Telemedicine-supervised cancer therapy for patients with an aggressive lymphoma and metastatic lung cancer in the U.S. Veterans Affairs National TeleOncology Service.

Abstract

1602 Background: Telemedicine is increasingly used in cancer care but has mostly been applied to surveillance and oral therapy rather than parenteral treatments. In the U.S. Veterans Affairs National TeleOncology service (NTO), patients receive intravenous cancer treatments locally under remote supervision from a disease-specialized oncologist. We analyzed care delivered by the NTO for patients with an aggressive lymphoma (AL) and metastatic lung cancer (mLC). Methods: The demographics of veterans with AL and mLC enrolled in NTO between 2020-2023 were compared to patients receiving in-person care at the VA. From these NTO cohorts, two subsets of patients receiving 1st line therapy for diffuse large B cell lymphoma (DLBCL) and stage IV non-small cell lung cancer (NSCLC) were extracted and compared to control arms of in-person care matched 1:4 by stage, age, PDL1 (NSCLC), and cytogenetics (DLBCL). Fisher’s exact test was used for categorical variables, t test for continuous variables, log rank for survival, and negative binomial for count outcomes. Results: 140 patients with AL or mLC (40 DLBCL, 13 Hodgkin, 2 Burkitt, 61 NSCLC, 24 SCLC) were enrolled in NTO, spanning 12 U.S. states. Compared to in-person care ( n = 7,561), NTO had more rural (56% vs. 34%, p < 0.001) and white patients (89% vs. 77%, p = 0.002). With a median follow-up of 256 days (IQR, 154 - 415), NTO mLC and AL patients had a median of 15 and 17 telemedicine visits, respectively. 13 of 55 AL (24%) and 56 of 85 mLC (66%) patients received systemic therapy of any line, while 38 (69%) of AL were on surveillance. 7 mLC and 2 AL patients were referred externally for care. 11 patients with DLBCL and 30 patients with stage IV NSCLC started 1st line therapy while in NTO, which were compared to matched controls. NTO and matched control had similar mean time from referral to first appointment and from diagnosis to first treatment. There were no significant differences in progression-free survival between NTO and matched controls for NSCLC (HR 1.1, 95% CI 0.7-1.8) or DLBCL (HR 0.5, 95% CI 0.1-2.3). COVID infections in the first 12 months and number of ED visits in the first 3 months of treatment were not statistically different from controls. Conclusions: The NTO service demonstrates the feasibility of infusional chemoimmunotherapy administration under the direction of a remote tele-oncologist. This model has the potential to improve access to specialized oncology care for rural populations and provides a framework for decentralized clinical trials.[Table: see text]