From COVID-19 to colorectal cancer, telehealth has changed how we look at preventive care

When the COVID-19 pandemic began in the United States last year, state and local governments mandated shelter-in-place orders, which upended the practice of medicine.

During this unprecedented time, the way we see and care for our patients has changed. Although in-person appointments and procedures are returning, it’s safe to say that care delivery has been forever impacted.

The pandemic has resulted in both positive and negative changes in health care. One of the most important positive changes is telemedicine, which allows us to be more accessible to patients who are now just a phone or video call away. On the negative side, however, the pandemic has led to delays in cancer screenings, which has important implications for our patients. Fortunately, we can take advantage of the expansion of telemedicine to help close the gaps in cancer screening related to the continuing pandemic and provide preventive care to our patients.

At my practice in Chicago, we rapidly transitioned to telemedicine visits following the start of the pandemic — both so we could preserve necessary medical resources and so our patients could avoid the potential risks of in-person visits. We have found that many of our patients prefer virtual visits, and we are happy to accommodate them. Telemedicine complements traditional in-person care and has allowed us to provide uninterrupted care and counsel to our patients on anything from COVID-19-related concerns to cancer prevention. Using videoconferencing technology and telephone calls, we can connect with patients on a regular basis from the comfort of their own homes. While some medical needs must still be addressed in person, telemedicine can allow us to be efficient, easily fitting in a virtual visit for a patient with an urgent medical concern. We plan to continue to offer telehealth visits for patients seeking or needing a socially distanced or more convenient option for their care.

Another key benefit of telehealth visits is that they give us the opportunity to be more proactive with our patients about preventive health measures, including cancer screening. This is critical given the sharp decline in cancer screening that occurred in the first several months after the pandemic began. This is particularly concerning regarding screening for colorectal cancer, the second deadliest cancer in the U.S.. A report from the Epic Health Research Network, released in July 2020, found that preventive cancer screenings performed across the U.S. dropped between 63% to 67% following the declaration of the COVID-19 national emergency in March 2020, with colorectal cancer screenings falling by 64%. Experts estimate that this screening drop-off could result in more than 4,000 excess deaths due to colorectal cancer over the next decade.

Prior to the pandemic, colorectal cancer mortality rates had been on the decline, dropping by 55% from 1970 to 2018, due in part to an emphasis on screening. Still, an estimated 52,980 Americans will die from colorectal cancer in 2021. The drop in screening over the last year could have a very real impact on the advances that occurred through 2018. While the number of colorectal cancer screenings began to rise by mid-June 2020 and has improved significantly since then, screening backlogs remain. To help address this, we can take advantage of a positive change resulting from the pandemic (ie, telemedicine) to address a negative consequence (ie, colorectal cancer screening gaps).

Socially distanced colorectal cancer screening

While vaccination efforts are improving and case rates are declining, anxieties around COVID-19 transmission remain, and many patients are hesitant to visit a hospital or other health care facility for cancer screening. For those patients, acknowledging concerns and discussing options is key. Colorectal cancer is unique in that we have various screening options to offer patients at average risk, including noninvasive tests such as multitarget DNA (Cologuard, Exact Sciences) that can be used at home, in addition to traditional colonoscopies. Discussing the option of an at-home test can help people aged 45 years and older stay up to date with screening and avoid concerns about potential exposure to COVID-19. Having conversations with patients about the measures that physician offices and hospitals are taking to prevent the spread of COVID-19 is also important.

We must do everything we can to ensure that patients avoid skipping or delaying routine colorectal cancer screening — even in a pandemic. Colorectal cancer is considered largely treatable when caught in its earliest stages, resulting in a 90% 5-year survival rate compared to just 14% when caught in a late stage (stage 4). For primary care physicians, using every opportunity to close screening gaps is essential, and telemedicine can be a useful tool. Virtual visits are an ideal time to inform patients about the importance of routine cancer screenings and to reinforce that early detection can save lives. When we have such discussions with our patients and outline options for screening, we empower them to play a meaningful role in our effort to combat colorectal cancer.

Every telemedicine visit can be a preventive health visit

The pandemic’s disruption of cancer screenings should reinforce that we must continue to address all aspects of our patient’s health at every opportunity — diseases such as cancer do not stop just because a pandemic is underway. Many of our patients are behind on their routine cancer screenings and want to delay screening until spring or summer when they believe the pandemic will be over. For those patients, we must make it clear that regular, on-time screening is critical. Screening can prevent colorectal cancer through the detection and removal of precancerous polyps before they can advance, as well as detect cancer in its early stages before it spreads, when it is more easily treatable. The pandemic has transformed the health care landscape, and physicians should use every opportunity — whether an in-person visit or a telehealth visit by phone or video — to prioritize preventive health measures.

References:

• American Cancer Society. Facts & figures 2021 reports another record-breaking 1-year drop in cancer deaths. https://www.cancer.org/latest-news/facts-and-figures-2021.html. Accessed March 12, 2021.
• American Cancer Society. Key statistics for colorectal cancer. https://www.cancer.org/cancer/colon-rectal-cancer/about/key-statistics.html. Accessed March 12, 2021.
• Epic Health Research Network. Delayed cancer screenings. https://ehrn.org/articles/delays-in-preventive-cancer-screenings-during-covid-19-pandemic/. Accessed February 5, 2021.
• Epic Health Research Network. Delayed cancer screenings – a second look. https://ehrn.org/articles/delayed-cancer-screenings-a-second-look/. Accessed February 5, 2021.
• Sharpless NE. Science. 2020;doi:10.1126/science.abd3377.
• NIH. Cancer stat facts: Colorectal cancer. National Cancer Institute. https://seer.cancer.gov/statfacts/html/colorect.html. Accessed January 29, 2021.
• Siegel RL, et al. CA Cancer J Clin. 2021;doi:10.3322/caac.21654.