In a single-institution study reported in JCO Oncology Practice, Hsiehchen et al found that replacement of in-person with telehealth visits among patients with cancer initiating systemic therapy during the COVID-19 pandemic was not associated with poorer efficiency in components of oncology care or increased frequency of emergency department visits or hospitalizations.
Study Details
The study assessed factors in clinical efficiency and treatment safety in a cohort of 105 newly referred patients starting systemic therapy at The University of Texas Southwestern Cancer Center during the 3-month period of March through May 2020, when in-person care was largely replaced by telehealth visits. Of these patients, 103 were propensity matched with 103 (of 206) newly referred patients starting care during the same 3-month time period in 2019, for whom all visits were in person.
Key Findings
"Our results indicate that replacement of in-person care with virtual care in oncology does not lead to worse efficiency or outcomes."— Hsiehchen et al
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A decrease in the number of new referrals at the beginning of the pandemic accounted for the large difference in the total size of the unmatched telehealth and in-person cohorts (105 vs 206). In the telehealth cohort, approximately two-thirds of all encounters were via telehealth, with 26% of the cohort having telehealth visits alone.
For the telehealth vs in-person propensity-matched cohorts, the median numbers of patient-initiated telephone encounters regarding care over the 3-month follow-up were 3 vs 3 (P = .40). The median time to staging was 8 vs 9 days (P = .27), and the median time to initiation of therapy was 15 vs 18 days (P = .09).
Palliative care referrals were made for 6.8% vs 10.7% of patients (P = .32). Among 51 vs 50 patients eligible for molecular testing, requisition of testing was made for 39.2% vs 40.0% of patients (P = .99). Chemotherapy discontinuation occurred in 13.6% vs 16.5% of patients (P = .56).
The total numbers of any-cause emergency department visits were 45 vs 51 (P = .70), and the numbers of cancer-specific emergency department visits were 35 vs 33 (P = .88). The total numbers of any-cause emergency hospitalizations were 31 vs 28 (P = .83), and the numbers of cancer-related emergency hospitalizations were 26 vs 24 (P = .85). The total numbers of treatment delays were 29 vs 35 (P = .58), and the mean durations of treatment delays were 10.8 vs 9.2 days (P =.26). No patients were hospitalized due to COVID-19.
The telehealth cohort avoided 192.2 miles of travel per patient, yielding an average of 211.4 minutes saved per patient.
The investigators concluded: “Our results indicate that replacement of in-person care with virtual care in oncology does not lead to worse efficiency or outcomes. Given the increased barriers to patients seeking oncology care during the pandemic, our study indicates that telehealth efforts may be safely intensified. These findings also have implications for the continual use of virtual care in oncology beyond the pandemic.”
David Hsiehchen, MD, of the Division of Hematology and Oncology, University of Texas Southwestern Medical Center, is the corresponding author of the JCO Oncology Practice article.
Disclosure: The study was supported by the Cancer Prevention and Research Institute of Texas. For full disclosures of the study authors, visit ascopubs.org.
