Oncologists Report Lasting Changes to Practice Due to COVID-19

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Community oncologists made various changes to clinical practice during the COVID-19 pandemic, including some practices that they expect to last long-term, according to a survey whose results were presented at the 2023 International Society for Pharmacoeconomics and Outcomes Research conference.¹

Participants in the survey of 242 community oncology providers across the United States predicted that many patients had their disease go undiagnosed due to their reluctance to visit a healthcare provider during the pandemic. The survey also found that many physicians used new strategies to manage their patients during the pandemic, some of which, such as the use of telehealth, are expected to continue into the future.

The research was based on a 20-minute survey of community oncologists that was conducted at Community Oncology Research Evaluation (CORE) meetings from December 2021 to May 2022.

One of the ways COVID-19 impacted cancer care was by reducing the number of patients visiting oncologists, which delayed or prevented timely diagnoses of life-threatening diseases. Eighty-one percent of those surveyed estimated that between 1% and 20% of potential patients had gone undiagnosed because they did not want to see a healthcare professional during the pandemic.

Forty-two percent said they saw up to 25% decrease in the number of in-office visits from their patients, with 9% reporting a 26% to 50% decrease. Over 20% reported an increase in in-office visits. Most community physicians made more use of telehealth appointments, with 71% reporting that they had used it for at least 20% of patients. Only 4% said they never shifted to telehealth during the pandemic.

The majority (62%) expected the use of remote, virtual, and telehealth services to decrease once COVID-19 was under control, including 22% who anticipated reducing its use by 51% or more. However, 27% said they expected no change in their use of telehealth in the future.

Physicians were also asked how they modified their clinical practice in consideration of the comorbidity of COVID-19 to the diseases they treat. Overall, 32% reported using less cytotoxic chemotherapy, and 24% reported using monoclonal antibodies less often during the pandemic, with a smaller percentage reducing their use of steroids, body-modifying agents, and other therapies. However, 36% responded ‘Other’ to this question, and 90% of this subset of respondents indicated that they did not change their use of these agents in light of the pandemic.

The vast majority (86%) said that COVID-19 had not affected their willingness to adopt new therapies. Ten percent said that it had increased their interest in such therapies, and only 4% said it made them less willing to try new treatments.

When asked about strategies they used to manage patients with cancer, the most common approach, reported by 55%, was the use of telemedicine to manage those who were stable and receiving oral chemotherapy. This allowed patients to avoid in-person visits if not needed.

Additionally, 39% said they made use of extended dosing strategies, and 38% switched from intravenous chemotherapy to oral or subcutaneous administration, reducing in-office time for patients. Other approaches they had used during the pandemic included using intermittent chemotherapy or treatment discontinuation (20%), delaying stem cell transplant if medically feasible (17%), delaying adjuvant chemotherapy within the recommended range of treatment initiation (11%), and use of home administration of chemotherapy and supportive care therapy (7%). Only twenty-four percent said they had made no strategic changes to manage their patients during the COVID-19 pandemic.

Many who made use of these strategies intend to continue them. Forty-eight percent said they planned to continue use of telemedicine for stable patients receiving oral chemotherapy, 26% would continue extended dosing schedules, and 19% would use oral or subcutaneous administration over intravenous administration. However, 29% indicated that they would not apply these management strategies once COVID-19 was under control.

Physicians were also asked which sources they consider most valuable for getting clinical information about advances in patient management following the COVID-19 pandemic. Sixty-eight percent indicated they use virtual speaker events, and 50% said they rely on scientific journals. Other sources of information included professional congress and society meetings (46%), digital media (44%), peer-to-peer interaction (43%), congress and society websites (23%), manufacturer representatives (15%), and in-practice support (9%).

Although not all community oncologists significantly changed their treatment approaches, the survey suggests that some healthcare providers intend to make long-term adaptations to their practice because of their experience with COVID-19, focusing on quality-of-life, safety, and convivence for patients.

_Reference:

_{1. Bhardwaj S, Manigault I, Maniaran R, Wright G, Vissers E. Impact of COVID-19 on delivery of cancer care: real-world insights from community oncology research evaluations (CORE). Presented at: ISPOR 2023; May 7-10, 2023; Boston, MA.}