Impact of Telemedicine for Lung Cancer Care during the COVID-19 Pandemic: Interrupted Time Series Analysis

Introduction: The COVID-19 pandemic greatly challenged the health systems and cancer care. Objective: To estimate the impact of telemedicine on outpatient visits (OPV) to reduce disease exposure for patients and healthcare providers and minimize the effect on cancer care continuum during the COVID-19 pandemic. Method: Longitudinal quasi-experimental time series using the institutional electronic medical records from January 2018 to December 2021, considering the implementation of telemedicine services in the first and second waves of COVID-19 in March and November 2020, respectively. The primary outcomes were a mean (A) monthly-overall-OPV, (B) monthlyin- person-OPV, (C) monthly-overall-cancer-OPV, and (D) monthly-in-person-cancer-OPV. Results: A total of 5,918 OPV were analyzed. 55.3% of the visits were for females, 87% were White, and the mean age was 66 years. Telemedicine accounted for 25.8% of the visits and 27.7% were cancer-related. White, Black, and Asian patients had a similar percentage of use of telemedicine (26.3%, 25.0%, and 26.8%), while Latinos were less likely to use telemedicine (18%, p=0.018). For outcomes (A) and (C), including telemedicine, the COVID-19 surges did not significantly impact the mean OPV. When telemedicine was not used, there was a statistically significant decline in overall in-person OPV (B) and cancer (D). In the first COVID-19 surge, telemedicine prevented a decrease in monthly-overall-OPV of 59.1% (p=0.001) and 40.9% (p=0.019) for cancer. In the second surge, these values were 64.4% (p=0.001) for monthly-overall-OPV and 59.8% for cancer (p=0.001). Conclusion: The use of telemedicine positively impacted the care for cancer patients in a thoracic surgery service.