Teleoncology for Veterans With Cancer During the COVID-19 Pandemic

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In a single-center study reported in JCO Oncology Practice, Jiang et al found an overall high level of satisfaction with teleoncology care during the COVID-19 pandemic among veterans with cancer in the United States, although a preference for in-person visits was commonly expressed. Teleoncology was associated with travel-related savings in cost, time, and carbon emissions.

As stated by the investigators, “There was rapid adoption of teleoncology care in the Veterans Health Administration during the COVID-19 pandemic. One-third of 9 million Veterans Health Administration–enrolled veterans live in rural areas. Although digital solutions can expand capacity, enhance care access, and reduce financial burden, they may also exacerbate rural-urban health disparities. Careful evaluation of patients’ perceptions and policy tradeoffs are necessary to optimize teleoncology postpandemic.”

Study Details

The study involved surveys of patients who had one or more teleoncology visits with medical, surgical, or radiation oncology at the Ann Arbor Veterans Affairs Medical Center between March 2020 and June 2020. A total of 366 patients with 560 teleoncology visits were eligible for the study. A total of 161 patients telephoned alphabetically according to surname were contacted to reach the goal of 100 survey responses (62% response rate; telephone = 81, paper = 19). Travel distance, time, cost, and carbon dioxide emissions were calculated based on zip codes.

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Key Findings

Patients reported overall general satisfaction with teleoncology (83% agree or strongly agree) and felt that providers answered their questions satisfactorily (90% agree or strongly agree), that they could explain their own medical problems well (80% agree or strongly agree), that providers engaged them in their care (85% agree or strongly agree), and that teleoncology saved time (88% agree or strongly agree).

Less than half of patients agreed that teleoncology visits were as satisfying as in-person visits (47% agree or strongly agree). A minority agreed that their health had improved as a result of teleoncology (23% agree or strongly agree). Themes cited in the optional comments section of the survey included preference for face-to-face visits (n = 13), the need for family members to assist with telehealth visits (n = 8), and poor access or difficulty using technology (smartphones or internet or connection issues, n = 14).

Visits were audio-only for 49 patients, audiovisual-only for 41, and audio-only and audiovisual for 10. Satisfaction with visits was reported by 90% with audiovisual-only, 90% with both audio and audiovisual, and 76% with audio-only visits. Patient satisfaction with their involvement in care was expressed by 61% with audiovisual-only, 40% with audio and audiovisual, and 33% with audio-only visits; perceived ability to self-manage health and medical needs was reported by 71%, 60%, and 41%, respectively; and comparability to in-person visits was reported by 63%, 40%, and 35%, respectively.

Estimated total travel-related savings for the 560 total teleoncology encounters between March 2020 and June 2020 were 86,470 miles, 84,374 minutes, $49,720 U.S. dollars, and 35.5 metric tons of carbon dioxide.

The investigators concluded, “Veterans are broadly satisfied with teleoncology. Audiovisual capabilities are critical to satisfaction. This is challenging for rural populations with lack of technology access. Patients experienced financial and time savings, and society benefitted from reduced carbon emissions. Continued optimization is needed to enhance patient experience and address secondary effects.”

Nithya Ramnath, MBBS, of the University of Michigan Rogel Cancer Center, Ann Arbor, is the corresponding author for the JCO Oncology Practice article.

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