What to Know About Telehealth for Pancreatic Cancer

Table of Contents
View All
Table of Contents

Telehealth services allow people with pancreatic cancer to receive some healthcare services within the comfort of their own homes at every stage of the disease. Since people with cancer are immunocompromised and often experience cancer fatigue, telehealth provides a great option for low-contact healthcare visits.

Below outlines when telehealth may be used for care (and when an in-person visit is a better option), what happens during a telehealth visit and how you can prepare, and the benefits and challenges associated with these visits. It's important to note upfront that these visits are considered to be the equivalent of an in-person visit, not a temporary alternative to in-person care.

man on teleheath call

Yoshiyoshi Hirokawa / Getty Images

COVID-19 and Telehealth

While oncologist offices are taking careful precautions to ensure safety, telehealth can be particularly helpful for people with cancer who are immunosuppressed and at risk for not only COVID-19 but other infections as well.

When to Use Telehealth for Pancreatic Cancer

People living with cancer often develop a strong relationship with their oncologist, but using telehealth instead of in-person visits doesn't change that. In fact, there are some advantages. Telehealth visits may be done with video on a smartphone or computer or via audio only by phone.

In the past, the use of telehealth visits was increasing slowly but was often not an option. For example, in the past, a first visit with a new physician always required an in-person visit.

Deregulation due to three federal stimulus packages following the COVID-19 outbreak, however, has led to changes that allow more than 80 services to be eligible for telehealth. This legislation allows face-to-face visits for consultations, follow-up, and more virtually via telehealth rather than requiring travel (and potential exposure to COVID-19 and other infectious agents) to a clinic or hospital.

In addition, some platforms that were not previously allowed (due to the fact that they are not necessarily compliant with the Health Insurance Portability and Accountability Act, or HIPAA) now are, such as Zoom and audio-only visits (in the past, only visual telehealth visits were allowed).

It's important to note that the stimulus benefits are guaranteed only for people who are on Medicare, though many private insurance companies have adopted similar changes.

There are many settings with any stage of pancreatic cancer in which a telehealth visit may be an appropriate (and sometimes preferable) substitute to an in-person visit.

Initial consultations regarding treatments: Many people still think of an initial diagnosis of cancer as something needing in-person care, but there are times when a telehealth visit will be an option. During these consultations, your oncologist may review your scans and blood work, talk about any symptoms you are having, and discuss treatment options, including any clinical trials that are available.

Follow-up visits after or between treatments: Telehealth is often an excellent option for follow-up visits after treatments such as surgery or chemotherapy or in between treatments. During these visits, a physician can ask about any symptoms you are having, answer questions, and discuss options going forward. In some cases, your doctor may recommend having a lab or radiology appointment prior to the telehealth visit and can then discuss your results during the visit. A virtual examination may be done by having you check your own weight, blood pressure, and pulse. If you have any symptoms such as a rash, these can be looked at using the camera on your device during the visit.

During these visits your doctor may ask about:

  • Pain
  • Fatigue and energy level
  • Nausea, vomiting, and diarrhea
  • Any problems with your medications
  • How your cancer is affecting your lifestyle
  • How you are feeling overall both physically and emotionally

Depending on your visit, your doctor may recommend changes to your medications (or new medications), suggest a new treatment plan, and more, just as if you were having an in-person follow-up visit.

Remote patient monitoring may also be done between follow-up visits. If you have a wearable device, you can connect this to your computer to share blood pressure readings, your weight, your calorie intake, and much more.

To discuss side effects of treatment or evaluate symptoms that may not require in-person care: If you are having symptoms that concern you but are not emergent, a telehealth visit may be a good first option. For many symptoms, management options can be discussed and initiated (for example, your doctor may call in a prescription for you). At other times, your doctor may recommend that you make an in-person appointment due to your symptoms.

Combination telehealth and in-person care: In some cases, a person may be seen both in person and through a telehealth visit. An example would be while going through radiation therapy. You might have your radiation visit in person, but a visit to discuss the radiation with your radiation oncologist via telehealth.

Education: Telehealth appointments can be used for physicians to educate patients and their families about their disease. As something that was often "squeezed in" during consultations and follow-up appointments, telehealth visits focusing on education can help people better understand their cancer in a proactive manner.

Pain management: Until the COVID-19 pandemic, healthcare providers were unable to prescribe opioid pain medications (often needed with pancreatic cancer) through telehealth services. With the current pandemic, the Drug Enforcement Administration has allowed doctors to prescribe controlled substances (schedule II–IV) through telehealth even for people who have not been evaluated in person.

For a second opinion: In the past, Medicare (and most private insurance companies) did not cover telehealth visits with a doctor you had not seen before. This changed with the 2020 COVID-19–related stimulus packages, and as of April 2021, is still an option. Not only can second opinions be done via telehealth, but doing so can often save considerable time and money, especially if the consultation is in a different city or state.

Second opinions via telehealth are not entirely new. Prior to the COVID-19 outbreak, a number of the larger cancer centers had begun to offer "remote second opinions." With these opinions, an out-of-town doctor could review electronic copies of your medical records, laboratory tests, and imaging studies and make recommendations on whether it would be worth traveling to the center for treatment or a clinical trial.

Counseling and mental health care: Telehealth options for counseling for people with cancer have been a silver lining since the COVID-19 pandemic began. It's been known for some time that such counseling can greatly benefit people living with cancer but was often left on the back burner; cancer requires enough time and travel on top of a baseline of fatigue for many that made the additional visits prohibitive. Since visits can now be done from the comfort of home without travel time, more people with cancer are pursuing this option. Counseling may include topics such as:

  • Learning to cope with your diagnosis
  • Dealing with anxiety and depression
  • Learning techniques that help you cope with fatigue and loss of energy
  • Discussing the impact of your cancer on your family relationships
  • Coping with the fear of death, anticipatory grief, when to stop treatment, and more

Palliative care: Palliative care is care that addresses a person's symptoms and quality of life. As of April 2021, consults with a palliative care team have become much more commonplace for people with cancer, whether the cancer is advanced or an early-stage cancer that is likely curable. Not only does this free up oncologists to focus on treating your cancer, but it can also significantly improve your quality of life. A study specifically addressing telehealth and palliative care for people with cancer found that telehealth visits were a very effective option for many people living with cancer.

Advanced care planning: Advanced care planning is important with cancer, and many physicians have found that the COVID-19 pandemic has been a good time to make this a priority for all adults. Whether this includes when you would choose to stop active treatment, lifesaving measures you would or wouldn't wish to receive, or even funeral plans, advance care planning often ends up tacked on to the end of an appointment or not discussed at all. Telehealth visits are an excellent way to address these very important but often overlooked topics.

For "multidisciplinary" visits: A clear advantage of telehealth for people with pancreatic cancer has been seen when people need to meet with a number of different specialists to discuss different aspects of their disease. Many of these visits can be done via telehealth appointments without traveling (and waiting) to see a number of different physicians.

This may include visits with your:

  • Oncologist or oncology nurse
  • Radiation oncologist
  • Palliative care physician
  • Gastroenterologist
  • Oncology nutritionist
  • Genetic counselor
  • Oncology counselors/mental health professionals

Sometimes it's very helpful to bring these specialists together when planning treatment, and this can be done via a virtual meeting.

When In-Person Care Is Needed

There are times when you will definitely need to be seen in person as well as times when in-person care is likely preferable.

In-person care for pancreatic cancer will be required for:

  • Surgery, including surgery for removal of a tumor, surgery for placement of stents for an intestinal or biliary blockage, or surgery to place a feeding tube
  • Treatments that need to be administered in person, such as chemotherapy, immunotherapy, and radiation therapy
  • Blood tests and imaging studies (in some cases, you may be able to have a lab or radiology appointment for these tests followed by a telehealth visit with your doctor to discuss the results). When possible, however, blood tests/imaging studies may be scheduled at an institution closer to a person's home.
  • Symptoms that could progress to complications, such as a significant fever (or any fever if on chemotherapy), abdominal pain that could suggest an obstruction, abdominal swelling (ascites) that is causing symptoms, or any symptoms that suggest hospitalization may be needed
  • Follow-up in some cases, such as when a person has had treatment for pancreatic cancer but has a high risk of recurrence
  • Complications of pancreatic cancer (or suspected complications), such as acute pancreatitis, worsening jaundice, or pneumonia
  • Tumor removal, for people who are diagnosed early and may have a tumor that can be removed with surgery. Many visits may be done via telehealth, but due to the complexity and risks associated with pancreatic surgery, an in-person consultation may be preferable.

Benefits and Challenges

There are both pros and cons when it comes to telehealth visits for pancreatic cancer, and it's important to understand these before you schedule your first visit.

Benefits

More insight into the benefits of telehealth are being uncovered as the use has increased dramatically in 2021. There is still little research on the benefits and challenges in people with cancer, but some studies are being published. For example, a study looking at people with head and neck cancers found that the primary benefits of telehealth according to patients were the increased accessibility and savings of both time and money, whereas the primary limitation was the inability to do a physical exam.

Reduced Infection Risk

The COVID-19 pandemic has brought the risk of infection when near other people to the front of most of our minds, but those living with cancer have understood the risk much longer. Immunosuppression related to cancer treatments or the presence of cancer alone can increase the chance of a serious bacterial or viral infection if you are exposed.

The reduction in hospitalizations from flu and other infectious diseases is evidence alone that distancing (such as having a telehealth vs. an in-person visit) can lower risk.

Less Travel

The opportunity to simply walk to the computer at a set time instead of driving to an appointment, walking from a parking ramp to a waiting room, and then waiting has been appealing to many, but especially those who are coping with cancer fatigue.

Comfort

Telehealth visits can be more comfortable physically (you can dress any way you'd like) but also emotionally for many people. Most people feel calmer in their own surroundings. Many people living with cancer also find temperature extremes to be very uncomfortable (hence, the common comment that chemotherapy breaks your internal thermostat), and having a telehealth visit allows you to set your home thermostat where you're most comfortable.

Opportunity for Your Doctor to See You as a Unique Person

As telehealth visits become more common, some unexpected benefits are being uncovered. By "seeing" inside a person's home, oncologists can better assess any limitations you may be facing (such as stairs you may have difficulty navigating). Your oncologist also has an opportunity to see the unique person you are through your surroundings instead of the four plain walls of most clinic exam rooms.

Increased Access

Many people have considered getting second opinions for pancreatic cancer at cancer centers far from their own homes, but the cost and energy needed to travel prevented many from pursuing these options. Telehealth visits can thus improve access to medical care beyond that of in-person care.

Possibly Better Quality of Life

There aren't yet any studies looking at the effect of telehealth on quality of life for people living with pancreatic cancer, but people living with stage 4 lung cancer cope with many of the same concerns. A study of people with lung cancer found that people who engaged in telehealth visits (when possible) with their physicians had a slightly higher quality of life than those receiving in-person care.

Challenges

There are also a number of challenges when it comes to telehealth.

Inability to Perform a Physical Exam

There are some situations in which telehealth is simply not possible, and the physical exam is one of these. With pancreatic cancer, it may be possible to get an idea of skin color to assess jaundice (although lighting can pose limitations), but it's not possible to do an adequate abdominal exam to assess pain, signs of obstruction, or ascites.

Access Limitations

Not everyone has access to (or can afford) a computer or smartphone through which to have video visits, and insurance companies may not cover audio-only (phone) visits. In addition, in some areas (especially rural areas), connection to the Internet isn't possible, or if it is, it is too slow to be effective.

There is also a limitation when it comes to using technology. For many older adults, setting up a computer (and downloading programs) for telehealth visits can be difficult, especially when distancing has kept away family members who previously may have been able to help. Even for those who are comfortable with computers, there is a learning curve that comes with telehealth visits.

Clinical Trials

Clinical trials have been a particular challenge during the COVID-19 pandemic. Sadly, many of these trials have either not been instituted or have been stopped mid-trial due to problems with enrollment, the ability of people to follow the study's protocol, and more.

Many clinical trials are conducted only in certain regions of the country, and sometimes at a single institution requiring air travel and lodging. In addition, clinical trial protocols often require in-person visits, not allowing telehealth as an option.

Fortunately, especially as clinical trials for pancreatic cancer offer the hope for new and more effective treatments, researchers are addressing these concerns in ways that may allow for fewer in-person visits and with the option for lab tests and imaging studies to be done at centers other than the institution supporting the clinical trial.

How to Prepare for a Telehealth Appointment for Pancreatic Cancer

There are a number of things you can do prior to your telehealth visit that will ensure the visit begins and progresses as well as possible.

The first step is to learn whether it will be a video visit on your computer or smartphone or an audio-only visit on your phone, and who will be present at the visit (just your doctor, their nurse, or other members of your cancer care team). Most visits will start with your doctor calling you (or "entering" the room on a video visit), but it's helpful to know how this will work.

  • Prepare your computer: If you will be doing a video telehealth visit, you will need to download the platform (such as Zoom) that your doctor uses. If possible, see if you can test the platform (such as with a friend or family member) before your first visit with your doctor.
  • Check with your insurance provider: If you have private insurance, make sure to check on its telehealth benefits. You may need to call a representative at your insurance company since these benefits may have changed due to the pandemic. If not covered, you may be able to obtain a prior authorization due to the COVID-19 pandemic, especially if you are immunosuppressed.
  • Think about questions you wish to ask: Writing down a list of questions to ask can be helpful even for in-person visits, but may be especially helpful as you are working with new technology for the first time. Some people keep a journal handy so they can write down questions and concerns in between visits. Think about questions your doctor may ask you (such as whether you are having any pain or problems with your appetite) and how you might answer. Have your list with you (as well as paper so you can take notes) during your actual visit. If you have concerns, such as a rash or other changes, you may wish to take a picture ahead of your visit.
  • Dress comfortably and accessibly: Wear clothes that make you feel comfortable. Some people like to dress casually, whereas others like to dress as they would when going to an in-person appointment. If you have an area on your body you would like to show your doctor, try to find clothes that make looking at that region as easy as possible.
  • Check your setting: Good lighting can make it easier for you and your doctor to see each other, and since body language is more difficult with telehealth appointments, this step is important. Check to make sure the light is bright enough, but also that there is no glare from nearby windows.
  • Feel free to bring a companion: Just as with in-person visits, you can "bring" a family member or friend with you to your telehealth appointment to lend support. It never hurts to have an extra set of ears to hear things you may not remember, to take notes, or to remind you to ask questions that are important to you.
  • Relax: Don't worry or get anxious if you have problems with the technology. Broken connections happen. Sometimes the audio just doesn't work. Hang in there. Doctors are accustomed to the learning curve as people first access telehealth options and don't expect your first visits (or even later visits) to go perfectly.

Will Insurance Cover Telehealth for Pancreatic Cancer?

Federal guidelines have increased the options for telehealth services under Medicare, and many private insurance companies have made similar provisions. With private health insurance companies, it's important to check with your provider to learn about your benefits.

People who are uninsured or have insurance coverage that requires a copay may be required to pay this at the time of visit.

What Happens During the Visit?

Your telehealth visit will, for the most part, proceed very much like an in-person visit. Your doctor will most likely call you (or invite you to the meeting) just as you would be brought to an exam room for a clinic visit. You may be asked to sign (using a digital signature) a treatment consent form before beginning.

Your visit will vary depending on whether it is a consultation or follow-up and whether it is with your oncologist or one of the other specialists who are part of your cancer team.

Whether an initial visit or a follow-up, your doctor will want to know about any symptoms you are experiencing. They will probably ask you to characterize your symptoms by asking:

  • When the symptoms began
  • If they are getting worse, getting better, or unchanged
  • If there is anything that makes the symptoms better or worse
  • What you have tried to relieve the symptoms
  • If you are using a medication for the symptoms, does it seem to be effective?
  • With pain, they will also ask you to describe the intensity on a scale of 1 to 10, with 1 being barely present and 10 being the worst pain you can imagine.
  • With nausea related to chemotherapy, they will want to know if the nausea started right away after your infusion, or was delayed, starting 24 or hours after your infusion.

If you have had previous treatments (such as surgery or chemotherapy), they will want to know how you did after treatment.

After learning about how you are doing and asking questions, your doctor will want to discuss your plans going forward. Are further treatments recommended? If so, how do you feel about these treatments? If that isn't effective, what is your plan B (or plan C or plan D)?

At the end of your visit, it's helpful to look over your list of questions to make sure that none have gone unanswered. You may wish to write down your next steps in care, such as any future telehealth or in-person visits, imaging tests, or blood work you will need. You may even want to take a moment at the end of your appointment to "introduce" your doctor to a bit of your life, whether that's a favorite pet, a painting in your room, or anything else.

Consent

The provider may ask you to sign a special consent for the visit and to acknowledge the following:

"This encounter was performed as a telehealth visit via secure two-way video and audio to minimize risk and transmission of COVID-19. I understand the limitations of a telehealth visit, including the inability to do a full physical exam, possibly missing subtle findings. Alternative options were presented to me, and I elected to proceed with the visit."

A Word From Verywell

Telehealth visits can certainly reduce some of the stress and fatigue associated with in-person visits with cancer, not to speak of reducing the risk of infection, but we are still learning about the potential benefits and drawbacks. Fortunately, studies are in place looking specifically at the role of telehealth for people with advanced and metastatic pancreatic cancer, and more should be known soon.

For now, a silver lining has been the opportunity for oncologists and patients to "see" each other in a less clinical and more human way. People living with cancer often state that they don't want to identify with their disease. Instead of a cancer patient, many people want to be seen for who they are. In this way alone, the disadvantage of lost in-person compassion may be offset by doctors gaining a better understanding of the human behind the cancer diagnosis.

Was this page helpful?
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Royce TJ, Sanoff HK, Rewari A. Telemedicine for cancer care in the time of COVID-19. JAMA Oncol. 2020;6(11):1698-1699. doi:10.1001/jamaoncol.2020.2684

  2. Paterson C, Bacon R, Dwyer R, et al. The role of telehealth during the COVID-19 pandemic across the interdisciplinary cancer team: implications for practice. Semin Oncol Nurs. 2020;36(6):151090. doi:10.1016/j.soncn.2020.151090

  3. U.S. Department of Justice. COVID-19 information page.

  4. Grewal US, Teraucchi S, Beg MS. Telehealth and palliative care for patients with cancer: implications of the COVID-19 pandemic. JMIR Cancer. 2020;6(2):e20288. doi:10.2196/20288

  5. Catanese S, Pentheroudakis G, Douillard JY, Lordick F. ESMO management and treatment adapted recommendations in the COVID-19 era: pancreatic cancer. ESMO Open.  2020;5(Suppl 3):e000804. doi:10.1136/esmoopen-2020-000804

  6. Triantafilou V, Layfield E, Prasad A, et al. Patient perceptions of head and neck ambulatory telemedicine visits: a qualitative study. Otolaryngol Head Neck Surg. 2020;194599820943523. doi:10.1177/0194599820943523

  7. Pang L, Liu Z, Lin S, et al. The effects of telemedicine on the quality of life of patients with lung cancer: a systematic review and meta-analysis. Ther Adv Chronic Dis. 2020;11:204062232096159. doi:10.1177/2040622320961597

  8. Waterhouse DM, Harvey RD, Hurley P, et al. Early impact of COVID-19 on the conduct of oncology clinical trials and long-term opportunities for transformation: findings from an American society of clinical oncology survey. Oncol Pract. 2020;16(7):417-421. doi:10.1200/OP.20.00275