Abstract
Dear Editor:
We read the article from Reddy and colleagues about transition from in-person care to virtual visits maintaining a high patient volume, continuity of care, and adherence to social distancing during coronavirus disease 2019 (COVID-19) pandemic. 1
We appreciate the important work of the use of “supportive telemedicine” for home cancer patients.
Despite the primary objective of the study, there are several important questions to remark.
Results were reported in terms of quantitative analysis for an increase or reduction in the number of patients followed, maintenance of social distancing, and continuity of care.
We know that home palliative care services have played an essential role during the first wave of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak by providing symptom control, drug procurement, and psychological support. How to meet these endpoints with virtual care models?
The study did not report any efficacy endpoint about patient-reported symptoms, as patient-reported outcomes. Importance of collecting patient-reported symptoms has been recognized in cancer care because patients with cancer often experience unpredictable subjective symptoms that can lead to unwarranted emergency room visits or hospital admissions. 2 For these outcomes, the study did not provide any short- or long-term data and it is unclear whether this type of analysis was planned. 3
There is another aspect to consider. As reported in the text, a large proportion of patients had access to Apple devices and quickly adapted to virtual care using FaceTime, which may not be generalizable to all populations. Older patients and those without access to the Internet or smartphones were contacted by telephone. We appreciate that it is a system designed for emergency, but at the same time it is not a system for the whole population. Elderly patients, low-income patients, and patients with limited access to telematic resources or even a telephone call are at a disadvantage.
No comparative assessment is made on the effectiveness of the visit through Apple devices or mobile phones and no data were collected detailing patient preferences and barriers regarding telemedicine evaluations.
No patient demographic data were provided, including insurance status or address. This information could be useful to determine the area deprivation index. 4
Although telemedicine has its advantages during the COVID-19 era, patient preferences, technological barriers, and limitations related to virtual surveillance must be addressed to maximize the effectiveness of telemedicine in supportive and palliative care in cancer.