Staying in touch with doctors online could help breast cancer survivors keep up their cancer treatment, according to a recent study from the University of Georgia.
After chemotherapy and surgery, most breast cancer survivors are prescribed oral endocrine therapy to prevent the disease from coming back. For these pills to be effective, they need to be taken regularly for several years. But it often comes with side effects such as fertility issues and other quality-of-life impairments, making long-term adherence challenging, especially for younger women.
The new study found that women using telehealth services were 58% more likely to adhere to their treatment plan. This is likely because telehealth helps reduce many transportation and logistical barriers, improves timely access to providers, makes follow-up visits easier and better supports the management of treatment side effects, the researchers said.
"The idea is to use telehealth to reinforce how important it is to keep taking these medications if you want to avoid a recurrence of your cancer or to have a metastasis," said Lorenzo Villa-Zapata, co-author of the study and an assistant professor and graduate program director in the department of clinical and administrative pharmacy at the UGA College of Pharmacy. "If you're a telehealth provider, you can ask if the patient has been taking their medication and if there are any issues they're facing."
Patients in urban regions more likely to use telehealth services
The new study analyzed data from the Merative MarketScan database and included more than 1,100 women under age 65. All had been diagnosed with breast cancer since 2018. Over five years, 77% of patients used telehealth services, totaling 8,350 visits.
The researchers found women in urban areas were more likely to use telehealth compared to their rural counterparts. Not having to worry about transportation may be a key reason why, the researchers said.
"Urban patients are likely trying to avoid traffic," Villa-Zapata said. "They're willing to just get a phone or video call from a provider rather than to drive to the office."
Location also played a role in how likely women were to use telehealth services, the researchers said. Patients living in the West were the most likely to use telehealth. This may reflect differences in broadband access, health system infrastructure and patient-provider preferences, the researchers said.
Women who used telehealth paid more out of pocket
Although telehealth was effective in supporting medication adherence, it did have a downside. Patients who used telehealth services paid 15% more in out-of-pocket costs compared to those who didn't.
Part of the reason could be that some patients had multiple chronic health conditions, leading them to use telehealth more often, the researchers said. Even so, the expense could be a barrier for patients.
"Reimbursement from insurance to cover the cost of telehealth has been a controversial issue recently," Villa-Zapata said. "If the service is not reimbursed, people are not going to use it."
Increasing technology access, insurance reimbursement could expand benefits
One reason rural regions use telehealth less could be because internet access and technology use tends to be lower, the researchers said.
"One of the things we started doing is collecting patient perceptions about telehealth to identify determinants of telehealth utilization, what benefits they perceive and what barriers they may experience," said Shaimaa Elshafie, lead author of the study and a recent doctoral graduate from the UGA College of Pharmacy. "From a policy perspective, expanding technology access like internet accessibility and ensuring reimbursement by insurance would help."
By making telehealth coverage more accessible, the researchers hope that more women will be able to stick to their treatment plans and reduce the chances of their cancer returning.
This study was published in the Journal of Cancer Survivorship.
