The efficiency and ease of tools that support virtualization will set the stage for the future of cancer care.
The COVID-19 pandemic has challenged clinicians to adapt to a world in which social distancing was introduced and point-of-care services have been turned on their heads. In addition to shifting the outlook on how cancer care is delivered, it has also significantly impacted patient care and outcomes, including delaying screenings, diagnosis and treatment.
Many countries have suspended cancer screening¹ programs due to the pandemic, delaying potential diagnosis. Delayed treatment due to the COVID-19 pandemic could result in increased cancer morbidity and mortality for years to come.² Despite the challenges, the goal remains the same for those at the forefront of cancer care — delivering quality and timely access to care. The tools that can help clinicians optimize their time include those that support virtualization of care.
In oncology, multidisciplinary tumor boards are universally adopted. Before the pandemic, in-person meetings were the norm. However due to COVID-19, social distancing and other infection prevention measures disrupted these in-person meetings. For example, at Aviano Cancer Center in Italy, multidisciplinary boards were limited to one specialist per board.³ Other precautions impacted the delivery of care, including suspension of morning meetings and journal clubs, and postponement of medical students' trainee programs––and while sensitive to pandemic concerns, researchers warn diverting attention exclusively to COVID-19 could overshadow everyday clinical practice and may have substantial negative implications.⁴
Clinicians must be able to collaborate on treatment options in a timely way, which is difficult when in-person meetings are restricted. In some cancer cases, increased time to treatment is associated with worsened patient outcomes.⁵ Time is of the essence, and clinicians must be able to collaborate on treatment options as many solid tumors and some hematologic cancers⁶ require immediate diagnosis and treatment. With digital solutions, many clinicians have the opportunity to move to virtual multidisciplinary meetings, which can help alleviate the risk of COVID-19 transmission concerns and prioritizing cancer care.⁷
Virtual tumor board meetings offered through a technology platform can help optimize and standardize workflow, aggregate and curate relevant patient data, and document as well as track treatment decisions. In fact, some dashboards have the ability to send these treatment decisions to the electronic medical record (EMR). One study of the transition from in-person to virtual multidisciplinary meetings during the pandemic found that the majority of respondents preferred the virtual multidisciplinary conference⁸ format to the traditional in-person format.
Through digital solutions, multidisciplinary teams can remotely access a broad set of data such as full patient history, original imaging data from radiology or digital pathology and lab results, which are essential for diagnosis and for making sound treatment decisions. In addition, clinicians can also tap into clinical trial opportunities based on an individual patient’s condition, genomic alterations and their institution’s postal code. They can also access credible resources, such as National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology and publication repositories like PubMed, American Society of Clinical Oncology and American Association of Cancer Research. With that, these tools can also support more personalized healthcare. The connectedness of digital tools offers an opportunity to decentralize multidisciplinary meetings. Almost as a byproduct, expertise from more experienced centers becomes available at virtual meetings at smaller, less specialized institutions.
The efficiency and ease enabled by tools that support virtualization of care set the stage for how we move forward in cancer care. For instance, cloud-based technology was found to be better at identifying biomarker-based treatment options in 80% of patients and delivery time for reports fell from 14 days to 4 days⁹ during a 4-year study conducted by researchers at Georgetown University Medical Center in Washington, D.C. In the same study, researchers found that the volume of cases reviewed each year increased exponentially — from 46 in 2014 to 622 in 2017.¹º In another example, the first large-scale prospective study on how digital tools impact tumor board meetings found a 30% reduction in preparation time¹¹ across multiple users and different tumor boards when digital tools were implemented. Increased speed can often turn into improved patient outcomes, as well as economic benefits.
Technology that supports clinicians in aggregating patient data, developing treatment plans and accessing the latest research is here for the long term. But it will take more than technically implementing digital tools to enhance the current standard of care. Policy makers need to simplify integration of digital health into the local reimbursement schemes, as done recently in Germany with the Digital Supply Act. Data security and privacy regulations might need to be refined to allow clarity for patients and healthcare providers alike. It is then up to clinicians to embrace and influence the development of digital health solutions to take full advantage of the opportunity to reshape patient care––now and beyond the COVID-19 pandemic.
Okan Ekinci, M.D., is head of medical and scientific affairs at Roche Information Solutions.
¹Richards, L., et al. (2020). ‘The impact of the COVID-19 pandemic on cancer care’, Nature Cancer.
²McNulty, R. (2020). ‘Cancer Care In COVID-19 Could Lead to Higher Morbidity, Mortality’, The American Journal of Managed Care.
³Cortiula, F., et al. (2020). ‘Managing COVID-19 in the oncology clinic and avoiding the distraction effect’, Annals of oncology: official journal of the European Society for Medical Oncology.
⁴Cortiula, F., et al. (2020). ‘Managing COVID-19 in the oncology clinic and avoiding the distraction effect’, Annals of oncology: official journal of the European Society for Medical Oncology.
⁵Khorana, A., et al. (2019). ‘Time to initial cancer treatment in the United States and association with survival over time: An observational study’, Plos One.
⁶Kutikov, A., et al. (2020). ‘A War on Two Fronts: Cancer Care in the Time of COVID-19’, Annals of Internal Medicine.
⁷Simpson, L. (2020). ‘Virtual Tumor Boards––Cancer Does Not Stop for COVID-19’, Health IT Outcomes.
⁸Dharmarajan, H., et al. (2020). ‘Transition to a virtual multidisciplinary tumor board during the COVID‐19 pandemic’, Wiley Periodicals, Head & Neck.
⁹Leask, H. (2019). ‘Virtual Tumor Board Faster and Better Than Real Life’, Medscape.
¹ºLeask, H. (2019). ‘Virtual Tumor Board Faster and Better Than Real Life’, Medscape.
¹¹Hammer, R. (2020). ‘Digital Tumor Board Solutions Have Significant Impact on Case Preparation’, JCO Clinical Cancer Informatics.