In July 2010, WSDAN News reported on research from the US state of Indiana on the effects of telecare on pain and depression management in patients with cancer – the 'INCPAD' (Indiana Cancer Pain and Depression) trial.1 The study used the premise that both these symptoms – pain and depression – were widely found in patients with cancer but often not afforded significance, despite the ability to treat them effectively.
A randomised controlled trial (RCT) involving more than 400 patients was carried out over a one-year period. Half of the participants were randomly assigned to the intervention, and half received usual care. All were defined as having depression and/or pain that was at least 'moderately severe' by recognised scales (Patient Health Questionnaire 9-item Depression Scale and Brief Pain Inventory).
Intervention patients received a three-way combination of 'telephonic care management' by a nurse care manager, automated monitoring of symptoms, and management of medication. Automated monitoring allowed patients to respond to a 21-part survey, using the telephone or internet.
Significant reductions were recorded for both pain and depression among patients in the intervention group compared with those in the usual care group. Researchers concluded that the combined telecare approach could be adapted for the management of other physical and psychological conditions too.
Telehealth evidence database
Participants in the INCPAD trial were drawn from both urban and rural oncology practices. The telehealth evidence database holds 10 entries on cancer, half of which explore the impact of telehealth on cancer patients living in rural communities.
Recently published research from Australia focuses on the effectiveness of telemedicine (telegenetics) for women with hereditary breast and/or ovarian cancer living in rural or outreach areas.2 Twelve women received telephone counselling by a genetic clinician. Most participants responded positively to the service which, on a practical level, reduced the need for – and the cost of – travel to appointments. Patients also felt a 'social presence' from the clinician, albeit via a virtual connection.
The New South Wales Cancer Institute's 2009 literature review acknowledges the importance of telehealth in cancer services, particularly among remote populations.3
In the United States, American Indian and Alaska Native patients who survived cancer were surveyed on their views about telehealth support groups.4 Thirty-two people responded. Many of them valued being able to connect with other patients, as this provided a sense of community for people who might otherwise have felt isolated.
Other research in the United States considered the quality, safety and cost outcomes for cancer patients living in rural areas who received telehealth interventions.5 Patients were seen by an oncologist for their initial appointment, and then for around half of their subsequent appointments, with the remainder being carried out using telemedicine. To break even, it was calculated that the clinicians needed to save five hours’ travel time a month through using telemedicine. The combination of reported patient satisfaction and potential financial savings led researchers to conclude that telemedicine was 'promising' and could be used for patients with conditions other than cancer.
A 2006 systematic review, carried out prior to the studies mentioned above, looked at the use of 'tele-oncology' for cancer patients in rural areas, and discovered limited evidence of benefit.6 The review concluded that services might be developed in future to better serve patients with cancer living in rural areas.
The take-up level of telehealth technologies by cancer patients and their carers has been documented in a number of studies, including American research which focused on health-related quality of life (HRQOL) among patients of widely different ages who were receiving chemotherapy.7 Daily tele-communication to discuss treatment-related symptoms with a care co-ordinator resulted in higher HRQOL scores among over-65s compared with under-19s. This indicates that the older participants placed greater value on the interaction.
A 2009 literature review looking at how the internet helps those who are caring for patients with cancer recorded a preference to consult health professionals rather than websites for information.8 Online support groups were found to be useful.
Parents of children who were recently diagnosed with cancer were involved in a pilot study that used videotelephone support.9 All participants reported satisfaction with the system, and researchers noted a cost saving compared with earlier models of videotelephone support.
The potential impact of telehealth on cancer patients living in remote areas can be significant, as it offers them a virtual connection with health professionals and other patients. Telehealth could therefore benefit patients, both in terms of clinical outcomes and improved quality of life, and not just those living in rural or outreach areas. Where studies have examined cost, indications are that telehealth can result in savings compared with usual care, although the evidence is not always clear. The type of cancer will dictate, to some extent, what telehealth intervention is most appropriate. Future studies will no doubt contribute further evidence regarding technical developments in this area, and user acceptance and satisfaction levels.
This article was taken from the Whole Systems Demonstrator Action Research Network (WSDAN) database
- 1. Kroenke K, Theobald D, Wu J, Norton K, Morrison G, Carpenter J, Tu W (2010). 'Effect of telecare management on pain and depression in patients with cancer'. The Journal of the American Medical Association, vol 304, no 2, pp 163-71. Available at: http://jama.ama-assn.org/content/304/2/163.short?rss=1 (accessed on 4 February 2011).
- 2. Zilliacus EM, Meiser B, Lobb EA, Kirk J, Warwick L, Tucker K (2010). 'Women's experience of telehealth cancer genetic counseling'. Journal of Genetic Counseling, vol 19, no 5, pp 463-72. Available at: http://ukpmc.ac.uk/abstract/MED/20411313/reload=0;jsessionid=2F2C11DCCA4144E3540FB8477DC89DE9.jvm1 (accessed on 4 February 2011)
- 3. Adams P, Hardwick J, Embree V, Sinclair S, Conn B, Bishop J (2009). 'Models of cancer services for rural and remote communities'. New South Wales: Cancer Institute.
- 4. Doorenbos AZ, Eaton LH, Haozous E, Towle C, Revels L, Buchwald D (2010). 'Satisfaction with telehealth for cancer support groups in rural American Indian and Alaska Native communities'. Clinical Journal of Oncology Nursing, vol 14, no 6, pp 765-70. Available at: www.ncbi.nlm.nih.gov/pubmed/21112853 (accessed on 4 February 2011).
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- 6. Hailey D, Paquin M-J, Casebeer A, Harris LE, Maciejewski O (2006). 'Evidence about tele-oncology applications and associated benefits for patients and their families'. Journal of Telemedicine and Telecare, vol 12, pp 40-43. Available at: http://jtt.rsmjournals.com/cgi/content/abstract/12/suppl_3/40 (accessed on 4 February 2011).
- 7. Mkanta WN, Chumbler NR, Richardson LC, Kobb RF (2007). 'Age-related differences in quality of life in cancer patients: a pilot study of a cancer care coordination/home-telehealth program'. Cancer Nursing, vol 30, no 6, pp 434-40. Available at: www.ncbi.nlm.nih.gov/pubmed/18025915 (accessed on 4 February 2011).
- 8. Kinnane NA, Milne DJ (2010). 'The role of the Internet in supporting and informing carers of people with cancer: a literature review'. Supportive Care in Cancer, vol 18, no 9, pp 1123-36. Available at: www.springerlink.com/content/a9u7l63q52086688/ (accessed on 4 February 2011).
- 9. Bensink M, Armfield N, Irving H, Hallahan A, Theodoros D, Russell T, Barnett A, Scuffham P, Wootton R (2008). 'A pilot study of videotelephone-based support for newly diagnosed paediatric oncology patients and their families'. Journal of Telemedicine and Telecare, vol 14, no 6, pp 315-21. Available at: http://jtt.rsmjournals.com/cgi/content/abstract/14/6/315 (accessed on 4 February 2011).