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

From Cancer Guidelines Wiki

Multidisciplinary meetings

Many cancer centres around the world have adopted videoconferencing for multidisciplinary meetings to connect tertiary, regional and rural centres. Initial evaluation of the Adelaide-Darwin link in Australia revealed a high level of patient satisfaction with the process of decision making at multidisciplinary meetings.[1]

Teleoncology was introduced for weekly tumour case conferences between Sahlgrenska University Hospital and two district hospitals in Sweden. The accuracy of teleoncology was determined using simulated teleoncology consultations, in which all the material relating to each case was presented but without the patient present in person. The people attending the conference were asked to determine the tumour classification and treatment. The patient was then presented in person, to give the audience the opportunity to ask questions and perform a physical examination. Then a new discussion regarding the tumour classification and the treatment plan took place, and the consensus was recorded.[2]

Of the 98 consecutive patients studied in this way, 80 could be evaluated by both techniques. Of these 80, 73 (91%) had the same classification and treatment plan in the teleoncology simulation as in the subsequent face-to-face consultation. In four cases the tumour classification was changed and for three patients the treatment plan was altered. The specialists also had to state their degree of confidence in the teleoncology decisions. When they recorded uncertainty about their decision, it was generally because they wanted to palpate the tumour. In five of the seven patients with a different outcome, the clinical evaluation was stated to be dubious or not possible. The results show that telemedicine can be used safely for the management of head and neck cancers.[2]

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Recommendation One

Evidence summary Level References
An Adelaide study suggests high level of patient satisfaction with multidisciplinary team model of teleoncology. A Swedish study reports 91% concordance rates in accuracy of classification and management plan in head and neck cancer assessed by teleoncology and in person. IV [1], [2]
Evidence-based recommendationQuestion mark transparent.png Grade
Multidisciplinary care can be provided through teleoncology models in a manner acceptable to health professionals and patients. Use of teleoncology for multidisciplinary team care could result in management decisions similar to face to face assessments.
C


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Waiting times

A study from the Townsville Cancer Centre (TCC) reported that access to care can be improved through teleoncology models. From 2007-2009, 60 new patients from Mt Isa traveled to TCC for their first consultation and their first dose of chemotherapy. Six of these patients required inter-hospital transfers and eight required urgent flights to attend outpatient clinics. Only 50% of these rural patients (n=30) were reviewed within one week of their referral, compared with 90% of TCC patients.

In 2009, face to face care in Mt Isa was mostly replaced by the Townsville teleoncology model. Between 2009 and 2011, TCC provided cancer care to 70 new patients from Mt Isa. Of these new patients, 93% (65/70) were seen within one week of referral. All 17 patients requiring urgent reviews were seen within 24 hours of referral and were managed locally, thus eliminating the need for inpatient inter-hospital transfers.[3]

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Recommendation Two

Evidence summary Level References
Limited evidence suggests that waiting time and inter-hospital transfers can be reduced using teleoncology models. IV [4]
Evidence-based recommendationQuestion mark transparent.png Grade
Teleoncology models may help reduce waiting lists and inter-hospital transfers for rural patients.
C


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Practice Point

Practice pointQuestion mark transparent.png

The nature of teleoncology services are determined by the service capability and resources of the providing and receiving centres. Centres wishing to embark on these models need to ensure that adequate resources, governance and quality control mechanisms are in place.

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References

  1. 1.0 1.1 Olver IN, Selva-Nayagam S. Evaluation of a telemedicine link between Darwin and Adelaide to facilitate cancer management. Telemed J 2000;6(2):213-8 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/10957733.
  2. 2.0 2.1 2.2 Stalfors J, Edström S, Björk-Eriksson T, Mercke C, Nyman J, Westin T. Accuracy of tele-oncology compared with face-to-face consultation in head and neck cancer case conferences. J Telemed Telecare 2001;7(6):338-43 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11747635.
  3. Sabesan S, Roberts LJ, Aiken P, Joshi A, Larkins S. Timely access to specialist medical oncology services closer to home for rural patients: experience from the Townsville Teleoncology Model. Aust J Rural Health 2014 Aug;22(4):156-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25123618.
  4. Sabesan S. Medical models of teleoncology: current status and future directions. Asia Pac J Clin Oncol 2014 Sep;10(3):200-4 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/24934093.

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Appendices