Patient Perceptions of Telehealth Use in Head and Neck Cancer Surveillance

Importance: Despite demonstration of telehealth feasibility, accessibility, and satisfaction among patients with various chronic diseases, there is low acceptability among patients with head and neck cancer (HNC). A critical gap exists in understanding patients' perceived barriers to telehealth and strategies to address them. Objective: To explore perceptions about telehealth for oncologic HNC surveillance. Design, Setting, and Participants: This qualitative study using semistructured interviews and surveys was conducted from January 1 to February 28, 2024. Individuals were included if they were 18 years or older, spoke English, and had been treated 3 to 24 months before the study at a tertiary center in Philadelphia, Pennsylvania, for oral cavity, oropharynx, larynx, hypopharynx, nasopharynx, or sinonasal squamous cell carcinomas without recurrence or distant metastasis. Interviews were analyzed from April 1 to August 31, 2024. Main Outcomes and Measures: Interviews explored patient perceptions of telehealth-delivered surveillance care, including a proposed hybrid surveillance model; were conducted until thematic saturation; and were audio-recorded, transcribed, and analyzed using a conventional content analysis approach. Surveys included demographic questions and the following measures: the BRIEF Health Literacy Screening (BHLS), the Oncology Opportunity Cost Assessment Tool (OOCAT), and the Comprehensive Score for Financial Toxicity (COST). Results: The study included 24 participants (mean [SD] age, 60.2 [8.1] years), of whom 16 (67%) were male. The most common primary site of carcinoma was the oropharynx (12 participants [50%]), with 13 participants (54%) having stage I disease. Mean (SD) BHLS and COST scores were 17.3 (3.8) and 29.4 (11.8), respectively. Mean (SD) OOCAT scores were 4.6 (1.4) for minimizing costs, 2.4 (1.6) for life impact, and 2.5 (1.9) for risk stress. Qualitative interviews revealed 7 themes: perceived benefits of telehealth, barriers to telehealth, technology barriers, opportunity costs of in-person appointments, patient responses to telehealth for surveillance, factors increasing telehealth acceptability, and incongruence between data and perceptions. Patients were more receptive to a hybrid model 2 years after HNC treatment. Conclusions and Relevance: In this qualitative study, telehealth was less acceptable than in-person visits for initial surveillance after HNC treatment but a hybrid in-person and telehealth model was more acceptable for remote cancer surveillance 2 years after HNC treatment. Strategies to incorporate telehealth in this population should account for patients' acceptability and preferences.