Photo: Augieray via Flickr
In the United States, people who live in rural America have higher rates of death from cancer than those in urban America – even though cancer-incidence rates are lower overall.
Part of this disparity, researchers suspect, comes from reduced access to high-quality care in rural communities.
As part of addressing that disparity, researchers from California recently presented an abstract at the 2020 American Society of Clinical Oncology Virtual Scientific Program suggesting that telehealth can contribute to improving cancer care for patients in rural areas.
Why It Matters
Researchers found that the telehealth infrastructure they implemented in the mountain communities of California "enhanced the reach and quality of care as measured by volume, in-migration, clinical trial activity, and national quality accreditations."
In 2006, Dr. Laurence J. Heifetz established what is now the Gene Upshaw Memorial Tahoe Forest Cancer Center in Truckee, California. Until then, Truckee had had a single critical access hospital.
"The hospital is located off an interstate highway and is 30 miles from Reno, Nevada, and 100 miles from Sacramento, California," Heifetz and his coauthors explained in a paper published in 2011. "Those distances are deceiving, as the weather in the area is extreme from November through April, with snow frequently causing major traffic and safety issues."
They added: "Patients with cancer from our rural communities had always needed to travel great distances at significant hardship to mid-sized cities for even primary cancer care."
The Truckee-based oncology program joined with four other facilities, explained Heifetz and his coauthors in the 2020 abstract. The program included structured virtual tumor boards addressing colorectal, prostate, lung and breast sites, which comprise the majority of cancer diagnoses.
"We built a small conference room designed to integrate multiple doctors into a communal tumor board using basic flat screen and video technology," said Heifetz in a 2015 interview about the boards.
"Each physician’s image and voice can be viewed along with the diagnostic imaging studies, pathology, and PowerPoint presentation. The high-definition images and sound are transmitted through encrypted Web-based technology, ensuring both security and quality," he said.
"Each site created a dedicated virtual conference room with two monitors and a video camera. One monitor is for the audiovisual transmission and can be divided so the participating members can see and speak with each other. The other monitor is for the presentation outline as well as radiology and pathology images viewed through a Web-conferencing interface," Heifetz continued.
"Remote telemedicine clinics outside the primary catchment area were also established to serve the mountain communities of Quincy, Portola, Loyalton, and South Lake Tahoe, California," wrote Heifetz and his coauthors in the abstract.
The authors of the abstract referred to the virtual tumor boards and the remote clinics as a "synaptic knowledge network of telehealth."
"The combination of virtual tumor boards and telehealth clinics associated with growth of the program to 3 medical oncologists, 1 radiation oncologist and expansion into a 20,000 [square-foot] facility," they wrote.
Researchers found that total new patient visits increased from 60 in 2006 to 506 in 2008, with 62% of patients in 2018 coming from zip codes outside of the primary catchment area. Clinical trial enrollments and accreditations also "steadily increased" during that time period, they found.
"The program is accredited by the Commission on Cancer with commendation, ASTRO’s APEX, ASCO’s QOPI and CancerLinq programs, and is a G02Foundation for Lung Cancer Community Center of Excellence," the authors wrote.
The Larger Trend
Rural access to care via telehealth has become an issue of increasing importance, particularly during the COVID-19 pandemic.
In June, the Federal Communications Commission announced that it would be allocating more money toward rural health providers, aimed at establishing the broadband connectivity necessary to implement telehealth and virtual care.
But leaders of rural hospitals pointed out in May that it takes more than telehealth alone to survive the pandemic – it will also take an overhaul in payment models to allow rural systems to control costs.
"What we should all be talking about now, looking at the last two months and how we go forward, is truly transformation," said Geisinger EVP and Chief Innovation Officer Karen Murphy, RN, during a webinar hosted by the Bipartisan Policy Center.
On The Record
"Patients in rural areas have reduced access to high-quality cancer care, which contributes to rural-urban disparities in cancer mortality. Telehealth technologies can connect providers across rural and urban communities," wrote the researchers in the ASCO abstract.
"Application of synaptic knowledge networks to other rural sites is a promising strategy to reduce rural-urban disparities in cancer care," they said.