Cancer Care from Home

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New study reveals the potential benefits of virtual care in a post-pandemic world.
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Princess Margaret Cancer Centre’s digital solution—Virtual Care Management System—facilitates virtual medical consultations. The system enables physicians to provide safe and convenient cancer care.

Princess Margaret (PM) Cancer Centre addresses over 200,000 visits each year. When the COVID-19 pandemic was declared, the Centre quickly devised a solution to minimize the disruption of care. Within just 12 days, a novel platform was launched that enabled providers and their care teams to co-ordinate virtual care visits so patients could be seamlessly assessed from the safety of their own home using a computer, tablet or phone.

Prior to the pandemic, only 1% of visits at PM Cancer Centre were conducted virtually, making it challenging to rapidly scale its use in response to the pressing needs imposed by COVID-19, and also difficult to study its impact on patients and health care providers.

Because virtual care has now become the norm, vast amount of data are available and have been used by a multidisciplinary team at UHN to explore the benefits of virtual care. The team, led by Techna Affiliate Scientist Dr. Alejandro Berlin and PM Clinician Investigator Dr. Monika Krzyzanowska, revealed how virtual appointments affect quality of care, patient and practitioner experience, and health care costs.

“Patients with cancer often have a weaker immune system due to their disease and/or treatments. It was imperative to find a solution that would protect our patients, allowing them to physically distance and stay home if possible,” says Dr. Berlin. “Additionally, moving eligible appointments to a virtual setting makes it safer for those coming to the hospital to receive essential cancer treatments like chemotherapy and radiotherapy.”

Designed by the Health Informatics Research Team (Techna) and PM’s Smart Cancer Care Program with the help of UHN Digital and Healthcare Human Factors, the custom virtual care platform seamlessly integrates with pre-existing booking systems and electronic medical records. The quality of care enabled by this system was evaluated using indicators of effectiveness, safety, timeliness, patient-centredness, equitability and efficiency.

Within one month, PM Cancer Centre returned to pre-COVID visit volumes (about 3,900 weekly visits) and in the first two months, the system facilitated 22,085 virtual appointments, accounting for over half of all visits.

The study found that switching to virtual appointments had no negative effect on the safety or timeliness of cancer care compared to standard in-person care.

Out of 284 practitioners and 2,738 patients, 72% and 82% respectively were satisfied with their remote appointment. Moreover, 64% of health care providers and 85% of patients indicated that the quality of care was comparable or better than in-person visits. Around two-thirds of patients also said that they would likely request virtual appointments in the future.

Using Canadian census data and Google application programming interfaces (APIs), the researchers also determined that patients saved a combined $3M on transportation costs accounting for the current fees for public transit and parking around PM.

“While the team is continuing to monitor and investigate whether virtual care has any impact on long-term disease outcomes, this study supports using virtual care in our post-pandemic world,” says Dr. Berlin. “Our findings suggest that telemedicine provides substantial benefits to patients and health care providers—both now and in the future.”

This work was supported by The Princess Margaret Cancer Foundation.

Berlin A, Lovas M, Truong T, Melwani S, Liu J, Liu ZA, Badzynski A, Carpenter MB, Virtanen C, Morley L, Bhattacharyya O, Escaf M, Moody L, Goldfarb A, Brzozowski L, Cafazzo J, Chua MLK, Stewart AK, Krzyzanowska MK. Implementation and Outcomes of Virtual Care Across a Tertiary Cancer Center During COVID-19. JAMA Oncol. 2021 Jan 7:e206982. doi: 10.1001/jamaoncol.2020.6982.

(L-R) Princess Margaret Clinician Investigator Dr. Monika Krzyzanowska and Techna Affiliate Scientist Dr. Alejandro Berlin.