January 2021Telehealth

Telehealth plays key role in Radiation Oncology, even though treatment is provided in person

If you tried to list the JGH departments where telehealth is helping patients maintain vital contact with healthcare staff during the COVID-19 pandemic, Radiation Oncology would not spring immediately to mind.

After all, cancer patients have to show up in person for radiation therapy. So what value is there in a digital system that lets them receive support from healthcare personnel while staying home?

The key, says Dr. Magali Lecavalier-Barsoum, is to recognize that even though in-person treatment is the climax of the process, getting to that point requires substantial interaction between patients and staff, and among members of the healthcare team.

Preparing the patient for treatment and determining the optimum dose of radiation is a painstaking process, much of which can now be accomplished remotely, explains Dr. Lecavalier-Barsoum, an oncologist in the JGH Division of Radiation Oncology.

“This is something we’ve wanted to do for many years,” she says. “It’s regrettable that the process had to be accelerated by COVID-19, but now we can confirm telehealth’s many benefits.”

Before the pandemic, Dr. Lecavalier-Barsoum used to meet in person with her patients to answer questions and record information that helped to determine whether and how often radiation treatments would take place.

Depending on the patient’s situation, additional follow-ups or investigations might also have been needed before treatment could begin.

While this was going on, members of the team held face-to-face meetings to discuss the patient’s needs and to agree on the many complicated details that had to be in place for treatment to be administered successfully.

However, when COVID-19 struck nearly a year ago, everything changed. According to Dr. Lecavalier-Barsoum, the use of phones and especially Zoom meetings has benefited patients in numerous ways:

  • Patients in a more vulnerable state of health—because of their treatments or the cancer itself—can stay at home to substantially reduce their exposure to risks such as hospital-borne infections.

  • Patients with limited mobility—due to a physical disability or the side effects of radiation treatment—no longer have to make so many energy-sapping trips. There’s also no need to sit in a waiting room that, because of their condition, they may find particularly uncomfortable.
  • Since travelling to the hospital now takes place less often, patients have less anxiety about arranging for transportation and making tiring trips. This is especially important for any patients from outlying areas who may be participating in clinical trials and want to minimize how often they have to travel to the JGH.
  • A visual platform like Zoom allows meetings with an oncologist or other healthcare specialists to include family members who are scattered in various locations.
  • Since patients are at home, they are much less likely to miss or be late for their meetings. Not only is this a health benefit, it allows staff to maintain an efficient work schedule.
  • If a patient is in distress, a telehealth consultation can generally provide relief more quickly than a trip to the Emergency Department. This has the added benefit of lightening the load on Emergency.

However, Dr. Lecavalier-Barsoum emphasizes that telehealth is not meant to fit every situation. Face-to-face meetings remain crucial in establishing a bond of trust and an emotional rapport between the patient and the oncologist.

For this reason, Dr. Lecavalier-Barsoum usually “meets” a new patient for the first time virtually, but follows up with an in-person appointment.

“Moving to telehealth was a major undertaking for Radiation Oncology.”

“Moving to telehealth was a major undertaking for Radiation Oncology,” says Elliott Silverman, Director of Logistics and the Internet of Things at CIUSSS West-Central Montreal. Until 2020, the notion of seeing a patient by Zoom or even speaking on the phone didn’t really exist.”

Mr. Silverman, whose directorate is responsible for Radiation Oncology, says a great deal of credit for the transformation goes to Anna D’Ambra, who is the CIUSSS’s Clinical Telehealth Lead and Pilot and a Specialized Clinical Informatics Analyst in the Digital Health team.

“Anna is doing a spectacular job,” he says. “As with any type of change, there’s always some resistance, but Anna got everyone to rally around this idea. She quickly got her hands on the necessary equipment, deployed it and brought the doctors on board.”

From the staff perspective, telehealth has enabled personnel to continue their regular discussions of individual cases, even though some of the participants are working from home, says Josina Van Den Nieuwenhof, Manager of Radiation Oncology.

According to Ms. Van Den Nieuwenhof, departmental staff favour Teams as a visual platform, since it also enables them to text-message among themselves—a much quicker way to communicate than sending emails back and forth.

“For example,” she recalls, “we had a very complex case where a cancer patient needed 36 treatments from Radiation Oncology, as well as chemotherapy. So we had to schedule a meeting promptly and cover a lot of ground.

“This is extremely important, because a lot of complex decision-making has to take place in Radiation Oncology in order for treatment to happen.”

“Before COVID-19, we would have had to figure out how to get everyone in a conference room at the same time. But in this case, we came together on Microsoft Teams, where we were also joined by someone from a CLSC, the head nurse from Oncology, a physician and others. It allowed us to quickly have a significant inter-disciplinary discussion on how best to move forward in treating this patient.”

As a result, Microsoft Teams has now become the standard collaborative tool and the means of communication in the department, says Krum Asiev, Chief Medical Physicist in Radiation Oncology. “This is extremely important, because a lot of complex decision-making has to take place among various groups in Radiation Oncology in order for the treatment to happen.”

Mr. Asiev also notes that the use of Microsoft Teams has enabled members of his team to dispense with pagers, which are not nearly as convenient for rapid communication.

Everyone agrees that after the pandemic has passed, key elements of telehealth are almost certain to become permanent in Radiation Oncology. As well, the department will keep searching for new uses for the technology to improve patient care.

“When we go back to normal, this will all have to evolve,” says Mr. Asiev, “but I’m sure we’ll figure it out. I can’t see having to make more than a few minor adjustments to what we’re doing now.”

“We’re bound to find our comfort zone,” Ms. Van Den Nieuwenhof agrees, “but we’ve got a ways to go before COVID-19 disappears. Telehealth will be our way of working at least for the foreseeable future.”

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