Three million people have now missed cancer screenings due to COVID-19 since March 2020, according to Cancer Research UK.
6,400 patients referred to cancer services have waited more than three months for a response Health Services Journal, the leading sector publication, highlights.
MacMillan Cancer support described this situation as a ‘ticking time bomb’.
During the pandemic, people have been scared to go to the NHS with symptoms, and access to GP practices has been difficult with no or limited face-to-face consultations. But timely access to care is crucial for cancer patients. Delays in diagnosis and treatment can have profound negative impacts on patient outcomes.
COVID-19 has acted as a catalyst to fast-track new technology-based ways of working in healthcare as a way to mitigate the negative impact.
Digital technology is being implemented at scale. In a matter of months, rather than the usual decade of development, an alternative to face-to-face contact between clinician and patient has been provided.
Both primary and secondary care settings now use video, telephone and online consultations. The number of these consultations has grown exponentially from 15% of 23 million primary care appointments taking place by phone or online in December 2019, to more than 90% of appointments being delivered virtually by May 2020 according to NHS Digital.
Changes in cancer care
Today more people than ever are living with and beyond cancer, with the number in England forecast to grow from 2.3m in 2018 to 3.3m in 2028.
Living a good quality of life after cancer is now as important as survival. This realisation has led to the development of a personalised care approach, which puts the person at the centre of services and wraps care around them.
What has developed is a new way of working between people, their healthcare professionals and the wider system. And with it, a shift in power has occurred with patients, who in the past had accepted their consultant’s advice without question, now heavily involved in the decision-making about their care and treatment so that they feel informed, heard and connected. This shared decision making ensures people have choice and control, and get access to the right expertise and support.
Professional best practice in cancer care advocates a MDT approach where clinicians and patients work together to make decisions about tests, treatment and follow up as part of a two-way dialogue which leads to co-ordinated continuity of care. Collaborating to achieve the best outcome for the patient helps to build a level of trust between patients and clinicians and between the members of MDT themselves.
When the multidisciplinary team and individuals involved develop shared dialogue, listening together, they can arrive at a common understanding with the best outcomes for the patient at the centre. Encouraging individuals to silence their own assumptions and to respect other people’s points of view, and really listen to what other people are saying and what they might not be saying can help to bring the real issues to light.
Dialogue raises the level of shared thinking of the group and not only impacts on how people act, but how they act altogether. The result is higher quality person-centred care.
Impact of digital technology
'Virtually' could be the safest way to deliver care for a large number of patients with cancer who, by the nature of their disease, are more at risk of unfavourable outcomes of COVID-19. The benefits seen could also continue to be relevant after the pandemic in providing convenient healthcare delivery, patient involvement, and possibly a reduction in healthcare costs.
Patients who use the technology like its convenience. Moreover, this flexibility has meant that in-person appointments can be reserved for urgent or more complex cases and to support those who may be digitally excluded.
Reviewing the effectiveness of the approach, the Royal Marsden Hospital Sarcoma Unit evaluated the impact of virtual consultations or what they termed ‘telehealth’ on patients, clinicians and care delivery in outpatients during the pandemic.
The majority of patients were reviewed virtually, with 75% of planned face-to-face appointments converted to virtual consultations. For a group of 108 patients involved, satisfaction with the digital approach was high with a mean score of 9 out of 10.
Clinicians involved found telehealth to be efficient, with consultations generally shorter than face-to-face and with no associated increased workload. Clinicians also did not see that the lack of physical examination adversely affected care provision when using telehealth. Among clinicians, 94% believed that the use of telehealth was practice-changing and interestingly 80% of patients expressed a desire for some telehealth as part of their future care.
From the aspect of holding virtual multidisciplinary teams (MDT) as part of cancer care, a survey of 50 practising UK and US doctors who had been using virtual MDTs since mid-March found that a significant majority (83.3%) reported that virtual MDTs provided the same standard of care as face-to-face MDTs. Two-thirds would support continuing to use them once the pandemic situation had ended.
In looking to the future of health and care, it will be important to see how much of the digital transformation is here to stay.
Most major cancer organisations have endorsed the use of telehealth to facilitate communication with patients, provide continuity of care and to continue to operate MDT meetings. The reality is face-to-face and digital both have benefits, and neither is perfect.
To design and build effective and resilient cancer care, that doesn’t exacerbate or create new inequalities, those involved need to consider digital alongside traditional care rather than instead of it. The decision is made in collaboration between the team and the patient as to which method is most appropriate for each person.
In the end, whether face-to-face or virtual, all involved need to strive for true dialogue in the process, as it is the quality of the conversations that continue to be most important in delivering the best patient-centred outcomes.