As a bill that would expand Medicare coverage for telehealth services makes its way through the U.S. Senate, a new study of people with advanced cancer suggests the practice could improve the lives of patients.
The use of telehealth skyrocketed during the pandemic: A U.S. Health and Human Services report found that usage grew 63-fold, from 840,000 users in 2019 to 52.7 million users in 2020.
As more Americans turned to telehealth, evidence that it was highly effective began to emerge, and this latest study is no exception.
After following about 1,200 patients with advanced cancer, researchers from the University of North Carolina, in Chapel Hill, found that those who reported their symptoms electronically on a weekly basis had better physical function and control of their symptoms than those who saw their doctors in person, but less frequently.
The weekly three-minute online questionnaire consisted of questions prodding about common cancer symptoms, from nausea to insomnia, as well as questions about financial stability, if they need help from a counselor and more. If the system concluded that further action was needed, or an alarming symptom was seen, it would trigger a response from a nurse or other monitoring attendant while offering standby instructions to the patient on how to best manage the symptom.
"One of the problems we have in general with cancer care is that a large percentage of patients don't report negative symptoms such as pain to their providers," said Dr. Arnold Baskies, former chair of the board of directors of the American Cancer Society, who was not involved with the study. "It's not a blemish on the provider and it's not a blemish on the patient, some are just fearful of divulging. This is a great way to get that information."
While Baskies added that more research is needed on the topic, some companies are already approaching hospital networks looking to install these electronic monitoring systems.
"A lot of things can be monitored remotely, like biometrics with the Apple watch," said Baskies. "It's about time we moved into this whole area."
The new study surveyed 1,191 participants with a mean age of 62, so it illustrates that older folks had no problem using a digital health service.
"We had a very, very high level of engagement from older patients," said study author Dr. Ethan Basch, director of the Cancer Outcomes Research Program at the University of North Carolina's Lineberger Comprehensive Cancer Center. "Sometimes they're even more engaged than younger patients. I think there's a mythology that they won't, but it's simply not true."
The study's monitoring program, dubbed PRO-TECT, builds on technology that's been percolating for over three decades. It showed a 33% improvement in physical function for patients who used it, as well as 15% better control of symptoms, compared to those who were evaluated at in-person doctor visits.
The findings were published online recently in the Journal of the American Medical Association.
The researchers added that the program is unlikely to cost patients more money, and that overall the tech will cost the health care industry less money, because investing in preventive care will drive down expensive emergency room visits and doctor consults in later stages of care.
"I think it'll reduce cost in the long run," said Baskies. "Think about all the calls that come in that might not need to be handled immediately but can be handled by a digital response, one that can generically take care of a lot of problems. That's what these systems tend to do. You cut down on a lot of mildly unnecessary calls, but increase the number of staff responding to real issues."
Exactly who will foot the bill for the new tech is still a question mark. Clinics and hospital networks would need to subscribe to the service and pay for the start-up costs, but the researchers said any billing sent to patients should be covered by insurance companies, though it may take some time to get to that point.
"If the insurance companies see efficiency and improvement in quality of life, then they'll have to approve coverage of this," said Baskies. "But it might take some encouragement from the federal government."
Visit the U.S. Department of Health and Human Services for more on telehealth.
SOURCES: Ethan Basch, MD, director, cancer outcomes research program, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, N.C.; Arnold Baskies, MD, former chair, board of directors, American Cancer Society; Journal of the American Medical Association, June 5, 2022, online