Addressing rural disparities in cancer care via telehealth.

Abstract

e19090 Background: Patients in rural areas have reduced access to high-quality cancer care, which contributes to rural-urban disparities in cancer mortality. Telehealth technologies can connect providers across rural and urban communities. Methods: In 2006, one author (LH) established an oncology program in Truckee, CA, a rural community with a single critical access hospital without oncology services. The program joined with 4 other facilities comprising the UC Davis Cancer Care Network, a central element being daily participation in structured virtual tumor boards addressing the four sites (colorectal, prostate, lung, & breast) that compromise ~80% of all cancer diagnoses. Remote telemedicine clinics outside the primary catchment area were also established to serve the mountain communities of Quincy, Portola, Loyalton, and South Lake Tahoe, CA. We assessed the reach and quality of the cancer program through referrals, in-migration, clinical trial accruals and accreditations. Results: The combination of virtual tumor boards and telehealth clinics associated with growth of the program to 3 medical oncologists, 1 radiation oncologist and expansion into a 20,000 ft2 facility. Total new patient visits, the percent of patients coming from zip codes outside of the primary catchment area, clinical trial enrollments, and quality accreditations steadily increased (Table). The program is accredited by the Commission on Cancer with commendation, ASTRO’s APEX, ASCO’s QOPI and CancerLinq programs, and is a G02Foundation for Lung Cancer Community Center of Excellence. Conclusions: We termed the knowledge dissemination that occurs through a telehealth connected rural oncology program involving a Comprehensive Cancer Center partner and disseminated rural telemedicine nodes a “synaptic knowledge network.” In this implementation, it enhanced the reach and quality of care as measured by volume, in-migration, clinical trial activity, and national quality accreditations. Application of synaptic knowledge networks to other rural sites is a promising strategy to reduce rural-urban disparities in cancer care. [Table: see text]

Cancer Patients’ Experiences with Telehealth before and during the COVID-19 Pandemic in British Columbia

“…Our findings support the reduction of the rural-urban disparities in cancer care through the use of telehealth by improving health care access in rural communities [ 48 , 49 ]. Cancer-related symptoms (e.g., pain and discomfort) impose mental and physical hardship to patients, which may make traveling to access cancer care challenging.…”

Disparity in cancer survivorship care: A cross-sectional study of telehealth use among cancer nurses in Australia

“…Although the services within the Primary Care Package will only be available until 30 September 2020 (unless extended), it is reasonable to conclude that the learnings to be gained by the unprecedented accelerated use of telehealth during this time will be critical to inform the development and routine implementation of telehealthfacilitated cancer survivorship care. Indeed, where there has been significant investment in infrastructure, clinician upskilling and telehealth models of care coordination in United States and Canadian cancer contexts, consultations between oncology clinicians and patients have shown high levels of satisfaction ( Heifetz et al, 2020 ;Williams, Aspden, Stetson, & Otto, 2020 ).…”

Cancer Australia consensus statement on COVID‐19 and cancer care: embedding high value changes in practice

“…The pandemic led to an unprecedented uptake in telehealth within Australia. Telehealth offers benefits regarding choice, convenience and safety for both patients and clinicians, 3 and potentially reduces rural–urban disparity in cancer care 4 . However, uptake of telehealth was impacted by administrative and coordination challenges, and software and network issues.…”

“…Establishing communication linkages, including technical capabilities to allow rapid data transfer, to enable team preparation and participation, integrate decision making, and implement comprehensive care 17 Evaluating the extent to which virtual MDTs affect patient outcomes and improve guideline adherence compared with traditional face‐to‐face MDTs, and evaluating the effectiveness and cost‐effectiveness of virtual MDTs in urban settings, to supplement established evidence in rural settings 4 …”