Telemedicine for Cancer Rehabilitation during COVID-19

What Is Telemedicine?

Telemedicine is a remote clinical service that offers the provision of real-time conversation between a healthcare provider and a patient using audio-visual electronic means. Also, telemedicine is more cost-effective than in-person consultations with the healthcare provider.

Benefits of Telemedicine:

• Telemedicine can be used to consult doctors on phone calls for some non-emergency medical problems in the comfort of the home or wherever convenient. However, face-to-face consultation cannot be replaced with telemedicine, as it can only make it more convenient by reducing unnecessary physical visits to clinics for health issues that do not require one to visit the doctor.

• It helps in infection control by prescreening patients for any infectious disease, COVID-19, or flu, thus, helping minimize exposure to other people around.

• It also helps some medical specialty practitioners to understand or assess the patient's condition better in their home environment, such as allergists may get some clue about the causative agents in a person suffering from allergies.

What Is the Role of Telemedicine in Cancer Care?

Due to the pandemic and restrictions, many people with cancer were worried that the disruption caused by COVID-19 could reduce the possibility of their treatments' success. The pandemic has also been particularly difficult for people who have been diagnosed with cancer. Cancer patients must stay connected to their medical team and ensure they get the best care. In-person clinic visits may be challenging in this pandemic, but telemedicine can provide a safe stand-in during this COVID-19 crisis. Telehealth can help people avoid direct physical contact, minimize COVID-19 transmission risk, and provide continuous care to the community. Therefore, clinicians and patients strongly recommend applying telehealth tools as an appropriate option to prevent and contain COVID-19 infection.

With telemedicine, cancer patients can keep their doctors up-to-date on their health while lowering their chance of infection from other people. Telemedicine can connect the patient to their doctor via technology while they stay home. These appointments can achieve many things, including:

• Real-time check-ups with a healthcare professional using video or audio chats.

• Sharing results of the laboratory tests and imaging tests.

• Audio or written communication is sent through an online patient portal or another messaging service.

What Is Cancer Rehabilitation?

Cancer rehabilitation is a program that supports people with cancer to maintain and restore their physical and emotional well-being. Cancer rehabilitation is done before, during, and after cancer treatment. They will also often incorporate manual therapy techniques into the treatment plan at the oncology rehabilitation center during the program. For cancer survivors who have attended this program, the foremost goal is to improve physiological and psychological values beyond the baseline. Cancer and its treatment will often cause physical, emotional, and cognitive problems. These problems can affect their daily activities or delay a person from returning to work. They may also have a constant effect on their health. Cancer rehabilitation can help with these issues, which happen during and after cancer treatment. The main goal is to:

• Help one stay as active as possible to participate in their work, family, and other life roles.

• Lessen the adverse effects and the symptoms of cancer and its treatment.

• Help keep one as independent as possible.

• Improve their quality of life.

It also helps one to:

• Improve their endurance, strength, and mobility.

• Increase their confidence and self-esteem.

• Cope with their anxiety, distress, or any other emotional issues.

• Reduce fatigue, pain, and other lingering side effects.

• Return to work.

• Prepare a long-term plan for cancer survivors.

What Are the Problems That Cancer Rehabilitation Can Address?

Physical Problems:

Cancer and cancer treatment can cause many kinds of physical problems. However, cancer rehabilitation can help with many of them, including:

• Pain.

• Swelling.

• Lymphedema.

• Fatigue.

• Weakness and loss of strength.

• Range of motion and flexibility issues.

• Decreased endurance.

• Skin changes from radiation therapy.

• Balancing issues and fear of falling.

• Numbness and tingling in hands or feet.

• Sexual dysfunction.

• Problems swallowing.

• Problems chewing food.

Mobility Problems:

Mobility problems affect the movement of a person. Cancer rehabilitation can help a person if they have difficulty in:

• Walking.

• Getting up off the floor.

• Climbing stairs.

• Getting out of a chair.

• Showering.

• Getting dressed.

Cognitive Problems:

Cognitive problems are mostly related to a person's mental abilities. They need to talk to their doctor about cancer rehabilitation if they have:

• Difficulty multitasking.

• Memory trouble.

• Difficulty thinking clearly or cognitive fogginess.

When Is Cancer Rehabilitation Needed?

It is better to prevent a bad situation before it happens. Therefore, cancer patients should talk with their healthcare team about cancer rehabilitation when they notice a change in their symptoms that makes them less active or makes their everyday tasks more difficult. They can ask themselves:

• If they are having any trouble getting around?

• If they are having pain, weakness, or any other symptoms?

• If they are having trouble with thinking?

It is essential to address the changes they notice as early as possible before they get worse. For example, a small amount of joint stiffness that keeps them from reaching overhead may restrict using their arm. As a result, the arm can become weaker and stiffer over time. A little bit of swelling can be an early sign of edema that should be treated before it gets worse. The rehabilitation professional can assess their strength, mobility, and activities before a problem starts. This approach can increase their quality of life.

How Can Cancer Rehabilitation Be Given Through Telemedicine?

The cancer rehabilitation team works closely with the doctor and includes various experts to ensure comprehensive care. For example, the care team may consist of physical therapists, physiatrists, psychologists, occupational therapists, social workers, rehabilitation nurses, and other experts as required. Telerehabilitation is not a new concept, and there are reports which indicate that telerehabilitation may have begun in the year 1950.

Initially, medical emergencies, exacerbations, or functional disorders are evaluated, and future remote consultations (therapist-patient agreement) are established. The first meeting is carried out by telephone, which lasts approximately 20 minutes. Following the patient's agreement to future check-ups through verbal consent, the following steps are determined according to patient needs. This can be a phone call, a personal video call via a mobile device (computer or smartphone), or a group video call, which depends on the availability and comfort of the individual's devices. Following check-ups last on average 50 minutes, and the frequency of these checks will depend on the risk posed by visiting the health center.

Telerehabilitation has the potential to lengthen the lives of people with cancer. For example, patients with advanced cancer who used an online tool to report symptoms between visits to their doctor saw a five-month increase in survival than the patients who did not use the online tool. Patients who use the online tool also have improved their quality of life.

Conclusion:

Telemedicine visits have been well received by both patients and providers in a cancer rehabilitation center due to COVID-19. However, in the case of a new or worsening problem, satisfaction declined. However, telemedicine visits should be considered essential as a part of comprehensive cancer rehabilitation care, particularly during a public health crisis.