Physician Perspectives on Telemedicine in Radiation Oncology

Telemedicine enthusiasm and uptake in radiation oncology rapidly increased during the COVID-19 pandemic, but it is unclear if and how telemedicine should be utilized after the COVID-19 public health emergency (PHE) ends. Despite ongoing COVID-19 risks and public payer support for telemedicine, several private payers have stopped reimbursing telemedicine weekly see video visits. We performed a large single-institution assessment of provider perspectives on telemedicine after we had achieved a more mature level of adoption to better understand factors considered when determining to use telemedicine and to estimate the percent of visits that could be safely performed with telemedicine. We distributed a survey to all radiation oncology attendings at our large academic institution in October 2021 to assess satisfaction, facilitators, and barriers to telemedicine implementation. We performed quantitative and qualitative analyses to characterize satisfaction and to identify factors influencing whether telemedicine is employed. For the qualitative analysis, two authors independently coded open-ended survey responses and identified categories and themes following established content analysis methodology. We calculated the average proportion of visits that providers expected could be appropriately performed with telemedicine without a clinically significant decline in the quality of care for each disease site and visit type. 60 of 82 eligible radiation oncologists (73%) responded to the survey. 78% of respondents were satisfied with telemedicine in the radiation oncology department, and 83% wished to continue offering video visits after the COVID-19 PHE ends. Common reasons providers endorsed for wanting to integrate telemedicine into practice included: patient and provider preference, increased access to care and clinical trials, allowing for greater relationship with the care team, and improved clinical safety, efficiency, and quality. Patient factors influencing whether physicians offer telemedicine included the patient's travel burden, patient preferences, and whether a physical exam is required. About 20% of new consultations and 50% of weekly management visits were estimated to be clinically appropriate for telemedicine. Central Nervous System/Pediatrics and Thoracic faculty considered telemedicine appropriate for the greatest proportion (50%) of new consultations. 93% of respondents felt comfortable determining whether telemedicine was appropriate. Surveyed radiation oncologists were satisfied with telemedicine in their practice and wished to continue offering video visits in the future. Although provider perceptions of clinical appropriateness of telemedicine varied widely based on disease site and visit type, providers felt comfortable determining when telemedicine would be appropriate for patients. Our data suggest payers should continue to support this patient-centered technology. [ FROM AUTHOR] Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

NCI's national treatment trial networks: Experience and adaptations during COVID-19

Background: The National Cancer Institute supports several national trial networks which responded rapidly to the COVID-19 pandemic to overcome operational barriers to clinical cancer research. The National Clinical Trials Network (NCTN) focuses on late phase treatment trials, while the Experimental Therapeutics Clinical Trials Network (ETCTN) conducts early phase treatment trials. We report findings on the experience and adaptations of these networks during COVID-19. Methods: Using 2019 and 2020 accrual data, we analyzed changes in accrual levels and demographics. We also evaluated changes in trial activation numbers and timelines. In July 2020, we surveyed 255 investigators from academic and community sites to assess changes in research practices and get feedback on modified processes implemented by NCI to address trial conduct during the pandemic. Results: Accrual across the NCTN and ETCTN fell significantly in midMarch 2020, dropping from a weekly average of 307 patients in February to 169 the week of March 23-29. Accrual began to recover in June and July but did not return to pre-pandemic levels until September. Accrual in November and December 2020 followed the patterns seen in 2019, with short-term drops around major holidays. Non-White participants were enrolled to NCTN and ETCTN trials at similar monthly rates throughout 2019 and 2020, with slightly higher overall enrollment in 2020 (23.7% vs. 22.7%). New trials continued to be developed and activated throughout 2020. Between 2017 and 2019, an average of 71 trials were activated per year (NCTN = 46, ETCTN = 25), compared to 84 activated in 2020 (NCTN = 58, ETCTN = 26). The average time to trial activation was similar or slightly longer in 2020 compared to 2019. The investigator survey yielded 111 responses (43.5% response rate). 43% of respondents' sites paused enrollment to phase 1 trials during the pandemic, compared to 18% for phase 3 trials. Many sites temporarily stopped opening new trials and processing specimens. Sites were more likely to keep enrolling to trials offering clear potential benefit and pause complex trials that required more patient contact. Respondents attributed some of the decline in accrual to a reduction in overall patient volume, increased patient concerns, and reduced research staff on site. Respondents were asked to rate the usefulness of modified trial processes NCI put in place during the pandemic. Telehealth was rated most useful (avg. 4.6/5), followed by shipping oral IND agents to enrolled patients (4.5/5), remote informed consent (4.2/5), coordinating care with local providers (3.9/5), and remote auditing (3.7/5). Conclusions: The cancer trials community has an opportunity to learn from working through the challenges of COVID-19. NCI will seek to continue and expand on modifications to clinical trial processes that have the potential to improve operational efficiency, reduce cost, and help bring trials to more patients.