Telehealth Can Help Reach Rural Patients with Cancer

Despite the fact that between 46 and 59 million Americans live in rural areas, patients in these regions with cancer often face myriad challenges in obtaining care. Novel approaches such as telemedicine, however, may be a way to reach these patients, according to a panel discussion Wednesday at the Hematology/Oncology Pharmacists Association 2020 Meeting in Tampa, Florida.

Those living in rural areas face higher rates of new cancers, as well as a greater risk of dying from cancers of the lung, colon, and cervix, according to moderator Jill Rhodes, BCOP, CSP, FHOPA, clinical oncology specialist at University of Louisville Health.

Minorities in rural areas are statistically younger, more likely to report their health as “fair” or “poor,” have higher rates of obesity, and are more likely to report being unable to see a physician in the previous 12 months due to cost. Despite these differences in rural and urban populations, the major deciding factor in patient outcomes continues to be access to care.

“Patients from rural America, if given the same opportunities and treatment services, should have the same outcomes as patients in urban areas,” Rhodes said.

Telemedicine offers many opportunities for patients and providers in the oncology field, Rhodes noted, including gaining expertise beyond the walls of your institution, improving education and adherence tools for patients, and increasing ancillary team support.

Panelist Renae Vaughn, MSN, ANP-c, AOCNP, oncology nurse practitioner at Munson Healthcare-Cowell Family Cancer Center, said ancillary services are where she sees the most need for rural patients.

“Being able to do some of the ancillary services, you know, dietician or social work, even though that patient needs it they just don’t have the resources to travel for those resources that are available,” Vaughn said. “Anything you can provide telehealth-wise or video conferencing is helpful for those patients.”

All 4 of the panelists agreed that geographic barriers are the most prohibitive for patients seeking care. Linda Bohannon, RN, BSN, MSM, president of Cancer Support Community, said she recently worked with a program providing hotel vouchers to patients with cancer and that the program spent approximately a million dollars in just 4 to 5 months.

Vaughn added that even with vouchers, rural patients may face other obstacles.

“At all of our cancer centers, we provide travel vouchers and gas vouchers, but do they have a car? Do they have somebody that can take them to their appointments?” Vaughn said.

Improving local resources not only make it easier for patients to reach the clinic, but they also afford the patients more support from family and friends, which can have a marked effect on health outcomes.

Although telemedicine may be extremely helpful in closing the gap between rural and urban oncological care, several attendees asked about the barriers to setting up telemedicine in a health system or other medical environment.

“I think if you’re looking at doing something like [telemedicine], you have to first identify if there’s a need in your community, and then have a champion to do the research,” Vaughn said. “Throughout the region and in our hospital, every single hospital is expanding telemedicine. It’s huge.”

The panelists agreed that convincing physicians can be a major challenge because they want to see patients face-to-face. Eric Jacobsen, MD, clinical director at the Dana-Farber Cancer Institute, recommended starting small and reminding physicians that an appointment via video is better than no appointment at all.

“If people have positive experiences, they will be more and more amenable to do it,” Jacobsen said.

REFERENCE

Bohannon L, Jacobsen E, Rhodes J, Vaugn R, Schneider L. Bringing Care Close to Home: Patient Outreach in Rural America. Presented at: Hematology/Oncology Pharmacists Association 2020 Meeting in Tampa, FL: March 11, 2020.