Using Telehealth for Pre-Anesthesia Evaluations for Cancer Patients

Using telehealth to conduct pre-anesthesia evaluations for cancer patients reduced travel and saved time and money while having no impact on cancellation rates, according to a retrospective study out of Florida’s H. Lee Moffitt Cancer Center.

Patients living with cancer travel frequently for lab work, imaging, surgeries, and treatment, many of which are time-sensitive. Family members also experience caregiver burdens and take time off work to assist with care and travel arrangements. 

Anesthesiologists at Moffitt Cancer Center launched a telehealth program in the PreAnesthesia Testing (PAT) Clinic in June 2020 in an attempt to facilitate care access for cancer patients and their families. 

The Florida-based center is the only National Cancer Institute (NCI) Comprehensive Cancer Center in the state. Studies have shown that CCCs produce better patient outcomes and lower cancer mortality rates compared to non-CCC health systems. These centers perform more complex surgeries with fewer complications, as well.

However, patients living with cancer sometimes struggle to receive treatment from a CCC due to barriers that may include distance between their home and the nearest center, insurance obstacles, and economic status.

With a telehealth program, patients could receive treatment from a CCC while reducing their travel time for preoperative evaluations. 

Between June 29, 2020 and September 22, 2020, 120 patients at the Moffitt Cancer Center had a pre-anesthesia evaluation via telehealth. Anesthesiologists compared distance traveled, money saved, and rates of cancellation of the telehealth patients to the outcomes of 120 patients who received in-person preoperative evaluations. 

The patients who received the evaluation via telehealth did not have to travel to the center and therefore saved time and money. The median distance of a round trip commute to the center was 80 miles and patients saved a median of 121 minutes by having a telehealth visit. Patients also saved a median of $46 on gas, with some saving over $600.

The telehealth group had a day-of-surgery cancellation rate of 1.67 percent compared to 0 percent for the in-person group, but it was not seen as statistically significant. The patients who canceled their appointments did so due to outside factors and not because of any inconsistencies in the preoperative evaluation, the anesthesiologists noted.

All cancer patients who had a surgery planned first received a screening from a registered nurse over the phone. If the nurse determined that the patient needed further evaluation before the surgery, the patient made an appointment with an advanced practice professional (APP) in the PAT Clinic.

Following the telehealth program launch, patients had visits with an APP via video conferencing. The telehealth visit included the same questions and assessment of the patient’s airway as an in-person visit. The heart and lung exams were moved to the day of surgery.

Patients who had breast/plastics, gynecologic and interventional radiology surgeries were more likely to have used telehealth for their preoperative evaluation. Gastrointestinal, neurosurgical, orthopedic, pulmonary, and sarcoma surgery patients were seen in person more than via telehealth.

The study results show that telehealth can help reduce burden on cancer patients and their families while also successfully preparing the patient for surgery. Patients underwent the pre-anesthesia evaluation without leaving their home, helping to cut down the frequent traveling they experience due to their illness. 

The study also highlighted that telehealth did not have any significant impact on surgery cancellation rates.  

Patients are likely to travel far distances to receive treatment at CCCs and using telehealth for preoperative evaluations may increase convenience for patients and boost access to care.

Though the Florida-based study did not analyze satisfaction rates, the anesthesiologists referenced other prospective studies in which telehealth pre-anesthesia evaluations left patients and providers as satisfied as they were with in-person evaluations.