First introduced in the late ‘80s, by the mid-90s pilot tele-oncology programmes were implemented. However, when the funding ended, most were discontinued, either as not cost-effective or inadequately utilised. Today, the ubiquity of the Internet and the sophistication of streaming video and audio technology eliminate the highest hurdles of adding teleradiology consultations to the repertoire of services provided by cancer treatment centre. Other than cost, now the biggest hurdle is specialist acceptance.
A model tele-oncology programme has flourished since 2003 in the far north-eastern Canadian provinces of Labrador and Newfoundland. This was the brainchild of Dr Max House, an emeritus professor at the Memorial University of Newfoundland. Dr House is not a household name, yet his pioneering initiatives, started in 1980, to put the earliest commercial telemedicine equipment on offshore North Atlantic drilling rigs to deliver remote triage to seriously injured rig workers, was instrumental in the development of teleradiology and telemedicine.
Since then, the clinical culture of the Memorial University of Newfoundland has been keen on implementing cost effective and beneficial ways to use telemedicine and has been a global leader in this field. In 2003, the Newfoundland Cancer Treatment and Research Foundation and Memorial University’s Telehealth and Education Technology Resource Agency began an 18-month pilot programme to demonstrate the effective development, integration and sustainability of delivering oncology clinical services remotely.
The Newfoundland and Labrador Tele-oncology Programme originates from the Dr H Bliss Murphy Cancer Centre in St. John’s, Newfoundland, and initially served 24 communities, some located a four-hour distance away. The video-conferencing system is used by patients for pre- and post-surgical and radiation therapy treatment consultations with an oncologist. The patient visits a participating clinic or hospital, where a clinician or nurse is in attendance.
Utilisation has increased dramatically. In the second half of 2005, Dr House, the principal investigator of the pilot programme, reported that 132 patients with prostate, breast, colorectal and lung cancer had remote consultations. In 2006, the success of the programme led to its transfer as a full-fledged, and fully funded Telehealth Programme operated by the Newfoundland and Labrador Centre for Health Information.
The Telehealth Programme now encompasses treatment for kidney disease, neurology, occupational therapy and in 2009, diabetes, as well as oncology in 42 rural communities. The Centre for Health Information reported that, between July 2006 and October 2008, more than 22,000 patient visits and physician case reviews with specialists had been conducted.
Tele-oncology has become one of the largest components in oncologist Dr Jonathan Greenland’s practice. He attributes the tele-oncology programme for being able to reduce his in-person travel to clinics in Central Newfoundland from five days to two days per month. ‘Elimination of two days of travel enables me to schedule more consultations with patients, whether remote or at our centre. Overall, the percentage of patients from rural areas in my practice has increased significantly. Patients are always welcome to meet with me in person. But many can be examined by the local physician or nurse. I can fit more patients into a video clinic than a real one because it is more efficient. Delays are eliminated or newly diagnosed patients, because
I can now see that patient almost immediately after referral, optimise their symptom control, and arrange for appropriate treatment before they travel to our hospital.’
A cost-evaluation of the Tele-oncology programme has not yet been issued by the Newfoundland and Labrador Centre for Health Information. However, from the perspective of patients, having access to oncology specialists available rapidly and efficiently is priceless.