PURPOSE: Determine the feasibility of telehealth as a safe and effective modality for CRC surveillance in the post-COVID era.
BACKGROUND: CRC survivors require routine cancer surveillance for a minimum of five years as directed by NCCN Survivorship guidelines. The onset of COVID inMarch 2020 severely limited the ability to have face to face encounters with New Mexico Veterans. Combining social distancing requirements and generalized fear among Veterans made it difficult to maintain routine face to face surveillance.
METHODS: Thirty CRC survivors in the surveillance phase were evaluated using VA Video Connect (VVC) technology. Established CRC Survivorship surveillance notes were completed during the VVC visit. The documented components included COVID screening, general and CRC focused symptomatology, psychological stress, physical exam, laboratory, and radiology studies. All surveillance questions were completed. Veterans were asked to complete a self-exam with video visualization of non-sensitive anatomical regions. Digital rectal exam was deferred. Lab and radiology studies were ordered to be done at a later time in VA/CBOC. To assist with poor hearing or visual acuity, VVC communication was enhanced by utilizing screen sharing with the Veteran to review the most recent lab/radiology results, as well as PowerPoint presentations to explain anatomy, disease process, and plan for continued surveillance. Veterans were assessed for level of anxiety regarding COVID and inability to seek routine medical care.
RESULTS: Veterans and their families were extremely satisfied with the ability to “see” a provider without incurring the risk of exposure and the cost of traveling with the economic hardship of COVID. As a result, the VA did not incur travel fees for remote Veterans. VVC improved access to Veteran specialty care and decreased overall anxiety and concerns regarding possible delayed diagnosis for cancer recurrence due to missed clinic appointments.
CONCLUSIONS: VVC is a viable option for CRC surveillance, however the Veteran still requires interval physical exam, labs, and imaging. A feasible option is to alternate in-person face to face visits with VVC appointments as a means to meet the expected long-term requirements for social distancing while still providing the vital care and reassurance to our Veterans.
