Cancer Australia consensus statement on COVID-19 and cancer care: embedding high value changes in practice

Meeting the needs of rural cancer patients in survivorship: Understanding the role of telehealth

OBJECTIVE

This study explores perceptions about the role of telehealth in providing health and supportive services to Australian rural/regional cancer patients and survivor during COVID-19 and the quality of these services to inform future practice.

DESIGN

Data were collected as part of a bi-annual survey on client satisfaction at a rural/regional community cancer wellness centre in Australia.

SETTINGS AND PARTICIPANTS

Rural/regional cancer patients and survivors (n = 66) completed an online survey.

MAIN OUTCOME MEASURES

The three main outcome measures were: (1) attitudes towards telehealth; (2) preference for future cancer support services; and (3) experiences with video/telehealth.

RESULTS

Younger participants were more likely to use allied health services via video/telehealth during COVID-19 than their older counterparts. The preferred format for cancer support services in future was face-to-face (59% for younger and 42% for older participants), telehealth (10% for both groups) and mixed (31% for younger and 48% for older participants).

CONCLUSIONS

Telehealth has benefits for the delivery of health and supportive services to rural/regional cancer patients and survivors. Nurses can play a key role in assessing the support needs of cancer survivors and facilitating strategies to ensure that survivors have the skills necessary to access telehealth support.

Consumers' experiences, preferences, and perceptions of effectiveness in using telehealth for cancer care in Australia

AIM

COVID-19 accelerated telehealth (video and telephone) use for cancer care to reduce disease exposure and transmission. Understanding consumers' health service delivery needs is required to sustain telehealth activity and develop new models of care. We explored consumers' experiences of telehealth in cancer care and their perspectives on improving and sustaining telehealth uptake in the future.

METHODS

Exploratory design mixed-methods study using the Model for Assessment of Telemedicine (MAST) framework. Consumers affected by cancer completed an online survey and semistructured interviews. Quantitative data were analyzed using descriptive statistics and chi-square. Qualitative data from the MAST consumer domain were thematically analyzed.

RESULTS

There were 1162 survey respondents and 18 interview participants. Video and telephone were used in cancer care with various providers. Telephone was used more frequently. Most respondents (85%) had reliable internet connections for video, however, 36% were not offered a video consultation. Video compared with telephone users were statistically significantly more likely to be satisfied with the quality of their treatment and perceived their consultation achieved as much as an in-person consultation. Telephone users (51%) compared with video users (31%) were more likely to perceive their concerns would have been better understood by their care provider if they were seen in person. Five themes emerged from the qualitative data. Consumers want modality choice, video provides superior experiences versus telephone, consultation mode preference is fluid, and consultation scheduling and administration need further consideration.

CONCLUSION

Consumers support telehealth in cancer care. Consumers want consultation mode choices based on their needs and purpose of consultation.

Patterns of mental health service utilisation in people with cancer compared with people without cancer: analysis of the Australian National Study of Mental Health and Wellbeing

PURPOSE

To compare the patterns of mental health service utilisation between people with and without cancer.

METHODS

We performed a cross-sectional study using data of all respondents aged ≥ 25 years from the Australian National Study of Mental Health and Wellbeing 2020-2021 conducted during the COVID-19 pandemic. Comparisons were made between the two groups (cancer versus non-cancer) using logistic regression models.

RESULTS

The study comprised 318 people with cancer (55% female) and 4628 people without cancer (54% female). Cancer survivors had a higher prevalence of reporting poor health (38% versus 16%) and mental distress (18% versus 14%) than people without cancer. There were no significant differences between people with and without cancer in the odds of consulting general practitioner, psychiatrist and other health professionals for mental health, although people with cancer were significantly more likely to consult a psychologist than people without cancer (adjusted odds ratio (aOR) = 1.64, 95%CI = 1.05-2.48). While the odds of being hospitalised for physical health was significantly higher in cancer survivors than people without cancer (aOR = 2.32, 95%CI = 1.78-3.01), there was only a negligible number of people reported being hospitalised for mental health between the two groups. Several factors were associated with higher odds of mental health service utilisation including younger age, unpartnered marital status and presence of a current mental condition.

CONCLUSIONS

Alarmingly, despite experiencing higher prevalence of poor health status and mental distress, cancer survivors did not utilise more mental health services than the general population. That is, there is a higher degree of untreated, or undertreated, distress in cancer than in the general population.

IMPLICATIONS FOR CANCER SURVIVORS

Further research to identify optimal approaches of mental health care delivery for cancer survivors are urgently needed.

Conceptual Framework for Cancer Care During a Pandemic Incorporating Evidence From the COVID-19 Pandemic

PURPOSE

With successive infection waves and the spread of more infectious variants, the COVID-19 pandemic continues to have major impacts on health care. To achieve best outcomes for patients with cancer during a pandemic, efforts to minimize the increased risk of severe pandemic infection must be carefully balanced against unintended adverse impacts of the pandemic on cancer care, with consideration to available health system capacity. Cancer Australia's conceptual framework for cancer care during a pandemic provides a planning resource for health services and policy-makers that can be broadly applied globally and to similar pandemics.

METHODS

Evidence on the impact of the COVID-19 pandemic on cancer care and health system capacity to June 2021 was reviewed, and the conceptual framework was developed and updated.

RESULTS

Components of health system capacity vary during a pandemic, and capacity relative to pandemic numbers and severity affects resources available for cancer care delivery. The challenges of successive pandemic waves and high numbers of pandemic cases necessitate consideration of changing health system capacity in decision making about cancer care. Cancer Australia’s conceptual framework provides guidance on continuation of care across the cancer pathway, in the face of challenges to health systems, while minimizing infection risk for patients with cancer and unintended consequences of delays in screening, diagnosis, and cancer treatment and backlogs because of service interruption.

CONCLUSION

Evidence from the COVID-19 pandemic supports continuation of cancer care wherever possible during similar pandemics. Cancer Australia's conceptual framework, underpinned by principles for optimal cancer care, informs decision making across the cancer care continuum. It incorporates consideration of changes in health system capacity and capacity for cancer care, in relation to pandemic progression, enabling broad applicability to different global settings.

Telehealth cancer care consultations during the COVID-19 pandemic: a qualitative study of the experiences of Australians affected by cancer

BACKGROUND

In response to the onset of the COVID-19 pandemic, telehealth was rapidly rolled out in health services across Australia including those delivering cancer care. This study aimed to understand people with cancer and carers' experiences with telehealth for cancer care during the COVID-19 pandemic and associated restrictions.

METHOD

Semi-structured interviews conducted with people with cancer and carers via telephone or online video link between December 2020 and May 2021. Participants were recruited through cancer networks and social media. Interviews were transcribed and thematic analysis undertaken.

RESULTS

Twenty-three patients and 5 carers were interviewed. Telephone-based appointments were most common. Responses to telehealth were influenced by existing relationships with doctors, treatment/cancer stage and type of appointment. Four themes were derived: (i) benefits, (ii) quality of care concerns, (iii) involving carers, and (iv) optimising use of telehealth. Benefits included efficiency and reduced travel. Quality of care concerns identified subthemes: transactional feel to appointments; difficulties for rapport; suitability for appointment type and adequacy for monitoring. Both patients and carers noted a lack of opportunity for carers to participate in telephone-based appointments. Aligning appointment mode (i.e. telehealth or in person) with appointment purpose and ensuring telehealth was the patient's choice were seen as essential for its ongoing use.

DISCUSSION AND CONCLUSIONS

While telehealth has benefits, its potential to reduce the quality of interactions with clinicians made it less attractive for cancer patients. Patient-centred guidelines that ensure patient choice, quality communication, and alignment with appointment purpose may help to increase telehealth's utility for people affected by cancer.