Jan 4, 2019
Rashid Bashshur, PhD, is senior advisor for eHealth at the
University of Michigan Health System (retired) and emeritus
professor of Health Management and Policy, University
of Michigan School of Public Health. He is a member of the Telemedicine Working Group.
When diagnosed with cancer, the typical patient responds
with trepidation, anxiety, and fear. This experience
engenders a bewildering set of questions, including the
cause, treatment options, prognosis, appropriate sources of care,
and affordability. Of paramount importance is ready access to expert
resources with the requisite knowledge and skill. Telemedicine is a
modality of care that addresses all these issues.
The underlying technology of telemedicine has become
an indispensable utility in all sectors of modern society. Of relevance
here, it facilitates the entire spectrum of cancer care,
including prevention, screening, diagnosis, treatment, rehabilitation,
and end-of-life care. Moreover, the wide availability of
electronic medical records (EMR) expedites intra- and interinstitutional
connectivity, thereby assuring continuity and quality
of care, the issues of interoperability and security notwithstanding.
Telemedicine enables providers to support the adoption of
healthy lifestyles as an integral part of the clinical care process. It
facilitates patient-provider communication at various levels,
enhances patient compliance with the prescribed regimen, enables
the development of virtual tumor boards, and facilitates remote
patient recruitment in clinical trials.
Patients diagnosed with cancer find themselves urgently seeking
information on interpreting symptoms, benefits and risks of
therapeutic options, when to seek care and where to go, and what
lies ahead. Patients living in medically underserved areas are especially
vulnerable and their resources may be limited. Telemedicine
connectivity mitigates their isolation, and potentially enables them
to remain in their home communities while their therapy is guided
by a distant provider.
Clinical depression is often associated with cancer. While
family members and friends can provide support, psychological
and psychiatric therapy may be indicated. The requisite expertise
is often in short supply and geographically inaccessible. Here
again, telemedicine can enable diagnosis and treatment from a
qualified resource. This can be complemented via voluntary informal
support networks, enabled by the internet. Informal support
networks can help with ongoing problems, and the service is free.
Some of the information on the internet may be dubious. Hence,
clinical professionals should vet veracity and content, where possible.
Telemedicine enables providers to assist patients in humane and
dignified end-of-life care, rather than be left to self-reliance. This
includes minimizing pain and suffering, monitoring and addressing
their issues, and promptly responding to their questions.
After more than half a century, telemedicine has moved into
mainstream medicine. Many cancer programs already benefit from
the integration of telemedicine into their clinical practice through
portals for patient-provider communication, virtual tumor boards,
and integrated multisite delivery networks. Looking ahead, advances
in artificial intelligence, robotics, data analytics, nanotechnology,
and genomics should be integrated with the connectivity of telemedicine
to usher in future cancer care and, indeed, the integrated
health delivery system of the future. This would fulfill the promise of
precision medicine to deliver the right treatment, to the right patient,
at the right time—both efficiently and effectively.