Virtual Second-Opinion Delivery for Oncology Patients.

Abstract

Purpose: Patients with cancer face increasing difficulty securing access to timely, quality oncologic care. A virtual consultation program at a tertiary academic center could eliminate physical barriers while providing treatment recommendations that could be executed locally.

Methods: We evaluated an Online Second Opinions Program to increase access to expert care via a cloud-based platform through Included Health. This program was open to any patient globally who had a local treating physician. Patient records were compiled and sent to a disease expert at Stanford Healthcare. A report detailing an assessment and treatment recommendation was then returned within 3 days. We analyzed the characteristics of the patient base and the frequency with which treatment change was recommended.

Results: Between November 2018 and August 2020, 657 patients participated in the program. The majority of patients were female (58.4%) with a mean age of 60 years. A majority lived out-of-state (62%, with 24.7% of total patients from outside the United States) and had advanced disease (77.2% diagnosed at stage III or IV). Breast cancer was the most common diagnosis (24.7%). Physicians providing the virtual service were primarily medical oncologists (67.6%) and reported to have recommended a treatment change in more than half of the cases reviewed (53.8%). A treatment change was most often recommended for patients with stage II disease (64%), and least often for stage I and III disease (both 45%).

Conclusion: To our knowledge, this is one of the first studies to describe patients who use virtual second-opinion programs for oncology, showing that more than half of the patients were recommended to have a treatment change. Although patients most often had advanced disease, those with stage II disease most often received a treatment change recommendation.