Original Title: État des connaissances - Soins virtuels en hématologie et oncologie

Authors' objectives: The aging of the population and the increasing prevalence of chronic diseases will, undoubtedly, lead to a significant increase in the demand for continuous home and institutional care, this in the current context of limited professional resources in Québec. Furthermore, the COVID-19 pandemic has led to the accelerated deployment of virtual care tools to ensure access to care and services and to promote the continuity of care. In addition to the information technologies now frequently used, the integration of virtual care modalities into care pathways is of growing interest for the evaluation, treatment and follow-up of patients in specialty medicine. These modalities have the potential to improve access to health care for most patients, but also to foster their engagement in the management of their illness. In the context of a national project on virtual care, the Ministère de la Santé et des Services sociaux (MSSS) has requested the Institut national d'excellence en santé et en services sociaux (INESSS) to provide a state-of-knowledge report to guide the use of virtual care in specialty medicine. This work will help maintain or optimize care pathways and support clinical practices and the provision of care and services to patients. The objective of this work is to inform public decision-makers, medical associations, and health and social services professionals about virtual care practices in specialty medicine. The project involves the following seven reports: 1) Pediatrics, 2) Psychiatry, 3) Neurology, 4) Hematology/Oncology (this report), 5) Respirology, 6) General Surgery and 7) Internal Medicine.

Authors' results and conclusions: RESULTS (#1 FINDINGS CONCERNING VIRTUAL CARE IN HEMATOLOGY AND ONCOLOGY): Teleconsultation and tele-education are the most studied interventions in the care pathways studied. • The results concerning virtual care interventions identified in the care pathways often incorporate several modalities (e.g., teleintervention, teleconsultation, teleassistance, telehealth, telemedicine, mobile health, case discussion, etc.). • Few studies have explored the efficacy of virtual care interventions in individuals with malignant or non-malignant hemopathy. (#2 CARE PATHWAYS IN HEMATOLOGY): Virtual care pathways in hematology-oncology/hematology reported as being clinically effective - Supportive care for individuals with hematologic cancer or hematologic disease or cancer survivor. • The active management of treatment-related symptoms for individuals with a hematologic cancer who are undergoing treatment. • The early identification and the management of chemotherapy-related symptoms in individuals with a hematologic cancer. (#3 CARE PATHWAYS IN ONCOLOGY): Virtual care pathways in oncology reported as being clinically effective - Rehabilitation for cancer-related disability for survivors from a solid or hematologic cancer. • Genetic and psycho-oncological counselling for individuals at high risk for a hereditary cancer or at risk for endometrial cancer recurrence. • The early identification and the management of chemotherapy-related symptoms in individuals with breast cancer. (#4.1 VIRTUAL CARE MODALITIES FOR WHICH A POSITIVE IMPACT HAS BEEN REPORTED, SUCH AS:): Telemedicine combined with teleconsultation adapted to rehabilitation for women with breast cancer in the context of the COVID-19 pandemic to improve their quality of life or decrease the complications related to their disease. • Teleconsultation adapted to genetic and psycho-oncological counseling for individuals at high risk for a hereditary cancer or at risk for endometrial cancer recurrence to improve their knowledge and long-term follow-up and to reduce the disease-related symptoms for those with endometrial cancer. • Mobile health, teleconsultation and tele-education combined with usual care for eligible individuals to improve colorectal cancer screening. (#4.2 ASPECTS OF CLINICAL EFFICACY THAT NEED TO BE CLARIFIED BY FURTHER STUDIES): The efficacy of active disease management and health-related quality of life via teleconsultation and teleintervention for individuals with gynecologic cancer. • The efficacy of supportive cancer care via telemedicine for cancer survivors from a solid cancer who live in rural or remote areas. (#4.3 VIRTUAL CARE MODALITIES REPORTED AS HAVING POTENTIAL ORGANIZATIONAL EFFICACY, SUCH AS): In hematology: – Teleconsultation to reduce consult time and the number of visits or consults for individuals with a hematologic disease or a hematologic cancer. • In oncology: – Teleconsultation to decrease the use of services for individuals with breast cancer. – Teleintervention, teleconsultation and tele-education to improve realtime communication with health professionals and as personalized psychological, educational and informational support for individuals with a solid cancer. (#4.4 VIRTUAL CARE MODALITIES REPORTED TO HAVE A POSITIVE IMPACT ON PATIENT SAFETY AND THE SAFETY OF INTERVENTION METHODS): An improved sense of safety and decreased anxiety about issues associated with the management of treatment-related symptoms for individuals with a solid cancer. • An improved sense of safety regarding the problems associated with the rapid detection of cancer. (#4.5 VIRTUAL CARE MODALITIES REPORTED AS HAVING A POSITIVE IMPACT ON EQUITY OF ACCESS TO CARE, SUCH AS): Teleconsultation, teleintervention and case discussion to improve access to care for individuals with a solid cancer during the continuum of care or for cancer survivors, particularly for those living in rural or remote areas. • Teleintervention and teleconsultation, particularly during the COVID-19 pandemic, to improve access to care for individuals with various hematologic malignancies undergoing active treatment or ongoing post-treatment monitoring, and for individuals with breast cancer. (#4.6 A PROMISING LEVEL OF SATISFACTION HAS BEEN REPORTED BY PATIENTS AND HEALTHCARE PROVIDERS ACCORDING TO THE STUDIES CONSULTED, WITH CERTAIN CONCERNS): Patients and care providers generally expressed satisfaction with virtual care regarding accessibility, flexibility, convenience, communication or easier care management. • Some patients expressed certain concerns about using virtual care (e.g., worry about the ability to use a new technology, problems with the technology, feeling distant and insecure, the lack of face-to-face contact and communication with health professionals, the failure to recognize their signs of distress, the lack of emotional support, etc.). LIMITATIONS: This report is limited by the following methodological constraints: the type of documents selected, the literature review period of 5 years, the independent study selection for only 10% of the studies, the absence of a formal evidence assessment, and the descriptive data synthesis with no meta-analysis. Most of the selected systematic reviews aggregate or consider, without distinction, data from primary studies conducted in various care settings with a variety of comparators, clinical situations, and technologies. For meta-analyses, the heterogeneity of the studies and interventions, the small number of studies compared and/or the small number of participants, and the poor quality of the studies are often listed in the limitations. In addition, cultural sensitivity or cultural adaptation and collaborative care, which are topics that should not be overlooked for equity in virtual care, were very rarely addressed. Confounding biases are especially present in hematology and oncology care pathways because the clinical situations included in a review are rarely perfectly identical (e.g., breast, uterine, colon, prostate cancer, hematologic disease, population undergoing treatment, in post-treatment, cancer survivors, etc.). Also, selection and measurement biases in the studies generally need to be taken into consideration. CONCLUSION: For the use of virtual care in hematology and oncology, the most studied two care pathways are 1) supportive care for individuals with cancer or a hematologic disease or in remission and 2) the active management of treatment-related symptoms in individuals with a solid or hematologic cancer who are undergoing treatment. Teleconsultation and tele-education are the most used care modalities in the care pathways studied. Overall, the modalities are used alone or in combination with other modalities, and virtual care can be used in place of or in addition to usual care.

Authors' methods: A scoping review of the scientific and grey literature was conducted for the past five years to portray the care pathways that might be supported or optimized with the use of virtual care. The existing national and international guidelines, guidance and discussion papers, and health technology assessment (HTA) reports published on the topic were also consulted to identify additional care pathways or confirm those identified in the systematic reviews. Documents were selected according to predefined inclusion and exclusion criteria. These steps were carried out by one reviewer, and 10% of the titles and abstracts evaluated were independently re-evaluated by a second reviewer. The data extraction from the selected documents was carried out by a reviewer. The extracted data were analyzed and presented in the form of a narrative synthesis and outcome tables for each of the clinical pathways examined. Given the rapid nature of this work and the type of review conducted, the methodological quality of the selected documents was not assessed. In addition, the findings on care pathways and virtual care modalities that maintain or optimize clinical practices in specialty medicine were formulated taking into account the consistency of the study results, the number and perceived quality of the studies, the biaises raised and the statistical analyses of the meta-analyses.

Project Status: Completed

URL for project: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/OrganisationsSoins/INESSS_Soins_virtuels_Hemato_Onco_EC.pdf

Year Published: 2023

URL for published report: https://www.inesss.qc.ca/fileadmin/doc/INESSS/Rapports/OrganisationsSoins/INESSS_Soins_virtuels_Hemato_Onco_EC.pdf

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)