In every aspect of our lives, whether it is online banking or shopping, we rely on technology to make things better, more convenient, and more efficient. Yet in health care, and particularly cancer care, that is not the case. Oncology has been revolutionized in recent decades by therapies targeted to specific biomarkers and immunotherapy. Despite being a leader in therapeutic innovation, oncology lags behind in adopting easy-to-use apps and other kinds of digital innovation that provide much needed support to patients.
Cancer care is an area ripe for digital transformation, as virtual care options can fill the void and be an always-on monitoring companion between treatment visits to improve health outcomes for patients. Digital platforms can also serve as a source of information and expert resources, expand access to cancer care, and improve the quality of life for those living with cancer.
Why oncology has lagged behind
Complexity and risk. Compared to other serious illnesses, cancer care is both complicated and high-risk. Often, multiple specialists are involved in a patient’s care, and even among clinicians, there can be a lack of familiarity with the risks and benefits of certain drugs. Cancer treatments can also cause significant side effects, with serious and even life-threatening implications for patients. In comparison, digital health has flourished in recent years when it comes to treating chronic diseases such as diabetes, hypertension, and obesity. Although the long-term impacts for these chronic illnesses can be serious, there are fewer short-term risks and complexities associated with their treatment.
False perceptions around older adults. Cancer is not exclusively a disease of older people but is much more common among older adults. There is a false perception that older people either don’t use or aren’t comfortable using technology. This stereotype is changing quickly, as 65 percent of the 65+ population owns a smartphone, and 45 percent use social media apps. Although younger generations continue to be early adopters of technology innovation, most adults over 65 are using smartphones and digital apps, challenging the pervasive perception that they are uncomfortable with technology.
Business model uncertainty. When it comes to implementing digital health in oncology, there is uncertainty around who will pay for this kind of support for patients with cancer, particularly given that outcome measures are less well-defined than for many chronic diseases. For example, with diabetes, you measure blood glucose and hemoglobin A1C. With hypertension, you measure blood pressure, and with obesity, you measure weight. In cancer care, it’s less clear which outcome measures are most important, and because those outcome measures are controversial, there is uncertainty about who should fund these programs and how to measure their success.
Benefits to implementing digital care models
Although there have been challenges to more widespread implementation, the benefits of virtual care options are numerous.
Timely problem identification. A significant advantage of implementing digital care models is around problem identification and catching emerging symptoms or side effects earlier when they are most amenable to intervention. Often, a patient who is undergoing cancer care will wait until a symptom is quite severe before seeking medical attention, which drives up the rate of emergency department visits, the length of hospital stays, and contributes to unnecessary suffering and poor patient experience.
For example, many chemotherapy treatments cause diarrhea, and if a patient observes that and reports it early, the appropriate medications can be started, and you can effectively prevent the symptom from worsening. However, once the diarrhea is prolonged or severe, it becomes very difficult to get that symptom back under control in the home setting, resulting in patients ending up in the ER or hospital. Symptom monitoring and management is a huge benefit when it comes to these digital interventions to address symptoms early, prevent hospitalization, and improve the patient’s quality of life.
Improved quality of life. Both quality of life and peace of mind increase when virtual care options are introduced. There is a lot of convenience with an “always on” monitoring management solution, so people can get symptoms, questions, and concerns addressed quickly and not have to live with as much uncertainty. Patients can also avoid the expenses and inconvenience of driving to the nearest clinic or hospital to get care, which can be hours away for some patients. In addition, virtual care opens new avenues for delivery of mental health care and supportive or palliative care services, all of which can help address quality of life concerns in meaningful ways.
For people with cancer, financial toxicity, or the financial burden that a cancer diagnosis and resulting treatment have on a patient’s life, is an extremely common occurrence. Time toxicity is another concept that meaningfully impacts quality of life. For example, it might take a person and their caregiver an hour to drive to the hospital, another hour of sitting in the waiting room to be seen, 30 minutes spent with the doctor, another two hours for the results to come back, and so on. For people diagnosed with cancer, especially those who have life-limiting diagnoses, spending weeks or months involved in medical care when time may be short is a very serious downside. Even for patients whose illness requires regular in-person visits, important adjunctive services such as nutrition support, social work, palliative care, and nurse navigation may be delivered virtually rather than extending already long clinic days. In many cases, offering these components virtually on non-clinic days may give patients more energy to optimally engage and benefit. Digital and convenient virtual solutions that can be delivered in people’s homes allow them to avoid some of that time toxicity as well for improved quality of life.
Expanded access to care. In recent years, the oncology community has recognized that certain subgroups, particularly socioeconomically disadvantaged and racial or ethnic minority subgroups, tend not to receive optimal therapies at the same rates as the overall population, and their outcomes are often worse. The costs of transportation for cancer care and medications, in addition to lost wages for both patients and caregivers when taking extended, often unpaid leaves from work, can represent enormous barriers. Patients who live in rural communities may also experience access challenges because of a relative death of cancer care facilities. Digital tools can help fill these access gaps, whether by providing virtual care options or helping navigate patients to local resources of which individuals might be otherwise unaware.
Even if you do have access to cancer care, depending on your racial or ethnic group, you may not have access to cancer care providers who look like you or speak the same language as you. Digital platforms represent a way of scaling a cancer care workforce that offers a whole host of different languages and incorporates cultural sensitivities, which may be perceived as more welcoming by members of underserved groups.
Looking ahead
Despite an initial lack of digital adoption in oncology, there are a variety of benefits for patients being treated for cancer to better track their symptoms, improve their quality of life, and expand access to cancer care in underserved communities. Looking ahead, there is going to be a growing move for cancer care to be delivered in non-traditional settings, particularly in the home. Digital tools will be instrumental in monitoring symptoms and providing access to providers and high-quality information within this care setting to ultimately improve outcomes for patients.
Andrew Norden is a physician executive.
