ABSTRACT
Aims: To understand consumer and clinician experiences in utilizing telehealth in cancer care since the introduction of newMedicare Benefits Schedule (MBS) item numbers for telehealth in response to the COVID-19 pandemic. Method(s): A mixed-methods approach was used to collect qualitative and quantitative data on telehealth use during the pandemic: MBS services for cancer-related professional attendances were examined by delivery type, provider type and population group. Health service staff (n = 59) and consumers (n = 1162) from cancer services acrossAustralia were invited to complete online surveys and semi-structured interviews about the use of video and telephone telehealth, perceived effectiveness of video and telephone compared to in-person consultations, and the key barriers and enablers. A virtual roundtable was held with more than 40 key cancer control stakeholders regarding strategies to support the cancer community to offer and utilize best practice approaches to telehealth. Result(s): Telehealth was used across all stages of the cancer care pathway, and was most frequently used during the 'treatment' and 'care after initial treatment and recovery' stages. Although video consults were perceived to be more effective than telephone consults, telephone use was more frequent. Patients and their carers often felt less engagedwith their clinician during telephone consults and perceived that they were rarely given a choice between the consultation modes. Key enablers included medical leadership and administrative support, remuneration (MBS telehealth items), reduced risk of infection, reduction in travel time and costs and existing relationship between patient and clinician. Key barriers included inadequate infrastructure, lack of training, access issues (e.g., internet connectivity) and not being offered the choice of a video consultation. Conclusion(s): Telehealth is appropriate for the delivery of cancer care. A hybrid model of care (telehealth and in-person options) and the ability to give consumers choice is integral to supporting best practice telehealth in cancer care.
ABSTRACT
Aims: Cancer clinical trials have traditionally been conducted inperson. The COVID-19 pandemic accelerated changes across the entire cancer care continuum, including in clinical trials and teletrials. This study aimed to investigate how telehealth was used in cancer clinical trials during the pandemic, including benefits and barriers to use;and to identify how telehealth can be further enhanced and routinely integrated into cancer clinical trials in Australia. Method(s): A mixed methods approach was used, involving a scoping review of literature, surveys of staff from 14 multi-site Collaborative Cancer Clinical Trial Groups across Australia (n = 98), and qualitative interviews with trial administrators and clinicians (n = 21). Result(s): The literature showed exponential increase in the use of telehealth in cancer trials internationally during the pandemic. Most study participants agreed that telehealth enabled continuation of trials which may have otherwise been postponed or terminated due to the pandemic. Participants indicated strong willingness to use telehealth for certain aspects of trials due to benefits including improved efficiencies in recruitment and consent processes;improved equity of access for people in rural and regional areas;expedited ethics reviews;convenience of e-prescriptions and reduced need for travel. Barriers included technology issues, inequitable access, activities requiring inperson attendance, regulatory obstacles, remote site capabilities, data quality and security issues, lack of training, and resistance to change. Conclusion(s): The rapid shift to telehealth models during the pandemic was viewed positively by participants, with increased innovation and efficiencies.Many, but not all, aspects of cancer clinical trials are appropriate to be delivered via telehealth. Telehealth is most appropriate in later phase trials;for oral (not IV) drugs;and for activities not requiring physical examinations or invasive interventions. Participants preferred hybrid models which include both telehealth and in-person methods, tailored by cancer type, interventions and patient preferences;supported by clear guidelines and staff training.
ABSTRACT
Introduction: The Covid-19 pandemic in the UK led to much un-certainty about the delivery of cancer services. A shift from established therapy (and its timing) in patients with Muscle invasive Bladder Cancer (MIBC) has potential deleterious consequences. To understand outcomes, we formed a collaborative to measure overall and diseasefree survival at 3-years in patients with non-metastatic MIBC (Figure 1) treated during the UK's first wave of Covid-19. Secondary aims included comparison between treatment modalities and pre-Covid controls. Patients and Methods: The collaborative included clinicians from 13 major centres, representing 3 UK nations. A prospective clinical audit, endorsed by the National Cancer Research Institute, was started to collect comprehensive data. MIBC patients discussed at the multidisciplinary meeting (MDM) between 1/3/2020-30/06/2020 were included. Results: At submission, data were available from 12 centres for 299 patients. The mean age was 69.3 years (27- 90), and there were 72 female and 227 male patients. Mean Charlson Co-morbidity Index was 5 (1-12). Preliminary analysis of available data indicate the following: MDM recommendations for (at least) 1 in 4 patients were deemed as being modified from standard practice. Twenty six patients received neoadjuvant chemotherapy. In total (from available data), 99 received radical radiotherapy and 146 underwent radical cystectomy (65 and 74 specified as open and robotic assisted, respectively). Preliminary analysis suggests that 1 in 3 patients had died within 1 year. Conclusions: Preliminary Results indicate that recommendations for MIBC patients were significantly altered consequent to the pandemic and mortality was high. Analyses towards endpoints are awaited.
ABSTRACT
INTRODUCTION: Telemedicine provides remote clinical support through technology tools. It can facilitate medical care delivery while reducing unnecessary office visits. The COVID-19 outbreak has caused an abrupt change in our daily urological practice, where teleconsultations play a crucial role. OBJECTIVE: To provide practical recommendations for the effective use of technological tools in telemedicine. MATERIALS AND METHODS: A literature search was conducted on Medline until April 2020. We selected the most relevant articles related to «telemedicine¼ and «smart working¼ that could provide valuable information. RESULTS: Telemedicine refers to the use of electronic information and telecommunication tools to provide remote clinical health care support. Smart working is a working approach that uses new or existing technologies to improve performance. Telemedicine is becoming a useful and fundamental tool during the COVID-19 pandemic and will be even more in the future. It is time for us to officially give telemedicine the place it deserves in clinical practice, and it is our responsibility to adapt and familiarize with all the tools and possible strategies for its optimal implementation. We must guarantee that the quality of care received by patients and perceived by them and their families is of the highest standard. CONCLUSIONS: Telemedicine facilitates remote specialized urological clinical support and solves problems caused by limited patient mobility or transfer, reduces unnecessary visits to clinics and is useful to reduce the risk of COVID-19 viral transmission.