Telemedicine Boost During COVID-19 Makes Lasting Impact on Cancer Care

David W. Dougherty, MD

COVID-19 has dramatically altered how cancer care is conducted. In the early days of the pandemic, treatment was delayed and both patients and providers were unsure of what was safe. Care providers had to make a quick shift from in-person visits to telehealth appointments, a system that required an entirely new infrastructure.

As the country continues to reopen and 3 vaccines are now widely available, some challenges created by the COVID-19 linger. These include telehealth, financial toxicities, and delayed patient treatment.

In an interview with Targeted Oncology, David W. Dougherty, MD, a medical oncologist at the Dana-Farber Cancer Institute discussed how the COVID-19 pandemic has changed the cancer care space, a topic he discussed on a panel earlier this year during the Association of Community Cancer Centers (ACCC) Annual Meeting. He also gave his opinion on what needs to go, and what innovations should stay after the pandemic. 

TARGETED ONCOLOGY™: Can provide brief overview of your ACCC presentation and its key points?

Dougherty: The purpose of the ACCC presentation was really to have a number of leaders in oncology care across the country come together to discuss how the COVID-19 pandemic impacted all of our organizations. It was really wonderful to hear the stories from all of my colleagues about how their organizations adapted and were flexible to really continue our operations and to take great care of patients with cancer throughout. A lot of the work we focused on at Dana-Farber was in how to leverage telehealth to be able to provide care safely to patients and keep our staff safe during the pandemic. Organizationally, we learned a lot and we grew a lot in a very short period of time. I think we learned a lot about ourselves and our ability to be flexible with this technology.

Some of the other important points that I and my colleagues made were wonderful stories of how teams came together to really support our patients and families as well as one another through such difficult times. The other thing that I learned and shared is that there are opportunities within this difficult time for us to grow into and take the things that we've learned, and then change the way that we provide care moving forward. So, I think those are some of the main concepts that we touched on.

The COVID-19 pandemic has affected cancer care dramatically. Can you discuss what the problems the pandemic has caused in cancer care? Also, what good things have come out it this?

There were multiple negative things. It could be in relation to deferring care, and there were people who needed screenings or had other priorities that were put off due to fear around COVID. In fact, I just met a patient 2 who had developed throat symptoms about 1 year ago, and they deferred their care.

The other main impact that was negative is that, because of the need for social distancing, most places had to impose visitor restrictions, and it's very much the opposite of how we would think about providing great patient-centered care in oncology. Not only having very personal interactions with the patients, but involving their family members, and their caregivers, and so forth. Because of the pandemic, oftentimes we weren't able to have visitors in person. We did everything that we could to try to engage family members through zoom or by phone, but it was very different. I think it lent a sense of loneliness to the process.

On the flip side, I think that there were some ways in which we could perhaps better connect with patients. To be able to have a telehealth visit with a patient in their home gave me a different insight into them as people and into their home lives and in their family. I think that was a really a positive thing.

Some of the other positives come back to us realizing that there are ways that we can take great care of patients in these difficult times that may be less traditional than we had before. We all got much more comfortable with asynchronous care, and we got more comfortable with providing care more remotely, and being able to make good decisions with patients. I think the other sort of negative impact is that it's such a meaningful interaction that we have and I personally believe that video conferencing actually does a good job of approximating an in person visit. But, not be able to have the in-person visits and hold the patient's hand or comfort them if you're giving them bad news, was one of the other big challenges for us and for our patients and families.

There's also the fear that came along with it. Is it safe for us to be around one another? Very early on in the pandemic, we didn't really know, so there was fear from patients and families for coming in and fear from our team members. That sort of dissipated as we learn more about COVID, and we were able to handle it better and put good processes in place. I would say the impact of the pandemic has been fairly mixed.

Telehealth is a concept that cancer care and health care in general has been kicking around for a while. How has the COVID-19 pandemic propelled telehealth into a more mainstream practice?

Prior to COVID, we were doing minimal telehealth. Then, early on in the COVID experience we had changed to a majority of our visits were taking place by some form of telehealth. It became a more integral part of our ability to continue our operations and care for patients. I think there were a lot of barriers to the implementation of telehealth on a more widespread basis, prior to COVID, including not understanding how to implement the technology, or figuring out how to incorporate it into what we do.

Also, things like medical licensure were a challenge.

I think a lot remains unknown. So, as we continue, and hopefully start to put COVID behind us a little bit, and the public health emergency goes away, there are likely still important questions that need to be answered on the legislative side and the reimbursement side, to maintain parity. It takes a fair amount of infrastructure investment to be able to do this. And so, I think those types of things need to be factored in as we collectively think about what the future of telehealth should look like.

What do you think the long-term effects of the pandemic is going to have on cancer care?

Obviously, there are financial implications for organizations that it's likely going to take a while for all of our organizations to be able to recover from. Then there's the result in delayed care that we talked about that. We're likely going to continue to feel the effects of that over the next couple of years. My hope is that post COVID, we remember how nimble we were and we really embrace that, and we figure out ways to continue that so that we can, again, keep the patient at the center, and figure out if there are ways that we can provide better care to patients from the experience that we had through this pandemic.

Then, I think the other aspect that is very meaningful to me and other colleagues is just that the experience of COVID in seeing our teams come together, and I would love for us to hold onto that as organizations.

What can be done now to start mitigating the negative effects of the pandemic in patients and organizations?

I think first and foremost, organizations need to be proactively communicating with patients about the importance of getting care that may have been deferred as a result of the pandemic. I think organizations need to continue their austerity measures to make sure that they're making good investments in their resources to be able to mitigate the financial impact in the longer term. We also need to continue to remain as efficient as possible with what we're doing with patients in order to continue to mitigate those downsides.

This has been such a profound experience for everyone. It hasn't broken the system, but it's certainly highlighted where the system was weak. We at Dana-Farber have really appreciated that and have tried to be mindful of that moving forward. My hope is, again, that collectively, we as a healthcare system and society can remember the pandemic, learn from it, and turn this extraordinarily difficult situation into a positive moving forward.