ASCO Guidelines for Telemedicine

OK, I know I've already done two posts on telemedicine and oncology in the last few weeks, but here's one more.  It's an important one -- the new guidelines from ASCO on when and how cancer patients should have telemedicine (a visit with the doctor by phone or video) instead of a face-to-face meeting.

And as I've said in the other two posts, I think this is important because my feeling is that telemedicine is going to be a big part of our lives as cancer patients from here on. In the United States, Covid-19 is making a return in many parts of the country, including the one I live in, after seeming to become less of a threat. Even if it recedes again soon, the lingering attitude is going to be "That's not good, but at least we can keep up doctor visits virtually." And it's going to just become a regular part of our lives. And then, since these visits are less expensive, we're likely to have insurance companies encourage them when possible.

It's not a bad thing -- there's a place for telemedicine, and as the two other articles show, both oncologists and cancer patients think it can be a good thing. But it has to be done right.

And that's where these new guidelines come in -- officially called "Telehealth Standards in Oncology." 

I won't go through the whole document. It's easy enough to read on your own if you're interested. But I can sum up the highlights. 

The guidelines were put together by studying all of the research on telemedicine and then putting together a panel of oncology experts to think about how cancer care should be delivered through technology. Public comments were also included in the discussions.

They considered some important questions -- Is there research that shows that there is a difference between telemedicine and face-to-face visits, good or bad? Is there a role in telemedicine for health professionals other than doctors, like nurses, or physician's assistants, or social workers? Is there a way to use telemedicine to include more patients in clinical trials?

Looking at the guidelines, it seems like the panel has thought pretty carefully about a very wide range of uses for telemedicine. 

Some of the interesting things that I find n the guidelines:

• There are lots of situations in which a cancer patient might have had to go into the doctor's office that can be handled by telemedicine, and not necessarily with the oncologist -- prescribing or changing medication, meetings about what to expect during treatment, discussions of lab and scan results, supportive care (finances and nutrition) and survivorship meetings, and routine follow-ups. Some other things are listed as OK that I think probably aren't (like discussions about hospice care, or genetic testing. A more personal touch might be nice).
• There are other situations that are listed as being better handled face-to-face -- initial meetings after diagnosis, complex cancer situations, meetings with patients who have hearing or vision problems that would make a telemedicine meeting difficult, and patients who do not have adequate technology for telemedicine.
• Patients need to be evaluated before a telemedicine visit to determine if it is the best choice. Patients should be given the option to meet face-to-face if possible.

As I said there is more to the guidelines than this, but probably not worth going into minute detail about it.

The important things are (again, in my opinion) telemedicine is probably going to be a regular part of our lives as cancer patients, there are now guidelines available for how it should be done to be most effective, and it is important that we advocate for ourselves, to make sure we are getting the care we need in the way that makes the most sense for us.

I'm fortunate, personally, to be fairly close to my oncologist, and to be physically able to travel to see him when I need to. I like the emotional comfort that comes with being in a room with my doctor,  getting a physical exam that confirms how I feel, being able to see the look on his face as we talk, and getting to spend some time with him. Those things are important to me. When it comes time, I will make those feelings known.