In early 2020, during the pandemic, veterans attended about 25,000 telehealth video appointments each day, including oncology visits, which was a 1,000% increase from 2019. Halfway through the year, VA already surpassed the total number of telehealth encounters completed in 2019 by 7 million. Photo from July 3, 2020, VAntage Point blog
OMAHA, NE – With patients in rural Nebraska who have trouble accessing the primary campus in Omaha, the VA Affairs Nebraska Western Iowa Health Care System (VA-NWIHCS) is using teleoncology and remote chemotherapy services to expand care to those veterans.
The patients are able to use remote sites in Lincoln, NE, 60 miles from Omaha, and Grand Island, NE, 150 miles from Omaha, to facilitate remote chemotherapy administration with oversight from oncologists at the main campus.
In a presentation at the American Society of Clinical Oncology annual meeting in June, researchers from that VAMC and the University of Nebraska Medical Center sought to compare clinical outcomes in patients receiving care at those remote sites vs. in Omaha.1
To do that, the study team retrospectively reviewed data for 151 patients receiving first-line chemotherapy at VA sites in Omaha, Lincoln or GI between Jan. 1, 2018, and Dec. 31, 2020. With 108 patients receiving chemotherapy infusions in Omaha, another 43 were treated at the remote sites.
Among the data collected were, age, gender, performance status, comorbidities, overall survival (start of treatment to death/last contact), malignancy type and stage, number of delayed or missed treatment cycles, chemotherapy-related toxicities, and emergency room (ER) visits or hospitalizations.
Participants from Omaha and remote sites (Lincoln/GI) were predominantly male, 96% vs. 91% respectively; median age was 69 years in each group; 82% vs. 93% (p = 0.24) had an ECOG PS of 0-1. In addition, the two groups were comparable in terms of common comorbidities:
- chronic obstructive pulmonary disease (36% vs. 37% p = 0.90);
- chronic kidney disease (38% vs. 28% p = 0.24); and
- coronary artery disease (41% vs. 19% p = 0.01).
The participant groups also had a similar proportion of patients with stage IV disease (39% vs. 33%; p = 0.54) and treatment with curative intent (60% vs. 51%; p = 0.32).
The most prevalent cancers were:
- head/neck (14% vs. 12% p = 0.80),
- lung (25% in each p = 0.99), and
- gastrointestinal (10% vs. 14% p = 0.57).
Results indicated no difference in median overall survival between the on-site treatment and remote treatment groups [96.8 (n = 84) vs. 92.4 (n = 32) months (p = 0.92) for patients with solid tumors; 67.7 (n = 24) vs. 94.3 (n = 11) months (p = 0.73) for hematologic malignancies].
Researchers pointed out that chemotherapy-related toxicities were noted in 61% vs. 53% of patients (p = 0.39) in Omaha vs. remote sites, including febrile neutropenia (6% vs. 2% p = 0.99), neutropenia (6% vs. 5% p = 0.67), other cytopenia (11% vs. 14% p = 0.59), dehydration (9% vs. 2% p = 0.18), nausea (5% vs. 7% p = 0.69), and neuropathy (3% vs. 7% p = 0.35). At least one hospitalization occurred in 33% vs. 21% (p = 0.13) of patients, and at least one ER visit in 42% vs. 26% (p = 0.07).
The study also noted that a delay in at least one treatment cycle occurred in 29% vs. 21% (p = 0.32) of cases, and at least one cycle of treatment was missed in 15% vs. 19% (p = 0.59).
“The evaluated outcomes in oncology patients treated in Omaha versus remote sites via telemedicine under the same providers were similar,” researchers concluded. “Effective oncology care, including parenteral chemotherapy administration, can be provided via telemedicine and this model can help mitigate issues with access to care.”
The program extends far beyond that specific VAMC, however. According to a VA blog published in July, the healthcare system’s National TeleOncology Program delivers screenings, diagnostics and treatment for medical oncology—including rehabilitation and palliative care. In 2019, over 3,000 veterans received access to high-quality cancer treatment through teleoncology, and that number increased dramatically during the pandemic.
- Arnold A, Asif S, Shostrom V, Ganti AK. Outcomes following off-site remote chemotherapy administration. J Clin Oncol. 2022;40 (suppl 16; abstr1516).