One study found that among patients undergoing surgery for tumors that have metastasized to the spine, those who participated in an ERAS program had reduced blood loss, shorter hospitalization, and significant reduction in opioid pain reliever utilization compared to those who did not participate (362). Another study showed that among patients undergoing surgery for colorectal cancer, those who participated in an individualized plan that included exercise, nutritional Telemedicine in Cancer Care According to NCI, telemedicine, also called telehealth, is the delivery of health care from a distance using electronic information and technology, such as computers, cameras, videoconferencing, satellites, wireless communications, and the Internet. Identifying innovative ways to use telehealth in cancer care and addressing telehealth-related disparities among vulnerable populations are a major focus of a new National Institutes of Health initiative (342). POTENTIAL BENEFITS Increased access to health care Allows access to health services that may not be available to patients locally. Based on a recent study, patients with cancer ranked telehealth higher than in-person care with regard to access and health care provider engagement (343). Improved health care outcomes Promotes continuity of care regardless of the location of the patient and the provider, potentially improving overall health outcomes. Facilitated caregiver and family engagement Allows caregivers and other family members to participate, which can facilitate patient care. Decreased infectious exposure Helps patients with cancer avoid exposure to infectious viruses, bacteria, and other pathogens. Many patients are immunocompromised because of their cancer or treatments. Reduced costs and/or work-related adjustments Helps patients with cancer save time, travel, and money (344). POTENTIAL DRAWBACKS Widened health care disparities Recent data indicate that patients with cancer from racial and ethnic minority and medically underserved populations are more likely to experience unsuccessful telemedicine visits (345). Lack of access to infrastructure that supports telehealth (e.g., computer, smartphones, Internet) is disproportionately experienced by patients from medically underserved populations and may widen cancer disparities. Rapidly changing policies and reimbursement rules The fast-paced nature of telemedicine may make it harder for health care providers to keep up with health care laws, reimbursement policies, and privacy protections. Costly initial implementation Implementing telemedicine at a health care facility, including restructuring information technology staff, purchasing necessary equipment, and training clinicians and support staff, takes time and costs money. Security of personal health data The security of personal health data transmitted electronically is also a concern, which can be mitigated by employing a Health Insurance Portability and Accountability Act (HIPAA)-compliant telemedicine platform. Adapted from (9). SIDEBAR 29 Advancing the Frontiers of Cancer Science and Medicine AACR Cancer Progress Report 2023 75
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