REAL WORLD DATA SUPPORTS POST-PANDEMIC CONTINUATION OF TELEMEDICINE SURVEILLANCE VISITS FOLLOWING RESECTION OF COLORECTAL LIVER METASTASES

ABSTRACT

INTRODUCTION The purpose of surveillance after resection of colorectal liver metastases (CLM) is to detect and treat recurrence using axial imaging, biomarker measurement, and a history/physical examination. In response to COVID-19 pandemic, telemedicine was used as a risk mitigation strategy to replace in-person visits, including for cancer surveillance. The objective of the study was to measure the uptake of telemedicine for cancer surveillance and outcomes following telemedicine surveillance after resection of CLM. METHODS Data from a prospective database was combined with real world data obtained from electronic health records using a cloud-based, data integration tool (Palantir Foundry) to identify patients in active surveillance following first surgical resection for CLM between April 2017 and April 2021. Telemedicine surveillance visit was defined as a follow-up visit >90 days following surgery using video or telephone. Recurrence was defined as detection of a new lesion. Bivariate statistical testing was performed using Student's t-test or chi-squared test. Retrospective chart review was used to validate identification of recurrence using the Foundry platform (100% interobserver agreement). RESULTS A total of 1,057 surveillance visits (306 patients) met our inclusion criteria. Prior to April 2020, 0% (0/686) visits utilized telemedicine. After April 2020, an average of 47.3% of visits per month utilized telemedicine (range 33.0 – 69.0%). The overall rate of identifying a recurrence during surveillance visit was 18.1% (191/1,057). There was no difference when comparing detection of recurrence using in-person (17.6%, 154/872) versus telemedicine visits (20.0%, 37/185, P=.371). The management of recurrence did not differ whether it was identified with an in-person or telemedicine visit;surgery, 36 (23%) vs. 10 (27%);ablation, 26 (17%) vs. 8 (22%);systemic therapy, 83 (54%) vs. 16 (43%);other, 9 (6%) vs. 3 (8%), respectively (P=.699). CONCLUSION Telemedicine was used in almost half of surveillance visits for CLM during the COVID- 19 pandemic. Detection and treatment of recurrence was similar for both telemedicine and in-person visits. Telemedicine-based follow-up is a safe and effective approach for surveillance after resection of CLM, supporting continued utilization beyond the pandemic.