One more positive area that has emerged during the pandemic is the deployment of telemedicine to support cancer care across Europe (using video, telephone, and other electronic communication, including software for virtual tumour boards). The impact of digital technology has been profound: As a senior clinical advisor at Cancer Research UK suggested in a recent Lancet Digital Health article, We’ve had five years of innovation in five weeks38. This has led to important benefits in order to overcome the adverse impacts of the pandemic, such as by increasing the number of cases managed daily by primary healthcare professionals, helping ensure continuity of care and research in cancer in spite of limited patient mobility and patients’ reluctance to attend medical facilities, and facilitating connection between large and small cancer centres.
While enhanced accessibility of cancer services for patients, with reduced need for travel, and consequent greater resource efficiencies are to be welcomed, more consideration is required as to how best, over the longer term, telemedicine is deployed in routine cancer care. In particular, the potential detrimental impacts of telemedicine on diagnosis and access to multidisciplinary care, including on supportive interventions typically provided in conjunction with an outpatient appointment, need to be given attention. Furthermore, the situation of underserved or marginalized populations, notably due to lower access to, or familiarity with, technological tools, must be addressed, in order to ensure that the implementation of telemedicine does not widen disparities and lead to worsened deconditioning and social isolation of such individuals.
In addition to telemedicine, other innovative solutions have been deployed during 2020, helping to enhance cancer control at a time of increased needs and decreased resources. These include:
• Novel settings for provision of HPV vaccination, such as through drive-through vaccination centres;
• Self and home delivery of cancer screening and diagnostic examinations, such as self-HPV DNA sampling and testing for cervical cancer screening, Faecal Immunochemical Testing (FIT) for colorectal cancer screening;
• Risk stratification, i.e. prioritisation of higher-risk cancer patients, according to cancer type (with lung and haematological cancer patients being at risk during the COVID-19 pandemic), tumour type or tumour stage (e.g., using Faecal Immunochemical Testing (FIT) to identify patients at greatest risk of developing colorectal cancer (CRC) and direct them to urgent colonoscopy, thereby best managing reduced colonoscopy capacity whilst ensuring rapid diagnosis and treatment of CRC39);
• Using community pharmacies and general practitioners as local diagnostic and monitoring hubs, thus minimising longer travels of patients to hospitals;
• Prioritisation of the provision of minimally invasive treatment modalities, of increased relevance in view of crowded ICU services;
• Self and home delivery of anticancer drugs, through oral chemotherapy or home infusion, as well as of blood tests; and,
• Provision of assisted home care and of online forms of support and therapy, in particular in the field of psychosocial interventions.
In order to provide care and support to cancer patients while avoiding unnecessary risks of infection, all health systems should set up strategies for the appropriate and proportional use of telemedicine in cancer care both during and after the pandemic period. This should incorporate appropriate training opportunities for relevant healthcare professionals and expertly formed guidance on the best use of telemedicine in the cancer setting. Relevant regulations in the field of telemedicine should also be urgently defined, as it has been reported to us, in some countries, legal and practice uncertainty has hampered the deployment of telemedicine.
At the EU and WHO Europe level, best practice sharing on the deployment of telemedicine in cancer care should be conducted. This, and other coordinating measures, can play a helpful role in mitigating against telemedicine exacerbating existing digital health divides in Europe.
Via instruments such as the Horizon Europe and EU4Health programmes, the EU should support much-needed independent research to generate robust evidence on the appropriate use of telemedicine in cancer care and inform future strategies.
Importantly, specific measures must be in place to ensure that the individual status and preferences of the patient are taken into account. Any telemedicine strategy must be focused on equity and equal access across countries and patient groups. In the post-COVID-19 era, hybrid systems combining the offer of telemedicine in specifically relevant situations with the provision of in-person appointments must be put in place. Any patient must be given the choice to access an in-person appointment, and never be denied his/her/their right to benefit from the latter.
To assist rapid sharing of best practices, the European Commission should urgently publish a report highlighting examplar initiatives by Member States to retain cancer services despite COVID-19 pandemic challenges. We recommend this be included as an early action of Europe’s Beating Cancer Plan. An important audience for this exercise will be regulatory bodies as some examples of best practice may demonstrate the need for amendments in regulatory approach (e.g. telemedicine, clinical decision-making on treatment options).
Through its research funding instruments, the European Commission should also help generate robust scientific evidence to evaluate and advise about innovative approaches to cancer care delivery during the pandemic and/or other health emergencies.