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Italian Study of Electronic Medical Record–Assisted Telephone Follow-up of Breast Cancer Survivors During the COVID-19 Pandemic


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In an Italian single-institution study reported in JCO Oncology Practice, Merz et al evaluated the use of electronic medical record–assisted telephone follow-up (E-TFU) of breast cancer survivors to minimize hospital exposure over a 3-month period during the COVID-19 pandemic. The strategy was viewed as satisfactory by the majority of patients, although less than half reported that they would like to use such follow-up in the future.

Study Details

The study included use of a 15-item survey e-mailed to breast cancer survivors who had been managed by E-TFU at Santa Chiara Hospital, Trento, during phase I and phase II of the COVID-19–related lockdown in Italy. Pandemic phase I started on March 9, 2020, and consisted of absolute prohibition of leaving home except to go to work or other valid reasons (eg, buying essential goods and going to the hospital). Phase II ran from May 4 to June 1, 2020, and allowed visits to relatives within the region and outdoor physical activity.

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Key Findings

The survey was completed by 137 (40%; mean age = 59 years [range = 34–86 years]) of 343 patients managed by E-TFU between March 9 and June 2. Excluding 78 patients who reported having no e-mail address to receive the survey, the response rate was 52%. The survey was completed during pandemic phase I by 66% of respondents.

Overall, 64% of respondents reported COVID-19–related anxiety about their health, and 83% of these were looking forward to a follow-up visit to feel relief. Approximately 68% reported that before the E-TFU, they believed it would be easy to have E-TFU instead of standard follow-up.

Ninety-two percent agreed with the medical decision to replace standard follow-up visits with E-TFU in the absence of emergency to minimize hospital exposure. Overall, 80% were satisfied with E-TFU when comparing it to a standard follow-up visit; however, only 44% reported that they would like to have a future E-TFU in a nonemergency setting.

Ninety-seven percent reported they understood the medical advice received during E-TFU; 93% agreed that the E-TFU doctors had understood their needs; 90% were satisfied with the duration of the phone contact; and 91% reported having the opportunity ask for clarifications.

Lower educational level was correlated with higher COVID-19–related anxiety (P = .025). Older age (P = .002) and lower educational level (P < .0001) were correlated with the need to be accompanied to the hospital. Personal history of second cancer was inversely correlated with understanding medical advice (P = .015) and expectation of feeling relief after a follow-up visit (P = .0027). Receiving E-TFU during pandemic phase II was correlated with satisfaction with E-TFU (P = .010).

The investigators concluded, “E-TFU was an important means of avoiding hospital contacts during the COVID-19 pandemic, and the majority of breast cancer survivors in the survey were satisfied with this procedure. Further studies are needed to investigate the implementation of telemedicine even outside an emergency situation.”

Carlo Messina, MD, of the Department of Medical Oncology, Santa Chiara Hospital, Trento, is the corresponding author for the JCO Oncology Practice article.

Disclosure: For full disclosures of the study authors, visit ascopubs.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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