‘Solid evidence’ shows telehealth a safe, cost-saving option for radiation therapy
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Key takeaways:
- Patients receiving remote radiation oncology care reported high levels of satisfaction.
- Individuals who had virtual care saved, on average, more than $450.
Patients who received remote radiation oncology care from Memorial Sloan Kettering Cancer Center reported high levels of satisfaction, saved hundreds of dollars and had no additional safety risks compared with in-person visits.
Results from the retrospective study, published in JAMA Network Open, also showed telehealth could have a positive impact on the environment.
“We were really thrilled to see these results, but not at all surprised,” John J. Cuaron, MD, radiation oncologist at Memorial Sloan Kettering Cancer Center, told Healio.
“These data provide solid evidence that, for well selected patients in certain circumstances, fully remote management of radiation oncology care is a great option that doesn’t compromise quality or safety of care,” he added. “We plan to continue support[ing] the practice as an option for certain patients and encourage others to do the same.”
Background and methodology
Virtual health care rapidly expanded during the COVID-19 pandemic, and multiple studies in the past few years have indicated potential benefits, including flexibility of care and reducing barriers to treatment, according to background information provided by researchers in the published study.
Previous research by investigators at Sloan Kettering showed patients who received radiation therapy had high levels of satisfaction and confidence in telehealth after going through remote care. However, many institutions have scaled back virtual care options.
“Managing patients remotely with established telehealth platforms has been in practice at our institution since the pandemic and has seemingly provided an increase in access and convenience for patients and providers,” Cuaron said. “We conducted this study to really quantify how safe this practice is and how satisfied patients are with the practice.”
Cuaron and colleagues conducted a retrospective cohort study of patients who received radiation therapy via remote management at Memorial Sloan Kettering between Oct. 1, 2020, and Oct. 31, 2022.
The cohort consisted of 2,817 adults (median age, 65 years; 52.1% men) 38.9% of whom had metastatic disease.
Between 100 and 160 patients received remote care per month, making up between 10% to 15% of patients who received treatment in the network overall.
Researchers evaluated satisfaction, financial implications and environmental impact as study endpoints.
Results and next steps
Cuaron and colleagues noted a total of 764 reported safety events during the study period.
All but one event either did not reach the patient (40.3% grade 0) or caused no harm (59.4% grade 1). Frequently occurring events included treatment planning issues (42.2%), treatment planning procedures or delivery delay (11.8%), scheduling errors (10.7%) and physician order entries (9.4%).
A seizure, classified as grade 2 (temporary or minor harm), occurred in one patient undergoing treatment. Virtual care did not have any association with the seizure and clinicians activated emergency services.
“The distribution of patient safety events was similar to that of patients in our department who did not receive remote management, indicating no notable physical or treatment delivery-related risks to patient safety from fully remote care,” researchers wrote.
However, certain individuals may benefit from telehealth more than others.
“The patient who has a small number of treatments that are unlikely to cause significant toxicity, and thus do not require significant coordination of physician and nursing care, are obviously straightforward to manage,” Cuaron said. “Highly symptomatic patients with a low performance status also benefitted as remote management prevented the need for unnecessary office trips.”
He also reported successful management of patients with acute disease requiring a large number of fractions.
Patients with unexpected treatment-related adverse events require ad hoc nursing care that is not well-sited to remote physician management, Cuaron said.
“In the future we plan to streamline the mechanism whereby patients in that scenario are more quickly transferred to an on-site physician for in person care,” he said.
Researchers calculated the total savings for individuals treated via telehealth to be $612,912.71, or $466.45 per patient.
They also tabulated a total saved driving distance of 434,530 miles, which produced a reduction of 174 metric tons of carbon dioxide.
Of the 31% of patients who responded to surveys, 97.6% rated their experience as good or very good, and 87.8% either preferred virtual care or had no preference between telehealth vs. in-person visits.
Researchers noted the study’s limitations included its single institution design and the study cohort being highly selected and technologically literate.
Cuaron said his group plans on further investigating which patients are best served virtually. They also want to measure satisfaction over an extended period and possibly improve the platform for the visually and hearing impaired.
“This report adds to the growing evidence that remote radiation oncology care is safe and feasible, and that all elements that make it possible — including telehealth infrastructure, reimbursement, and care team coordination — should be strengthened and supported at both an individual practice and national level,” Cuaron said.
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