Leading Areas of Innovation in COVID-Era Oncology: Telemedicine, Triage and Remote Monitoring

When Winship Cancer Institute at Emory University in Atlanta faced the pandemic in spring 2020, it opened a COVID urgent care unit for Winship oncology patients who had COVID or were suspected of having it because of symptoms or high risk. The unit made it easier to separate suspected cases whose PCR results were not yet confirmed positive from other cancer patients.

Dr. Caleb Raine, an oncology assistant specializing in bone marrow transplantation at Winship, said a strict triage system was also used to ensure that the right patients reached the new clinic. Raine, who ran the COVID urgent care clinic, shared his experience of pandemic innovations worth keeping in oncology practice during a panel at the annual conference of the Journal of the Advanced Practitioner in Oncology, held online on 7 October 2021.

Triage is a system for prioritizing medical intervention in emergencies. Priorities are based on factors such as a patient's chance of survival and the urgency of their condition, determining who needs rapid intervention or admission to specialized units such as intensive care.

Telephone triage was performed by nurses or advanced smart mobile device applications (Apps) using an algorithm developed by Raine that included COVID exposure and symptoms such as fever or loss of taste and/or smell. To maintain consistency in admissions, Raine made the final decisions about which patients would come to the clinic.

Raine said triage helped improve communication with other clinical teams at Winship. Based on his COVID urgent care experience, he hopes to retain a strict approach to triage in future program development, including a 14-bed urgent care center planned to open the following spring. It will offer services similar to a day hospital for cancer patients, with more facilities than urgent care and 24-hour opening. It will target people who need to visit the emergency department and those recently discharged who need follow-up.

Remote Monitoring

Another conference speaker, Aaron Begue of Memorial Sloan Kettering Cancer Center (MSKKM), described the pandemic telemedicine intervention implemented for cancer patients. Before seeing patients in person, the care team asked them to use MSKKM's secure online MyMSK patient portal and complete a symptom questionnaire.

If symptom alerts reached a critical color-coded threshold, a nurse or mobile application from MSKKM was prompted to contact the patient at home, usually by telephone. These smart mobile applications also monitored patients remotely, including data uploaded from portable home pulse oximeters. Similar symptom trackers were later adapted to monitor cancer symptoms.

Some applications collected information needed for hospital admission from patients at home and uploaded it to medical records. This helped deploy healthcare staff more efficiently and accommodate some staff at high risk of infection because of existing health conditions or quarantined after a positive test.

Begue said: “We were able to make our staffing more flexible”. Even working one day in the vaccination clinic could provide a break from the intensity of frontline COVID treatment. “We are all still trying to figure out how to manage staff stress and burnout, but flexible scheduling seems an important strategy.”

Early in the pandemic, gestures such as crowds cheering New York healthcare workers in the evenings—like people applauding healthcare workers from balconies in Türkiye—had a major impact on staff by showing community support. “Later, when public schools closed, we used outdoor playgrounds for staff relaxation—places where staff could rest outside undisturbed,” he said.

Telemedicine was a major component of healthcare at the peak of New York's COVID surges, but as the waves subsided, Begue found many patients requesting in-person visits again. “We thought telemedicine would become an integral part of medicine in the future and that patients would love it. We still do thousands of telemedicine visits, but they are no longer the majority,” he said.  

MSKKM also conducts remote telemonitoring visits with patients living in other states who want to come to New York for surgery, other procedures or annual checkups. The logistics of practicing telemedicine across state lines, however, involve trying to reconcile differing medical licensing requirements.

Bargue hopes some state requirements may be relaxed in the future, which could also make it easier to enroll more people nationwide in clinical trials and encourage collaboration between cancer centers.

Raine said, “COVID taught us to think further ahead and prepare for crises. In the future, we need to be ready for when the next crisis comes, rather than if—even though we have not yet emerged from this one.”