ASCO Releases Standards on Using Telehealth for Cancer Care

After conducting a systematic review of literature focusing on telehealth use for cancer care, the American Society of Clinical Oncology (ASCO) has released a series of standards and guidelines on employing virtual care in the oncology setting.

As telehealth use for cancer care increased during the COVID-19 pandemic, ASCO identified the need for detailed oncology-based telehealth standards to ensure all patients have equal access and are receiving quality care.

In addition to offering standards that are specific to oncology care, ASCO’s standards include endorsements of existing general guidelines from other telehealth groups.

The first set of standards focuses on patient selection and telehealth implementation guidelines in oncology. According to ASCO, using telehealth is an acceptable modality for the treatment or long-term management of cancer.

Telehealth can be used for new patient visits, medication prescribing, pretherapy and drug adherence evaluations, chronic care management, acute care issues, and follow-up visits. Virtual care is also a reasonable option for discussing lab tests or imaging results, providing patient education on chemotherapy and other treatments, wellness or distress interventions, counseling, and survivorship visits.

The standard also states that providers should utilize telehealth when patients have trouble accessing in-person care, when multiple family members or caregivers want to be a part of an appointment, and for second opinion evaluations in order to expedite treatment.

Prior to telehealth visits, providers should assess patients to determine if virtual care is the right choice for them. For example, patients with hearing, vision, or cognitive impairments may be better suited to in-person care. Patients may also prefer one modality over the other.

Patients who have low digital literacy and limited broadband access may require in-person visits as well, though health systems should offer resources to help patients overcome these barriers and ensure equal access to telehealth.

Additionally, certain circumstances or procedures may be a better fit for in-person care, including delivering a new diagnosis, relapse or progression discussions, and physical examinations.

ASCO also determined that asynchronous telehealth can be a helpful tool for certain diagnoses, such as skin lesions, as patients can send images to their providers.

Providers must document the details of the telehealth visit, including the location of all participants and the modality. Patients and providers alike should also participate in an orientation that offers information on how to successfully access and navigate the telehealth platform. In addition, a technology support staff member should be available to solve any technical issues.

Another ASCO standard highlighted the importance of patient-provider relationships when using telehealth for cancer care. The relationship should be established before a telehealth visit, and patients should have the option to visit the provider in person if needed. Follow-up care should also be a staple of telehealth-enabled treatment.

Virtual platforms can also support multidisciplinary cancer conferences, in which providers gather to discuss the treatment options for a patient. Providers should use videoconferencing to conduct these meetings. Further, the discussion must be documented in the patient’s EHR, and it must adhere to the same guidelines as in-person conferences.

Finally, ASCO recommended that cancer patients participate in virtual oncology clinical trials to increase recruitment and reduce the burden of trial participation.

Discussion of the trial and eligibility can be done virtually and providers can use resources like patient portals, email, and telephone calls to review patient symptoms. Any drugs included in the trial can be shipped to patients with an accompanying follow-up call to confirm the patient received them and that they understand the dosing schedule.

Virtual trials can help providers reconsider if frequent testing and imaging are necessary, but patients should be able to receive any required blood tests or biopsies at local clinics during the trial.

Conducting clinical trials via telehealth could also lead to the increased use of patient-reported outcomes in studies, ASCO said.

“Telehealth has a high potential for success when it is fully reimbursed, and patients and health care professionals are supported through implementation and ongoing use,” the review concluded. “The expert panel supports the use of telehealth in oncology and provides these standards as a resource for its implementation among oncology practices.”