GU Cancers 2021 | Impact of telemedicine on patient-reported outcomes in urologic oncology

Telemedicine was probably a minor part of most people’s practices, pre-COVID. Here, locally at the University of Washington, I had a telemedicine clinic and that was in part to support our research program around telehealth. We have a massive rural catchment, so the University of Washington is the only university-based academic and comprehensive cancer center for a five state area called the WWAMI region, which is Washington, Wyoming, Alaska, Montana, and Idaho. And because of that, we have patients that travel massive distances for our care.

So we had implemented a telemedicine pilot to understand how telemedicine might preserve quality and satisfaction with care while providing for some improved patient-centered outcomes like reductions in direct and indirect costs of care. But that was dramatically accelerated with the COVID pandemic. As the pandemic itself created a need for us to have fewer in-person contacts with patients, but still maintain high-quality cancer care. And so, our telemedicine volumes went from five to ten patients per week to 50 to a 100 patients per week and that gave us an opportunity to really track the patient-reported outcomes of our telemedicine visits in comparison with our in-person visits. And most reassuringly, we found that patient-perceived satisfaction with care and their ratings of the quality of their visit and their connection with their provider were just as good as they were for in-person visits.

And then not surprisingly the costs of care were dramatically reduced. And so we often think about things like the length of time in a car that a patient spends, but there were other factors that we often don’t tabulate as we think about the burden on our patients, we don’t think about whether or not they have a hotel stay associated with their visit. What their needs were for food as part of their travel. And then a big thing for our genital urinary cancer patients, because they do tend to be older, is, was a caregiver with them, was a son or a daughter with them? Did they take a day off of work or two days off of work to accompany them on their visit?

So, most astoundingly, 12% of our patients who were more rural and came for in-person visits, had a combination of direct and indirect costs over a thousand dollars to see us and that’s a lot. And you would think that that number is probably fairly unacceptable, especially if it’s for a surveillance visit, you know, for a patient to spend a lot of money to see us so we can tell them that they continue to be cancer-free is a lot. So, I think telemedicine, we know that it’s here to stay, but I think we’ve also been reassured that it preserves satisfaction and quality of care. While having some really important patient-centered positives.