名媛直播

Telemedicine has emerged as an alternative to office visits for routine radiation oncology practice since the start of the COVID-19 pandemic. A study presented at the San Antonio Breast Cancer Symposium (SABCS) aimed to identify factors associated with patient preference for an initial consult via telemedicine and whether there was a correlation with clinical trial enrollment.

In this exclusive 名媛直播 video, investigators Camille Hardy Abeloos, MD, a resident at NYU Grossman School of Medicine, and Naamit Gerber, MD, program director of the Department of Radiation Oncology at NYU Langone's Perlmutter Cancer Center, discuss of the study, and how the future of telemedicine in breast cancer might continue to affect treatment and clinical trial enrollment.

The following is a transcript of their remarks:

Abeloos: We evaluated breast cancer patients during the open enrollment of a prospective breast cancer trial during June 2020 to May 2021. This was about 3 months after the COVID-19 announcement of the global pandemic. So it was a time when patients were offered both inpatient and telemedicine visits. And the purpose of the study was to find factors associated with patient preference in choosing telemedicine versus in-person consultations, and its impact on clinical trial enrollment.

Gerber: From June 2020 through May of 2021, which was our study period, we had just under 500 women who had new consultations for radiation oncology appointments for breast cancer. And just the number of telemedicine versus in-person was split almost 50/50. And also as we looked at the trend over time, not surprisingly in June of 2020, telemedicine really outnumbered in-person [visits]. Then of course, as the pandemic receded, people became more comfortable, the in-person visits steadily increased relative to telemedicine. But overall for our study period about equal numbers of both.

And then when we looked at patient and disease characteristics between telemedicine and in-person we found that older age was associated with more in-person visits, which actually is not surprising when you think about it in terms of potential comfort with technology. We also found that women who were receiving chemotherapy were more likely to come in-person, which also made sense to us because they might be coming anyway for infusions and may be more comfortable coming to our building. We found that of the patients who had received telemedicine visits, those women were actually less likely to receive their radiation at NYU compared to the in-person visits. Which also you wonder whether there was some lack of therapeutic relationship that led to them getting radiation elsewhere or just whether the same factors that led them not to come in person for their consult also led them not to come to NYU for their main treatment. But we interestingly didn't see a difference in terms of where they lived when we compared the two.

And then on the clinical trial question, we found that of the women who were eligible for this clinical trial, which was about 10-15% of the patients, there were no differences among the eligible patients who enrolled in the clinical trial between the telemedicine versus the in-person. In the telemedicine, it was just over three-quarters; in the in-person, it was a little bit over 50%, not statistically different. So we were very pleased to see actually that clinical trial enrollment was not adversely affected by telemedicine.

Abeloos: Some of the challenges are in terms of improving access to older patients who may not be as technologically savvy, patients who are potentially of lower economic status, lower educational status, and then more systemically also looking at reimbursements for telemedicine, as well as physician licenses in between states, because that was all made more flexible during the pandemic. And those kind of systemic regulations are being pulled back a little bit and that will highly influence, I believe, the number of telemedicine visits that are continued to be done.

Gerber: One thing, just on telemedicine here to stay, right away I think it was interesting that when women had the choice between telemedicine and in-person, you saw this 50/50 split. And I think that's one of the reasons telemedicine will be here to stay. I think there really is from the patient side, so much convenience and added benefits of telemedicine. Interestingly, some other studies that have looked at provider preferences have found that many oncology providers prefer in-person visits. But certainly I think there's real arguments being made on both sides for the value of telemedicine. And then I think in terms of clinical trial enrollment we need to brainstorm ways to make sure we're not losing out on clinical trial enrollment with telemedicine.

Of course, it has to be mentioned that all the patients who said they would do the clinical trial still needed to come in person for consent. So this wasn't a total absence of in-person, but I do think we should be brainstorming ways to make clinical trials more accessible both to our telemedicine patients, but just patients more generally. And that's a really important aspect of oncology. And we need to just think of creative ways to make sure that we're only able to increase diversity on clinical trials and increase patient enrollment.

Abeloos: Takeaways, I think telemedicine overcomes the geographic limitation that some patients face, especially if they're in underserved areas where they have less access to specialized providers. So I think it's a great modality to continue to use for that purpose. And I think we just have to all work together to try and improve access to technology and ease of use of the telemedicine platform to improve its overall access to everyone.

Comment