Addressing Gaps in Digital Health, Telehealth in Patients With Cancer

When addressing gaps in remote cancer care, older adults with cancer, cancer-related bereavement, oncology provider wellness, and implementation outcomes were identified as areas of concern in need of continued innovation in a digital health setting.

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“The spread of digital health and telehealth in cancer care during the COVID-19 pandemic necessitated an overview of the state of this science, to identify gaps in what is known about remote cancer care delivery,” wrote the researchers of the study. “Our scoping review revealed an extensive and recent body of review literature on digital health and telehealth interventions in cancer care.”

The meta-analysis study is published in The Lancet Digital Health.

An electronic literature search was conducted for systemic reviews from database inception to May 1, 2022, from PubMed, Cumulated Index to Nursing and Allied Health Literature, PsycINFO, Cochrane Reviews, and Web of Science.

Eligibility criteria of reviews included exposure to cancer, whether as a patient, survivor, at risk for the disease, care giver, or health care provider, and evaluation of a digital health or telehealth intervention as defined by the US Health Resources and Services Administration. A total of 1196 records were screened. After exclusion, 134 systemic reviews were included in the analysis.

Of these records, 128 reviews summarized interventions intended for patients, 18 addressed family caregivers, and 5 addressed health care providers. Fifty-sixreviews did not target a specific phase of the cancer continuum, compared with 48 reviews that addressed the active treatment phase.

The reviews in the analysis included 128 (95.5%) patients, 18 family members (13.4%), and 5 (3.7%) health care personnel. Cancer types covered were brain (0.7%), breast (12.7%), colorectal (3.7%), gynecological (5.2%), hematological (3%), lung (2.2%), prostate (3%), skin (4.5%), and multiple or not specified (70.9%).

Telehealth components included synchronous telehealth (58.2%), text messaging or short messaging service (27.6%), email or secure messaging (29.1%), e-Health (64.9%), and mobile application (58.2%). Types of intervention or care included health behavior change (17.9%), psychosocial support or distress management (13.4%), disease detection or management (10.4%), medical decision-making (1.5%), and multiple or not specified (54.5%).

Additionally, 29 of these reviews included a meta-analysis and showed positive effects on quality of life, psychological outcomes, and screening behaviors. On the other hand, 83 reviews did not review intervention implementation outcomes. However, when reported, reviews included acceptability (n = 36), feasibility (n = 32), and fidelity outcomes (n = 29).

The researchers also noted several gaps in digital cancer care. None of the reviews specifically addressed older adults with cancer, cancer-related bereavement, or sustainability of interventions. Furthermore, only 2 reviews compared telehealth with in-person interventions.

The researchers acknowledged some limitations to the study. First, the review was a scoping review of reviews, in which identified gaps in the literature only established that a review was not identified in any given area of remote cancer care and may not be generalized in primary literature. Furthermore, the researchers did not include patient information that may be important when evaluating health equity, such as race and ethnicity, as well as rurality.

Despite these limitations, the researchers believe this study was able to summarize existing literature on digital health and telehealth interventions across cancer care, as well as identify possible gaps in remote cancer care.

“Establishing the state of the science in these areas with high-quality reviews might help guide continued innovation in remote care delivery, particularly for older adults and bereaved families, and support the integration and sustainability of these interventions within standard oncology practice,” wrote the researchers. “This work will support continued growth in the reach and effects of digital health and telehealth interventions to reduce cancer risk and improve cancer care for all individuals.”

Reference

Shaffer KM, Turner KL, Siwik C, et al. Digital health and telehealth in cancer care: a scoping review of reviews. Lancet Digit Health. 2023;5(5):e316-e327. doi:10.1016/S2589-7500(23)00049-3