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Telehealth Can Expand Lung Cancer Treatment Options in Rural Areas

Rural patients tend to have diminished access to appropriate, routine cancer screening studies, leading to patients with cancer being diagnosed with more advanced stage disease.
BY M. CLARK, M.D., AND ELIZABETH A. DAVID, M.D., MAS, FACS
PUBLISHED November 25, 2017
Implementation of telehealth into cancer centers across the United States has allowed for outreach to patients in many locations that are often far from large, urban medical centers.

The development of modern multidisciplinary treatment of patients with cancer with the coordination of medical oncologists, radiation oncologists and surgical oncologists has led to regionalization of treatment teams within specialized care centers in some areas.

These medical centers are commonly located in large, urban areas, leading to significant hurdles for patients in rural areas to access specialized treatment teams. Many studies have demonstrated that greater geographic distance from urban advanced-care centers worsens patient survival.

Rural patients tend to have diminished access to appropriate, routine cancer screening studies, leading to patients with cancer being diagnosed with more advanced stage disease.

Advanced-stage cancers, which are often associated with disease spread to other organs or lymph nodes beyond the original tumor, are invariably associated with decreased patient survival and are more difficult to treat. In the past decade, there have been several Australian studies demonstrating that mortality is higher in patients with lung cancer who live farther from specialty hospitals with thoracic surgeons on staff.

Improved lung cancer survival is linked to earlier stage at diagnosis. One study found that those patients treated at these specialty hospitals were more likely to undergo surgical excision of their lung cancer, leading to improved overall survival.

Data from the United Kingdom corroborates these findings, showing that greater geographic distance from a facility with a thoracic surgeon has an even larger effect on patient survival than the patient’s cancer stage at diagnosis.

Although there is inconclusive evidence that U.S. rural patients have worse survival rates than their urban counterparts, data from the American Society of Clinical Oncology indicate that only 3 percent of medical oncologists work in rural areas, resulting in significantly higher travel times for rural patients to be seen by medical and radiation oncologists. In addition, oncologists find it more difficult to enroll these patients in clinical trials of novel therapies.

To overcome these discrepancies in urban and rural patient outcomes, health care systems are turning toward multidisciplinary tumor teleconferences to link community cancer treatment centers with regional specialist hospitals.

These telehealth conferences tap video conference technology to provide real-time discussions between oncologists on the front line of patient cancer care in a rural setting and specialists in urban tertiary care centers.

A patient’s oncologist often is instrumental in coordinating a patient’s care leading up to and after surgery or specialized radiation therapy.

As such, it is vital that oncologists communicate frequently and directly with those specialists in the tertiary care center.

Regular telehealth video tumor conferences allow real-time decision-making with a large group of specialists to consider each patient’s case individually. Each patient with cancer is unique. Collaborative discussion between specialists facilitates optimization and personalization of each patient’s cancer care.

Often, tertiary or quaternary medical centers participate in clinical trials to study novel chemotherapeutic agents or treatment regimens. Many community oncology centers may have limited access for patient enrollment in these clinical trials, but the collaboration of a virtual tumor board allows some patients in rural areas to participate in therapeutic clinical trials to which they may not have otherwise been exposed.

As cancer therapy, especially lung cancer care, becomes more individualized with analysis of genes expressed by tumors, it is important for all patients with cancer to have access to such trials.

Lung cancer screening with low-dose computed tomography scanning of the chest has recently been recommended in select patients with significant smoking history. However, it is thought that a majority of patients in the community who would benefit from such screening will never receive it for various reasons.

Lung cancer continues to be responsible for the largest numbers of cancer deaths in the U.S. and is the second most commonly diagnosed cancer in both men and women.

As such, it is even more important to reach these rural patients who more often have advanced-stage lung cancer for enrollment in trials that could provide them potentially lifelengthening therapies.

The multidisciplinary cancer center at University of California, Davis has regular telehealth video conferences with surrounding community oncology groups to discuss all avenues of our patients’ care.

By nurturing this network of satellite oncology sites with our thoracic oncology specialists, our medical and radiation oncologists, surgeons, pathologists and radiologists are able to personalize the treatment plans for each patient.

In an era when oncology is becoming more and more individualized with identification of unique tumor characteristics, the advent of telehealth is an excellent adjunct to the care of patients with lung cancer, especially for rural patients whose access to specialized care may be limited.
JAMES CLARK, M.D., is a general surgery resident at the University of California, Davis. He plans to specialize in general thoracic surgery with an interest in surgical management of advanced stage lung cancer.

ELIZABETH DAVID, M.D., MAS, FACS, specializes in general thoracic surgery, with a particular interest in thoracic surgical oncology at the University of California, Davis. She is interested in minimally invasive thoracic surgery, including robotic surgery, tracheal and airway procedures, esophageal resection and stenting and palliative oncologic procedures. David has a special interest in surgical management of advanced stage lung cancer.
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