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ORIGINAL ARTICLE
Consultation via telemedicine and access to operative care for patients with
head and neck cancer in a Veterans Health Administration population
Daniel M. Beswick, MD,
1,2
Anita Vashi, MD, MPH,
3
Yohan Song, MD,
1,2
Rosemary Pham, MS,
2
F. Chris Holsinger, MD,
2
James D. Rayl, CNP,
4
Beth Walker, MSPT,
5
John Chardos, MD,
6
Annie Yuan, NP,
1
Ella Benadam–Lenrow, RN,
1
Dolores Davis, RN, FNP, MSN,
7
C. Kwang Sung, MD, MS,
1,2
Vasu Divi, MD,
1,2
Davud B. Sirjani, MD
1,2
*
1
Department of Otolaryngology – Head and Neck Surgery, Palo Alto Veterans Affairs Health Care System, Palo Alto, California,
2
Department of Otolaryngology – Head and Neck
Surgery, Stanford University School of Medicine, Stanford, California,
3
Center for Innovation to Implementation, Palo Alto Veterans Affairs Health Care System, Palo Alto,
California,
4
Department of Otolaryngology – Head and Neck Surgery, New Mexico Veterans Affairs Health Care System, Albuquerque, New Mexico,
5
Ambulatory Care Service,
Palo Alto Veterans Affairs Health Care System, Palo Alto, California,
6
Department of Medicine, Stanford University School of Medicine, Stanford, California,
7
Department of
Surgery, Central California Veterans Affairs Health Care System, Fresno, California.
Accepted 4 December 2015
Published online 21 February 2016 in Wiley Online Library
(wileyonlinelibrary.com). DOI 10.1002/hed.24386
ABSTRACT:
Background.
The purpose of this study was to evaluate a
telemedicine model that utilizes an audiovisual teleconference as a preoper-
ative visit.
Methods.
Veterans Health Administration (VHA) patients with head and
neck cancer at 2 remote locations were provided access to the Palo Alto
Veterans Affairs (PAVA) Health Care System otolaryngology department
via the telemedicine protocol: tissue diagnosis and imaging at the patient
site; data review at PAVA; and a preoperative teleconference connecting
the patient to PAVA. Operative care occurred at PAVA. Follow-up care
was provided remotely via teleconference.
Results.
Fifteen patients were evaluated. Eleven underwent surgery,
4 with high-grade neoplasms (carcinoma). Average time from referral to
operation was 28 days (range, 17–36 days) and 72 (range, 31–108
days), respectively, for high-grade and low-grade groups. The average
patient was spared 28 hours traveling time and $900/patient was saved
on travel-related costs.
Conclusion.
A telemedicine model enables timely access to surgical care
and permits considerable savings among select VHA patients with head
and neck cancer.
V
C
2016 Wiley Periodicals, Inc.
Head Neck
38:
925–929,
2016
KEY WORDS:
telemedicine, telehealth, head and neck, cancer,
access, Veterans Health Administration, Veterans Affairs
INTRODUCTION
Head and neck cancer is a complex disease that is optimally
treated with a multidisciplinary care team and a well-
developed infrastructure. For patients who reside at a signifi-
cant distance from a center with these capacities, determin-
ing a treatment plan and providing subsequent intervention
can be associated with significant delays as well as travel-
related costs and inconveniences. Even without such geo-
graphic hurdles, the average delay from referral to definitive
treatment for cancers of the upper aerodigestive tract has
been estimated at 14 to 21 weeks in the United States and
Canada.
1
The Veterans Health Administration (VHA) is the largest
healthcare system in the United States, providing compre-
hensive healthcare to almost 9 million veterans annually.
2
The VHA system is not immune to treatment delays, a
problem that has not only been highlighted recently in the
press
3,4
but also spurred governmental action.
5
Traditionally, VHA patients who live in remote areas
and present with new diagnoses of head and neck cancer
are transported to tertiary care VHA hospitals for evalua-
tion and workup, or their care is fee-based to a local,
non-Veterans Affairs tertiary care hospital. Transporting
patients to tertiary care VHA hospitals can be associated
with travel-related delays because patients with head and
neck cancer often require multiple visits before beginning
treatment to evaluate the tumor and determine a care
plan. The use of non-VHA hospitals can permit rapid
access to non-VA health systems,
6
but can be associated
with significant costs for the VHA healthcare system.
Telemedicine has been proposed as a mechanism to facil-
itate treatment of head and neck cancer.
7
To date, telemedi-
cine has been used to remotely present patients with head
and neck cancer at multidisciplinary tumor boards
8–11
and
provide guidance via secure text messaging as patients
undergo treatment.
12,13
To our knowledge, no prior studies
have evaluated the role of telemedicine in remote presurgi-
cal evaluation, workup, and counseling for patients with
*
Corresponding author:
D. Sirjani, Department of Otolaryngology – Head and
Neck Surgery, 801 Welch Road, Stanford, CA 94305. E-mail: dsirjani@ohns.
stanford.eduThis work was presented as a poster at the Triological Society’s Combined
Otolaryngology Spring Meeting in Boston, Massachusetts, April 23, 2015.
This work represents the views of the authors and not the Veterans Health
Administration.
HEAD & NECK—DOI 10.1002/HED JUNE 2016
Reprinted by permission of Head Neck. 2016; 38(6):925-929.
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