Impact of Telemedicine for Lung Cancer Care during the COVID-19 Pandemic: Interrupted Time Series Analysis
DOI:
https://doi.org/10.32635/2176-9745.RBC.2025v71n2.4872Keywords:
Lung Neoplasms/epidemiology, COVID-19, Health Services, Telemedicine, Remote ConsultationAbstract
Introduction: The COVID-19 pandemic greatly challenged the health systems and cancer care. Objective: To estimate the impact of telemedicine on outpatient visits (OPV) to reduce disease exposure for patients and healthcare providers and minimize the effect on cancer care continuum during the COVID-19 pandemic. Method: Longitudinal quasi-experimental time series using the institutional electronic medical records from January 2018 to December 2021, considering the implementation of telemedicine services in the first and second waves of COVID-19 in March and November 2020, respectively. The primary outcomes were a mean (A) monthly-overall-OPV, (B) monthlyin- person-OPV, (C) monthly-overall-cancer-OPV, and (D) monthly-in-person-cancer-OPV. Results: A total of 5,918 OPV were analyzed. 55.3% of the visits were for females, 87% were White, and the mean age was 66 years. Telemedicine accounted for 25.8% of the visits and 27.7% were cancer-related. White, Black, and Asian patients had a similar percentage of use of telemedicine (26.3%, 25.0%, and 26.8%), while Latinos were less likely to use telemedicine (18%, p=0.018). For outcomes (A) and (C), including telemedicine, the COVID-19 surges did not significantly impact the mean OPV. When telemedicine was not used, there was a statistically significant decline in overall in-person OPV (B) and cancer (D). In the first COVID-19 surge, telemedicine prevented a decrease in monthly-overall-OPV of 59.1% (p=0.001) and 40.9% (p=0.019) for cancer. In the second surge, these values were 64.4% (p=0.001) for monthly-overall-OPV and 59.8% for cancer (p=0.001). Conclusion: The use of telemedicine positively impacted the care for cancer patients in a thoracic surgery service.
Downloads
References
World Health Organization. Report of the WHOChina joint mission on coronavirus disease 2019 (COVID-19) [Internet]. 2020 Feb 20 [cited 2025 Jan 25]. Available from:https://www.who.int/docs/defaultsource/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
Wang C, Horby PW, Hayden FG, et al. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-3. doi: https://www.doi.org/10.1016/S0140-6736(20)30185-9 DOI: https://doi.org/10.1016/S0140-6736(20)30185-9
Velavan TP, Meyer CG. The COVID-19 epidemic. Trop med int health. 2020;25(3):278-80. doi: https://doi.org/10.1111/tmi.13383 DOI: https://doi.org/10.1111/tmi.13383
Kolifarhood G, Aghaali M, Saadati HM, et al. Epidemiological and clinical aspects of COVID-19; a narrative review. Arch Acad Emerg Med. 2020;8(1):e41.
Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia. N Engl J Med. 2020;382(13):1199-207. doi: https://doi.org/10.1056/NEJMoa2001316 DOI: https://doi.org/10.1056/NEJMoa2001316
Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the chinese center for disease control and prevention. JAMA. 2020;323(13):1239-42. doi: https://doi.org/10.1001/jama.2020.2648 DOI: https://doi.org/10.1001/jama.2020.2648
Centers for Disease Control and Prevention [Internet]. Washington, D.C: CDC; [2020]. Coronavirus disease 2019 (COVID-19) in the U.S. centers for disease control and prevention, COVID-19 Update for the United States,2020 May 10. [cited 2024 Mar 25]. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-inus.html
Centers for Disease Control and Prevention [Internet]. Washington, D.C: CDC; [2020]. Coronavirus Disease 2019 (COVID-19). Centers for Disease Control and Prevention, 2020 Feb 11. [cited 2020 May 25]. https:// www.cdc.gov/coronavirus/2019-ncov/hcp/dialysis/ screening.html
Massachusetts Department of Public Health [Internet]. Boston: Mass.gov; [2020]. First presumptive positive case of COVID-19 identified by Massachusetts state public health laboratory. [cited 2020 Mar 25]. Available from: https://archives.lib.state.ma.us/server/api/core/bitstreams/ eb0c8ef4-38f4-4451-aa5b-93584e75eaba/content
UMass Memorial Medical Center [Internet]. Worcester: UMass Memorial Health Care; [2020]. First coronavirus patient in Worcester County was treated at UMass Memorial Medical Center in Worcester. [Cited 2020 May 18]. Available from: https://www. umassmemorialhealthcare.org/umass-memorial-medicalcenter/ first-coronavirus-patient-worcester-county-wastreated- umass-memorial-medical-center-worcester
Cai Y, Hao Z, Gao Y, et al. Clinical characteristics of seven cases infected with sars-cov-2 in the perioperative period of lung resection: a retrospective study from a single thoracic department in Wuhan, China. Preprint Lancet; 2020. doi: https://doi.org/10.2139/ssrn.3546042 Mehta V, Goel S, Kabarriti R, et al. Case fatality rate of cancer patients with COVID-19 in a New York Hospital System. Cancer Discov. 2020;10(7):935-41 doi: https://doi.org/10.1158/2159-8290.cd-20-0516 DOI: https://doi.org/10.1158/2159-8290.CD-20-0516
Lei S, Jiang F, Su W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020;21:100331. doi: https://doi.org/10.1016/j.eclinm.2020.100331 DOI: https://doi.org/10.1016/j.eclinm.2020.100331
Harky A, Chiu CM, Yau THL, et al. Cancer patient care during COVID-19. Cancer Cell. 2020;37(6):749-50. doi: https://doi.org/10.1016/j.ccell.2020.05.006 DOI: https://doi.org/10.1016/j.ccell.2020.05.006
Jheon S, Ahmed AD, Fang VW, et al. General thoracic surgery services across Asia during the 2020 COVID-19 pandemic. Asian Cardiovasc Thorac Ann. 2020;28(5): 243-9. doi: https://doi.org/10.1177/0218492320926886 Liang W, Guan W, Chen R, et al. Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol. 2020;21(3):335-7. doi: https://doi.org/10.1016/S1470-2045(20)30096-6 DOI: https://doi.org/10.1177/0218492320926886
Cai Y, Hao Z, Gao Y, et al. Coronavirus disease 2019 in the perioperative period of lung resection: a brief report from a single thoracic surgery department in Wuhan, people’s republic of China. J Thorac Oncol. 2020;15(5):e66-7. doi: https://doi.org/10.1016/j.jtho.2020.04.003 DOI: https://doi.org/10.1016/j.jtho.2020.04.003
Mojsak D, Dębczyński M, Kuklińska B, et al. Impact of COVID-19 in patients with lung cancer: a descriptive analysis. Int J Environ Res Public Health. 2023;20(2):1583. doi: https://doi.org/10.3390/ijerph20021583 DOI: https://doi.org/10.3390/ijerph20021583
Sud A, Jones ME, Broggio J, et al. Collateral damage: the impact on outcomes from cancer surgery of the COVID-19 pandemic. Ann Oncol Off J Eur Soc Med Oncol. 2020;31(8):1065-74. doi: https://doi.org/10.1016/j.annonc.2020.05.009 DOI: https://doi.org/10.1016/j.annonc.2020.05.009
Maringe C, Spicer J, Morris M, et al. The impact of the COVID-19 pandemic on cancer deaths due to delays in diagnosis in England, UK: a national, population-based, modelling study. Lancet Oncol. 2020;21(8):1023-34. doi: https://doi.org/10.1016/S1470-2045(20)30388-0 DOI: https://doi.org/10.1016/S1470-2045(20)30388-0
Kuderer NM, Choueiri TK, Shah DP, et al. Clinical impact of COVID-19 on patients with cancer (CCC19): a cohort study. The Lancet. 2020;395(10241):1907-18. doi: https://doi.org/10.1016/S0140-6736(20)31187-9 DOI: https://doi.org/10.1016/S0140-6736(20)31187-9
Richards M, Anderson M, Carter P, et al. The impact of the COVID-19 pandemic on cancer care. Nat Cancer. 2020;1(6):565-7. doi: https://doi.org/10.1038/s43018-020-0074-y DOI: https://doi.org/10.1038/s43018-020-0074-y
Alhalabi O, Subbiah V. Managing cancer care during the COVID-19 pandemic and beyond. Trends Cancer. 2020;6(7):533-5. doi: https://doi.org/10.1016/j.trecan.2020.04.005 DOI: https://doi.org/10.1016/j.trecan.2020.04.005
Gazivoda V, Greenbaum A, Roshal J, et al. Assessing the immediate impact of COVID-19 on surgical oncology practice: experience from an NCI-designated comprehensive cancer center in the northeastern United States. J Surg Oncol. 2021;124(1):7-15. doi: https://doi.org/10.1002/jso.26475 DOI: https://doi.org/10.1002/jso.26475
Federal Communications Commission (USA) [Internet]. Washington, DC: FCC; [undated]. Telehealth, telemedicine, and telecare: what’s what? [Cited 2025 Feb 21]. Available from: https://www.fcc.gov/general/telehealth-telemedicine-and-telecare-whats-what
World Health Organization. Telemedicine: opportunities and developments in member state [Internet]. Geneva: WHO Regional Office for Africa; [2020]. [Cited 2025 Feb 21]. Available from: https://www.afro.who.int/publications/telemedicine-opportunities-anddevelopments- member-state
Dorsey ER, Topol EJ. State of telehealth. N Engl J Med. 2016;375(2):154-61. doi: https://doi.org/10.1056/NEJMra1601705 DOI: https://doi.org/10.1056/NEJMra1601705
Bashshur RL, Shannon GW, Bashshur N, et al. The empirical evidence for telemedicine interventions in mental disorders. Telemed J E Health. 2016;22(2):87- 113. doi: https://doi.org/10.1089/tmj.2015.0206 DOI: https://doi.org/10.1089/tmj.2015.0206
Pardolesi A, Gherzi L, Pastorino U. Telemedicine for management of patients with lung cancer during COVID-19 in an Italian cancer institute: SmartDoc Project. Tumori. 2021;108(4):357-63. doi: https://doi.org/10.1177/03008916211012760 DOI: https://doi.org/10.1177/03008916211012760
Krupinski EA, Bernard J. Standards and guidelines in telemedicine and telehealth. Healthcare. 2014;2(1):74- 93. doi: https://doi.org/10.3390/healthcare2010074 DOI: https://doi.org/10.3390/healthcare2010074
Wagner AK, Soumerai SB, Zhang F, et al. Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. 2002;27(4):299-309. doi: https://doi.org/10.1046/j.1365-2710.2002.00430.x DOI: https://doi.org/10.1046/j.1365-2710.2002.00430.x
Linden A. Conducting Interrupted Time-series analysis for single- and multiple-group comparisons. Stata J. 2015;15(2):480-500. doi: https://doi.org/10.1177/1536867X1501500208 DOI: https://doi.org/10.1177/1536867X1501500208
Fretheim A, Soumerai SB, Zhang F, et al. Interrupted time-series analysis yielded an effect estimate concordant with the cluster-randomized controlled trial result. J Clin Epidemiol. 2013;66(8):883-7. doi: https://doi.org/10.1016/j.jclinepi.2013.03.016 DOI: https://doi.org/10.1016/j.jclinepi.2013.03.016
Fretheim A, Zhang F, Ross-Degnan D, et al. A reanalysis of cluster randomized trials showed interrupted timeseries studies were valuable in health system evaluation. J Clin Epidemiol. 2015;68(3):324-33. doi: https://doi. org/10.1016/j.jclinepi.2014.10.003 DOI: https://doi.org/10.1016/j.jclinepi.2014.10.003
Zhang F, Wagner AK, Soumerai SB, et al. Methods for estimating confidence intervals in interrupted time series analyses of health interventions. J Clin Epidemiol. 2009;62(2):143-8. doi: https://doi.org/10.1016/j.jclinepi.2008.08.007 DOI: https://doi.org/10.1016/j.jclinepi.2008.08.007
Zhang F, Wagner AK, Ross-Degnan D. Simulation-based power calculation for designing interrupted time series analyses of health policy interventions. J Clin Epidemiol. 2011;64(11):1252-61. doi:https://doi.org/10.1016/j.jclinepi.2011.02.007 DOI: https://doi.org/10.1016/j.jclinepi.2011.02.007
Stevens JP, Mechanic O, Markson L, et al. Telehealth use by age and race at a single academic medical center during the COVID-19 pandemic: retrospective cohort study. J Med Internet Res. 2021;23(5):e23905. doi: https://doi. org/10.2196/23905 DOI: https://doi.org/10.2196/23905
Paterson C, Bacon R, Dwyer R, et al. The role of telehealth during the COVID-19 pandemic across the interdisciplinary cancer team: implications for practice. Semin Oncol Nurs. 2020;36(6):151090. doi: https://doi.org/10.1016/j.soncn.2020.151090 DOI: https://doi.org/10.1016/j.soncn.2020.151090
Darrat I, Tam S, Boulis M, et al. Socioeconomic disparities in patient use of telehealth during the coronavirus disease 2019 surge. JAMA Otolaryngol Neck Surg. 2021;147(3):287-95. doi: https://doi.org/10.1001/jamaoto.2020.5161 DOI: https://doi.org/10.1001/jamaoto.2020.5161
Grenda TR, Whang S, Evans III NR. Transitioning a surgery practice to telehealth during COVID-19. Ann Surg. 2020;272(2):e168-9. doi: https://doi.org/10.1097/SLA.0000000000004008 DOI: https://doi.org/10.1097/SLA.0000000000004008
Toni E, Ayatollahi H. An insight into the use of telemedicine technology for cancer patients during the Covid-19 pandemic: a scoping review. BMC Med Inform Decis Mak. 2024;24(104):1-24. doi: https://doi.org/10.1186/s12911-024-02507-1 DOI: https://doi.org/10.1186/s12911-024-02507-1
Sirintrapun SJ, Lopez AM. Telemedicine in cancer care. Am Soc Clin Oncol Educ Book. 2018;38:540-5. doi: https://doi.org/10.1200/EDBK_200141 DOI: https://doi.org/10.1200/EDBK_200141
Garavand A, Khodaveisi T, Aslani N, et al. Telemedicine in cancer care during COVID-19 pandemic: a systematic mapping study. Health Technol. 2023;13:665-78. doi: https://doi.org/10.1007/s12553-023-00762-2 DOI: https://doi.org/10.1007/s12553-023-00762-2
Garavand A, Aslani N, Behmanesh A, et al. Telemedicine in lung cancer during COVID-19 outbreak: a scoping review. J Educ Health Promot. 2022;11(1):348. doi: https://doi.org/10.4103/jehp.jehp_50_22 DOI: https://doi.org/10.4103/jehp.jehp_50_22
Restrepo JG, Alarcón J, Hernández A, et al. Clinical outcomes in patients with solid tumors living in rural and urban areas followed via telemedicine: experience in a highly complex latin american hospital. BMC Cancer. 2023;23(253):1-7. doi: https://doi.org/10.1186/s12885-023-10717-5 DOI: https://doi.org/10.1186/s12885-023-10717-5
Published
How to Cite
Issue
Section
License
Os direitos morais e intelectuais dos artigos pertencem aos respectivos autores, que concedem à RBC o direito de publicação.
This work is licensed under a Creative Commons Attribution 4.0 International License.
