Is teleoncology as effective as standard oncology care for the palliative care of cancer patients?

From Cancer Guidelines Wiki

Introduction

Patients with advanced cancer often have unmet physical, psychological, social and spiritual needs. While most will benefit from a palliative approach to care provided by their usual treating team, many will require referral to specialist palliative care for management of their more complex needs (Palliative Care Australia, 2005).[1] Palliative care in rural and remote areas of Australia is often delivered and coordinated by generalist nurses and doctors with minimal palliative care training and limited access to palliative care specialists. If specialist palliative care services are available in rural Australia, it often involves significant travel for either the patients or clinicians, which has associated time and cost implications.[2]

New innovative and cost-effective models of palliative care delivery that provide efficient and effective care to advanced cancer patients, regardless of location and care setting, are urgently required.[3] Telehealth is one strategy for extending the reach of specialist palliative care support to rural and remote or isolated patients. Telehealth in the context of palliative care may include, but is not limited to the use of:

  • after-hours telephone support services
  • telephone, video or internet-based conferencing
  • coaching sessions.

While there is evidence to suggest that telehealth approaches are acceptable to patients, caregivers and the treating multidisciplinary team,[2][4][5] little is known about the effectiveness of these methods in meeting the needs of palliative cancer patients and their families.A number of studies have explored the feasibility and acceptance of teleoncology for advanced cancer patients, but few have examined the effectiveness of these interventions. One study has examined the effectiveness of palliative care video-conferencing interventions for advanced cancer patients,[6] while two randomised controlled trials have explored the use of nurse led telephone or internet delivered interventions to support patients with advanced cancer living at home.[7][8]

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Evidence summary and recommendations

Recommendation One

Evidence summary Level References
A weekly telephone multicomponent nurse-led coaching session (focused on problem solving, symptom management, self-care, identification and coordination of care resources, decision making, advance care planning and a life-review component) delivered within 60 days of an advanced cancer diagnosis improved one-year survival. A nurse-led telephone follow-up intervention (involving symptom assessment, review of medication & adverse effects, patient education and psychosocial support) or a controlled telephone intervention provided by non-professional staff improved several cancer related symptoms. Advanced cancer patients who underwent a web-based multi-component caregiver intervention had less symptom distress. This was maintained at eight months post-intervention. II [7], [9], [8]
Evidence-based recommendationQuestion mark transparent.png Grade
Regular nurse-led telephone or web-based multi-component coaching sessions (focused on problem solving, symptom management, self-care, identification and coordination of care resources, decision making, advance care planning and a life-review component), provided shortly after diagnosis may lead to some improvements in the symptom distress of advanced cancer patients.
C


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Recommendation Two

Evidence summary Level References
A feasibility study of multi-disciplinary palliative care video-conference consultations found that patients had lower levels of anxiety and increased appetite at the follow-up teleconference visit, with potential time and cost savings. IV [6]
Evidence-based recommendationQuestion mark transparent.png Grade
If rural, remote or isolated patients with advance cancer have unmet palliative care needs and do not have access to a specialist palliative care team, it is feasible to provide a specialist palliative care video-consultation involving the patient, their family and members of their treatment team.
C


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References

  1. Quill TE, Abernethy AP. Generalist plus specialist palliative care--creating a more sustainable model. N Engl J Med 2013 Mar 28;368(13):1173-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23465068.
  2. 2.0 2.1 Collier A, Morgan DD, Swetenham K, To TH, Currow DC, Tieman JJ. Implementation of a pilot telehealth programme in community palliative care: A qualitative study of clinicians' perspectives. Palliat Med 2015 Aug 19 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/26290500.
  3. Luckett T, Phillips J, Agar M, Virdun C, Green A, Davidson PM. Elements of effective palliative care models: a rapid review. BMC Health Serv Res 2014 Mar 26;14:136 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24670065.
  4. Sabesan S, Simcox K, Marr I. Medical oncology clinics through videoconferencing: an acceptable telehealth model for rural patients and health workers. Intern Med J 2012 Jul;42(7):780-5 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/21627743.
  5. Phillips JL, Davidson PM, Newton PJ, Digiacomo M. Supporting patients and their caregivers after-hours at the end of life: the role of telephone support. J Pain Symptom Manage 2008 Jul;36(1):11-21 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/18411012.
  6. 6.0 6.1 Watanabe SM, Fairchild A, Pituskin E, Borgersen P, Hanson J, Fassbender K. Improving access to specialist multidisciplinary palliative care consultation for rural cancer patients by videoconferencing: report of a pilot project. Support Care Cancer 2013 Apr;21(4):1201-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23161339.
  7. 7.0 7.1 Bakitas MA, Tosteson TD, Li Z, Lyons KD, Hull JG, Li Z, et al. Early Versus Delayed Initiation of Concurrent Palliative Oncology Care: Patient Outcomes in the ENABLE III Randomized Controlled Trial. J Clin Oncol 2015 May 1;33(13):1438-45 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25800768.
  8. 8.0 8.1 Gustafson DH, DuBenske LL, Namkoong K, Hawkins R, Chih MY, Atwood AK, et al. An eHealth system supporting palliative care for patients with non-small cell lung cancer: a randomized trial. Cancer 2013 May 1;119(9):1744-51 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23355273.
  9. Bruera E, Yennurajalingam S, Palmer JL, Perez-Cruz PE, Frisbee-Hume S, Allo JA, et al. Methylphenidate and/or a nursing telephone intervention for fatigue in patients with advanced cancer: a randomized, placebo-controlled, phase II trial. J Clin Oncol 2013 Jul 1;31(19):2421-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23690414.

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Appendices