Safety and Efficacy of Telemedicine for Patients With Advanced Cancer in the Outpatient Setting: Lessons Learned From a Pilot Trial.

Background: Telemedicine (TM) was studied, particularly during the COVID-19 pandemic, to ascertain its utility in delivering remote medical services.

Study question: What palliative care (PC) interventions can be provided through TM consultations compared with face-to-face (FF) consultations? What is their efficacy in reducing the intensity of suffering in the physical, emotional, social, and spiritual domains? What is the level of satisfaction with the care given?

Study design: Randomized controlled trial with 2 arms: TM consultations using Zoom and WhatsApp secure platforms (Intervention group) and FF consultations (Control group). Participants received 8 scheduled weekly consultations and on-demand consultations.

Measures and outcomes: The patients completed weekly Edmonton Symptom Assessment System, Problems and Needs in Palliative Care Short Form, and Patient Satisfaction Questionnaire Short Form monthly questionnaires. Statistical analyses were performed using GraphPad Prism 10.0.2.

Results: Between July 2023 and January 2024, 26 patients with newly diagnosed advanced cancer were randomized, 23 completed the study and 3 died in the TM arm (attrition rate 11.53%). Enrolled participants had predominantly advanced head and neck cancer (30.76%) and digestive tract cancer (23.07%). Patients in the TM arm had a lower performance status compared with the FF group. One thousand one hundred sixty-eight PC interventions were performed, 628 (FF) versus 540 (TM). In the physical domain, 343 versus 266; in the emotional domain, 219 versus 206; in the social domain, 18 versus 18; in the spiritual domain, 48 versus 50. Higher reductions in symptom intensity scores were reported in the TM arm (100% for depression, anxiety, hemorrhage, dysphagia, and secretions; >90% for pain, nausea, and appetite; >80% for sleep, dyspnea, and constipation; and >70% for cough), with statistical significance for pain (P = 0.0140), nausea (P = 0.0148), depression (P = 0.0318), and constipation (P = 0.0100). High satisfaction scores (>80, range 18-90) were reported for both arms.

Conclusions: This exploratory pilot study shows that TM PC interventions are feasible and lead to high reductions in intensity scores for symptoms, with high satisfaction scores.