Bridging the Digital Divide of Rural Cancer Care With Telehealth

At the Denver regional Institute for Value-Based Medicine® event, expert panelists discussed ways to elevate value in cancer care across different disease states. Glenn Balasky, executive director of Rocky Mountain Cancer Centers, led the session, “Implementing New Technology and Innovations in Cancer Care in Rural Communities."

Balasky here discusses the potential of telehealth as a solution to bridge geographic gaps and provide timely cancer care in rural areas, noting its significant advancement during the pandemic. He emphasizes the need for government action to sustain telehealth, which could benefit both rural and urban settings. He also addresses the challenge of providing innovative cancer care in rural areas, suggesting a compromise where high-tech care is centralized but supported by remote monitoring and follow-up, ensuring patients can access advanced treatments while staying connected.

This transcript has been lightly edited.

Transcript

How can telehealth be effectively utilized to bridge the geographic gap and provide timely cancer care services to patients living in rural regions?

That's a biggie. First of all, we're in a little bit of a telehealth limbo right now with the federal government and maintaining some of the telehealth capabilities, or encouraging a system that is alive and well for telehealth. I'm not saying it doesn't exist, or didn't exist before the pandemic in the rural environment, but it really took a big leap with the pandemic, and the government hasn't quite really decided when or how it's going to promote that. But if that can be done, I think that's a great prospect for keeping people connected, not only in rural settings, even in busy urban settings.

A person can still be 45 minutes away from the doctor in an urban setting, but they're only 10 miles away, whereas here in the rural settings, they can be truly 45 miles away, 45 minutes away, so connecting people is really a calling for the government. Hopefully some of the stickiness that's going on with endorsing telehealth for the long term can incrementally get resolved in Washington, and then the private payers will go along with that, and think we can have that as a tool like we did during the pandemic.

How can the digital divide be addressed in rural areas to ensure equitable access to innovative cancer care technologies?

I think that's a real tough one because innovative cancer care, almost by definition, says it's got to be in a place where things are more concentrated. And innovative cancer care is complicated, involves genomic testing, involves drugs that are difficult to deliver by any institution, any medical provider. I think we have to bridge to connect with people but I think ultimately, if you want high tech, the best in class cancer care, it can't be delivered everywhere. How do we bring people closer to these settings and connect them so that they can access care and then still be connected to be followed up and be watched remotely? I think this strategy could be a good working compromise.

How can knowledge and best practices from other countries be adapted and applied to improve cancer care in rural communities?

The beauty of the US is we are bringing the best care. Although, I was with some colleagues earlier this week and research is getting more and more pressure because we're not reaching [all the] population for research, and yet it's hard to extend and bring research out to a rural setting.

We have it in the urban areas, we have it in the medium-sized cities, but again, the patients are going to have to connect up and be connected. I think even those that bring clinical trials, technology, are going to have to think about the distance factor as they ponder or as they decide what to do to better accommodate the rural world.

The regulatory climate is like, "Well, we want the patient there, we want them in our site," but it's not necessary for everything. So, how can we bridge with technology? Does even a small local hospital in a more rural area have enabling technology to connect back up to institutions?

I think that's where government and even the private payers and the fabric that exists can think about working together. My best idea would be that we bridge the connection with people and then they make trips into the big city for what they need or there are ways to get them to the city. Transportation can be overcome, but you can't just bring very sophisticated care out to everywhere. It's just not economically feasible.