Cancers

Research

15 pages, 259 KiB

Open AccessArticle

Clinician Perceptions of Barriers and Facilitators for Delivering Early Integrated Palliative Care via Telehealth

by Katrina Grace Sadang, Joely A. Centracchio, Yael Turk, Elyse Park, Josephine L. Feliciano, Isaac S. Chua, Leslie Blackhall, Maria J. Silveira, Stacy M. Fischer, Michael Rabow, Finly Zachariah, Carl Grey, Toby C. Campbell, Jacob Strand, Jennifer S. Temel and Joseph A. Greer

Cancers 2023, 15(22), 5340; https://doi.org/10.3390/cancers15225340 - 09 Nov 2023

Viewed by 1139

Abstract

Early integrated palliative care (EIPC) significantly improves clinical outcomes for patients with advanced cancer. Telehealth may be a useful tool to deliver EIPC sustainably and equitably. Palliative care clinicians completed a survey regarding their perceptions of the barriers, facilitators, and benefits of using [...] Read more.

Early integrated palliative care (EIPC) significantly improves clinical outcomes for patients with advanced cancer. Telehealth may be a useful tool to deliver EIPC sustainably and equitably. Palliative care clinicians completed a survey regarding their perceptions of the barriers, facilitators, and benefits of using telehealth video visits for delivering EIPC for patients with advanced lung cancer. Forty-eight clinicians across 22 cancer centers completed the survey between May and July 2022. Most (91.7%) agreed that telehealth increases access to EIPC and simplifies the process for patients to receive EIPC (79.2%). Clinicians noted that the elderly, those in rural areas, and those with less-resourced backgrounds have greater difficulty using telehealth. Perceived barriers were largely patient-based factors, including technological literacy, internet and device availability, and patient preferences. Clinicians agreed that several organizational factors facilitated telehealth EIPC delivery, including technological infrastructure (85.4%), training (83.3%), and support from study coordinators (81.3%). Other barriers included systems-based factors, such as insurance reimbursement and out-of-state coverage restrictions. Patient-, organization-, and systems-based factors are all important to providing and improving access to telehealth EIPC services. Further research is needed to investigate the efficacy of telehealth EIPC and how policies and interventions may improve access to and dissemination of this care modality. Full article

(This article belongs to the Special Issue Telemedicine across the Continuum of Cancer Care)

11 pages, 516 KiB

Open AccessArticle

Persistence of Telemedicine Usage for Breast and Prostate Cancer after the Peak of the COVID-19 Pandemic

by Susan Chimonas, Allison Lipitz-Snyderman, Zoe Spiegelhoff, Nirjhar Chakraborty, Kenneth Seier, Charlie White and Gilad Kuperman

Cancers 2023, 15(20), 4961; https://doi.org/10.3390/cancers15204961 - 12 Oct 2023

Viewed by 730

Abstract

While COVID-19 catalyzed a shift to telemedicine, little is known about the persistence of remote cancer care in non-emergent times. We assessed telemedicine use at a high-volume academic cancer center in New York City and analyzed breast and prostate cancer visits pre-COVID-19, peak [...] Read more.

While COVID-19 catalyzed a shift to telemedicine, little is known about the persistence of remote cancer care in non-emergent times. We assessed telemedicine use at a high-volume academic cancer center in New York City and analyzed breast and prostate cancer visits pre-COVID-19, peak COVID-19, and post-peak. Descriptive statistics assessed visit mode (in person, telemedicine) and type (new, follow-up, other) by department/specialty, with Fisher’s exact tests comparing peak/post-peak differences. The study included 602,233 visits, with telemedicine comprising 2% of visits pre-COVID-19, 50% peak COVID-19, and 30% post-peak. Notable variations emerged by department/specialty and visit type. Post-peak, most departments/specialties continued using telemedicine near or above peak levels, except medicine, neurology, and survivorship, where remote care fell. In psychiatry, social work, and nutrition, nearly all visits were conducted remotely during and after peak COVID-19, while surgery and nursing maintained low telemedicine usage. Post-peak, anesthesiology and neurology used telemedicine seldom for new visits but often for follow-ups, while nursing showed the opposite pattern. These trends suggest department- and visit-specific contexts where providers and patients choose telemedicine in non-emergent conditions. More research is needed to explore these findings and evaluate telemedicine’s appropriateness and impact across the care continuum. Full article

(This article belongs to the Special Issue Telemedicine across the Continuum of Cancer Care)

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16 pages, 2725 KiB

Open AccessArticle

Telemedicine in Neuro-Oncology—An Evaluation of Remote Consultations during the COVID-19 Pandemic

by Jonas Feldheim, Teresa Schmidt, Christoph Oster, Julia Feldheim, Martin Stuschke, Walter Stummer, Oliver Grauer, Björn Scheffler, Carsten Hagemann, Ulrich Sure, Christoph Kleinschnitz, Lazaros Lazaridis, Sied Kebir and Martin Glas

Cancers 2023, 15(16), 4054; https://doi.org/10.3390/cancers15164054 - 11 Aug 2023

Viewed by 999

Abstract

In order to minimize the risk of infections during the COVID-19 pandemic, remote video consultations (VC) experienced an upswing in most medical fields. However, telemedicine in neuro-oncology comprises unique challenges and opportunities. So far, evidence-based insights to evaluate and potentially customize current concepts [...] Read more.

In order to minimize the risk of infections during the COVID-19 pandemic, remote video consultations (VC) experienced an upswing in most medical fields. However, telemedicine in neuro-oncology comprises unique challenges and opportunities. So far, evidence-based insights to evaluate and potentially customize current concepts are scarce. To fill this gap, we analyzed >3700 neuro-oncological consultations, of which >300 were conducted as VC per patients’ preference, in order to detect how both patient collectives distinguished from one another. Additionally, we examined patients’ reasons, suitable/less suitable encounters, VC’s benefits and disadvantages and future opportunities with an anonymized survey. Patients that participated in VC had a worse clinical condition, higher grade of malignancy, were more often diagnosed with glioblastoma and had a longer travel distance (all p < 0.01). VC were considered a fully adequate alternative to face-to-face consultations for almost all encounters that patients chose to participate in (>70%) except initial consultations. Most participants preferred to alternate between both modalities rather than participate in one alone but preferred VC over telephone consultation. VC made patients feel safer, and participants expressed interest in implementing other telemedicine modalities (e.g., apps) into neuro-oncology. VC are a promising addition to patient care in neuro-oncology. However, patients and encounters should be selected individually. Full article

(This article belongs to the Special Issue Telemedicine across the Continuum of Cancer Care)

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12 pages, 553 KiB

Open AccessArticle

Engagement, Advance Care Planning, and Hospice Use in a Telephonic Nurse-Led Palliative Care Program for Persons Living with Advanced Cancer

by Rebecca Liddicoat Yamarik, Laraine Ann Chiu, Mara Flannery, Kaitlyn Van Allen, Oluwaseun Adeyemi, Allison M. Cuthel, Abraham A. Brody, Keith S. Goldfeld, Deborah Schrag, Corita R. Grudzen and on behalf of the EMPallA Investigators

Cancers 2023, 15(8), 2310; https://doi.org/10.3390/cancers15082310 - 15 Apr 2023

Viewed by 1654

Abstract

Persons living with advanced cancer have intensive symptoms and psychosocial needs that often result in visits to the Emergency Department (ED). We report on program engagement, advance care planning (ACP), and hospice use for a 6-month longitudinal nurse-led, telephonic palliative care intervention for [...] Read more.

Persons living with advanced cancer have intensive symptoms and psychosocial needs that often result in visits to the Emergency Department (ED). We report on program engagement, advance care planning (ACP), and hospice use for a 6-month longitudinal nurse-led, telephonic palliative care intervention for patients with advanced cancer as part of a larger randomized trial. Patients 50 years and older with metastatic solid tumors were recruited from 18 EDs and randomized to receive nursing calls focused on ACP, symptom management, and care coordination or specialty outpatient palliative care (ClinicialTrials.gov: NCT03325985). One hundred and five (50%) graduated from the 6-month program, 54 (26%) died or enrolled in hospice, 40 (19%) were lost to follow-up, and 19 (9%) withdrew prior to program completion. In a Cox proportional hazard regression, withdrawn subjects were more likely to be white and have a low symptom burden compared to those who did not withdraw. Two hundred eighteen persons living with advanced cancer were enrolled in the nursing arm, and 182 of those (83%) completed some ACP. Of the subjects who died, 43/54 (80%) enrolled in hospice. Our program demonstrated high rates of engagement, ACP, and hospice enrollment. Enrolling subjects with a high symptom burden may result in even greater program engagement. Full article

(This article belongs to the Special Issue Telemedicine across the Continuum of Cancer Care)

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17 pages, 658 KiB

Open AccessArticle

Results of DUET: A Web-Based Weight Loss Randomized Controlled Feasibility Trial among Cancer Survivors and Their Chosen Partners

by Wendy Demark-Wahnefried, Robert A. Oster, Tracy E. Crane, Laura Q. Rogers, W. Walker Cole, Harleen Kaur, David Farrell, Kelsey B. Parrish, Hoda J. Badr, Kathleen Y. Wolin and Dori W. Pekmezi

Cancers 2023, 15(5), 1577; https://doi.org/10.3390/cancers15051577 - 03 Mar 2023

Cited by 2 | Viewed by 2179

Abstract

(1) Background: A healthful diet, regular physical activity, and weight management are cornerstones for cancer prevention and control. Yet, adherence is low in cancer survivors and others, calling for innovative solutions. Daughters, dUdes, mothers, and othErs fighting cancer Together (DUET) is a 6-month, [...] Read more.

(1) Background: A healthful diet, regular physical activity, and weight management are cornerstones for cancer prevention and control. Yet, adherence is low in cancer survivors and others, calling for innovative solutions. Daughters, dUdes, mothers, and othErs fighting cancer Together (DUET) is a 6-month, online, diet-and-exercise, weight-loss intervention to improve health behaviors and outcomes among cancer survivor-partner dyads. (2) Methods: DUET was tested in 56 dyads (survivors of obesity-related cancers and chosen partners) (n = 112), both with overweight/obesity, sedentary behavior, and suboptimal diets. After baseline assessment, dyads were randomized to DUET intervention or waitlist control arms; data were collected at 3- and 6-months and analyzed using chi-square, t-tests, and mixed linear models (α < 0.05). (3) Results: Retention was 89% and 100% in waitlisted and intervention arms, respectively. Dyad weight loss (primary outcome) averaged −1.1 (waitlist) vs. −2.8 kg (intervention) (p = 0.044/time-by-arm interaction p = 0.033). Caloric intake decreased significantly in DUET survivors versus controls (p = 0.027). Evidence of benefit was observed for physical activity and function, blood glucose, and c-reactive protein. Dyadic terms were significant across outcomes, suggesting that the partner-based approach contributed to intervention-associated improvements. (4) Conclusions: DUET represents a pioneering effort in scalable, multi-behavior weight management interventions to promote cancer prevention and control, calling for studies that are larger in size, scope, and duration. Full article

(This article belongs to the Special Issue Telemedicine across the Continuum of Cancer Care)

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Review

Jump to: Research, Other

16 pages, 273 KiB

Open AccessReview

Telemedicine in Hematopoietic Cell Transplantation and Chimeric Antigen Receptor-T Cell Therapy

by Arpita P. Gandhi and Catherine J. Lee

Cancers 2023, 15(16), 4108; https://doi.org/10.3390/cancers15164108 - 15 Aug 2023

Viewed by 956

Abstract

Telemedicine has played an important role in delivering healthcare for primary care, chronic disease patients, and those with solid organ malignancies. However, its application in subspecialties such as hematologic malignancies, hematopoietic cell transplantation (HCT), or chimeric antigen receptor-T cell (CAR-T) therapy is not [...] Read more.

Telemedicine has played an important role in delivering healthcare for primary care, chronic disease patients, and those with solid organ malignancies. However, its application in subspecialties such as hematologic malignancies, hematopoietic cell transplantation (HCT), or chimeric antigen receptor-T cell (CAR-T) therapy is not widespread since physical examination is a vital component in delivering care. During the COVID-19 pandemic, we widely used telemedicine, since protecting our immunocompromised patients became our top priority. The employment of HCT and CAR-T therapies continues to grow for high-risk hematologic malignancies, particularly in older and frail patients who must visit specialty centers for treatment access. Generally, HCT and CAR-T therapy care is highly complex, necessitating commitment from patients, caregivers, and a multidisciplinary team at specialty academic centers. All healthcare systems adapted to the crisis and implemented rapid changes during the COVID-19 public health emergency (PHE). Telemedicine, a vital modality for delivering healthcare in underserved areas, experienced rapid expansion, regardless of the geographic region, during the COVID-19 PHE. The data emerging from practices implemented during the PHE are propelling the field of telemedicine forward, particularly for specialties with complex medical treatments such as HCT and CAR-T therapy. In this review, we examine the current data on telemedicine in HCT and cellular therapy care models for the acute and long-term care of our patients. Full article

(This article belongs to the Special Issue Telemedicine across the Continuum of Cancer Care)

19 pages, 3508 KiB

Open AccessReview

Psychosocial Impact of Virtual Cancer Care through Technology: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

by Caterina Caminiti, Maria Antonietta Annunziata, Paola Di Giulio, Luciano Isa, Paola Mosconi, Maria Giulia Nanni, Michela Piredda, Claudio Verusio, Francesca Diodati, Giuseppe Maglietta and Rodolfo Passalacqua

Cancers 2023, 15(7), 2090; https://doi.org/10.3390/cancers15072090 - 31 Mar 2023

Cited by 1 | Viewed by 2072

Abstract

This meta-analysis of RCTs aimed to determine whether replacing face-to-face hospital care with telemedicine deteriorates psychosocial outcomes of adult cancer patients, in terms of quality of life (QoL), anxiety, distress, and depression. RCTs on interventions aimed at improving patient psychosocial outcomes were excluded. [...] Read more.

This meta-analysis of RCTs aimed to determine whether replacing face-to-face hospital care with telemedicine deteriorates psychosocial outcomes of adult cancer patients, in terms of quality of life (QoL), anxiety, distress, and depression. RCTs on interventions aimed at improving patient psychosocial outcomes were excluded. MEDLINE, EmBASE, and PsycInfo were searched on 13 May 2022 without language or date restrictions. In total, 1400 records were identified and 8 RCTs included (4434 subjects). Study methodological quality was moderate. Statistically significant improvements were observed in favor of the intervention for QoL (SMD = 0.22, 95% CI 0.01 to 0.43, p = 0.04), anxiety (SMD = −0.17, 95% CI −0.30 to −0.04, p < 0.01), and global distress (SMD = −0.38, 95% CI −0.51 to −0.25, p < 0.01). A meta-analysis on depression could not be performed. In subgroup analyses, the intervention appeared to be more beneficial for patients receiving active treatment vs. follow-up, for “other cancer types” vs. breast cancer, and for “other modes of administration” vs. telephone. Given the many potential advantages of being assisted at home, telemedicine appears to be a viable option in oncology. However, more research is necessary to determine the types of patients who may benefit the most from these alternative care modalities. Full article

(This article belongs to the Special Issue Telemedicine across the Continuum of Cancer Care)

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11 pages, 255 KiB

Open AccessReview

Best Practices for Providing Patient-Centered Tele-Palliative Care to Cancer Patients

by Grecia Lined Aldana, Onyinyechi Vanessa Evoh and Akhila Reddy

Cancers 2023, 15(6), 1809; https://doi.org/10.3390/cancers15061809 - 16 Mar 2023

Cited by 4 | Viewed by 1885

Abstract

Cancer patients receiving palliative care may face significant challenges in attending outpatient appointments. Patients on controlled substances such as opioids require frequent visits and often rely on assistive devices and/or a caregiver to accompany them to these visits. In addition, pain, fatigue, and [...] Read more.

Cancer patients receiving palliative care may face significant challenges in attending outpatient appointments. Patients on controlled substances such as opioids require frequent visits and often rely on assistive devices and/or a caregiver to accompany them to these visits. In addition, pain, fatigue, and shortness of breath may magnify the challenges associated with in-person visits. The rapid adoption of telemedicine in response to the COVID-19 pandemic has proven to be highly beneficial for advanced cancer patients and caregivers. The hurried COVID-19-related implementation of telemedicine is now evolving into a permanent platform for providing palliative care. This review will focus on the best practices and recommendations to deliver high-quality, interdisciplinary tele-palliative care. Full article

(This article belongs to the Special Issue Telemedicine across the Continuum of Cancer Care)

Other

Jump to: Research, Review

6 pages, 206 KiB

Open AccessPerspective

Strategies to Make Telemedicine a Friend, Not a Foe, in the Provision of Accessible and Equitable Cancer Care

by Brook A. Calton, Sarah Nouri, Carine Davila, Ashwin Kotwal, Carly Zapata and Kara E. Bischoff

Cancers 2023, 15(21), 5121; https://doi.org/10.3390/cancers15215121 - 24 Oct 2023

Cited by 1 | Viewed by 742

Abstract

Telemedicine has the potential to improve access to cancer care, particularly for patients with functional limitations, high symptom burdens, or financial or geographic constraints. However, there is also a risk that telemedicine can widen healthcare disparities among patients facing systemic disadvantages like those [...] Read more.

Telemedicine has the potential to improve access to cancer care, particularly for patients with functional limitations, high symptom burdens, or financial or geographic constraints. However, there is also a risk that telemedicine can widen healthcare disparities among patients facing systemic disadvantages like those with technological barriers, poor digital literacy, older age, or non-English language preferences. To optimize telemedicine usage, we must implement practical strategies like video onboarding programs, user-friendly technology platforms, optimizing the clinician’s environment, and best practices for using interpreters. Policy changes such as state licensing requirements, controlled substance prescribing requirements, and payment parity are also crucial. This Perspective highlights these practical strategies and policy recommendations to ensure accessible and equitable cancer care augmented by telemedicine. Full article

(This article belongs to the Special Issue Telemedicine across the Continuum of Cancer Care)

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