Colorectal cancer is the second most common cause of cancer death in the United States. It is estimated that about 55,000 patients will die this year due to advanced colorectal cancer. These grim statistics persist despite a marked increase in the rate of screening colonoscopies and improvements in adjuvant chemotherapy. Successful chemoprevention strategies may reduce the risk of new colorectal cancers, thus decreasing related overall morbidity and mortality.
Hearing the words, "You have cancer," is psychologically traumatizing. For the newly diagnosed cancer patient, there is a heightened vulnerability, a sense of sudden isolation from the world of the healthy. For cancer patients living in rural America, this sense of vulnerability and isolation is magnified by having to travel long distances to access oncology services that those in metropolitan areas may take for granted. Together with financial and symptom-related issues such as fatigue and pain, these barriers to care often prove insurmountable.
In the heart of the nation, the state of Kansas inspires images of vast, storm-swept plains and sprawling farms. While Kansas's remote communities offer an idyllic contrast to bustling metropolitan life, access to cancer care can be particularly challenging. In 1983, the University of Kansas Medical Center (KUMC) began offering outreach oncology services to several rural communities. Each month, an oncologist would fly in and partner with a local primary care physician for a monthly cancer clinic, allowing patients to be treated close to home. But rising costs and weather-related flight delays eventually shut down the program. The "fly in" program was no longer economically viable in a place known as "tornado alley."
But now, a relatively new innovation called teleoncology has provided patients in remote areas another way to receive quality oncology care. In 1995, KUMC established its first tele-oncology connection with a rural medical center located more than 250 miles away in Hays, Kansas, connecting a university-based oncologist with a center in the central part of the state. After developing the initial clinic at Hays Medical Center, a second telemedicine clinic was established 2 years later in Horton, Kansas.
Teleoncology delivers clinical oncology services using electronic devices to aid diagnosis, treatment, and follow-up. The clinics use an interactive televideo system consisting of a video monitor, video camera, and Internet protocol.
These services are made possible by the collaboration of professionals including the KUMC oncologist, nurses located at the remote sites, administrative personnel, and a technical support system.
Teleoncology closely mirrors the traditional visit to the oncology office, but there is no face-to-face doctor-patient encounter. After the patient is given a brief overview of the telemedicine technology and is familiar with the system, the teleoncology specialist (eg, an oncology nurse) takes the patient history and is assisted by the oncologist at the remote site with the physical examination, reviewing radiographs and lab work, and ultimately discussing diagnosis and potential treatment options.
KUMC data indicate that teleoncology practices have been well received by patients. Key to alleviating patient concerns is the presence of a staff nurse in the examination room during the teleoncology appointment. Patients know and trust a nurse to explain any questions that might arise.
In today's budget-conscious environment, the long-term existence of every medical practice is rooted in its cost-effectiveness. Even though teleoncology practices serve an important role in delivering care to an underserved population, these specialty practices are not exempt from hard financial scrutiny. To that end, several cost-analysis studies have demonstrated that the costs of providing cancer care via telemedicine are comparable with costs of delivering traditional oncology care. Teleoncology has additional cost-related benefits, too, such as providing education to nurses in the rural sector, and assisting health-care providers in enrolling rural patients in cancer clinical trials.
Communication between physicians and patients is fundamental to the delivery of high-quality, compassionate cancer care. It might seem odd to connect compassion with the hard circuitry of novel technology. But to cancer patients in remote communities like Hays, Kansas, the technology that connects them with an oncology team is synonymous with compassionate care.
The science of oncology is rapidly evolving. So, too, are our electronic medical capabilities. The oncology community would be wise to pay attention to success stories like that of KUMC's teleoncology program. Telemedicine has exponential benefits that can be realized not only in rural areas, but in other underserved populations as well.
Electronic medical technology, and teleoncology in particular, is one more ally in the battle to ensure that all Americans have access to high-quality cancer care. Any perceived barriers to its implementation, such as initial cost outlay or practice management disruption, pale in comparison to its benefits. Just ask the doctors and their cancer patients in Hays, Kansas.
Senior Editor, ONCOLOGY