The Impact of Virtual Cancer Care on Chemotherapy Delivery and Clinical Outcomes in Colorectal Cancer Patients Receiving Systemic Therapy: A Pre- and Intra-Pandemic Analysis

Abstract

(1) Background: The coronavirus 2019 pandemic has resulted in an abrupt transition to virtual oncology care worldwide. This study’s objective is to evaluate chemotherapy delivery and clinical outcomes in patients on systemic treatment for colorectal cancer before and during the pandemic. (2) Methods: Clinical data was collected on patients with colorectal cancer receiving intravenous chemotherapy at The Ottawa Hospital from June 2019 to March 2021. Patients were stratified by whether they were started on chemotherapy pre-pandemic (June 2019–January 2020) or intra-pandemic (February 2020–March 2021). Multiple regression analysis was used to compare outcomes between pandemic periods; (3) Results: There were 220 patients included in this study. The proportion of virtual consultations (1.2% to 64.4%) and follow-up visits (5.2% to 83.3%) increased during the pandemic. There was no difference in the incidence of treatment delays (OR = 1.01, p = 0.78), chemotherapy dose reductions (OR = 0.99, p = 0.69), emergency department visits (OR = 1.23, p = 0.37) or hospitalizations (OR = 0.73, p = 0.43) between pandemic periods. A subgroup analysis revealed no difference in outcomes independent of the presence of metastases; (4) Conclusion: These findings serve as an important quality-care indicator and demonstrate that virtual oncology care appears safe in a cohort of high-risk colorectal cancer patients.

Patient Safety and Satisfaction With Fully Remote Management of Radiation Oncology Care

“…The authors found no differences in rates of serious side effects, hospital admissions, or mortality between groups . Similar studies demonstrated that safety, efficiency, and outcomes were preserved during the COVID-19 era among patients treated with systemic therapy managed via telemedicine . To our knowledge, this study represents the first investigation of the safety of remote care among a cohort of patients treated with radiotherapy.…”

“…35 Similar studies demonstrated that safety, efficiency, and outcomes were preserved during the COVID-19 era among patients treated with systemic therapy managed via telemedicine. 36,37 To our knowledge, this study represents the first investigation of the safety of remote care among a cohort of patients treated with radiotherapy. Although the rate of safety events per patient (ie, 765 total events, 0.27 events per patient per year) seems high, it reflects the culture of safety within our department and highlights the widespread adoption and ease of use of our patient safety reporting system.…”

Virtual Care for Patients with Advanced Well Differentiated Gastroenteropancreatic Neuroendocrine Tumor (GEP-NET)

“…Most patients with unresectable advanced disease can initiate first-line SSA therapy and avoid more intensive treatments such as chemotherapy, targeted agents or PRRT until progression [13,14]. Although virtual care has been shown to be safe in patients undergoing active treatment and even combination intravenous chemotherapies, its role is felt to be greatest in patients with a stable clinical status [15][16][17]. GEP-NETs may be well suited for virtual care under this principle.…”

“…Virtual care provides flexibility to patients and can reduce the time away from work, family and other commitments. It also seems to be safe, even in patients undergoing active treatment for cancer, although high-quality data are lacking [16]. From a system standpoint, virtual care is efficient and cost-effective [7,22].…”