Supporting best practice telehealth in cancer care: Findings from a national study of telehealth use by cancer services and consumers during the COVID-19 pandemic

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.

Telehealth use in cancer clinical trials during the COVID-19 pandemic

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.