COVID-19 and Stay-at-Home Orders Propel the Use of Telemedicine

Response from oncologists and other clinicians who participated in a series of online educational seminars and Twitter polls showed that the conversion of follow-up visits to telemedicine for patients with lung cancer continues to expand, mainly due to effects of the coronavirus disease 2019 (COVID-19) pandemic. The majority of participants reported that at least some of their appointments had been converted to videoconferencing since the Spring of 2020, with the group of 15 oncologists who were polled in May indicating the highest rate of telemedicine use (FIGURE).

Although the extent of its use varied, the analysis depicts the rates of telemedicine uptake as the response to COVID-19 evolved over the first few months of 2020. A majority of the responses came from those who participated in online educational seminars, but the most recent responses from November 11, 2020, were collected through a Twitter poll.

The trend of telemedicine use follows on the recommendations issued by the Centers for Disease Control and Prevention, who reported seeing a 154% increase in telemedicine visits during the last week of March in 2020 versus 2019.¹

In November 2019, Laurence J. Heifetz, MD, founder of the Gene Upshaw Memorial Tahoe Forest Cancer Center, discussed the idea of telemedicine in everyday oncology practice—something that was being touted mostly for rural areas with less access to oncology services and which had yet to be implemented across the country—during an interview with Targeted Therapies in Oncology.

“As patients are feeling more comfortable with being on the [receiving] end of telehealth, the doctors can see the benefit of doing that,” Heifetz said. “…the key to success in a small community practice [is] the more you can make it easy on your patient to stay close to home, the better your practice is going to survive.”

Now, in 2020, telemedicine has become unavoidable for most medical facilities because of the pandemic. By the end of March, the FDA, along with local and state government health officials, expanded the use of telemedicine for patients due to concerns over safety and to limit exposure to the virus and support stay-at-home orders.²

Concerns arose surrounding the treatment of patients with cancer in clinical trials and in community practices, as well as for annual cancer screenings in those at risk. Worries about patient safety clashed with the need to diagnose and treat disease before the cancer worsened. This made telemedicine the logical choice in many cases, even if clinicians used it to decide whether a patient should come into the clinic or infusion center.

“Telemedicine expanded greatly in a short time out of necessity, but with that we have seen how valuable it can be as an alternative to live visits for some patients. I believe that we will continue to employ telemedicine far beyond these acute issues,” H. Jack West, MD, told Targeted Therapies in Oncology in April.

Many oncologists in the United States had the same sentiment, and many have realized that patients who need only surveillance or routine check-ups can have the same visit using telemedicine instead of physically coming in.

“In the era of COVID-19, the optimal management of patients with lung cancer remains unknown and the oncology community should have increased awareness to prevent the emergence of an increase in cancer-related and infectious mortality,” the authors of a paper in Annals of Oncology wrote in April 2020.³ Their paper explored testing for COVID-19 in patients with lung cancer from data collected in China and Italy.

impact of COVID-19 on patients with cancer. As of November 2020, there were significant short-term disruptions in care delivery, which may cause long-term consequences for morbidity and survival in these patients.4 Although this was due to limited access to in-person care, it may be necessary that clinicians continue to use telemedicine to avoid worse outcomes for patients who are concerned about coming in to the office as COVID-19 rates rise at the end of 2020.

_References:

_{1. Koonin LM, Hoots B, Tsang CA, et al. Trends in the use of telehealth during the emergence of the COVID-19 pandemic—United States, January–March 2020. MMWR Morb Mortal Wkly Rep. 2020;69(43):1595-1599. doi:10.15585/mmwr.mm6943a3}

_{2. Digital health policies and public health solutions for COVID-19. FDA. Updated March 26, 2020. Accessed November 18, 2020. https://bit. ly/2IU2OPd}

_{3. Passaro A, Peters S, Mok TSK, Attili I, Mitsudomi T, de Marinis F. Testing for COVID-19 in lung cancer patients. Ann Oncol. 2020;31(7):832-834. doi:10.1016/j.annonc.2020.04.002}

_{4. Patt D, Gordan L, Diaz M, et al. The impact of COVID-19 on cancer care: how the pandemic is delaying cancer diagnosis and treatment for American seniors. Published online November 30, 2020. JCO Clin Cancer Inform. doi:10.1200/CCI.20.00134}