Cancer care in the age of telemedicine

“You have can­cer.” These are the words no one ever wants to hear. But thanks to the pan­dem­ic, many peo­ple in the past year have received this earth-shat­ter­ing news via a tele­phone or video call. 

Before Covid-19 struck, just one in 10 health­care providers saw patients via telemed­i­cine meth­ods, accord­ing to Ipsos Mori. Now it’s about sev­en in 10 in some areas of med­i­cine. 

The past year’s adop­tion of telemed­i­cine – plus the need to tack­le the unprece­dent­ed back­log of cas­es fac­ing the NHS – mean more of us are like­ly to be told of and treat­ed for can­cer through a phone or lap­top screen in the future. 

“We all have the train­ing mantra from med­ical school of ‘you have those dif­fi­cult con­ver­sa­tions in per­son to be able to read the body lan­guage and make sure things are okay’,” says Richard Roope, a GP and Can­cer Research UK pri­ma­ry care advi­sor. But deal­ing with the pan­dem­ic and the con­straints Covid put on the health ser­vice mean that hasn’t always been pos­si­ble. 

“Covid has taught us all a new skill, which is to give bad news over the phone, because some­times there hasn’t been anoth­er option,” Roope adds.

While the sup­port­ive hand on the shoul­der will nev­er go amiss, some patients, par­tic­u­lar­ly those who have already received the bad news and are on their treat­ment jour­ney, have found it a boon. 

“We were real­ly con­cerned that it would have a real­ly bad impact on patients and fam­i­lies,” says Robin Jones, a con­sul­tant med­ical oncol­o­gist at The Roy­al Mars­den Hos­pi­tal NHS Trust in Lon­don. “But I think, on a pos­i­tive note, it real­ly helped some peo­ple.”

A matter of convenience

When the pan­dem­ic struck, three quar­ters of Jones’s planned face-to-face appoint­ments at the Roy­al Mars­den Hospital’s sar­co­ma unit became vir­tu­al. Those that remained in-per­son were the most press­ing cas­es: patients who had to urgent­ly begin their ther­a­py or an assess­ment of the per­for­mance sta­tus of treat­ment. 

Jones end­ed up sur­vey­ing his patients about the use of telemed­i­cine. Per­haps sur­pris­ing­ly, he found they enjoyed the expe­ri­ence, rank­ing telemed­i­cine con­sul­ta­tions at nine on a 10-point scale. Pre­vi­ous­ly, the aver­age patient at the hos­pi­tal trav­elled one and a half hours to make their appoint­ment, per­haps explain­ing their enthu­si­asm to see a spe­cial­ist from the com­fort of their own home.

With pub­lic trans­port still a risky propo­si­tion for many, par­tic­u­lar­ly those under­go­ing treat­ment who may be immuno­com­pro­mised, and taxis or car park­ing charges quick­ly rack­ing up, the con­ve­nience of a quick Zoom call can out­weigh the imper­son­al touch. 

But besides the con­ve­nience, the loca­tion in which you’re told the news could make telemed­i­cine a pre­ferred solu­tion for can­cer treat­ment going for­ward.  Hos­pi­tals, iron­i­cal­ly, can often be inhos­pitable places; many have well-found­ed fears of find­ing them­selves with­in their walls. 

Roope can see how a safe, com­fort­ing and known envi­ron­ment could be a salve dur­ing trau­mat­ic times in med­ical treat­ment. It allows the sup­port unit that will help car­ry a can­cer patient through their treat­ment – and the highs and lows – to be clos­er when bad news arrives.

“The option of being at home with mul­ti­ple mem­bers of the fam­i­ly, a lot of peo­ple found that a bet­ter way,” agrees Jones. “Some found it a real­ly use­ful change.” 

Adapting telemedicine for the future

Ipsos Mori found that three quar­ters of doc­tors say they will con­tin­ue with vir­tu­al vis­its post-pan­dem­ic, includ­ing for can­cer treat­ment. While it’s not for every­body, “hav­ing the option of telemed­i­cine con­sults is real­ly good for some peo­ple”, says Jones. 

For those who are deep into their can­cer jour­ney and under­go­ing rou­tine appoint­ments, the con­ve­nience of telemed­i­cine appoint­ments can hold appeal. But for key flash­points in the course of treat­ment, it’s still impor­tant for patients to be able to look into the eyes of those break­ing bad news. 

“If we look at the whole patient path­way, we’ve seen the rise in phone triage in pri­ma­ry care,” says Roope. “That’s forced us to think about path­ways and whether what we’ve done is the best way to do things.” 

He cau­tions that telemed­i­cine doesn’t always pick up some of the most urgent cas­es because doc­tors miss impor­tant con­text when they lose the face-to-face ele­ment. Patients can give away tell-tale signs of con­cern in a clin­ic or GP’s surgery that could trig­ger an urgent refer­ral, some­thing that might more eas­i­ly be hid­den by the con­trolled gaze of a Zoom call. 

“Very often you can pick up something’s awry from the patient’s demeanour because you know them,” Roope says. It’s the gestalt — the over­all view of a patient — that is often key.

Yet despite its pit­falls, there are plen­ty of plus points to the tele­health rev­o­lu­tion. Jones is fur­ther inves­ti­gat­ing how telemed­i­cine can be used and when it’s most rel­e­vant for patients. 

“Some­one who’s had mul­ti­ple treat­ments with us and knows us real­ly well is prob­a­bly more pre­pared to have a tele­phone con­sult, rather than a face-to-face con­sult,” he says. 

Doc­tors will have to learn new skills, such as triag­ing and pick­ing up prob­lems through dig­i­tal and phone con­tact with patients. Most impor­tant­ly of all, they’ll have to decide when to direct patients to phys­i­cal meet­ings. 

“That will be a new skill,” says Roope: know­ing “when to bring patients in”.