When the COVID-19 pandemic limited in-person medical checkups last year, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center offered video visits for the first time for long-term follow-up appointments for childhood cancer survivors. Due to the pandemic, virtual visits were adopted widely throughout the health-care world, without much data on how effective they would be as a substitute for in-person encounters.

Lisa Kenney, MD

In a report by Lisa Kenney, MD, and colleagues published in Pediatric Blood and Cancer, the Dana-Farber/Boston Children’s researchers said that health-care providers, patients, and parents were highly satisfied with the video encounters—and many would like the remote option for future visits. The satisfaction level was high, even while providers said not being able to examine patients physically was a drawback.

Most patients and their families were receptive to the opportunity to have their annual visit via teleconferencing, said Dr. Kenney, a pediatric oncologist in the David B. Perini Jr. Quality of Life Clinic for Childhood Cancer Survivors at Dana-Farber. Even without the pandemic restrictions, barriers to in-person follow-up visits existed, such as patients or families having to miss school or take a day off work, she explained. Survivors of childhood cancers are advised to have lifelong checkups for cancer-related health issues and to learn about potential future health risks.

Study Methods

The study team collected data from medical providers who conducted 94 virtual visits from April to June 2020, as well as satisfaction surveys from 38 patients who participated in a virtual visit.

Most patients had been treated for blood cancers as children; the majority in the study were aged 18 to 29, though 11 were younger and 12 were older than 30. About one-third of the patients were classified by providers as being at low risk for treatment-associated complications; another third were classified as moderate risk, and the remaining third were at high risk.

Dr. Kenney, who conducted some of the virtual visits, said that during the COVID 19 pandemic, “Video visits gave us the opportunity to check in with our patients and continue to provide survivorship care, including ongoing assessment for possible long-term complications of cancer treatment and patient education about health risks and prevention. The main differences between the video conference and the in-person visits were not having information from the physical examination and not having results of laboratory tests or imaging available at the time of visit. This information is routinely used in survivorship care to monitor patients’ health.”

Dr. Kenney added, “If the video visit raised a concern about a physical finding, we would have the patient see their local primary care doctor, come to the cancer center for urgent in-person care, or if necessary, go to the emergency room. However, this rarely was the case.”

Survey Results

While providers said that in about half of their encounters their clinical objectives weren’t met because of not having a physical exam, 37% of providers said they were “completely satisfied” and 49% were “very satisfied” with the encounters.

As for the patients and/or their parents or guardians, 61% said they were completely satisfied and 34% were very satisfied. In addition, 66% said the virtual visit was nearly as helpful as an in-person visit, while 82% expressed a preference for virtual visits either in combination with in-person appointments or as a substitute for all or nearly all in-person encounters.

“Given that this was our first experience delivering care to survivors using virtual visits, we were pleasantly surprised to see that patients want this service to continue in the future,” said senior study author Christopher J. Recklitis, PhD, MPH.

The study authors added that further studies are needed to explore ways of enhancing virtual care for survivors, including hybrid care with physical exams and laboratory testing done by primary care providers, as well as virtual care that incorporates remote examination technology.

Disclosure: The research was supported by the Swim Across America Foundation. For full disclosures of the study authors, visit onlinelibrary.wiley.com.