Thanks to Covid-19, doctors do much of their work online or over the phone. But is this suited to cancer care?
“You have cancer.” These are the words no one ever wants to hear. But thanks to the pandemic, many people in the past year have received this earth-shattering news via a telephone or video call.
Before Covid-19 struck, just one in 10 healthcare providers saw patients via telemedicine methods, according to Ipsos Mori. Now it’s about seven in 10 in some areas of medicine.
The past year’s adoption of telemedicine – plus the need to tackle the unprecedented backlog of cases facing the NHS – mean more of us are likely to be told of and treated for cancer through a phone or laptop screen in the future.
“We all have the training mantra from medical school of ‘you have those difficult conversations in person to be able to read the body language and make sure things are okay’,” says Richard Roope, a GP and Cancer Research UK primary care advisor. But dealing with the pandemic and the constraints Covid put on the health service mean that hasn’t always been possible.
“Covid has taught us all a new skill, which is to give bad news over the phone, because sometimes there hasn’t been another option,” Roope adds.
While the supportive hand on the shoulder will never go amiss, some patients, particularly those who have already received the bad news and are on their treatment journey, have found it a boon.
“We were really concerned that it would have a really bad impact on patients and families,” says Robin Jones, a consultant medical oncologist at The Royal Marsden Hospital NHS Trust in London. “But I think, on a positive note, it really helped some people.”
A matter of convenience
When the pandemic struck, three quarters of Jones’s planned face-to-face appointments at the Royal Marsden Hospital’s sarcoma unit became virtual. Those that remained in-person were the most pressing cases: patients who had to urgently begin their therapy or an assessment of the performance status of treatment.
Jones ended up surveying his patients about the use of telemedicine. Perhaps surprisingly, he found they enjoyed the experience, ranking telemedicine consultations at nine on a 10-point scale. Previously, the average patient at the hospital travelled one and a half hours to make their appointment, perhaps explaining their enthusiasm to see a specialist from the comfort of their own home.
With public transport still a risky proposition for many, particularly those undergoing treatment who may be immunocompromised, and taxis or car parking charges quickly racking up, the convenience of a quick Zoom call can outweigh the impersonal touch.
But besides the convenience, the location in which you’re told the news could make telemedicine a preferred solution for cancer treatment going forward. Hospitals, ironically, can often be inhospitable places; many have well-founded fears of finding themselves within their walls.
Roope can see how a safe, comforting and known environment could be a salve during traumatic times in medical treatment. It allows the support unit that will help carry a cancer patient through their treatment – and the highs and lows – to be closer when bad news arrives.
“The option of being at home with multiple members of the family, a lot of people found that a better way,” agrees Jones. “Some found it a really useful change.”
Adapting telemedicine for the future
Ipsos Mori found that three quarters of doctors say they will continue with virtual visits post-pandemic, including for cancer treatment. While it’s not for everybody, “having the option of telemedicine consults is really good for some people”, says Jones.
For those who are deep into their cancer journey and undergoing routine appointments, the convenience of telemedicine appointments can hold appeal. But for key flashpoints in the course of treatment, it’s still important for patients to be able to look into the eyes of those breaking bad news.
“If we look at the whole patient pathway, we’ve seen the rise in phone triage in primary care,” says Roope. “That’s forced us to think about pathways and whether what we’ve done is the best way to do things.”
He cautions that telemedicine doesn’t always pick up some of the most urgent cases because doctors miss important context when they lose the face-to-face element. Patients can give away tell-tale signs of concern in a clinic or GP’s surgery that could trigger an urgent referral, something that might more easily be hidden by the controlled gaze of a Zoom call.
“Very often you can pick up something’s awry from the patient’s demeanour because you know them,” Roope says. It’s the gestalt - the overall view of a patient - that is often key.
Yet despite its pitfalls, there are plenty of plus points to the telehealth revolution. Jones is further investigating how telemedicine can be used and when it’s most relevant for patients.
“Someone who’s had multiple treatments with us and knows us really well is probably more prepared to have a telephone consult, rather than a face-to-face consult,” he says.
Doctors will have to learn new skills, such as triaging and picking up problems through digital and phone contact with patients. Most importantly of all, they’ll have to decide when to direct patients to physical meetings.
“That will be a new skill,” says Roope: knowing “when to bring patients in”.