Is teleoncology safe for cancer patients and health professionals compared with standard oncology care?

From Cancer Guidelines Wiki

Introduction

A small number of studies have investigated the safety of delivering chemotherapy by teleoncology. A comparison of side effects and hospital admission between patients receiving chemotherapy at Mt Isa and Townsville Cancer Centre showed there were no significant differences in most of the demographic characteristics, including the mean number of treatment cycles, dose intensities, proportion of side effects and hospital admissions.[1] An earlier study from the same group demonstrated it was safe to administer intensive chemotherapy regimens at standard doses to rural patients without increased morbidity or mortality. Only two of 106 rural patients were transferred to Townsville for admission. No toxic death occurred in either group.[2]

A qualitative approach was used to explore the experiences of health professionals delivering oncology services using the Queensland Remote Chemotherapy Supervision model (QreCS). Medical oncologists, chemotherapy competent nurses and pharmacists in Townsville as well as medical officers, nurses and pharmacists located at the three rural sites were surveyed. None of the health professionals expressed concerns about the safety of the teleoncology model being used.[3]

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Evidence summary and recommendations

Evidence summary Level References
There were no significant differences in outcomes for rural patients receiving chemotherapy directed by teleoncology (Mt Isa) and patients in an urban setting (Townsville). Outcomes included mean number of cycles, dose intensities, proportion of side effects, hospital admissions and febrile neutropenia, diarrhoea and vomiting. III-1 [1], [2]
Evidence-based recommendationQuestion mark transparent.png Grade
It may be safe to administer chemotherapy in rural towns under the supervision of medical oncologists from larger centres by teleoncology, provided that rural resources and governance arrangements are adequate.
C


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The nature of chemotherapy regimens administered at rural and regional centres is determined by the rural service capabilities. Rural centres that have high dependency or intensive care units may be able to administer most chemotherapy regimens locally under remote supervision by medical oncologists using teleoncology. Centres that lack high dependency units may only be able to provide selected low and moderate risk chemotherapy regimens. In the latter case, it is advisable that first dose of chemotherapy is administered at the supervising center.


New centres embarking on remote chemotherapy supervision models could adopt a staged approach to the selection of medications administered at rural sites based on experience,confidence and service capabilities.

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References

  1. 1.0 1.1 Chan B, Watt KA, Evans R, Larkins S, Sabesan S. Is it safe to remotely supervise chemotherapy administration in rural towns via teleoncology models of care? MJA 2015;inpress.
  2. 2.0 2.1 Pathmanathan S, Burgher B, Sabesan S. Is intensive chemotherapy safe for rural cancer patients? Intern Med J 2013 Jun;43(6):643-9 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/23347337.
  3. Jhaveri D, Larkins S, Kelly J, Sabesan S. Remote chemotherapy supervision model for rural cancer care: perspectives of health professionals. Eur J Cancer Care (Engl) 2015 Apr 14 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/25871852.

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Appendices