What to Know About Telehealth for Lung Cancer

Telehealth refers to the use of telecommunications technology to provide health care from a distance. It started out with programs which connected patients to nurses over the phone. Telehealth has evolved over the years, and healthcare providers now make use of videoconferencing, mobile health apps, emails, and secure texts to deliver care to their patients.

While the idea of telehealth has been around for some time, the COVID-19 pandemic has given rise to a rapid expansion in the availability of telehealth services. Conditions which have not traditionally been treated remotely are now being addressed via telehealth.

Studies have shown that telehealth can be valuable in the management of many chronic diseases. Patients with lung cancer, which requires comprehensive, multidisciplinary care, may derive benefit from care delivered from a distance.

Telehealth

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When to Use Telehealth for Lung Cancer

Since the beginning of the COVID-19 pandemic, oncologists have been forced to balance the need to continue cancer treatment while protecting patients from the risk of infection. Decisions about whether to delay care or use telehealth platforms have to be highly individualized, as patients with lung cancer can vary widely in condition and prognosis.

Remember also that treatment for lung cancer is multidisciplinary (involving many medical disciplines) and multimodal (can take the form of chemotherapy, surgery, radiation, etc.). While in-person visits for therapy or imaging may be unavoidable, many facets of comprehensive cancer care can be conducted through telehealth.

Patients who could safely receive care via telehealth include asymptomatic patients newly diagnosed with early-stage lung cancer, or established patients with symptoms related to their treatment. The lowest-risk patients should be converted to telehealth visits whenever possible.

Patient visits for psychological support, follow-up visits for patients at low risk for relapse, and postoperative visits for patients with no surgical complications can be done through telehealth. If home health aides are available, simple procedures such as blood draws can be performed at the patient’s home.

Treatment for the psychological symptoms of lung cancer seem particularly well suited for the telehealth approach, as is pulmonary rehabilitation for symptoms related to cancer or its treatment. Researchers have explored the use of telephone-based systems to practice emotional coping skills with patients with lung cancer and their caretakers. Telemedicine visits or downloadable apps can help with adherence to exercise-based rehabilitation programs, which have physical and emotional benefits for patients with symptoms like depression, fatigue, or breathlessness.

Telemedicine may also work well in the practice of palliative care, which focuses on symptom management, improving coping mechanisms, increasing patients’ understanding of their disease, and end-of-life care. However, more research is needed before such interventions are incorporated into routine daily practice.

For those who require medical imaging, radiation, or surgery, in-person visits may be unavoidable. Again, patients who stand to derive the most benefit from cancer treatment must take priority for in-person care.

If a delay in surgery or radiation could compromise the outcome, patients should stick to the usual treatment schedules. Talk with your surgeons or oncologists about whether it is appropriate to delay less urgent procedures. Likewise, if you require radiation therapy, different therapeutic schedules may be available that minimize the number of in-person visits.

Although medical imaging is critical to the diagnosis and follow-up of patients with lung cancer, oncologists may consider postponing imaging studies performed for the follow-up of patients at low risk of recurrence.

The patients at highest risk should stick to the usual imaging schedule. This includes patients who need imaging to confirm a suspected diagnosis of lung cancer or patients who have recently started a new therapy.

When to See a Doctor in Person

Some patients with lung cancer are at high risk for deterioration, and they should most likely continue care through the traditional in-person route. These include patients with a new diagnosis of lung cancer and disease-related symptoms (like shortness of breath, pain, or coughing up blood) or those with suspicion of advanced disease. Patients who require administration of treatment (like radiation or IV chemotherapy) also need to be seen in person.

Benefits and Challenges

Every decision in medicine must be made after considering the risks and benefits of a particular treatment or test. During the pandemic, oncologists must consider the risk patients incur when entering a clinic to be seen in person. Patients with lung cancer may be immunosuppressed or taking medications which affect lung function.

Patients who live in remote areas may have trouble getting to a clinic, especially if they have reduced mobility due to decreased lung function. Telehealth has been shown to increase patients’ access to health care in places where access to medical specialists is limited. Crucially, it may allow cancer care to continue while minimizing COVID risk to vulnerable groups.

It is important to note that telehealth does not represent “second rate” care. In fact, research has shown that patients who use telehealth for their lung cancer care report better quality of life than patients who undergo standard care. This is especially true with psychological outcomes, like anxiety and depression, which frequently afflict patients with lung cancer.

Potential barriers to the widespread adoption of telehealth include the need for additional communications equipment, training of staff, education of patients, and the inability to perform in-person physical examination. In order to expand the use of telehealth, federal regulation changes have been made which make it easier for providers to deliver telehealth services.

For example, during the COVID-19 pandemic, telehealth visits will be covered for patients on Medicaid and Medicare. The government has also changed some of the guidelines regarding what telecommunications software can be used so that telehealth services can be offered more widely.

Despite the challenges, the benefits of telehealth are undeniable, and there is much ongoing research looking into how best to expand telehealth care options for patients with lung cancer.

How to Prepare for a Telehealth Visit

If you have been recently diagnosed with lung cancer or are an established patient undergoing lung cancer treatment, ask your doctor if telehealth is available, whether it is a good option for you, and how to schedule a visit. Your health insurance company website may be able to help you find telehealth practitioners who treat lung cancer.

Another option is telehealth companies that work through web-based portals or apps that you can access on your phone or other devices. If you do not have health insurance, community health centers may be available that see patients regardless of their ability to pay. You can search for community health centers in your area via the telehealth website of the Department of Health and Human Services.

Before a telehealth visit with an oncologist, you will need a phone or computer with video capabilities so that you can interact with the nurse, doctor, or other professional on the other end of the line. You may need some method of transmitting test results or other records, like email or secure messaging.

Depending on the telehealth practice, you may need to download an app on your device. Test your device to make sure the video and messaging functions work. If all else fails, your oncologist may be able to conduct some of your care through a phone call.

You may be asked to sign the following statement: “This encounter was performed as a telemedicine visit via secure two-way video and audio to minimize the risk and transmission of COVID-19. The patient and we understand the limitations of a telemedicine visit, including the inability to do a full physical exam, possibly missing subtle findings that would otherwise have been found. Alternative options were presented to the patient, and the patient elected to proceed with the visit.”

Think of the questions you would like to ask, and note whether you need new prescriptions or refills. If you are following up after surgery or radiation therapy, the surgical incision or treated area may need to be visible, a fact that should be kept in mind when choosing your clothing.

After the visit, your doctor or nurse may schedule additional tests or imaging, a follow-up telehealth visit, or a visit by a home health aide. If your condition is stable, at low risk for return of disease, you may be able to continue much of your follow-up care via telehealth.

A Word From Verywell

A diagnosis of lung cancer is life changing, and the COVID-19 pandemic has further complicated an already difficult situation. You may be anxious about whether your care will be delayed or altered. At the same time, you may be reluctant to go to a crowded hospital or clinic to get in-person care. If you don’t have health insurance or live in a remote area, it may be challenging to access the care you need.

Fortunately, the rapid growth of telecommunications technology has enabled doctors and nurses to care for their patients via telehealth. Although some in-person care may be unavoidable, many aspects of lung cancer care can be conducted online, and research has shown that telehealth can be as effective as traditional care in some disciplines.

Many resources exist so that patients in remote areas or with limited mobility or no insurance can find the care they need. Oncology practices around the world are finding creative new ways to deliver care that is safe and effective. 

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