The Lynx Group

Telemedicine Saves Time, Resources for Palliative Radiotherapy

October 2012, Vol 3, No 7

Montreal, Canada—Telemedicine re­duces time spent on new-patient consultations for palliative radiotherapy, according to a study presented at the 2012 World Cancer Congress. Patients spent half as long attending a telemedicine consultation than an in-person consultation, and did not have to spend time on traveling to a radiotherapy center for this.

In addition, telemedicine consults allowed physicians to satisfactorily complete consultation tasks and have confidence in their resulting recommendations, said Rebecca Wong, MBChB, Professor of Radiation Oncology, University of Toronto, and Staff Radiation Oncologist at the Princess Margaret Hospital/University Health Network in Toronto, Canada.

Overall, among those who completed a questionnaire on the experience, 40 of 44 patients said they prefer telemedicine over an initial in-person consultation, and 32 of 39 physicians felt telemedicine was as good as, or better than, in-person consultation.

“While radiotherapy itself can’t be delivered at a distance, providing a consultation via telemedicine can facilitate informed consent and organization of radiotherapy planning and treatment,” said Dr Wong, who presented the study results.

The team prospectively studied 50 patients who live closer to a telemedicine center than a radiotherapy center and hence were given a first consultation with telemedicine, as well as another 50 individuals who live closer to a radiotherapy center and hence received an in-person consultation.

The 2 groups had similar baseline characteristics, but the patients using telemedicine were more likely to have a genitourinary cancer as the primary tumor, were more likely to be referred for brain metastases, and had a life expectancy of <6 months.

The primary outcome was time spent in the consultation. Tele­medicine patients spent an average of 90 minutes in consultation compared with an average of 176 minutes for an in-person consultation. The average time to referral to radiotherapy was 11.7 days in the telemedicine group and 8.2 days for the in-person consultation group.

Patients and physicians expressed satisfaction with telemedicine, and a large majority of them said they prefer it over an in-person consultation. Fur­thermore, the physicians rated telemedicine and in-person consultation equally in terms of establishing a rapport with patients, adequate history-taking and evaluation of diagnostic tests, discussion of treatment options, and discussion of the radiotherapy plan.

The areas in which the 2 approaches were not comparable were the ability to perform the relevant physical exam only with in-person consultations and a lower level (60%) of confidence in the radiotherapy recommendations when telemedicine was used compared with 100% for in-person consultation. In all cases, however, the treatment decision was confirmed in a subsequent in-person assessment.

Investigations of this use of telemedicine should include ways to incorporate telemedicine into routine clinical practice.

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