Timely diagnosis and treatment have always been critical in oncology and with waiting lists lengthening, achieving them has come under intense pressure. The pandemic has caused unprecedented delays and service dislocation that has put strain on both patients and healthcare professionals.

The European Cancer Organisation reported that one million people missed out on a diagnosis that might save their life over the last year and healthcare workforces that have battled through the pandemic are now faced with backlogs and burn-out.
Technology, in the form of virtual consultations and remote monitoring, offers a route to cut through system delays but observers caution that patient-centricity must be central to adoption and developments.
The hallelujahs for the pandemic’s acceleration of technology uptake can have a hollow ring across oncology as virtual consultations and remote monitoring augment rather than replace the human touch, which is essential in cancer care.

“The pandemic has had a devastating impact on all aspects of oncology but particularly in creating a wave of people who have been diagnosed late because they were unable to access healthcare,” said Philippa Pristerà, Patient Engagement Strategy Lead at healthcare communications agency Cuttsy+Cuttsy. “It has been an extremely stressful and worrying time for patients, and the HCPs who support them.

“Diagnoses and treatments have been delayed but the pandemic has also caused issues in the supply chain so the manufacturing and distribution of therapies has been affected as well as the waiting lists for consultations, treatments and surgery.”
The use of technology that monitors chemotherapy regimens and minimises clinic and hospital attendances proved effective and popular in a number of studies, particularly during the pandemic when keeping vulnerable patients away from acute care settings was desirable.

“Technology is opening doors for many people and, as there are many things that don’t need to be done in person, it will have a positive impact on waiting lists. Being able to monitor at home, or closer to home, will improve cancer care,” added Philippa, whose core focus is listening to and working with patients, carers or healthcare professionals to understand needs and develop innovative solutions.

“A lot of people do feel more comfortable at home where they can be with family and friends to provide support when they have consultations as it enables them to be more relaxed, ask the questions they may have forgotten in a more formal hospital setting and, ultimately, gain more knowledge to help manage their condition.
“But we have to be aware of the impact of the pandemic on HCPs and ask if we can expect them to engage and involve patients in service delivery and design if they’re struggling under the weight of day-to-day delivery.”

Cuttsy+Cuttsy – which is based in Cambridge and specialises in gathering insights from emotional intelligence and deep connections with audiences – takes a user-centred design approach to get to the heart of issues and develop innovative solutions that improve people’s access to, understanding of and/or confidence with their health, well-being and care.

Philippa added: “We work collaboratively with patients and HCPs and are committed to improving health literacy and want patients to not feel dislocated from their care by the disruptions caused by the pandemic.

“This is about more than deploying technology. It is important to recognise that not everyone is digitally savvy so it is vital that they understand what is happening, what the next steps are and how to get the best from it.

“Our message is always that services are better when you involve the patient in the design of that service. Their feedback is critical to how effective technology can be.
“It is clear that technology can improve efficiencies and increase integrations while eliminating waste but they have to be matched with a human element. It needs to give them greater access, control and the confidence and skills to manage their own health. There is a spectrum of technological capability and more work needs to be done to reach those patients who are not that engaged with their health or don’t have access to technology.

“We can’t just think we have all these tools and that everybody is ready and waiting to use them.”

Philippa believes that greater support for patient groups and technology that improves the daily work practices of healthcare professionals is a key component of keeping patients at the heart of the digital revolution.

“Smarter health and smarter hospitals are not just about technology because there is only so much that a machine can measure” she said. “It can’t survey quality of life – talking to someone about their feelings and issues to understand what they are experiencing can only be done by a human.

“We should use technology in any way we can and recognise the benefits it can bring but we also need to be aware that it will not solve everything and that we need to hear the patient voice – and act on it – now more than ever.”

The emergence of technology as a potent force in healthcare has crystallised the need for patient-centric levers to focus its deployment.

Rebecca Goldstein, scientific solutions division lead at Alligent Medical Affairs, part of the Envision Pharma Group, believes the pandemic highlighted and accentuated existing disparities in care. “One of those disparities is access to technology,” she said. “There have long been financial, location and health literacy barriers to getting healthcare but, as more people became reliant on technology for healthcare during the pandemic, it became more obvious that inequities in technology access and literacy means inequities in care.

“We need a better understanding of these advances in technology; what works best for patients and how we can use resources to close those gaps so everyone benefits. Taking the best bits and making them accessible to underserved groups might be a better use of resources than chugging along towards the next high-tech advance in telemedicine.”

Envision Pharma, specialists in medical strategy and patient support, has a deep understanding of the impact of technology in oncology and monitors its influence on industry and patient communities.

Rebecca sees a pressing need for greater collaboration to ensure technology is used to improve and democratise care across oncology and across patient involvement and capability.

“I know that the advances in tech that we’ve seen over the past two years will result in a positive impact to healthcare overall,” she said. “I am confident that there are people who are going to have access to care that they didn’t before, and there will be more options for healthcare providers in their practices that were not there before.

“But I don’t have confidence that it will happen in a streamlined or organised fashion.

“The challenge is that really looking at this holistically and breaking down walls between different payer systems across the world requires a collective effort. We just don’t just have that in place at the moment.” Rebecca added: “Technology can be a double-edged sword. For some patients, it offers a substantial benefit because they have more options from telemedicine, particularly those in rural areas who could suddenly be connected to a tertiary medical centre with more specialists. Less travelling into the clinic could make it easier for caregivers to attend visits and lighten logistical barriers for patients who do not have reliable transportation.

“But a lot of oncologists are concerned about the lack of personal contact for the physical examination or the holistic evaluation of a patient – you can’t do that if you are looking at a patient from the waist up on a screen.”

Many telemedicine programmes were rolled out as emergency measures. Healthcare must guard against them being rolled back now the pandemic is receding.

The goldrush effect of technology also needs to be controlled to ensure that patient experiences do not get trampled under the lure of gleaming new devices. “If we are using telemedicine to reform services or reduce system costs, it would be good if that was informed by data,” added Rebecca.

“We need reputable sources of information on which aspects of telehealth positively impact outcomes that can be used as data points with regulators. As we learn more about the best way to use technology in the oncology space, we can harness that data to inform policy.

“Right now, decisions for longer-term use of telemedicine after the pandemic are being made with little information. People are looking at how much things cost and making decisions without really understanding the positive and negative impact.”

Trust and technology are key words in future oncology care, she believes, with greater equality and access across clinical trials for ethnic minorities being a principal element of closer connections between patients, healthcare and telemedicine. They need to progress in tandem for the best results.

Rebecca added: “Trust or mistrust in the healthcare system is a point of disparity that reduces quality of care, particularly in cancer when your life is on the line. For specific social and cultural groups, it is very important that the person on the other end of your care is viewed as a trustworthy figure who has your best interests at heart, as opposed to someone who’s part of an institution that you do not trust, and might withhold the best standards of care from you. These issues existed before the pandemic but now it is much more difficult to establish a sense of trust and rapport, if you’re looking at someone over Zoom, as opposed to if you’re sitting in an office across from someone.
  
“Getting creative about finding out which aspects of telemedicine are serving us well, and then making them more accessible and relatable will go a long way toward closing those gaps with trust and rapport for groups who desperately need it.”

She continued: “A lot of cancer got a whole lot worse during those months of the pandemic when everything was shut down. People missed their treatments or didn’t report side effects or signs that the cancer may be coming back. There was also a surge in cancer that was diagnosed at a later stage because people, who were at high risk and ordinarily would have been screened in some sort of continuing care, were not being screened.”

Technology presents a golden opportunity for oncology with targeted care and support but it must not be seen as a plugin and play panacea. Reaching patients across oncology will take thought, understanding and nuanced application.