TRACE program to study impact of cancer care telehealth services

Like other medical specialties, cancer care telehealth services became more prevalent during the COVID-19 pandemic. Under a declared public health emergency (PHE), federal policy measures loosened telehealth restrictions while state-based licensure waivers opened new opportunities for clinicians to provide the service.

Early indicators show positive results. For instance, a surgical oncology study reported that postoperative telehealth visits reduced emergency department visits and readmissions, with an associated rise in patient satisfaction. What’s more, a survey of approximately 200 oncologists revealed that the majority were satisfied with telehealth and wanted to continue using it; nearly 60 percent of respondents said video visits worked sufficiently for most aspects of cancer care management, including treatment plan discussion and review of lab results.

Federal funding backs new initiatives 

The National Cancer Institute (NCI) wants to sustain the momentum by establishing Telehealth Research Centers of Excellence (TRACE) to explore how the technology can contribute to improved health outcomes across the cancer care continuum. NCI has allocated $23 million to the TRACE program at the following four academic centers to create an evidence base for using telehealth in oncology:

• Memorial Sloan Kettering Cancer Center in New York will study the effectiveness of a remote monitoring system for patients receiving systemic treatments for prostate and breast cancer. A trial program will assess whether at-home monitoring reduces the need for in-patient visits.

• The University of Pennsylvania in Philadelphia will compare the effectiveness of multiple telehealth strategies on shared decision-making for lung cancer screening. The center will also evaluate ways to improve timely access to molecular testing for advanced lung cancer.

• Northwestern University in Evanston, Ill., will use telehealth to extend services to cancer survivors with emphasis on reducing key risk behaviors such as smoking, obesity and physical inactivity. The approach combines activity self-reporting with at-home weight and fitness readings. The cancer team stays current with data integrated into each patient’s electronic health record. A trial with 3,000 participants will span 11 Northwestern Medicine Hospitals.

• New York University will partner with the Veterans Health Administration to determine how social factors such as race/ethnicity, poverty and rural residence affect telehealth delivery for cancer care.

NCI describes the TRACE work as “cutting-edge” — with focus on creating sustainable and effective telehealth options designed specifically for cancer care. At the same time all four centers have committed to training the next generation of telehealth researchers.

Related story: Telehealth visits face uncertain flexibility amid tepid investment

The path ahead for cancer care telehealth services

The rollout of telehealth’s practical applications in cancer care comes at a crucial time. Many of the telehealth “flexibilities” adopted during the pandemic will lapse at the end of the COVID-19 PHE. The current PHE declaration is effective through Oct. 13, 2022, with an additional 151-day transition period specified in congressional appropriations legislation. Unless lawmakers push through measures ensuring permanent flexibility, restrictions on where patients receive Medicare telehealth services, as well as where the services originate, will revert to regulations in place prior to the COVID-19 PHE.

In the meantime, hospitals and health systems need to demonstrate continued success in using telehealth for evaluation and management of cancer patients. Telehealth can prevent potentially deadly delays in cancer care while reducing treatment-related costs for patients. However, to serve the most vulnerable patients, emerging initiatives must also address disparities in access to digital technologies, as about one-quarter of Medicare beneficiaries lack either a smartphone or a computer with high-speed internet connection.

Frank Irving is a Philadelphia-based content writer and communications consultant specializing in healthcare, technology and sports.