook. Available at https://www.ama-assn.org/system/files/2020-04/ama-telehealth-playbook.pdf. Accessed July 13, 2021.
6. American Telemedicine Association: ATA’s Quick-Start Guide to Telehealth During a Crisis. Available at https://www.americantelemed.org/resources/atas-quick-start-guide-to-telehealth/. Accessed July 13, 2021.
7. Clinical Oncological Society of Australia: Clinical practice guidelines for teleoncology. Available at https://wiki.cancer.org.au/australia/COSA:Teleoncology. Accessed July 15, 2021.
Originally published in ASCO Daily News. © American Society of Clinical Oncology. ASCO Daily News, August 4, 2021. All rights reserved.
