How Telehealth is Changing the Field of Oncology
Today telemedicine is used throughout the medical field in order to help provide better care to patients. Telemedicine is a fast-growing healthcare segment and is estimated to grow 50 percent annually in the next few years. Currently in the U.S., 76 percent of hospitals are using virtual technology to help care for their patients.
telehealth oncology is the use of technology to provide better care to cancer patients and has become a big topic since a tele-oncology study was presented at the 2017 Annual Meeting of American Society of Clinical Oncology (ASCO). Telehealth oncology can help increase the quality and affordability of care for cancer patients, while giving them the convenience of staying home. It has changed the way physicians can diagnose, treat, and collect/share data for cancer patients.
Cancer itself can come in many shapes and forms, and this can often make it difficult for oncologists to diagnose cancer. In the past, physicians have been unwilling to share information between hospitals about patients. Now with the help of telemedicine and telehealth oncology, physicians are finding seamless ways to transfer data. This in fact, has been a hot topic at the ASCO meeting in Chicago. The new approach would require data to be uploaded to a database along with a patient’s molecular and genomic profile. Physicians would be able to share the treatment and outcomes of their treatments to this online portal. From there, physicians who have access to this database and compare their current patient to the information available from other patients with similar genetic makeup or cancer cases, of course all while following HIPAA cybersecurity protocol.
Unfortunately, there are issues when it comes to sharing data. Nearly every institution stores data differently for there is no clinical standard for how patient data is reported or stored internally. However, technology is allowing for larger data sets to be complied due to telemedicine and companies are providing these platforms for medical professionals, especially in the oncology space. For example, Providence St. Joseph’s Health and the University of Miami Health system currently use a platform called Syapse. Syapse is a database system that allows the sharing cancer patient and oncology data at a national level. In using this technology, and others like it, oncologists can have more information than ever on this illness and others like it.
This type of data sharing can be beneficial to underrecognized cancers such as mesothelioma, which is usually more common in occupational workers due to toxin exposure on the job. Do to the rarer nature of this type of cancer, physicians treating mesothelioma are looking for any data they can find in order to compare it to their current patients. Unfortunately, it can be hard to come by in comparison to the more common cancers. By collecting and utilizing the common cancer as well as the rarer cancer data, patients who have unlikely cancers like mesothelioma, would have access to more information for basing their treatment direction.
Monitoring patients with cancer is vital to making sure treatments are working. Cancer treatments like chemotherapy, immunotherapy, radiation, etc., can all take a major toll on even a healthy person’s system. Telehealth oncology lends itself to at home cancer treatments and monitoring patients results after those treatments, through the help of technology from the comfort of their own homes. A study tested this out when they monitored cancer patients for 5 days post-chemotherapy. They measured the quality of the care and patient acceptance of the service to discover the feasibility of the service.
Patients were treated as outpatients so physicians could monitor their symptoms from the treatment so in turn they be treated and managed. Patients were asked to report their chemotherapy-induced nausea and vomiting (CINV) through virtual messaging after their chemotherapy treatment. They measured if the program was successful to treating the symptoms through the patient’s adherence, satisfaction, and the number of physician interventions. Through this they found that the majority (90 percent) were comfortable with the monitoring and found it to be helpful and that it was feasible monitoring CINV after chemotherapy.
Telehealth oncology is also allowing home-based chemotherapy to thrive. Through the aid of technology and an at home nurse, cancer patients are able to receive chemotherapy treatment from the comfort of their own homes. In fact, many patients are interested in this type of treatment and a study showed that cancer patients overwhelming preferred therapy at home. It showed that home-based cancer care let to reduced use of emergency services and decreased hospital administration, ultimately saving money for insurance agencies, hospitals, and patients alike.
Oncologists are able to have virtual communication with patients receiving the at home care, along with the at home nurses administering the treatment. Nurses then take vital signs and report back on the treatment as usual, for safety purposes. There are many benefits for this type of treatment, one being that patients reported better management of their symptoms and chemotherapy schedules. For providers they reported that the machines connected to patients to monitor and record, were more accurate. Furthermore, nurses were able to provide on-site education to patients at their homes, which reduced calls to the doctor’s office, freeing up time for physicians and waiting patients on site.
Telemedicine is currently being used in the U.S. but is more popularly used in higher-income countries like Japan on a more regular basis. Lower-income countries are also benefiting from telemedicine in order to get the proper care they need for both basic and chronic illness care. For the future of telemedicine and tele-oncology there are three distinctive areas of growth: reimbursement, technological advancements, and direct-to-consumer models.
Changes in reimbursement will help push growth for telehealth oncology practices. According to the Dee W. Ford, MD, MSCR from the Medical University of South Carolina, “2019 we will see continued and likely accelerated growth in telehealth activities as patients, providers, and health systems continue to embrace technology as one way to improve effectiveness and/or efficiency of care.” The start the idea to reevaluate reimbursement plans was sparked in 2018 when the CHRONIC Care Act and new billing codes for Medicare and Medicaid Services were passed. With this act allowing for new billing codes, services that were once not covered by Medicare or Medicaid will now have the opportunity to be covered. This will now inspire more physicians and healthcare providers to try new means of providing care including, telehealth oncology.
Efforts to expand the direct-to-consumer models are ways that telehealth oncology and telemedicine is appealing to the masses. This can help improve the quality of care while also reducing costs. In fact, management of chronic illness is a key area of growth that many telehealth providers are looking into expand. The continuing expansion of telemedicine for behavioral health will also continue to grow. 60 percent of Americans have at least one chronic illness, which account for 81% of hospital admissions. The unfortunate growth of chronic disease in the U.S. leaves for telehealth oncology other telemedicine technology to cater to those with serious illness. On average the treatment plans of those with serious illness is more aggressive and, in the future, we will be seeing more innovative treatment plans that bring care directly to the patients.
Technology has always been leading factor in medical advancements and telehealth oncology relies heavily on up and coming new technology. Everyday technology like video conferencing and sms messaging are what’s keeping telemedicine alive, but in the future, we are bound to see software like artificial intelligence make its way into virtual care practice. Artificial intelligence (AI) is a software that has the ability to learn and make inferences from the information given to it. Some of this technology has already been tested but is not used currently in medicine today.
Inception-v3 is an example of AI technology that was made for medicine. Created by Google, the software has the ability to identify 1,000 different classes of objects and was taught to distinguish cancerous tissue from healthy tissue. Experts at Google fed the machine thousands of images of both healthy tissue and cancerous tissue from the Cancer Genome Atlas. The machine took that information, stored it and was then able to later identify them on its own with a 99 percent accuracy. This is something that could be utilized in telehealth oncology practices. By being able to show images or input information to an AI system, we might one day have the potential to have computers diagnose and treat patients on its own.
Telehealth oncology is a great resource for helping cancer patients in between visits to their oncologists and to help with data collection for future cancer insights. In high-income countries, such as in Japan, New Zealand, and Australia, tele-oncology is used regularly in these ways. In clinical trials there have been negative impacts and errors in diagnosis, staging and treatment delivery, so many physicians suggest a hybrid of in-person care and telehealth oncology. There is a gap in access to quality cancer care globally and according to the World Health Organization, about 80% of chronic disease deaths occur in low- and middle-income countries. While telehealth oncology is less available in low-income countries, physicians are looking into bringing this technology to lower-income areas to help reduce the high percentage of disease-related deaths for these people. In the future, we hope to see telehealth oncology grow into a more regular treatment option for patients with cancer and we hope to see new technology take healthcare to the next level.
Anna Dussing is a communications coordinator for the Mesothelioma Cancer Alliance. As an advocate for helping those in the cancer community, her goal is to help raise awareness about mesothelioma, asbestos, and the dangers of harmful toxins. She fully supports the fight for the complete ban of asbestos in the United States and hopes to spread the word about new treatments for mesothelioma patients.
Social Work Today Magazine Publishes “Telebehavioral Health: New Digital Directions for Social Work Education”
Journalist Beth VanOstenbridge called in early Spring of 2019 to ask for an interview. She is with Social Work Today and was asking about telebehavioral health and graduate education/training. Given that I’m always happy to chat about telehealth, we spent some time discussing the future of telehealth and graduate social work training, and in particular, the telebehavioral health competencies that I and my colleagues recently published in the Journal for Technology in Behavioral Science.
The Social Work Today article was published in the May/June issue and entitled, Telebehavioral Health, New Digital Directions for Social Work Education. This is a quote from Ms. VanOstenbridge’s article:
Marlene Maheu, PhD, founder and executive director for the Telebehavioral Health Institute, has been practicing and training TBH skills and concepts since 1994. Most recently, she and several colleagues developed the Interprofessional Framework for Telebehavioral Health Competencies (Maheu et al., 2018). The framework includes 149 competencies organized by seven domains, including clinical evaluation and care, virtual environment and telepresence, technology, legal and regulatory issues, evidence-based and ethical practice, mobile health technologies such as applications and social media, and telepractice development. Maheu explains, “TBH is not an entirely new treatment. It is a tool to extend the treatment that practitioners already give.” Maheu notes the importance of identifying competencies that span behavioral health fields—her team examined ethical codes from across disciplines. She says that social work leaders were directly involved in the development of the framework.
For those of you who are graduate students or faculty members of graduate behavioral education, it may interest you to know that we are currently completing a new book about telebehavioral health best practices. It will go to Cognella, our publisher by July 1, 2019, and will be accompanied by a complete eLearning module for graduate training. If you’d like more information about the release date for these graduate materials, write to Cognella directly.
Current TBHI Trainees or Prior Graduates?
For those of you who have studied here at TBHI, you can practice telehealth knowing that your training is pinned to those published competencies. If you are looking for professional training in telehealth, you may want to look at our list of CME and CE, 1-hour webinars, and training courses, or if you are serious about developing a telepractice, our Level I and Level II Certificate training programs. Whatever you choose, you know that you will be studying with industry leaders. See the FAQ for more information about TBHI.
Free Interprofessional Framework for Telebehavioral Health Competencies Article
To get your free download of the telebehavioral health competencies article, click this link.
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