Telehealth vs. physical examination during COVID-19 in gynaecologic cancer survivors

June 2022 Covid-19 Andrea Enguita

Telehealth has been widely adopted during the SARS-CoV-2 pandemic, and some of its elements will likely be integrated into long-term cancer care. This study assessed patient perception of telehealth among gynaecologic cancer survivors. Although these patients were satisfied with the telehealth care they received, the majority thought a physical examination was critical to detect cancer recurrence.

Convenience, decreased costs, and reduced perceived distress are some of the benefits of telehealth. Telehealth has been widely adopted during the SARS-CoV-2 pandemic, and some of its elements will likely be integrated into the long-term cancer care. However, the preferences of cancer patients regarding telehealth are unknown, and may vary depending on individual circumstances. This study assessed patient perspectives on telehealth among gynaecologic cancer survivors and explored factors associated with the interest in continuing telehealth. The authors hypothesised that patients with a preference for telehealth would be those with great concern about the pandemic, or with a primary cancer with reliable tumour markers for progression/recurrence. In contrast, older patients without access to technology and patients who view a physical exam as critical would prefer in-person visits.

Study design

This study included patients from the ongoing Gynaecologic Oncology-Life after Diagnosis (GOLD) study. This study recruited individuals between 2017 and 2020, ≥ 18 years, and with treated gynaecologic cancer. After closing the recruitment, the cohort was transitioned from longitudinal surveys to a cross-sectional design, with approximately biannual one-time surveys on specific research questions. 316 patients (out of 457) were alive in May 2021 and invited to complete a cross-sectional survey regarding telehealth use during the SARS-CoV-2 pandemic, and their preferences for gynaecologic cancer care hereafter. A total of 199 (63.0%) participants completed the survey, with 188 providing sufficient data for this analysis.
The University of Minnesota Gynaecologic Oncology clinics converted almost all survivorship visits to telehealth starting March 2020, except for patients with cervical and lower genital tract malignancies where physical examination was deemed imperative. This study described cohort characteristics, use of, preferences for, and satisfaction with telehealth visits, and perceived importance of a physical exam. Two categories of patients were defined: those favouring an in-person-only care model vs. those favouring telehealth alone or in combination with in-person care.

Results

The median age of the patients was 64.1 years. Most participants were not currently receiving cancer treatment, had access to reliable transportation and technology enabling telehealth, and felt confident in using telehealth technology. Among those who used telehealth, at least 80.3% were satisfied with the experience. Most patients agreed that it saved time (75.7%) and was easier (61.4%) compared with in-person visits. Greater difficulty building a relationship with their provider (29.8%) was the most cited disadvantage of telehealth, while not having to travel (45.2%) and greater ease of scheduling around other obligations (30.3%) were frequently mentioned advantages.

A majority (53.7%) preferred exclusively in-person visits for their cancer care and surveillance. A few preferred telehealth exclusively (1.6% telephone, 1.6% video visits). Those who were younger (<65 years old), had used telehealth during the pandemic, or were on active treatment, were more likely to consider continuing some telehealth in the future. Around half (58.8%) of participants considered a physical examination critical to detecting recurrence. The concern that their provider may miss something during telehealth visits was more common (43.9% vs 19.5%) among those who preferred in-person visits only. Patients who had undergone imaging for cancer surveillance or monitoring of tumour markers were more open to continuing telehealth visits as part of their care. Primary cancer site and concerns about contracting SARS-CoV-2 were not associated with preference for future visit modalities.

Conclusion

Although most gynaecologic cancer survivors were satisfied with the telehealth care they received, the majority thought a physical examination was critical to detect cancer recurrence. Concern that their provider may miss something during telehealth visits was greater among those who preferred in-person visits. With many gynaecologic cancer survivors preferring in-person care, building a future care model that includes telehealth elements will require adaptations, careful evaluation of patient concerns, as well as patient education on telehealth.

Reference

Quam N, Stenzel AE, Brown K, et al. Perception of Telehealth During the COVID-19 Pandemic Among Survivors of Gynecologic Cancer. Oncologist. 2022;oyac041.

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