Virtual Oncology in the Time of COVID-19 Pandemic: Moving Forward!

At the start of 2020, it was not imaginable to conduct a full clinical visit with cancer patients, hearing their concerns, discussing their disease status, and making management plans without being with them in the same room. In March 2020, forced by the Coronavirus Disease 2019 (COVID-19) pandemic, which impacted many countries around the world in a few short months, we had to resort to an unconventional approach to practice medicine in response to this defining crisis of healthcare. Yet, after going through multiple virtual sessions with our patients, we realized that the new framework is worth studying, with the goal of incorporating innovative approaches into our future standard practice of oncology.¹ 

We can list multiple benefits to this approach, which will justify its adoption into the mainstream of oncology practice. We are not suggesting that it should always be applied for all patients with cancer; that is not realistic. As we know, patients with cancer face a life-threatening disease that affects all aspects of their lives, with a plethora of physical, psychosocial, and financial challenges. However, using a telemedicine approach, when performed correctly, may be of great benefit to the patients themselves, their families, and to the healthcare system. There are multiple potential applications for this approach in cancer care.² 

Reflecting on our recent experience, we can think of many scenarios that can serve patients better at home without the need for an office visit with its associated challenges and inconveniences and obvious lack of social distancing in times of epidemics (Table 1).

In terms of tools for connecting with patients, having video conferencing abilities may be better for connecting with patients, but since video meetings are not essential in our field ; a regular phone call may suffice. However, with booming choices for video conferencing, it is not difficult to find a reliable and practical platform.

The ability to conduct a remote (telehealth) office visit with patients creates multiple options for valuable services such as close follow-up after treatment cycles or discharge and reassessment of pain control, other symptoms, or potentially adverse events. The latter is even more critical for palliative and end-of-life care; sparing the patient a clinical visit and substituting a physical home visit by home health teams will enable the teams to serve more patients.³ 

This technology may serve another important purpose, namely, hospitalized patient visitation by family members who cannot visit them because of isolation or distance. Video conferencing arranged by the staff can connect patients with their loved ones. Furthermore, physicians can use the technology to have conferences with family members who cannot be physically present to discuss the condition of their patient, discuss goals of care, and make a shared decision.

Global oncology is an emerging field that facilitates access to international experts who can help their colleagues build programs, projects, or address local challenges that require special expertise. It can be used to build local capacity via mentoring, education, and consultation.⁴  The utilization of telehealth in oncology has the potential of closing the gap in cancer care in low- and middle-income countries and should be systematically explored by all stakeholders.

Major travel restrictions imposed during the COVID-19 pandemic, in addition to inherent problems with domestic or international travel for advanced medical care, necessitates remotely based second-opinion services, where the patient's records laboratory, and imaging results are reviewed electronically and recommendations provided in a timely fashion via a virtual consultation.

Multidisciplinary tumor boards are critical for optimal cancer care, and it is mandatory for the tumor board to discuss all new cancer cases in some countries. Many of the institutional tumor boards went virtual during the pandemic, a trend that is likely to continue afterwards to enable better participation of board members. It would enable even other healthcare professionals to join, such as the primary care physicians of the patients whose cases are presented. Virtual tumor boards were used before the pandemic; however, they were scaled up significantly during the pandemic and this will likely continue at a larger scale.

Clinical trials and research studies have encountered many challenges during the crisis, with inability to perform patient visits, required investigations, patient monitoring, and auditing/monitoring visits. Virtual solutions will address some of these issues, and some studies can be amended to allow a virtual approach when appropriate. For research projects to continue to completion, reengineering the process of conducting data and especially capturing patient-reported outcomes virtually should be scaled up significantly.

Finally, with the shift of all academic and educational institutions to online learning, oncology is no exception to the rule. Many educational and training activities in oncology can be conducted online in various formats. This will enrich the educational experience of learners by accessing a huge repository of online materials and convenient educational opportunities.

In summary, implementation of telehealth in oncology has been accelerated greatly by the COVID-19 pandemic, owing to concerns of infection and adherence to social distancing. We should spare no efforts in capitalizing on this experience to reach a “new normal” oncology practice that will meet the new challenges in healthcare delivery. This requires a critical look at all our practice patterns and at the development of new algorithms and work processes to select patients who are appropriate candidates for a telehealth visit. Issues related to reimbursement, licensing, credentialing, and technical issues with proper security and feasibility should be worked out to make telehealth part of mainstream practice.^4,5